Rethinking infection control protocols can yield big returns

While infection control has always been a crucial focus in hospitals, the COVID-19 pandemic has created new challenges to keep patients safe. This has pushed infection control protocols and the expertise of infection prevention specialists to the forefront.

With a crisis come new opportunities. The pandemic has opened the door to rethinking our patient safety strategies and taking advantage of cost-effective solutions that previously could take years to implement. It is time for infection prevention specialists to have a more prominent voice to influence facilitywide decisionmaking and help hospital leaders with these infection control challenges.

While COVID-19 is top of mind, hospital-acquired infections, including MRSA, continue to be a concern.

Infection control specialists who are in tune with innovative technologies and strategies can help hospital leaders enact changes that will benefit patient care as well as reduce infection rates. An example of how this can happen is our experience at AdventHealth North Pinellas.

We wanted to take new steps to help prevent MRSA infections, not only because they are dangerous and expensive, but also because we heard about a promising new strategy with a protocol that could help us rethink everything we had previously done. The innovative approach involved rethinking how we mitigate MRSA colonization risk, leveraged the role of the nose in infection and utilized an alcohol-based nasal antiseptic for nasal decolonization. The program helped lower our MRSA rates substantially. It did not require a financial investment since the net result could include substantial savings, but it did call for a change in our processes. As we all know, rethinking protocols can be difficult for healthcare facilities.

Once leadership understood the importance of rethinking our MRSA surgical-site infection protocols, we needed a plan that would show the program's efficacy and the benefit to our hospital system. The next step was to educate all staff involved and put this new protocol through a trial.

The program was designed and implemented across all inpatients and all surgery patients with vendor help. We chose a vendor that could provide those services and that offered an alcohol-based nasal antiseptic for decolonization that had 15 years of safe use and had reference accounts and published outcomes data giving us confidence in our plan. The results were impressive. Within 12 months, we saw a 100% decrease in MRSA surgical wound infection. We also experienced no MRSA surgical site infections during the study period. The universal decolonization protocol reduced isolation, resulting in a 60% reduction in the need for contact precautions. That, in turn, led to more than $104,000 in savings for gowns, gloves and nasal screening tests. Reducing personal protective equipment for these patients became even more important with increased PPE demand because of COVID-19.

Our system leadership was quick to adopt the new protocol as we had results to back it up. However, without leadership buy-in, none of this would have happened. But with a leadership team that encouraged learning and innovation, and that was willing to make operational changes to adopt this new strategy, we implemented this new protocol and saw immediate results that have improved our infection rates and bottom line.

Infection control specialists must be able to address questions from stakeholders. For example, the chief financial officer needs to understand the resources needed, while the chief nursing officer asks about how these processes will affect the nursing staff or patient experience. Preparing a solid, well-thought-out plan means thinking ahead and anticipating questions regarding every aspect of hospital leadership.

When presented with a new concept, decisionmakers tend to be hesitant to make major changes without clinical data or proof of efficacy. When we adopted the new program there were few published studies, so we conducted a small-scale trial. We and other facilities have published outcomes data confirming efficacy so a test today would be unnecessary. Seeing positive results from a number of similar facilities, before implementing a change, can serve as a major proof point in the effort to gain buy-in from key decisionmakers.

It all comes down to embracing innovation and empowering teams. Making major improvements in patient care and outcomes, staff utilization and costs with no major capital investment is a challenge asked of all healthcare professionals, but it can be done. It just takes some innovation, preparation and follow-up. But most importantly, it takes support from senior leadership.

In this COVID-19 era, which has affected so much of our lives, there has to be a continuing commitment to finding better ways of preventing and treating infections within hospitals. A promising way forward includes enabling infection preventionists to have a prominent voice, along with more nimble thinking and support of hospital leaders as they navigate to a new, post-pandemic world.