Identifying and addressing weak links in any infection control protocol

It might be helpful for some to think of healthcare-associated infection prevention as an algebraic equation. That's because so many factors tie in to effectively combating HAIs, and each has a variety of complex and moving parts to be managed, monitored and assessed on an ongoing basis. 

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There's hand hygiene, antibiotic stewardship, clinical practices, fecal waste management, environmental disinfection — and the list can go on. In a webinar presented by Jim Gauthier, Senior Clinical Advisor, Infection Prevention for Sealed Air Diversey Care, , broke down where lapses in hospital practices occur that may allow opportunistic bacteria to infect patients, and the questions hospitals and health systems should ask themselves when deciding how to improve their HAI rates. A good place to start, Mr. Gauthier said, is understanding why Clostridium difficile (C. diff), in particular, poses such a significant threat in healthcare settings.

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A unique challenge

"C. diff brings a unique challenge, because hand hygiene and disinfectant products may not be effective against the organism itself," Mr. Gauthier says. The bacteria’s spores are resistant not only to alcohol-based hand rubs, but to natural UV rays and several of the most commonly used disinfectants. Studies have also shown that C. diff spores are more difficult than other HAI-causing bugs to wash off of the hands. 

What's more, research shows that rates of C. diff infection are increasing, and it now rivals Methicillin-resistant Staphylococcus aureus, or MRSA, as the No. 1 HAI-causing pathogen. Patients are also more frequently entering hospitals with the bacteria already in their systems, as about 75 percent of cases have onset outside of the acute care setting, which increases risk of contaminating already-hospitalized patients when carriers are admitted for care. The infections can significantly impact patient outcomes, including playing a role in death and morbidity, increasing length of stay by more than five days in some instances, and costing the U.S. healthcare system as much as $4.9 billion annually.

Organizations like the Infectious Disease Society of America, the Society for Healthcare Epidemiology of America and the Association for Professionals in Infection Control provide guidelines to help hospitals keep the HAI menace at bay, but patients still contract thousands of infections from C. diff and other harmful bacteria every year. That may be, Mr. Gauthier said, because standard infection control practices often aren't what they seem. 

Basic practices

All hospitals should use a certain set of baseline practices to ensure infection prevention, Mr. Gauthier said. Before going beyond these to adopt special approaches to fighting specific bacteria, infection preventionists should thoroughly assess the factors that could lead to gaps in their practice.

A good place to start is implementing protocols for disinfecting all equipment on a routine basis. This might require new training and education be put into place, as frontline workers could have misconceptions about which equipment does or doesn't need to be disinfected in which way, or cleaning some equipment might be ‘out of practice’ for some healthcare providers. Equally important to ensuring staff are aware of the proper techniques for thoroughly cleaning and disinfecting is implementing regular assessments of their ability to do so correctly.

If a hospital has trouble warding off infections from easily killed organisms, such as MRSA, Vancomycin-resistant Enterococci or Carbapenem-resistant Enterobacteriaceae, it is likely that their baseline infection prevention measures need some work. Bugs like these are usually taken care of with proper hand hygiene, thorough cleaning and disinfection and a good understanding of patient isolation and personal protective equipment practices.

The No. 1 way HAI-causing bacteria are transmitted between patients is via healthcare worker’s hands . Therefore, it is critical that frontline care workers know what to do and have the right tools in the right place to disinfect their environment and themselves. Communicating those same messages and practices to patients and their visitors can also make the difference between vanquishing potentially deadly bacteria or transmitting another infection.

Is a special approach right for you?

When a hospital is confident its basic practice is strong but it is still having issues with C. diff, which is much harder to kill than bacteria such as MRSA or VRE, it could be time to consider a more serious approach — sporicidal disinfection.

Sporicidal disinfectants are more ruthless about taking out lingering C. diff spores, but there are a number of side effects to consider. Sporicidal disinfectants are powerful and can negatively impact workers and the environment. They can be asthmagens, emit a foul odor, or cause irritation to the eyes, lungs and skin. Surfaces don't always stand up well to sporicidal disinfectants, which can cause discoloration, wear, oxidation and generally shorten the life cycle of hospital equipment.

What's more, the data is a bit shaky on whether inactivating C. diff spores is completely necessary to prevent transmission, which would undermine the primary reason for introducing sporicidal disinfection. While some hospitals that have tried other methods of getting C. diff transmission under control may have good reason to turn to the sporicidal option, infection preventionists should review basic practices before taking it on. Mr. Gauthier reviewed two studies where meticulous cleaning and disinfection were used with an agent that was not ‘sporicidal’, and the hospitals saw reductions in all infections (MRSA, VRE and C. diff) during the study.

The best offense

"There is no substitute for good hand hygiene," Mr. Gauthier says. Research has shown that even good old elbow grease — usingb moderate force and a wet cloth — can go some ways toward removing C. diff spores from the healthcare environment.

Where many hospitals turn to the big guns, such as sporicidal disinfectants based on the assumption that they are always the best option, a careful review of current practices and consideration of where improvement could be made might make all of the difference in curbing HAI rates and saving money without compromising the health and safety of patients and workers. 

To download the webinar, click here.

To view the webinar on YouTube, click here.

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