Bundle Up to Fight Infections: Patient Safety Efforts Widen to Help Hospitals Combat Antibiotic-Resistant Bacteria

By Kehoe, Bob | Health Facilities Management, December 2015 | Go to article overview

Bundle Up to Fight Infections: Patient Safety Efforts Widen to Help Hospitals Combat Antibiotic-Resistant Bacteria


Kehoe, Bob, Health Facilities Management


In 2012, South Seminole Hospital in Orlando, Fla., began a broad-based initiative to improve patient safety and reduce health care-associated infections at the 200-bed facility. All links in the infection prevention chain were examined as part of a systemwide movement within Orlando Health, a seven-hospital system. The efforts produced impressive results.

"After a year, we had solid data from South Seminole Hospital," notes Tom Kelley, M.D., chief of quality and clinical transformation for Orlando Health. "We reduced our hospital-acquired Clostridium difficile infection [CDI] rate by 47 percent even though community-acquired C. difficile rose by 7 percent during this time."

The facility also reduced hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) by 30 percent and hospital-acquired vancomycin-resistant enterococci (VRE) by 50 percent, Kelley notes.

Bundle up

An evolving bundle of interventions implemented by the clinical and quality staff, environmental services (ES) personnel, infection preventionists and others led to the safety improvements. The measures included stepped-up efforts to monitor hand-hygiene compliance, including reporting and auditing findings by department, which led to greater peer accountability. Antibiotic stewardship became a deeper systemwide focus. Previously, ultraviolet light (UV) disinfection was added as a supplemental step to terminal cleaning in the intensive care unit, operating rooms and all contact isolation precaution rooms.

Other steps were taken in what was reminiscent of a previous multilevel effort that cut surgical-site infection rates by 30 percent throughout the Orlando Health system.

"What we've learned is there doesn't seem to be a single magic bullet," Kelley says.

Leading infection prevention organizations, patient safety groups, clinical and ES leaders and others have come to this conclusion as well. In June, leaders from these areas gathered at the White House to discuss implementing the National Strategy for Combating Antibiotic-Resistant Bacteria and to address recommendations from the President's Council of Advisors on Science and Technology.

The group covered such issues as:

* Misuse and overuse of antibiotics in health care and food production.

* Implementation of evidence-based infection control practices to prevent the spread of resistant pathogens.

* New technologies like whole genome sequencing to develop next-generation tools to strengthen human and animal health.

Together, the national plan's five goals could cut by 50 percent the incidence of C. difficile compared with estimates from 2011 and carbapenem-resistant enterobacteriaceae (CRE) infections acquired during hospitalization by 60 percent.

The synergistic effect

To achieve goals like this, infection prevention experts believe there must be more comprehensive, carefully coordinated initiatives deployed across health care facilities and health systems. Likewise, more qualitative and quantitative research will be needed to demonstrate which infection prevention protocols and technologies definitively reduce HAIs.

For example, while Kelley is convinced that UV disinfection played a significant role in reducing HAIs in treated rooms, he says it's impossible to quantify the number of infections that were prevented from this or any other single measure. He believes the combination of overall efforts produced a synergistic effect.

"We think it was the combination of using UV disinfection with increased attention among patients; better communication with staff and families on hand hygiene; antibiotic stewardship; careful use of proton pump inhibitors; bagging and labeling contaminated equipment [from rooms of infected patients before sterile processing]; and cordoning off rooms after being treated with UV disinfection to prevent recontamination that helped us to achieve these results," Kelley says. …

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