Neil Osterweil

November 22, 2013

BOSTON — Try as they might, hospitals still face challenges when it comes to preventing nosocomial infections, according to a review of infection-control practices.

"The spread of nosocomial infections increases with poor hygiene and poor or deferred maintenance practices. There is a positive and direct association between a clean, sterile environment and healthy patients, although the reverse is also true," report Verteena Phillips, a graduate student at the Rutgers School of Public Health in New Brunswick, New Jersey, and her team.

Investigators are calling for new technology to remind hospital personnel to comply with healthcare regulations, such as alarms for scheduled filter changes or inspections and pressurized mats in front of hand-washing areas in operating rooms and intensive care units that sound a reminder if the hand-washer has spent too little time at the sink.

Ventilation systems equipped with high-efficiency particulate absorption filters can only filter out particles larger than 1 µm, making it challenging for hospitals to contain the spread of smaller particles such as viruses. In addition, the most thorough infection-prevention guidelines are only as good as the people who are supposed to follow them, noted Phillips.

The results of the review were presented in a scientific poster here at the American Public Health Association (APHA) 141st Annual Meeting.

Hospital-acquired infections are defined as those occurring 48 hours after admission, within 3 days of discharge, or within 30 days of surgery. They can be caused by organisms lurking on the bodies or clothing of healthcare workers and on surfaces such as doorknobs, curtains, and furniture.

"Nosocomial infections are getting to be a big problem in our area, especially with resistant bacteria like methicillin-resistant Staphylococcus aureus, erythromycin-resistant Enterococcus, and carbapenem-resistant Enterobacteriaceae," said Amanda Taylor, MPH, an epidemiologist with the Tennessee Department of Health in Chattanooga. "Carbapenems are thought of as last-resort antibiotics and are given to people who are resistant to other drugs. Now people are becoming resistant to carbapenems, so they have a very high fatality rate."

Taylor, who was not involved in the study, explained that the source of carbapenem-resistant infections in the hospitals she visits is unclear. She noted that Klebsiella infections are the most common carbapenem-resistant infections.

Sultry Air Carries Bugs

Phillips and her team performed a literature search and identified 10 studies looking at the best nosocomial infection–prevention practices.

They found that most healthcare facilities adhere to the recommendation that there be a minimum of 6 complete air exchanges per hour, with at least 2 involving outside air.

However, "not only is the direction of airflow important, the temperature and relative humidity of the air in healthcare facilities are also paramount to the prevention of nosocomial infections. Warm, humid air is dense and carries more particulates and aerosols," report researchers.

Additionally, hand hygiene, a must for preventing the provider-to-patient spread of infectious organisms, is spotty in some institutions.

For example, in a 1998 study, a medical student spent 6 weeks observing hand-washing and infection-control practices in a community teaching hospital in Ohio. Even in surgical units, the prevalence of hand washing was only 56.4% (Infect Control Hosp Epidemiol. 1998;19:858-860).

In a 2005 study, investigators found that in European hospitals, poor hand hygiene accounted for 40% nosocomial infections (Contin Educ Anaesth Crit Care Pain. 2005;5:14-17).

Phillips and her team point out that studies of ventilation systems are not readily reproducible because of the unique size, use, and design characteristics of various buildings within and among healthcare facilities.

They recommend that specialists in occupational safety work with hospitals to organize twice-yearly training on infection prevention and health and hygiene regulations and practices.

This study was supported by the New Jersey Department of Education. Verteena Phillips and Amanda Taylor have disclosed no relevant financial relationships.

American Public Health Association (APHA) 141st Annual Meeting: Abstract 286011. Presented November 3, 2013.

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