Healthcare Hygiene magazine January 2020

infection prevention By Sylvia Garcia, MBA, RN, CIC Leading the Way to Zero: Moving Purposefully Forward Together At the opening of the 2006 annual meeting of the organizational priority when the Joint Commission added Association for Professionals in Infection Control three new requirements to national patient safety goal and Epidemiology (APIC), then-APIC president Kathleen (NPSG) 7: Reduce the Risk of Healthcare Associated Infection Arias said, “Zero tolerance is not a number—it’s a culture in 2009 and an additional topic area in 2012 in which healthcare providers strive to prevent as many • Implement evidence-based practices to prevent health healthcare-associated infections as possible. We may never care–associated infections due to multidrug-resistant eliminate every infection, and many cannot be prevented, organisms (MDRO) but infection control professionals should accept nothing • Implement evidence-based practices to prevent CLABSI less than the very lowest rates of infection.” • Implement evidence-based practices for preventing Back then, I sat in the audience and thought to myself, surgical site infections (SSI) great idea, but is it achievable? • Implement evidence-based Which infections should we practices to prevent CAUTI prioritize? What are the key Today, the results of con- interventions? How do we get centrated efforts to identify key We are making progress but there is still interventions and reduce risk by support from leadership and staff? (I wasn’t even thinking evidence-based much work to be done both for the common implementing about the patient or their family practices are clear. Nationally, infections that occur in healthcare such as among acute care hospitals, at that point.) There were already ev- SSI, and those, such as antibiotic resistant significant progress has been idence-based guidelines made. For example, between organism and other high- consequence available from Centers for 2017 and 2018, an 8 percent Disease Control and Prevention to 12 percent statistically organisms, that loom on the horizon. (CDC) and other professional significant decrease in CAUTI, organizations on a variety of CLABSI and hospital-onset key topics. The next year, the C. difficile infections was Centers for Medicare & Med- reported. However, there was icaid Services (CMS) published payment reforms intended no significant decrease in SSI rates. to increase emphasis on value-based purchasing which According to point prevalence surveys of hospitals identified central line-associated bloodstream infections conducted in 2011 and then again in 2015, there has also (CLABSI) and indwelling catheter-associated urinary tract been a statically significant (p<0.0001) decrease in HAI infections (CAUTI) as “never events.” So, I knew CLABSI amongst hospitalized patients: 1 in 25 (4 percent) versus and CAUTI would be on leaderships’ list of priorities, but 1 in 31 (3.2 percent), respectively. Pneumonia, gastroin- was this enough? testinal infections (most of which were due to Clostridium The answer would become clearer during 2008 when difficile) and surgical site infections were the most common the Society for Healthcare Epidemiology of America (SHEA), healthcare-associated infections infection identified. the Infectious Diseases Society of America (IDSA), the As the following NPSGs are moved to standards effective American Hospital Association (AHA), APIC, and the Joint July 1, 2020, organizations need to continue to implement Commission worked together to create the Compendium evidence-based practices. of strategies to prevent healthcare-associated infections • NPSG.07.03.01—Multidrug-resistant organisms in acute-care hospitals. These documents focused on • NPSG.07.04.01—Central line–associated bloodstream implementation of basic strategies to prevent the most infections common healthcare associated infections (HAIs) as well • NPSG.07.05.01—Surgical site infections as providing special approaches when basic practices were • NPSG.07.06.01—Catheter-associated urinary not enough. They also recommended that accountability tract infections be assigned and proposed performance metrics to monitor Organizations should also be aware that in November quality improvement efforts. 2019, the CDC released a report about the threat of antibi- Information from the CDC, the Compendium and other otic-resistant organisms and the statistics are eye-opening: professional organizations soon became an even greater “…antibiotic-resistant bacteria and fungi cause more than www.healthcarehygienemagazine.com • january 2020 11

Healthcare Hygiene magazine January 2020 | Page 11