Premier Safety Share

In this issue

Premier Safety Web site

April 2004

Dear Colleague:

We have lots of new resources on our Web site this month, including:

  • CDC pneumonia guidelines
  • Construction — risk assessment
  • OSHA sharps safety — frequently asked questions
  • Bariatric products/resources

Please share this newsletter with your colleagues and encourage them to subscribe to Safety Share so they don't miss any issues.

Sincerely,
Gina Pugliese, editor
Vice President, Premier Safety Institute

News

Safety tools

Premier provides resources to combat obesity; supports national initiatives

A new national education campaign and research strategy is targeting two of the nation's leading preventable causes of death -- poor diet and physical inactivity. According to the Centers for Disease Control and Prevention (CDC) poor diet and inactivity are poised to become the leading preventable cause of death among Americans. The Department of Health and Human Services (HHS) and the Food and Drug Administration (FDA) have launched new initiatives to address the problem, and Premier provides practical tools in its new comprehensive Web-based Bariatrics resources.

The HHS national education campaign includes multimedia public service announcements and an interactive Web site, which encourages Americans to make small activity and dietary changes such as using the stairs instead of an elevator or taking a walk instead of watching television. The FDA’s recommendations for combating the nation's "epidemic of obesity" focus on the message "calories count." The Obesity Working Group was established by the FDA last August, and proposes changing food labels to more prominently display calories, encouraging restaurants to provide calorie and nutrition information, and educating consumers about how to maintain a healthy diet and weight.

According to the CDC, poor diet and inactivity are poised to become the leading preventable cause of death among Americans. About 64 percent of Americans are overweight, including more than 30 percent who are considered obese. According to a CDC study published in the March 10, 2004 Journal of the American Medical Association, about half of all deaths in the U.S. can be attributed to largely preventable behaviors and exposures. Tobacco use, poor diet and physical inactivity account for the majority of preventable deaths. The study also states that while most of the major preventable causes of death had declined or showed little change since 1990, deaths due to poor diet and physical inactivity had increased by one-third. The top three causes of death were tobacco (18.1 percent), poor diet and physical inactivity (16.6 percent), and alcohol consumption (3.5 percent).

To address the health risks and improve the management of severely obese patients, Premier has launched a new Web-based bariatric resource. The site, www.premierinc.com/bariatrics, provides comprehensive resources and products for clinicians and other healthcare professionals involved in the treatment of bariatric patients. More commonly known as the study of the causes, prevention and treatment of obesity, bariatric medicine addresses an increasing problem that creates serious health risks to patients. As a result, hospitals are seeking new products and resources to effectively manage this patient population. Premier's bariatric Web site provides resources that include market trends, links to published research, clinical guidelines, and patient education materials.

Downloads and links

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Electronic monitoring improves hand hygiene; infection rates

Electronic monitoring of hand hygiene and use of voice prompts were examined in a study in the February 2004 issue of Critical Care Medicine. The study measured compliance with hand hygiene using both alcohol-based hand rubs and handwashing by comparing several methods including electronic monitoring and direct observation; electronic monitoring and computerized voice prompts for failure to perform hand hygiene on room exit; and electronic monitoring only. As a result of these methods, the investigators found improved hand hygiene compliance and healthcare-associated infections (HAIs) rates.

The study, conducted in a surgical intermediate care unit, tested a novel electronic monitoring system that recorded entry and exit from patient rooms, the use of toilet and dirty utility facilities, as well as use of handwashing (sink and soap dispensers) and hand hygiene (waterless alcohol systems) devices throughout the unit. In the second phase of the study, an electronically generated voice was activated if individuals did not perform hand hygiene after exiting a patient's room. Electronic monitoring provided effective ongoing feedback about hand hygiene compliance. During both the voice prompt phase and post-intervention phase, hand hygiene compliance and healthcare-associated infection rates improved, suggesting that ongoing monitoring and feedback had both a short-term and potential longer-term effects.

Additional studies on hand hygiene among healthcare workers, including the use of alcohol-based hand rubs and infection risks of artificial nails, appear in the March 2004 issue of Infection Control and Hospital Epidemiology. In one study, researchers who studied an outbreak of Klebsiella pneumoniae in a neonatal intensive care unit determined that a healthcare worker who wore artificial nails was the source of exposure. Facilities should require that healthcare workers who have direct contact with patients maintain short, well-groomed, natural nails, the researchers recommend. Additional information on hand hygiene can be found in the March 2004 issue of Infection Control and Hospital Epidemiology.

Downloads and links

  • Download the CCM abstract Electronic monitoring and voice prompts improve hand hygiene and decrease nosocomial infections in an intermediate care unit (29 KB)
  • The Critical Care Medicine study is available to subscribers at www.ccmjournal.com
  • Download the ICHE abstract Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails (24 KB)
  • The Infection Control and Hospital Epidemiology article is available to subscribers at http://www.ichejournal.com. Contact ICHE customer service at 800.257.8290.
  • More information is available from the hand hygiene module on Premier’s Safety Institute Web site.

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First-ever guideline released for clinical management of sepsis

Sepsis, one of the nation's leading causes of death, strikes one out of every 50 people admitted to the hospital, and kills 1,400 Americans daily -- more people annually than lung, colon and breast cancer combined. In the United States alone, 750,000 people yearly develop sepsis and about 30 percent of them die. Worldwide, there are 18 million cases of severe sepsis each year, incurring staggering healthcare costs: $17.4 billion in the United States, and about $9.4 billion in Europe. Severe sepsis will strike an estimated 934,000 people – in America alone – by 2010. Part of the problem is antimicrobial overuse that has created drug-resistant microorganisms.

The first clinical management guidelines ever to address the treatment of patients with severe sepsis were unveiled in late February at the 33rd Annual Critical Care Congress of the Society for Critical Care Medicine (SCCM). The product of an historic collaboration of critical care professionals from around the world, the “Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock” provide clinicians with evidence-based recommendations as part of an effort that could save over 50,000 lives annually in the United States, and hundreds of thousands worldwide.

The guidelines also appear in the March issues of both Critical Care Medicine and Intensive Care Medicine. Following publication, the guidelines were posted online, free of charge, at the SCCM site, and the sites of participating organizations.

Among the recommendations made by the guidelines committee to their colleagues:

  • More aggressive recognition and diagnosis of sepsis in all hospital departments
  • Monitoring of central venous oxygen saturation levels
  • Empiric, timely antibiotic therapy to fight the underlying infection
  • Maintenance of adequate blood pressure through IV fluids and/or medications
  • When localizable, removal or reduction of the source of the infection (for instance, removal of a potentially infected catheter or drainage of an abscess)

The new guidelines outline key symptoms of severe sepsis, including high fever, elevated heart rate and low blood pressure. The guidelines recommend aggressive treatment beginning in the emergency room and include immediate use of broad-spectrum antibiotics rather than waiting a few days for test results to identify the specific germ. 

Downloads and links

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Global prevention efforts target spread of resistant TB

A report issued by the World Health Organization (WHO) describes an increase in cases of multidrug-resistant tuberculosis (MDR-TB) in several eastern European countries and China, Ecuador, Israel, and South Africa. Patients in these affected areas are 10 times more likely to develop MDR-TB than patients in other parts of the world, WHO noted. Global TB-prevention efforts are necessary to halt the spread of MDR-TB, according to WHO, including research and development of new drugs. The report also states that TB rates in the United States have decreased over the past four years. The document, "Anti-Tuberculosis Drug Resistance in the World - Third Global Report," presents data from the examination of 67,657 TB patients in 77 countries and regions.

Although the report states that overall TB rates have declined in the United States, a recent CDC report illustrates the importance of maintaining a heightened vigilance to identify TB. A tuberculosis outbreak at a community hospital in 2002 shows that a single tuberculosis patient has the potential to come into contact with a large number of patients and staff in a hospital setting, according to a case study highlighted in the Centers for Disease Control and Prevention's (CDC) March 19 Morbidity and Mortality Weekly Report. The study determined that, during a three-week period in which a patient was hospitalized at a large community hospital with unrecognized TB, 1,045 people, 75 percent of whom were hospital staff, were exposed to the patient. Ultimately, four patients and a healthcare worker were diagnosed with TB; all were on the same ward as the TB-positive patient, whose symptoms may have been masked by HIV infection. The CDC report reinforces the importance of including protocols for HIV-infected patients with pulmonary symptoms suggestive of TB in hospital infection-control programs. The same issue of Morbidity and Mortality Weekly Report contains a report titled, “Trends in Tuberculosis – United States, 1998-2003,” which noted that average year-to-year TB rate continues to decrease, even though 2003 had the smallest annual decrease.

Downloads and links

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Ear infection treatment guidelines recommend pain relief before antibiotics

Newly released guidelines provide an option to observe select children with symptoms of ear infection, and start antibiotic treatment only if symptoms have not improved in 48-72 hours. The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) have released the new guidelines to help physicians and parents decide on the best treatment for acute otitis media (AOM), or middle ear infection. AOM is the most common bacterial illness in children and the one most commonly treated with antibiotics. Frequently asked questions about AOM are available from AAP and AAFP Web sites.

Allan Lieberthal, M.D., FAAP, co-chair of the guideline panel, stated that an accurate diagnosis of AOM is the key to this guideline. According to Dr. Lieberthal, clinicians must ensure that the child has AOM before prescribing an antibiotic. If a child is given an antibiotic and doesn't need it, he or she may build up an antibiotic resistance and not respond to them when needed to fight a more serious infection, such as pneumonia or meningitis. The guidelines stress that about eight in 10 children with ear infections get better with no antibiotics at all. The guidelines state that the most important step to take in the case of any ear infection is to relieve the child's pain.

Antibiotics may be the right choice for children up to the age of two who have ear infections - not just fluid in their ears. They may also be appropriate if a child is very sick or has a high fever.

Downloads and links 

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End-of-life care varies greatly among hospitals

A study in the March issue of the British Medical Journal evaluates the use of hospitals, physician visits, and hospice care by patients during the last six months of life. The study, focusing on 77 hospitals with a reputation for high-quality care, found dramatic differences in all measures. The frequency of physician visits was strongly associated with the workforce supply in the area. The availability of hospital beds also affects the physician decisions about admission and discharge. Increased hospice use did not show any decreases in intensive care unit use or in physician visits during the last six months of life.

The pattern of practice during end-of-life care highly correlated with variations at other stages in the progression of chronic illness. End-of-life care can then be used as a measure of how hospitals treat all patients with a chronic illness, not just those near the end of their life. Patients with chronic illnesses with high rates of use of hospitals, physician visits, and hospice care did not have better health outcomes. The study argues that the research focus for academic medical centers providing end-of-life care should be aimed at reviewing their own patterns of practice when managing these patients, specifically looking at how many hospital beds and physicians are needed to provide optimal care. The Institute for Healthcare Improvement (IHI) also cites this study under “Improvement Methods” in the “Topic Improvement” section of its Web site.

Downloads and links

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Risk assessment guidelines for construction reduce infection risks

Improperly designed and maintained environments pose numerous risks for patients, including hazards from fires, chemical exposures, or contaminated air, water or environmental surfaces. Premier ‘s Safety Institute is providing a new resource to assist in planning for risk reduction in healthcare construction and renovation projects. For example, improper ventilation design or maintenance has been associated with opportunistic infections such as Aspergillosis in highly immunosuppressed populations such as bone marrow transplant patients. Potential threats related to terrorism have dramatically highlighted the importance of facility design for enhancing the control of infectious agents. Related issues include designing with patient safety principles in mind, as well as consideration for “green buildings.”

The Safety Institute has organized a series of resources that should assist a variety of professionals with early planning, design and assessment activities. The “Construction - Infection Control Risk Assessment (ICRA)” module includes resources to assist in planning and conducting an ICRA, suggestions on designing for safety, and resources for protecting the environment from airborne, chemical, biologic and radiologic hazards.

Downloads and files

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Safety tools

Updated CDC guidelines - Preventing health-care associated pneumonia

The Centers for Disease Control and Prevention (CDC) released new guidelines for preventing healthcare-associated pneumonia and other severe lower respiratory infections. These guidelines update and replace the 1981 guideline. In addition to the latest pneumonia and respiratory infection recommendations, the guidelines expand the list of recommended antiviral treatments for influenza patients and recommends that potable water be kept at temperatures above 124 degrees Fahrenheit or below 68 degrees Fahrenheit to reduce the risk of Legionnaire's disease. The Guidelines for Preventing Health-Care-Associated Pneumonia, 2003 were published in the March 26, 2004 issue of Morbidity and Mortality Weekly Report (MMWR).

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OSHA compliance tools - Bloodborne pathogen standard FAQs

The Premier Safety Institute has updated a popular tool (75 KB) used to understand the Office of Safety and Health Administration’s (OSHA) Bloodborne Pathogen Standard. The “Frequently Asked Questions” (FAQs) regarding sharps safety were updated following a recent Premier-sponsored audio conference that featured speakers from OSHA and CDC.  Issues addressed include specific devices, device selection, evaluation and replacement, worker training and compliance, record keeping, schedules and implementation and a list of OSHA resources.

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Web-based resources - Patient representative on safety committee

The Institute for Family Centered Care has produced a number of useful resources to support the involvement of patients on hospital/healthcare advisory committees and boards. These resources have been developed from the experiences of many hospitals/healthcare facilities and the patients, family members and community representatives who have worked with them. The Web site is at www.familycenteredcare.org.

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Medication safety newsletter - ISMP safety news for nurses

A peer-reviewed newsletter published by the Institute for Safe Medication Practices (ISMP), Nurse Advise-ERR (February, 2004), addresses issues such as mixing up IV lines while setting up or programming a multiple-channel IV pump, the risks of leaving an unnecessary intra-arterial line in place, a list of high-alert medications, and questions to use when evaluating infusion pumps. Nurse Advise-ERR, a medication safety newsletter written especially for nurses by nurses, is offered free for the remainder of 2004. Register at www.ismp.org/NursingArticles/index.htm.  Back issues of the newsletter are available at http://www.ismp.org/NursingArticles/list.htm.

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New medication safety Web sites – FDA and AHRQ

FDA searchable database – In an effort to see that patients and consumers have the information they need to make informed choices, the Food and Drug Administration has launched a new easy-to-use Web site to help consumers and health professionals find information about FDA-approved drug products more quickly and efficiently. The new interface, Drugs @ FDA, is a searchable database that includes information on approved prescription drugs, some over-the-counter drugs, and discontinued drugs. Located on the Web page of the FDA's Center for Drug Evaluation and Research (CDER), it is the first Web resource to offer a comprehensive overview of a drug product's approval history. Users can easily search or browse this site by drug name or active ingredient to retrieve a complete approval history and accompanying documents for a particular drug product. Users can also find out if therapeutic equivalents, including generics for brand name drugs, exist.

AHRQ Studies on medication and patient safety - Content for a new Web site, "The Tools and Techniques of Improved Medication Use," is intended for those in the healthcare community who design medication safety programs and/or seek information to enhance existing patient safety efforts. The site was developed by the AHRQ-sponsored Research Network Center for Education and Research on Therapeutics (CERTs) in collaboration with the American Association of Health Plans-Health Insurance Association of America (AAHP-HIAA). The site includes selected studies, as well as resources needed to replicate strategies known to achieve important results in medication safety and use. The studies fall into three categories: disease management and interventions, educational interventions and monitoring and feedback.

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Editorial team

Gina Pugliese, RN, MS editor
Judene Bartley, MS, MPH, associate editor
Donna Bernstein, MPH, marketing consultant
John Hall, BSJ, contributor
Derek Kleckner, BA, Web master
Judith Luca, RN, BSN, contributor

About Premier

Premier, Inc. is a healthcare alliance entirely owned by 200 of the nation's leading not-for-profit hospital and healthcare systems. These systems operate or are affiliated with 1,500 hospital facilities and hundreds of other healthcare sites. Premier provides an array of resources supporting health services delivery, including clinical and operational comparative data applications for quality/safety performance improvement, group purchasing and supply chain services, and insurance programs. The Centers for Medicare and Medicaid Services (CMS) has recently partnered with Premier for a three-year quality incentive demonstration project. Participating hospitals using Premier’s Perspective Online database can receive recognition and additional Medicare payment when they meet or exceed specific quality measures.

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