General Orientation Made Easy!

For new hires in healthcare and their Educators, General Orientation is like running a marathon. So many topics to cover, so little time. It is true that general orientation is the window of time that the facility has to officially welcome you as a new hire to the organization and take care of the business of getting you on board. But beyond the Human Resources necessities regarding payroll, benefits and such, there are many topics that must be covered that are designed to introduce you to the vision and priorities of the organization. These include the mandatories dictated by The Joint Commission and other accreditation bodies, the Centers for Medicare and Medicaid Services (CMS), and the Occupational Health and Safety Administration (OSHA).

C. diff training video for healthcare staff!

Can Environmental Cleaning Keep C. diff At Bay?

Because it is a hot item of discussion these days, another C. difficile discussion seems in order. While our recent post discussed the best practice recommendations for antibiotic stewardship and infection prevention strategies, a post regarding environmental cleaning and disinfection in particular is especially timely since the cleanliness of the environment is a known factor in transmission of this antibiotic resistant pathogen.

Ambulatory Settings Pose Infection Prevention Challenges

When we think of receiving healthcare, we typically think of hospitals first. But in fact, there has been a significant shift in the last 30 years or so to care for patients in ambulatory settings, such as hospital and non-hospital based outpatient clinics, urgent care centers, ambulatory surgery centers, imaging centers, oncology clinics, physician offices, among others. And in these settings, infection rates have risen dramatically.

Properly Performed Cleaning and Disinfection in Ambulatory Surgery Centers is Critically Needed

For some time now accreditation agencies and the Centers for Medicare and Medicaid Services (CMS) have heard the cries of infection preventionists and realized the importance of a clean healthcare environment in preventing healthcare-associated infections. Yet the transfer of this information to the ambulatory sector, most notably surgery centers, has apparently been slower in coming – with potentially tragic consequences.

Don’t Ask Me To Wash My Hands!?

In an effort to improve hand hygiene, the CDC and others have promoted the “Hand Hygiene Saves Lives” campaign, educating patients on the importance of practicing hand hygiene while in the hospital, and that it is appropriate to ask or remind their healthcare providers to practice hand hygiene as well. http://tinyurl.com/9ftf4mr In fact, the public has become a great deal more savvy regarding the need for hand hygiene through this campaign, patient safety organizations, and a growing number of articles in consumer media. Many hospitals have patient education videos or buttons that encourage patients to ask providers to clean their hands. But patients are still reluctant to ask their providers to do so, despite their concerns for quality care. http://tinyurl.com/9srboyl Why could this be? Do they assume that their providers are washing their hands? Or are they afraid they will anger their providers or give offence, perhaps fearing it will affect their care? As it turns out, they could be right.

CRE – The Latest & Greatest MDRO Threat

By now, the threat posed by multiple drug-resistant organisms (MDROs) to healthcare is well documented. When antimicrobial resistance among gram-negative bacteria create disease, treatment is frustrated by the inability to use standard antibiotics. In the past decade the most well-known of MDROs, including methicillin-resistant staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE) and Clostridium difficile, have caused thousands of deaths, extended lengths of stay in hospitals, and resulted in billions of dollars in care. In recent years, a new MDRO has come to claim its place in the annals of the CDC, and while it thus far does not have the number of victims that other MDROs have, it threatens to have a major impact in healthcare.

Instrument Processing Gets National Attention

On Febuary 23rd, 2012, an NBC Today Show segment focused its attention on the dangers of contaminated instruments. Surgical instruments that are improperly cleaned and disinfected can play an important role in the acquisition of healthcare-associated infections or HAIs. One great thing that may come out of the recent media attention is the spotlight on the many CS professionals who commit themselves to improving the quality and professionalism of their department.

Catheter-Associated UTI’s Can Be Avoided!

Invasive devices such as catheters are the leading causes of infection in healthcare facilities. And there is one type of catheter that is responsible for more healthcare-associated infections (HAIs) in hospitals, long term care and home care than any other device – the indwelling urinary catheter.

Here are the facts: More than 1 million cases of catheter-associated urinary tract infections (CA-UTIs) occur each year in U.S. hospitals and nursing homes,and CA-UTIs account for up to 40% of HAIs. It is estimated that 25% of patients in the acute care setting will have an indwelling urinary catheter at some point in their hospitalization, and 69% of patients in medical ICUs hospitalized in NNIS hospitals from 1992-1997 had urinary catheters.

So what’s the problem?  Catheter-associated urinary tract infections or CA-UTIs are generally assumed to be benign. However, CA-UTIs may be associated with significant complications, such as cystitis, pyelonephritis, infection, prostatitis, epididymitis, orchitis in males, and encrustation; less commonly, bacteremia and complications of metastatic infection including endocarditis, septic arthritis, endophthalmitis, and meningitis may occur. CA-UTIs are the second most common cause of healthcare-associated bloodstream infection. CA-UTIs increase length of stay by 1 to 3 days and add to overall patient costs, especially if bacteremia occurs. In addition, urinary catheters often precipitate unnecessary antimicrobial therapy, and are a major reservoir for resistant pathogens. One study has linked CA-UTIs and surgical site infections.

Can all CAUTI’s be avoided? No, not all catheter-associated urinary tract infections or CA-UTI are preventable. For example, there are certain factors that increase the risk of infection that may not be modifiable in a patient. However, there are many CA-UTI that are avoidable. The fact is, many urinary catheters are left in place longer than necessary, simply because physicians forget to look for the catheter, or reassess whether the patient still needs one.  A report published in the September issue of the journal Clinical Infectious Diseases suggests that hospitals can cut CA-UTI infections by 52% simply by implementing an  automatic reminder in the electronic health record or other system that requires a clinician to check daily on the catheter and determine whether it is still needed.

Need more incentive? As of October 1, 2008, Medicare discontinued reimbursement for the extra cost of treating catheter-associated urinary tract infections that occur while the patient is in the hospital. In addition, there is a national push to “get to zero” in the incidence of reportable healthcare-associated infection rates by the Agency for Healthcare Research and Quality (AHRQ), The Joint Commission, and the Association for Professionals in Infection Control (APIC) to name a few. And as of May 2011, The Joint Commission announced a new National Patient Safety Goal to prevent CAUTIs to be fully implemented by 2013.

Follow evidence-based practices! If we are to reduce the numbers of infections, clinicians will need to first follow evidence-based practices such as those in the CDC Guideline for the Prevention of Catheter-Associated Urinary Tract Infections 2009; the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), and The Joint Commission; Diagnosis, Prevention and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from IDSA;Clinical Fact Sheets by the Wound, Ostomy and Continence Nurses Society (WOCN); and other professional guidelines, and get back to the fundamentals for the care and maintenance of the urinary catheter.

Training videos can help get clinicians on board. Envision, Inc. has an award-winning staff training video that offers 1 Hour CE credit for nurses, available for free preview prior to purchase at http://www.envisioninc.net/index.php/programs/details/preventing_catheter_associated_urinary_tract_infections/.

Immediate-Use Steam “Flash” Sterilization? Not So Fast!

Every day, acute care and ambulatory surgery centers face challenges on how to lower healthcare-associated infections. In the operating room, a large part of this effort involves the proper cleaning and sterilization of surgical devices and equipment. But with limited numbers of instruments, tight turnaround schedules, and decreasing budgets, many facilities are performing immediate-use steam sterilization (aka “flash” sterilization) in an effort to sterilize items quickly to avoid buying additional surgical instruments. The fact is, rather than save money and time, immediate-use steam sterilization has been implicated in increasing a patient’s risk for infection, which may lead to lawsuits and loss of accreditation for a facility.

Originally, this type of sterilization was intended for use only in an emergency, such as when a one-of-a-kind instrument was contaminated or dropped from the sterile field. Unfortunately, it has now become common place and used too frequently due to time and budget constraints. Because items do not recieve the complete traditional sterilization processing, professional groups and accreditation agencies believe that IUSS should not be  a routine practice, but rather used only in select clinical situations, and in a controlled manner.

“The reason that it’s not looked upon as a good solution is because oftentimes in the tight timeframe that we use, there are chances that corners may be cut; that during that rushed process to get the instrument turned around there could be processes and protocols that are missed completely, or at least not fully complied with. Immediate-use steam sterilization is denoted as a process that is used only in emergencies and only if the devices that are to be sterilized are compatible with that process.” – Natalie Lind, CRCST, CHL, FCS, IAHCSMM Education Director.

In this day and age, healthcare facilities are under great pressure to prevent surgical site infections. It seems obvious that items that do not receive full sterilization cycles are likely to be the source of infections. Surgical Technicians and Central Service professionals must become aware of the issues surrounding this form of sterilization, and the standards, regulations and best practices regarding its use. It is vital that immediate-use steam sterilization be utilized in accordance with professional guidelines; facility policies and procedures; as well as in strict compliance with validated written instructions provided by device manufacturers, sterilization equipment manufacturers, and container or textile manufacturers. This is especially critical for short sterilization cycles, as it takes time for steam to penetrate a sterilizer load and achieve an acceptable sterility assurance level.

In an effort to promote best practices regarding the use of IUSS, a multi-agency position paper was released January 2011 by the International Association of Healthcare Central Service Materiel Management (IAHCSMM), the Association for the Advancement of Medical Instrumentation (AAMI), the Association of peri-Operative Registered Nurses (AORN), the Association for Professionals in Infection Prevention and Control (APIC), the ASC Quality Collaboration,  and the Accreditation Association for Ambulatory Health Care (AAAHC) .  In addition, the Centers for Disease Control and Prevention (CDC) has recommendations, and The Joint Commission has standards regarding proper use and protocols for IUSS that must be followed and closely documented.

Envision, Inc. and IAHCSMM are proud to present a NEW 11 minute staff training program entitled “Protocols for Immediate-Use Steam Sterilization,”  part of the Of Critical Importance staff education series for Central Service and Operating Room professionals who process surgical instruments and devices.  For a preview of the program in it’s entirety, visit www.EnvisionInc.net.