A multi-pronged approach reduces healthcare-associated infections in Mediclinic hospitals

Posted on 12 June 2018

Healthcare-associated infections at Mediclinic hospitals are showing a downward trend, thanks to well-established infection prevention and control protocols, with well-trained and dedicated managers in all facilities.

Mediclinic implemented an infection prevention and control (IPC) programme in all its hospitals in 2005, with ongoing upgrades and improvements. Recent statistics show how well it’s working: healthcare-associated infections (HAIs) in Mediclinic hospitals dropped from 2.72/1 000 patient days in 2014 to 1.85/1 000 patient days in 2016.

‘Our multimodal approach includes a strong focus on surveillance; continuous monitoring and improvement of hand hygiene; adherence to IPC bundles; focus on environmental cleaning; training of healthcare workers in infection prevention and control; and using quality improvement methodology,’ says Briёtte du Toit, Infection Prevention and Control Officer for Mediclinic Southern Africa.

Care bundles

‘All hospitals have implemented the IPC bundles to reduce HAIs,’ says du Toit. These, previously called BCA (‘Best Care … Always’) bundles, are a set of simple, cost-effective, evidence-based measures that when performed together consistently have proven to reduce HAIs.

Hand hygiene

Mediclinic follows the World Health Organization’s multimodal approach to hand-hygiene compliance. This compliance is measured by adherence to the five important moments for hand hygiene. As du Toit says, ‘Interventions include training of all healthcare workers and auditors; reminders in the workplace in the form of posters; alcohol-based hand rubs at the point of care; a hand-hygiene trophy for each hospital; badges for healthcare workers trained in the hand-hygiene procedure; and making information available patients to inform them about the importance of hand hygiene and to encourage them to remind their healthcare workers to perform hand hygiene.’ Visitors are also expected to perform hand hygiene.

Environmental cleaning

Care is taken to ensure that the hospital environment and equipment are clean, says du Toit. ‘Despite new technology, basic manual cleaning and disinfection are still required, and that’s what Mediclinic focuses on,’ she explains. ‘Compliance to cleaning practices is monitored with UV lights and a fluorescent marker. Hydrogen-peroxide fogging is used as an additional measure when indicated.

Mediclinic continues to evaluate new technology and investigate areas for improvement in this area. Hydrogen-peroxide fogging, for example, has both benefits and limitations, du Toit says: ‘The room has to be evacuated, and it’s problematic to use in an open ICU.’

Training

‘Dedicated, trained IPC personnel are necessary to implement the programme with strong support from management,’ du Toit says.

Training of IPC managers responsible for the implementation of the IPC programme begins with a four-month basic IPC course, followed by a 10-month advanced IPC course.

‘IPC isn’t recognised as a speciality by the South African Nursing Council, and there aren’t many tertiary institutions offering further studies in IPC,’ du Toit says, pointing to the wider issue in the healthcare sector of a lack of investment in human resources in this area.

Surveillance

A world-class electronic surveillance system was implemented in all 52 Mediclinic hospitals in southern Africa in 2012. The surveillance definitions of the Center for Disease Prevention and Control (CDC) in the USA is utilised to classify infections.

Education and care of support staff

Healthcare workers are educated about infection prevention and control and how to protect themselves. ‘They receive training on why and how to wear personal protective equipment, including how to put it on and remove it,’ du Toit explains.

Staff receive IPC training, information sessions, communication books in each nursing unit, and regular nursing-unit meetings and newsletters.

There are vaccination programmes for Hepatitis B and influenza, and staff are also screened for TB.

In some cases, for example, when caring for a patient with meningococcal meningitis, post-exposure prophylactic treatment is administered if indicated.

Good communication

Communication to doctors is done via the Mediclinic Doctor Relationship Managers, the doctors’ portal on the intranet, and representatives of hospital management teams who make appointments with doctors to inform them about specific new initiatives says du Toit. ‘We also communicate with doctors via the Hospital Clinical Committees, and relevant Mediclinic policies and position papers are shared with the doctors.’

Good communication also ensures that patients understand their role in the prevention of infections, such as remaining isolated and performing hand hygiene, du Toit notes.

In-patient vs out-patient care

Patients who don’t stay in hospital for long periods are less exposed to the risk of developing HAIs. ‘Doctors and nurses have to weigh up the benefits and risks of each proposed admission in order to make decisions that are in the best interest of their patients,’ says du Toit.

Antibiotic stewardship

One of the aspects that Mediclinic focuses on is that the correct prophylactic treatment is given, at the correct time and dose prior to surgery if indicated. ‘Good progress has been made with this specific measure during recent years,’ says du Toit. ‘However, it’s important to note that on its own, surgical prophylaxis has limited effect in the reduction of surgical site infections. The more important aspect is that it is part of an IPC bundle to prevent infections. Inappropriate use of antibiotics contributes to the development of antimicrobial resistance.’

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