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A recent article from Health Europa has some valuable lessons in infection control for everyone. Karolinska University Hospital, affiliated with the world-renowned Karolinska Institute in Sweden, agreed to participate in a study to identify its key areas of risk and reduce the spread of infection Health Europa 2020. Researchers there did bacterial screenings and had 2 individuals (a doctor or nurse plus a second person with another background, such as an industrial designer or psychologist) do direct observation by following a patient through the ward for four hours.
Risk factors identified by the observers could be specific to individual wards or common to all the screened wards:
Results of bacteriologic screenings correlated inversely with the degree of compliance with basic hygiene routines. Wards with the highest levels of compliance had the lowest number of surface bacteria, while the highest number of bacteria were found in the wards with the lowest rates of compliance.
So, what did the hospital do? It switched its cleaning services contract to a new company and mandated that its new cleaning contract staff must be trained in the fundamentals of infection prevention and control, antibacterial measures, and the necessary standards of hygiene within healthcare environments. It updated cleaning routines and established checklists to ensure each cleaning task was documented. Hospital staff were detailed to clean the ‘near-patient environment’ – the equipment used near the patient and while caring for the patient, such as the bed, bedside table, bedside lamp and wheelchair. The hospital’s personnel and the cleaning operatives were trained or retrained in basic infection control cleaning and disinfection processes. The fabric drapes, which had represented a significant vector of infection, were replaced with screens which were less bacteria-retentive and substantially easier to clean.
The hospital continued to take monthly culture samples at the sites in each ward which had initially been identified as having a high bacterial load. A second observational study conducted nine months after the first found that compliance with basic clinical hygiene routines had risen by an average of 16 percentage points. Hospital management found that making staff aware of the initial screening results had rendered them more motivated to improve their compliance with hygiene regulations, leading to positive trends in all the wards which were observed.
Our bet is that Karolinska University Hospital is not alone in having these infection control vulnerabilities. In fact, most of them probably exist at many hospitals. Combining the screening cultures with direct observational methods is likely to help any hospital identify such risk factors. We’d also bet that you’ll find even more if you extend your observation to following patients on intrahospital transports.
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