Hospital Consult - September 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
Things That Go Beep in the Night: How to Reduce Hospital Noise
ANN ARBOR, MI – For you and many other hospital professionals, the beeps of multiple monitors, squawks of paging systems and squeaks of wheelchairs, gurneys and carts are white noise. You ceased to notice them years ago.
For patients, however, the racket can make the difference between a therapeutic night’s sleep and a fitful rest.
To remedy that, a new initiative at the University of Michigan Health System, described recently in an article published online by BMJ Quality, used sound panels as a test to make hospitals quieter.
During a pilot study, researchers strategically placed sound acoustic panels to help diffuse sound in the hallways around patient rooms. While modest, the 3-4 sound decibel drop is recognizable to the human ear and consistent with a fall in noise generated by a car slowing down from 80 mph to 60, according to the article.
"In hospital environments where noise levels are often double what they should be according to the World Health Organization's standard decibel guidelines for patient rooms, the difference is significant," explained co-author Mojtaba Navvab, PhD, associate professor of architecture and design at the University of Michigan.
Similar to methods used at recording studios, rehearsal rooms and concert halls to control sound, four custom panels, covered in cones and made with sound-absorbing material, were installed for three days in the walls and ceilings of a cardiovascular care unit.
While sound levels remained at 60 decibels during the daytime, they dropped to 57 decibels at night, according to study results.
"This architectural design could complement on-going strategies for addressing noise," co-author Peter M. Farrehi, MD, said. “The panels help diffuse sound, rather than attempt to eliminate the sounds generated in a modern hospital environment."
In addition to the sound patterns, the hospitals provide complimentary ear buds, headphones and earplugs for patients and their families; require that hallway conversation, in person and cellphone, is kept to a minimum, especially at night; enforce quiet hours in all inpatient areas and encourage that volumes on cell phones, televisions, radios, pagers and other devices be turned down and pagers set to vibrate when medically appropriate.
The hospitals also:
- coordinate care to reduce unnecessary entry into patient rooms during quiet hours;
- remind staff to use quiet voices and behaviors in the patient care setting;
- require that doors be closed quietly;
- provide a "white noise" TV channel in all patient rooms;
- encourage staffers to wear soft sole shoes;
- use a dedicated system to have noisy carts, doors and other items repaired, and
- schedule floor cleaning times that don't conflict with nighttime resting hours.
Researchers also have employed devices to track noise levels in some patient rooms.
Nurses Say Enough Is Enough: No More Violence, Bullying
SILVER SPRING, MD– Nurses are sending a very clear message to hospitals: They will no longer tolerate physical violence, most often promulgated by patients and their families, or verbal abuse, i.e. bullying, from superiors or colleagues.
The nursing profession “will no longer tolerate violence of any kind from any source,” the American Nurses Association (ANA) asserted in a new position statement on violence in the healthcare workplace.
“Taking this clear and strong position is critical to ensure the safety of patients, nurses and other healthcare workers,” ANA President Pamela F. Cipriano, PhD, RN, said. “Enduring physical or verbal abuse must no longer be accepted as part of a nurse’s job.”
The position statement was developed by a range of nurses – clinicians, executives and educators – in response to a continuum of harmful workplace actions and inactions, ranging from incivility to bullying to physical violence.
Nearly one quarter of respondents to a recent ANA survey of 3,765 RNs said they had been physically assaulted while at work by a patient or a patient’s family member. Half reported they had been bullied by a peer, with 42% saying the harassment had come from a person at a higher level of authority.
The ANA report defines bullying as “repeated, unwanted harmful actions intended to humiliate, offend and cause distress,” such as hostile remarks, verbal attacks, threats, intimidation and withholding support. It further notes that some form of incivility occurs in nearly every nursing specialty, whether in practice or academic settings, and affects all educational and organizational levels of the nursing profession.
In calling on RNs and employers to work together to create a culture of respect and to implement evidence-based strategies, the ANA also underscores the financial advantages to doing so. The association cites a 2014 study which found that a U.S. hospital employing 5,000 nurses spent $94,156 annually because of workplace violence –$78,924 for treatment and $15,232 for indemnity of the 2.1% of nurses who reported injuries.
As part of its zero tolerance policy, the ANA calls on hospitals and other employers to:
- establish a shared and sustained commitment to a safe and trustworthy environment that promotes respect and dignity;
- encourage employees to report incidents of violence, and never blame employees for violence perpetrated by non-employees;
- urge RNs to participate in educational programs, learn organizational policies and procedures, and use “situational awareness” to anticipate the potential for violence; and
- develop a comprehensive violence prevention program aligned with federal health and safety guidelines, with input from staff nurses.
Failure to Follow Guidelines Threatens Increase in Arterial Catheter Infections
PROVIDENCE, RI – Despite the risk of increased infections, a large percentage of hospital personnel fail to follow guidelines on placement of arterial catheters in intensive care unit patients, according to a recent report.
The research, published recently in Critical Care Medicine, was based on a survey conducted by Rhode Island Hospital researchers. It found significant variability in how those catheters are managed, despite infection prevention guidelines provided by the Centers for Disease Control and Prevention.
"Barrier precautions are employed inconsistently by critical care clinicians across the nation, and such individuals underestimate the infection risks posed by arterial catheters," said co-author Leonard A. Mermel, DO, ScM, "Every effort should be made to prevent such infections since they lead to increased cost, length of stay, and morbidity."
CDC recommendations published in 2011 specify that clinicians wear sterile gloves, a surgical cap and surgical mask, and use a small sterile drape when inserting arterial catheters. Yet, of 1,265 study respondents, only 44% reported using the CDC-recommended barrier precautions during insertion and only15% reported using full barrier protections.
"There appears to be a significant deviation from clinical guidelines regarding a very commonly performed procedure in critically ill patients," corresponding author Andrew Levinson, MD, MPH, added in a Lifespan Hospitals press release. "Bloodstream infections are largely preventable, and if the survey results mirror the clinical practice in the U.S., there's work to be done in reducing risk of such infections."
Respondents to the anonymous survey included 1,029 members of the Society of Critical Care Medicine, specifically attending physicians, fellows, residents, nurse practitioners, physician assistants, registered nurses and respiratory therapists. The survey was sent to 11,361 and had an 11% response rate before exclusions were applied.
Recent studies have indicated that the occurrence rate of bloodstream infections associated with arterial catheters, used to monitor blood pressure and directly sample blood gasses, is 0.9-3.4 per 1,000 catheter-day, which is comparable to central venous catheters.
“Clinicians significantly underestimated the infectious risk posed by arterial catheters, and support for mandatory use of full barrier precautions was low,” study authors conclude. “Further studies are warranted to determine the optimal preventive strategies for reducing bloodstream infections associated with arterial catheters."
Serious Respiratory Virus Brought Into NICU by Clothing of Visitors, Caregivers
ATLANTA – As diligent as you are about hand washing, you and your colleagues might still be bringing respiratory syncytial virus (RSV) into the neonatal intensive care unit at your hospital.
That’s according to a presentation at the recent International Conference on Emerging and Infectious Diseases in Atlanta which reported that RSV, the leading cause of childhood respiratory hospitalizations among premature babies, can be detected from the clothes worn by caregivers/visitors visiting the NICU.
The Australian study was led by researchers from the University of New South Wales.
"The aim of this study was to identify potential sources of transmission of RSV in the NICU to better inform infection control strategies," said UNSW researcher Nusrat Homaira, PhD.
For the study conducted in May and June 2014, researchers collected specimens once every week from the hands, nose and the clothes of physicians, nurses and visitors to the NICU at the Royal Hospital for Women in Sydney. A nasal swab specimen was also collected from the infants admitted.
Detectable RSV was found in 4% of the swabs collected from the personal clothing of caregivers/visitors, and the virus also was detected from 9% of the high-touch areas in the NICU, including computers on the nurse's table, chairs adjacent to the infant patients and their bed rails.
"Though the detection rate is low, personal clothing of caregivers/visitors do get contaminated with RSV,” Homaira said in an American Society for Microbiology press release.
Although caregivers/visitors are not required to change clothing when they walk into the NICU at that hospital, "there is a need for further research to evaluate how long the virus remains infectious on personal clothing, which will have policy implications in terms of need for use of separate gowns by the visitors while they are in the NICU," she added.
Interestingly, RSV was not detectable in the hands of the doctors, nurses or the visitors with readily available alcohol-based hand rub and good hand hygiene practices overall.
The study authors conclude that frequent cleaning of high touch areas and periodic screening of visitors for RSV as they enter into the NICU during period of annual seasonal epidemics might help to limit transmission of the disease, adding, “Although detection of RSV was infrequent, the intimate contact between preterm neonates and visitors means personal clothing may play a role in RSV transmission."
Upcoming Hospital [Webinars]
[Live Webinar Series] September 17 & 23 and October 1 & 8 Credits: 6 CCM & 6 CNE
Case Management & the Revenue Cycle
September
[Live] September 17 Credits:1.5 CCM & 1.5 CNE
Mandatory Bundled Payments: Show Your CM Team and Hospital the Way
[Live] September 22 Credits: 1.5 CNE
Grievances and Complaints: Compliance with CMS and TJC Standards
[Live] September 23 Credits:1.5 CCM & 1.5 CNE
Ensure Revenue Integrity: Use Your Appeals Coordinator to the Fullest
[Live] September 23 Credits:1 CNE
Prepare for the Healthcare-Specific Federal OSHA National Emphasis Program
[Live] September 23 Credits:1.5 CNE
Comprehensive Diet and Nutrition Training: Guarantee Superior Patient Care and Compliance for Your Facility
[Live] September 29 Credits:1.5 CNE
Ambulatory Surgery Centers: Infection Control Standards & Safe Injection Practices from CMS
[Live] September 30 Credits:1.5 CNE
Contracted Hospital Services: Certifying Compliance with CMS, TJC & DNV
October
[Live] October 1 Credits:1.5 CCM & 1.5 CNE
The Case Management Leader and the Revenue Cycle
[Live] October 8 Credits:1.5 CCM & 1.5 CNE
Strategies to Decrease the Financial Impact of Readmissions
[Live] October 12 Credits:1.5 CNE
New CMS QAPI Standards and Revised QAPI Worksheet
[Live] October 14 Credits:1.5 CCM & 1.5 CNE
Have You Observed the Changes the NOTICE Act Will Make to Your Policies and Procedures?
[Live] October 15 Credits:1 CNE
Building a Medicare “Fix” Strategy