One of the biggest complications for people receiving chemotherapy, especially those who undergo bone marrow transplants, is infections that can occur because these treatments weaken the immune system. Preventing these infections is a major effort at Memorial Sloan Kettering.
Hospital-acquired infections, or HAIs, affect nearly 2 million patients in the United States every year and kill about 100,000. The rise in multidrug-resistant microbes, which don’t respond to treatment with conventional antibiotics, makes preventing the transmission of infectious illnesses more important than ever.
Encouraging Hand Hygiene
Hand washing is one of the most important ways to prevent the spread of infectious microbes to patients, as well as one of the easiest. Yet according to the Centers for Disease Control and Prevention, many studies have shown that healthcare workers clean their hands less than half as often as they should.
“I’m proud to say that MSK has one of the best hand-hygiene programs in the country,” Dr. Kamboj says. “It’s been publicly lauded in articles written by leaders in infection control.”
MSK encourages hand washing largely through a peer-to-peer monitoring program, in which colleagues keep an eye on each other to make sure it’s done when necessary. Patients are also encouraged to watch their healthcare providers and make sure hand washing is done properly, and they’re encouraged to speak out if they see a potential problem.
Enforcing Flu Prevention Measures
New York State mandates that healthcare workers receive the flu vaccine every year, and that those who don’t must wear surgical masks at all times during flu season when they are in patient-care areas. Last year, about 90% of MSK’s employees in patient areas received the vaccine.
Beyond making sure employees follow the rules, MSK is focused on teaching patients and their family members about the importance of flu vaccines as well. A major education effort, including signs throughout patient-care areas, tells people how they can protect others when they might be sick.
“If patients in any of our outpatient areas have any flu symptoms, we ask them to wear a mask and also to inform the care coordinator right away,” Dr. Kamboj says. “If a visitor is sick, we ask them not to come into areas where there are high-risk patients. It’s very important to take these proactive approaches to protect those who are most in danger.”
Ensuring the Safety of Medical Devices
Medical devices can range from simple equipment like thermometers and blood pressure cuffs to complex instruments such as endoscopes.
“These are things that go from patient to patient, and we want to make sure there’s appropriate cleaning, disinfection, handling, and storage of these devices so they can’t carry any germs that can make someone sick.” Dr. Kamboj says. “This has been one of our major initiatives over the past year, and it’s something that we’re focused on not only at the main hospital but at all of our regional outpatient centers.”
Monitoring for Outbreaks of HAIs
One of the most common HAIs is Clostridium difficile — C. diff for short — a bacterial infection in the intestines that can cause severe diarrhea and abdominal pain. Because C. diff bacteria have natural genetic variations, investigators at MSK can molecularly “fingerprint” them to determine how and where they are spreading. “If an infection goes from patient A to patient B, we would expect the bacteria to have identical fingerprints,” Dr. Kamboj explains.
Based on fingerprinting infections found in patients throughout MSK, Dr. Kamboj’s team determined that the majority of C. diff cases were not genetically related to each other. This strongly suggested infections that otherwise seemed to be acquired in the hospital could not be traced back to a source patient at MSK. “Among our transplant population, we find that patients who develop C. diff infection are already carrying these bacteria at the time of admission,” she says.
For infections that were contracted by patients after entering the hospital, investigators were able to identify infectious hot spots where the level of transmission was higher and to take enhanced measures to reduce the spread of harmful germs in those areas.
Changing How Hospital Rooms Are Cleaned
On one of the hospital floors, where the Pediatrics Department is housed, “we found out there were a high number of refusals when it was time to clean rooms,” Dr. Kamboj explains. A multidisciplinary team was created to devise strategies to overcome this barrier and to ensure that adequate environmental cleaning was done. “It’s completely understandable. These are kids, and if they’re sleeping or not feeling well, their parents don’t want to move them out to have their room cleaned,” she says.
Working as a team, staff from Nursing and Environmental Services implemented a new program in which patients and families can decide when they want the room cleaned and pick a time that’s convenient for them, or if that isn’t possible, the team will inform families in advance when they should expect cleaning to occur to allow them ample time to clear the area with the least amount of disruption. “The program has been very well received, and refusals have gone way down,” Dr. Kamboj says. “We are beginning to see a downtrend in HAIs in that area since the approach was implemented.”
On the bone marrow transplant floor, where patients are particularly susceptible to infections, the team brought in a high-tech disinfectant robot that uses ultraviolet light to zap germs and supplement regular cleaning. The robot, which cannot be used when anyone is in the room, visits on a daily basis to clean bathrooms in patients’ rooms, and cleans the entire room between patient stays.
Instituting an Antibiotic Management Program
Overuse of antibiotics is the primary cause of drug-resistant bacteria, which makes it critical to prescribe antibiotics prudently and to ensure that patients take them properly and complete all their doses. MSK’s Antibiotic Management Program, led by infectious diseases physician Susan Seo, provides guidance and oversight in determining the optimal selection and dose of antibiotics for every MSK patient and ensuring that these drugs are used properly. MSK was a pioneer in developing this kind of program, which has now been duplicated at many other hospitals around New York and the country.