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CDC Warns of New Wave of Antibiotic-Resistant Germs in U.S.

A new Centers for Disease Control and Prevention (CDC) Vital Signs report released this week said health departments found more than 220 cases of germs with “unusual antibiotic resistance genes” in the United States last year. These germs include those that cannot be killed by all or most antibiotics, are not common to a geographic area or the U.S., or have specific genes that enable them to spread their resistance to other germs, according to a CDC release.

The CDC’s Antibiotic Resistance (AR) Lab worked with local health departments to deploy a containment strategy to stop the spread of antibiotic resistance. The first step is rapid identification of new or rare threats; after a germ with unusual resistance is detected, facilities must quickly isolate patients and begin aggressive infection control and screening actions, according to the release.

“CDC’s study found several dangerous pathogens, hiding in plain sight, that can cause infections that are difficult or impossible to treat,” said Anne Schuchat, MD, CDC’s principal deputy director, in the release. “It’s reassuring to see that state and local experts, using our containment strategy, identified and stopped these resistant bacteria before they had the opportunity to spread.”

After rapid identification of antibiotic resistance, the CDC strategy calls for infection control assessments, testing patients without symptoms who may carry and spread the germ, and continued assessments until the spread is stopped. It requires coordinated response among healthcare facilities, labs, health departments, and the CDC through the AR Lab Network.

The CDC study also found that about one in 10 screening tests of patients without symptoms found a hard-to-treat germ that spreads easily, which means the germ could have spread undetected in that facility. For carbapenem-resistant Enterobacteriaceae (CRE), the report estimates that the containment strategy would prevent as many as 1,600 new infections in three years in a single state, which would be a 76% reduction.

Story originally published by our friends at PSQH!

Avoid Eyewash-Related Regulatory Compliance Issues

Eyewash stations continue to confuse and confound healthcare organizations (HCO). Not only can they pose infection control and safety issues for workers, they can be a point of contention between HCOs and surveyors, who often seem to work by different sets of rules.

During this 90-minute webinar on May 31, former hospital administrator and accreditation expert John R. Rosing, MHA, FACHE, will explain what regulators like CMS, The Joint Commission, and OSHA expect from an HCO’s eyewash stations. He will provide the steps personnel can take to keep staff safe and the organization in compliance with rules and regulations. Attendees will learn how to avoid eyewash-related regulatory compliance issues, how to perform a risk assessment to determine when an eyewash station is necessary, and what type of eyewash station they need.

At the conclusion of this program, participants will be able to:

  • Avoid eyewash-related regulatory compliance issues
  • Perform a risk assessment to determine when an eyewash station is needed
  • Identify what type of eyewash station is needed
  • Properly maintain eyewash stations

Presented on:
Thursday, May 31, 2018
1:00-2:30 p.m. ET

Presented by:
John R. Rosing, MHA, FACHE

Level of Program:

Intermediate

To register or get more information, please visit the event page at HCMarketplace.com.

The Joint Commission: Comments open on proposed suicide risk NPSG through May 7

Wishing you could weigh in on The Joint Commission’s expectations about suicide risk? You have your chance. Through May 7, The Joint Commission is accepting comment on proposed revisions to National Patient Safety Goal 15 on reducing the risk of patient self-harm.

The Joint Commission published the revisions on its Standards Field Reviews web page on March 26. The revisions, which will require hospitals to be more proactive in removing risks from the physical environment, include proposed changes to both the general Hospital and the Behavioral Health Care accreditations programs.

Under the Hospital Accreditation program, a revised Element of Performance (EP) 1 applies only to hospitals, whereas the rest of the now seven EPs — up from just three — will apply only to those patients in psychiatric hospitals or being treated for behavioral health problems in general hospitals, according to the field review information.

The other EPs for both programs outline expectations of conducting suicide assessment of patients, documenting a patient’s risk and the plan to deal with that patient’s suicidal ideation, the need for written policies and procedures and quality monitoring of the programs, among other things.

You can comment on the proposed revisions online or by mail. To read the full set of revisions, and for links and instructions on how to comment, go to the Field Reviews page, https://www.jointcommission.org/standards_information/field_reviews.aspx. — A.J. Plunkett (aplunkett@h3.group)

Healthcare and Law Enforcement: Working Together Instead of Against Each Other

A working relationship with law enforcement is key to the safety, efficacy, and well-being of everyone in the hospital. That said, hospitals and law enforcement have different goals, and while the two usually work well together, they can find themselves at odds.

During this 90-minute webinar on May 22, industry expert Lisa Terry, CHPA, CPP, will review the hospital’s role in successfully partnering with law enforcement. She will discuss how to balance best practices for ensuring the safety of patients as well as the hospital staff. Participants will also learn how they should communicate with law enforcement, as well as how to plan and implement “crucial conversations” between hospitals and law enforcement.

At the conclusion of this program, participants will be able to:

  • Access and use the best resources on how hospitals who are treating patients “under arrest” should interact with the police
  • Plan and implement “crucial conversations” between the hospital/healthcare executive team and local law enforcement leadership
  • Use the tenets and teachings of “Verbal Judo” to benefit both clinicians and law enforcement first responders
  • Understand how hospitals can support and help facilitate law enforcement’s “guardians of the peace” mentality as they partner with hospitals
  • Apply enterprise security risk management (ESRM) to situations that may arise

Presented on:
Tuesday, May 22, 2018
1:00-2:30 p.m. Eastern

Presented by:
Lisa Terry, CHPA, CPP

Level of Program:
Intermediate

To register or get more information, please visit the event page at HCMarketplace.com.

Lawmakers want more AO oversight

In a letter to CMS Administrator Seema Verma, the committee is asking for what could be reams of information from the agency about patient harm and incidents of misconduct at acute care hospitals. The committee has also asked for similar information from each of the four hospital accrediting organizations (AOs).

The committee was particularly concerned about information in a report to Congress published last summer that indicated AOs “conducting hospital surveys did not report 39% of ‘condition level’ deficiencies that were subsequently reported following validation surveys conducted by [CMS] State Survey Agencies no later than 60 days following the AO survey.”

“Although CMS has worked to strengthen its oversight of AOs, the committee is concerned about the adequacy of CMS’ oversight as well as the rigor of the accrediting organization survey process,” wrote the committee leaders.

Noting that the Department of Health and Human Services, through CMS, must provide oversight of accrediting organizations, including CMS’ own survey agencies, “the Committee is concerned about the adequacy of CMS’ oversight as well as the rigor of the AO survey process,” read the letter to Verma.

More coverage of this story will be in the May edition of Briefings on Accreditation and Quality

3 Ways to Knock C. diff Rates Down to Zero

For Necia Kimber, RN, CIC, MHA, infection control practitioner at Stillwater (Oklahoma) Medical Center, “one infection is too many.” Fortunately, when it comes to C. diff, Kimber has infection rates at the healthcare organization at just the right number: zero.

Thanks to a multifaceted approach, the 177-bed hospital with average daily census of 60 patients, has not seen a hospital-acquired case of C. diff since October 2017.

While the organization’s rates were not above the national average, Kimber still wanted to reduce the bioburden—particularly of C. diff, MRSA, VRE, and CRE—within the hospital.

“We didn’t have a high rate that made me say, ‘Oh, my goodness!’ It was just wanting to do overall good and making sure we were doing the best we could,” she says. “This is the hospital I’m going to bring my family to and I want to provide the best care for anybody who walks through that door.”

Here are three ways Kimber achieved lower infection rates at Stillwater Medical Center:

1. Education
Kimber spearheaded an antimicrobial stewardship program at the facility in 2017. There was also assessment of and education regarding ordering of C. diff testing.

“[As healthcare professionals], when you have a patient and you can’t find anything with normal testing, we tend to expound our testing,” she says. “Sometimes it would end up hurting us with pay-for-performance—if [the patient] tested positive for [C. diff, it] didn’t mean they were actually infected with it. They can just be colonized with it.”

The infection control team provided education on national standards for ordering C. diff testing, including testing only when patients were symptomatic of the infection. The IC team provided nurses and physicians with education on when to implement C. diff precautions with the intent that earlier intervention would prevent transmission.

2. Hand hygiene and cleanliness
Hand hygiene was a focus area for preventing the spread of infections at Stillwater.

“We do a program that’s a commitment to excellence,” she says. “Last year we did a huge push on hand hygiene.”

Each month, “secret shoppers” do direct observation on the units to assess issues regarding hand hygiene.

“What we check for is hand hygiene upon entering the room and upon leaving the room,” Kimber says.

To increase patients’ sense of safety, Kimber says she has reinforced hand hygiene practices with clinicians so that even if nurses or physicians have just cleaned their hands with alcohol foam or gel after exiting a room, they need to reapply it if they are going directly into a new room, even if they have not touched anything between rooms.

In addition, Stillwater Medical Center is using a bleach-based product to clean all rooms and equipment after a patient is discharged.

“We used to only [use bleach] on positive C. diff rooms,” Kimber explains. “Now we use it on all rooms because there are so many people who are carriers and not showing signs [of infection] until after they’ve been discharged.”

Kimber also educates environmental services staff on the “why” behind cleaning techniques.

“What we honed-in on is the actual cleaning of the area—friction and leaving the products on for the allotted time to disrupt the replication of cells and bacteria,” she says. “We’ve done a ton of education on how to clean, when to clean, and why to clean.”

3. Robots
While the campaign took place over a year, Kimber says it was the addition of pulsed xenon ultra-violet robots that drove C. diff rates down to zero.

“What we saw with our use of the UV robots, which we started in October 2017, was that for the last quarter of the year, our C. diff hospital onset cases have been zero,” she says. “I’ve been an infection control nurse for almost 18 years and I’d never seen a drop as dramatically as I had in C. diff after implementation of the UV robots.”

While the robots are not cheap, Kimber estimates that each machine costs about $100,000. Stillwater purchased six robots.

“You always worry about surgical-site infections, and you always worry about those infections that patients get in the hospital such as C. diff, MRSA, CRE, and VRE,” she says. “By national standards one C. diff infection is about $30,000 when you look at morbidity and length of stay. For surgical-site infection, if it’s a hip or a knee, you’re getting into the hundreds of thousands. So, for example, with surgical-site infections if you could just save one surgical-site infection—say a hip or a knee—you’ve already saved $100,000, so your ROI will be pretty quick in knocking your infection rates down.”

Kimber says she encourages infection control practitioners to talk with their colleagues about effective solutions for decreasing infections—whether it’s using education, technology, or something else.

“I recommend people do their own research and find out what’s best for their facility and what their actual needs are,” she says. “Infection control nurses have a pretty tight network, so talk to your colleagues and see what they’re doing in their hospitals. Talk to the ones that are the same size as you and bigger than you and see how you can glean information from that.”

Kimber says, “There were tons of things that went into [reducing hospital onset infections]. Having that rate down to zero for three months has been a huge accomplishment.”

Orignially published in HealthLeaders Media

Joint Commission releases 2017 sentinel event stats

Unintended retention of a foreign body, patient falls, and wrong-site surgery top The Joint Commission’s full list of reported sentinel events for 2017.

Every year, The Joint Commission complies a list of all the sentinel events that hospitals reported to them. Since the list only comes from self-reported data, it tends to underrepresent the real frequency of these problems. However, it’s useful in identifying trends, causes, and outcomes of adverse events. The top 10 sentinel events in 2017 were:

  1. Unintended retention of a foreign body
  2. Falls
  3. Wrong patient, wrong site, wrong procedure
  4. Suicide
  5. Delays in treatment
  6. Other unanticipated events
  7. Criminal events
  8. Medication errors
  9. Operative/postoperative complication
  10. Self-inflicted injury

The only new addition to the list since 2016 is “self-inflicted injuries,” which replaced “perinatal death/injury.” While a few hopped up or down one on the list, for the most part, there wasn’t much change.

CMS Cites Baltimore Hospital for Abandoning Patient in January

A Baltimore hospital was cited by CMS in a report released this week for its actions in removing a mentally ill patient from its emergency room (ER) and leaving her at a bus stop wearing just a hospital gown. The Washington Post reports that the University of Maryland Medical Center (UMMC) was cited for failing to comply with the Emergency Medical Treatment and Labor Act (EMTALA).

The hospital came under fire in January after a bystander filmed the incident as the woman was left by security guards at a bus stop on a cold night. According to the Post, the patient was admitted to the hospital earlier that day after a fall from a motorized bike. She was cleared for discharge, but resisted and refused to dress, the report said. Security then dropped the patient off at a nearby bus stop, where the man who filmed the incident and then called for an ambulance. The woman was brought back to the hospital and then taken to a homeless shelter in a taxi without an exam, and it was not registered that she returned to the facility, the Post reports.

According to the Baltimore Sun, CMS found that UMMC violated a federal law that hospitals must protect and promote each patient’s rights. The hospital also was found to have violated the woman’s right to receive care in a safe setting, to be free from all forms of abuse or harassment, and her right to confidentiality of records because non-clinical staff were given access to or made aware of part of the patient’s medical history. CMS also found that UMMC failed to meet data collection and analysis standards and failed to perform quality improvement activities.

The Sun reports that the hospital has now begun to record every time patients visit the ER. It also conducts audits of the patient log each month, provides additional staff training on federal requirements, and keeps ER doors unlocked. The staff bylaws were updated to specify who can perform medical screenings.

In a statement reported by the Post, a UMMC spokesperson admitted that mistakes were made. “We take responsibility for the combination of circumstances in January that failed to compassionately meet our patient’s needs beyond the initial medical care provided. While our own thorough self-examination revealed some shortcomings, the regulatory assessment punctuates the necessity to more firmly demonstrate our unwavering commitment to safety quality, compassionate patient care.”

EMTALA, in general, requires hospitals to care for patients with emergent conditions, regardless of their ability to pay. Violations of EMTALA are often cited by CMS surveyors under patients’ rights or failure to do an adequate medical screening exam. In addition to potentially impacting a hospital’s accreditation or ability to bill Medicare, EMTALA violations can also come with a civil penalty, which can reach nearly $105,000 for each citation. The newspaper reports did not mention whether the hospital was fined in relation to the CMS findings.

Webinar: How Vanderbilt University Medical Center Established a Hand Hygiene Program

Presented on: March 22, 2018, 1:00-2:30 p.m. EST
Presented by: Thomas R. Talbot, MD, MPH
Level of Program: Intermediate
Registration:  http://hcmarketplace.com/hand-hygiene-program

HCPro Webcast Icon

Summary: 
Hand hygiene is the top way to prevent the spread of healthcare-associated infections. It has also become a major focus of Joint Commission and CMS surveyors, so hospitals need to ensure their healthcare workers are complying with hand washing guidelines.

During this 90-minute webinar, Thomas R. Talbot, MD, MPH, will explain how he led a successful effort to establish a hand hygiene compliance program at Vanderbilt University Medical Center. Dr. Talbot will help attendees overcome barriers to hand hygiene compliance, set up a compliance program in their facility, and create a culture of safety that encourages increased accountability.


Who Should Listen?

  • Infection preventionists
  • Quality improvement personnel
  • Operational quality leaders
  • Safety directors
  • Patient safety professionals
  • Risk managers

Report: Six opportunities to improve patient safety

Over the next four years, $383.7 billion will be spent on adverse patient safety events in the United States and Western Europe. These events will have cumulatively affected 91.8 million patient admissions and caused 1.95 million deaths. Researchers at Frost & Sullivan analyzed 30 major patient safety concerns to find the areas where a change could make the most impact.

“Up to 17 percent of all hospitalizations are affected by one or more adverse events and around 15% of hospital expenditure is attributable to addressing them. The fact that 30 to 70 percent of these are potentially avoidable makes it imperative to prevent them from happening,” said Anuj Agarwal, Transformational Healthcare Senior Research Analyst at Frost & Sullivan in a press release.

Researchers boiled their list down to six areas that have the biggest opportunities for improvement:

  1. Medication safety: Ensuring patients get the right medicine at the right time and dosage is an ongoing challenge for providers. Even with new medication management approaches that have sprouted up, researchers say, there’s plenty of room for hospitals to step up on unifying health IT integration and value.
  2. Sepsis: Sepsis is the underlying cause in nearly 50,000 deaths each year, and one of multiple causes in more than 182,000 deaths each year. The condition is hard to diagnose and needs to be caught early.
  3.   Antibiotic resistance: Drug-resistant diseases have been a big worryin recent years. And 60% of U.S. hospitals don’t have an antibiotic stewardship program (ASP) that meets all seven components of the CDC’s stewardship guidelines. With research on new antibiotics still slow to develop, hospital need to improve their diagnostic capabilities, antibiotic stewardship, and infection-control strategies.
  4. Cybersecurity: Healthcare organizations are prime targets for computer viruses and hacking since they’re relatively easy targets with the resources to pay off hackers. Providers need to work fast to adopt new technologies such as blockchain to protect patients’ privacy.
  5.  Diagnostic safety: Researchers wrote that providers are reexamining diagnostic approaches to reduce errors. They also expect calls for improved diagnostics to drive interest in new lab management systems.
  6. Unnecessary ED admissions: People using the emergency room as their primary physician has placed a major burden on EDs. The study recommends investing more into remote monitoring and telehealth to fight this problem.