In the specialized neurosurgical unit, patients are often supported in their breathing for extended periods on the ventilator and their bodies are cooled while their brains recover from strokes or other injuries. These specialized interventions increase the risk of VAP. Also, due to aspiration, many of these patients have pneumonia upon admission, and continued ventilation makes this difficult to cure. Interventions in ventilator care have significantly reduced VAP rates in this select group of severely compromised patients.
We have also been successful at reducing our central line-associated bloodstream infections (CLABSIs), with zero CLABSIs in adult ICUs at all Cottage hospitals for two years, and zero CLABSIs in the Neonatal ICU for more than three years.
For inpatient and outpatient surgical site infections, Cottage hospitals are 75 percent below the national average.
Clostridium difficile colitis, a severe intestinal infection that paradoxically results from antibiotic use, is an international epidemic now, because a new strain of this bacterium has emerged over the last decade. Although this infection is on the rise in Santa Barbara as a whole (partially because of antibiotic use in outpatient settings), Cottage's rates are well below national benchmarks for hospitals.
Interventions are also in place and being developed for significantly reducing rates for catheter-associated urinary tract infections (CAUTIs). In addition to daily checks on patients with catheters, we are promoting bladder ultrasound to avoid catheter reinsertion, plus the prompt removal of unnecessary catheters. Intense education of staff on interventions to reduce CAUTIs is occurring and contributing to reduced CAUTI rates throughout the system.
How have we achieved such low rates of infection overall at our hospitals? We have outstanding clinicians, nurses, technicians, and other support staff caring for our patients. We have an administration dedicated to the prevention of hospital-associated infections and one that partners with healthcare providers to do so. Our Infection Prevention and Control Department spearheads this effort and provides evidence-based guidance to the hospitals aimed at eliminating these infections.
Hand hygiene, a simple yet crucial step in preventing infection, is actively promoted and monitored in all clinical departments, and as a system our compliance is consistently in the top 10th percentile nationwide. We are diligent in providing education to all personnel and physicians to help us achieve our goal of 100 percent compliance.
State-of-the-art UV lighting is installed in air handlers throughout our hospitals, the best technology available to prevent ongoing microbial growth on air conditioning coils. Studies show that this UV lighting system reduces microbial contamination within the HVAC system by more than 99 percent.
Although Cottage's surgical site infection rates are well below national averages, we work to identify process improvements that could have prevented these infections. A multidisciplinary team reviews the entire process of surgical preparation, surgery, and post-operative recovery in order to implement process improvements that can stop post-operative infections before they ever get started.
We follow every surgical patient for 365 days after any implant. If an infection occurs any time during the first year after surgery (as defined by the National Health and Safety Network), we document it as a healthcare-associated infection in our database and seek process improvements.
To drive already low surgical site infection rates towards zero, the Infection Prevention and Control Department, Pacific Diagnostic Laboratories, and Quality Department have worked closely with surgeons, cardiologists and primary care physicians. A process to test patients pre-operatively for colonization with Staphylococcus aureus was implemented in order to be able to decolonize them before any elective surgeries, or before procedures that lead to hardware implantation (i.e. pacemakers). More than 80 physicians associated with Cottage are using this program, and roughly 1/5 of patients screened have these bacteria on their skin and are candidates for Staph aureus decolonization before surgery. They are then treated with topical medications. Few hospitals have been able to implement such a comprehensive program because of the complex coordination required, despite compelling data that screening and decolonization drives down surgical site infections by about 2/3.
Knowing that the increase in superbugs has been linked to the overuse of antibiotics, Cottage has launched a comprehensive program to reduce unnecessary antibiotic prescriptions. Staffed by Infectious Disease physicians and pharmacists with specialization in antibiotics, it partners with prescribing physicians to refine antibiotic use. Since launching the program last July, we've seen significant reduction in antibiotic use; the acceptance rate of our recommendations is approximately 90%, well ahead of the 60% seen in published reports.
Fighting infection is a never-ending battle. Cottage's mission is to achieve and maintain a zero rate of hospital-acquired infection for every patient who comes into our hospitals. It is an ambitious goal, but nonetheless the standard to which all hospitals should strive.
Cottage Health System is one of the few healthcare organizations nationally that posts its infection rates on its public website, and we encourage other hospitals to share such information with their communities. We invite you to review our quality report information and infection rates here and to contact us for further information.
David Fisk, MD
Medical Director of Infection Prevention and Control,
Co-Medical Director of Antibiotic Stewardship,
Cottage Health System,
Clinical Assistant Professor of Medicine, USC School of Medicine
Leslie Stanfield, RN, BSN, CIC
Director of Infection Prevention and Control,
Cottage Health System