Sleuths at the MUHC: the essential role of Infection and Prevention Control

For some staff at the MUHC, the Infection Prevention and Control (IPC) Services are responsible for making sure you’ve washed your hands and disinfected all surfaces. But the dedicated teams of twelve specialists and four support staff working at the adult and pediatric sites do much more than that.

“The role of Infection Control is to gather information, uncover issues and collaborate with the clinical and administrative teams to find solutions to those issues. We also advocate for best practices, by suggesting changes in procedures and behaviours,” says Ramona Rodrigues, Manager, Infection Prevention and Control, MUHC-adults.

Multi-team approaches have shown great promise, with increased compliance to hand hygiene and environmental surface cleaning, lessened risks for cardiac surgeries, identification of antibiotic overuse in urinary tract infections and improvement of communication on infectious disease markers in the emergency room, all with the ultimate goal of keeping patients safe.

A chain of successes using a multidisciplinary approach

The IPC services count several successful projects that have not only helped bring down rates of infection and kept patients healthier but also prevented outbreaks (see sidebar), saved money in hospitalization costs and won accolades (See article: MSSS honours team behind interdisciplinary initiative that reduced infections). Essential to their achievement is a multidisciplinary approach based on the collaboration between nursing, physicians and various clinical departments. Here are a few examples:                                                     

• After the move to the Glen site in 2015, the Royal Victoria Hospital’s transplant unit declared outbreaks of vancomycin-resistant enterococci (VRE) and C. difficile. The action plan, which included audits to make sure hand hygiene and environmental surface cleaning were properly performed, brought down the VRE rate by 92 percent and the C. difficile infection rate by 48 percent, in just one year.
• The adult IPC team found high rates of infection in cardiac surgeries such as valve replacements and grafting. Looking closer into the records, they narrowed the problem down to high glucose readings in those patients who had developed infections. A multidisciplinary approach and directive to control glucose levels prior to, during and after surgeries was implemented.
• The Camille Lefebvre Pavilion at the Lachine Hospital was seeing a high incidence of urinary tract infections among its geriatric patients. The review found antibiotics and urinary catheters were being overused. A multidisciplinary approach with directives to use catheters only when medically necessary and to administer antibiotics only for diagnosed infections, brought down the rate of infection by 11 percent in its first year and 48 percent the following year. 
• Emergency triage nurses have been using software to quickly spread important patient information – such a fever of 40°C and a trip to a country in an outbreak. The information is colour coded in the patient’s file so that all subsequent healthcare staff can take the necessary precautions.
• The adult IPC team has been implementing more consistent administration of prophylactic antibiotics among patients undergoing ERCP, an endoscopic procedure for pancreatic and bile ducts, with the objective of bringing down infection rates.
• Infection rates have been going down among neurosurgical patients with brain shunts, following close discussions with the neurosurgical medical and nursing teams.
• A multidisciplinary collaboration was instrumental in decreasing the incidence of central venous line infections.
• The adult IPC service has introduced prevention bundles specific to each surgery, service and department, to decrease surgical site infections. The bundles include evaluation and revision of surgical prophylaxis done in collaboration with pharmacists and the systematic use of pre-printed physicians’ orders (PPOs) done in collaboration with nursing and physicians.
• After the move to the Glen, an increase was seen in the rate of central venous line infections in the NICU. A multidisciplinary team was formed at the Children`s – including IPC, vascular access specialists and members of the NICU nursing leadership – and trained 85 percent of NICU nurses on proper care of central venous lines. This led to an almost 50 percent decrease in the rate of these infections.
• In 2016-2017, several exposures to chickenpox occurred in outpatient clinics at the Children’s as patients with chickenpox were not being assessed and isolated quickly enough. In response, a team composed of nurses, clerks, physicians and IPC staff members developed a questionnaire for patients and families inquiring about symptoms of chickenpox at appointment registration. Since then, exposures have greatly diminished.

Fast mobilization to contain measles spread

This past March, the MUHC’s IPC Service and other sectors of the hospital mobilized themselves quickly and swiftly contained a measles exposure at its Glen (Adult) site.

A MUHC employee, who had been experiencing vague symptoms, developed the telltale rash and underwent a test for measles. Nine days later, a positive result for the highly contagious virus came back from the provincial laboratory.

A multidisciplinary team, overseen by Infectious Diseases Specialist Dr. Marie-Astrid Lefebvre, kicked into gear. They pinpointed a five-day period and three hospital locations where the patients and staff would have been exposed. They then drew up a list of employees and patients who worked in or visited those locations during specific time periods. They sent out 271 registered letters to exposed patients and issued a press release informing visitors of the MUHC of the measles exposure. Dr. Lefebvre’s concerns lay in the airborne virus’s highly contagious nature and the vulnerability of some of the exposed patients, especially the elderly and immune-compromised patients.

But she kept to some basic principles: “Not to panic and to be very methodical.” She says she was grateful for her team and several other sectors (such as the Occupation Health and Safety Department for example) who helped track down vaccination and other information, tested employees who did not have proof of vaccination against measles, and kept the MUHC community and the public informed.

In the end, no transmission of measles occurred from this exposure.

Dr. Lefebvre credits vaccination as essential to containing the spread of the disease. Many of those potentially exposed to the virus had been immunized and created what’s called herd immunity, or a good measure of protection in a high proportion of individuals. But Dr. Lefebvre saves her real praise for members of senior administration, Occupational Health and Safety, and Public Health, as well as nurse and physician managers and the Human Resources and Communications departments, who all worked extra hours to help avoid a worst-case scenario. “A multidisciplinary team approach is really important,” she says. “And we are grateful to have in place at the MUHC.”