Health care–associated infections (HAIs) remain a critical patient safety concern in health care facilities across the US. 

that more than 680,000 infections occur each year in the US alone, with costs reaching into the billions of dollars.

 Approximately 1 in every 31 hospital patients has at least 1 HAI. While progress has been made in preventing these infections, this remains an unacceptable outcome that negatively impacts patients and health care professionals.

Over the last few years, the health care industry has paid significant attention to hand hygiene adherence, as countless health officials have stressed its importance. According to the CDC,

 consistent hand hygiene is the most crucial tool for helping prevent infection transmission and control outbreaks. However, achieving high and consistent hand hygiene adherence remains challenging in health care settings.

Even so, this issue has a relatively simple solution: automated hand hygiene monitoring devices that use real-time location sensors to monitor hand hygiene events and provide comprehensive data.

Hand hygiene systems develop best practices in staff, increase adherence to hospital policies, and mitigate the risks associated with HAIs. Successfully implementing an 

electronic hand hygiene monitoring system

 can improve results, mainly when the system provides real-time insights and a thoughtful approach to guided change management is taken from the start. As outlined below, strategically implementing an electronic hand hygiene system can result in several benefits.

Why Implementing Real-Time Technology Helps Increase Hand Hygiene Adherence

Many hospitals use manual observation methods when reporting and increasing hand hygiene adherence.

 Still, this time-consuming, ineffective approach takes only a snapshot of daily handwashing activity and usually excludes data from night shifts, understaffed units, weekends, and holidays. Alternatively, an electronic hand hygiene solution automatically captures and reports all possible handwashing events by department, role, and individual, allowing actionable improvements in adherence while flagging areas for growth and reducing rates of HAIs. 

The technology behind a real-time location system (RTLS)

 includes radio-frequency identification location-enabled badges that wirelessly communicate with hand hygiene sensors embedded within dispensers, sinks, and handwashing stations. An RTLS-based hand hygiene monitoring solution supports custom settings for specific rooms, such as using soap vs sanitizer or time frames for expected hand hygiene adherence upon entering a room. An RTLS that detects both the presence of a badge and the use of a dispenser, in conjunction with patient care, provides more accurate information on missed opportunities and adherence trends.

Even though infection preventionists (IPs) and health care leaders have implemented hand hygiene policies, recommendations, and adherence procedures for decades, not all facilities are equipped with the latest technology. Many facilities across the country still use manual processes. The manual process, known as the secret shopper method, provides a limited dataset and proves costly, time intensive, and burdensome for IP teams. Additionally, it introduces vulnerabilities such as human error, biases, and the 

 (when habits temporarily change due to being observed),6 compromising data accuracy. Instead, an electronic system reallocates valuable time for IPs to work on preventing, detecting, and coaching to improve hand hygiene practices.

Electronic monitoring and real-time insights offer a more comprehensive, efficient, and effective method of monitoring hand hygiene events. They provide an all-encompassing view of handwashing activities that is unbiased when identifying adherence and nonadherence. Electronic monitoring can help facilities flag where additional support or education is necessary to establish best practices for handwashing habits. Advanced systems can also offer custom real-time reminders to perform handwashing before a patient interaction occurs, further reducing the risk of spreading HAIs.

Increase the Success Rate of Your Implementation With a Thoughtful Approach

As health care leadership considers the best fit for their hand hygiene adherence monitoring needs, some of the top solution providers supply a secure, high-performance cloud environment for their software applications. Scalable cloud-based software simplifies implementation and maintenance, reducing costs and easing the labor-intensive management typically associated with physical servers. Upon reviewing Software as a Service options, select 1 that provides unified access to a comprehensive suite of RTLS solution applications (ie, staff duress, asset tracking, clinical workflow, etc) and wider system management tools with single sign-on capabilities. Utilizing a cloud environment provides automatic and proactive application updates and further eases processes for health care professionals. Essential functions such as user management, staff assignments, facility maps, site structures, and device configurations can be consolidated into 1 RTLS platform. 

Staff support and stakeholder buy-in can be significant considerations when implementing new technology or equipment. The key to buy-in success is early goal transparency, proactive communications, and staff education on the technology’s use cases. Successfully deploying and earning support for new solutions requires incorporating the proper expertise within the health care facility, vendor, and key stakeholders from the relevant departments that will play a role. Bringing together leadership with varied viewpoints and expertise allows health care facilities to better develop the implementation roadmap, communication plans, and comprehensive educational programs. By providing transparency and education on the technology’s purpose and benefits, health care professionals are likelier to adopt the technology and see its value. This is especially important when it comes to new safety tools. Without widespread staff adoption, the solutions won’t be as effective nor bring the desired return on investment.

A medical center in Denver, Colorado, improved its hand hygiene adherence rates by 30% by following a thoughtful approach to implementing an 

RTLS-based hand hygiene compliance solution

Previously, the medical center relied on a manual process, documenting only a few hundred observations monthly within regular business hours at the 500-bed facility. With the introduction of an electronic hand hygiene monitoring system, real-time data collection now captures 100% of handwashing events. This enables continuous auditing of facility-wide adherence. The system generates adherence reports in alignment with The Joint Commission requirements and offers analytical insights into areas necessitating further education and training.

Similarly, a Georgia health care facility implemented the same hand hygiene solution, remarkably improving hygiene adherence. This achievement positions the facility among the nation’s top performers in maintaining consistent adherence standards of over 90%. Furthermore, the facility’s cost of 

 since reenergizing its hand hygiene adherence campaign.

Actionable Data Bring a Better, Healthier Experience

The most powerful feature of the RTLS electronic hand hygiene adherence system is the real-time actionable analytics. These insights, gathered across designated areas, hospital-wide, or an entire health system or integrated delivery network, are seamlessly and automatically relayed to IPs and hospital administrators via the system’s dashboard. Hand hygiene events can then be audited by unit, time of day, room, and individual to review adherence, consider trends, and pinpoint areas needing improvement. These reports can be automatically delivered on a custom schedule and offer real-time awareness of operations, identifying the need for additional interventions (such as increased staff training or a change in clinical workflow) where adherence is lower. To encourage adherence and boost morale, intel should be used to celebrate high performance and share best practices across the health system.

Strategically implementing automated monitoring solutions can significantly reinforce hand hygiene best practices among staff, enhancing the patient care experience and optimizing care delivery. Concurrently, IPs can focus on targeted areas for improvement, ultimately assisting in improving hospital finances. Hospitals embracing enterprise location technology throughout their facilities have real-time access to actionable data to mitigate threats like HAIs. Moreover, utilizing an RTLS solution as a foundational tool empowers hospitals and health care facilities to scale operational capabilities as needed. This includes solutions ranging from staff duress and nurse call automation to workflow and asset management, ensuring adaptability and efficiency for future needs.

Rhee C, Dantes R, Epstein L, et al. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014. 

. 2017;318(13):1241. doi:10.1001/jama.2017.13836

Hand hygiene in healthcare settings. CDC. April 28, 2023. Accessed April 25, 2024. 

https://www.cdc.gov/handhygiene/index.html

Hand hygiene compliance monitoring. CenTrak Inc. Accessed 25, 2024. 

https://centrak.com/solutions/infection-control/hand-hygiene-compliance-monitoring

Genovesi G. Infection Control Today exclusive: the challenge of health care-associated infections (HAIs) and evolving prevention: a focus on hand hygiene. 

. November 6, 2023. Accessed April 25, 2024. 

https://www.infectioncontroltoday.com/view/infection-control-today-exclusive-challenge-health-care-associated-infections-hais-evolving-prevention-a-focus-on-hand-hygiene

Infection Control Today Editorial Staff. CenTrak unveils revolutionary BLE Multi-Mode Platform for health care RTLS solutions. 

. March 22, 2024. Accessed April 25, 2024. 

https://www.infectioncontroltoday.com/view/centrak-unveils-revolutionary-ble-multi-mode-platform-health-care-rtls-solutions

Srigley JA, Furness CD, Baker GR, Gardam M. Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study. 

. 2014;23(12):974-980. doi:10.1136/bmjqs-2014-003080

Centrak Resource Center: case studies. CenTrak Inc. Accessed April 25, 2024. 

https://centrak.com/resources?type=caseStudies

. February 22, 2022. Accessed April 24, 2024. 

https://www.hpnonline.com/infection-prevention/article/21256422/the-contagion-contingent

Articles

Health care-associated infections (HAIs) affect over 680,000 patients annually in the U.S. Unlike manual methods, automated hand hygiene monitoring can significantly improve compliance and reduce HAIs.

How Emerging Technologies Increase Hand Hygiene Adherence and Reduce Infections

During the childbirth process, whether through vaginal delivery or cesarean delivery, preventing infections is paramount to ensuring the health and safety of both the mother and the newborn. While vaginal delivery presents its own set of challenges, cesarean deliveries, being surgical procedures, carry a heightened risk of postpartum infections. 

Health care workers employ a variety of strategies to mitigate these risks and maintain sterile conditions throughout the delivery process. Here are the specific strategies used to prevent infections during both vaginal and cesarean deliveries, high­lighting the importance of adherence to hygiene protocols, sterile techniques, and proactive measures to safeguard maternal and neonatal health.

The likelihood of acquiring a postpartum infection during vaginal delivery varies depending on several factors, such as the presence of risk factors, the specific circumstances of labor, and the health care setting. Generally, the incidence of postpartum infections following vaginal delivery ranges from 1% to 5% in developed countries, according to various studies.

Vaginal delivery should begin and end with stringent hand hygiene practices to minimize the transmission of pathogens. Sterile conditions must also be maintained during the procedure, ensuring proper sterilization of all equipment used during delivery. All medical devices should be handled with aseptic techniques, including hand hygiene and glove usage. Once these devices are no longer needed, the appropri­ate health care personnel should remove them quickly to reduce the risk of infection.

Immediate postpartum care, including prompt removal of placental tissue and proper perineal care, is essential. Addition­ally, maintaining a clean birthing environ­ment through regular cleaning and sanita­tion minimizes cross-contamination risk.

A clean birthing environment includes regularly sanitizing and clearing the deliv­ery room of clutter, properly disinfecting surfaces and equipment between uses, and maintaining adequate ventilation and temperature control to help maintain a comfortable and hygienic environment. Infection preventionists (IPs) should also ensure that health care workers adhere to hand hygiene and wear appropriate personal protective equipment.

Compared with vaginal delivery, cesarean delivery comes with a higher risk of post­partum infection. This surgical procedure, while crucial, introduces a heightened risk of infection compared with vaginal deliv­ery, amplifying the likelihood by a notable margin ranging from 5 to 20 times higher.

 The incision during a cesarean delivery creates a direct pathway for pathogens to enter the body, increasing the likelihood of infection at the surgical site.

Additionally, prolonged exposure to the hospital environment during the surgery elevates the chances of exposure to pathogens. The disruption of the nat­ural barriers provided by the cervix and birth canal, which typically help protect against infection during vaginal delivery, further contributes to the heightened risk. Moreover, cesarean deliveries are commonly performed in situations where there may already be underlying maternal health issues, such as diabetes or obesity, which can compromise the body’s ability to fight off infections.

As a cesarean delivery is conducted under sterile conditions, it is imperative to uphold sterility meticulously throughout the procedure to prevent infections in the mother and newborn effectively. Before the procedure, hair around the surgical site may be shaved, and the skin will be cleaned with an antiseptic solution.

 A sur­gical drape will be draped on the patient.

Health care workers play a pivotal role in preventing infections during childbirth through a multifaceted approach. This includes stringent adherence to hygiene protocols such as thorough handwashing and sterilized equipment during cesarean delivery. It is also essential that aseptic techniques are used during catheteriza­tion and intravenous line insertion.

Single-dose antibiotic prophylaxis will be administered intravenously during cesarean delivery and in high-risk patients of vaginal delivery to prevent infections such as neonatal sepsis, wound infection, endometriosis, and urinary tract infection.

Infection prevention measures are critical in reducing the risk of infections during cesarean delivery. IPs should adhere rigorously to sterile techniques, including proper hand hygiene, sterile draping, and sterile instruments and equipment. IPs should also monitor the timely removal of catheters and invasive devices, administration of antibiotic pro­phylaxis, and preoperative screenings.

Wong AW, Rosh AJ. Postpartum infections. Medscape. March 27, 2024. Accessed April 25, 2024. 

https://emedicine.medscape.com/article/796892-overview?form=fpf

Kluytmans JAJW, Veenemans J. Chapter 40: infection control obstetrics. In: 

Guide to Infection Control in the Hospital

. International Society for Infectious Diseases; 2018. Accessed April 25, 2024. 

https://isid.org/wp-content/uploads/2018/02/ISID_InfectionGuide_Chapter40.pdf

Cesarean section. Johns Hopkins Medicine. Accessed April 25, 2024. 

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/cesarean-section

Infection prevention during childbirth, via vaginal or cesarean delivery, is crucial for maternal and neonatal health. Strategies include strict hygiene, sterile techniques, and antibiotic prophylaxis to reduce postpartum infection risks.


 Strategies to Prevent Infection During Childbirth: Vaginal vs Cesarean Delivery

In an age of increasing antimicrobial resistance, evidence shows that the traditional use of contact precautions in nursing homes is not reasonable for most residents to prevent multidrug-resistant organism (MDRO) transmission. Contact precautions require room restrictions and are generally intended to be time-limited. Citing the inability to restrict residents to their rooms and negatively impacting their quality of life, the Health­care Infection Control Practices Advisory Committee published a white paper, “Consideration for the Use of Enhanced Barrier Precautions in Skilled Nursing Facilities.”

 Released in June 2021; the report noted that “more than 50% of nursing home residents may be colonized with an MDRO.”

The CDC then updated enhanced bar­rier precautions (EBP) recommendations in July 2022 with the report “Implemen­tation of Personal Protective Equipment (PPE) Use in Nursing Homes to Prevent Spread of Multidrug-Resistant Organisms (MDROs).”

 Indwelling medical devices and wounds are major risk factors for col­onization with an MDRO. Once colonized, these residents can serve as transmis­sion sources throughout the facility. The expansion of EBP for all residents with wounds and indwelling medical devices is intended to protect these high-risk individuals from acquisition and from serving as a source of transmission if they are already colonized.

The CDC has been targeting MDROs in the health care setting since 2006, when it released the Management of Multi­drug-Resistant Organisms in Healthcare Settings guidelines.

 Even so, MDROs continue to form and spread in health care settings across the US, so prevention efforts in transmission are still needed. Because these infections are often con­firmed by labs long after patients are infectious, the basic prevention approach limits transmission.

Prevention efforts and activities are based on epidemiology, and this can vary by facility characteristics such as resident acuity, average length of stay, comorbid­ities, and facility design. The strategies included are designed to reduce trans­mission of MDROs at all stages of spread, from before a targeted MDRO is identified to after infection. These efforts are also designed to reduce the transmission of MDROs across a health care region, as facilities such as hospitals, dialysis clinics, and primary care offices often share the same patients. Communication of known MDROs with an interfacility transfer form or notification is critical in breaking the chain of transmission so all agencies can respond effectively during patient care.

According to the CDC, EBP refers to an infection control intervention designed to reduce transmission of multidrug-resistant organisms that employ targeted gown and glove use during high-contact resident care activities.

 EBP was introduced in 2019 to prevent MDROs from spreading in long-term care environments. Until now, this guidance has not been included in the CMS/ State Survey Agency guidelines. However, the F880 Infection Prevention and Control regulations will include the EBP recommen­dations to align with national standards.

EBP has been used historically in long-term care settings to aid in preventing the spread of MDROs in patients who have been colonized. For example, in the long-term care setting in Veterans Health Administration (VHA) facilities, every patient is screened for methicil­lin-resistant 

(MRSA) on admission. If a patient has a positive nasal swab result, they are placed on EBP, per the national VHA MDRO prevention initiative. This means when staff enter the room, they expect the room to be a high-germ area for MRSA, and they wear gowns to protect their clothing from transferring the germ if they have close physical contact with the patient.

Infection preventionists (IPs) in long-term care will have new compliance recom­mendations for EBP. CMS has incorpo­rated the new guidance into the Infection Prevention and Control section listed in the appendix as F880. CMS often pro­vides guidance via memos that further explain changes in regulations. Memo QSO-24-08-NH was released on March 21,

2024, updating the use of EBP in nursing homes.

 Effective April 1, 2024, long-term care surveyors will evaluate the use of EBP when performing resident tracers.

The bottom line is that if a patient in a long-term care facility has a wound or an indwelling device, they will be expected to be on EBP to prevent MDRO infection. Staff having direct/close physical contact should wear a gown to protect the resident from germs they may have picked up from other residents during care.

CMS is now adding EBP during high-contact activities for residents with chronic wounds or indwelling medical devices, regardless of their MDRO status.

 This is to prevent the spread of MDROs in the long-term care population. If the resident’s wound heals or the device is removed, they can return to standard precautions. Surveyors may interview staff to determine whether they know which residents require EBP before providing high-contact care activities and may cite facilities if personal protective equipment (PPE) is not readily available to staff.

Close physical contact refers to any time high-contact resident care is taking place. Examples include dressing, bathing/show­ering, transferring, providing hygiene, changing linens, and assisting with toilet­ing or changing briefs. This also includes using or caring for devices such as central lines, urinary catheters, feeding tubes, tracheostomy tubes, or ventilators. The idea is to protect the resident’s opening from germs that could be transmitted from the health care worker.

Defining Wounds and Indwelling Medical Devices

Wounds are considered chronic and not shorter-lasting skin breaks, such as skin tears covered with a dressing. They refer to chronic wounds such as pressure ulcers, dia­betic foot ulcers, unhealed surgical wounds, and venous stasis ulcers. Indwelling medical devices include central lines (an intravascular catheter that terminates at or close to the heart or in one of the great vessels), urinary catheters, feeding tubes, and tracheostomy tubes. Peripheral IVs are not considered indwelling medical devices for EBP.

In a postpandemic world, PPE fatigue is rampant, and convincing staff to take an extra step before patient care may be chal­lenging. Implementing routine EBP would incur additional costs for PPE (gowns/gloves), signage, staff training, and time to don and doff PPE. Staffing shortages and retention are already challenging the quality of care. Lack of executive leadership support can negatively impact efforts, as can a negative workplace culture.

On the contrary, potential savings would include avoiding infections and hospitalizations and creating a safer environment for residents. This intervention would be a good start to decreasing health care–associated infections (HAIs) for facilities with increased MDROs in their resident population. These measures could also prevent subsequent outbreaks of serious infections such as 

by requir­ing screening and culturing and more rigid isolation and visitation procedures.

The CDC has provided tools and resources for implementing EBP, including educa­tional materials and signage. There is a continuing education webinar recording with slides, a preimplementation planning tool, an observations tool with a summary spreadsheet, and template letters that can be modified to use for leadership. There is a video called “Enhanced Barrier Precau­tions in Nursing Homes.”

 There are print resources, such as an EBP step-by-step poster, staff pocket guides, and a poster called “Enhanced Barrier Precautions: How We Keep our Residents Safe.”

One sure thing is that guidance will change as we learn how MDROs spread. During the COVID-19 pandemic, IPs held their breath while infection control standard practices like EBP gowning in MRSA-colonized rooms were not sustained to conserve PPE. The CDC now shows that significant increases in HAIs infections in 2021 compared with 2019 were the result.

 Despite the multiple reasons for this, it cannot be ignored that infection rates increased without using PPE. Preventing the transmission of MDROs will support resident safety and well-being, and any efforts supporting that should be encouraged.

Consideration for the use of enhanced barrier precautions in skilled nursing facilities. Healthcare Infection Control Practices Advisory Committee. June 2021. Accessed April 5, 2024. 

https://www.cdc.gov/hicpac/pdf/EnhancedBarrierPrecautions-H.pdf

Implementation of personal protective equipment (PPE) use in nursing homes to prevent spread of multidrug-resistant organisms (MDROs). CDC. July 12, 2022. Accessed April 5, 2024. 

https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html

Siegel JD, Rhinehart E, Jackson M, Chiarello L; the Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. CDC. February 15, 2017. Accessed April 5, 2024. 

https://www.cdc.gov/infectioncontrol/pdf/guidelines/mdro-guidelines.pdf

Enhanced barrier precautions in nursing homes to prevent spread of multidrug-resistant organisms (MDROs). Memorandum QSO-24-08-NH. Centers for Medicare and Medicaid Services. March 20, 2024. Accessed April 5, 2024. 

https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/policy-memos-states/enhanced-barrier-precautions-nursing-homes-prevent-spread-multidrug-resistant-organisms-mdros

COVID-19 impact on HAIs. CDC. Updated June 10, 2022. Accessed April 5, 2024. 

https://www.cdc.gov/hai/data/portal/covid-impact-hai.html

Policy & memos to states and CMS locations. Centers for Medicare and Medicaid Services. Updated March 29, 2024. Accessed April 12, 2024. 

https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/policy-memos-states-and-cms-locations

Enhanced barrier precautions in nursing homes. CDC YouTube page. Accessed April 12, 2024. 

https://www.youtube.com/watch?v=NoL8PVp5KKc

Enhanced barrier precautions: how we keep our residents safe. CDC. Accessed April 12, 2024. 

https://www.cdc.gov/hai/pdfs/containment/EBP-KeepResidentsSafe-Poster-508.pdf

Enhanced barrier precautions (EBP) in nursing homes are vital to prevent multidrug-resistant organism (MDRO) transmission, address antimicrobial resistance, and ensure resident safety and well-being.

Updated CMS Recommendations for Infection Prevention in Long-Term Care

As health care disparities continue to exist in many areas globally, particularly in health care deserts, Sage Memorial Hospital, Navajo Health Foundation, serves as a positive example by providing health care to the Native American community in Ganado, Arizona, and beyond.1 Like many health care facilities in the US and the world, Sage Memorial Hospital faces limited resources, services, and infrastructure. Despite these limitations, the Sage Memorial Hospital remains committed to providing accessible, quality health care to its diverse patient population. 

) spoke with Sage Memorial Hospital leader­ship again to learn more

about the hospital and its community’s unique challenges and innovative strategies, which sheds light on its journey toward excellence in health care delivery and serves as an example of how these types of challenges can be overcome. 

spoke with Christian Bigwater, BSBA, director of public relations and marketing, and Tiyarra Wauneka, environmental services supervisor.

: Please provide an overview of your hospital and its specific challenges in providing health care services to the Native American community.

Sage Memorial Hospital1 is a 25-bed** facility in Ganado, Arizona, in the Navajo Nation. It serves as the primary health care provider for over 20,000 members of the Navajo community and surrounding areas. Our main challenge is ensuring access to quality health care services for all community members. The remote location of many Navajo communities makes it difficult for patients to travel to our hospital for care, and there are also limited resources, services, and infrastructure in the area to support health care needs. We work hard to address these challenges and provide the best possible care for our community. The completion of our new hospital will help address some of these challenges.

**This is a correction. The print version said 45 beds. Although the new hospital will have the shell space for it, there is no plan yet for that many. 

: How does the hospital address language barriers when serving a diverse Native American population with various tribal languages and dialects?

Our facility has collaborated with Diné College Navajo language instructors to provide Navajo language medical terminology training for interested staff.

The course is over several days and certifies health care workers to be Navajo-English translators. This helps ensure that our patients can communicate effectively with diverse staff. It is also part of our culture here at Sage Memorial Hospital to teach our staff of other nationalities simple and basic Navajo words used in everyday life. This could include words such as “hello,” “thank you,” “yes,” or “no,” “grandma,” “grandpa,” or “Where does it hurt?” Our leadership team highly encourages respect, beauty, and sacredness among all who enter the facility through K’é [kinship].

 This practice brings the unity of all diverse cultures into one, and we practice that each day.

: Native American hospitals are often located in remote or rural areas. What logistical challenges does this location pose for infection control and the delivery of health care services?

Sage Memorial Hospital serves several rural communities; we call them chapters. Most patients we serve live miles off the main US highways on dirt roads. Our biggest challenge is ensuring that our patients can be transported to the hospital for service, and our facility is making efforts to do home visits as needed. Although we have advanced in infection control practices, our patients still face the challenges of having no running water, no electricity, and sometimes poor living conditions. Our hospital, quality department, and behavioral health [services] have significantly addressed these issues. Because of these challenges, we have implemented innovative practices such as UV robot technology

 to enhance disinfection protocols and reduce the risk of hospital-acquired infections.

How do cultural practices and traditions influence infection control measures and health care delivery in your hospital?

Our hospital is guided by our mission, vision, and values. Our core values include respect, sacredness, beauty, kinship, and unity. These values are rooted in our Navajo culture and guide all our decisions and practices. This extends to health care delivery and infection control measures as well. For example, the notion of “K’é [kinship] and Hózhó [beauty/balance]” is a reflection of what we want our patients to see in us once they leave the hospital. We strive to create a clean, safe, and comfortable environment for our patients.

: Can you share any innovative strategies or programs your hospital has implemented to overcome the unique challenges related to infection control in a Native American health care setting?

Our hospital will be implementing a new software called SmartFacility. This advanced software is designed to optimize the team’s efficiency by helping to determine the adequate number of environmental services [EVS] staff per square foot to meet our facility’s demands. It will also provide real-time requests for areas of concern for infection control. The software has a built-in step-by-step process for EVS to follow to reduce the amount of human error. Our facility has considered electronic hand hygiene dispensers that will track staffing efforts and the importance of hand hygiene before and after service is given to our patients. It will help infection control to target clinical areas of high traffic. These innovative solutions will further enhance our infection control practices and streamline our processes, ultimately improving the quality of care we provide to our community.

: Native American hospitals may encounter financial constraints. How do these limitations impact the ability to invest in infection control resources and initiatives?

Financial limitations will always be a part of any health care facility and impact our hospital’s operations. As Native Americans, it is in our nature to persevere, adapt, and improvise. For infection control specifically, we have worked very closely with our grant writer to research and secure funding for infection control remediation. I have also built well-rounded, professional relationships with the vendors I work with to establish ways of securing new equipment and tools to aid in infection control most cost-effectively. We are committed to trying new equipment and sharing our experience with vendors as part of the promotion of products

: Have there been any partnerships or collaborations with tribal organizations, government agencies, or other health care providers that have helped address the challenges related to infection control and health care delivery?

The EVS team recently had the chance to build relationships with the Association for the Health Care Environment through training in best practices for the EVS staff. This helps standardize all processes to limit human error and ensure that infection control processes are efficient. We have already trained using the CHEST [American College of Chest Physicians]

 training, which focuses on cleaning procedures in inpatient rooms. We have also trained in CNACC [Certificate in Non-Acute Care Cleaning Program], focusing on high-risk areas such as behavioral health, offices, and mobile health clinics.

 Our facility will soon include the Association for the Health Care Environment Certified Surgical Cleaning Technician8 training focusing on surgical suite cleaning. I have also contacted surrounding facilities and shared experiences and best practices on infection control. San Carlos Apache Healthcare in Graham County, Arizona, and Chinle Comprehensive Health Care Facility, part of the Indian Health Service program in Chinle, Arizona, have been great partners to work with to progress with infection control remediation.

: How has the COVID-19 pandemic affected infection control practices and resources in your hospital, and what lessons have been learned from managing infectious diseases during this time?

The COVID-19 pandemic has significantly impacted infection control practices in our hospital. It has helped us realize how quickly infection can spread and the importance of understanding how pathogens are transmitted. The EVS team has now taken more time to understand how common pathogens impact health, and we are more aware of emerging pathogens. We have become more prepared by having a plan of action, understanding the disinfecting solutions we use, and utilizing best practices that The Joint Commission, the American Hospital Association, and the Association for the Health Care Environment recommend. It is about creating a network with other EVS professionals and collaborating on what works best through experience. Overall, this pandemic has reinforced the importance of infection control measures in protecting the health and well-being of our patients and staff.

: Looking ahead, what are your hospital’s priorities and strategies for improving infection control while continuing to address the unique needs of the Native American population it serves?

Our new facility will heavily work off technology. Infection control effort demands a lot of manual work; however, with new technology, such as electronic floor scrubbers, robotic floor sweepers, UV robots,

and consistent training, our facility can accomplish the highest level of care. The EVS team’s goal is to become proficient in knowing the correct tools, disinfecting chemicals, and having the knowledge of pathogens to accomplish our goals for infection control. It is amazing to see our hospital go from limited technical operation to full operation on technical systems. This, for us, is a win in innovative strategies.

Navajo Health Foundation - Sage Memorial Hospital. Accessed April 25, 2024. 

Navajo medical terminology & interpreter course. Navajo Health Foundation - Sage Memorial Hospital. Accessed April 25, 2024. 

https://sagememorial.com/2023/05/15/navajo-medical-terminology-interpreter-course-june-7-9-800-a-m-500-p-m/

Whitacre Martonicz T. Infection prevention department displays Navajo traditions. 

. June 22, 2023. Accessed April 25, 2024. 

https://www.infectioncontroltoday.com/view/infection-prevention-department-displays-navajo-traditions

Whitacre Martonicz T. Providing infection prevention on the Navajo Nation. 

. June 2, 2023. Accessed April 25, 2024. 

https://www.infectioncontroltoday.com/view/providing-infection-prevention-navajo-nation

Whitacre Martonicz T. Increasing infection prevention in the Navajo Nation with UV-C robots. 

. June 15, 2023. Accessed April 25, 2024 

https://www.infectioncontroltoday.com/view/increasing-infection-prevention-navajo-nation-uvc-c-robots

CHEST - American College of Chest Physicians. Accessed April 25, 2024. 

Certificate in Non-Acute Care Cleaning Program (CNACC). Association for the Health Care Environment. Accessed April 25, 2024. 

Certified surgical cleaning technician (CSCT) training model & resources. Association for the Health Care Environment. Accessed April 25, 2024. 

https://www.ahe.org/csct-training-model-and-resources

Sage Memorial Hospital, Navajo Health Foundation in Arizona tackles health care and infection control challenges through innovative strategies and cultural sensitivity, serving the Navajo community with respect and resilience.

Overcoming Limitations in a Low-Resource Facility: Spotlight on the Navajo Nation

Bug of the Month helps educate readers about existing and emerging pathogens of clinical importance in health care facilities today. Each column explores the Bug of the Month's etiology, the infections it can cause, the modes of transmission, and ways to fight its spread. The pathogen profiles will span bacterial, viral, fungal, and parasitic species. We encourage you to use Bug of the Month as a teaching tool to help educate health care personnel and start a dialogue about microbiology-related imperatives.

Bug of the Month helps educate readers about existing and emerging pathogens of clinical importance in health care facilities today.



Infection Control Today, May/June 2024 (Vol. 28 No.3)

How Emerging Technologies Increase Hand Hygiene Adherence and Reduce Infections

Strategies to Prevent Infection During Childbirth: Vaginal vs Cesarean Delivery

Updated CMS Recommendations for Infection Prevention in Long-Term Care

Overcoming Limitations in a Low-Resource Facility: Spotlight on the Navajo Nation

Bug of the Month: Travelers Beware!