Hospitals across the country are diligently working to reduce infection rates. According to the World Health Organization, hospital-acquired infections affect as many as 1.7 million patients in the United States each year. These infections come at an annual cost of $6.5 billion and contribute to more than 90,000 deaths.
Proper hand hygiene is essential in helping to prevent hospital-acquired infections. A recent study performed by French researchers examined three types of healthcare workers. The first type spent a large amount of time with a discreet group of patients like a nurse would. The second group saw more patients but spent less time with each one - similar to doctors. Group three consisted of healthcare workers who interacted with every patient every day like therapists. The study found that if a healthcare worker in group three failed to wash their hands, the spread of disease was three times worse than if someone from group one or two didn't. The study was published online in Proceedings of the National Academy of Sciences. To read more about the study, continue here.
To read another take on hand hygiene and about the Joint Commission's national hand hygiene project, click here.
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Almost two million patients hospitalized in the U.S. each year develop an infection. These infections occur in as many as one in every 10 patients, result in close to 100,000 deaths and cost upwards of $6 billion. The Wall Street Journal created a top 10 list of infection prevention strategies based on interviews with medical professionals, administrators a non profit company and the Association for Professionals in Infection Control and Epidemiology.
- Undercover Operations - Dr. Philip Carling, an epidemiologist at Caritas Carney Hospital in Dorchester, Mass. developed a solution to uncover how well patient rooms are cleaned. His invisible solution contains fluorescent markers which glow in black light. After spraying patient rooms with the solution, cleaning crews were brought in to perform their normal routine. Later, rooms were examined with a black light and areas missed by the cleaners glowed fluorescent. Sharing results with cleaners helped boost compliance with proper cleaning techniques.
- High-Tech Cleaning Systems - When hospital equipment is disinfected by hand, bacteria often remains. For more thorough disinfecting hospitals are utilizing machines such as Bioquell which sprays a disinfecting hydrogen-peroxide vapor.
- Data Mining - Many hospitals are tracking data to determine how to prevent infections. Lee Memorial Health System in Florida tracks infection rates by surgeon and reports on the results. Low ranking surgeons can then make adjustments to lower their infection rates and improve their ranking.
- Patient Hygiene - Research suggests a daily wash with mild antibacterial soap can dramatically reduce the rate of bloodstream infections. The recommended cleanser is chlorohexidine glutonate.
- Reporting Crackdown - Numerous states have passed laws which require hospitals to report on infection rates. In many cases the reports are publicly available. In addition, Medicare is limiting reimbursement for treatment of hospital-acquired infections.
- Clean hands - Hospitals that utilize strategically-placed dispensers of hand sanitizer have noticed an increase in hand hygiene compliance from less than 50% to more than 80%.
- Embracing the Checklist - Incorporating checklists into bedside medical charts can help reduce rates of infection by requiring shift nurses to answer questions such as: Does this patient have a catheter? If so, is it still necessary?
- Portable Kits - Utilizing all-inclusive kits for common procedures such as intravenous line insertions or dressing changes can limit the possibility for infection. Kits contain all the items needed for procedures and prevent the nurse from running in and out of the patient room during a procedure to find a forgotten item.
- Mouth Maintenance - Regularly cleaning patients' mouths, gums and teeth can help prevent ventilator-associated pneumonia, a common infection found in intensive care units.
- Infection ID - Quick diagnostic tests can identify infected patients in a matter of hours rather than days. This allows for a quick response when patients show symptoms, are tested and found to be infected.
To read the complete article with expanded descriptions of the top 10, click here.
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Hospitals in Michigan lowered the rate of bloodstream infections in their patients by following a five-step checklist. The study published in the
New England Journal of Medicine found that implementing the checklist reduced the rate of bloodstream infections related to catheter use by 66%. Despite this success, utilization of the checklist remains limited. The checklist itself isn't complicated:
- Wash hands
- Clean patient's skin with chlorohexidine
- Wear protective cap and gown and use a surgical drape during the procedure
- Avoid catheter insertion through the groin if possible
- Remove unnecessary catheters
Peter Pronovost, the patient-safety expert who led the study, spoke with The Wall Street Journal to share insights on why more hospitals haven't benefited from using the checklist. To read excerpts from his interview, click here.
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Each year U.S. News & World Report releases "America's Best Hospitals" rankings which is a listing of top hospitals in the United States. One category in the report is nursing care. Patients filling out the survey are asked how often their nurses were courteous, listened carefully and gave clear explanation. The hospitals ranked highest for nursing for the year ending December 2008 are:
Mayo Clinic Hospital, Phoenix, AZ
New England Baptist Hospital, Boston, MA
Mayo Clinic, Rochester, MN
University of Kansas Hospital, Kansas City, KS
Brigham and Women's Hospital, Boston, MA
Methodist Medical Center of Illinois, Peoria, IL
Poudre Valley Hospital, Fort Collins, CO
University of North Carolina Hospitals, Chapel Hill, NC
Central DuPage Hospital, Winfield, IL
Christ Hospital, Cincinnati, OH
To see the other top hospitals for nursing care and those hospitals ranked as worst, continue here.
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A recent study published in the American Journal of Infection Control examined the levels of bacteria on healthcare workers' lab coats. The study involved a cross section of medical and surgical grand rounds attendees at a large teaching hospital. Participants completed a survey and cultured their lab coat using a moistened swab on the lapels, pocket and cuffs. Of the 149 white coats in the study, 34 (23%) were contaminated with S aureus, of which 6 (18%) were methicillin-resistant S aureus (MRSA). Providers working with patients had higher contamination levels and the study suggests that white coats may contribute to patient-to-patient transmission of S aureus. Read the entire study in the March 2009 issue of the American Journal of Infection Control, the official journal of the Association for Professionals in Infection Control and Epidemiology (APIC).
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Coming soon to a hospital near you: nurses with mobile technology. And for patients at the University of Minnesota Medical Center and Sarasota Memorial Hospital smartphones are already in use. In Minnesota, the phones have created a direct line between patients and nurses. Prior to adopting the technology, patients would ring their call button which someone at the nurse's station would answer. Then the patient request would be relayed to their specific nurse via pager. With this method, patients could be waiting upwards of 10 minutes for a response. With the new system, patient requests are answered almost instantaneously. For more information, click here.
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There has been a lot of buzz around how medical device and pharmaceutical brands are starting to explore social media. To see social media in action though, you may only need to look as far as a local hospital. In the United States, there are more than 360 hospitals actively using social media tools. As a group they have 186 YouTube channels and have created 267 Twitter accounts. Some real-world examples include:
- A patient being treated for a rare carcinoid cancer shared her experience via YouTube which generated enough requests for the surgery for a hospital to open a monthly clinic for the condition.
- Children's Hospital Boston launched the first health and science blog from a pediatric hospital called Thrive.
- A hospital near Detroit used Twitter to connect with almost 2,000 people to answer questions during brain surgery on a 47-year-old patient.
To read more about how hospitals are incorporating social media and why it matters, continue here.
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Peripherally inserted central catheters are being used more frequently in hospitalized patients. The benefits of using a PICC can be offset by complications including upper extremity deep vein thrombosis (UEDVT). A recent study published in the Journal of Hospital Medicine examined 7,444 PICC-days for 777 patients at the Methodist University Hospital (MUH) in Memphis, TN. Of the 777 patients studied, 38 experienced one or more venous thromboembolisms (VTEs). Patients with a PICC inserted in a location other than the SVC had an increased risk of VTE. PICC-related VTE was also more common in patients with a past history of VTE.
To read the study abstract or to purchase the full study, click here.
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With the current state of the economy, hospitals are looking for ways to save money while maintaining high standards of patient care. Hospitals are examining supply management, employee turnover and drug usage as well as getting employees involved in the analysis. "They are training staff to see where waste is and how to get rid of it," said Richard Gundling, Vice President of the Healthcare Financial Management Association.
Continue reading here to learn how some Kansas City hospitals are cutting costs.
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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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