Preventing Hospital Acquired Infections: An Interview with Dr. Russell Ryono

According to the World Health Organization (WHO), at any given time, healthcare-associated infections affect between 3.5% and 12% of patients in developed countries, and between 5.7% and 19.1% of patients in low and middle-income countries. In the United States, the Centers for Disease Control and Prevention (CDC) estimates roughly 1.7 million hospital-associated infections cause or contribute to 99,000 deaths each year. 

I recently had the chance to explore this issue in more depth with Russell Ryono, who has over 30 years of experience as an infection preventionist and pharmacist at the US Department of Veterans Affairs (VA). Dr. Ryono oversees Bitscopic’s team of clinical subject matter experts. Prior to joining Bitscopic, Dr. Ryono provided 31 years of service to the Department of Veterans Affairs employed as an inpatient clinical pharmacist, inpatient pharmacy supervisor, Infectious Diseases (Antimicrobial Stewardship) Pharmacy Specialist (10 years), and Pharmacoeconomics Pharmacy Specialist. In the years following, Dr. Ryono served an Infection Preventionist (10 years; 7 as the lead preventionist), and an Epidemiologist for VA Public Health Surveillance and Research (6 years). Dr. Ryono was instrumental in writing and implementing formal Standard Operating Procedures for cleaning and disinfecting all reusable medical equipment (e.g., endoscopes/colonoscopes, probes, etc) as per VA policy.

Why is contracting a serious infection more of a problem in a hospital as opposed to say, a coffee-shop?

Obviously, a person who is in the hospital is already sicker than a person who is well enough to be in a coffee shop, so they may experience a more difficult time responding to the infection. Also, the organisms causing hospital acquired infections are much more likely to be more resistant to antimicrobial drug therapy compared to those acquired from the community. Organisms that are resistant to multiple antimicrobial drugs are generally more difficult (and sometimes extremely difficult) to treat effectively. In the hospital environment, there is always the possibility to contract infections, directly or indirectly, from other patients or health care staff.

How has the focus on healthcare acquired infections impacted the workflow for Infection Preventionists in hospitals?

When I began working as an Infection Preventionist, the recommended approach was to do targeted surveillance. We focused on bloodstream infections, urinary tract infections, and ventilator-associated pneumonia in the ICU. By the end of my Infection Preventionist stint 10 years later, our surveillance had expanded to include central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated infections, and the addition of infections caused by multiple drug resistant organisms such as MRSA (methicillin-resistant Staphylococcus aureus), CRE (carbapenem-resistant Enterobacteriaceae), and Clostridium difficile, not just for the ICU, but throughout the entire hospital. Also related to that, we were also required to conduct hand hygiene surveillance and report compliance rates assessing hand hygiene and infection control precautions practices. This required running different reports and using a variety of methods each day to identify potential patients. It was a lot to keep track of for the three practitioners in the program. With this list now getting so much bigger, the load is becoming overwhelming, and that’s where I think automated tools help tremendously.

Can you give an example of how technology can help hospitals manage this complexity? 

I think software designed for infection prevention, like PraediAlert, can streamline infection surveillance activities into a more efficient workflow. First, the software can be set up to identify patients with potential healthcare acquired infections and alert the Infection Preventionist in an automated fashion, thus eliminating the need to run multiple reports. Second, it is set up for the Infection Preventionist to designate the results of their review (e.g., healthcare acquired infection or no infection, etc.) eliminating the need to maintain separate spreadsheets for recordkeeping purposes. And finally, it comes with a report function that assembles the designated infections into a report presented in a downloadable line list or chart formats for use in facility monthly/quarterly/annual reports. 

Also, let’s say a given patient received care at a different VA facility. PraediAlert makes that data available to the Infection Preventionist. If, for example, the patient had a history of a positive culture for a multidrug resistant organism at that different facility, it would provide extremely valuable information to guide the Infection Preventionists’ decision making. That was not available to me back then. What I like most about a tool like PraediAlert is that it allows us to expand the scope of surveillance without requiring extra effort and time on the Preventionist’s part. It can be set up to alert when there is an unusually high occurrence of something. Let’s say there were three positive blood cultures for a relatively rare organism over the span of a month. Something like that can often go unnoticed. This automated “passive” surveillance can broaden the search for infection clusters and possible outbreaks and contributes to our charge to protect patients.

PostScript

We hope you enjoyed Part 1 of this ongoing discussion with Russell Ryono. In future articles, we will continue the conversation on Hospital Acquired Infections, as well as explore other topics. If you have any questions you would like to ask Russell for next time, please send us an email or you can also drop a note in the comments section.