Are your doctor's hands clean?

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IN 20 PATIENTS CONTRACTS AN INFECTION IN A HOSPITAL EACH YEAR. ABOUT 90,000 DIE AS A RESULT.

Are your doctor's hands clean?

Presbyterian Hospital starts workplace hygiene blitz as S.C. passes legislation requiring hospitals to make their infection rates public

KAREN GARLOCH

kgarloch.

Are your doctor's hands clean? Presbyterian Hospital starts workplace hygiene blitz as S.C. passes legislation requiring hospitals to make their infection rates public Karen Garloch

When student nurse Tara Hartsell left a patient's room at Presbyterian Hospital last week, she pressed the bar on a Purell dispenser near the door and rubbed her hands with cleanser.

Standing in the hall, watching approvingly and making notes on her clipboard, was nurse Renae Spradlin.

Spradlin's job is to monitor and improve hand hygiene among nurses, doctors and health care workers at four Presbyterian hospitals in the Charlotte area.

It's part of an aggressive campaign that includes training, as well as posters and computer screen-savers with messages such as "You could kill him with your bare hands" and "What you can't see is killing them."

Hospitals across the country are paying more attention to hand hygiene to reduce hospital-acquired infections. This comes in response to a rise in antibiotic-resistant bacteria and efforts to get hospitals to be more open about infection rates.

One in 20 patients, or about 2 million a year, contracts an infection in the hospital each year, and about 90,000 die as a result, estimates the U.S. Centers for Disease Control and Prevention.

Fourteen states, including South Carolina, have passed laws requiring hospitals to report their rates of some hospital-acquired infections. A similar bill died in the N.C. legislature last year.

"It's critical for consumers to have this information," said Helen Haskell of Columbia, founder of Mothers Against Medical Error.

"Even more critical is that physicians can compare hospitals. They don't have this information, either," said Haskell, who said her 15-year-old son died in 2000 as the result of medical errors in an S.C. hospital.

"It's just a matter of human decency to give people the information they need to save their own lives."

It's rare for hospitals to have well-organized hand-hygiene monitoring programs like Presbyterian's, said Lisa McGiffert, director of StopHospitalInfections.org, a project of the nonprofit Consumers Union.

Until recently, she said the attitude among hospitals was that "these infections are inevitable."

But McGiffert says research shows that's not true. "If you can get everyone in the hospital to be cleaning their hands between touching patients, every time, you're going to see your infection rates go down."

Despite that, research shows handwashing compliance among hospital staff is about 50 percent.

At Presbyterian, compliance with recommendations to clean hands before and after each patient encounter was above the national average before Spradlin took her job as hand-hygiene monitor in January, said Diana Best, a senior vice president.

Since then, Best said, hand-hygiene habits have improved by 25 percent. She won't disclose the actual compliance rate until the end of this year.

Carolinas Medical Center designates various nurses each month, in addition to their regular duties, to monitor their colleagues' handwashing habits.

Policy is to "foam in-foam out" -- use alcohol-based hand cleanser or soap and water before and after entering a patient's room. CMC officials would not disclose the hospital's hand-hygiene compliance rate.

After an outbreak of MRSA (methicillin-resistant staphylococcus aureus) in the CMC neonatal intensive care unit in spring 2004, spokesman Alan Taylor said the staff did a "terminal cleaning" that involved removing patients and equipment and "cleaning every inch of the unit."

The hospital also stepped up educational programs on handwashing for staff, doctors and visitors. "We even implemented a requirement that (doctors and nurses in the NICU) wear no hand jewelry," CMC's Baker said.

Without continual emphasis on handwashing, Best said, employees often forget.

"About 30 years ago, when I was a practicing nurse, we'd all wash our hands for about a month (after training) and then we'd go on," she said. "You're taught it. You understand it. But it doesn't sink in."

Infection rates

Consumer advocates believe laws that require reporting of infection rates will also make hospitals more serious about infection control.But many hospitals oppose such laws, arguing that reports would not be meaningful. For example, they say, a high infection rate at one hospital could mean it does a better job of surveillance or sees more critically ill patients at higher risk of infection.

When hospitals have been required to report other data publicly, "the quality of the reports is worse because of serious underreporting by hospitals," said Dr. John Baker, a CMC vice president. "If hospitals in North Carolina (were required to report infection rates) and they start underreporting, then we've gotten nowhere."

Presbyterian's Best said her hospital would support a state law to require public reporting of hospital infection rates. "We believe it's a good thing."

South Carolina

South Carolina's law passed in May, and its first public report will be available in February 2009.

If Debbie Ford of Rutherfordton has her way, North Carolina will soon have a similar law.

Ford said her newborn twins died in April 2004 after contracting MRSA during the outbreak in the NICU at Carolinas Medical Center.

CMC officials acknowledge the NICU experienced a higher-than-expected number of MRSA infections that spring. They say an investigation found multiple strains of MRSA and no single source of the infections.

MRSA used to be contracted almost exclusively in hospitals. But in recent years, it has spread in community settings, such as gyms and locker rooms. Because of that, Baker said it's hard to know whether patients with MRSA infections contract them in the hospital or bring them in from the outside.

"Mine were not the only ones to die there from this infection," Ford said. "Had (a law) already been passed, I would have had the right to know their rates were up and could have chosen another NICU."

 

FOR INFORMATION:

Consumers Union: www.stophospitalinfections.org. U.S. Centers for Disease Control and Prevention: www.cdc.gov. Association for Professionals in Infection Control and Epidemiology: www.preventinfection.org.

SOURCE: Consumers Union, www.consumersunion.org/campaigns//learn_more/001735indiv.html.

States with Laws Requiring Public Reporting of Hospital Infection Rates

• Connecticut

• Florida

• Illinois

• Maryland

• Missouri

• New Hampshire

• New York

• Pennsylvania

• Rhode Island

• South Carolina • Tennessee • Virginia

• Vermont

 

http://www.charlotte.com/mld/charlotte/living/health/15049969.htm

 

 

 

 

 

 

 

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