Quality & Patient Safety

A hospital-associated infection is one in which the signs and symptoms of infection don’t develop until after the patient has entered the hospital. If an infection develops after 48 hours from the time the patient was admitted, the infection is considered to be hospital-associated.

Yes. Infections occur more frequently in parts of the hospital where the sicker patients are and where more procedures and surgeries are done. Typically there are more infections in intensive-care units than we do on general medical or surgical floors.

Because it’s a particularly vulnerable time for patients. They’re ill. They may have a number of different chronic illness as well as the acute illness that brought them into the hospital. They may be here because they have a weak immune system. They’re getting chemotherapy or have other underlying illnesses that put them at risk.

When patients are in the hospital, they tend to have a lot of things done to them. They may undergo surgery or other procedures that break the skin barrier, which normally protects them from getting infections.

The best way to prevent infections is for health care professionals to wash their hands every single time before touching a patient or something in a patient’s environment, so we don’t spread bacteria to other patients. Other prevention efforts depend on what’s happening with the patient, such as employing proper sterile techniques during surgery. There are also evidence-based best practices for various procedures, such as how you prepare the skin, how you cover a patient, what sort of clothing you’re wearing when you insert a central line, minimizing the number of devices used with a patient, and removing central lines and catheters as soon as possible.

ChristianaCare has been very focused on reducing hospital infections for years. Preventing infections is part of our overall culture of patient safety, and it involves personal accountability among all of our staff. We have a team of people who are called infection preventionists who are assigned to all areas of the hospital and to outpatient areas. We all work as a team with the staff on those units to reduce infections by working on hand hygiene, best practices and surveillance. We’ve been very conscious of what our infection rates are, particularly in our intensive-care units, and have taken specific steps to prevent infections.

We have two priorities when patients come into the hospital: to fix whatever it is that’s bringing them in and to keep them safe while we’re doing it. Patients and their families need to know that it’s OK to be an advocate for themselves and their loved ones. It’s OK to ask the doctor or nurse, “Did you wash your hands before you came into the room?” They may have done it right before they entered, right outside the door. But if you didn’t see it, ask. We welcome those questions, and we appreciate when patients are involved and engaged about their medical treatments.

A central line is a large catheter that is inserted into a large vein, usually in the upper chest or the neck, the upper arm or occasionally the groin. It’s important to know that it’s not the same as a peripheral intravenous (IV) line that’s usually in the hand or the lower arm, which most patients will get when they come in to the hospital.

Central lines are used for patients who are sicker, who need certain types of medications that can’t be given through a peripheral IV (such as chemotherapy), or who need large volumes of blood or other fluids to resuscitate them. Most central lines are seen in our intensive-care units, although patients can have them out in other units.

At times, patients in the hospital may have a tube delivering vital fluids and medicines during their stay. When placed in a large, central vein, most often in the chest, they are called central lines. Every year in the United States, between 5 million and 7 million central lines are used to save lives. Nearly half of patients in intensive-care units (ICU) receive central lines to assist with their care.

While central lines save lives, they can cause certain problems in a small fraction of cases. Having a central line can lead to bacteria getting into and growing in the blood. This is known as central-line associated bloodstream infection or CLABSI. In the United States, there are about 250,000 CLABSIs each year, nearly 80,000 of them in ICUs. These can lead to longer stays in the hospital, higher health care costs and even death.

As far as we’re concerned, one infection is too many. So we’re working aggressively to prevent and control infection. We have set priorities, and established procedures and measures to track how well we’re doing. Our focus is on increasing transparency and accountability by sharing information throughout our health care system.

The central line checklist is a list of evidence-based practices that should be done every time that a central line is inserted. It’s like the checklist a pilot uses before takeoff to make sure that everything is ready and done properly.

C. Diff is a bacterial infection whose full name is Clostridium difficile. C. Diff has been seen commonly in hospitals in the past several decades. We’re seeing it a little bit more in the community now among people who haven’t been in a hospital. It’s a bacteria that causes diarrhea, high fever or abdominal pain. On rare occasions, patients with C. Diff need to have surgery to have part of their colon removed, and occasionally it has caused deaths.

People get C. Diff when they have been exposed to the organism and usually when they have been on antibiotics. Antibiotics destroy the normal healthy bacteria in their gut, allowing the C. Diff to overgrow and then cause disease.

MRSA, commonly pronounced “MER-suh,” stands for methicillin-resistant Staphylococcus aureus. It’s a type of staph bacteria that everyone has on their skin, in their nose and in different parts of the body. MRSA, in particular, is resistant to a class of antibiotics known as methicillin/oxacillin, and it is much harder to treat. MRSA can cause infections in the blood, on the heart valves and very common skin infections like boils.

MRSA used to be seen only in hospitals. But now we see it out in the community. Many people in the community have MRSA. They either have it on their bodies and it is not causing any problems, or they get the common skin infections it causes.

VRSA stands for vancomycin-resistant Staphylococcus aureus. For MRSA, the treatment of choice over the past few decades has been vancomycin. But now we’re seeing that the Staphylococcus aureus has even become resistant to vancomycin. It’s very uncommon; there have only been a dozen or so cases reported in the country. It has been reported in Delaware. But typically, it’s seen in patients who have longstanding chronic infections and are very chronically ill, who have been on a lot of antibiotics. They’ve had MRSA in the past, and it’s evolved into VRSA.