Infection Control Showcase: Battling the Bugs
May/June 2011
Infection Control Showcase
Battling the Bugs
The headline would scream if print could speak: Superbug found in California hospitals!
Over seven months in 2010 there were more than 350 cases of carbapenem-resistant Klebsiella pneumoniae (CRKP), according to a study by the Los Angeles County Department of Health. The cases were in healthcare facilities such as hospitals and nursing homes. CRKP has been officially reported in 36 states, but health officials expect it’s also in the 14 other states where reporting is not required.
Only one antibiotic, colistin, is effective against CRKP and, according to Dr. Arjun Srinivasan, associate director for healthcare associated infection prevention at the Centers for Disease Control and Prevention, it doesn’t always work and can cause kidney damage.
Once news like this hits the papers, people get nervous about hospitals; procedures that should be done are postponed; doctors are inundated with queries about the safety of family members who are currently in the hospital; infection control becomes highly visible. In some respects, that last point is actually a benefit from the headline.
People need to be reassured that infection control procedures are in place throughout the facilities they depend on for their healthcare. This is especially true in the ICU according to Cindy Plante-Jenkins, infection control specialist at RL Solutions, a Toronto-based software and services company offering solutions for infection surveillance. “This is obviously due to the invasive nature of the treatments and the fact that patients are often immune compromised while there. Other areas of concern are wards and shared rooms and, of course, the emergency department where already-infected admissions can take place. The problem is that healthcare workers do not follow routine practices. Rapid detection and identification, initiating the proper precautions, and following up contacts are important in preventing further transmission.”
Trish Roberts, infection prevention and control consultant at RL Solutions adds, “The operating suite must be a sterile environment with an effective instrument reprocessing program, adherence to surgical technique, attention to skin asepsis, the administration of appropriate prophylactic antibiotics, and maintenance of normothermia. Once the patient is transferred to ICU/CCU the concern moves to compliance with ‘5 moments for hand hygiene,’ adherence to CVC & VAP* bundles, cleaning shared patient equipment, strict adherence to cleaning protocols, and healthcare worker education around infection control principles.”
Hospitals need strong infection control departments with administrative support; proper staffing to ensure education of patients, staff and visitors; and modern tools to be able to quickly track, follow up, monitor, and analyze infections within the facility. There must be properly staffed and trained environmental services departments to ensure environmental cleaning is done properly and thoroughly.
For example, Bemis Health Care, Sheboygan Falls, Wisc. offers its Quick–Drain system as a means for safe liquid-waste management, reducing cost and exposure by emptying canister contents directly into a sanitary sewer system. By confining liquid infectious waste and thereby reducing splash and airborne risks, Quick–Drain eases environmental impact, reduces red bag waste cost, removes the need for solidifiers or disposables, requires no electricity and satisfies OSHA’s Bloodborne Pathogen Standard while complying with EPA, CDC and NIOSH guidelines.
High turnover areas such as emergency, endoscopy, diagnostic imaging, etc. require special consideration as there is pressure to get another patient into the bed as soon as possible. And, of course, senior management needs to support, model and value infection control and environmental services initiatives and activities.
Still, as Plante-Jenkins says, “Patients need to be their own advocates, often when they are not in a state to do so — asking the surgeon about his or her infection rates, asking caregivers if they have washed or sanitized their hands prior to delivering care, asking hospitals about any current or recent outbreaks, looking at the publicly reported data of the healthcare organization they are going to be in and comparing to other hospitals of similar size and mix of patients.”
*CVC – central venous catheter, VAP – ventilator-associated pneumonia
Tom Inglesby is an author based in Southern California who has covered automatic identification since the early 1980s.