Archive for: April, 2018

New study found that 71% of reusable scopes tested positive for bacteria

By: April 25th, 2018 Email This Post Print This Post

Infection control (IC) issues with endoscopes aren’t limited to duodenoscopes.

In a study published last month in the American Journal of Infection Control, researchers found that 71% of reusable medical scopes that were deemed ready for use on patients tested positive for bacteria at three U.S. hospitals. The study found problems in scopes used for routine operations such as colonoscopies and kidney stone removal.

IC issues related to endoscopes have been frequently linked to inadequate reprocessing. This study “evaluated the effectiveness of endoscope drying and storage methods and accessed associations between retained moisture and contamination” through visual examinations and tests, wrote the authors.

They found that reprocessing and drying practices were substandard at two of the three hospitals they studied last year, and damaged endoscopes were used at all three. Fluid was detected in 22 of 45 endoscopes (49%) and microbial growth was found in 32 (71%). Bacteria discovered on the scopes included Stenotrophomonas maltophilia, Citrobacter freundii, and Lecanicillium lecanii/Verticillium dahliae.

The authors said that the complex design of most endoscopes makes them difficult to clean, which can be compounded when healthcare workers, rushing to reprocess the scopes for the next patient, are not following reprocessing protocols.

These results are pretty scary,” Janet Haas, president of the Association for Professionals in Infection Control and Epidemiology, told Kaiser Health News. “These are very complicated pieces of equipment, and even when hospitals do everything right, we still have a risk associated with these devices. None of us have the answer right now.”

The study’s authors, led by Minnesota-based epidemiologist Cori Ofstead, concluded that “more effective methods of endoscope reprocessing, drying, and maintenance are needed to prevent the retention of fluid, organic material, and bioburden that could cause patient illness or injury.”

Their findings reinforced that duodenoscopes aren’t the only concern, though those have rightfully been scrutinized after being tied to at least 35 deaths in the U.S. since 2013. They are still being eyed by the FDA, which was also criticized for not alerting the public to the threat until after a 17-month investigation.

Don’t let your facility be the next statistic and ensure your organization complies with requirements set by The Joint Commission and CMS. Check out this 90-minute HCPro webinar led by infection control experts Peggy Prinz Luebbert, MS, (MT)ASCP, CIC, CHSP, CBSPD, and Terry Micheels, MSN, RN, CIC, who discussed the critical steps of high-level disinfection that must be met each and every day.

New report on emergency preparedness says U.S. healthcare system is improving

By: April 18th, 2018 Email This Post Print This Post

We recently published online an article from the upcoming edition of our Healthcare Life Safety Compliance newsletter about a recent report by the Johns Hopkins Center for Health Security that examined how the U.S. healthcare system has fared while responding to emergencies both large and small.

Their conclusion? The bigger the emergency, the less prepared healthcare facilities are for handling the crush of patients that come through their doors.

“Although the healthcare system is undoubtedly better prepared for disasters than it was before the events of 9/11, it is not well prepared for a large-scale or catastrophic disaster,” the authors wrote in the report, which was released in late February. “Just as important, other segments of society that support or interact with the healthcare system and that are needed for creating disaster-resilient communities are not sufficiently prepared for disasters.”

Their research, however, spanned from 2010 to 2015, meaning that responses to recent emergencies such as Hurricane Harvey, the wildfires that torched California, the harrowing mass shootings at a country music concert in Las Vegas and at Stoneman Douglas High School in Florida were not examined.

Now a new report has come out, this one concluding that hospital readiness for managing health emergencies has improved over the last five years.

From our colleagues at Patient Safety & Quality Healthcare:

The Robert Wood Johnson Foundation (RWJF) this week released the 2018 National Health Security Preparedness Index, which found that the U.S. scored a 7.1 out of 10 for preparedness, up 3% over the last year and almost 11% since the Index was begun in 2013.

The assessment found improvements in most states, but also noted serious inequities in health security across the country, according to a RWJF release. Maryland was the highest scoring state, 25% higher than the lowest-ranked states, Alaska and Nevada. The report found that states in the Deep South and Mountain West scored poorly compared to those in the Northeast and Pacific Coast.

“Five years of continuous gains in health security nationally is remarkable progress,” said Glen Mays, PhD, MPH, who led the University of Kentucky research team that developed the index, in the release. “But achieving equal protection across the U.S. population remains a critical unmet priority.”

The index found that 18 states had preparedness levels exceeding the national average, while 21 states fell below the average. Thirty-eight states and the District of Columbia increased their overall health security last year, with eight remaining steady and four declining.

So, while this new RWJF report suggests that the response of the U.S. healthcare system to emergencies has generally improved in recent years, a lot of work still needs to be done, which aligns with what the authors of the report from the Johns Hopkins Center for Health Security wrote a couple of months ago.

TJC creates new Sentinel Event Alert for violence against healthcare workers

By: April 17th, 2018 Email This Post Print This Post

The Joint Commission (TJC) is the latest healthcare heavy-hitter to call for better protection of healthcare workers, announcing on Tuesday the creation of Sentinel Event Alert 59, which addresses violence — physical and verbal — against healthcare workers.

TJC writes in this latest Sentinel Event Alert publication that the purpose of the new alert is to help hospitals and other healthcare organizations better recognize workplace violence directed by patients and visitors toward healthcare workers and better prepare healthcare staff to address workplace violence, both in real time and afterward.

TJC notes that Sentinel Event Alert 59 has some overlap with Alerts 40 and 57 — which were released in 2008 and 2017, respectively, and focused on the development and maintenance of safety culture — and therefore were not addressed in this alert.

Per the Occupational Safety and Health Administration (OSHA), about 75% of workplace assaults annually occurred in the healthcare and social service sector. Violence-related injuries are four times more likely to cause healthcare workers to take time off from work than other kinds of injuries, according to the Bureau of Labor Statistics (BLS).

TJC cites both of those facts in this Sentinel Event Alert publication and adds that TJC data show 68 incidents of homicide, rape, or assault of hospital staff members over the past eight years – and that’s mostly only what hospitals voluntarily reported.

TJC is calling for each incident of violence or credible threat of violence to be reported to leadership, internal security, and — if necessary — law enforcement, and TJC also wants an incident report to be created. Under its Sentinel Event policy, TJC says that any rape, any assault that leads to death or harm, or any homicide of a patient, visitor, employee, licensed independent practitioner, or vendor on hospital property should be considered a sentinel event and requires a comprehensive systematic analysis.

Additionally, TJC says it’s up to the healthcare organization to specifically define unacceptable behavior and determine what is severe enough to warrant an investigation.

This Sentinel Event Alert, which you can download here along with other resources, comes on the heels of an emergency preparedness rule from CMS that recently went into effect and efforts from the National Fire Protection Association to fast-track its new standard for active shooter events and other violent incidents. OSHA is also considering a standard to help protect healthcare and social workers from violence.

Three proposed tweaks to ASHRAE’s ventilation standard open for comment

By: April 6th, 2018 Email This Post Print This Post

The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) is now accepting public comment on a trio of proposed changes to ANSI/ASHRAE/ASHE Standard 170-2017, Ventilation of Health Care Facilities.

Addendum o to Standard 170-2017 is scheduled for public comment until May 7. This “voluntary risk-based approach” to establish “operational ventilation rates for spaces” calls for infection control and prevention professionals to segregate infected persons to both protect them and prevent them from putting others at risk.

Addendum p to Standard 170-2017, also scheduled for public comment until May 7, would update Table 7.1 by, amongst other things, moving requirements for Residential Health, Care, and Support spaces to a new table in a different addendum; relocating and updating filtration requirements; and also revising the “space name terminology, table organization, and subheadings to better correlate with” 2014 FGI Guidelines for Design and Construction of Hospitals and Outpatient Facilities.

Addendum q to Standard 170-2017, scheduled for comment until April 22, would change the scope of the standard by including “resident” to differentiate from “patient” in residential health applications and by clarifying that the standard addresses more than outside air quantities and that it does not establish “comprehensive thermal comfort design requirements,” which are addressed in Standard 55.

This is just a summary of the proposed changes. To access these public review drafts, see a full rundown, and comment, visit ASHRAE’s online database.

CDC calls for ‘aggressive approach’ after ‘nightmare bacteria’ found in many states

By: April 5th, 2018 Email This Post Print This Post

The Centers for Disease Control and Prevention (CDC) sounded the alarm this week after it found that “nightmare bacteria” capable of resisting most antibiotics have popped up across the country. But officials also expressed optimism that “an aggressive approach can snuff them out” before those germs become widespread.

That new Vital Signs report released by CDC this week said that U.S. health departments found 221 cases of germs with “unusual antibiotic resistance genes” during 2017. Those 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 bottom line is that resistance genes with the capacity to turn regular germs into nightmare bacteria have been introduced into many states,” Anne Schuchat, MD, CDC’s principal deputy director, said Tuesday during a conference call with media. “But with an aggressive response, we have been able to stomp them out promptly and stop their spread between people, between facilities and between other germs.”

Antibiotic-resistant germs kill more than 23,000 Americans each year and approximately 2 million Americans are sickened by antibiotic-resistant germs annually. “As fast as we have run to slow resistance, some germs have outpaced us,” said Schuchat. “We have had some success, but it just isn’t enough to turn the tide. We need to do more and we need to do it faster and earlier with each new antibiotic resistance threat.”

The CDC’s Antibiotic Resistance 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, healthcare facilities must quickly isolate patients and begin aggressive infection control and screening actions, according to the CDC release.

“CDC’s study found several dangerous pathogens, hiding in plain sight, that can cause infections that are difficult or impossible to treat,” stated Schuchat. “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’s 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 Antibiotic Resistance Lab network.

The CDC study also found that 11% of screening tests of patients without symptoms found a hard-to-treat germ that spreads easily, which means that 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 — a 76% reduction.

While the CDC tried to put a positive spin on the findings of this Vital Signs report, some experts remain concerned about the rise of antibiotic-resistant germs.

“This isn’t an acute crisis where a wave just hits you,” Dr. Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, told Liz Szabo of Kaiser Health News. “But we see these rare cases of resistance in remote areas of the world, and within a year or two, it’s everywhere.”

CDC study: Excessive noise can contribute to high blood pressure and cholesterol

By: April 3rd, 2018 Email This Post Print This Post

Door alarms, heart monitors, surgical equipment, and Ted Nugent? Yes, Ted Nugent.

As I wrote in this month’s Medical Environment Update newsletter, excessive noise is an issue in the OR, where the eardrums of surgical team members are often bombarded by a bunch of different sources. Believe it or not, that sometimes includes classic rockers like the aforementioned Mr. Nugent, a popular playlist pick among surgeons.

Excessive noise in the OR can affect auditory processing among surgical team members, leading to miscommunication in critical moments and, subsequently, medical mistakes that affect patients plus needlestick injuries and slip-ups with a surgical knife.

I also focused on how it can expose surgical team members to hearing damage, too.

“[The surgical team is] like a construction crew,” Matthew Bush, MD, of the University of Kentucky, told me in a phone conversation. “Perhaps there are some people who have to use jackhammers and there’s other people who are using paintbrushes.” But in any case, that noise can add up, and “we need to be very conscious of that.”

Another thing to be wary of, according to a recent CDC study published in the American Journal of Industrial Medicine, is high blood pressure and high cholesterol.

“A significant percentage of the workers we studied have hearing difficulty, high blood pressure, and high cholesterol that could be attributed to noise at work,” Liz Masterson, MD, one of the study’s authors, said in a CDC press release. “This study provides further evidence of an association of occupational noise exposure with high blood pressure and high cholesterol, and the potential to prevent these conditions if noise is reduced.”

While the healthcare was not mentioned in that press release as an industry “with the highest prevalence of occupational noise exposure,” OR staff members often must work through loud bursts of noise that occur throughout many surgeries.

This is a concern that Lisa Spruce of the Association of periOperative Registered Nurses brought up during our recent chat about excessive noise, saying it “has been linked to impaired sleep, increased stress, physical discomfort, increase in blood pressure, heart rate, and breathing. And that all just has an effect on a person’s well-being.”

Spruce says some healthcare facilities have noise-related policies. And if yours doesn’t, she recommends forming an interdisciplinary team to evaluate noise in facilities and by individual types of surgery, and then determining what actions you can take to decrease noise levels, including exploring quieter alternatives for surgical equipment.

“I think we’re bringing more attention to [noise] as a problem where we haven’t in the past,” she said. “So, I think we are going to see more and more hospitals having policies and looking at it from a patient safety, and also a staff safety standpoint.”

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