Prevention and Control of Hospital-Acquired Infections
Up to a third of hospital-acquired infections are preventable. The two main arms of prevention are stopping the development of antibiotic resistance and preventing the spread of resistant organisms between patients. Many of the prin-ciples for preventing spread of hospital-acquired organisms are well known. There is no single successful recipe, and the approach for individual hospitals is usually based on the epidemiology of the organism and the resources available. For example, the most important measures for prevent-ing nosocomial UTIs are (a) the placement of catheters only when absolutely necessary and not solely for the con-venience of caregivers, (b) the use of aseptic technique for catheter insertion and for urinary tract instrumentation, (c) the manipulation and opening of drainage systems as infre-quently as possible, and (d) the removal of catheters as soon as feasible.
Strategies shown to decrease the risk of surgical wound infection include (a) antibiotic prophylaxis, (b) short preopera-tive hospital stay, (c) optimization of patient’s risk factors (e.g., diabetes control), and (d) surveillance of surgical-site infections with feedback to the operating teams. Components of a pro-gram to prevent hospital-acquired infection are many.
Hospital surveillance is the key for successful hospital infection control. This includes prospective collection of high-quality data, their analysis, and timely feedback to healthcare practi-tioners. To achieve this, hospital surveillance systems need to be prospective, targeted, and risk-adjusted, to use validated definitions and methods, and to be open to valid inter-hospital comparison.
A further recent advance in hospital infection surveillance is the use of molecular methods to identify and type organisms, thereby clarifying the clonal or polyclonal nature of apparent outbreaks. Molecular testing has confirmed that some appar-ently “endemic” infections are caused by MRSA strains and other bacteria.
In the twenty first century, the specialty of infection control requires a breadth of expertise that no sole practitioner can possess. Therefore, every hospital should have an infection control committee. The major responsibilities of the committee should be the control of hospital-acquired infection and monitoring of hygienic practices in the hospital.
The committee essentially is a multidisciplinary team consisting of clinicians, infection control practitioners, a hospi-tal epidemiologist, biostatistician, medical records officer, infectious diseases physician, blood bank officer, and micro-biologist. The committee is usually chaired by the medical superintendent with the medical microbiologist being the member-secretary.
The committee (a) reviews regularly the infection control activities of the hospital, (b) monitors emergence of drug resis-tance, (c) formulates the antibiotics policy of the hospital, (d) recommends suitable sterilization and disinfection procedures in a hospital, and (e) maintains data on the incidence and types of infections and antibiotics susceptibility patterns of the com-mon prevalent pathogens.