The Centers for Disease Control and Prevention (CDC) recently announced that strains of completely drug-resistant “nightmare” bacteria have quadrupled in the last decade or so, and the bugs have been lurking around in hundreds of hospitals around the nation, greatly increasing the problem of hospital-acquired infections (HAIs).
These bacteria carry special genes on a plasmid (a circle of DNA) that can be transmitted from one bacteria to another and confer resistance to the most important and useful antibiotics that we have for that class of bacteria.
While medical science searches for a solution to these nightmare bacteria, some hospitals are examining how automation can reduce the human errors that can spread this threat.
One thing is evident. If the best defense against the latest superbug scare is hand washing, we may be in a lot of trouble.
The Joint Commission requires all medical personnel to wash their hands before and after interacting with patients. In fact, the commission and the American College of Surgeons recommend placing hand sanitizers right on the patient’s bed. Yet, while self-reporting shows compliance at nearly 100 percent, “secret shopper” studies place the national average at 28 to 32 percent.
That’s a very disturbing statistic. However, even at 100 percent compliance, hand-washing protocol can be subverted if environmental and transport personnel walk into an isolation room without being forewarned to don protective clothing.
When this happens, usually because of antiquated, manually based infection control communications, these staff members and their equipment can then become carriers for hospital-acquired diseases such as MRSA, C. diff. and carbapenem-resistant Enterobacteriaceae, or CRE.
These facts have generated significant interest in two forms of hospital automation: real-time location systems (RTLS) that can automatically determine when staffers are compliant with hand-washing protocol, and early warning infection alerts generated by on-line patient flow systems.
For example, TeleTracking Technologies offers these capabilities in a hand-hygiene system that works with any RTLS system and patient-tracking software, which makes a patient’s infection status apparent in advance to all who need to know.
The hand-hygiene system monitors hospital workers’ usage of alcohol and soap dispensers on a 24/7 basis, along with their entry and exit to patient-care areas. This automated monitoring proactively alerts staff to compliance percentages via a hand-hygiene index – delivering enterprise reports that can identify units that have compliance problems or those that are doing very well. Compliance tracking can help hospitals learn where the issues are or identify how specific people have found a way to increase compliance.
The system uses infrared, motion, proximity and behavioral timeframes to confirm nurses, physicians and other staff members have washed their hands before touching anything or anyone in patient rooms.
It employs a badge-recognition process to register entry to a room and count the seconds until the entrant moves to the room’s hand sanitizer. A site-specific amount of time is allotted for this action before the entrant becomes non-compliant.
The system then uses a reading device on the sanitizer to acknowledge the staffer’s proximity and tracks the touch of the sanitizer handle or a hand motion beneath to signal and register compliance. The staffer must also engage in hand washing a set amount of seconds before leaving the room or again be judged non-compliant.
RTLS reveals the current status of resources, including infection-control information. IMAGE COURTESY TELETRACKING
Other examples of how human error factors into the spread of HAIs are wheelchairs, gurneys or other medical equipment. Equipment “gets sick” this way. An infected patient needs to go to radiology, but because most infection-control alerts are done manually and take a significant amount of time, transporters and EVS personnel often don’t get word that they are entering an isolated room. This exposure happens several times a week in some hospitals.
Since the transporter was not aware the patient was infected, he doesn’t perform the special “clean” required to rid the wheelchair of germs. Now the chair becomes a rolling epidemic, since it will be handed off to the next transporter for another patient trip, and another, and another and so on.
This “inadvertent exposure” also applies to housekeepers. For instance, when an infected patient is moved to another room, the isolation sign very often goes with that patient. When EVS personnel enter the first room to clean it, they can be inadvertently exposed. Even if they don’t become infected, they can unknowingly become disease carriers throughout the hospital.
Since these workers don’t know they have been exposed, they can spread disease to other workers, patients and family members when they go home. And, since they are the most travelled employees in any hospital, it’s reasonable to assume that they may be a cause for superbug infection moving from the ICU to the general hospital population at an alarming rate. According to the CDC, in 2009 over 60 percent of hospital-based MRSA cases reported in the U.S. were in the general medical wards, up from just 2 percent in 1970.
How often does this happen? Hospitals don’t keep statistics about “inadvertent” exposures, but the anecdotal evidence is startling.
To combat this problem, the University of Virginia Medical Center now has infection-control nurses in the patient flow loop, with exclusive control over isolation indicators in their automated patient-flow system. This replaces the old system of having IF nurses hand-deliver isolation notifications to every floor, a process that took hours to complete.
Methodist Healthcare System of San Antonio, Texas, requires infection status to be logged for all incoming patients before any bed is assigned. This system then flags and automatically disseminates patient infection status to all levels of staff involved in the care cycle, from admissions and ED, through in-patient care, and on through to housekeeping and transport workers, all in real time.
According to Susan Kilgore, R.N., vice president of patient management, the eight-hospital system made infection control one of its top priorities.
Methodist integrated TeleTracking’s Capacity Management Suite with its ADT system to track every patient move, call up patient histories and monitor bed availability. Alerts were automated to all personnel with a need to know, including housekeeping and transportation, who receive electronic notification when isolation is declared.
Methodist went one step further by including a field for isolation in its bed-request system. Placement personnel must indicate an infection attribute in the system or indicate “none” in order for the placement request to go through. This assures that infection status is addressed by all admissions personnel throughout the hospital.
To address possible equipment contamination, Methodist implemented TeleTracking’s RTLS to track all moveable medical equipment and determine which wheelchair went where with whom, and which transporter took them there.
“You need buy-in from the top down,” Kilgore says. “We had reluctance when we decided to put a full-stop on patient placement before infection attributes were defined, but when we made the senior leaders and nursing directors aware of the impact, they supported our decision.”
Beyond the obvious issue of patient well-being, another reason for that buy-in is that HAIs cost U.S. hospitals $45 billion per year, according to the CDC, and that the average HAI patient is in the hospital 20.6 days versus the national length-of-stay (LOS) average of 4.5 days – stunning numbers in light of healthcare reform initiatives to lower LOS.
Still, a recent survey by the Association for Professionals in Infection Control and Epidemiology (APIC) said only 30 percent of its membership reported that top executives at their hospitals were willing to budget for preventive measures.
HAIs already cost this nation 100,000 lives each year. That’s too great a cost for this problem to be ignored.
About the Author
Jon Poshywak is managing director, RTLS division, TeleTracking Technologies. For more on TeleTracking Technologies: www.rsleads.com/306ht-207