Premier Safety Share

In this edition

Premier Safety Web site

January 2004

Dear Colleague:

Looking for a tool, resource or training program on a particular aspect of patient or worker safety? We now have two years of archives of all the safety tools that have been featured in our Safety Share newsletter. They are all indexed by topic and most of them are downloadable. We hope you will find this feature valuable to your work.

Gina Pugliese, editor
Vice President, Premier Safety Institute


Safety tools


Best practices for labeling intravenous lines

In response to inquiries regarding the best way to label intravenous lines on patients with multiple lines, Michael Cohen, president of the Institute for Safe Medication Practices (ISMP) issued a response on the Institute for Healthcare Improvement (IHI) Web site that discusses the issue of color coding, color differentiation, and user-applied versus commercially applied color cues.

Color-coding is a systematic application of unique colors to identify specific products. No other product is allowed to have the same color. Dr. Cohen noted that color differentiation entails the use of color to make certain features stand out or to help with identifying items, but the color itself has no specific meaning, and is not necessarily applied in the same consistent way as it is with color coding. Color coding schemes have been shown to cause dispensing errors within categories.

Dr Cohen concluded that there is very little information to scientifically guide application of user-applied labels for IV lines. It is difficult to standardize user-applied labeling of IV lines, especially when more than a few individuals are involved, he added. Cohen went on to note that not everyone will even use the color-coding scheme; some will apply labels on the wrong IV line, and other individuals may mistakenly identify the color because they are not familiar with the system. If colored labels are going to be added to the IV line, users must be educated in order to properly trace the IV lines and apply the labels, Cohen said.

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Adverse events decline with pharmacist participation in medical rounds

Seventy-eight percent fewer preventable adverse drug events (ADEs) occurred among patients in a hospital's general medicine unit when a pharmacist participated in weekday medical rounds according to a study recently published in the Archives of Internal Medicine. The study concludes that preventable adverse events decline when a pharmacist participates in general medicine rounds.

Additional studies also describe the positive effect a pharmacist’s presence on patient rounds has on adverse events. The findings from the three-month study at Henry Ford Hospital in Detroit build on the landmark results reported in 1999 by Lucian L. Leape and colleagues, who studied a pharmacist's participation on medical rounds in an intensive care unit (ICU) at Massachusetts General Hospital. Leape found that pharmacist participation in ICU medical rounds decreased the incidence of preventable ADEs to 3.5 per 1000 hospital days and that the rate of ADEs caused by prescribing errors decreased by 72 percent when a pharmacist made rounds with the patient care team, spent the rest of the morning in the ICU, and was on call for the unit's staff the rest of the day. The Henry Ford group attributed its slightly higher ADE incidence of 5.7, despite the lack of patients considered critically ill, to possible differences in how the two research teams interpreted the identical definitions of preventable ADEs. The group also attributed the higher ADE rate to the potential for drug reactions in ICU patients to resemble deteriorations in health status.

By joining the general medicine team in its daily rounds, a pharmacist hears patient information – such as history, origin, therapy compliance problems, and comments spoken by a physician during the physical examination – that might not be documented in detail in the medical record, but nevertheless useful.

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Quality indicators incorporated into national reports

The first comprehensive national efforts to measure the quality of healthcare in America and the differences in access to healthcare services for priority populations have been completed. The National Healthcare Quality Report and the National Healthcare Disparities Report provide baseline views of the quality of healthcare and differences in use of healthcare services by priority populations, including: women; children; the elderly; racial and ethnic minority groups; low-income groups; residents of rural areas; and individuals with special healthcare needs, specifically children with special needs, people with disabilities, people in need of long-term care, and people requiring end-of-life care. These reports use several AHRQ Quality Indicators selected from the Prevention Quality Indicators and Patient Safety Indicators modules based on data included in the Healthcare Cost and Utilization Project (HCUP).

The reports were prepared by the Agency for Healthcare Research and Quality (AHRQ) as directed by Congress. The reports are available on a new Web site that serves as a Web-based clearinghouse to make it easier for healthcare providers, health plans, policymakers, purchasers, patients and consumers to take effective steps to improve quality. Print copies of the reports also can be obtained by calling 800.358.9295; additional information about the AHRQ Quality Indicators can be found on the Quality Indicators Web site at

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Nurses report frequent back pain – Few using lifting equipment

Only 11 percent of nurses who completed a survey on occupational low-back pain reported using patient lifts routinely, despite the fact that 84 percent of respondents indicated they had experienced low back pain in the past, according to a study published in the January 2004 Journal of Occupational and Environmental Hygiene.

The most common reasons cited for not using lifting equipment included unavailability (76 percent), time constraints (19 percent), and lack of training (17 percent). Results of a separate study published in the same issue identified top musculoskeletal risks for nursing assistants. Lifting a patient who has fallen to the floor and intervening to prevent a patient fall were identified as the highest-risk tasks by responding nursing assistants.

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Premier sponsors free sharps safety audio conference February 11

On February 11, 2004 the Premier Safety Institute will host “Sharps Injury Prevention: Milestones and Opportunities,” a free audio conference featuring nationally known speakers from the CDC, OSHA and Premier member hospitals. The audio conference will be held from 1 to 3 p.m. ET.

For updated information, to register for the free conference, or to obtain audiocassettes/CDs of the proceedings ($35 each) go to or call KRM Information Services at 800.775.7654 (mention seminar code PSI 8378-0). Participants are limited to one line per facility, with unlimited participants at each site. Dial-in instructions for the program, as well as the Web site location to access handout materials, will be e-mailed to registered participants prior to the conference.

The Safety Institute mailed a complimentary copy of “Sharps Safety and Needlestick Prevention, 2nd Edition” (published by ECRI) to directors of infection control and employee health at each Premier member hospital. The 250-page guide provides information to evaluate and select protective devices, implement a comprehensive sharps safety program, and assess the effectiveness of the program.

A limited number of copies of the ECRI sharps safety guide will be available (while supplies last) after the audio conference, in the Safety Institute's online store at

Downloads and links

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CDC’s influenza infection control guidelines provide prevention tips

Although influenza cases are decreasing in some states, the overall reported cases remain high, requiring continued influenza control efforts in healthcare facilities. The Centers for Disease Control and Prevention (CDC) has released guidelines for preventing and controlling influenza in healthcare facilities. The guidelines include precautions to prevent flu patients from transmitting the virus through coughing, sneezing and other close contact. The guidelines also include respiratory hygiene and cough etiquette such as: covering the nose or mouth while coughing or sneezing; discouraging visitors who have respiratory illness symptoms from visiting patients; and restricting healthcare personnel (HCP) who are ill from working until they are healthy.

Vaccination of patients and healthcare practitioners is the primary measure to prevent patients from getting the flu in healthcare settings. If a suspected flu outbreak occurs among nursing home or hospitalized patients, the guidelines recommend taking steps to identify influenza as the cause and to control its spread. The CDC also published guidelines on the use of antiviral drugs for influenza. Both documents can be found on the Web.

During the current influenza season (2003-2004), severe complications from influenza and influenza-associated deaths among children are being reported, though this increase may be due to increased testing. CDC is continuing surveillance and advises healthcare providers to report all deaths associated with laboratory-confirmed influenza virus infection among children younger than 18 to their state health department. Information on individual state health departments is available on the Council of State and Territorial Epidemiologists' Web site. State health departments are asked to report information about these fatal cases to the CDC.

In addition, cases of influenza-associated encephalopathy in persons younger than 18 should also be reported to the state health departments. An influenza update was given via satellite broadcast in late December 2003 and a slide presentation available for use. The update includes the status of the influenza activity in the United States, an update of the vaccine supply, current vaccine recommendations, influenza laboratory and diagnostics, antiviral drugs and infection control.

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Green guidelines released for comment

Guidelines designed to provide healthcare providers with a quantifiable tool to guide facility planning, design, construction and operation toward enhanced environmental and health performance are now available for public comment. The “Green Guidelines for Healthcare Construction” (GGHC) have been released by the American Society of Healthcare Engineering (ASHE), with plans to finalize and publish in the spring of 2004.

This tool will help evaluate the health and sustainability of building design, construction, maintenance and operations for the healthcare industry. It uses a scoring system modeled after the U. S. Green Building Council's (USGBC) LEED™ rating system, but is self-certifying. (LEED is an acronym for Leadership in Energy & Environmental Design.) The GGHC is built on the Green Healthcare Construction Guidance Statement developed by the American Society of Healthcare Engineering. It addresses the particular structural, usage, and regulatory challenges of healthcare buildings and emphasizes environmental and public health issues. Although the GGHC focuses on institutional occupancies such as acute care hospitals, its principles can be applied to a wide range of healthcare facilities. It is applicable to new freestanding facilities, additions to existing facilities coupled with renovation, and extensive rehabilitation and adaptive reuse projects.

As reported in Safety Share, February 2003, Children's Hospital of Pittsburgh is building one of the first environmentally "green" hospitals in the nation. The construction of the new hospital will create at least 1,500 new jobs and about 500 new healthcare jobs within the facility by the time the facility opens in 2007.

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JCAHO field review – Infection control standards - Deadline February 12

As reported in Safety Share, December 2003, the Joint Commission on Accreditation of Hospitals is seeking one more round of input on newly proposed standards that address the management of antimicrobial resistant pathogens and the role organizations play in limiting the emergence of these pathogens. The second proposed standards revision would extend the existing Emergency Preparedness standards to address the specific roles of organizations in preparing for potential epidemics or the resource-intensive management of other serious infections. The formal review process was announced January 14; responses may be provided online or by mail (see form below) but are due by February 12, 2004.

Downloads and files

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Severe Acute Respiratory Syndrome (SARS) resurfaces in China

The World Health Organization (WHO) confirmed on January 5 that a man in southern China has acquired the first case of Severe Acute Respiratory Syndrome (SARS) in 2004. Two more suspect SARS patients have been reported, but all three patients are reported to be doing well. Moreover, to date no signs or symptoms of SARS-like illness have been reported among those persons with whom the patient had contact. No link among the cases has been established, and details on the clinical features and laboratory results of the two suspected SARS cases are not yet available.

The confirmed SARS patient is a 32-year-old freelance television producer who was discharged from a hospital in Guangdong after recovering fully and uneventfully from pneumonia. The man denied having any contact with civets, an animal related to the mongoose. All 81 of his contacts are well, and the observation period is over. The second reported patient suspected to have SARS is a 20-year-old waitress who worked at a restaurant in Guangzhou, the province capital. She reported coming in contact with 100 people in the 14 days before her illness, and all are reported to be doing well. The third suspect case, reported on January 12 involves a 35-year old man from the same province (Guangdong). He has been hospitalized in isolation since January 6. No link has been established at present between the confirmed case and the two recent suspect SARS cases, and the source of exposure for all three cases is unclear. (It is noteworthy that the Department of Health and Human Services has issued an advisory on January 14, banning importation of civet cats into the United States unless approved for educational or scientific purposes.)

The disease was previously declared contained in July 2003 after an international outbreak that began earlier in February. The outbreak caused more than 774 deaths in 27 countries. According to WHO, the 32-year-old SARS patient had been in isolation at a Chinese hospital since December 20. Epidemiological investigations in China have not yet been able to link the patient to exposure to wild animals or any other known or suspected source of the virus. The provincial health department is conducting additional epidemic and laboratory investigation.

Laboratory exposure

On December 17, 2003, the Taiwanese Department of Health reported a single case of infection with SARS-associated coronavirus (SARS-CoV) in a research scientist in Taiwan. The researcher had been working on a study of severe acute respiratory syndrome in a Taiwan laboratory. So far, no fever has been detected in the researcher's colleagues or family members. Taiwanese health officials plan to put close contacts of the patient under home quarantine if fever develops, and will restrict travelers with a fever from leaving Taiwan. This is the second case of SARS-CoV infection that was likely acquired in a laboratory setting since the initial worldwide outbreak, and it reinforces the need for careful adherence to recommended laboratory safety practices for SARS-CoV. Since this appears to be a laboratory-acquired infection with no evidence of secondary transmission reported to date, the guidelines and recommendations for SARS surveillance, evaluation, and reporting in the absence of SARS-CoV transmission still apply. For more information, see the CDC health advisory at:

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CDC publishes new dental infection control guidelines

The first comprehensive recommendations in 10 years for dental infection control have been released by the Centers for Disease Control and Prevention (CDC). The new document, “Guidelines for Infection Control in Dental Healthcare Settings, 2003,” updates previous guidelines issued in 1993 and 1986 and consolidates recommendations from other relevant CDC guidelines and standards, as well as those of other major infection control organizations.

The new guidelines use the broader term "standard precautions," which are protocols to protect against exposures to blood, other body fluids including saliva, mucous membranes, and broken skin, rather than "universal precautions," which are measures intended only to prevent exposures to blood.

Developed by CDC staff in collaboration with a working group of infection control experts, the document reviews scientific evidence regarding dental infection control issues, and offers consensus and evidence-based recommendations. The 2003 guidelines cover several issues not specifically addressed in earlier CDC dental guidelines. These issues include: management of occupational exposures to infectious microorganisms transmitted through contact with blood and other body fluids; dental unit water quality; selection and use of dental devices with features designed to prevent needlesticks and other injuries from sharp objects; hand hygiene products, including alcohol handrubs; latex hypersensitivity; dental radiology; and program evaluation. The 2003 guidelines also address management of personnel health and safety issues in dental practices.

A slide presentation for training in dental healthcare settings will be available on the CDC Oral Health Infection Control Web site in early 2004. A companion workbook for the guidelines, as well as six Web-based training modules, is also being developed by the Organization for Safety & Asepsis Procedures (OSAP), under a CDC cooperative agreement. Once completed, OSAP will make these materials available at The materials also will be available by contacting OSAP at 800.298.6727.

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Safety tools

JCAHO video – Standards background for healthcare executives, trustees

A new video, “Governance, Quality and Safety: The Impact of Joint Commission Accreditation on Health Care Delivery,” is designed for hospital governing board members and executives. In addition to providing a background on JCAHO standards that apply to the governing board, the video identifies other risk-reduction JCAHO initiatives, including the National Patient Safety Goals and Sentinel Event Alerts. Through interviews, narration and a viewer's guide, the program highlights actions that trustees can take to improve patient safety within their organizations. This video can also aid orientation efforts for new trustees while reinforcing current trustees' understanding of their role in creating an organizational culture that focuses on patient safety. The video can be purchased for $275 using order code V02/03AAH.

  • To order, call Joint Commission Resources (JCR) Customer Service at 877.223.6866 weekdays from 8 a.m. to 8 p.m. CT,
  • or visit Infomart on the JCR Web site at:

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CMS Web resources – New sites for surgical infection prevention and pneumonia

The Department of Health and Human Services has new designated new Web sites for accessing current information on the National Surgical Infection Prevention (SIP) and Pneumonia Medicare National Projects. The updated links are:

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CDC training slides - smallpox disease, prevention, and intervention

A training course originally developed by the World Health Organization and Centers for Disease Control and Prevention for training smallpox response teams is now available. These presentations are being shared to help planners and first responders prepare for the possibility of the use of smallpox as a terrorist weapon. Note that all slide sets may be downloaded directly from the Web sit below but many are very large files.

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Fire safety tips – FDA bed fires; NFPA elevator and fire alarms

On December 18, 2003 the Food and Drug Administration (FDA) released a public health notification outlining safety tips for preventing hospital bed fires. Since 1993, the FDA has received more than 95 reports of fires involving electrically powered hospital beds. The safety recommendations apply to both electrically powered and manual healthcare beds, as well as adjustable medical beds. Some of the initial safety-check suggestions involve simple observations. For example, the FDA noted that the bed's power cord should be directly connected to a wall-mounted outlet instead of an extension cord or multiple power strips. The bed's power cord should be visually inspected for damage on a regular basis, and it should not be covered with a rug or carpet.

On a related note, the National Fire Protection Association (NFPA) now provides information on how to interface elevators and fire alarm systems. The information ensures safe emergency operation of modern elevators that meet requirements under NFPA and American Society of Mechanical Engineers codes. For example, the information details various acceptable methods for causing elevator shutdown to prevent water damage from sprinkler systems. Environmental health, safety, and security managers may find this extremely useful.

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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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