It is estimated that almost two million hospital patients in the United States contract a hospital acquired infection (HAI) every year, which is one out of every twenty patients (“Hand Hygiene Basics.”) These HAIs are responsible for close to 100,000 deaths per year (Anti Microbial Copper.) HAIs also cost the US healthcare system between $4.5–5.7 billion per year (Collins). It is every hospital administrator’s top concern to address this risk to protect their patients.
HAIs are primarily attributed to a small handful of bacteria: Methicillin resistant Staphylococcus aureus (MRSA), Vancomycin resistant Enterococcus (VRE), Clostrudium difficille, Psueudonomas aerciginasa and Enterobacter aerognes (Hospital Hygiene). It is thought that most of these infections that are contracted in the hospital are from bed rails, stethoscopes, hospital worker’s clothing (scrubs and white coats) and other common hospital surfaces. However, implementing a standard Hand Washing Protocol has not eliminated the risk to patients (“Hand Washing Basics.”)
A Hand Washing Protocol, however is a very important step in reducing the occurrence of HAIs. This is the first line of defense in any hospital. Health-care workers (HCWs) should be instructed on proper hand washing and use of alcohol-based hand-rubs. The World Health Organization (WHO) has developed instructional posters and materials to educate HCWs on the importance of hand washing/rubbing (“How to Handwash.”) When hands are obviously soiled, WHO recommends hand washing of 40-60 seconds. If the hands are not visibly soiled, an alcohol-based rub is recommended for 20-30 seconds (“How to Handrub”). It is also recommended that infection control practitioners be used to monitor HCWs adherence to the Hand Washing and Rubbing Protocols (Collins).
The proper use of personal protective equipment (PPE) is also important in preventing the spread of HAIs. Personal protective equipment includes gloves, protective eyewear, face shields and gowns. These are used to protect HCWs from blood and other contaminated body fluids. HCWs need to receive adequate training in the use of this equipment to ensure it maximizes the protection to both themselves and the patients (Collins).
The next step concerns HCW’s clothing. It has been demonstrated that doctors only wash their “white coats” from every 3 days to up to a year! Studies indicate this is a primary source for bacterial transfer in the hospital setting. Doctor’s white coats carry more bacteria with the longer the time between laundering. In patients with MSRA and VRE, 69 % of doctor’s white coats carried the bacteria (Hospital Hygiene). One recent study showed that up to 60% of HCW’s uniforms were contaminated, even though the employees stated they had fair to excellent laundering practices (Wiener-Well, et al. 2011).
One further step is the use of antimicrobial copper surfaces for items such as bed rails, IV poles, nurse call buttons, tray tables, etc. The use of these surfaces in a hospital in the United Kingdom reduced HAIs by 95% (Hospital Hygiene). The US Environmental Protection agency has registered antimicrobial copper as the only surface material that will kill 99.9% bacteria that cause HAIs within two hours of contact (Anti Microbial Copper). Although this material is more expensive, it is not harmful, never wears out and is recyclable.
Based on the science, I would suggest the following preventive measures to reduce the number of HAIs. First, I would recommend educating HCWs on proper “Hand Washing and Rubbing Protocols” and use of personal protective equipment. I would also suggest employing an infection control practitioner to monitor if HCWs are doing these practices and doing them correctly. An infection control practitioner would also be responsible for collecting data on how successful each of the practices is at reducing bacterial contamination. This information would be very helpful in demonstrating how effective the current program is in reducing HAIs.
Second, I would recommend the more frequent laundering of HCW’s clothing. This could substantially reduce the transmission of HAIs. It is important to have a Uniform Hygiene Protocol to instruct HCWs on the required laundering of their white coats and scrubs to minimize the spread of HAIs. It is recommended laundering occurs at least once a week, but ideally every three days (Hospital Hygiene). In order to encourage the HCWs compliance with the Uniform Hygeine Protocol, the hospital could provide laundry facilities for the staff. The hospital should also consider extending the Uniform Hygiene Protocol to include patient drapes, another source of bacteria in patient rooms.
Third, I would like to use more antimicrobial copper in common surfaces in the hospital environment. Priority will be the Intensive Care Unit and HCW’s stethoscopes. As the hospital budget allows though, I would like to start using antimicrobial copper in all patient rooms. This material could be used for the IV stands, nurse call buttons, light switches, bed rails and bed tray tables.
I believe if the hospital establishes a Hand Washing and Rubbing Protocol and a Uniform Hygiene Protocol, this will substantially reduce the incidence of HAIs in our hospital. It is also important to use an infection control practitioner and provide education to the HCWs on these protocols. As a further step, I recommend the hospital start using antimicrobial copper for common hospital surfaces in the future. These practices will save both lives and money.
Works Cited
Antimicrobial Copper. np. nd. Web. 21 Feb. 2013. < http://www.antimicrobialcopper.com/us/>
Collins, Amy S. “Preventing Health Care-Associated Infections.” National Center for Biotechnology Information. np. nd. Web. 21 Feb. 2013.
“Hand Hygiene Basics.” CDC. Web. np. nd. Web. 21 Feb. 2013.
Hospital Hygiene. np. nd. Web. 21 Feb. 2013. < http://www.hospitalhygiene.info/>
“How to Handwash.” World Health Organization. np. nd. Web. 22 Feb. 2013.
“How to Handrub.” World Health Organization. np. nd. Web. 22 Feb. 2013.
Wiener-Well, Yonit, Margalit Galuty, Bernard Rudensky, Yechiel Schlesinger, Denise Atlias, and Arnos Yinnon. “Nursing and physician attire as possible source for nosocomial infections.” Association for Professionals in Infection Control and Epidemiology, Inc. (2011): 55. Web.
