Oops Not Acceptable!

5 08 2013

One of the many reasons our family likes to stay out of hospitals is to avoid nosocomial infections.  Those are infections you get while you’re in the hospital (not what sent you to the hospital in the first place).

And there are other reasons to steer clear of hospitals.  Do you recall the study in the April 2008 issue of Pediatrics that tells us one out of 15 hospitalized kids are harmed by hospital errors, including mix-ups of medicines, bad drug reactions and overdoses?

As parents, we ask of no one in particular and everyone in general:  What are we supposed to do?  We want to take our sick or hurt children to a place that will, at the bare minimum, do no harm, and in theory, do some good.  But the risks associated with a hospital stay are pretty serious.

The National Initiative for Children’s Healthcare Quality worked on a tool that helped investigators get a more accurate count of numbers of children harmed while in the hospital.  Prior to the use of this tool, the count of children harmed by hospital error was much lower because errors were supposed to be voluntarily reported, and we now know that wasn’t happening.

I can accept the fact that no one is perfect, but the bar for standard of care is pretty low.  As our children’s advocates, we have the responsibility to insist that bar be raised.

Hospital staff: please worry less about political fall-out and more about doing what you have to do to stop mistakes from occurring, or worse, reoccurring.  And strive for transparency – it will relieve unnecessary suspicion and mistrust on the part of patients and their families and will serve to keep everyone working toward an error-free environment.  Ask questions, involve the family in patient care, stay focused on the tasks at hand, and communicate thoroughly with those taking over your patients when shifts change.

Families: as much as possible, stay with your loved one in the hospital and ask questions about everything that is being done. If something doesn’t seem right, don’t be afraid to ask about it. If someone’s feathers get ruffled because you ask questions about what they’re doing, just remember: better that than a mistake.


By Trish Parnell

Mandatory HCW Vaccination. Good idea?

11 08 2010

During 2003-2004, 54% of Virginia Mason Medical Center employees were vaccinated against flu. Six years later, that rate more than doubled (to 98.9%) due to the first mandatory healthcare worker vaccination program in the U.S.

Despite increasing healthcare worker flu vaccination rates, these programs remain controversial. The unionized nurses at Virginia Mason successfully filed a complaint against the hospital, claiming the mandatory program should have been included in the bargaining agreement.

Last October, New York State Judge Thomas MacNamara issued a restraining order which halted implementation of a mandatory vaccination program for healthcare workers in the state. 

To many people, healthcare workers resisting flu vaccination makes as much sense as doctors refusing to wash hands between patients. “Low healthcare worker influenza vaccination rates can no longer be tolerated, because our patients and our coworkers are at risk,” declare Dr. Thomas Talbot and Dr. William Schaffner of Vanderbilt University, describing the need for mandatory vaccination programs.

And Arthur Caplan opines, “If you can get close to 100 percent vaccination rates you can cut patient death rates from flu by 40 percent.”

For those against mandatory vaccination programs for healthcare workers, the primary concerns are worker rights and civil rights. To those in support of these programs, saving patient lives is paramount.

If Virginia Mason’s program is any indication, there is little question that mandatory healthcare worker vaccination programs can be successful if implemented correctly.  What is in question is whether these programs will remain hamstrung by legal challenges indefinitely.


25 06 2010

When we’re in an Intensive Care Unit (ICU), either as a patient or as the caregiver of a loved one, we’re pretty scared and looking for all the help we can get.

Next time you find yourself headed to an ICU, ask for the Intensivist, or critical care specialist for the unit.

Intensivists are big picture people who review all available information and then develop a diagnosis and course of treatment for the critically ill patient. The plan they devise for the patient may change daily or hourly, because they stay on top of details and adjust the course as new information emerges—an essential element of high quality care.

Intensivists relish thinking outside the box, and their methods work. The survival rate of patients with an Intensivist running the ICU is greater than for those in an ICU without one.

Though qualifications and experience levels vary, these specialists are game-changers and often are the difference between successful and unsuccessful outcomes for critically ill patients.

An Intensivist gets information from many sources, including the patient and  the caregiver. If he or she starts asking you questions, don’t leave out even the smallest details. This is NOT the time to keep secrets.  You might be asked if your loved one has a substance abuse problem, or if the patient is supplemented with concoctions not on the “official list of medications.”  Share everything you know, as it’s impossible to say what might have bearing on the diagnosis and treatment of the patient.

An Intensivist usually has a specific time when he or she makes rounds. If you can manage to be there during that time, it’ll help you become part of the decision-making team.

Some tips for surviving the ICU:

  • Try not to be afraid.  The sights and sounds in the ICU are intense.
  • Use hand sanitizer or soap and water every time you enter and exit the area.
  • Don’t be afraid to touch and talk to your loved one.  And watch what you say, they can hear you.
  • Be considerate of the privacy of others, and obey the rules.
  • Ask questions of your doctors and nurses.  They have a lot of information to offer.
  • Rest when you can. You will be advised if you should NOT go home.  Keep a spare change of clothes and toiletries, if the circumstance warrants it.  Things can change quickly when someone is in ICU


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?!”