Journal Reviews

ICPs are a key part of patient safety puzzle

But look to other fields to learn new skills

Barnard BM. Lessons from others: Integration in patient safety programs. Editorial AJIC 2002: 30:259-260.

The key to a successful patient safety program is integration of people, functions, and information, the author emphasizes. There is no doubt that nosocomial infections are a safety issue and that infection control professionals should be included among the many disciplines contributing their knowledge to the health care/patient safety domain.

"Although infection control professionals have much to contribute to the health care safety domain — an expertise in the development of surveillance systems, an ability to use evidence-based information, and an ability to educate and communicate at all levels in health care — we also have a lot to learn," she notes. "Other disciplines provide us with keen insights into approaches that might be applied to decreasing infectious adverse outcomes."

Although the title of the landmark 1998 Institute of Medicine (IOM) Report is "To Err is Human," endeavors over the last several years have clearly focused on the role of poorly designed and implemented systems of care in the occurrence of errors. The IOM’s second report in 2001 — Crossing the Quality Chasm: A New Health System for the 21st Century — may in the end, have a more sweeping impact on the health care system as a whole, she notes.

"It is a call for a total shift in the way health care is delivered, in the roles and responsibilities of patients and families, and in the role, self-image, and work of frontline health care workers," she says.

The support for these initiatives has been great among government agencies, the business community, health care insurers, accreditation agencies, health care providers, and patient advocate groups. "The train has left the track and is gaining great momentum," she says.

The time has come to take VRE seriously

Little-feared bug helped create first VRSA

Mayhall CG. Control of vancomycin-resistant enterococci: It is important, it is possible, and it is cost-effective. Editorial. Infect Control Healthcare Epidemiol 2002; 23:420-423.

With the onset of the first clinical case of vancomycin-resistant Staphylococcus aureus, it is time to shake off the "malaise" in the hospital epidemiology and infection control community about the need to control the spread of vancomycin-resistant enterococci (VRE), the author of this editorial argues. "In the past decade, VRE have spread throughout the country, and the only places where they have not been found are probably in places where no one has looked," he says.

There have been persistent perceptions that VRE are not pathogenic; it is impossible to prevent spread in hospital populations; and control of VRE is not cost-effective. On the contrary, he says, there are data from several studies that document the pathogenicity of VRE and a large number of studies showing that VRE can be controlled by use of the 1995 recommendations by the Centers for Disease Control and Prevention (CDC). Moreover, the possibility that VRE may transfer genetic elements that code for vancomycin resistance to strains of methicillin-resistant S. aureus — present at the same time in patients colonized with VRE — should also provide a strong impetus for implementation of control measures. The vanA gene has been transferred in vitro from Enterococcus faecalis to S. aureus, and was observed for the first time in a clinical isolate of S. aureus in Michigan in June 2002.

"It is time for a renewed effort to control VRE," he says. "It is important, it is possible, and it is cost-effective."