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November 2008

Hospitals Making Gains on Joint Commission Safety Goals, But Performance Varies

JClogo The Joint Commission’s annual report on hospital quality and safety suggests there have been improvements over the last six years.  These findings are based on hospital compliance with the Joint Commission’s National Patient Safety Goals, as well as compliance with processes associated with better outcomes for heart failure, pneumonia and certain surgical conditions. 


Many more hospitals, for example, are providing smoking cessation counseling when warranted.  Hospitals provided such advice to heart attack patients 98.2 percent of the time in 2007 compared with 66.6 percent in 2002.  There were even more substantial gains in smoking cessation counseling for heart attach and pneumonia patients.

Over the same six year period, hospitals also got better at providing discharge instructions to heart failure patients (from 30.9% to 77.5%) and providing pneumococcal screening and vaccination to pneumonia patients (from 30.2% to 83.9%).


However, performance across hospitals varies tremendously.  For example, hospitals provided discharge instructions to heart failure patients on average 92.1 percent of the time in the highest performing state, but only 56.5 percent of the time in the lowest performing state.


For a complete copy of the report, visit the Joint Commission web site.

Clostridium Difficile on the Rise Among Hospitalized Patients

Cdiff The fight against hospital-acquired infections is even more challenging than experts previously thought.  Yesterday, the Association for Professionals in Infection Control and Epidemiology (APIC) released the results of a new survey showing that Clostridium difficile is more prevalent among hospital patients than experts had estimated. 


The National Prevalence Study of Clostridium Difficile in U.S. Healthcare Facilities, conducted by APIC members who gathered sample data from the 648 hospitals in which they work, found that more than 1% of (13 out of 1,000) hospital patients are either infected or colonized with C. difficile.  This incidence is between 6.5 and 20 times higher than earlier assessments.  C. difficile is spread by hand contact with items contaminated by feces.


Based on the 1% incidence, 7,000 hospital patients in the U.S. have C. difficile on any given day.  Of those infected, 94% exhibited symptoms including diarrhea, fever, loss of appetite, nausea and abdominal pain.  Of the 7,000, about 300 will die from the infection.  According to APIC, the costs to care for the infection range from $17.6 to $51.5 million annually.

Important preventive measures for C. diff include:  adherence to the Center for Disease Control’s hand hygiene guidelines, use of contact precautions, identification of high-risk areas within the institution, surveillance programs, environmental and equipment cleaning and decontamination, and antimicrobial stewardship.

APIC has published a guide to help the health care industry reduce the incidence of C. difficile. APIC summarizes the issues with C. difficile and APIC's recommendations on its web site.

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