The latest on reducing HAIs in the operating room

By Don Sadler

We know how to protect patients from these events—they can and must be prevented.” –Dr. Michael Bell

Despite all of the wonderful medical advances that have been made in recent decades, thousands of patients still die in hospitals each year from one of the simplest of causes: infections.

Superbugs such as methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa (Pseudomonas) and E. coli result in deadly health care-associated infections (or HAIs) at hospitals all over the country. When it comes to HAIs, there’s some good news and some bad news.

The bad news: HAIs occur in approximately five to 10 percent of all hospitalized patients, or more than two million patients a year. They are the fourth leading cause of death in the country, resulting in approximately 90,000 deaths each year.

The good news: There has been an increased level of awareness among health care professionals in recent years about the risks and dangers of HAIs. This has led to a number of new HAI prevention techniques and technologies, as well as a “back to basics” approach to infection prevention in many ORs.

A Hot-button Issue

“HAIs are a hot-button issue right now that’s generating a lot of attention. They remain a very serious problem today,” says Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, the executive director and CEO of the Association of periOperative Registered Nurses (AORN). “According to the Centers for Disease Control, HAIs cost hospitals between $26 billion and $33 billion a year. This is especially alarming when you consider that most HAIs are preventable.”

In testimony before Congress last year, Dr. Michael Bell of the Centers for Disease Control and Prevention (CDC) stated that an estimated one in 20 hospital patients has HAIs. “These infections are associated with increased mortality and greater cost of care, and they can occur in any health care setting. Infections caused by lapses in basic infection control are unacceptable. We know how to protect patients from these events—they can and must be prevented.”

According to Bell, four frequent infections related to specialized care procedures account for approximately three-quarters of all HAIs: urinary tract infections, surgical site infections, bloodstream infections and pneumonia.

“HAIs occur primarily due to improper practices and poor technique,” Groah adds. This includes things like reusing disposable syringes, medication vials and lancers; improper cleaning and disinfection of instruments (especially endoscopes); inappropriate reprocessing of equipment; and improper hand washing.

“These are basic, fundamental things nurses and physicians learned early in their training, but they sometimes get sloppy and take shortcuts,” Groah says. “A nurse or physician may say ‘I’ve never had an infection before,’ but it only takes one.”

To help hospitals guard against HAIs, AORN has issued Recommended Practices in the following areas:

• Surgical Attire

• Hand Hygiene

• Maintaining a Sterile Field

• Traffic Patterns

• Sterilization

• Cleaning and Care of Instruments and Powered Equipment

In addition, a new Recommended Practice will be released at the end of 2012 in the area of Transmissible Infection.

Raising Awareness of HAIs

HAI prevention was a major theme at last October’s Infection Prevention Leadership Summit, which was titled “All for None: Eliminating HAIs through Knowledge, Collaboration and Leadership.”

After the summit, AORN, the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), and the International Association of Healthcare Central Service Materiel Management (IAHCSMM) collaborated to create a white paper that presents conclusions and recommendations to improve patient care through reducing SSIs. You can download the white paper by visiting http://bit.ly/ipls_wp.

In addition, Advanced Sterilization Products (ASP) launched a public health message last October in conjunction with the 25th annual International Infection Prevention Week in which infection prevention experts from all over the world discussed how to prevent HAIs. ASP also launched a Professional Education & Learning Solutions website last year (at www.aspjj.com/us/prof-ed) that houses research, standards and regulations regarding infection prevention.

New Techniques and Technologies

As awareness has been raised about the dangers of HAIs, a number of new prevention techniques and technologies have been developed to help combat HAIs.

For example, Cone Health, a hospital system in Greensboro, N.C., implemented the Xenex automated room disinfection system—which uses pulsed xenon ultraviolet light to destroy viruses, bacteria and bacterial spores in patient areas—in early 2011 as part of an aggressive infection prevention program. The program also included a “Step Up, Scrub Up” campaign, expansion of MRSA surveillance testing, and an electronic data mining system that provided real-time data on whether patients had MRSA so measures could be taken to prevent spreading it.

Cone Health reported zero MRSA cases in the intensive care units that were part of the program, and a 42 percent decrease in the total number of HAIs during the time period studied. “This has saved the organization and community an estimated $2.3 million in infection-associated hospital costs,” noted Terry Akin, Cone Health’s Chief Operating Officer.

Also, a study conducted at the University of Texas MD Anderson Cancer Center determined that the Xenex device reduced contamination found on 75 surfaces in 12 inpatient rooms and eliminated a type of bacteria known as VRE, or Vancomycin-Resistant Enterococci, an organism that is resistant to a wide range of antibiotics.

The GLOSAIR Healthcare Environmental Decontamination system from ASP is another new disinfection technology that can help prevent HAIs. This system creates a mist of approximately 5 percent hydrogen peroxide that is uniformly dispersed to disinfect all hard nonporous surfaces, including difficult-to-reach areas.

According to ASP, studies have shown that hydrogen peroxide vapor decontamination devices are effective at reducing surface contamination by pathogens in hospital rooms and operating suites and may be associated with a reduction in infection transmission. “When used to augment manual cleaning processes, this system can provide healthcare facilities with increased confidence that the patient environment has been thoroughly disinfected against the many bacteria and viruses that cause HAIs,” says ASP’s Medical Officer Dr. Utpal Khambholja.

Groah says that AORN is watching these and other new technologies closely to determine if there is sufficient evidence that they are effective in reducing HAIs. “But you can’t substitute technology for sound practices. Technology can sometimes provide a false sense of security that results in a failure to perform basic, fundamental techniques.

“We’re not satisfied with the status quo when it comes to HAIs,” Groah adds. “We believe that health care professionals have to look at the delivery of care differently. To prevent HAIs, teams have to be more collaborative and get rid of silos, focusing on the continuum of patient care from pre-op all the way through post-op.”

Sidebar: Sobering Stats

A survey recently conducted by Harris Interactive for Advanced Sterilization Products found that:

• 34 percent of Americans either have or know someone who has acquired an infection after being exposed to germs during a hospital stay.

• 64 percent of Americans do not think they would be better protected from germs in the hospital than in their daily lives.

• 75 percent of Americans say it is more important to choose a hospital based on lower infection rates than on convenience when in a non-emergency situation.

• 94 percent of Americans would prefer seeking care at a hospital that uses the latest technology available for preventing the spread of infection.