“ In the real-world healthcare system , no intervention is perfect , so that ’ s why we have different layers of control to implement .
The key is to adhere to sustainable , hard-wired infection prevention practices .”
on those interventions that are proven to fight infections , you could risk experiencing escalating HAI rates .”
Yokoe emphasizes that the heart of the ongoing challenge is around sustainability of HAI prevention practices .
“ HAI rates look better in 2022 , but it ’ s clear that if we take our eyes off the ball , we could be back in the same place we were before , so we should take this opportunity to think about what we need for sustainable HAI prevention efforts ,” she says . “ As Dr . Talbot mentioned , we need to build resilience into our infection prevention and control programs . They must be adequately staffed . They must be adequately funded and resourced to be able to withstand ongoing challenges by emerging pathogens in the future . We will face a continuing series of infectious disease crises , so we must be prepared to contend with issues similar to what we experienced with COVID-19 . I agree with Dr . Talbot that we are in a much better position now than we were early in the COVID-19 pandemic , even with the possibility of increased influenza and RSV cases , but we should take this opportunity to learn from our experiences and build and reinforce an IP & C foundation that is able to sustain basic infection prevention practices , even in the face of competing demands .”
Maintaining consistency in the application of evidence-based HAI prevention practices is key , but as studies demonstrate , compliance by healthcare personnel is often subpar . ( See a related article on IP & C compliance in this issue on page 18 .) Many studies indicate that embracing a multi-faceted approach toward improving IP & C intervention strategies can drive improvements . Lack of knowledge of guidelines for infection prevention and control , combined with an unawareness of preventive indications during daily patient care and the potential risks of transmission of microorganisms to patients , constitute barriers to infection prevention and control compliance .
Talbot encourages hospitals to revisit the foundational , pragmatic basics of infection prevention and control to ensure they have been mastered by healthcare personnel .
“ In the real-world healthcare system , no intervention is perfect , so that ’ s why we have different layers of control to implement ,” he says . “ The key is to adhere to sustainable , hard-wired infection prevention practices . We need to be transparent and educate people around why we take these precautions and make it exceptionally easy for them to do them during the delivery of care . For instance , hospitals should make it so that healthcare personnel don ’ t need to stop to wonder if the supplies are there , the resources are there , whether it ’ s PPE or hand hygiene products . It ’ s also about understanding the workflow in healthcare .”
Yokoe adds that hospitals must continue to try to make it as easy as possible for healthcare personnel to do the right thing , making interventions effortlessly implementable . “ Especially in the busy healthcare environment that we all work in ,” she emphasizes . “ And continuing to remind healthcare personnel that everyone is accountable for infection prevention . Infection prevention practices must be built into everyday standard work practices for all healthcare professionals . I think that ’ s the only way we ’ re going to make any improvements that we achieve sustainable over time .”
The 2022 HAI Progress Report showed little progress in reducing HAIs in other healthcare settings . For example , among long-term acute-care hospitals ( LTACHs ), there were no significant changes in the 2022 SIRs compared with 2021 . In Inpatient rehabilitation facilities ( IRFs ), only IRF-onset CDI observed a 9 percent decrease in 2022 compared to 2021 .
“ I ’ m very concerned about the harms that are occurring in these other healthcare settings ,” Talbot says . “ These are settings in which the infection prevention and control programs are likely even less resourced and possibly more elementary than in acute-care settings . There are nuances to any practice setting , of course . If you think about long-term care residents , you might have different approaches to HAI prevention interventions . Currently , there ’ s some particularly good work being done to examine those strategies . No matter the setting , the resiliency and the resourcing of the infection prevention and control program is critical , so that it can be proactive and effective . It is an area to continue to push for more attention .”
“ As Dr . Talbot mentioned , I think the basic infection prevention principles and practices are similar , but there are real challenges in terms of resourcing and staffing in these non-acute-care settings ,” Yokoe says . “ The CDC has been focused on long-term care settings , and SHEA is developing a guidance document focused on long-term care that will be issued sometime this year . So , I agree that it ’ s an area interest and priority for SHEA .” Yokoe adds that , “ Hospitals should continue to prioritize HAI-prevention work and invest in the resources needed to implement and sustain effective infection prevention strategies , including those highlighted in the SHEA ’ s Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals . This is essential for safe , high-quality healthcare .”
HAI prevention efforts are only as successful as their degree of resourcing and funding allows them to be . Talbot and Yokoe share their thoughts on how to make the business case of infection prevention and appealing to the C-Suite for HAI prevention leadership and support .
“ SHEA is in the process of developing a whitepaper around the resources of an infection prevention and control program , and we hope to make this guidance available in the spring ,” Talbot says . “ All stakeholders , from the leaders of the healthcare facility to regulatory partners , need to see these programs as foundational infrastructure to the effective running of the healthcare institution . We ’ ve got so much data about not just reduction of harms , but reduction in length of stay , enhanced throughput , reduced costs , reduced waste , etc . You wouldn ’ t have a hospital without a lab and a lab director , and so you must have that foundational infection prevention and control program appropriately resourced , with input and participation from all the individuals in the hospital who partner with that program to set expectations around the mission and the goal for the coming year . Infection prevention and control programs are foundational infrastructure programs for hospitals , not just something that allows you to say to Joint Commission , ‘ I ’ ve checked these boxes .’ To be truly effective and reduce harm , it ’ s got to be foundational .”
Yokoe adds that it ’ s vitally important to get the message across to hospital executives and others about the importance of the work that is led by healthcare epidemiologist infection preventionists and antimicrobial stewards . “ I ’ m not sure if all hospital executives truly understand the role of a healthcare epidemiologist . So , some of the work that Dr . Talbot is leading during the coming year will be to highlight the critical role that we play and the fact that we are the subject matter experts around HAI prevention and prevention of the spread of antimicrobial resistance .”
References :
Centers for Disease Control and Prevention ( CDC ). 2022 National and State Healthcare-Associated Infections Progress Report . Accessible at : https :// www . cdc . gov / hai / data / portal / progress-report . html Lastinger LM , Alvarez CR , et al . Continued increases in the incidence of healthcare-associated infection ( HAI ) during the second year of the coronavirus disease 2019 ( COVID-19 ) pandemic . Infect Control Hosp Epidemiol . 2023 Jun ; 44 ( 6 ): 997-1001 . doi : 10.1017 / ice . 2022.116 . Epub 2022 May 20 .
16 • www . healthcarehygienemagazine . com • january 2024