Does your department control infections, prevent infections, or both control and prevent infections? Most healthcare institutions probably think that their focus is on prevention. An article in Prevention Strategist highlighted the efforts of the University of Vermont (UVM) Medical Center to eliminate healthcare-acquired infections (HAIs).1
The chief quality officer asked the infection prevention (IP) manager and hospital epidemiologist for data from a different perspective. Instead of rates and bar graphs, the quality officer wanted to see a list of every patient, who developed an HAI over a one-month period, along with their medical record number and type of infection.
When pages of names were generated, the IP manager and epidemiologist realized that the focus was more on infection control than prevention. The infection preventionists were doing the requisite data collection and reporting, but that information collected was not being used to develop strategy.
In order to shift this focus, the IP department coordinated a plan to roll out the data to the bedside with the ultimate goal of zero infections in five priority areas: total knee and hip replacement surgical site infections (SSIs), orthopaedic spinal fusion SSIs, central line-associated bloodstream infections (CLABSIs) in the medical intensive care, central line access-related bloodstream infections in outpatient dialysis centers, and neonatal intensive care CLABSIs.
These key factors were involved in their program:
- Senior leadership support
- Infection prevention advocate program
- Environmental services improvements
- Quality improvement consulting
- Establishing multidisciplinary team
The department was able to significantly reduce infection rates and shorten the list of patients who developed an HAI. Sally Hess, MPH, CIC, the IP manager at UVM, offers this advice to other facilities that want to reach zero: “Ask your team, ‘How will the next infection happen on your watch?’ By listening to the collective information and really paying attention to what people are reporting is happening at the bedside, you really can get to zero.”
Infection preventionists can get caught in a vortex of data collection, analysis, and reporting at multiple committees. Electronic surveillance systems have certainly helped to sift through the mountains of culture reports, but the infection preventionists are still bogged down by regulatory and internal reporting requirements.To prevent infections and not just control them, it is important for infection preventionists to get out of the office and go to the bedside, the unit, or the operating room to observe actual practices and talk to the people that are physically taking care of the patient.
APIC stands for Association for Professionals in Infection Control and Epidemiology but the tagline on the APIC website is “Spreading knowledge, Preventing infection.” I think most people would want these departments to focus on preventing infections, not just controlling them.
Do you have a system that has worked for you to prevent and control infections?
V. Uhland. Leadership on all levels: How UVM Medical Center shifted from infection control to infection prevention. Prevention strategist. Spring 2015. pp. 48-51.