Download Healthcare associated infections and medical imaging

Healthcare associated infections and medical
imaging - infection prevention is everybody's
business: A case report
By Dr D Neil Jones, Staff Consultant Radiologist
Flinders Medical Centre, South Australia
Description:
Case details
An imaging study was requested for an inpatient. Radiology staff called the ward to confirm
the request, and arrange transport. The patient was transferred to the patient waiting bay area
in the Radiology department by a “patient transport” staff member. On review of the patient's
accompanying medical notes, it was evident that the patient had a hospital-acquired methicillin
resistant staphylococcus aureus (MRSA) infection. The Medical Imaging and Patient Transport
staff members were annoyed that nobody had been informed. There was no information about
this on the imaging request form (“Alerts” box left blank), nor on the Radiology Information
System.
Discussion
This case study raises several issues.
Firstly, effective and timely communication, including clinical handover, is essential1. This
includes the intra-hospital transfer of patients, and the Medical Imaging department is a site of
frequent patient visitations with multiple interactions involving Imaging staff members
(clerical, nursing, radiographic, medical), ward staff, and transport staff. Additionally, patient
information/alerts should be uniformly and readily available, for example, through electronic
means, to treating healthcare workers2. Sometimes, variable quality information may reside in
disparate and non-integrated information systems within the healthcare organization. Imaging
referral forms must contain accurate, complete and relevant information. Involvement of the
patient in their own healthcare management may also help prompt appropriate clinical action.
Secondly, this case study highlights the issue of Healthcare Associated Infections (HAIs)3,4,5
and the Medical Imaging department. A HAI occurs when a patient acquires an infection as a
result of receiving healthcare. HAIs acquired in the hospital setting are a major cause of death
and increased morbidity for hospital patients worldwide. Multinational point prevalence studies
demonstrate a HAI rate of around 8-10%4. It is estimated that there are 200,000 such
infections in Australian hospitals annually5. There are also many indirect impacts of HAIs
including a reduction in throughput for elective surgery, stress and workload pressure for staff
and reduced time to attend to other patients. HAIs can occur in any patient and most
commonly include urinary tract, respiratory tract, surgical site (wounds) and blood stream
infections. They are the most common complication affecting patients in hospital, and involve
bacterial (with or without antibiotic multiresistance) and viral infections. Healthcare workers
HAI and medical imaging - infection prevention is everybody's business: A Case Report
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can also be involved. MRSA is the most commonly reported multiresistant organism and is
responsible for a significant burden of disease.
The prevention and management of such infections is therefore critically important. HAIs are a
major and growing issue in the quality and safety of health care in both the hospital and
community settings requiring urgent national consideration and action and has been
nominated as a priority area by the Australian Commission on Safety and Quality in Health
Care (ACSQHC)3. This HAI program aims to build on facility and jurisdictional initiatives to
develop a national approach to reducing HAI by identifying and addressing systemic problems
and gaps, and ensuring comprehensive actions are undertaken in a nationally coordinated way
in both public and private health sectors.
There are five key initiatives in the overall strategy:
1.
2.
3.
4.
5.
National Hand Hygiene Project6,7
National Infection Control Guidelines
National HAI Surveillance System
Building Clinician Capacity in this area
Antibiotic Utilisation/stewardship
In other countries recognition of the impact of HAIs is growing and considerable measures are
being taken in this area8,9.
HAI and medical imaging: Your role in their prevention
There are actions you can take to minimise the risk of your patients acquiring HAIs. These are
listed below and adapted from the Tasmanian Infection Prevention and Control Unit
document4. Up to 70% of hospital-acquired infections could be prevented if infection control
procedures were optimised.
1)
Hand hygiene6,7: The highest priority area to reduce the risk of healthcare-associated
infections is improved healthcare worker hand hygiene.
Improving hand hygiene among healthcare workers is currently the single most effective
intervention to reduce the risk of healthcare associated infections. Transfer of microbial
pathogens (including MRSA) on the hands of healthcare workers is a key driver of healthcare
associated infection. Healthcare workers inadvertently transfer nosocomial pathogens as they
move from patient to patient. Colonised patients become the major reservoir of hospitaladapted pathogens, shedding these organisms into their immediate surroundings. The final
transition from colonisation to infection occurs by transfer of a colonising organism to a sterile
site during medical care or as a result of the breach of primary defences (injury or medical
device).
The purpose of the National Hand Hygiene Initiative is to develop a national approach to
improving hand hygiene and monitor its effectiveness. The initiative is based on the World
Health Organisation (WHO) - World Alliance for Patient Safety campaign – "Clean Care is Safer
Care" launched in 2005. The ACSQHC plans to launch the program in February 2009. At their
December 2008 meeting, Australian Health Ministers endorsed a national approach to the
implementation and monitoring of hand hygiene standards and a standardised national audit
tool auspiced by the ACSQHC10.
The Medical Imaging department is characterized by very frequent patient interactions and
contact involving multiple staff groups. Some of these patients or patient groups seen in
Medical Imaging are at high risk for HAI. There is a real potential for breakdown of hand
hygiene involving such a high-density, high-acuity patient population in frequent contact with
health-care workers. Additionally, some imaging is performed outside of the Medical Imaging
department in high-risk environments such as ICU.
2)
Policies and procedures
It is important to be aware of and comply with infection control policies and procedures that
reflect current best practice and standards, including sharps disposal. For example, this RaER
case study highlights the need for adherence to institutional protocols in relation to the
prevention, detection/surveillance, and management of MRSA infection. Procedures and
HAI and medical imaging - infection prevention is everybody's business: A Case Report
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practices need to consider and include infection control risks. Aseptic and non-touch
techniques must be carried out correctly. Control of the re-use of single use devices must
occur.
The Medical Imaging environment is a highly relevant one in relation to these issues. Patient
procedures are performed routinely and frequently, ranging from peripheral intravenous access
and drug/contrast administrations, through to highly complex and invasive interventional and
therapeutic interventions. Body fluids are often involved. Nuclear Medicine imaging techniques
can involve in vitro laboratory blood product radio-labeling, and patient reinjection of blood
products, and serious adverse events have been reported in both processes11,12.
3)
Cleaning
Clean and decontaminate equipment and your environment appropriately. Sterilise equipment
as appropriate. Medical Imaging equipment may harbour potential pathogens, e.g. MRI
scanners and ultrasound equipment13,14.
4)
Consider your patients
Consider the “risk” your patients pose to others in respect to infection control, and manage
those patients appropriately. Also consider whether any of your patients are at risk of HAI.
5)
6)
Personal protective equipment
•
Wear personal protective equipment appropriately and correctly
•
Always perform hand hygiene after removing personal protective equipment.
Surveillance
•
Participate in surveillance of HAIs
•
Organizational monitoring of infection control standards, compliance (for example,
hand hygiene) and infections.
In December 2008, all Australian Health Ministers agreed to a national approach to
surveillance of Staphylococcus Aureus blood stream infections (including MRSA) and other
virulent microorganisms. All hospitals will establish healthcare associated infection surveillance
and monitor and report on Staphylococcus Aureus (including MRSA) blood stream infections
and Clostridium Difficile infections, through their jurisdiction, into a national data collection10,15.
7)
Get informed and promote action
Understand the issues of HAI and promote a culture of awareness, patient safety and action.
8)
Antibiotics
Use antibiotics appropriately. Occasionally, antibiotic prophylaxis is administered in the Medical
Imaging/Interventional Radiology department, although this is a relatively minor feature of
overall Medical Imaging work practice. Antimicrobial resistance is one of the major threats to
the great advances in treatment of infectious disease. The leading example has been the
emergence and dissemination of penicillin resistance in Staphylococcus aureus. Hospitals are
the major focus for the spread of highly resistant organisms. Antimicrobial resistance increases
the morbidity and mortality associated with infections, and contributes to increased costs of
care due to prolonged hospital stays and other factors, including the need for more expensive
drugs.
9)
Immunisation
Ensure you are up to date with your immunisations and receive yearly influenza vaccinations.
Summary
Healthcare Associated Infections are a major public health concern, and all stakeholders are
paying serious attention. There is a growing recognition of the safety and quality aspects of
HAIs. Medical Imaging departments and staff need to understand these important issues, and
actively participate in solutions to reduce the risk to our patients.
HAI and medical imaging - infection prevention is everybody's business: A Case Report
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References
1.
ACSQHC Clinical Handover (accessed Feb 14, 2009)
2.
Kho, A. An effective computerized reminder for contact isolation of patients
colonized or infected with resistant organisms Int J Med Inform. 2008 Mar;77(3):
194-8.
3.
ACSQH Healthcare Associated Infection (HAI) (accessed Feb 13, 2009)
4.
Tasmanian Infection Prevention & Control Unit "Healthcare Associated Infections
Information for health professionals" (accessed Feb 13, 2009)
5.
ACSQH "Reducing harm to patients from healthcare associated infection: the role of
surveillance" (accessed Feb 13, 2009)
6.
Hand Hygiene Australia http://www.hha.org.au/ (accessed Feb 13, 2009)
7.
ACSQH National Hand Hygiene Initiative (accessed Feb 13, 2009)
8.
NHS UK "Healthcare associated infection" (accessed Feb 14, 2009)
9.
Public Health Agency of Canada "Healthcare-associated infection practices and
resources among provinces and territories in Canada: results of a survey" (accessed
Feb 14, 2009)
10.
ACSQH Update; Issue 7, December 2008 (accessed Feb 13, 2009)
11.
Patel P. et al. 'Hepatitis C Virus Infections From a Contaminated
Radiopharmaceutical Used in Myocardial Perfusion Studies' JAMA 2006;296:20052011.
12.
Rojas-Burke J. 'Health Officials Reacting to Infection Mishaps'. J Nucl Med 1992 33:
13N-27N.
13.
Fowler, C, McCracken D, 'US Probes: Risk of Cross Infection and Ways to Reduce ItComparison of Cleaning Methods'. Radiology 1999; 213: 299-300.
14.
Diagnostic Imaging 'Irish radiologists take urgent action to eradicate superbug'. Nov
28, 2006. (accessed Feb 15, 2009)
15.
Dendle, C 'Staphylococcus aureus bacteraemias as “signal event” surveillance in a
busy hospital' (accessed Feb 13, 2009)
HAI and medical imaging - infection prevention is everybody's business: A Case Report
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© RANZCR - 2009
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COPYRIGHT NOTICE:
This report is protected by copyright. No part of this publication may be reproduced or copied
in any form or by any means without the written permission of the Royal Australian and New
Zealand College of Radiologists.
For written permission to use the information contained in this report, please contact the
RANZCR: [email protected]
DISCLAIMER:
Responsibility for the content of this report resides solely with the authors. The views and
opinions expressed in this report, including key recommendations and findings are strictly the
views and opinions of the authors and not officially sanctioned by the Royal Australian and New
Zealand College of Radiologists.
NOTE:
The RaER project was funded by the Australian Commonwealth Department of Health and
Ageing under the Quality Use of Diagnostic Imaging Program.
HAI and medical imaging - infection prevention is everybody's business: A Case Report
QUDI eNews, February 2009
© RANZCR - 2009
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