infection prevention
infection prevention
By Melissa Travis, MSN, RN, CIC, FAPIC
Infection Prevention Risk We Think We’ ve Solved( But Haven’ t)
Over the last two decades, we have experienced the emergence and re-emergence of multiple infectious diseases. Each one bringing its own defense mechanisms and transmission risks which lead to stress and uncertainty for those of us working in infection prevention. Amid uncertainty, I take comfort in knowing that while the diseases may change, there are proven, core infection prevention strategies that don’ t. In my experience, the issue isn’ t that we don’ t know what to do. The problem is we haven’ t embedded the fundamentals deeply enough to withstand time, staffing pressures, and human behavior. Despite decades of hard work, persistence, and innovation, certain infection prevention risks remain, and in some cases are worsening.
Progress with HAI Prevention
The Centers for Disease Control and Prevention( CDC) recently published its 2024 annual National and State Healthcare-Associated Infections( HAI) Progress Report. This report reflects the data from a variety of healthcare settings that are submitting specific infections to the National Healthcare and Safety Network( NHSN). The report shows improvements in several HAIs including central line-associated bloodstream infections( CLABSI), catheter-associated urinary tract infections( CAUTI), Methicillin-resistant Staphylococcus aureus( MRSA) bacteremia, and Clostridioides difficile( C. diff). These improvements provide evidence that prevention efforts work.
Despite the progress, CDC reports 1 in 31 hospitalized patients and 1 in 43 nursing home residents still acquire a healthcare-associated infection. We know that many of these infections are preventable. Additionally, there are more resources and products to address infection prevention now than when I became an infection preventionist more than two decades ago. Progress is real, but elimination eludes us.
Basic Principles
I have heard this phrase many times throughout my career in both nursing and infection prevention.:“ We just need to go back to the basics.” While I don’ t disagree with the statement, I think“ the basics” are defined differently by each individual. For infection prevention, I consider the basics to be summed up in the unsung hero, Standard Precautions. Standard Precautions require all blood, body fluids, and contaminated surfaces to be treated as infectious in the healthcare environment by using“ common sense practices.” It includes hand hygiene, personal protective equipment( PPE) use, respiratory hygiene, cleaning and disinfection, appropriate patient / resident placement, proper linen handling, and safe injection practices. While Standard Precautions have been around since the 1990s, they are not consistently applied. Most of us have written and implemented hand hygiene protocols based on current guidelines. We have also conducted education and activities to promote awareness and adherence. Additionally, we have monitored compliance and reported the findings. While these interventions seem to work for a little while, they are often not sustainable.
Likewise, cleaning and disinfection protocols exist in nearly every healthcare facility. Yet audit data often reveal missed high-touch surfaces, inconsistent dwell times, and confusion about product use. In addition, cleaning the environment is not seen as part of patient care even though it directly impacts their
health. The policies and procedures may be in place, but proper execution is not.
From my point of view, these are just a couple of examples where we seem to be doing everything to promote the right practices and behaviors, but the outcome is not desirable. There appears to be a disconnect between knowledge, effort, and consistency.
Reality Check Even though most healthcare workers could probably articulate the basic meaning of Standard Precautions, I don’ t think they truly understand the full scope. In my experience, they recognize certain pieces— but not the entirety of the practice. In other words, it is not hardwired into their everyday tasks and interactions. I believe this is where we still need to focus our time and energy. Knowing the definition of Standard Precautions is not the same as operationalizing them under pressure habitually.
The Risk
The risk of infection in healthcare settings is well established, and the CDC reinforced this reality in its recent progress report: 1 in 31 hospitalized patients and 1 in 43 residents in long-term care facilities continue to acquire healthcare-associated infections. There is no question that our patients and residents are at risk for an HAI. We also know that Standard Precautions were introduced over 30 years ago. If it is not a question of risk and we have a primary mitigation strategy, why is there still a problem?
White Noise I do not believe anyone intends to ignore Standard Precautions. Very few people go into healthcare intending to do harm. I think it’ s something that happens over time as we become more confident and comfortable in our healthcare roles. We have heard the same things over and over again such as“ clean your hands” and“ cover your cough”. Perhaps we have heard these in the same way for so long that they have become white noise in the background.
Breaking Through
Like many others, I sleep with a white noise machine every night. It is part of my routine, and I don’ t even notice the noise anymore. It doesn’ t disrupt my sleep. On the contrary, it actually helps me sleep more soundly. A crash, loud music, or a child crying would wake me up temporarily then I would go back to
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• www. healthcarehygienemagazine. com march-april 2026