Photo by Carol Insalaco
Cancer treatment leaves patients with weakened immune systems. So it would seem obvious that an outpatient cancer clinic would be a prime breeding ground for infections because of the constantly revolving door of patients, visitors and staff, all of whom could be exposed to bacteria and viruses at home or in the community. After all, infections are among the most common causes of illness and death among cancer patients.
However, an aggressive infection-control program at the Seattle Cancer Care Alliance that mixes common sense measures with medical informatics has drastically reduced the number and rate of infection-caused illness since its inception three years ago. “Our rates of infection appear to be several fold lower than those seen at comparable institutions,” said Dr. Corey Casper, medical director of the infection-control program.
Consider what’s happened in three years, according to Casper:
- Mortality linked to respiratory viruses such as respiratory syncytial virus (RSV) has fallen 20 fold due to a novel program that screens every person entering the building in the fall and winter for infections.
- Rates of infection by so-called “superbugs” that are resistant to multiple broad-spectrum antibiotics such as MRSA (Methicillin-resistant Staphylococcus aureus) are “negligible.”
- Staff compliance with vaccinations has more than doubled and hand-washing before and after a provider has seen a patient is at 97 percent.
The SCCA’s program is the only one of its kind devoted to outpatient care of any cancer center in the world, according to Casper. Lessons learned here are important ones because the majority of cancer care is provided in an outpatient setting. Outpatient cancer care poses more challenges when it comes to protecting patient health because the environment is less controlled than that of a hospital.
A cornerstone of the SCCA infection-control program is a real-time, automated surveillance system that is the first of its kind among comprehensive cancer centers. It queries several clinical and laboratory databases maintained at the SCCA and Hutchinson Center (a co-owner of the SCCA) daily, providing numbers and rates of infections among patients.
The automated query replaces the traditional paper chase that makes most other surveillance time consuming and inefficient.
One result of constantly tracking infections is the ability to focus infection control resources on real emerging outbreaks, Casper said. For example, when the surveillance system showed few cases of MRSA, more attention could be paid to preventing the annual expected uptick in respiratory infections.
The screening system goes live every Oct. 1.
“It’s such a simple system,” Casper said. “We ask everyone entering building to fill out a survey asking whether they have one of 11 respiratory symptoms. A licensed practical nurse staffs the survey desk. If you answer yes to any of those questions you are placed into isolation, tested for a respiratory virus and put somewhere else so you don’t put other patients at risk. If you’re an employee you are furloughed from work. If you are a visitor whose clinic visit is not essential you are asked to reschedule your appointment. That system alone has been incredibly effective in reducing the amount of respiratory viruses.”
The SCCA also has instituted some novel patient and staff education programs to keep infection control top of mind. For example:
infection control rounds. Once monthly, the infection-control team joins with senior administrators for a top-to-bottom inspection of the clinic building, soliciting staff input. “It has really revolutionized the way the infection control program has been perceived and how effective it is,” Casper said.
The next superbug—MRSA isn’t the only bacterial infection that haunts hospitals and clinics. Vancomycin-resistant enterococcus (VRE) is transmitted through stool. Bathrooms must be kept immaculate, especially after use by infected patients. How to know when to call in housekeeping and preserve the dignity of patients? Inside each bathroom is a card that the user can hang on the outside handle; clinic staff can see the card and arrange for cleaning right away. The method empowers patients to take control, according to Casper.
Did you remember to wash your hands? Once a quarter bright orange cards are placed inside patient exam rooms. The cards are a survey for patients to fill out—and for care providers to take notice of—asking whether the doctor or nurse washed their hands before and after their interactions with the patient. The unique survey debuted in January 2008. Hand-washing rates rose from 80 percent “before and after” to about 97 percent. Washing hands after seeing a patient increased from about 70 percent to about 95 percent.