Feature | October 17, 2007| Melissa Allen

Taking Control

With nosocomial infections on the rise, hospitals must protect their most vulnerable patients.

When hot water and anti-bacterial soap are not available, PDI SaniHands can come to the rescue.

When hot water and anti-bacterial soap are not available, PDI SaniHands can come to the rescue.

When hot water and anti-bacterial soap are not available, PDI SaniHands can come to the rescue.

When hot water and anti-bacterial soap are not available, PDI SaniHands can come to the rescue.

During the last several decades, the prevalence of Methicillin-Resistant Staphylococus Aureus (MRSA) and other nosocomial infections in U.S. hospitals and medical centers has increased dramatically. According to the Centers for Disease Control and Prevention (CDC), MRSA has climbed from accounting for 25 percent of Staphylococcus Aureus isolates from hospitalized patients in 1990 to almost 60 percent in 2003.

With nosocomial infections, notably MRSA, lurking around every corner, hospitals must keep constant vigil and develop a strong plan of attack to fight infections that always seem just a step ahead.

While these infections are on the rise, so are the methods to combat them. With dedication and attention to detail and procedure, nosocomial infections can be contained, prevented and treated.

Nosocomial Infections: Opportunistic, Resilient and Resistant
MRSA, an antibiotic resistant form of staph, is characterized by redness, swelling and drainage of an infected area. If the infection settles in the form of pneumonia, symptoms include fever, cough and productive sputum.

Other common hospital-acquired infections include ventilator-associated pneumonia (VAP), central line associated infections, influenza, strep and staph.

“These infections have always been around, but now more attention is being given to healthcare-associated infections,” said Jean Fleming RN, MPM, CIC and clinical director of infection prevention and education at Professional Disposables International Inc. (PDI). “There are, however, a number of prevention strategies available.”

According to Fleming, there are a number of reasons resistant organisms are on the rise, with a major problem being the misuse of antibiotics. With antibiotics being prescribed more often than necessary, bacteria have been able to build up resistance, and continue to do so.

Another reason for the rise is increasing numbers of patients in hospitals as well as more patients that spend a longer time in care, thus having more time to contract an infection and spread it to others.

“Unfortunately, we have had a lapse in care practices by healthcare workers in the past,” said Fleming. “Monitoring hand hygiene and good cleaning practices were not always a top priority and people never thought twice about taking an item from patient to patient without cleaning it.”
But times are changing, and with understanding nosocomial infections and how they are transmitted comes better prevention knowledge and strategy.

Prevention: Sticking to Procedure
According to the CDC, the simplest form of nosocomial surveillance is monitoring of clinical microbiology isolates resulting from tests ordered as part of routine clinical care.
The CDC recommends a culture of the nares to identify most carriers with MRSA and periretal and wound cultures to identify additional carriers. According to the Society for Healthcare Epidemiology of America (SHEA), each patient who enters the healthcare facility should be cultured in order to prevent infection spreading.

“Early identification of infected patients is very important,” said Fleming. “Especially in the emergency setting, where you have people coming in with open wounds, it is critical that cultures are done. All patients are unfortunately potential carriers. We may not know who is carrying it, but if we look for it, we will find it.”

According to Fleming, while all patients should be viewed as potential carriers, certain patient populations have a higher risk of infection than others. Persons with proper hospitalizations, chronic illnesses and those who have been in a long-term care facility such as a nursing home are at greater risk for being colonized with infections such as MRSA.

“What this all means is that we need to pay attention to protective gear, wearing gloves and gowns if necessary, and above all, good hand hygiene,” she said.

MRSA and other nosocomial infections are most often spread by bodily fluids and the items that come into contact with them. Because of this, hands, which are easily contaminated during the process of care-giving and commonly used and shared surfaces, must be disinfected regularly.

Several studies have shown that gloves can dramatically reduce hand contamination and transmission of healthcare-associated pathogen, preventing contamination 77 percent of the time, according to SHEA.

Hand hygiene includes washing and sanitizing hands in between each patient and throughout the care-giving process. When hot water and anti-bacterial soap are not readily available and time is of the essence, products such as PDI SaniHands can come to the rescue. This product is a wipe coated in a 65.9 percent alcohol gel that works as a disinfecting washcloth, wiping off bacteria and killing 99.9 percent of germs along the way, according to the manufacturer.

According to SHEA, several investigations have also found that wearing gloves can dramatically reduce hand contamination and transmission of nosocomial infections when changed between patients. Though gloves can reduce the instance of hand contamination by as much as 77 percent, SHEA stresses that hands must still be washed after their removal.

Just as hands may carry MRSA and other nosocomial infections, so do commonly touched and shared surfaces such as counters and bedrails, stethoscopes, blood pressure units, IV poles, call buttons and light switches.

“In the emergency room and operating room it is critical to always pay attention to good cleaning of surfaces frequently touched by healthcare workers, patients and visitors as well,” said Fleming. “A once-a-day cleaning may not be adequate for these surfaces.”

According to SHEA, facilities should develop cleaning and disinfection polices to control environmental contamination with antimicrobial-resistant pathogens. MRSA and other nosocomial infections are susceptible to low-level and intermediate-level disinfectants, quaternary ammonium compounds, phenolics and idophors.

Another device that is commonly handled by many people and often neglected in disinfection is the suction wand.

“The wand often ends up under a pillow or on the floor and the nurses will use it again and again, making a patient susceptible to [VAP],” said Monica Bornemisza, product manager at Iapyx Medical. “Bacteria not only ends up on the floor and the bed, but healthcare workers and subsequent patients could acquire infection.”

Iapyx’s solution to this problem is the Isoline Holster, which attaches to the bedrail and provides a designated place for nurses to store the wand, reducing instances of bacteria coming into contact with both the patient and hospital surfaces.

Fleming points out that aside from hand and surface disinfection it is also crucial to provide proper skin antisepsis whenever a skin infraction is made in order to prevent the spread of infection. Antiseptic swabs such as PDI’s Chlorascrub are necessary to disinfect the area around an opening in the skin.

Chlorascrub is a pre-injection skin antiseptic swab that consists of 3.15 percent Chlorhexidine Gluconate and 70 percent isopropyl alcohol. It reportedly dries quickly and is persistent and effective against bacteria, viruses and fungi.
Using Chlorhexidine is a must for prepping a cite for catheter insertion, according to Bornemisza.

“Once a catheter is inserted there is still a risk of infection due to movement back and forth on the line, whether when fluid is being added or removed or in other instances. When the line moves, bacteria can migrate up the catheter, leading to infection,” Bornemisza said.

Catheter-associated infection can be minimized or prevented by the use of a stabilization device such as the Iapyx Stable Line Family. These disposable devices hold the line in place, reducing movement and infection, while being discarded following patient use.

Another helpful product in the fight against MRSA and other resistant infections comes in the form of Gaymar’s antimicrobial mattress covers with Silver3 technology. The covers are designed to respond to humidity and moisture, reportedly reducing the instance of MRSA and other bacteria that come into contact with the mattress by 99.9 percent.

“There is a high cost associated with these infections,” Bornemisza said. “Whether it is MRSA, a bloodstream infection or VAP, the cost per incident could be anywhere from $4,000 to $40,000. Adopting some simple procedures and products can save money and lives.”

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