By J. Hudson Garrett Jr., PhD
Infection preventionists face a challenging and often times daunting task meeting the day-to-day regulatory requirements for public reporting of healthcare-associated infections (HAIs). The Centers for Disease Control and Prevention (CDC) have identified hand hygiene as the single most important intervention to reduce the transmission of infection. Clinical studies have also repeatedly demonstrated the role that contaminated environmental surfaces play in transmission of infection in healthcare facilities. The most successful approach for reducing the transmission of infection is a multi-discipline infection prevention program that applies the latest evidence-based standards and includes ongoing monitoring and training. This article provides a blueprint for an effective infection prevention program that will protect patients, visitors and the healthcare providers involved in the daily care of patients.
Elements of Infection Prevention
Management Support and Adequate Resources are the Foundation to Success
Any successful initiative within a healthcare facility requires top level support prior to initiating the intervention. By securing commitment from your leadership team, many obstacles will be eliminated during program implementation. It is critical to accurately describe your plan, goals and objectives. It is equally important to identify the resources required to establish and sustain the infection prevention program. You don’t have to start from scratch in building an infection prevention program. The Association for Professionals in Infection Control and Epidemiology (APIC) offers a wide variety of infection prevention resources including opportunities to network with other infection preventionists.
Build a Team of Infection Prevention Champions
The key to compliance with infection prevention and control policies is staff involvement and accountability. A multi-disciplinary infection prevention committee will increase the compliance with basic infection prevention policies and procedures. When creating the initial program (and after securing support from upper management), gain the support of bedside clinicians and support staff. The team should also include representatives from non-clinical areas, such as dietary and administrative staff members. The greater the level of staff commitment you secure at the beginning of the process, the more compliance you will see demonstrated later on. Convey the message that all staff members have responsibility for infection prevention. This inclusive approach will foster a sense of personal accountability and help create a 360-degree commitment to infection prevention.
Be Smart About Infectious Disease Surveillance
Surveillance of patient infections allows for prompt identification of potential outbreak situations, as well as other abnormal infectious disease patterns within the facility. However, it is not always necessary – or possible – to engage in whole house surveillance. To determine which infections should be monitored routinely, conduct a formal assessment of the most significant risks to the facility by evaluating these factors:
-The demographic served
-Most prevalent microorganisms
Based on the findings of this risk assessment, strategic surveillance should be implemented accordingly. Finally, electronic surveillance systems are available for use if necessary based on the patient diagnosis.
Reporting Communicable Disease is Mandatory
Most states within the United States have regulations and protocols for public reporting of illnesses that pose a threat to public health. This is also true for acute and non-acute care settings (such as long term care facilities). It is recommended that the infection preventionist establish a relationship with the respective public health authorities so that any possible signs of significant communicable illness or outbreak can be promptly reported. Public health personnel also serve as a valuable resource for pandemic preparedness and analysis of disease outbreaks.
Be Prepared to Investigate Outbreaks
Because the frequency of multidrug-resistant microorganism (MDRO) outbreaks is increasing in U.S. hospitals, the infection preventionist should have a written plan for initiating an outbreak investigation that includes descriptions of the respective roles and responsibilities of all clinical providers and administrative staff. A formal policy will ensure a thorough investigation of the outbreak. It is critical to involve public health personnel at the first sign of a suspected outbreak so they may assist with laboratory and epidemiological analysis. When performing an investigation, collect as much information about the symptoms of the patients, commonalities among the cohort such as last known location, meals, etc., so that epidemiological patterns can be established quickly. During the outbreak, clinical staff should utilize the appropriate personal protective equipment (PPE) for the suspected pathogen. The CDC guidelines for Isolation and the Prevention of Multi-Drug Resistant Organisms (MDRO) explain the appropriate precautions.
Develop Policies and Procedures According to Established Guidelines
To ensure consistent compliance with established guidelines, detailed written policies should be in place to guide staff members in handling all infection prevention and control matters. Policies should reflect the most current recommendations and guidelines from as authorities such as the CDC. They should be concise and provide clear direction to staff, as well as cite the standard and/or guideline that are the basis for the recommendation. Policies and procedures should be reviewed on an annual basis. Feedback from staff should also be solicited and utilized during the updates to ensure that the policies are not only evidence-based, but also practical for staff members to adhere to. The appropriate supplies, i.e. gloves, masks and gowns, should be available if listed as required items. Concise policies, access to the appropriate equipment and routine updates to the documents will encourage compliance from staff members.
Keep Current on Regulatory Requirements
Facilities must comply with regulatory requirements from various accreditation bodies including the Joint Commission (JC), Centers for Medicare and Medicaid (CMS), the Occupational Safety and Health Administration (OSHA), and state authorities. These regulations are continuously evolving; therefore, the infection preventionist must participate in routine continuing educational activities in order to maintain a complete knowledge of these requirements. Many organizations, such as APIC and CDC, offer online continuing education opportunities on hot topics such as Multi-Drug Resistant Organisms (MDRO) and C-Diff, among others.
You Are Not Alone! Educational Support and Professional Development Resources are Available
As the facility’s infection preventionist, you will play an active role in annual competency education for infection prevention and/or occupational health. Topics such as blood borne pathogens and tuberculosis transmission prevention are required on an annual basis by OSHA. In addition, updates to CDC guidelines, respiratory precautions, MDROs, and reporting of communicable diseases to public health should also be reviewed on an annual basis to ensure clinical staff members have a thorough understanding of their respective roles and responsibilities in infection prevention.
With these challenging economic times, it may be difficult for the facility to sponsor continuing education and other professional development. There are several resources available free of charge to all healthcare providers. These are listed below with their respective websites. One of the most beneficial resources for an infection preventionist, however, is a membership to APIC, which is available for a nominal fee. APIC is the premier source of information, education, guidance, networking, and advocacy regarding Infection Prevention and Control. APIC provides members with access to a vast community in infection prevention using e-communities, list serves, member directories andchapter and section networks. It gives the infection preventionist the ability to play a direct role in advocacy by staying up-to-date on the issues and taking action by using various tools on the website, participating in research, leadership, award, and scholarship opportunities. For more information regarding APIC, contact them at (202) 789-1890.
The role of the infection preventionist is constantly expanding, and with the addition of new regulatory requirements from the Centers for Medicare and Medicaid Services, this position will only increase in importance. The time to develop a comprehensive infection prevention program is now. A unified, aggressive infection prevention program will assist you in your efforts to Targeting Zero Healthcare Associated Infections.
For additional information:
Association for Professionals in Infection Control and Epidemiology www.apic.org
The U.S. Centers for Disease Control and Prevention www.cdc.gov
Society for Healthcare Epidemiology of America www.shea-online.org
J. Hudson Garrett Jr., PhD, is director of clinical affairs for PDI Healthcare. He can be reached at firstname.lastname@example.org/.