May 2014

How Can Hospitals Prevent Healthcare-Associated Infections?

By Brian McCurdy, Senior Editor

Acknowledging the prevalence of healthcare-associated infections, a recent study in the New England Journal of Medicine supports the notion that hospitals should consider expanding surveillance and prevention activities against such infections, particularly those caused by Clostridium difficile.

   The authors conducted a survey of 183 hospitals, finding that of 11,282 patients, 452 (4 percent) had one or more healthcare–associated infection. Out of 504 such infections, the study notes 21.8 percent were pneumonia, 21.8 percent were surgical-site infections and 17.1 percent were gastrointestinal infections with Clostridium difficile the most commonly reported pathogen.

   As Nicholas Giovinco, DPM, says, old-fashioned hand washing is an effective way to prevent infection and washing hands before and after patient interaction is a must. Although the innovative tracking solutions and large data algorithms are greatly augmenting the surveillance of hospitals and living communities, he notes these are not in everyday use yet but may be in the future.

   Ryan Fitzgerald, DPM, notes a paucity of data on how best to perform surveillance for C. difficile infections, either in healthcare or community settings. He notes the Centers for Disease Control and Prevention (CDC) has recommended a case definition for surveillance that requires the presence of diarrhea or evidence of megacolon, and either a positive laboratory diagnostic test result or evidence of pseudomembranes demonstrated by endoscopy or histopathology. Dr. Giovinco concurs, saying one should take seriously issues of increased bowel activity and the onset of diarrhea.

   Testing for C. difficile or its toxins occurs via an assay test, which Dr. Fitzgerald notes yields historically high rates of both false positive and false negative test results. Although newer tests are improving the sensitivity of the tests over immunoassays, their specificity remains relatively low, according to Dr. Fitzgerald, an Assistant Professor of Surgery at the University of South Carolina School of Medicine-Greenville in Greenville, S.C.

   The CDC’s Clinical Practice Guidelines for Clostridium difficile Infection in Adults recommend education on hygiene and contact isolation appropriate to the level of the contaminant to reduce the chance of infection, according to Dr. Fitzgerald. Additionally, he notes the judicious use of antibiotics and attempts to minimize the frequency and duration of antimicrobial therapy, and the number of antimicrobial agents prescribed can greatly reduce the risk of C. difficile.

   What other infection prevention protocol should hospitals initiate? Dr. Giovinco supports having more biocompatible solutions to promote healthy topical flora. Similar to having a probiotic for the gut, he advocates looking into methods of maintaining skin and surface colonization with competitive bacteria that are less opportunistic.

   “Trying to maintain a sterile hospital environment is not paying off like it should be,” says Dr. Giovinco, the Director of Education of the Southern Arizona Limb Salvage Alliance (SALSA).

   Dr. Fitzgerald emphasizes the necessity of developing improved screening tests with a greater level of sensitivity and specificity to more accurately identify those patients suffering C. difficile infection. He says this allows early and aggressive management of this disease process. Dr. Fitzgerald notes other solutions include improved surveillance modalities and improved efforts at cleaning and disinfection.

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