APIC survey finds: IC rituals die hard
Continuing use of outmoded practices reported
Disproven infection control rituals that waste money and provide no benefit to patients continue to be practiced, underscoring the need for improved education of infection control practitioners, according to a recent survey by the Association for Professionals in Infection Control and Epidemiology in Washington, DC.
"If this sampling is any indication of practice, we can conclude that many inpatient facilities are still performing ritualistic, outdated and costly infection control practices," said Sandy Pirwitz, RN, MS, CIC, nurse epidemiologist at the Cleveland Clinic Foundation, who presented the findings recently at the APIC conference in Atlanta.
The practices included needless double-bagging of medical waste, total hospital surveillance rather than targeted programs, and frequent changing of ventilator breathing circuits despite numerous studies indicating they can be safely left in place for extended periods.
"There is obviously a need for education regarding the value of performing sound, cost-effective infection control practices, and there is also needed education to show people how to affect change," she said.
"Another significant conclusion is that having a certified ICP may result in a more cost-effective and scientific infection control program."
Survey: Rituals die hard
ICPs were asked which of the practices are part of their facility's infection control program and whether they were interested in changing those that were.
The survey was sent to some 10,000 APIC members, but only those that worked inpatient facilities were asked to respond. Even so, only 506 ICPs responded, but the sampling was sufficient to raise concerns that infection control rituals die hard.
For example, 58% were still doing total surveillance, 17% reported double-bagging of isolation trash, and 29% of respondents were changing ventilator circuits every 24 to 48 hours.
Fogging is outmoded
In addition, 11% reported routine annual chest X-rays for health care workers who are skin-test positive for tuberculosis.
The practice is not recommended unless the workers have signs and symptoms suggestive of TB. A handful of ICPs even admitted to conducting disinfectant "fogging" of isolation rooms, a practice long considered outmoded, Pirwitz noted.
"I think the two that surprised me the most were the annual chest X-rays on [TB skin test] positive employees, which not only is very costly but potentially hazardous, and also disinfectant fogging," she said.
"I was not even aware that any equipment was still available to do that. I have been in the field for 20 years and even back then in 1976 we knew that disinfectant fogging was an outmoded practice." *
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