City of Hope vigilant in fight against infection
The three-dozen cancer patients on City of Hope's top floor are among those least able to fight off infection. They've received bone marrow transplants to infuse their blood with healthy new cells.
Their white blood cell counts hover near rock bottom. A healthy person might have a count of 5,000 disease-fighting white blood cells. Some patients on the top floor have no white blood cells at all.
"If you added up all their white blood cells, on a good day, you might get enough for one normal person. On a bad day, not so much," said Annemarie Flood, coordinator of the infection control program at City of Hope, a nationally known, 177-bed cancer center in Duarte.
City of Hope is an outlier in the world of hospital infections. Its physicians perform 500 bone marrow transplants a year, a third of all such transplants in California.
Its infection totals are higher than at most hospitals listed in the state's inaugural Dec. 30 report on hospital-acquired infections. That's largely because its patients are so vulnerable, and the staff must be extra vigilant in diagnosing and recording infections, said Flood, a member of the state's panel on health-care acquired infections.
For instance, extra air is pumped into many patient rooms at City of Hope. When the door opens, the air pushes out, warding off dust, bacteria and other contaminants.
Here, as at many hospitals, doctors, nurses and other staff are trained how to guard against transferring bacteria via equipment or a soiled sleeve.
But nothing is simple in a universe without white blood cells.
Take the rule-of-thumb that so-called central lines used to feed and medicate intensive-care patients should be removed quickly to prevent bacteria from slipping into the bloodstream. For many patients in a general hospital, the line can come out in a week or two.
"Our patients keep their central lines for months," Flood said.
That means that employees who might handle those lines 10 or 20 times a day must follow iron-clad rules to stop bacteria from entering a line.
Several years ago, Flood and her colleagues detected what she calls "some drift in practice" where some workers weren't in sync on certain protocols.
So the infection control team took action.
"We spent over eight eight-hour days educating every RN on the campus who accesses central lines as part of their daily job. Floor nurses. Clinical nurses. Radiology nurses," Flood said.
"It was, 'This is how you access central lines. This is how you do the dressing changes. This is our practice. This is how you will set up your sterile fields. This is how you will repair lines. This is how you will anchor the catheter.' "
The team began giving nurses the infection counts for their specific units so that they could see exactly where they stood. "It was not just, 'Mr. Jones had a fever, so we gave him antibiotics.' It became, 'There were four patients with this infection.' They like the count."
Units doing well were recognized, one with a pizza party.
Infections began to ebb.
"It's tough, especially when there is a lot of literature out there that talks about zero infections," Flood said. "I think there should be zero infections. But not all health care-associated infections are preventable. That being said, we all have to do as well as we can."