Healthcare‐acquired infections: prevention strategies

Abstract

Healthcare‐acquired infections (HAI) impact on patient care and have cost implications for the Australian healthcare system. The management of HAI is exacerbated by rising rates of antimicrobial resistance (AMR). Health‐care workers and a contaminated hospital environment are increasingly implicated in the transmission and persistence of multi‐resistant organisms (MRO), as well as other pathogens, such as Clostridium difficile. This has resulted in a timely focus on a range of HAI prevention actions. Core components include antimicrobial stewardship, to reduce overuse and ensure evidence‐based antimicrobial use; infection prevention strategies, to control MRO – particularly methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant Enterococcus spp. (VRE) and, more recently, multi‐resistant Gram‐negative bacteria; enhanced institutional investment in hand hygiene; hospital cleaning and disinfection; and the development of prescribing guidelines and standards of care. AMR surveillance and comparisons of prescribing are useful feedback activities once effectively communicated to end users. Successful implementation of these strategies requires cultural shifts at local hospital level and, to tackle the serious threat posed by AMR, greater co‐ordination at a national level. HAI prevention needs to be multi‐modal, requires broad healthcare collaboration, and the strong support and accountability of all medical staff.

Historical background to maternal‐neonate separation and neonatal care

“…There is a microbiotic "race for the surface," therefore the baby's first contact ("immediate") should be with mother (Dominguez-Bello et al, 2010). Hospital germs are potentially deadly, and handwashing remains essential (Fernando, Gray, & Gottlieb, 2017). However, the old policy of "strict separation" of mother from baby lacks evidence.…”

Author reply

“…We feel this approach is fraught with danger unless there is a culture of safe practice that relies on having staff on every shift, appropriately trained in the monitoring and assessment of PIVC, early identification of signs of infection, empowerment of nursing and medical staff to remove immediately questionable PIVC, and for healthcare facilities to have exemplary processes in place, including documentation, review and surveillance of PIVC infection. As highlighted in our article, there is still, unfortunately, difficulty in engaging healthcare workers in strategies to reduce healthcare‐associated infections and in busy institutions diligent PIVC monitoring may be left wanting. This can have devastating consequences for individual patients, which we would argue outweigh the discomfort of cannula change.…”

Breaking the routine of peripheral venous catheter replacement

“…Fernando et al . list the routine removal of peripheral venous catheters at 72 h as a strategy for preventing hospital‐acquired Staphylococcus aureus bacteraemia . Readers would be interested to know that this widespread practice is not supported by evidence.…”