Posts Tagged ‘infection control’

Can Copper Surfaces and Duct Tape Reduce Hospital Infections and Deaths?

Thursday, July 7th, 2011

Image from medgadget.com

How many times have you heard about someone entering the hospital healthy, or relatively so, and developing a dangerous infection while hospitalized? What about the number of times that you may have visited your own doctor’s office or your child’s pediatrician’s office and wondered whether the cold you got a few days later was coincidence or the result of having been in the waiting and exam rooms following other sick patients? Have you ever considered what cleaning procedures are done in hospital rooms when one patient is discharged before another takes their place?

In the past, Brian Nash and the other legal bloggers here at Eye Opener have written posts and made mention of the importance of hospital cleanliness and sterility, see the related posts below. We have been involved in cases involving the devastating results of infections. However, everyone knows that there are going to be germs in hospitals. Even the best hospitals have to work to keep the patients, rooms and visitors clean and safe.

Well, there is news that may make keeping hospitals and other health care environments less germy in the future. Two recent articles have focused on seemingly simple solutions, copper and duct tape, that may have major impacts on infection control.

Copper Surfaces Dramatically Reduce Infections by Killing Bacteria

A Reuters’ article reports that a recent study “presented at the World Health Organization’s 1st International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland” shows that “replacing the most heavily contaminated touch surfaces in ICUs with antimicrobial copper will control bacteria growth and cut down on infection rates.” According to the Reuters’ article:

[a]ntimicrobial copper surfaces in intensive care units (ICU) kill 97 percent of bacteria that can cause hospital-acquired infections, according to preliminary results of a multisite clinical trial in the United States. The results also showed a 40 percent reduction in the risk of acquiring an infection.

This news could have a profound impact on health-care costs, disease spread, and most importantly lives lost. If hospitals are able to replace some of their current surfaces with copper surfaces, at least in the parts of the hospital that are most frequently the source of infections, there could be a dramatic improvement in hospital-acquired infections.

Hospital-acquired infections (HAIs) are the fourth leading cause of death in the United States behind heart disease, strokes and cancer.

According to estimates provided by the Centers of Disease Control and Prevention, nearly one in every 20 hospitalized U.S. patients acquires an HAI, resulting in 100,000 lives lost each year.

From Reuters

Perhaps even more infections could be prevented if these changes could be made outside of just ICUs. For instance, perhaps copper surfaces could replace highly touched surfaces on sink handles, the doors to hospital rooms, hospital bed rails, or in out-patient surgery centers and long-term care facilities that are not housed within hospitals.

Duct Tape Warnings Keep Others Far Enough Away from Infected Patients

Image from ducttapesales.com

An article from Medicalnewstoday reports that some hospitals are using plain duct tape – just colored red – to achieve a reduction in infection rates from highly infectious patients without having to deal with the hassle and expense of all visitors or hospital personnel who enter the room having to rescrub and use new gowns every time they enter the room of an infected patient. The study looked at highly infectious diseases like C. diff that require isolation of patients and very careful hand washing to avoid spreading the infection. So how does duct tape help?

The Association for Professionals in Infection Control and Epidemiology (APIC) commissioned a study to corner off a three foot perimeter around the bed of patients in isolation. Medical personnel could enter the room unprotected if they stayed outside the perimeter. Direct patient contact or presence inside the perimeter meant a redo of the cleansing process. The concept, called “Red Box” employs red duct tape, a color used as it provides a strong visual reminder to those who enter the room to be aware.

The study found that 33% of all who entered the rooms could do so without the addition of gowns and gloves, saving the environment, hospital and patient costs, and time without compromising the patient or the medical personnel.

From Medicalnewstoday

How Else Can We Reduce Infections?

What ideas do you have for the use of copper surfaces? Do you think that copper surfaces or duct tape could make a dramatic difference in the safety of hospital admission? What about the cost? Do you think that hospitals would pay the upfront costs of replacing surfaces with copper to be able to dramatically cut infection rates? What about other low cost solutions like duct-tape around the perimeter of the bed? Can you think of other low-cost solutions that could minimize infections and maximize safety?

Related Posts:

New federal study finds ‘lax infection control’ at same-day surgery centers

FDA warning to healthcare professionals: use sterile prep pads!

Summer Vacation Checklist: Add Vaccination to Your List!

Monday, May 30th, 2011

Photo from guardian.co.uk

Ahhh, summer vacation is coming. Passport? Airline tickets? Three 1oz containers? Zipper-lock bag? Sunblock? Camera? Vaccination status?

Summer is typically the busiest time for vacationers to explore new territories, or even old ones. Granted, the economy has replaced some travelers’ grand plans with much more modest ones, but many are still planning trips to Mexico and other foreign destinations. The summer is also a big time for missionary groups to head to underserved areas to provide assistance and medical care. The events of September 11th have forever changed travel for the United States and countries all over the world. There is now a new concern…..your vaccination status!

According to the Centers for Disease Control, the United States is experiencing its largest outbreak of measles in 15 years! USA Today reported a record 118 cases of confirmed measles in the USA between January 1 and May 20 of this year, mostly acquired abroad by unvaccinated individuals and brought back to the States. Measles was reported to have been “eradicated” from the USA as of the year 2000 due mostly to the efforts of immunization, but measles is still prevalent in other parts of the world.

Over 42,000 cases were diagnosed in an outbreak among young adults in Brazil in 1997! Third-world countries are not the only ones affected; over 7,500 cases have been diagnosed in France between January and March of this year, according to the CDC! And the outbreaks continue across most countries of Europe. Failure to vaccinate and receive periodic “booster shots” to provide immunity allows the virus to infect that individual who then gets sick. Since the virus is spread via respiratory droplets (coughing and sneezing), public modes of transportation allow for contact with infected individuals.

Measles is NOT just a rash!

According to the Associated Press, 2 of every 5 of these 118 patients required hospitalization; none died, but measles can have deadly consequences. Worldwide, measles causes nearly 800,000 deaths annually, mostly in small children. Some of the bad consequences include encephalitis characterized by vomiting, seizures, coma and even death; of those who survive this, approximately one-third are left with permanent neurologic deficits.

Once the spots are gone…

Interestingly, there is a late complication of measles infection, called subacute sclerosing panencephalitis (SSPE), that occurs from 5 to 15 years after the acute infection; the virus causes a slow degeneration of the brain and central nervous system long after the initial infection. Measles can also cause bronchiolitis or bronchopneumonia, and it can be associated with secondary bacterial infections due to the depleted immune system that occurs while fighting the virus.

Measles is NOT the only vaccine-preventable disease available for infection!

There have been recent outbreaks of mumps, another viral disease that has potential complications of pancreatitis, orchitis and even meningitis and encephalitis.

There have been outbreaks of Bordetella pertussis (part of the DPT vaccine), otherwise known as “whooping cough.” Pertussis can severely affect young children under 2 years, but it affects adults as well. Since the vaccine does not impart lifelong immunity, adults become a reservoir for this disease, unless a booster shot is given, and the adults spread the disease to unvaccinated children.

Haemophilus influenza type B, known as HIB, can cause typical cases of upper respiratory infections, sinusitis and otitis media (common ear infection); it can also cause epiglottitis, a potentially fatal infection of the epiglottis. The epiglottis is a flap of tissue that acts like a valve, protecting our airway when we eat and swallow food. This “valve” swells up so large from the infection that it can totally obstruct the airway and prevent a child from breathing; it is a medical emergency that can require emergent tracheostomy! An HIB vaccine has been available for years, and this infectious culprit had nearly been eradicated, as well, in the USA. The anti-vaccine movement has produced many children, adolescents and even young adults who have never received this vaccine  - et voila….there is a resurgence of HIB and Haemophilus epiglottitis.

Hepatitis B is a virus (HBV) for which a vaccine has also been available for over 20 years. It is a 3-shot regimen, but it also requires that titers be drawn after vaccination to prove immunity. HBV can be transmitted through sexual contact or any exchange of body fluids, including contaminated food in rare instances. Although the human body can fight some cases of HBV, other cases become chronic and lead to liver failure and/or liver cancer. Wouldn’t you know it? May is “Hepatitis Awareness Month” for the CDC!

There are plenty more vaccines available for a multitude of viral, bacterial and other infectious agents. Additionally, there are immunoglobulin shots that can address other infectious conditions and act as prophylaxis during your time abroad.

The Moral of the Story

Check your own vaccination status first. If you are not sure, your doctor can do blood tests to determine if you are immune to specific infectious agents…even the chicken pox virus! Secondly, take the time to check the CDC website (www.cdc.gov) for infections endemic to the area to which you are traveling. Follow guidelines offered for disease prevention and possible vaccines, medications or immunoglobulins available.

Be aware and be prepared! Protect yourself and those near and dear to you!

 

FDA warning to healthcare professionals: use sterile prep pads!

Tuesday, February 8th, 2011

Sterile Prep Pads

On February 1, 2011, the FDA issues a News Release about the use of non-sterile alcohol prep pads in certain clinical situations.

“Non-sterile pads are not intended to prep patients prior to procedures requiring strict sterility measures and should not be used on patients with a depressed immune system, to prep patients for catheter insertion, or to prep patients prior to surgery.”

This reminder/warning was issued in the wake of a recall on January 5th of all lots of alcohol prep pads and swabs manufactured by The Triad Group of Hartland, Wisconsin citing concerns about the product’s potential contamination with Bacillus cereus, a bacterium that can be harmful to humans.

While I guess we all need reminders now and then, do healthcare professionals really use non-sterile pads for pre-procedure prep when sterile technique is called for? Isn’t this basic training?

We have heard over and over again about the problems with infection control in medical facilities. Isn’t this a basic way to improve infection control – using sterile prep pads when doing open or penetrating skin procedures? Oh my!

While we in law deal with the end-result of failures to use “sterile techniques” – including the basic concept of using sterile pads - is this really such a problem in the healthcare industry that the FDA needs to remind providers to use the right kind of pad?

A number of our readers are members of the healthcare profession. Tell us – please, is this really a problem in the industry? Are there not basic protocol, stock control, safety measures in place that deal with this apparent problem? The rest of our readers either have been a patient or have a family member who’s been a patient; have you ever encountered a problem with an infection because your provider used the wrong type of prep pad?

Image from dailymed.nlm.nih.gov

Sepsis – Simple steps in ER saves lives

Thursday, October 7th, 2010

Following summer headlines citing extensive hospital deficiencies in screening a fatal illness known as sepsis, there is some good news out of Kaiser Permanente this week.

Sepsis as defined by Wikipedia as a serious medical condition affecting the whole body. As we know, it can even be fatal. Sepsis is caused when a harmful infectious organism invades the body. Invasion can occur through the blood, urine, lungs, skin, or body tissue. The body reacts with an inflammatory response that is characterized by fever or low body temperature, low blood pressure, and an increasing high white blood cell count.  In earlier times the condition was commonly called “blood poisoning”.

As the patient becomes sicker, the body becomes overwhelmed by an acid called lactate acid. It is formed as a result of lowered oxygen to organs and tissue resulting in a condition known as lactic acidosis. As the condition progresses, the body eventually can not overcome the acidosis and low tissue oxygen perfusion. Death ensues often despite aggressive medical treatment.

Kaiser reported 17 participating hospitals in Northern California began using a 6-step diagnostic and treatment tool known as a “sepsis bundle” in 2008 to rapidly diagnose and treat sepsis. Using this new tool and computerized medical records, Kaiser found the patient death rate improved significantly from 25% to 11%, the patients’ hospital stays were 3 days shorter, and $36 million was saved.

However, just the day before Kaiser released their data, another article in FierceHealthcare – daily news for healthcare executives - listed infections add an average 19 days to a hospital stay with a cost per patient of $43,000. This study was published by the Agency for Healthcare Research and Quality who concluded that 12% of all infections were classified as sepsis. Two months ago, Fierce Healthcare reported excerpts from new research published in the Archives of Surgery by a surgeon named Laura Moore practicing at Houston’s Methodist Hospital. Dr. Moore performed a retrospective review of 364,000 general surgery patients registered in the American College Of  Surgeons National Surgical Quality Improvement Database. Sepsis occurred in 2.3% totaling 8,372 patients.  She also wrote mortality from sepsis has doubled in the last 20 years. Sepsis is the leading cause of death in general surgery ICU’s.

In December 2008, the European Society of Critical Care Medicine, the International Sepsis Forum, and the Society of Critical Care Medicine launched the Surviving Sepsis Campaign. Sepsis is estimated to kill 1,400 people worldwide each day. Mortality rates from severe sepsis are rated as high as lung, breast, and colon cancer. The campaign wrote severe sepsis is expected to grow at 1.5 % annually with an additional 1 million cases per year in the USA by 2020. The campaign sited the cause for this is due to the aging population and increasing invasive medical procedures. HIV and cancer rates are increasing, which will also impact severe sepsis rates.

Sepsis varies greatly in its progression and symptoms seen in each patient. This makes early diagnosis and treatment challenging for even the best ICU physicians. Symptoms such as fever, rapid pulse rate, and respiratory difficulty are commonly seen in a host of other medical conditions. Obtaining an accurate diagnosis can take precious time. In an effort to improve the diagnosis and survival rates, the campaign challenged to USA hospitals to adopt and implement a “sepsis bundle” program and begin reducing mortality by 25% over the next 5 years.

So what is a sepsis bundle? The Surviving Sepsis Campaign chose medical therapies called “elements” designed to give physicians worldwide a framework to standardize sepsis practices. Their specific intent was to reduce the chaotic approaches seen in many clinical settings. The campaign founders consolidated world medical care data and practices that had shown clear positive impact on outcomes. They challenged critical care physicians to choose a grouping of these elements based on their patient population. Next,  physicians were to apply their individualized “sepsis treatment bundle” and  study the outcomes by using the campaign’s measurement database. By choosing to delete an element(s), the hospital would be classified as non-compliant and their performance data would likely show poorer outcomes.

In the sepsis resuscitation bundle, there were 5 critical elements. In the sepsis management bundle there were 4 elements.  So neither bundle is too complicated or intricate to put into medical practice. Now two years later, those early hospitals that accepted the challenge and implemented a sepsis bundle program are publishing their success data. Another fine example was published by Barry Evans, RN, MSN, Adult Critical Care Data Coordinator at the University of Rochester/Strong Health.

Kudos to Kaiser Permanente California, Strong Health, and all the other critical care services who accepted the 2008 challenge for US patients and are making it happen. Can’t wait to see the campaign’s worldwide end data in 2013!