"Bugbusting" - Preventing hospital-acquired infections with EBP

Don’t you wish it was that easy? You could just pick up the phone, hire Bugbusters, and they’d come out and use their Sci-fi equipment to rid your facility of all those nasty “bugs” or organisms that cause health care-associated infections (HAIs). Unfortunately, it isn’t that easy; there’s no Sci-fi equipment to magically rid your facility of organisms. We’ve made strides, however, towards reducing the incidence of these infections by using a variety of evidence-based best practices.

Progress report

The Centers for Disease Control and Prevention recently published the National and state healthcare associated infections: Progress report using 2014 infection data from national acute care hospitals. This report revealed significant progress towards reducing HAIs:

• Central line-associated bloodstream infections declined by 50% between 2008 and 2014.

• Catheter-associated urinary tract infections showed no change overall, but there was progress made in non-critical care settings between 2009 and 2014, and in all settings between 2013 and 2014.

• Surgical site infection declined by 17% between 2008 and 2014.

• Clostridium difficile infections declined by 8% between 2011 and 2014.

• Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia declined by 13% between 2011 and 2014.

As you can see, we’ve made significant progress, but there’s still much more work to be done. Every day, nearly one in 25 patients in the United States has at least one infection that they acquired during their stay in a health care facility. This shows the need to improve infection control and prevention practices in health care facilities, and other various settings.

Bugbusting best practices

So, what can we do to bust those “bugs” and prevent HAIs in our health care facilities? To start, research shows that when members of the multidisciplinary team are aware of infections and join together to take steps to prevent those infections, infection rates can be reduced by more than 70%.  Developing a culture of safety that includes teamwork, evidence-based infection prevention processes, and accountability for preventing infections is key.

Making it real

Make infections real to all members of the health care team, including environmental services personnel, transportation staff, sterile processing department staff, patients, visitors, and volunteers; not just those directly involved in patient care. After all, everyone plays a role in preventing the spread of infection.

Share stories… nothing hits home like a story of a patient who suffered harm as a result of an infection that could’ve been prevented. Take for instance, the story of an elderly patient admitted to a health care facility for knee replacement surgery.  The surgical procedure itself went smoothly, but the patient soon developed a surgical site infection, the responsible organism was MRSA. The patient spent months in the hospital for IV antibiotics, prosthetic joint removal, spacer insertion, and eventually an above the knee amputation of the affected leg. The patient, the mother of a staff physician, eventually succumbed to complications of the MRSA infection.

How could a seemingly uncomplicated surgery result in an infection that ultimately resulted in this patient’s death? Was it by the hands of a health care worker who didn’t take time to perform hand hygiene? An operating room team member who failed to follow sterile technique during the procedure? An environmental services staff member who didn’t properly clean surfaces in the patient care area? A sterile processing staff member who didn’t properly sterilize surgical instruments? A visitor who failed to perform hand hygiene before visiting the patient? The patient herself who failed to properly perform personal hygiene after surgery? Any of these scenarios could’ve caused the patient’s infection and subsequent death. When this story was told, it was difficult not to feel accountable.

Zero tolerance

There are many opportunities for infection to spread in a health care facility.  It’s important to make sure that everyone is educated about measures to prevent infection, using methods that they understand. Start with the basics...we’ve all heard it before, hand hygiene is the single most effective thing you can do to keep infection from spreading. Make sure everyone performs hand hygiene properly, every time that it’s indicated.

Develop a culture that has zero tolerance for infection and zero tolerance for failure to follow proper infection prevention practices. Empower patients, family, and other staff to speak up when infection prevention practices aren’t followed. Getting to zero is the only sure way to keep our patients safe from infection.

What infection prevention practices have been successful at your facility? Have you done anything creative to engage staff, patients, and visitors; something outside the box that you’d like to share with us?

References:

Centers for Disease Control and Prevention. (2016). “National and state healthcare associated infections: Progress report” [Online]. Accessed April 2016 via the Web at http://www.cdc.gov/HAI/pdfs/progress-report/hai-progress-report.pdf

Institute for Healthcare Improvement. (n.d.). “What zero looks like: Eliminating hospital-acquired infections” [Online].

Yokoe, D.S., et al. (2014). SHEA/IDSA practice recommendation: Introduction to a compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infection Control & Hospital Epidemiology, 36(5), 455-459.
 

Collette Bishop Hendler, RN, MS, CIC
Senior Clinical Editor
Clinical Project Manager, Lippincott Procedures
Wolters Kluwer, Health Learning Research & Practice