Why are hospital patients the critical control point for doctor handwashing?

People in the hospital are invariably immunocompromised. They shouldn’t be fed things like deli meats that may harbor Listeria.

jon.stewart.handwashing.2002And it shouldn’t be the patient’s responsibility to ask if their doctor or nurse washed their hands.

A February audit shows more than 40 per cent of health-care workers and support staff at hospitals in the Regina area (that’s in Canada) failed to wash their hands properly. 

A follow-up report in June also reveals that 67 per cent of 204 doctors observed didn’t follow regional handwashing rules before patient contact. 

Regina Qu’Appelle Health Region (RQHR) requires all staff to wash their hands with soapy water or alcohol-based gels for a minimum of 20 seconds before and after contact with patients. They’re not allowed to wear excessive jewellery on their hands or wrists and can’t have gel nails. 

Kateri Singer, the woman in charge of infection prevention for RQHR said the region’s goal is 100 per cent compliance with handwashing rules “because it is the single most important thing we can do as health-care workers.” 

CBC’s iTeam has combed through RQHR’s February and June reports and has highlighted some of the least compliant facilities. The following percentages indicate non-compliance rates:

Broadview Union Hospital (February) - 94.8%​

Grenfell Health Centre (June) - 77.4%

Regina Lutheran Home (June) - 77.8%​

Wolseley Memorial Hospital (June) - 66.7%

Regina General Hospital – Day Surgery (February) - 86.7%

Regina General Hospital – Labour and Birth (June) - 94%

Pasqua Hospital – Day Surgery (February) - 100%

Pasqual Hospital – Short Stay (February) - 95.2%

Pasqua Hospital – Operating Room (February) - 68%

Pasqual Hospital - 3A (June) - 97%

Transparency is a key to change

handwashing.junk.apr.13Singer said though these numbers look bad, she’s committed to disclosure because “the public has the right to know” whether or not their doctor or nurse is keeping their hands clean. And she said patients have the right to hold them to account.

RQHR seems to have taken the lead in Saskatchewan when it comes to transparency regarding handwashing practices. Its public reports are far more comprehensive than any other region in the province.

Singer said transparency can be a catalyst to change behavior.

Michael Gardam, director of infection, prevention and control at Toronto’s University Health Network, told CBC Saskatchewan’s Morning Edition host Sheila Coles patients often do not feel they can stand up for themselves.

“I have seen patients get screamed at by health care providers,” Gardam said. “I’ve seen patients be told, ‘Don’t come back to my clinic. How dare you challenge me.’”

Cafeterias in Boston hospitals get failing grades

Boston is home to many of the nation’s best hospitals, but the I-Team discovered some of these institutions may not always be as careful with the food they serve as they are with patient care.

UnknownThe I-Team obtained inspection reports for 12 Boston hospitals and we found several facilities failing on many levels. Dana Farber Cancer Institute and Carney Hospital both failed inspections for not keeping food cold enough. At Dana Farber, inspectors found boiled eggs at 54 degrees, tuna at 53 degrees and chicken at 51 degrees. Carney Hospital also had food items above 50 degrees. According to Boston University nutritionist Joan Salge-Blake, anything higher than 41 degrees is asking for trouble.

Culture change isn’t about training, education and environment

Over the past decade lots of folks have been throwing around the term food safety culture to describe how a business operates. Education, training, equipment, tools, the environment, investment and support from higher-ups all influence how well an organization addresses risk, there’s something else that binds it together.

The culture, or value system, can be difference between having an outbreak or not. The values dictate decisions from the front-line staff to the CEO.

Maybe it’s the hippie in me but it’s sort of like the vibe of the organization that can be gauged by asking does anyone really care?

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And if they do, do they know what they should be caring about?

The health care world struggles with the same issues, with similar consequences. According to Yahoo News the Vanderbilt University Hospital dealt with a culture change around infection control. And it’s taken six years to turn things around.

Dr. Gerald Hickson had two primary concerns after his wife’s double-knee replacement operation at Vanderbilt University Hospital in July 2008: making sure she received appropriate pain control and getting her moving as quickly as possible to avoid blood clots. But as he sat with her during her recovery, Hickson made a disturbing discovery. Most of the nurses, doctors and other hospital workers filing in and out of the room to care for his wife, who was at risk of contracting an infection after surgery, were not washing their hands.

A compulsive person by nature, Hickson started counting. He found 92 instances when staff members should have soaped up or used antiseptic foam. The total number of times they actually did? 32. Hickson did not want to humiliate anyone, but he was also fiercely committed to protecting his wife. With polite Southern collegiality, he calmly pointed out the 60 opportunities when staffers could have provided safer care but didn’t. Some staffers were immediately embarrassed. Several wondered if he was kidding, got defensive and offered explanations for their lapses. 

Hickson reported his findings to Dr. Tom Talbot, VUMC’s chief epidemiologist, and Talbot ran with it, spearheading an ambitious clean hands initiative that was launched in July 2009. Since then, hand-washing rates at Vanderbilt have jumped from 58 percent to 97 percent; at the same time, the number of several stubborn infections has dropped, one of them by as much as 80 percent. “We get into bad habits, all of us do, and sometimes we need somebody to remind us to get back on the right pathway,” says Hickson. “That’s the key to transforming health care.”

Talbot orchestrated a number of practical changes right away, including installing additional hand sanitizer dispensers at the entrance and exit of every patient’s room or bay and within easy reach inside. Staffers were instructed to clean their hands before and after every encounter with patients, even if all they planned to do was have a conversation. Even the smallest details were addressed. Clinicians who complained that their skin had become irritated by excess antiseptic gel were told to cut back to a dime-size portion, and moisturizing lotion dispensers were added throughout the hospital.

That was the easy part. Talbot knew that it would take an all-out culture shift to see dramatic improvement. A prior hand-washing program, which focused largely on education and random surveillance, had done little to boost rates. This time, Talbot drilled down on what he believed would be the keys to success: training, communication and shared accountability up and down the staff hierarchy.

Because the hospital’s top leadership would be the ultimate enforcers, Hickson and Talbot knew they needed buy-in before the program was officially launched. The old days of giving high-performing doctors a pass on unprofessional conduct — “Oh, that’s just Dr. So and So, that’s how he is” — would be over. Every hospital worker, no matter his or her rank, would be held to the same high standards. “We had to have support from leadership, so if we had pushback, we would elevate that up and they wouldn’t blink,” says Talbot. “Instead, they would say, ‘That’s not the kind of behavior we expect here.’”

Competition is a big motivator at Vanderbilt, too. Hand-washing scores for individual units and departments are tallied up from highest to lowest, and results are posted every month in break rooms and other staff areas so that everyone can see how his or her team compares with the one down the hall. “You want to look better than other services when that scorecard comes out,” says Johnson. “You don’t want to be at the bottom. That’s just human nature.”

Today, after more than 200,000 hand-washing observations, Vanderbilt’s overall hand-washing compliance rate has almost doubled. At the same time, three major types of infections linked to the insertion of tubes and catheters have been reduced considerably, according to Talbot. Urinary tract infections related to catheters in intensive care units have dropped by 33 percent; pneumonia linked to ventilators by 61 percent; and bloodstream infections associated with central lines — the tubing that delivers fluids and medications to patients — by 80 percent in ICUs.

Culture change is not about mission statements and core values written on a poster. It’s about fostering feelings within the organization from top-to-bottom that this stuff matters.

UK women bruises elbow, goes to hospital, dies from Norovirus

The inquest opens on Thursday (19 June) into the death of a Silverton woman who was in the care of a hospital and placed on the controversial Liverpool Care Pathway (LCP).

norovirus.elderly womanMrs Christine Walker, 86, was admitted to Cheltenham General Hospital on 17 March last year, following a fall.

She had hurt her elbow but, when examined, it was found she only suffered some bruising. However, she was kept in for monitoring.

The next day she was transferred to Kemerton ward, but was not seen by a doctor for three days. When a consultant finally attended her, she was found to be vomiting and suffering from diarrhoea.

She was confirmed as having contracted norovirus in the three days she was left unattended whilst on the ward.

Mrs Walker’s condition continued to deteriorate and her son Nick claims that, on 10 April, he discovered she had been placed on the Liverpool Care Pathway two days previously.

The LCP is a controversial strategy for managing end-of-life care, in which food, water and medicines are gradually withdrawn.

But this approach is only supposed to be used with full consent of the family. The hospital claims they had consulted the family, but Mrs Walker’s son denies the subject had ever arisen.

The family are represented by Oliver Thorne, a medical negligence specialist with Exeter-based lawyers Michelmores.

125 ill with norovirus at Oregon V.A. hospital

Retirement homes and hospitals have a lot of trouble with norovirus. If an ill resident, patient or staff member sheds the virus through vomit or poop in a public area a lot of folks can get sick.

According to KDRV ABC Channel 12, The V.A. hospital in White City Oregon is dealing with its own norovirus outbreak with over 125 veterans and 25 staff ill.vomit

“This is very contact oriented, it’s not airborne, it’s by touch,” said V.A. Infection Preventionist Sue Thurston.

Thurston said about 470 vets live at the V.A, and more than a quarter of them are sick.
Veterans are being asked to not leave their rooms until they feel better and bag meals are dropped off at their rooms.

“We’re wiping down everything you can touch –  all the side rails, all the doorknobs, all the vending  machines, all the rooms, all the surfaces, every single flat surface is being wiped down and disinfected,” said Thurston (I wonder what sanitizer they are using and wiping may just be spreading virus particles around -ben).

Although the virus isn’t respiratory, epidemiological investigations of past outbreaks suggest that virus particles can be aerosolized through vomit events. At IAFP 2013, North Carolina State University graduate student Grace Tung showed a simulated vomit event would yield a spread of droplets 8-12 ft.; the greatest distance traveled in any one experiment was 14.5 ft.

4 dead, 101 sick; Norovirus strikes hospital in Japan

Norovirus continues to ravage Japan after four elderly patients died in an outbreak at a hospital in the western Japanese city of Kyoto.

Earlier, at least 77 contracted Norovirus after consuming bentos from a store, and over 1,000 schoolchildren were stricken after consuming norovirus.elderly womanbread that was probably contaminated by food workers.

The four victims at the hospital were in their 80s and 90s and were among 101 patients and staff members who have exhibited the virus-caused gastroenteritis symptoms of vomiting and diarrhea over the past five weeks at the hospital in Fushimi Ward of the city.

Police to investigate 2012 listeria deaths in NZ hospital

In July 2012, it was publicly revealed that two people had died and two others sickened in a listeria outbreak linked to hospital food in New Zealand.

The two elderly women died after contracting listeria found in cold cuts supplied to the Hawkes Bay Hospital.

imagesNow, police have taken over the investigation.

In May, the Ministry for Primary Industries laid Food Act charges against Napier company Bay Cuisine.

It is understood the company is facing more than 100 charges. It was due to have made its first appearance in Napier District Court today, but this has been adjourned to November.

Listeria was found in pre-packaged ready-to-eat meats that had been supplied to Hawke’s Bay Hospital. Listeria was also found at Bay Cuisine, the sole supplier of pre-packaged meats to the hospital. The company issued a recall notice for affected products.

Robin Hutchinson, whose wife Patricia was one of the women who died, said he was determined that someone be held accountable for her death.

Mrs Hutchinson, a 68-year-old great-grandmother, was admitted to Hawke’s Bay Hospital on May 5 last year with symptoms similar to a stroke. It was later discovered she had contracted listeria. She died on June 5.

For the past year Mr Hutchinson has battled ACC and the Hawke’s Bay District Health Board, which he feels should contribute to his wife’s funeral costs.

He said his wife was not properly informed of risks associated with prescribed immunosuppressants, and that the hospital should not have served her cold meat that presented a risk to people on the medication.

Hospital food contaminated with C. diff

Could Clostridium difficile be circulating in hospitals through food? A new report suggests, yes.

Houston researchers found that about one-fourth of nearly 100 hospital food samples they tested were positive for C. diff. Among the worst culprits: turkey, chicken, and egg products, vegetables and fruits, and desserts. Almost all were cooked.

It’s only one hospital. And no cases of human infection were linked to the food.

But together with past research, the findings suggest that contaminated food may be an important route of spread of C. diff in hospitals, says researcher Hoonmo Koo, MD, an infectious diseases specialist at Baylor College of Medicine in Houston, Texas.

Moreover, the temperatures at which hospital foods are cooked may be too low to kill the bug, he says.

An infectious diseases expert not involved with the research says the major C. diff strains that contaminate food are different from the ones responsible for human disease.

“You should be more concerned about whether your doctor or nurse is washing their hands before touching you than about anything coming up from the cafeteria,” says Stuart Cohen, MD, professor of medicine at the University of California School of Medicine, Davis. Contaminated hands are a proven risk factor for infection.

The new study was presented at the annual meeting of the Infectious Diseases Society of America in San Diego.

Listeria in sandwich cold-cuts killed 8, sickened 20 over past 10 years in UK hospitals

Who are these dieticians in hospitals or aged facilities that keep feeding cold-cuts to the vulnerable? Do they have any food safety training? Didn’t they hear about the 23 elderly who were killed by Maple Leaf cold-cuts in Canada in 2008? Are they like the rest of us and ignore bland messages that state, refrigerated ready-to-eat foods like cold-cuts shouldn’t be consumed by immunocompromised people like the elderly or pregnant? How hard is it to heat the meat?

The UK Sun reports hospital sandwiches were yesterday revealed to have killed eight patients.

Watchdogs yesterday demanded a crackdown on shoddy handling of food after the grim toll over the past ten years was disclosed by the Health Protection Agency.

Twenty others were also poisoned by listeria but survived.

Sarnies were found to account for almost three quarters of outbreaks in hospitals — with the bug found in ham salad, sliced sausage, tuna, cheese and prawn mayo varieties.

Almost all were pre-packed by commercial firms — but at some stage had not been kept below 5°C.

Half of those hit were cancer patients weakened by chemotherapy treatment — leaving them less able to fight off the deadly bug.

The HPA warned: “Vulnerable patients and pregnant women can develop severe illness after ingesting levels that would not have an effect on other individuals. This suggests catering and ward staff are not aware of the importance of temperature control, or that proper methods of refrigeration were not used.”

3 dead, 51 sick; Clostridium perfringens illness at a state psychiatric hospital — Louisiana, 2010

On May 7, 2010, 42 residents and 12 staff members at a Louisiana state psychiatric hospital experienced vomiting, abdominal cramps, and diarrhea. Within 24 hours, three patients had died. The three fatalities occurred among patients aged 41–61 years who were receiving medications that had anti–intestinal motility side effects. For two of three decedents, the cause of death found on postmortem examination was necrotizing colitis. Investigation by the Louisiana Office of Public Health (OPH) and CDC found that eating chicken served at dinner on May 6 was associated with illness. The chicken was cooked approximately 24 hours before serving and not cooled in accordance with hospital guidelines. C. perfringens enterotoxin (CPE) was detected in 20 of 23 stool specimens from ill residents and staff members. Genetic testing of C. perfringens toxins isolated from chicken and stool specimens was carried out to determine which of the two strains responsible for C. perfringens foodborne illness was present. The specimens tested negative for the beta-toxin gene, excluding C. perfringens type C as the etiologic agent and implicating C. perfringens type A. This outbreak underscores the need for strict food preparation guidelines at psychiatric inpatient facilities and the potential risk for adverse outcomes among any patients with impaired intestinal motility caused by medications, disease, and extremes of age when exposed to C. perfringens enterotoxin.

Clostridium perfringens, the third most common cause of foodborne illness in the U.S., most often causes a self-limited, diarrheal disease lasting 12–24 hours. Fatalities are very rare, occurring in <0.03% of cases. Death usually is caused by dehydration and occurs among the very young, the very old, and persons debilitated by illness.

The full report is available from the U.S. Centers for Disease Control at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6132a1.htm?s_cid=mm6132a1_x.