Although many infection headlines are related to hospitals, individual doctor's offices are facing similar challenges. Almost 30 cases of hepatitis B were recently tied to one doctor's office in New Jersey. When health inspectors visited the office they found blood on the floor of a room where chemotherapy was administered, blood in a bin where blood vials were stored, unsterile saline and gauze as well as open medication vials. Inspectors also noticed cross-contamination of pens, refrigerators and countertops, use of contaminated gloves and misuse of antiseptics.
Patients were sent a letter from state epidemiologist Dr. Christina Chan urging testing for hepatitis B. "Evidence gathered at this time suggests that since 2002, some clinic staff provided care in a manner that puts patients at risk for infection caused by bloodborne viruses, including hepatitis B," the letter told patients. "The investigation to date suggests that hepatitis B infections identified may be associated with the method by which medications were administered and procedures performed at the practice."
Numerous checklists and recommendations have been published around infection control. The American Academy of Pediatrics Committee on Infectious Diseases and Committee on Practice and Ambulatory Medicine offers these infection control musts:
- Hand washing
- Barrier precautions to prevent skin and mucous membrane exposure
- Proper handling of sharps and contaminated waste
- Appropriate cleaning and disinfecting of surfaces and equipment
- Aseptic technique for invasive procedures
For the full recommendation on infection control in physician's offices, click here.
To read more about the hepatitis B outbreak in New Jersey, continue reading here.
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The Joint Commission is urging healthcare leaders to take steps to promote high quality, safe healthcare. They are also encouraging healthcare organizations to apply lessons learned in high-risk industries including aviation, energy and manufacturing. In a Sentinel Event Alert issued in late August, the commission wrote: "Inadequate leadership was a contributing factor in 50 percent of the sentinel events reported to the Joint Commission in 2006."
To promote an increased focus on safety, the Joint Commission has suggested 14 specific steps:
- Define and establish an organization-wide safety culture.
- Institute an organization-wide policy of transparency that sheds light on all adverse events and patient safety issues.
- Make the organization's overall safety performance a key, measurable part of the evaluation of the CEO and all leadership.
- Ensure that caregivers involved in adverse events receive attention that is just, respectful, compassionate, supportive and timely.
- Create and communicate a policy that defines behaviors that are to be referred for disciplinary action.
- Regularly monitor and analyze adverse events and close calls quantitatively and communicate findings and recommendations.
- Regularly hold open discussions with all relevant personnel to develop a true, unvarnished view of the safety risks and barriers to safety facing patients and staff.
- Prioritize and address safety risks and barriers to safety according to a timeline, with the highest priority items getting immediate attention.
- Establish partnerships with physicians and align their incentives to improving safety and using evidence-based medicine.
- Add a human element and a sense of urgency to safety improvements by having patients communicate their experiences and perceptions.
- When planning and implementing safety improvements, use the expertise of front-line staff who understand the risks to patients and how processes really work.
- Regularly measure leadership's commitment to safety.
- When leaders assess managers during annual performance reviews, make sure they ask about the safety issues the manager encountered, how they were handled and the impact their actions had on reducing unsafe conditions.
- Communicate to staff when their work improves safety.
To read the entire Sentinel Event Alert, click here.
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The relationships that develop between patients and healthcare providers are interesting ones. Being sick or injured forces a person to divulge a detailed health history to a complete stranger. When a person is thrust into the healthcare process nurses are the most consistent presence, following patients from admission to discharge. By establishing the right tone of caring, a nurse can provide a patient with a much-needed source of understanding and comfort. Mary Washington Hospital in Fredericksburg, VA utilizes a Care Delivery Model that demonstrates commitment to patient care. To see the model and learn more, click
here.
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Hint of Plum
A favorite song can give you a lift on a bad day but do certain melodies have healing properties? A growing number of hospitals are including music in treatments for conditions such as Parkinson's disease and cancer. 
Dr. Michael Miller, Director of the Center for Preventative Cardiology at the University of Maryland Medical Center presented data to the American Heart Association late last year. His study examined 10 healthy non-smoking volunteers both before and after they listed to music of their choosing. The results post-tunes - a 26 percent increase in the diameter of their upper arm blood vessels. Note that dilated blood vessels lead to increased blood flow. To further prove his point, his research subjects' blood vessels narrowed after suffering through music they hated. To read more about the healing properties of music, click here.
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