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Infection Control's 78% Solution

 |  By jcantlupe@healthleadersmedia.com  
   April 19, 2012

When you're a hospital infection prevention and control official, sometimes talk around the dinner table isn't about patients, but about what to do before greeting them, like washing your hands.

"Don't they all wash their hands?" Barbara Russell, RN, MPH, CIC, director of infection control at Baptist Health of Miami, FL, recalled her mother asking.

 

Well, many do, but not all.

Russell talks about her job as an infection prevention and control official as being akin, in part, to being the "handwashing police," (my words, not hers).  And when she and her like-minded colleagues confront some co-workers who haven't washed their hands, they are "polite," (her words, not mine).

A major focus is to ensure hospitals have plans in place to stop infections, including the simple task of hand washing. But who monitors the infection prevention officials?

Beyond Handwashing
Russell says one of the best things a hospital can do to improve infection control monitoring is to hire a certified infection prevention official, as she is.

 

Most are nurses, but the category also includes microbiologists and physicians.  Certification requires up to two years of training about infection control. 

A recent study  in California showed that only 89 of 174 control directors, about half, were certified in infection control, which suggests that evaluations of infections may not be as good as they should be.

Russell estimates that about one-third of hospitals nationwide have certified infection prevention officials. "It's like having a certified cardiologist or internist; it shows [that] this person is not the new kid on the block, but someone who has really delved into the issue and knows it," Russell says. "By being part of such a group, you are able to learn from each other and share what you are doing, or have done, to reduce (infection) rates—which another participant could also try." 

The study in question was published in the March issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology.

"We found that having an infection control director certified in infection prevention was associated with lower rates of MRSA bloodstream infections," Monika Pogorzelska, PhD, MPH, told HealthLeaders Media. She is associate research scientist, P-NICER study director at the Columbia University School of Nursing and a co-author of the study.

Digging Into the Stats
While news releases touted the "significantly" lower rates associated with the certified infection control directors, they did not mention the exact rates. I asked Pogorzelska why not. She told me her study found that the "presence of an infection control director certified in infection control has .3 times lower MRSA infection rates compared to hospitals that did not have a certified infection control director."

So, that's like a batting average of .300—a 30% success rate,  correct?

No, not really. "It's a bit of a weird statistic, so I can't easily turn it into a percentage," Pogorzelska said, but she added that "this association was statistically significant."

After I asked her again, Pogorzelska said she would revisit the numbers and try to find a percentage.

A few minutes later, she emailed me. Bingo.

"I double checked with my statistician on the correct interpretation in terms of percentages and it is about a 78% reduction in terms of rates."

Wow.

So, indeed, there is a significant impact on MRSA that is associated with having certified infection control officers in hospitals. But in this day of multidisciplinary teams in health care, it's not up to the infection control specialists alone to do the job, Pogorzelska says.

Infection Prevention a Team Effort
"It is clear that infection prevention is a team effort and all clinicians and personnel need to be working together to prevent infections," Pogorzelska says.  In essence, a "multidisciplinary team of qualified professionals that work together is needed to implement prevent strategies appropriately."

The study found that 97 percent of the hospitals surveyed performed some type of screening upon patient admission, especially for MRSA. By contrast, few hospitals reported the use of universal and targeted screening for two other multidrug-resistant organisms: vancomycin-resistant Enterococcus (VRE) and Clostridium difficile (C. difficile).

One major reason for this focus on MRSA is legislative requirements in California for these screening programs, but Pogorzelska says the "level of specification on one type" of pathogen may limit the ability to address others like VRE and C. difficile.

Some organizations  are forming interdisciplinary task forces and successfully decreasing C. diff incidence by developing specific cleaning protocols after observing staff cleaning routines. The Hunterdon Medical Center in Flemington NJ established a task force that launched protocols that revised existing cleaning protocols.
For physicians, nurses and other hospital workers, the possibility of infection is always there.

"Whether a hospital uses universal contact precautions or universal MRSA screening, or some combination of interventions—infection prevention strategies need to be carried out by all personnel at the bedside at all times," she says.

It can make the 78% difference.

See Also
Cleaning Up C. Diff, Together

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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