Tag Archives: health care associated infections

Infection-reduction measures vs. the real world

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The Wall Street Journal‘s Katherine Hobson writes about the recent JAMA study which she says demonstrates that publicly reported infection control measures, including checklists, “don’t actually correlate with post-op infection rates.”

The study was designed to evaluate the six infection control measures tracked by the Surgical Care Improvement Project. Those measures include everything from antibiotics to hair removal and blood glucose levels.

None of those measures correlated with infection rates individually, Hobson writes, but when taken in aggregate things start to look a little better.

Study lead author Jonah Stulberg, a recent graduate of Case Western Reserve University School of Medicine (where the research was conducted) tells the Health Blog that the score is called an “all-or-none” composite, which is like a pass/fail: The hospital gets credit for a particular patient only if all the appropriate measures are taken.

With the statistics out of the way, Hobson addresses the biggest question: Why aren’t these prevention measures making a difference in the real world? The answer, as it always seems to be in these situations, is that life is complicated and human beings aren’t robots.

… there’s a big difference between a practice being proven to be effective in a clinical trial and then developing a measure that tries to estimate how often it’s done and then report it publicly.” Real life is messier, and factors such as surgical skill and hand-washing practices are tougher to measure.

Dale Bratzler, CEO of the Oklahoma Foundation for Medical Quality, tells the Health Blog the results don’t surprise him. Individual process of care measures for things such as heart attack and pneumonia also haven’t been shown to correlate with outcomes, he says.

Outpatient care can lead to more infections

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

With a nod to the established dominance of outpatient surgery, NPR health blogger Scott Hensley explores a recent JAMA study which demonstrates that outpatient, same-day surgery carries with risks of infection that Hensley said were “a lot higher than they should be.”

Random inspections of nearly 70 surgery centers in three states found that two-thirds had at least one significant lapse in controlling infections. One common problem was the use of single-dose medication vials for more than one patient — found in 28 percent of the inspections.

Quite a few stakeholders have thoughts on the study, starting with a companion editorial by surgery professor Philip S. Barie (bio). The relevant trade group has also produced a response, as has HHS Secretary Kathleen Sebelius. Both say about what you might expect. The industry group says that an industrywide infection clampdown and new CMS standards for such activities have helped control the problem in the time since the study’s data was collected, and Sebelius trumpets current and future HHS efforts to avoid as many health-care-associated infections as possible.

outpatient
Taken from an industry group report, this graph shows at a glance exactly why outpatient surgery is such a significant issue.

CDC report includes state data on infections

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

The CDC has released a report detailing health-care-associated infections, specifically central line-associated bloodstream infections.

This is the first such report to include any state-specific information, according to the CDC, though it only includes states that require reporting of CLABSIs to the National Healthcare Safety Network. The CDC expects this to serve as a baseline report to help guide prevention plans and activities.

Peter Pronovost, M.D., who spoke about patient safety and health care associated infections at Health Journalism 2010, was among the participants in a telebriefing about the report. A transcript of that briefing should be available later today.

Pronovost strategy influences Ore. infection data

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Prompted by Peter Pronovost’s keynote speech at Health Journalism 2010, The Oregonian‘s Joe Rojas-Burke has been digging through the data on hospital infection rates to be released in accordance with an Oregon law that went into effect last year. The final statewide reporting date comes later this month, but The Oregonian has early results for 11 local hospitals.

Peter Pronovost, M.D., delivers the keynote speech at Health Journalism 2010. (Photo: Pia Christensen/AHCJ)

Peter Pronovost, M.D., delivers the keynote speech at Health Journalism 2010. (Photo: Pia Christensen/AHCJ)

As part of the story, Rojas-Burke profiled hospitals with particularly low infection rates, especially one which had joined the Stop BSI network championed by Pronovost last month at AHCJ’s conference in Chicago. AHCJ members can see a copy of Pronovost’s presentation here.

The story builds on several things Pronovost shared at the conference, including the program’s background and state-by-state participation statistics.

Related

Other stories and blog posts related to Pronovost’s presentation:

AHCJ members can read more stories from the conference

Transmitter tracks health-care workers’ washing

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Despite constant reminders and a high-level of industrywide awareness, studies indicate that less than half of American health care workers wash their hands as frequently as they ought to. This contributes to the health-care-associated infections that kill tens of thousands annually. Now, NPR’s Gigi Douban reports, one Alabama hospital has resorted to high-tech monitoring devices to keep tabs on the handwashing practices of its employees.

washing
Photo by Arlington County via Flickr.

Workers wear a special wireless transmitter, from which, Douban writes, “the hospital can tell when she entered a patient’s room, whether she washed her hands and whether she washed again on the way out. The information is sent to hospital officials, including the CEO.”

“If they’re habitually not complying, we can send them an e-mail or send them a text message, something that goes to them personally,” says Harvey Nix, CEO of Proventix, the company that developed the monitoring system at Baptist Princeton.

According to Douban, the CDC is currently investigating the effects of the technology upon the behavior of health workers.

Hearst project looks at toll of medical mistakes

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

A team of reporters from Hearst news organizations across the country contributed to “Dead by Mistake,” a broad investigation into deaths caused by “preventable medical injuries,” of which the reporters estimate there are almost “200,000 per year in the United States.” A decade after a federal report challenged the medical community to halve the accidental death rate, the toll taken by medical mistakes has instead increased even further, the Hearst reporters found. Furthermore, reporters found that “the medical community, the federal government and most states have overwhelmingly failed to take the effective steps outlined in the report a decade ago.”

According to the report, the American Medical Association and American Hospital Association are partly to blame, as they have opposed any mandatory reporting of medical accident. Even in the 20 states that have implemented mandatory reporting rules, research indicates that only a small fraction of accidents are actually reported. Despite this “chaotic, dysfunctional patchwork,” the Obama administration is not supporting national mandatory reporting.

Cathleen Crowley and Eric Nalder’s centerpiece, which focuses on hospital reporting of mistakes, is an informative read for anyone interested in the availability of hospital safety data on national and local levels, both now and in the future.

The package as a whole includes local stories for Hearst markets including California, Texas, Washington, Connecticut and New York as well as a number of in-depth anecdotes and stories with a national scope.

Editor Phil Bronstein explains how the project was reported, including compiling and analyzing nine databases and conducting hundreds of interviews. The cross-platform project involved journalists from print, television reporters and the Web. BayNewser has a Q&A with Bronstein about how the project was done.