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MUSC Excellence at
the medical center
New infection control
program under way
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
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.
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
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