Safety & Quality: Infection Prevention

SafetyAnd Quality: Infection Prevention TeamStamford Health is on the leading edge of care for infectious diseases. Our Infectious Diseases Division oversees appropriate antibiotic use in the hospital, prevention of hospital-acquired infections, quality assurance in maintaining sterility, appropriate isolation policies and the development of practice guidelines for various types of infectious diseases. The Division also plays an important role in helping community residents prepare for emergencies.

Infection prevention is a vital component of Stamford Health’s program to maximize safety and avoid hospital acquired infections. Many studies have shown that infections acquired in the hospital can be life-threatening, and may be avoided with certain safe practices.

Led by national leaders in infection prevention and control, Michael Parry, MD and Brenda Grant, RN, the Infection Prevention Program at Stamford Health has employed a number of approaches to reduce harm. These include detailed “bundles” of safe practices specifically designed for each type of infection, and the use of new and innovative approaches.

C. Difficile

Approach

A recent example of excellence in Infection Prevention is the organization’s strategy to minimize C. difficile infections. C. difficile is a bacteria that causes a possibly life-threatening colon infection. It is becoming more common as the necessary (and unnecessary) use of antibiotics to treat different types of infections is growing. Because many patients in the hospital are being treated for infection, they are also at risk for acquiring C. difficile.

Brenda Grant using fluorescent marking to find germs

Brenda Grant using fluorescent marking to find germs

The organization uses a number of approaches in its efforts to combat C. difficile. These include following guidelines for antibiotic use, review of antibiotics used at the Hospital to make sure they are necessary, careful hand washing, use of gowns when C. difficile is suspected, using the best testing technology to find C. difficile at its earliest stages, and use of special disinfectants for patients and their rooms.

The Infection Prevention team also tracks rates of hand washing and C. difficile on each unit and reports the findings to leadership and providers at the Hospital.

Xenex "Germ-Zapping" Machine

Xenex "Germ-Zapping" Machine

Most recently, the organization began using a new “germ-zapping” ultraviolet light technology. The light helps to kill C. Difficile, because it can be resistant to common disinfectants. After a room is disinfected on specific patient units, a “robot” is put into the empty room, which flashes bursts of ultraviolet light to help kill the C. difficile spores.

Results

The organization’s approach to fighting C. difficile has resulted in a great reduction in the number of infections.

C. Difficile by Year Since 2009

Click Image to Enlarge (Fig. 1)

Figure 1 shows rates of C. difficile have decreased by 44% since many of the approaches described above have been implemented.

For more information on the Program’s quality improvement program and approach to care, contact us.

For more information on C. difficile in the United States, visit the Centers for Disease Control and Prevention.

Catheter Associated Urinary Tract Infection

Approach

A recent example of the Infection Prevention’s team approach to address a common problem is its effort to minimize infections from urinary catheters. Urinary catheters are used in hospitalized patients who cannot urinate on their own because of their medical condition.

Though the catheters are inserted under sterile conditions, after they remain in, they become colonized with bacteria and can become infected; known as catheter associated urinary tract infections (CAUTI's). These infections require antibiotic treatment, often leading to longer hospital stays and further complications.

The organization developed a group of interventions to minimize the risk of catheter associated urinary tract infections. The most important goal of the effort was to ensure the catheters are only used in those patients who need them, as patients who do not have them cannot acquire this infection. The Infection Prevention team developed guidelines that require physicians ordering a catheter to document the reason why and to revisit the reason in their daily notes. This allows nurses to review the reason for use regularly and remove catheters when no longer needed, a “Nurse Driven Protocol.” To do this, the organization used its computerized medical record system, so doctors and nurses could document and communicate related to the need for catheters.

Results

Click Image to Enlarge (Fig. 1)

The Infection Prevention team reviews lab results daily to look for bacteria that may be linked to urinary catheter use. It produces reports for each unit on how often they are using the catheters, and what the rates of infection are. The organization’s overall approach has resulted in a great reduction in catheter use and catheter associated urinary tract infection rates. Figure 1 shows Hospital-wide catheter utilization and urinary tract infections by year since 2009. The reduction in CAUTI achieved the 2011 New York Presbyterian Quality Signature Award. The results and innovation of the team’s approach was also published in the American Journal of Infection Control (Parry MF, Grant B, Sestovic M. Am J Infect Control. 2013;41:1178-1181)

For more information on the Program’s quality improvement program and approach to care, contact us.