Prevention Update INFECTION PREVENTION
Multiple strains of C. diffi cile cause severe patient outcomes No single genetic strain of the widespread Clostridium diffi cile (C. diffi cile) bacteria appears to be any more harmful than other strains, according to new research published in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America. The fi ndings contradict previous research suggesting
that the emergence of the most severe C. diffi cile infec- tions (CDI) could be linked with a particular strain known as Ribotype 027 (R027). C. diffi cile is a highly infectious diarrhea that is the most common cause of healthcare- associated infections (HAI) in the United States. "Clinical severity markers of CDI, such as white blood cell count and albumin level, a protein in blood, are more important predictors of severe outcomes than any specifi c strain, especially in hospitals with no single predominant strain," said Samuel L. Aitken, PharmD, lead author of the study. Although C. diffi cile R027 was the most prevalent strain associated with severe onset of the disease, it was found to not be any more likely to cause severe outcomes than other C. diffi cile strains. However, researchers noted that continued use of non-C. diffi cile antibiotics was a strong predictor of severe CDI outcomes in all strains. The continued use of other antibiotics has previously been associated with prolonged diarrhea and CDI treatment failure.
CDC provides Ebola PPE guidance clarifi cations The Centers for Disease Control and Prevention (CDC) has clarifi ed its guidance regarding personal protec- tive equipment (PPE) for healthcare personnel caring for suspected and confi rmed Ebola patients in U.S. healthcare facilities. Based on feedback from healthcare facilities that have implemented the current guidance (originally posted October 2014), the guidance clarifi es the use of fl uid- resistant and impermeable gowns and coveralls. Speci- fi cations are provided in the guidance to assist facilities in selecting and ordering the recommended garments. In addition to clarifying the specifi cations of gowns
and coveralls recommended, the PPE guidance for con- fi rmed Ebola patients is being updated with additional explanation, including: • expanding the rationale why respiratory protection is recommended;
• clarifying that the trained observer should not serve as an assistant for taking off (doffi ng) PPE;
• suggesting a designated doffi ng assistant, especially in doffi ng with the Powered Air Purifying Respirator (PAPR) option;
• modifying the PAPR doffi ng procedure to make the steps more clear;
• changing the order of boot cover removal. boot covers are now removed after the gown or cov- erall; and
• emphasizing the importance of frequent cleaning of the fl oor in the doffi ng area. The updated PPE guidance can be found at www.
cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html.
All eyes on hand hygiene
Effective, gentle products and compliance monitoring give hygiene a helping hand by Susan Cantrell, ELS
oes your medical facility have a culture of safety that emphasizes the importance of handwashing compliance in all areas—patient care, food service, housekeeping? Does your staff take to heart the simple knowledge that clean hands can mean the difference between life and death? Too often, that is not the case. According to the Centers for Disease Control and Prevention (CDC), hand washing com- pliance remains, outrageously, embarrass- ingly, at approximately 40 percent. To healthcare workers (HCWs), being instructed to wash your hands at every opportunity probably falls under the cat- egory of “easy-for-you-to-say.” There are legitimate impediments to compliance with handwashing best practices, and each im- pediment requires a different intervention. One of the organizations that provides
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information on hand-hygiene (HH) compli- ance is The Joint Commission Center for Transforming Healthcare. In their info sheet “Hand Hygiene Factors and Solutions” reasons for noncompliance are addressed and practical solutions are offered for those working with patients, as well as house- keeping and food service.1 Here is a snapshot of some of those no- cost or low-cost solutions: • Keep sinks and hand-rub or soap dispens- ers in good working condition, fi lled, and located in areas where they are readily available and easy to access.
• When using shared equipment, such as mobile vital sign machines, perform hand hygiene prior to touching patients. Wear gloves when appropriate and wash hands prior to donning personal protec- tive equipment.
• Use hand hygiene technologies that can provide real-time monitoring of hand hygiene compliance.
• Incorporate a hand hygiene standard into meal tray deliveries; wash hands prior to entering and exiting patient rooms.
• Avoid having hands full of medication by keeping supplies near the patient and within arm’s reach of a hand wash station.
20 October 2015 • HEALTHCARE PURCHASING NEWS •
www.hpnonline.com
• Use a phrase or code word that can be used as a reminder among peers to per- form hand hygiene.
• Ensure housekeeping staff perform hand hygiene during daily or turnover room cleaning.
• Patient admission is a time when fre- quent entry and exit occurs, meaning that health care personnel need to per- form hand hygiene multiple times. Staff should create a standard work process for patient admission using specifi c roles.
• Implement just-in-time coaching for real-time reinforcement and feedback to health care personnel. JIT coaching does not end when the baseline data collection period ends.
• Leadership commitment, change man- agement principles, measurement, managing expectations, and making it simple to achieve hand hygiene success are critical.
For the complete list of Hand Hygiene Factors and Solutions, visit http://www.
centerfortransforminghealthcare.org/ UserFiles/fi le/hand%20hygiene%20fac- tors%20and%20solutions.pdf. The Leapfrog Group, a voluntary pro- gram, recognizes and rewards hospitals making big leaps in health care. In 2014, 1,501 hospitals completed the Leapfrog Hospital Survey.2
The section on HH safe
practices measures hospitals’ compliance to an HH program in four areas: awareness, accountability, ability, and action. Is there awareness of the need for hospital-wide ed- ucation and activities to improve HH? Are clinical and administrative lead- ers accountable? Does the hospital conduct staff training, and does the budget provide for safe HH? Are HH poli- cies and procedures implemented across the organization? According to Leapfrog Group’s report, 77 percent of reporting hospitals earned all possible points, meeting all 10 HH safe practices. Clearly, these are questions every hospital should be asking, Leapfrog Group mem- bers or not.
See INFECTION PREVENTION on page 22
INFECTION PREVENTION
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