Premier Safety Share
In this issue
Premier Safety Web Site
May 2003
Dear Colleague:
We hope you enjoy this free safety newsletter.
Each individual issue is archived on the Safety Institute Web site with all of the resources available any time you need the information.
Please continue to share with your colleagues and encourage them to subscribe so they don't miss any issues.
Sincerely,
Gina Pugliese, editor
Vice President, Premier Safety Institute
News
- JCAHO, others, agree on use of alcohol-based hand cleaners
- H2E honors healthcare organizations for environmental leadership programs
- CDC issues guidelines on HIPAA implications for public health
- President signs smallpox vaccine compensation bill
- Most hospitals meet JCAHO 2003 safety goals; prohibited abbreviation biggest challenge
- OSHA's bloodborne pathogen violations on the rise
- ECRI issues special report on IV infusion pumps
- FDA guidance aimed at safeguarding blood from SARS
Safety tools
- SARS triage tools – Algorithms for ED, ambulatory clinics
- IHI –Premier ADE trigger tool – Tracking adverse drug events
- Bioterrorism preparedness guide – Template for regional, community planning
- Online chemical agent resource – NIOSH fact sheets, cards
- Slides from AHRQ teleconference - Planning and executing disaster drills
- Audiotapes, slides – New AHRQ bioterrorism preparedness on smallpox
JCAHO, others, agree on use of alcohol-based hand cleaners
In October 2002, the Centers for Disease Control and Prevention released the new Guideline for Hand Hygiene in Health Care Settings. The guideline emphasizes the use of alcohol-based hand rubs as a part of comprehensive hand hygiene. However, as noted in the March 2003 edition of Safety Share, healthcare organizations installing alcohol-based cleaning agent dispensers must consider fire and life safety issues.
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and professional organizations such as the Association for Professionals in Infection Control and Epidemiology (APIC) agree on basic approaches to dispenser installation as efforts to achieve a final consensus among regulators remain in development. All organizations support placing dispensers inside patient rooms and recommend avoiding dispenser placement in egress (exit) corridors until a study of fire safety risks can be completed and interpreted. The American Society for Healthcare Engineering (ASHE) is overseeing an independent study to help determine risk reduction strategies for installation and storage of alcohol-based hand hygiene products. Safety Share will publish results when new information is available from the ASHE study.
- JCAHO endorses the use of hand hygiene products in an interim position statement on hand hygiene and fire safety issues.
- APIC has an interim position paper addressing hand hygiene implementation and dispenser placement, following input from the American Hospital Association and ASHE.
- ASHE also has published a position paper for its members, supporting the importance of hand hygiene for patient and healthcare personnel safety, while emphasizing safe storage issues.
Premier’s Safety Institute provides a number of related resources including OSHA’s recent interpretation of the CDC guidelines concerning appropriate use of alcohol-based hand hygiene products.
- Download the Hand Hygiene guideline and documents from JCAHO, APIC, ASHE and OSHA.
- See Premier Safety Share archive, March 2003
- Safety Institute’s IC article on hand hygiene controversy
- Hand hygiene resources
H2E honors healthcare organizations for environmental leadership programs
Hospitals for a Healthy Environment (H2E) honored more than 100 healthcare-related groups for their outstanding environmental programs to eliminate mercury and reduce toxicity and overall waste. H2E is a joint partnership between the Environmental Protection Agency (EPA) and the American Hospital Association (AHA) and an industry wide collaborative effort to assist hospitals with their environmental health and safety programs. See the complete list of 2003 award recipients.
What are the H2E awards?
- The Environmental Leadership Award is the premier H2E award given annually to facilities setting the "industry standard" for environmental programs and policies. These facilities maintain active, ongoing waste and mercury-use elimination programs serving as models for other healthcare facilities across the country.
- The Champions for Change Award is given to H2E Champions for Change that have taken a leadership role in promoting the H2E goals to their members. Members that have implemented programs supporting these goals are eligible to apply for the H2E Champion Award.
- The Partners for Change Award is given annually to facilities that have made significant progress toward reducing waste, preventing pollution, and eliminating mercury, specifically by initiating comprehensive waste minimization and pollution prevention programs in ways that are measurable, sustainable, and contribute to the goals of H2E.
- Partner Recognition is given annually to Partner facilities that have met their self-identified H2E goals for the previous year.
- The Making Medicine Mercury-Free Award is a one-time award given to facilities that have met the challenge of becoming "mercury free."
Get involved
Premier Inc., as a H2E Champion for Change, encourages and helps healthcare facilities to participate as H2E partners and commit to making changes in their facilities that protect community and environmental health.
As of April 18, 2003, the H2E program had a total of 440 partners representing 1,475 facilities: 473 hospitals, 828 clinics, 37 nursing homes and 137 other types of facilities. These partners are healthcare facilities that have pledged to eliminate mercury and reduce waste consistent with the overall goals of H2E.
H2E’s initiatives to reduce and eventually eliminate toxic materials from our waste stream and reduce overall medical waste are not only beneficial to the environment and the overall health of communities, but also help healthcare facilities reduce their supply and operating costs. Partners also benefit from their H2E status by reducing potential liability from the harmful effects of waste while gaining community recognition.
H2E partners and membership include health care facilities, hospital associations, governmental agencies, companies, and group purchasing organizations. Information is readily available for becoming a member or partner of H2E.
As a H2E Champion for Change, Premier's Safety Institute’s comprehensive Web-based tools and resources provide a wealth of information on environmental safety, environmentally preferable purchasing, mercury elimination, latex allergies, and sharps injury prevention. It also houses the industry’s only publicly available list of mercury-containing pharmaceuticals to help hospitals identify, manage, and dispose of these drugs as potentially hazardous waste.
- List of 2003 H2E winners
- Become a member or partner of H2E
- Premier Safety Institute Web-based tools and resources
- Premier Safety Share monthly e-newsletter -- news on EPP-related issues.
CDC issues guidelines on HIPAA implications for public health
The change in medical record keeping from paper to electronic increases the potential for individuals to access, use, and disclose personal health data. The U.S. Department of Health and Human Services (DHHS) addresses these concerns with new privacy standards setting a national minimum of basic protections.
These standards are issued according to the Health Insurance and Accountability Act of 1996 (HIPAA). In the April 11, 2003, Morbidity and Mortality Weekly Report (MMWR), the Centers for Disease Control and Prevention (CDC) and DHHS provided direction for public health reporting. The Privacy Rule regulates how covered entities use and disclose protected health information. (Protected health information is individually identifiable health information that is transmitted or maintained in any form or medium, but excludes certain educational records and employment records.) This report provides direction to public health authorities and other healthcare providers in interpreting the Privacy Rule as it affects public health.
Together, the National Committee for Quality Assurance (NCQA) and the JCAHO also announced plans for a certification program that evaluates applicant business associates to determine whether they are meeting standards for safeguarding personal health information based on the HIPAA privacy rule. Those organizations have signed a Letter of Intent to explore a possible collaboration to offer this “Privacy Certification Program for Business Associates.” Any business associate that handles personal health information for health plans; providers or health care clearinghouses would be eligible for the program. Such entities include, but are not limited to: software firms; healthcare IT firms; data collection, analysis and processing firms; practice management firms; third-party administrators; disease management organizations; and survey vendors. Program launch is anticipated following release of the final standards.
Additional interpretive information is available from the American Hospital Association. In February, the AHA released updated guidelines for the release of information on the condition of patients under HIPAA. The brochure is designed to inform hospital staff about how and when hospitals can release information on a patient's condition to media, family members and clergy.
- Download CDC HIPAA Guidelines (243 KB)
- More privacy information from CDC at: http://www.cdc.gov/privacyrule/
- Additional comprehensive DHHS guidance at: http:/www.hhs.gov/ocr/hipaa
- Download AHA’s Guidelines for Releasing Information on the Condition of Patients (135 KB). Printed copies can be ordered by clicking on the "Order Guidelines" for the brochure at http://www.hospitalconnect.com.
President signs smallpox vaccine compensation bill
The measure to compensate those disabled or killed from smallpox inoculations was passed recently by Congress and signed by President Bush. The supplemental spending bill (HR 1559) covers the costs of the war in Iraq and includes $42 million addressing the smallpox vaccination program for healthcare workers and first responders who suffer side effects of the smallpox vaccination.
The program to inoculate up to 439,000 doctors, nurses, and emergency workers who would be the first to respond in a smallpox attack yielded only 25,000 volunteers, apparently because of fears of harm from the vaccine. Specifically, it ensures that hospitals not be held liable for inoculated staff's inadvertent spread of vaccine-related illnesses to non-vaccinated individuals. Individuals suffering vaccine-related injuries would receive federal compensation for reasonable and necessary health expenses in connection with the injury. Permanently disabled recipients would be eligible for up to $50,000 a year in lost wages. Partially disabled recipients could also collect that benefit, up to a maximum of $262,000. The government would pay a $262,000 benefit to spouses of people killed by the vaccinations. Spouses with children would be eligible for either $262,000, or $50,000 a year until the children turn 18.
- Public Law 108-11 or HR 1559. Search on either term: http://thomas.loc.gov/
Most hospitals meet JCAHO 2003 safety goals; prohibited abbreviation biggest challenge
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) noted that compliance with some of the 2003 National Patient Safety Goals (NPSG) was more challenging than others. In January 2003, JCAHO began surveying organizations for compliance. As of February 21, 2003, JCAHO completed 313 surveys, finding most healthcare organizations in compliance with the goals. However, some of the recommendations are more challenging to adhere to than others, including prohibited abbreviations (7 percent non-compliance), two identifiers (2.6 percent non-compliance) and surgical site marking (2.2 percent non-compliance).
As of March 21, JCAHO had received 63 “Requests for Review of Alternatives” to the NPSGs; 39 were from hospitals. Of the 63 alternatives, 27 were deemed “no review necessary” meaning the organization was meeting the goal, or the request was not a true alternative. Among the remaining, 10 were not acceptable, six were acceptable with modification, five were acceptable, three requests were withdrawn, and 12 are being reviewed. Examples of JCAHO approved alternative approaches to the recommendations will be provided on the JCAHO Web site at a future date.
On a related note, the Sentinel Event Alert Advisory Group met in March to begin identifying the 2004 NPSGs. The Sentinel Event Alert Advisory Group conducts thorough reviews of all Alert recommendations, identifies candidates for inclusion, and forwards final recommendations to JCAHO's Board of Commissioners for approval. The group:
- Reviewed the existing 2003 goals for potential continuation in 2004.
- Identified potential new topics for 2004 goals, including preventing surgical fires, eliminating kernicterus, and reducing the risk of serious nosocomial infections.
- Discussed the linkage between JCAHO's NPSGs and the National Quality Forum's Safe Practices for Better Health Care and Serious Reportable Events
The JCAHO will announce 2004 Goals and Recommendations in July following Board approval.
- Complete details on 2003 compliance and 2004 goals are available.
OSHA's bloodborne pathogen violations on the rise
Fines and inspections concerning OSHA's bloodborne pathogens standard are on the rise. For the third year in a row, Infection Control Monitor reports bloodborne pathogens were the most common citations given to hospitals by OSHA.
- Inspections conducted from October 2001 to September 2002 yielded over $1 million in penalties for bloodborne pathogens violations, an increase of over 25 percent from penalties assessed over the same period last year.
- A total of 44 hospitals received 115 bloodborne violations totaling $75,380 in fines, an average penalty of $655 per violation. A year earlier, OSHA issued only 54 bloodborne pathogen violations.
- The increase in fines and overall enforcement of the standard was attributed to two factors: 1) new compliance requirements imposed by the Needlestick Safety and Prevention Act of 2000; and 2) OSHA's national emphasis program targeting nursing homes and personal care facilities.
OSHA's bloodborne pathogens standard applies to all employees who have occupational exposure to blood or other potentially infectious materials (OPIM). The goal of the standard is to reduce the risk of worker exposure to bloodborne pathogens such as Hepatitis and HIV. Though the standard applies primarily to healthcare workers, non-healthcare workers at manufacturing, retail, hotels, and restaurants may also be covered by protections of the standard if they are designated as first aid responders to cover workplace incidents. Under the standard, employers are required to establish an Exposure Control Plan that eliminates or minimizes employee exposures to blood and OPIM. This requirement includes the implementation of engineering controls, work practice controls, vaccinations, signs, labels, training, and personal protective equipment into workplace operations.
Due to the increasingly high injury and illness rates at nursing home and personal care facilities, OSHA last year established a national emphasis program to target inspections toward facilities in those injuries. Increased enforcement is only one element of the national emphasis. The second component – increased outreach – provides additional compliance assistance to nursing homes and personal care facilities on ergonomics and bloodborne pathogens.
The new needlestick requirements and the targeting of nursing home and personal care facilities have resulted in a sharp increase in fines and inspections related to the bloodborne pathogens standard. As increased enforcement continues, affected businesses must ensure their compliance with the standard (including the needlestick safety revisions) or face fines of up to $7,000.00 per violation.
- Safety Institute resources and frequently asked questions.
- OSHA information on bloodborne pathogens
- Access the Infection Control Monitor
ECRI issues special report on IV infusion pumps
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recently recognized ECRI, a nonprofit health services research agency, as an “authoritative source of information about the safety considerations related to infusion pumps.” JCAHO's 2003 National Patient Safety Goals require JCAHO-accredited healthcare facilities, including hospitals and long-term care facilities, to improve the safety of using infusion pumps through exclusive use of "free-flow protected" general-purpose and patient-controlled analgesia (PCA) infusion pumps.
JCAHO-accredited hospitals now must show compliance with this goal. To promote compliance, ECRI has posted its updated Health Devices Alerts Special Report titled “JCAHO’s 2003 National Patient Safety Goal for Infusion Pump Free-Flow Protection: Assessing General-Purpose and Patient-Controlled Analgesic (PCA) Pumps” on its Web site. The report is free for a limited time. The report includes ECRI's list of "safe" and "unsafe" general-purpose infusion pumps.
ECRI’s Special Report (No. SR0018, March 2003) classifies most models of general-purpose infusion pumps that may be in use in North America – and therefore will be exposed to JCAHO scrutiny – into three categories: those with free-flow protection, those without it, and those with free-flow protection dependencies. The report categorizes 70 models of general-purpose infusion pumps and identifies 28 models as not providing adequate protection from free-flow under any circumstance. ECRI recommends that hospitals replace these units with “safe” free-flow-protected pumps as soon as possible. The report also expands product-specific guidance on general-use and PCA intravenous infusion pumps used in hospitals, skilled nursing facilities, and home care infusion groups.
Another important infusion pump safety resource for hospitals is the October, 2002 issue of ECRI’s Health Devices. It includes comprehensive brand-name evaluations on general-purpose infusion pumps and presents findings for four newly evaluated pumps from three suppliers: the Abbott Plum A+; the Alaris Medley Medication Safety System (MSS); and the Baxter Colleague CX and 3CX. The article also summarizes findings and updates ratings for 22 additional models. For more information and pricing, contact ECRI at 610.825.6000, Ext. 5891, or at info@ecri.org.
- ECRI has posted its updated Health Devices Alerts Special Report at http://www.ecri.org
FDA guidance aimed at safeguarding blood from SARS
The U.S. Food and Drug Administration (FDA) is recommending that blood establishments defer potential donors who may have been exposed to severe acute respiratory syndrome (SARS) until it's known whether the infectious disease can be transmitted through blood. The FDA guideline, issued April 17,2003, calls for additional questioning of potential donors to ascertain if they may be at elevated risk for SARS due to recent travel to high-risk areas or exposure to someone with the disease.
The agency said people without SARS symptoms who have traveled to areas where a relatively large number of SARS cases have been reported (People's Republic of China; Hanoi, Vietnam; and Singapore) should be deferred from donating blood for two weeks after their return to the United States. People who have suffered from a case of SARS, as evidenced by a combination of symptoms and travel history, should be deferred from donating until four weeks after their symptoms are resolved and treatment is completed, the agency added.
The FDA said prior blood donors should be encouraged to report any SARS-related exposure in the two weeks before donation or SARS illness or treatment in the four weeks before donation. New donors should be encouraged to report SARS illness or treatment experienced within two weeks after donation. Blood identified as having come from potentially exposed or infected donors will be indefinitely kept out of the blood supply. The FDA expects the guidance to have a minimal effect on the number of available donors and blood supply quantity.
The guidance reflects consultation with the Centers for Disease Control and is intended as an interim measure to protect against the potential blood contamination risk posed by SARS. At this writing there were no known cases of SARS transmission via blood products. However, detection of the genes of the possible causative virus in blood has been reported in a patient with SARS. Also, as in some other viral infections, persons with SARS could potentially have the virus in their blood early in an infection without any symptoms. Therefore, transfusion transmission of SARS may be possible.
The FDA also released the final guideline to protect the blood supply from WNV, adding a new recommendation to ask donors a specific question about history of fever with headache within the week prior to donation. The final document may be downloaded.
Safety tools
- SARS triage tools – Algorithms for ED, ambulatory clinics
- IHI –Premier ADE trigger tool – Tracking adverse drug events
- Bioterrorism preparedness guide – Template for regional, community planning
- Online chemical agent resource – NIOSH fact sheets, cards
- Slides from AHRQ teleconference - Planning and executing disaster drills
- Audiotapes, slides – New AHRQ bioterrorism preparedness on smallpox
SARS triage tools – Algorithms for ED, ambulatory clinics
Although of the number of new cases of SARS has dropped globally, vigilance is critical to maintain the gains. One health system, the Detroit Medical Center, has shared its tools for rapid assessment of a patient who may present with one or more symptoms suggestive of SARS (for example, high fever, severe respiratory symptoms). These algorithms and a “stop” sign that can be printed and used in these settings – if this becomes necessary – are available on Premier’s Emergency and Public Health Preparedness site.
You may download these tools here:
Visit the CDC web Site for daily updates on SARS recommendations for infection control. On May 7, 2003, the Centers for Disease Control and Prevention (CDC) advised that health care workers (HCWs) developing a fever or respiratory symptoms within 10 days of caring for or being exposed to a SARS patient should not report for duty, but should stay home and report symptoms to the appropriate point-of-contact at their facility. If the symptoms begin while at work, HCWs should be instructed to immediately apply a surgical mask and leave the patient care area. If symptoms improve or resolve within 72 hours after onset, HCWs can return to duty after consulting with infection control and local public health authorities. Previously, CDC recommended only that HCWs wait 72 hours after first symptom onset before returning to duty after their symptoms had improved or resolved. Updates and advisories are routinely posted on Premier’s Emergency and public health preparedness page.
IHI –Premier ADE trigger tool – Tracking adverse drug events
The Institute for Healthcare Improvement (IHI) offers a tool to help identify adverse drug events (ADEs). The use of "triggers," or clues, to identify adverse drug events is an effective method for measuring the overall level of harm from medications in a healthcare organization. The trigger tool, developed by IHI in partnership with Premier, Inc., measures adverse drug events and provides instructions for conducting a retrospective review of patient records using triggers to identify possible ADEs. This tool includes a list of known ADE triggers and instructions for measuring the number and degree of harmful medication events. The tool provides instructions and forms for collecting the data you need to measure ADEs per 1,000 doses and percent of admissions with an ADE.
- To learn more, view web Site and download the trigger tool.
Bioterrorism preparedness guide – Template for regional, community planning
The Texas Institute for Health Policy Research, a subsidiary of the Texas Hospital Association, has developed a bioterrorism disaster preparedness guide for hospitals. The guide, “Disaster Preparedness and Response in Texas Hospitals: Part I, Bioterrorism,” was developed for regional and community bioterrorism planning under a contract with the Texas Department of Health and with funding by HHS' Health Resource and Services Administration. The agency hopes the manual becomes a template for regional planning in other states. Future editions of the manual will address other types of terrorist attacks and disasters. The 159 page manual is available online.
Online chemical agent resource – NIOSH fact sheets, cards
The National Institute for Occupational Safety and Health (NIOSH) recently added a segment to its Internet-based Emergency Response Resources providing information on agents likely to be used in a chemical terrorist attack. This resource highlights agent-specific identification, medical symptoms, personal protective equipment, and decontamination considerations for responding to events involving cyanide, sarin, and nitrogen mustard. NIOSH's chemical agent information includes downloadable tools such as fact sheets, emergency response cards, and toxicological profiles.
Slides from AHRQ teleconference - Planning and executing disaster drills
Disaster drills are most effective when designed by an interdisciplinary team that clearly establishes goals before the drill begins. An April 2003 Agency for Healthcare Research and Quality (AHRQ) teleconference on disaster drills and readiness assessment also concluded that the drills should also include a plan to evaluate whether the goals were reached. While there is no standard formula for conducting effective drills or disaster management, the Hospital Emergency Incident Command System (HEICS) is emerging as the most widely agreed-upon system.
A new AHRQ-sponsored questionnaire that hospitals can use to evaluate bioterrorism preparedness will be released later this year after being pilot tested in June. The questionnaire will focus on 12 key areas, including regional links among facilities, planning and structure, training, infection control, and information systems. See an early version of the questionnaire.
A streamed video, text transcript or slide presentations from the teleconference as well as a Web-based audio archive of the conference are available. Audiotapes are available for $10 from AHRQ by calling 888.358.9295 (ask for product AHRQ 03-AV06A). Analyses on emergency preparedness and HEICS are available in the Emergency Preparedness section of the Healthcare Hazard Control System.
Audiotapes, slides – New AHRQ bioterrorism preparedness on smallpox
Free Microsoft® PowerPoint slides of AHRQ's March 3 Web-assisted audioconference, "Addressing the Smallpox Threat: Issues, Strategies, and Tools," are now available, as well as a streamed video or text transcripts of each presentation. Copies of a 90-minute audiotape may be purchased for $10 from the AHRQ Publications Clearinghouse. Call 800.358.9295 or send an e-mail to ahrqpubs@ahrq.gov and request AHRQ 03-AV04A.
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 national strategic alliance of leading hospitals and healthcare systems representing more than 200 not-for-profit owners that own, operate, or are affiliated with approximately 1,600 facilities. Premier members have access to a wealth of resources that support them as they evolve into integrated delivery systems and improve community health across the continuum of care. Premier maintains corporate offices in San Diego, CA; Charlotte, NC; Chicago, IL; and Washington, DC. For information, visit www.premierinc.com.