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News Update from Global Autoclave Compliance

A Letter from the New York State Department of Health

Richard F. Daines, MD
Commisioner of Health

Dear Colleague,

I am writing to all physicians in New York State to stress the utmost importance of strict adherence to proper infection control techniques while delivering care to your patients. I am urging all physicians to carefully review their infection control practices and practices of all staff under their supervision.

Several investigations conducted by the New York State Department of Health (NYSDOH) and the local departments of health have identified patient-to-patient transmission of hepatitus B and C associated with unsafe injection practices. These outbreaks are believed to be caused by the reuse of syringes and/or needles and the contamination of multi-dose vials.

These lapses in infection control techniques have had very serious consequences - most importantly for the affected patients, but also for the physician and his/her practice. Infection control lapses have resulted in:

• Transmission of hepatitus B or hepatitus C to patients;
• Direct site infections due to accidental cutting or punctures with non-sterile instruments.
• broad notification of patients to inform them that they may have been exposed to bloodborne pathogens and should be tested for hepatitus B, hepatitus C
• referral to the NYSDOH's Office of Professional Medical Conduct; and
• malpractice suits filed by patients

Based on these recent events, I am urging all physicians to carefully review their infection control practices and the practices of all staff under their supervision. I am enclosing an overview of the key infection control practices that should be followed at all times by all health care providers. I cannot stress enough the gravity of this issue; as physicians we must assure the public that the safe delivery of healthcare is our top priority.

If you have any questions or would like additional information, please contact the NYSDOH Bureau of Communicable Disease Control at (518) 473-4439. Thank you for your immediate attention to this matter.

Sincerely,
Richard F. Daines, MD
Commisioner of Health

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Why Aren't Hospitals Cleaner?

U.S. News & World Report
July 23 - July 30, 2007 Issue

COMMENTARY: Not all deadly infections come from dirty hands. Check the lab coats
by Betsy McCaughey

Restaurants and cruise ships are inspected for cleanliness. Food processing plants are tested for bacterial content on cutting boards and equipment. But hospitals, even operating rooms, are exempt. The Joint Commission, which inspects and accredits U.S. hospitals, doesn't measure cleanliness. Neither do most state health departments, nor the federal Centers for Disease Control and Prevention.

No wonder hospitals are dirty. New data presented in April at the annual meeting of the Society for Healthcare Epidemiology of America documented the lack of hygiene in hospitals and its relationship to deadly infections. Boston University researchers who examined 49 operating rooms found that more than half of the objects that should have been disinfected were overlooked. A study of patient rooms in 20 hospitals in Connecticut, Massachusetts, and Washington, D.C., found that more than half the surfaces that should have been cleaned for new patients were left dirty.

Germ-coated. Sad to say, cleanliness is not a priority for hospital administrators or most medical professionals. A new University of Maryland study shows that 65 percent of physicians and other medical professionals admitted they hadn't washed their lab coat in at least a week, even though they knew it was dirty. Nearly 16 percent said they hadn't put on a clean lab coat in at least a month. Lab coats become covered in bacteria when doctors lean over the bedsides of patients who carry the organisms. Days later the bacteria are still alive, repeatedly contaminating doctors' hands and being carried to other patients.

The CDC and other organizations urge caregivers to clean their hands between patients, and even advise patients to speak up and request that caregivers have clean hands (box, Page 85).

That's a start, but it's not enough. As long as hospitals are inadequately cleaned, doctors' and nurses' hands will be recontaminated seconds after they are washed—when they touch a keyboard, open a supply closet, pull open a privacy curtain, or contact other bacteria–laden surfaces. In a recent Johns Hopkins Hospital study, 26 percent of supply cabinets were contaminated with a dangerous bacterium, methicillin–resistant Staphylococcus aureus (MRSA) and 21 percent with another stubborn germ, vancomycin-resistant Enterococcus (VRE). Keyboards are such reservoirs of deadly bacteria that a few hospitals are installing washable keyboards, including one that sounds an alarm if it isn't disinfected periodically.

Hand to mouth. Stethoscopes, blood pressure cuffs, and EKG wires are used on successive patients without being cleaned. Studies published as long ago as 1978 warn that blood pressure cuffs frequently carry live bacteria, including MRSA, and are a source of infection. In a newly released British report, one third of blood pressure cuffs were found to be contaminated with Clostridium difficile, a germ that can cause lethal diarrhea if it enters via the mouth. It's a short trip from a cuff to a patient's bare arm, then to the fingertips and into the mouth. At a hospital in Galveston,Texas, where a burn patient became infected with VRE, molecular typing traced the bacteria to an unclean EKG wire. The VRE on the wire had been left behind by a patient discharged 38 days earlier.

The good news is that a simple solution–thorough cleaning with ordinary detergents and water–curbs the spread of deadly bacteria. When researchers at Rush University Medical Center in Chicago trained the staff to soak surfaces with detergent rather than merely spraying and wiping, and to clean commonly overlooked objects such as telephones, remote controls, and faucets, the spread of VRE to patients was reduced by two thirds.

Even the cash–strapped British National Health Service recognizes that intensive cleaning is a bargain compared with the cost of treating infections. By nearly doubling cleaningstaff hours on one ward, a hospital in Dorchester reduced the spread of MRSA by 90 percent, saving 31/2 times the added cleaning costs.

Hospitals once tested surfaces for bacteria, but in 1970, the CDC and the American Hospital Association advised them to stop, saying testing was unnecessary and not cost effective. MRSA infections since then have increased 32–fold, and numerous studies have linked unclean hospital equipment and rooms to infections. Yet the CDC's latest guidelines still deem routine testing for bacteria unnecessary. "If you culture on a regular basis, you're always going to find something," says Denise Cardo, who runs the CDC's division of healthcare quality promotion. "You don't want the labs to be used for that instead of tests on patients."

Are we to believe that it is less important to test for bacteria in operating rooms than in hot dog factories?

Testing is essential because bacteria are invisible. A study in the Journal of Hospital Infection showed that 76 percent of various hospital sites checked by researchers had unacceptably high levels of bacteria, although only 18 percent of them looked dirty. In another study, Boston University researchers found that cleaning improved significantly once they sampled surfaces for bacteria and showed cleaning personnel the areas they had missed.

Unreasonable standard? You'd think that a hospital accredited by the Joint Commission would be clean, but it's no guarantee. California hospital inspectors, investigating complaints from the public, found that 25 percent of hospitals where conditions were unsanitary had been inspected and accredited by the Joint Commission within the previous year.

If Joint Commission inspectors walk into a noticeably messy and unclean patient room, they will trace back to find out how that happened, explains Robert Wise, vice president for standards and survey methods. Otherwise, Joint Commission standards don't specify how rooms should be cleaned or what bacterial levels are unacceptable. Asked whether bacterial levels should be measured, Wise answers: "You can only ask hospitals to do so much."

That seems to be the CDC's attitude as well. For over 30 years, the CDC has been collecting monthly data recording a sharp rise in drug–resistant hospital infections. A new report from a nursing organization, the Association for Professionals in Infection Control and Epidemiology, shows that the CDC has consistently underreported MRSA in hospitals, giving them an excuse to do too little.

In 2005, health officials in Ireland and Scotland began rating hospitals annually for cleanliness—red (the dirtiest), amber, or green—and publishing the ratings. The first-year results made headlines, putting pressure on the worst Irish hospitals to clean up and earn higher marks in 2006.

In England last month, Gregory Barker, a member of Parliament, rolled up his sleeves and worked a shift with the cleaning staff at a hospital in his district. "Hospital cleaning is a vital part of patient care," he said in a statement released by his office. Where are his counterparts in Washington, D.C.? Congress has been virtually silent about hospital infections—and no member has displayed any interest in picking up a mop.

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AAAASF Underscores Importance of Spore Testing as Part of its Patient Safety Initiatives

OR Today Magazine
January 2006 Issue

With the renewed industry-wide initiative to reduce the incidence of infections resulting from improperly sterilized equipment, the American Association for Accreditation of Ambulatory Surgery Facilities’ (AAAASF) is reiterating the role of its Standard 220-040 in promoting patient safety. The AAAASF Standard mandates that a “weekly spore test is performed and the results filed for each autoclave”. AAAASF maintains that despite some industry discussion about how often spores should be tested, the Association’s recommendations for weekly spore testing conform with the recommendations of OSHA, AAMI, CDC, JCAHO, AORN, ADA, AHA and many insurance companies.

"We recognize that our Gold Standard of 100% compliance may seem overly stringent at times, but health care professionals should not compromise on patient safety. While it may seem unrealistic to smaller facilities, like fertility clinics that make less frequent use of the autoclave, to conform with the standard, the AAAASF Board has continually supported strict regulations to verify that every facility’s sterilization process is destroying microorganisms and spores," said James A. Yates, MD President of AAAASF.

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HEALTHIER HOSPITALS

New Law To Make Infection Rates Public
Timothy Bolger 08/04/2005 12:01 am

For more than 2 million Americans each year, a hospital visit ends not in health but in sickness. A new state law will now make statistics on infection rates at every hospital in the state available to the public, so that patients—and workers and insurers—can avoid facilities with a history of high infections. Gov. George Pataki signed the bill a week after the Press published a story on the subject ["Hospital Hell," July 14].

Details of the data gathering are yet to be ironed out, but the law establishes a statewide database of all hospital-acquired infection cases. In part, the idea is to push hospitals to enact stricter patient-safety measures by revealing the worst offenders. "I am just very pleased that the bill has passed and been signed by the governor, and we hope that it will be an important first step towards improving cleanliness in New York's hospitals," says Betsy McCaughey, founder and chair of the Committee to Reduce Infection Deaths. Her organization, the chief proponent of this potentially lifesaving legislation, is already moving for similar laws to be enacted in other states. NY's law puts it in league with Texas, Virginia, Florida, Illinois, Missouri and Pennsylvania.

Infections acquired in hospitals account for approximately 103,000 deaths nationally each year, making it the fourth most common cause of death. In New York State alone, hospital infections kill at least 7,000 people annually.

"Making risk-adjusted data available to the hospital community and the public will promote improvement and patient safety," says Sen. Kemp Hannon (R-Garden City), chair of the Senate Health Committee. The reporting system will require hospitals to inform the New York State Department of Health as to the number of infections acquired from surgical wounds, central line placements, ventilators and urinary tract catheters. "The governor will establish an advisory work group comprised of government, industry and community leaders to develop guidelines," says Robert Kenny, spokesperson for the state health department, adding that hospitals won't begin reporting until January 2007 and results won't be public until 2008.

Eliminating infections acquired in hospitals is not unachievable, McCaughey says. Her group hosts annual forums for hospital administrators to learn how infection rates can be reduced and how improving hospital hygiene not only saves lives, but also millions of dollars in treatment fees and lawsuits.

"It doesn't cost more per year to prevent infections," she says. "It costs much less."
Clean hospitals: one step closer