Working to reduce hospital
Reducing hospital acquired infections, such as Clostridium difficile, Methicillin-Resistant Staphylococcus aureus (MRSA) and ventilator-associated pneumonia, to name a few, is a priority at St. Joseph’s Health Centre.
With the arrival of Dr. Jennie Johnstone, the new Infection Control Officer and Dr. Mark Downing, antibiotic stewardship physician, St. Joe’s has been able to provide additional resources to support their work toward infection prevention and control.
“Increasing the overall profile of the Infection Prevention and Control Department is one of my key responsibilities as well as overseeing the surveillance of antimicrobial-resistant organisms, C. difficile and other hospital-acquired infections. I also help to identify problems, such as C. difficile outbreaks, and work to implement the appropriate measures during an outbreak,” says Dr. Johnstone.
The best strategy is prevention when it comes to hospital-acquired infections explains
Dr. Johnstone. “HAIs are associated with significant morbidity and mortality and increased patient lengths of stay. If our goal is to keep our patients safe then preventing HAIs is essential and is a hospital priority.”
One major area of focus for St. Joe’s as part of their quality strategy is reducing the spread of C. difficile, with a goal of decreasing the number of cases by 30 per cent by March 31, 2013.
“C. difficile is an ongoing challenge for all hospitals in the province and one that doesn’t appear to be going away,” Dr. Johnstone says.
“People are at increased risk for C. difficle when they are older, have multiple co-morbidities and are exposed to antibiotics. As the population ages and becomes more frail, it’s only getting harder (to fight C. difficile) because these are the individuals who are at higher risk for C. diffcile,” she adds.
A three-pronged strategy to support this goal in reducing C .difficile cases includes focusing on hand hygiene, environmental cleaning and antimicrobial stewardship.
“Being vigilant about hand washing with running water and soap and using alcohol-based hand sanitizer is key,” says Dr. Johnstone. “There are many benefits of hand washing that don’t just apply to C. difficile but to all organisms and also prevents infection in health care providers.”
Environmental cleaning practices that follow the Provincial Infectious Diseases Advisory Committee (PIDAC) guidelines are essential in stopping the spread of C. difficile. Infection Prevention and Control works closely with the Environmental Services team to ensure regular cleaning, using the appropriate sporicidal cleaning products, since
C. difficile spores are extremely difficult to kill.
Through antimicrobial stewardship, Dr. Johnstone explains that, “Our goal is that we don’t want to have anyone on an antibiotic that isn’t necessary (so that they don’t end up with C. difficile).
With Dr. Downing’s arrival to St. Joe’s as the antibiotic stewardship physician, he has been able to bring his infectious diseases background and in-depth knowledge of antibiotics to work in partnership with Brad Langford, the lead pharmacist for the Antimicrobial Stewardship Program.
“Antibiotic stewardship is a method of optimizing a patient’s antibiotic therapy, to improve their outcomes, making sure you cure the infection but at the same time, reduce any unintended consequences of therapy such as side effects, opportunistic infections (C.difficile), and reduce resistance rates,” explains Langford.
Stewardship has many components to it, including education and daily reviews of patients on antibiotics to make therapy recommendations to the patient’s physician, said Langford. Often times, recommendations include reducing antibiotic use by shortening the duration, changing the antibiotic to one that is a “narrower spectrum” (so it affects less organisms in the patient’s body), changing the route of antibiotics from intravenous to oral or changing the dose to optimize the dose level (higher or lower) to avoid unintended outcomes.
“Through working with Dr. Downing, it gives our recommendations that much more power because cases have been reviewed by both the pharmacist and a physician,” explains Langford. This ongoing collaboration will help to ensure that antibiotic use in patients continues to be monitored so that antibiotic usage and patient treatment options are examined thoroughly to minimize risk.
“I find physicians are very receptive to our advice. Brad has been very successful in setting up the program and has had a good response across the board. They are accepting to what we do and eager to have our advice,” says Dr. Downing. “Everyone knows that C.difficile is one of the big issues that face not only St. Joe’s – but all hospitals in general – and physicians are interested in doing what is necessary to reduce those rates.”
The link between antibiotics and preventing hospital acquired infections like C. difficile is important because while they can be life saving, there is a fine balancing act to ensuring that patients who do need antibiotic treatment are on the right one, for the right amount of time.
Sustaining strategies that involve education, ongoing reviews of practices and processes, and continuous collaboration across the organization are critical to maintaining a safe environment for patients and our staff.
“Infection prevention and control, at times, requires thinking outside the box and there is a lot of room for innovation and new ideas within this area to explore (to keep patients safe),” says Dr. Johnstone.