Thousands of veterans were told they should get blood tests for HIV and hepatitis because three hospitals might have treated them with unsterile equipment. Nearly 11,000 former sailors, soldiers, airmen and Marines could have been exposed to infectious diseases because three VA hospitals in the Southeast did not properly clean endoscopic equipment between patients.
For a long time, ventilator associated pneumonia (VAP) had been viewed as an unavoidable evil, particularly in intensive care units (ICU).
The healthcare-associated infection (HAI) was a common occurrence among patients who had been on mechanical ventilation on an endotracheal or tracheostomy tube for more than 48 hours. As with many HAIs, however, the healthcare world's view on preventability has changed. Lee Memorial Health System, a Ft. Myers, FL-based health system, targeted VAP as an HAI the organization would wipe out completely.
And the health system has succeeded, going 24 months without a case.
There were a number of reasons why Lee Memorial chose VAPs as a target for zero—part of the Association for Professionals in Infection Control and Epidemiology's (APIC) Targeting Zero campaign. First and foremost, VAPs occurring in the ICU have the highest rate of fatality of any HAI, says Stephen Streed, MS, CIC, system director of epidemiology and infection prevention with Lee Memorial. Streed is a board member with APIC.
Studies show that "14% of patients who has had VAP has had a fatal outcome," he says. "That is too much."
In the past, says Marilyn Kole, MD, medical director of system intensive care services at Gulf Coast Medical Center, part of the Lee Memorial Health System, common parlance said that if a patient was in the ICU, there was a 30% chance the patient would contract VAP.
Medical professionals "talked about them being expected," says Kole.
The historical statistics on VAP are particularly frightening: it was considered a 5% cumulative chance of contracting a VAP, meaning after 10 days in the ICU, there was a 50% chance the patient would come down with a VAP.
Matter of perspective
One reason for the hospital's success has been a dual-level approach to looking at VAPs. On one side of the coin they have the intensivist perspective—the individual patient, the individual case. But they now also incorporate an epidemiology angle to their perspective, looking at groupings, recurrences, and trends.
"The difference is looking at patients one at a time versus groups, the way an epidemiologist would look," says Streed. "An intensivist will look at the patients one at a time."
The facility now reviews each case, but also looks at long-term trends to try to evaluate if they're headed in the right direction.
Ownership
This improvement process has increased awareness among staff and also built a sense of pride—particularly following the organization's extended success in combating VAP.
"They take it very personally now," says Streed. "They have ownership. If a VAP case were to occur, everyone would be distressed. Were one to happen now, we'd do an almost root-cause analysis level exploration of the individual and the case."
This ownership has taken root in everyone, not just clinical staff. And everyone is paying attention.
"That was an evolution," says Kole. "Now you get an infection and everyone wants to know what's going on, they want to know which patient it is."
State and national health experts are baffled as to how a rare and deadly strain of meningitis killed four people and infected eight others in South Florida since December, an unprecedented outbreak in the United States. The cases of the W135 strain of meningitis were disclosed by Miami-Dade health officials. They were recommending vaccinations for those in high-risk groups, mainly those living in close and crowded situations such as college dorms or military barracks.
Pressed by insurance companies, some drug makers are beginning to adjust what they charge for their drugs based on how well the medicines improve patients' health. Such pay-for-performance contracts started to take hold a few years ago in countries with national health systems, in which the government could effectively block a drug from being used if it was too costly. Some experts hail such arrangements as a welcome step toward healthcare that rewards good outcomes for patients.
The surgery was meant to take out the patient's gallbladder, but when the patient was sewn up a 13-inch medical instrument was left behind.
Operating room staff typically count sponges, sharp objects and instruments three times during and after surgery, but in this case, which occurred in January at Hartford Hospital, the final instrument count took place before the patient's incision was fully closed.
The case, cited in a report by Connecticut regulators, reflected a rare but potentially severe operating room occurrence: leaving objects in patients after surgery.
For most stroke patients, receiving a clot-dissolving drug shortly after arriving at a hospital can reduce the effects of stroke and limit permanent disabilities. But for some patients with a certain type of stroke, such a drug can actually increase bleeding in the brain. Stroke experts say the best way to tell which patients should get the drug is by having a CT scan of their heads read within 45 minutes of their landing in the emergency room. But a rule that would call for a CT scan within 45 minutes was rejected last fall by a quasi-governmental group that sets medical guidelines used by Medicare to evaluate and reimburse U.S. hospitals. The group, known as the National Quality Forum, said the vague wording of the rule raised too many questions.