Special Edition on Infection Prevention & Control | Page 30

Adaptive Strategies
As Patel, et al. (2019) explain, “Infection prevention has
two modalities: technical and adaptive. Technical interventions
can make an impact in a straightforward manner: for example,
incorporating alcoholic chlorhexidine in central line kits
because it is the most effective type of skin cleanser instead
of povidone–iodine. Adaptive strategies help an organization
change the culture and influence behaviors that are connected
to a culture of safety. These strategies include behavior change–
based interventions, human factors engineering, and positive
deviance.” They add that supporting the attitudes, values and
behaviors shown to promote infection prevention can cause
real and lasting change. The authors advise that successful
interventions include strategies that incorporate planning,
introspection, and use of qualitative and quantitative tools.
Patient and Family Engagement
Patel, et al. (2019) emphasize that patients and family
members are aware of HAIs and are interested in being a
partner in prevention: “Patient education concerning how
to prevent HAIs should be universal and easy to understand;
however, a recent multihospital study showed that only 7
percent of hospitals were very confident that patient-directed
CDI education was happening. When patients were asked in the
same study what the biggest risk factor for recurrence of CDI
is, more than one half did not know that it was antibiotic use.
Active patient engagement can lead to unique interventions and
effects. For example, a study found that when an intervention
to clean patients’ hands with chlorhexidine in the ICU was
implemented, trends toward reduced CLABSI and CAUTI
rates and increased nurse handwashing rates were observed.
Another study asked patients who had experienced recurrent
CDI to speak with their infectious diseases physician before
taking any new antibiotics prescribed by other physicians.
Despite the high risk for recurrent CDI in this population, 60
percent of the antibiotics prescribed for the patients in this
high-risk group were considered unnecessary. Empowering the
patient and their family can foster a culture of safety, reduce
the chance of HAI, and improve health care worker infection
prevention practices.” The authors say interventions include
the recognition that patients are essential partners in making
care safe, the fact that patients can help reduce HAIs from
the bedside to the board room by serving on HAI reduction
teams, and infection prevention education efforts that include
patients and families.
Business Case for Infection Prevention
Patel, et al. (2019) observe that, “The clear value of investing
in infection prevention should be established to hospital
administrators who are often confronted by numerous pressing
issues. Strategies include calculating current attributable cost of
HAI at the hospital, potential savings, economic analyses, and
prospectively measuring the economic impact of interventions
to reduce HAI. Leadership support has been associated with
success of infection prevention and establishing a comprehensive
antimicrobial stewardship program. Leadership buy-in
propagates patient safety culture in the hospital and can inspire
employees at all levels, help form interdisciplinary partnerships,
and strategically champion infection prevention at various
executive and committee levels. Support from the executive
level increases chances of achieving true organizational culture
change, which often can make or break infection prevention
interventions. Leadership support also means salary support
or financial resources for technological advancements that
may be required. Inability to obtain these resources can be
barriers for hospital epidemiologists and infection prevention
teams.” The authors say that there is value in taking the time
and effort to build a business case to engage senior leaders
and document the value and impact of cross-cutting education
and the importance of working with a diverse team within an
organization to maximize the effectiveness of the business case
for infection prevention.
Preventing Pathogens of Concern in Hospitals
The STRIVE curriculum addressed some of healthcare’s
most prevalent pathogens, including methicillin-resistant
Staphylococcus aureus and Clostridium difficile.
Researchers constructed a two-tiered intervention approach
for each HAI in the STRIVE project, where foundational elements
as described above were the main components across tier 1
strategies and were considered practices that are standard
of care and should be routinely implemented in all hospitals.
Therefore, tier 1 interventions included foundational elements
that targeted multiple HAIs (horizontal strategies, such as
hand hygiene) as well as interventions specific for a given HAI
(vertical strategies, such as conducting a MRSA risk assessment).
Conversely, tier 2 interventions were defined as those that are
more labor intensive or costly and less supported by current
scientific evidence but could be considered if rates of an HAI
remained elevated despite implementation of tier 1 practices.
An incremental approach was taken for tier 2 interventions, with
additional strategies used if rates of an HAI remain elevated.
MRSA
Let’s review what Popavich, et al. (2019) outlined as the
interventions for MRSA.
MRSA Tier 1 Interventions
Tier 1, Intervention 1: MRSA Risk Assessment: A
risk assessment allows a hospital to understand the extent
to which that facility is able to control MRSA spread and,
potentially, highlight specific hospital populations or units
where infection prevention improvements are needed. For
example, an assessment tool could determine the rates of MRSA
transmission and infection, describe the local epidemiology of
these events at an individual facility, and identify opportunities
for MRSA transmission for a specific unit or hospital wide.
Results from a risk assessment can allow hospitals to develop
and optimize an infection prevention plan for reducing MRSA
transmission in the facility, as well as serve as a comparator
for future assessments.
Tier 1, Intervention 2: Case Review of Hospital-Onset
MRSA Bloodstream Events: For each National Healthcare
Safety Network–defined case of hospital-onset MRSA bacteremia,
hospitals should conduct a case review to identify
patient and population-level risk factors in which these events
occur, building an understanding of the path to infection. A
case review tool is helpful for several reasons. First, it allows a
systematic assessment of events, including the route through
which infection may have occurred. Second, by using the
created epidemiologic profile, a hospital can identify the
source of and contributing factors for each MRSA bacteremia
30 IP&C Special Edition June 2020 • www.healthcarehygienemagazine.com