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Why So Many Foleys?

Categories: CAUTI, Clostridium difficile, Healthcare-associated infections

Wendy Kaler, CLS, MPH,CIC

Wendy Kaler, CLS, MPH,CIC

Guest Author: Wendy Kaler, MPH, CIC
Dignity Health Clinical Lead for CAUTI Prevention

At Dignity Health, our goal is to reduce the rate of hospital-acquired infections (HAI) by 40 percent and readmissions by 20 percent before 2015, and we are well on our way. We have introduced specific evidence-based practices and bedside intervention activities to evaluate full adoption of safe preventive practices and assure coordination of care at the bedside with clinicians, including physicians. When I am provided the opportunity to share my experiences with Dignity Health’s “No Harm Campaign” to prevent catheter-associated urinary tract infection (CAUTI), I am often asked “why is it so difficult to get Foleys discontinued?”

Weighing the Benefits and Risks of Using a Foley

During training, physicians and nurses are made aware of the advantages of indwelling urinary catheters indwelling urinary catheters, but oftentimes the instructors do not focus on the associated risks of these devices. With competing priorities and time constraints, health care providers do not prioritize indwelling urinary catheters as a device that should be assessed daily for need, especially in the critical care units. Historically, the intensive care unit (ICU) staff believed that all critical care unit patients need a Foley. Lack of good alternatives available to provide bladder management and output measurement have contributed to this practice. Bedside nurses are ultimately managing the Foley and the advantages for them are understandable, including reducing the amount of time they must spend managing the bladders of their patients and keeping their patients skin dry. However, bedside nurses need to be aware that the risks to the patient are greater than the advantage to themselves. For example, if a patient develops a UTI and is treated with antibiotics, they are at an increased risk to develop multi-drug resistant organisms or C. difficile infection.

Moving the Needle to Safe Dentistry

Categories: Healthcare-associated infections, Injection Safety

John O’Keefe, BDentSc, MDentSc, MBA

John O’Keefe, BDentSc, MDentSc, MBA

Guest Author – John O’Keefe, BDentSc, MDentSc, MBA
Board Chairman,
Organization for Safety, Asepsis and Prevention (OSAP)

Because safe injection and sharps management practices are central to dentistry, the One & Only Campaign resonates strongly in the dental care sector. That is why the Organization for Safety Asepsis & Prevention (OSAP), the dental sector’s premier organization dedicated to infection prevention and control, is joining the Campaign as a Member. We whole-heartedly support the Campaign and pledge to spread its messages to our members. We are also eager to share information on how we in the dental care sector promote safe injection practices with the healthcare community at large.

It was through my own personal experience in 1984 that I really learned about the importance of safe injection practices and how they relate to creating the safest dental visit possible. I had joined a practice where I was replacing another dentist who had left to set up his own practice elsewhere. I quickly learned that for months this dentist had been taking partially-used local anesthetic carpules from the old practice and re-using them in his new office. I was shocked by this behavior, especially when “one needle, only one time” thinking was already so ingrained in dentistry with regard to local anesthetic practices.

Mind the “Learning Gap!”

Categories: Healthcare-associated infections, Injection Safety

Kim James, MS/FNP-BC RN, Nurse Practitioner, Director of Occupational Health Services, Brookdale University Hospital & Medical Center

Kim James, MS/FNP-BC RN

Guest Author: Kim James, MS, FNP-BC
Director, Occupational Health,
Brookdale University Medical Center

When teaching about Safe Injection/Safe Needle Practices, I always like to determine the students’ knowledge base regarding these principles. I’m often surprised to find that what I take for granted as a “given” is anything but!

This is one reason why, at my “In-Services”, I always ask for a show of hands and ask: “True or False? Changing the needle (between patients) makes a syringe safe to reuse?”  (If you’re familiar with the One & Only Campaign’s “Dangerous Misperceptions” flyer, the answer is “false”.)

I posed this question at in-services recently conducted at my hospital for Resident Physicians.  I hoped all residents would shout “That’s wrong!!!”  Very few responded that this statement was False.  Imagine my surprise when, at another in-service attended by 23 Dental Residents, only one hand shot up with the comment, “That is FALSE!”

Upon asking the Resident why this was a false statement, he said he was not sure.  This triggered a spirited discussion about the importance of changing both the needle as well as the syringe. I suspect some of those Residents questioned it and didn’t speak up, but this is just too important to leave to chance.

Success in Controlling Outbreaks in an Intensive Care Unit Using CDC Toolkit Interventions

Categories: Antimicrobial Resistance, Gram negatives, Healthcare-associated infections

Dr. Kyle Enfield

Dr. Kyle Enfield

Guest Author: Kyle B. Enfield, MD,
Assistant Professor of Medicine,
Assistant Hospital Epidemiologist,
Medical Director, Medical Intensive Care Unit,
University of Virginia

Infections due to carbapenem-resistant Enterobacteriaceae (CRE) are on the rise globally. These infections have limited therapeutic options, and invasive infections due to CRE are associated with a mortality rate upwards of 40 percent. A scary statistic for patients!

My institution, the University of Virginia Health System, identified our first case of CRE in August 2007. We had low level transmission with periods of improvement; however, in January 2010 we noted both an increase in CRE transmission among patients in the surgical intensive care unit (SICU), as well as a cluster of infections caused by a nosocomial pathogen new to the unit and our institution – extensively drug-resistant Acinetobacter baumannii (XDR-AB).

It was critical that we address this potential issue head-on in order to ensure positive patient outcomes and do our best to limit our institution’s exposure to CRE. After initial attempts to control these concurrent outbreaks of multidrug-resistant Gram negative pathogens using reinforced standard infection control practices failed, we implemented a bundled set of infection control interventions aimed to assess the prevalence of CRE and XDR-AB colonization or infection in the unit. The collective set of measures we implemented became recommended practice in the Centers for Disease Control and Prevention 2012 Carbapenem-resistant Enterobacteriaceae Toolkit. The interventions were developed by units in collaboration with Infection Prevention and Control and Environmental Services.

Drug Diversion Defined: Steps to Prevent, Detect, and Respond to Drug Diversion in Facilities

Categories: Healthcare-associated infections, Injection Safety

Injection Safety

Injection Safety

Guest Author: Kimberly New, JD BSN RN,
President, Tennessee Chapter of the National
Association of Drug Diversion Investigators

In my last blog, I talked about the impact of drug diversion on hospitals and healthcare facilities. Today, I will be discussing the frequency of diversion within healthcare facilities and what facilities can do to prevent, detect, and appropriately respond to diversion.

There are no reliable statistics about diversion by healthcare providers. This is because diversion is done covertly, and methods in place in many institutions leave cases undetected or unreported. At a facility with a strong diversion program and a nursing staff of about 1,000, I identified 1-2 new cases of staff members diverting each month. Well over 50% of those caught were diverting and using injectable opioids.

Diversion of controlled substances happens at all institutions. Because diversion can’t be stopped entirely, facilities must prevent it to the extent they can, identify cases quickly, and respond appropriately.

The essential elements of a healthcare facility diversion program include

  • Policies to prevent, detect, and properly report diversion,
  • A method of observing processes and auditing drug transaction data for diversion,
  • Prompt attention to suspicious audit results,
  • A collaborative relationship with public health and regulatory officials, and
  • Diversion education for all staff. 

In conjunction with its investigation of a diversion incident, the New Hampshire Department of Health and Human Services observed, “Highly educated and well-trained staff failed to recognize or overlooked behaviors indicative of addiction…or failed to follow established policies to address staff with substance abuse problems.” Ensuring that all staff are aware of the signs of diversion and impairment, and that they know reporting avenues, can facilitate quick recognition and response.

Whenever diversion is identified, healthcare facilities should promptly report to appropriate enforcement agencies and, ideally, obtain complete details from anyone caught diverting.  If injectable medications were diverted and tampering is suspected, facilities should also engage public health officials to assess the need for patient notification.

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