IPC: Working towards the irreducible minimum

Posted on 27 June 2019

Mediclinic takes an evidence-based, practical approach to reduce the spread of multidrug resistant microorganisms and reduce hospital acquired infections.

Dr Warren Lowman, who oversees the infection prevention and control (IPC) programme at Mediclinic’s Wits Donald Gordon Medical Centre, explains the key role constant, cutting-edge surveillance can play. 

Preventing and controlling healthcare-associated infections is critically important to Mediclinic, as they are associated with a range of morbidities and economic costs. Many of these infections are avoidable, says Dr Warren Lowman, who is responsible for ensuring the infection prevention and control (IPC) programme at Mediclinic’s Wits Donald Gordon Medical Centre aligns with international best practices. 

One challenge: in South Africa, there is no centralised source of national HAI prevalence data. As a result, in-hospital IPC experts are often not guided by a thorough appreciation of the extent of the problem across the country.

Dr Lowman aims to change that. “To properly understand and mitigate the risks of infection, hospitals need an effective surveillance system,” he says. “This surveillance needs to be specific to the hospital, and narrowed down to each and every unit.”

Mediclinic’s Wits Donald Gordon Medical Centre is a referral hospital, with no casualty or emergency facility. This means patients who arrive at the hospital have already had some hospital exposure, he says: “We see a lot of solid organ and bone marrow transplants, oncology and complex surgical patients – in that context, we have some unique IPC challenges, and a relatively distinct patient population, that would not necessarily apply in a general hospital environment.”

Hospital-acquired infections (HAIs) are most often caused by viral, bacterial and fungal pathogens. The most common and preventable types of HAIs are central line associated bloodstream infections (CLABSI), pneumonia – such as ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI) and surgical site infection (SSI). 

HAIs usually develop in one of two ways:

  1. A patient carries the pathogen at the time of admission, without signs of infection. The infection then develops while the patient is in hospital, due to his or her compromised state.
  2. Cross-contamination and cross-infection: during their stay in hospital, a patient comes into contact with new pathogens, becomes colonised with these pathogens and develops an infection..

Unfortunately, there is a minimum proportion of infections that are unavoidable, or that would develop regardless of a patient’s in-hospital exposure, says Dr Lowman. This is known as the irreducible minimum. “When a patient comes across a pathogen, they are part of that interaction,” he explains. “Some of our patients are immuno-suppressed, or have a low baseline functional status. Some of them have co-morbidities – and all of these are additional, host-related risk factors that can lead to your becoming infected.”

Mediclinic hospitals are committed to taking a proactive approach in reducing infection rates to this minimum rate wherever possible, and Dr Lowman believes a key part of that challenge involves utilising cutting-edge surveillance technology. 

“We cannot gauge the effectiveness of our IPC interventions unless we know, down to the smallest detail, exactly how, when and why these infections occur,” he says. “Our surveillance technology allows us to understand our unique risk factors, by breaking down data. We are able to investigate these risk factors by looking at specific patient groups, and narrowing down our focus to identify not only what types of infections we face – surgical site, or catheter-related bloodstream infections, for example – but also which organisms we are dealing with, specifically.”

For example, Dr Lowman points to a new trial of a non-touch decontamination strategy, which involves the use of ultraviolet light to target multi-drug resistant organisms – a semi-automated surface disinfection system that can be used to destroy potential pathogens . While this strategy shows great promise, it is only through close and careful monitoring, in the form of collecting and assessing data, that its efficacy can be accurately measured.

Surveillance is the backbone of any effective IPC strategy, says Dr Lowman. “By basing our IPC interventions on reliable data, we are working towards achieving the irreducible minimum.”

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