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Janis.Y.Chen
Sat 27th April '13, 11:14pm
Since the landmark 1999 Institute of Medicine report, “To Err Is Human,” made national headlines, the pressure has been on physicians and hospital officials to reduce the toll of preventable medical harm. Yet with so many competing pressures and studies that often offer contradictory conclusions, it is not always clear which problems to target and which safety strategies to pursue first.

A panel of experts, several of whom spoke with American Medical News, worked for more than three years to produce a 955-page Agency for Healthcare Research and Quality report that for the first time in a decade comprehensively reviews the effectiveness of more than 100 patient safety interventions. The panel identified 10 strategies that are “strongly encouraged.”

The report, published in March, recommends that most health care organizations implement these interventions within the next three years. Current use of these practices varies widely depending on the safety strategy, but the report's authors say it is clear that implementation is far from universal.

1. Improve hand hygiene compliance.
The link between dirty hands and the transmission of health care-associated infections has strong backing in epidemiological literature, and the importance of hand hygiene has been touted by the World Health Organization, the Joint Commission and the Centers for Disease Control and Prevention. Yet rates of hand washing are low, averaging 39%, with many doctors and nurses underestimating the activity's safety value.

Research shows that effective hand hygiene initiatives improve knowledge of when to clean and how to clean, require demonstration of the knowledge, ensure that alcohol-based rub and gloves are available at the bedside, and guarantee that compliance is monitored continuously.

For Robert Wachter, MD, a health care organization's hand hygiene compliance rate is a proxy for its overall commitment to patient safety. “I see it as a marker of an organization's ability to change practices in an area where it does take some work,” says Dr. Wachter, chief of the medical service at the University of California, San Francisco, Medical Center. “If you can't get hand hygiene right, I'm skeptical of your ability to get other things right that are harder to do.”

2. Use barrier precautions to stop the spread of infections.
Along with hand hygiene, barrier precautions are key to reducing the 1.7 million health care-associated infections that occur in the U.S. each year, which the CDC says kill about 99,000 patients annually.

When a patient has a serious nosocomial infection such as vancomycin-resistant Enterococcus, health workers should wear gowns and gloves when providing care. They should use dedicated disposable equipment and follow the encounter with immediate hand hygiene. A care bundle including barrier precautions has been shown to cut the spread of VRE from 21% to 9% in intensive care units.

3. Implement care bundles to prevent central line-associated bloodstream infections.
Using barrier precautions also is an element in the steps that dramatically can cut the rate of central line-associated bloodstream infections. When placing central venous catheters or peripherally inserted central catheters, health professionals should wear caps, masks, sterile gowns and gloves, and a full body drape should be placed on the patient.

About 250,000 bloodstream infections occur each year in the U.S., and these infections can triple hospital stays from seven to 21 days. Bloodstream infection rates in ICUs fell by nearly 60% between 2001 and 2009 thanks to wider use of a prevention protocol bundle first implemented statewide in Michigan. In addition to barrier precautions, the care bundle calls for hand hygiene, cleaning the patient skin with chlorhexidine, avoiding the femoral site for catheter insertion and removing unnecessary catheters.

“The evidence is so clear that this is the shining example of the patient safety field right now,” says Dr. Wachter, author of the 2012 medical textbook Understanding Patient Safety.

4. Use real-time ultrasonography when placing central lines.
Another patient harm linked to central venous catheters is difficulty with inserting the lines correctly. Relying on the anatomic “landmark” approach to determine where the underlying vein is located, health professionals often need multiple attempts to place the catheter successfully. The frustrating process leads to complications and higher infection rates.

Using portable ultrasound machines to get a real-time, two-dimensional view while placing the catheter has been shown in randomized trials to lower infection rates and improve other outcomes. For every 1,000 patients, ultrasonography-guided central-line placement helps avoid 90 complications, research shows.

For more information please visit http://www.amednews.com/article/20130415/profession/130419969/4/

wolvarinz
Thu 18th July '13, 11:50am
Nice to read the post. It is way more important to follow these tips to make the patients more safer in the hospital. Not only that the article link you shared is also very helpful in order to know more well. Thank you for sharing such tips buddy.

Janis.Y.Chen
Thu 18th July '13, 2:04pm
Nice to read the post. It is way more important to follow these tips to make the patients more safer in the hospital. Not only that the article link you shared is also very helpful in order to know more well. Thank you for sharing such tips buddy.

You are welcome, Wolvarinz.

WebmasterJames
Tue 28th January '14, 9:06pm
Practising medicine is complex and growing increasingly complex every day. This includes even simple patient safety measures such as hand washing.It is the best and very important tip to improve the safety of patient.Very nice information sharing.