Editor's Note: This is the second in a two-part series on infection control. Last month's feature was on the Alabama Hospital Quality Initiative and how this state is leading with its model. This month's report focuses on how selected Birmingham-area hospitals are making progress in the nosocomial infections fight.


The battle against nosocomial infections, like most wars, is fought in the "trenches." Although state hospital administrators, BlueCross BlueShield of Alabama representatives and MedMined Services are providing the plans, materials and "enemy intelligence" through the Alabama Hospital Quality Initiative, it's the "soldiers," including physicians, nurses and infection control specialists, who put those plans into place.

The AHQI effort, which began in 2002 with six hospitals, has grown to include almost every hospital in Alabama. It is now a model for BlueCross BlueShield programs in five states. Hospitals anonymously share information processed by infection control practitioners, pharmacists and other specialists within each hospital. Coordinated by hospital administrators, the data is available to physicians, who can access real-time microbiology reports and serve as leaders in the effort.

Kim Foster is one of the area's registered nurses serving as an infection control practitioner. Serving Medical Center East, a beta test site for MedMined, Foster uses the firm's data-mining methods each morning, tracking reports to see whether developing infections occurred before or after hospital admittance. She makes sure physicians are notified of patient progress, even tracking the lab work of discharged patients to ensure patterns are recognized.

Foster serves on a committee at Medical Center East that assesses specific trends, tracking bacteria seen both in the immediate community and across the city and state. Specific bacteria sensitivity and resistance is monitored, with reports available for physicians.
The program, analyzing more than 20 billion possible warning signs, gives hospitals real-time, monthly and biannual findings that far surpass previous manually-collected reports. Louise Standridge, RN, is the infection control practitioner for Physicians Medical Center Carraway and president of the Association for Professionals in Infection Control and Epidemiology, Alabama Chapter. She said the emergence of methicillin-resistant Staphylococcus aureus is a big challenge, with MedMined reports assisting in treatment antibiograms.

Carraway's lab also does so many outpatient cultures, Standridge said, "that trends in community-acquired pathogen sensitivities are identified and can be shared with physicians to assist them in antibiotic selection and, hopefully, prevent the necessity of hospitalization for their patient."

Each facility sees different patterns, making the report's unique nature critical. Standridge said Carraway sees many patients in its wound care center, providing different infection patterns than might otherwise be seen.

Children's Hospital of Alabama also has its unique challenges, with a continuing influx of patients, parents and students. Brenda Vason, RN, BSN, CIC and manager of the hospital's infection control, said her challenge is to provide physicians with objective, detailed and compact information about their patient population.

"We hope they will get involved in the informatics of patient care, letting that be a part of their continuing education. We want to emphasize that from the attending down to the medical student. I think we can do a better job in showing them what we have," Vason said.

Vason said her efforts begin with the hospital's leadership, including its nursing leaders, to help show them process improvement assessment tools that allow them to "think outside the box" in infection control. Although every organism cannot be kept out of a hospital, "We can make prevention and process improvement a priority," Vason said, reviewing everything down to collection processes.

In addition to physicians using the MedMined reports that Standridge said gives physicians an edge while awaiting lab reports, she suggests good stewardship of antibiotics and modeling aseptic practices as additional helps. Others agree.

"They can also be leaders in the effort by washing their hands and setting an example," Foster said. "We call them our 'white coat leaders.'"

"It does help to have physicians model the process," agreed Vason.

Like many area hospitals, Medical Center East began a hand washing campaign in 2005. Hand hygiene continues to be a top priority for the institution. "The hospital encourages hand hygiene practice to visitors and physicians as well as associates," Foster said. She credits lowered infection rates in part to that effort.

All hospitals are implementing multifaceted approaches to the AHQI effort. Standridge cites what she calls a "bundled" approach of high-tech and practical initiatives as being a key to the effort.

From information-gathering to communication, education to innovation, hospitals around the city are making strides that other states are watching. The word from the trenches is that great progress is being made. However, physicians can help, say infection control practitioners, by making full use of available reports and serving as team leaders in this crucial effort.



June 2007