Infection control grows in spotlight

Colorado hospitals were cited more than 80 times in the past five years for infection control lapses when employees didn’t take steps such as washing their hands, properly sterilizing equipment or using protective gloves — mistakes that could spread infections if they’re repeated during the current coronavirus pandemic.

An emergency such as COVID19 can cut both ways — it raises awareness of infection control, but it also may overwhelm staff members, who could forget a step, said Dr. Michelle Barron, medical director for infection control and

prevention at University of Colorado Hospital. University of Colorado Hospital was cited for infection control lapses on four occasions in the last five years. None of the reported lapses involved harm to a patient.

Infection control specialists have been training staff on how to properly use all protective equipment, because while employees may have used a face shield or a respirator before, they typically don’t need to use so many protective layers as they do now, Barron said. Staff providing care also are keeping an eye on each other and pointing out if someone forgets a step, she said.

“It happens that sometimes when you’re preoccupied, you miss things, so we’re encouraging those types of interactions,” she said.

The 2003 SARS outbreak showed how infections can spread in health facilities. A study in the Center for Disease Control and Prevention’s Emerging Infectious Diseases journal estimated that about 72% of cases in Toronto were transmitted in hospitals, and 44% of those infected were people working in health care. When health care workers become sick, as they did during the SARS epidemic, hospitals are less able to care for a surge of patients — a scenario some experts worry could happen with COVID-19.

State and federal officials do routine inspections of most health care facilities every three to six years, as well as investigating complaints about poor care. Their findings are only a snapshot of any particular facility, but they do show how common mistakes in infection control can be.

Since 2015, 37 Colorado hospitals have been cited 87 times for lapses such as staff forgetting to wash their hands, using masks improperly, or not following the correct procedures to disinfect equipment. Typically, hospitals don’t face a penalty if they show they’re implementing a plan to prevent future mistakes, such as forgetting to wipe down surfaces a patient touched, while another could have only been cited once even if it exposed dozens of patients to diseases by failing to clean surgical instruments or scopes.

Only one incident involved harm to patients — though it’s possible other infections were never reported. Dozens of patients sued Porter Adventist Hospital over infections linked to poor disinfection practices, which left blood and hair on surgical instruments. Dr. Stephen Cobb, chief medical officer for Centura Health’s Denver-area hospitals, including Porter, said the problems have been corrected, and that the previous problems with complex disinfecting procedures aren’t relevant to a respiratory virus.

“We’re very confident of the procedures at Porter,” he said. “That’s like comparing not an apple and an orange, but an apple and a house.”

Cobb said Centura’s hospitals have procedures in place, including intercepting patients on their way in the door, routing them through low-traffic areas of the hospital and deep-cleaning the isolation rooms they stay in. They also are assigning certain staff to COVID-19 patients and others to everyone else, to minimize the number of people potentially exposed, he said.

“More than any other time in my time in health care, people are acutely aware of” infection control, he said. “I think the overall environment is making sure we have good adherence.”

State health officials say the greatest risk of infection is to people who spend 10 minutes or longer within 6 feet of an infected person, which would likely include those providing medical care for him or her. A study suggests the virus can live on hard surfaces for up to three days, meaning if it might be able to pass from one patient to the next if furniture and equipment aren’t properly disinfected.

The processes to avoid spreading the new virus are relatively simple. Staff need to put on their full protective equipment and quickly move the patient to an isolation room, then decide if the patient needs to be tested, stay in the hospital or go home, said Dr. Darlene Tad-y, vice president of clinical affairs for the Colorado Hospital Association. Some hospitals are considering changing how they use their space and staff, if the number of cases continues to grow, she said.

“If we have a huge outbreak or a prolonged outbreak, we’re thinking about a dedicated wing or dedicated staff,” she said.

Some of the responsibility for preventing the spread of COVID19 will fall on individuals, who should call ahead if they think they might be infected and need medical care, Tad-y said.

“Certainly we wouldn’t want to expose other people in the waiting room,” she said.