Special Edition on Infection Prevention & Control | Page 29

the attitudinal and cultural changes that must occur to ensure
consistent application of evidence-based guidelines. STRIVE also
encouraged statewide collaboration on HAI reduction efforts
for hospitals by bringing together state hospital associations,
state health departments, and quality innovation networks/
quality improvement organizations.”
Let’s review what Patel, et al. (2019) outlined as the
foundational elements of competency-based training for
infection prevention.
Hand Hygiene
Patel, et al. (2019) note, “Despite evidence and a clear
biological basis that performing hand hygiene prevents HAI,
hand hygiene rates are often dismal in all types of healthcare
settings. One systematic review found that median compliance
rates for hand hygiene in hospitals were about 40 percent.
Barriers to excellent hand hygiene can include limited access to
supplies, skin irritation from disinfectants, and time; however,
these can be mitigated through hand hygiene role models and
adaptive strategies. Technological innovation can also be used
to enhance hand hygiene rates.” The authors emphasize that
helpful tools include educational materials that highlight the
importance of hand hygiene, training films, visual posters,
highlights of published work in this area, and standardized
data collection and hand hygiene monitoring forms.
Personal Protective Equipment (PPE)
Patel, et al. (2019) explain that, “Ensuring appropriate use
of PPE in healthcare environments is a cornerstone of infection
prevention. Standard precautions are infection prevention
practices used to prevent transmission of infectious agents. The
effectiveness of these techniques, however, depends on health
care workers’ adherence to correct use of PPE. One study that
used video monitoring to evaluate adherence to PPE found
that it was used correctly only 34 percent of the time. Standard
precautions change according to the expected interaction
with the patient (for example, if there is potential for splashes
of blood or body substances, then mask and eye protection
is recommended) and if the patient is colonized or infected
with a known transmissible infectious organism.” The authors
emphasize that improving use of PPE can reduce transmission of
infectious agents within the hospital, protect healthcare workers
and patients, and prepare hospitals for possible outbreaks of
emerging infectious diseases. Interventions to encourage PPE
use include competency-based training, hand hygiene, adaptive
strategies, and engaging patients and families.
Environmental Hygiene
Patel, et al. (2019) point to the hospital environment’s
important role in infection transmission: “One study done
during a CDI outbreak found that environmental contamination
with CDI was prevalent not just in infected patient rooms, but
also in physician and nurse work areas and on shared pieces of
equipment, such as pulse oximetry finger probes, medication
carts, and mobile computers, and personal equipment, such
as mobile phones. Cleaning protocols are often not in place
for portable medical equipment, particularly wheelchairs,
which are often colonized with pathogenic bacteria. Because
infectious agents can last for several months in the hospital
environment and be an ongoing source of transmission,
effective hospital cleaning and disinfection practices are vital.
Including environmental services as a part of the infection
prevention team can help prepare for outbreaks and reduce
risk for HAI.” The authors emphasize that, “Incorporating
other foundational elements, such as periodic assessment of
competency of environmental cleaning procedures, can also
help assure that best practices are in place for the hospital
environment.” Interventions to improve environmental hygiene
include visual data-sharing tools, fishbone diagrams, terminal
cleaning checklists, and tools to calculate a thoroughness of
disinfection cleaning score.
Antimicrobial Stewardship
Patel, et al. (2019) say that antimicrobial stewardship can
prevent some infections from occurring altogether and reduce
colonization with multidrug-resistant organisms (MDROs): “As
antimicrobial resistance continues to rise domestically and
globally, treatments for bacterial infections, including HAI, are
becoming limited. For this reason, antimicrobial stewardship
has become required by acute-care hospitals and long-term
care settings by accreditation groups, such as the Joint Commission
and the Centers for Medicare & Medicaid Services.
A CDC study indicates that because of national stewardship
efforts, an estimated 619,000 HAIs and 37,000 deaths will be
avoided between 2015 and 2020. CDI prevention is intrinsically
intertwined with antimicrobial stewardship. A national study in
England found that compared with other infection prevention
measures, antimicrobial stewardship had the greatest effect
on preventing CDI.” The authors note that antimicrobial
stewardship programs can be bolstered by establishing common
targets for stewardship (such as pneumonia and asymptomatic
bacteriuria) and constructing an effective multidisciplinary
antimicrobial stewardship team. Interventions can include the
CDC core elements of antimicrobial stewardship, guidance on
addressing multidisciplinary stewardship education and tools
that address patient education, such as posters explaining that
antibiotics do not work against viruses, and sample patient/
provider interactions.
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