 |
 |
 |
|||||||
|
|
 |
|
|||||||
          |
Infection Connection by Susan Cantrell, ELS The national focus on patient safety and reduction of medical errors has spawned numerous initiatives and products designed to impede or eliminate infections acquired by patients during hospital stays. Healthcare Purchasing News examines a few of these initiatives and products, as well as organizations that support and promote best practices in preventing nosocomial infection. Putting the kibosh on bloodstream infection Organizations such as VHA Inc. make it their business to help their healthcare-organization members deliver safe, efficient, and cost-effective care to communities. Some roads they use to this end are education, collaboration, fostering teamwork, and making available list serves that allow communication among members who consult their peers on best practices and how to make them work in their own facilities. Debbie Falkenberg, RN, MSN, critical care clinical nurse specialist, Covenant Healthcare, Saginaw, MI, has used her facility’s membership with VHA Inc. to good advantage. "VHA helps us to stay connected through networking. We are able to compare our institution with others, and we can keep current on information regarding best practices as it is being released." Covenant Healthcare also participates in the Keystone initiative, a grant-funded initiative directed by the Michigan Health and Hospital Association Center for Patient Safety and Quality, under the guidance of Johns Hopkins Center for Innovation and Quality Patient Care. Falkenberg told HPN how VHA and the Keystone initiative have helped her institution’s three critical care units to be free of bloodstream infection (BSI) since November 2004. She first pointed out that staff buy-in is critical, because, by incorporating best practices, staff participation in the initiatives has a direct impact on patient outcomes." "Some of the things we did specifically for the BSI initiative were to evaluate products and some were bundling of those products," Falkenberg told HPN. "Procedure carts were secured for the critical-care unit to reduce traffic in the room. We included chlorhexidine (ChloraPrep; Medi-Flex, Leawood, KS) on the cart instead of alcohol or the Betadine swab, which we traditionally had used. Full barrier protection was placed on the cart, which is part of the Keystone Initiative and the 100,000 Lives campaign, because it has been proven to reduce rates of infection. Because VHA’s BSI initiative advocates for several of the products that are now available in a kit," said Falkenberg, "we’re looking at going with the Arrow (Reading, PA) central-line kits that have all the components bundled instead of pulling individual products, which will save time and improve efficiency." "We’ve made an effort to communicate best practices in preventing BSI to staff in several different ways. We developed an insertion-line checklist that gave nurses authority to step in and question doctors if they thought technique or protocol were being compromised; we developed a BSI fact sheet for educational purposes; and the Keystone newsletter reiterated initiatives in patient safety and reported results of our data collection, so the staff had feedback on the results." Falkenberg also has found of benefit the Friday morning Keystone meetings. "There’s one committee, instead of many separate ones, to review the results of our efforts," explained Falkenberg. The committee is comprised of the medical director, an intensivist, who is head of the committee; the vice president of patient services and the vice president of medical affairs; the three critical-care nurse managers; a staff nurse from each unit who collects the data; the safety engineer; the clinical resource management (CRM) director and the CRM secretary; the two clinical nurse specialists who are responsible for best practices and performance improvement; a PharmD; infection control; cardio-pulmonary; the outcomes coordinator; the critical-care director; a social worker; a hospitalist; and pastoral care. "The group evolved over time, so that the right people were around the table for particular initiatives and decision making," noted Falkenberg. "We all have the same goal: to improve patient safety and outcomes." News on pneumonia Cost often rears its ugly little head when health care is the topic of discussion, but best practices can sometimes alleviate the pain. Through their Hospital Quality Incentive Demonstration (HQID), a pay-for performance project, Premier Inc. (San Diego, CA), in collaboration with Centers for Medicare and Medicaid Services, has demonstrated that improved delivery of healthcare can reduce costs for the hospital while reducing incidence of infection and saving patient lives. Premier collects a set of 33 quality indicators from more than 250 hospitals countrywide and extrapolates that data to reveal national implications. Recently released data analysis on the project’s pneumonia and coronary artery bypass graft (CABG) study show outcomes associated with improved process delivery include $1 billion in hospital savings, 3,000 fewer deaths, 6,000 fewer complications, 6,000 fewer readmissions, and 500,000 fewer days in the hospital. Basic best practices for preventing pneumonia include oxygenation assessment; vaccination against pneumonia and influenza; blood culture before the first antibiotic is administered; counseling patients to stop smoking; and initial antibiotic selection and administration within 4 hours of hospital arrival. Upon release of the results, Douglas Hawthorne, who is chairman of the Premier board of directors, and president and CEO of Texas Health Resources, which has hospitals participating in the project, said, "This is dramatic proof that hospitals can take relatively simple steps to significantly reduce costs without infringing on clinical decisions regarding patients’ care. It makes intuitive sense that improving care delivery should eventually reduce costs, if only because of reduced complications and readmissions. Most of us in health care have taken that on faith." Detailed results of the project Stamping out SSI 3M offers a new service with an eye on eliminating surgical-site infection (SSI). The Hospital Consulting Services uses current guidelines from leading healthcare organizations, such as CDC, AORN, APIC, and AAMI, that outline best practices on preventing SSI, but it goes beyond that. Consultants go into the operating room (O.R.) to observe staff, identifying where they fail to practice recommended guidelines. The consultants then figure out the best ways to educate personnel, filling in gaps in their knowledge of current guidelines, so staff can achieve best practices in their O.R.
Dennis R. Graham, marketing manager, 3M Health Care, St. Paul, MN, explained how the service works: "3M Hospital Consulting Services offers a systematic, evidenced-based, quality-improvement approach to the perioperative process, with the objective of improving education and practice, thereby reducing the risk of SSI. Partnering with O.R. management and the infection control team, 3M Hospital Consulting will first establish a baseline by quantifying the O.R. staff’s current level of knowledge on recommended guidelines and best practices via a customized Infection Prevention Review. The goal of the review is to identify existing knowledge gaps that could contribute to SSI. The detailed outcomes report includes recommendations to assist the facility in targeting educational activities, based upon these identified knowledge gaps among O.R. personnel." Graham continued: "3M Perioperative Nurse Consultants, who have expertise in perioperative processes, perform the observation assessment and data collection on one surgical specialty. Baseline data is collected along the perioperative continuum and then compared to standards of practice and published guidelines. This assessment focuses on processes included in 3M’s proprietary Perioperative Process Map, which provides an expert guide in elucidating processes critical to reducing the risk of SSI. The perioperative observation assessment includes a review and analysis of specific policies and procedures that are related to prevention of SSI. The result of the focused perioperative observation is a detailed report, which includes suggestions for policy and procedure revisions, detailed notation of variances from best practices, and prioritized recommendations for process-improvement activities." Cranking up the heat When washer-disinfectors don’t do their job effectively, sickness and even death can follow. Getinge USA takes an extra measure to ensure their washer-disinfectors perform at their best. "Most competitors’ products heat their water to 1800F for 1 to 2 minutes," stated Mike Cain, senior products marketing manager, Getinge USA, Rochester, NY. "Getinge washer-disinfectors have a higher disinfection parameter: 1940F for 1 minute. It’s more effective at killing nosocomial pathogens. An extra measure of safety is provided by using higher water temperature."
"This temperature-exposure parameter complies with European standards," explained Cain. "There is no U.S. industry standard for thermal disinfection. It’s wide open for independent testing by different companies. Getinge washer-disinfectors are European-made, so the equipment complies with their standards. Our approach to cleaning is different: low pressure, high volume. The cleaning is effective but not harmful to instruments. The higher temperature offers more assurance of eliminated pathogenic microorganisms." Once disinfected, best practices dictate handling instruments in such a way that they stay pathogen-free. "Clean hands on clean goods mean no cross-transmission from you to the devices," said Cain. "There are many ways that infectious organisms can be transmitted. One way to prevent transmission is by touching clean goods only with clean hands." Be safe: endoscope processing Best practices include, but are not limited to, consistency, effectiveness, safety, and ease of use. These qualities are vitally important in endoscope processing, which removes patient soils that may be seeded with harmful bacteria, rendering endoscopes safe for use on other patients. The chemicals used for disinfecting endoscopes also can be harmful to patients and workers if they come in contact with it. STERIS (Mentor, OH) has addressed these concerns in their Reliance Endoscope Processing System (EPS). The system, originally launched in 2004 in Canada, Europe, and Australia, became available in the United States in August 2006.
Rem Siekmann, product manager, explained how Reliance EPS works. "One or two endoscopes are placed into the processor’s endoscope-processing support, which includes control handle ‘boots.’ Within the boots, high-level disinfection (HLD) solution flows into the channels and around the exterior of the endoscopes to achieve HLD of all surfaces. Proprietary oxidative chemistry germicidal solution is created within the processor. No peracetic acid exists outside the processor; rather, it is generated when filtered water mixes with the two-part powder chemistry from a single-use container. The Reliance EPS Endoscope Processing System includes the Reliance PI Process Indicator, a chemical indicator that independently monitors the generated HLD solution for an effective dose of the active ingredient during each cycle. An on-board, automatic, 0.2-micron filter integrity test is part of every HLD cycle, to ensure that the filter used to produce the rinse water is intact. "Two additional cycles are programmed into the processor. One optional cycle is used to wash endoscopes prior to HLD. Although it does not replace required manual endoscope pre-cleaning, it can be used to assist in reducing the variability of that process. Optimal pre-cleaning is necessary to achieve consistent and effective HLD. A second set of automated decontamination cycles are intended to prevent the formation of biofilm within the processor, which can be a source of endoscope cross-contamination." STERIS believes that best practices in infection control are furthered, said Siekmann, because "Reliance EPS provides process consistency. It eliminates variability that can come from allowing human errors to have an impact on expected results by having pre-programmed cycles that are validated as an entire system (equipment, chemistry, and endoscopes). It minimizes the use of connectors. It controls and monitors critical process parameters automatically. Reliance EPS provides documentation and ease of data entry. It minimizes variability in entering endoscope data by providing an optional bar-code entry system. It has cycle data automatically printed, along with cycle errors printed in red, providing accurate and complete information for each processed endoscope, increasing traceability. Reliance EPS also uses process alarms. If cycle parameters are not properly met or errors are detected, both audible and printed alarms alert the operator, and the cycle will be safely terminated. This will minimize the chance of an improperly processed endoscope being used." Wiping out environmental pathogens The phenomenal rise in drug-resistant organisms and emerging and reemerging infectious diseases in recent years makes vigilance on all quarters of paramount importance. Kimberly-Clark Professional, Roswell, GA, is attacking the problem in the one aspect of hospitalization that patients all have in common: the patient room. Their new KIMTECH PREP Wipers for disinfectants and sanitizers are used with the WETTASK Refillable Wet Wiping System to stop cross-contamination of the environment in its tracks.
"WETTASK is a refillable system that allows users to make their own wet wipes," explained Lori Morrell, director, wiper business. "Kimberly-Clark provides the bucket and a specially designed wiper; the customer provides the disinfectant of their choice." Kim Dennis MacDougall, research scientist, added: "The wipe is retrieved from a dispensing port; so, staff are not exposed to chemicals. There are no vapors or splashes, and there is no easy opportunity for cross-contamination of the disinfectant or the wipes. The pre-saturated wipes are better than the spray bottle, because with the spray there is the temptation to dry after spraying. The pre-saturated wiper stays wet. How long it stays wet depends on the disinfectant being used. The bucket is disposable, so there’s no need to clean buckets or to launder rags. There are 90 wipers on the roll, and it’s stable with most quaternary amines for 14 days. Cellulose and cotton rags are not able to deliver quats effectively; so, mechanical cleaning just isn’t as effective." "KIMTECH PREP wipers deliver chemicals in the correct concentrations, and the chemical can be adjusted as needed," advised Morrell. "It’s all about ensuring that staff are delivering the chemical to the surface and disinfecting at appropriate concentrations." "Our focus is on best practices," said MacDougall, "the best system to deliver the best concentration for surface disinfection. People are just discovering that the cotton-rag-and-bucket or wipe-and-spray systems are not the best ways to disinfect the environment. We’re at the beginning of an ‘understanding curve’. Using wipers that have been designed to be compatible with disinfecting solutions helps to optimize infection control practices." More help in your quest The World Wide Web makes available educational tools in fighting hospital-acquired infections, and more infection-related sites are popping up all the time. Here are just a few that you might find useful as you seek ways to incorporate best practices in infec-tioncontrol at your facility. • www.iceinstitute.com: Infection Control Education Institute. Offers continuing education courses and free webinars. • www.preventinfection.org: A collaboration by APIC and Tyco Healthcare/Kendall. A resource for infection prevention information for patients and consumers. • www.premierinc.com/all/safety/: Offers resources and tools to promote a safe healthcare-delivery environment for patients, workers, and their communities. • www.hospitalinfection.org/: Committee to Reduce Infection Deaths, a non-profit organization devoted solely to providing safer, cleaner, hospital care. HPN
|
|
|||||||
|
|
|||||||||
 |
|||||||||
