Improvements in infection control

In an attempt to reduce rates of antibiotic resistance and nosocomial infections, multifaceted interventions also have been directed at bolstering infection control practices. In 1996, officials from the Siouxland region of Iowa, Nebraska, and South Dakota noted increased rates of VRE. A taskforce requested CDC assistance to institute comprehensive surveillance and isolation precautions. Under CDC guidance, they enacted active screening, via perianal swabs, for VRE at the majority of the 32 Siouxland acute and long-term care facilities. By 1999, 92 percent of the facilities actively screened for VRE and 88 percent of the facilities had implemented strict barrier isolation precautions and environmental disinfection policies for VRE-infected or -colonized patients. The overall prevalence of VRE decreased from 2.2 percent in 1997 to 0.5 percent in 1999 (Ostrowsky et al, 2001).

Multifaceted interventions also have been aimed at improving hand hygiene. Between 1994 and 1997, Pittet and colleagues carried out a campaign to improve compliance with hand disinfection recommendations. Their interventions included educational posters in strategic areas, wide distribution of personal bottles of alcohol hand-rub, and bedside-mounted alcohol hand-rub dispensers. During 1994-1997, this sustained effort improved hand hygiene compliance from 48 to 66 percent. There also was a decreased prevalence of HAIs, from 17 to 10 percent, and a decreased rate of MRSA transmission, from 2.16 to 0.93 episodes per 10,000 patient-days (Pittet et al, 2000).

Importantly, the intervention by Pittet and colleagues attacked the problem of poor hand hygiene on two fronts. While they attempted to change behavior through educational interventions, they also used the "technologic advance" of alcohol-based hand-rubs to simplify hand hygiene. By reducing skin irritation and the time needed for hand antisepsis, alcohol-based hand-rubs address key barriers to hand hygiene compliance. This study demonstrates how both the assiduous application of low technology (e.g. educational posters) along with technologic innovation (e.g. alcohol-based hand-gels) can play key roles in advancing infection control and limiting HAIs.

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