Becker's Clinical Quality & Infection Control

14 Special Focus on Infection Prevention More Contact Precautions Do Not Lead to Better Infection Control Practices, Study Shows By Ellie Rizzo I ncreases in contact isolation do not have corresponding increases in isolation practice compliance among healthcare workers, ac- cording to a study published in Infection Control and Hospital Epidemiology. Researchers monitored healthcare workers' compliance with indi- vidual components of contact precautions — hand hygiene, gloving behavior and doffing upon exit — at 11 teaching hospitals over 9 months in 2009. With 20 percent or less of a patient population under contact precau- tions, total compliance with the practice was 28.9 percent. With patient populations between 20 percent and 60 percent under contact isolation, compliance fell in some cases to as low as 6.5 percent. Researchers concluded 40 percent of patients under contact precautions appeared to be the threshold for the change in proportion of contact precaution-compliant healthcare workers. n 7 Core Elements of Antimicrobial Stewardship Programs By Ellie Rizzo T he Centers for Disease Control and Prevention has released a guide for improving antimicrobial stewardship programs in healthcare settings. According to the agency, the following steps are necessary for a successful program: 1. Leadership commitment. Leadership must dedicate necessary hu- man, financial and IT resources to the project. 2. Accountability. A single leader should be responsible for program outcomes. According to the CDC, physician leaders may be particularly effective for antimicrobial stewardship programs. 3. Drug expertise. A single pharmacist leader should also be responsible for working to improve antibiotic use. 4. Action. Implement at least one recommended action, such as systemic evaluation of ongoing treatment need, after a set period of initial treatment. 5. Tracking. Monitor antibiotic prescribing and resistance patterns. 6. Reporting. The program should include regular reporting of informa- tion on antibiotic use and resistance to doctors, nurses and relevant staff. 7. Education. Educate clinicians about resistance and optimal prescrib- ing techniques. n T he fluoroquinolone-resistant North Ameri- can pulsed-field gel electrophoresis type 1 strain of Clostridium difficile was found to be linked to greater odds of adverse events, accord- ing to a study in Clinical Infectious Diseases. Researchers analyzed more than 2,000 C. diff infections to identify the link between certain strains and certain adverse events. Of all C. diff cases, 17.7 percent resulted in severe disease, 4.9 percent resulted in a severe outcome and 2.7 percent resulted in 14-day mortality. Researchers found the NAP1 strain to be the most common, accounting for 28.4 percent of all in- fections, followed by NAP4 (10.2 percent) and NAP11 (9.1 percent). Additionally, the NAP1 strain was the strain most likely to cause severe disease, severe outcome and 14-day mortality. Researchers suggest strategies to reduce NAP1 infection, including antimicrobial stewardship programs and reduced fluoroquinolone use, may help reduce mortality rates. n information upon admission and face-to-face conversations between pa- tients and healthcare professionals could be effective strategies for empower- ing patients. "Hospitalized patients are often vulnerable, and vast asymmetries and medi- cal knowledge exist between providers and patients. These conditions can jeopardize adequate consideration of patients' values and interests. Actively empowering patients, ensuring them an opportunity to act in light of their values and interests, supports patient autonomy," said the authors of the wis- dom of collaborating with patients on HAI prevention. n Should Providers Be Obligated to Involve Patients in HAI Prevention? (continued from cover) NAP1 Strain of C. diff Linked to Highest Mortality By Akanksha Jayanthi

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