_______________________________________________________________ Healthcare-Associated Infections
The CDC reports that vaccination rates are highest (98%) among healthcare personnel whose employers require that they be vaccinated, compared with personnel whose employers who do not recommend or have a policy recommending vac- cination (42.0%%) [309]. Efforts to increase the vaccination rate among healthcare workers are ongoing. The APIC issued a position paper acknowledging the problem and highlighting suggestions to improve vaccination rates [310]. Additionally, the CDC has provided resources to healthcare employers to increase vaccination rates among healthcare personnel [309]. PRECAUTIONS AND ISOLATION TECHNIQUES The CDC guidelines for isolation precautions in hospitals, updated in 2007, synthesize a variety of recommendations for precautions based on the type of infection, the route of transmission, and the healthcare setting [25]. As defined by the CDC, Standard Precautions represent measures that should be followed for all patients in a healthcare facility, regardless of diagnosis or infection status. Standard Precautions apply to blood; all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain visible blood; nonin- tact skin; and mucous membranes [25]. For patients who are known to have or are highly suspected to have colonization or infection, Contact Precautions should be followed. This type of precaution is designed to reduce exogenous transmission of micro-organisms through direct or indirect contact from healthcare workers or other patients. Airborne Precautions are used for patients who have or are highly suspected of hav- ing infection that is spread by airborne droplet nuclei, such as tuberculosis, measles, or varicella. Droplet Precautions target infections that are transmitted through larger droplets gener- ated through talking, sneezing, or coughing, such as invasive Haemophilus influenzae type b disease, diphtheria (pharyngeal), pertussis, group A streptococcal pharyngitis, influenza, mumps, and rubella [25]. The CDC guidelines include descriptions of all the elements involved in the four types of precautions, including hand hygiene; the use of personal protection equipment (gloves, gown, and face protection); handling of patient-care equip- ment; environmental services and occupational health; and placement of the patient. New elements of Standard Precau- tions added to the 2007 guidelines are respiratory hygiene/ cough etiquette and safe injection practices [25]. Recom- mendations in this area address the importance of educating healthcare workers about adherence to measures to control the transmission of respiratory pathogens, especially during seasonal outbreaks of viral respiratory tract infections. In addition, the guidelines state that efforts should be made to contain respiratory secretions in patients and other individu- als who have signs and symptoms of a respiratory infection, beginning at the point of initial encounter in a healthcare setting. Signs should be posted to instruct patients and visitors with symptoms of respiratory infection to cover their mouths/ noses when coughing or sneezing, to use and dispose of tissues,
and to perform hand hygiene after contact with respiratory secretions. Masks should be offered to coughing patients and other individuals with symptoms, and such persons should be encouraged to maintain an ideal distance of at least 3 feet from others in common waiting areas. The safe injection practices element was included as a result of breaches in infection con- trol practice that contributed to four large outbreaks of HBV and HCV among patients in ambulatory care facilities [25]. These outbreaks could have been prevented by adherence to basic principles of aseptic technique, including the use of a sterile, single-use disposable needle and syringe for each injec- tion. A survey of U.S. healthcare workers who provide medica- tion through injection found that 1% to 3% reused the same needle and/or syringe on multiple patients [25].
PREVENTION OF ANTIBIOTIC- RESISTANT INFECTION
Managing the problem of emerging drug-resistant microbial infection is a crucial aspect of an institution’s infection control program. Any use of an antibiotic exerts selective pressure that can lead to the development of drug-resistance. The growing prevalence of antibiotic resistance is a serious problem for hospitals and for public health. Studies show that treatment indication, choice of antibiotic, or duration of therapy can be incorrect in up to 30% of instances in which antibiotics are prescribed. The national effort to promote antibiotic steward- ship is intended to slow the development of resistance, help prevent untreatable infection, and extend the useful lifetime of the most urgently needed antibiotics [2]. Updated guidelines for the management of MRSA and other drug-resistant micro-organisms were published by the CDC in 2006 and the SHEA in 2014 and 2022; the guidelines focus on the prevention of drug-resistant infections and the judicious use of antibiotics (antimicrobial stewardship) ( Table 19 ) [25; 33; 41]. The CDC’s Be Antibiotics Aware program provides fact sheets, pocket cards, posters, and slide sets for a variety of patient populations, including hospitalized adults, individuals to have surgery, patients receiving dialysis, long-term care patients, and hospitalized children [311]. All of the resources are available on the CDC website at https://www.cdc.gov/antibiotic-use/ php/usaaw-partner-toolkit/social-media.html?CDC_AAref_ Val=https://www.cdc.gov/antibiotic-use/week/toolkit.html. Universal surveillance of MRSA at hospital admission has been suggested as a measure to help prevent the transmission of this infection in the healthcare setting; however, the CDC guide- lines state that the evidence on universal surveillance is limited and recommends surveillance only in specific subpopulations, defined in the context of the infection characteristics of the facility [25]. The guidelines additionally state that surveillance for certain epidemiologically important organisms may need to be facility-wide and that surveillance methods will continue to evolve as healthcare delivery systems change [25].
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