Forget Antibacterial Soap: Computers may be a Hospital's Best Germ Fighter

While the Food and Drug Administration let health care centers off the hook on a proposed rule that could lead to the banning of certain antibacterial hand soaps and body washes for consumers, it doesn't mean that doctors and nurses should rely solely on these products to prevent their patients from acquiring deadly infections.

To keep patients safe while simultaneously protecting against the dire threat of “superbugs” – deadly strains of antibiotic resistant bacteria – hospitals must continually reimagine their germ-fighting practices and protocols. Fighting today's evolved strains of bacteria requires an equally evolved strategy, relying on an unlikely ally – computers.

At the north side's Swedish Covenant Hospital, checklists and protocols have been hardwired into the same system that coordinates patient care and health records, resulting in one of the lower rates of hospital acquired infections reported to The Leapfrog Group in 2013. For example, the hospital just completed its 18th consecutive month without a central line infection in its ICU, and has reduced the number of clean surgical site infections by 73 percent in one year.

“Our hospital's efforts to fight infections are based not only on our own experience, but also on what the science says about what is effective,” said Janis Rueping, Swedish Covenant Hospital vice president of quality improvement/risk management. “We are very strategic and judicious in our selection and use of antibiotic drugs.”

The misuse of certain drugs has been linked to the evolution and proliferation of antibiotic-resistant bacteria like MRSA and C. difficile. Antibacterial soaps are also a potential culprit, with the FDA finding that triclosan – the ingredient most often used in antibacterial soaps – may contribute to making bacteria resistant to antibiotics.

Being more strategic when administrating antibiotics is one way hospitals can thwart the evolution of these “superbugs,” while also delivering better care to patients. Swedish Covenant Hospital has an antibiotic stewardship committee that evaluates the efficacy and effectiveness of antibiotic use. By integrating mandatory checklists into its electronic clinical documentation systems, Swedish Covenant Hospital has engineered a series of orders – or prompts – for its doctors and nurses that remind them about safe infection control practices, and encourage their documentation.

Health information technology also helped Swedish Covenant Hospital doctors dramatically lower the rate of clean surgical site infections. When ongoing review of these infections identified that a number had occurred in implant cases, surgery's standing antibiotic protocols were modified to more closely match the hospital's experience and prevent infections.

After this change was made, the rate decreased nearly 75 percent, from 15 to four. It is this kind continued focus on reducing infections by re-designing systems and processes that helped Swedish Covenant earn Chicago's only ‘Top Hospital' designation this year from The Leapfrog Group.

But interventions don't always have to be high-tech. Swedish Covenant Hospital's relatively low rate of catheter-associated urinary tract infections is supported by a process that prompts clinical staff to provide their reason for using or continuing to use catheters. Misuse of catheters is the biggest culprit in these infections, and easily one of the most preventable. The hospital also uses a ‘secret shopper' program in which staff on each unit conduct confidential observations of all categories of patient caregivers to make sure they are following safe infection control practices.

“Hospitals have a responsibility to their patients to constantly evaluate how they can deliver the safest care and treatment possible,” said Rueping. “Preventing infections goes beyond just scrubbing in – it's a central part of a culture that prioritizes safety, outcomes and the patient experience.”