Healthcare Hygiene magazine August 2023 | Page 8

By Rodney E . Rohde , PhD , MS , SM ( ASCP ) CMSV CM , MBCM , FACSc

As we approach 2024 , the rapidly changing world of healthcare continues to collide with a dangerous , complex , and ongoing global emergency of antimicrobial resistance .

Climate change leading to expanding microbial reach , global travel in less than a 24-hour time span , healthcare and public health systems that may collapse in a single moment continue to challenge our global efforts to maintain quality patient care .”

Infection prevention and control ( IP & C ) has come a long way in the United States . IP & C was established in the U . S . in the 1950s as a hospital discipline in response to a nationwide epidemic of nosocomial Staphylococcus aureus and the recognition of the need for nosocomial infection surveillance . As we approach 2024 , the rapidly changing world of healthcare continues to collide with a dangerous , complex , and ongoing global emergency of antimicrobial resistance . Climate change leading to expanding microbial reach , global travel in less than a 24-hour time span , healthcare and public health systems that may collapse in a single moment continue to challenge our global efforts to maintain quality patient care .

Recently , the American Journal of Infection Control ( AJIC ) published a major article , “ Recommendations for change in infection prevention programs and practice .” The authors provide guidance and recommendations in 14 key areas and why these interventions should be considered for implementation by United States . I will briefly list and discuss these 14 key areas alongside my insight and experience in infectious diseases and related areas in this article .

Core Challenges and Recommendations

The standardization of infection prevention is a difficult , challenging , and complex issue to tackle . All successful business models work diligently towards “ best practices ” and infection prevention must be no different . Staffing levels , reporting structure , and physician participation need scientific evidence for determining the best allocation of time practice .

Surveillance . The National Healthcare Safety Network ( NHSN ) has served as the backbone of HAI surveillance with nearly 25,000 participating medical facilities . Given the scope and complexity of surveillance activities , it has been estimated that 45 percent of an infection preventionist ( IP )’ s time is consumed by this activity . It is critical for current and future IPs to have a robust and current knowledge of automated surveillance software and platforms .

Ongoing , multimodal improvement and strategies for hand hygiene practices and compliance .

The environment is a living microbiome . We have long known and researched the sources and routes of pathogen transmission with the patient being the most significant . IP practices must continue to address the patient while keeping the environment in health care and community settings in their scope of cleaning , disinfection , and sterilization .

Global burden of bacterial antimicrobial resistance ( AMR ) has been estimated to be 4.95 million deaths globally . “ IPs , in coordination with other key healthcare personnel , should review core information regarding AMR to in order to determine facility policy on such issues as isolation , appropriate therapy , and antibiotic stewardship : ensure accurate microbiology test results using the latest Clinical and Laboratory Standards Institute ( CLSI ) determination of minimum inhibitory concentration ( MIC ) antibiotic breakpoints ( failure to implement these breakpoints may lead to negative impacts on patient care , infection control , as well as public efforts to limit the spread of such organisms ); prioritize pathogens using WHO document that categorizes ( Critical , High , Medium ) resistant bacteria based on treatment options and potential for spread , for example , carbapenem-resistant A baumannii , P aeruginosa , Enterobacteriaceae ; or CDC ’ s phenotype definitions and Antibiotic Resistance Threats report .”

Colonization with healthcare-associated pathogens ( MRSA , VRE , etc .) is directly correlated with increased infection risks . The process of decolonization is an evidence-based intervention for IPs and other health care professionals to consider in practice .

The topic of how healthcare and IP should effectively use and decrease contact precautions . Key to this challenge include “ which antibiotic resistant bacteria trigger an isolatable condition , and whether the patient is deemed colonized or infected with the particular AMR bacteria , what type of isolation is appropriate , and whether a healthcare facility implements advances in healthcare strategies to reduce transmission risk or bioburden .”

As a medical laboratory and public health professional in the area microbiological infectious diseases , I and my colleagues have stressed how critical the issue of diagnostic stewardship is to patient care and quality . Questions that every health care provider and professional should always ask include , has the correct laboratory test been ordered ? Has the specimen been collected and transported correctly ? Has the test been accurately interpreted and reported ? Diagnostic management teams led by a Doctor of Clinical ( medical ) Laboratory Science ( DCLS ) and similar professionals are the leaders in this point .

Improvement of Healthcare associated infections ( HAIs ) for bloodstream infection ( BSI ) “ surveillance in surveillance and prevention of BSI including expansion of the definition , improved documentation of clinical findings to prevent missed events and over-diagnosis .”

8 august 2023 • www . healthcarehygienemagazine . com