Healthcare-Associated Infections _ ______________________________________________________________
• Comply with the institution’s recommendations regarding the use of antibiotics • Educate patients, visitors, and staff about techniques to prevent the transmission of infection As direct providers of care in a healthcare facility, the nursing staff plays a substantial role in carrying out infection control practices. Nursing administrators should promote the develop- ment and enhancement of nursing techniques, review nursing policies regarding aseptic techniques, and offer educational training programs on best practices [18]. Nurses on patient care units have the following responsibilities [18]: • Comply with established infection control practices • Monitor aseptic techniques, including handwashing and use of isolation precautions • Report evidence of infection immediately to the attending physician • Initiate patient isolation and order culture specimens when infection is suspected and a physician is not immediately available • Limit patient exposure to infections from others (visitors, hospital staff, other patients, or equipment used for diagnosis or treatment) Community hospitals have had success with participating in an infection control network. In 12 community hospitals in North Carolina and Virginia that joined such a network (the Duke Infection Control Outreach Network), there were sig- nificant decreases in the annual rates of healthcare-associated bloodstream infections, infection and colonization with MRSA, ventilator-associated pneumonia, and exposure of staff to bloodborne pathogens [292]. After network participation for five years, the average decrease in the number of device-related infections and HAIs due to MRSA decreased by an average of 50% [293]. The cost savings were approximately $100,000 per hospital, and in total, an estimated 52 to 105 deaths related to ventilator-associated pneumonia or intravascular device-related infection were prevented [293]. Most prevention and control policies focus on general mea- sures, such as surveillance; adherence to guidelines for hand hygiene, influenza vaccination, precautions and isolation techniques, management of drug-resistant micro-organisms, and standards for environmental services; and education of healthcare workers as well as patients and families. SURVEILLANCE Surveillance is an essential component of an infection con- trol program. The infection control team has traditionally conducted surveillance through open communication with the nursing staff and physicians and meticulous review of patient records and microbiology results. The infections most commonly targeted for surveillance are those associated with substantial costs in terms of morbidity, mortality, or econom- ics, and those difficult to treat. In addition, infections with a predilection for epidemics are a focus. The data gathered
INFECTION CONTROL The development of formal infection control programs in hos- pitals and other healthcare facilities was spurred by the Joint Commission accreditation standards for infection control, published in 1976. According to the standards, accredited facilities must have a program for the surveillance, preven- tion, and control of HAIs [89]. In 1974, the CDC designed the Study on the Efficacy of Nosocomial Infection Control project to determine if infection surveillance and infection control programs could reduce the number of HAIs [289]. The nationwide study evaluated rates of HAIs in hospitals before and after the implementation of infection control programs; the researchers noted that programs with four components were associated with a one-third reduction in the rate of HAIs: an effective hospital epidemiologist, one infection control prac- titioner for every 250 beds, active surveillance mechanisms, and ongoing control efforts [290]. With the increased focus on prevention of HAIs, infection control professionals have come to be known as infection preventionists [291]. An infection control program is usually overseen by a commit- tee chaired by an infectious disease physician and consisting of staff representing departments throughout the facility, such as nursing, pharmacy, surgery, clinical microbiology, central sterilization services, housekeeping, maintenance, food ser- vices, and laundry services. Among the responsibilities of an infection control program are to: • Conduct surveillance of HAIs • Develop policies regarding prevention and control, such as hand hygiene and precautions • Ensure adherence to standards for environmental services • Establish a program to monitor and evaluate antimicrobial therapy • Provide education to healthcare workers about adherence to infection control policies • Develop guidelines for outbreak preparedness The policies and procedures in each of these areas, as well as guidelines for adherence, should be documented in an infec- tion control manual. All physicians and staff within a healthcare facility have responsibility for helping to advance infection control goals. Physicians should assume the following responsibilities [18]: • Protect their patients from other infected patients or staff • Comply with the practices approved by the infection control committee • Obtain appropriate microbiologic specimens when infection is suspected or present • Notify the infection control committee about confirmed cases of HAIs
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