Infection Control
The Alfred ICU caters to a range of infections and infectious complications.
The new ICU has 4 class N rooms designed for the treatment of highly infectious diseases, such as Ebola. These rooms have an ante-room where the protective clothing is put on and taken off, and 2 of these rooms have en-suites.
The new ICU was specifically designed with infection control in mind, with more than half of cubicles being closed, special air-handling measures and designs for improved infection control.
We , in conjunction with the Infectious Diseases Unit, manage a wide range of opportunistic infections in highly immuno-suppressed patients, such as bone marrow and solid organ transplants. The Alfred also provides a State Service for HIV/Aids. There are also a number of patients with these diseases in the Haemophilia Service, another State Service provided by the Alfred.
Because of our ECMO service, we are also a referral centre for patients with severe flu, such as Swine-origin influenza A (H1N1), developing respiratory failure.
We have a very active surveillance program in ICU, currently targeting, hand washing, central line associated blood stream infections (CLABSI), ventilator associated pneumonia, and urinary tract infections, and reporting back to staff rates of infection, rates of pathogenic organisms, and providing comparative data over time
There are daily ward-rounds on weekdays by the infectious diseases laboratory registrars to provide up-to-date information on culture results and an infectious diseases consultative service to provide advice as required, and regular involvement by our Infectious Diseases Consultant; Dr. Alex Padiglioni.
Basic Infection Control procedures and other procedures, such as correct techniques for taking blood cultures, are taught in the BASIC course for all new Junior Medical Staff prior to commencing their ICU term.
Infection prevention in the Alfred ICU
Hospital acquired infections have long been an area of interest for the Alfred ICU. Decreasing the incidence of Central line associated blood stream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) has been particularly challenging. Using careful antibiotic stewardship and general infection control measures we have also successfully fought a number of multi-resistant bacteria outbreaks over the last 8 years. These included multi-resistant Acinetobacter and MBL-producing gram negative bacteria.
In the last 2 years, as a result of concerted efforts over the previous years, we have seen a welcome trend towards increasing antibiotic sensitivity in the bacteria isolated from blood cultures. In parallel with this trend, our MRSA bacteraemia rate continues to fall and is currently at historically low levels. Our antibiotic stewardship program is run jointly with our Infectious Diseases Consultant, Alex Padiglioni. All positive blood cultures are reviewed every 6 months for antibiotic sensitivity profiles and our empiric antibiotic regimen is modified according to the results. We have emphasised de-escalation of empiric antibiotics, where possible, restriction of broad spectrum antibiotic use, and timely cessation of antibiotics. We will shortly be rolling out GUIDANCE, an electronic antibiotic stewardship program.
Underpinning our infection prevention campaign is our determination to improve compliance with the WHO “5 moments for Hand Hygiene”. Through a combination of staff briefings and use of social media we have managed to double the compliance with Hand Hygiene over the last 2 years. Our target is to exceed 80% compliance.
Our CLABSI rate has fallen significantly over the last 8 years. We have hit zero infections per month on 4 occasions over the last year but more work remains to be done. Our patients are particularly vulnerable including those with burns, ventricular assist devices and transplant recipients. Nonetheless, our target is zero central line associated bloodstream infections. We have implemented nearly all interventions described to reduce the CLABSI rate including antibiotic catheters, chlorhexidine patches and daily chlorhexidine patient washes. We are currently working on improving medical staff accreditation for CVC insertion.
We recognise that hospital acquired infections will always be a potential problem in the ICU. Short term solutions are not the answer; we need long lasting change. Our goal is an intensive care in which staff are only satisfied with zero hospital acquired infections. Our patients deserve nothing less.
