HAIs and Patient Safety

27 01 2011

Did you know the landmark health reform law requires Medicare- and Medicaid-participating hospitals (i.e., most hospitals in the country) to make public their infection rates for certain healthcare-associated infections?

Consumers can use this information to determine whether a hospital is taking appropriate steps to minimize a patient’s chance of acquiring an infection such as staph or MRSA as a result of their hospitalization.

Beginning in January 2011, hospitals are required to report rates of central line-associated bloodstream infections (CLABSI) in the intensive care and neonatal intensive care units. Other reportable infections include surgical site and ventilator-associated pneumonia infections.

The CDC estimates that about 250,000 central line-associated bloodstream infections occur each year in hospitals, resulting in approximately 130,000 deaths.

The CDC defines healthcare-associated infections (HAIs) as “a localized or systemic condition that (1) results from an adverse reaction to the presence of an infectious agent(s) or its toxin(s), (2) that occurs during a hospital admission, (3) for which there is no evidence the infection was present or incubating at admission, and (4) meets body site-specific criteria.”

These infections include blood infections, staph infections, meningitis, pneumonia, and other infections that can be very serious and even fatal. Beginning in 2012, Medicare payments to hospitals will be tied to how well hospitals perform relative to the new safety standards.

Consumers should avail themselves of this information so they can protect themselves and loved ones from getting sicker during a hospital stay. It’s another tool to protect ourselves and our loved ones against the various risks associated with hospitalization.

Hospital-specific information is available at the Stop BSI website.

More patient safety information relative to the new health care reform law is available on the health reform website.





Medical Tourism is Risky

14 10 2010

Skyrocketing healthcare costs in the U.S. have been a boon to medical tourism, with eager patients globetrotting for anything from cosmetic surgery to organ transplantation.

These “medical tourists” often believe they will receive quality care at affordable costs, with the added benefit of recuperating in a vacation spot.  It sounds too good to be true, doesn’t it?  That’s because it often is.  The quality care they seek may not be what they get.

There are several reasons to pause before packing, including ethical concerns related to organ and tissue donor sources, and legal and physical issues should one be harmed rather than helped by the procedure and follow-up care.

Another worry includes the potential for infection with a superbug that is resistant to most drugs.  Traveling patients could be bringing home serious infections along with their newly formed scars.

Currently, the number of identified cases of infection with a superbug in the U.S. is small.  However, the potential for antibiotic-resistant bacteria (the superbug) to grow in dominance is real.  There has been some success in treating these superbugs with an older drug (Colistimethate), but this drug has a number of toxic side effects.

Potential medical tourists need to ponder the risks, including exposure to a drug-resistant superbug that may not only endanger them, but also contribute to a global public health problem.





Scrubs and Lab Coats and Germs – ‘Twas Ever Thus

11 12 2009

Most of us multitask our way around town, constantly checking our to-do lists and cramming as much as we can into small windows of time.

Healthcare professionals, the ones who work in hospitals and wear the nifty lab coats and scrubs, are no different. They hurry out during lunch break to run errands, hurry to catch the bus to go home, and hurry to pick up their kids from soccer practice – they multitask.

But, if they don’t change their clothes and shoes before leaving the hospital, they can easily spread Clostridium difficile (C. difficile) and other germs around and make lots of people sick.  One hospital survey said that almost 500,000 people a year in the U.S. are getting sick just from C. difficile infections, which can cause diarrhea and inflammation of the colon.

In a January 2009 Wall Street Journal piece, author BetsyMcCaughey noted that:

At the University of Maryland, 65% of medical personnel confess they change their lab coat less than once a week, though they know it’s contaminated. Fifteen percent admit they change it less than once a month. Superbugs such as staph can live on these polyester coats for up to 56 days.

These multitasking, scrub and lab coat wearing healthcare professionals are spreading germs they pick up in the hospitals to their homes, to bus and subway seats, to restaurant chairs and tables and elsewhere.

Concern isn’t being aimed squarely at scrubs or lab coats: any type of unnecessary clothing is being criticized for carrying germs as workers move from patient to patient, person to person.

Loose clothing and long-sleeved shirts are culprits, as are neckties. In a 2004 New York Hospital Medical Center of Queens study, a test of 40 medical employees and 10 security guards found that half of the employees’ ties were a significant source of germs compared to only one in ten of the guards.

Hospitals are supposed to enforce rules about wearing scrubs or lab coats outside of the office, but sometimes these rules aren’t enforced. Budget concerns may prevent hospitals from improving their laundry habits or purchasing additional clothing for employees.

Using more care to clean hands, sterilize equipment, and wear clean scrubs without below-the-elbow items like long-sleeve shirts or neckties can lower hospital-related infection rates.  It’s worked in Denmark and other countries that have pushed for stricter regulations regarding hospital apparel.

Why not give it a try here?

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Hospitals Making You Sick?

7 12 2009

For centuries, hospitals have been havens for the unwell to receive aid or rest, and recover from injury or illness.

The word “hospital,” derived from the Latin word “hospes,” refers to either a host or visitor of a host. Makes the place sound all warm and cozy, doesn’t it!

But beware: this cozy haven full of healthcare professionals is a dangerous place when we’re talking about nosocomial infections, also called hospital-acquired infections (HAIs).

Nosocomial infections are infections we get while in the hospital that are unconnected to the problems that brought us to the hospital in the first place.

Studies show that five to 10 percent of patients admitted to hospitals develop nosocomial infections. Seniors and children are at most risk of developing such an infection, and the risk is compounded when an invasive procedure must be performed.

To make matters worse, hospitals are full of patients with lowered immune systems, and the chance for spreading illness from patient to staff member to patient is high. Visitors with good intentions may bring the leftovers of a cold or flu with them, in addition to their cards and flowers.

If a patient has had surgery, it takes longer to identify a nosocomial infection because the symptoms of a new infection are often the same as the after-effects of surgery: Fever, rapid breathing, mental confusion, low blood pressure, reduced urine output, and a high white blood cell count. A localized infection begins with swelling, redness, and tenderness on the skin or around a wound. Sometimes it takes a while to recognize the new problem and fight it.

Science has progressed and disease prevention methods have improved over the years. The use of gloves, soaps, hand sanitizers, and face masks limit the dangers when used regularly. However, mistakes are made. The CDC says that 40 percent of patients’ nosocomial infections could have been prevented by adequate hygiene and sterilization techniques.

It’s up to us to keep watch over our hospitalized family members or friends, so trust your gut instincts and speak up when it comes to your family’s healthcare.

Here are some things to remember the next time your loved one requires a stay at the hospital:

  • Wash your hands carefully before assisting your hospitalized loved one, after using the bathroom, after entering the room ( because of germy doorknobs and elevator buttons) and after any other activity that might transfer germs to your hands. Make sure you scrub thoroughly: the CDC cites hand washing as the single most effective way to control the spread of disease.
  • Make sure the doctors and nurses adequately clean their hands before performing an examination. Better yet, ask them to clean commonly shared equipment, even their stethoscope.
  • Politely insist that friends and family postpone visiting if they’re not feeling well or have been around someone that was recently ill. If they come to visit, have them wash their hands, too! Also, don’t let them sit on the patient’s bed, as contaminants can hitch a ride on their clothing.
  • For recovery after invasive procedures, make sure that dressings and bandages are changed regularly.
  • For IVs and catheters, insist that they only be provided to the patient for as short a time as possible. Make sure tubes and dressings are clean, dry, and secure.
  • Request that your loved one be tested for Staphylococcus aureus before any surgery. One-third of people carry staph on their skin, and if he or she is a carrier, extra measures can be taken to protect the patient from infection and from spreading staph to others.
  • Pay attention to your loved one’s condition in between doctor examinations. If something seems amiss, don’t be afraid to speak up, even if you’re afraid of being a nuisance. You might be saving a loved one’s life.

The Society for Healthcare Epidemiology of America (SHEA) created patient guides on HAIs. Take a look, should you or someone you know end up in the hospital. The guides will prove helpful.

How do you ask healthcare professionals to thoroughly clean their hands before touching your loved one? How do you push it even further and ask them to clean a stethoscope, or get a tube out a day early, or change a dressing more often? How do you do this and maintain a constructive and communicative relationship with these professionals?

Well, no one likes to be told what to do. When a lay person is telling an expert what to do in the expert’s field of expertise, that’s a sensitive area.

We asked a few healthcare professionals for ideas on how to bring up this subject.  Most of them provided general ideas for reducing nosocomial infections, and some had practical suggestions for how to say: “Clean your hands” without someone’s nose getting out of joint.

To avoid awkwardness with the healthcare professional (you do want communication lines to stay open), we suggest taking the onus on yourself, saying something like: I’m such a germophobe, would you mind cleaning your hands just before you examine my son/daughter/mother (and so on)?

Comments from the pros were:

“This is challenging along with other things – exam table paper running up the middle of the vinyl exam table with strips of vinyl table on each side of the paper that are cleaned how often? Once a day if lucky? If the HCW shakes your hand – which I don’t want them to do but many still do – if they shake then wash then what have they already given me, and if they wash then shake then what am I giving them? And what if they haven’t received flu vaccines because of refusing them – is this more dangerous to me than not washing stethoscope? I haven’t figured out a good way to ask about any of this for myself or my kids so will be interested to see what you come up with. Maybe when the HCW comes into the room, everyone in the room should use sanitizer gel from a wall dispenser or the HCW can wash her/his hands.”

“The best way to address this is the hospital, office or clinic makes handwashing and equipment cleaning a standard of care and expectation for all staff and visitors. Put up signs to this effect and then enforce it; including signage inside rooms. That way, no one, including other staff, feels uncomfortable asking everyone to follow the rules.”

“I don’t want to be shaking hands with health professionals and many still do this – I’m sure out of the best of motives of wanting to be respectful and “equal partners” with the patient/family.”

“Respectfully pointing out standard of care should not offend anyone.  No need to be apologetic about it.”

“As with most things in life, it depends on the people.  Most pediatricians I know do clean their hands, sometimes in the hallway so it isn’t obvious to a parent; but again, the ones I know would be embarrassed if they had forgotten and would apologize and wash or rub immediately.  My own style is to clean my hands, walk to the bedside, take a history and depending on how much writing that requires, I sometimes rewash before the examination.  However, if I stop back just to chat, I might not wash before chatting.  As far as the equipment goes, this is tough.  I think you could say that you heard that stethoscopes carry germs and see; the truth is that we know the organism can be on the stethoscope but we aren’t sure if this is a usual route of transfer.  Cell phones and beepers are a problem and neckties can be trouble as well.  We don’t want germaphobics but it is essential to have clean hands so with everything there is a balance.  I think the best approach is the direct approach.  It is even better if the hospital has a campaign to reinforce washing and you can comment on the signs.”

“[Our hospital] had hand hygiene rates to 88% last year. This year I think we will get above 90%. As often we use alcohol based gel, we refer to hand hygiene not hand washing. Also our practice is to “gel in” and “gel out”: that is to use alcohol gel before entering and on leaving a room, rather than in the room.”

“We had an experience about a month ago when we brought our five-year-old to the ER for a suspected fracture in his arm. We were forced to share a waiting room with a teen who showed clear signs of H1N1 and when my husband requested that we be offered a different triage room since the teen had literally just left the little room (now with a face mask) they refused and made us feel foolish stating that “its an epidemic…you can’t avoid H1N1”. We had been sitting at what we thought was a good distance from the teen only to be informed that we were in the corner nook typically reserved for flu patients. They did clean the stethoscope with alcohol but only because we requested it. It seemed to us that some small precautions could have been put in place to sequester those with potential flu from those with non respiratory illness in the ER. And yes, the doctor kindly offered to shake our hands and as much as I used to appreciate this in my physicians I questioned it myself before putting forth my hand…which I washed as soon as he left the room.”

“As a mom, I’d make a joke about it to start the conversation.  Or say “Oh, we’re asking everyone these days!  I try to be a good example…”  Another idea is to get your child asking…But asking the kid is bordering on exploitation – but it’s all in the name of a good cause/outcome!  I always feel we’re paying customers – if they have signs up for restaurant employees, why not these?!”

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