|
BROADCAST TRANSCRIPT
Video Monitoring Services of America, Inc.
Date December 17, 2007
Time 09:00 AM - 10:00 AM
Station WPKT-FM
Location Hartford/New Haven, Conn.
Program Where We Live
JOHN DANKOSKY, host:
While the superbug MRSA has made news through its impact
On
schools, most of the MRSA cases happen in hospitals. This
is WHERE WE LIVE.
I'm John Dankosky.
Some 85 percent of all cases of the infection happen
inside
hospital walls. And that is just one of the many
statistics cited by patient advocates trying to make
hospitals safer. Among these numbers, only about 37
percent of hospital employees regularly wash their hands.
And out of every 100 hospital admissions, there are about
40 incidents of medical harm.
Today on WHERE WE LIVE, we're going to look at the
prevalence of infections inside hospitals, what they're
doing to keep patients safe, and what patients should do
themselves. We'd like you to join the conversation:
(860)-275-7266. Or you can email us:
wherewelive@wnpr.org.
It's all coming up WHERE WE LIVE (sic) right after this
commercial.
* * *
(Unrelated Material)
* * *
DANKOSKY: This is WHERE WE LIVE, I'm John Dankosky.
For a few weeks this fall, TV news was inundated with
worry
about MRSA, a form of resistant Staph infection that
spread
through some schools and killed some students. But the
chances of a child getting MRSA at a school is tiny
compared to the odds of getting it inside a hospital.
Some
85 percent of all MRSA cases happen within hospital walls.
It's just one of many infections present in an environment
that's meant to do no harm to patients. Many advocacy
groups are working to stop hospital infections, in part by
pushing tougher laws about reporting such events. But how
bad is the problem really, and what can you do to make
sure
you don't contract an infection in the hospital?
Today, WHERE WE LIVE--a discussion of hospital safety and
hygiene with medical experts and patient advocates. We'd
like you to join our conversation. 860-275-7266, or
wherewelive@wnpr.org.
Joining us in the studio today--Jean Rexford is executive
director of the Connecticut Center for Patient Safety.
Jean Rexford, welcome to WHERE WE LIVE.
Ms. JEAN REXFORD (Executive Director, Connecticut Center
for Patient Safety): Good morning.
DANKOSKY: Also welcome to Dr. Brian Fillipo. He's vice
president for Quality and Patient Safety for the
Connecticut Hospital Association.
Doctor, thank you so much for being here.
Dr. BRIAN FILLIPO (Vice President, Quality and Patient
Safety for Connecticut Hospital Association): Thank you,
John. It's a pleasure being here.
DANKOSKY: Joining us by phone is Lisa McGiffert. She is
from Consumers Union. She is the director of the Stop
Hospital Infections campaign.
Lisa McGiffert, welcome to WHERE WE LIVE.
Ms. LISA McGIFFERT (Director, Stop Hospital Infections
Campaign): Thank you. It's good to be here.
DANKOSKY: I'd like to start with you, Lisa, if we would.
We hear an awful lot about infections within hospitals.
And I'm wondering, first, if you can give a sense as to
how
worried we really should be, because an awful--often when
you talk about these things on, I don't know, television
newscasts, people get very, very worried and the odds
aren't terribly good about something happening.
So, how worried should we be about hospital infections do
you think?
Ms. McGIFFERT: Well, hospital-acquired infections are a
serious problem. They infect 2 million people every year.
So, it reaches out to many of us. Probably everyone who
is listening knows someone who has had an experience with
a
hospital-acquired infection.
And these infections cost about $27 billion a year in
hospital costs alone and about 100,000 people die every
year from these infections. So, it's a very serious
problem that is preventable.
DANKOSKY: Jean Rexford, how big a problem is it right
here
in Connecticut? Give us a sense locally.
Ms. REXFORD: Well, a few years ago, when we introduced
legislation that would have required hospitals to report
hospital specific--their infection rates--we figured that
between 21,000 and 42,000 people going into Connecticut
hospitals probably got an infection while they were there.
Meanwhile, the hospitals were reporting only two or three
or four or five infections per year. So, clearly they
weren't being tracked and the accurates (sic) were
underreported. So, it was interesting because I--I
started
doing some research and I found the Stop Hospital
Infection
program that Consumers Union had done. And we just
started
to get to work along with other activists from around the
country.
DANKOSKY: Is--specifically, Lisa McGiffert--what is Stop
Hospital Infections trying to do? What is the role of
your
organization?
Ms. McGIFFERT: Well, we started about four years ago
pushing for state laws to publish hospital infection
rates.
And Connecticut is among the first wave of states adopting
such laws.
We believe that the reporting of these infections is
important for many reasons. One is that we believe people
have a right know. And we think consumers can make better
choices when they have more information. But really it's
an important thing to push hospitals to look more closely
at what's happening in their facilities and the--we know
that the--the infection control--the quality of infection
control programs varies among hospitals.
It's just, as a consumer, we can't see which ones have the
most effective programs. So, public reporting has had
a--an impact on stimulating activity within the hospitals
as well as raising public awareness around this--around
the
country and in the states where it has been adopted.
DANKOSKY: And what kind of infections are we talking
about? Is there a broad range? Are there things that are
more common than others?
Ms. McGIFFERT: Well, there are some types of infections
that are more common, usually associated with surgery or
some kind of a line into the body like an IV or something
that is going into your body to deliver food or medicine.
And there are--that's very common. Also, there is a
common
infection called ventilator-associated pneumonia for
people
who are on ventilators. And people who have urinary
catheters often get infections too. So those are really
the four main types.
But then you get them broken down with the organisms that
cause them. And that's--that's where--I'm sure we're
going
to talk some more about MRSA, or M-R-S-A--is one of the
organisms that causes an infection. It's a bacteria.
DANKOSKY: So Dr. Brian Fillipo is here. He is the vice
president for Patient Safety and Quality for the
Connecticut Hospital Association.
So, are we overstating these numbers at all? Do any of
these numbers jive with you? Do you think that the
problem
is as bad as these advocates are saying?
Dr. FILLIPO: Well, I think that we all agree that the
issue of healthcare related infections is a huge issue and
actually one that hospitals have been addressing and have
a
long track record of fighting over the last 50 years.
We've been dealing with MRSA and other multi-drug
resistant
organisms for the last 50 years. I think there is a lot
more that needs to be done and there is a lot of attention
and focus being addressed to it right now.
And, quite frankly, if we're going to win this battle
against multi-drug resistant organisms--kind of the
invisible enemy--it's going to take consumers, it's going
to take patients, it's going to take healthcare providers,
physicians, nurses, all working together to really combat
and win this battle.
DANKOSKY: Why exactly has this process taken so long? If
it has been such a problem for such a long time, what are
the things that are keeping it from getting solved?
Dr. FILLIPO: Well, it's a complicated issue. And the
most
important things we can do to try to prevent
healthcare-related infections are standard precautions.
It's washing your hands; it's disinfecting the
environment;
it's using contact precautions, protective garments where
appropriate.
And to get those things and help providers do the right
thing in a very complicated environment is very tough.
Providers come to work everyday trying to do the very
best.
They don't come to work and say, 'well, how can I mess up
today?' So, they come to--but they're practicing in a
very
complicated environment, which is--where they have to
multi-task and things are very coupled and things happen
very quickly.
DANKOSKY: Very--go Jean.
Ms. REXFORD: Well, I think from the consumer point of
view, the thing that is frustrating is hand washing
compliance--that some hospitals, when they were tracked,
were only doing--physicians were only washing their hands
50 percent of the time when they should have.
So, I know that Yale is very proud of having an 80 percent
hand washing compliance record right now. But if you're
the one who gets that infection, that's not good enough.
DANKOSKY: Wait--at the top of the show, we actually
talked
about a number. It says only an estimated 37 percent of
hospital employees wash their hands.
First of all, I'll ask you, Lisa McGiffert, where do we
get
that number from? Thirty-seven percent of hospital
employees wash their hands? Does that mean at all or just
regularly or when they're supposed to?
Ms. McGIFFERT: Well, I don't know where that specific
statistic came from. But I do know that consistently over
the last 10 or 20 years, almost every study ranges from 40
to 50 percent as the average hand hygiene compliance.
And what that means is we usually go--we usually say about
half the time because they usually--most of the studies
cluster around 50 percent--about half the time, nurses and
doctors are not cleaning their hands between patients.
And again, some hospitals have higher compliance rates
than
others. But from the consumer perspective, we don't have
that kind of information. And that--that is not typically
included in the public reporting laws.
But I think we're going to see some pushes to include it
because, frankly, hospitals have been dealing with this
for
decades, but they haven't been doing enough. We know that
there are preventive measures to--that can be used to
prevent all of these infections that we've talked about.
And when you look at something like MRSA, which in
other--and other infections that are resistant to the
antibiotics we have--prevention is the only key. It's the
only thing that can make this go away.
DANKOSKY: And I just wanted to say that the number that I
got was taken from--I believe, from a Web site or at least
the Connecticut Center for Patient Safety. That's a
number
that Jean Rexford's organization is going with.
Ms. REXFORD: I believe that was originally from Dr.
Lucian
Leape in Boston...
DANKOSKY: OK.
Ms. REXFORD: ...and the Leapfrog Group. And his figures
have come out higher than others. For instance, he says
that hospital infections cost $30 billion a year to add to
our healthcare dollar.
But one of the things our group is asking the legislature,
and hopefully the hospital association, to look at this
year is to screen people who are at risk coming into the
hospital. The trade-off that happens between nursing
homes, let's say, and going into the hospital with
bedsores
is an increasing problem in our state.
Those people should be tested and, if they have MRSA, they
need to be isolated. If you're going in for hip
replacement surgery, you need to be tested pre-operative
to
make sure that you aren't carrying it and that--then you
would know if you got it in the hospital--that that's
where
you got it.
DANKOSKY: And Dr. Fillipo, part of the reason, of
course--MRSA is spread through open sores--it is spread
through contact with sores as opposed to spread through
the
air or something like that.
Dr. FILLIPO: Right. First, just commenting on the hand
hygiene numbers--
DANKOSKY: You wanted to get to that--yes?
Dr. FILLIPO: I'm not sure that I totally agree with the
number, although, as Jean said, I don't think it matters
if
it's 50 or 80 percent. We need to be at 100 percent...
DANKOSKY: One hundred percent would be preferable?
Dr. FILLIPO: ...and we're not there. And a lot of work
has been done over the last several years to try to
improve
the compliance with hand hygiene--the development of
alcohol-based rubs and making sure the rubs are in all the
places that providers are delivering care so that they're
easily accessible--developing lotions, making sure that
the
containers are full all of the time. So I think that's
very important.
Jean talks about active surveillance. Active surveillance
is a tool in the armamentarium combating multi-drug
resistant organisms. But again, I don't think it's the
answer. It has a role in high risk populations where we
can't get the rate where we need it to be.
But just coming back to the most important thing: our
standard precautions. It is hand hygiene; it's
disinfecting of the environment.
DANKOSKY: Do you think, Doctor, that part of the problem
has to do with people not taking care to follow through
with the best practices, or that the best practices aren't
really in place as far as protocol?
Do you think that hospitals need to do more to say that
'this is what you need to do,' or do you think those
things
are already in place and that people just aren't following
through--that physicians and others in the hospitals just
aren't following through with that?
Dr. FILLIPO: Well, again, as I think we talked about
before, healthcare is just provided in a very complex
environment where things are tightly coupled to move them
very quickly. We need to provide processes and procedures
and tools that help providers do the right thing. And
again, we just can't tell somebody, 'wash your hands
between every contact.'
We've got to make sure that those alcohol rubs are
available at the point of contact--when they are exiting
and entering the rooms. And they're the types of things
we
need to do. We need to create what I call affordances, or
the things that help providers do the right things all the
time.
And if we do all that and we make it easy for them to do
their jobs and then they don't do it, then that's reckless
behavior.
DANKOSKY: I just want to stop real quick. We're going to
take a quick break. Lisa McGiffert, before we let you
go--before we get to the break, I'd love to get a sense
from a national perspective--certainly with federal
legislation or things that you're doing on the national
level--what's being done state-by-state--I know different
states are looking at new laws to try to get hospitals to
report more infections. What's happening at the national
level?
Ms. McGIFFERT: Well, there are 20 states that have laws
to
report infections. And there are actually three states
that have passed laws to require all their hospitals to do
the screening that Jean was talking about. It's a whole
bundle of activities that prevent the spread of MRSA. And
so, three states have gotten out there in front.
And this--in the last couple of months, several new bills
in Congress have been filed to require all hospitals to
publicly report infections and to implement some
prevention
techniques regarding MRSA and other drug resistant
infections.
And then there is a bill that has been filed by
Representative Murphy from Pennsylvania for about six or
seven months that calls for public reporting of infections
also.
DANKOSKY: Lisa McGiffert is director of the Stop Hospital
Infections campaign as part of Consumers Union.
You can find more at consumersunion.org. That's
www.consumersunion.org. She joined us on the phone today
from Austin, Texas. Lisa McGiffert, thanks so much for
being here. I appreciate it.
Ms. McGIFFERT: Thank you.
DANKOSKY: We're going to continue our conversation about
hospital infections--what you can do to help stop them,
what doctors and others in the hospital industry are
trying
to do to stop them as well.
Join our conversation. 860-275-7266. This is WHERE WE
LIVE.
* * *
(Commercial Break)
* * *
DANKOSKY: This is WHERE WE LIVE. I'm John Dankosky.
Today we're talking about hospital infections. Some of
the
numbers can be a little scary when you think about it, but
what we're trying to do is get through--get through the
numbers and actually talk a little bit about what patients
can do to keep themselves from contracting infections when
in the hospital and what doctors and others in the
hospital
industry are doing as well.
Joining us in the studio: Jean Rexford, executive director
of the Connecticut Center for Patient Safety and Dr. Brian
Fillipo, he's vice president for quality and patient
safety
for the Connecticut Hospital Association.
Before our break I was asking Lisa McGiffert about
national
trends in legislation. Jean Rexford, maybe we can talk a
little bit about what's happening at the state level, as
far as trying to get new laws passed to get hospitals to
report more--more information about the infections that
are
happening within their hospital walls.
Ms. REXFORD: Well, I think one of the things I've learned
over the last four or five years is that people think we
have a health--healthcare system and really we have a
collection of industries who independently treat the
healthcare patient. And so everybody is concerned about
their bottom line, and hospitals have been particularly
hard pressed financially. And so we want to make sure
that
when you go into a hospital you're going to get the very,
very best care that you possibly can, and we want patients
to be pushed first.
The numbers on hospitals that have dealt effectively and
early on with hospital infections, it greatly reduces
their
costs. On screening, they would have to make an initial
outlay to do the screening. But after that, because these
infections are so expensive--for every person who gets an
infection it adds at least $36,000 to the hospital bill.
DANKOSKY: And again this is--this is screening for
patients coming into the hospitals.
Ms. REXFORD: Screening for patients coming into the
hospitals. Illinois, New Jersey, and Pennsylvania are now
doing that. And hos--the Veterans Administration is
requiring all of their hospitals to do it. Johns Hopkins
has instituted programs to make sure that people are
screened.
And when this happens the infection rate goes way, way
down. I mean, I want to see our hospitals say, 'I'm the
cleanest hospital in the state,' and somebody else will
say, 'No, I'm the cleanest hospital; this is our infection
rate.' Let's make it competitive, transparent, and really
clean up our act.
DANKOSKY: Dr. Brian Fillipo, have enough hospitals done
enough to try to make this information transparent to let
the public know what is happening as far as infection
goes?
Dr. FILLIPO: Well, the hospitals of Connecticut support
transparency and support public reporting, but we've got
to
be careful of what we decide to public report. We can't
be
public reporting as--so we can shame and blame people.
It's got to be a way to improve the healthcare for the
folks of Connecticut.
So what--the things that we've decided to publicly report,
they need to be meaningful, they need to be comparable
information, and there have to be clinically proven ways
to
improve what we're reporting. If we're just reporting for
the sake of reporting, there is the potential for
unintended consequences.
DANKOSKY: Well, give us an example of what really should
be reported and what you believe shouldn't be reported.
Dr. FILLIPO: Well, one of--Jean sits on a subcommittee
for
the Department of Public Health where we're actually
addressing this issue. And one of the first things we're
gonna start public reporting, as of January, is a central
line, or, you know, catheters they can put in large blood
vessels--the infections associated with the central lines.
I think that's a very important thing to public report.
It's something that there are proven ways to decrease the
incidents of those infections and we can share best
practices amongst hospitals--that's a very important
thing.
One thing that probably I wouldn't support public
reporting
is ventilator associated pneumonias, where--you know,
pneumonias are infections of the lung that people get when
they're on breathing machines. And the reason I wouldn't
support that is because it's--it's very difficult to
clinically get two clinicians to agree when somebody has
ventilator associated pneumonia. So that's not very
reliable information and it's not meaningful so I don't
think it would lead to improvement.
DANKOSKY: Is there a chance, though, that you can make
strides in trying to find that information out, and so,
hopefully, you can, I suppose, learn something about
whether or not people are picking up an infection through
using the ventilator.
Dr. FILLIPO: Right. And again, I think the approach that
we're taking through the subcommittee with the Department
of Public Health is a step-wise process so we're--we're
getting the procedures down in place of how to public
report these infections and starting with ways that we
know
are meaningful. And we'll be looking over the next
several
months of what the next type of infection we'll be looking
to public report is.
DANKOSKY: Let's go to the phones. Melvin is calling from
Hartford.
Go ahead, Melvin. You're on WHERE WE LIVE.
MELVIN (Caller): Hello, John.
DANKOSKY: Hi.
MELVIN: My wife, about two-and-a-half years ago, went to
a
major teaching hospital in Boston for a significant
cardiac
surgery and contracted MRSA about 10 days post-op. And
what we learned through that experience was that not only
was the hospital reluctant to disclose the percentage of
patients that were contracting MRSA within their facility,
their own teaching fellows were not well apprized of the
risks of MRSA or the onset of symptoms.
In fact, in my wife's case, she was showing symptoms for
almost 36 hours before the fellow, who had been assigned
to
track her post-op recovery, even picked up on these
symptoms.
And it was apparent through a lot of investigation that we
conducted following this incident--which, by the way,
resulted in seven weeks of additional hospitalization,
over
half a million dollars worth of medical bills incurred as
a
result of that, and, frankly, a near-death experience--we
learned that even the teaching--even the people who were
being taught at the hospital--were not well apprized of
the--of the frequency of MRSA occurring in that hospital.
While in the hospital, broadly, MRSA was occurring at
about
a 3 percent rate and in the cardiac unit it was almost 10
times that. That was something that was not disclosed to
us when we chose that hospital. The hospital remains
reluctant to disclose that to its patients today who are
still going to that hospital.
DANKOSKY: Well, and let me put this to Dr. Filllipo, with
something like this we're talking about a lot of simple
solutions. I think you and Jean Rexford have agreed
generally that there are some simple things that people in
hospitals need to be doing better in order to keep the
number of infections down.
What this caller is talking about though is just a basic
lack of understanding about something that is fairly
common
within hospitals and people just weren't looking out for
it. Is this something that you find? Is this something
that's being worked on?
Dr. FILLIPO: Well, I think--you know, again, it's a
process where we've been working through the hospitals for
a long time to try to improve the awareness, improve the
tools that are available to providers to help prevent
these
infections. And I think education is part of that.
I mean, we're looking right now, as Jean's aware, to do a
statewide program in February looking at multi drug
resistant organisms to help, one, educate providers, but
then kick off--potentially kick off a statewide
collaborative where all the hospitals will come together
and try to look at the scientifically proven ways to
prevent infections and develop ways to implement them in
all of the hospitals.
DANKOSKY: And Jean, it helps if patients know too--if
patients know what to look for, if patients know a little
bit about something like MRSA and they know how to look
for
it themselves.
Ms. REXFORD: We are developing--developing materials
right
now for people to take with them when they go into the
hospitals. And one of the things that's very hard for
people to do is just speak up and say, 'Have you washed
your hands? I don't want you to touch me until you've
washed--until I see you wash your hands.'
Those are hard things. Another strategy is to get nurses
or other healthcare personnel to learn to speak up, to
make
it an environment where it's safe to say, 'Doctor I did
not
see you wash your hands.'
Dr. FILLIPO: Because there is something about when you're
in a hospital, certainly you're put in a very vulnerable
position. Quite often you're there in a strange bed
wearing hardly any clothes and there's people surrounding
you who you don't know, and--and you want to assume that
the people taking care of you have done every last
possible
thing, including, the simplest thing of just--of just
washing up.
Ms. REXFORD: Right. Well, now many hospitals suggest
that
you have a 24-hour-a-day advocate with you, you know to
check on the medications. The hospitals have been under
enormous stress, but I don't think that the patients
should
expect any less from them.
And one of the reasons we want to do the MRSA screening is
I really don't think the hospitals understand how
prevalent
MRSA is. If they haven't been following it, if they
haven't been tracking it, then the fellow in the ICU can
think, 'oh you know this'--we've had people who were told
that the person had a migraine when it was really a MRSA
infection in her brain.
And--and so the consumer doesn't understand that. Here's
something that's prevalent: national statistics--all
studies support that, and we want our hospitals to do the
very best that they can.
Dr. FILLIPO: I mean, I would agree with Jean that it's
very important that this is a partnership, I mean...
Ms. REXFORD: It is.
Dr. FILLIPO: ...it's going to take a partnership of
everybody and I also agree with you that we can't rely on
the patient who's in a very vulnerable state to be the
traffic cop. But they play a part in trying to help
everybody do--do the right thing.
DANKOSKY: Melvin, I appreciate you sharing your story. I
hope your wife is doing better.
MELVIN: Thank you very much. She is.
DANKOSKY: Thank--thank you for your phone call. I
appreciate it.
Let's go to Alison Kanaris (sp); she's calling from Rocky
Hill, Connecticut. Alison is one of many patients in
Connecticut and, of course, around the nation who's been
negatively affected by a hospital infection.
Alison, welcome to WHERE WE LIVE. I appreciate you
joining
us.
Ms. ALISON KANARIS (Caller): Thank you.
DANKOSKY: Could you tell us a little bit of--of your
story? What exactly happened to you when you went in for
surgery?
Ms. KANARIS: Well, it's similar to what Melvin stated. I
went in for surgery and was infected, I believe, in the
hospital. And once again that's probably because they're
not employing proper hand wash techniques. And I agree
with everything that's been said about the intimidation
factor, and you don't question the doctors.
We've been raised, don't forget, our entire life to just
trust our doctors. My situation was a little bit
different
in that I contracted it and was not diagnosed for seven
and
a half weeks, in which case the infection became quite
systemic and I was given 24 to 48 hours to live--twice.
I did pull through, however. But I had an awful lot of
severe repercussions. And I--I think that I would like to
do anything to help patients that going into the hospital
not to have to go through what I went through.
DANKOSKY: I want to ask you Dr. Fillipo about how long it
does take for some infections to show up. Quite often one
of the problems I think, just in general with people and
their--their healthcare, is that so little time is spent
in
the healthcare system because of the costs involved.
You spend just as little time as possible in the hospital.
You spend as little time as possible in front of a doctor,
most of the time, and then something appears down the
road.How common is it for an infection to take place in a
hospital setting, and then to have it only show up,
symptomatically, down the road--five, six, seven weeks?
Dr. FILLIPO: Well, it--it's very common for in--for
healthcare related infections to occur after the patient
leaves the hospital. I mean hospital stays are so short
now. You know the average length of stay is four, four
and
a half days, and an infection may not show up for--for
several days after somebody leaves the hospital.
Ms. KANARIS: And I don't want to imply, John, that
I--that
it didn't show up...
DANKOSKY: I understand.
Ms. KANARIS: ...for several weeks. It showed up fairly
rapidly. It was not diagnosed.
DANKOSKY: It was not diagnosed for quite a while.
Ms. KANARIS: Right. I think lack of education--the same
thing Melvin was saying--I think the doctor didn't know
what he was looking for.
DANKOSKY: So one of the things I think a lot of people
would--would ask in your situation, Alison, is did you
sue?
Did you--did you find out about this and say, 'My
goodness, I almost lost my life. I went in for--I believe
it was elective surgery in your case--
Ms. KANARIS: Yeah.
DANKOSKY: Am I correct? You would have--
Ms. KANARIS: It was elective surgery. And I--I
understood
that there was a risk of infection going in. What I
didn't
sign up for was for not being diagnosed, not being treated
properly. I never signed up for that. I did in fact sue;
I did in fact win. However, I did not recover to the full
extent.
I--I basically--between what I went through and the
different medical--I lost an awful lot of work. I lost
probably almost three years of work because---not just
because of the infection--the infection and the
ramifications, which was a severe depression. I think
that
I was never compensated for that.
DANKOSKY: Jean Rexford, I'm just wondering, you know she
mentions this idea of knowing that there's a risk of
infection going in. Talk about that from a patient
standpoint. When you go in, especially for elective
surgery in a hospital, you're basically told
there's--there's a lot of things that could happen.
What should the patient really expect as far as a risk, a
possibility that you may contract something while you're
undergoing surgery or while you're--you're being--spending
lots of time in a hospital post-operatively?
Ms. REXFORD: Well, I think the consumer wants to make
sure
the hospital's doing it's--it's best to minimize those
dangers. But there are things that--you can wash yourself
with a special soap before you can have--before you have
surgery. You can say 'do--never shave the--the surgical
site.'
Ms. KANARIS: And I think we're expecting--I think we're
expecting maybe an infection--no one mentioned life
threatening infections.
Ms. REXFORD: Right.
Ms. KANARIS: No one said that. No one said like a risk
of
infection, you're--you're led to believe a couple of
antibiotics and you're good.
Ms. REXFORD: And so many of these are
antibiotic-resistant, which is the real danger.
Vancomycin
is the drug that is the antibiotic that is used most
frequently to deal with MRSA, but so many patients have
severe reactions to that drug. And--
Ms. KANARIS: It's a very potent drug.
Ms. REXFORD: It's very potent. And then for those people
who get MRSA and cannot tolerate Vancomycin, then what
happens to them? And now there's a whole new group called
VRE, which is Vancomycin-resistant drugs. These are--it's
very scary.
DANKOSKY: Well, Alison I appreciate you very much
spending
some time with us and sharing your story a little bit.
I--I trust that you're--you're feeling better and you're
starting to get things back together after this--after
this
terrible incident you've gone through.
Ms. KANARIS: Yes, I think I am. I think I'm fortunate
that I'm able to do that. But I was--I would--wouldn't
wish it on anyone.
DANKOSKY: Alison Kanaris joined us on the phone from
Rocky
Hill. Thank you so much for being here. I appreciate it.
Ms. KANARIS: You're welcome.
Ms. REXFORD: John, there's one point I'd like to bring
up.
Let's say you go in for day surgery at a surgical
center...
DANKOSKY: Yeah.
Ms. REXFORD: ...and you go home and two days later you're
running a fever. That--when you--when you get this--an
infection in those cases, the physician has no
responsibility to report that to anyone.
We need to have public understanding that this is a
prevalent occurrence and that it is the healthcare
industry's responsibility to take good care of this--of
these infections.
DANKOSKY: If you'd like to join our conversation, we're
talking about hospital infections today. What hospitals
are doing to try to stop them. What you can do as a
patient to try to stop them. The number to call
860-275-7266. You can also join us by email,
wherewelive@npr.org.
Joining us now by phone is Dr. Jamie Roche, vice president
of Patient Safety and Quality at Hartford Hospital. Thank
you so much for being here.
Dr. JAMIE ROCHE (Vice president, Hartford Hospital):
Thank
you.
DANKOSKY: I appreciate you joining us. So what is
Hartford Hospital specifically doing to insure patients'
safety? You've been listening to some of our
conversation.
Some of the things that are being proposed by advocates,
some of the things that the Connecticut Hospital
Association says needs to done. What is Hartford Hospital
doing?
Dr. ROCHE: We--thank you very much for that question.
First off, I'd like to say Hartford Hospital as other
institutions in this state are--we're--we're committed to
the highest levels of body and safety. The--the issue is
not necessarily what to do but how to do it and how to
ramp
up.
It's interesting that over the last ten years the level of
awareness has just increased remarkably. Not only the
leadership level, but also the staff level. The recent
caller was--just mentioned how surprised they were at the
lack of understanding by the fellows at the institution
that he was at in terms of hospital acquired infections
and
that's--that's an accurate statement.
This is a cultural mind set. We used to think that
infections were inevitable, and I think because how our
industry evolved and that physicians were craftsmen and
came together and used hospital facilities, essentially
not
employed and without the awareness of needing to really
work in a truly collaborative environment and
understanding
responsibility that the system holds for many of these
issues.
We came to--essentially, to have a system that was not
addressing and meeting the needs of our patients;
certainly
not exceeding them. And now today with the pressure
that's
out there, we are really called on to bring about a
transformation within the organization.
What we're realizing is that this is not a responsibility
of the physician alone, that this is a responsibility of
everyone who interacts with the patient and enters the
patient's life from the time that they come into contact
with the provider.
DANKOSKY: If you would, please be specific about--about a
little bit of the responsibility you're putting on your
staff now that you--you perhaps hadn't in the past.
Something that hasn't changed recently, specifically at
Hartford Hospital.
Dr. ROCHE: Absolutely. We began to touch on it earlier
in
the conversation here--is that one would think that when a
physician for example is placing on the central line
that--that--that this would be completely within the realm
of the physician to be aware of the entire situation and
to
be held responsible and accountable for anything that
might--might occur as a negative outcome.
When in fact the human mind is only capable of--of--of
processing so much info--information. What we're talking
about is the need in placing the central line to insure
that one, anyone involved with patient close contact has
what we call "maximum barrier precautions," that hand
hygiene is in place.
That we've actually selected the right site for the--for
the catheter and--and the environment that we're talking
about creating, which is the cultural transformation, is
that anyone on the team, whether it's a scrub nurse in the
OR or a nurse at the bedside, is participating and can
call
off the procedure or ask a question.
That may seem--come as a surprise to our audience, but
because of the hierarchy within the healthcare industry,
with often physicians at the top, a nurse may be--may be
intimidated to speak up when she's 95 percent certain that
she's got a valid point to make. So, you know, this
doesn't sound like hard stuff, but this is really where
the
rubber meets the road and this is the challenge to
introducing change in--in delivery system. Just--just
getting that--that to happen.
We're doing what we call "bundles," and I think that was
brought up a little bit earlier as--as I--as part of the
conversation, but when we're putting in central lines,
there's a set of--of--of evidence-based practices that we
need to adhere to and anyone on the team--and everyone on
the team--is accountable that these take place.
Ventilator bundles, making sure that the head of the bed
is
elevated so that secretions don't end up increasing
the--the risk for contamination and that the lungs inflate
adequately during--during the respirations.
DANKOSKY: Yeah.
Dr. ROCHE: Getting patients daily sedated, to take a--to
take a vacation, we call it, from sedation, so they
lighten
up a bit and--and prepare it that way for earlier
extirpation. The earlier we can get that tube out, the
better.
But--but these are things that require tremendous
coordination on every caregiver that--that's involved--the
respiratory therapist, the nurse, the doctor that has to
write the order-- and we're relying more and more now on
protocols and team input. So it takes a while for this to
happen.
I mean, it--it--it is incredible but it is true that tens
years ago when I trained here at Hartford Hospital we
believed that these infections were inevitable. And when
you believe something is inevitable, you don't look for
root cause because there's essentially little you feel you
can do about it.
DANKOSKY: Dr. Jamie Roche is vice president of patient
safety and quality at Hartford Hospital. Thanks so much
for joining us for a few minutes. I appreciate your
insight.
Dr. ROCHE: Thank you.
DANKOSKY: We're going to continue our conversation about
patient safety and hospital infections coming up in just a
moment. WHERE WE LIVE on WNPR.
* * *
DANKOSKY: This is WHERE WE LIVE. I'm John Dankosky.
Today we're talking about the problem of hospital
infections and patient safety. Joining us in the studio,
Jean Rexford, executive director of the Connecticut Center
for Patient Safety, and Dr. Brian Fillipo. He's
vice-president for quality and patient safety for the
Connecticut Hospital Association.
We've got a lot of phone callers who'd like to get in on
the conversation, so let's go to Paul from East Haddam.
Go
ahead, Paul. You're on WHERE WE LIVE.
PAUL (Caller from East Haddam): Hi, John. My name is
Paul. I'm calling from East Haddam.
Since the insurance companies are paying for these
extended
hospital stays as a result of hospital-related infections,
I'd like to know what role that they're playing in getting
the hospitals to improve their procedures and reduce the
number of infections.
And I'll be happy to take my answer off the air. Thank
you.
DANKOSKY: Paul, I appreciate your phone call very much.
So what role are the insurance companies playing?
Dr. FILLIPO: Well, I mean, there's a lot of attention
being put on this whole issue of avoidable complications
right now. The Centers for Medicare and Medicaid Services
is now looking at not paying for complications, not just
infections but other complications, and I think you're
gonna see other payers following suit in that as we move
forward.
DANKOSKY: And go ahead, Jean.
Ms. REXFORD: Well, it just makes sense for them not to
pay
for wrong site surgery, for some of the what we call never
events that they have been paying for. And it doesn't
make
any sense to the consumer that they would do those
reimbursements.
DANKOSKY: Let's go to Denise, who's calling from East
Hampton, New York. Denise, go ahead. You're on WHERE WE
LIVE.
DENISE (Caller from East Hampton, New York): Hi. Thank
you so much for taking my call. What an excellent show!
DANKOSKY: Thank you very much. So, what's on your mind?
DENISE: Oh, I just wanted to make one quick comment. I
don't know if it's the proliferation of how cool doctors
are from certain television shows, but a comment I often
make is I'm really tired of seeing doctors shopping at
Whole Foods in their scrubs. And I know people aren't
supposed to leave hospital premises in scrubs, but it's a
practice that has been ignored, as far as I can tell, for
decades.
And I'll take my comments off the air. Thank you.
DANKOSKY: Denise, thank you very much for bringing that
up. It's something that we periodically see, especially
if
you're very, very near a hospital.
Are those sort of common problems the sort of thing that,
Dr. Fillipo, you're trying to get into the medical
community? 'Hey, we want to make sure we keep a little
closer eye on this.'
Dr. FILLIPO: Again, trying to identify all the ways to
try
to reduce infections.
But, again, just coming back to the most important things
we can do are, again, hand hygiene, contact precautions,
and disinfecting the environment.
Ms. REXFORD: Two points. England now has gone to a
system
where anyone, any health care personnel going into the
hospital, there are no lab coats, there are no ties, there
are no watches, there are no jewelry, and precautions are
taken so that it's a very sterile environment.
I understand that that would affect 20 percent of the
infection rate. And somebody said, 'Well, that's only 20
percent.' But if you were one of the people that got the
infection, I think you would care a lot.
DANKOSKY: It's interesting you mention things like ties
and other things.
There's lots of things that go on in a hospital which, if
you take a real, real close look, are very odd because,
for
instance, the doctor will put on a coat which you assume
is
clean, and maybe he'll put on gloves. Certainly he'll put
on gloves to examine you. But then quite often with the
gloves on he'll, oh, pull himself up a little closer by
touching the bed that you're--that you've been laying in.
And those are the sort of things that doctors, that
just--I
mean, they go on every single day in every single patient
interaction, I think, in America and in the entire world.
Dr. FILLIPO: Which is, again, why it's so important to
disinfect the environment and make sure that we have a
checklist to make sure that all aspects of the environment
has been disinfected.
DANKOSKY: We're all under the assumption here we can't
get
to 100 percent anything, though. Right? I think part of
the thing that our earlier caller, our guest, who had been
very sick, of course, because of a hospital infection,
said
it's really trying to cut down on these things that are
going to be life-threatening.
The idea that you may pick up an infection from being in a
place with a bunch of other sick people probably isn't out
of the realm of possibility. It just seems as though
these
life-threatening types of infections that really can cause
so much damage, these are the things that need to be taken
care of more than anything else.
Dr. FILLIPO: Right. I mean, you got to remember,
hospitals now are taking care of sicker and sicker
patients
who have more compromised immune systems than we did
probably 10 years ago, which puts patients at even greater
risk.
Ms. REXFORD: Dr. Betsy McCaughey from Reduce Infection
Death talks about hospitals only allowing 11-18 minutes to
clean rooms between patients. And that's probably--80
percent of infection is spread through touch.
So we have to clean surfaces. She talks about spraying
and
soaking. We can't just spray and wipe the stethoscope,
the
blood pressure cuff. All those things can carry awful
organisms between rooms.
DANKOSKY: Is the basic way the hospital is set up to care
with people, is it just set up wrong? I mean, do you have
too many people clustered together who are all sick in
various ways who are coming in close contact with one
another?
If you had an opportunity, doctor, to just sort of blow up
the whole hospital system and put it back together again
in
a way that worked better for doctors and nurses and
patients, what would it be? Would it be a lot different
than it is today?
Dr. FILLIP: Yeah, that there's a great deal of attention
now being focused on just the physical layout of hospitals
and how we plan, how we deliver care. And I think there's
a lot of things that need and can change in that whole
process. A lot of it was developed for a lot different
reasons when hospitals were originally designed.
DANKOSKY: But, of course, one of the things we've talked
about on this show before, too, is we can lay out the best
possible plans, and then many hospitals are seeing
patients
in the hallways and many hospitals are seeing patients
outside the bathrooms and in the waiting rooms.
It happens in hospital after hospital across America where
maybe all the best practices are set up so that once
you're
in the ICU, things are perfectly sanitary and clean, but
if
you've got an overcrowded hospital and you're seeing
people
out in the front lobby, everything just blows up. It just
doesn't work any more.
Dr. FILLIPO: Over-capacity is a huge issue for all of our
hospitals, particularly in Connecticut, and a lot of
attention is being focused on flow through the facilities
and how do we improve flow, how do we make sure the
providers--our patients are taken care of in the place
that
they should be taken care of by the provider they should
be
taken care of by.
DANKOSKY: Jean, do you have a sense of how much of the
problem of hospital infections or patient safety issues
come down to the problem of overcrowding?
Ms. REXFORD: No, I don't. But I think that there's a
foundation in Texas that funds The Intelligent Patient
where the hospital gets feedback and gets them to ask
questions.
They just sort of morphed into what they are. I don't
think anybody goes into a hospital and figures out the
logic of the rooms or the floors. It's--they just grew
here, they grew there. And consumer feedback might be a
really interesting thing for hospitals.
DANKOSKY: Let's go to the phones. Joseph McCannon joins
us. He's vice president of the Institute for Healthcare
Improvement in Boston and the manager of the Five Million
Lives Campaign. Joe McCannon, thank you so much for being
here. I appreciate you joining us.
Mr. JOE McCANNON (Institute for Healthcare Improvement
Vice
President): Thanks for having me.
DANKOWSKY: What's the Five Million Lives Campaign?
What're you trying to accomplish?
Mr. McCANNON: The Five Million Lives Campaign is a
national campaign that seeks to avoid five million patient
injuries in hospitals over a two-year period. We estimate
that there are about 15 million patient injuries in
hospitals each year due to a variety of causes:
medication
errors, infections, surgical complications. And so our
goal is to make sure that we reduce as much harm as
possible through this national effort.
Over 3,700 hospitals have joined us. That represents
about
75 percent of all the hospital beds in the country. And
the goal is to create a national learning network where
together we're sharing best practices around how to reduce
infection and reduce other forms of harm so that we can
accelerate the rate at which we stop harming patients.
DANKOSKY: Isn't it darn near impossible, though, to
measure this stuff, to find out when you've avoided harm
in
a certain, specific instance?
Mr. McCANNON: It's complex and work-intensive but not
impossible.
So through things like retrospective chart review, where
we
go back and look in patient charts and study sort of what
we would call flags in the chart which let us know that
perhaps there's been a harmful event of some kind, we're
able to get a sense of harm. And certainly we can track
infection. All hospitals do. We can track medication
error.
So it's not impossible to do, and it's something that we
need to do in a way that's meaningful for patients and
families.
DANKOSKY: You've just completed the 19th National Forum
on
Quality Improvement in Health Care. So what exactly was
the outcome of this? What are some things that you've
made
progress on here?
Mr. McCANNON: Well, this is a gathering that we have
every
year. About 7,000 people gathered in Florida this year.
And it's a community of people from hospitals and other
health care settings in the US and around the world who
are
focused on issues of quality and safety. The goal is to
make sure that a byproduct of health care is not
unnecessary harm.
Most of the people there are clinicians and practitioners,
all of whom are deeply devoted to their patients, and I
think that's true of most of the clinicians that we come
across. But they're operating in some of the most chaotic
systems in the world, so we need to make those systems
less
chaotic and safer and foolproof them in such a way that no
one gets harmed.
DANKOSKY: Are there systems elsewhere in the world that
are much different than the American system where things
are really, really working well? I mean, can you point us
to a model that we might want to look at?
Mr. McCANNON: There are fabulous pockets inside and
outside the country.
You know, if I were to look outside the country, there's a
county in Sweden, of all places--although that may not be
a
surprise--called Jonkoping County, and they've got some of
the best integrated care we've ever seen. Hospital
setting, outpatient setting, primary care setting,
community setting. It's a comprehensive system of care
with the patient at its center.
There're other countries that have made great strides in
other areas. Reductions of waiting times in the UK, for
instance. We know that there's great progress on reducing
infection in some states in this country, and that's a
priority in places like Illinois and Pennsylvania.
And then in Connecticut itself there's--there have been
terrific efforts led by groups like the Hospital
Association, which is acting actually as a field office in
our campaign for Connecticut where they're focusing on
reducing infection and harm and things like pressure
ulcers
as well.
Which, again, we know these are things that can be
avoided.
The question is, how do we create systems that avoid them
100 percent of the time?
DANKOSKY: One last thing for you, very quickly, if you
would, Joseph McCannon.
A specific, concrete step that you'd ask a hospital to
take
here in Connecticut, anywhere else in the country. What's
something that you're out there trying to get hospitals to
pay attention to?
Mr. McCANNON: Well, the primary thing is to set a
hospital-level aim for reduction of harm, to say, 'This is
what we're gonna do as a hospital to make it transparent
to
the community, to be proactive about making that change.'
An example would be, 'We're going to reduce our infection
rate by 15 percent' or 'We're going to reduce central line
infections. We're gonna get those down to zero across the
entire hospital.'
Ambition is important. Getting to zero is possible.
We know now, for instance, that over 65 hospitals around
the country have gone over a year without a
ventilator-associated pneumonia in a unit.
So that type of performance, which was previously thought
to be impossible, can actually happen. And that's the
change that we need to see.
DANKOSKY: Joseph McCannon is vice president of the
Institute for Healthcare Improvement and the manager of
the
Five Million Lives Campaign. Joe McCannon, thank you so
much for joining us. I appreciate it.
Mr. BUCHANAN: Thanks for having me.
DANKOSKY: In just the last little bit of time we have,
Jean Rexford, we mentioned this a little bit earlier, but
if--for people who are just joining us, what are some
things that you are asking patients to do, questions to
ask, while staying at the hospital, so they can cut down
on
the possibility that they're going to be infected in the
hospital?
Ms. REXFORD: Well, I think they have to be willing to--a
friend of mine just went in--she had cancer surgery--and
she learned to say, 'I'm totally neurotic but I need you
to
wash your hands and I need to see you wash your hands.'
And I think that demand for a sterile environment is
something that the patient or the patient's advocate can
make.
DANKOSKY: And I think it's fair to say, though, Dr. Brian
Fillipo, that just because the doctor washes his or her
hands does not mean that all of the possible risks of
infection are now taken care of. That's something
patients
should understand. Right?
Dr. FILLIPO: Absolutely. Although we're striving for
zero
infections, I think, given the complex environment and how
sick patients are and compromised patients are, it's very
difficult to totally eliminate them. But there's a lot
that we can do and need to be doing.
DANKOSKY: Dr. Brian Fillipo is vice president for quality
and patient safety for the Connecticut Hospital
Association. Jean Rexford is executive director of the
Connecticut Center for Patient Safety. Thank you both
very
much for joining us on WHERE WE LIVE.
Ms. REXFORD: Thank you.
Dr. FILLIPO: Thank you, John.
DANKOSKY: Coming up tomorrow: tough new ethics
legislation coming through the statehouse in this upcoming
legislative session. I'll be joined by State Senate
President Don Williams tomorrow, WHERE WE LIVE.
I'm John Dankosky. Thanks so much for joining us.
# # #
For a videocassette(TV) or audiocassette(radio) of this
news segment contact your nearest VMS office
Material supplied by Video Monitoring Services may only be
used for internal review, analysis or research.
Any publication, re-broadcast or public display for profit
is forbidden.
|
