Hospital Consult - March 2015
Hospital Access Management - Hospital Case Management - Hospital Employee Health
Hospital Infection Control - Hospital Peer Review - Healthcare Risk Management
Case Management Advisor - IRB Advisor - Medical Ethics Advisor - Same-Day Surgery
New Infection Control Guidance for Furry Hospital Care Providers
NEW YORK – Some of the most effective hospital care providers have fluffy tails and soulful eyes. Because hand washing – or more specifically paw washing – for this group usually involves their tongues, a national group now has developed model infection prevention policies for animals in healthcare facilities.
The expert guidance by the Society for Healthcare Epidemiology of America (SHEA) is designed to help acute care hospitals develop policies on the use of animals in healthcare facilities, including animal-assisted activities, service animals, research animals and personal pet visitation. The information was published online in Infection Control & Hospital Epidemiology, the journal of SHEA.
"Animals have had an increasing presence in healthcare facilities," said co-author David Weber, MD, MPH. "While there may be benefits to patient care, the role of animals in the spread of bacteria is not well understood. We have developed standard infection prevention and control guidance to help protect patients and healthcare providers via animal-to-human transmission in healthcare settings."
With little data on transmission of pathogens in healthcare facilities by animals, the SHEA Guidelines Committee developed the recommendations based on available evidence, practical considerations, a survey of SHEA members, writing group opinion and consideration of potential harm where applicable. The Association for Professionals in Infection Control and Epidemiology (APIC) also endorsed the guidance.
In terms of animal-assisted activities, SHEA recommends that hospitals should develop policies and designate a liaison with these provisions:
- Only dogs should be allowed to serve in animal-assisted activities, such as pet therapy.
- Animals and handlers should be formally trained and evaluated.
- Animal interaction areas should be determined in collaboration with the Infection Prevention and Control team and clinical staff should be educated about the program.
- Animal handlers must have all required immunizations, restrict contact of their animal to patient(s) visited and prevent the animal from having contact with invasive devices.
- Everyone who touches the animal should practice hand hygiene before and after contact.
- The hospital should maintain a log of all animal-assisted activities visits including rooms and persons visited for potential contact tracing.
As for service animals, the guidelines recommend that hospitals comply with the Federal Americans for Disability Act, other applicable state and local regulations and include a statement that only dogs and miniature horses are recognized as service animals under federal law. In addition, SHEA recommends that that infection prevention staff consult with each patient/owner to make sure the service animal complies with institutional policies.
More difficult issues can arise with personal visitation from patients’ pets.
While noting that pets, in general, should be prohibited from entering healthcare facilities, authors of the SHEA guidelines concede that exceptions can be considered with dogs if visitation would be of benefit to the patient and can be performed with limited risk. Hand hygiene is recommended immediately before and after contact with the animal.
The authors add that, as the role of animals in healthcare evolves, there is a need for stronger research to establish evidence-based guidelines to manage the risk to patients and healthcare providers.
Cost-Effective Recommendations for Preventing, Treating Bed Sores
PHILADELPHIA – Despite the lack of evidence of any benefit in the reduction of bedsores in high risk populations, many hospitals still use alternating air and low-air-loss mattresses and overlays, which are expensive and add an unnecessary burden on the healthcare system, according to a new report from the American College of Physicians.
Instead, for patients who are at increased risk of developing bedsores, ACP recommends that an advanced static mattress (a mattress made of foam or gel that does not move when a person lies on it) or an advanced static overlay (a material such as sheepskin or a pad filled with air, water, gel, or foam that is secured to the top of a bed mattress) be used instead. The recommendations, contained in two evidence-based clinical practice guidelines on preventing and treating pressure ulcers, were published recently in the Annals of Internal Medicine.
Advanced static mattresses and overlays are also less expensive than alternating-air or low-air-loss mattresses and can be used as part of multicomponent approach to bedsore prevention, the article points out.
"Up to $11 billion is spent annually in the United States to treat bedsores and a growing industry has developed to market various products for pressure ulcer prevention," said David Fleming, MD, ACP’s president. "ACP's evidence-based recommendations can help physicians provide quality care to patients while avoiding wasteful practices."
The ACP guideline suggests that risk factors for development of bed sores include older age, black race or Hispanic ethnicity, lower body weight, cognitive impairment, physical impairments, and other comorbidities that affect soft tissue integrity and healing, such as urinary or fecal incontinence, diabetes, malnutrition, edema, impaired circulation of the blood in the smallest blood vessels, and low blood level of albumin.
To reduce wound size, ACP recommends the use of protein or amino acid supplementation and hydrocolloid or foam dressings in patients with bedsores. Evidence indicated hydrocolloid dressings are better than gauze dressings for reducing wound size and resulted in similar complete wound healing as foam dressings, according to the report. Electrical stimulation was suggested as adjunctive therapy in patients with pressure ulcers to accelerate wound healing.
Although low-quality evidence indicate that dressings containing Platelet Derived Growth Factor (PDGF) promoted healing, ACP supports the use of other dressings, such as hydrocolloid and foam dressings, which are effective at promoting healing and cost less than PDGF dressings.
Death Toll Grows from Hospital-Related C. Difficile Infections
ATLANTA – Almost two-thirds of the nearly half a million C. difficileinfections in the United States last year were found to be associated with an inpatient stay in a healthcare facility, but only 24% occurred among patients while they were hospitalized, according to a new report.
The national Centers for Disease Control and Prevention (CDC) notes that almost as many cases occurred in nursing homes as in hospitals, while the remainder of the healthcare-associated cases occurred among recently discharged inpatients.
About 29,000 patients died within 30 days of the initial diagnosis of C. difficile, and 15,000 of those deaths were estimated to be directly attributable to C. difficile, according to the report.
More than 80% of the deaths associated with C. difficile– related to inflammation of the colon and deadly diarrhea – occurred among Americans aged 65 years or older, according to the CDC.
C. difficile has become the most common microbial cause of healthcare-associated infections in U.S. hospitals and costs up to $4.8 billion each year in excess healthcare costs for acute care facilities alone, according to past research.
The new study points out that 1 out of every 5 patients with a healthcare-associated C. difficileinfection suffered a recurrence of the infection, and 1 of 9 patients aged 65 or older with a healthcare-associated C. difficileinfection died within 30 days of diagnosis.
“C. difficile infections cause immense suffering and death for thousands of Americans each year,” said CDC Director Tom Frieden, MD, MPH. “These infections can be prevented by improving antibiotic prescribing and by improving infection control in the healthcare system.”
Frieden emphasized the importance of state antibiotic resistance prevention programs launched in all 50 states.
Noting that patients who take antibiotics are most at risk for developing C. difficileinfections, the report points out that more than half of all hospitalized patients get an antibiotic at some point during their hospital stay, although studies have shown that 30% to 50% of antibiotics prescribed in hospitals are unnecessary or incorrect.
“When a person takes broad-spectrum antibiotics, beneficial bacteria that are normally present in the human gut and protect against infection can be suppressed for several weeks to months. During this time, patients can get sick from C. difficilepicked up from contaminated surfaces or spread person to person. Unnecessary antibiotic use and poor infection control may increase the spread of C. difficilewithin a facility and from facility to facility when infected patients transfer, such as from a hospital to a nursing home,” the CDC explains in a press release.
Older Americans, especially women and Caucasians, are especially vulnerable to the deadly diarrheal infection, according to the CDC study finding that 1 out of every 3 C. difficileinfections occurs in patients 65 years or older and 2 out of every 3 healthcare-associated C. difficileinfections occur in patients 65 years or older.
The Agency for Healthcare Research and Quality (AHRQ) has developed a toolkit to help hospitals implement antibiotic stewardship programs to reduce C. difficileinfections.
“AHRQ’s HAI Program funds projects that generate new scientific knowledge and, like the work on C. difficile, make this knowledge practical and approachable so clinicians on the front lines of care can prevent infections and make care safer for their patients,” said AHRQ Director Richard Kronick, PhD.
What Happens When Inpatients Have Access to Their EHRs?
AURORA, CO – Allowing patients to see their medical records while they are hospitalized will increase their anxiety while expanding the workload for hospital staff – or at least that’s the conventional wisdom.
A small study, published as a research letter recently in JAMA Internal Medicine, showed a different result, however.
A study team lead by researchers from the University Of Colorado School Of Medicine sought to find out if providing the information to hospitalized patients would allow more transparency.
“Giving outpatients direct access to their health information helps clinicians find errors and improves patient satisfaction, although the implications of this type of access have not been well studied in the inpatient setting,” the researchers note. “This hospital-based study evaluates the experiences of patients, clinicians (including physicians and advanced practice providers), and nurses with immediate (real-time) release of test results and other EHR information through a patient portal.
The prospective cohort study was performed on a medical unit of the University of Colorado Hospital in Aurora, a 412-bed academic tertiary hospital, from Oct. 1, 2012, to March 31, 2013. The 50 patients participating were provided electronic tablets to access portions of their electronic health records, including medication schedules and test results.
Surveys were completed by patients, physicians and nurses to help determine the effect on caregiver workload, patient confusion and worry, patient empowerment, errors detected and discharge planning.
While 92% of patients said beforehand that reviewing the electronic charts would help them understand their medical condition and 80% said they would be better able to understand physicians’ instructions, those percentages dropped to 82% and 60%, respectively, after EHRs were viewed.
On the other hand, patients did not become more anxious and confused, with the percentage of patients expressing worry dropping from 42% to 18% and those reporting fear of confusion declining from 52% to 32%.
Giving patients access to the information also did not create more work for physicians or nurses. While 68% of the doctors said they thought they would be asked for more time by patients before the charts were reviewed, that dropped to 36% afterwards. Responses from nurses were similar.
While hospital staff expressed initial optimism that patients would be able to spot medication errors, that view decreased across-the-board after the electronic records were shared.
Concerned About Patient Rights? Worry No More!
Attend one or attend both, either way you’re sure to be prepared for your inpatients and their questions.
Topics:
What the CMS Patient’s Bill of Rights Means to Your Hospital: 2 CNE
Patient Role & Rights from The Joint Commission: 1.5 CNE
Speaker: Sue Dill Calloway, RN, MSN, JD
Dates: March 24th & March 31st
Time: 10 - 11:30 AM PT & 1 - 2:30 PM ET