Considering the fact that Poland is one of the countries with the highest mortality rate due to various types of infections, it is time to take a closer look at the procedures protecting against infections. An infusion service may be the solution. We talk about changes, the health of patients and the planet with Maria Budnik-Szymoniuk from the Collegium Medicum in Bydgoszcz, a specialist in epidemiological management and nursing.
Hospitals are commonly associated with places where a patient can get help with a health problem. The concepts of sterility, hygiene and disinfection are associated with hospitals. These, in turn, accompany the performance of various medical procedures. Can we therefore say that thanks to this the patient will not experience an infection in the hospital? Of course, this is not true. It is not without reason that there is so much talk about hospital infections. They are analyzed systematically, paying attention to the increasingly emerging multidrug-resistant microorganisms. To sum up, it is necessary to ensure the safety of procedures performed by doctors, optimize risk, and use, among other things, modern hardware, procedural and organizational solutions.
Why are patients at risk of infection?
There are at least several reasons. Firstly, there are staff shortages in almost every medical professional group, which, given the multitude of tasks, significantly increases the likelihood of not entirely appropriate procedures – including those related to infection prevention. Secondly, it is not always taken into account that the performed medical procedure (e.g. creation of peripheral vascular access, popularly known as insertion of a venflon) may influence the final effect of the therapeutic process.
It is enough to mention the impact of infusion therapy on the postoperative course – including the development of surgical site infection (SSI). When referring to infusion therapy, it should be remembered that it is important not only what drugs the patient receives intravenously, but also how, which means rigorous adherence to the procedures for creating vascular access, drug preparation and its delivery. If we add the information that infusion procedures are performed in 60-100% of hospitalized patients, and that these procedures are high-risk, especially regarding infections, it is easy to draw the conclusion: something should be done to ensure that procedures with indicated critical control points (CCP) appear ) and ensure that they are performed conscientiously. I hear from many hospitals that these procedures should be standardized.
Just a quick note about critical control points. One of them, present in every procedure, is hand hygiene. I think all medics know this. Therefore, it may be worth making sure that you do not use gloves even when you are busy, e.g. when completing medical documentation.
Can patients’ actions influence the spread of infection?
Of course. While nurses, midwives, doctors, pharmacists and representatives of other medical professional groups are prepared during pre- and postgraduate education to follow anti-epidemic procedures, patients do not have to know them. Unfortunately, it sometimes happens that patients touch the elements of vascular access, manipulate the caps or unscrew the roller clamps on the infusion devices so that the “drip ends faster.” It is not always clear that such interference may lead to adverse drug reactions or infections, requiring long and expensive treatment.
Perhaps it would be worth educating patients in this area, if possible, e.g. during their stay in hospital, teaching them how to limit the transmission of microorganisms. Perhaps even going further, make such education part of the curriculum as part of security education? This will likely impact public health.
Do you see an opportunity and a way to solve the problem?
Already in the mid-1990s, the first infection control teams were established, then nutritional teams and wound care teams. It is nothing more than a combination of appropriate procedures used by trained and competent employees of the health care sector to achieve the expected effects in given treatment processes and minimize their undesirable effects.
At the end of the first decade of the 2000s, people began to talk about the so-called Vascular Access Teams. Their members were to take care of the quality of these access points (commonly called venflon lines, central lines or vascular ports). Today we talk about vascular access management. However, it seems that we need to go a step further, remembering that the so-called the patient’s injection occurs for some reason. Namely, for diagnostic purposes (e.g. when we want to take blood for tests or administer contrast) or therapeutic purposes (the patient receives medications in this way). Each of these procedures requires both precise preparation and execution. It is common knowledge that this cannot be done alone. Hence the direction towards a broader formula, namely towards infusion services.
When preparing the first publication in 2014: “Safety of infusion therapy: ser-wis/infusion team – a solution that improves the quality of the procedure and increases the epidemiological and organizational safety of health care facilities”, together with the co-authors, we paid attention to the interdisciplinary nature of the services, pointing out, among others, tasks of a doctor, nurse and pharmacist.
Now, natural members of the infusion service also include an epidemiologist, microbiologist and laboratory diagnostician, says Maria Budnik-Szymoniuk, nurse, specialist in management and epidemiological nursing from the Collegium Medicum of the Copernicus University in Toruń.
So the antidote to the problem is an infusion service?
Definitely yes. This is a natural next step in caring for the health of patients and medical staff. It is also a way to reduce the risk of adverse events related to medical care, because, as I mentioned at the beginning, the method of conducting infusion therapy affects the final effect of the therapeutic process, and irregularities in this area may be the cause of adverse events requiring expensive treatment. For the reasons previously indicated, the consequence also seems to be the economization of medical activities.
It would be good if the professional competences of health care professionals were used in interdisciplinary activities within the infusion service. So that, in addition to being very well constructed, the patient can count on its perfect execution. The staff of individual departments could count on help or consultation from the service, and the managers could count on information about the level of training of the medical staff, the consumption of drugs or medical devices, adverse events and their costs, the impact of infusion therapy on the effects of treatment, or a reduction in the number of patient complaints and claims. Today, several hospitals in Poland are successfully implementing this project.
How much does health cost?
The topic of money in the context of health care is always controversial. Maintaining the Polish system is a multi-billion annual investment. Continuing the topic of parenteral (infusion) therapy, it is worth paying attention to several aspects. Let the first of them be the use of the drug. The question arises: if blood flows back from a blood vessel into the tubing of the infusion machine, or if air bubbles appear in the tubing, will the patient receive the full dose of the drug? Of course not, because the infusion device needs to be replaced and some of the medicine is placed in the waste container with it.
Another question is whether the use of unprotected intravenous cannulas (to protect against injuries to staff) may generate costs? And again the answer is yes. An injury with an unprotected cannula, and therefore occupational exposure to blood, is enough to cause sickness absence, e.g. of a nurse. Then there are staffing problems, overtime costs, etc. A patient with infective endocarditis, which is a consequence of, among others, problems in the area of infusion therapy is a seriously ill person who requires a series of subsequent, undoubtedly costly medical interventions and a prolonged hospital stay. It all costs money.
So we go back to the assumptions of infusion services. Let’s economize the work of medical entities by using the competences of the professionals employed there, while looking at the patient holistically. Let’s use less medical devices and various materials and resources, not in the sense of misconceived savings, but in connection with risk optimization. Let us draw conclusions from possible failures to improve procedures and implement them better.
Referring to the infections that started this conversation. Fewer infections mean a shorter hospitalization time for the patient, which means lower costs related to treatment, food and even utility consumption. Unfortunately, patients’ claims related to infection or medication errors also cost huge amounts of money. Court proceedings and, consequently, the verdict are costly not only financially, but also in terms of image.
Does a patient’s health impact the planet?
Yes. A healthy patient – a healthy planet. However, we must not forget about the health of medical staff. And, of course, I am coming back to infusion services, which can have a real impact on environmental protection on a global scale. Let’s imagine hospitals that use less cotton pads, dressings, gauze, needles, cannulae, plastic and foil drug packaging. How much less waste will there be? How will hospital operating costs be reduced?
Let’s take RTU (ready to use) medications as an example. This eliminates the need to use a needle, syringe, gloves and disinfectants because the medicine has been prepared at the factory and does not require any additional steps. And these drugs should be used first by hospitals, in accordance with the provisions of the EU Resolution. This seems like a huge step towards a cleaner planet.
Is the world opening up to infusion services? Does he understand its necessity?
The Aesculap Academy Foundation already has sufficient know-how on infusion services to effectively implement the assumptions of this important system in Polish hospitals, which can influence changes both in medical entities and in society, and therefore in the area of public health, e.g. to infections, which are a huge problem, especially in the face of increasing drug resistance of microorganisms. It seems that the creation of infusion services may be one of the elements of the strategy to prevent multidrug resistance of microorganisms, which are responsible for the occurrence of serious infections among our patients.
Maria Budnik-Szymoniuk, MA. A nurse for 35 years, an academic teacher for 15 years. A long-time manager of nursing staff. Author and co-author of publications mainly regarding the safety of nursing procedures. Trainer of nurses and midwives in the areas of procedural safety. Scientific and teaching assistant, specialist in management and epidemiological nursing, Nicolaus Copernicus University in Toruń.
The interview was conducted by Paulina Szczepaniak