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SURGICAL SUITES: Guidelines on best practices to prevent surgical site infections

The number of unresolved issues in this guideline reveals substantial gaps that warrant future research.” (page E6)

Best practices in avoiding surgical site infections were studied by the Centers for Disease Control and Prevention with the assistance of the Healthcare Infection Control Practices Advisory Committee.  This guideline is based on the full text review of nearly 900 journal articles and studies.  The guideline is organized according to specific surgical practices – for example the efficacy of wearing a space suit during orthopedic surgery – and assigns each practice a rating on a continuum as to whether the practice is highly recommended, unresolved, or somewhere in between.  The rating on the space suits, for instance, is that it is unresolved.

Source: Berrios-Torres, S.I., and others. (2017, May 3). Centers for Disease Control and Prevention guideline for the prevention of surgical site infection 2017. JAMA Surgery. Click here: http://jamanetwork.com/journals/jamasurgery/fullarticle/2623725  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

MRSA: 1.2 percent of hospital stays in California (2013)

In 2013, there were over 3.1 million inpatient stays in California hospitals, according to the California State Inpatient Database – which includes information on patients of all ages.  This study examines characteristics of those patients who had a hospital stay associated with Methicillin-resistant Staphylococcus aureas (MRSA).  Here are some of the findings:

  • 1.2 percent of California hospital stays involved MRSA
  • 1 in 100 California hospital stays involved MRSA
  • Over 40 percent of the MRSA was associated with cellulitis or skin ulcers
  • Only 8 percent of hospitalized patients with MRSA acquired their MRSA in a hospital
  • Another 41.9 percent of hospitalized patient with MRSA acquired their MRSA in the community after contact with some type of health care facility

Source: Sutton, J.P., and Steiner, C.A. (2016, Oct.). Hospital-, health care-, and community-acquired MRSA: Estimates from California hospitals, 2013. Healthcare Cost and Utilization Project Statistical Brief, 212.  Click here: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb212-MRSA-Hospital-Stays-California-2013.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PATIENT SAFETY: Checklist compares ‘never events’

This article contains two interesting tables related to “never events,” a term introduced in 2001 by Dr. Kenneth Kizer, then the CEO of the National Quality Forum, to describe the most serious types of health care errors.  The first table itemizes the lists of never events developed by four organizations in a side-by-side comparison.  For example, retention of a foreign object in the patient after surgery is listed by all four organizations, which include:

  • National Quality Forum / Leapfrog Group
  • Centers for Medicare & Medicaid Services (CMS)
  • The Joint Commission
  • The National Health Service (United Kingdom)

The second table compares each of the states and the District of Columbia on whether hospitals are required to report adverse events, whether the state reports individual hospital data, and whether the state reports aggregate data.

What I like about this article: 1.) Useful side-by-side comparison of existing lists of never events.  (One of the recommendations of the article is that work should be done on creating a single definition of never events.)  2.) Authoritative source – the authors are with the Armstrong Institute for Patient Safety and Quality at Johns Hopkins.  Dr. Pronovost, especially, is a prolific author on topics related to patient safety.

Source: Austin, J.M., and Pronovost, P. (2015, June). “Never events” and the quest to reduce preventable harm. The Joint Commission Journal on Quality and Patient Safety, 41(6), 279-288. Retrieved from http://www.jcrinc.com/reducing-never-events-and-preventable-harm-in-health-care/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HEALTH CARE ASSOCIATED INFECTIONS: Gowning and gloving needed for ALL ICU patients? Maybe not.

Whether the practice of gowning and gloving should be expanded beyond the current Centers for Disease Control recommendations to include staff caring for ALL patients in intensive care units was studied in this large-scale randomized trial.  The researchers collected data from 20 participating hospitals in 2012 to see if universal gowning and gloving would be found to reduce the acquisition of MRSA or VME (antibiotic-resistant infections).  There was no compelling statistical evidence that universal gowning and gloving should be used for all patients in ICUs to achieve this objective.

Source: Harris, A.D., Belton, B., and others.  Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial.  JAMA, Oct. 4, 2013 [published online before print].  Click here for access to article: http://jama.jamanetwork.com/article.aspx?articleID=1746112&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=JAMA%3AOnlineFirst10%2F04%2F2013.  There is also an editorial and a video!  Posted by AHA Resource Center (312) 422-2050, rc@aha.org




Annual Cost of Medical Errors Estimated at $17.1 Billion

Analysts with the actuarial firm Milliman estimate that measurable medical errors cost the nation $17.1 billion in 2008. Pressure ulcers, postoperative infections, and post-laminectomy syndrome were the most frequently occurring errors identified in their examination of medical claims data. Ten types of errors were the most costly, accounting for two-thirds of annual medical error costs. Postoperative infections, pressure  ulcers, and mechanical complication of a noncardiac device, implant, or graft topped the most costly list of errors. Data is provided on the incidence,  expense per error,  and the national aggregate cost for each of the most frequent and most costly error types.

Source: Van Den Bos J and others. The $17.1 billion problem: the annual cost of measurable medical errors. Health Affairs, vol. 30, no.4, Apr. 2011, pp. 596-603. http://content.healthaffairs.org/content/30/4/596.abstract

Hospital-acquired infections: Can UTIs really be eliminated?

Urinary tract infections are the leading cause of hospital-acquired infection, occurring in 3.5 percent of post-op cases.  The Centers for Medicare and Medicaid Services have included catheter-associated UTIs on the nonpayment list of reasonably preventable events.  In this study based on the American College of Surgeons’ National Surgical Quality Improvement Program Participant User File, a large number of colorectal surgery patients and vascular surgery patients were compared to see whether there is a difference in UTI rate based on the nature of the surgical procedure and other patient-related factors.  The colorectal procedures were associated with a higher risk of UTI.  The authors, who are with the Cleveland Clinic, conclude that the goal of cutting the catheter-related UTI rate to zero may not be possible because “a certain rate of UTI is always present.”  They suggest a risk-adjustment approach for hospitals as a more realistic way to help move toward reducing the national UTI rate without unduly penalizing hospitals caring for certain types of patients.

Source: Attaluri, V., and others.  Risk factors for urinary tract infections in colorectal compared with vascular surgery: a need to review current present-on-admission policy?  Journal of the American College of Surgeons;212(3):356-361, Mar. 2011.

Hospital-acquired infections: ICU CLABSI rates declining

 The US Department of Health and Human Services (DHHS) has set a goal of cutting central line-associated blood-stream infections (CLABSIs) in half by 2013.  Some substantial progress has already been made, as seen in the new CDC Vital Signs article cited below.  In intensive care units, the CLABSI rate has decreased from an estimated 43,000 infections in 2001 to an estimated 18,000 in 2009, or a reduction of 58 percent.  CDC also provides 2009 estimates for CLABSIs in other inpatient units (23,000), and in outpatient hemodialysis clinics (37,000).  The impact of the reduction in CLABSIs in ICUs in 2009 is estimated to from 3,000 to 6,000 lives saved and $414 million in averted extra health care costs.  Providers spotlighted as having best practice initiatives in place for reducing CLABSI include the Pittsburgh Regional Healthcare Initiative and the MHA Keystone Center for Patient Safety & QualityBest practices for reducing CLABSIs can be found in the CDC document: Guidelines for the Prevention of Intravascular Catheter-Related Infections, cited below.

Sources: Vital signs: central line-associated blood stream infections, United States 2001, 2008, and 2009.  MMWR. Morbidity and Mortality Weekly Report;60:1-6, Mar. 2011.  http://www.cdc.gov/mmwr/pdf/wk/mm60e0301.pdf; and, Guidelines for the prevention of intravascular catheter-related infections.  MMWR. Morbidity and Mortality Weekly Report;51(RR10):1-26, Aug. 9, 2002.  http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm