Bloodstream infections... surgical site infections... urinary tract infections... pneumonia... One in every 20 hospital patients acquires a health-care-associated infection (HAI), according to the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC). The damage: prolonged hospital stays, billions of dollars in medical costs and tens of thousands of lives lost annually.
One of the primary risk factors for HAIs is the transmission of communicable diseases between patients and health-care workers, often preventable by a worker simply cleansing his or her hands with soap or sanitizer, both before and after patient contact. In 2008, the U.S. government established the Federal Steering Committee for the Prevention of Health Care-Associated Infections, which has since been developing initiatives to improve hand hygiene and other HAI-prevention techniques. Yet, getting even the most dedicated health-care practitioners—doctors, nurses, technicians and others—at the most well-respected medical centers to comply with hand-hygiene guidelines is a notorious challenge.
In March 2012, Guthrie Robert Packer Hospital, in Sayre, Pa., implemented the nGage automated hand-hygiene-monitoring system from Proventix, a Birmingham, Ala.-based RFID solution provider, within its 5 Main Oncology Unit, where patients are especially vulnerable to infection. The solution—in conjunction with education and reinforcement of compliance guidelines for caregivers—has significantly reduced the rate of HAIs, according to Andrew Klee, the hospital's infection preventionist. "Based on our data for the past five fiscal years," he says, "we had the most significant decrease in C. difficile [Clostridium difficile, a potentially life-threatening bacterial HAI] between fiscal year 12 and fiscal year 13, when we implemented the nGage system and then started holding our staff accountable for maintaining a high rate of compliance."
"The expectation for staff now is to achieve a compliance rate of at least 90 percent," Klee adds. "It is actually part of their job description to hit that rate."
Motivated by Mounting Concerns
"We were really worried about our hand hygiene," recalls Bonnie Morris, the nurse manager of Robert Packer's 5 Main Oncology Unit. The 254-bed regional facility, part of the not-for-profit Guthrie Healthcare System, is a state-of-the-art teaching hospital that has received "Magnet" recognition for quality nursing care and innovation by the American Nurses Credentialing Center. Hand hygiene is essential on the 20-bed cancer floor. "We're a smaller floor, with some very ill patients," Morris explains. "Many of them have severe neutropenic fever, they're undergoing chemotherapy... They have no immune system. It's our job to minimize their exposure to C. diff and other bacteria."
C. diff, Methicillin-resistant Staphylococcus aureus (MRSA), ventilator-associated pneumonia (VAP) and other HAIs "can be deadly," Morris notes. "We're continually reviewing best professional practices and reevaluating our approaches so we can be a role model for other facilities. We needed to be better stewards, better educators and better advocates for our patients. But no matter how hard we tried, even with 'secret shoppers' [unannounced observation and manual recording of caregivers' hand-cleansing behavior] and educational talks, nothing seemed to work," she states.
"My first concern is for my patients," Morris adds, "but there are also [government and commercial] reimbursements and other financial aspects" that hospital administrators must factor into any HAI-prevention investment decision. "That's how we ended up on this technology journey."
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