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Attention to Employee Health
Employee health programs are necessary to monitor the health of all employees within the medical institution and to administer immunizations. The objectives of an employee health program include the following—
• Educating health care staff concerning IC
• Monitoring and investigating potentially harmful infections in employees
• Providing care to employees with work-related illness
• Providing immunizations to staff
As a part of any employee health program, the following vaccinations should be administered to decrease risk of contacting infections and transmitting infections to patients—
• Hepatitis A and B
• Influenza (yearly)
• Measles
• Rubella
• Varicella zoster
• Bacillus Calmette-Guérin (BCG)
• Polio vaccine
• Tetanus/diphtheria
Proper Handling of Food and Water
Food- and water-borne outbreaks in U.S. hospitals have been shown to be caused by contaminated food and water, inadequate cooking, infected food handlers, and contaminated equipment. Written policies and procedures that describe proper food and water handling within the hospital environment are necessary to reduce the incidence of nosocomial infections.
Careful Antimicrobial Use Monitoring and Evaluation
This program is crucial in controlling the use of antimicrobials in the hospital. Control and restrictions on antimicrobials are essential to ensuring that antimicrobial treatment and prophylaxis are appropriate. Unnecessary and inappropriate use of antimicrobials results in prolonged hospitals stays, adverse drug reactions, increased incidence of AMR, and increased costs. The DTC and ICC should establish antimicrobial therapeutic guidelines, prophylactic guidelines, and specific guidelines for surgical prophylaxis. A monitoring system is essential to ensure appropriate use of these medicines.
The following case study (Donald Goldman, unpublished) illustrates inappropriate antimicrobial use in cesarean section surgical prophylaxis. This kind of antimicrobial use leads to increased infections, antimicrobial resistance, higher health care costs, and increased adverse drug reactions.
The risk of endometritis after cesarean section exceeds 30 percent and antimicrobial prophylaxis reduces the incidence by 66 percent. Two hospitals are compared for antimicrobial use in surgical prophylaxis of cesarean section procedures. Hospital A treats 70 percent of their patients with prophylaxis and 31 percent of patients receive prophylaxis within one hour after delivery. Hospital B treats 32 percent of their patients with prophylaxis and 70 percent of patients receive antimicrobials within one hour after delivery.
How would you describe the use of antimicrobial prophylaxis for these two hospitals?
• Hospital A uses a prophylaxis for too many patients because it should be used only for high-risk procedures. Only 32 percent received the medicine on time, adding to the inappropriate use in this case.
• Hospital B uses prophylaxis more appropriately (i.e., administered to the high-risk population) and gives the medicine at the appropriate time in 70 percent of cases—still too low for administering a single dose. This 70 percent represents an improvement over hospital A, but is still unacceptable because many failures will result from the poor timing of the doses. As antimicrobial administration is given closer to the surgical procedure, there is a corresponding decrease in the incidence of post-operative infections. Appropriate antimicrobial prophylaxis is one of the most important activities that an IC program can do to reduce the incidence of nosocomial infection in cesarean section procedures. Administering these antimicrobials is within the capacity of staff to improve practices in almost all settings and results can be seen in a relatively short period of time. Appropriate use of antimicrobials is an important issue for the DTC and the ICC. The committees must work together to achieve rational use.