Stewardship and scopes are just two issues that are top of mind for stakeholders in infection prevention and healthcare epidemiology for the new year. Let's explore the imperatives, as suggested by leaders in the infection prevention and control community.
Park and Seale (2017) say that provision of information plays a critical role in supporting patients to be engaged or empowered to be
Hygienically Clean Healthcare certification demonstrates linen and uniform services companies’ commitment to cleanliness through independent, third-party laundry inspection and quantified microbial testing. Inspection and re-inspection verify that items are maintained, washed, dried, ironed, packed, transported and delivered using best management practices (BMPs) to meet key disinfection criteria. Between scheduled and supplemental inspections, ongoing microbial testing quantifies cleanliness and indicates laundry process adjustments. Certification requirements are based on international standards for processing healthcare linens and garments.
By Teresa Daniels, MSN, RN, CIC
The healthcare landscape is, of course, very different today than it was 40 years ago, when a landmark study first called for the involvement of an individual tasked with paying attention to infections in the hospital environment. As Dhar, et al. (2016) observe, "Infection prevention programs (IPP), now a standard in healthcare, saw their inception in the1970s and 1980s after studies (such as the CDC’s Study on the Efficacy of Nosocomial Infection Control [SENIC]) showed a 32 percent reduction in HAIs in hospitals with established programs compared with the 18 percent increases in infection in hospitals without." In the ensuing years, the National Nosocomial Infection Surveillance System for voluntary reporting of surveillance data was created, the Joint Commission has introduced accreditation into the picture, and, as Dhar, et al. (2016) point out, "Since this time, there have been several groups that have had direct influence on the development of IPP ranging from professional societies, government agencies, nonprofit organizations, and payors. This complex landscape for infection prevention has led to the development of quality initiatives, legislative reforms, shifts in payment for HAIs, and an increased demand for transparency through public reporting of HAI data."
With the U.S. healthcare reform mandate for increasing transparency and improved quality, the need for infection prevention and control in long-term care facilities (LTCFs) is becoming more critical than ever before for the more than 3 million Americans receiving geriatric care in U.S. annually. Consider these facts regarding infection in long-term care:
• An estimated 1.6 million to 3.8 million infections occur in long-term care facilities each year.
• More than 1.5 million people live in 16,000 nursing homes in the United States. Estimates suggest infections could result in as many as 380,000 deaths among those residents each year.
• The nursing home population is expected to increase to about 5.3 million people by 2030.
Policies relating to newly emerging and highly infectious diseases in outpatient healthcare settings within the context of infection prevention and control are highly variable, according to public health experts, leaving many gaps in patient protection from healthcare-associated infections (HAIs). For example, only a minority of outpatient facilities are certified by the Centers for Medicare and Medicaid Services (CMS) and few are licensed by states or maintain accreditation status. As a result, many of these facilities are opened and operated without being held to minimum safety standards for infection control or other aspects of patient care, potentially putting patients at risk. In an October 2015 document, Outpatient Settings Policy Options for Improving Infection Prevention, the Centers for Disease Control and Prevention (CDC) outlined four key elements for states and their supporting HAI multidisciplinary advisory groups who are interested in more effective and proactive oversight of out-patient facilities: facility licensing/accreditation requirements; provider-level training, licensing and certification; reporting requirements; and establishment and effective application of investigation authorities.
The intensive care unit patient is susceptible to a number of common healthcare-acquired infections, including ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and Clostridium difficile infections (CDIs), among others. There are numerous predisposing factors to take into consideration, say Dhillon, et al., who add, "Critically ill patients in the ICU are more likely to have invasive catheters, devices, or undergo surgical treatments that disrupt the skin barrier. Burn victims also develop HAIs as a result of the physical barrier disruption. The ability to clear infections may further be reduced by an underlying chronic diseases, thus increasing the risk of HAI. Other significant risk factors include urinary catheter >10 days, ICU confinement >3 days, presence of intracranial pressure monitor/arterial line/central venous catheter, and shock."
The sterile processing department (SPD) can be one of the more challenging environments in which to uphold infection prevention and control principles. As an example, the decontamination area of the SPD can pose a significant threat to its technicians "because of the numerous and unknown microorganisms that pass through," confirms Nancy Chobin, RN, AAS, ACSP, CSPM, a sterile processing educator and consultant. "In addition, there is the potential for a sharps injury due to sharps that are handled in this area as well such a towel clips, etc.," she says.