Work continues on reducing infections at ARRMC

As we return to our new normal, Asante continues to focus efforts on quality initiatives, including the reduction of hospital-acquired infections. After a spike in CLABSI cases over the winter, ARRMC’s clinical and support teams rallied to examine processes, aseptic technique and the environment to break the chain of transmission.

This diligence brought a drop in central-line-associated blood infections.

Asante engaged the Oregon Health Authority and the Centers for Disease Control and Prevention for an assessment of Asante’s action plans and to solicit feedback on other potential contributors. Both agencies commended current efforts and encouraged continuing the path of reinforcing the basics.

• Hand hygiene – every time.
• Aseptic technique for line insertions, line monitoring and maintenance, and removing lines as soon as no longer clinical necessary. Ongoing education and competency assessments are also encouraged.
• Clean environment, including disinfection of high-touch surfaces, cleanable surfaces, barriers to prevent contamination (e.g., splash guards) and proper linen storage.
• Clean equipment, including written policies and procedures and ongoing education and competency assessment.

As we move into the summer months, new CLABSI events are still occurring at ARRMC, emphasizing the need for continued efforts. A new uptick in CAUTI cases was also observed.

One of the most important means to prevent infections is to perform hand hygiene. Coat hands with alcohol-based hand rub (even if it takes a couple of squirts), rub wet hands together for 20 to 30 seconds and then until hands are dry. Wash hands with soap and water when visibly soiled or after caring for patients with enteric infections (e.g., Clostridioides difficile or norovirus). Artificial nails are prohibited.

Actions you can implement today to prevent CLABSI:

• Perform hand hygiene and refresh education on aseptic insertion, including use of full precautions and cleaning the insertion site with CHG.
• Ensure appropriate central line maintenance, performing hand hygiene before and after touching the line.
• Replace administration sets at established intervals, 400-PCS-NURS-0402.
• Promptly remove central line when no longer needed.
• Avoid excessive (daily) blood cultures, such as for streptococcal bacteremia, uncomplicated gram-negative bacteremia, and bacteremia associated with cellulitis, community-acquired pneumonia or pyelonephritis. Order a repeat culture two to four days after index culture for MRSA or if patient’s condition has not improved after 72 hours of treatment.

Actions you can implement today to prevent CAUTI:

• Perform hand hygiene and refresh education on aseptic insertion.
• Ensure patient has appropriate indications and question placement for those not meeting criteria (inappropriate indications).
• Consider alternatives to indwelling urinary catheters: bedside commodes/urinals, straight catheters, external (condom) catheters.
• Ensure appropriate line maintenance, performing hand hygiene before and after touching the line.
• Promptly remove catheters when no longer needed. Reassess patients daily with do-not-remove orders, confirming current documentation for reason or inquire with providers if daily reason is not present.
• Avoid excessive urine cultures to prevent unnecessary antimicrobial use.

Interdisciplinary teams are working hard to assess everyday clinical practices and opportunities to break the transmission cycle of infections. Together we can protect our patients and community from hospital-acquired infections.