Mac’s Safety Space: The front line of infection prevention

By Steve MacArthur, Hospital Safety Consultant

While 100% of the potential for elevated risks of a healthcare-acquired infection (HAI) does not walk through the doors of your emergency department, you could certainly make the case that a fairly high quotient of at-risk “traffic” is going to enter your facility through the emergency department. And there’s no reason to think that your emergency department is going to continue to be anything but an opportunity for those peskily opportunistic buggers.

Look no further than the fungal meningitis outbreak currently winding around (and hopefully winding down) to see that, while not exactly coming out of “nowhere,” there are infection risks all around us—and not necessarily ones for which “fair warning” will be received (every outbreak/pandemic has to start somewhere, doesn’t it).

While I suspect that, empirically, vigilance is a constant, at this point it comes tied to a level of existential exhaustion for healthcare workers than might very well be unprecedented in its magnitude. Just yesterday, in a conversation with some professional colleagues, the whole notion of boarding of patients for extended periods in emergency departments was noted—“traffic jams” due to staffing, patient volumes and a whole host of other variables has become the norm (it was always there, but it does seem to be driving numbers in ways not seen recently), creating something of a “perfect storm” of risks to be managed.

Interestingly enough (or perhaps not—what was a hot topic once is now new again), this week’s chat was driven by an article that crossed my path—from 2016! The article discussed the concern among healthcare leaders regarding the management of infection prevention in the emergency department and outlines some best practices derived from a study of a sample of emergency departments in the United States with sustained department compliance of infection-avoidance practices at 80% or above (there were 14 facilities in the study):

• Motivation tended to be tied to departmental or institutional factors rather than regulatory compliance
• Emergency department departmental infection rate data was an important motivator in achieving sustained department compliance
• Having a management “champion” who makes decreasing infection rates their mission
• Staff feeling accountable for patient morbidity and length of stay (also known as a culture of safety)

That being said, the “trick” sometimes becomes a function of how one effectively manages both the physical environment and individual behavior(s). One physical environment “finding” that I think is going to continue to rise in frequency (as well as criticality when it comes to accreditation survey results) is the presence of “damaged surfaces” in the care environment—and I can think of few places in any hospital for which this “risk” is more prevalent than in emergency departments (keeping up with this stuff in even a moderately busy ED can be like trying to change the wings on a jet—while it is in flight).

So once again, it comes down to how far “upstream” you can manage this stuff. (Identify the issue, Report it, Correct it – IRC.) This damage comes in more forms than we have time to even think about – just like the physical environment itself, “damage” (or, if you prefer, imperfection) is everywhere and a non-intact surface is very much an infection control risk.

While it is not necessarily a surprise to find that folks are somewhat skittish when it comes to using public restroom facilities, it may become another potential survey vulnerability if your restroom facilities are not “up to snuff.” As a frequent air traveler, I can tell you that some airports provide a much more reliable restroom experience than others, but I generally feel comfortable using public restrooms in hospitals. However, I do try to manage infection risks (if a restroom door handle needs to be pulled in order to exit, I am generally unhappy if the only drying medium is an air blower—I trust me, but I’ve seen enough instances of failed handwashing to know that it takes a busload of faith to grab a handle).

The challenge of all this is that the physical environment is, literally, everywhere – and that’s a whole lot of ground to cover (and re-cover – and re-cover…)

About the Author: Steve MacArthur is a safety consultant with Chartis Clinical Quality Solutions (formerly known as The Greeley Company) in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Healthcare Safety Leader. Contact Steve at stevemacsafetyspace@gmail.com.