Monday, March 27, 2017

Stopping the Spread of Infections Through Cleanliness

Infection: often ranked the #1 fear among patients, and it is the sixth leading cause of death.
Simply stated, poor cleanliness equals Hospital Acquired Infections (HAI). HAIs lead to unnecessary readmissions, and unnecessary readmissions are not being reimbursed by CMS or insurance companies. Why would they?

The priority focus has to be that cleanliness and hygiene issues receive immediate care.

Consider This

Nearly 1 in 5 Medicare patients discharged from the hospital are readmitted within 30 days - at a cost of over $15 billion every year (CMS Report, 2012). The cost of HAIs impact approximately two million patients and cause about 100,000 related deaths every year, and an estimated $30.5 billion dollars in unnecessary costs.

This is a critical issue, and one that requires a shift in culture. If no housekeepers are immediately available and a cleanup needs to be performed, all staff must be prepared to grab a mop and address the situation. 

Hospital Acquired Conditions (2013): On the Hit List for CMS…and They Aren’t Happy About It

1.       Foreign Object Retained After Surgery
2.       Air Embolism
3.       Blood Incompatibility
4.       Stage III and IV Pressure Ulcers
5.       Manifestations of Poor Glycemic Control
6.       Catheter-Associated Urinary Tract Infection
7.       Vascular Catheter-Associated Infection
8.       Surgical Site Infection Following Specified Procedures
9.       Coronary Artery Bypass Graft
10.   Bariatric Surgery
11.   Orthopedic Procedures
12.   Cardiac implantable Electronic Device
13.   Deep Vein Thrombosis
14.   Iatrogenic Pneumothorax with Venous Catheterization

Risk Factors for Bacterial Infections

Contact between the patient and a microorganism does not by itself necessarily result in the development of clinical disease—other factors influence the nature and frequency of nosocomial infections (HAIs). Factors like urinary tract infections, respiratory tract infections, skin sepsis/wounds and gastro intestinal infections.

The problem is that drug resistance to these nosocomial infections is rather strong and the risk of bacterial infections awaits the patient within hours of admission.

1.       Iatrogenic Risk: From medical staff, if ventilation lines are not clear, if vascular lines are perhaps not sterile, if catheters are not sterile.
2.       Organizational Risk Factors: Contaminated air-conditioning systems or water systems, infection spread due to short-staffing, not enough people on the floor, or AVS people to take care of vital functions. Physical layout of the facility: how far are rooms from the nursing station?
3.       Patient Associated Risks: Severity of illness contributes to more infection. Underlying immune-compromised state of the patient. Consider the length of the visit: the longer they stay, the more vulnerable the patient might be.

So what are some of the routes of transmission of these infections?

1.       Air-borne: anything in the atmosphere of the hospital
2.       Contact: hands, clothing, catheters, food trays
3.       Food-borne: kitchen may have insects, rodents, or other unsanitary conditions
4.       Blood-borne: needle sticks, spills
5.       Self-Infection: i.e., operation in the lower bowel where bacteria is already present

It really goes without saying that daily cleaning of machines, equipment and materials used is vitally important in the fight against HAIs.

Best Practices: Tools, Equipment and Resources

Job number one for management is to make sure your staff has the non-negotiable tools for cleanliness; this is critical.

1.       Obviously, patient rooms are to be kept infection-free.
2.       Regular in-sink hand-washing is performed by all hospital personnel. One study reports 60% of healthcare workers do not maintain good hand hygiene!
3.       Take extra care in disinfecting a room previously occupied by a patient with a “pathogen of interest”. Remember those curtains that pull around - infections can live on the fabric.
4.       Alcohol-based hand-sanitizers are located throughout the hospital and are constantly filled and in use.
5.       Care-givers’ uniforms/scrubs/lab coats are fresh daily. If soiled in the course of work-day, these garments are exchanged for clean issue.

So what are critical housekeeping tasks?

1.       Cleaning patient rooms daily.
2.       Performs twice-daily cleanings of patient bathrooms.
3.       You are not a snitch when you share the things you’ve heard from patients that they haven’t yet told their doctors or nurses. It is critical that this information be passed along to ensure the best patient care and experience.
4.       Utilize a housekeeper calling-card that includes the time and date the patient’s room and bathroom were cleaned. Patients are impressed and their perception of safety and comfort is greatly increased (and so is your HCAHPS Score!).

Immediate, clear and continuous action must be taken to transform the culture of your hospital to a cleanliness culture.

The Take Away

Discuss this post with your staff and agree upon a Standard Operating Procedure (SOP) for your hospital. Have a two-way conversation about it, and decide what needs to be done differently or better. It is the process of creating ownership that changes the shift in culture to “Everyone a Housekeeper”. 

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