Showing posts with label Iatrogenic Infections. Show all posts
Showing posts with label Iatrogenic Infections. Show all posts

Thursday, April 28, 2011

Time to Eliminate Dangerous Injection Practices by Clinicians : Health in 30

By Barbara Ficarra, RN, BSN, MPA

Thanks to Laura Landro for shining light on unsafe injections in her WSJ blog, “Unsafe Injection Practices Persist Despite Education Efforts.”

Landro writes:

“A new push is underway to eliminate unsafe injection practices, which remain a persistent safety problem despite years of efforts to educate clinicians about the risks of re-using needles, syringes and drug vials.

In the U.S., failure to follow safe practices in delivering intravenous medications and injections has resulted in more than 30 outbreaks of infectious disease including hepatitis C, and the notification of more than 125,000 patients about potential exposure just in the last decade, according to health-care purchasing alliance Premier Inc.”

As a registered nurse this is unthinkable.  Learning to administer injections safely is “patient care 101.”  There is no excuse for any health care professional to unsafely inject patients.

Click on the "via" link for the rest of the article.

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Thursday, April 21, 2011

Hand sanitizers: don't kill MRSA or E. coli, says FDA - Health Key

Hey, hand sanitizers. You can only do so much – and preventing MRSA infection isn’t one of those things -- so stop over-promising! That was the gist of warning letters from the Food and Drug Administration to four makers of the popular products.

Apparently, the manufacturers of Staphaseptic, Safe4Hours, Dr. Tichenor’s and CleanWell products had suggested that various gels, protectants and what-not could protect against infection with methicillin-resistant Staphylococcus aureus bacteria. The FDA takes issue with that.

It wasn’t too enamored with claims about preventing infection from E. coli or the flu either.

The letter to one of the companies, which claimed their product kills 99.9% of MRSA, gives the general tone: “Below is an analysis of the regulatory status of Staphaseptic First Aid Antiseptic/Pain Relieving Gel which includes excerpts of the violative labeling and the specific new drug and misbranding charges. Note that this is not an all inclusive description of all violative labeling for your OTC drug product.”

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Saturday, April 16, 2011

Multidrug-Resistant Staphylococcus aureus in US Meat and Poultry

Abstract

We characterized the prevalence, antibiotic susceptibility profiles, and genotypes of Staphylococcus aureus among US meat and poultry samples (n = 136). S. aureus contaminated 47% of samples, and multidrug resistance was common among isolates (52%). S. aureus genotypes and resistance profiles differed significantly among sample types, suggesting food animal–specific contamination.

Antimicrobials are used extensively in food animal production, where they are often applied subtherapeutically for growth promotion and routine disease prevention [1]. Surveys conducted by the National Antimicrobial Resistance Monitoring System (NARMS) indicate that retail meat and poultry products are frequently contaminated with multidrug-resistant Campylobacter species, Salmonella species, Enterococcus species, and Escherichia coli [2]; but little is known about the prevalence of other antibiotic-resistant pathogens in the US food supply.

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Andrew Lopez, RN
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Thursday, April 14, 2011

When to sue your doctor or hospital Should you? | Eye Opener: The Nash & Associates Blog | %post_tags%

Recently, a CNN article titled “Harmed in the Hospital? Should You Sue?” described the story of a two-year-old baby with a septic infection who waited about five hours in the emergency department before being seen by a physician. The child ultimately needed several amputations as a result of the delay in medical treatment.

Using this tragic story as a point of reference, the article suggests a number of criteria to help patients decide when to sue and when not to sue a health care provider. For example, the article correctly suggests that a patient who has not sustained injury should not sue a health care provider even if the health care provider’s conduct might have been negligent. In medical malpractice cases, a plaintiff seeks monetary compensation for injuries. If there are no identifiable injuries, there simply isn’t a case for medical malpractice.

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--

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Monday, April 11, 2011

Hospital scrubs and sandwiches should not mix | Reporting on Health

You probably have been to a restaurant near a hospital (or a cafĂ© inside a hospital) and seen a doctor, nurse or medical assistant wearing scrubs and standing in line for a sandwich. You probably didn’t give this a second thought, the way you wouldn’t if you saw a police officer in uniform or a priest wearing a collar.

Dr. David C. Martin, a retired Sacramento anesthesiologist a former assistant professor in the Department of Anesthesiology and Pain Medicine at UC Davis Medical Center, thinks you should be alarmed. He has a niche mission that Antidote has never seen championed before. He wants to rid America’s restaurants of medical staff eating in scrubs. He makes his case over a three-part series that begins today. The first part is below.

Part two will run later this week and conclude with part three, in which I will bring in some voices from the larger health care community to talk about this confrontational approach to a covert public health issue. Here’s Dr. Martin.

I was enjoying lunch at a popular Sacramento restaurant last week, when two patrons walked in wearing green surgical attire, “scrubs” as they are commonly called. Both were wearing official badges from a large, local hospital, revealing one to be a physician, the other a registered nurse. Concerned that these scrubs had been exposed to communicable bacteria, I politely asked that the healthcare workers leave the restaurant, and return only in regular attire. Both were mildly annoyed but agreed to depart. I asked them to leave because the use of scrubs in the community can create a serious and avoidable public threat. I am also convinced that simple public action can play a powerful role in effecting change. I hope to bring misuse of hospital attire to greater public awareness and to solicit broader public action in addressing this potentially dangerous problem of scrubs transmitting pathogens from the hospital into the public and from public places back to the hospital, where these pathogens may cause grave harm to vulnerable patients.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which certifies and accredits healthcare organizations, has launched a bold initiative called “Speak Up,” which encourages individuals to take an active role in reducing our risk of infection by assuring that our providers wash their hands and wear gloves. JCAHO has even published a coloring book for children, to teach, early in life, that it is not disrespectful or inappropriate to speak up and remind our physicians and other providers to take appropriate safety measures.

For adults, the Joint Commission issues buttons, to be worn by healthcare providers, which say, “Ask me if I’ve washed my hands.”  This initiative is supported by the American Hospital Association and the Centers for Disease Control and Prevention, among many other quality and safety organizations. Some hospitals and clinics have embraced and enforced rigorous hand washing protocols have reduced their rate of institution-acquired infections, in some cases quite dramatically.   

Yet, believe it or not, many healthcare workers have not complied with institutional policy on hand washing.

At a forum on hand hygiene organized by Loyola University Medical Center and Medline Industries in March, experts reported that hand-hygiene compliance was lax nationwide. But it takes a lot of effort to get everyone “on board.”  I believe that the growing concern over scrubs as a vector of disease, while less important than sound hand-washing practices, is a substantial problem that merits similarly aggressive action.

Most California hospitals have official or unofficial policies, which restrict the use of hospital scrubs to surgical suites and related patient-care areas. Wearing them or laundering them outside of the hospital is forbidden or discouraged, but enforcement of such policy is a difficult task.

I spoke about this concern with quality assurance personnel at two of the four major hospital organizations in the Sacramento area. The two others failed to return several calls. One of the quality assurance staff members shared an observation that her organization had been effective in curtailing scrub misuse by non-physician staff, but that physicians were frequently allowed to break the rules. She said that many considered themselves to be “above the law” in this regard. Some travel to and from their own homes in contaminated scrubs, which suggests that this practice stems less from a disregard for others and more from a curious type of denial and disbelief that hospital-contaminated scrubs offer any real threat.  Are these the same professionals who have resisted aggressive hand-washing protocols, which make a huge difference in institutional infection rates?  As a physician who has spent most of my career in the surgical suite, I find this perplexing.

The notion that our physicians and nurses are immune to error, or unapproachable regarding its potential should have been laid to rest long ago. None of us should share public space with those who unnecessarily risk compromising public safety, knowingly or otherwise. I believe, as does the medical community at large, that it is time for all of us to take responsibility for our health and safety, rather than displacing the entirety of this onus to our caregivers. Purging public spaces of hospital-exposed garments could make more than a public fashion statement. It could reduce illness and even death from infectious disease.

Next: Why superbugs may show up wearing scrubs

Click on the "via" link for the rest of the article.

--

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Andrew Lopez, RN
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Monday, April 4, 2011

Hospital Acquired Infections Becomes A Leading Cause In Patient Deaths | OneMedPlace

Patients today are between a rock and a hard place because when they get sick a hospital may be the last place they want to go. Hospital Acquired Infections, also known as Healthcare-associated infections (HAI) are the 4th leading cause of patient deaths, killing 270 people per day in the USA. Recently the Federal Government and Payers are implementing incentives and penalties on hospitals that are not doing all they can to reduce HAIs.

HAIs are defined as infections not present and without evidence of incubation at the time of admission to a health care setting. Within hours after admission, a patient’s flora begins to acquire characteristics of the surrounding bacterial pool. Most infections that become clinically evident after 48 hours of hospitalization are considered hospital-acquired. Infections that occur after the patient is discharged from the hospital can be considered healthcare-associated if the organisms were acquired during the hospital stay.  There have been several cases of patients going into the hospital for minor surgeries and coming out in coffins, yet limited media coverage has been devoted to this area of concern.

Healthcare-associated infections can be localized or systemic, can involve any system of the body, be associated with medical devices or blood product transfusions. Three major sites of healthcare-associated infections are bloodstream infection, pneumonia, and urinary tract infection. HAIs result in excess length of stay, mortality and healthcare costs. In 2002, an estimated 1.7 million healthcare-associated infections occurred in the United States, resulting in 99,000 deaths.  In March 2009, the CDC released a report estimating overall annual direct medical costs of healthcare-associated infections that ranged from $28-45 billion.

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Andrew Lopez, RN
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Friday, April 1, 2011

MRSA Protocols- Are They Being Used In Practice? | Registered Nurse Blog

Posted: April 2nd, 2011

In Advance For NPs and PAs, a March 9, 2011 article was featured on the following study of protocols used by health care providers to treat MRSA infections. I was surprised to see that some providers were still using Keflex to treat these infections. Some providers still were not sending cultures on these infections. How can we adequately treat an infection without knowing what will actually kill the bacteria? My impression of the following information is that the protocol that I do is somehow a new treatment regimen. I have been doing incision and drainage with appropriate culturing with first line Septra for the last 3 plus years. I also use mupricion ointment to nares twice daily and Hibaclens during the regimen if they have had more than one outbreak within a 6 month period.

Taking Aim at MRSA
Protocol use by an NP-PA team
Anita D. Barnes is a family nurse practitioner who is an assistant professor of nursing at Stephen F. Austin State University in Nacogdoches, Texas.
A 2009 study reported a variety of approaches used by ED physicians to treat CA-MRSA SSTIs.6 The study surveyed 225 ED physicians nationwide: 56% reported always sending cultures for testing and 19% said they never did so. The physicians prescribed trimethoprim-sulfamethoxazole (TMP-SMX) 60% of the time, either alone or in combination with another antibiotic. Nineteen percent treated patients with cephalexin alone, and 13% prescribed cephalexin in combination with another antibiotic. Cephalexin is not recommended in the CDC protocol.

What are you doing as providers to treat MRSA infections? Do you find the information alarming that some providers are still not culturing infections?

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
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Wednesday, March 30, 2011

Hospital worker had deadly blood infection

All Children's Hospital has contacted all the families whose children were exposed to an outpatient therapist who died Monday from a contagious infection that can lead to meningitis.

As they continue to notify staff who may be affected, officials want the public to know the hospital is safe, and the general public is not at risk.  However, they do want all of us to be aware of two key facts about the infection that could save lives.

Doctor Juan Dumois, The Director of Pediatric Infectious Diseases at All Children's, has spent the last two days answering questions about a blood infection that likely killed an outpatient therapist.  “It’s an organism that we call meningococcal. And this organism has the potential to cause very serious life threatening blood infections and sometimes, once it's in the blood it can get into the brain and that's when we call it meningitis."

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Andrew Lopez, RN
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How safe is your hospital? - chicagotribune.com

Just before it was disclosed that a medical error at the University of Chicago led to the death of James Tyree, a well-known financier and philanthropist being treated for cancer, I was putting together a presentation examining the quality of care at some of the area's best-known hospitals.

Using publicly available data, I told a meeting of local health care executives that there were warning flags at several institutions, including the U. of C. Tyree, ironically, would have known about any actual problems in far greater detail. He served on the board of the hospital where he died from an air embolism in a dialysis catheter, and hospital officials said in an interview that they regularly report safety data to board members.

There's an important distinction between great doctoring and great safety. The U. of C. has a reputation for outstanding cancer care. That's likely the reason that Tyree, suffering from stomach cancer and pneumonia, had a relatively good prognosis when he entered the hospital and why his death so shocked his family and friends. But as a wise physician once warned, "Every hospital should have a plaque at its entrance that reads, 'There are some patients whom we cannot help; there are none whom we cannot harm.'"

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Andrew Lopez, RN
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The Epidemic of Preventable Medical Harm, HealthcarePSI.org

The Centers for Disease Control reports that 1.7 million people who enter the hospital this year - for any reason - will contract a Hospital Acquired Infection which is completely unrelated to the condition they entered with, and 99,000 of those patients infected will die within the year. Many thousands more will never fully recover.

The Sepsis Alliance - a physician group studying the condition - states that 215,000 people die each year from sepsis, a blood stream infection. The Alliance also states that half of those deaths could be prevented if hospitals would identify and treat patients in a timely manner.

In November 2010, the Office of the Inspector General released a damning report stating that every month in US hospitals, 15,000 Medicare patients over the age of 65 are killed by preventable medical harm. That's 180,000 needless deaths a year. Another 45,000 Seniors on Medicare are injured every month, but survive their hospitalization.

The three studies above document more than 386,000 preventable deaths a year in US hospitals - and that's only a small glimpse of a problem that has reached epidemic proportions. 

The Institutes of Medicine estimates there are 100,000 documented preventable harm deaths per year, however they also reluctantly admit that only 5%-20% of preventable medical harm incidents are ever documented on patient records. That means their figure is badly underestimated. By how much? You do the math. 

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Monday, March 21, 2011

Education Resources, Association for Professionals in Infection Control and Epidemiology, Inc APIC |

APIC works to provide information to both the general public and healthcare professionals. The brochures on this page are regularly reviewed and updated as needed to insure that the information provided is current. These materials are available for you to download, copy and distribute free of charge.  These pamphlets are intended to provide a general reference to each topic. No brochure can adequately diagnose a medical condition. If in doubt regarding your symptoms, please contact a healthcare professional.

 


  • 10 tips for preventing the spread of infection
  • Los Hechos Sobre Chlamydia
  • Antibiotic Safety
  • Meningococcal Meningitis
  • Chlamydia
  • Mold in Your Home
  • Companion Animals and Your Health
  • Patient Safety - Protecting Yourself from Medical Errors
  • Click on the "via" link for the rest of the article.

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    Monday, March 14, 2011

    Hospitals Could Save Millions By Eliminating Five Hospital-Acquired Conditions

    An average 200-bed hospital could save approximately $2 million annually if it eliminates common but high-cost hospital-acquired conditions among inpatients, according to the Healthcare Management Council, Inc. (HMC), a Needham, MA-based company focusing on hospital and healthcare performance improvement.

    The information was compiled using federal Agency for Healthcare Research and Quality (AHRQ) indicators and recent proprietary cost-benchmarking information, according to Shelley Burns, HMC's director of knowledge management. HMC has reviewed the performance of hundreds of facilities ranging in size from 75 beds to more than 800 beds.

    "The cost of quality is what we call it, but bringing that number [together] for our folks to see lets us align the financial side of the house and the clinical side of the house so they can work together [on this issue]," Burns says

    Click on the "via" link for the rest of the article.

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    Monday, February 28, 2011

    Sponge Count Off, Patient Develops Sepsis, Surgeon Blames Nurse.

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    Summary:  Sponge Counts are a basic and critical safety measure during a surgical operation.  In this case, the standard three counts were not performed.  A sponge was left in the patient that would later lead to infection.  When the issue went to court, the surgeon claimed "it was not his responsibility" to keep track of the sponges.

    The patient was admitted for surgical repair of a hernia.  The operation was performed and the patient returned to the floors without obvious incident.

    "A hernia is a weakness or defect in the abdominal wall. It may be present from birth, or develop over a period of time. If the defect is large enough, abdominal contents such as the bowels, may protrude through the defect causing a lump or bulge felt by the patient. Hernias develop at certain sites which have a natural tendency to be weak; the groin, umbilicus (belly button), and previous surgical incisions."1

    Post-operatively, the patient's incision would not heal.  It would soon after start to display signs of active infection.

    "Postoperative wound infections have an enormous impact on patients' quality of life and contribute substantially to the financial cost of patient care. The potential consequences for patients range from increased pain and care of an open wound to sepsis and even death. Approximately 1 million patients have such wound infections each year in the United States, extending the average hospital stay by one week and increasing the cost of hospitalization by 20 percent."5

    In investigating the situation, it would be found that a sponge had been left in the patient in the Operating Room.  The patient sued both the surgeons and the nurses who had assisted in the procedure.

    "Materials counts are necessary to provide a standard of quality of care for the surgical patient and to provide a method of accounting for items placed on the sterile field for use on a surgical procedure."2

    The patient claimed that substantial negligence on the part of the surgeon and nurses contributed to the sponge being missed and the development of complications.  These complications, the plaintiff asserted, could have been avoided had proper procedure been adhered to.  Specifically, if accurate sponge counts had been maintained and the missing sponge accounted for.

    Questions to be answered:

    1. Who is primarily responsible during an operation to verify sponge counts and prevent one from inadvertently being left in a patient.

    2. What are the explicit responsibilities of the Nurses and Physicians involved.

    For the operation in question, less than a dozen sponges were required.  It was standard policy and procedure for three sponge counts to be performed during the operation.

    Anytime there is a discrepancy, the surgeon is to be notified immediately.  Upon notification, it is his duty to the patient to resolve the discrepancy to the best of his ability.

    "In cases where there is an incorrect sponge count, wound closure absolutely must not be completed (unless the patient is unstable) until the missing sponge is accounted for. The surgeon should not pressure the nursing staff to ignore an incorrect count. If after appropriate steps have been taken to find the missing sponge or instrument and it is unsuccessful, every detail of the search should be documented and the surgery completed."3

    Neither the nurses or the surgeon involved stated that they clearly remember the operation in question.   The nurses' documentation of the event would show that only a single sponge count had been performed.  The hospital policy in effect at the time required three per procedure.

    "The nurses count the unused, sterile sponges and note on a form that sponges were counted.   When the surgeon completes the operation, the nurses do a second count by combining the number of  unused sponges with the number of used sponges that have been removed from the patient.  The total of the unused and used sponges must correspond to the number of sponges originally laid out prior to surgery.

    If the sponge count does not correspond, the surgeon is to be notified by the nurses.  The nurses complete a third count shortly before the surgeon closes the incision.   If nurses fail to account for a sponge, they are to report this directly to the surgeon.  The nurses must note the results of the second and third counts on the same form on which they  noted the initial count."

    The surgeon in his notes would document that a third count had been performed.  He also documented that only after receiving this confirmation from the nurse, did he "close" up the patient.

    Is it plausible that the surgeon simply documented as if by habit, that the third count had been completed?  A nurse documenting her assessment may sometimes by habit write "lungs clear" and "bowel sounds active x 4q."  A moment later it is realized that in fact that was not the case and a correction made.  Could the surgeon have fallen into the same trap?

    Upon discovery of the missed sponge and resulting infection, the surgeon insisted that "counting sponges" was not his responsibility.  He went on to explain how in the body cavities they can become soiled with blood and take on the color of internal viscera.

    It was the surgeon's argument that it was the nurses' responsibility, not his that a proper sponge count be maintained.  The surgeon, not the nurse is the person manipulating the sponges inside the patient's body.  Can the surgeon release himself from responsibility for a sponge left in a patient because he relied on an inadequate sponge count given by a nurse?

    "Counting is the legal responsibility of the surgical team. Each institution must develop a policy and procedure for such counts and should include the delineation of materials counted, interval of counts, mechanism for performing the count , and documentation of the count status on the intraoperative record. The responsibility for accurate sponge counts rests with the circulating and scrub nurses. The operating room nurses are charged with the responsibility to ensure that no foreign objects remain in the body at the conclusion of surgery."

    The standards of care clearly state that if a sponge is missing, the nurse must notify the surgeon.  There's little mystery to the fact that objects "left" inside patient's bodies can have catastrophic effects.

    The question remains, will the surgeon blaming the nurses get "off the hook" because a count was incorrectly reported?

    "While the surgeon may rely on the nurses' sponge counts the surgeon is ultimately responsible and liable for any foreign object left in a patient after surgery. Only x-ray detectable sponges should be utilized. A retained sponge occurs almost always in the presence of a normal sponge count."

    The trial court held, and appeals court confirmed that the surgeon shared in the negligence.  The standard of care governing both the nurses and the physicians respectively had been breached.

    It is quite interesting to observe how quickly the physician sought to "dump" the blame on the nurses.

    The nursing staff by poorly documenting the sponge counts (omitting the 2nd and third) left themselves open to scrutiny.  Had a proper count at least been documented, the surgeon would have had less ground to stand on when blaming the nurses for his mistake. Related Link Sections:

    Sponge Counts, Operating Room Links:

    Sources:

    1. Pleatman, MD, Mark A. No date given.  "Questions and Answers about Hernias."   Retrieved May 23, 1999 from the World Wide Web:  http://www.laparoscopy.com/pleatman/hernia.htm

    2. San Antonio Chapter of AORN.  No date given.  "Counts, Sponge, Needle, Instrument."  Retrieved May 23, 1999 from the World Wide Web: http://www.connecti.com/~remmert/p0008.txt

    3. The Standard of Care. August 1998. "Retained Surgical Foreign Body."  Retrieved May 23, 1999 from the World Wide Web: http://www.standardofcare.com/publications/980801.htm

    4. 38 RRNL 2 (July 1997

    5. Woods, Ronald K.  and Dellinger, E. Patchen. June 1998.  "Current Guidelines for Antibiotic Prophylaxis of Surgical Wounds." Retrieved May 23, 1999 from the World Wide Web: http://www.aafp.org/afp/980600ap/woods.html
     

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    Send comments and mail to Andrew Lopez, RN

    Created on Saturday, May 22, 1999

    Last updated by Andrew Lopez, RN on Monday, February 28, 2011

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    Sunday, February 20, 2011

    Antiseptic baths 'reduce infection risk' | News | Nursing Times

    Using 2% chlorhexidine gluconate cloths for the daily bathing of inpatients, instead of soap and water, reduces the risk of hospital-acquired infections, according to US researchers.

    The study found a 64% decrease in the risk of acquiring either MRSA or Vancomycin-resistant Enterococcus. A group of 7,699 general medical patients were bathed daily by healthcare assistants with CHG antiseptic cloths for the duration of their admission, while a control group of 7,102 patients were bathed with soap and water.

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    Friday, February 18, 2011

    C. Difficile Spreads from Hospital to Community, ACG from MedPage Today

    Clostridium difficile infection has spread from the hospital to the community but has proved manageable thus far, according to data reported here.

    From 1991 to 2005, the incidence of community-acquired C. difficile in Olmsted County, Minn., quadrupled but still remained less common than the hospital-acquired gastrointestinal infection, Sahil Khanna, MD, of the Mayo Clinic in Rochester, Minn., said at the American College of Gastroenterology meeting.

    "Patients with community-acquired C. difficile infection were younger, more likely to be female, and less likely to have severe infections," Khanna observed.

    Epidemiologic studies have shown an increasing incidence of both nosocomial and community-acquired infections. However, few studies have looked at the incidence of community-acquired C. difficile, said Khanna.

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    Sick doctors who work are doing more harm to their patients than good

    Doctors: if you’re sick, don’t go to work.

    The stereotype of doctors is that they go to work, despite whatever symptoms ail them. Calling in sick places strain on colleagues. Especially in residency, where team members are expected to pick up the slack.

    In a recent column, the New York Times’ Pauline Chen discusses the image of self-sacrifice that a sick doctor going to work portrays:

    Hacking, febrile or racked with the sequelae of chronic illnesses, doctors who are sick have continued for generations to see their patients. Although published reports for over a decade have linked patient illnesses like the flu, whooping cough and resistant bacterial infections to sick health care workers, as many as 80 percent of physicians continue to work through their own ailments, even though they would have excused patients in the same condition.

    In today’s age of H1N1 influenza and other assorted public health worries, presenteeism is being looked at. Interestingly,

    researchers in the business world have begun to question this assumption. Instead of focusing on problems incurred by absenteeism, these researchers have analyzed the impact of what’s been called presenteeism, or working despite being ill. And it turns out, at least in early studies, that those employees who choose to go to work sick are expensive. Presenteeism costs companies more than $150 billion a year in lost worker productivity.

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    Friday, February 11, 2011

    Balancing infection control with the patient experience, KevinMD.com

    by Kevin Pho, MD

    Hospitals have recently been stepping up their infection control procedures, in the wake of news about iatrogenic infections afflicting patients when they are admitted.

    Doctors are increasingly wearing a variety of protective garb — gowns, gloves and masks — while seeing patients.

    In an interesting New York Times column, Pauline Chen wonders how this affects the doctor-patient relationship.

    She cites a study from the Annals of Family Medicine, which concluded that,

    fear of contagion among physicians, studies have shown, can compromise the quality of care delivered. When compared with patients not in isolation, those individuals on contact precautions have fewer interactions with clinicians, more delays in care, decreased satisfaction and greater incidences of depression and anxiety. These differences translate into more noninfectious complications like falls and pressure ulcers and an increase of as much at 100 percent in the overall incidence of adverse events.

    Hospitals are in a no-win situation here. On one hand, they have to do all they can to minimize the risk of healthcare-acquired infections, but on the other, doctors need to strive for a closer bond with patients — which protective garb sometimes can impede.

    More research is clearly needed to determine how much protection is actually needed to prevent the spread of infectious disease.

    For instance, Dr. Chen cites studies where,

    researchers at the Medical College of Virginia in Richmond found that the rate of infection was identical whether health care workers wore gowns and gloves with only the patients in isolation or whether they wore only gloves with all patients.

    So there’s some evidence that being overly protective may not necessarily help.

    The key is finding the right balance between infection control and preserving the physician-patient relationship. With rapidly advancing, and sometimes impersonal, technology, combined with the legitimate fear of hospital-acquired contagion, it’s easy to forget about the patient experience during their hospital stay.

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