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Effective infection control requires
diligence 24/7 by physicians
By Jeffrey R. Starke, M.D.
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Photo by Paul Kuntz |
Infection control has always been an
important part of patient care at Texas Children’s Hospital.
However, several recent national initiatives have raised the
profile of infection control across the country. First, the rise
of the quality of care movement in health care has its origins
in the goals and methodologies of infection control. Second,
several years ago, the Institute of Medicine (IOM) determined
that almost 100,000 people die in U.S. hospitals every year, at
least in part, from health care-associated infections (HAI).
Third, in response to this, almost every state – including Texas
– is considering requiring all hospitals to report publicly
certain infection rates measured in their institution.
We often joke that the Infection Control department is the one
department at Texas Children’s that does not directly lower
infection rates. The most important determinant of infection
rates is the behavior of health care workers, especially
physicians, nurses and other staff. Physicians must take the
lead and set the tone to create an environment that encourages
infection control – to protect their patients and themselves.
Of course, the Infection Control department plays a central role
in helping to prevent HAIs. Our department is responsible for
all aspects of infection control across the Texas Children’s
enterprise – inpatient, ambulatory, primary care practices and
home health care. We have four full-time infection control
practitioners to do this: Jessica Hilburn, M.T. (manager,
832-824-3940), Kathy Ware, R.N., Tjin Koy, M.T., and Darlene
Yepes, R. N. I serve as the Infection Control officer. We do
many forms of routine surveillance – especially intense in the
special care areas – and special projects when a need or request
from a physician is brought to our attention.
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Photo by Paul Kuntz
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Texas Children’s Hospital is involved in a new nationwide
program by the Institute for Healthcare Improvement called
“100,000 Lives” in reference to the IOM report. We are
attempting to lower the rates of surgical wound infections by:
using hair clippings instead of shaving; proper use of
prophylactic antibiotics; better intraoperative glucose control;
and better maintenance of normothermia. A second project is the
reduction of central-line related bloodstream infections by
optimum use of sterile techniques and line care.
To effectively reduce the incidence and severity of HAIs at
Texas Children’s, we need physicians to be champions (first, by
example) of several important concepts:
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Hand hygiene
This remains the most important activity for all health care
workers to stop the spread of infection. Unfortunately, recent
observational surveys performed at Texas Children’s have shown
that less than 50 percent of physicians appropriately perform
hand hygiene surrounding patient encounters. Although
“traditional” hand hygiene using water and chlorohexidene soap
is acceptable, the use of alcohol-containing foams and gels is
preferred since alcohol kills a greater proportion of organisms,
and the effect lasts longer because the alcohol is not washed
off. Small, refillable bottles of alcohol-based hand hygiene
products are available at the Texas Children’s Hospital Medical
Staff Office.
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Standard precautions
The basic principle of standard precautions is that all patients
should be approached as if their secretions (except sweat) or
excretions could harbor a transmissible infectious agent, and
appropriate barrier precautions (gloves, gowns, masks) should be
used in addition to excellent hand hygiene. Use of standard
precautions is important in offices and ambulatory settings, as
well as in the hospital.
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Isolation precautions
These are used in the hospital when it is suspected that a
patient has a transmissible infectious agent. The mantra is
“Isolate for Symptoms.” The need for isolation should be
considered for every patient admitted to the hospital. Almost
all patients with upper or lower respiratory tract infection,
diarrhea and skin infections should be placed initially in
isolation while the diagnostic evaluation proceeds.
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Influenza vaccination
The annual administration of influenza vaccine to high-risk
children and health care workers is a fundamental tenet of
infection control. This year, the killed influenza vaccine
(injected) supply will be adequate, but will not be fully
available until November. The Centers for Disease Control and
Prevention (CDC) has recommended that only high-risk individuals
– which includes health care workers – should be given killed
vaccine at this time. The inactivated nasal vaccine (Flumist) is
available and can be given to healthy individuals 5 to 49 years of
age, including most health care workers (except those in contact
with severely immunocompromised persons, e.g. bone marrow
transplant recipients).
For physicians, infection control
must be a 24/7/365 effort. We need your help to keep Texas
Children’s a safe environment for patients and all of us.
Jeffrey R. Starke, M.D., is director of Infection Control at
Texas Children’s and professor and vice chairman of Pediatrics
at Baylor College of Medicine.
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