How does Cottage combat the spread of infection within its hospitals?
It's everywhere: in the media, on websites and even introduced through Senate bills. Healthcare-associated infections (HAIs) are a subject that the public doesn't usually worry about -- until they or a close loved one is going to become a patient. There are lots of stories about what's happening on the larger scale, but what is happening here in our own back yard? What is Cottage Health System (CHS) doing to prevent the spread of infections throughout our system?
Methicillin Resistant Staph Aureus (MRSA) is one of those infections frequently seen in the news. Staph is an organism that occurs naturally on the skin and mucous membranes. MRSA is a type of staph that is resistant to antibiotics called beta-lactams, including methicillin and more common antibiotics such as amoxicillin and penicillin.
Not everyone is at the same risk for developing an infection and approximately 30% of the population is already colonized (when bacteria are present but not causing an infection) with MRSA. Risk factors include:
Increased length of hospital stay
- Multiple hospitalizations
- Multiple invasive procedures
- Severe underlying disease
- Patients 65 years or older
To address this nationwide problem, our Infection Control Department has developed an MRSA reduction project which consists of:
- The purchase of an instrument for the rapid detection of MRSA. It gives results in two hours instead of three days, allowing us to identify and quickly isolate patients colonized with MRSA.
- Isolation rooms with signage and a supply of protective clothing and supplies.
- Following policies based on Centers for Disease Control (CDC) guidelines to prevent the occurrence and spread of drug-resistant organisms.
- Using our computer system to identify patients with a past history of MRSA who are readmitted. Those patients are placed directly into isolation.
- Monitoring the incidence of patients who either carry the MRSA organism or have an active MRSA infection. In 2007 the rate for CHS hospitals was 10.2 per 1,000 admissions versus a recent national study which reported 46 per 1,000 admissions.
CHS consistently outperforms national benchmarks for hospital-acquired infection rates:
- Our surgical site infection rate for 2007 was 1.2 per 100 surgeries, well below the national benchmark of 2.1.
- The central line (intravenous catheter) infection rate for the critical care units at Santa Barbara Cottage Hospital is 0.3 per 1000 central line days, again well below the national benchmark of 2.2.
- At 1.8 per 1,000 admissions, we have a very low rate of hospital-acquired MRSA. (There is not yet a valid and reliable national benchmark for this measure.)
But it's not just a matter of collecting data. Our Infection Control Department actively promotes best practice throughout all our facilities, and there's a systemwide culture of support for this critically important goal and the need for ongoing promotion and education of staff and physicians.
Some of these efforts include:
- The Observation Hand Hygiene Compliance Improvement Project - One-on-one education is used with our staff and physicians to obtain hand hygiene compliance scores of 90 percent, well above the national benchmark of 54 percent. And we're continuing to work on that score.
- The Surgical Care Improvement Project (SCIP) - Focused on prophylactic antibiotic timing, selection, and discontinuation; appropriate hair removal, glucose control and temperature regulation for patients in the operating room in order to reduce the chance of acquiring a surgical site infection.
- Following evidenced-based best practices proven to reduce the incidence of central line (IV) related infections, ventilator-associated pneumonia, and urinary catheter-associated infections.
- House-wide computerized infection surveillance - Results indicate that we're a top performer among like hospitals. CHS was one of the leading organizations in California to use this sophisticated computer program. We are now a mentor hospital for fifty hospitals throughout California, sharing our knowledge and our success as an innovative Infection Control Department.
- Transmission-based precaution project - A year-long project focusing on isolation practices and aimed at education through the use of data and best practice for Cottage employees.
- To encourage hand hygiene among visitors and staff, bilingual hand hygiene and respiratory etiquette signs, along with alcohol hand rub, have been mounted in public areas and waiting rooms throughout Cottage facilities.
- Multidisciplinary environmental rounding in every unit throughout the system, including the kitchens, to address education, quiz staff, and report opportunities for improvement.
Our Infection Control Department at CHS doesn't just stay in its own backyard. It is involved in statewide and regional collaboratives which seek to eliminate healthcare-associated infections. And staff members reach out to the local community by providing education on a wide range of topics such as hand hygiene, pandemic planning and multi-drug resistant organisms. It's our way of helping to promote a safer, healthier community.
If you would like information on how you can help prevent the spread of germs, including influenza, in your household, please call our Infection Control Department, 805-569-7204.