Healthcare-associated infections are a critical public health challenge in Arizona and in the US. Healthcare associated infections (HAIs) are acquired during healthcare treatment and can be devastating and even deadly- and they’re largely preventable. You may have seen the article in last week’s Republic about dirty needles and their link to transmission of viruses and drug-resistant superbugs. The article mentions a recent Arizona incident in which unsafe injection practices at a pain management clinic- which had been investigated by our disease detectives in AZ’s public health system and summarized in an MMWR article last Summer.
Arizona’s public health system takes a layered approach to preventing HAI’s in our state. It starts with our Licensing team- who regulates the healthcare institutions where care is given. Our regulations set the standards that prevent infections and our teams of surveyors do routine checks and complaint investigations to make sure facilities are in compliance with our standards. We already have solid infection control regulations for hospitals and nursing homes… but our current Rulemaking for healthcare institutions will be establishing new infection control standards across the board that’ll be applied consistently across all health care institutions in the second half of 2013.
At another level, our Medical Facilities Licensing team and our HAI Program collaborate to ensure the safety of patients in Arizona by jointly providing technical assistance and guidance to licensed healthcare facilities in response to identified infection control breaches. Through our HAI Program and our HAI Advisory Committee- we generate guidance documents for all healthcare facilities and promote best practices for infection control and injection safety like materials produced through the CDC’s One and Only Campaign and our No Place Like Home initiative which is Arizona’s approach to the national Partnership for Patients: Better Care, Lower Costs project.
The next layer is our network of public health disease detectives. Our Healthcare-Associated Infections Program and the counties conduct epidemiologic investigations when we get reports of unsafe injection practices affecting multiple patients. For example… last year we investigated 3 separate instances of unsafe injection practices- exposing 327 people to disease and resulting in 3 infections. Each of the investigations identified unsafe injection practices like: 1) Re-inserting a used syringe into a medication vial; 2) Using a single-dose vial for more than one patient; 3) Diluting medicine beyond the manufacturer’s recommendations; 4) Improper use of personal protective equipment prior to spinal/lumbar injections; and 5) Illegal contamination of needles/syringes and injectable reagents.
Many of the gaps in infection control have roots at the national level. A national drug shortage on many reagents and medications (including appropriate concentrations and single-use vial sizes) has compelled some healthcare practitioners to search for alternate solutions to ensure availability and to use medications as economically as possible. Some practices, like using single-dose vials for multiple patients, may be considered an industry standard in some fields and may still be taught and practiced, despite CDC injection safety guidelines inclusion in Standard Precautions since 2007. Many of these challenges can be safely addressed through medication repackaging into single-dose vials by a licensed compounding pharmacy appropriately applying the U.S. Pharmacopeia standards.
In short- healthcare associated infections remain a public health problem nationally and in Arizona- but by continuing to effectively use our licensing survey teams, effectively using the network of disease detectives we have in our county and state public health system, and by leveraging the work of our HAI Advisory Committee, the One and Only Campaign, and Arizona’s No Place Like Home Initiative- preventing healthcare associated infections remains a Winnable Battle.