We have always been aware of these issues in hospital settings, but what's even more troubling is the fact that most patients aren't aware of the facts.  Five percent of patients compared to 26 percent of nurses said that the hospital staff did not always wash their hands.

Are you equally as troubled as I am? Do you think this issue has been ignored and under-addressed? I feel that infection prevention has been addressed within the nursing profession - especially with the awareness efforts of so many organizations and within the medical device industry with the introduction of so many disposable devices and product lines. I am also somewhat surprised that hospital staff is still failing to follow even basic handwashing guidelines - despite the constant reminders. 

What do you think can be done to improve these statistics?

What do you think about this? Is your facility doing anything to encourage infection prevention? If so, do you think it is working?

• $300 million for the section 317 immunization program
• $50 million for state health-associated infections reduction strategies
• $650 million for evidence-based clinical and community-based prevention and wellness strategies that deliver specific, measurable health outcomes addressing chronic disease rates."

Has your healthcare facility used any stimulus money to ramp up infection control and if so, how?

In lieu of the growing concern around the potential for the mass outbreak of the H1N1 flu I am hearing that many facilities are reviewing their disinfection practices in preparation for treating larger amounts of patients and controlling the spread of the illness as much as possible.

I turn to a CDC document released last fall to highlight a few key considerations, including the increased use of disposable products as a preventative measure.

According to the CDC "The ultimate goal of the Recommendations for Disinfection and Sterilization in Health-Care Facilities, 2008, is to reduce rates of healthcare-associated infections through appropriate use of both disinfection and sterilization."

In light of this possible pandemic, has your facility been rethinking its approach to disinfection and the use of disposables? What are your thoughts on the benefits vs. the downsides you see?

"I'd especially like to know if it's safe for 4 hours, 8 hours, 12 hours."

I haven't found much detailed research but the WSJ blog posting I cited in the previous entry indicated Superbugs such as staph can live on these polyester coats for up to 56 days.

I also found a few other interesting articles, and even a Web site introducing new "germ free" scrubs

Have any of you tried these new uniforms at your facility and what have been the results?

Physicians are considering a new measure at their annual conference to urge hospitals to adopt dress codes of "bare below the elbows" to avoid transmission of bacteria between patients via coat sleeves. Countries like England and Scotland have already adopted policies mandating dress codes that eliminate the use of clothing below the elbow.

Back in 2007, an article in U.S. News and World Report cited a study where 65% of doctors surveyed indicated they had not washed their lab coat in more than a week!

And, a few stories in the media recently have extended the discussion even into medical scrubs, uniforms, etc. because this clothing harbors infectious bacteria.

Even with proper hand washing, lab coats could be harboring bacteria and carried room-to-room.  

I'm interested to get your perspective on this issue - is this going to extremes, or do you think it's a valid argument?  Have you made any adjustments in your uniform policy as part of your infection control protocols?

Most infection preventionists at the meeting felt they knew how to address the challenges of this new pandemic or knew where to look for resources on how to manage as there's a plethora of information available. The real buzz seemed to be the concern around the lack of staffing and that impact on both the infection preventionist group as well as the nursing profession in general.

The fear with the economy suffering and the impact that is having on hospitals and healthcare in general, is that there will be reductions in infection control spending or limitations of such small staffs to manage these programs. APIC even released the results of a study on June 9 stating that "Prevention departments are under-financed, under-staffed, patient safety weakened."

According to the survey, three-quarters of those whose budgets were cut experienced decreases for the necessary education that trains healthcare personnel in preventing the transmission of healthcare-associated infections (HAIs) such as MRSA and C. difficile. And it's not only impacting infection prevention staffs, economic cuts are affecting the overall nursing shortage and impacting the availability of people on the floor to carry out these standard practices.

I am curious to know how your facility has been impacted, and what issues you face or fear. Leave a comment here, and take this survey to see how your experience compares with that in other facilities.

There's been some interesting dialog in the news lately about the problems the VA had this week with the improper cleaning of colonoscopes and the major repercussions. How many of you have been surprised (or not) by what's happened and the resulting media response?

I think it points back again to the simple importance of good cleaning practices, or substituting disposables for products that are at greater risk of contamination. What do you think?

I am attending the annual Association for Professionals in Infection Control (APIC) in Ft. Lauderdale this week. There will be significant information on the latest topics in infection prevention from leading experts on pandemics, of course, including H1N1. Plus sessions on the latest in compliance, infection prevention in various settings (hospital, ambulatory surgical sites, LTC, and outpatient clinics), and device-related infections - and a thousand other topics.

Visit the APIC Web site for more information.

When I return I'll give you highlights of the conference and what I learned from some of the more interesting sessions.  

In the meantime, if you have an area of infection control you'd like me to address, or if you have questions about infection control practices, post a comment here and I'll be sure to address it. Also, remember to check out the Infection Control Resource Center on the main ADVANCE for Nurses Web site.

You may know that the CDC has a site dedicated to H1N1 Flu (swine flu). This site contains valuable information from general information about the new strain to guidance documents. One specific area has a wealth of information for a variety of heathcare setting issues, including epidemiology and surveillance, clinician guidance, clinician guidance for specific audiences, infection control, lab testing, etc. 

Novel influenza A (H1N1) is a new flu virus of swine origin that was first detected in April 2009. The virus has infected people and is spreading from person-to-person, and has sparked a growing outbreak of illness in the U.S. with an increasing number of cases being reported internationally as well.

As such, we are all impacted by this outbreak especially those of us who work in healthcare. The CDC recommends some simple steps on how to stay healthy.

What are you doing in your facilities? What precautions have you taken to prevent the spread of H1N1? 

Recently I attended the 19^th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America (SHEA) in San Diego. The updates at the meeting provided the latest information on new and emerging issues such as resistant gram negative bacteria, problematic outbreaks and cost-effective infection control, but I was most intrigued by continued concern around hand hygiene, and startling statistics about lack of compliance to basic handwashing practices.

Many factors have contributed to poor handwashing compliance among healthcare workers, including a lack of knowledge among personnel about the importance of hand hygiene in reducing the spread of infection and how hands become contaminated; lack of understanding of correct hand hygiene technique; understaffing and overcrowding; poor access to handwashing facilities; irritant contact dermatitis associated with frequent exposure to soap and water; and lack of institutional commitment to good hand hygiene.

Handwashing is one of the most fundamental practices we can take to prevent healthcare acquired infections yet the concern exists. Unless all factors that contribute to poor handwashing compliance are addressed, we will continue to see poor compliance with rates generally below 50% of hand hygiene opportunities.

The CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) published a comprehensive Guideline for Hand Hygiene in Health-Care Settings in 2002. One of the principal recommendations of this guideline was that waterless, alcohol-based hand rubs (liquids, gels or foams) are the preferred method for hand hygiene in most situations due to the superior efficacy of these agents in rapidly reducing bacterial counts on hands and their ease of use.

In addition, in the "How-to Guide: Improving Hand Hygiene

A Guide for Improving Practices among Health Care Workers, Institute for Healthcare Improvement, notes there are four components that are critical to a successful hand hygiene program.

1. Clinical staff, including new hires and trainees, understand key elements of hand hygiene practice (demonstrate knowledge)

2. Clinical staff, including new hires and trainees, use appropriate technique when cleansing their hands (demonstrate competence)

3. Alcohol-based hand rub and gloves are available at the point of care (enable staff) \

4. Hand hygiene is performed at the right time and in the right way and gloves are used appropriately as recommended by CDC's Standard Precautions (verify competency, monitor compliance, and provide feedback)

Some facilities have moved to surveillance methods to monitor handwashing practices in an effort to address this issue. Are any of you aware of surveillance policies in your facility? Have they worked for you? If so, can you share your experience?

I recently participated in the conversion from reusable cuffs to a single-patient disposable blood pressure cuff at St. Joseph's Hospital Health Center in Syracuse, NY.  The hospital made this decision to convert to a single-patient cuff in an effort to reduce inventory levels, make purchasing easier and more efficient, and to prevent infections by reducing the risk of bacteria being passed from patient to patient. 

"With all the multi-drug resistant organisms out there, we really felt the disposable would be something to help lower the risk of hospital-acquired infections," said Chris Pines, St. Joe's manager of patient safety and risk, in a recent press release.

Another study (posted on the Infection Control Resource Center on ADVANCE for Nurses home page) shows that using one cuff per patient, and adhering to diligent cleaning and disinfection practices, reduces the risk of cross contamination significantly.

I look forward to sharing the results this conversion has on St. Joseph's in the weeks and months to come. As you assess your infection control processes, has your hospital considered converting to disposables?

Thank you for your interest in this critically important area in healthcare today. I'm hoping this space will give you an opportunity to share your opinions and comments as professionals who deal with this important topic each and every day.

While writing this first blog entry, I thought to myself, "What can I offer to you to bring some value to my fellow professionals?" The truth is, we all bring different perspectives and areas of expertise from our experience and work. We are all feeling the impact of our current economic situation and doing our best to work with the resources we have. Our first priority is the patient, and it seems as though all of the other "priorities" sometimes fall by the wayside. My hope for this blog is that you walk away with tools, resources, and an overall fresh perspective on the issue of infection control and how improving our workflow can help make our lives easier and our patients safer.  

From our work environment to our homes and schools, our society is riddled with evidence of the catastrophic impact the lack of infection prevention has had on our communities.  From C.diff to MRSA, to lives lost or forever changed, we cannot ignore what had once been a focus of the lonely infection control professional. I hope to bring some focus to what CMS, related legislation, and the media are all highlighting in the discussion on healthcare in America: medical errors and healthcare associated infections are preventable-with a streamlined approach to workflow and patient safety.

In my next post I'll discuss the use of single-use and single-patient products as a way to reduce the potential for cross contamination and infection. In future posts I will share professional articles, white papers, interviews and opinions from colleagues along with links to sites that can provide a world of information. I also look forward to your thoughts, resources and insights that can be shared with our fellow nursing professionals.

So what are the issues that concern you most on infection control today? 

For more information on infection control issues, go to the Infection Control Center on the home page.