SACH cuts infections by 55 percent

COAL TOWNSHIP - Shamokin Area Community Hospital (SACH) has drastically reduced in the past three years the number of infections acquired by patients during hospital stays.

Hospital-acquired infections have been a major problem nationwide. SACH wants to be a leader in preventative measures aimed at improving patient care, said hospital CEO Tom Harlow.

In the past, the hospital employed an infection control nurse. Now, rather than controlling the problem, hospital leaders are preventing inflection.

Infection prevention nurse Liz Duell said Thursday that the instances of hospital-acquired infection has been reduced by more than 50 percent from 2006 to 2008. That number has been even further reduced this year, she added.

Duell took over as infection prevention nurse in March 2008. She said the high number of hospital-acquired infection was simply unacceptable and sought to do something about it. She said the staff has been working together, getting more education and preventing infections.

Nosocomial infections

A hospital-acquired infection, also called a nosocomial infection, is an infection that first appears between 48 hours and four days after a patient is admitted to a hospital or other health-care facility.

According to the Encyclopedia of Surgery, about 5 to 10 percent of patients admitted to acute care hospitals and long-term care facilities in the United States develop a hospital-acquired infection. More than one-million people acquire nosocomial infections each year.

Hospital-acquired infections are usually related to a procedure or treatment used to diagnose or treat the patient's initial illness or injury, Duell said.

Hospital-acquired infections can be caused by bacteria, viruses, fungi or parasites. These microorganisms may already be present in the patient's body or may come from the environment, contaminated hospital equipment, health care workers or other patients.

"Anything that comes into the body can be a set-up for infection," said Corinne Klose, vice president of patient services at SACH.

Depending on the cause, an infection may start in any part of the body. Hospital-acquired infections may develop from a surgical procedure, from the insertion of catheter tubes into the urinary tract, nose, mouth or blood vessels or from material inhaled into the lungs from the mouth or nose.

The most common types of hospital-acquired infections are urinary tract infections, ventilator-associated pneumonia, surgical wound infections and central-line infections, Duell said.

Urinary tract infection (UTI), the most common infection, has been shown to occur after urinary catheterization. Catheterization is the placement of a catheter through the urethra into the urinary bladder to empty urine from the bladder, deliver medication, relieve pressure or measure urine in the bladder.

Normally, a healthy bladder is sterile, with no harmful bacteria or other microorganisms present, according to the Encyclopedia of Surgery. Although bacteria may be in or around the urethra, they normally cannot enter the bladder. A catheter, however, can pick up bacteria from the urethra and give them an easy route into the bladder, causing infection.

According to the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, these infections can be preventable through the adherence to strict guidelines by health care workers when caring for patients.

Duell has been working tirelessly to create strict protocol for the hospital staff. And her hard work has paid off.

In 2006, 56 hospital-acquired infections were reported at SACH. Thirty of those infections, or 53 percent, were UTI cases, Duell said. In 2007, the number of overall infections was reduced to 35, 17 of which were UTI cases. In 2008, 25 infections and six UTI cases were reported.

So far in 2009, 15 infections, three of which were UTI cases, were reported, Harlow said.

"This is a huge improvement," Duell said.

"This is a big credit to the staff," Klose added.

'Real-time' monitoring

SACH, along with more than 2,000 other health-care facilities in 19 states, has been reporting the number of nosocomial infections to a newly-activated database, run by the CDC. With this information, hospitals can find ways to prevent these infections and improve patient care, Duell said. The database is in "real-time," which gives health-care professionals an advantage and helps determine how these infections are being acquired.

"We had a different perspective and this made patient care even more personable," Duell said.

Hospitals are required to report nosocomial infections to the Patient Safety Authority of Pennsylvania. The hospital is also required by law to notify the patient and the patient's family of the infection.

All hospitalized patients are at risk of acquiring an infection from their treatment or surgery. Some patients are at greater risk than others, especially young children, the elderly and persons with compromised immune systems.

Other improvements

Duell said in addition to more than 30 new protocols for staff to follow, the staff has been highly educated on the prevention of infection.

SACH has also begun to use only top-of-the-line Foley catheters. The staff now uses silver alloy-coated urinary catheters that destroy bacteria before they can migrate up into the bladder. And, the nursing staff is monitoring closely how many days a catheter is used. The risk for infection increases with each day the catheter is left in the patient.

Pneumonia is the second most common type of hospital-acquired infection. Bacteria and other microorganisms are easily introduced into the throat by procedures performed to treat respiratory illnesses. For example, patients using a ventilator are at risk for infection.

If a microorganism is introduced to the patient's throat, it can be aspirated into the lungs, causing an infection that leads to pneumonia.

The staff at SACH has reduced the amount of time a patient spends on a ventilator. With that, the hospital has not had a ventilator-related infection since before 2006, Duell said.

Duell has also added caddies to each hospital room door. These caddies hold sterile equipment, gloves and other items aimed at preventing infection.

Nurses are also paying more attention to signs and symptoms of infection and conduct a daily assessment of patients, Duell said.

Increased technology has also enabled nurses to track any possible signs of infection. In fact, all patient charts have been transferred to mobile computers.

Prevention is the key to stopping these infections, Duell said.