Fighting resistance with foundation and focus
Dana Stephens, MT, BS, CIC
St. Joseph Hospital, KentuckyOne Health
Dana Stephens is a vital member of the St. Joseph Hospital Antimicrobial Stewardship Program (ASP), integrating foundational practices and innovative strategies to create programs that have reduced antimicrobial transmission, resistance and economic impact at the 433-bed tertiary care center.
“We can’t rely on new antimicrobial therapies,” said Stephens. “The pipeline is dwindling as pathogens and microbial resistance continues to evolve. Infection prevention in collaboration with antimicrobial stewardship can decrease microbial resistance, resistant-organism prevalence and antimicrobial therapy failure.”
In response to increasing rates of multidrug resistant organism (MDRO) infections at St. Joseph, Stephens worked with the ASP, Department of Infection Control, and Environmental Services (EVS) to develop institutional guidelines targeted at reducing carbapenem resistance and preventing environmental cross-contamination. This initiative included a three-tiered Patient Care Cleaning (PCC) program for all patient-care areas: direct, monthly observation of cleaning procedures; fluorescent markers applied to high-touch patient surface areas prior to terminal cleaning; and finally, patient-care service and equipment monitoring with ATP Bioluminescence. Monitoring was followed by education to all front-line EVS providers and management team members.
In the four years following PCC implementation, the total number of Pseudomonas aeruginosa infections at St. Joseph Hospital decreased from 274 to 176 and the carbapenem susceptibility rate among patients with the microbe increased from 78 to 94 percent. Reduction in the total number of carbapenem-resistant infections resulted in approximately $1.1 million in total cost avoidance in 2013.
Stephens points to the combination of innovative technology and emphasis on foundational practices such as hand hygiene, environmental cleaning, and standard transmission-based precautions as key to the success of this and other ASP initiatives.
“Get everyone engaged and focused on the effort,” she says. “If these practices become part of their daily routines, you don’t have to retrace your steps constantly and patients will be safer.”