Most of you in the healthcare safety profession spend your career trying to keep your facility out of the way of mayhem and destruction.
Last week, I spent some time talking to Wayne Hellerstedt, the interim CEO of Curry General Hospital in Gold Beach, Oregon. If you’ve ever been to the beautiful beaches of Oregon you understand why the folks who live there along Route 101 wouldn’t want to be anywhere else.
But living there is a gamble: Only about 100 miles off the U.S. Pacific Coast lurks a seismically active fault that emergency management professionals have been saying for years will produce an earthquake of magnitude 8 or greater – as well as a monster Tsunami—within the next 50 years.
So why is it that the town of 22,000 just approved the construction of a brand-new, $28-million critical access hospital right in the path of such a potentially destructive wave?
Call it necessity. The town’s current 18-bed Curry General Hospital was built in 1949 when there were no seismic building codes, and the building was last renovated in 1969. A one-envelope building located four blocks from the beach, the facility has no smoke corridors or fire doors, leaving it woefully behind today’s accreditation standards and has left it in constant threat of being shut down by local fire marshals. So what needs to be considered?
Risk assessment. For one, tsunamis are mercifully rare. The new Curry General Hospital is being built based on the risk of the area being hit by a monster tsunami. While yes, recent events in Indonesia and Japan show that a monster tsunami is indeed possible, the odds of a 100-foot tsunami hitting any one place on the planet are really very small.
Height above sea level. In Gold Beach, the town proper is only about a half-mile wide before the mountains start rising behind it. While the new hospital may be located only four blocks from the water’s edge, it’s still located 50 feet up on the hillside, a bet the town’s planners were willing to take.
Location. Gold Beach, while a beautiful place, is quite isolated, with the closest hospital facility located about 60 miles away to the north and the south. For that reason, the facility had to be designed to operate independently and cost-effectively—and it had to be located in the part of town where the population was centered. While going uphill would place the building out of the way of a higher tsunami, it puts it in danger from landslides and unstable ground. The building footprint is designed so water from a tsunami would drain back to the ocean.
Contingency plans. In the event of a crippling earthquake or tsunami, there’s a good chance the town of Gold Beach would be isolated for weeks or months, and may not have access to outside government resources.
Emergency plans call for transportation arrangements with local ambulance services to help patients and staff get to and from the hospital, and if needed, air ambulance service would be coordinated with helicopters and fixed-wing aircraft. In Gold Beach, the municipal airport is located right on the beach, so the new hospital is being built with a helipad in case it was unusable after a tsunami.
If you’ve been paying attention to the news you know that the perennial battle of the benefits of using diagnostic GI scopes versus the struggle to keep them properly disinfected is back again.
While the benefits of using the diagnostic instruments to peer deep into the digestive tracts of a patient is not in debate, the cost of technological advances in the scopes, some of which are being designed with high resolution cameras and surgical tools on the end, is that they are more difficult to keep clean.
And in an industry where disposable, single-use instruments is becoming the norm, there’s not much chance of a $40,000-diagnostic scope becoming a disposable tool in the near future, so education and awareness is the key to winning the battle against these killer bugs, say safety experts.
Recent outbreaks of antibiotic-resistant bacterial infections in hospitals in the Los Angeles and Philadelphia areas. In the first, officials at The University of California’s Ronald Reagan Medical Center were faced with an outbreak of carbapenem-resistant Enterobacteriaceae, or CRE, which is highly resistant to antibiotics and can kill up to 50% of infected patients. Then in early March, officials at Cedars-Sinai Medical Center in Los Angeles discovered that four patients were infected with CRE and 67 other people may have been exposed.
Here’s a quick list of what safety experts say you should be doing to keep your scopes clean:
Develop a checklist. Everyone from surgeons to emergency management folks are developing checklists for seemingly routine procedures. Why? Because they are only human, and we forget everything. With a process as complicated as it is for disinfecting GI scopes, experts say the best thing your facility can do is write the process and put in front of any staff that handles disinfection processes.
Never underestimate human error. Your staff—especially those who have been on the job for a long time—may think they know all they need to know about disinfection processes, but all it takes is one missed step by a distracted employee for an outbreak of a deadly infection to kill people, your reputation, and maybe the business at you clinic. Make proper practices the only way at your facility, and make sure that any tasked with scope disinfection focuses only on that task—and doesn’t get distracted with other patient care or administrative duties.
Your patients have been exposed more than you think. So, you think your clinic’s patients have escaped the dangerous bugs? Think again. Your facility should treat every single patient as if they could carry bugs from the common cold to HIV to hepatitis. Don’t pretend to know how to spot someone with an infection, don’t expect someone to be honest enough to tell you about it, and don’t let your GI scope disinfection processes fall behind.
Consult those who know best. Manufacturers of scopes provide written cleaning instructions in hard copy and online for a reason. They don’t people getting sick from being treated by their equipment, and they know their equipment better than you do. Download the written instructions, print them out, and place them in full view wherever reprocessing is carried out. Many manufacturers are now offering to send out representatives to train clinic employees in proper techniques; take advantage of this.
Make disinfection a team effort. During last year’s Ebola scare, the CDC recommended that hospitals and clinics being instituting teams of “spotters” that observe each other donning and doffing PPE when treating patients suspected of having the virus. The intent was simple: multiple pairs of eyes are better than one, and cuts down on the number of mistakes made. The same approach can be applied to your disinfection process for scopes. Perhaps you could try forming teams of two who go through the process together and check each other’s work, much the same as a pilot and a co-pilot do so in the airline industry.
One of the most feared things in healthcare safety circles is the dreaded surprise OSHA inspection, but it can also be a learning experience.
That was the case for Melrose–Wakefield Hospital, a suburban Boston hospital that was penalized $28,000 (eventually reduced to $22,000) in April 2014 for several violations of the agency’s bloodborne pathogens standard and safe sharps violations.
William Doherty, MD, Chief Operating Officer of Hallmark Health System, and the parent system of the hospital, shared some of the lessons he learned from the experience in a story I wrote recently for Briefings on Hospital Safety. Perhaps you can use some of them in your own facility.
Make sure you know what OSHA wants. This isn’t always as easy as it sounds. The Joint Commission has earned a reputation for being what many call the “top cop” of survey expectations, mainly because hospitals pay thousands of dollars for surveyors to come in and scrutinize their processes and procedures. So it came as a bit of a surprise to Doherty that OSHA fined his hospital $6,000 for not having locking containers designed to contain spills while transporting medical waste and used surgical instruments.
“You need to understand exactly what OSHA is looking for. Just because the Joint Commission it’s okay doesn’t mean OSHA thinks it’s okay,” Doherty says.
OSHA inspectors are people too. An inspection by OSHA doesn’t happen often, mainly because the agency doesn’t have enough inspectors to routinely inspect all of the workplaces in America—there are millions of them and only about 2,000 inspectors. For that reason, there is an unspoken belief among the safety crowd that inspectors are grouchy robots bent on catching your every mistake, and fining you for it.
That’s simply not true, and anyone who has been through an inspection will tell you that, yes, while an inspector’s job is to ensure the safety of the workplace, most of them are nice people willing to make the inspection into a learning opportunity.
“They are reasonable people,” says Doherty. “There is a willingness on the part of OSHA to have a dialogue.”
He added that after the inspections, the hospital was served with what’s called an “Invoice Debt Collection Notice,” which is essentially a bill for the fines owed. Because of the hospital’s cooperation, and willingness to fix mistakes made and show a written abatement plan, he said inspectors lowered fines from $28,000 to $22,000 during the settlement conference.
If you can, fix your mistakes immediately. You are only human: sometimes you make mistakes and didn’t know it. Own up to your mistakes and don’t do it again. The same goes for an OSHA violation. In the case of Melrose-Wakefield, fixing their mistakes immediately lowered their fines. When an OSHA inspector pointed out that storage containers needed to have a locked lid on them, the problem was fixed the very next day and made a permanent procedure at the hospital. New sharps will never be instituted at the facility without staff input from all departments—even the pharmacy and other departments not normally associated with sharps. A new sharps committee will review all sharps needs and purchases. Lastly, a staff checklist was produced to help ensure all sharps are safe and accounted for when transferring to central sterile processing staff.
Be willing to change your ways. Even when mistakes are fixed, unless the overall culture of a facility is changed the same mistakes can be made over again. If you’re serious about fixing a broken system, actions speak louder than words.
In addition to instituting new checklists and ways of keeping staff members involved in helping make decisions about sharps, the hospital had to deal with problems inspectors found with the training program, specifically that there were no managers on site during the third shift that could answer safety questions the staff had. Now, the hospital has a policy that even at 2 a.m., there will be a nurse manager or administrator on call that can be reached 24 hours a day, 7 days a week. This simple change in culture helped reduce a fine by $2,000 and has helped raise employee morale at the hospital, Doherty said.
With the word Ebola all but gone from the front pages, and the actual disease seemingly beaten back from our borders, one has to wonder if it’s okay to relax. Have we won the battle against one of the ugliest superbugs known to man?
Safety folks—a skeptical bunch by nature—say nope, now’s not the time to take the silence for granted. Ebola is still lurking out there, and it’s a still a big problem in Africa. As we have learned, all it takes is a plane ride to introduce the virus to healthcare facilities in the U.S.
We took a good look at the issue in the April issue of Briefings on Hospital Safety, and experts had quite a bit to say about what you should be doing to prepare your facility during this lull in Ebola activity. Here’s a taste of what they had to say:
Don’t drop your guard. Be glad it’s quiet, because the alternative (which includes both patients and healthcare workers suffering awful and dramatic deaths) is quite a nightmare scenario. Ebola should be something that is always prepared for. Triage questions that seek to determine an incoming patient’s travel history and symptoms should always be asked. Training sessions that practice proper PPE and response should be required for all staff, no questions asked.
There’s still no sign it’s going airborne. That’s extremely good news, especially considering a large part of the media hysteria surrounding Ebola centered on the question of whether the virus could go airborne somehow. The CDC still says no. What does that mean for healthcare workers? They aren’t likely to see a planeload of 250 passengers come in with symptoms of Ebola. It also means PPE and protocols don’t have to change much.
Keep practicing. Now is not the time to relax your protocols, intake procedures, or PPE. Nor is it time to let your supplies of equipment such as protective gowns, goggles, and respirators dwindle or lie dormant. If something requires batteries, check them to make sure they are working and that you have extras. And keep those training sessions going: make sure you are doing drills that challenge your staff, catch them by surprise so they can learn to work under stress while wearing PPE, and most of all, make sure they can learn to work as a team.
Plan for any hazards. You’ve more than likely heard this one many times by now. Your infection control planning as such shouldn’t focus on Ebola; rather, you should be focusing on the hardships your facility will face in an outbreak of any infectious disease. For instance, how will you protect your staff? How will you change the flow of patients into the hospital to ensure as few people as possible will be exposed? Is your media relations crew ready to handle the onslaught of misinformation that is likely to come out of the situation?
Hospitals worldwide got a wake-up call about dealing with potentially explosive and flammable substances January 29 when a tanker truck that was unloading gas at a Mexico City children’s hospital exploded, reducing the facility to rubble and killing at least three people and wounded dozens.
The truck had been filling kitchen gas tanks at the hospital, reports said, and the explosion occurred as about 110 people in the Hospital Materno Infantil Cuajimalpa were being evacuated after a leak was discovered.
Shortly after the explosion, U.S. safety agencies, including the American Society for Healthcare Engineering (ASHE) started sending out alerts, telling hospitals stateside that they should review their safety protocols, procedures for storing and transporting flammable and explosive substances, and making sure their employees were up to date on the latest training.
“You can never be too careful with the delivery of flammable gases,” says Marge McFarlane, PhD, CHSP, CHFM, HEM, MEP, CHEP, principal of Superior Performance, LLC, in Eau Claire, Wisconsin. “It’s a conscious acceptance of familiar risk, as people forget that it’s bad stuff. They probably receive deliveries 500 times without incident.”
We’d like to know – with the events that unfolded in Mexico City, will you be changing your protocols or doing anything to change the way hazardous substances are handled?
Feel free to drop me a line any time at email@example.com.