Hospital-acquired infections — illnesses that attack patients after they have been admitted — have health care officials taking myriad steps to combat, control and prevent this insidious enemy.
One of those steps is a name change courtesy of the U.S. Department of Health and Human Services. They now are called healthcare-associated infections, or HAIs.
Jessica Rigler, HAI prevention coordinator at the Arizona Department of Health Services, explains the reasoning behind the terminology change: Health care infections occur not only in hospitals, but in all health care venues, including long-term care, assisted living, and urgent care centers. In addition, Rigler says, these infections are brought into a hospital by an ailing patient, and not necessarily acquired there.
Nevertheless, whatever term applies, HAIs present a serious challenge for hospitals in Arizona and throughout the country. In 2007, the Centers for Disease Control and Prevention estimated the number of HAIs in U.S. hospitals was 1.7 million, resulting in nearly 99,000 deaths each year.
In April 2008, Banner Baywood Medical Center in Mesa was thrust into the spotlight following an HAI outbreak. The staff launched an aggressive program to deal with the situation, such as correcting air-pressure problems in some of the 10 operating rooms, and firing an overnight cleaning crew that was found to have missed germs on operating room floors, equipment and operating tables.
The hospital also limited the number of students and observers allowed in operating rooms, switched to thicker surgical wrap, and directed surgeons to wear only hospital-laundered scrubs.
Seven months after numerous changes were implemented, Banner Baywood, a general, acute-care hospital that performs about 10,000 surgeries each year and serves many senior citizens, detected just one surgical-site infection, according to Chris Halowell, director of perioperative services at the hospital.
Arlene Gimbel, chief nursing officer at Banner Baywood, says some infections are the direct result of overuse of antibiotics.
“We have dealt with this for quite some time, and we will continue to do so,” she says. “Our rate (of infection) has improved over the last couple of years due to our infection prevention program.”
While the hospital’s goal is to have zero infections, Gimbel says, “It’s almost impossible to be at zero, but it’s something we strive for every day. An area we can control is personal hygiene.”
A key element in preventing the spread of HAIs is to identify patients with an infection upon admission and take appropriate precautionary measures, Gimbel says. Every single patient found to have an infection was treated successfully, she adds.
Rigler says the problem is not as serious as it was some months ago because of infection prevention and control measures taken by health care facilities. Each hospital tracks its own data, but Arizona does not require public disclosure of infections that occur in health care facilities.
“We’re continually moving in the direction of preventing infections,” she says.
Early this year, ADHS established a new healthcare-associated infection advisory committee to follow up on recommendations of a legislatively created HAI panel in 2008. The original committee issued a report last December concluding that “strategies other than public reporting would be more successful in preventing healthcare-associated infections,” Rigler says. Four subcommittees, which Rigler calls the workhorses, focus on prevention strategies, surveillance, public education and provider education.
“The prevention strategies subcommittee is working to synthesize HAI prevention, gather the best practices and guidelines recommended from institutions nationally, and pull together a tool kit of information to help health care organizations decide on costs, how to implement programs, and how sustainable interventions are going to be,” Rigler says.
The surveillance panel is exploring how health care facilities are monitoring infections, what data they are collecting, and will then work closely with the National Healthcare Safety Network, which is run by the CDC.
Regarding the need for more transparency, Rigler says ADHS has an excellent relationship with its partners throughout the state. If ADHS notices an increase in infections, it contacts local health agencies, which then provide expertise and assistance.
“We have an obligation not to disclose certain pieces of information about one’s health condition,” Gimbel says. “It’s true that the public has a right to know, but one of the reasons health care facilities are reluctant is because of our responsibility toward patient privacy.”
To provide guidelines for other hospitals facing an outbreak of infections, Banner Baywood published an extensive article on its outbreak and plan of action in the March 2010 issue of AORN, a publication of the Association of periOperative Registered Nurses.
“We wanted to share our experience with the rest of the community,” Halowell says. “We included a timeline of what we did. They can use that as a check list if they have an outbreak. We’re proud of our infection prevent program and feel very good about our patients being safe when they come to Baywood.”