New MRSA Study Reveals Infection Rates are Eight Times Greater Than Previous Estimates
The Association for Professionals in Infection Control and Epidemiology (APIC) has released initial results from a nationwide study of 1,237 U.S. healthcare facilities, examining the prevalence of methicillin- resistant Staphylococcus aureus (MRSA), a virulent multi-drug resistant organism. Findings demonstrate MRSA prevalence rates to be at least 46 cases per 1,000 patients significantly more widespread and established than previous estimated rates.
In the most comprehensive MRSA survey of its kind, infection control personnel from approximately 21 percent of U.S. healthcare facilities in all 50 states participated in the study. The survey took a one-day snapshot of MRSA prevalence at these facilities between October and November, 2006. The detailed survey looked at facilities caring for virtually every type of patient: acute care, cancer, cardiac, pediatric, rehabilitation and long-term care, and included county, public and private facilities. The survey also represents a cross-section of all sizes of facilities, from less than 100 to more than 300 bed facilities.
This is the first study to measure rates of both MRSA infection and colonization (patients carrying and able to transmit MRSA), to more accurately determine MRSA prevalence. Of the 46 in 1,000 MRSA patients, approximately 34/1,000 were infected while 12/1,000 patients were colonized.
Additionally, the survey determined that 77 percent of MRSA patients were identified within 48 hours of admission. This finding suggests that 35 out of 46 patients walk into healthcare facilities with MRSA, having acquired it either in a previous stay in a healthcare facility or in the community.
APICs MRSA survey presents a grim picture, says William Jarvis, MD, principal investigator of the study and president and co-founder of Jason and Jarvis Associates, a private consulting firm in healthcare epidemiology. The findings argue for immediate, aggressive efforts to detect and prevent transmission of MRSA. Because the true magnitude of the total MRSA burden in the U.S. healthcare population is unknown, our objective was to provide the first national estimate of MRSA in U.S. healthcare facilities.
The research indicated that once MRSA cases are identified, healthcare facilities employ recommended practices to prevent transmission of the organism, such as practicing barrier precautions (use of gloves and gowns), hand hygiene and isolating MRSA patients. 81 percent of patients in the study were not identified until they presented signs or symptoms of an active infection prompting doctors to order lab tests. This finding implies that a significant number of patients are potentially transmitting MRSA to healthcare workers and other patients before the bacteria are identified.
Quite simply this survey is a wake up call for healthcare facilities to save lives by dedicating more resources to infection prevention and control because the transmission of MRSA is preventable, says Denise Murphy, president of APIC and vice president of Safety and Quality, and chief patient safety and Quality Officer at Barnes-Jewish Hospital at Washington University Medical Center in St. Louis. Some healthcare facilities are aggressively addressing MRSA, but the scope of this public health threat demands commitment and participation from every hospital, at all levels of the facility. Hospitals should commit the resources to conduct a thorough risk assessment of patient populations and implement viable strategies to prevent MRSA and other antimicrobial-resistant infections. These measures could help prevent this epidemic from continuing to spiral upward and out of control.
APIC guidelines for the elimination of MRSA transmission include a risk assessment to identify high-risk areas for MRSA within the hospital; surveillance program to outline activities and procedures to identify MRSA cases; adherence to CDC hand hygiene guidelines; use of contact precautions (e.g., gloves, gowns and separating MRSA patients from other patients); environmental and equipment cleaning and decontamination, especially items that are close to patients such as bedrails and bedside equipment, and targeted active surveillance cultures.
CDC Infection Tracking System Now Available to All U.S. Hospitals
A secure, Web-based reporting network that lets facilities track infections is now available to all healthcare facilities in the United States, the Centers for Disease Control and Prevention (CDC) announces. The National Healthcare Safety Network (NHSN) provides multiple options for data analysis and more flexibility for sharing information both within and outside a facility including the general public, if the facility so chooses.
Opening this system to all hospitals is a milestone for health protection, says Denise Cardo, MD, director of CDCs Division of Health Care and Quality Promotion. Information is power, and the information tools that NHSN provides help healthcare facilities prevent health care-associated infections (HAIs), including MRSA.
The system builds upon CDCs National Nosocomial Infection Surveillance (NNIS) system which, for more than 30 years, was the gold standard system for tracking HAIs. CDC developed the NNIS system to help infection control professionals and hospitals stay abreast of the rapidly expanding science and practice of infection prevention and control, and better manage episodes of HAIs. The NNIS system had about 300 participating facilities nationwide.
We expect nearly 1,000 facilities will take advantage, in coming months, of NHSNs many capabilities, says Cardo. The information collected from this system is essential to develop and maintain effective prevention programs at the local level. This information allows a hospital to track their progress and direct efforts toward patient safety improvement.
To date, NHSN has more than 600 participants and is used in 45 states. The CDC is already partnering with dozens of healthcare facilities, including Department of Veterans Affairs (VA) hospitals, to use NHSN as a tool to track the prevention of a common infection caused by MRSA. Opening the NHSN to all facilities nationwide will allow even more hospitals to focus on preventing this potentially deadly infection, as well as others.
NHSN has been recently improved to meet the needs of states with mandatory public reporting of HAIs. Public reporting of HAIs is determined on a state by state basis by legislatures. California, Colorado, New York, Oklahoma, South Carolina, Tennessee, Vermont and Virginia have designated NHSN as part of their mechanism to implement legislation requiring hospitals to report HAIs.
New National Study Reveals Medication Errors and Syringe Safety are Top Concerns for Nurses
The American Nurses Association (ANA) announces the findings of the 2007 Study of Injectable Medication Errors, an independent nationwide survey of 1,039 nurses. According to the research, the overwhelming majority of nurses (97 percent) say they worry about medication errors, and more than two-thirds (68 percent) believe medication errors can be reduced with more consistent syringe labeling.
Registered nurses play a critical role in the healthcare system. ANAs Code of Ethics demands nurses take an active role in addressing the environmental system factors and human factors that present increased risk to patients, says Rebecca M. Patton, MSN, RN, CNOR, president of the American Nurses Association. Proper and consistent syringe labeling is one way to reduce risks associated with medication errors.
The 2007 Study of Injectable Medication Errors was developed and co-sponsored by the ANA and Inviro Medical Devices. It was designed to capture opinions, concerns and experiences about challenges related to labeling on syringes, which has been a Joint Commission recommendation since 2006.
Injectable Medication Errors
When asked the point in the process medication errors are most likely to occur, the majority of nurses say either during the preparation and administering of medication to patients (48 percent), or during the transcription of the initial order (47 percent). To help reduce injectable medication errors, the vast majority of nurses (81 percent) believe their healthcare facility should ensure sufficient staff is available for timely and efficient administration.
Nurses indicate the most common factors contributing to injectable medication errors are:
- Too rushed / busy environment (78 percent)
- Poor / illegible handwriting (68 percent)
- Missed or mistaken physicians orders (62 percent)
- Similar drug names or medication appearance (56 percent)
- Working with too many medications (60 percent)
Frequency of Syringe Usage
Nearly half (44 percent) of nurses say they inject medicine via a syringe more than five times per shift, and more than one-third (37 percent) administer injectable medication at least one time per shift.
Labeling Injectable Medication
Slightly more than one-third (37 percent) of nurses claim injectable medications are always labeled. However, this study identified that as many as 28 percent of nurses nationwide do not label syringes when using them. Of the 72 percent who do, in fact, label syringes, they do so by:
- Writing on self-adhesive labels then applying to syringe (54 percent)
- Writing on pieces of tape and adhering to syringe (31 percent)
- Using a Sharpie® marker and writing directly on syringe (11 percent)
- Writing on paper or sticky note and taping to syringe (4 percent)
While 62 percent are aware of the Joint Commissions 2007 National Patient Safety Goals addressing the labeling of all medications and medication containers, only half (51 percent) of respondents are aware that The Joint Commission has determined that the pre-labeling of syringes does not meet labeling goals, since the label should be prepared only at the time the medication or solution is prepared.
Challenges of Labeling
Challenges often arise when attempting to label a syringe. Labels covering measurement gradations on the syringe barrel pose the greatest problem (65 percent). Fifty-five percent of nurses consider the absence of a suitable label poses the greatest challenge, while 39 percent think a label impairs their ability to accurately check the dosage when comparing it to the order.
Benefits of a Write-on Stripe
When nurses were asked their opinions about a write-on stripe manufactured on the syringe, the vast majority (95 percent) believe the greatest benefit is the fact that it would not interfere with visibility of the syringe content or gradations on the syringe barrel. Ninety-three percent believe it will reduce the risk of error, while 92 percent of nurses say a write-on stripe also helps address the Joint Commissions goal for medication labeling.
This research confirms that our healthcare systems need new technology that simply and efficiently improves patient and employee safety, says Gareth Clarke, chief executive officer of Inviro Medical Devices.
Eighty-one percent of nurses reveal that safety syringes are used in most or all departments within their healthcare facility. Even though the 2000 Needlestick Safety and Prevention Act (NSPA), adopted as public law 106-430 by the 106th Congress, mandates that institutions conduct annual product reviews and that nurses be involved in the decision-making process, the majority of nurses (58 percent) say they do not have an opportunity to influence the selection of sharps safety devices used at their healthcare facility.
Additional health and safety concerns
According to 65 percent of nurses, health and safety concerns play a key role in determining the specific area in which they choose to work, as well as their decision to continue practicing.
The top four health and safety concerns for nurses nationwide are acute/chronic effects of stress and overwork (72 percent), back injuries (67 percent), infection of tuberculosis or other infectious disease (38 percent), and getting HIV or hepatitis from a needlestick injury (35 percent).
The study also reveals that 55 percent of nurses have experienced needlestick injuries from needles contaminated by blood or body fluids.
We are honored to support ANAs goal to continue bringing value to its members by addressing topical workplace issues with this survey, says Jean McDowell, vice president of clinical affairs for Inviro Medical Devices. Inviro Medical will apply the input secured from front-line nurses to further improve our safe medication delivery systems.
This study clearly indicates a need for the right safety equipment especially in regard to injectables to reduce the risk of medication errors and sharps-related injuries, adds Patton.
Conducted in April, the 2007 Study of Injectable Medication Errors is based on an online, nationwide survey of nurses. The study is sponsored by the American Nurses Association, with support provided by Inviro Medical Devices. The surveys margin of error is plus or minus 3 percent.
Of the 1,039 nurses surveyed:
- 22 percent have been a nurse for one to five years
- 12 percent have been nurses for 6 to 10 years
- 15 percent have been nurses for 11 to 15 years
- 51 percent have been nurses for more than 15 years
Source: American Nurses Association (ANA) and Inviro Medical Devices
Joint Commission Announces 2008 National Patient Safety Goals
The Joint Commission has announced the 2008 National Patient Safety Goals and related requirements that will apply specifically to accredited hospitals and critical access hospitals. Major changes in this sixth annual issuance of National Patient Safety Goals include a new requirement to take specific actions to reduce the risks of patient harm associated with the use of anticoagulant therapy, and a new goal and requirement that address the recognition of and response to unexpected deterioration in a patients condition. These changes were recently approved by the Joint Commissions board of commissioners.
The new anticoagulant therapy requirement addresses a widely-acknowledged patient safety problem and becomes a key element of the goal: Improve the safety of using medications. It is applicable to hospitals, critical access hospitals, ambulatory care and office-based surgery settings, and home care and long-term care organizations. The new goal and requirement respecting the deteriorating patient will ask hospitals and critical access hospitals to select a suitable method for enabling care-givers to directly request and obtain assistance from a specially- trained individual(s) if and when a patients condition worsens. Each of the foregoing new requirements has a one-year phase-in period that includes defined milestones. Full implementation is targeted for January 2009.
Additionally, the requirement related to hand hygiene has been expanded to permit use of the World Health Organization (WHO) Hand Hygiene Guidelines as an alternative to the Centers for Disease Control and Prevention (CDC) guidelines.
Finally, the requirement to limit and standardize drug concentrations that is part of the goal to improve the safety of using medications will be retired as a National Patient Safety Goal, but organization compliance will continue to be evaluated as part of Medication Management standards compliance.
The 2008 National Patient Safety Goals seek to focus the efforts of healthcare organizations on the priority areas where opportunities for improving patient safety are greatest, says Dennis S. OLeary, MD, president of the Joint Commission. Consistently putting these requirements into action will benefit millions of patients.
The development and annual updating of the National Patient Safety Goals and Requirements continue to be overseen by an expert panel that includes widely recognized patient safety experts, as well as nurses, physicians, pharmacists, risk managers and other professionals who have hands-on experience in addressing patient safety issues in hospitals and other health care settings. Each year, this Sentinel Event Advisory Group works with the Joint Commission to undertake a systematic review of the literature and available databases to identify candidate new goals and requirements. Following a solicitation of input from practitioners, provider organizations, purchasers, consumer groups, and other parties of interest, the Advisory Group determines the highest priority goals and requirements and makes its recommendations to the Joint Commission.
The 2008 Hospital and Critical Access Hospital National Patient Safety Goals are:
- Improve the accuracy of patient identification.
- Use at least two patient identifiers when providing care, treatment, or services.
- Improve the effectiveness of communication among caregivers.
- For verbal or telephone orders or for telephonic reporting of critical test results, verify the complete order or test result by having the person receiving the information record and read-back the complete order or test result.
- Standardize a list of abbreviations, acronyms, symbols, and dose designations that are not to be used throughout the organization.
- Measure and assess, and if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the responsible licensed caregiver, of critical test results and values.
- Implement a standardized approach to hand-off communications, including an opportunity to ask and respond to questions.
- Improve the safety of using medications.
- Identify and, at a minimum, annually review a list of look-alike/sound-alike drugs used in the organization, and take action to prevent errors involving the interchange of these drugs.
- Reduce the likelihood of patient harm associated with the use of anticoagulation therapy.
- Reduce the risk of healthcare-associated infections.
- Comply with current World Health Organization (WHO) Hand Hygiene Guidelines or Centers for Disease Control and Prevention (CDC) hand hygiene guidelines.
- Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a healthcare-associated infection
- Accurately and completely reconcile medications across the continuum of care.
- There is a process for comparing the patients current medications with those ordered for the patient while under the care of the organization.
- A complete list of the patients medications is communicated to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization.
- The complete list of medications is also provided to the patient on discharge from the facility.
- Reduce the risk of patient harm resulting from falls.
- Implement a fall reduction program including an evaluation of the effectiveness of the program.
- Encourage patients active involvement in their own care as a patient safety strategy.
- Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so.
- The organization identifies safety risks inherent in its patient population.
- The organization identifies patients at risk for suicide. (Applicable to psychiatric hospitals and patients being treated for emotional or behavioral disorders in general hospitals.)
- Improve recognition and response to changes in a patients condition.
- The organization selects a suitable method that enables healthcare staff members to directly request additional assistance from a specially trained individual(s) when the patients condition appears to be worsening.
Source: Joint Commission