Towns, gowns, and gloves : The status of infection control in community hospitals

Dr. Valenti is from Epidemiology and Infection Prevention, Maine Medical Center, Portland, Maine. Received January 24, 2006; accepted February 10, 2006; electronically published March 6, 2006. Infect Control Hosp Epidemiol 2006; 27:225-227 2006 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2006/2703-0001$15.00. On February 10, six hundred fifty-one years ago, a group of Oxford scholars vociferously objected to the wine they were served at the Swindlestock Tavern. A student launched a flagon at the wine merchant, roiling existing tensions between the university and townies. Three days of deadly rioting ensued. Today, contentious relations between academic medical centers and community hospitals may seem as pointless as the St. Scholastica Day riots, but, although encouraging signs of increasing collaboration among healthcare factions exist, a growing public edginess over hospital-acquired infections is developing into a town-and-gown controversy. The rhetoric surrounding this issue in California, Pennsylvania, and elsewhere in recent years is enough to prompt the innocent observer to watch for flying quart pots. No hospital in the United States, regardless of its size, resources, or location, can ignore the patient-safety movement, which properly views hospital-acquired infections as preventable adverse events. Many state legislatures are under pressure from various groups to enact laws requiring hospitals to disclose “infection rates.” In 2004, the Society for Healthcare Epidemiology of America’s board made the process of public reporting—which is too often driven by impatience and, in some instances, disconnected from sound epidemiologic principles—a priority. Likewise, accrediting bodies have introduced more infection and infection prevention measures into their indicators of quality. Although this intensified scrutiny of nosocomial infections is likely to increase the burden on infection control departments, especially in smaller hospitals, it might lead to a greater appreciation for the role of hospital epidemiology and infection prevention in all healthcare facilities, regardless of size or affiliation. This issue of the journal offers a number of articles that examine some important challenges facing infection control today from the perspective of the community hospital. I will comment on 4 of them here. Of note, 2 of these studies were conducted within small healthcare systems and one within a large healthcare alliance. Regional infection control consortia give small hospitals the opportunity to share valuable resources and expertise with larger neighbors and, as these articles demonstrate, provide arable ground for scientific study. These studies look at how infection control efforts are configured in community hospitals and how these hospitals are dealing with the challenges of resource availability, control of drug-resistant organisms, and antibiotic stewardship. Each of these articles is sure to be of particular interest to readers working in community-based institutions, but they should also stimulate academicians to consider how they might support their colleagues who are striving to bring evidence-based practices, which result from scientific studies, to the community. Though small, the study by Christenson et al. of VHA hospitals in various regions of the country provides insight into the state of infection control in community hospitals. The authors surveyed 31 hospitals ranging in size from fewer than 50 beds to more than 500 beds to assess the staffing, structure, and functions of infection control departments in participating facilities. In addition to the demographic survey, participants were asked to submit data for an observational study of compliance with infection control guidelines. The study used process measures of interest to key accreditation bodies: hand hygiene practices, rates of ventilator-associated pneumonia, catheter-related bloodstream infection, and catheter-related urinary tract infection. A third of the hospitals surveyed had levels of infection control staffing below the level of 1 infection control professional per 100 occupied beds, and only 1 hospital reported data support within the infection control department. It is encouraging that some hospitals felt their infection control program was supported by their administrations and medical directors, but lack of physician support underscored the need to identify and correct the reasons for this resistance. The observational study revealed inconsistencies in infection control practices, as well as in compliance with evidence-based recommendations for reducing specific healthcare-associated infections among participants. This is well analyzed and discussed by Christenson et al. One hopes that larger studies of this type will appear in the future.