INFECTION CONTROL
Bath basins awash in bacteria
Patients' bath basins are a reservoir for bacteria and a possible source of infection for high-risk patients, according to results of a study by nurses who evaluated 92 bath basins from three acute care hospitals. These included basins from 3 ICUs and a rehabilitation unit. Using sterile sponges, they obtained culture specimens at least 2 hours after patient bathing, after the water had been emptied and the basin allowed to air dry. All basins were disposable and used for only one patient.
The specimens were sent to an outside lab for qualitative and quantitative microbial testing. The result: Some form of bacteria grew in 98% of the sample sponges, including enterococci, gram-negative organisms, Staphylococcus aureus, vancomycin-resistant enterococci, methicillin-resistant S. aureus, Pseudomonas aeruginosa, Candida albicans, and Escherichia coli.
While noting that the study had some weaknesses (for example, incontinence matter found in basins wasn't tested), researchers say their findings are a "call to action" for nurses to develop interventions that minimize the risk of healthcare-associated infections from contaminated wash basins. Although sterilizing bath basins is probably not cost-effective, they suggest investigating alternate bathing methods and using prepackaged bathing supplies to minimize patients' exposure to pathogens.
Source: Johnson D, Lineweaver L, Maze LM. Patients' bath basins as potential sources of infection: a multicenter sampling study. Am J Crit Care. 2009;18(1):31-38, 41.
TREATMENT IN THE ED
Is penicillin skin testing feasible?
When an ED patient reports having a penicillin allergy, the clinician prescribes an alternate drug-often a more expensive broad-spectrum antibiotic. But research has indicated that more than 85% of patients who report a penicillin allergy have negative penicillin skin test results.
To determine if confirming a true penicillin allergy with a skin test is feasible in an ED setting, researchers studied 150 ED patients who reported a penicillin allergy. An ED physician performed skin prick and intracutaneous tests with penicillin major and minor determinants.
In all, 137 of the 150 patients (more than 90%) tested negative for penicillin allergy. No patients experienced adverse reactions to the skin test, which produces results in about 30 minutes. Noting that skin testing is quick, safe, and reliable, researchers say their study supports "the need for a rapid test for penicillin allergies in the ED patient population."
Source: Raja AS, Lindsell CJ, Bernstein CJ, Codispoti CD, Moellman JJ. The use of penicillin skin testing to assess the prevalence of penicillin allergy in emergency department setting. Ann Emerg Med. Published online before print February 17, 2009.
BLOODSTREAM INFECTIONS
Encouraging news about MRSA rates
Among ICU patients, the rate of methicillin-resistant Staphylococcus aureus (MRSA) central line-associated blood stream infections (BSI) dropped by almost 50% between 1997 and 2007, according to a report from the CDC involving patients from 1,684 ICUs. The data show that the decline in MRSA infections occurred in most types of ICUs that reported these infections to the CDC during the study period. The exception was pediatric ICUs, where MRSA BSI rates remained static.
In 1997, an estimated 43 MRSA BSI developed for every 100,000 ICU patients who had a central line in place for at least 1 day. By 2007, the rate had fallen to 21 BSI per 100,000 patients. Researchers credit healthcare professionals who've worked harder at preventative measures, including frequent hand hygiene and instrument sterilization.
Source: Burton DC, Edwards JR, Horan TC, Jernigan JA, Fridkin SK. Methicillin-resistant Staphylococcus aureus central linebloodstream infections in US intensive care units, 1997-2007. JAMA. 2009;301(7):727-736.
NEW FDA WARNING
Hidden hazard in transdermal patches
Transdermal medication patches containing metallic material can burn the skin if worn during magnetic resonance imaging (MRI). The FDA recently issued a new warning about this hazard after receiving injury reports and learning that the labeling for some patches doesn't alert patients and clinicians to the risk.
Many brand name and generic patches, including over-the-counter products, contain aluminum or another metal in the nonadhesive backing. The metal may not be visible or identified on the product labeling. Although the metal isn't attracted to the MRI equipment's magnetic field, it can conduct electricity and generate enough heat to burn the skin.
Teach patients scheduled for an MRI to tell their healthcare providers, including those at the MRI facility, about any transdermal patches they use. For more information, visit the FDA's Web site at http://www.fda.gov and search for "medicated patches during MRIs."
ETHNIC DISPARITIES
Giving culturally competent care
The National Quality Forum (NQF) has introduced guidelines to make healthcare more patient-centered and culturally appropriate. Certain racial and ethnic groups experience disproportionately high rates of death and disability from heart disease, diabetes, and other chronic illnesses. The guidelines' goal is to reduce these persistent disparities. "Truly high quality care is also culturally competent care," says Janet Corrigan, president and CEO of the NQF.
Here are some of the 45 practices that NQF endorses to guide healthcare systems in providing better care.
* Determine and document patients' language needs at first point of contact and reassess routinely throughout treatment.
* Educate healthcare workers to address patients' cultural needs and provide appropriate services mandated by federal and state laws and regulations.
* Maintain a current demographic, cultural, and epidemiologic profile of the community to help plan and implement services.
To read more, visit the NQF Web site at http://www.qualityforum.org.
POST-OP OUTCOMES
More teaching, better survival
Having surgery at a hospital that has an intense teaching program improves chances of survival, new study findings show. Researchers used Medicare claims data to compare patient outcomes with teaching intensity in 3,270 acute care hospitals in the United States. Teaching intensity was determined by a ratio of residents to patient beds. The data included more than 4.5 million patients undergoing general, orthopedic, and vascular procedures.
Surgical patients at hospitals with higher teaching intensity had a 15% lower risk of dying compared with patients who had surgery at nonteaching hospitals or at teaching hospitals with few residents. No differences existed between teaching and nonteaching hospitals in complication rates. Instead, improved survival rates at teaching hospitals reflected better failure-to-rescue rates, which were 15% lower in hospitals with higher teaching intensity.
However, black patients didn't experience the same benefits associated with higher resident-to-bed ratios as white patients. While patients in both groups experienced fewer complications at higher teaching intensity hospitals, black patients had increased failure-to-rescue rates. Researchers couldn't explain this disparity, which wasn't related to income level. A major shortcoming of the study was its reliance on Medicare claims rather than medical records, which would reveal more about the severity of complications.
Source: Silber JH, Rosenbaum PR, Romano PS, Rosen AK, et al. Hospital teaching intensity, patient race, and surgical outcomes. Arch Surg. 2009;144(2):113-120.
JOB SATISFACTION
13 hospitals among the best workplaces
Even in this faltering economy, some hospitals still do what it takes to please employees. This year, 13 hospitals and health systems have made Fortune Magazine's list of the "100 Best Companies to Work For."
The magazine defines a great workplace as a place where employees "trust the people they work for, have pride in what they do, and enjoy the people they work with." Relationships between employees, management, and the company are the heart of a great workplace.
To be eligible for consideration, a company must be at least 7 years old and have a minimum of 1,000 United States employees. Researchers randomly survey at least 400 of a company's employees. More than 81,000 employees at 353 companies answered the 57-question survey.
Two-thirds of a company's score is based on survey results. The remaining score comes from a "culture audit" that includes data about demographics and other variables, such as pay, benefits, philosophy, and communication.
The top three hospitals and healthcare systems on this year's list are The Methodist Hospital System (Texas), OhioHealth (Ohio), and King's Daughters Medical Center (Kentucky). For the complete list of companies and profiles of each one, visit Fortune's Web site at http://money.cnn.com/magazines/fortune/bestcompanies/2009/.
PATIENT CARE
Calling Dr. What's-Her-Name
Most hospital patients can't identify the names or roles of healthcare providers assigned to their care, according to a recent study. Researchers say hospitals, especially teaching facilities, have to do more to promote awareness.
In a study at a large teaching hospital, researchers interviewed 2,807 patients admitted to the general medicine service in 2005 and 2006. Three-quarters of the patients couldn't name anyone in charge of their care, said study author Vineet Arora, MD, "and when they did name somebody, they got it wrong, incorrectly naming their primary care provider or some specialist."
Dr. Arora, a medical educator, urges healthcare professionals to "actively introduce themselves in a way that patients can understand what their role is."
Source: Arora V, Gangireddy S, Mehrotra A, Ginde R, Tormey M, Meltzer D. Ability of hospitalized patients to identify their in-hospital physicians. Arch Intern Med. 2009;169(2):199-201; Many hospital patients can't ID their doctors, HealthDay, February 13, 2009. http:www.nlm.nih.gov/medlineplus/news/fullstory_80425.html.
SURVEY RESPONSES
Is nurse-activated PCA allowed at your facility?
Nurses who recently visited our Web site answered this question:
Nurse-activated PCA isn't recommended because patient-only activation is an important safety feature.1 Visit http://www.nursingcenter.com/poll to answer our monthly survey question and view results from other surveys.
SHIFT WORK
Working nights is hard on the heart
Results of a small study suggest that working the night shift is linked to hormonal and metabolic changes that open the door to obesity, diabetes, and heart disease. Researchers conducted a study to mimic the effects of jet lag and the chronic impact of regular shift work. For 10 days, they noted physical responses in five men and five women who followed a changing sleep/eat schedule. By the end of the study, all participants had eaten and slept during all phases of the circadian cycle.
Researchers found that when the normal sleep/wake cycle was disrupted and eating occurred at atypical times, levels of the weight-regulating hormone leptin decreased. Low levels of leptin can hasten the onset of obesity and heart disease.
Researchers also noted changes that resulted in impaired glucose tolerance and decreased insulin sensitivity. Three participants who didn't have a history of diabetes developed postprandial glucose levels that resembled those of pre-diabetes. The degree of hormonal change was highest when schedules were 12 hours off the normal sleep/wake cycle-in effect, sleeping during the day and staying awake at night.
A longer and larger study is needed to investigate the relationship between work patterns and metabolic disorders.
Source: Scheer FAJL, Hilton MF, Mantzoros CS, and Shea SA. Adverse metabolic and cardiovascular consequences of circadian misalignment. Proc Natl Acad Sci. Published online ahead of print, March 2, 2009.
1. D'Arcy Y. Are opioids safe for your patient? Nursing. 2009; 39(4):40-44. [Context Link]