Information on Hospital Associated Infections

Healthcare Associated Infections

What are we measuring and why?
Healthcare associated infections (HAI) are infections that patients acquire while receiving medical treatment in a healthcare facility. These infections are often harmful, but can usually be prevented with proper precautions and infection control practices. The Centers for Medicare and Medicaid Services (CMS) publishes hospital HAI results, which are used to assess the quality and safety of patient care. Data are reported as a standardized infection ratio (SIR), which compares a hospital’s observed number of infections to its predicted number of infections, after adjusting for institutional characteristics known to cause differences in incidence. A lower SIR is better, with the ultimate goal of zero infections.

Highlights

  • Zero Catheter associated Urinary Tract Infection for over the past 17 months.
  • A 90 % reduction in our Methicillin Resistant Staphylococcus Aureus (MRSA) infections in 2019 compared to 2018
  • A 50 % reduction in our Central Line Associated Bloodstream Infections (CLABSI) in 2019 compared to 2018

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Central Line Associated Bloodstream Infections

What are we doing to improve?
East Orange General Hospital has ongoing efforts aimed at reducing the rate of preventable CLABSIs. This includes observing best practice techniques outlined by the Centers for Disease Control and Prevention (CDC), such as proper hand hygiene, cleansing of the patient’s skin before line placement, using full barrier precautions during insertion, daily assessment of need of central line and early line removal. The cumulative effect of these interventions, and the hard work of our staff, has led to a remarkable reduction in CLABSI incidence over the past five years.

Catheter associated UTI (CAUTI)

How are we doing and how do we compare to best practice?
Though considered largely preventable, Catheter Associated Urinary Tract Infection (CAUTI) is the most common HAI reported to the Centers for Disease Control and Prevention (CDC). These infections are associated with insertion, maintenance, or prolonged usage of a urinary catheter – a sterile tube inserted into a patient’s bladder to drain urine. While catheterization is necessary in many circumstances (such as postoperative recovery), when not inserted or maintained properly, catheters can allow germs to enter the urinary tract. To reduce the risk of infection, it is important to avoid inappropriate catheter use, follow evidence-based practices when catheters are in place, and remove these devices as soon as they are no longer medically necessary.

Publicly reported CAUTI rates include adult and pediatric medical, surgical, and combined medical/surgical units and all intensive care units except the neonatal ICU. In 2017, EOGH’s CAUTI SIR (0) was statistically better than the national benchmark (0.774).

What are we doing to improve?
EOGH has aligned our clinical processes and technologies with national guidelines to ensure that every catheterized patient receives the safest, most appropriate care possible. Our computerized physician order entry system helps identify appropriate indications for catheter placement and issues reminders to our nursing team for catheter removal. Additionally, we have centralized review of all indwelling catheters to judge for need of removal. The cumulative effect of these interventions, and the hard work of our staff, has led to a zero CAUTI infections over 1 year period.

Methicillin Resistant Staphylococcus Aureus (MRSA) infection

How are we doing and how do we compare to best practice?
Staphylococcus aureus (Staph) is a common bacterium that is present in the nose or on the skin of about one quarter of healthy adults at any given time. Though generally harmless, Staph occasionally causes infections that are treated with antibiotics. Methicillin Resistant Staphylococcus Aureus (MRSA) is a strain of Staph that is resistant to certain antibiotics, which can make MRSA infections more difficult to treat. In healthcare settings, MRSA is often spread through direct contact with an infection or contaminated hands; therefore, it is important that hospital staff take appropriate precautions to reduce the transmission of MRSA and prevent associated complications.

Publicly reported hospital-onset MRSA events are identified through laboratory testing and defined as MRSA-positive blood specimens collected four or more days after inpatient admission.

What are we doing to improve?
At EOGH, we link MRSA infections closely with use of central lines and are focused on implementing best practices that include utilizing best practice techniques outlined by the Centers for Disease Control and Prevention (CDC,) such as: proper hand hygiene, cleansing of the patient’s skin before line placement, using full barrier precautions during insertion, daily assessment of need of central line and early line removal. Additionally, we focus on screening all our patients admitted to ICU for colonization with MRSA and implement:
Surveillance of blood cultures to track bacterial outbreaks
Isolation of infected & screened colonized patients, use of protective garments, and other precautionary techniques to prevent hospital spread of the infection.
The cumulative effect of these interventions, and the hard work of our staff, has led to a remarkable reduction in MRSA incidence over the past year.

Clostridium Difficille Infection (CDI)

How are we doing and how do we compare to best practice?
Clostridium Difficile (C. diff) is a type of bacteria that can cause diarrheal illness and colon inflammation. It is associated with antibiotic treatment; long-term use of such medications can disrupt the normal intestinal flora, thus making patients more susceptible to an overgrowth of C. diff bacteria. It produces spores that can survive outside the human body for an extended period of time. In healthcare settings, C. diff is often spread through contact with contaminated surfaces; therefore, it is important that hospital staff take appropriate precautions, such as proper hand hygiene practices, to reduce the transmission of C. diff.

Publicly reported hospital-onset C. diff events are identified through laboratory testing and defined as C. diff-positive stool samples collected four or more days after inpatient admission.

What are we doing to improve?
Reducing hospital-acquired C. diff infections is an institutional priority at EOGH. The key to limiting its transmission is to consistently follow Infection Control protocols for Contact Precautions, which require all employees to wear gowns and gloves while providing care to known or suspected C. diff patients. Once finished and before exiting a patient’s room, employees are required to wash their hands with soap and water.
Increased focus on hand hygiene, environmental cleanliness, and appropriate testing over the past three years are being implemented as well. We are also working with our physician partners to ensure appropriate antibiotics are utilized and are stopped once the infection is resolved to ensure reduction in cases of C diff.