Preventing Hospital-Acquired Infections

As the economic burden of hospital-acquired infections (HAI) continues to grow, more healthcare facilities are ramping up efforts to lower their HAI rates — with the ultimate goal of eradicating nosocomial infections completely. Medicare and Medicaid will not cover hospital-acquired infections, but these government restrictions are not the only catalyst for change: Consumers can now access state HAI records online and use that information to make hospital choices.

Today, the most common hospital-acquired infections are Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile (C. diff) — bacteria that live in the body and are resistant to certain antibiotics. This resistance makes infection challenging to treat and poses special risks for people who are ill. According to environmental services managers, hospital-acquired infections are associated with the over-prescription of antibiotics.

“We’re in a society where we just want to give a prescription and medicate,” says Laurie Tostenson, training and quality assurance manager for the housekeeping department of Dartmouth-Hitchcock Medical Center, Lebanon, N.H. “When used appropriately, antibiotics are a good thing. But when your normal intestinal flora is disturbed by antibiotics, it can have a negative impact on some patients.”

Darrel Hicks, director of environmental services and patient transportation at St. Luke’s Hospital in Chesterfield, Mo., concurs: “When you take a strong antibiotic like Vancomycin or Methicillin, sometimes it does some harm and kills the good flora in our digestive system.”

This reality leaves patients susceptible to new infections and bacteria that can spread through hospitals. Often “super bugs” are spread through indirect contact with contaminated surfaces or direct contact with a patient, which is why a combination of good hand hygiene and proper cleaning procedures is the best line of defense.

“It’s a hand-in-glove approach,” says Hicks. “We have to have clean surfaces and clean hands touching those surfaces so we’re not picking these germs up and transferring them to the patients.”

Tracking Hospital-Acquired Infections

One reason departments are so diligent in preventing hospital-acquired infections is because the National Healthcare Safety Network now requires that all hospital-acquired infections be reported to the CDC. Some believe this new reporting requirement, which makes HAI reports available to the public, will hurt hospitals. But environmental services directors say that’s not necessarily the case — as long as hospitals are compliant and continue efforts to lower hospital-acquired infection rates.

“HAI records won’t have a negative impact on hospitals, if they’re doing what they’re supposed to be doing,” says Babette Beene, environmental services manager, University of Texas MD Anderson Cancer Center in Houston. “In fact, I think it’s a good thing because people are aware of the safety measures hospitals are taking, and that keeps hospitals more accountable.”

Well-educated consumers are more likely to motivate hospital personnel to lower hospital-acquired infection rates and improve services.

“Cleaning in a hospital has always been important, but now with HCAHPS (Hospital Care Quality Information from the Consumer Perspective) and value-based purchasing, people are looking at a hospital as a choice,” says Doug Green, director of environmental services, Mercy St. John’s Hospital in Springfield, Mo. “We have to be the best at what we do, because a patient can look us up and say to his doctor, ‘I don’t want to go there, I want to go to ‘Hospital X’ instead.’”

Hicks agrees: “The public is becoming savvy about their healthcare, and that’s putting pressure on hospitals to do a better job,” he says. “Hopefully the cleanliness of hospitals is going to become a major focal point.”

One thing that environmental services managers can agree on is that lowering hospital-acquired infection rates is a collaborative effort.

“In our facility, we work closely with infection control and we have a very low HAI rate here,” says Hicks. “That tells us we have efficient housekeeping protocols, but I don’t want to take all the credit for low HAI rates. It’s more the result of a team approach where everyone sees value in their teammates.”

Similarly, the infection rate at Dartmouth-Hitchcock Medical Center has always been low, according to Tostenson.

“We work extremely closely with our infection control department,” she says. “I collaborate with the infection preventionists on articles so that the information can be shared by many, not only housekeeping but also our nursing colleagues and others involved in patient care. As far as reporting infection rates, I think hospitals need to be willing to work collaboratively with infection control to find areas where they can improve, then change procedures and protocols to make that improvement happen. Ultimately this is in the best interest of our patients.”   

Kassandra Kania is a freelance writer based in Charlotte, N.C.

For tips and techniques to reduce hospital-acquired infections, click here.