Photo by Todd McNaught
The Seattle Cancer Care Alliance (SCCA) outpatient clinic is not a hospital, yet it must be equally vigilant against the same invisible enemy — infection.
It's a never-ending battle against spores, viruses and bacteria — a battle the clinic is better equipped to win than ever thanks to a new early warning system.
"Exposure to infection in health-care settings is one of the biggest and fastest-growing medical challenges we face in this country," said Dr. Corey Casper, medical director for infection control at the SCCA. "Far and away the most exciting thing our team is doing right now is tracking the source of infections on a real-time basis. It's a revolutionary new system."
Given the clinic's record — no epidemic infections acquired in the facility since it opened — the new system might seem unnecessary. However, health-care facilities soon may be asked to include infection statistics as one of the quality-of-care benchmarks they report to national organizations that review health-care providers. "This will show we're a leading facility in preventing infection among our patients," Casper said.
SCCA patients come to the clinic — typically before and/or after a stay in the hospital — as part of a life-and-death fight against cancer. Since their immune systems are typically weakened by the radiation and chemotherapy treatments they receive to destroy their cancer, any contact with infection-causing agents in the clinic — even those not normally considered a serious threat — also threatens their lives.
That's true in any outpatient clinic serving cancer patients. What sets the SCCA outpatient clinic apart is geography. As a freestanding facility located on the Hutchinson Center campus, the clinic is miles away from the hospital units it supports at the University of Washington Medical Center and Children's Hospital and Regional Medical Center. As a result, it cannot depend on hospital-based infection-control programs as it would if it were co-located with a hospital.
That makes the SCCA outpatient clinic unique. "As far as I know, we are the only cancer center in the world that has its own infection-control team dedicated solely to an outpatient facility," Casper said.
While the clinic's system, layout and policies and procedures are designed to minimize exposure to infection, it's impossible to erase the threat entirely. Consequently, it's vital to quickly identify the source of any elevated rates of infection and, if the source were found to originate in the clinic, eliminate it.
Tracking outpatient infections
Depending on the circumstances, that can be easier said than done. In hospitals, it's fairly certain that the source of any infection a patient develops two or more days after being admitted resides somewhere within the hospital. However, since clinic patients come and go on a regular basis, it's much tougher to determine whether they were exposed within the clinic or in the community. "It's pretty routine for hospitals to have systems that extract data from the laboratory to track rates of infection occurring among patients in the hospital," Casper said. "It's a lot more difficult to do in an outpatient setting."
This summer, the SCCA infection-control team unveiled a new early warning system that tracks outpatient infections in real time. The system has worked so well that Sara Dreitzler, the SCCA infection control coordinator, recently presented it at a conference involving all 17 of the nation's comprehensive cancer care centers.
The key is an algorithm that merges laboratory data with information from an SCCA registry filled with the latest follow-up information from patients. The system automatically compares historical rates of infection to actual instances of infection and quickly raises a red flag if it detects any spikes. From there, the infection-control team searches for any experiences at the clinic that the patients might have in common — experiences than can then be investigated for possible links to the elevated infection rate.
In recent months, the infection-control team has had special cause to remain vigilant due to the ongoing expansion of the clinic building. The chief concern is that construction activities could cause spores from a soil-dwelling fungus to become airborne, Casper said. When inhaled, the fungus can cause fatal infections in people with weakened immune systems.
Maintaining negative air pressure within the construction site and erecting physical barriers to the existing clinic are the primary lines of defense against the spores entering the building. However, the precautions don't stop there. The infection-control team also monitors the clinic's air to check for any increases in particulate levels. In addition, it collects air samples from which it attempts to grow the fungus to detect if any spores are present.
Another potential threat requiring special attention is the so-called "bird flu." Many cancer patients — especially those who have received bone-marrow transplants — must make regular visits to the clinic for a prolonged period of time. Led by the infection-control team, the SCCA has taken steps to safely accommodate any patients who might be diagnosed with bird flu in the future. They include forming a specially trained and equipped team to work with flu-stricken patients as well as designating spaces for them to be treated and places for them to enter and exit in isolation from other patients, Casper said.
Holiday decoration limitations
Protecting SCCA clinic patients from infection is a year-round job, but the arrival of the holidays as well as the cold and flu season requires heightened awareness by everyone who visits or works in the building.
The following natural holiday decorations are off limits in patient-care areas because they pose a risk of infection.
- No fresh or dried plants, flowers, grasses.
- No live or fresh-cut Christmas trees.
- No holiday wreaths using fresh/dried pine or other tree or plant cuttings.
For other holiday displays that could potentially pose a risk, check with an infection-control or registered-nurse manager prior to use or display. Artificial plants, flowers, fruits and vegetables are allowed but should be kept dusted. As always, anyone with cold or flu-like symptoms should refrain from entering patient-care areas.