News & Events
March 9, 2010
HOUSEKEEPERS, TRANSPORTERS MAY “INADVERTENTLY” SPREAD HOSPITAL INFECTION
They're overlooked, under-protected in infection puzzle
PITTSBURGH, March 9, 2010 – One cause of the rampant international hospital-infection epidemic may be the “inadvertent exposure” of hospital housekeepers and transporters to antibiotic-resistant “Superbugs” such as MRSA, says TeleTracking Technologies CEO Anthony Sanzo.
Sanzo, a former health system CEO, was commenting on a recently-released study which suggests that many of the 48,000 hospital-acquired pneumonia and sepsis deaths recorded nationwide in 2006 might have been avoided with better infection control. The study said the blood infection sepsis killed 20 percent of patients who contracted it after surgery. Pneumonia killed 11 percent of those who acquired it in a hospital.
The study, conducted by Extending the Cure and published in The Archives of Internal Medicine, said those two infections alone, which can be caused by drug-resistant microbes such as MRSA, increased U.S. healthcare costs by $8.1 billion that year due to protracted hospital stays and treatment. MRSA is a host organism causing Sepsis, which produces multi-system organ failure and is the leading cause of deaths in intensive care units.
“Inadvertent exposure” results when hospitals fail to alert environmental and transport personnel in advance about isolation rooms holding infected patients. This denies workers the opportunity to protect themselves from exposure or initiate special cleaning procedures, especially wiping down the litter and wheelchair with antimicrobial wipes. This can significantly increase the possibility of wider contamination because the workers continue about their business without knowing they’ve been exposed, using equipment that has not been properly sanitized.
The hazard also may extend to the next patient who occupies a “blocked” room, because the presence of MRSA requires hospital workers to use specific chemicals and procedures to rid the room and bed of the microbes.
The communications gap results from the fact that most infection control nurses must still prepare blocked room lists manually. Very often, those lists are outdated even before the nurses leave their offices.
“Isolation is ineffective if all workers are not alerted to the room’s status,” Sanzo said. “Yet, though housekeepers and transporters are among the most widely-travelled hospital personnel, they are being overlooked and under-protected.”
“Hand washing has proven to be very effective when properly enforced,” he continued, “but if we continue to contaminate support service employees and mobile equipment, then infection spreads with or without hand washing.”
To support his observation, Sanzo points to the fact that over 60 percent of hospital-acquired infections (HAIs) are now in the general patient population, up from only two percent in the mid-70s, when infections were mostly confined to acute care areas.
“It’s going to take a great deal of effort on many fronts,” says Lisa Romano, TeleTracking’s Vice President/Chief Nursing Officer and Director of the company’s Avanti consulting division.
According to Romano, communicating information about isolation in real-time, reducing overcrowding and smoothing out patient flow “are powerful weapons that hospitals cannot ignore in the war against MRSA and Gram-negative organisms like Acinobacter, which are resistant to virtually all modern antibiotics.”
Gram-negative germs, so called because of their reaction to the Gram stain test, have a cell structure which makes them more difficult to attack with antibiotics than Gram-positive organisms like MRSA. The microbes, which survive for long periods on hospital surfaces, enter the body through wounds, catheters and ventilators. They primarily infect hospitalized patients whose immune systems are weak.
Existing patient flow technology can automatically alert hospital workers in real-time to the presence of infection when they are assigned to clean a “blocked” room, Sanzo notes, virtually eliminating the likelihood of inadvertent exposures. It also can create an audit trail that records where a patient has been, so staff having prior contact with an infected patient can be notified if necessary. And, it gives infection control nurses a mobile visual reference tool to help them assess isolation needs as they make clinical rounds.
During periods of extreme overcrowding, creating private isolation rooms can be problematic because of increased demands for patient beds. If used as designed, patient flow technology makes it easier to “cohort,” or pair, patients with similar infections and to limit the possibility of mismatching infected and non-infected patients in the same room.
The Centers for Disease Control and Prevention estimates that nearly 100,000 people die each year either directly from, or in association with, hospital-acquired infections. Patients with HAI are seven times more likely to die than the average patient. In 2005, nearly one in five of the 94,000 hospital-acquired MRSA cases was fatal. Deaths that experts say were largely preventable.
“Preventing the spread of MRSA involves a multi-faceted approach,” according to Sanzo. “Real-time identification and effective yet protected communication of patients with MRSA is critical so that isolation and/or cohorting can occur. For their safety as well as others, support service staff must be aware of MRSA when transporting patients so that mobile equipment is sanitized properly and EVS staff must use the correct cleaning protocols to ensure the MRSA bug is eliminated from bedside surfaces.”