Hospitals across the country are diligently working to reduce infection rates. According to the World Health Organization, hospital-acquired infections affect as many as 1.7 million patients in the United States each year. These infections come at an annual cost of $6.5 billion and contribute to more than 90,000 deaths.
Proper hand hygiene is essential in helping to prevent hospital-acquired infections. A recent study performed by French researchers examined three types of healthcare workers. The first type spent a large amount of time with a discreet group of patients like a nurse would. The second group saw more patients but spent less time with each one - similar to doctors. Group three consisted of healthcare workers who interacted with every patient every day like therapists. The study found that if a healthcare worker in group three failed to wash their hands, the spread of disease was three times worse than if someone from group one or two didn't. The study was published online in Proceedings of the National Academy of Sciences. To read more about the study, continue here.
To read another take on hand hygiene and about the Joint Commission's national hand hygiene project, click here.
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Almost two million patients hospitalized in the U.S. each year develop an infection. These infections occur in as many as one in every 10 patients, result in close to 100,000 deaths and cost upwards of $6 billion. The Wall Street Journal created a top 10 list of infection prevention strategies based on interviews with medical professionals, administrators a non profit company and the Association for Professionals in Infection Control and Epidemiology.
- Undercover Operations - Dr. Philip Carling, an epidemiologist at Caritas Carney Hospital in Dorchester, Mass. developed a solution to uncover how well patient rooms are cleaned. His invisible solution contains fluorescent markers which glow in black light. After spraying patient rooms with the solution, cleaning crews were brought in to perform their normal routine. Later, rooms were examined with a black light and areas missed by the cleaners glowed fluorescent. Sharing results with cleaners helped boost compliance with proper cleaning techniques.
- High-Tech Cleaning Systems - When hospital equipment is disinfected by hand, bacteria often remains. For more thorough disinfecting hospitals are utilizing machines such as Bioquell which sprays a disinfecting hydrogen-peroxide vapor.
- Data Mining - Many hospitals are tracking data to determine how to prevent infections. Lee Memorial Health System in Florida tracks infection rates by surgeon and reports on the results. Low ranking surgeons can then make adjustments to lower their infection rates and improve their ranking.
- Patient Hygiene - Research suggests a daily wash with mild antibacterial soap can dramatically reduce the rate of bloodstream infections. The recommended cleanser is chlorohexidine glutonate.
- Reporting Crackdown - Numerous states have passed laws which require hospitals to report on infection rates. In many cases the reports are publicly available. In addition, Medicare is limiting reimbursement for treatment of hospital-acquired infections.
- Clean hands - Hospitals that utilize strategically-placed dispensers of hand sanitizer have noticed an increase in hand hygiene compliance from less than 50% to more than 80%.
- Embracing the Checklist - Incorporating checklists into bedside medical charts can help reduce rates of infection by requiring shift nurses to answer questions such as: Does this patient have a catheter? If so, is it still necessary?
- Portable Kits - Utilizing all-inclusive kits for common procedures such as intravenous line insertions or dressing changes can limit the possibility for infection. Kits contain all the items needed for procedures and prevent the nurse from running in and out of the patient room during a procedure to find a forgotten item.
- Mouth Maintenance - Regularly cleaning patients' mouths, gums and teeth can help prevent ventilator-associated pneumonia, a common infection found in intensive care units.
- Infection ID - Quick diagnostic tests can identify infected patients in a matter of hours rather than days. This allows for a quick response when patients show symptoms, are tested and found to be infected.
To read the complete article with expanded descriptions of the top 10, click here.
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Hospitals in Michigan lowered the rate of bloodstream infections in their patients by following a five-step checklist. The study published in the New England Journal of Medicine
found that implementing the checklist reduced the rate of bloodstream infections related to catheter use by 66%. Despite this success, utilization of the checklist remains limited. The checklist itself isn't complicated:
- Wash hands
- Clean patient's skin with chlorohexidine
- Wear protective cap and gown and use a surgical drape during the procedure
- Avoid catheter insertion through the groin if possible
- Remove unnecessary catheters
Peter Pronovost, the patient-safety expert who led the study, spoke with The Wall Street Journal to share insights on why more hospitals haven't benefited from using the checklist. To read excerpts from his interview, click here.
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A recent study published in the American Journal of Infection Control examined the levels of bacteria on healthcare workers' lab coats. The study involved a cross section of medical and surgical grand rounds attendees at a large teaching hospital. Participants completed a survey and cultured their lab coat using a moistened swab on the lapels, pocket and cuffs. Of the 149 white coats in the study, 34 (23%) were contaminated with S aureus, of which 6 (18%) were methicillin-resistant S aureus (MRSA). Providers working with patients had higher contamination levels and the study suggests that white coats may contribute to patient-to-patient transmission of S aureus. Read the entire study in the March 2009 issue of the American Journal of Infection Control, the official journal of the Association for Professionals in Infection Control and Epidemiology (APIC).
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Central venous catheters (CVC) are essential for treating children with cancer. They reduce the need for multiple needlesticks and the associated pain and anxiety. In addition, they can be used to deliver chemotherapy, parenteral fluids, blood products and analgesics. Despite the positives, children with CVCs are at increased risk for bloodstream infections. Complications associated with CVCs include pneumothorax, air embolism, nerve injury, catheter malposition, infection and occlusion.
A recent study had four objectives:
1. To decrease CVC-related bloodstream infection rates in children with cancer through a comprehensive educational intervention.
2. To determine if the frequency of catheter hub colonization of CVCs in children with cancer would decrease following the educational intervention.
3. To evaluate nurses' knowledge of CVC care.
4. To determine risk factors influencing CVC-related bloodstream infections in children with cancer.
The study was conducted in the cancer center of a large children's hospital and included patients ranging in age from infancy to 18 years. A 45 minute educational program on CDC guidelines, most frequent guideline violations and information on catheter-related infections was presented to all caregivers. Following the educational presentation, catheter-related bloodstream infections were tracked for six months in order to determine the rate of infection. Study findings showed that the educational program increased nurses' knowledge and instances of catheter-related bloodstream infections decreased. You can read the full article in the March 2009 issue of Oncology Nursing Forum or purchase it online here.
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According to a 2009 study, approximately 5 million central venous catheters are placed each year. Implantable ports provide reliable venous, arterial, epidural and peritoneal access and can be used to administer IV fluids, medications and to obtain blood samples. However complications including occlusion, infection, catheter migration and catheter separation from portal body can frequently occur.
A recent study conducted in a rural hematology-oncology clinic focused on infection. A port infection can present as local tenderness, pain, erythema, induration or edema at the insertion or exit site or over the port pocket. Patients may also have purulent or serous drainage, fever and chills. To prevent infection, aseptic technique should be utilized for dressing changes. In addition, clinicians should follow accessing and deaccessing procedures and keep the exit clear of potential sources of infection. The 62 patients included in the study were receiving a minimum of two complete cycles of chemotherapy after port insertion. Ports were accessed and deaccessed following outlined protocol.
*Steps for Accessing Ports:
- Wash hands. Assess the port site for erythema, warmth or drainage.
- Palpate the outline of the portal body.
- Wash hands.
- Apply nonsterile gloves. Cleanse port site with chlorohexidine swab in a circular motion for 30 seconds. Allow to dry for 30 seconds.
- Spray ethyl chloride.
- Stabilize portal body with one hand. Insert Huber needle (link to EZ Huber product page) into septum with other hand. Ensure patency by blood return. If no blood return, use interventions to assess port's patency.
- Stabilize port with gauze and tape or apply transparent dressing.
*Steps for Deaccessing Ports:
- Wash hands. Apply nonsterile gloves.
- Inspect exit site.
- Flush device with 20 ml normal saline followed by 5 ml heparin flush (100 units/ml). During final flush, clamp tubing to port.
- Stabilize port and remove needle.
- Apply bandage.
Six of the 62 patients in the study experienced a port infection, with four of the six ports requiring removal. The total number of catheter days for the implanted ports was 7,277. Patient catheter days ranged from 32-288. The study concluded that consistent, routine care is the best preventative measure against port complications. The entire study can be found in the October 2009 issue of the Clinical Journal of Oncology Nursing.
*The port access and de-access protocols are those that were used by the authors for this study. Please follow institutional policies and procedures regarding port access and de-access.
Although many infection headlines are related to hospitals, individual doctor's offices are facing similar challenges. Almost 30 cases of hepatitis B were recently tied to one doctor's office in New Jersey. When health inspectors visited the office they found blood on the floor of a room where chemotherapy was administered, blood in a bin where blood vials were stored, unsterile saline and gauze as well as open medication vials. Inspectors also noticed cross-contamination of pens, refrigerators and countertops, use of contaminated gloves and misuse of antiseptics.
Patients were sent a letter from state epidemiologist Dr. Christina Chan urging testing for hepatitis B. "Evidence gathered at this time suggests that since 2002, some clinic staff provided care in a manner that puts patients at risk for infection caused by bloodborne viruses, including hepatitis B," the letter told patients. "The investigation to date suggests that hepatitis B infections identified may be associated with the method by which medications were administered and procedures performed at the practice."
Numerous checklists and recommendations have been published around infection control. The American Academy of Pediatrics Committee on Infectious Diseases and Committee on Practice and Ambulatory Medicine offers these infection control musts:
- Hand washing
- Barrier precautions to prevent skin and mucous membrane exposure
- Proper handling of sharps and contaminated waste
- Appropriate cleaning and disinfecting of surfaces and equipment
- Aseptic technique for invasive procedures
For the full recommendation on infection control in physician's offices, click here.
To read more about the hepatitis B outbreak in New Jersey, continue reading here.
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The Joint Commission Center for Transforming Healthcare is working on its first improvement venture: The Hand Hygiene Project. According to the Centers for Disease Control and Prevention, an estimated 2 million patients get a hospital-related infection every year and 90,000 die from their infection.
Causes of Failure to Clean Hands
- Ineffective placement of dispensers or sinks
- Hand hygiene compliance data are not collected or reported accurately or frequently
- Lack of accountability and just-in-time coaching
- Safety culture does not stress hand hygiene at all levels
- Ineffective or insufficient education
- Hands full
- Wearing gloves interferes with process
- Perception that hand hygiene is not needed if wearing gloves
- Healthcare workers forget
Early results of the program found on average that caregivers washed their hands less than 50 percent of the time. "Demanding that healthcare workers try harder is not the answer. These healthcare organizations have the courage to step forward to tackle the problem of hand washing by digging deep to find out where the breakdowns take place so we can create targeted solutions that will work now and keep working in the future," said Mark R. Chassin, M.D., M.P.P, M.P.H., president, The Joint Commission.
By January, 2010, the Joint Commission Center for Transforming Healthcare plans to have data to demonstrate whether the proposed hand hygiene solutions can be sustained to achieve a 90+ percent compliance rate.
Eight hospitals are participating in this project:
- Cedars-Sinai Health System, Los Angeles, California
- Exempla Lutheran Medical Center, Wheat Ridge, Colorado
- Froedtert Hospital, Milwaukee, Wisconsin
- The Johns Hopkins Hospital and Health System, Baltimore, Maryland
- Memorial Hermann Health Care System, Houston, Texas
- Trinity Health, Novi, Michigan
- Virtua, Marlton, New Jersey
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
To read the full release from the Joint Commission for Transforming Healthcare, click here.
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Healthcare providers are on alert due to an increase in a new strain of hospital-acquired infections. A recent study released by Arlington Medical Resources (AMR) and Decision Resources, found that recurrent Clostridium difficile
is difficult to treat in a hospital setting.
Clostridium difficile is a bacterium that can cause symptoms as minor as diarrhea and as life threatening as severe inflammation of the colon. The elderly are most at risk and the Centers for Medicare and Medicaid services is considering adding Clostridium difficile to its list of "never events" or preventable hospital-acquired infections. Hospitals will receive reduced or no Medicare payments for infections on the "never events" list.
Read more about how the study was conducted as well as more information on Clostridium difficile here.
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Jeanne Hahne was working as a nurse in a burn ward when inspiration struck. Because the patients were so vulnerable to infection, Hahne and other healthcare providers had to wear full protective gear including a cap to cover her hair and a mask that covered the majority of her face. Even though she worked with many of the burn patients every day, most couldn't recognize her.
Flash forward almost 30 years and Hahne has designed a face mask made of clear plastic so patients can see her smile. Hahne believes she can reassure patients with a smile and help decrease their anxiety. The masks also have utility for patients and healthcare providers with hearing loss since they allow for lip reading. In addition, the masks have helped improve communication between healthcare workers which can help decrease the chance for mistakes or misunderstanding. To read more and see pictures of the face mask, click here.
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