How Many People Have to Die Before We Get it Right?

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Editor's note: This article originally appeared in the September 2010 issue of Infection Control Today.

By Karen Y. Cherry, MBA

Have you ever stopped to think that you may hold the power of life and death in your hands? We go to the hospital to feel better. We trust that doctors and nurses will give us outstanding care and protect us from harm. However, hospital negligence leave patients suffering from serious infections that may even cause death. According to the Centers for Disease Control and Prevention (CDC), approximately 2 million patients develop infections during a hospital stay and almost 100,000 patients die as a result of healthcare-acquired infections (HAIs). As more bacteria become resistant to standard antibiotic treatment, it is more important than ever for healthcare providers to follow strict infection prevention and control methods.

Infection caused by negligence on the part of healthcare workers should never occur. Simple infection prevention and control measures and precautions, such as handwashing and equipment disinfection and sterilization, can control or eliminate the spread of serious infections in hospitals. When a hospitalized patient does contract an infection, the results can be deadly. Bloodstream infections, for example, can require lengthy hospitalization, additional surgery, IV antibiotics, and/or radical interventions such as amputation.

Consider information from a study of hospital discharge records from 69 million patients at hospitals in 40 U.S. states between 1998 and 2006 that looked for two diagnoses: hospital-acquired pneumonia and sepsis. This study is one of the first to put a price tag on a widespread problem, which continues to grow and some experts say, is adding to the growing cost of healthcare in the United States. In most cases, these conditions could have been avoided with better infection control. Researchers found patients that acquired pneumonia stayed an extra 14 days after surgery, at a cost of $46,400 per patient, and more than 11 percent of them died.

Patients who developed sepsis after surgery extended their hospital stay on average nearly 11 days, at a cost of $32,900 per patient -- approximately 20 percent of them died. This is 1 in every 5 patients.

In some cases, relatively healthy people check into the hospital for routine surgery. They develop sepsis because of a lapse in infection control and they can die. Again I ask you, "How many people have to die?"

In the United States, HAIs are listed as the fourth major cause of death annually; researchers show that 1.7 million infections are diagnosed every year. And consider these statistics:

Annual deaths in the United States due to cancer: 565,000

Annual deaths in the United States due to tobacco: 440,000

Annual deaths in the United States due to obesity: 400,000

Annual deaths in the United States due to hospital infections: 99,000

I watched a good friend (and her mother) visit her father in the hospital (where I practiced) daily for a month. He was admitted for a simple procedure during which he contracted an infection that lead to a coma. You can imagine how hard it was for me to comfort them knowing they had put their trust in our hands but now faced an emotional roller coaster -- unsure if he would survive. I also met a young man on a plane who was widowed at a young age. In the hospital to deliver their youngest child, his wife contracted an infection and died.

The list goes on and on. When things are not happening to us directly, we tend to ignore them. However, we owe it to the people who trust us with their lives to take all measures possible -- no matter how costly or time-consuming. Who wouldn't take extra measures to save a life?

Measures to prevent infection are simple. They include, but are not limited to, the following:

-- Careful handwashing by all staff members

-- Extensive training of the staff responsible for reprocessing instruments

-- Proper cleaning, disinfection and sterilization of instruments

Supplies are also an intricate part of improving infection prevention. SIPS Consulting recommends that facilities have an outside source come in to do an assessment of current practices and supply utilization. It has been said, "If you do what you have always done, you will get what you’ve always gotten."

It is the responsibility of sterile processing and central sterile department leaders to get organizations to understand the importance of investing in the training and supplies needed to prevent infections. For example, how many times has an implant set been flashed because the wrap had a hole in it? Facilities often say they can not afford containers; or that if they invest in containers, then they will have to pay for the filters; or that they will have the same problems if the filters are incorrectly placed or not replaced at all. There are always reasons not to - we will continue to have issues if we continue to find excuses.

The days of status quo should no longer exist. You owe it to yourself, your organization, and the patient to research products that meet sterility needs. Take the time to research and evaluate products to see what has improved in the market. For example, Medline offers a patented container with a permanent valve filter that eliminates the risk of a hole in the wrapper or improperly placed/missing filters. Another example that reduces the risk of an unsterile item and minimizes the risk of infection is to utilize a complete delivery system (CDS); the case cart items are placed in a box, which eliminates the opportunity for items to be handled multiple times, thereby removing the possibility for compromising items.

Let's also review the steps to proper handwashing:

1. Hands should be washed using soap and warm running water

2. Hands should be rubbed vigorously during washing for at least 20 to 30 seconds with special attention paid to the backs of the hands, wrists, between the fingers and under the fingernails

3. Hands should be rinsed well while leaving the water running

4. With the water running, hands should be dried with a single-use towel

5. Turn off the water using a paper towel, covering washed hands to prevent re-contamination.

Now let’s talk about sneezing and coughing. A powerful sneeze can produce nearly 40,000 aerosol droplets that are propelled through the air at great force. The most common estimates for the speed these droplets travel is around 95 mph; this is the main reason that airborne diseases can be so easily spread throughout the populace. When you think about 40,000 infectious droplets being propelled through the air at 95 mph, it paints a pretty clear picture about how far these droplets can go.

Let's also review respiratory etiquette. Coughing or sneezing into a tissue only adds to the potential for spreading germs.

Cough or sneeze into fabric such as your sleeve, as recommended by the CDC. Many of the microorganisms do not fare well on fabric and die. Coughing or sneezing into your hands, handkerchief or a tissue is not the right thing to do, contrary to what we have been socialized to believe. Slightly turn away from people you are around and crook your elbow over your nose and mouth whenever you feel the urge to cough or sneeze. Politely excuse yourself and take the opportunity to go wash your hands in the nearest restroom or apply hand sanitizer, working it through your fingers and allowing it to dry properly. While the evidence says that nothing beats good old soap and water for washing your hands, hand sanitizer has its place when access to a restroom is limited.

Talk to your co-workers when appropriate to remind them not to take short cuts, and to use proper hygiene. In addition talk to your administration team about having your department assessed by an outside party to see if you are using best practices in your healthcare institution.

Karen Y. Cherry, MBA, has worked in the healthcare industry for more than 20 years. She is the principal of SIPS Healthcare Consults, and is a certified central sterile training instructor.

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