Hospital Infection Control

Is hospital janitor really an infection preventionist?

September 28, 2011 – 1:48 am | By Gary Evans | No comments yet

Those who have been in infection prevention for lo these many years will remember a time when the health care environment was discounted as a significant source of transmission of HAIs. This was in part a healthy reaction to the endless culturing of environmental sources in an era when IPs were focused more on data collection than intervention. The bug has turned again, and the environment is a reborn area of emphasis – thanks in no small measure to the ability of C. diff and some of the emerging gram negatives to claim squatters rights to any given surface or fomite. Enter the Association for Professionals in Infection Control and Epidemiology (APIC) and the Association for the Healthcare Environment (AHE). They are partnering to “strengthen the relationship between infection prevention (IP) and environmental services (EVS) to improve patient outcomes and reduce infections,” according to a press release. A joint educational campaign, entitled “Clean Spaces, Healthy Patients: Leaders in Infection Prevention and Environmental Services working together for better patient outcomes,” will incorporate educational resources, training materials, and other solutions to help IP and EVS professionals combat the spread of healthcare-associated infections (HAIs). To determine the focus of the educational campaign, 2,000 members of APIC and AHE were surveyed to determine how they work together to protect patients. Survey results were presented at the AHE 2011 Annual Conference in Kissimmee, Fla.  The survey found that infection prevention and environmental services professionals believe there is a need for additional education and resources to facilitate successful prevention of HAIs:

• Half find it difficult to locate useful resources about proper cleaning and disinfection (51%).
• 73% say their facility educates EVS front line staff well about their role in infection prevention; 54% believe other staff could be better educated about their role in cleaning.
• About six in 10 respondents believe educational resources on cleaning, disinfection, and infection prevention and control should be directed to executives and also to physicians. Half believe patients and families of patients should be a target audience, while one-third state the general public should be an audience.
• Nearly nine in 10 respondents believe EVS team members are treated with respect (85%).
• Almost nine in 10 are interested in hearing how other facilities have created successful IP-EVS partnerships (88%).

Low infection rates? Market it!

September 23, 2011 – 11:44 am | By Gary Evans | No comments yet

You knew it would come to this, as public reporting of healthcare associated infections becomes more common: Marketing! That’s right, hospitals are touting their low infection rates to potential customers while their less fortunate counterparts “peek and shriek” at the infection rate reports.  Add the invisible hand of capitalism to the various forces now working to lower infection rates. One could argue that this also applies more pressure to “game” the reporting systems when possible, particularly if competitors are pulling away from fiscally troubled rivals. That said, welcome to the new age of transparency. Any competitors of New York’s Hospital for Special Surgery (NYHSS), read their press release and weep. “[NYHSS] is the only hospital in New York State with an infection rate that is significantly lower than the state average for hip replacement or revision surgeries, according to the 2009 report on hospital infection rates released today by the State Department of Health. [Our] surgeons performed 15% of the nearly 26,000 hip replacement or revision procedures in New York State in 2009. Special Surgery was the only hospital of the 169 hospitals included in the report that had a statistically lower surgical site infection rate than the state average of 1.3 percent for that particular procedure. Hospitals that performed the highest number of hip replacement procedures had the lowest infection rates, according to the report." “When patients select a hospital, a low infection rate should be one of the items at the top of their list,” said Louis A. Shapiro, president and CEO. “At Hospital for Special Surgery, we believe that infection prevention is everyone’s responsibility. Success can only be achieved with contributions from our entire staff, from surgeons and nurses to technicians and housekeepers.”

CDC boils down egg allergy flu shot exemption

September 22, 2011 – 1:30 pm | By Gary Evans | No comments yet

            As mandatory flu immunization policies continue to gain momentum in health care settings, egg allergy -- one of the classic exemptions to the vaccine -- is being redefined by public health officials. As a result, fewer health care workers may receive exemptions from flu vaccine mandates, based on recent recommendations from the Advisory Committee on Immunization Practices (ACIP), which provides expert consultation to the Centers for Disease Control and Prevention.FN1  The panel listed trivalent inactivated vaccine (TIV) as a possible alternative for some people with mild reactions.  Some package inserts for the trivalent inactivated vaccine no longer list hypersensitivity as a contraindication, although severe allergic reaction, such as anaphylaxis, remains a contraindication, says Lisa Grohskopf, MD, a medical officer with CDC’s influenza division. “We are recommending in these guidelines that essentially only individuals who have hives – specifically, only hives -- as a symptom as their allergy, [can] go ahead and receive vaccine without some further risk stratification,” she says. “It's possible for a health-care worker to be stratified for the risk.” People who experience only hives following exposure to eggs should be monitored for at least 30 minutes for signs of reaction. Other people with more severe reactions should be referred to a physician “with expertise in management of allergic reactions,” the guidelines state. The vaccine should be administered in a setting where there can be rapid recognition and treatment of anaphylaxis, CDC says. If someone has previously had a severe reaction to any component of the influenza vaccine, they should not receive the vaccine, the guidelines state. Reference 1. Centers for Disease Control and Prevention. Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011. MMWR 2011; 60(33);1128-1132

AHA: Get the flu shot or wear the mask

September 14, 2011 – 9:56 am | By Gary Evans | No comments yet

[caption id="attachment_226" align="alignleft" width="100" caption="AHA: Get the shot or don the mask"][/caption]             Hospitals gearing up for their annual influenza immunization campaigns this fall have a greater emphasis on mandatory policies to achieve the highest possible coverage of employees. A recent  advisory from the American Hospital Association  gives the push toward mandatory vaccination of health care workers another surge of momentum.  The AHA stated: “To protect the lives and welfare of patients and hospital employees, the American Hospital Association’s Board of Trustees recently approved a policy supporting mandatory patient safety policies that require either influenza vaccination or wearing a mask in the presence of patients across health care settings during flu season. This policy aims is to achieve the highest possible level of protection.” In contrast, the American Medical Association has endorsed “universal vaccination” but stopped short of advocating mandatory policies, stating that the medical staff should determine the structure of the programs.                  The AHA responded to recommendations from major infection control organizations, including the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America, says Nancy Foster, AHA’s vice president for quality and patient safety.             “While the resources needed to implement a mandatory policy are significant, especially in terms of financial and personnel resources, the benefits of protecting vulnerable patients and reducing employee illness and absenteeism far outweigh the costs,” the AHA advisory states. “Further, employee resistance can be overcome through careful education and open communication between hospital leadership and staff, as well as policies that permit certain reasonable exclusions and allow employees who cannot receive influenza.” Michele Marrill Special update from our sister publication, Hospital Employee Health 

What if they gave an epidemic — and nobody cared?

September 7, 2011 – 8:02 pm | By Gary Evans | No comments yet

Three decades ago this year, Pneumocystis carinii pneumonia — an opportunistic infection then virtually unheard of in healthy individuals — was diagnosed in five gay men in Los Angeles. These were the first official cases of AIDS, an historic epidemic that inspired many a heroic response but now appears to be strangely beset by apathy among its highest-risk victims. Consider this warning in a recent report  by the Centers for Disease Control and Prevention:  “Gay and bisexual men of all races and ethnicities remain the group most severely and disproportionately affected by the epidemic,” the CDC states. “Men who have sex with men (MSM) represent approximately 2% of the U.S. population, but accounted for 61% of all new HIV infections in 2009. By race, age and risk group, young, black gay and bisexual men (ages 13-29) are the only population in the United States in which new HIV infections increased between 2006 and 2009.” Though the CDC spin is generally upbeat in this report – estimating that more than 350,000 infections have been prevented since the AIDS epidemic began – there is something passing strange about this finding that goes beyond the usual-suspects list of factors cited:  “[A] range of social, economic, and demographic factors affect some Americans’ risk for HIV, such as stigma, discrimination, income, education, and geographic region,” the CDC reports.  Is it fair to ask if apathy should be added to that list? Has the public health response to HIV/AIDS been undercut by its own success? No longer a death-sentence diagnosis in the U.S., this plague has become a chronic condition that is apparently no longer feared enough to prevent high-risk behavior. Maybe it never was, but it’s getting harder to believe in this information age that a given individual does not know his actions may put him at risk of HIV.  Sure there are a lot of contributing factors — disease is all too predictable among the disenfranchised.  But is the CDC asking us to  believe that there remains a vast and abiding ignorance of the basic facts that avoiding unprotected sex and IV drugs could prevent many of these new cases? When does the lack of individual responsibility for one’s own bloodstream translate to a failed public health response at the highest levels?   I don’t know the answers, but the band is playing on. According to the CDC,  some 50,000 Americans become infected with HIV annually, and 16,000 people with AIDS died in 2008. As a result, the number of people living with HIV in the United States, now at nearly 1.2 million, continues to grow by tens of thousands each year, creating more opportunities for transmission.  After 30 years.