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MRSA Meets its Match in Certified Infection Preventionists

 |  By cclark@healthleadersmedia.com  
   March 14, 2012

Hospitals use dozens of practices to prevent hospital-acquired infections, but those facilities that employed infection preventionists who met certification requirements saw the least number of methicillin resistant Staphylococcus aureus bloodstream infections in their patients, according to a study of California hospitals with at least 100 beds.

The 2010 survey, conducted by three researchers at the Columbia University School of Nursing in New York, received survey responses from 203 out of 331 hospitals surveyed, each of which was asked about their infection control practices. The 24 methods ranged from screening all patients upon admission to the use of isolation and contact precautions and antibiotic restriction. 

Other strategies included participation in Institute for Healthcare Improvement programs, having an electronic surveillance system, and participation in CHART, the voluntary California Hospital Assessment and Reporting Taskforce. California hospitals are required by state law to report bloodstream and Clostridium difficile infections to the Centers for Disease Control and Prevention's National Healthcare Safety Network.

Though "few infection control policies were shown to be significant predictors of infection rates in our study," the authors wrote, "having an infection control director who was certified in infection control was a significant independent predictor of lower MRSA BSI rates."  The authors said that 91 of those 203 hospitals provided information on their MRSA infections.

The paper was published in the March issue of the journal, Association for Professionals in Infection Control and Epidemiology by Monika Pogorzelska, an associate research scientist, and colleagues at Columbia. The credentials referred to are granted by the Certification Board of Infection Control and Epidemiology, Inc., after applicants pass a three-hour test.

Asked what practices these certified professionals employee, which other practitioners don't, that might result in fewer infections, the study's co-author Patricia Stone, associate professor of nursing, gave a few examples. She hypothesized that organizations that have people with this level of expertise elevate the priority of infection control within the hospital culture. They also are able to maintain san expert who keeps up with the latest infection control trends, she says.

"For example, should pre-surgical patients take a bath with chlorhexidine or not. They should. For someone on a ventilator, there's mouthwashes to maintain oral hygiene, which is important to prevent patients from getting pneumonia.

"And we just went through a major revolution with alcohol hand rubs—these weren't around eight years ago and represent a major change in hand hygiene, which should be a basic behavior for everyone in the hospital, whether the clinician, the candy striper or the chaplain, or even the housekeeper."

Speaking of which, Stone says, certified infection preventionists carry more authority because they are higher up on the hospital hierarchy. They can tell physicians, who she says are "notoriously" bad at hand hygiene, "that there is a process in place for people who are not routinely following procedures such as washing their hands and that those who aren't will be told 'this is not acceptable.' "

Stone says that the certification test is extremely difficult, requires a lot of study, and must be retaken every few years.

These infection preventionists are more effective than hospital epidemiologists, she added, because the latter, who are often physicians, are rarely dedicated to the task full time. They may be infectious disease specialists whose attention is frequently diverted to seeing patients in the hospital or clinic, aren't responsible for making sure nursing and environmental services staffs have necessary training and education in infection control, and aren't responsible for the everyday process.

The infection preventionist tracks infection rates to provide surgical site infection rate reports back to surgeons, which otherwise may go unmonitored.

"We think the certification piece seems to be doing something, and part of that may be the overall investment, in that the hospital that has one is saying this is so important, to make sure we are up to date and well qualified."

Not all infection preventionists, most of whom are nurses, are certified, and many of them work part time doing other things, such as providing direct patient care.

Among other findings from the study, fewer than half of the hospitals reported the presence of a hospital epidemiologist, and only six hospitals said theirs worked full time. "Half of hospitals reported that the director in charge of the infection control department was certified in infection control," the researchers said.

Stone says that over the last 10 years, the number of infection preventionists certified or not has gone down, from one IP per 115 acute care beds in 1999 to one IP per 144 beds in 2009.  Only about half of these professionals have received certification, she said.

The authors mentioned a caveat that their study may have been influenced by selection bias, because hospitals with "high intensity" infection control processes and low hospital-acquired infection rates "may have been more likely to participate." Also, they regretted the lack of MSRA data from those 112 hospitals that chose not to volunteer them.

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