June 19, 2012
Background: Mitigating or reducing the risk of harm associated with the delivery of healthcare is a policy priority. While the risk of harm can be reduced in some instances (i.e. preventable), what constitutes preventable harm remains unclear. A standardized and clear definition of preventable harm is the first step towards safer and more efficient healthcare delivery system. We aimed to summarize the definitions of preventable harm and its conceptualization in healthcare.
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April 10, 2012
“Background: Clostridium difficile infection (CDI) is a common and sometimes fatal health-care–associated infection; the incidence, deaths, and excess health-care costs resulting from CDIs in hospitalized patients are all at historic highs. Meanwhile, the contribution of nonhospital health-care exposures to the overall burden of CDI, and the ability of programs to prevent CDIs by implementing CDC recommendations across a range of hospitals, have not been demonstrated previously.
Methods: Population-based data from the Emerging Infections Program were analyzed by location and antecedent health-care exposures. Present-on-admission and hospital-onset, laboratory-identified CDIs reported to the National Healthcare Safety Network (NHSN) were analyzed. Rates of hospital-onset CDIs were compared between two 8-month periods near the beginning and end of three CDI prevention programs that focused primarily on measures to prevent intrahospital transmission of C. difficile in three states (Illinois, Massachusetts, and New York).
Results: Among CDIs identified in Emerging Infections Program data in 2010, 94% were associated with receiving health care; of these, 75% had onset among persons not currently hospitalized, including recently discharged patients, outpatients, and nursing home residents. Among CDIs reported to NHSN in 2010, 52% were already present on hospital admission, although they were largely health-care related. The pooled CDI rate declined 20% among 71 hospitals participating in the CDI prevention programs.
Conclusions: Nearly all CDIs are related to various health-care settings where predisposing antibiotics are prescribed and C. difficile transmission occurs. Hospital-onset CDIs were prevented through an emphasis on infection control.
Implications for Public Health: More needs to be done to prevent CDIs; major reductions will require antibiotic stewardship along with infection control applied to nursing homes and ambulatory-care settings as well as hospitals. State health departments and partner organizations have shown leadership in preventing CDIs in hospitals and can prevent more CDIs by extending their programs to cover other health-care settings.”
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March 30, 2012
“Overview: Antibiotic resistance development is a natural process of adaption leading to a limited lifespan of antibiotics. Unnecessary and inappropriate use of antibiotics favours the emergence and spread of resistant bacteria. A crisis has been building up over decades, so that today common and life-threatening infections are becoming difficult or even impossible to treat. It is time to take much stronger action worldwide to avert an ever increasing health and economic burden. A new WHO publication “The evolving threat of antimicrobial resistance – Options for action” describes examples of policy activities that have addressed AMR in different parts of the world. The aim is to raise awareness and to stimulate further coordinated efforts.”
Posted in READ Portal, Reports & Papers | Tagged with Infection control, Prevention and control | No Comments
March 26, 2012
“The health of hospitalized Canadians and their visitors is being seriously put at risk by hospitals that have cut corners in cleaning budgets to save money, a Marketplace investigation has revealed.
The program took hidden cameras inside 11 hospitals in Ontario and British Columbia. What they found in many of them were surprisingly inadequate cleaning regimens – in short, dirty hospitals that could make you sick…
The program talked to cleaners, supervisors, nurses, doctors, and hospital administrators to get a handle on what has become a major problem at Canadian health-care facilities – a shocking number of hospital-acquired infections.”
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March 19, 2012
“Putting Health in context: What is health? For some, health means the absence of disease and pain; for others, it is a general feeling of wellness. The World Health Organization (WHO) defines health more broadly: ‘the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’
This broad definition aligns with the Conference Board’s overarching goal in benchmarking Canada’s performance—to measure quality of life in Canada and in its peer countries. Most Canadians would agree that without health, quality of life is severely compromised.
How do we measure health performance?: To measure health performance, we evaluate Canada and 16 peer countries on the following 11 report card indicators: life expectancy; self-reported health status; premature mortality; mortality due to cancer; mortality due to circulatory disease; mortality due to respiratory disease; mortality due to diabetes; mortality due to diseases of the musculoskeletal system; mortality due to mental disorders; infant mortality; and mortality due to medical misadventures.
It is important to note that the Conference Board is not attempting to rate Canada’s health care system. Although the health care system has an impact on the health status of a population, our goal is to evaluate the health status of Canadians and of their peers in other countries.
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March 16, 2012
This article examines the impact of workload imbalance on healthcare providers. Specifically, it looks at the “repercussions of a patient census that is either too high or too low for a hospitalist service.” Further, “Ellis Knight, MD, MBA, FHM, senior vice president for physician and clinical integration at Palmetto Health in Columbia, S.C., recalls conducting root cause analyses after every serious adverse event when he was vice president for medical affairs at a large teaching hospital. ‘For every one of them—it was just like a broken record—every one of them, the nursing staff or the physicians involved would start the recount by saying, ‘It was a very, very busy day; we had a very high census,’’ Dr. Knight says. ‘When that happens, when you get those, what I call tsunami waves of patients coming into a unit or being admitted at one time, it can really wreak havoc and it can make even the best clinicians get rushed, take shortcuts, and make mistakes.'”
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February 22, 2012
“Background and objective: Wearing of gloves reduces transmission of organisms by healthcare workers’ hands but is not a substitute for hand hygiene. Results of previous studies have varied as to whether hand hygiene is worse when gloves are worn. Most studies have been small and used nonstandardized assessments of glove use and hand hygiene. We sought to observe whether gloves were worn when appropriate and whether hand hygiene compliance differed when gloves were worn.
Participants and setting: Healthcare workers in 56 medical or care of the elderly wards and intensive care units in 15 hospitals across England and Wales.
Methods: We observed hand hygiene and glove usage (7,578 moments for hand hygiene) during 249 one-hour sessions. Observers also recorded whether gloves were or were not worn for individual contacts.
Results: Gloves were used in 1,983 (26.2%) of the 7,578 moments for hand hygiene and in 551 (16.7%) of 3,292 low-risk contacts; gloves were not used in 141 (21.1%) of 669 high-risk contacts. The rate of hand hygiene compliance with glove use was 41.4% (415 of 1,002 moments), and the rate without glove use was 50.0% (1,344 of 2,686 moments). After adjusting for ward, healthcare worker type, contact risk level, and whether the hand hygiene opportunity occurred before or after a patient contact, glove use was strongly associated with lower levels of hand hygiene (adjusted odds ratio, 0.65 [95% confidence interval, 0.54–0.79]; P ! .0001).
Conclusion: The rate of glove usage is lower than previously reported. Gloves are often worn when not indicated and vice versa. The rate of compliance with hand hygiene was significantly lower when gloves were worn. Hand hygiene campaigns should consider placing greater emphasis on the World Health Organization indications for gloving and associated hand hygiene.”
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February 21, 2012
“Introduction: The role of ICU design and particularly single-patient rooms in decreasing bacterial transmission between ICU patients has been debated. A recent change in our ICU allowed further investigation.
Methods: Pre-move ICU-A and pre-move ICU-B were open-plan units. In March 2007, ICU-A moved to singlepatient rooms (post-move ICU-A). ICU-B remained unchanged (post-move ICU-B). The same physicians cover both ICUs. Cultures of specified resistant organisms in surveillance or clinical cultures from consecutive patients staying >48 hours were compared for the different ICUs and periods to assess the effect of ICU design on acquisition of resistant organisms.
Results: Data were collected for 62, 62, 44 and 39 patients from pre-move ICU-A, post-move ICU-A, pre-move ICUB and post-move ICU-B, respectively. Fewer post-move ICU-A patients acquired resistant organisms (3/62, 5%) compared with post-move ICU-B patients (7/39, 18%; P = 0.043, P = 0.011 using survival analysis) or pre-move ICUA patients (14/62, 23%; P = 0.004, P = 0.012 on survival analysis). Only the admission period was significant for acquisition of resistant organisms comparing pre-move ICU-A with post-move ICU-A (hazard ratio = 5.18, 95% confidence interval = 1.03 to 16.06; P = 0.025). More antibiotic-free days were recorded in post-move ICU-A (median = 3, interquartile range = 0 to 5) versus post-move ICU-B (median = 0, interquartile range = 0 to 4; P = 0.070) or pre-move ICU-A (median = 0, interquartile range = 0 to 4; P = 0.017). Adequate hand hygiene was observed on 140/242 (58%) occasions in post-move ICU-A versus 23/66 (35%) occasions in post-move ICU-B (P < 0.001).
Conclusions: Improved ICU design, and particularly use of single-patient rooms, decreases acquisition of resistant bacteria and antibiotic use. This observation should be considered in future ICU design.”
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February 14, 2012
“The ultimate goal of this study was to help providers of healthcare within Pennsylvania acute care hospitals find solutions to the ever-present problem of the occurrence of medical errors. Scholarly literature states that the majority of medical errors occur due to systems that breakdown and fail healthcare workers. This study sought to provide new knowledge in regard to where one particular system may be breaking down, specifically the error reporting system. The purpose of this study was twofold; 1) to develop two structured interview questionnaires, and 2) to conduct structured interviews as a means to collect data that focused on the occurrence of medical errors; specifically through assessing the error reporting systems within a sample of Pennsylvania acute care hospitals.
This researcher investigates the procedures taken by healthcare administrators within Pennsylvania acute care hospitals with respect to the detection of medical errors in order to provide corrective measures. In response to structured interview questions, the overwhelming majority of research participants stated that the procedures for corrective actions focused upon various training interventions as deemed appropriate by management. However, scholarly literature states that the majority of medical errors do not occur due to the lack of competence, skills, or knowledge of healthcare professionals. Thus, using training interventions to solve non-training problems may not prove effective. The outcome of the study has lead to several important implications for the healthcare industry.”
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February 8, 2012
“There is a simple and effective way of getting hospital workers to wash their hands consistently: Watch them wash, and then congratulate them for having done so.
Employees at a Long Island hospital installed cameras with views of every hand-washing sink and hand sanitizer in an intensive care unit. For 16 weeks, without collecting identifying personal information, they monitored workers as they entered and left patient rooms. The results were reported last month in the journal Clinical Infectious Diseases.”
To read the the rest of the article visit the New York Times website. To read the original study go to the journal Clinical Infectious Diseases. As this is a subscription resource, contact your institution’s librarian for information on how to access it. The full citation is:
Armellino, D., Hussain, E., Schilling, M.E., Senicola, W., Eichorn, A., Dlugacz., & Barber, B.F. (2012). Using High-Technology to Enforce Low-Technology Safety Measures: The Use of Third-party Remote Video Auditing and Real-time Feedback in Healthcare. Clinical Infectious Disease, 54(1). Available from http://cid.oxfordjournals.org/content/54/1/1.abstract.
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