Infection Control in Alternate Settings

Research shows that compliance to infection control (IC) precautions is internationally suboptimal and, according to European researchers, compliance at suboptimal levels has "significant implications for staff safety, patient protection and the care environment."¹

On large health campuses or at satellite offices, ensuring IC practices are implemented throughout can seem like an international undertaking. The many types of healthcare organizations can run the gamut, and today’s healthcare campuses and medical malls can exhaust even the healthiest of long distance runners.

According to literature provided by the University of North Carolina at Chapel Hill, a healthcare organization is a hospital, clinic, chiropractic office, home health agency, nursing home, local health department, community health center, mental health agency, hospice, ambulatory surgical center, urgent care center, emergency room or any other healthcare provider that provides clinical care.

Add to that list the following infectious diseases that may be transmitted and/or acquired in healthcare settings, and the need for strong IC practices is compounded:² Acinetobacter, bloodborne pathogens (HIV, hepatitis, etc.), Burkholderia cepacia, Clostridium difficile, Clostridium sordellii, Creutzfeldt-Jakob Disease (CJD), ebola (viral hemorrhagic fever), gastrointestinal (GI) infections, hepatitis A, hepatitis B, hepatitis C, HIV/AIDS, influenza, methicillin-resistant Staphylococcus aureus (MRSA), mumps, norovirus, parvovirus, poliovirus, pneumonia, rubella, SARS, Streptococcus pneumoniae (drug resistant), tuberculosis, varicella (chickenpox), vancomycin intermediate Staphylococcus aureus (VISA), vancomycin-resistant Enterococci (VRE), and more.

Hospitals are not the only place healthcare acquired infections are transferred. In a nine-site MRSA surveillance program titled "Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network," researchers found that most of the 8,987 observed cases of infectious MRSA were healthcare associated (classified as either hospital onset or healthcare community onset). The numbers speak for themselves: 2,389 cases (26.6 percent) were hospital onset infections and 5,250 (58.4 percent) were healthcare community onset infections.⁴ Still another facet of the ABCs study found that of 126 MRSA isolates obtained from dialysis patients, 80 percent of the strains were of healthcare origin.

The aforementioned research shows that IC compliance is suboptimal.¹ "Adherence has been problematic," they assert, "and the practice of standard and universal precautions is globally suboptimal." The researchers note that this is because practitioners are selective in which IC-related practice they regularly implement.

Every healthcare system and stand-alone center will have its own set of IC standards, but the following general IC-related best practices should be implemented in any healthcare setting and offers a good starting point:⁵

Universal blood and body fluid precautions

Any workers with lesions or weeping dermatitis shall refrain from handling patient care equipment and devices used in performing invasive procedures and from all direct patient care that involves the potential for contact of the patient, equipment, or devices with the lesion or dermatitis until the condition resolves.

All equipment used to puncture skin, mucous membranes, or other tissues in medical, dental or other settings must be either disposed of or properly sterilized prior to reuse.

Every healthcare organization should have a written infection control policy.

All workers must be trained in the principles of infection control and the practices required by the policy.

Epidemiologic principles of infectious disease

Principles and practice of asepsis

Sterilization, disinfection, and sanitation

Disposal of sharps and sharp injuries

Sterilization and disinfection, including a schedule for maintenance and microbiologic monitoring of equipment; the policy shall require documentation of maintenance and monitoring.

Sanitation of rooms and equipment, including cleaning procedures, agents, and schedules

Accessibility of infection control devices and supplies

Structured intervention is cited to hold the more impressive results, but "research fails to indicate for how long the intervention affects practitioner compliance, or whether compliance after a period of time returns to the norm."¹

Behavior at the onset is where it must begin, but behavioral change is very difficult to reach. "Infection control teams and researchers need to consider the reasons for non-compliance and provide a supportive environment that is conducive to the routine," the researchers conclude.

References

1. Gammon J, Morgan-Samuel H, Gould D. A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions. J Clin Nurs. 2008 Jan;17(2):157-67.

2. CDC. Infectious Diseases in Healthcare Settings. May 22, 2006. http://www.cdc.gov/ncidod/dhqp/id.html.

3. CDC. Invasive Methicillin-Resistant Staphylococcus aureus Infections among Dialysis Patients, United States, 2005. MMWR. 56(09);197-199. March 9, 2007. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5609a3.htm?s_cid=mm5609a3_e.

4. Klevens, R. Monina. Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States. JAMA. Vol 298, No. 15. October 17, 2007.

5. North Carolina Administrative Code. Health: Epidemiology. Chapter 41A. http://www.unc.edu/depts/spice/NC-law-.0206-.0207.html.