This article was medically reviewed by Dr. Donald T. Allegra.
Contracting an infection can be an unfortunate side effect of hospitalization, but the good news is that it’s happening less frequently than it did in the past. That’s because most hospitals and nursing homes are required to establish formal infection control plans, and many residential facilities and schools are voluntarily following suit. Particularly as the COVID-19 pandemic continues, these plans are essential not only for the protection of patients and staff members, but for the preservation of institutional reputations built around excellent care in a safe environment. In this blog, ID Care’s Dr. Donald T. Allegra discusses the top three reasons that both healthcare leaders and patients should be invested in the implementation and success of infection control plans.
The Top 3 Reasons an Infection Control Plan is Crucial
The simplest and most pressing mission of hospitals is to take care of patients, so of course a top priority is making sure these vulnerable individuals don’t acquire new illnesses while admitted.
“The last thing we want to do is have somebody come into the hospital for a simple hernia surgery and wind up with a massive, life-altering infection,” Dr. Allegra said. “That’s why patient care is so greatly enhanced when infection control is employed.”
A second important goal is keeping hospital stays as short as possible, which supports both safety and convenience for patients. By helping to ensure timely release after proper treatment, infection control plans allow patients to go home when expected to resume their everyday activities. Healthcare facilities also value this approach because it helps to preserve budget dollars for investment in patient care.
A third consideration is that the prolonged hospitalization of even just a few patients due to facility-acquired infections can negatively affect the public’s perception of an institution.
“The consumer now looks online and says, ‘What are the outcomes at the hospital for hip replacement and how many infections do they have?’” Dr. Allegra said, “and if they find out infection rates are high, people don’t go to that hospital for required procedures.”
Infection Control Plans Gain Importance as Medicine Advances
To protect both patients and staff members, facilities these days must manage a new set of infection risks that, ironically, have emerged due to the latest medical advances.
Simply put, healthcare is becoming increasingly sophisticated: A greater proportion of people are surviving cancer, in part due to new immunotherapies; patients are being fitted with 3D-printed organs and bones; treatments for AIDS and hepatitis C have improved; an artificial pancreas is available to patients with type 1 diabetes; and augmented-reality headsets are helping surgeons excel.
As a result, fragile, sick, and elderly patients are living longer and being admitted to hospitals for treatment of age-related and other health issues. Unfortunately, many of them face a heightened possibility of infection — for instance, because treatment for cancer or rheumatoid arthritis has left them immunocompromised, or due to the risks associated with joint-replacement surgery or pacemaker implantation. Infection control plans today are designed to protect these patients.
The success of this approach is best demonstrated by the steady decline of hospital-acquired infection rates over time. According to the HAI Hospital Prevalence Survey, about 3% of hospitalized patients contracted infections in 2015, the Centers for Disease Control (CDC) reports. The likelihood of a patient acquiring an infection that year was 16% less than the rate recorded in a 2011 study, according to the CDC. Collecting and analyzing this data is key to developing effective infection control plans. Today, approximately 1 in 31 hospital patients has at least one healthcare-associated infection.
In the old days, people would go into the hospital, and a significant percentage of them would get illnesses just as side effects of what we were doing for them,” Dr. Allegra said. “Now, because we are so focused on making sure that no one gets ill or contracts an infection from getting procedures done in the hospital, we’re cutting it down close to 0% for some infection types.”
Infection Control Plan Pillars: The Top Three
Fortunately, there are several evidence-based strategies for preventing infection among both patients and staff. It may seem simplistic to tell staff members to wash their hands before touching a patient, but that mantra is repeated often in hospitals for good reason, with progress carefully monitored. “Hand hygiene is not only simple and inexpensive, but it’s one of the best things we can do in terms of preventing infections in the hospital or spreading infections from patient to patient,” Dr. Allegra said.
A second important measure is environmental cleaning, which involves frequently disinfecting all the surfaces in a room. This helps to ensure that infectious conditions don’t facilitate the spread from affected patients to others.
The third pillar of infection control is antibiotic stewardship. “It’s pretty well known that antibiotics are overused in the United States. In fact, it’s estimated that 30% to 50% of all the antibiotics used are given inappropriately,” Dr. Allegra said. “When there’s an overuse of antibiotics, we tend to develop organisms that are resistant, and that’s a big problem in infection control today, because we’re seeing more and more infections around the world that can’t be reliably treated with any antibiotic. So, the more focused we are on limiting the use of antibiotics to the people who need them, the less we will develop these very resistant organisms.”
How Infection Control Plans Improve Outcomes
While hand washing, environmental cleaning, and antibiotic stewardship form the basis of any good infection control plan, other components are also key, such as programs for conducting surveillance to determine a facility’s infection rate. “If we do detect an infection, we take measures to keep it isolated to one individual while figuring out how the person got it and what we can do to intervene, so it doesn’t happen again,” Dr. Allegra said.
To gather that information, specialists can assess the infection rates associated with individual surgeons — and investigate if numbers are unexpectedly high. That can involve exploring whether infections are associated with conditions in a particular operating room, such as a faulty air-conditioning system, or with a team member who is carrying a resistant organism.
“We look at the type of resistant bacteria that is homegrown in that institution: What bacteria are infection control specialists isolating?” Dr. Allegra said. “If they’re isolating a lot of resistant organisms, we make rounds on all the patients who are getting antibiotics to make sure they’re on the appropriate regimen so that resistant organisms do not develop in that organization.”
How a Good Infection Control Plan is Structured
Nearly all healthcare facilities and most nursing homes are required to have an infection control plan. As part of those programs, facilities are encouraged to provide infection control nurses based on the number of beds they have available to patients, with the World Health Organization recommending one nurse per every 250 beds and the authors of a large 2018 study suggesting a lower ratio of one nurse per 69 beds. The nurses, who must first complete coursework administered by the CDC, are then tasked with monitoring all infections that arise within the hospital. They are typically supervised by infection control specialists such as Dr. Allegra and his colleagues at ID Care.
In addition to reporting infection numbers to the New Jersey Department of Health, ID Care physicians guide their partner facilities in working with the federal government, which enacts all regulations related to infection control and monitors outcomes. As part of that program, any facility that accepts payment from Medicare or Medicaid receives oversight from the Centers for Medicare & Medicaid Services.
In addition, the nonprofit Joint Commission on Hospital Accreditation inspects the facilities annually, assessing surveillance data and ensuring that infection control policies are up to date. “If you’re not up to par, they will not give you certification, which is the lifeblood of any health facility,” Dr. Allegra said. “You have to be certified by the Joint Commission in order to do business.”
The Role of Infection Control Specialists
Contracted by many healthcare organizations, Dr. Allegra serves as infection control chairman for New Jersey’s Atlantic Health System as well as for some nursing homes, and his colleagues at ID Care do similar work for most of the acute-care hospitals and health systems across New Jersey.
“Because we’re infectious disease specialists we’re often asked to monitor and oversee the infection control plans and committees at these facilities,” he said. “That involves reviewing policy, having frequent conversations with the practitioners who are collecting data about infection cases, and speaking with the microbiology lab about any resistant infections they may have identified. We assemble all this data and discuss action plans every month or two at meetings attended by all the appropriate people from environmental health, nursing, and facility administration.”
The ID Care team is uniquely prepared for the task. As board-certified and fellowship-trained infectious disease doctors, the practice’s more than 50 physicians are experts in supporting antibiotic stewardship and functioning as infection control epidemiologists. In fact, Dr. Allegra previously worked for the CDC as an epidemic intelligence service officer, charged with traveling the world to investigate outbreaks of disease. Furthermore, the team of over 70 providers at ID Care includes advanced-practice nurses who have been trained in infection control so that they can help conduct surveillance at partner hospitals, healthcare facilities, and practices.
“We have so much depth and flexibility in our organization that there’s always another doctor who can step in when I’m either busy or away on vacation to answer questions or be available for crisis situations,” Dr. Allegra added. “So, we pretty much have 24-hour, seven-day-a-week, 365-day-a-year availability for the organizations we work with.”
It’s work Dr. Allegra has remained excited about throughout his career. “I enjoy the fact that we can cure infectious diseases,” he said. “If someone has a heart attack, you can help that person, but you can’t cure him — there’s still damage to the heart. But when it comes to infections, many can be cured, and I’ve always been intrigued by that notion as it is rewarding to see lives impacted.”
The Principles of Infection Control During the COVID-19 Pandemic
Of course, the COVID-19 pandemic has introduced new challenges for infection control specialists.
Those at ID Care are grateful that there is no longer a shortage of personal protective equipment, as items from gloves to N95 masks and even self-enclosed respiratory units known as powered air-purifying respirators (PAPRs) can do a lot to protect practitioners from contracting the virus. “We’ve also recognized that the virus can spread into mucous membranes like the eyes, as well as the mouth, so now we always wear eye shields when we go into the rooms of patients who have COVID-19,” Dr. Allegra said.
Due to the contagiousness of the Delta variant, other recommended strategies include limiting the number of visitors to patients who have COVID-19, conducting extra cleaning of both hospital rooms and high-flow areas, assigning people who have the virus to private rooms, and restricting movement through the hospital by staff members who have treated affected patients.
As the pandemic continues to unfold, having the expertise of an infection control doctor can be vital in helping facilities keep up with appropriate protocols.
“During the pandemic, we have cared for over 25% of New Jersey patients hospitalized with COVID-19, and we continue to set standards for policy and infection control,” Dr. Allegra said. “We’re learning as we go along with COVID-19, and every couple of weeks, something new comes out in the science that makes us change our policies a little bit. This is why it’s really important to have somebody who’s sophisticated in infection control to monitor the changing policies on the governmental level, as well as the evolving science that gets published every couple of weeks about how to prevent transmission of the disease.”
Infection Control Plans Are Moving into New Settings
The advent of COVID-19 has highlighted the importance of infection control plans for smaller facilities that are not required to establish formal programs, yet nonetheless recognize the need to take action.
In recent months, Dr. Allegra has worked with numerous school systems that were preparing to reopen. “I’ve done a number of talks to teachers and the administrators of some our school systems in New Jersey about the risks of COVID-19 and how to address it,” he said.
Other facilities that may be interested in establishing infection control plans include those that have inpatient housing for people recovering from drug problems or who have developmental delays or autism. In fact, the leaders of a residential program for teenagers with eating disorders recently consulted with Dr. Allegra about their visitation policy.
“They certainly don’t want to have an outbreak in their institution and have to close to new admissions,” he said. “Once you have an outbreak, it can be a public-relations disaster. It’s just like when a restaurant has an outbreak of food poisoning: No one wants to go there for a long time.” That’s why it’s vital for every healthcare organization to institute proactive preventive measures in the form of infection control plans to protect the integrity of their care and reputations.
How ID Care’s Infection Control Doctors Can Help You
The best way for hospitals and other facilities to avoid the challenges that come with an outbreak is to recognize that prevention is a complex art best executed by infection control specialists. As the largest infectious disease practice in New Jersey and the second largest in the country, ID Care boasts a team of leaders in the prevention and treatment of any type of hospital-acquired infection, from clostridium difficile (C. diff) to COVID-19. To learn more, call 908-281-0610 or visit idcare.com to schedule a consultation with an ID Care infectious disease expert to enhance your facility’s infection control policies and plans.