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MUSC Excellence at the medical center New infection control program under way Quality Hospital Infections Disclosure Act On May 31, 2006, Gov. Mark Sanford signed the Hospital Infections Disclosure Act (HIDA) into law requiring all hospitals in the state to publicly report their rates of health care associated infections (HAIs). The law specifically requires public reporting of central line associated blood stream infections (CLABSIs), surgical site infections (SSIs) and others.   On July 1, 2007, South Carolina hospitals began inputting data for CLABSIs in adult medical/surgical ICUs and SSIs for hysterectomies and coronary artery bypass grafts. Additional infection reporting was mandated on Jan. 1 for CLABSIs in pediatric medical/surgical ICUs and SSIs for cholecystectomies, total hip replacements and total knee replacements. For information on the act and to access the February infections report, visit http://www.scdhec.gov/health/disease/hida/.   The Medical Center Infection Control, Prevention and Epidemiology Depart-ment has been preparing for HIDA reporting for more than a year. The department hired data coordinator Charmaine Wilson  in February 2007. Cassandra Salgado, M.D., and Beth Rhoton serve on the HIDA advisory committee. The data coordinator and infection control practitioners have undergone training regarding definitions for HAI and for data entry into National Healthcare Safety Network.   The next HAIs report will be published Aug. 1 with reports following every six months. As time passes more HAIs, as well as infection prevention processes, will be required to be reported. Pulsed Field Gel Electrophoresis—An Asset to Infection Control/Epidemiology Most health care workers are familiar with the term vancomycin resistant enterococcus (VRE) but pulsed field gel electropheresis (PFGE) may be a part of health care jargon workers are not as familiar with.   PFGE is a technique that allows the comparison of large fragments of DNA. For infection control purposes, bacterial isolates, which can be VRE or many other types of bacteria, are treated with enzymes to digest the cell wall and proteins and leave the naked DNA. DNA is separated into segments by electrical charge. This causes the DNA to group into bands. The banding patterns are compared for similarities/differences.   PFGE is most often used by infection control and hospital epidemiology to distinguish spread of related organisms, or clones, from spread of unrelated bacteria. PFGE also has been used to determine if colonization with one strain of bacteria has led to infection with the same organism. It can help determine if infection with the same species at two different time periods represents relapsing disease or infection. In summary, PFGE is a powerful tool that can be used in a number of ways in a variety of clinical settings.   Recently, the hospital saw an increase in the number of VRE isolates. The Infectious Diseases Department (with the Microbiology Laboratory) has a small PFGE lab staffed by Katie Blake, a medical technologist with experience in PFGE. Blake took a representative sampling of the VRE isolates for PFGE typing.   Salgado, of Hospital Epidemiology, reviewed the banding patterns and was able to determine that just a few clones were responsible for the majority of VRE isolates, meaning that the organisms had been transmitted from patient to patient. This information was shared with managers and the increase was not sustained in the next two months.   It is a vivid reminder to practice excellent hand hygiene, Standard Precautions and Contact Precautions, and thoroughly clean and disinfect the environment and equipment. This is especially important for those who provide direct patient care.   The goal of the medical center is to eliminate the transmission of VRE and other epidemiologically important organisms. Employees need to follow all infection control policies and procedures. People Managing Up in the Children’s services clinics According to Rosemarie Battaglia, nursing clinical care coordinator for the Children’s Hospital, at the last children's services staff meeting, each nurse in the clinic was asked to present one provider in their clinic to Manage Up to all the pediatric staff.   “We refer patients to other clinics and felt this would be a great way for staff to learn about the providers in their area and the areas they frequently refer,” said Battaglia. “The staff was instructed to either Google MUSC for information on the provider or they could conduct interviews. Most staff did a combination of both.”   The result was that the staff received useful information and a deeper respect for the providers they work with. Communication opened up between the nurses in the clinic and the providers. The nurses shared with the providers what it was to Manage Up and the physicians were impressed with the initiative.   “I would highly recommend this exercise in your unit as it had a positive outcome for all involved,” said Battaglia.     Friday, April 25, 2008 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.