Special Edition on Infection Prevention & Control

As Patel, et al. (2019) observe, preventing HAIs “often requires the use of cross-cutting methods, such as antimicrobial stewardship and environmental cleaning strategies, to achieve improvements.” infections for the first time. Some hospitals saw moderate improvements while others maintained their zero status. However, the researchers noted, in aggregate, the findings revealed no statistically significant differences in infection rate changes during the intervention period. They observed, “It’s important to note that this new data doesn’t conclude that the practices were ineffective; rather they indicate that challenges are unique to each hospital and more work needs to be done.” Bhatt and Collier (2019) report that: • There are many reasons why preventing infections is still so hard, chief among them is that the inpatient population is complex, leaving patients vulnerable to these potential infections. As more care moves to the outpatient setting, patients admitted to hospitals now are more medically complex with a higher likelihood of having multiple chronic conditions. • Hospitals that are making a positive difference say that leadership, starting with the CEO, must be fully committed to infection prevention and control. They must make infection prevention a chief business strategy, engage in developing and deploying best practices, provide incentives for achieving goals and follow the performance indicators. • High staff turnover rates, inconsistent staff engagement and competing priorities are key barriers to success. To help overcome these barriers, hospitals need to create a safety culture that puts people first – patients and staff. • Comprehensive and real-time data reports on the spread of infections and adherence to strategies for prevention are fundamental tools every hospital needs. And it’s most effective when that data is shared among state-based HAI prevention stakeholders, including state hospital associations and public health departments. These local resources can provide technical assistance, coaching, and education. • When hospitals and health systems make state-based partners a part of their team, they create an optimal network of care. These healthcare teams work smarter, not harder, by sharing resources and group brainstorming. Together they learn, grow and benefit from each other’s knowledge and experience. • Infection prevention can be especially complicated for small hospitals. Lower volume creates an environment of infrequent interaction with complex conditions that require specific and consistent action from front-line staff. And clinicians at small hospitals tend to be stretched thin. As Bhatt and Collier (2019) state, “Did our program accelerate the journey to zero preventable HAIs? Although all hospitals worked hard at this effort, some achieved greater success than others. This reality begs the question: Why is HAI prevention so difficult? Many reasons have been cited in the literature that include the immense financial and workforce challenges and staff turnover experienced by participating hospitals. These challenges can be especially difficult for hospitals that need resources to educate staff on standardized, evidence-based practices shown to reduce HAIs. Access to HAI consistent staff training and development and other evidence-based guidelines and systems to easily implement them and review data sounds like a simple solution, but in reality, HAI prevention is challenging, especially for hospitals that may struggle with numerous technical and socio-adaptive barriers in the environment.” How, then, do healthcare professionals advance the HAI-prevention agenda? As Bhatt and Collier (2019) explain, “We need to redouble our efforts to standardize HAI prevention processes throughout the U.S. healthcare system. Every health care delivery organization should be able to implement evidence-based HAI prevention processes. We need to enhance the resources and knowledge of hospital teams to prevent HAIs. This commitment includes educating health care workers in HAI prevention, robust processes to measure infection rates, and continuous use of evidence-based practices with every patient in every setting by all clinicians and team members. Other commitments may include coordinated federal and state funding support across all agencies; tools and resources for infection control leadership in every hospital; consistent collection, analysis, management, reporting, and sharing of HAI incidence rates; rigorous implementation of known and effective policies and procedures to prevent HAI, such as hand hygiene, environmental disinfection, antimicrobial stewardship, and engagement of patient and family advisors in prevention teams; consistent training and retraining of team members; and use of medical technologies and devices designed to prevent infections and identify patients colonized or infected with HAI-associated pathogens.” As Patel, et al. (2019) observe, preventing HAIs “often requires the use of cross-cutting methods, such as antimicrobial stewardship and environmental cleaning strategies, to achieve improvements.” They add, “Competency-based training should be performed with various members of the healthcare team, such as physicians (for example, insertion of a central line), nursing staff (for example, insertion of a urinary catheter), and environmental services (for example, thoroughness of room cleaning). Assessing competency of infection prevention practices through audit and feedback has been associated with success in HAI prevention.” References: Bhatt J and Collier S. Supplement: “States Targeting Reduction in Infections via Engagement (STRIVE).” Reducing Healthcare–Associated Infection: Getting Hospitals and Health Systems to Zero. Ann Intern Med. October 2019. https:// www.acpjournals.org/toc/aim/171/7_Supplement Centers for Disease Control and Prevention (CDC). Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings –Recommendations of the HICPAC. Patel PK, Popovich KJ and Collier S, et al. Foundational Elements of Infection Prevention in the STRIVE. Supplement: “States Targeting Reduction in Infections via Engagement (STRIVE).” Reducing Healthcare–Associated Infection: Getting Hospitals and Health Systems to Zero. Ann Intern Med. October 2019. https:// www.acpjournals.org/toc/aim/171/7_Supplement Popovich KJ, Davila S and Chopra V, et al. A Tiered Approach for Preventing Methicillin-Resistant Staphylococcus aureus Infection. Supplement: “States Targeting Reduction in Infections via Engagement (STRIVE).” Reducing Healthcare– Associated Infection: Getting Hospitals and Health Systems to Zero. Ann Intern Med. October 2019. https://www.acpjournals.org/toc/aim/171/7_Supplement Rohde JM, Jones K and Padron N, et al. A Tiered Approach for Preventing Clostridioides difficile Infection. Supplement: “States Targeting Reduction in Infections via Engagement (STRIVE).” Reducing Healthcare–Associated Infection: Getting Hospitals and Health Systems to Zero. Ann Intern Med. October 2019. https://www.acpjournals.org/toc/aim/171/7_Supplement www.healthcarehygienemagazine.com • IP&C Special Edition June 2020 37

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