January spotlight — Infection Prevention: What we’re focused on

By Mark Ingerman, MD, System Division Chief, Infectious Diseases & Preventive Medicine

 

Over the last five years, the Main Line Health System Infection Prevention Program has focused on decreasing the rate of hospital-associated infections (HAIs), specifically catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), surgical site infections (SSI), and C. diff rates. The rates have dramatically decreased throughout the years. However, the goal has become more challenging to attain as expectations of decreasing HAIs have pervaded the country.

 

We encourage all clinicians to focus on policies and procedures that are now in place to help lower HAIs. For example, it is recommended all clinicians check their inpatients for the necessity to retain a Foley or a central line daily. Whenever feasible, these devices should be removed. Please refer to the nurse driven Foley removal protocol. In addition, daily lists are also printed on each clinical unit at 8:00 AM to be reviewed by clinicians and nurses when rounding. We have also instituted a new device — an alcohol disinfectant cap for all central lines. Our target for CAUTI and CLABSI is to attain zero preventable infections.

 

Extensive work has been done within our surgical services regarding pre-operative, operative and post-operative care.

  • Prophylactic antibiotic regimens have been standardized throughout the system for orthopedic and neurosurgical procedures.
  • The Infection Prevention Team is investigating pre-operative risk factors such as diabetes and obesity.
  • A pre-operative shower with Chlorhexidine Gluconate (CHG) has been advised for many of our surgical procedures, such as orthopedic, neurosurgical, cardiothoracic, and OB/GYN.
  • Surgeons in the Main Line Health System receive Standardized Infection Ratios (SIRs) which benchmark their performance against national standards and peers at their individual campuses.

 

C. diff has become a major HAI, increasing patient morbidity and mortality throughout the country. The Main Line Health System is focused on antibiotic usage within the hospitals, as well as effective cleaning methods on each campus. We have piloted use of a TRU-D Ultraviolet Disinfection unit as a mechanism to terminally clean hospital rooms including those rooms that had a patient with C. diff.  Our hope is that this technology will be expanded to each hospital and used in other venues such as ICUs and ORs. 

 

In summary, Infection Prevention is a vital patient safety initiative and, with continuing focus on proven prevention activities, we will further improve care for our patients.

 

 

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2 Responses to January spotlight — Infection Prevention: What we’re focused on

  1. Firas Saidi, MD says:

    There needs to be a focus on our outpatient use of antibiotics when it comes to multidrug resistant organisms as well as C. Diff. I wonder if there is a possibility of adding the frequency of antibiotic prescription to our report cards and be ranked among peers within each specialty.

  2. Al Celidonio, RPh; Director of Pharmacy-Paoli Hospital says:

    Antibiotic resistance in the community is a big concern. Prescriber discretion to limit antibiotic use, as Dr. Saidi stated, is a commitment carefully balanced between treating an appropriate infection with proper antibiotic selection, and overuse. I agree that it would be a helpful tool to create scorecards on the volume of outpatient antibiotics orders. Unfortunately, the current records of outpatient prescriptions is a mix of paper prescriptions and electronic prescribing that will make it challenging to track. As we progress to a full complement of electronic records it will be easier to track these volumes and more importantly, the appropriateness and selection of the antibiotics.

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