Just as the evidence of low overall compliance is consistent with previous research, so is the finding of lower compliance rates among physicians than among nurses.
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With the pool of nurses typically made up of a larger proportion of women and the pool of physicians made up of a greater proportion of men, the discrepancy might be gender-related, Dr. Doron suggested. Doron said. Hand-hygiene campaigns can help address the problem, but can also suffer from their own success as a sense of urgency wanes, Dr.
Doron noted. That occurred eight times in the state during the month time period, including four times at Yale-New Haven Hospital, CMS data shows. Connecticut hospitals also collectively saw higher rates of catheter-related blood and urinary tract infections, as well as poor control of blood sugar for patients with diabetes.
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In-state medical providers had rates below the national average for conditions including patient falls, blood incompatibility, air embolisms, and pressure ulcers. On an individual basis, many local hospitals rates lagged the national average. Hospital officials have raised red flags about the data, questioning its relevancy and accuracy, but most agree transparency is a good thing. They also have a financial incentive to reduce or eliminate the number of hospital acquired conditions, or HACs, that occur within their facilities. Medicare and private insurance companies including Aetna are reducing or eliminating payments to medical care providers that make certain preventable errors.
Although not every HAC represents a medical error, some do putting pressure on hospitals to improve quality, or risk losing revenue. Jamie Roche, senior vice president for patient safety and quality at Hartford Hospital. Besides the potential harm to patients, medical errors add to the cost of health care, accounting for 2. Roche said many hospitals are using evidence-based medicine to improve care quality and reduce costs.
And a lot of the improvements are being driven by new technology and data tracking, which is helping to pinpoint problem areas. One area Hartford Hospital has been working to improve is its hospital acquired bloodstream infections. According to CMS data, out of 22, patient discharges from October to June , Hartford Hospital experienced 14 vascular catheter-associated infections, for a rate of 0.
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The national average during that time period was a rate of 0. By promoting better collaboration among all the players involved with the insertion, maintenance and withdrawal of a central line, and adopting a checklist to ensure proper evidence-based procedures are followed, the hospital has reduced those infections by a factor of six over the past two and a half years, Roche said.
Yale-New Haven Hospital experienced a higher than average rate per 1, patient discharges of hospital acquired conditions in five of the eight categories tracked by CMS. Out of 24, discharges, the hospital experienced 17 patient falls, 32 vascular catheter-associated infections and 17 catheter-associated urinary tract infections, CMS data shows. Thomas J. Balcezak, vice president of performance management and associate chief of staff at Yale-New Haven Hospital, said he thought the numbers appear to be overinflated but he still believes the hospital needs to improve its performance.
Regardless, the need to avoid hospital acquired conditions is something that is universally accepted among payers and providers in order to improve the quality of care and reduce costs. The Society for Healthcare Epidemiologists of America has long been a proponent of working toward the elimination of HAIs, and the launch of this partnership represents an opportunity for healthcare workers at every level, healthcare institutions and patients alike to join in this effort. The costs associated with not addressing HAIs and their causes are dire. With estimates as high as 2 million Americans contracting an infection during hospitalization and nearly , dying annually, the elimination of HAIs should be one of our highest national health priorities.
Headline-making HAIs caused by resistant germs such as methicillin-resistant staphylococcus aureus and clostridium difficile, along with many others as serious, are extremely difficult to treat and can be deadly. The overuse and misuse of antibiotics are the root causes of highly resistant organisms and by failing to address this problem, we leave ourselves and our patients vulnerable to disease, death, higher healthcare costs and at the mercy of fewer treatment options.
Increasing drug resistance and the failure of society to keep pace with antibiotic development pose the threat of a return to the pre-antibiotic era of the past century. Now that the Obama administration has focused the attention of those of us working within the healthcare system, as well as the public, on improving patient safety in a collaborative and coordinated way, how exactly do we go about doing so, and what specifically should we focus on in order to achieve results?
The answers lie in applying what we know now and in learning more about the problems we face.
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First, we must adhere to proven practices for infection prevention. Hand hygiene, isolation precautions and the guidelines promulgated by SHEA, the Centers for Disease Control and Prevention and other professional societies serve as the foundation of our current efforts. However, these tools are necessary but insufficient in our current battle against HAIs. We must invest in the medical research and technology that will enable us to identify how our healthcare system can avoid the errors leading to HAIs.
Unfortunately, despite the fact that HAIs are among the top 10 causes of death in the U. We are in desperate need of deeper levels of understanding regarding the epidemiology, pathogenesis and prevention of these infections. The only way to address these gaps is through broad and multifaceted research. The launch of the Partnership for Patients, along with recent public and legislative interest in reducing rates of HAIs, are signs of an encouraging momentum needed to address and answer important research questions about these infections.
Current levels of research funding for HAIs will be inadequate to advance the cause of elimination. Finally, we must enhance our surveillance networks, a critical factor in the detection and control of infectious diseases. A prime example of the need for such a mechanism is a recent study of an extremely antibiotic-resistant bacterium known as carbapenem-resistant Klebsiella pneumoniae in Los Angeles. Last spring, the L. County Department of Public Health voluntarily chose to monitor for this bacterium in its hospitals and nursing homes, despite the widely held belief that the infection was limited to the East Coast.
Through the use of mandatory lab reporting of CRKP when found during testing, county officials discovered startlingly high rates of the germ, particularly in long-term acute-care hospitals. County health officials are to be commended not only for monitoring and reporting the presence of CRKP, but for providing such a lucid example of the critical importance of such action. Had a national surveillance network to identify such infections been in place, CRKP may have been kept in check when it was first discovered in the New York-New Jersey area almost 10 years ago.
Partnership for Patients is a commendable effort that is encouraging to those of us in the field of epidemiology who are dedicated to working toward the elimination of HAIs. Achieving that goal will require the collaboration of health professionals, patient engagement and dedication of resources that are described in the plan.
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One of the things that epidemiology has taught us is that implementing changes and improvements to the healthcare system without understanding and advancing the science behind those changes would have dire consequences. Not only would we fall short of the worthy goals of improving patient safety, ensuring high-quality care and reducing medical costs, but we would leave ourselves poorly equipped to face the emerging threats that lie ahead. Neil Fishman is associated chief medical officer of the system. Both are past presidents of the Society for Healthcare Epidemiology of America.
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Classen dclassen csc. Frances Griffin is a faculty member at the Institute for Healthcare Improvement.
Frank Federico is an executive director at the Institute for Healthcare Improvement. Terri Frankel is a director at the Institute for Healthcare Improvement. John C. Whittington is a senior fellow at the Institute for Healthcare Improvement. Brent C. Identification and measurement of adverse medical events is central to patient safety, forming a foundation for accountability, prioritizing problems to work on, generating ideas for safer care, and testing which interventions work.
We compared three methods to detect adverse events in hospitalized patients, using the same patient sample set from three leading hospitals. Overall, adverse events occurred in one-third of hospital admissions. Reliance on voluntary reporting and the Patient Safety Indicators could produce misleading conclusions about the current safety of care in the US health care system and misdirect efforts to improve patient safety.
May 26, Dallas, Texas — Feedback based on psychological theories improves hand hygiene compliance among healthcare workers, according to a study presented here at the Society for Healthcare Epidemiology of America 20th Annual Scientific Meeting. Research has shown that feedback helps healthcare workers follow guidelines, and that hand hygiene interventions must be repeated regularly to be effective. Most existing studies of hand hygiene interventions involve small samples and short time periods, and few use psychological theories in the design of interventions. The researchers conducted a 3-year randomized controlled trial of a feedback intervention designed from psychological theory.
The study took place between October and December at 60 wards — 16 intensive treatment units ITUs and 44 acute care of the elderly ACE wards — in 16 English and Welsh hospitals. An intention-to-treat analysis revealed an increase in the odds ratio OR for hand hygiene compliance in ITUs 1. In ITUs, the degree to which the intervention was followed tracked with compliance OR for compliance, 1. The study lends more credence to the long-held belief that psychology-based feedback could improve hand hygiene compliance. Srinivasan believes the results could be transferable to other institutions.
They really did work in a real-world setting. The study did not receive commercial support. Stone and Dr.