Patient Safety

Patient Story

University of Pittsburgh Medical Center (UPMC) Presbyterian closed the 20-bed cardiothoracic ICU on September 3, 2015 and relocated patients after discovering one patient got an infection from mold. That patient was seriously ill with a fungal infection called rhizopus, and had a poor prognosis. Investigators found mold behind a wall of one room in the ICU and also in toilets of other rooms in the ICU. As hospital staff reviewed patient records as part of the mold investigation, they discovered that two previous transplant patients who had stayed in that ICU room had fungal infections possibly linked to the mold and died. The infections contracted were lichtheimia (in a patient in October 2014) and rhizomucor (in a patient in June 2015). All three molds (rhizopus, lichtheimia and rhizomucor) were in the same fungi phylum, called zygomycetes, and they were related.The reason these patients infections weren't connected sooner was because they were different, though related. The fungi that caused these infections did not usually negatively affect healthy humans. All affected patients were transplant patients, meaning they were immunosuppressed, hence the reason they were affected (Punke, 2015)

Infection Prevention and Control

Health care-associated Infection (HCAI) is defined as an infection acquired in a hospital by a patient who was admitted for a reason other than that infection and/or an infection occurring in a patient in a hospital or other facility in whom the infection was not (latently) present at admission. This includes infections that are acquired in the hospital, but appear only after discharge, as well as occupational infections among health-care staff.

Hundreds of millions of patients are affected by HCAI worldwide each year, leading to significant mortality and financial losses for health systems and patients. Of every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one HCAI. There is an increased risk of HCAI in developing countries. Pooled data from a limited number of studies in hospitals show the prevalence of HCAI to be 15·5% and as high as 47·9 per 1000 patient-days in adult ICUs.

Recent recommendations include two levels of precautions:

Standard precautions can be applied to all patients in all health-care settings, regardless of a suspected or confirmed infectious agent. These precautions constitute the primary strategy for infection prevention. They are based on the principle that all blood and other bodily fluids, secretions and excretions, excluding perspiration, may contain transmissible infectious agents. These precautions include: hand hygiene, the wearing of gloves, a gown, a mask, eye protection or a face shield, depending on the anticipated exposure; and safe injection practices.

Transmission-based precautions should be used when treating patients who are known or suspected of being infected or colonized with infectious agents. Precautions are applied according to the clinical syndrome and the likely etiologic agents, and then modified based on test results. There are three categories: contact precautions; droplet precautions; and airborne precautions.

HCAIs are caused by bacteria, viruses and fungi from human or environmental sources and transmission can occur by the following routes:

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• Transmission through direct contact: Person-to-person transmission can occur when microbes present in blood or other bodily fluids of a patient are transmitted to a health-care worker (or vice versa) through contact with a mucous membrane or breaks (cuts, abrasions) in the skin.

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• Indirect transmission: Infections can be transmitted indirectly through devices such as thermometers, stethoscopes, other inadequately decontaminated equipment, medical devices or toys, which health-care workers pass from one patient to another. This is probably the most common mode of transmission in health-care settings.

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• Droplet transmission: Respiratory droplets carrying pathogens are generated when an infected person coughs, sneezes, or talks, as well as during procedures such as suctioning or intubation.

Airborne transmission of infectious diseases occurs through the dissemination of either airborne droplet nuclei (particles arising from desiccation of suspended droplets) or small particles in the respirable-size range containing infectious agents that remain infective over time and distance (e.g. spores of Aspergillus spp. and Mycobacterium tuberculosis).

Percutaneous exposure occurs through contaminated sharps.

The following four types of infections account for about 80% of all HCAI:

• surgical site infections;

• urinary tract infections, usually associated with catheters;

• bloodstream infections associated with the use of an intravascular device;

• pneumonia associated with ventilators.

Priority areas for healthcare-associated infection include:

• Environmental cleanliness                   

• Sterilization/disinfection of equipment, devices and instruments

• Medical Devices labelled for “single use” must be used once and never reused       

• Hand hygiene           

• The use of personal protective equipment (PPE) which includes gowns, gloves, aprons, eye protection, shoe covers and face masks.

• The safe use and disposal of sharps

In order to minimize the incidence of HCAI, healthcare professionals should:

• know the main guidelines in each of the clinical environments where they are working;

• accept responsibility for minimizing opportunities for infection transmission;

• apply standard and transmission-based precautions;

• let staff know if supplies are inadequate or depleted;

• educate patients and their families/visitors about clean hands and infection transmission.                                

Read more using WHO handout, Infection Prevention and Control (WHO, 2012)

Optional reading for this Topic includes Protecting Patients and Stopping Outbreaks (CDC, 2020) by Centers for Disease Control and Prevention USA.

References

Centers for Disease Control and Prevention (CDC)(2020) Antibiotic/Antimicrobial Resistance. Protecting Patients and Stopping Outbreaks [Online][Accessed on 1st October 2023[Available at https://www.cdc.gov/ncezid/what-we-do/2018-highlights/protecting-patients-from-infections.html]

Punke (2015)UPMC probes link between mold, patient deaths: 7 things to know. Becker’s Infection Control and Clinical Quality [Online][Accessed on 1st October 2023 [Available at http://www.beckershospitalreview.com/quality/upmc-probes-link-between-mold-patient-deaths-6-things-to-know.html]

World Health Organization (WHO) (2021).Infection Prevention and Control [Online][Accessed on 1st October 2023][Available at https://cdn.who.int/media/docs/default-source/patient-safety/curriculum-guide/resources/ps-curr-handouts/course09_handout_infection-prevention-and-control.pdf?sfvrsn=f7724fa5_9&download=true]