Infection Control

Hospital Borne Infections and Careful Hand Washing Tactics

By Mariana Ashley

There are several bacteria and fungi that have learned to thrive in our hospitals. Hospital-acquired infections (HAI) are infections that have found a way to better develop and prosper in a hospital setting. These infections are particularly worrisome for health care professionals and patients because they are strong in such vulnerable places of our existence. Many of these bacteria and fungi have developed resistances to antibiotics that were at one point effective on them. Gaining resistance to some of the most commonly useful and effective drugs helps these would be minor infections become a real worry for doctors and patients. 

Part of what makes HAIs such a difficulty is that patients who are in the hospital are typically already in a state of weakened immunity. So, individuals who could normally fight off these infections cannot within the hospital. Many of the bacteria and fungi spores that cause these infections are present on nearly all surfaces throughout a hospital. For this reason, one of the most common ways to transmit these bacteria or fungi to an individual is through poor hand washing. Doctors and nurses who are able to fight off the infections caused by these microorganisms will transmit them to more vulnerable patients through wound care, contaminated instruments, invasive instruments, and more. These two infections are among the most common hospital-acquired infections in hospitals today, each of which can be better prevented with thorough hand washing techniques. 

Methicillin Resistant Staphylococcus Aureus (MRSA)

As a form of staph infection, MRSA is one of the more common infections among hospital patients and is also one of the most varied. MRSA comes in many forms and is resistant to any penicillin antibiotic. MRSA most typically presents as a painful skin infection, causing irritated red bumps that look like pimples or bug bites. Other common symptoms associated with MRSA at this stage are fever and other rashes on the skin. These bumps will eventually engulf with white blood cells and the bacteria will attack other parts of the sufferer's immune system. If the infection becomes harsh enough, painful abscesses will have to be cut out of a patient's skin. Healthy individuals can be carrying the MRSA bacteria on them and remain asymptomatic. This makes it very difficult to control. With careful hand washing and anti-microbial practices, MRSA can be more easily managed and prevented. It is still believed that poor hygiene habits of health care professionals are the primary setback for reducing the spread of MRSA.

 Clostridium Difficile (C. Diff)

C. Diff is a bacterium that causes severe intestinal distress and disease within sufferers. This bacterium takes over the intestinal tract of a patient when a course of antibiotics has already eliminated all of the natural bacteria in the gut that would normally fight off the C. Diff strains. C. Diff can result in several very severe infections and illnesses, including colitis, bloating, and potentially life threatening toxic megacolon. While the primary cause of this infection is the improper prescribing of antimicrobials, infection control measures such as careful hand washing and area sanitation can drastically hinder the spread of this illness. C. Diff spores are present on almost any surface throughout the hospital. For this reason, it is essential that doctors, nurses, and visitors use gloves and carefully wash their hands with soap and water to eliminate the transmission of these spores to a more vulnerable host.

 By-line:

Mariana Ashley is a freelance writer who particularly enjoys writing about online colleges. She loves receiving reader feedback, which can be directed to mariana.ashley031@gmail.com.

Missouri Purges Data From Infection Records

An article by Jim Doyle exposes the fact that the State of Missouri has deleted hospital infection data from their records citing that it is too costly to maintain and too sensitive for the public to review for more than a year. 

Doyle writes:  "Without access to infection data from previous years, consumers won't be able to adequately assess a hospital's performance in preventing infections, consumer advocates say. Specifically, the policy of the Department of Health and Senior Services makes it difficult to review how hospitals have performed over time and whether they perform consistently above or below the national average."

This decision to purge data has stirred a heated political, legal and social debate regarding public health records. 

Rep. Rob Schaaf, R-St. Joseph, a family-practice physician who pushed the infection bill in the Legislature is quoted as saying, "It's pretty sad to me that the (health) department can't give you a trend to show that a hospital is getting better or worse. It shows that the department doesn't really care,"

Senator Sarah Steelman, one of the original bill's sponsors, said "I'm surprised at the agency. The job of the health department is to protect people. It makes no sense at all to eliminate data after one year."

Ken Bunting, executive director of the National Freedom of Information Coalition, weighed in on the topic by stating, "It sounds like they're violating the spirit if not the letter of the law, If it's being posted online, they don't need to take it down."

To read Doyle's entire article please visit "Missouri Purges Data From Infection Records".

Protecting Healthcare Workers from H1N1 While They Work

39170697 Just before the Labor Day weekend, the Institute of Medicine (IOM) issued recommendations for how health care workers can protect themselves from H1N1 in the work place.  Commissioned by the Centers for Disease Control and Prevention (CDC) and the Occupational Health and Safety Administration, the report has fewer evidence-based recommendations for healthcare workers than it has suggestions for needed research.

For healthcare workers who encounter patients with unidentified febrile respiratory illness or in close contact with those known or suspected to have H1N1, the IOM report suggests they wear "fit-tested" N95 respirators or others equally or more effective.  This recommendation builds on CDC and World Health Organization guidelines, which also point to the importance of vigilant hand hygiene practices in all situations involving H1N1, and to isolation precautions (gloves, gowns, eye protection, masks).

But because the evidence is very limited for what protections to use when, the IOM recommends future research on influenza transmission and respiratory protection, particularly in the clinical setting.

Can Health Reform Work if Focused Only on Coverage? -- by Suzanne F. Delbanco, Ph.D.

30446062 In today's New York Times, Paul O'Neill, former Secretary of the Treasury, points out one of the big holes in the health reform debates in Washington, D.C.  While all of the talk about covering the uninsured and creating cost savings from enhancing competition among health insurance companies is very important, what about reducing the financial and human costs from preventable medical mistakes, including hospital-acquired infections?

If we are to aim to reduce current trends in health care costs and simultaneously find new resources to help provide care to a broader population, we best look at all our options.  According to a report by the Centers for Disease Control and Prevention (CDC), the costs of healthcare-associated infections in the U.S. each year range from $28.4 to $45 billion.  On the other hand, the savings from infection control measures could be as great as $5.7 to $31.5 billion.  We literally cannot afford to ignore this financial opportunity.

O'Neill lists a few examples of health care providers that have reduced infection rates drastically.  This means it can be done, and one can extend that fact to argue that there is no excuse for not doing it.  Arrowsight's approach to helping hospitals get it right - such as washing or sanitizing hands every time - is one example of the tools available to hospitals today. 

O'Neill challenges President Obama to add an important audacious goal to his list:  "ask medical providers to eliminate all hospital-acquired infections within two years."  On top of providing health insurance to everyone, that would be real health care reform.

Suzanne Delbanco is President, Health Care Division, Arrowsight, Inc.

Hospitals Wise to Cut Spending on Infection Control? -- by Suzanne Delbanco, Ph.D.

7322389 Does it make sense to cut spending on infection control when certain hospital-associated infections are on the rise and pressure is mounting to curb such infections?  Logical or not, a new study released today by the Association for Professionals in Infection Control suggests that hospitals are cutting staff, resources and educational efforts.

Almost 2,000 infection preventionists responded to the 2009 APIC Economic Survey.  Of those, 41 percent said that their budgets had been cut in the last year and half, due primarily to the economic downturn.  Among those who experienced cuts, three-quarters lost training money, and half had cuts for infection prevention resources like technology, staff, and equipment.  One in three of the survey respondents say that cuts in resources and staffing have restricted their capacity to focus on infection prevention.  On a related note, one quarter say they have cut back on surveillance activities to detect, track and manage hospital-associated infections. 

While infection prevention is not a source of revenue, APIC points out it can help reduce costs significantly.  The U.S. Agency for Healthcare Research and Quality estimates based on its Health Cost and Utilization Project (HCUP) data that acquiring an infection with methicillin-resistant Staphylococcus aureus (MRSA) during a hospital stay can double a patient's length of stay and almost double the cost of the stay (from $7,600 to $14,000).  Perhaps hospitals will get a chance to see the return on investment for infection prevention more clearly when they reduce the investment and need to live with the financial consequences.

Suzanne Delbanco is President, Health Care Division, Arrowsight, Inc.

New Monograph on Hand Hygiene May Push Us Forward -- by Suzanne Delbanco, Ph.D.

Hand hygiene The Joint Commission, along with several partners, has just released a new framework for determining "when, why and how to measure compliance with hand hygiene."  The monograph, entitled Measuring Hand Hygiene Adherence: Overcoming the Challenges, is the result of a two-year collaboration among the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), the Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiology of America (SHEA), the World Health Organization (WHO) World Alliance for Patient Safety, the Institute for Healthcare Improvement (IHI) and the National Foundation for Infectious Diseases (NFID).

What's the big deal?  There has yet to be agreement about how to measure compliance with hand hygiene protocols. Without some standardization, it is very difficult to measure the comparative effectiveness of different interventions to improve and sustain hand hygiene practices.  And depending on the measurement method, hospitals may produce for themselves a false sense of security that their hand hygiene practices are sufficient when they are not.  My suspicion is that the more rigorously we measure hand hygiene practices, the more disappointed we will be with performance - that is, until we also implement successful interventions to drive and maintain improvement.

The monograph does not create a single international standard for measurement of hand hygiene practices, though it draws from examples from several countries.  It moves us closer, however.  So let's cross fingers and get to the hard work ahead.

At Arrowsight, we offer a powerful methodology for implementing many of the features and elements of measurement the monograph outlines.  Arrowsight's deep experience in video monitoring and feedback in other industries allowed us to jump start our efforts in health care.  Our work is too new to have been cited in the monograph, though we have recently briefed many of its authors.  With 24/7 video monitoring, a very large and continuous sampling process, rigorous quality assurance and near-real-time feedback to front-line staff, we are excited for our Hospital Video Auditing approach to be part of the solution going forward. 

As a side note, it may not be a surprise to readers that the project was underwritten by GOJO Industries, the makers of Purell hand sanitizer.

Patient Sharing Among Hospitals Could Impact Spread of Infectious Diseases

CDC MRSA photo Twenty-two percent of people who are discharged from acute-care hospitals are readmitted at different hospitals within one year, according to a study released today by the University of California, Irvine School of Medicine.  This has big implications for the spread of infectious diseases, as hospitals typically only track direct transfers of patients from one hospital to another.  Patients can carry organisms like MRSA for long periods of time, even if they aren't actively experiencing symptoms of infection.  As a result, they can bring these organisms with them from one facility to another, even with gaps between admissions.

The study was conducted by Susan S. Huang, MD, MPH, assistant professor and hospital epidemiologist and colleagues, and funded by both UC Irvine and the National Institutes of Health's Models of Infectious Disease Agent Study (MIDAS).  The study analyzed nearly 240,000 patient admissions at 31 acute care hospitals in Orange County, CA using a retrospective evaluation of 2005 California Hospital Discharge Data.

Does Public Reporting Prompt Hospitals to Reduce Infections? -- by Suzanne Delbanco, Ph.D.

16357414 In the U.S., exactly half of the 50 states now require public reporting of hospital-specific rates of hospital-acquired infections.  There are multiple purposes behind public reporting, including making hospitals accountable to the communities they serve, and providing information to help patients make informed decisions about where to seek care.  But does public reporting prompt hospitals to reduce the incidence of hospital-acquired infections?

In Pennsylvania, where the Pennsylvania Health Care Cost Containment Council has been reporting hospital outcomes publicly for many years, the evidence is mounting that public reporting is associated with improved outcomes over time.  The Council released a report on January 22 that analyzes data from 2007 and compares it to data from 2006.  The data submitted by hospitals was the same for both years, allowing a first year-over-year comparison.  From 2006 to 2007, the Council found an 8% decrease in the number of infections contracted by patients in Pennsylvania hospitals.

Pennsylvania hospitals must have implemented variety of measures to reduce the spread of infections between 2006 and 2007.  The spotlight shined on the problem by the Pennsylvania Health Care Cost Containment Council no doubt added to their vigilance.

Curious about a new approach to assuring infection control practices are implemented?  Learn about Hospital Video Auditing (HVA) by clicking here.

Suzanne Delbanco is President, Health Care Division, Arrowsight, Inc.

Even Patient's Bath Basins Can Harbor Infections

In a study released January 1, 2009 in the American Journal of Critical Care, researchers found that patient's bath basins are a reservoir for bacteria and could be a source of transmission of hospital-acquired infections.

Three hospitals participated in the study:  Presbyterian Hospital in Albuquerque, New Mexico; Wishard Health Services in Indianapolis, Indiana; and Westerly Hospital in Westerly, Rhode Island.  Across the three facilities, researchers analyzed 92 bath basins from three intensive care units and a rehabilitation unit.  They swabbed the basins after they had been used to bathe patients and had been given a chance to air dry, and sent the samples to a microbiological testing laboratory.

Some form of bacteria grew in 98% of the samples, including enterococci, staphylococcus aureus, vancomycin-resistant enterococci and methicillin-resistant S aureus.  These findings suggest a need to develop and implement bathing protocols that protect the patient from exposure to pathogens.  The researchers site prepackaged bathing supplies as a helpful component.

Clostridium Difficile on the Rise Among Hospitalized Patients

Cdiff The fight against hospital-acquired infections is even more challenging than experts previously thought.  Yesterday, the Association for Professionals in Infection Control and Epidemiology (APIC) released the results of a new survey showing that Clostridium difficile is more prevalent among hospital patients than experts had estimated. 

 

The National Prevalence Study of Clostridium Difficile in U.S. Healthcare Facilities, conducted by APIC members who gathered sample data from the 648 hospitals in which they work, found that more than 1% of (13 out of 1,000) hospital patients are either infected or colonized with C. difficile.  This incidence is between 6.5 and 20 times higher than earlier assessments.  C. difficile is spread by hand contact with items contaminated by feces.

 

Based on the 1% incidence, 7,000 hospital patients in the U.S. have C. difficile on any given day.  Of those infected, 94% exhibited symptoms including diarrhea, fever, loss of appetite, nausea and abdominal pain.  Of the 7,000, about 300 will die from the infection.  According to APIC, the costs to care for the infection range from $17.6 to $51.5 million annually.


Important preventive measures for C. diff include:  adherence to the Center for Disease Control’s hand hygiene guidelines, use of contact precautions, identification of high-risk areas within the institution, surveillance programs, environmental and equipment cleaning and decontamination, and antimicrobial stewardship.

APIC has published a guide to help the health care industry reduce the incidence of C. difficile. APIC summarizes the issues with C. difficile and APIC's recommendations on its web site.

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