Infection monitoring 101

Starting a program from scratch

When Lillia Rosenheimer, MPA, RN, associate director of nursing at Community Home Health in San Pablo, CA, was asked to do an illness and safety manual for a former employer, she had to look at the agency’s infection log — a document that was supposed to note any infections that occurred among staff and patients. "Nurses were supposed to write it down and tell their supervisors. But the reality was, they didn’t."

Rosenheimer says getting nurses to fill out an additional piece of paper would be next to impossible. She knew she had to come up with a way to monitor infections that came from existing documentation. "I thought about using change orders, but doctors didn’t want to sign an order if something was done in their office — like if a prescription was written or something."

She went to one of the labs she used. They were working to put physicians on-line so lab results could be sent directly to the doctors’ offices from the lab. By talking with office staff, Rosenheimer was able to get secretaries to send her copies of culture reports that provided her with confirmation of infection.

"Once you find out the level of infection, you can look at the numbers over a course of a year and notice what is high and what isn’t," she says. "Then, you can start to do something about it."

Rosenheimer’s program is in use at her new agency, as well as at other facilities around the country. In conjunction with another infection control expert, Freida Embry, RN, director of risk management and infection control for Lifeline Home Health Care of Somerset, KY, Rosenheimer has been working on a study that compares infection rates across four agencies that have the same monitoring process in place.

"We really don’t have any national benchmarking rates on infection," Rosenheimer says. "For a fee, you can get comparison figures to other groups, but that information isn’t out there in the literature."

The agencies involved in the study — which Embry and Rosenheimer hope to publish in 1997 — have already seen results from their efforts. In mid-1994, the agency in Indianapolis noted a huge increase in bladder infections, Rosenheimer says. Possible causes: new staff, new caregivers, or Foley catheters. Agency staff noted that it was a very hot summer, and that patients didn’t have air conditioning, were not drinking enough, and were not opening their windows. The agency immediately started a campaign to get clients to drink more fluids. The next month, bladder infections were down to zero.

"If they hadn’t been monitoring infections effectively, they wouldn’t have noticed the jump," she says.

Device-related infections are most common

For those starting a monitoring program, Rosenheimer says the best bet is to begin with device-related infections, says Rosenheimer. "We can have more effect on that," she says. "With shorter lengths of stay, with doctors doing flu shots themselves, and less prevention programming, the population turns over too fast for us to monitor other factors."

Wound infections, although part and parcel of daily home care visits, are harder to monitor than device-related illnesses, she says. "Treat ment changes frequently with wound care, but that is not necessarily due to infections," she says. "It could be that you were using the wrong product. There are no conclusive numbers on wounds. It is easier to stick to IVs, ventilators, or catheters. It is an area where we can teach family and patients proper care, and where our own policies can have an effect."