Author Archive for: Matt Vensel

AOHP asks healthcare organizations to ‘consider’ mandatory flu shot policies

May 22nd, 2018 Email This Post Print This Post

The Association of Occupational Health Professionals in Healthcare (AOHP) has joined the growing ranks of industry groups that are calling for hospitals and other healthcare facilities to consider a vaccination policy that makes annual flu shots mandatory for healthcare workers, which AOHP defines as any paid or unpaid person working in any healthcare setting.

AOHP, which calls itself “the only national professional organization with the exclusive mission of addressing the needs and concerns of occupational health professionals in healthcare settings,” recently released a position statement that recommends annual flu shots along with other mandatory vaccinations, including hepatitis B and MMR, for healthcare workers.

AOHP also asks administrators “to consider a policy that makes annual influenza vaccination mandatory (with medical exemptions) or offer alternatives to vaccination such as requiring the use of surgical masks for patient care by healthcare workers who refuse the vaccine.” It says the vaccines should be offered for free and must comply with state and federal regulations.

Mandatory flu vaccination for healthcare personnel is already recommended by organizations such as the Society for Healthcare Epidemiology of America (SHEA), the Pediatric Infectious Diseases Society (PIDS), and the Infectious Diseases Society of America (IDSA).

Many healthcare workers know that getting a flu shot each fall helps protect not only themselves, but coworkers, friends, family, and, most notably, patients. Some have legitimate objections to being vaccinated, such as an allergy or a strong religious belief. However, there are still healthcare workers who simply oppose the mandatory nature of these policies.

Despite that, the Centers for Disease Control and Prevention, which recommends flu shots for all healthcare personnel, reported a vaccination rate of over 95% during the 2015-16 flu season for healthcare workers whose employers required them to get vaccinated for seasonal influenza, which compared to a 79% vaccination rate overall among healthcare workers.

“Over and over again, the research has shown that the mandatory vaccination policies are the strongest indicator of high vaccination rates among healthcare personnel,” says Terri Rebmann, PhD, RN, CIC, FAPIC, the director of the Institute for Biosecurity at Saint Louis University and a professor in epidemiology and biostatistics at the university.

She adds: “It’s really important for healthcare personnel to be vaccinated because they are in really close contact with the most vulnerable of our populations. If the healthcare personnel become infected, regardless of whether or not they have symptoms, when they shed the influenza virus during patient care activities, they can then expose those really high-risk patients.”

Editor’s note: With the next flu season right around the corner, Rebmann will host on July 31 an HCPro webinar entitled “Infection-Free Vaccination: Safely Storing, Handling, Injecting, and Infusing Medications.” During the 90-minute webinar, she will explain how improper administration of vaccines can result in injuries or prevent the vaccines from providing optimal protection. She will also discuss the components of safe storage, handling, injection, and infusion practices for vaccines and how to put them into action. Click here for more information.

AORN expects to revise its guideline for operating room headwear

May 17th, 2018 Email This Post Print This Post

After participating with other healthcare heavy-hitters in February in a task force that met to discuss recommendations for OR attire, specifically ear and hair covering, The Association of periOperative Registered Nurses (AORN) expects to make changes to its Guideline for Surgical Attire.

Lisa Spruce, DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN, AORN’s director of evidence-based perioperative practice, tells us that AORN will still recommend complete hair coverage in that revised guideline, but “there’s not going to be a recommendation on which head covering.”

As for the coverage of ears, AORN is “probably going to come out in our new guideline and say the ears don’t need to be covered” because the task force feels the research focusing on its necessity has been inconclusive. “However,” she says, “our guideline stands as is until it’s revised.”

It is significant that AORN will be changing its official guideline. While the organization is the world’s largest professional association for perioperative nurses, it has been a tone-setter for issues that affect all healthcare workers who enter the OR. CMS and subsequently The Joint Commission followed AORN’s lead on headwear and has cited healthcare organizations accordingly.

AORN decided to reconsider its stance on headwear after a study led by Troy Markel, MD, assistant professor of surgery at Indiana University, examined the effectiveness of disposable bouffant hats and skull caps as well as newly-laundered cloth skull caps in preventing airborne contamination.

Not only did Markel and his peers observe no significant differences between the disposable bouffant hats and disposable skull caps “with regard to particle or actively sampled microbial contamination,” they also determined that the disposable bouffant hats had greater permeability, penetration, and greater microbial shed compared to both disposable and cloth skull caps.

Therefore, the researchers wrote in conclusion that disposable bouffant hats “should not be considered superior to skull caps in preventing airborne contamination in the operating room.”

The Markel study made the strongest case to date in the contentious debate over OR headwear, which started several years ago when AORN began, depending on who you ask, either promoting the use of bouffant hats among surgical staff or advocating for skull caps to be banned. AORN encouraged full coverage of the ears in the OR, one of the reasons why it favored bouffant hats.

Spruce says the study “just sparked everybody’s interest and opened up this discussion.” AORN and others felt the evidence was enough to revisit the controversy and, according to Spruce, the American College of Surgeons assembled the task force. That group met in February and recently released a joint statement that “covering the ears is not practical for surgeons and anesthesiologists” and also that “available scientific evidence does not demonstrate any association between the type of hat or extent of hair coverage and [surgical site infection] rates.”

Spruce says AORN had already decided “that it was time to revise that guideline” but “it was valuable” to hear the thoughts among that multi-disciplinary group. She adds, “The perioperative setting has always been a team environment and we’ve always promoted that, so we want the teams to come together and agree on issues that are important to patient safety.”

AORN’s Guideline for Surgical Attire will be reviewed by AORN’s advisory board, which includes representatives from organizations that formed the task force and others. That revised guideline will be available for public comment early next year and will be ready for publication in April.

OSHA cites another healthcare facility for not protecting staff from violence

May 16th, 2018 Email This Post Print This Post

Be aware that OSHA is continuing to cite healthcare organizations for not protecting their staff from workplace violence.

In the latest announced penalty, an acute care inpatient behavioral health facility in Bradenton, Florida is facing more than $71,000 in fines for “failing to institute controls to prevent patients from verbal and physical threats of assault, including punches, kicks, and bites; and from using objects as weapons,” according to information released by the U.S. Department of Labor.

OSHA cited Premier Behavioral Health Solutions of Florida Inc. and UHS of Delaware Inc., which operates Suncoast Behavioral Health Center in Bradenton, after investigating a complaint that employees were “not adequately protected from violent mental health patients.” The citation, announced May 2, follows the OSHA citation of another UHS subsidiary in 2016 “for a deficient workplace violence program.”

“This citation reflects a failure to effectively address numerous incidents over the past two years resulting in serious injuries to employees of the facility,” said Les Grove, OSHA Tampa Area Office Director, in a published news release.

OSHA, CMS, The Joint Commission (TJC), and other regulators are cracking down on failures to protect workers from violence. TJC issued a Sentinel Event Alert in April and OSHA is considering proposing a new standard to deal just with workplace violence, which currently is cited under the General Duty clause requiring employers to protect workers from hazards “that are causing or are likely to cause death or serious harm.”

The OSHA citation report offered up a list of problems and potential solutions for Premier Behavioral Health Solutions and UHS to consider. Those solutions included:

  • evaluating the configuration of the nurses’ workstations to keep patients from jumping over desks or otherwise gaining access to personnel as well as weapons such as staplers, phones, cords, pens, and computers
  • develop a “disruptive behavior response team” and provide that team with “clear written procedures for how employees should respond to clients making threats, showing aggression, and assaults
  • evaluate intake procedures to better identify incoming patients with potential for violence
  • ensure security cameras are continuously monitored
  • provide panic alarms
  • discourage employees from wearing necklaces or lanyards that can be used for strangulation, and encourage staffers to secure “loose hair so that it is not accessible to patients, to minimize the risk of neck strains and hair pull injuries”
  • to regularly train staff in methods to protect themselves when patients become violent
  • conduct effective investigations and root cause analyses into violent events
  • establish a comprehensive medical and psychological counseling and debriefing for employees experiencing or witnessing violent assaults or incidents

Premier Behavioral and UHS have 15 business days from when they were notified of the citations and penalties to pay the fines, request an informal conference with OSHA’s area director, or contest the findings before the independent Occupational Safety and Health Review Commission.

This OSHA citation follows a similar case last year in which a psychiatric treatment center in Massachusetts faced more than $207,000 in proposed penalties after OSHA accused the facility of failing to adequately protect employees from workplace violence, despite having promised specifically to do so. That center said it was contesting OSHA’s allegations.

In another case, a hospital in New Jersey was able to successfully defend itself against allegations that it had failed to protect workers from workplace violence.

Editor’s note: This post is from AJ Plunkett, our colleague over at DecisionHealth.

There’s a new Ebola outbreak overseas, so make sure your organization is ready

May 10th, 2018 Email This Post Print This Post

Ebola is back in the news, which means it wouldn’t be a bad idea to make sure your healthcare organization has a pandemic plan and staff is familiar with it.

At the moment, the only confirmed current cases of Ebola were reported in a remote location in the Democratic Republic of the Congo. But the World Health Organization is concerned that the outbreak, which may have been underway for weeks or months, could spread to major cities in that African country — and then who knows from there.

That’s not to say it is likely this outbreak will lead to cases of Ebola in the U.S. But the outbreak here four years ago serves as a reminder to be ready just in case.

In the fall of 2014, a Liberian national who was visiting family in Dallas became the country’s first confirmed case of Ebola after he checked into a hospital with symptoms. He later died. Two nurses caring for the man at the hospital also came down with symptoms but were treated and recovered. Also that fall, a New York doctor who had been in Guinea treating Ebola patients tested positive for the virus and was later cured.

The cases, the first ever in American hospitals, set off a near panic as the Centers for Disease Control and Prevention released a new guidelines and videos to help healthcare workers learn better how to work with personal protective equipment and remain poised when dealing with one of the most infectious diseases on the planet.

According to the World Health Organization, the Ebola virus causes “an acute, serious illness which is often fatal if untreated.” The virus is transmitted from wild animals and spreads in the human population through human-to-human transmission.

Ebola is not the only dangerous infectious disease lurking out there, so, as we wrote in our Briefings on Hospital Safety newsletter in 2016, smart, proactive hospital safety pros “are already thinking of ways to get their staff better trained and bolster their hospital’s defenses should the next pandemic come through their doors.”

While that article is a couple of years old now, the expert advice within it still holds up. Give it a read if your healthcare organization doesn’t currently have a pandemic plan in place, or if you want to make sure yours is thorough and complete.

Task force weighs in with conclusions on bouffant hat vs. skull cap debate

May 3rd, 2018 Email This Post Print This Post

Back in February, a task force that included The Association of periOperative Registered Nurses (AORN), The Joint Commission (TJC), and others met to discuss recommendations for operating room (OR) attire, specifically ear and hair covering, a topic that continues to be debated by researchers and interested parties.

Earlier this week, the task force jointly released a few collective conclusions.

One conclusion the task force made was that “the requirement for ear coverage,” a selling point for bouffant hats and a sticking point for AORN in its latest guideline for OR attire, “is not supported by sufficient evidence.”

The task force wrote in a joint statement: “Over the past two years, as recommendations were implemented, it became increasingly apparent that in practice, covering the ears is not practical for surgeons and anesthesiologists and in many cases counterproductive to their ability to perform optimally in the OR.”

It also concluded that “available scientific evidence does not demonstrate any association between the type of hat or extent of hair coverage and [surgical site infection] rates.” To back up that conclusion, the task force referenced this recent study on head coverings that identified the disposable bouffant hat, not the skull cap hat, as “the least effective barrier to transmission of particles.”

The joint statement added that “in reassessing the strength of the evidence for this narrowly defined recommendation,” the task force concluded that “evidence-based recommendations on surgical attire developed for perioperative policies and procedures are best created collaboratively, with a multi-disciplinary team representing surgery, anesthesia, nursing, and infection prevention.”

AORN — which a year ago sought to publicly clarify its stance on skull cap hats, saying they were fine as long as they confined all hair and completely covered the ears, scalp skin, sideburns, and nape of the neck — released a separate statement in addition to the joint statement.

It said that AORN’s Guideline for Surgical Attire will be reviewed by the AORN Guideline Advisory Board comprised of representatives from the task force, as well as the International Association of Healthcare Central Service Materiel Management (IAHCSMM), the Society for Healthcare Epidemiology of America (SHEA), and the American Association of Nurse Anesthetists (AANA).

“AORN welcomed the opportunity to reach consensus on the new evidence,” said Lisa Spruce, DNP, RN, CNS-CP, CNOR, ACNS, ACNP, FAAN, director of evidence-based perioperative practice for AORN. “AORN guidelines are developed following an extensive review of all literature and the resulting recommendations are based on the quality of the studies. We are pleased that surgical attire is continuing to be evaluated and AORN will reflect the latest evidence in the revised guideline.”

AORN said its revised guideline will be available for public comment from January 2, 2019 through February 22, 2019 and ready for publication in April 2019.

In addition to AORN and TJC, the task force that met to discuss recommendations for OR attire included the American Society of Anesthesiologists (ASA), the Association for Professionals in Infection Control and Epidemiology (APIC), the Association of Surgical Technologists (AST), the American College of Surgeons (ACS), and the Council on Surgical and Perioperative Safety (CSPS).

In the joint statement, the task force also said “other issues regarding areas of surgical attire need further evaluation,” so more conclusions could be on the way.

NFPA unveils new standard to help with response to active-shooter incidents

May 1st, 2018 Email This Post Print This Post

Early this year, the NFPA promised to fast-track a new standard to help first responders, healthcare providers, facility managers, and others prepare for an active-shooter incident, and they have delivered, complete with its own acronym.

NFPA 3000, a Standard for an Active Shooter/Hostile Event Response (ASHER), is now available in paperback for $52, or, as with other NFPA codes and standards, it is also available on the National Fire Protection Association’s website for free in a read-only format. The format cannot be printed, searched, or copied. But it is a quick read at only 48 pages.

Designed as a roadmap for the multidisciplinary response needed in the aftermath of an active-shooter incident, there is a separate chapter for “Hospital Preparedness and Response for Out-of-Hospital ASHER Incidents.”

The chapter outlines minimum expectations for hospitals in preparing for, reacting to, and receiving patients from an active-shooter event in the area. Among other things, it says hospitals should:
• plan and drill regularly with other local authorities having jurisdiction (AHJs)
• have at least two ways to communicate with public safety officials about how patients are being distributed to health care sites, and to test communications at least once a month
• expect spontaneous arrivals of injured patients and those looking for them
• have a way to identify victims and reunite children with their families
• and have a security plan to restrict access as needed, and to search the facility for devices and weapons if that becomes a concern

Other chapters detail expectations for the variety of first responders, government agencies, and other organizations who might be involved in an ASHER response to prepare, plan, and recover from an incident.

The publication marks only the second time the NFPA has fast-tracked a provisional standard.

While most standards or codes can take years of planning, the ASHER standard was born of an urgency brought by the request of Otto Drozd, the chief of Orange County Fire and Rescue in Florida, three months after the June 2016 shooting at the Pulse nightclub in Orlando.

In that attack, 49 people died and more than four dozen others were shot, with many of the injured walking to nearby hospitals or in some cases physically carried by friends or others down several blocks. Since then, hospitals nationwide have responded to mass shooting incidents at a church, a concert, and a high school, among others.

At the time of Drozd’s request for a standard, there was an abundance of guidance material available but “there was no consensus standard for the components of a multidisciplinary response for preparedness, response, and recovery to active shooter and/or hostile events,” notes the NFPA in the opening to NFPA 3000.

A committee of 46 experts from law enforcement, fire services, emergency medical services, hospitals, physicians’ groups, and others was formed to receive technical, expert, and public comments and arrive at a consensus of standards.

The fast-tracked standard will now move into the normal biennial review and update process for other NFPA publications, according to the NFPA.

Editor’s note: This blog post was written by A.J. Plunkett, our colleague over at DecisionHealth.

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

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

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

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

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

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

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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