Even though some days it feels like the pathogens are winning, we are making progress in reducing hospital-acquired infections (HAIs). According to the CDC’s 2016 HAI Progress Report, significant reductions for nearly all infection types were seen at the national level in 2014 when compared to baseline data. CLABSI and abdominal hysterectomy SSI showed the greatest reduction, while hospital-onset MRSA bacteremia and C. difficile infections also showed progress.1 This is great news, but there is still a lot of work that needs to be done.
The theme for International Infection Prevention Week this year is “Break the Chain of Infection.” The first thing that came rushing into my head when I heard this year’s theme was Fleetwood Mac’s song “The Chain.” Accompanied by driving drum and guitar rhythms, Stevie Nicks and Lindsey Buckingham decisively echo the words “We will never break the chain / never break the chain.” Oddly enough, this could be the anthem of today’s superbugs: They will never break the chain.
Superbugs may not ever break the chain, but we as healthcare practitioners can. Breaking the chain of infection really comes down to some of the foundational components of infection prevention. According to APIC, healthcare professionals can break the chain by frequent hand hygiene, getting a flu shot and being current with other vaccinations, understanding and following the rules of standard and contact isolation, using personal protective equipment correctly, cleaning and disinfecting the environment, sterilizing medical instruments and equipment, following safe injection practices, and using antibiotics wisely to prevent antibiotic resistance.2
These may seem like logical and easy things to accomplish, but healthcare is complex. Some of the factors that lead to this complexity include:
- Number of people involved (clinicians, physicians, ancillary healthcare providers, supply chain etc.);
- Explosion of processes, procedures and technologies;
- Patient throughput / ratio of nurses to patients;
- Acuity of patients; and even
- Design and layout of the clinical areas.
All of these factors can play a role in the effective introduction of new infection prevention products or procedures. So although you may have a great product or process, low compliance sabotages a successful outcome. When looking at infection prevention initiatives an attitude often conveyed by already overwhelmed clinicians is, “I can either practice infection prevention or I can treat patients, you choose.”3
Employ Total Solutions
The Joint Commission’s Center for Transforming Healthcare in their Colorectal Surgical Site Reduction Project identified key attributes that project participants with the most success in reducing colorectal SSI had in common. They included high level of (surgical) process compliance, robust process improvement, commitment of key stakeholders, which included administration, and sustainability over time.
Participants that lacked these key attributes had varying levels of success.4 So when starting a new infection prevention initiative, look for total solutions rather than isolated products or process. Solutions should include a risk assessment to understand the contributing factors; products that are design by clinicians so that they are intuitive to use, reduce variation, drive standardization and increase compliance to the process; education; training and of course, outcomes monitoring.
Medline’s infection prevention offerings are comprehensive solutions that focus on all of these key attributes. Solutions like ERASE CAUTI work to educate staff on insertion techniques and catheter care that can help reduce the opportunity for infection. ERASE BSI Line Access and Dressing Change system bundle the proper tools and reduce practice variance when delivering medication and changing dressings to limit the possibility of infection. ERASE SSI Pre-Surgery Patient Engagement kit is a complete program to drive patient compliance with pre-surgical bathing.
Encourage Compliance One Step at a Time
Handwashing compliance alone is a constant challenge for facilities. Some of the factors that may influence compliance include a high workload, downsizing and understaffing, and lack of leadership. Change is a complex process, and single interventions will often fail. Try finding solutions that work on a multidisciplinary strategy. Encourage an appropriate process of change, and promote the fact that interdependent elements—such as hand hygiene—interact to achieve the larger shared objective of infection prevention. The creation of a new chain of preventative actions could be the very thing to break the chain of infection.
We may each only feel like one person, but one person can make a difference in breaking the chain of infection. And if we all commit to breaking the chain, our combined determination will go further than any of us could on our own, resulting in improved infection prevention and ultimately, better patient outcomes.
What are some ways your facility has committed to breaking the chain of infection during International Infection Prevention Week?
- CDC National and State Healthcare-Associated Infections Progress Report, published March 2016. http://www.cdc.gov/hai/surveillance/progress-report/
- APIC website, http://consumers.site.apic.org/iipw/promotional-toolkit/ , Accessed September 27, 2016.
- Integrating human factors with infection prevention and control. Available at: http://socialwelfare.bl.uk/subject-areas/services-activity/health-services/healthfoundation/1532972013_integrating_human_factors_with_infection_prevention_and_control.pdf. Accessed October 12, 2016.
- Joint Commission Center for Transforming Health Care website, http://www.centerfortransforminghealthcare.org/projects/detail.aspx?Project=4, Surgical Site Infection Storyboards, Accessed September 27, 2016.