Holyoke Medical Center winning war against hospital infections

Date: 12/30/2008

HOLYOKE The health care industry has advanced technology that improves and saves the lives of patients on a daily basis. Similar to other technological advancements, however, it also carries risk. Life-saving devices like intravenous lines, indwelling catheters and minimally invasive surgical instruments can carry a risk of infection to the patient.

"The human body has fantastic natural defense mechanisms, like skin and mucous membranes, that protect us, but we often have to bypass them in to order administer medical treatment in an effort to improve someone's condition," Carol Wojnarowski, manager of Holyoke Medical Center (HMC)'s Infection Control Department, said. "The fact is that in a hospital setting, a patient's immobility and invasive devices like an indwelling urinary catheter or intravenous lines can put the patient at risk of an infection."

The most common hospital-contracted infections are urinary tract infections (from catheters), bloodstream infections (from intravenous lines), surgical site infections (post-procedure) and pneumonia, said Wojnarowski.

The good news is that staff at HMC is doing everything in its power to reduce and eliminate infections from the moment a patient enters the hospital environment, she said.

The Centers for Disease Control and Prevention have recommendations for all hospitals regarding infection prevention. HMC regularly goes above and beyond many recommendations to ensure they are minimizing the patients' risk for infection during any therapy or procedure.

Over the last three years, HMC's rates of bloodstream infection and ventilator-associated pneumonia in the ICU have steadily decreased, and Wojnarowski has only documented one central line infection in the ICU in the last 10 months, attesting to the effort of HMC's intensivists to use antimicrobial dressings and to be vigilant in the utilization of devices as conditions improve.

HMC's practices for infection control begin with individual employees, who use antibacterial soap for hand hygiene, get annual flu shots and maintain the highest sterilization practices in the Central Sterile Department. At the bedside, they wear hats, goggles, gowns, booties and sterile masks before initiating a procedure.

Every morning, Wojnarowski rounds in the ICU with HMC's intensivist on duty, nurses, physicians, nutritionists and case management staff to ensure they are providing the highest quality of care to every ICU patient as well as to review each patient's treatment plan. This highly motivated team emphasizes the nationally recognized model of multidisciplinary rounds, which helps them to monitor and control the spread of any hospital-acquired infections.

HMC's pharmacy is also on the cutting edge this summer, the area where IV medications are prepared was completely renovated. The new "Clean Room" brings the hospital into compliance with new government regulations, known as "USP 797," which seek to ensure that the production of IV medications is carried out in an environment that minimizes the chance for contamination (and thus, infection). HMC is now 100 percent compliant with these regulations.

"The environment in which we make IVs is now very similar to the environment in which surgery is performed," said Pharmacy Director Dave Gamblin. In the clean room HEPA filters remove particles, counters are stainless steel, floors are sealed and cleaning is accomplished with sterile alcohol and non-shedding wipes. Staff who enter the clean room must wear shoe covers, hair nets and disposable smocks over their clothing and face masks. Hand washing must also occur prior to any entry.

The introduction of the "Mini-Bag Plus" system for mixing certain IV medications outside of the clean room may also decrease the chances for product contamination and subsequent infection, Gamblin said.

The system consists of a capped bag (sealed until use) of IV fluid. Within the cap is a puncture mechanism that inserts into the top of a medication vial. Once inserted, the IV fluid is mixed with the medication via a squeezing motion, eliminating the need for a needle and syringe. Decreased steps and less product manipulation results in decreased chances for contamination and subsequent infection, Gamblin said.