Keeping New Jersey patients safe from healthcare associated infections — in the hospital or in the physician's office — was the topic of a day-long education conference Friday sponsored by several health quality organizations, including Healthcare Quality Strategies, Inc. (HQSI)
The conference provided strategies and guidance to prevent infections, such as appropriate use of antibiotics, patient education and the creation of a culture of safety throughout a health care organization. Infections can be transmitted to patients in many ways, such as through spinal injections, intravenous lines, catheters or surgery.
"New Jersey has been improving its infection rates, but we are not improving as quickly as other states. We need to accelerate that improvement," said Suzanne Dalton, HQSI's project manager for reducing health care acquired infections. "This conference brought together all the organizations working to reduce infections and keep patients safe."
Also sponsoring the education conference was Quality Insights Renal Network 3, Healthcare Quality Professionals of New Jersey and the New Jersey Hospital Association.
In New Jersey, the rate for some common health care associated infections is above the national average. The rate for central line-associated blood stream infections (CLABSI) is 0.544 nationwide; the rate for New Jersey is higher at 0.810.
The national rate for infection related to abdominal hysterectomy is 0.991; the rate in New Jersey is 1.046.
New Jersey does slightly better in two areas. The national rate for infection related to colon surgery is 0.811 nationally versus 0.6658 in New Jersey. Catheter-associated urinary track infections is 1.092 nationally and 0.6658 in New Jersey.
Experts said infection control requires sustained efforts and continually updated protocols.
"At our hospital we've seen dramatic drops in PICC (peripherally inserted central catheter) infections, but you need to sustain those changes. It takes about three years to truly, truly make long-lasting changes," said Brian Koll, MD, FACP, FIDSA, Medical Director and Chief of Infection Prevention at Beth Israel Medical Center in New York. He also said support for infection control must reside throughout the organization, from the CEO to the chief nursing officer.
Dr. Barbara Montana, MD, MPH, FACP, Medical Director for the Communicable Disease Service of the New Jersey Department of Health, recalled the early days of the 2012 outbreak of fungal infections related to epidural steroid injections. She explained how health officials traced the first case of fungal meningitis in Tennessee to contaminated steroid injections created in a compounding factory in Massachusetts.
"I received a call from the CDC, saying, 'We have a problem'," Dr. Montana recalled. She said the New Jersey Department of Health immediately began working with local physicians' offices and health centers to contact patients who also received the infections and to provide treatment guidelines. There were 51 cases in New Jersey.
Dr. Montana said many states, including New Jersey, and well as the U.S. Food & Drug Administration, are now working to create greater oversight of high-risk compounding pharmacies.
Also at the conference was an infectious disease physician whose own wife developed sepsis. Dr. Chester R. Smialowicz, Director of Infectious Disease at Deborah Heart and Lung Center, described the harrowing experience after his wife, Barbara, contracted a health-related infection at another hospital he declined to name.
The infection was related to the catheter used to provide nutritional support for his wife's treatment. Dr. Smialowicz recalled racing to the hospital after he recognized that his wife was developing sepsis, a bloodstream infection, and her blood pressure was dangerously low. Her teeth were chattering.
As his wife's health quickly deteriorated, he recalls that she learned over to him and said, "Don't let me die," he recalled. Dr. Smialowicz responded with the humor that characterized much of his talk: "I said, 'I won't let you die. I am an infection disease physician and do you know how embarrassing it would be if my wife died of an infection?"
Barbara Smialowicz recalled how the nurse who inserted the line to provide the nutritional support had momentarily placed the sterile line on the hospital bed.
"I saw what happened and I should have said something," she told those present at the conference.
Kevin James, a private practice vascular surgeon, talked about infections related to kidney dialysis, a fast growing area among the Medicare population. He talked about access methods of providing dialysis, and offered insight and guidance on ways to reduce infections.
"This is an area ripe for improvement," he said.
In addition, Kathy Duncan, RN, a member of the faculty of the Institute for Healthcare Improvement, focused on SSIs, or surgical site infections. She outlined methods to reduce infections for hip and knee arthroscopy, such as having patients bath or shower with chlorhexidine gluconate soap for at least three days prior to surgery.
Dalton, of HQSI, said the session was valuable to those working on the front lines of medicine who need to remain current on the latest infection prevention strategies.