Achieving a low healthcare-associated infection (HAI) rate seems simple until challenges arise. No quick, one step solution exists for hospitals. Only multiple strategies working together reduce the risk of error and lower HAI rates. Such strategies include frequent training reviews, successful interventions, and effective use of HAI surveillance.
According to Doctor Donald E. Fry, adjunct Professor of Surgery at the Northwestern University Feinberg School of Medicine in Chicago and Emeritus Professor of Surgery at the University of New Mexico, “you can do 48 out of 50 things correct, but 1 or 2 violations will result in a patient getting an infection.”
Through frequent training reviews, hospitals are capable of lowering the risk of misusing sterilization products, helping lower HAI rates. Hospital staff may misuse a sterilization product because they may not know the details that are required for appropriate use, or, as Dr. Fry points out, they may be misinformed, believing the label requirements do not make a difference. After years of working, their performance may have relaxed, without conscious awareness, when it comes to certain procedures. “We all need a refreshment on what we should be doing,” proclaims Dr. Fry.
Training is not the sole option for hospitals to lower their infection rates. Dr. Fry believes feedback of care is an important intervention to put into place. Nurses in the OR are not always aware of the results of their care. Hospitals could obtain such feedback for nurses by requiring staff to complete surveys, for example. By knowing how their actions affect the patient’s experience after surgery, nurses can better assess their performance and correct their actions. The same feedback intervention would also be beneficial if applied to surgeons and doctors.
If a patient develops an HAI, feedback may have insight into actions that may have impacted the development of the infection. With feedback hospital staff continually grow professionally and hospitals can better assess areas where training may be needed.
Several reports claim that 1.7 million patients develop an HAI each year, while others claim more conservative numbers around 700,000. This inconsistency may not be intentional because, as Dr. Fry informs, no standardized definition or categorizing based on severity for HAIs exist. All infections, no matter how serious, get summed into one count. This becomes problematic when some hospitals do not report trivial wounds, while other hospitals are strict in reporting every infection into their count.
Summing up HAIs into one number is an ineffective way to track an HAI rate. Hospitals must take in account the severity of the HAI, says Dr. Fry. How are hospitals supposed to know what areas they need to improve on, if they do not know how serious the infections were?
Effective surveillance is vital in determining opportunities for improvement. The truth is, it is insufficient to document only the number of HAIs. Hospitals need to have a strong system in place that will effectively keep track of how serious each infection is and the preexisting HAI risk of each patient. By taking into account the severity and risks, hospitals are able to determine areas needing improvement. Dr. Fry recommends that hospitals begin developing focus groups to determine why certain patients acquired serious infections.
If a hospital realizes their SSI rates are higher than average, they can put more emphasis on skin preparation before insertion, antibiotic use, and their overall procedures in the OR.
A hospital’s own HAI information may be difficult to interpret without the right definitions in place, so how is the public expected to interpret the numbers? When people see the high HAI rates, they do not consider outside causes that lead to higher numbers. Some hospitals may have strict reporting policies. Hospitals with trauma and emergency surgery services tend to have larger HAI rates no matter if they report all infections or only the serious ones.
“The reality is when one takes care of lots of patients…there is a higher risk of a patient getting an HAI or SSI,” says Dr. Fry.
In Dr. Fry’s opinion, the public assumes hospitals are always responsible for their high HAI rates even though external influences may be to blame. Therefore, there is a heightened sense of accountability for some hospitals whose HAI rates are higher. High HAI rates can be present within a higher risk population, even if the hospital offers excellent care.
If a patient comes in with serious abdominal wounds and after surgery, even they develop a minor SSI, that surgery is considered successful because the patient was already at high-risk for an infection. A patient coming in for an elective breast surgery and acquires an HAI, the hospital should investigate the situation because there was a low-risk of infection from the start.
Hospitals need to begin surveillance of HAIs as soon as possible. Once an effective way is established to track HAIs and their severity, the hospital can begin further improving procedures by creating focus groups, giving feedback, and tracing issues to the root the problems. Hospitals should begin working with their staff to determine the best way for them to track HAIs and reduce their infection rates.