Friday, March 25, 2011

Blaming the health care worker: KPCs in Ireland

Mike posted yesterday about KPCs in LA, and now there is a report of a KPC outbreak in Ireland. I have read several reports of the outbreak, which involved 5-7 patients (two infected, three colonized) at the Mid-Western Regional Hospital in Limerick, and there is one consistent aspect to what is reported:  It's the health care workers fault. See the article "Hospital Staff Warned" in the Irish Times.

The articles state that "steps had been taken to improve hand hygiene standards among hospital staff but warned that a zero-tolerance approach was being enforced in respect of anyone who failed to comply with these standards" and that "This will include disciplinary action and or notification to relevant professional registration bodies if warranted in any particular case." 

Mike has written before about the dangers of this adversarial approach to infection prevention, so I won't belabor the point.  However, when the authorities state that they are already doing everything right since MRSA and C. diff prevention efforts are all you need to control KPC, I get a bit worried.  There is no evidence that this one-size-fits-all approach works for infection prevention.  Yes, compliance with infection prevention is important, but there must be other approaches besides punishing the health care worker that will protect our patients. 

The larger problem is that little to no research funding is available to study the epidemiology and optimal prevention methods for Gram-negative (or Gram-positive) bacteria.  Before we blame the health care worker, perhaps we could ask why there is almost no funding for infection prevention research and implementation and why there are no new antibiotic classes in the pipeline.  You do get what you pay for...

1 comment:

  1. Well, if you have strategies that control MRSA and C. diff, AND they are properly applied, it could be that with the exception of some antimicrobial stewardship issues, it might help control KPCs. This does not seem to be happening, even in some areas of the US, and after doing considerable amounts of watching behaviors, my guess is that we still have a ways to go with the basics, but I agree. Adversarial approaches don't change behaviors in the long run.

    Considering KPCs are an environmental hygiene issue AND a undiscovered colonization issue as well as a hand hygiene issue AND an antibiotic stewardship issue, a cricket bat in the wrong area just beats up on the staff who have the least power in the first place, but these are also the staff who can have the greatest impact on patient physical and psychosocial outcomes. Not the best people to make feel really bad about their jobs.

    We need research in all levels of healthcare. Why is it that healthcare seems to get dogmatic about the wrong things? (I read the fine article by Karen B. Kirkland). At least let people get dogmatic about evidence based interventions. Like getting their immunizations, and cleaning their hands, clothes and equipment. Sigh.