You won’t find two stronger proponents of good, old-fashioned hand hygiene than Donna Neufelder and Mellodee Montgomery. Neufelder, executive director of quality management at St. Mary’s Health System, could tell you some toe-curling stories about what the human hand touches in the span of a day, or even in a matter of minutes, that would make most adults think twice before ever placing a finger in their mouth again.
Ensuring good hand hygiene, as simple as it sounds, is the first step to battling pesky staph infections that attack people with lowered immune systems, leaving hospital patients particularly vulnerable. Methicillin-resistant Staphylococcus aureus, commonly known as MRSA, is a type of staph infection carried by one in three people. Though it is hardly noticeable most of the time, when a carrier’s immune system drops, the usually benign bug can become contagious and dangerous, even leading to death in extreme cases.
While staph infections will always be a reality in health care facilities, the use of aggressive practices to identify and treat potential patient carriers has decreased their prevalence in hospitals over the past decade.
At the forefront of those practices is hand washing.
“We just teach and preach hand hygiene,” says Neufelder, who has worked in the quality arena for St. Mary’s for the past six years. “The basic expectation for every health care worker is that they wash their hands before and after every patient contact, that they use their non-sterile gloves with every patient contact, and they change gloves between every procedure that they do.”
Yet, it’s human nature that the simplest things to consider are often the first forgotten, says Montgomery, a medical technologist at Deaconess Health System. “We do a lot of screens to make sure everybody cleans their hands,” she adds. “You may wonder why there would be such a campaign for that, but people forget the simplest things, and hand hygiene is the number one way to prevent the spread of infection.”
Antibiotic stewardship, the practice of optimizing antimicrobial therapy for viral infections, is also a key tenet of hospitals’ attempts to fight staph infections. The early prescription of a strong antibiotic to cure a staph infection may actually make the next generation of that infection more resistant to a stronger antibiotic. Stewardship encourages the health care team to adopt a stepping stone approach to fight infections, working up to a drug strong enough to cure the infection, yet not resorting to the strongest antibiotic first.
The Battle Begins
The first step in battling staph infections is to evaluate new patients as they arrive, Montgomery says. Detailed histories and physicals can immediately give hospital personnel vital information to consider, such as whether the patient came from a nursing home or other setting where they may live in close quarters to staph carriers, or whether the patient may have an open wound. If any red flags are raised during this process, a nasal screen can determine if a patient has a staph infection within two hours.
“Even if the MRSA on the patient isn’t causing them any problems at the moment, it could potentially cause them problems in the future,” Montgomery says.
As a precautionary measure to protect patients, health care workers, and visitors, infected patients are put in “contact isolation,” meaning they are placed in single rooms and health care workers wear a gown and gloves to protect themselves. Aside from protective equipment, workers still wash their hands.
Both hospitals practice “bundles,” a checklist of items to do or consider when dealing with situations that can give rise to staph infections, including methods to prevent ventilator-associated pneumonia, central line, or catheter insertion.
St. Mary’s implemented its ventilator-associated pneumonia bundle several years ago, including several standard practices such as keeping the head of the patient’s bed up at 35-45 degrees to prevent drainage into the lungs, as well as regular mouth care, and a daily sedation vacation. “We give them a chance every day to see if they can breathe on their own and come off of the ventilator,” Neufelder says.
The central line insertion bundle is another key set of guidelines. Any time a line is being inserted into a patient, that patient has an increased chance of infection. A central line goes into one of the main veins of the body that goes directly to the heart. Bacteria has a straight shot to the heart once that line is introduced, putting those patients at extremely high risk for contracting hospital-acquired infections.
Hospitals have been very successful in limiting central line infections over the past decade. In fact, according to the Centers for Disease Control and Prevention, the number of central line infections in intensive care patients has dropped by 58 percent since 2001.
“It’s a constant battle to ensure that we are keeping ourselves safe in the process of giving good care,” Montgomery says.
For more information on staph infections, visit www.cdc.gov.
Under Your Skin
MRSA is a crafty little bug. The constantly evolving “staph” germ is the leading cause of hospital infections. Since one in three people carry the bug, it’s nearly impossible for hospitals to eradicate infections.
The bug is part of the normal flora of organisms living on its carrier’s skin or nasal membranes. MRSA particularly likes the nose, but can also flourish in armpits or groin areas. Normally, the infection won’t cause its victim any problems, unless the carrier’s resistance to disease decreases.
Then, MRSA can become deadly. During times of weak immunity, the bug (or, in scientific terms, the microorganism) can go from the skin and into the bloodstream where it can travel just about anywhere.
Most staph germs are spread by skin-to-skin contact, leaving doctors, nurses, other health care providers, and even the patient’s family and friends capable of spreading the germs to the patient.
The microorganism is constantly evolving so that even if the parent bug can’t survive in its immediate surroundings, its offspring often can. Improper use of antibiotics to treat MRSA and other staph infections can actually have the opposite effect, making the infection worse (which is why completing the recommended prescription is important).
MRSA infections aren’t hospital exclusive. Healthy, uninfected individuals can be exposed in locker room facilities, day cares, public gyms, or anywhere there are people.
