Hand hygiene is the most challenging area of compliance in infection prevention, according to results of a survey conducted by Infection Control Today (ICT). Half of infection preventionists who responded to the survey identified hand hygiene as the biggest issue.
The ICT survey uncovered an apparent increase in compliance with best practices and methods among various institutions. Among respondents, 69% said they believe their institutions have increased compliance with infection prevention in the last five years. And 56% say they are spending more time boosting healthcare workers’ compliance.
Most respondents said they feel that their institution supports a culture of safety and accountability, and that they believe their faculty supports them in their efforts to prevent infection. Opinions are mixed, however, on whether an incentivized or punitive approach affects compliance.
Overall, this ICT survey shows a positive trend in infection compliance. While cost pressures will certainly impinge upon infection-prevention efforts, factors supporting more infection prevention include financial incentives within the Affordable Care Act, as well as the expanding adoption of improved infection-prevention technology.
1. In 2011, 4 percent of inpatients at acute-care hospitals had at least one HAI, totaling approximately 648,000 patients with 721,800 infections.
2. One in 25 patients will contract at least one infection during a hospital stay.
3. Approximately 75,000 patients with HAIs died during hospitalization.
4. Pneumonia and surgical site infections were the most common HAIs, each accounting for 21.8 percent of all infections.
5. Gastrointestinal infections accounted for 17.1 percent of all HAIs.
6. Urinary tract infections totaled 12.9 percent of all infections.
7. Primary bloodstream infections totaled 9.9 percent of all infections.
8. Approximately a quarter of all HAIs, 25.6 percent, were associated with medical devices, such as catheter-associated urinary tract infection, ventilator-associated pneumonia and central-catheter associated blood stream infection.
9. Approximately 43 percent of non-surgical site infections developed within 48 hours of a stay in the critical care unit.
10. Colon surgeries experienced the highest number of SSIs, at 14.5 percent, followed by hip arthroplasties (10 percent) and small bowel surgeries (6.4 percent).
11. The median interval from hospital admission to HAI symptoms was six days.
12. One in five HAIs was present on admission and was related to a previous admission to the same hospital.
13. The most common pathogen was Clostridium difficile, accounting for 12.1 percent of infections.
14. The majority of gastrointestinal infections, 70.9 percent, were due to C. diff.
15. Staphylococcus aureus accounted for 10.7 percent of infections.
16. Klebsiella pneumoniae and K. oxytoca accounted for 9.9 percent of infections.
17. Escherichia coli accounted for 9.3 percent of infections.
Susan Carr, editor of Patient Safety & Quality Healthcare, does a good job on the PSQH blog of beginning to answer questions about healthcare risk managers and the transformation of care. Carr discusses comments by futurist Ian Morrison at the annual conference of the American Society for Healthcare Risk Management.
Morrison says the Affordable Care Act isn’t the only factor shaping the changing world of healthcare risk managers. Other influences —consolidation, cost reduction, and realignment of risk—are also crucial.
Morrison’s key issues as outlined in Carr’s article:
1. ) Implementation of the Affordable Care Act and expansion of healthcare coverage to previously uninsured individuals. We may be heading toward two Americas, represented by Texas and California. The difference? The first is one of about half of the states that have refused to expand Medicaid. California, in comparision, has embraced the ACA and expanded Medicaid.
2.) Growth of the individual consumer market in which people have to make many more choices about details of their health insurance: “Morrison believes that individuals’ awareness of the narrow provider networks that come with ‘cheap’ plans is a ‘shoe still to drop.’ “
3.) Realignment of risk. Morrison foresees a country of “100 to 200 large regional systems of care across the country that assume risk on a population basis.”
4.) The changing business model for hospitals and health systems. That means more price pressure, along with an emphasis on value-based purchasing. “Morrison believes this shift ultimately means that hospitals will go from being in the business of filling beds to the business of emptying beds” – while trying to remain financially viable.
5.) Implementing and sustaining a culture of low risk and high quality is critical, and we’re not there yet. It will, he said “make the difference between life and death, between affordability or not.”
When most of the business news is about big companies, it’s easy to forget that there’s still room for a little guy with a great idea. Medical device maker Focal Therapeutics is clearly one of the latter, as a new scientific presentation underlines. The presentation was given at the 2014 Breast Cancer Coordinated Care (BC3) conference, held in February in Washington D.C.
Focal Therapeutics developed the BioZorb™ three-dimensional surgical marker, to help identify the surgical excision site following soft tissue removal, such as breast lumpectomy cavities. The marker makes it possible for physicians to visualize the surgical region post-surgery. This helps to improve clinical precision for post-operative treatments and follow-up.
To understand the difference this makes, consider a woman who has just had a lumpectomy and now needs post-surgical radiation to prevent her cancer from returning. Once this 3D marker is placed by her surgeon, her radiation oncologist can locate the exact site more precisely, clinicians can better target the radiation (thereby decreasing the volume of tissue that receives radiation minimizing radiation exposure to nearby healthy areas such as the heart and lungs.
The presentation showed BioZorb as an alternative to traditional tissue landmarks such as seroma and clips as well as post-operative density changes seen on CT scans done for treatment planning. The results were dramatic. The device enabled physicians to achieve a greater-than-50% percent reduction in planned treatment volume, according to poster co-author Robert R. Kuske, Jr., M.D. Dr. Kuske is an internationally known radiation oncologist who uses BioZorb in his medical practice at Arizona Breast Cancer Specialists.
What’s more, there appeared to be no downside to using the BioZorb marker. Patients tolerated placement of the device without complications, and cosmetic outcomes were excellent.
With traditional methods, treatment planners have to do a certain amount of guesswork and treat a bigger area because the borders of the area needing treatment aren’t obvious. That can mean a higher radiation dose, more risk to healthy tissue and organs, and negative impacts on the patient’s appearance.
Co-author Linda Smith, M.D. of Comprehensive Breast Care in Albuquerque, N.M. said “It was a revelation to see the surgical edges so clearly with the BioZorb device in place.” Read more about the presentation here.
Dr. Gail Lebovic
BioZorb’s inventors appear to be true visionaries, because there’s no other device like theirs in the medical marketplace. Unlike other markers, BioZorb defines the treatment area in three dimensions. Its unique open spiral is made of a bioabsorbable material, which means the patient’s body absorbs it slowly over time. That makes surgical removal after completion of therapy unnecessary.
Dowling & Dennis has worked with Focal Therapeutics’ George Hermann, president and CEO, Gail Lebovic, M.A., M.D., FACS, the company’s chief medical officer, as they have created several innovative devices in breasthealth. From all appearances, BioZorb is extending their career-long hot streak.
