Archive for: Infection Control

Top 10 Medical Technology Hazards for 2020 Announced

By: October 24th, 2019 Email This Post Print This Post

By Christopher Cheney, HealthLeaders Media

Surgical staplers are the top medical technology hazard for 2020, according to the ECRI Institute.

Twenty years after publication of the Institute of Medicine’s landmark report To Err is Human: Building a Safer Health System, patient safety remains a significant concern for the healthcare sector. The Institute of Medicine report estimated 98,000 Americans were dying annually due to medical errors. Estimates of annual patient deaths due to medical errors have since risen steadily to 440,000 lives, which make medical errors the country’s third-leading cause of death.

Earlier this year, the U.S. Food and Drug Administration published an analysis of more than 109,000 adverse stapler incidents from 2011 to 2018, including 412 deaths and 11,181 serious injuries.

“Injuries and deaths from the misuse of surgical staplers are substantial and preventable. We want hospitals and other medical institutions to be in a better position to take necessary actions to protect patients from harm,” Marcus Schabacker, MD, PhD, president and CEO of the Plymouth Meeting, Pennsylvania-based ECRI Institute said this week in a prepared statement.

The following is the ECRI Institute’s Top 10 list of medical technology hazards for 2020.

1. Surgical staplers:  

“Consequences of a staple line failing or staples being misapplied can be fatal. Patients have experienced intraoperative hemorrhaging, tissue damage, unexpected postoperative bleeding, failed anastomoses, and other forms of harm,” an ECRI Institute executive report released this week says.

Most surgical stapler adverse incidents are linked to human error such as picking an incorrect staple size and clamping on tissue that is too thick or too thin, the executive report says. ECRI Institute’s recommendations for safe use of surgical staplers include hands-on practice with specific staplers that are used in healthcare settings.

2. Point-of-care ultrasound:

“A lack of oversight regarding the use of point-of-care ultrasound (POCUS)—including when to use it and how to use it—may place patients at risk and facilities in jeopardy,” the executive report says.

Although POCUS has been established as a valuable technology for diagnosis and guiding interventional procedures, safeguards are insufficient at many healthcare facilities, the executive report says. “Safeguards for ensuring that POCUS users have the requisite training, experience, and skill have not kept pace with the speed of adoption.”

Recommendations for POCUS safety include user training and credentialing, exam documentation, and data archiving.

3. Infection risks from sterile processing:

“Insufficient attention to sterilization processes in medical offices, dental offices, and some other ambulatory care settings can expose patients to contaminated instruments, implants, or other critical items,” the executive report says.

Physician practice offices and dental offices are high-risk locations because they often do not have the sterilization resources found in hospitals, the executive report says. Recommendations to improve sterile processing in these settings include designating a qualified staff member to support infection prevention and control practices.

4. Hemodialysis risks with central venous catheters in the home health setting:

“Many hemodialysis patients receive treatment through a central venous catheter (CVC) well beyond the period when transition to another form of vascular access is recommended. And the U.S. federal government recently announced a push to increase the use of home treatment for kidney disease patients,” the executive report says.

CVCs are often placed through the jugular vein and can result in severe adverse events such as infection, clotting, and disastrous blood loss if there is a disconnection. “Family members or other caregivers may be ill-equipped to manage the risks or to respond when a CVC problem occurs. The possibility that an increasing number of patients with CVCs might receive hemodialysis in the home raises concerns,” the executive report says.

5. Surgical robotic procedures:

“While the use of surgical robots in innovative ways or for new procedures can help advance clinical practice, such uses can also lead to injury or unexpected complications and the potential for poorer long-term outcomes,” the executive report says.

Although robots have benefits during surgical procedures such as improved dexterity and tremor reduction, they have drawbacks, including limited tactile feedback for forces exerted on tissue, the executive report says. Recommendations for safe use of surgical robots in new procedures include training, credentialing, and privileging operating room staff in the new applications.

6. Alarm, alert, and notification overload:

“More than ever before, clinicians have to divide their attention between direct patient care tasks and responding to prompts from medical devices and health IT systems. As the number of devices that generate alarms, alerts, and other notifications increases, so too does the risk that the clinician will become overwhelmed, creating the potential for a clinically significant event to go unaddressed,” the executive report says.

Recommendations to address alert overload include decreasing overall notification burden and helping clinical staff to develop critical thinking skills to ease cognitive overload.

7. Cybersecurity risks in the home health setting:

“Remote patient monitoring technologies are increasingly being used for at-home monitoring to help clinicians identify deteriorating patients before they require hospitalization. As network-connected medical technologies such as these move into the home, cybersecurity policies and practices that address the unique challenges involved must be instituted,” the executive report says.

8. Missing implant data for MRI scan patients:

“Patients presenting for magnetic resonance imaging (MRI) studies must be screened for implanted devices to avoid harm. Some implants can heat, move, or malfunction when exposed to an MRI system’s magnetic field. Thus, MRI staff must identify and follow any contraindications or conditions for safe scanning prescribed by the implant manufacturer,” the executive report says.

Recommendations include creating implant lists in patients’ electronic medical records.

9. Medication errors from dose timing discrepancies in electronic medical records:

“Missed or delayed medication doses can result from discrepancies between the dose administration time intended by the prescriber and the time specified within the automatically generated worklist viewed by the nurse,” the executive report says.

10. Loose nuts and bolts in medical devices:

“The nuts, bolts, and screws that hold together medical device components can loosen over time with routine use. Failure to repair or replace loose or missing mechanical fasteners can lead to severe consequences: Devices can tip, fall, collapse, or shift during use—any of which could lead to patient, staff, or bystander injury or death,” the executive report says.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

Multidrug-resistant infections can cost $4,600 per hospital stay

By: October 16th, 2019 Email This Post Print This Post

By Christopher Cheney, HealthLeaders Media

Infections linked to multidrug-resistant organisms (MDROs) cause a significant cost burden for U.S. healthcare, recent research shows.

The development of antibiotic-resistant infections is one of the most severe public health problems in the country, according to the Centers for Disease Control and Prevention. About 23,000 Americans die annually from an antibiotic-resistant infection, the CDC says.

The national price tag for treating infections linked to MDROs in the hospital setting is at least $2.39 billion, according to the recent research, which was published in the journal Health Services Research.

The researchers also tallied the treatment cost per inpatient hospital stay for methicillin-resistant Staphylococcus aureus (MRSA)Clostridium difficile (C. difficile), and other MDROs.

  • Treatment of infection with MRSA cost about $1,700
  • Infection with C. difficile cost about $4,600
  • Infection with another MDRO cost about $2,300
  • Infection with multiple MDROs cost about $3,500

“We find the highest incremental and total costs for C. difficile and the lowest incremental costs for MRSA, consistent with estimates from previous reports. The higher costs appear to be driven largely by a higher average length of stay, but may also be due to additional testing and increased risk for ICU admission with C. difficile,” the researchers wrote.

In 2014, the President’s Council of Advisors on Science and Technology made several recommendations to combat antibiotic resistance, including surveillance of MDROs in healthcare settings and the community, anti-microbial stewardship campaigns, precautions to limit exposure, and education of patients and physicians about the dangers of overprescribing antibiotics.

Calculating superbug economics

The lead author of the Health Services Research article, Kenton Johnston, PhD, MPH, told HealthLeaders that determining the cost effectiveness of efforts to reduce MDRO infections is challenging.

“Essentially, you are comparing the costs of MDRO-reduction efforts to the savings generated by those efforts. The costs of MDRO-reduction efforts would be the programmatic costs of interventions. This is tricky because the interventions are wide-ranging throughout society such as hand-washing campaigns. The savings part is also tricky because the savings also accrue throughout society,” said Johnston, an assistant professor at the College for Public Health & Social Justice, St. Louis University.

Johnston’s research team only examined hospital costs of efforts to combat MDRO infections.

“A systematic review of the literature on just the cost side of this equation found that the cost of measures to combat and eradicate MDROs ranges from $331 to $66,772 per MDRO-positive patient. This is obviously an unacceptably huge range for calculating the cost side of the equation alone. As a result, more research needs to be done,” he said.

7-Part EMS screening tool boosts early sepsis treatment

By: October 16th, 2019 Email This Post Print This Post

By Chris Cheney, HealthLeaders Media

Emergency medical service screening for sepsis speeds administration of the Surviving Sepsis Campaign 3-hour bundle of treatment, new research shows.

On an annual basis, sepsis affects about 1.7 million American adults and the infection is linked to more than 250,000 deaths. Timely application of the 3-hour bundle has been associated with reduced mortality.

In the new research, EMS crews conducted sepsis screening of patients before emergency department arrival, a co-author of the study told HealthLeaders.

“We implemented a standard operating procedure for sepsis screening—seven questions for the emergency department RN to ask EMS in any adult patients excluding trauma. When sepsis was suspected, the radio RN would notify the charge nurse to help get them into a room. The key takeaways are that implementing a sepsis screening tool for EMS to use is feasible and it helps to expedite care in these patients,” said Megan Rech, PharmD, MS, an emergency medicine clinical pharmacist and adjunct assistant professor, Department of Emergency Medicine, Stritch School of Medicine, Loyola University, Chicago.

In the primary finding of the research, 3-hour bundle compliance was significantly higher using the EMS sepsis screening tool compared to a control group, 80.0% vs. 44.2%, respectively.

The bundle has four main components: measurement of serum lactate concentration, fluid resuscitation, blood cultures prior to antimicrobials, and broad-spectrum antibiotics for suspected or documented infection.

The EMS sepsis screening tool had seven elements:

  1. Respiratory rate: N20 breaths per minute
  2. Heart rate: N90 beats per minute
  3. Systolic blood pressure: b90 mm Hg
  4. Documented fever or history of temperature: N100.9 °F or b96.8 °F
  5. Onset of mental status change
  6. Oxygen saturation: b90%
  7. Suspected infection

“There is great potential in the pre-hospital setting for earlier recognition of sepsis in patients arriving to the ED via EMS. Early recognition of sepsis will allow medical personnel to initiate sepsis protocol and decrease an important variable in sepsis mortality: time. We demonstrated that the use of a pre-hospital sepsis screening tool was associated with significant improvement in 3-hour bundle compliance, likely due to improved recognition of sepsis,” Rech and her co-authors wrote.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

Doing more harm than good? Study finds healthcare workers often provide care while ill

By: October 11th, 2019 Email This Post Print This Post

Many healthcare workers may be putting patients at risk by continuing to work when they have symptoms of cold, flu, or other respiratory illnesses, according to a new study published in Infection Control & Hospital Epidemiology.

The study found that 95% of healthcare workers have worked while sick, most often because the symptoms were mild or began during their work shift.

“We found that physicians and people working in areas that required the most intensive contact with patients were less likely than other workers to stay home or to leave work if symptoms progressed after the start of the day,” said Brenda Coleman, PhD, clinical scientist in the Infectious Disease Epidemiology Research Unit at Mount Sinai Hospital, Toronto, and lead author of the study, in a release. “Managers and senior staff need to both model and insist on workers staying home when symptomatic as it protects both patients and coworkers from infection.”

The study, published in the journal for the Society for Healthcare Epidemiology of  America, found that 92% of healthcare workers report to work while symptomatic for an acute respiratory viral illness. Hospital-acquired respiratory viral infections cause significant illness and death, in addition to increased healthcare costs. The Centers for Disease Control and Prevention recommends that healthcare workers with fever and respiratory symptoms consider temporary reassignment or exclusion from work while they are symptomatic.

Researchers conducted a four-season prospective cohort study of influenza and other respiratory illnesses in nine Canadian hospitals in Toronto, Hamilton, and Halifax. Healthcare workers in hospitals who worked more than 20 hours per week filled out daily online illness diaries whenever they developed symptoms; these included information about symptoms, possible exposure, attendance at work, reason for work or absence, and medical consultations.

In all, 10,156 illness diaries were completed by 2,728 participants. Diaries of workers who were not scheduled to work were excluded, which left 5,281 diaries for analysis. Sixty-nine percent of participants said they worked during an illness because their symptoms were mild and they felt well enough to work, 11% said they had things to finish at work, 8% said they felt obligated to work, and 3% responded that they couldn’t afford to take the time off. Half of the participants said they had episodes of acute respiratory viral illness during influenza season, with 95% of those working one or more days of their illness. Of the study participants, 79% said they were entitled to paid sick leave.

Coleman said the study illustrates the need to educate healthcare workers, managers, workplace health/safety/infection control staff, and administrators about the transmission risk associated with respiratory viral infection. Organizations should also clarify what symptoms require exclusion from work and develop and roll out policies for working while symptomatic, she added.

Safety Month showcase: Steps for when a worker is exposed to bloodborne pathogens

By: June 11th, 2018 Email This Post Print This Post

The National Safety Council has designated June as its annual National Safety Month as a way to focus on “reducing leading causes of injury and death at work, on the road, and in our homes and communities.” In accordance with that, HCPro’s safety team will highlight a different healthcare-oriented safety topic each week in the month of June by sharing an excerpt from one of our many books, all available on HCMarketplace.com.

The focus this week is on infection control. The excerpt is from The Infection Control Manual for Outpatient Settings, authored by Gwen M. Rogers, DBA, RN, CIC.

Her book explains the steps that physicians and staff at outpatient facilities should take to protect patients, employees, and the environment and to prevent the spread of infectious diseases, though safety pros who work at hospitals may also find this excerpt useful. It looks at the OSHA Bloodborne Pathogen Standard and what should be done when one of your employees is exposed to blood or other potentially infectious material (OPIM).

Are your employees familiar with the Bloodborne Pathogen Standard from OSHA? They should be; it is one of the key documents for healthcare best practices in preventing the spread of and bloodborne pathogens (BBP). It is important for you to maintain a safe work environment for yourself and your employees, and to provide documentation that you have done so, especially because agencies such as OSHA and The Joint Commission are narrowing their scrutiny of the physician’s office environment. Representatives from these and other groups want to see whether physician practices have a plan in place to educate and train employees in enacting an infection control plan.

The goal of OSHA’s Bloodborne Pathogens Standard, published in 1991 in the Federal Register, is to guide you in minimizing exposure. A good way to introduce employees to the concept of the standard is simply to tell them that they must assume that any needle and any specimen (i.e., anything relating to blood or bodily fluids) should be considered infectious. The standard applies to all employees who have occupational exposure to blood or other potentially infectious material. Occupational exposure is defined as “reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or OPIM that may result from the performance of the employee’s duties.”

As employers, physician practices are required by OSHA to take precautions to protect staff members likely to be exposed to blood or OPIM while on the job. Separate but dependent sets of rights and responsibilities were established for both employees and employers within the OSHA standards. Employees are obligated to follow office rules, wear personal protective equipment (PPE), and report hazardous conditions. Meanwhile, employers are required to become familiar with all OSHA standards, communicate them to employees, and enforce them in the workplace.

So, what steps must be taken when an employee is exposed to BBP?

Employees should follow a certain protocol after bona fide BBP exposure has occurred. Protocols for evaluation and management of an employee or patient exposure to the blood (or other potentially infectious material) of a patient need to be outlined in the exposure control plan. Any response should begin with providing immediate first aid.

What information must the employer provide to the healthcare professional following an exposure incident? The healthcare professional must be provided with a copy of the standard, as well as the following information:

  • A description of the employee’s duties as they relate to the exposure incident
  • Documentation of the route(s) and circumstances of the exposure
  • The results of the source individual’s blood testing, if available
  • All medical records relevant to the appropriate treatment of the employee, including vaccination status (which are the employer’s responsibility to maintain)

What serological testing must be done on the source individual?

The employer must identify and document the source individual if known, unless the employer can establish that identification is not feasible or is prohibited by state or local law. The source individual’s blood must be tested as soon as is feasible, after consent is obtained, to determine HIV and HBV infectivity. The information on the source individual’s HIV, HBV, and Hepatitis C testing must be provided to the evaluating healthcare professional. Also, the results of the testing must be provided to the exposed employee. The exposed employee must be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.

What if consent cannot be obtained from the source individual?

If consent cannot be obtained and is required by state law, the employer must document in writing that consent cannot be obtained. When law does not require the source individual’s consent, the source individual’s blood, if available, shall be tested and the results documented.

When is the exposed employee’s blood tested?

After consent is obtained, the exposed employee’s blood is collected and tested as soon as is feasible for HIV and HBV serological status. If the employee consents to the follow-up evaluation after an exposure incident but does not give consent for HIV serological testing, the blood sample must be preserved for 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested for HIV, testing must be done as soon as is feasible.

What information does the healthcare professional provide to the employer following an exposure incident?

The employer must obtain and provide to the employee a copy of the evaluating healthcare professional’s written opinion within 15 days of completion of the evaluation. The healthcare professional’s written opinion for hepatitis B is limited to whether hepatitis B vaccination is indicated and whether the employee received the vaccination. The written opinion for post-exposure evaluation must include information that the employee has been informed of the evaluation results and has been told of any medical conditions resulting from exposure that may require further evaluation and treatment. All other findings or diagnoses must be kept confidential and must not be included in the written report.

What type of counseling is required following an exposure incident?

The standard requires that post-exposure counseling be given to employees following an exposure incident. Counseling should include U.S. Public Health Service recommendations for transmission and prevention of HIV. These recommendations include refraining from blood, semen, or organ donation; abstaining from sexual intercourse or using measures to prevent HIV transmission during sexual intercourse; and refraining from breastfeeding infants during the follow-up period. In addition, counseling must be made available regardless of the employee’s decision to accept serological testing.

What should be done with an employee’s confidential medical records?

Records of all employees with occupational exposure must be maintained for 30 years after the employee terminates employment. These records should be stored separately from patient records, and access to the records requires the employee’s written permission. The medical records include a copy of the employee’s vaccination status and copies of the results of all medical examinations and tests. Post-exposure records must include the employee’s name, Social Security number, hepatitis B vaccination status, results of follow-up procedures to exposure incidents, and a copy of the evaluator’s written opinion.

To purchase The Infection Control Manual for Outpatient Settings, please click here. And check back next Monday for a free HCPro book excerpt focusing on a different healthcare safety topic.

AORN expects to revise its guideline for operating room headwear

By: 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.

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

By: 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

By: 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.

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.

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.”

Joint Commission shares 2017 standards compliance data for healthcare facilities

By: 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%)

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