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A New Approach to Reducing the HAI Burden

The prevention of hospital-acquired infections (HAIs)—particularly bloodstream infections (BSIs) and ventilator-associated pneumonia (VAP)—has become a focus of critical care and a marker for quality among ICUs due to their significant burden. Under rules created by the CMS, a catheter-related BSI (CR-BSI) is now considered one of the preventable complications that will not be incrementally reimbursed. As a result, hospitals are more closely scrutinizing rates of HAIs and increasingly making efforts to reduce their impact. Assessing Potential Strategies In the March 2010 Archives of Surgery, my colleagues and I published a retrospective analysis of data collected 6 months before and after institution of a chlorhexidine gluconate bathing protocol in a trauma ICU. Chlorhexidine is an antiseptic preparation that has demonstrated broad activity against yeasts, viruses, and bacteria (including multi-drug resistant organisms, such as MRSA and Acinetobacter baumannii). The study compared the efficacy of daily bathing with washcloths impregnated with 2% chlorhexidine with that of disposable washcloths without this substance to determine the effect on HAI rates as well as its effect on the rate of isolation of multidrug-resistant organisms. “Using routine decontamination bathing regimens may help decrease the potential for organism transmission.” We observed that introduction of 2% chlorhexidine gluconate to routine, daily whole-body bathing of trauma ICU patients was associated with a significant reduction in the incidence of CR-BSIs. While the incidence of VAP was not significantly affected by chlorhexidine baths, patients who received these baths were less likely to develop MRSA VAP. The rate of colonization with MRSA and Acinetobacter was significantly lower in the chlorhexidine group than in the comparison group. The intervention also appeared to change...

Helpful Guidelines on Hand Hygiene in Healthcare

Throughout the world, surveillance and prevention of healthcare-associated infections (HCAIs) have become a greater priority for institutions committed to making healthcare safer. These infections have been associated with prolonged hospital stays, long-term disability, increased resistance of microorganisms to antimicrobials, massive financial burdens, high costs for patients and their families, and excess deaths. One prominent reason for the spread of HCAIs has been poor hand hygiene. In an effort to address this issue, the World Health Organization (WHO) issued guidelines on hand hygiene in healthcare in May 2009. Available at www.who.int, the guidelines offer a thorough review of evidence as well as specific recommendations to improve hand hygiene practices and reduce transmission of pathogenic microorganisms to patients and healthcare workers (HCWs). “The new WHO guidelines are an extension to recommendations issued by the CDC in 2002,” explains Maryanne McGuckin, ScEd, MT, who was on the task force that created both the WHO and CDC guidelines. “They provide an extensive literature review and inform clinicians on strategies for improvement that have tested successfully.” The WHO guidelines are designed to be used in any setting in which healthcare is delivered. Individual adaptation of the recommendations is encouraged, based on local regulations, settings, needs, and resources. Assessing Practices & Adherence According to the WHO guidelines, understanding hand hygiene practices among HCWs is essential to planning interventions. Adherence by HCWs to recommended procedures has been reported with significant variation, reaching unacceptably poor levels in some cases. Risk factors for poor adherence to hand hygiene recommendations have been well-documented, and there appears to be an inverse relationship between intensity of patient care and adherence to...
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