Coming Clean Holyoke Medical Center Has Infection Control Down to a Science

It’s a fine balance that health care workers walk: seemingly every technological advance that promises to save lives also carries with it new risks.

In the hospital setting, for instance, infection risks can arise from a variety of sources: IV lines, catheters, and minimally invasive surgical equipment are all examples of products that are inserted into the body and therefore pose the possibility of introducing contamination.

“The human body has fantastic natural defense mechanisms, like skin and mucous membranes, that protect us, but we often have to bypass them in to order administer medical treatment in an effort to improve someone’s condition,” said Carol Wojnarowski, manager of the Infection Control Department at Holyoke Medical Center (HMC). “The fact is, in a hospital setting, a patient’s immobility and invasive devices like an indwelling urinary catheter or intravenous lines can put the patient at risk of an infection.”

However, she said, Holyoke is among many hospitals that have made infection control a priority, with a series of efforts that aim to eliminate infections from the moment a patient enters the hospital environment. As a result, over the past three years, HMC’s rates of bloodstream infection and ventilator-associated pneumonia in the ICU have steadily decreased, and Wojnarowski has documented only one central-line infection in the ICU in the last 10 months.

HMC’s practices for infection control begin with individual employees, she said, who use antibacterial soap for hand hygiene, get annual flu shots, and maintain proper sterilization practices in the Central Sterile Department. At the bedside, they wear hats, goggles, gowns, booties, and sterile masks before initiating a procedure.

Meanwhile, intensive-care doctors use anti-microbial dressings and carefully monitor the use of devices such as ventilators, IVs, and catheters, paying close attention to the way such items are removed and changed.

Every morning, Wojnarowski conducts rounds in the ICU with the hospital’s intensivist on duty, nurses, physicians, nutritionists, and case-management staff to ensure they are providing a high quality of care to every ICU patient as well as to review each patient’s treatment plan. This team concept, she explained, reflects the nationally recognized model of multidisciplinary rounds, which helps care providers monitor and control the spread of any hospital-acquired infections.

“Many of these practices are on the low-tech side, and they’re absolutely universal,” Wojnarowski explained. “As with everything else, we monitor these practices and refresh and educate our staff on these issues. We don’t want these successes to slip away or erode.”

Mix Messages

Attention to infection risk at HMC extends to the medications themselves, not just the IVs inserted into the skin.

Last summer, for example, the area of the hospital pharmacy where IV medications are prepared was completely renovated and transformed into a ‘clean room.’ The changes bring the hospital into compliance with new government regulations that seek to ensure that the production of IV medications is carried out in an environment that minimizes the possibility of contamination and, thus, infection.

“The environment in which we make IVs is now very similar to the environment in which surgery is performed,” said Pharmacy Director Dave Gamblin.

In the IV room, HEPA filters remove particles from the air, and the surfaces are non-porous; the counters are stainless steel, and the floor is sealed. Pharmacy workers clean the area with sterile alcohol and non-shedding wipes, and anyone who enters the clean room must wear shoe covers, hair nets, and disposable smocks over their clothing and face masks. Handwashing before entry, followed by application of an antimicrobial product on the hands once inside, are also a must.

“The air is strictly controlled to avoid particles, because fewer particles means less chance of microbial contamination,” Gamblin said. “We keep air quality at a high level.”

The introduction of a system called the ‘Mini-Bag Plus’ for mixing certain IV medications outside of the clean room may also decrease the chances for product contamination and patient infection, he said. “That’s a system by which nurses mix IV products without using syringes. Essentially, it decreases the potential for contamination when nurses mix the IV products,” Gamblin explained.

The system consists of a capped bag (sealed until use) of IV fluid. Within the cap is a puncture mechanism that inserts into the top of a medication vial. Once inserted, the IV fluid is mixed with the medication by squeezing the bag, eliminating the need for a needle and syringe. Fewer steps and less product manipulation results in reduced chances for contamination and subsequent infection, he noted.

What it amounts to is a culture change in the pharmacy, one in which all employees there are well-versed.

“All of our folks are intensively trained in how to mix IV products,” Gamblin added, as well what to wear in the IV room and how to clean that area. “It’s quite a process to keep the IV room as close as possible to, basically, the environment in an OR, as close to sterile as possible. We use the same things you’d use in an operating room in order to safeguard the public.

“There have been occasions where individuals have hospital-acquired infections, and it’s difficult to be sure where these infections come from,” he continued. “In the pharmacy, we want to make sure we do everything possible to make sure we’re not the source. That’s why we have the clean room and the most sterile product possible.”

Drive to Succeed

Well-publicized studies over the past decade revealing tens of thousands of avoidable deaths occurring from hospital errors has put all institutions on alert. Wojnarowski said she and her staff must remain vigilant because the game is ever-changing.

“Our technology has us at a point where there’s a risk in everything we do,” she said. “It’s like driving — there’s a risk in that, but also great benefits.”

Likewise, “the invasive devices that go into the bloodstream and lungs always carry a risk,” she said. “The goal is to always minimize this risk. We all play a role in preventing infection. Everyone in the hospital has to be on board.”