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HL20: Michael Edmond, MD—Ethics and Results in Infection Control

Cheryl Clark, for HealthLeaders Media, December 13, 2011

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Michael Edmond, MD.

This profile was published in the December, 2011 issue of HealthLeaders magazine.

 "It really appears that you don't have to do active surveillance in order to reduce infections in your hospitals."

Back in 2003, Virginia Commonwealth University Medical Center epidemiologist Michael Edmond, MD, realized that the way hospitals try to prevent infections, with active surveillance, just didn't make any sense.

They were testing so many patients for just one type of infection, Methicillin-resistant Staphylococcus aureus. If the patients were found to be carriers, they would be isolated, with potential for adverse consequences.

"Isolation is not a benign procedure, because it increases patients' risk of falls, pressure sores, and electrolyte disturbances, and we know they get fewer visits from doctors and nurses," Edmond says. And from an ethical standpoint, he said, "Here's a group of isolated patients who don't get any benefit from that, but just bear the burden, because all the benefit accrues to the patients who are not colonized and not isolated."

It occurred to him that MRSA is only responsible for 10% of the nosocomial infections in a hospital, so controlling for it alone misses many other important organisms, "like some of the gram negative rods that are now essentially resistant to all the antibiotics we have."

So in 2004, he persuaded officials of the 779-bed hospital not to adopt active surveillance. He was, as he put it, "pushing the edge."

Instead of testing for MRSA, hospital staffers focus on central venous catheter insertion bundles, head of bed elevation for mechanically ventilated patients, and chlorhexidine baths for patients in the intensive care unit. 

Edmond and his teams also zero in on simple hand hygiene. They hire graduate students—three at a time—to walk the halls and observe healthcare providers washing their hands, a cost of only $25,000 a year.

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