Five years ago, St. John's Mercy Medical Center encountered a new multi-drug resistant type of bacteria, the potentially deadly Acinetobacter baumannii complex (ABC).
The bacteria infected wounded U.S. soldiers from the war in Iraq and was surfacing at many large hospitals across the country. St. John's Mercy first encountered these bacteria in burn victims and later among patients with severe trauma and others in intensive care.
"We haven't had any outbreaks. We haven't had to shut down any floors," said Dr. Farrin Manian, who heads the hospital's infectious diseases division. "But we found that we should do more to basically try to help our patients get through the maze of health care without getting these infections."
In the battle against health care associated infections, Manian and his colleagues have determined that environmental factors contribute significantly, even when medical staff clean rooms frequently, follow sterile procedures and wash their hands between patients.
Since ABC emerged as a threat, St. John's Mercy in Creve Coeur has embraced one of the most aggressive programs to combat such infections, adopting a technology to clean its hospital rooms that was developed in England and has been used to kill anthrax spores.
In 2006, St. John's Mercy turned to Bioquell, a British firm that uses hydrogen peroxide vapor against the germs and bacteria that can be difficult to destroy. After one round of bleach cleaning, a room is sealed, then vaporized, so to speak.
Similar methods have been used at Johns Hopkins University Medical Center in Baltimore, Md., and the Hospital of Saint Raphael in New Haven, Conn. Manian said tests this year show no presence of ABC bacteria at St. John's Mercy.
The hospital focuses on the areas of the hospital most likely to house the bacteria, especially rooms where patients have been infected. "You do have limited resources, so basically you have to prioritize," said Manian.
When the ABC bacteria emerged, the hospital began a testing procedure to gauge the effectiveness of standard room cleaning. Manian's team found that one round of bleach cleaning did little to kill either ABC or other culprits. Some rooms required 12 rounds of cleaning to remove all traces of these bacteria.
Area hospitals have embraced other germ-fighting methods, including the pre-screening of patients to determine earlier which ones may have been infected by drug-resistant bacteria.
Two decades ago, Barnes-Jewish began using "germ watch" computer software that culls through the hospital's database to search for deadly microorganisms. When an infection is identified, the patient's care history is reviewed to explore what went wrong.
A growing number of hospitals are fighting central line bloodstream infections by using a stringent protocol developed by patient safety expert Dr. Peter Pronovost of Johns Hopkins.
The five-step checklist not only calls for the use of surgical procedures for inserting a catheter, but also empowers nurses to speak up — with the backing of hospital administrators — if a step has been skipped. Studies show that the checklist has significantly reduced infection rates at Johns Hopkins and in hospitals in the state of Michigan.
The Missouri Center for Patient Safety is working with 14 hospitals in the Kansas City area and northwestern Missouri to implement Pronovost's checklist. Soon, the center will begin recruiting hospitals in the St. Louis area.
