Author Archive for: Matt Vensel

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.”

Joint Commission shares 2017 standards compliance data for healthcare facilities

March 27th, 2018 Email This Post Print This Post

The Joint Commission (TJC) has released its lists, each based on the type of facility surveyed, of the requirements most frequently scored as “not compliant” during accreditation surveys and certification reviews during the 2017 calendar year.

The list of requirements scored as “not compliant” during 1,443 hospital surveys:

  1. LS.02.01.35: Systems for extinguishing fires are provided and its systems/devices are appropriately installed and maintained. (86%)
  2. EC.02.05.01: Utility systems are well designed, inventoried, monitored, and managed according to written procedures when disruptions in the utility system occur. (73%)
  3. LS.02.01.30: Building features are maintained which prevent the spread and fueling of fire and smoke. (72%)
  4. IC.02.02.01: Infection prevention and control activities are performed relative to the cleaning, storing, and disposing of medical equipment/devices. (72%)
  5. EC.02.06.01: Physical environment (e.g., lighting, temperature, ventilation, equipment, furnishings, space, etc.) is safe and functional. (70%)
  6. LS.02.01.10: Effects of fire, smoke, and heat are mitigated through the design and maintenance of building and fire protection features. (66%)
  7. EC.02.02.01: Risks related to hazardous materials and hazardous waste are managed as described in written policy. (63%)
  8. LS.02.01.20: Means of egress are maintained. (62%)
  9. EC.02.05.05: Testing and regular inspections of utilities are done. (62%)
  10. EC.02.05.09: Medical gas and vacuum systems are labeled, tested, inspected, and maintained. (59%)

The list of requirements scored as “not compliant” during 104 surveys of office-based surgery practices:

  1. IC.02.02.01: Infection prevention and control activities are performed relative to the cleaning, storing, and disposing of medical equipment/devices. (63%)
  2. HR.02.01.03: Individuals permitted by law and the organization to practice independently are granted by the practice initial, renewed, or updated clinical privileges. (61%)
  3. EC.02.04.03: Testing and regular inspections of medical equipment are done. (37%)
  4. MM.03.01.01: The hospital’s medications are stored in a manner which maintains their integrity, minimizes their diversion, reduces dispensing error, and promotes availability while following manufacturer guidelines, laws, and regulations. (34%)
  5. IC.02.01.01: Implementation of the written infection surveillance, prevention, and control plan is implemented by the hospital. (27%)
  6. NPSG.03.04.01: Medications, medication containers, and other solutions removed from their original container and placed into a container, both on and off the sterile field, are labeled as consistent with safe medication practices. (24%)
  7. HR.01.06.01: The organization has a competency assessment process in place. (23%)
  8. EC.02.05.07: Emergency power systems are tested, inspected, and maintained as required by the Life Safety Code®. (22%)
  9. WT.04.01.01: Quality control checks are performed as defined in the quality control plan for waived testing. (20%)
  10. MM.01.01.03: High-alert and hazardous medications defined by the hospital are safely managed. (18%)

Study: Antibiotic-resistant infections cost U.S. hospitals $2.2 billion annually

March 26th, 2018 Email This Post Print This Post

Editor’s note: A version of this blog post first appeared on the website for BLR’s Patient Safety & Quality Healthcare magazine.

A new study found that in addition to being a deadly killer of patients, and in some cases afflicting healthcare workers, antibiotic-resistant infections cost U.S. hospitals more than $2 billion each year. The study was conducted by researchers from Emory University and Saint Louis University and published in Health Affairs last week.

The researchers cite a Centers for Disease Control and Prevention estimate that antibiotic-resistant infections kill 23,000 Americans annually. The study used data from the Medical Expenditure Panel Survey to estimate incremental healthcare costs of treating these infections, which the researchers say is the first national estimate of the price tag for this treatment.

The study found that antibiotic resistance adds $1,383 to the cost of treating a patient with a bacterial infection. Taking the estimated number of these infections in 2014, the researchers say the national cost of treatment is $2.2 billion annually.

The findings point to “the need for innovative new infection prevention programs, antibiotics, and vaccines to prevent and treat antibiotic-resistant infections,” the researchers wrote.

New IAHSS guideline aims to help healthcare facilities respond to workplace violence

March 20th, 2018 Email This Post Print This Post

Looking to reduce the likelihood of workplace violence in healthcare, the International Association for Healthcare Security & Safety Foundation (IAHSS) released a new Threat Management guideline earlier this month stating that “healthcare facilities should establish a process and multidisciplinary team to identify, assess, validate, mitigate, and respond to threats of violence or other behaviors of concern.”

The multidisciplinary threat management team should, says IAHSS, identify threats and determine their seriousness and severity. Additionally, IAHSS recommends the team develop intervention plans that protect potential victims and address problems that precipitate threats, document the threat assessment process with privacy and confidentiality in mind, and conduct a review after addressing each threat.

The IAHSS guideline suggests the development of a threat management program “that is informed by data and research in this area.” To do so, IAHSS says that healthcare facilities should designate individuals who are responsible for, amongst other things, educating staff and promoting the reporting of threats; assessing all reports of concerning behavior; implementing timely response plans; and advocating for victims and offering support and counseling if needed.

IAHSS says all healthcare staff should get education —  based on their job function and potential risk — about identifying concerning behavior, reporting protocols, activating an emergency response, and documenting threats and incidents.

The new Threat Management guideline was initially developed by the IAHSS Council on Guidelines and incorporated feedback from IAHSS membership, the Emergency Nurses Association, and the American Hospital Association, according to a press release announcing the guideline.

“Implementing the intent of this guideline will be one of the least expensive and effective steps an organization can take to reduce the likelihood of violence,” Tom Smith, chair of the IAHSS Council on Guidelines, said in a statement. “The Threat Management Guideline establishes a framework for healthcare organizations to proactively identify and manage threats of violence. Input from our colleagues at the AHA and ENA helped us enhance the quality and value of the final product.”

The issuing of the guideline comes several months after a report by IAHSS, entitled “Mitigating the Risk of Workplace Violence in Health Care Settings,” encouraged healthcare facilities to take immediate steps to mitigate violent incidents.

Make us even better with your feedback… and maybe win $50 off any HCPro product

March 6th, 2018 Email This Post Print This Post

Feedback from safety professionals is essential to us at HCPro as we strive to develop products that help healthcare organizations like yours stay up to date and in compliance, keeping your workers safe. Please take just a few minutes to share your thoughts with us regarding ongoing and new challenges faced by you and your safety colleagues in 2018.

In gratitude for your participation in our survey, you have a chance to win $50 off any product in the HCPro Marketplace. Simply click on the link below to begin the survey. If the click-through does not work, please cut and paste the URL below into the address bar of your browser.

Here’s the link to the survey: https://www.surveymonkey.com/r/2J6FVNC

All your answers are confidential and anonymous. If you have questions related to this survey, please contact me at mvensel@hcpro.com. The deadline to fill out the survey is March 30, 2018.

TJC: Unintended retention of foreign body, falls most common sentinel events in 2017

March 1st, 2018 Email This Post Print This Post

The Joint Commission (TJC) on Wednesday released an updated list of its sentinel event statistics for 2017, and you’ll find some familiar medical miscues at the top.

TJC reviewed 805 reports of sentinel events, which it defines as unexpected events that result in death or serious physical or psychological harm to patients. That’s down slightly from a year ago, when they decreased from 934 in 2015 to 824.

The most frequently reported sentinel event was again the unintended retention of a foreign body (116), edging out falls (114). Rounding out the five most common were wrong patient, site, or procedure (95), suicide (89), or delay in treatment (66).

To view the latest sentinel event info, here’s a link to TJC’s quarterly reports.

New HHS fact sheet gives guidance for handling long-term patient surge

February 27th, 2018 Email This Post Print This Post

One of the deadliest flu seasons in recent memory has prompted the Department of Health & Human Services (HHS) to release a fact sheet that gives guidance on handling an influx of patients flocking to healthcare facilities for treatment of the flu and other seasonal illnesses.

While the latest briefing from the CDC suggests that this flu season has peaked, the fact sheet provides useful information healthcare facility emergency planners should consider when developing plans to deal with a similar surge of sick patients in the future. Note that this fact sheet states “these considerations are different than those of planning to handle surge from a no-notice, short duration event” like the recent mass shootings in Orlando, Las Vegas, and Parkland, Florida.

The HHS fact sheet states that “all hospitals must have an emergency operations plan” to deal with a long-term surge. Among the strategies it recommends are expanding normal clinic hours to limit the number of clinic patients coming to the ED, rescheduling elective procedures to free up beds, and setting up “surge sites” such as tents or mobile units located next to the ED.

It also recommends preventive steps that could minimize the surge during a severe flu season, including the use of telehealth, telephone prescribing, virtual information, community paramedicine programs, and risk communications and creating media campaigns encouraging vaccinations, handwashing, and other infection control practices.

The HHS fact sheet states that “there is little an individual hospital or health system can do to prevent patient surge from seasonal illness, but a region or healthcare coalition, in partnership with public health, can use coordinated strategies to help provide situational awareness to support patient surge management throughout the community.”

To download the fact sheet from the HHS website, click right here.

Our expert answers a couple of reader questions related to waste disposal

February 19th, 2018 Email This Post Print This Post

When you’ve got healthcare safety or standards questions, we’ve got answers. More specifically, we’ve got a stable of industry experts who are only an email away and are willing and able to give you the guidance you are seeking.

This time, we turned to Dan Scungio, MT(ASCP), SLS, the laboratory safety officer for Sentara Healthcare in Virginia, to answer a pair of waste disposal questions recently posed by our readers. Scungio, aka “Dan, the Lab Safety Man,” writes a monthly column for our monthly Medical Environment Update newsletter.

Question No. 1, from a blog commenter named Sarah Winters: “I am the nursing supervisor for a school district. At the end of every year, the nurses at the schools close and seal their full sharps boxes and transport them in their vehicles to [our] central office, where I then take them to EMS for disposal. A safety/health inspector has told us this is unsafe and violates the OSHA standard. I cannot find how that violates any OSHA regulation. Suggestions? Resources? Thanks.”

Answer from Dan, the Lab Safety Man: “OSHA does not directly regulate the transport of hazardous waste, but the U.S. Department of Transportation does. The DOT states that if you are not in the business of transporting hazardous materials, the process of sharps transport for the schools falls under the DOT’s Materials of Trade exemption. That means it is acceptable to transport used sharps in your private vehicle provided they are packaged in containers constructed of a rigid material that is resistant to punctures and securely closed to prevent leaks. That said, individual state regulations may supersede federal DOT rules, so it is important to know what the transport laws are in your specific state.”

Question No. 2, submitted anonymously via email: “Can we dispose of irrigation fluid from the anterior chamber of the eye in the regular garbage if not visibly contaminated with blood and is self-contained in a sealed bag?”

Answer from Dan, the Lab Safety Man: “Eye irrigation fluid may not be considered an infectious waste if it does not contain blood, but it is probably not a good idea to place it into the regular (non-hazardous) waste stream. It is important to consider those who handle the trash after it leaves your site. If there is breakage of a sealed container or bag that creates an exposure, that would create a scenario that will raise questions for the person exposed and a situation that should be avoided.”

Got a question you’d like answered? Shoot us a note at mvensel@hcpro.com.

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