Patient Safety

Hospital Borne Infections and Careful Hand Washing Tactics

By Mariana Ashley

There are several bacteria and fungi that have learned to thrive in our hospitals. Hospital-acquired infections (HAI) are infections that have found a way to better develop and prosper in a hospital setting. These infections are particularly worrisome for health care professionals and patients because they are strong in such vulnerable places of our existence. Many of these bacteria and fungi have developed resistances to antibiotics that were at one point effective on them. Gaining resistance to some of the most commonly useful and effective drugs helps these would be minor infections become a real worry for doctors and patients. 

Part of what makes HAIs such a difficulty is that patients who are in the hospital are typically already in a state of weakened immunity. So, individuals who could normally fight off these infections cannot within the hospital. Many of the bacteria and fungi spores that cause these infections are present on nearly all surfaces throughout a hospital. For this reason, one of the most common ways to transmit these bacteria or fungi to an individual is through poor hand washing. Doctors and nurses who are able to fight off the infections caused by these microorganisms will transmit them to more vulnerable patients through wound care, contaminated instruments, invasive instruments, and more. These two infections are among the most common hospital-acquired infections in hospitals today, each of which can be better prevented with thorough hand washing techniques. 

Methicillin Resistant Staphylococcus Aureus (MRSA)

As a form of staph infection, MRSA is one of the more common infections among hospital patients and is also one of the most varied. MRSA comes in many forms and is resistant to any penicillin antibiotic. MRSA most typically presents as a painful skin infection, causing irritated red bumps that look like pimples or bug bites. Other common symptoms associated with MRSA at this stage are fever and other rashes on the skin. These bumps will eventually engulf with white blood cells and the bacteria will attack other parts of the sufferer's immune system. If the infection becomes harsh enough, painful abscesses will have to be cut out of a patient's skin. Healthy individuals can be carrying the MRSA bacteria on them and remain asymptomatic. This makes it very difficult to control. With careful hand washing and anti-microbial practices, MRSA can be more easily managed and prevented. It is still believed that poor hygiene habits of health care professionals are the primary setback for reducing the spread of MRSA.

 Clostridium Difficile (C. Diff)

C. Diff is a bacterium that causes severe intestinal distress and disease within sufferers. This bacterium takes over the intestinal tract of a patient when a course of antibiotics has already eliminated all of the natural bacteria in the gut that would normally fight off the C. Diff strains. C. Diff can result in several very severe infections and illnesses, including colitis, bloating, and potentially life threatening toxic megacolon. While the primary cause of this infection is the improper prescribing of antimicrobials, infection control measures such as careful hand washing and area sanitation can drastically hinder the spread of this illness. C. Diff spores are present on almost any surface throughout the hospital. For this reason, it is essential that doctors, nurses, and visitors use gloves and carefully wash their hands with soap and water to eliminate the transmission of these spores to a more vulnerable host.

 By-line:

Mariana Ashley is a freelance writer who particularly enjoys writing about online colleges. She loves receiving reader feedback, which can be directed to mariana.ashley031@gmail.com.

Missouri Purges Data From Infection Records

An article by Jim Doyle exposes the fact that the State of Missouri has deleted hospital infection data from their records citing that it is too costly to maintain and too sensitive for the public to review for more than a year. 

Doyle writes:  "Without access to infection data from previous years, consumers won't be able to adequately assess a hospital's performance in preventing infections, consumer advocates say. Specifically, the policy of the Department of Health and Senior Services makes it difficult to review how hospitals have performed over time and whether they perform consistently above or below the national average."

This decision to purge data has stirred a heated political, legal and social debate regarding public health records. 

Rep. Rob Schaaf, R-St. Joseph, a family-practice physician who pushed the infection bill in the Legislature is quoted as saying, "It's pretty sad to me that the (health) department can't give you a trend to show that a hospital is getting better or worse. It shows that the department doesn't really care,"

Senator Sarah Steelman, one of the original bill's sponsors, said "I'm surprised at the agency. The job of the health department is to protect people. It makes no sense at all to eliminate data after one year."

Ken Bunting, executive director of the National Freedom of Information Coalition, weighed in on the topic by stating, "It sounds like they're violating the spirit if not the letter of the law, If it's being posted online, they don't need to take it down."

To read Doyle's entire article please visit "Missouri Purges Data From Infection Records".

NQF Releases Updated Safe Practices with Help of Dennis Quaid

Yesterday, at the National Press Club in Washington D.C., the National Quality Forum released an updated manual on Safe Practices for Better HealthcareDennis Quaid, the well-known Hollywood actor, participated in the release by sharing his personal story of a medication error experienced by his newborn twins in 2007.  He cited his partnership with the Texas Medical Institute for Technology, a key contributor to the report, and underscored leadership, safe practices and technology as the most important pillars of improvement.

The updated report, replete with tools to improve safety, draws on new evidence published since the last report was issued in 2009.

More Research Needed on Patient Handoffs

16444899 According to a study released today in the American Journal of Nursing, more research is needed to create an evidence base of how best to handle handoffs of patients between nurses as they come and go with shift changes. 

Two-thirds of sentinel events in hospitals are thought to happen because of poor communication (Joint Commission), and inadequate nursing handoffs are widely believed to increase the chances of negative consequences for patients.  However, this systematic review of nursing handoff literature from the 1987-2008 discovered that little research has been done to determine best practices.  The Joint Commission now wants hospitals to standardize this process, but there is little evidence to support one approach over another.

Physicians Not Optimistic About Quality Trends

Yesterday, Sermo, Inc. and athenahealth released a joint survey of 1,000 physicians called the Physician Sentiment Index.  The first survey of its kind, it suggests that physicians are pessimistic about the future of health care.  In fact,

  • 64% say that the health care environment is detrimental to their delivery of quality care
  • 59% believe the quality of medicine will decline in America over the next five years

Despite the medical advances that enter into the health care delivery system on an ongoing basis, only 18% believe that the quality of medicine will improve over the next five years.  However, seven in ten physicians believe that electronic health records can help reduce medical errors and improve physician compliance with clinical guidelines and feel that the benefits justify the costs of installing such systems.

Medical Schools Falling Short in Equipping Future Doctors to Provide Safe Care

16444899 According to a report issued last week by the National Patient Safety Foundation, medical schools are not doing enough to train future doctors to provide safe care.  The Lucian Leape Institute convened 40 leading experts in medical education, patient safety, and health care improvement.  They found:


  • Medical schools do not teach safety science and do not equip doctors in training with needed interpersonal skills
  • Medical schools and teaching hospitals need to create learning cultures that emphasize patient safety, transparency, and collaborative behavior.
  • Medical Schools and teaching hospitals need to begin intensive patient safety training for faculty so that they can serve as adequate models for their students

The report also suggests that the accrediting bodies for medical schools (the Liaison Committee on Medical Education) and residency programs (the Accreditation Council for Graduate Medical Education) revise their accreditation standards to promote a more significant focus on patient safety.

Experts Argue for Partnership to Reduce Harm to Patients from Devices

32141354 Modeled after the Commercial Aviation Safety Team, a new partnership in health care could greatly reduce errors that harm patients, say leading experts in patient safety.  Citing growing awareness of the dangers of radiation therapies, such as reported in the New York Times and elsewhere, Peter Pronovost and colleagues suggest that to reduce the risk of harm to patients from medical devices, health care needs a private-public partnership to supplement the professional, regulatory and financial incentives in place today.  Clearly, the mounting data on patients harmed from mistakes in radiation therapy provide one strong case example on the need for such a partnership. 

To achieve a successful partnership modeled after the Commercial Aviation Safety Team, which has contributed to the ongoing decline in deaths due to aviation, Dr. Pronovost and his colleagues cite the need for leadership, financing and active participation by relevant government agencies, provider groups and health care delivery systems.

Leapfrog Group Issues List of Top 2009 Hospitals

Leapfrog_Logo_Tagline  On December 3, 2009, The Leapfrog Group issued its annual list of "Top Hospitals."  For the first time, The Leapfrog Group added efficiency measures into the equation.  Across three categories including urban, rural and children's, Leapfrog recognized 34 hospitals, among the 1206 who participated in the voluntary Leapfrog Hospital Survey, as hitting high marks on quality, patient safety and efficiency.

Arrowsight Referenced in NEJM Sounding Board Article on Accountability -- by Suzanne Delbanco, Ph.D.

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In this week's New England Journal of Medicine, nationally-recognized patient safety experts Peter Pronovost, MD, Ph.D. and Robert Wachter, MD argue that the "no blame" approach to improving patient safety needs to be balanced with accountability.  While refraining from blaming individual health care workers for making preventable medical mistakes makes them feel more comfortable to report mistakes, it may not be enough to propel forward efforts to improve care that are stalled.

Citing poor hand hygiene practices as an example, the authors review the structural changes and information campaigns that hospitals have implemented and conclude that they have not done enough to bring hand hygiene compliance to an acceptable level.  What's left to do? Hold health care workers accountable when they fail to adhere to patient safety practices known to protect patients from adverse outcomes.

There are certainly different ways to assess how well workers comply with critical protocols as well as myriad ways to hold them accountable.  But the authors highlight, in the case of hand hygiene, that one prerequisite is to have in place a fair and transparent auditing system of which clinicians are made well aware.  By way of footnote, Arrowsight is referenced as providing one methodology - video - that can be used both to measure and to provide feedback to clinicians.  Pronovost and Wachter cite the fact that meatpacking plants use remote video to hold workers accountable for performance (also Arrowsight's work) -- isn't it time we offer the same protection to patients?

Suzanne Delbanco is President, Health Care Division, Arrowsight, Inc.

HHS Allocating $25 Million to Address Patient Safety and Medical Liability

The U.S. Department of Health and Human Services has announced that it is allocating $25 million to address patient safety and medical liability.  Through the Agency for Healthcare Research and Quality(AHRQ), HHS will provide grants of up to $3 million each to states and health care systems wanting to implement or evaluate demonstration projects aimed at improving patient safety while fixing the problems with the liability system.  There will also be smaller planning grants available for up to $300,000.  AHRQ will also conduct a "review of what works," to be done by December 2009, of initiatives to improve quality and reduce medical liability to help guide HHS' work and investments in this area.

The Funding Opportunity Announcement will be available on www.grants.gov by October 17, 2009.

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