Curbing Infections in American Hospitals

It’s a common occurrence for people to be admitted to a hospital and develop an un-related infection during their stay. In fact, according to government data, it happens to 1.7-1.9 million patients a year and results in 99,000-100,000 deaths.

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These frightening numbers from the Centers for Disease Control and Prevention [CDC] show going to a hospital or other facilities where care is administered brings the risk of hospital or health care-acquired infections [HAIs] from all types of microorganisms including bacteria. But the medical community has developed—and continues to develop—resources to combat them, particularly in the last seven to 10 years. In the past, HAIs were considered unfortunate, but not unexpected parts of health care. Today, experts say, evidence-based medicine proves that HAIs are preventable.

The Department of Health and Human Services [HHS], advocacy groups like the Institute for Healthcare Improvement [IHI], Consumers Union and Leapfrog, and at least 28 states have joined the medical community in calling these infections unacceptable. CDC Director Dr. Thomas Frieden lists HAIs as one of the agency’s six priorities or “winnable battles,” saying there is sufficient HAI information to make a big impact on prevention.

All Infections are Not Equal

Infection monitoring systems are now in place to aid the fight, particularly against Central Line Associated Bloodstream Infections [CLABSI], which have become the infection control prototype in the prevention effort.

The high incidence of CLABSI has led to approximately 30,000 to 62,000 deaths yearly, and nearly $3 billion are spent on these infections worldwide. Since 2001, the number of patients in intensive care units [ICU] with CLABSI has dropped 58%. The CDC also reports that recent successes in HAI elimination have been very encouraging: sustained reduction in CLABSIs has reached as high as 70% in hospitals in which caregivers adhere to available guidelines.

These percentages are encouraging, and the industry’s monitoring of CLABSI can help researchers and clinicians understand how infections occur as well as how they can be prevented.

A central line is a tube usually placed in a large vein to give important medical treatment. If the line is not inserted correctly or kept clean, it can become a highway for germs to enter the body and cause serious bloodstream infections. Cleanliness is compromised when a hand or glove touching the line is dirty, the point at which medicines are injected becomes dirty or the skin where the line is placed is dirty.

“Dirty” means the introduction of a germ like candida and staph, which includes the recently much talked about Methicillin-resistant Staphylococcus aureus [MRSA]. These germs are among the group that causes other HAIs as well as CLABSI like surgery site infections [SSI], ventilator-associated pneumonia [VAP] and catheter-associated urinary tract infection [CAUTI].

Another common infection, clostridium difficile, C diff, is slightly different in origin. C diff, a bacterium that causes diarrhea or more serious intestinal conditions like colitis, typically develops from the prolonged use of antibiotics during health-care treatment. Best practice now dictates that physicians eliminate antibiotics as quickly as possible during a hospital stay. Contaminated or unclean surfaces or spores transferred through the air cause C diff, which can be lethal.

Five Steps to Prevention

The Comprehensive Unit-based Safety Program [CUSP] is a five-step program designed to change hospital workplace culture. Adhering to CUSP can bring about safety improvements by holding staff responsible for safety in their environment through education, awareness, access to an organization’s resources and a toolkit of interventions.

Instituted by Dr. Peter Pronovost, professor of anesthesia and critical care medicine at Johns Hopkins Hospital, and his research team, CUSP has been adopted by about 40 units at the Johns Hopkins Hospital and hundreds of units outside of Hopkins to target a wide range of problems including patient falls, medication administration errors, as well as HAIs.

CUSP for caregivers includes:

*Wash hands, for at least 15 to 20 seconds before interacting with a patient; current thinking is that soap and water is preferred as is careful attention to the areas between the fingers and under fingernails; Chlorahexadrine is a secondary substitute

*Cover yourself and the patient; wear gowns and gloves as a protective barrier

*Use Phisohex to thoroughly scrub the body at the point at which a line is inserted

*Avoid groin veins because they are likely contaminated

*Ask the patient whether he or she continues to feel the need for a catheter

Alignment with Health Reform

The Centers for Medicare and Medicaid Services [CMS] also play a role in infection control by instituting initiatives that align with patient safety and pay-for-performance criteria in health-care reform.

So far, CMS has used quality measures to make provider and plan performance public, and to link payment incentives to reporting on measures. It will soon extend the use of quality measures as a tool to link payment to actual performance, making infection control as much a business case as a public-health issue.

One-bed hospital rooms like those at Johns Hopkins and the elimination of double room or four-bed wards is a growing trend, especially in the construction of new hospitals.

Patients Play a Role

The initiative does not stop with caregivers. Patients need empowerment and implicit in that goal is the reeducation of doctors and nurses to welcome the questions of patients and their families. Patients should check to verify a hospital adopted the CUSP checklist and ask whether a doctor or nurse has washed his or her hands.

Above all, before entering a hospital, the patient or patient’s family should inquire about the hospital’s infection rate. The “right” answer: 1% to 2 %; the best answer: at or near 0.

A percentage higher than 3% is a sign that the hospital’s practices are not optimal—and a warning for you to consider treatment somewhere else.