Infection Control Starts Here: Highlights from APIC and AcademyHealth
Nurses are on the front lines when it comes to controlling infection in patients, families, and communities. Columbia Nursing faculty and students shared their findings from more than a dozen research projects in infection control and prevention at two medical meetings last month - AcademyHealth's Annual Research Meeting and the Association for Professionals in Infection Control and Epidemiology (APIC) Annual Educational Conference.
The following are selected highlights from the meetings:
When states make infection reporting mandatory, infection rates go down, several studies found. Patricia Stone, PhD, RN, FAAN, Centennial Professor of Health Policy, was senior author on a study titled, "Impact of State Reporting Laws on CLABSI Rates in US Adult Intensive Care Units," that was presented at AcademyHealth. The study found those states that passed laws requiring hospitals to report health care-associated infections (HAIs) experienced a significant decrease in rates of central line-associated bloodstream infections (CLABSI). Co-authors from Columbia Nursing were Carolyn Herzig, MS, project director for the Prevention of Nosocomial Infections and Cost Effectiveness Refined study; Elaine Larson, PhD, RN, FAAN, associate dean for research; and Monika Pogorzelska-Maziarz, PhD, MPH, associate research scientist.
Patricia Stone, Carolyn Herzig, and Monika Pogorzelska-Maziarz were also among the co-authors on another study presented at AcademyHealth, "The Association of State Legal Mandates for Data Submission of Central Line-Associated Bloodstream Infections in Neonatal Intensive Care Units with Process and Outcomes Measures." The study found that neonatal intensive care units in states with laws requiring infection reporting had significantly increased compliance with CLABSI prevention practices, and they were also associated with lower infection rates among the tiniest infants.
At APIC, a team of researchers from Columbia Nursing summarized results from several studies in a presentation titled, "State Regulated Mandatory Reporting of Healthcare-Associated Infections in Acute and Long-Term Care Settings." As part of the presentation, Carolyn Herzig shared findings from a review of national trends in HAI reporting as well as findings from another study demonstrating that state reporting laws helped decrease CLABSI rates beginning six months prior to the laws taking effect. The findings suggest that providers stepped up infection control efforts to prepare for the new reporting laws. Monika Pogorzelska-Maziarz summarized views of state mandated reporting based on interviews with key stakeholders in infection control and found that lack of funding might be an impediment to more robust infection control programs. PhD student Catherine Cohen, RN, MSN, shared findings from a study identifying state health department activities to reduce HAIs in nursing homes. She found that few states mandate infection reporting for this setting and that states are taking other, diverse approaches to address this problem such as providing information to consumers to choose a nursing home based on state inspection reports.
Beyond protecting patients, infection control efforts have also been credited with reducing the unnecessary health care costs of preventable HAIs. But as Catherine Cohen found out in a study she led, "Costs of Infection Prevention Practices in Long-term Care Settings: A Systematic Review," more research is needed because previous studies in this setting were not researching the same types of infections or interventions, which would be needed to show which activities may have a financial benefit. Patricia Stone was senior author on the study presented at AcademyHealth, and PhD candidate Yoon Jeong Choi, RN, MSN, MPhil, was a co-author.
Several studies at APIC featured research on children in long-term care facilities who are particularly vulnerable to infections. Meghan Murray, MPH, surveillance officer, was a co-author on a study titled "The Effect of Infection Control Policy on Acute Respiratory Illnesses in Pediatric Long Term Care." The study found that a comprehensive infection control and prevention policy that addresses residents and visitors may be helpful in decreasing transmission of acute respiratory infections.
Bevin Cohen, MPH, program director for the Center for Interdisciplinary Research to Prevent Infections, was lead author on a study titled, “Using Workflow Assessments to Improve Hand Hygiene in Pediatric Long-Term Care Facilities." Elaine Larson was senior author on the study, and co-authors included PhD candidate Eileen Carter and Meghan Murray. The study found that assessing when and how each worker comes in contact with residents can be especially helpful in residential settings where infection control must be practiced in varied environments such as dining halls, recreational areas, and classrooms.
Meghan Murray was lead author on a study titled, "Implementation of an Electronic Hand Hygiene Monitoring System in Pediatric Long-Term Care Facilities," with Elaine Larson as senior author and Bevin Cohen among the co-authors. The study found that while electronic monitors accurately tracked hygiene frequency, the staff couldn’t easily interpret the reports generated by the monitors. Another study titled, "Outbreak of Group a Streptococcus at a Pediatric Long-term Care Facility," with Meghan Murray as a co-author, found that availability of strep testing and maintenance of isolation areas for infected and exposed individuals helped end an outbreak.
One of the simplest, and lowest-cost interventions to prevent infections is hand hygiene. At AcademyHealth, Eileen Carter presented findings from a study she led titled, "Emergency Department Crowding Negatively Associated with Hand Hygiene." The study looked at an overcrowded emergency department and found that clinicians often failed to use soap or hand sanitizer in situations when proper hand hygiene is recommended by the World Health Organization. She was a co-presenter on an oral presentation titled "Lessons from the Field: Successful Infection Prevention Strategies in the Emergency Department." After making site visits and conducting more than 100 interviews with key staff and administrators at emergency departments with high-performing infection prevention programs, the researchers found that multifaceted approaches including workflow modifications, data feedback mechanisms, and interdisciplinary champions were viewed as critical to program success.
Infection preventionists can fill a vital role in improving compliance with HAI policies. Elaine Larson highlighted research by PhD candidate Laurie Conway, RN, MPhil, CIC, in a presentation at APIC titled, "IP Role Recognition: Developing a Professional Advancement Ladder for the Changing Role of the Infection Preventionist." The qualitative analysis, based on surveys of IPs at hospitals around the country, found that while these clinicians have the ability to reduce HAIs, they sometimes lack the resources necessary to do their jobs effectively.
Prisons are another setting with unique infection control challenges. Elaine Larson was senior author on a study at APIC titled "Obesity as a Determinant of Staphylococcus aureus Colonization among Maximum Security Prisoners in New York State." While obesity is a risk factor for non-communicable diseases, its influence on susceptibility to infections isn't well understood. The study, which looked at both male and female inmates, found that obesity is a possible risk factor for staphylococcal infections among women.
Assistant Professor Lusine Poghosyan, PhD, MPH, RN, presented a study titled "Effective Deployment of Nurse Practitioners in Primary Care: State and Organizational Forces." The study found that despite the shortage of primary care providers, NPs are not being deployed optimally in many primary care practices.
Jingjing Shang, PhD, assistant professor, presented a study titled "Healthcare Associated Infection in Home Health Care Setting - Results from the National OASIS Data." She found that these patients are at risk for infection because the home isn't often a sterile environment and caregivers in this setting are often family members who lack training in infection control. She was also lead author on a study titled "Hospitalization among Home Health Care Patients - Results from the Outcome and Assessment Information Set (OASIS)" that found that African Americans, smokers and patients with pre-existing medical conditions have a high risk for hospitalization. Another study she presented, titled "The Prevalence of Infections and Patient Risk Factors in Home Health Care: A Systematic Review," found that more research is needed to assess infection risk among patients who receive parenteral nutrition.
A study led by Yoon Jeong Choi, “Systematic Review of the Determinants of Medication Adherence among Adult Diabetes Patients,” examined factors that can prevent diabetics from consistently using prescription drugs that can help to halt the progression of the disease and alleviate symptoms. The study findings suggest that control of depression, simple and affordable access to prescription refills, and support from health professionals can improve adherence to medication. Arlene Smaldone, PhD, RN, assistant dean for scholarship and research, was senior author.