Nursing

The Future of Infection Prevention

Nurse Leader Insider, December 13, 2018

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This aritcle first appeared in Patient Safety Monitor Journal.

By Lena Browning, MHA, BSN, RN

Healthcare organizations are feeling the repercussions of noncompliance when it comes to infection prevention. For several years now, the most cited clinical standard in hospitals, critical access hospitals, and ambulatory healthcare by The Joint Commission has been:

IC.02.02.01: The hospital reduces the risk of infections associated with medical equipment, devices, and supplies.

According to The Joint Commission, the most common reasons for noncompliance include:
 

  • Not following current, nationally accepted, evidence-based guidelines and manufacturers’ instructions for use
  • Orientation, training, and assessments of staff competency not conducted by an individual qualified to do so
  • Lack of quality assurance process
  • Lack of collaboration with infection prevention professionals
  • No pre-cleaning at point of use
  • Recordkeeping: Incomprehensible or non-standardized logs, incomplete documentation, and lack of bidirectional tracing of scopes and/or surgical instruments
  • Inconsistent processes in performing high-level disinfection and sterilization such as handling, transporting, and cleaning reusable instruments


As infection prevention challenges evolve—such as emerging infectious organisms and resistance—healthcare organizations must focus on preventing hospital-acquired infections and ensuring better patient outcomes. To achieve these goals, infection prevention professionals must be involved in all decisions affecting the delivery of patient care. Healthcare is ever-changing, and innovative approaches are critical as we look to the future of infection prevention.

On the surface
As innovative technology is developed and new processes are implemented to prevent hospital-acquired infections (HAI), infection prevention professionals need support from leadership, as well as a strong collaboration with all service lines.

When conducting infection prevention and control risk assessments, hospitals may consider the following innovative techniques for preventing HAIs:
 

  •  Implement “no touch” systems that use UVA light or hydrogen peroxide mist to disinfect patient care areas
  • Use disinfecting wipes that change color indicating when contact time is met and surfaces are completely covered to effectively kill microorganisms
  • Implement continuous visible light technology in patient care areas
  • When possible, use disposable non-critical, semi-critical, and critical devices instead of reprocessing these types of devices
  • Implement a central surveillance program for infection control programs
  • Implement quality checks at established intervals (adenosine triphosphate bioluminescence, chemical reagent tests)


In addition to the above innovative techniques, robust collaboration among infection prevention, nursing, environment of care, and leadership is imperative to effectively monitor quality assurance and minimize the potential risks of infection transmission.

Emerging pathogen: Candida auris
There is a new Candida species, and it is a multidrug-resistant organism: Candida auris.

C. auris presents new challenges, as it is often misidentified, is resistant to antifungal drugs, can cause rapid outbreaks in healthcare settings, and is emerging globally.

Numerous challenges exist in implementing measures to reduce the transmission of C. auris, including hand hygiene noncompliance, standard precautions and transmission-based precautions noncompliance, inconsistent cleaning of surfaces and medical equipment, and ineffective interfacility communication (handoffs).

Current CDC recommendations to prevent the spread of C. auris focus on proper prevention practices and the importance of communication, specifically:
 

  •     Ensuring contact precautions with a private patient room
  •     Reinforcing hand hygiene
  •     Daily and terminal cleaning of the room and equipment using EPA-registered, bleach-based disinfectants that are also active against C. difficile
  •     Ensuring notification of C. auris status upon handoff and facility transfer



Healthcare professionals need to collaborate with infection prevention and proactively educate staff and implement processes to reduce the spread of infection. The healthcare professionals closest to the patient can make the biggest impact in reducing HAIs by providing education to patients, families, and visitors. Routine infection prevention education and training are necessary for success.

Innovative approaches in surveillance
Centralized infection surveillance programs change infection control surveillance radically by removing the sole burden of surveillance responsibility from the infection prevention professional. Many organizations struggle with accuracy of infection prevention data due to lack of standardization in HAI surveillance, no leadership oversight of HAI event determination or mandatory reporting, and inadequate National Healthcare Safety Network (NHSN) training among auditors.

The CDC and CMS require that the following infections be reported to NHSN:
 

  •     Infections meeting specified NHSN criteria
  •     Requirements by CMS for incentive payments or public reporting purposes


Infection definitions and criteria are needed to ensure accuracy, completeness, and comparability of infection information. Centralized surveillance staff would be responsible for staying current on NHSN updates and criteria changes and regularly updating infection prevention professionals on these changes.

Standardized surveillance, identification, and reporting of central line–associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections improves accuracy and decreases errors, which results in improved patient outcomes and reduced financial risks for organizations.

Steps to successfully implement a centralized surveillance program should include the following:
 

  •     Develop current and future state process mapping
  •     Review and update NHSN mapped locations
  •     Develop a standardized process for HAI event review
  •     Develop standardized HAI collection forms
  •     Develop standardized scripts for HAI event communication
  •     Develop schedules and responsibilities of required data entry
  •     Develop definitions for accurate ADT data (inpatient vs. outpatient, date of admission)



Infection prevention professionals commonly wear many hats; having a centralized infection surveillance program with well-trained individuals to perform surveillance improves efficiency and provides more accurate and reliable data. Furthermore, such a program allows infection prevention professionals to do what they do best: prevention.

Midline catheter HAI surveillance

As we focus on the future, we can’t forget midline catheter HAI surveillance. Midlines—for example, peripherally inserted central catheters—have been reported to decrease CLABSI rates, but few organizations have assessed the incidence of midline catheter–associated bloodstream infections. New York Presbyterian Hospital System conducted a study on the incidence of midline catheter–associated bloodstream infections in five acute care hospitals and determined that the incidence of these infections is not significantly lower than CLABSI incidence.

Future work is needed to evaluate the association between midline catheter use and central line utilization and CLABSI rates. Hospitals using midline catheters should consider including midline catheter–associated bloodstream infection surveillance as part of an overall vascular access safety program.
 

Lena Browning, MHA, BSN, RN is a consultant with Compass Clinical Consulting.



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