May / June 2012
Mayo Clinic Study Reports on Incidence and Origins of Clostridium difficile Infections
A study presented by Mayo Clinic researchers during Digestive Disease Week 2012 provides clear evidence that the number of people contracting the hard-to-control and treat bacterial infection Clostridium difficile (C. difficile or C. diff) is increasing, and that the infection is commonly contracted outside of the hospital.
“We have seen C. difficile infection as a cause for diarrhea in humans for more than 30 years, and the incidence of infections has been increasing in the last decade,” says Sahil Khanna, M.B.B.S., Mayo Clinic Division of Gastroenterology and Hepatology, and lead author of the study. “It has been believed that the typical profile of a person with C. difficile is an older patient, taking antibiotics, while in the hospital. For the first time, we have described a significantly increased incidence of C. difficile in children with diarrhea in a population-based cohort. Importantly, we also found that more than three-quarters of cases of C. difficile in children are being contracted in the community, not in the hospital.”
Results of the study showed that the incidence of C. difficile infection (CDI) in children was more than 12 times higher between 2004 and 2009, compared to the period 1991–1997 (32.6 cases per 100,000 vs. 2.6). In addition, 75 percent of cases were “community-acquired,” meaning that the patients had not been hospitalized for at least four weeks prior to contracting C. difficile.
C. difficile is an environmental infection, commonly seen on surfaces in the hospital and described to be present in some food sources, including ground beef. Because the infection can be spread from person to person, Mayo Clinic researchers recommend practicing prevention, including:
• Wash hands with soap and water.
• Clean suspected contaminated surfaces with bleach-based solutions.
• Avoid contact with people who are known to have CDI.
• Take extra hygiene precautions if you are living with a person who has CDI or who works in a healthcare setting where a person might be exposed to patients with CDI.
About Clostridium difficile
C. difficile is a bacterium that is common in the environment. According to the Center for Disease Control and Prevention, approximately 337,000 cases of CDI are reported each year, causing 14,000 deaths. Common symptoms of a mild infection include watery diarrhea two or more times a day for two or more days, and mild abdominal cramping and tenderness. In severe cases, CDI can lead to inflammation of the colon, resulting in fever, blood or pus in the stool, nausea, dehydration, loss of appetite, and significant weight loss.
Other authors of the study include Larry Baddour, M.D.; W. Charles Huskins, M.D., Ph.D.; Patricia Kammer, M.D.; Alan Zinsmeister, Ph.D.; W. Scott Harmsen, M.D.; and Darrell Pardi M.D.
Christiana Care Health System Participates in Key Infection Prevention Study
Funded by CDC, AHRQ, and JC, study investigates effect of universal gown and gloving in critical care.
Christiana Care Health System’s healthcare workers are participating in a major study to determine if wearing gowns and gloves for all patient care in one unit will reduce healthcare-acquired infections.
Christiana Care is one of only 20 academic medical centers nationwide participating in the Benefits of Universal Gown and Gloving, a $5.7 million study supported by the federal Centers for Disease Control and Prevention (CDC), the Agency for Health Care Research and Quality (AHRQ) and the Joint Commission.
The study is comparing 10 hospital intensive care units that use gowns and gloves for all patients against 10 hospitals using current CDC guidelines for prevention of MRSA (methicillin-resistant Staphylococcus aureus) and VRE (vancomycin-resistant enterococci). The CDC currently recommends gloves and gowns whenever healthcare workers come into contact with patients who already have been diagnosed with MRSA or VRE infections.
Christiana Hospital’s Surgical Critical Care Complex has been selected as one of the 10 intensive care units in which gloves and gowns must be worn by all healthcare workers and visitors whenever they enter a patient’s room. The intervention began in January 2012 and will end in September.
“What we’re trying to do through this study is find a definitive answer—universal gown and gloving may become the new standard of care, or might have no benefit or might even cause harm,” said Marci Drees, MD, hospital epidemiologist and medical director of infection prevention at Christiana Care. “We are honored to be included in such a prestigious study.”
Participation in the study requires a coordinated team approach that touches several components of the hospital, including nursing and medical staff, quality and safety, purchasing, materials management, environmental services and infection prevention.
“Our teams have come together in a coordinated fashion to help make this study a success,” Dr. Drees said.
Dr. Drees believes the findings from the study will result in improvements in the U.S. healthcare system. An estimated one out of every 20 hospitalized patients will contract a hospital-acquired infection, according to the CDC. The CDC estimates that the overall annual direct medical costs due to hospital-acquired infections can be as high as $45 billion.
News from the ONC
New Positions Created: Chief Medical Officer and Consumer eHealth
The Office of the National Coordinator (ONC) for Health Information Technology has announced the creation of two new positions: Chief Medical Officer and Office of Consumer eHealth. On the ONC blog, Health IT Buzz, Chief Farzad Mostashari described the new positions:
The primary function of the Office of the Chief Medical Officer will be to infuse a clinical perspective across ONC on all activities which have clinical implications. Activities located in this office will include safety, usability, clinical decision support, meaningful use policy development, and quality including metrics and measurement development. The Chief Medical Officer will report directly to me, and will play a key role in helping ONC satisfy its mission of improving health and healthcare through health IT.
The Office of Consumer eHealth will continue the work on consumer engagement begun in our Office of Policy and Planning. Creation of this new office provides exciting opportunities for ONC to expand upon the work that is currently underway, including the pledge program and patient-focused challenges. Creation of the Office of Consumer eHealth demonstrates ONC’s strong commitment to enabling patient and family engagement in healthcare.
A national search will be conducted for both positions, which will be listed at www.usajobs.gov.
Developer Challenge: Reporting Patient Safety Events
Also on Health IT Buzz, Will Yu, special assistant for innovations at the ONC, announced a challenge designed to “spur development of platform-agnostic health IT tools to facilitate the reporting of medical errors in hospital and outpatient settings.” The contest is open for submissions through August 31, 2012.
The first-prize winner will receive $50,000, with $15,000 for second prize and $5,000 awarded for third prize. Further information about the challenge and application process is available at www.health2con.com/devchallenge/reporting-patient-safety-events-challenge/.
On the Health 2.0 Developer website, the challenge’s background describes the “reality” the contest intends to address. Existing paper and electronic tools are inadequate for the current environment, in which healthcare organizations need to fulfill multiple reporting requirements (PSOs, state agencies, FDA), clinicians are under increasing pressure to report incidents, and quality and risk management staff struggle first to increase reporting and then deal with the volume of information generated.
With this challenge, the ONC hopes to spur innovation “beyond the existing tools” and develop a system that will:
• Collect and analyze information that characterizes patient safety events in a standardized, discrete, measurable way
• Increase the rate of reporting of patient safety events and improve the quality of the reported data
• Leverage existing health information technology (HIT) to eliminate duplicate data entry, as well as transcription and transposition errors
• Analyze patient safety event data to provide useful reports and actionable information to providers and PSOs
Lallie Kemp Regional Medical Center to Receive NPSF Stand Up for Patient Safety Management Award
Medical Center Recognized for Falls Prevention Effort
The National Patient Safety Foundation (NPSF) has announced that the 2012 Stand Up For Patient Safety Management Award goes to Lallie Kemp Regional Medical Center, part of the Louisiana State University system, LSU Health. The award was conferred at the 14th Annual NPSF Patient Safety Congress held May 23-25, 2012, in Washington, DC.
The Patient Safety Management Award is given in recognition of the successful implementation of an outstanding patient safety initiative led or created by mid-level management and within a member organization of the NPSF Stand Up for Patient Safety program. The initiative must have demonstrated evidence of patient safety improvement, with involvement of staff at all levels of the organization.
Lallie Kemp Regional Medical Center (LKRMC) was chosen for a program to reduce falls among the inpatient population. Although the medical center already had better-than-average fall rates, the staff believed they could improve further, and designed a comprehensive program to evaluate falls and their cause, train staff, and institute preventive measures. Their efforts resulted in an overall 95 percent reduction in falls, with zero serious injuries from falls and no repeat falls for the year after implementation compared to the prior year.
“This effort, designed by a multidisciplinary team, resulted in measurable, positive change at their facility that took them beyond the ‘acceptable’ range and closer to ‘zero’ for this particular form of patient harm,” said Diane C. Pinakiewicz, MBA, CPPS, president of NPSF. “We offer our congratulations to the Lallie Kemp organization for the success of this initiative and their ability to not only meet, but greatly exceed, their goals.”
Shawn Hariel, risk manager at LKRMC, accepted the award on behalf of his organization. “Our success is due to the determination and dedication of our staff to improve patient safety,” Mr. Hariel said. “With the full support of our administration, we developed and implemented a sound inpatient fall reduction and prevention program, thoroughly investigated each incident, and made improvements whenever the opportunity arose.”
About Lallie Kemp Regional Medical Center
Lallie Kemp Regional Medical Center, in Independence, Louisiana, is part of the Health Care Services Division of LSU Health, one of the largest public health care delivery systems in the country. LKRMC is a critical access hospital, with the maximum capacity of 25 acute care/swing beds, and meets federal regulations for this designation: it is in a rural area, provides 24-hour emergency care services, and maintains an average length of stay of 96 hours or less. As part of LSU Health and fully accredited by the Joint Commission, LKRMC is a clinical training site for physicians, allied health professionals, and students for technical and nursing schools. Extensive outpatient services and clinics with NCQA recognition status complement LKRMC’s superior inpatient care.
About the NPSF Stand Up for Patient Safety Program
The Stand Up for Patient Safety program at NPSF caters exclusively to hospitals, health systems, physician offices, and ambulatory facilities. Whether an organization is starting a new patient safety program or looking to enhance existing quality and safety efforts, membership provides the support and resources necessary to embed patient safety principles into organizational practice and align with national patient safety goals and critical regulatory requirements. Through participation, Stand Up members around the world gain access to field-tested tools and resources, expertly designed educational programs, and the invaluable support network created by the National Patient Safety Foundation. Visit npsf.org to learn more.
Six Authors of Winning Patient Safety Essays Recognized at NPSF Congress
The Doctors Company Foundation and the Lucian Leape Institute Present Young Physicians Patient Safety Awards
The Doctors Company Foundation, in partnership with the Lucian Leape Institute at the National Patient Safety Foundation (NPSF), has announced the winners of The Doctors Company Foundation Young Physicians Patient Safety Awards, which recognize young physicians for their deep personal insight into the significance of patient safety work.
The awards were conferred at the 14th Annual NPSF Patient Safety Congress, May 23-25, 2012, in Washington, DC. This year’s award winners are:
• Elizabeth Butler, BA, University of Massachusetts
• Brian A. Freeman, MPH, CPH, University of Louisville
School of Medicine
• Kevin Koo, MPhil, Yale University School of Medicine
• Lorette Johnson, MSIII, SUNY Upstate Medical University
• Andrew Robert Lee, BS, Washington University in St. Louis
• Joshua M. Liao, BA, BS, Baylor College of Medicine
The winners were chosen from a field of third- and fourth-year medical students and first-year residents who were in hospital settings as of June 2011 or later. Candidates meeting the criteria were eligible to submit an essay explaining their most instructional patient safety event, one that resulted in a personal transformation.
The awards were conferred at the Patient Safety Congress, adjacent to the Lucian Leape Town Hall plenary session on Friday, May 25. Winners of this prestigious award were also provided with registration and travel expenses to this highly respected patient safety conference, helping to further their commitment to patient safety, and $5,000 each.
This year’s Patient Safety Congress was held at the Gaylord National Hotel & Convention Center in Washington, DC. This annual meeting is a cornerstone of the National Patient Safety Foundation’s educational activities and the only conference whose sole focus is sharing the latest best practices and tools for delivering safe patient care.
The winning essays are available on the NPSF Congress website, npsfcongress.org.
About the Doctors Company Foundation
Created in 2008 by the largest national insurer of medical liability for physicians, surgeons and other health professionals, the Doctors Company Foundation provides charitable grants to support patient safety research, forums and pilot programs, patient safety education programs and medical liability research.
About the Lucian Leape Institute at NPSF
The Lucian Leape Institute at NPSF was formed in 2007 to provide a strategic vision for improving patient safety. Composed of national thought leaders with a common interest in patient safety, the Institute functions as a think tank to identify new approaches to improving patient safety.
About the National Patient Safety Foundation
NPSF has been pursuing one mission since its founding in 1997--to improve the safety of care provided to patients. As a central voice for patient safety, NPSF is committed to a collaborative, multi-stakeholder approach in all that it does. NPSF is an independent, not-for-profit 501(c)(3) organization.
To learn more about the work of the National Patient Safety Foundation, please visit: www.npsf.org.