New approaches to infection control in hospitals
07/01/2007
Stricter procedures, reporting, and new antimicrobial products play a role
By Frank Sylvester, Sylvester Solutions
For anyone who has ever been admitted to a hospital for an emergency, illness, or scheduled procedure, usually the last thing on their mind is exposure to another, potentially more devastating health problem-infection. Yet there is no denying that drug-resistant pathogens are a growing threat to all people, especially in health care settings.
The Centers for Disease Control and Prevention (CDC) reports that “each year nearly 2 million patients in the United States get an infection in a hospital. More than 70% of the bacteria that cause hospital-acquired infections [HAIs] are resistant to at least one of the drugs most commonly used to treat them. Persons infected with drug-resistant germs are more likely to have longer hospital stays and require treatment with second- or third-choice drugs that may be less effective, more toxic, and/or more expensive.”1
The Committee to Reduce Infection Deaths (RID) goes on to say that “infections contracted in hospitals are the fourth largest killer in America. Every year in this country, an estimated 103,000 patients die as a result of these infections, a startling statistic since it is larger than the combined deaths from AIDS, breast cancer, and auto accidents.”2 But the cost is not in lives lost alone. Says Betsy McCaughey, PhD, RID founder and chair, “Hospital infections affect 2 million Americans every year and add $30.5 billion to the nation’s health care tab.” For example, McCaughey points out that depending on the type of infection, the additional 1.9 million or so patients who contract a non-fatal infection will spend from one to 30 extra days in the hospital for treatment.
There’s no denying that, in hospitals throughout our nation, marvelous procedures save patients at the threshold of death every day, and the health care profession should be applauded for its successes. Unfortunately, there’s also the fact that as many as one out of every 20 patients contracts an infection-and therein lies the problem waiting for resolution.
The ‘Superbug’
One of the deadliest germs responsible for hospital infection and one of the hardest to treat is called methicillin-resistant Staphylococcus aureus (MRSA)-more commonly known as “staph.”
Infectioncontroltoday.com describes staph as “bacteria commonly carried in the nose and skin.”3 Around 25 percent of the population carry “colonized” staph in their noses, meaning they don’t suffer from any symptoms or complications. However, an injury to the skin can give the bacteria a chance to enter the body. Although most staph infections of the skin are minor, causing pimples or boils, and are treatable with antibiotics, more serious versions can lead to bloodstream, lung, or other infections.
Generally, staph is most often spread via skin-to-skin contact and through open wounds. Indirect contact from infected towels, benches, gurneys, chairs, bedding, or clothing is another major source of bacterial transfer (see Fig. 1).
The legal position
Many people and organizations believe that health care institutions should be required to publicly report their infection rates, giving patients the ability to review infection control data and thereby providing them with a more educated and informed decision as to what facility to select. But, according to a New Hampshire Public Radio (NHPR) report, as of February 2007, only 15 states were mandating hospitals to report cases of infection by law. Furthermore, the infection rate data that is made available to the public by those hospitals mandated to supply them can be skewed.
The State of Pennsylvania is one of the 15 that currently does mandate the reporting of infection data. In 1986, the Pennsylvania Health Care Cost Containment Council (PHC4) was established as an independent state agency by the General Assembly and Governor of the Commonwealth. As stipulated in its report “Hospital-acquired Infections in Pennsylvania,” “the main objective of PHC4 is to help improve the quality and restrain the cost of health care. PHC4 promotes health care competition through the collection, analysis, and public dissemination of uniform cost and quality-related information.”4
On the surface, this all sounds well and good, but the actual data being compiled and made public may not be. Says Alice McDonnell, MPA, RN, an infection control nurse since 1977, “Some of the data used by PHC4 is certainly skewed. The billing procedure codes do not differentiate between those [persons] who have acquired an infection while a patient in the hospitals vs. those who already had an infection when they arrived.”
For example, according to the current reporting procedures, if during the course of gall bladder surgery surgeons determined that the organ was infected (an infection acquired prior to being admitted to the hospital), this incident would be coded/billed as an HAI-when, in fact, it was not.
In fact, the CDC reports that 20 to 30 percent of patients admitted to hospitals may already carry infectious germs, bringing them into the facility rather than acquiring them while there.1 This data is supported by McDonnell’s experience. “We perform nasal swabs on every patient admitted to our ICUs to determine if the patient is infected with, or colonized with, methicillin-resistant Staphylococcus aureus. And since the inception of this program, the CDC statistics have held true: 20 to 30 percent of the patients tested have proven positive,” she says.
McDonnell notes that the turnaround time for the swab tests is quick, usually within two hours, and “once we know that a patient has a resistant organism, we can take appropriate precautions to prevent transmission to other patients or to our employees.”
Although infection control principles are absolute, McDonnell says staff sometimes have difficulty applying the principles to certain patients because each patient and condition is different. “I always tell the staff to think about three basic concepts: What disease or organism does the patient have; how is that disease transmitted to others; and what precautions do you need to take to prevent it from being transmitted?”
Dealing with HAIs
So what steps can hospitals take to combat the problem of HAIs? Well, McDonnell points out that “the easiest, most efficient, and cost-effective means of reducing HAIs is washing your hands.” And some hospitals have implemented a “no necktie” policy in an effort to further reduce the rate and mode of spreading germs.
But Kathy Bartkowski, an RN since 1969 and an infection control nurse for the past eight years, says that ultimately, “You need to determine policies, protocols, and strict procedures that must be followed by all hospital staff-from nurses to physicians right on down to house cleaning personnel.”
Still, though establishing standard hospital policies and procedures is certainly a major component in combating HAI, enforcing them effectively may present another issue. For example, although hospital administration, nurses, and other employees are required to follow infection control rules and protocols, physicians, who are independent practitioners, are not.
“Some physicians are very good at infection control procedures-e.g., washing hands, cleaning stethoscopes-while others simply are not,” says Bartkowski. “To expect a physician to wipe his/her stethoscope with an alcohol swab before and after seeing every patient just isn’t going to happen. It comes down to time and resources-in other words, cost.”
Antimicrobial materials
While the most common means of bacterial transmission remains the hands, it follows that if you can reduce the amount of bacteria present on surfaces to begin with, you’re less likely to pick it up and pass it along.
This is the thinking behind the introduction of new antimicrobial fabrics into the seating and bedding products used in health care environments including hospitals, clinics, dental offices, and nursing homes.
One such product is CMI Enterprises’ (Miami, FL) “Dimensions” fabric line, which incorporates the company’s Nanocide™ antimicrobial treatment. The treated fabric features embedded nanoscale silver particles, as opposed to a topical application that would wear off over time. Silver is a powerful, natural antibiotic. Acting as a catalyst, the silver disables the enzyme that one-celled bacteria, viruses, and fungi need for oxygen metabolism. As a result, the microbes suffocate (see Fig. 2).
The nanotechnology employed does not require the bacteria to ingest or absorb the biocide. It is killed when it comes into contact with the ion field on the surface. Test results for CMI’s “Dimensions” line have shown that 99.9% of resistant staphylococcus germs that come in contact with it are killed within 30 minutes (see Fig. 3).
“The use of silver at the nanoscale is allowing manufacturers to innovatively add antimicrobial properties to an ever expanding range of products,” says Marlene Bourne, president and principal analyst of Bourne Research LLC (Scottsdale, AZ). “Even better, with this approach, there’s a greater assurance of longevity and performance. Since the germ-fighting properties won’t wear off in a short period of time, hospitals can confidently make the capital investment necessary for this kind of next-generation infection control.”
Antimicrobial fabrics represent one more important and effective tool for the health care community to bring to bear against the growing problem of hospital infection.
Frank Sylvester is president of Sylvester Solutions, a market and business development company. He graduated from Syracuse University in 1983 with a B.A. in business.
References
- The Centers for Disease Control and Prevention (CDC) web site; http://www. cdc.gov.
- The Committee to Reduce Infection Deaths (RID) web site; http://www.hospitalinfection.org.
- Infection Control Today web site; http://www.infectioncontroltoday.com.
- “Hospital-acquired Infections in Pennsylvania,” Pennsylvania Health Care Cost Containment Council (PHC4), 2006; http://www.phc4.org
eports/hai/05/docs/hai2005report.pdf.