Infection Control

[Guest guest]

This articles is from the iatrogenic.org list.

It has been shown again and again that handwashing is the first defense

against the spread of infection; yet, ambulance manufacturers have yet to

provide a

reasonable setup for doing it. RVs have been doing it for decades.

As we contemplate the possibility of pandemics, hand washing will receive

more attention.

What are your service's handwashing policies? Are there any?

Gene G.

April 5, 2006

The Wall Street Journal

THE INFORMED PATIENT

By LAURA LANDRO

Hospitals Get Aggressive

About Hand Washing Staff Surveillance Programs, New Penalties Aim to

Boost Sagging Compliance Rates

April 5, 2006; Page D3

Hospitals are finally turning up the heat on hand hygiene.

With rising alarm over hospital infections, which cause 90,000 deaths

annually, a growing number of hospitals are adopting aggressive hand-hygiene

surveillance and monitoring programs, and in some cases imposing penalties for

doctors, nurses, and other health-care workers who don't follow the rules.

In an effort to be launched this week, the Centers for Disease Control and

Prevention is collaborating with the nonprofit Institute for Healthcare

Improvement and two leading infection-control professional societies in a

program to

boost compliance using behavior-modification techniques, " best practice "

guidelines, and rigorous programs to monitor adherence.

Despite strict guidelines issued by the CDC to stop the spread of bacteria

on contaminated hands, and wide adoption of alcohol-based hand-rub dispensers

in patient rooms and hospital corridors to make it easier for harried

health-care workers to disinfect between patients, compliance rates remain mired

at 40%

to 50% nationwide, studies show.

The IHI program recommends a far more activist approach that holds hospital

administrators and staffers accountable for failure.

" It no longer is tolerable to accept noncompliance rates of more than 50%

when we are dealing with critically ill patients, " says Don Goldmann, a senior

vice president of IHI and a professor of pediatrics at Harvard Medical School,

who notes that computer-chip makers have better hand-cleaning standards than

most hospitals. While the IHI program emphasizes education and positive

feedback, " repeated violations in health-care, or any industry, need to have

consequences, " Dr. Goldmann says.

The CDC's hand-hygiene guidelines, issued in 2002, asked hospitals to track

and monitor compliance, " but we've increasingly recognized that there is a

tremendous gap between what we are recommending and what's out there in

practice, " says Jernigan, a medical epidemiologist and one of the experts

leading

the CDC's efforts to improve adherence to infection-control recommendations.

By collaborating with IHI on the new program, the aim is to help " remove

barriers that exist in the health-care system " to good hand hygiene.

Some hospitals already have adopted tougher tactics, with encouraging

results. After outbreaks of the drug-resistant bacteria MRSA a few years ago,

Greenview Regional Hospital and the Medical Center, two hospitals in Bowling

Green,

Ky., that share medical staffs, found widespread noncompliance with basic

hand-hygiene rules among hospital employees and doctors. The hospitals began a

program to identify offenders, requiring them to undergo hand-hygiene tutorials

and education, and then escalating the severity of penalties for noncompliance

-- including disciplinary action or dismissal for repeated violations.

Compliance rates, which had been in the single digits in some units and

barely measurable in others, improved to 85% for health-care workers overall and

95% for physicians alone last year at Greenview Regional and close to 100% for

all staffers at the Medical Center, while bacteria outbreaks were resolved,

according to reports presented at the recent meeting of the Society for

Healthcare Epidemiology of America.

" We are in an era of smarter bacteria and we need to be more aggressive in

ensuring patient safety, " says Shadowen, the infectious-disease

specialist who led the study. While only one health-care worker -- who also had

numerous unrelated violations -- was dismissed, the program emphasized that the

hospital's top officials were monitoring compliance and prepared to use

disciplinary action, just as they would for any serious infraction of hospital

policies, Dr. Shadowen says.

Shands Hospital at the University of Florida uses staff monitors who observe

workers and report violations. Hand-hygiene compliance is now part of the

hospital's performance evaluations, with punitive measures for repeat offenders,

says Loretta Litz Fauerbach, director of infection control and a board member

of the Association for Professionals in Infection Control and Epidemiology, a

sponsor of the IHI hand-hygiene program. But compliance rates have risen to

95% from 80% over the last year, she says, and " we'd rather take a positive

approach and keep reinforcing that. "

Boyce, an infectious-disease specialist who helped write the CDC

guidelines and runs a free instructional Web site, handhygiene.org1, says

hospitals

often view monitoring hand-hygiene compliance as time-consuming, tedious and

ineffective. " We need to come up with monitoring strategies that are simple,

whose results are believable, " Dr. Boyce says.

Wise, vice president of the Joint Commission on Accreditation of

Health Care Organizations, which requires hospitals to have infection-control

programs as a condition of accreditation, warns that workers may feel animosity

and resentment toward those trying to monitor them. " While you may achieve an

increase in hand hygiene, I don't know if you'll produce a culture of

cooperation, " Dr. Wise says.

IHI also admonishes hospitals to do their part, such as making sure

employees know they have to clean their hands after removing gloves, because

bacteria

from the gloves can be transferred to the hands. Hospitals also have to be

vigilant about maintaining alcohol-rub dispensers, which often don't work,

aren't

refilled, or aren't placed conveniently, the group says.

Hospitals also can enlist staffers in making hand-hygiene rules easier to

follow, says Huskins, an author of the IHI tool kit for hand hygiene and

an infectious-disease expert at the Mayo Clinic in Rochester, Minn.

Compliance rates at Mayo hospitals were sharply improved, in part, because

employees

were allowed to test different alcohol hand rubs, and chose one with strong

moisturizers to avoid irritation that might lead to discontinued use. " That made

a

really big difference in a chilly northern climate in winter, " Dr. Huskins

says.

Visit the American Iatrogenic Association web site at

http://www.iatrogenic.org

[Guest guest]

In a message dated 04-Jun-06 00:24:10 Central Daylight Time,

wegandy1938@... writes:

This articles is from the iatrogenic.org list.

It has been shown again and again that handwashing is the first defense

against the spread of infection; yet, ambulance manufacturers have yet to

provide a

reasonable setup for doing it. RVs have been doing it for decades.

As we contemplate the possibility of pandemics, hand washing will receive

more attention.

What are your service's handwashing policies? Are there any?

Gene G.

The best I've seen in ambulances would be the alcohol based 'jels'... I

prefer AlCare pressurized foam, but some fire marshalls don't like that one...I

used to carry a can of it in my 'white coat' pocket and offer a spritz around

to the folks rounding with me as we left a patient's room...few refused, and

none who had not kept their hands in their pockets refused a second time...

ck

ck

S. Krin, DO FAAFP

[Guest guest]

In a message dated 04-Jun-06 07:08:48 Central Daylight Time,

texaslp@... writes:

Speaking of Infection Control…. I’d like to add a question to the

all-inclusive, knowledge gathering, EMS improving, statistical survey we’re

preparing

to mail out to every Certified or Licensed person in the state (I am kidding

about this actually being done, but it would be nice):

“Have you taken a college level Microbiology course?â€

Of course all of the RN’s and Docs will answer in the affirmative but I want

to know about the run of the mill street-level EMT’s through LP’s.

Tater:

'Back in the Day', we used to do a rather dramatic demonstration, one that

is more difficult to do now that we know more about microbiology.

There is a particular bacteria called Serretia marcesens which produces

vivid scarlet colonies on the proper growth plates...the hand washing

demonstration involved swabbing one person's hands with a known amount of S.

marcesens

laden broth, and then the hand shakes started...the class was divided into

half, and the first group shook hands in order before the 'test subject' washed

his hands, and the second half shook hands afterwards. Three culture plates

were done on each person during the scenario...one was started at the

beginning of class, the second after the hand shake and the third after washing

hands

(and groups were assigned different types of soaps for the initial

handwashing!).

Now a days, we know that S. marcesens is actually an opportunistic pathogen,

so we don't use it any more...but it was a definite eye opener for some of

the folks to see those bright red colonies popping up after five or six

handshakes...and even more of an eye opener to see how quickly even plain Ivory

soap and water reduced the number of colonies recovered.

ck

S. Krin, DO FAAFP

[Guest guest]

Speaking of Infection Control…. I’d like to add a question to the all-inclusive,

knowledge gathering, EMS improving, statistical survey we’re preparing to mail

out to every Certified or Licensed person in the state (I am kidding about this

actually being done, but it would be nice):

“Have you taken a college level Microbiology course?”

Of course all of the RN’s and Docs will answer in the affirmative but I want

to know about the run of the mill street-level EMT’s through LP’s.

My “guess” is that less that 5% have and I’m a very conservative person when

it comes to statistical guesses, so it’s probably more like 1% - 2% in

actuality.

I have always been somewhat obsessive compulsive about hand washing and such.

However, I really developed a complex when sitting in phine Coursey’s

lectures and getting my hands-on in Jimmy Rozell’s laboratory at Tyler Junior

College some years back. (Special thanks to the person on this list that strong

armed me into taking this course; I really had to increase my Paxil during and

immediately following it. Not to mention the fact that I was scared of my beer,

wine, tequila, bread and most antibiotics……. )

For the personnel out there that did not take the college route I HIGHLY

recommend this course. As well as A & P I, A & P II, and English (Technical Report

Writing) at the very least; Oh wait that’s another thread all together……. well

at least read up on the microbiology somehow if you can’t take the class.

Food for thought,

Tater

wegandy1938@... wrote: This articles is from the iatrogenic.org list.

It has been shown again and again that handwashing is the first defense

against the spread of infection; yet, ambulance manufacturers have yet to

provide a

reasonable setup for doing it. RVs have been doing it for decades.

As we contemplate the possibility of pandemics, hand washing will receive

more attention.

What are your service's handwashing policies? Are there any?

Gene G.

April 5, 2006

The Wall Street Journal

THE INFORMED PATIENT

By LAURA LANDRO

Hospitals Get Aggressive

About Hand Washing Staff Surveillance Programs, New Penalties Aim to

Boost Sagging Compliance Rates

April 5, 2006; Page D3

Hospitals are finally turning up the heat on hand hygiene.

With rising alarm over hospital infections, which cause 90,000 deaths

annually, a growing number of hospitals are adopting aggressive hand-hygiene

surveillance and monitoring programs, and in some cases imposing penalties for

doctors, nurses, and other health-care workers who don't follow the rules.

In an effort to be launched this week, the Centers for Disease Control and

Prevention is collaborating with the nonprofit Institute for Healthcare

Improvement and two leading infection-control professional societies in a

program to

boost compliance using behavior-modification techniques, " best practice "

guidelines, and rigorous programs to monitor adherence.

Despite strict guidelines issued by the CDC to stop the spread of bacteria

on contaminated hands, and wide adoption of alcohol-based hand-rub dispensers

in patient rooms and hospital corridors to make it easier for harried

health-care workers to disinfect between patients, compliance rates remain mired

at 40%

to 50% nationwide, studies show.

The IHI program recommends a far more activist approach that holds hospital

administrators and staffers accountable for failure.

" It no longer is tolerable to accept noncompliance rates of more than 50%

when we are dealing with critically ill patients, " says Don Goldmann, a senior

vice president of IHI and a professor of pediatrics at Harvard Medical School,

who notes that computer-chip makers have better hand-cleaning standards than

most hospitals. While the IHI program emphasizes education and positive

feedback, " repeated violations in health-care, or any industry, need to have

consequences, " Dr. Goldmann says.

The CDC's hand-hygiene guidelines, issued in 2002, asked hospitals to track

and monitor compliance, " but we've increasingly recognized that there is a

tremendous gap between what we are recommending and what's out there in

practice, " says Jernigan, a medical epidemiologist and one of the experts

leading

the CDC's efforts to improve adherence to infection-control recommendations.

By collaborating with IHI on the new program, the aim is to help " remove

barriers that exist in the health-care system " to good hand hygiene.

Some hospitals already have adopted tougher tactics, with encouraging

results. After outbreaks of the drug-resistant bacteria MRSA a few years ago,

Greenview Regional Hospital and the Medical Center, two hospitals in Bowling

Green,

Ky., that share medical staffs, found widespread noncompliance with basic

hand-hygiene rules among hospital employees and doctors. The hospitals began a

program to identify offenders, requiring them to undergo hand-hygiene tutorials

and education, and then escalating the severity of penalties for noncompliance

-- including disciplinary action or dismissal for repeated violations.

Compliance rates, which had been in the single digits in some units and

barely measurable in others, improved to 85% for health-care workers overall and

95% for physicians alone last year at Greenview Regional and close to 100% for

all staffers at the Medical Center, while bacteria outbreaks were resolved,

according to reports presented at the recent meeting of the Society for

Healthcare Epidemiology of America.

" We are in an era of smarter bacteria and we need to be more aggressive in

ensuring patient safety, " says Shadowen, the infectious-disease

specialist who led the study. While only one health-care worker -- who also had

numerous unrelated violations -- was dismissed, the program emphasized that the

hospital's top officials were monitoring compliance and prepared to use

disciplinary action, just as they would for any serious infraction of hospital

policies, Dr. Shadowen says.

Shands Hospital at the University of Florida uses staff monitors who observe

workers and report violations. Hand-hygiene compliance is now part of the

hospital's performance evaluations, with punitive measures for repeat offenders,

says Loretta Litz Fauerbach, director of infection control and a board member

of the Association for Professionals in Infection Control and Epidemiology, a

sponsor of the IHI hand-hygiene program. But compliance rates have risen to

95% from 80% over the last year, she says, and " we'd rather take a positive

approach and keep reinforcing that. "

Boyce, an infectious-disease specialist who helped write the CDC

guidelines and runs a free instructional Web site, handhygiene.org1, says

hospitals

often view monitoring hand-hygiene compliance as time-consuming, tedious and

ineffective. " We need to come up with monitoring strategies that are simple,

whose results are believable, " Dr. Boyce says.

Wise, vice president of the Joint Commission on Accreditation of

Health Care Organizations, which requires hospitals to have infection-control

programs as a condition of accreditation, warns that workers may feel animosity

and resentment toward those trying to monitor them. " While you may achieve an

increase in hand hygiene, I don't know if you'll produce a culture of

cooperation, " Dr. Wise says.

IHI also admonishes hospitals to do their part, such as making sure

employees know they have to clean their hands after removing gloves, because

bacteria

from the gloves can be transferred to the hands. Hospitals also have to be

vigilant about maintaining alcohol-rub dispensers, which often don't work,

aren't

refilled, or aren't placed conveniently, the group says.

Hospitals also can enlist staffers in making hand-hygiene rules easier to

follow, says Huskins, an author of the IHI tool kit for hand hygiene and

an infectious-disease expert at the Mayo Clinic in Rochester, Minn.

Compliance rates at Mayo hospitals were sharply improved, in part, because

employees

were allowed to test different alcohol hand rubs, and chose one with strong

moisturizers to avoid irritation that might lead to discontinued use. " That made

a

really big difference in a chilly northern climate in winter, " Dr. Huskins

says.

Visit the American Iatrogenic Association web site at

http://www.iatrogenic.org

[Guest guest]

Microbiology, A & P I and A & P II

krin135@... wrote:

In a message dated 04-Jun-06 07:08:48 Central Daylight Time,

texaslp@... writes:

Speaking of Infection Control…. I’d like to add a question to the

all-inclusive, knowledge gathering, EMS improving, statistical survey we’re

preparing

to mail out to every Certified or Licensed person in the state (I am kidding

about this actually being done, but it would be nice):

“Have you taken a college level Microbiology course?â€

Of course all of the RN’s and Docs will answer in the affirmative but I want

to know about the run of the mill street-level EMT’s through LP’s.

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response

Office

Fax

[Guest guest]

In a message dated 04-Jun-06 19:40:17 Central Daylight Time,

texaslp@... writes:

Good hand washing procedures with a mild soap and warm water solution is my

hand sanitization method of choice. I have far fewer dermatological problems

when I have this as my preferred method as opposed to routine use of the

alcohol based gels.

that was one advantage of the original AlCare foam...it contained a

significant amount of lanolin, and prevented much of the drying associated with

frequent hand washing.

ck

S. Krin, DO FAAFP

[Guest guest]

I would consider the use of alcohol gels in EMS. There have been some

studies that show that they reduce trransmission of bugs better than typical

handwashing (i.e. hand washing probably superior if you really do it well.)

As a practical matter, people tend to use the gels effectively.

I would recommend looking at the automatic dispensers and mounting in the

box. They have been used on cruise ships with good success in decreasing

Norwalk outbreaks.

I recently had a patient who has patented a wrist band that looks like a

watch made of silicone. It holds alcohol gel and you tap it with one hand

and it dispenses some. He will be marketing it to folks on the go (EMS? ER

RNs?).

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248

[Guest guest]

I think the alcohol gels are good for those times when your options are limited,

but I personally don't like them for routine hand sanitizing. My concern is

that alcohol dries the skin. This dryness then leads to small cracks which in

turn cause problems.

There are several studies out that conclude that alcohol is a better choice,

however all of the studies I have seen used untrained laypersons as the test

subjects. I wonder what the results would be after an intensive hand washing

training program with healthcare professionals. Maybe this has already bee

done, if someone has the reference please post.

Good hand washing procedures with a mild soap and warm water solution is my

hand sanitization method of choice. I have far fewer dermatological problems

when I have this as my preferred method as opposed to routine use of the alcohol

based gels.

Tater

Kirk Mahon wrote: I would consider the use of alcohol

gels in EMS. There have been some

studies that show that they reduce trransmission of bugs better than typical

handwashing (i.e. hand washing probably superior if you really do it well.)

As a practical matter, people tend to use the gels effectively.

I would recommend looking at the automatic dispensers and mounting in the

box. They have been used on cruise ships with good success in decreasing

Norwalk outbreaks.

I recently had a patient who has patented a wrist band that looks like a

watch made of silicone. It holds alcohol gel and you tap it with one hand

and it dispenses some. He will be marketing it to folks on the go (EMS? ER

RNs?).

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248

[Guest guest]

Is it my imagination--or--- is infection control training mandatory on an annual

basis for

Healthcare organizations: I.E.-------- EMS/ Transfer services ?????????????

Sorry if this is repetitive--------- I haven' read any of the other postings

Thank you in advance

" E. Tate " wrote:

I think the alcohol gels are good for those times when your options are

limited, but I personally don't like them for routine hand sanitizing. My

concern is that alcohol dries the skin. This dryness then leads to small cracks

which in turn cause problems.

There are several studies out that conclude that alcohol is a better choice,

however all of the studies I have seen used untrained laypersons as the test

subjects. I wonder what the results would be after an intensive hand washing

training program with healthcare professionals. Maybe this has already bee

done, if someone has the reference please post.

Good hand washing procedures with a mild soap and warm water solution is my

hand sanitization method of choice. I have far fewer dermatological problems

when I have this as my preferred method as opposed to routine use of the alcohol

based gels.

Tater

Kirk Mahon wrote: I would consider the use of alcohol

gels in EMS. There have been some

studies that show that they reduce trransmission of bugs better than typical

handwashing (i.e. hand washing probably superior if you really do it well.)

As a practical matter, people tend to use the gels effectively.

I would recommend looking at the automatic dispensers and mounting in the

box. They have been used on cruise ships with good success in decreasing

Norwalk outbreaks.

I recently had a patient who has patented a wrist band that looks like a

watch made of silicone. It holds alcohol gel and you tap it with one hand

and it dispenses some. He will be marketing it to folks on the go (EMS? ER

RNs?).

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248

[Guest guest]

In fact, I just finished taking a microbiology course this semester at UNT (I

got an A cuz I rock ). It was extremely helpful, and now I really understand

a lot more about various diseases, particularly infections. (And, if I'm ever

able to get back on the truck, I'll be able to look like a real smartass. )

I really think that they should make micro part of the paramedic curriculum--I

think only about maybe 10% of the class wasn't something I could use out in the

field.

(Who now knows what an Enterotube is & how to read it)

Message: 5

Date: Sun Jun 4, 2006 5:08 am (PDT)

From: " E. Tate " texaslp@...

Subject: Re: Infection Control

Speaking of Infection Control…. I’d like to add a question to the all-inclusive,

knowledge gathering, EMS improving, statistical survey we’re preparing to mail

out to every Certified or Licensed person in the state (I am kidding about this

actually being done, but it would be nice):

“Have you taken a college level Microbiology course?”

Of course all of the RN’s and Docs will answer in the affirmative but I want to

know about the run of the mill street-level EMT’s through LP’s.

My “guess” is that less that 5% have and I’m a very conservative person when it

comes to statistical guesses, so it’s probably more like 1% - 2% in actuality.

I have always been somewhat obsessive compulsive about hand washing and such.

However, I really developed a complex when sitting in phine Coursey’s

lectures and getting my hands-on in Jimmy Rozell’s laboratory at Tyler Junior

College some years back. (Special thanks to the person on this list that strong

armed me into taking this course; I really had to increase my Paxil during and

immediately following it. Not to mention the fact that I was scared of my beer,

wine, tequila, bread and most antibiotics……. )

For the personnel out there that did not take the college route I HIGHLY

recommend this course. As well as A & P I, A & P II, and English (Technical Report

Writing) at the very least; Oh wait that’s another thread all together……. well

at least read up on the microbiology somehow if you can’t take the class.

Food for thought,

Tater

Blake-

TX LP, NREMT-P, TX EMSI

As seen on facebook.com (Yes, I acquiesced to peer pressure)

AIM: SinaptiK

" Medicine, the only profession that labors

incessantly to destroy the reason for its

existence. " Bryce

__________________________________________________