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No hand hygiene? It could cost you
Outbreak spurs UPMC to set fines
At the first sign of nosocomial spread of Acinetobacter baumannii, the University of Pittsburgh Medical Center Presbyterian took a bold stance. Hospital employees and physicians would be held accountable for their hand hygiene.
That meant nurses could be sent home if they failed to follow hand hygiene procedures and physicians could be fined $1,000 or even lose their hospital privileges.
The tough policy got everyone's attention. The heightened awareness of infection control helped stem an outbreak, as cases of acinetobacter declined. It also showed how education and commitment could rally health care workers around hand hygiene.
"We have not fined a single physician nor have we had to send a single employee home, which is what we wanted," says Holly Lorenz, RN, MSN, chief nursing officer at UPMC Presbyterian and chief nurse executive at UPMC's 21 hospitals. "It was a great opportunity for us to heighten everyone's awareness. 'Wash your hands.' That's the No. 1 prevention, whether you're in the hospital or at home, to prevent the spread of infection."
Hardy bacteria a threat in ICU
Acinetobacter is a gram-negative bacteria that has been especially troubling in recent years because it has developed resistance to multiple antibiotics. While it is not a threat to healthy people, it can cause serious problems in a hospital environment, says Alexander J. Kallen, MD, MPH, medical officer in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention.
"It is very hardy in the environment and it can live for a very long period of time on surfaces," says Kallen, who notes that acinetobacter can be spread by contaminated equipment or on the hands of health care workers.
UPMC Presbyterian typically saw two to three patients a month in the 156-bed ICU who had acinetobacter. When surveillance showed that five ICU patients had the bacteria, the hospital sprang into action.
"This is one of those infections that we've got to crush and attack immediately," says Lorenz. "One of our worries with this infection is that because it is resistant to some of our newer drugs, we're relying on antibiotics that are older. Those old antibiotics are a lot more toxic to the body."
Infection control worked with hospital executives and human resources to develop the outbreak-related policy. They placed a blue line above the door of rooms with patients with acinetobacter (in addition to the usual sign indicating the level of infection control precautions needed). Antiseptic hand gel containers were ubiquitous. Monitors observed whether employees and physicians performed hand hygiene and offered reminders.
The disciplinary action only went into effect if an employee, physician or medical resident was not compliant despite a reminder.
Awareness lasts beyond outbreak
Both awareness and surveillance were important aspects of the infection control campaign. The hospital held educational forums for workers with patient contact, including housekeeping and maintenance. Patients were identified with a banner bar on the electronic medical record, and if they were transferred to another department for tests, they wore a yellow gown and had a yellow gown draped on their blanket.
"We sent a special announcement to every associate at the hospital through email. We used screensavers on PCs and we have a robust physician communication module here through our MedCall, our communication for physicians," says Lorenz.
By also initiating surveillance culturing of some of the patients admitted to the ICU, the hospital was able to detect patients coming with acinetobacter, an infection that is sometimes seen in long-term care facilities or in patients who are admitted with wounds from trauma. UPMC also randomly cultures the hands of health care workers, with their consent. They have not found acinetobacter on hands of employees, says Lorenz.
"Our attention to hand hygiene has always been high," she says. "We just upped the ante for an infection we wanted to make sure we could minimize what's in our hospital."
With the enhanced vigilance, the cases of acinetobacter dropped. But the hospital is still benefiting from the new awareness, and infection control is a routine topic at staff meetings. "We're keeping this in the forefront of all our caregivers' minds," says Lorenz.