Anyone who has been a clinician in healthcare is fully aware of the possibilities of infections during admissions. In fact according the CDC, 1 in 25 hospital patients becomes infected with at least one type of Healthcare-Associated Infections (HAI) or another. To add insult to injury at least 75,000 hospital patients out of 722,000 who acquired an infection die. Furthermore, it should be stated that most infections were found to be acquired outside the ICU arena. So what is the common factor that could be contributing to these many infections?
Since the introduction of health care informatics, healthcare facilities have aggregated data on the most common infections that affect our patient population today. According to the CDC, the most common infections that affect the patient population are pneumonia, gastrointestinal illness, urinary tract infection (CAUTI), Primary Bloodstream Infections (CLABSI), Surgical Site Infections (SSI) from any inpatient surgery, and finally other type of infections. These infections result up to $4.5 billion in additional healthcare costs annually. To combat, regulatory bodies form prescripted suggestions on how to tackle these common culprits from infections to medication errors, to even falls. Then it is up to a medical facility to design a workflow, form policy, and instruct health care providers to follow the outlined workflow or be fined by insurance companies for failure to rectify the situation. But what if our good intentions cause a greater risk to all patients? Well let’s look at the workflow common in healthcare facilities today.
It Is All About Understanding the Workflows
When a patient is admitted to a healthcare facility the common workflow is for a Registered Nurse to fill out a nursing assessment and admission paperwork. Within that paperwork a patient is asked about their current and past health history regarding falls or anything that could be a trigger to falls. Could it be true that our fall prevention programs have anything to do with HAI rates? Based on the adopted practice for falls prevention a patient is given a wristband, instructions of what to do or not to do, as well as non-skid socks in which the patient wears throughout their stay. Whether you are clinician or a patient, you know that being admitted is a journey. This journey may consist of being transported all over a medical facility while never taking off those same issued, non-skid socks. These same fall prevention socks have walked around patient rooms, hospital units, into bathrooms and have touched footplates on wheelchairs picking up all kinds of infective particles. Then a patient is assisted or climbs back into bed where any and all infectious particles contaminate the patients bedding and sheets. As we lovingly cover our patients with these now deadly sheets their fresh surgical sites, Foley catheter tubes, central lines, or any other access points have now become breeding grounds for the same infections that are plaguing our patients today.
While patients in the ICU have different Registered Nurse to patient staffing ratios and their skill sets in lifesaving equipment is advance this does not mean patients receive better quality of care in the ICU than on another unit. Simply put, a patient in the ICU does not have the same freedom that a patient on a medical surgical floor experiences. These patients are usually too sick, on lifesaving monitors and they cannot ambulate around their rooms or even the unit. They also are usually transported to diagnostic tests via a gurney, their own bed or these diagnostic machines can be transported to them. Therefore, it could be stated that the ICU workflows alone prevent their patients from experiencing the same rate of infections than patients who are on medical surgical units.
But We Are Getting Better Aren’t We
Skeptics may point to the data and state that there are noted decreases in SSI and CLABSI rates, but this may only be due to the newly adopted practices of using sliver impregnated dressings or discouraging the practice of inserting central lines into a patient’s groin. But how many more workflows are we going to add to our already task saturated clinicians before we admit we are working harder, but not smarter in decreasing our infections rates?
As clinicians we all strive to return the patient back to as normal a wellness state as possible. This can only be achieved if we all decide to work together and admit that we may have glossed over the most obvious root cause effect to our hospital acquired infections. Here are just a few suggestions that may pave the way for change and in the process to save lives:
1. Establish a program to determine if infection rates are directly correlated to non-skid socks contaminating patient bedding and patients themselves.
2. Educate your entire facility what was identified as the root cause for potential infections and how it could also effect another regulatory body prescription such as falls preventions.
3. Initiate a hospital wide campaign: You May Hold the Key to Change Health Care Infection Rates.
a. Employees thrive on competition
i. Use the competitive spirit to help solve your healthcare facilities problems.
4. Share the fruit of your facilities labor and watch how some small changes can make the biggest impact in healthcare today.
Anyone who has been a clinician in healthcare is fully aware of the possibilities of infections during admissions. In fact according the CDC, 1 in 25 hospital patients becomes infected with at least one type of Healthcare-Associated Infections (HAI) or another. To add insult to injury at least 75,000 hospital patients out of 722,000 who acquired an infection die. Furthermore, it should be stated that most infections were found to be acquired outside the ICU arena. So what is the common factor that could be contributing to these many infections?
Since the introduction of health care informatics, healthcare facilities have aggregated data on the most common infections that affect our patient population today. According to the CDC, the most common infections that affect the patient population are pneumonia, gastrointestinal illness, urinary tract infection (CAUTI), Primary Bloodstream Infections (CLABSI), Surgical Site Infections (SSI) from any inpatient surgery, and finally other type of infections. These infections result up to $4.5 billion in additional healthcare costs annually. To combat, regulatory bodies form prescripted suggestions on how to tackle these common culprits from infections to medication errors, to even falls. Then it is up to a medical facility to design a workflow, form policy, and instruct health care providers to follow the outlined workflow or be fined by insurance companies for failure to rectify the situation. But what if our good intentions cause a greater risk to all patients? Well let’s look at the workflow common in healthcare facilities today.
It Is All About Understanding the Workflows
When a patient is admitted to a healthcare facility the common workflow is for a Registered Nurse to fill out a nursing assessment and admission paperwork. Within that paperwork a patient is asked about their current and past health history regarding falls or anything that could be a trigger to falls. Could it be true that our fall prevention programs have anything to do with HAI rates? Based on the adopted practice for falls prevention a patient is given a wristband, instructions of what to do or not to do, as well as non-skid socks in which the patient wears throughout their stay. Whether you are clinician or a patient, you know that being admitted is a journey. This journey may consist of being transported all over a medical facility while never taking off those same issued, non-skid socks. These same fall prevention socks have walked around patient rooms, hospital units, into bathrooms and have touched footplates on wheelchairs picking up all kinds of infective particles. Then a patient is assisted or climbs back into bed where any and all infectious particles contaminate the patients bedding and sheets. As we lovingly cover our patients with these now deadly sheets their fresh surgical sites, Foley catheter tubes, central lines, or any other access points have now become breeding grounds for the same infections that are plaguing our patients today.
While patients in the ICU have different Registered Nurse to patient staffing ratios and their skill sets in lifesaving equipment is advance this does not mean patients receive better quality of care in the ICU than on another unit. Simply put, a patient in the ICU does not have the same freedom that a patient on a medical surgical floor experiences. These patients are usually too sick, on lifesaving monitors and they cannot ambulate around their rooms or even the unit. They also are usually transported to diagnostic tests via a gurney, their own bed or these diagnostic machines can be transported to them. Therefore, it could be stated that the ICU workflows alone prevent their patients from experiencing the same rate of infections than patients who are on medical surgical units.
But We Are Getting Better Aren’t We
Skeptics may point to the data and state that there are noted decreases in SSI and CLABSI rates, but this may only be due to the newly adopted practices of using sliver impregnated dressings or discouraging the practice of inserting central lines into a patient’s groin. But how many more workflows are we going to add to our already task saturated clinicians before we admit we are working harder, but not smarter in decreasing our infections rates?
As clinicians we all strive to return the patient back to as normal a wellness state as possible. This can only be achieved if we all decide to work together and admit that we may have glossed over the most obvious root cause effect to our hospital acquired infections. Here are just a few suggestions that may pave the way for change and in the process to save lives:
1. Establish a program to determine if infection rates are directly correlated to non-skid socks contaminating patient bedding and patients themselves.
2. Educate your entire facility what was identified as the root cause for potential infections and how it could also effect another regulatory body prescription such as falls preventions.
3. Initiate a hospital wide campaign: You May Hold the Key to Change Health Care Infection Rates.
a. Employees thrive on competition
i. Use the competitive spirit to help solve your healthcare facilities problems.
4. Share the fruit of your facilities labor and watch how some small changes can make the biggest impact in healthcare today.
