IP Operations Worth Watching

One of the most critical roles in healthcare is protecting patients and staff from dangerous and deadly pathogens and infections. Everyone’s lives ultimately depend on it.

This, of course, is no small task. It entails attention, resources and teamwork from care teams, environmental services workers, sterile processing technicians, infection preventionists and others to maintain hygienically clean patient surgical sites, sterilized medical instruments and equipment, and disinfected rooms and facilities to deliver high-quality and safe patient care.

Healthcare Purchasing News recognizes and salutes the 2021 Infection Prevention Operations Worth Watching at a variety of hospitals and health systems. These organizations are noted for their outstanding dedication, practices and successes in infection prevention:

Stopping SSIs with nasal, skin decolonization

A Georgia-based hospital

Surgical site infection (SSI) after total joint replacement results in significant patient suffering and healthcare costs. In a 2020 study¹ published by The American Journal of Infection Control, a 300+ bed hospital in Georgia introduced a preoperative universal nasal and skin decolonization protocol to reduce the risk of surgical site infection after total joint procedures. The study outcome data demonstrated reduced infection rates, a decrease in associated patient morbidity and lower costs to the facility.

This facility utilized a universal decolonization protocol as recommended by the Nozin NOVA program and was able to reduce colonization risk and decrease total hip SSI rate from 0.91 to 0.00 and total knee SSI from 0.36 to 0.00 per 100 procedures. Along with the reduction of patient infections, the hospital achieved $400,000+ in estimated cost savings.

Nozin NOVA colonization risk mitigation programs are also being introduced to help replace traditional strategies, such as screen and isolate, while lowering costs and improving care. NOVA programs include a proprietary method powered by Nozin Nasal Sanitizer antiseptic.

Hunterdon Medical Center, Flemington, NJ

Hunterdon Medical Center targets zero preventable infections for all surgical patients. Nasal decolonization is a proven intervention to help reduce the risk of infections by removing harmful pathogens that live in the nose and could transfer to the patients during surgery. Hunterdon evaluates new solutions on an on-going basis that allow the facility to improve outcomes, improve patient satisfaction, and reduce cost.

Hunterdon selected PDI’s Profend Nasal Decolonization Kit as its nasal decolonization product for a number of reasons, including:

• efficacy profile, killing 99.7 percent of Staphylococcus aureus at 10 minutes and 99.9 percent up to 12 hours after a 60-second application
• time savings for staff, due to the pre-saturated swabs and easy patient application
• patient experience, allowing nurses to help explain to patients the importance of nasal decolonization

Ultimately, Hunterdon was able to improve outcomes, improve patient satisfaction, and reduce cost as a result of its implementation of the kit for the prevention of surgical site infections.

Combating COVID-19 with PPE, room disinfection

Houston Methodist System Infection Prevention and Control department, Houston

Throughout the last year, the team has worked very closely with every department, each hospital in the system, and the various ambulatory care settings within the system to coordinate efforts with COVID-19. This included strengthening their relationship with Supply Chain Management to ensure that they had adequate supplies to keep staff safe while caring for patients and could quickly transition to alternative items when supply lines to usual supplies began to be threatened.

Infection Control team, Sturdy Memorial Hospital, Attleboro, MA

This team is noted for their effectiveness in dealing with the COVID-19 pandemic. Under the oversight of Dr. Fine, Donna Sears and others, they have worked tirelessly to protect the health and safety of the patients and staff of this hospital.

Children’s Mercy Hospital Kansas, Kansas City, MO

Children’s Mercy Hospital Kansas is on a mission to ensure the cleanest environment possible for both its patients and staff. The facility implemented three Tru-D disinfection robots in 2019 and has since added to its fleet as well as has expanded use of the technology throughout the hospital. The facility has the highest volume of Tru-D robot disinfection cycles completed of all other Tru-D device customers, often using them up to 40 times daily.

When the COVID-19 pandemic hit, the devices gave staff peace of mind knowing that the facility was taking additional measures to make the staff feel safe, and nurses were paid overtime to run the devices as much as possible.

Currently, the facility is using the devices to disinfect the following:

• Inpatient rooms (320 rooms) at patient turnover
• Radiology clinic on weekends
• Sedation rooms and orthopedic procedure rooms weekly
• Inpatient procedure rooms and playrooms weekly
• Hematology/oncology clinic rooms weekly
• Dental clinic procedure rooms weekly
• GI procedure rooms weekly

“Our broad use of Tru-D disinfection across our institution provides an additional level of protection to both our patients and staff. I am extremely pleased with this product,” said Michael Sayer, senior director at Children’s Mercy Hospital - Kansas City.

Safety in the workplace and care

Hospitals and health systems strive for clean, healthy and infection-controlled settings of care for patients and staff. That means having the right supplies and equipment in place for staff to perform at the highest and safest level.

The emergence of COVID-19 disease, caused by the SARS-CoV-2 virus, undoubtedly, struck the world like no other health crisis before. Personal protective equipment (PPE), air and surface disinfection, patient and family isolation, contactless deliveries, and other safety guidelines and measures became top priorities in preventing cross-contamination and transmission of the virus.

Accessing supplies for infection control

Healthcare facilities

According to a press release from the Association for Professionals in Infection Control and Epidemiology (APIC), “As cases of COVID-19 surge in the U.S., a national survey of infection prevention experts, conducted October 22 to November 5, 2020 by the Association for Professionals in Infection Control and Epidemiology (APIC), found that while healthcare personnel have better access to PPE than they did in the spring, many healthcare facilities have implemented PPE crisis standards of care.”²

Healthcare-associated infections (HAIs) have risen amid the COVID-19 crisis.

“Respondents also reported an increase in healthcare-associated infections at their facilities since the pandemic began, with 27.8 percent reporting specific increases in central line-associated bloodstream infections (CLABSI), 21.4 percent in catheter-associated urinary tract infections (CAUTI), and 17.6 percent in ventilator-associated pneumonia (VAPs) or ventilator-associated events (VAEs),” ² continued APIC.

Lack of supplies and an increase in patient volumes have further impeded care.

“The survey also asked IPs about possible medical supply shortages and capacity issues during the confluence of the pandemic and the 2020/2021 flu season,” added APIC. “Nearly three quarters (72 percent) are strongly (35 percent) or somewhat (37 percent) concerned about their facility’s surge capacity; more than half of respondents (54 percent) are strongly (23 percent) or somewhat (31 percent) concerned about their facility’s ability to provide safe care. Nearly 80 percent of respondents said that they are concerned about the impact of medical supply shortages in their healthcare facility related to the current flu season, and 84 percent are more concerned about supply shortages compared to previous years because of the pandemic.” ²

New guidance on PPE in healthcare settings was established by the industry.

The Society for Healthcare Epidemiology of America (SHEA) reported in a press release that, “To guide facilities and healthcare personnel in management of suspected or confirmed COVID-19 patients amid ongoing critical shortages of personal protective equipment, the Society for Healthcare Epidemiology of America (SHEA) joined with the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society in releasing the infection prevention and control portion of a three-part guideline based on the best evidence available.”³

The eight recommendations cover:

1. “Masks
2. Masks in shortage scenarios
3. Gloves
4. Shoe covers
5. N95 masks
6. Reprocessed N95 masks
7. Extended use of N95s through face shields and surgical masks
8. Reuse of N95s with face shields and surgical masks”³

APIC, additionally, set forth a new collaborative initiative to strengthen infection prevention practices in medical settings, APIC announced in a press release.

“The APIC Strategic Partner program establishes long-term relationships with industry partners united in the common goal of reducing the risk of infection in healthcare facilities,” stated APIC. “According to the Centers for Disease Control and Prevention, an estimated 633,000 hospitalized patients get healthcare associated infections (HAIs) each year and 72,000 die during their hospital stay. APIC Strategic Partners play an important role in supporting many of the educational initiatives and services that benefit APIC’s almost 16,000 infection preventionist (IP) members fighting on the front lines against the spread of harmful microorganisms and viruses, such as C. diff, MRSA, and SARS-CoV-2 in healthcare facilities.”⁴

Shielding infants from Staph infections

Neonatal intensive care units (NICUs)

Aiming to keep infants safe from infections, the “SHEA neonatal intensive care unit (NICU) white paper series: Practical approaches to ylococcus aureus disease prevention provides expert opinion and evidence-based responses to frequently asked questions clinicians may have in implementing the updated CDC guidance for preventing, detecting, and controlling the spread of Staph infections, including methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA),”⁵ according to a SHEA press release.

“Staph infections can become serious in NICU patients and are often associated with medical devices, like catheters used for feeding and medication, as well as direct and indirect exposure to bacteria on healthcare personnel, parents, caregivers, family members, other critically ill infants, and the healthcare environment,” added SHEA. “The document discusses how to safely handle Staph bacteria colonization and infection in parents or visitors and in NICU patients, including hospitalized multiples (e.g., twins or triplets) with different colonization or infection statuses. The document can also help guide decisions about when and how to decolonize infants who have asymptomatic S. aureus or MRSA, while taking into account safety considerations for this patient population.” ⁵

Testing floor cross-contamination

Northeast Ohio VA Healthcare System

Examining hospital floors as carriers of pathogens and potential spread, SHEA reported in a press release that, “Researchers with the Northeast Ohio VA Healthcare System closely tracked contamination in hospital rooms of 17 newly admitted patients to identify the timing and route of transfer of bacteria within patients’ rooms.”⁶

SHEA continued, “Before testing, rooms were thoroughly cleaned and sanitized and all patients screened negative for methicillin-resistant Staphylococcus aureus (MRSA) and other healthcare-associated bacteria. Researchers then observed patients’ interactions with healthcare personnel and portable equipment, collecting cultures one-to-three times per day from patients, their socks, beds and other high-touch surfaces, as well as key sections of the floor. Nearly half of rooms tested positive for MRSA within the first 24 hours, and MRSA, C. difficile, and vancomycin-resistant enterococci (VRE) pathogens were identified in 58 percent of patient rooms within four days of admission. Contamination often started on the floors, but ultimately moved to patients’ socks, bedding, and nearby surfaces.”⁶

Additionally, SHEA noted that, “In a related study published in August in Infection Control & Hospital Epidemiology, the authors reported similar findings of frequent detection of SARS-CoV-2 nucleic acid on floors and on shoes of personnel on a COVID-19 ward. The authors note that further research is needed to clarify the role of floor contamination in transmission of both bacterial and viral pathogens and to identify practical approaches to address contamination. On the COVID-19 ward, contamination was reduced with simple modifications of floor cleaning and disinfection protocols.”⁶

References:

1.  A safer, less costly SSI prevention protocol – Universal versus targeted preoperative decolonization, Susan Franklin, RN, Published: April 29, 2020: https://doi.org/10.1016/j.ajic.2020.02.012, https://www.ajicjournal.org/article/S0196-6553(20)30135-8/fulltext

2.  National Survey Shows Healthcare Facilities Implementing PPE Crisis Standards of Care, Arlington, Va., December 3, 2020, https://apic.org/news/national-survey-shows-healthcare-facilities-implementing-ppe-crisis-standards-of-care/

3.  New Guidelines Outline COVID-19 Infection Prevention and Control Evidence, Arlington, VA (April 27, 2020), https://www.shea-online.org/index.php/journal-news/press-room/press-release-archives/778-new-guidelines-outline-covid-19-infection-prevention-and-control-evidence

4.  APIC Announces 2021 Strategic Partnerships, Arlington, Va., January 25, 2021, https://apic.org/apic-announces-2021-strategic-partnerships/

5.  Guidance Balances Staph Infection Prevention in Critically Ill Infants with Family Contact, NEW YORK (September 14, 2020), https://www.shea-online.org/index.php/journal-news/press-room/press-release-archives/836-guidance-balances-staph-infection-prevention-in-critically-ill-infants-with-family-contact

6.  Hospital Floors Are Hotspot for Bacteria, Creating Route of Transfer to Patients, NEW YORK (November 2, 2020), https://www.shea-online.org/index.php/journal-news/press-room/press-release-archives/854-hospital-floors-are-hotspot-for-bacteria-creating-route-of-transfer-to-patients

7.  Safety Leader Lists Provider Management of Medical Devises with COVID-19 Emergency Use Authorization a Top Hazard for 2021, January 28, 2021, https://www.ecri.org/press/covid-19-emergency-use-authorization-top-hazard-2021/

8.  Decennial 2020 Research Sets the Agenda for Advancing Safe Healthcare, NEW YORK (November 2, 2020), https://www.shea-online.org/index.php/journal-news/press-room/press-release-archives/855-decennial-2020-research-sets-the-agenda-for-advancing-safe-healthcare