The rates of healthcare-associated infections in the age of antibiotic resistance and the Affordable Care Act are important measures of patient safety and the fiscal health of a hospital. Though progress has been made toward HAI reduction in recent years, still, on any given day, approximately 1 in 25 patients may encounter a dangerous infection while being treated in a healthcare facility, according to the CDC. Why is this and what can hospitals do at a system level to stem the HAI tide?
During a Sept. 15 webinar sponsored by Sealed Air Diversey Care and hosted by Becker's Hospital Review, Jim Gauthier, the senior clinical advisor in infection prevention at Sealed Air Diversey Care, led a discussion aimed at identifying the multiple factors that can influence HAI risk, evaluating if a facility's current practices are comprehensive enough to address these risks and ultimately creating a successful formula to improve compliance and reduce HAIs.
Here are four key strategies for HAI reduction examined during the webinar:
1. Know all the contributing factors
"[HAIs] really are a multifactorial problem," said Mr. Gauthier, who has more than 35 years of experience in medical laboratory technology and infection prevention, in his introductory remarks.
Mr. Gauthier went on to identify six facets of an effective HAI prevention program:
• Comprehensive assessment of a patient's health (or patient acuity) upon entry into the hospital. Factors that influence patient acuity include comorbidities, the patient's age, whether or not the patient is on antibiotics, whether they are on a ventilator and the number of infection 'portals of entry' associated with care elements like surgical incisions, central lines, skin breakdown, and catheters.
• Getting hand hygiene compliance over 70 percent. Strategies for improving compliance include providing staff feedback on hand hygiene compliance with auditing by secret shoppers to avoid inflated compliance numbers due to the Hawthorne effect (the alteration of behavior due to awareness of being observed), and having alcohol-based hand rub at the point of care locations as determined by staff.
"We had peel off stickers that we gave to the staff," said Mr. Gauthier, relaying his experience as part of a team launching a hand hygiene program at Providence Care in Kingston Ontario in 2008. "If staff were performing a care activity and they turned and thought it would be handy to have a hand hygiene dispenser there, they put a sticker on the wall, and maintenance installed a dispenser at that point of care."
• Maintaining a comprehensive antibiotic stewardship program by delivering patients the right drug via the correct pathway (intravenous, oral, inhaled) for the proper duration with the right dose by narrowing the spectrum of antibiotics.
• Recognizing the best options for clinical practices like skin preparation for line insertion and surgeries, bathing in chlorhexidine and potentially using prophylactic antibiotics before surgery to prevent against infections.
• Improving fecal waste management by assessing practices with bedpans and commode buckets, using single use disposable plastic waste receptacles, thermal disinfection machines to empty and wash receptacles, using macerators, or using liner bags with absorbent pads that solidify the waste.
• Refining environmental disinfection practices by determining who [nurses, environmental services] is cleaning what and when through an audit system.
Because many different factors influence HAI risk, it can be difficult for hospitals to narrow down where to focus infection prevention efforts. Many choose to partner with cleaning solutions providers, such as Sealed Air, that offer products and services designed to increase cleaning productivity and effectiveness, facility cleanliness and hygiene.
Mr. Gauthier explained in greater detail what is involved in effective HAI prevention programs.
2. Expand environmental disinfection policy
Beyond implementing a precise system by which a hospital can determine what needs to be cleaned by which staff members and when, Mr. Gauthier suggests getting the patients and visitors voluntarily involved in cleaning practices by providing safe, disinfectant products within the patient's room that they can then use of their own initiative to clean parts of the care environment.
"I know if I was sitting in a hospital room with a loved one of mine and there was a disinfectant wipe that was safe enough to be within the patient bed space, I'd probably be wiping things down," said Mr. Gauthier.
Also, Mr. Gauthier suggested that care practices that could soil the environment, or put the patient at risk of coming in contact with healthcare organisms, be reviewed and protocols be put in place for using a disinfectant wipe either before or after the event. For instance, the overbed table should be disinfected before the patient's food tray is placed on this surface.
3. Involve the patient in hand hygiene efforts
An aspect of infection prevention that is often overlooked is assessing a patient's ability to perform his or her own hand hygiene tasks upon admission. Key questions to be answered in this assessment include:
• Does the patient know that the product is there?
• Does the patient understand when they need to perform hand hygiene?
• Can the patient perform their own hand hygiene?
If the patient can't appropriately use hand sanitizer either due to a cognitive inability to recognize the product or the lack of physical strength to depress the product's plunger, Mr. Gauthier suggested, "Let's get some signage above this patient's bed space to let people know they need assistance."
4. Change the way we handle fecal waste
Perhaps the most important element of HAI prevention is the management of fecal waste. Mr. Gauthier surmised that feces are the primary reservoir for infections like vancomycin-resistant enterococci, Clostridium difficile and, according to study published in Infection Control and Hospital Epidemiology, methicillin-resistant Staphylococcus aureus.
In addition to using the proper equipment to collect and dispose of patient fecal waste, Mr. Gauthier suggested prohibiting the rinsing of any bedpans or commode buckets in the patient's room or the patient's washroom and advised that any frontline staff should wear personal protective equipment anytime they may come into contact with a patient's feces. Diaper changing protocols for incontinent patients should be established to determine when to change protective gloves, where to place soiled articles and what should be disinfected after a change.
"We've got to get better at the way we handle fecal waste; there's no question in my mind," said Mr. Gauthier.
To view the webinar, click here.
To download the webinar's slides, click here.
To view past webinars, click here.
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