A lot of people go to the hospital because of infections that begin at home. Doctors prescribe antibiotics for these infections and millions of patients have been miraculously cured. But there is a flipside to this story: people who go to a hospital for an unrelated illness and develop a new and unexpected infection while in the hospital – a hospital-acquired infection.
Infections have been a constant threat since hospitals were first created. In the mid-1850s, it was discovered that if doctors washed their hands – a revolutionary and controversial concept at the time – hospital infections could be significantly reduced. Before surgeons wore gloves, surgical instruments were sterilized, and patients got preventive antibiotics, infection was a major risk during surgery.
Infections have since been reduced but never eliminated, and remain a threat as more patients have lived into old age, have weakened immune systems, and receive high-tech critical care and surgery that save many lives but paradoxically put patients at risk for infection. Academic medical centers such as the UVM Medical Center that are larger, provide higher risk treatments , train nurses and doctors, and care for the sickest patients transferred from smaller community hospitals have the greatest challenge controlling infection.
It is estimated that as many as 5% of hospitalized patients in the United States develop an infection, which translates into millions of infections each year. Urine infections, blood infections, pneumonias, surgical wound infections and antibiotic-associated diarrhea are the most common, ranging from mild to life-threatening. Clearly, the practice of infection prevention must be a key part of hospital efforts to improve patient safety. Our rates of blood infection, post-surgical infections after total hip, total knee replacement, coronary bypass and hysterectomy infections, to name a few, are all at or below national averages for an academic medical center.
The basics of infection prevention include hand hygiene (either with alcohol-based products or soap and water), environmental cleaning, sterilization of surgical instruments, appropriate use of antibiotics, and isolation (private room, gowns and gloves for selected patients). Patients can help protect themselves by making sure those caring for them always wash their hands.
The good news is that more attention and resources than ever are being devoted to prevention, resulting in lower rates of infection. At the UVM Medical Center, preventing hospital-acquired infections is a major priority and an integral part of our mission to provide the safest care possible. We have seven infection prevention professionals with 88 years of experience, whereas other hospitals in Vermont are able to dedicate one or two staff to infection prevention, and they may wear other hats as well. Physicians, nurses, environmental services, the operating room, pharmacy, the microbiology laboratory, and respiratory therapy all collaborate with the staff in our James. M. Jeffords Institute for Quality and Operational Effectiveness to reduce infections.
Here are some of the ways we work to prevent infections at the UVM Medical Center:
- Focus on Hand Hygiene: We practice and emphasize good hand hygiene. As part of our hand hygiene program, we engage 6 to 10 UVM student volunteers per semester who perform hand hygiene observations of our staff to determine our compliance rate with hand washing.
- Aggressive Cleaning Efforts: We have an aggressive cleaning program to keep our hospital rooms and environment clean of microscopic germs. Our Environmental Services team (i.e. our housekeepers/cleaners) received a national award in September, 2010 for their success and innovation in cleaning and testing the cleanliness of our rooms after disinfecting.
- Infection Prevention Advocates: Two years ago, we implemented a program to educate nurses in the evidence base related to infection prevention. These nurses participate in a total immersion infection prevention program, then meet monthly to share ideas and continue their learning. They take what they learn back to their nursing units to share with their colleagues to help increase the collective knowledge and skills of infection prevention of the unit.
- Active Surveillance of Methicillin-Resistant Staphylococcus Aureus (MRSA) Infections: We proactively test everyone admitted to the Intensive Care Units for MRSA to see if they are carrying the bug. For selective surgery patients (patients who are pre-scheduled for a surgical procedure) , we “de-colonize” them, or remove staph bugs from their skin using an evidence-based protocol.
- Advanced Testing Technology: the UVM Medical Center is one of only seven hospitals in the country that own a new machine that can test for genetic material showing an infection in just a few hours. This new technology allows us to diagnose infections such as MRSA or C. difficile in a couple of hours, and begin treatment immediately.
- Special Training on Central Lines for Residents: We have started a new program to train our residents at the UVM Medical Center on how to put in a “central line” on a simulation dummy in a laboratory so they can practice their skills and be observed performing “best practice”. At a national level, Vermont was rated as having the lowest infection rates for central lines of any of the other 17 states which publicly report these data.
The State of Vermont has also made infection prevention a priority, with an evolving program for publicly reporting rates of hospital infection, and a unique, federally-funded, statewide initiative to reduce infections in Vermont hospitals and long-term care facilities which is supported by the Centers for Disease Control (CDC).
Preventing hospital-acquired infections is a challenge for all hospitals. The good news is the UVM Medical Center has a state-of-the-art prevention program dedicated to providing our patients and their families with the care they need in an environment that minimizes the risk of infection.
For more details on the UVM Medical Center’s infection prevention efforts, visit our Quality web page.
W. Kemper Alston, MD, MPH is an Infectious Disease Specialist and Hospital Epidemiologist at the UVM Medical Center.