Shift emphasis from surveillance to action
Focus on counting and reporting bugs 'misguided'
Concerns regarding patient safety have produced numerous pieces of new legislation focused on infection control surveillance and reporting of antibiotic-resistant organisms in healthcare facilities nationwide. National organizations such as the Society for Healthcare Epidemiology of America (SHEA) have published position papers and the Institute for Healthcare Improvement (IHI) has created "bundles" to address the important aspects of an effective infection control program to reduce the spread of antibiotic resistant organisms in our hospitals. Included in these approaches is a focus on the key role that the health care environment plays in transmission of these organisms and the need to ensure adequate cleaning of surfaces and patient care equipment.
In California, [recently passed] SB 1058 calls for more surveillance and reporting to state health departments and increased resources in infection control professionals to accomplish this task. It is questionable as to whether this approach will provide reduction in transmission risk. We propose a shift in focus and in hospital resources away from increased surveillance to increased action. What is needed are increased FTEs in the housekeeping department so that the necessary amount of time to appropriately clean the environment is allotted. Standardized education and observed competency on optimal cleaning techniques must be made mandatory as is suggested in a recent publication (Infect Control Hosp Epidemiol 2008; 29:593-599). Hospital administrators need to be aware of the key role that the Environmental Services staff play in the infection control aspect of patient safety. None of us wants to be the patient placed into a room that has not been adequately cleaned.
In January 2004, California AB 394 required minimum nursing staffing ratios to improve patient safety. Unfortunately, this resulted in a reduction of the use of certified nursing assistants. With fewer nursing assistants available, it is less common for tasks such as cleaning of unit-based equipment and patient hygiene to be accomplished. Effective control of the spread of infection — patient safety — has been compromised. Nursing assistants play a vital role in the infection control program.
Transmission of antimicrobial resistant organisms is only one component of the antimicrobial resistance crisis. Prudent use of antibiotics by clinicians and "antibiotic stewardship" within our health care facilities has long been know to be an effective method to reduce risk of antimicrobial resistance. To date, we have not seen legislation that focuses on that key element.
Counting and reporting the number of antibiotic-resistant organisms within our health care facilities is a misguided use of resources. It will not provide us with the immediate improved outcomes that we and the public desire. The rates of transmission will only be reduced by taking immediate action to increase the use of support staff to perform optimal cleaning and hygiene protocols and consistent application of protocols for prudent antibiotic use in our health care facilities.
Wendy Kaler, MT,MPH, CIC
Shabnam Hashemi, MT,RN, CIC
Infection Control Consultants