Premier Safety Share

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November 2002

Dear Colleague:

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

All issues of Safety Share are archived on the Safety Institute Web site. They are indexed by date and topic. All of the resources mentioned in each news story are always available for download. To find a particular story or topic, use the search engine found by selecting Search Safety Web site from the Safety Web navigation.

Sincerely,

Gina Pugliese, Editor
Vice President, Premier Safety Institute

News

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Providers could face liability, staff shortages from smallpox inoculation effort

In the wake of a federal agencys recommendation that more than half a million healthcare workers be immunized for smallpox, Premier and other allied healthcare organizations are asking that providers get protection from the potential legal claims and staff shortages stemming from the inoculation effort.

The U.S. Department of Health and Human Services (HHS) and the Bush administration are expected to soon announce a final decision on the recent recommendation by the HHS Advisory Committee on Immunization Practices (ACIP) stemming from realistic concerns that smallpox could be used in a bioterrorist attack. ACIP had to balance any possible adverse reactions healthcare workers would experience due to preemptive vaccination against waiting to conduct a massive vaccination initiative after a case is identified. ACIP consists of 15 immunization experts selected by the Secretary of HHS to provide guidance on the most effective means to combat vaccine-preventable diseases.

Premier and the Catholic Health Association (CHA) urged HHS Secretary Tommy Thompson to develop a "fair and responsible smallpox vaccination plan" that considers hospital and institutional provider liability, as well as staff shortages that could result from health workers' experience of adverse reactions related to a smallpox inoculation.

Without provisions for protecting them, providers could face dire financial consequences stemming from lawsuits, workers' compensation claims, and other sources the organizations told Thompson. Hospitals also fear they could be subject to acute workforce shortages, especially in critical departments like emergency, as a result of post-vaccine, illness-related staff absences.

The National Vaccine Compensation Program (NVCP), created in 1998 as a no-fault alternative to the traditional tort system for resolving vaccine injury claims, could provide an instructive framework by which to address compensation issues, Premier and CHA told the HHS secretary.

Downloads and links

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CDC highlights alcohol-based hand rubs in new guidelines

New hand hygiene guidelines by the Centers for Disease Control and Prevention (CDC) may not shed a lot of new light on the importance of handwashing in patient care, but they do implicitly endorse the use of alcohol-based hand rubs as one way for busy healthcare workers to reduce spreading germs between patients.

The guidelines, released October 25, explore new research showing the ability of alcohol-based hand rubs to reduce bacteria on the hands more effectively than soap or water, noting that healthcare workers in general do not practice thorough hand hygiene procedures. Moreover, alcohol-based hand preparations such as hand gels have been shown to actually promote handwashing because they are convenient to use and cause less irritation and drying than many types of soap. Soap and water, however, are still recommended if hands are visibly soiled. Improved hand hygiene practices have also been shown in studies to reduce patients risk of infection, the CDC noted.

While alcohol-based preparations are a convenient and effective way of killing germs, the CDC cautioned that they are only part of a comprehensive handwashing regimen that should be adopted in every hospital and healthcare setting.

The guidelines also address the incidence of contact and allergic dermatitis from hand hygiene measures; the role understaffing plays in hand hygiene; and factors healthcare institutions should consider when choosing hand hygiene products.

The frequent and repeated use of hand hygiene products, particularly soaps and other detergents, is a primary cause of chronic irritant contact dermatitis among healthcare workers, according to the document. The CDC noted that surveys find that approximately 25 percent of nurses report symptoms or signs of dermatitis, and as many as 85 percent report a history of skin problems. Detergents in hand hygiene preparations, antimicrobial agents in soaps, iodine compounds, and other antiseptics are implicated in dermatitis. Other factors contributing to dermatitis include: using hot water for handwashing, low relative humidity, failure to use supplementary hand lotion or cream, and the quality of paper towels. The guidelines added that shear forces associated with wearing or removing gloves and allergy to latex proteins also contribute to the condition.

Outbreak investigations have also linked infections with understaffing or overcrowding, according to the CDC. The association was consistently linked with poor adherence to hand hygiene.

When evaluating hand hygiene products for potential use in healthcare facilities, administrators or product selection committees should consider the relative efficacy of antiseptic agents against various pathogens. Because acceptance of hand hygiene products by healthcare workers promotes compliance with recommended practices, healthcare workers should be consulted on issues like fragrance, feel of products on hands, and degree of skin irritation or skin tolerance.

The CDC also provides guidance on the use of gloves, the wearing of rings and artificial nails, and elements for educational and motivation programs to improve hand hygiene compliance. Educational resources are being developed to assist with implementation, but the CDC has several items available now, including a hand hygiene fact sheet.

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Poster deadline nears for 2003 NPSF Patient Safety Congress

Mark your calendars now to attend the National Patient Safety Foundation's (NPSF) Fifth Annual Congress, March 12-15, 2003, at the Renaissance Washington (DC) Hotel.

Please note that there is a November 30, 2002, deadline to submit abstracts of success stories for the poster presentations at the 2003 meeting. The posters are intended for practitioners, nurses, coalitions and other allied healthcare professions to advance the dissemination of patient safety success stories and showcase the results from their organizations patient safety efforts.

Premier is a co-convener of the 2003 NPSF Congress whose theme, "Let's Get Results: Improving the Safety of Patients," reflects the organizers intention to share and disseminate important information about successful patient safety initiatives by hospitals, medical groups, health plans, government agencies and others. More than 600 people attended last years event.

The NPSF Annual Congress will address issues vital to enhancing patient safety and reducing errors in healthcare. Formerly known as the NPSF Annenberg conferences, these events are a major part of the nation's patient safety education and awareness effort.

Who should attend?

  • Hospital CEOs and other executives
  • Patient safety officers
  • Quality improvement directors
  • Risk managers
  • Clinicians (physicians, nurses, pharmacists, etc.)
  • Employers
  • Insurers
  • Regulators
  • Government officials
  • Medical associations and colleges, educators, and researchers
  • Patients and families

The educational programs include five keynote/plenary addresses and 32 breakout sessions covering eight tracks: hospitals, ambulatory care and medical groups, technology and system solutions, health plans, consumers, employers, media, and pharmaceutical and device manufacturers. The Institute for Healthcare Improvement, in collaboration with NPSF, is conducting patient safety mini-courses on March 12.

All tracks focus on what specific results each of these groups have accomplished in their efforts to improve patient safety. Roundtable breakfast discussions and a private breakfast for CEOs round out this year's education program. The Congress is an accredited provider of continuing education for healthcare professionals.

A special poster session at the 2003 meeting highlights the changes that have demonstrated reductions in risk of harm or improved patient safety across all areas of healthcare. By sharing success stories, others will be able to implement similar changes, accelerating the pace of safety improvement. Poster abstracts must be submitted by November 30, 2002, to: Carol Lieser, conference service director, National Patient Safety Foundation, 69230 Peachtree Court Cathedral City, CA 92234. Abstracts also may be sent via e-mail to Ms. Lieser at clieser@npsf.org, or via fax at 760.770.0298.

Sponsors and exhibitors should contact Paul Quin at info@pjquin.com or 952.746.2522.

For complete event information, visit the Congress Web site at http://www.mederrors.org and the NPSF Web site at http://www.npsf.org.

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Premier drives home environmental commitment at "CleanMed" conference

Key Premier staff presented at "CLEANMED 2002: An International Conference On Environmentally Preferable Medical Products and Green Buildings," held in Chicago October 25-26.

Hundreds of leaders in healthcare, green buildings, and purchasing organizations gathered at CleanMed 2002 to discuss the latest developments in environmentally preferable purchasing and building design. The conference was co-sponsored by Premier, Inc.; Catholic Health Initiatives, Inc.; and Health Care Without Harm.

Premier joins healthcare providers from around the world in recognizing that product choices can impact our health and the environment. They are finding opportunities to minimize the healthcare system’s ecological impact and to improve the health of the communities they serve by choosing safer, cleaner, more sustainable products and practices. Premier has implemented an environmentally preferable purchasing (EPP) program to assist members’ efforts to protect the health of patients and healthcare workers, as well as support industry’s efforts to reduce or eliminate environmentally harmful products. Environmentally preferable purchasing is the act of purchasing products and services found to be less damaging to the environment and human health than similar, competing products and services.

Premier GPS Senior Vice President Howard Sanders reinforced the alliance’s commitment as he joined executives of other group purchasing organizations (GPOs) on a CleanMed plenary panel discussion on environmental initiatives in GPOs. Gina Pugliese, vice president, Premier Safety Institute, who moderated a CleanMed discussion on safer needle devices, also affirmed Premiers commitment among the organizations.

As part of its ongoing EPP program efforts, Premier is receiving input from member hospitals to define environmentally preferable purchasing, and continually reviews state and national laws, regulations and guidelines, Sanders explained to attendees at the session.

Additionally, Premier is implementing environmentally preferable purchasing strategies in its portfolio by collaborating and sourcing with companies that have made a business decision to support EPP products. Premier will give special consideration to business partners supporting environmentally friendly products and packaging, Sanders added. This includes active identification of companies providing EPP solutions. Premier also has incorporated environmental issues into its supplier qualification review process.

Environmentally preferred purchasing also encompasses packaging and products that are less toxic, prevent pollution, are more energy efficient, and are safer and healthier for patients, workers and the environment when compared to competing products and services. This includes products that can be recycled or are biodegradable, contain less toxic and hazardous chemicals and additives, do not contain mercury, promote good indoor air quality, can be re-used or recycled to minimize waste, and reduce the risk of adverse outcomes in patients and workers.

Premier’s notable current EPP initiatives include:

  • Developing the industrys most comprehensive list of pharmaceutical products containing mercury to help hospitals identify these drugs and manage or dispose of them appropriately. Premier is committed to the "Memorandum of Understanding" between the American Hospital Association (AHA) and the Environmental Protection Agency (EPA) to virtually eliminate mercury in the nation’s waste stream by 2005, and is working toward phasing out mercury-containing products in its purchasing portfolio.
  • Serving as a "Champion for Change" as part of the Hospitals for a Healthy Environment (H2E) program, sponsored by the AHA and the EPA, along with other national groups concerned with promoting a healthy environment.

Premier’s Safety Institute provides guidance documents, product lists, and a wealth of other information for members and business partners interested in learning more about EPP in general, as well as specific knowledge bases on mercury, latex, PVC, and reuse of single use devices. The information is available on the Safety Institute’s Web site at www.premierinc.com/safety.

For more information on Premiers EPP program, contact Weldon Johnson at weldon_johnson@premierincom, (630.891.4407); or Gina Pugliese at gina_pugliese@premierinc.com, (630.891.4863).

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IOM states government should take the lead in improving patient safety

An October 30, 2002, report issued by the Institute of Medicine (IOM) states that the federal government should take the lead in improving the safety and quality of treatment provided to the nearly 100 million beneficiaries of six government healthcare programs: Medicare, Medicaid, the State Children's Health Insurance Program, the Department of Defense TRICARE programs, the Veterans Health Administration, and the Indian Health Service. "The government and health providers must unify and standardize their quality improvement efforts," the report says, "with the government setting the standard for the sector as a whole."

American Hospital Association (AHA) President Dick Davidson states that the report recommends greater coordination by the federal agencies in quality improvement activities, and is a long overdue move and an important step toward better care for the public. He noted that advancing this goal requires federal agencies to make hospitals and patients a part of the process.

The IOM recommends that standardized performance measures be established and clinical computerized records developed to facilitate accurate measurement and comparisons. The report suggests that the federal government pursue purchasing strategies that act as incentives for healthcare providers to adopt "best practices." Such strategies and inducements may include differential or expedited payments for delivery of improved care, public recognition for improvements, and the release of comparative quality data.

The report recommends that in 2003, the Quality Interagency Coordinating Task Force (QuIC) establish, in concert with the private sector, standardize performance measures for five common health conditions, and another ten the following year. These "priority conditions" (to be outlined in a separate IOM report in the coming weeks) will include such ailments as diabetes, asthma, stroke and congestive heart failure, as well as end-of-life care and pain management. Each government health program should then pilot the measures and collect patient data to include in comparative performance reports. Subsequently, Congress and the relevant departments should provide tax credits, subsidized loans, and grants to support providers in their development of information technology systems. Finally, each program should generate publicly-available quality reports so that consumers, healthcare professionals and accreditation groups can make more informed decisions.

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AIA seeks input on construction guidelines revision

The American Institute of Architects (AIA) and the Facility Guidelines Institute (FGI) have begun revising the 2001 edition of the "Guidelines for Design and Construction of Hospital and Health Care Facilities." Interested parties, such as facility engineers, architects, and safety and infection control professionals are invited to submit revisions and/or additions to update the existing Guidelines. The proposals will be considered for inclusion in the next edition, to be published in 2005. Proposals must be submitted on a special form and received by the AIA no later than December 31, 2002. Revisions may be submitted electronically on the required form, which is now available on the AIA Web page.

The Guidelines recommend minimum program, space, and equipment needs for all clinical and support areas of hospitals, nursing facilities, freestanding psychiatric facilities, outpatient and rehabilitation facilities, and long-term care facilities. The document also addresses minimum engineering design criteria for plumbing, medical, gas, electrical, heating, ventilation, and air conditioning systems. Aspects to be given particular consideration in this review process include:

  • Therapeutic environments (includes environment of care, green design, and sustainability)
  • IT and healthcare technology and communications (includes patient documentation and imaging)
  • Infection control (includes biohazard control, hand washing, infection control risk assessments, and construction materials)
  • Disaster planning
  • Safety and security
  • Dimensional considerations (includes space planning and costs)
  • Energy and cost-effectiveness

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Nearly 25 percent of hospitals reuse single use devices

More than 24 percent of all U.S. hospitals reuse single-use devices (SUDs), according to the findings from a U.S Food and Drug Administration (FDA) survey of hospitals. The most commonly reused SUDs are sequential compression device sleeves, which are reused by 15.8 percent of all hospitals, followed by drill bits, saws, blades, burrs, biopsy forceps, and snares. Of the hospitals reusing SUDs, the large majority (84.0 percent) use third-party reprocessors to reprocess these devices. The survey was conducted between December 2001 and February 2002.

Most hospitals have moved their sterile reprocessing of single use devices from "in house" to third-party reprocessing companies following additional burdens placed on hospitals by the FDA through guidelines issued in August 2000. These FDA guidelines require that hospitals comply with regulations originally applicable only to manufacturers and third party reprocessors, including registration requirements, documented quality systems, and submission of a 510(k) application for each device to reprocess.

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FDA issues guidance on West Nile virus blood donor deferral

The U.S. Food and Drug Administration (FDA) issued a guidance on October 25, 2002, for immediate implementation on West Nile virus. The guidance is designed to protect the safety of the blood supply by reducing the risk of infection through transfusions. Because 20 percent of those with the virus have symptoms that vary from mild symptoms to fever and other flu-like symptoms, the FDA said that donor screening procedures already in place should identify these people. Therefore, no additional screening questions are being recommended.

The new guidance recommends deferring a potential donor with a medical diagnosis of West Nile virus until 14 days after the condition is resolved or at least 28 days from the onset of symptoms or diagnosis, whichever is longer. However, a persons blood would not be deferred if he/she has not had recent symptoms but has a positive antibody test result.

From August 28 to October 26, the Centers for Disease Control and Prevention (CDC) received reports of 47 people with possible transfusion-related West Nile virus infection. Investigations showed that 14 of these people either did not have the virus or did not acquire the infection through transfusion. The remaining 33 cases, reported from 17 states, occurred in people who had confirmed or probable West Nile virus infection and had received blood components in the month before the onset of their illness. To date, evidence that West Nile Virus can be transmitted through blood transfusion has been found in six of the 33 cases; investigations are ongoing for the other 27 cases. Cases of infection in patients who have received blood transfusions within the month preceding the onset of illness should be reported to the CDC through state and local public health authorities. Serum or tissue samples should be retained for later studies. In addition, cases of infection in people who have an onset of illness within two weeks after a blood donation should be reported to the CDC. Prompt reporting of these cases will help remove potentially infectious blood components.

Efforts are currently underway by pharmaceutical companies to develop effective nucleic acid amplification testing (NAT) to screen blood donations for the virus. Pharmaceutical companies believe a PCR (NAT) assay or test can be ready to meet the FDA's call for assays by the second quarter of 2003. Because mosquitoes most commonly transmit the disease, there is pressure to create viable screening tests by next summer, when the mosquito season peaks in the United States.

Blood donors should note that while the risk of acquiring the West Nile virus through transfusion remains extremely low, there is no risk of acquiring the virus by donating blood.

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Safety tools

 

Brochure Patient advocate tips on patient safety

A study recently released in the Journal of the American Medical Association (JAMA) states that hospitals with high patient-to-nurse ratios are putting nurses at greater risk for burnout and increasing patient mortality rates. According to the article, the National Patient Safety Foundation (NPSF) realizes that the challenges in nurse staffing directly affect patient safety. Because nurses have more personal contact with patients, they can detect subtle changes in their condition and therefore can react immediately when needed. In this era of nursing shortages, patients should have their own advocates during their hospital stay, ideally friends or family members actively involved in their healthcare. Therefore, the NPSF has developed an online brochure, "Role of the Patient Advocate," that offers valuable tips on how patients can choose "advocates" to look out for their best healthcare interests

Download the "Role of Patient Advocate" brochure (74 KB),  or go to http://www.ihi.org/collaboratives/breakthroughseries/PatientSafety/index.asp.

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Slide Presentation Hand hygiene training materials

A new Web site called, "Hand Hygiene Resource Center," provides updated educational materials dealing with hand hygiene practices. The Web site contains:

  • A link to the new Hand Hygiene Guideline at the CDC
  • PowerPoint presentations (downloadable) that can be used for educating healthcare personnel (both clinical and non-clinical such as dietary or transport services) about hand hygiene
  • An annotated bibliography of articles dealing with hand hygiene, frequently asked questions and a glossary of terms
  • Direct links to PubMed abstracts for each article and links to other useful, non-commercial hand hygiene web sites

To access this information, go to http://www.handhygiene.org.

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OR design tools Infection control construction resources

If your facility is involved in building new operating rooms, a Web site is available providing a variety of resources to ease the process. The OR Design and Construction site includes resources and advice, not only from professional designers and infection control experts but also from surgical services leaders who have been involved in designing and building new operating rooms. This site includes details of the design process, infection control and case studies. Links to other operating room resources are also available, such as OR Manager, OR Benchmarks and OR Business Management. View this site at http://www.ordesignandconstruction.com.

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Products and equipment Emergency preparedness materials

Premiers Safety Institute provides several resources to assist in emergency equipment planning, including a safety inventory or sample list of selected products. This was developed by one healthcare system (Inova) and suggests the types of supplies to consider. On-line catalogs provide emergency preparedness supplies available from several companies. Products available through Premier are itemized in tables and sorted by product or by vendor.
Go to http://www.premierinc.com/quality-safety/tools-services/safety/topics/
disaster_readiness/prod_equip.htm.

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Editorial team

Gina Pugliese, RN, MS editor
Judene Bartley, MS, MPH, associate editor
Donna Bernstein, MPH, marketing consultant
Derek Kleckner, BA, Web master

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.

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