This case study entitled “Airborne Infection Control Case Study: Bay Oaks” (n.d.) describes a rare success story in the fight against Hospital Acquired Infections (HAIs) or “superbugs” as they are sometimes called. This Miami assisted-living facility has virtually eliminated HAIs, using a system called Novaerus HAI Eradication Technology that filters and processes all the air within the building, including all common areas and the rooms occupied by the home’s residents. A typical resident in Bay Oaks is 84 years old and female, and the oldest resident is 102. A spokesperson noted that if a resident becomes ill and needs hospitalizing, they return in a weakened condition and are then more likely to fall victim to infections and respiratory problems, especially after surgery. Whilst Bay Oaks rigorously observes all normal practices for infection prevention including hand washing, cleaning of rooms and frequent linen changes, the Novovaerus airborne infection control system has made a difference. All air passes through a “disruptive plasma field” emitting harmless electrons which destroy the “protein bio-fields of viruses” as well as breaking down bacteria cell walls and denaturing molds, odors and allergens, all while using less energy than a single 40W lamp bulb. The system eradicates virtually 100 percent of airborne pathogens. Since installation, it is claimed that Bay Oaks residents and staff “have never been healthier”.
Questions: 1. Is control of airborne infections the most important control method?
2. Should hand washing and other basic hygiene routines be maintained?
As reported in “Methicillin-Resistant Staphylococcus Aureus (MRSA)” (2004), outbreaks of MRSA, one of the commonest of the antibiotics-resistant so-called “super bugs”, have increased in recent decades. According to the article, such infections have not been restricted to hospitals, but have also been found in the community and in long term care facilities (e.g. nursing homes) where studies have indicated rates have ranged from 25 to 35 percent. Although infection can be by indirect contact (e.g. from inanimate objects such as bed linen, utensils, etc), the most likely source is via direct contact with what are termed “reservoirs”, which can be staff members, other patients, or visitors, who may be colonized with the bug without being themselves infected. MRSA in residents in Long Term Care Facilities (LTCFs) such as nursing homes is more likely following hospitalization. Surgery wounds are the most likely to become infected, although catheters, etc can also be the source. Studies have shown that while basic methods of infection control (washing of hands, general hygiene, etc) are important, colonization should not be confused with infection, to avoid excessive and perhaps unnecessary treatment with antibiotics. MRSA has acquired resistance to several antibiotics, but vancomycin continues to be effective against most MRSA strains.
Questions: 1. When are LTCF residents more susceptible to MRSA infection?
2. Why is vancomycin the most used antibiotic for treating MRSA?
“Patient Safety Authority Examines Nursing Homes with High and Low Infection Rates to Identify Barriers for Best Practice Implementation” (Sept 2012), describes a study undertaken in Pennsylvania. By means of a combination of a survey, a series of interviews and clinical observations, the authority assessed the implementation of a total of 50 “evidence-based infection prevention best practices” to determine care patterns that could be targeted to improve the situation. Best practices cited include what the article calls “hand hygiene protocols” and prevention of infections of the urinary tract. It was found that the nursing homes having higher rates of HAIs implemented these practices less well than homes with lower HAI rates. In total, the seven areas assessed were: “hand hygiene, environmental, urinary tract infection (UTI), respiratory tract infection (RTI), gastrointestinal (GI) and multidrug-resistant organism (MDRO) infection, skin and soft-tissue infection (SSTI) and outbreaks.” For all nursing homes surveyed, rates of infection were lowest where hand hygiene procedures were fully implemented, emphasizing its importance. However, some nursing homes featuring high HAI rates were nonetheless better in respect of such aspects as implementing a plan, educating staff, documentary systems, formal monitoring and assigning accountability for control of outbreaks.
Questions: 1. What seems to be the most important HAI preventive measure?
2. Why is that the most effective way to prevent MRSA outbreaks?
“MRSA: A Challenge to Norwegian Nursing Home Personnel” (2011) is a research article published in the journal Interdisciplinary Perspectives on Infectious Diseases. The article describes a study of 388 nursing home staff in 42 Oslo nursing homes, in an environment where in accordance with Norwegian guidelines healthcare workers (HCWs) are tested if previously exposed to MRSA and are excluded from work if found to be carrying it. Over 50 percent of those questioned were concerned about becoming infected and the effects on their social life, their family, work restrictions and the effect on their economy. Those concerns were based on the old and therefore unsuitable buildings (difficult for infection control), and the low levels of staffing – many without healthcare training or education – and inadequate cleaning and decolonization procedures, as well as a lack of facilities for isolation of MRSA patients. These anxieties were exacerbated by Norwegian MRSA guidelines permitting freedom of movement within the nursing homes for patients with “persistent MRSA infections.”
Questions: 1. Should MRSA-exposed HCWs be excluded from work?
2. What changes would you make to Norwegian MRSA guidelines?
“Clostridium Difficile Infections in Nursing Homes” (March 2010),discusses the increasing numbers of clostridium difficile infections (CDIs), particularly in nursing homes because elderly patients are especially susceptible due to lower immune functionality and are more likely to suffer what the article calls “adverse outcomes.” It reports that mandatory reporting of what it calls healthcare-acquired infections (HAIs) begin in 2009 in Pennsylvania nursing homes and the figures for the third quarter of that year show that CDI was the cause of circa 40 percent of all gastrointestinal infections in nursing homes across the state. As a consequence, the key to increasing the safety of the environment in these healthcare facilities is the implementation of risk-reduction strategies, including basic infection prevention measures and the “judicious” use of antibiotics, because it has been found that prescribed antibiotics can actually be a cause of a CDI outbreak.
Questions: 1. Why are the elderly more susceptible to CDIs?
2. Why should antibiotics be used “judiciously” in nursing homes?
References
“Airborne Infection Control Case Study: Bay Oaks.” (n.d.). Retrieved from http://www.slideshare.net/Novaerus/novaerus-bay-oaks-case-study-1-revised-51413
“Clostridium Difficile Infections in Nursing Homes.” (March 2010). Pennsylvania Patient Safety Authority Vol. 7, Suppl. 1—March 18, 2010. Retrieved from http://www.henrythehand.com/wp-content/uploads/2011/02/C.-Dif-article-2010.pdf
“Methicillin-Resistant Staphylococcus Aureus (MRSA).” (2004). Retrieved from http://www.ndhealth.gov/disease/documents/resources/mrsa%20book/mrsavre.pdf
“MRSA: A Challenge to Norwegian Nursing Home Personnel.” (2011). Interdisciplinary Perspectives on Infectious Diseases (journal). Retrieved from http://www.hindawi.com/journals/ipid/2011/197683/
“Patient Safety Authority Examines Nursing Homes with High and Low Infection Rates to Identify Barriers for Best Practice Implementation.” (Sept 2012). Pennsylvania Patient Safety Advisory. Retrieved from http://www.prnewswire.com/news-releases/patient-safety-authority-examines-nursing-homes-with-high-and-low-infection-rates-to-identify-barriers-for-best-practice-implementation-168591516.html
