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INFECTION PREVENTION BUYERS GUIDE


Products, practices & partnerships key to prevention


by Valerie J. Dimond


ealthcare-associated infections (HAIs) are a troubling reality that healthcare providers have wrestled with for ages. Sometimes they win, sometimes they don’t. According to the Centers for Disease Control and Prevention (CDC), an estimated 722,000 HAIs occur each year in U.S. hospitals and about 75,000 patients with these infections die during their hospital stays.


H


What’s important is that infection prevention (IP) professionals, clinicians and other healthcare workers continue to huddle and find ways to prevent and control them.


Infection rate update — confronting CAUTI (still) Some of the most common types of HAIs that the CDC tracks annually include central line- associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), select surgical site infections (SSI), hospital-onset Clostridium difficile (C. difficile) infections, and hospital-onset methicillin-resis- tant Staphylococcus aureus (MRSA) bacteremia (bloodstream infections). According to the CDC’s latest Healthcare-


associated Infections Progress Report, health- care facilities are making notable progress in most areas. But it also revealed an interesting development in the CAUTI category: Incidence remains unchanged in the acute care setting but is improving in long-term acute care and inpatient rehabilitation facilities.1


Why?


Communication Committee Member at the Association for Professionals in Infection Control and Epidemiology (APIC) Barbara A. Smith, RN, BSN, MPA, CIC, Mount Sinai St. Luke’s/Mount Sinai West, New York City, says the longer a catheter remains in the patient, the more likely it is for CAUTI to develop. Compared to hospital patients, she says it may be that it’s easier to reduce unnec- essary usage in long-term acute care and rehab facility patients. “These facilities recognized that some patients who would have previously been catheterized did not have a clinical rationale for the catheter; it will be interesting to see if there was a concomi- tant reduction in device utilization in these facili- ties,” said Smith. “Appropriate device usage has been a challenge in acute care hospitals because patients’ condition may indeed warrant a cath- eter. The HAI report does show improvement


Barbara Smith


in non-ICU settings — indicating that acute care hospitals have been able to reduce inappropriate usage in some populations. “One of the most effective measures to reduce CAUTIs is a nurse-driven protocol,” continued Smith. “A registered nurse is empowered to discontinue the catheter once it is no longer needed using predetermined clinical indicators for indwelling catheters. The ANA endorses this practice and has developed a Streamlined Evidenced Based RN tool to achieve this goal.”2 Smith says adopting a unit-based initiative such as the CUSP (Comprehensive Unit-based Safety Program), which is endorsed by the Agency for Healthcare Research and Quality, is another effective strategy. “In order for staff to be successful and effect change in practice, the facility needs to provide tools and additional resources both material and educational,” Smith asserted. “These include bladder scanners, reliable scales for patients’ weights, alternative incontinence devices such as external catheters and pads and skin care products to maintain skin integrity.


It is noteworthy that in the HAI report,


33 states have mandatory reporting of CLABSI but only 20 mandate it for CAU- TIs,” Smith added. “Similarly, reporting surgical site infections after colon surgeries and hysterectomies was mandated by CMS in January 2012 whereas comprehensive reporting of CAUTIs in hospitals did not occur until 2015. I’m delighted that other HAIs have decreased because that implies that CAUTI reduction is possible as well.”


Ousting other infections When it comes to catheter-associated blood- stream infections, J. Hudson Garrett Jr., PhD, MSN, MPH, FNP-BC, CSRN, VA-BC, Vice President, Clinical Affairs, PDI, says they often occur because the patient’s own endogenous flora wasn’t properly removed during the skin antisepsis process prior to device insertion. “One of the other significant routes for contam-


ination is that of the needleless access sites which includes needleless connectors, medication ports, and injection ports,” Garrett said. “Clinicians rarely dedicate the necessary time and attention to properly disinfecting these medical devices prior to each access with a syringe. This can lead to contamination and result in infection.” PDI’s Prevantics Device Swab, which comes


Prevantics Device Swab by PDI


in strip format and hangs easily from IV poles, is a chlorhexidine gluconate/isopropyl alcohol medical device specifically available for the dis- infection of needleless access sites prior to use. Studies show the product is more effective than isopropyl alco- hol prep pads and Garrett says scrub and dry time is an efficient five seconds each.


Clinicians favor the product because it makes it easier to comply with evidence-based recom- mendations.3 Reducing bacteria in the nose preoperatively


To help patients reduce their risk of develop- ing CAUTI, Avadim Technologies Inc. offers a patented, non-toxic, topical product called Thera- worx which has helped several hospitals reduce its CAUTI rates from 85 percent to 100 percent,3 according to CEO Steve Woody. “When used in our patent-pending, protocol for standardized Foley insertion and perineal care, not only does it offer broad spectrum skin hygiene for creation of a true ‘zone of inhibition’ in the perineum, but also helps preserve the normal antimicrobial acidic mantle and integrity of the stratum corneum, the outer layer of the epidermis,” said Woody. “Hospitals using Theraworx have seen significantly reduced CAUTI rates from customers even in the most challenging environments, like neuro ICU.”


34 June 2016 • HEALTHCARE PURCHASING NEWS • hpnonline.com


is also a proven strategy for reducing SSIs, says Caroline Johnson, RN, BSN, Technical Services Specialist, 3M, maker of 3M Skin and Nasal Antiseptic.


“The nose works continuously to clear mi- croorganisms and debris making it difficult for antimicrobials to reach and kill bacteria,” said Johnson. “3M Skin and Nasal Antiseptic is an innovative, patented formula that contains a polymer to help increase adhesion of the prep to nasal tissue.”


Johnson noted several clinical studies3 that


Theraworx by Avadim Technologies Inc.


show the product’s efficacy and association with “readmission cost avoidance and substantial cost savings when part of a comprehensive preoperative protocol.” The product can also serve as a viable alternative to using topical antibiotics — a move that helps to support antiobiotic stewardship. The increasing prevalence of antibiotic-resistant bacteria causes two


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