Promoting Patient Safety: Overcoming Challenges at the Local Level

March 12–18 is Patient Safety Awareness Week, a campaign developed by the National Patient Safety Foundation to increase awareness about patient safety among health professionals and the public. Broadly defined, patient safety refers to the prevention of harm to patients, such as accidental or preventable injury or infection, while receiving medical care. Patient safety practices are designed to prevent a myriad of possible risks, including healthcare-associated infections (HAIs). According to a CDC progress report on healthcare-associated infections, the infection rate for many HAIs have decreased compared to the national baseline. However, despite this progress, more action is needed at every level of public health and health care to eliminate HAIs and to reach the Department of Health and Human Services targets for 2020.

The Evolving Role of Local Health Departments
The local health department (LHD) role in HAI prevention and response has changed over time to meet community and regional needs. In 2011, NACCHO conducted telephone interviews with 13 LHDs to learn more about this evolving role and the challenges, barriers, and opportunities for LHDs working in HAIs. The interviews uncovered that LHDs were more involved in HAI outbreak response than prevention and primarily encountered reportable diseases. Further, the communication between LHDs and facilities in their jurisdictions was significantly reduced for HAIs compared to reportable diseases. In addition to the lack of communication, LHDs cited challenges such as lack of resources, lack of access to data, and lack of authority as barriers to getting more involved in HAI prevention and control.

Fortunately, LHDs continue to find ways to support patient safety by responding to outbreaks and providing recommendations for improving infection prevention and control practices. One such example comes from an April 2016 Notes from the Field published by CDC summarizing the Kanawha-Charleston Health Department response to an epidemic keratoconjunctivitis (EKC) outbreak in West Virginia. In September 2015, the West Virginia Bureau for Public Health (WVBPH) was notified by a local healthcare facility of 13 patients with EKC, an eye infection which can result in vision loss. The Kanawha-Charleston Health Department conducted an investigation to determine the source, identify additional cases, and implement control measures. Through the investigation, an additional 10 cases were identified; eight were associated directly with the facility, including two staff members.

During the investigation, LHD staff conducted site visits to collect swab samples and identify the existing infection control procedures, which included an unwritten protocol of once-daily cleaning of commonly touched surfaces, and wiping instruments with alcohol pads after each patient contact. The LHD recommended a written infection control policy, cleaning all touched surfaces between symptomatic patient encounters, segregating infectious patients from others, mandatory leave for symptomatic staff members, and patient education regarding EKC transmission prevention. These efforts and recommendations led to development of a toolkit which includes patient education, a health advisory to providers, and a chart abstraction template. The toolkit is available upon request to the WVBPH, Division of Infectious Disease Epidemiology.

The Kanawha-Charleston case demonstrates that despite facing obstacles, some LHDs successfully engage in HAI prevention and response activities from responding to outbreaks and conducting case investigations to proactively bringing stakeholders together in regional collaboratives. Through these activities, LHDs are able to promote updated guidance and share best practices that help healthcare facilities provide the best care possible; provide a critical opportunity to increase inter-facility communication; and address community-wide gaps.

Supporting Patient Safety at the Local Level
In addition to promoting tools and resources, NACCHO is supporting three LHD demonstration sites with funding and technical assistance to expand their role in addressing HAIs and antimicrobial resistance. NACCHO also advocates for LHD needs and ensures the LHD voice is represented in national coalitions and committees related to patient safety, such as the Healthcare Infection Control Practices Advisory Committee (HICPAC), the Safe Injection Practices Coalition, and the Council for Outbreak Response: Healthcare-Associated Infections & Antibiotic-Resistant Pathogens (CORHA). These groups aim to improve practices and policies for detection, investigation, control, and prevention of HAIs and antimicrobial resistance, provide guidance, and increase awareness among the general public and healthcare providers.

For more information on promoting and advancing patient safety in your jurisdictions, see the below resources:

  • Participate in or follow the Patient Safety Awareness Week Twitter Chat on March 14 at 2pm ET.
  • Check out the CDC website to view the HAI progress report for your state. This report includes progress data for specific infections, as well as localized information about relevant mandates and activities.
  • Use this public health communications toolkit from the Association for State and Territorial Health Officials to help communicating the role of public health in HAI prevention and response and engage with clinical partners in patient safety activities. The toolkit includes key messages and talking points, a social media guide, and tips for working with the media.
  • Promote the Patient Safety Pledge and download campaign materials from the National Patient Safety Foundation website.

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