March 01, 2018
The focus today is on healthcare-associated infections—a topic that should be of interest to anyone who has been, or ever will be, a patient. According to a survey conducted by the Centers for Disease Control and Prevention (CDC) in 2011, one in 25 patients develops an infection related to a hospital stay. It’s hard to believe, but in the not so distant past, physicians thought that healthcare-associated infections (HAI) were just part of being hospitalized, an unfortunate complication that could not be prevented. Today we know that there is a lot that can be done to reduce the risk of infection. The goal is always ZERO. Our physicians and hospital partners—together with the larger medical community—are working hard to reduce the risk of HAI, an important patient safety concern and preventable complication.
Dr. Luis Ostrosky-Zeichner, professor of infectious diseases and vice chair of quality for the Department of Internal Medicine, provides an update on this important topic.
Is today’s hospital patient at risk for infection?
We are particularly concerned with four types of infections among hospitalized patients: blood stream infections related to use of central lines, catheter-associated urinary tract infections, pneumonia related to being on a ventilator, and surgical-site infections. In addition, we monitor and try to reduce risk for infections caused by specific pathogens—including methicillin resistant Staphylococcus aureus (MRSA), Clostridium difficile, multidrug-resistant gram-negative bacteria, and emerging pathogens and viruses that may be transmitted in hospital or other healthcare settings.
Is it safe to be a hospital patient?
The risk of infection is real. But, as scary as all of that sounds, it is safer to be in the hospital today compared to 5, 10, or 15 years ago. According to the CDC, there was a 50 percent decrease in central line-associated infections between 2008 and 2014. In addition, for accreditation, hospitals are required to have infection control programs to monitor and prevent infection. We realize that there is a lot to be done to reduce infections, and we can’t leave infection prevention to chance.
What role do caregivers, physicians, residents, and medical students, play in reducing the risk of HAI?
Healthcare-associated infections remain an important public health problem, with more than a million patients in the United States infected every year. Education is a key component of prevention. We have moved from a passive role to a more active role, focusing on prevention for every patient. We start with our medical students—our curriculum includes lectures in infection prevention in the first semester. We work with our house staff, introducing evidence-based measures to prevent infection, and provide training and updates to our faculty and staff. This requires a big educational push for us all.
What is our medical school doing on a departmental level to reduce these risks?
Under the leadership of Dr. Bela Patel, vice dean for healthcare quality and Graham Distinguished University Chair, each clinical department has named a vice chair for quality. These vice chairs meet together monthly to share best practices and to review data on a variety of quality and patient safety issues—not only infection. More importantly, they interact on an almost daily basis working together to reduce HAIs and other hospital complications. The infectious diseases divisions, in the departments of Internal Medicine and Pediatrics, work with the care teams at Memorial Hermann and LBJ hospitals, as well as with the infection prevention team at UT Physicians.
How has the medical school’s role changed in infection prevention?
We have gone from a passive relationship – one of surveillance and response to specific infections in the hospitals – to an active, evidence-based, infection prevention program. In our outpatient UT Physicians clinics, we are pioneers, tackling infection risk and showing national leadership. UT faculty lead committees at the hospitals and have written national guidelines and given presentations at national meetings. We work diligently every day to reduce HAIs. Most importantly, this improves the outcomes of our patients. In the process we are also working to avoid millions of dollars in quality of care penalties for our hospital partners from CMS and other insurers.
Does the patient have a role in preventing hospital infections?
It’s important to remember that infections can have devastating consequences for patients. Every healthcare-associated infection is one too many. Patient education and empowerment is an important part of our strategy to reduce infections. We are empowering patients to ask questions—to question the use of antibiotics and to remind physicians and other care providers to wash their hands.
All healthcare workers have a role to play in reducing healthcare-associated infections. Please join me in thanking Dr. Ostrosky, Dr. Patel, our vice chairs for quality, and their teams who work every day to keep our patients safe.
P.S. I thought you may enjoy reading this article about a resident’s encounter with Dr. Bernard Lown, one of the icons of American medicine.