In spite of efforts to make Minnesota hospitals safer, the number of deaths and injuries from errors or accidents rose again last year, according to a report released by the Minnesota Department of Health. Minnesota Health Commissioner Sanne Magnan said that changing the attitudes among hospital staff has proved harder than adding new safety procedures. Hospital officials, however, and experts say there's a growing belief that Minnesota hospitals are safer today than they were five years ago, when they first started publicly disclosing mistakes.
Some medical devices for sensitive uses have won government approval without a close scientific review, congressional investigators said. Although Congress ordered the Food and Drug Administration years ago to resolve the issue, the agency approved 228 medical devices without a full scale review from 2003-2007, the Government Accountability Office said in a report. Some devices approved under the less rigorous process have been recalled because of malfunctions and other problems, according to the consumer group Public Citizen.
Cleveland Veterans Affairs Medical Center researchers recently showed healthcare workers there the importance of hand hygiene. A medical student examined a patient known to have a drug-resistant Staph on his skin with no sign of the infection, and placed her hand on a dish containing a jelly that promotes the growth of germs before washing her hands. She then washed her hands and pressed them into a separate dish. Within 24 hours, the germ contamination became evident.
Nine scientists from the Food and Drug Administration are concerned that FDA managers have become too lenient in approving medical devices. They believe that some devices are not properly tested, which not only increases the risk of human error, it could ultimately compromise patient safety.
First, let me say that controlling the spread of healthcare-associated infections is important. Nearly 100,000 people die in U.S. hospitals every year from some sort of HAI. Providers around the world consider infection control to be an extremely serious matter, and so do I.
That said... looking back on 2008, the prize for Most Misguided Patient Safety Initiative of the Year has to be this item from the other side of the Atlantic: A public health trust in Great Britain ordered toys removed from all of its clinics because of the risk of spreading infections among children. The move was reportedly an effort to follow a Department of Health guideline requiring health trusts to ensure "a clean and appropriate environment for healthcare," according to a story in The Daily Mail.
Part of me wasn't, and still isn't, surprised by this. The British have shown a willingness in the past to take aggressive action to prevent infections from spreading; in April of last year, we ran a story in HealthLeaders magazine about British hospitals banning below-the-elbow clothing for physicians—everything from neckties to fake fingernails—because of the infection risk. With HAIs affecting more and more people, merely maintaining the same prevention efforts is no longer acceptable. So in some ways, I applaud the attempts at meaningful change. And I should mention that since the story ran, the health trust in question has purchased plastic toys (easier to clean, I presume) to replace the soft toys and wooden toys that were removed.
But this issue got me thinking about the fine line between caution and paranoia. I'm sure kids can spread plenty of nasty little bugs by touching and coughing on toys. Just like kids (or adults, for that matter) can spread plenty of nasty little bugs by touching and coughing on books, magazines, chairs, doorknobs, and everything else in the waiting room. If the toys are cleaned thoroughly and regularly, why are they a greater threat than anything else? In fact, at least you can disinfect a toy. How do you disinfect a newspaper? To the physicians among you: Am I oversimplifying here? If the toys are kept as clean as possible, help kids feel better about visiting the doctor, and give parents a little help during long waits in a crowded room... the benefits, to me, outweigh the risks.
The broader point is that taking the task of infection control seriously and living in fear are two different things. As 2009 brings continued challenges in the fight against organisms that are growing ever more drug-resistant, irresponsible behavior like failing to wash one's hands or skipping a surgical timeout or neglecting to disinfect the toys in a waiting room can't be tolerated—the cost is just too high. But risk can never be truly eliminated. And there is such a thing as going too far.
Jay Moore is managing editor for HealthLeaders magazine. He can be reached at jmoore@healthleadersmedia.com.
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Surgical teams that followed a basic checklist in the operating room reduced the rate of deaths and complications by more than a third, according to a year-long, eight-nation project. The low-cost, low-tech intervention tested in eight hospitals around the globe could have enormous financial implications. If every operating room in the United States adopted the surgical checklist, the nation could save between $15 billion and $25 billion a year on the costs of treating avoidable complications, according to calculations by the authors.