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Hospital detectives

Proactive efforts that involve all healthcare workers often aid infection prevention

EACH YEAR, MORE THAN 1 million healthcare-associated infections (HAIs) occur in a variety of healthcare settings; in hospitals alone, the Centers for Disease Control and Prevention (CDC) estimates that 1 in 20 hospitalized patients has an HAI. These infections can be devastating and even deadly, and they add tremendously to the cost of healthcare.

“Germs are evolving and are very difficult to treat because the antibiotics to treat them haven’t been developed,” says Karen Hilmy, infection preventionist at the Greater Binghamton Health Center in New York. “The drugs that once seemed like miracles could someday, and someday soon, be useless. We can no longer limit ourselves to treating infections, due to resistance, but must prevent the development of infection.”

For example, when there was a deadly outbreak of antibiotic-resistant bacteria at the National Institutes of Health Clinical Center in Bethesda, Md., last year, staff struggled to contain it.

A patient from New York City carrying a multidrug-resistant strain of Klebsiella pneumoniae, a germ frequently associated with hospital-borne infections, introduced the dangerous bacteria into the 243-bed research hospital in the summer of 2011. Despite enhanced infection control practices, including patient isolation, the germ began to spread to other Clinical Center patients at an alarming rate.

The infection control team used increasingly aggressive strategies to stop the infection from spreading. They used a vapor of hydrogen peroxide to sanitize rooms, and removed sinks and drains where the germ had been detected. They also limited the activities of hospital staff and the use of equipment that had been exposed to infected patients so the germ wouldn’t spread to uninfected patients. Ultimately, the outbreak was contained, but only after 11 patients had died.

“Infection-control specialists need a facilitywide support system. No one person can engineer away the infections we are seeing in hospitals today,” says Hilmy. “Keeping hospitals infection-free is the job of every healthcare professional. As professionals, we need to chip in and do our part too. It takes a team approach.”

There are ways that healthcare workers can help their hospitals combat “superbugs,” and many of the hospitals where AFT Healthcare represents members are doing these things, including using hand hygiene procedures and personal protective equipment, and providing proper training and education for patients and staff on the appropriate use of antibiotics.

“Infection is preventable, not inevitable,” says Hilmy. “It sounds like a cliché, but it’s the truth.”

No superbugs here

“Luckily, we haven’t seen superbugs in our hospitals, but we are aware of them and having that awareness allows us to be proactive,” says Deb Snell, a registered nurse at Fletcher Allen Health Care in Burlington, Vt. A nurse for 12 years, Snell is a member of the Vermont Federation of Nurses and Health Professionals (VFNHP).

She says the health professionals at Fletcher Allen encounter infections found in hospitals like methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and gram-negative bacteria.

Snell splits her time between the intensive care unit and infection prevention department. Being on the frontlines gives her an opportunity to see how infection control practices are working or, in some cases, not working. “It’s nice to divide my time between two completely different places, and it’s very eye-opening,” says Snell.

Snell is one of two part-time infection prevention nurses in the department. “We have the support to capture information we need. That allows us to have a good handle on what’s happening in the hospital.”

We have the support to capture the information we need. That allows us to have a good handle on what’s happening in the hospital.

—Deb Snell, Infection Prevention Nurse

The AFT member points to the hospital’s infection prevention advocate program as one of the reasons the hospital’s infection rate is under control. The program was started in 2009; it is completely voluntary and open to all staff. The volunteers who take part are given intensive training on infection control practices. “The advocates are out on the hospital floor keeping an eye out for things, and they are trusted resources for the infection prevention department,” says Snell. “Having the program has really stepped up the vigilance in the hospital.”

Infection prevention nurses also work closely with the hospital’s pathology and laboratory medicine staff to stay on top of lab work. “The staff will call us if they find anything suspicious or notice an infection trend,” says Snell.

Last year, the state used money it received from the American Recovery and Reinvestment Act to help its hospitals and local health departments reduce multidrug-resistant organisms in their facilities. To this end, the infection control unit at Fletcher Allen collaborates with long-term healthcare facilities in the area to monitor patients who are transported frequently back and forth to and from the hospital and may carry infections with them.

The VFNHP also has played a role in keeping the infection rate down at Fletcher Allen. During the most recent contract negotiations between the VFNHP and the hospital, the local’s negotiating team used data gathered by its infection control nurses to show how nurse staffing affects infection rates. “Moving nurses from unit to unit and using traveling nurses causes infection rates to go up,” says Snell. “Being able to present that data to hospital administration helped support our goal of keeping nurse staffing ratios up.”

Be proactive

Nancy Dupont, an infection control specialist at the University of Connecticut Health Center in Farmington and a member of the University Health Professionals, says superbugs are a significant issue and are a major focus of all of infection control practices.

Dupont notes that while some specific organisms like MRSA and Clostridium difficile have a higher prevalence in hospitals, no place is completely safe. “We may have them controlled here, but infections travel. No institution is safe from having infections. Patients and visitors may have the organism but not be sick, and they can still pass the organism on,” she says. “It’s a sticking point in infection control. And you might hear about one particular organism, but there are others out there that are just as pathogenic.”

You might hear about one particular organism, but there are others out there that are just as pathogenic.

—Nancy Dupont, Infection Control Specialist

One of the best ways to combat infections is to be proactive, says Dupont. The Health Center has been working with the Connecticut Department of Public Health, and they have established an Antibiotic Stewardship Committee. The committee is charged with monitoring the use of antibiotics in healthcare facilities—an issue that relates to the development of drug-resistant infections—to determine if they are being used appropriately and to limit the frequency of their use. The committee also wants to educate patients about not relying on antibiotics. “We have to be more thoughtful and judicious about prescribing antibiotics,” says Dupont.

As infection preventionist Hilmy notes, being proactive also means teaching staff about good hand hygiene and the proper use of protective equipment, and educating patients and visitors about containing infections—such as explaining why it’s important for everyone to wash their hands.

As in most hospitals, Dupont and her colleagues encourage everyone to follow CDC guidelines that promote good hand hygiene, and they also educate staff about the different infections, provide resources for patients and their families, and advocate for adequate staffing ratios.

“Our role is to support our colleagues and provide them with comprehensive infection control education,” says Dupont. “We have our finger on the pulse of what’s happening in the hospital every day. The biggest benefit for us is being on the units, working on the frontlines, to show how we can prevent infections.” [Adrienne Coles]