Prevention Update
Infection control practices not adequately implemented at many hospital ICUs: study U.S. hospital intensive care units (ICUs) show uneven compliance with infection prevention policies, accord- ing to a study in the February issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC). In the largest study of its kind, researchers from Columbia University collaborated with the Centers for Disease Control and Prevention (CDC) to undertake a nationwide survey of 1,534 ICUs at 975 hospitals as part of the larger Prevention of Nosocomial Infections and Cost Effectiveness Refined (P-NICER) study. The survey inquired about the implementation of
16 prescribed infection prevention measures at point- of-care, and clinician adherence to these policies for the prevention of central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTI). These infections are among the most com- mon infections acquired by patients in ICUs. According to the survey, hospitals have more poli- cies in place to prevent CLABSI and VAP, than CAUTI. The presence of infection control policies to prevent CLABSI ranged from 87 to 97 percent depending on the measure being counted; the presence of policies for VAP ranged from 69 to 91 percent; and policies for CAUTI lagged behind with only 27 to 68 percent of ICUs reporting prevention policies. The use of a checklist for CLABSI insertion practices was reported by the vast majority of hospitals (92 percent), while the use of a ventilator bundle checklist was reported by fewer hospitals (74 percent). “Evidence-based practices related to CAUTI preven- tion measures have not been well implemented,” state the authors. “These findings are surprising, given that CAUTI is the most frequent healthcare-associated infection. Clearly, more focus on CAUTI is needed, and dissemination and implementation studies to inform how best to improve evidence-based practices should be helpful.” In adhering to policies, many hospital ICUs fell short,
according to the survey. Adherence to prevention poli- cies ranged from 37 to 71 percent for CLABSI, 45 to 55 percent for VAP, and 6 to 27 percent for CAUTI. “Establishing policies does not ensure clinician ad-
herence at the bedside,” state the authors. “Previous studies have found that an extremely high rate of clinician adherence to infection prevention policies is needed to lead to a decrease in healthcare-associated infections. Unfortunately, the hospitals that monitored clinician adherence reported relatively low rates of adherence.” The survey also assessed structure and resources of
infection prevention and control programs, evaluat- ing characteristics such as staffing, use of electronic surveillance systems, and proportion of infection pre- ventionists with certification. Visit APIC for the study.
www.apic.org
INFECTION PREVENTION
Electronic hand-hygiene surveillance systems: The new gold standard?
by Susan Cantrell, ELS
ealthcare workers (HCWs)’ adherence to hand hygiene (HH) traditionally has been well below par. The Centers for Disease Control and Prevention (CDC) handwashing guidelines point out that compli- ance to HH protocols needs to become a mind- set: “Ultimately, adherence to recommended hand-hygiene practices should become part of a culture of patient safety where a set of interdependent quality elements interact to achieve a shared objective.” 1
H
In their guidelines, the CDC recommends, “When outbreaks of infection occur, assess the adequacy of health-care worker hand hygiene.” 1
This is where surveillance of HH comes into play. Kim Lees, Marketing Direc- tor, Ecolab Healthcare, St. Paul, MN, observed, “Tracking HH is important not only because it is required by agencies such as the Joint Commission and Centers for Medicare and Medicaid Services (CMS) but also because measurement leads to improved compliance and infection prevention.”
Traditionally, HH compliance has been assessed by the direct observation method. Unfortunately, this method has serious draw- backs, not the least of which is the Hawthorne effect (see sidebar).
Technology is coming to the rescue with
automated performance indicators for mea- suring improvement in HCWs’ adherence to HH protocols, as recommended by the CDC: “Periodically monitor and record adherence as the number of HH episodes performed by personnel/number of HH opportunities, by ward or by service. Provide feedback to personnel regarding their performance. Monitor the volume of alcohol-based hand rub (or detergent used for handwashing or hand antisepsis) used per 1,000 patient-days.”1 Heather McLarney, Vice President, Mar-
keting, DebMed, Charlotte, NC, briefly highlighted why incorporating an electronic surveillance system is an important com- ponent of an HH program. “In the United States, 1 in 20 patients contracts a healthcare- associated infection (HAI), equaling roughly 1.7 million infections each year, and costing the healthcare industry an estimated additional $45 billion dollars in costs. Clearly, monitoring HCWs’ HH activity should be part of any hos-
30 March 2014 • HEALTHCARE PURCHASING NEWS •
www.hpnonline.com
pital’s patient-safety and quality-improvement programs. With electronic HH monitoring systems, tracking has not only become less time consuming and more cost-effective but taking the human factor out of compliance reporting provides hospital staff with a more accurate picture of what is going on real-time in their facility.”
Patient Safeguard System, from UltraClenz
Charles Johnston, Executive Vice President, UltraClenz, LLC, Jupiter, FL, continued that line of thought: “Each year 99,000 patients die from HAIs. The cost to the hospital system is in the billions each year. Many of these infec- tions are preventable, and the number 1 way to prevent the spread of infection is through proper HH practices.” Johnston pointed out that automated surveillance enables HH activity to be monitored continuously at the patient-bed level over a 24-hour period, includ- ing nights and weekends, which is unlikely with the direct observation method.
Limitations of direct observation Direct observation is considered the gold standard for HH surveillance. However, the direct observation method has limitations, explained McLarney, DebMed. “While direct observation has historically been the standard, and still plays a role in on-the-spot feedback and education, there are several flaws inherent in direct observation for tracking HH compli- ance. The first of these is the Hawthorne ef- fect. The second is cost; direct observation is resource-intensive and time-consuming. The third constraint is timeliness; direct observa- tion takes time to perform and to calculate compliance rates. By the time feedback gets
See INFECTION PREVENTION on page 32
INFECTION PREVENTION
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