Programs to improve hand hygiene reduced infections, increased compliance

 

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UPMC Presbyterian Hospital's infection prevention teams have improved hand washing and sanitizing compliance at the hospital to nearly 100 percent among clinical staff through accountability and educational measures. In a separate effort at UPMC Mercy Hospital, rates of a deadly infection were reduced by educating patients about hand hygiene.

The successful techniques will be reported Saturday in presentations in Philadelphia at ID Week 2014, an annual meeting of health professionals in infectious disease fields.

"Hand hygiene compliance in health care facilities nationwide is not satisfactory, yet is the single most important way to prevent infections," said senior author Carlene Muto, M.D., M.S., medical director for infection control at UPMC Presbyterian Hospital.

According to the U.S. Centers for Disease Control and Prevention, U.S. hospital patients contract an estimated 722,000 infections each year.

Since June 2012, an initiative called Just Culture at UPMC Presbyterian, has affected behavior and changed attitudes. Through a coordinated program that includes education, videos, internal newsletter articles, posters and verbal reminders, health care personnel are held accountable for conscious disregard of patient safety, including hand hygiene. They are not held accountable for system failures. Staff who fail to wash or sanitize their hands are warned and progress through disciplinary action for continual disregard for hand hygiene.

Within four months of launching the Just Culture initiative, hand hygiene compliance rates at UPMC Presbyterian increased from 70 percent to 99 percent. Since then, the near-perfect rates have been maintained with re-education and the cultural shift to accountability.

"Hand hygiene can be increased with educational campaigns, but we've found that these gains can only be sustained when a health system makes it unacceptable to be lax on hand-washing," said lead author Ashley Querry, infection prevention coordinator at UPMC Presbyterian.

At UPMC Mercy, infection preventionists led another study to determine the effectiveness of efforts to encourage hand hygiene among patients.

Pre-packaged alcohol wipes were made available at patients' bedsides and health care staff reminded, assisted and encouraged patients to use the wipes.

Rates of C. difficile, an antibiotic-resistant bacteria that causes inflammation of the colon and can be deadly, fell significantly after the patient encouragement program was implemented.

"These results show that patient hand hygiene can be improved with easily implemented measures that have very meaningful and potentially life-saving consequences," said lead author Marian Pokrywka, M.S., infection preventionist at UPMC.

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Story Source:

The above story is based on materials provided by University of Pittsburgh Schools of the Health Sciences. Note: Materials may be edited for content and length.

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Notorious pathogen forms slimy 'streamers' to clog up medical devices

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A group of researchers from the US has moved a step closer to preventing infections of the common hospital pathogen, Staphylococcus aureus, by revealing the mechanisms that allow the bacteria to rapidly clog up medical devices.

In a study published today, 27 June, in the Institute of Physics and German Physical Society's New Journal of Physics, the researchers have shown that the bacteria colonizes into large groups, called biofilms, using a biological glue, and form thin, slimy, thread-like structures called streamers.

The streamers adhere to a surface and are able to trap passing cells as they flow through medical devices such as stents and catheters, becoming more rigid and eventually clogging up the whole device.

In their study, the researchers, from Princeton University, recreated the physical environments of medical devices with curvy channels, multiple networks and a flowing fluid, and showed that streamers can rapidly expand and create a blockage in a surprisingly short space of time.

Moreover, if the surfaces were coated with human blood plasma, which the bacteria often encounter in infectious sites, the biofilm streamers appeared in the structures even more quickly.

Methicillin-resistant Staphylococcus aureus (MRSA) is a notorious strain of the bacteria that has developed a resistance to antibiotics, making it particularly difficult to treat in humans.

MRSA is the most widespread cause of hospital-associated infections in the US and Europe, and has a high mortality rate. Patients with open wounds, implanted devices and weakened immune systems are at the greatest risk of infection.

Infections that are associated with medical devices are a primary concern, as the biofilms that the bacteria form have an enhanced resistance to antibiotics.

Co-author of the research Professor Howard Stone, from Princeton University, said: "We have shown that Staphylococcus aureus can create slimy, thread-like biofilm streamers in environments that mimic the physical and chemical conditions of medical devices such as stents and catheters.

"By studying the morphologies and growth dynamics of the bacteria, we believe there is potential to develop novel methods that prevent diseases associated with this notorious pathogen."

In their study, Professor Stone and colleagues investigated how surface geometry, surface chemistry, and fluid flow affected the formation of streamers.

They examined four strains of Staphylococcus aureus by staining the cells with fluorescent dyes and taking high-resolution images as a flow was passed through the microfluidic structures, which contained curvy channels and multiple networks.

Their results showed that the flow of fluid through the structures was the major contributor to the shape of the biofilm streamers, as opposed to movements of the cells themselves, and that the biofilm streamers could form in a number of different complex environments, leading the researchers to believe that the streamers are ubiquitous in natural environments.

Compared to another common pathogen, Pseudomonas aeruginosa, which the researchers previously studied, Staphylococcus aureus formed and clogged up the channels much more quickly.

"The different dynamics of biofilm formation may result from different mechanisms, and different flows of the biofilm matrix, which are research directions we are currently pursuing," Professor Stone continued.