LOUISVILLE, Ky. — Healthcare-associated infections (HAI) strike 2 million Americans annually, killing 99,000—more people die from HAI than car accidents and homicides combined.
“The statistics are pretty brutal,” says Linda Homan, RN, CIC, a longtime infection-control professional who works for Ecolab Healthcare’s Clinical and Professional Services. “They really do speak for themselves.”
CHAIN OF INFECTION
One potentially infectious site is the operating room, with possible sources including instruments and equipment, textiles, the room itself, the surgical staff, and even the patient. Most surgical site infections are caused by the patient’s own bacteria or by the hands of healthcare workers, according to Homan.
People—either a healthcare worker or the patient himself—could be a source. Hand hygiene—carefully washing with soap and water or cleaning using alcohol rubs—is followed only 40% of the time. And doctors’ and nurses’ coats carry MRSA (methicillin-resistant Staphylococcus aureus) 65% of the time.
“There is the presence of bacteria on those coats,” Homan says. “[But] it has to get from that coat into the patient in a way that can cause an infection.
“A lot of things have to line up just right in order for that to happen.”
The typical chain starts with an infectious agent—a biological, physical or chemical agent capable of causing disease. Next is a reservoir (something to carry the agent) such as a human, the environment or an animal.
Next is a portal of exit, say, the respiratory tract or a person’s blood, leading to a mode of transmission, such as a sneeze or a handshake.
Next is a portal of entry—the gastrointestinal tract or the skin, for example—into a susceptible host, particularly a person already hospitalized for another reason.
“All of these pieces have to be in place for you to get an infection,” Homan says. “It’s not hard to figure how you can break the chain.”
TEXTILES AS VECTOR?
Few studies have proven that textiles have been a vector for infection, according to Homan. “It doesn’t happen often, but when it does, it affects the sickest patients or those who are most susceptible.”
A medical study published in March describes a zygomycosis outbreak associated with linens at an unidentified hospital, she says. There were nine cases of skin infection in high-risk children, and hospital linens were the only items found to be common to all cases.
“They did some sampling and found that 40% of clean linens and areas in contact with clean linens were positive for zygomycosis. And seven of the eight surface cultures from the linen (supply) company’s facility were positive.”
The hospital changed linen supply companies, replaced all linen and disinfected its linen storage areas, and the outbreak was stopped.
Hand hygiene, the use of personal protective equipment, environmental hygiene, instrument reprocessing, linen reprocessing and infection-control best practices are just some of the tools at your disposal, Homan says.
“What we’re trying to do is break the chain of infection,” she says. “Just put something in place to stop it from moving from the reservoir to the portal of exit, or from the portal of exit to the portal of entry. Do something to stop that.”
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