Prevention of Multidrug Resistant Organism Infections: Hand Hygiene
Hand hygiene is the biggest strategy for reducing hospital acquired infections and one of the hardest to get people to follow. Compliance rates remain less than 100%. Healthcare workers should wash their hands with conveniently located soap (the preferred method) or an alcohol based hand rub (except when the patient has C. Difficile):

• Before direct contact with a patient
• Before preparing and giving medications
• When their hands are visibly dirty (soiled with blood or other body fluids) or after using the toilet
• Before touching a contaminated part of the body and then planning to touch a clean body site on the same patient
• Before preparing food
• Before and after inserting or handling an invasive device
• After contact with the patient’s environment
• After removing gloves

Gloves are essential when the healthcare worker expects to come in contact with blood or body fluids.

What else reduces multidrug resistant organisms?
The interventions needed to eradicate Multidrug Resistant Organisms include:

• Educating staff throughout the facility about hand hygiene and other control measures
• Gaining administrative support for the equipment and personnel needed to adhere to infection reduction practices
• Directly observing healthcare providers to determine if they are adhering to practices
• Carefully using of antibiotics
• Keeping track of Multidrug Resistant Organisms infections in order to measure the effectiveness of the infection reduction program
• Cleaning and disinfecting the healthcare environment
• Treating patients who are colonized but not infected by daily bathing with antimicrobial soaps, especially with MRSA
• Using standard precautions (also known as Universal precautions)

Standard Precautions versus Contact Precautions
Standard precautions are designed to limit the healthcare worker’s contact with secretions, biological fluids, skin lesions, mouth, blood or body fluids. In these situations, the provider wears gloves for each contact that may lead to contamination. The provider wears gowns, masks and eye protection where contamination of clothing or the face is expected. Standard precautions also include washing hands immediately after removing gloves, taking care when handling sharps used on the patient (to avoid needle punctures), and promptly cleaning up spills of infective material. The healthcare worker also ensures that waste is appropriately handled and that contaminated patient care equipment is either discarded, disinfected or sterilized between each patient use.

Standard Precautions versus Contact Precautions
Contact precautions are designed to prevent transmission of organisms that are spread by direct or indirect contact with the patient or the patient’s environment. It is preferable to have the patient in a single room and when that is not possible to be with a patient who is at low risk for getting the infection or already has the same infection. (This is called cohorting.) A low risk roommate has no major wounds or tubes and a good immune system. Healthcare providers caring for a patient on contact precautions should wear a gown and gloves for all interactions that may involve contact with the patient or potentially contaminated areas in the patient’s environment. The gown and gloves are discarded before leaving the room in order to contain the organisms.

Progress in Reducing Healthcare-Associated Infections
The news is mixed on how we are doing as a nation in reducing infections within healthcare facilities. A Federal Steering Committee for the Prevention of Health Care Associated Infections set goals for reducing these infections. Here are the highlights.

In 2013, U.S. Hospitals were on track to meet these goals.
1. Reduce central line-associated blood stream infections by 50% in ICUs and general nursing units.
2. Reduce MRSA invasive infections within the community by 50%.
3. Reduce surgical site infections by 25%.

In 2013, U.S. hospitals were not on track to meet these goals:
4. Reduce C. Difficile hospitalizations by 30%.
5. Reduce C. Difficile infections which developed in the healthcare facility by 30%.
6. Reduce catheter-associated urinary tract infections by 25% in ICUs and general nursing units.
7. Reduce MRSA invasive infections within the hospital by 25%.

As you can see, there is still a lot of work to be done to protect patients from developing hospital acquired infections.

See these blog posts for details of the multidrug resistant organisms: part 1 and part 2.

At Med League, we supply well-qualified nursing and physician experts for infection as well as other cases. Contact us for help with your next case.