Methods to Decrease Healthcare Associated Infections

Michael Calderwood, MD, MPH, previously assistant hospital epidemiologist and associate director of antimicrobial stewardship at Brigham and Women’s Hospital, discusses some up and coming infection prevention strategies.

Interview Transcript (slightly modified for readability).

“I think we definitely need to continue to make improvements on the basics, and so when we think about infections, we have infections that we are already preventing; we have infections that we have the means to prevent, but are not yet preventing because we have not optimized all of the infection prevention [methods] we have at our disposal; and then we have those where we need further research or further technology to really continue to push our infection rates down to zero.

If we look at the things that are coming out on the horizon, [there is] a focus on the environment, and thinking about how [to] reduce contamination in the environment. Some of this is tracking the contamination in the environment and looking at our effort to clean areas in the patient’s room and the risk to the next patient that’s going to go into that room. [These are] methodologies we can use to track adequate cleaning by environmental services and use as educational moments.

The other thing is some of these newer technologies using UV and hydrogen peroxide. There’s been some mixed evidence that’s been presented at a variety of conferences over the past two years. I think there have been a lot of people excited about the promise of these technologies. There has been some thought to how it impacts patient flow in the hospital and how best to use them. I will be very interested over the next two to three years to see how these are adopted, and outside of studies, how well they make an impact on the real world. I think that’s one area where there’s some excitement.

There’s a lot of excitement now. Thankfully we’re coming out of the scare from Ebola, but we learned a lot from that in the need to improve our personal protective equipment (PPE) technologies and there are a lot of academic and industry partnerships looking at ways that we can improve PPE. This is both in terms of respiratory pathogens, [and] in terms of things that are spread via contact, [as well as] thinking about how we can continue to block transmission at the point of care and continue to protect our healthcare workers.

The other things that I am excited about, that I think are going to be critical, are how we use our electronic health records to really help streamline some of the surveillance work. This is also true for how we are going to use our electronic health records to improve what we’re doing in antimicrobial stewardship, so, we’re reducing some of the drivers of increasing resistance in the hospital setting.

When we talk about electronic health records, as national organizations begin to think about how to best utilize some of these technologies, organizations such as The Society for Healthcare Epidemiology of America (SHEA), Infectious Diseases Society of America (IDSA), hospital organizations, really need to, rather than work in silos and begin to develop solutions that work in just one hospital, learn from each other and say, ‘That worked for you, how might I be able to adopt that for my own hospital?’ and then bring that back to the individual vendors. Particularly, as we move into things that are mandated on a national level, for all of us to begin to report, we need to think about how we can streamline that process because right now we are stuck in a situation where there are so many calls for surveillance, that a lot of the infection preventionists are spending an inordinate amount of time behind a computer, trying to meet these mandates. That’s [less] time they’re out on the floor working to prevent these infections. As we continue to think about how best to utilize the technologies to reduce the amount of time that [we’re] doing the surveillance, [we] therefore, spend more time in the prevention of infections; that’s the ultimate goal.

That communication is not just true for hospitals communicating with one another, but actually we’ve heard a lot about these communities that it’s not just the hospital, but it’s now the patients going out to long term care facilities and the nursing homes, coming back into the hospitals and really understanding the transmission patterns between all of these healthcare facilities. It’s not just an acute care hospital alone; you really have to have communication across the entire spectrum of care."