Infection Control: New York State Mandatory Training

Chapter One - Element I

Chapter 1: Element I

Chapter 2: Element II

Chapter 3: Element III

Chapter 4: Element IV

Chapter 5: Element V

Chapter 6: Element VI

Chapter 7: Conclusion

Resources

References

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Element I: The first element of the mandatory coursework addresses the professional's responsibility to adhere to scientifically accepted principles and practices of infection control and to monitor the performance of those for whom the professional is responsible.

The Nosocomial Infections Surveillance (NNIS) system was developed by the Centers for Disease Control and Prevention (CDC) (2005) in the early 1970s to monitor the incidence of healthcare-associated infections (HAIs) and their associated risk factors and pathogens; it is the only national system for tracking HAIs. This voluntary reporting system currently has approximately 315 participating hospitals.

Nosocomial infection is defined by the NNIS as an infection that is a localized or systemic condition:

  • Resulting from adverse reaction to the presence of an infectious agent(s) or its toxin(s); and
  • Not present or incubating at the time of admission to the hospital.

As indicated previously, nosocomial infections occur in more than 2 million hospitalizations each year. Of those infections, 90,000 people die from these infections (CDC, 2004). More than 70% of the bacteria that cause HAIs are resistant to at least one of the medications used to treat them (CDC, 2004). Persons infected with antimicrobial resistant organisms are more likely to have longer hospital stays and require treatment with 2nd or 3rd choice drugs that may be less effective, more toxic and/or more expensive (CDC, 2004).

According to a Press Ganey (2005) review of literature during the 1990-2000 timeframe, the following factors were related to HAIs:

  • Increased average lengths of stay in the hospital by 7.4-9.4 days;
  • Contributed to a 35% increased morbidity;
  • Increased cost per survived patient of approximately $40,000;
  • The mean cost of nosocomial infection was $13,973;
  • The mean cost of bloodstream infection was $38,703;
  • The mean cost of methicillin-resistant Staphylococcus aureus infection (MRSA) was $35,367;
  • The mean cost of surgical site infection was $15,646.

Clearly the prevalence of HAIs contributes significantly to increased morbidity, mortality and cost in healthcare. Therefore, it is critical that healthcare professionals do all they can to minimize the risk that their behavior contributes to the spread of infection.

Healthcare professionals, although well aware of the importance of accepted principles and practices of infection control, may at times cut corners or fail to take these principles and practices seriously. Despite how busy one is, despite the availability of broad-spectrum antibiotics, and despite all the factors that may contribute to a breach in practice, professionals have both an ethical and professional responsibility to adhere to scientifically accepted or evidence based practices and principles of infection control.

There are multiple organizations that have developed "best practices" related to infection control. For example, the CDC has developed, on its website (www.cdc.gov), a feature entitled "CDC Recommends". Included in this feature are guidelines that the CDC has developed independently or in cooperation with other agencies that focus on the prevention and treatment of infection.

Some examples include:

  • Guidelines for Infection Control in Hospital Personnel;
  • Guidelines for Isolation Precautions in Hospitals;
  • Updated US Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV and HIV and Recommendations for Postexposure Prophylaxis (2001);
  • Guidelines for the Prevention of Nosocomial Pneumonia;
  • Guidelines for Environmental Infection Control in Health-Care Facilities (2003).

Other organizations that focus on scientifically accepted practices and principles of infection control include:

Multiple professional disciplines' Codes of Ethics require that the professional maintain current knowledge in the field.

In 1999 New York State included the legal responsibility to adhere to such principles. A law was passed in which the professional may be charged with unprofessional conduct to fail to adhere to scientifically accepted principles and practices of infection control. This is true for the professional her or himself, but also true for those whom the professional has clinical or administrative oversight.

Some examples may include:

  • An attending physician does not correct the resident physician in the emergency room who has neglected to utilize the "sharps" containers after giving injections to patients;

  • A registered nurse does not intervene to correct a certified nursing assistant who does not wash his/her hands after providing care to a resident in a long term care facility;

  • Certified nursing assistant, for whom the nurse has supervisory responsibility, does not wash her hands after providing care to a resident in a long term care facility, can be charged with unprofessional conduct if she does not intervene to correct the situation;

  • A laboratory supervisor who looks the other way with one lab technician, an excellent employee, who just can't seem to remember to wear gloves during phlebotomy;

  • A dentist who witnesses the assistant not changing gloves between patients and does not intervene.

All of the examples above illustrate that professionals must take the responsibility to adhere to scientific principles of infection control. They must themselves practice in such a manner, but in addition, New York State Law requires that these professionals must also insure that those for whom they have administrative or clinical oversight also practice to this standard.

Mycobacterium tuberculosis

Mycobacterium tuberculosis

Continue on to Chapter 2: Element II