Patients at Shepherd Center are at risk of infection for a few important reasons.
The risk goes up the longer a person is in a facility, and Shepherd’s average inpatient is in the hospital for more than six weeks.
Because Shepherd Center is a rehabilitation facility, patients are very mobile throughout the hospital, which sacrifices some infection protection afforded by having them stay put in their rooms.
Also, a high proportion of Shepherd patients use medical devices that add the risk of infection; these include certain kinds of IVs, tracheostomies and urinary catheters.
Listen in as Sarah Culberson, RN, discusses how Shepherd Center is working to decrease the risks of infection to patients.
Infection Prevention in the Acute Rehabilitation Setting
Featured Speaker:
Sarah Culberson, RN, BSN, CIC
Sarah Culberson, RN, BSN, CIC, has been the infection preventionist at Shepherd Center since March 2010. She has practiced nursing for 21 years and specialized in infection prevention since 2001. Sarah graduated from Kennesaw State University’s School of Nursing. She has been certified in infection prevention and epidemiology since 2005. Sarah and her husband Tim and have four children. Their eldest child, Robert, is a volunteer at Shepherd Center. Sarah enjoys spending time with family, reading and leading a Girl Scout troop. Transcription:
Infection Prevention in the Acute Rehabilitation Setting
4Melanie Cole (Host): Patients at Shepherd Center can be at risk for infection for a few very important reasons. Patients are very mobile throughout the hospital which sacrifices some infection protection afforded by having them stay put in their rooms. A high proportion of Shepherd patients use medical devices which could add to the risk of infection. But, here to counter these risks my guests today is Sarah Culberson. She is the infection preventionist at Shepherd Center. Welcome to the show, Sarah. So, tell us a little bit about infection risk with patients in the rehab setting.
Sarah Culberson (Guest): Thanks, Melanie. I’m glad to speak to you today. We get patients from all over the country, even sometimes other countries, and most of these people were trauma patients at the hospitals where they started and have already had a lot of medical complications. We get these patients already knowing that they have an infection sometimes. We don’t know exactly what all they have been exposed to and we do our best to try to minimize that once they get here.
Melanie: What’s involved in minimizing that risk?
Sarah: Our number one tactic is clean hands. The reverse is true. Clean hands prevent infections but we know that when people don’t have great adherence to hand washing or using sanitizer that that’s literally how germs get moved through the building and passed from person to person. That’s our number one tactic. We know that our staff does a great job with that. We also want to educate families and patients themselves about how important that is for them to do that while they’re here.
Melanie: If someone is a brain injury or spinal cord injury patient and they’re not always able to remember and/or take care of this for themselves, how do you help them?
Sarah: That is a great question. Nursing staff and therapy staffs assist patients with cleaning their hands. They’re modeling the great behavior, they’re showing the technique and for brain-injured patients, they usually do have to repeat this every day to walk them through the process. It does become kind of a habit, a skill that they’re learning, along with all of the other skills they’re learning while they are here.
Melanie: What about the staff itself, Sarah? How do they help to prevent this infection risk from spreading?
Sarah: Hand hygiene is still our primary way. When patients already have certain kinds of infections, we do take some extra precautions. If patients are carrying bacteria that we know are the resistant things – the things that the news calls the “super bugs,” the “super germs”—occasionally, we do extra precautions for the patients where the staff wear gowns and gloves when they do certain tasks, when they have a direct contact with the patient or even when they’re cleaning equipment or things in the patient’s environment. That’s another great tactic to disrupt the way things get transmitted and transferred from person to person.
Melanie: What about equipment? How is that helping to reduce this risk?
Sarah: We use so much equipment in the facility, not just things in a traditional hospital room like the bed and the table that goes over the bed and maybe a chair or bathroom equipment, but our patients spend a lot of time in the rehabilitation gyms. There’s so much equipment in there – mats and bolsters and treadmills--and we have a great, strong program of cleaning those. We have a couple of different products that we use that are disinfecting or germicidal products. Usually, they are in wet wipes which are easy for the staff to use. They have a very diligent program of cleaning that equipment in between patients. We don’t want germs left from one patient still on the equipment when the next person goes to use it. So, that’s really, really important.
Melanie: Its cold and flu season, so sometimes people are in the gym and they’re getting their therapy and they are coughing or they’re sneezing what do you do for that situation?
Sarah: If patients can tolerate wearing a mask, that can be a tactic that we use to stop them from spreading their germs. We can sometimes separate people in the gym, use some partitions if they’re actively coughing or sneezing or something like that. There are times where patients might be confined to their room for a short period of time but therapy can be done at the bedside. They lose the ability to use some of the equipment when that happens because, obviously, there’s not a treadmill in every patient’s room or other devices. So, we can do that kind of as a last resort. We also try to vaccinate our patients for flu while they’re here. If they don’t have documentation that they have had a flu vaccine already for this season, we offer them one as soon as they arrive in our facility.
Melanie: it sounds very comprehensive and it’s wonderful service that you provide. What about when a patient goes home? Do you help the family to learn these good hygiene habits when they are at home?
Sarah: Yes, we do. We have a pretty comprehensive discharge planning process that starts early, early in their stay. We are preaching hand hygiene to families the entire time they are here and they need to carry that over at home. We literally walk them through a hands-on process of how to properly wash your hands or how to use the alcohol sanitizer products because they come in different forms. We want patients and families to do that when they go home. There are some other things that we encourage at home, too. Healthy diet is one way to prevent infections and can help your body to ward off minor things. We tell patients who smoke that they need to quit smoking. We tell families that smoke that they need to quit smoking. We tell patients to avoid all second hand smoke if they can because that really sets them up for infection. Respiratory infections are pretty common in our patients after they leave us. That spinal cord injury or brain injury makes them a little more vulnerable to respiratory infections. So, an annual flu shot, not just the one that they get while they’re with us, but they’re going to need to get one every year after they leave. There are some other vaccines, too, that we encourage them to discuss with their personal physician what other vaccines might be helpful for them when they leave.
Melanie: What about monitoring and reporting any infections? Do you tell the family if somebody has come up with an infection, what they can do? What treatment goes on after that?
Sarah: It kind of depends on what the specific infection is. We try to always explain to patients’ families while they are here what the infection is that they’re being treated for, what are some signs that they would need to watch for, for it worsening or resolving. Some of these might tend to reoccur, perhaps the MRSA germ is the number one reason that we do some extra precautions while they’re here. That is at times difficult to completely eradicate. We want patients to be informed of what to look for after they go home and families to be savvy about hygiene in the home, housekeeping in the home. Patients who have had MRSA infections or other drug resistant infections shouldn’t share a lot of items with other family members, like towels or razors or toothbrushes, things like that. But, normal home hygiene dishwashers and normal laundry, is enough to protect other family members from those germs in the home.
Melanie: That’s great advice about not sharing things like towels and home things that you might not even otherwise think about. So, in just the last few minutes, Sarah, give your best advice for infection prevention in the rehab setting and at home and why people should come to Shepherd Center for their care.
Sarah: Well, I feel like I’m repeating myself but the number one thing people can do while they’re here and at home to prevent spreading infection is hand hygiene. Thorough soap and water, hand washing at the sink has not gone out of style. It still works. The hand sanitizer products have come on the market, maybe in the last 15 or so years, and they’re very effective. They come in lots of different forms and are pretty portable. You can keep those in your car or in your handbag and they’re easy to use. That really is the primary prevention for patients and families while they are here and once they leave.
Melanie: As an infection preventionist, which is a word that absolutely explains exactly what you do, what do you want people to know about Shepherd Center?
Sarah: We strive so hard to minimize the risk and the consequences of health care acquired infections. If people get infections while they are with us, besides the normal medical complications that can come about from those, patients lose time from therapy and that is so valuable. We don’t want patients to lose their momentum that they are making progress in therapy. We don’t want to have that happen. Also, we have very low rates of almost every hospital acquired infection that we track. We do report the incidence of these through the state and through the CDC on a national level and we are pretty proud of our outcomes.
Melanie: Thank you so much and I applaud all the great work that you do at Shepherd Center. You’re listening to Shepherd Center Radio and for more information you can go to shepherd.org. That’s shepherd.org. This is Melanie Cole. Thanks so much for listening.
Infection Prevention in the Acute Rehabilitation Setting
4Melanie Cole (Host): Patients at Shepherd Center can be at risk for infection for a few very important reasons. Patients are very mobile throughout the hospital which sacrifices some infection protection afforded by having them stay put in their rooms. A high proportion of Shepherd patients use medical devices which could add to the risk of infection. But, here to counter these risks my guests today is Sarah Culberson. She is the infection preventionist at Shepherd Center. Welcome to the show, Sarah. So, tell us a little bit about infection risk with patients in the rehab setting.
Sarah Culberson (Guest): Thanks, Melanie. I’m glad to speak to you today. We get patients from all over the country, even sometimes other countries, and most of these people were trauma patients at the hospitals where they started and have already had a lot of medical complications. We get these patients already knowing that they have an infection sometimes. We don’t know exactly what all they have been exposed to and we do our best to try to minimize that once they get here.
Melanie: What’s involved in minimizing that risk?
Sarah: Our number one tactic is clean hands. The reverse is true. Clean hands prevent infections but we know that when people don’t have great adherence to hand washing or using sanitizer that that’s literally how germs get moved through the building and passed from person to person. That’s our number one tactic. We know that our staff does a great job with that. We also want to educate families and patients themselves about how important that is for them to do that while they’re here.
Melanie: If someone is a brain injury or spinal cord injury patient and they’re not always able to remember and/or take care of this for themselves, how do you help them?
Sarah: That is a great question. Nursing staff and therapy staffs assist patients with cleaning their hands. They’re modeling the great behavior, they’re showing the technique and for brain-injured patients, they usually do have to repeat this every day to walk them through the process. It does become kind of a habit, a skill that they’re learning, along with all of the other skills they’re learning while they are here.
Melanie: What about the staff itself, Sarah? How do they help to prevent this infection risk from spreading?
Sarah: Hand hygiene is still our primary way. When patients already have certain kinds of infections, we do take some extra precautions. If patients are carrying bacteria that we know are the resistant things – the things that the news calls the “super bugs,” the “super germs”—occasionally, we do extra precautions for the patients where the staff wear gowns and gloves when they do certain tasks, when they have a direct contact with the patient or even when they’re cleaning equipment or things in the patient’s environment. That’s another great tactic to disrupt the way things get transmitted and transferred from person to person.
Melanie: What about equipment? How is that helping to reduce this risk?
Sarah: We use so much equipment in the facility, not just things in a traditional hospital room like the bed and the table that goes over the bed and maybe a chair or bathroom equipment, but our patients spend a lot of time in the rehabilitation gyms. There’s so much equipment in there – mats and bolsters and treadmills--and we have a great, strong program of cleaning those. We have a couple of different products that we use that are disinfecting or germicidal products. Usually, they are in wet wipes which are easy for the staff to use. They have a very diligent program of cleaning that equipment in between patients. We don’t want germs left from one patient still on the equipment when the next person goes to use it. So, that’s really, really important.
Melanie: Its cold and flu season, so sometimes people are in the gym and they’re getting their therapy and they are coughing or they’re sneezing what do you do for that situation?
Sarah: If patients can tolerate wearing a mask, that can be a tactic that we use to stop them from spreading their germs. We can sometimes separate people in the gym, use some partitions if they’re actively coughing or sneezing or something like that. There are times where patients might be confined to their room for a short period of time but therapy can be done at the bedside. They lose the ability to use some of the equipment when that happens because, obviously, there’s not a treadmill in every patient’s room or other devices. So, we can do that kind of as a last resort. We also try to vaccinate our patients for flu while they’re here. If they don’t have documentation that they have had a flu vaccine already for this season, we offer them one as soon as they arrive in our facility.
Melanie: it sounds very comprehensive and it’s wonderful service that you provide. What about when a patient goes home? Do you help the family to learn these good hygiene habits when they are at home?
Sarah: Yes, we do. We have a pretty comprehensive discharge planning process that starts early, early in their stay. We are preaching hand hygiene to families the entire time they are here and they need to carry that over at home. We literally walk them through a hands-on process of how to properly wash your hands or how to use the alcohol sanitizer products because they come in different forms. We want patients and families to do that when they go home. There are some other things that we encourage at home, too. Healthy diet is one way to prevent infections and can help your body to ward off minor things. We tell patients who smoke that they need to quit smoking. We tell families that smoke that they need to quit smoking. We tell patients to avoid all second hand smoke if they can because that really sets them up for infection. Respiratory infections are pretty common in our patients after they leave us. That spinal cord injury or brain injury makes them a little more vulnerable to respiratory infections. So, an annual flu shot, not just the one that they get while they’re with us, but they’re going to need to get one every year after they leave. There are some other vaccines, too, that we encourage them to discuss with their personal physician what other vaccines might be helpful for them when they leave.
Melanie: What about monitoring and reporting any infections? Do you tell the family if somebody has come up with an infection, what they can do? What treatment goes on after that?
Sarah: It kind of depends on what the specific infection is. We try to always explain to patients’ families while they are here what the infection is that they’re being treated for, what are some signs that they would need to watch for, for it worsening or resolving. Some of these might tend to reoccur, perhaps the MRSA germ is the number one reason that we do some extra precautions while they’re here. That is at times difficult to completely eradicate. We want patients to be informed of what to look for after they go home and families to be savvy about hygiene in the home, housekeeping in the home. Patients who have had MRSA infections or other drug resistant infections shouldn’t share a lot of items with other family members, like towels or razors or toothbrushes, things like that. But, normal home hygiene dishwashers and normal laundry, is enough to protect other family members from those germs in the home.
Melanie: That’s great advice about not sharing things like towels and home things that you might not even otherwise think about. So, in just the last few minutes, Sarah, give your best advice for infection prevention in the rehab setting and at home and why people should come to Shepherd Center for their care.
Sarah: Well, I feel like I’m repeating myself but the number one thing people can do while they’re here and at home to prevent spreading infection is hand hygiene. Thorough soap and water, hand washing at the sink has not gone out of style. It still works. The hand sanitizer products have come on the market, maybe in the last 15 or so years, and they’re very effective. They come in lots of different forms and are pretty portable. You can keep those in your car or in your handbag and they’re easy to use. That really is the primary prevention for patients and families while they are here and once they leave.
Melanie: As an infection preventionist, which is a word that absolutely explains exactly what you do, what do you want people to know about Shepherd Center?
Sarah: We strive so hard to minimize the risk and the consequences of health care acquired infections. If people get infections while they are with us, besides the normal medical complications that can come about from those, patients lose time from therapy and that is so valuable. We don’t want patients to lose their momentum that they are making progress in therapy. We don’t want to have that happen. Also, we have very low rates of almost every hospital acquired infection that we track. We do report the incidence of these through the state and through the CDC on a national level and we are pretty proud of our outcomes.
Melanie: Thank you so much and I applaud all the great work that you do at Shepherd Center. You’re listening to Shepherd Center Radio and for more information you can go to shepherd.org. That’s shepherd.org. This is Melanie Cole. Thanks so much for listening.