Year In Review: Healthcare's Hurdles Of 2002
By Kelli M. Donley
Healthcare workers (HCWs) have faced unprecedented healthcare challenges in the past 12 months. Just when officials thought the American healthcare system was safe from variant Creutzfeldt-Jakob disease, a 23-year-old college student was diagnosed with the brain-wasting illness. Healthcare officials rushed to ensure instrumentation used on such patients did not infect others. After preaching about the necessity of hot water, soap and regimented behavior to prevent nosocomial transmission of disease, the hand- hygiene guidelines updated by the Centers for Disease Control and Prevention (CDC) now emphasize the importance of alcohol-based rubs.
However, not all health-related news items caught HCWs off guard. Legislation regarding bioterrorism and nursing retention was anticipated, as were several leadership appointments to prominent health agencies. Infection control expert Julie Gerberding, MD, MPH, was named as the director of the CDC. Mark B. McClellan, MD, was named commissioner of the Food and Drug Administration (FDA).
Other health topics receiving national attention include: mold in the healthcare setting, preventing IV catheter-related infections, antimicrobial resistance, OSHA tuberculosis control, smallpox vaccinations, West Nile virus, bronchoscope-related infections and Vancomycin-resistant Staphlococcus aureus, to name a few.
Infection control practitioners (ICPs) are reviewing the industry's progress in 2002 to pick apart areas of improvement and suggest solutions to patch holes where experienced nurses and cushy budgets once remained.
EXPERTS PRIORITIZE IC GOALS
William Jarvis, MD, with the Hospital Infection Program at the CDC, agrees there are a variety of pressing issues facing infection control leadership.
"Downsizing of infection control programs and decreased support, antimicrobial resistance and the nursing shortage resulting in decreased nurse-to-patient ratios, which increase breaks in technique and result in more infections and adverse outcomes (are the most pertinent issues facing ICPs today)," he says.
Lawrence Muscarella, PhD, director of research and development for Custom Ultrasonics and editor of The Q-Net Monthly e-zine, says the economics of healthcare have shaped the past year and will continue to sculpt the industry.
"One issue of particular concern to ICPs is balancing the growing interests of the patient against the never-ending reduction in financial resources," he says. "Some healthcare facilities, under pressure to reduce costs, may reassign their ICPs to other responsibilities or terminate the position altogether. Only after an outbreak or some other infection-related adverse event is identified does the facility realize the shortsightedness of its downsizing and the true value and importance of an ICP. Surveillance and the analysis of infection-related data are crucial to the detection of outbreaks and to preemptive and quick action. Facilities that place emphasis and proper funding on infection control and its related activities are likely to reduce not only the risk of patient infection, but also the risk they face of litigation if inadequate care is provided, resulting in serious patient injury."
Fatal infections drew national attention to sterilization systems and product design in 2002. Bronchoscopes were investigated after outbreaks of Pseudomonas aeruginosa infections at Johns Hopkins Medical Center in Baltimore and Allegheny General Hospital in Pittsburgh, Pa. Also, officials at Henry Ford Hospital in Detroit tested patients for possible hepatitis infection after ICPs noticed the foam-lined cases housing nasal pharyngoscopes may have been contaminated.
While vectorborne illness got headline news coverage, those in the industry were more startled by the first two cases of vancomycin-resistant Staphylococcus aureus (VRSA). The first was reported by the CDC in July. The second, a patient in Pennsylvania, was admitted September 20 with a chronic foot ulcer. A culture of the wound found S. aureus and later tests determined vancomycin resistance. As soon as the patient was able, officials from the Pennsylvania Department of Health and the CDC moved the patient into home-healthcare to receive antimicrobial treatment and reduce the possibility of transmitting VRSA to others.1
PREVIEW OF 2003
With the nursing shortage, a struggling economy and federal cutbacks to public health systems, the resources to meet the healthcare needs of the United States may not be available.
Where does Jarvis see the future of healthcare? "In crisis," he says. "Decreased resources, mergers, financial trouble ..."
Muscarella's view is more optimistic.
"With regard to infection control, I am hopeful that recent reports that suggest the risk of patient injury increases with a reduction in the number of attending nurses will be sufficient to sound an alarm and cause healthcare facilities to upgrade their infection control capabilities and allocate additional resources to hire more infection control staff," he says. "Those facilities with foresight are bound to understand that infection control staff contribute to the reduction -- not increase -- of overall healthcare costs."
ACTION ON CAPITOL HILL
Legislative solutions were presented to ease the national nursing shortage. The Nurse Reinvestment Act, signed into law August 1 by President Bush, has been hailed as a progressive step. The amendment to the Public Health Service Act was initially proposed by Congressman Michael Bilirakis (R-Fla.) in December 2001. The law provides scholarships and loan repayment options to nursing students, gives funding to graduate-level nursing education and supports public service announcements promoting the field.4
Luisa Blue, RN, president of the SEIU Nurse Alliance, the largest union of nurses nationally, says continued funding is necessary.
"Any measure that will improve recruitment and educational opportunities for nurses is a step in the right direction," she says. "Now we need to take further action to make our hospitals better places to work and receive care. We don't have a shortage of nurses. We have a shortage of nurses willing to work in hospitals."
Jarvis says the solution to the nursing shortage is to give nurses the opportunity to work with patients, rather than overwhelm them with red tape.
"(We need) improved incentives, including reimbursement," he says. "(Nurses should) return to helping patients and have less paperwork."
Blue, who represents more than 110,000 nurses in the United States, says providing more resources is beneficial, but not the cure.
"Recruiting new nurses without fixing the underlying problems driving them out of the profession is like pouring water into a leaking bucket," she says. "It's time to cure the diseases -- not just treat the symptoms."3
Bioterrorism control also received federal funding via legislation in 2002. The Bioterrorism Preparedness Act of 2001 was signed into law by President Bush June 12. The law had been initially introduced by Congressman W.J. Tauzin (R-LA) Dec. 11, 2001. It provides $4.6 billion toward preparing for a bioterrorism attack and funds mental health services in the instance an attack does occur.5 Monies will be spent to protect the national food supply, improve the health system's ability to handle a bioterrorism attack, improve federal response to an attack and increase the fight against such attacks at the local state and national level.6
Jarvis says improving the national healthcare system will require the effort of the government, individual hospital administration, employees and communities.
"Hospitals need to spend money on important things, such as patient care, rather than decorative things, such as fancy lobbies," he says. "Administrators who do not do a good job should be removed. Communities and industry should demand better healthcare. Government should improve reimbursement, but also demand and require better data to show that the resources are resulting in improved patient outcomes. (There should be) less talk and PR from regulatory agencies and more decision-making and accreditation based on data."