Handwashing Requirements in Restaurants

By Donna Armellino, Erfan Hussain, William Senicola, Mary Ellen Schilling, Ann Eichorn, Yusaf Dlugacz, Bruce F. Farber

By Tina Rosenberg

There are several bacteria and fungi that have learned to thrive in our hospitals. Hospital-acquired infections (HAI) are infections that have found a way to better develop and prosper in a hospital setting. These infections are particularly worrisome for health care professionals and patients because they are strong in such vulnerable places of our existence. Many of these bacteria and fungi have developed resistances to antibiotics that were at one point effective on them. Gaining resistance to some of the most commonly useful and effective drugs helps these would be minor infections become a real worry for doctors and patients. 

Part of what makes HAIs such a difficulty is that patients who are in the hospital are typically already in a state of weakened immunity. So, individuals who could normally fight off these infections cannot within the hospital. Many of the bacteria and fungi spores that cause these infections are present on nearly all surfaces throughout a hospital. For this reason, one of the most common ways to transmit these bacteria or fungi to an individual is through poor hand washing. Doctors and nurses who are able to fight off the infections caused by these microorganisms will transmit them to more vulnerable patients through wound care, contaminated instruments, invasive instruments, and more. These two infections are among the most common hospital-acquired infections in hospitals today, each of which can be better prevented with thorough hand washing techniques. 

Methicillin Resistant Staphylococcus Aureus (MRSA)

As a form of staph infection, MRSA is one of the more common infections among hospital patients and is also one of the most varied. MRSA comes in many forms and is resistant to any penicillin antibiotic. MRSA most typically presents as a painful skin infection, causing irritated red bumps that look like pimples or bug bites. Other common symptoms associated with MRSA at this stage are fever and other rashes on the skin. These bumps will eventually engulf with white blood cells and the bacteria will attack other parts of the sufferer's immune system. If the infection becomes harsh enough, painful abscesses will have to be cut out of a patient's skin. Healthy individuals can be carrying the MRSA bacteria on them and remain asymptomatic. This makes it very difficult to control. With careful hand washing and anti-microbial practices, MRSA can be more easily managed and prevented. It is still believed that poor hygiene habits of health care professionals are the primary setback for reducing the spread of MRSA.

 Clostridium Difficile (C. Diff)

C. Diff is a bacterium that causes severe intestinal distress and disease within sufferers. This bacterium takes over the intestinal tract of a patient when a course of antibiotics has already eliminated all of the natural bacteria in the gut that would normally fight off the C. Diff strains. C. Diff can result in several very severe infections and illnesses, including colitis, bloating, and potentially life threatening toxic megacolon. While the primary cause of this infection is the improper prescribing of antimicrobials, infection control measures such as careful hand washing and area sanitation can drastically hinder the spread of this illness. C. Diff spores are present on almost any surface throughout the hospital. For this reason, it is essential that doctors, nurses, and visitors use gloves and carefully wash their hands with soap and water to eliminate the transmission of these spores to a more vulnerable host.

 By-line:

Mariana Ashley is a freelance writer who particularly enjoys writing about online colleges. She loves receiving reader feedback, which can be directed to mariana.ashley031@gmail.com.

For the past several years, the health care industry, as well as federal and state governments, have been aggressively pursuing converting a mostly paper-based system inherent in clinical care to a system that is handled completely electronically. In theory, this conversion would bring about an abundance of advantages to an industry that is seeking to heavily reform. Not only are more and more health care professionals and policy makers jumping on board, but the healthcare IT industry is big business as well. Indeed, as recently noted in Market Wire, the healthcare IT business is estimated to grow at an 18% rate annually until 2015. The article explained:

"EMR is a part of healthcare information technology that is used to make paperless computerized patient data in order to increase efficiency of hospital systems and reduce chances of errors in medical records. A substantial growth rate (more than 16%) of the U.S. healthcare IT spending and the government initiatives towards development of a nationwide healthcare information network are expected to push EMR implementation across the healthcare sector in the U.S. The rising demand for the healthcare cost containment and need to improve the quality of healthcare service are driving the growth of the EMR market in the U.S. The U.S. EMR market is expected to grow from $2,177 million in 2009 to $6,054 million in 2015 at an estimated CAGR of 18.1% during the forecast period 2010-2015."

Ironically enough, however, there very thing that health IT was designed to combat—reducing "chances of errors in medical records"—has, in some instances, caused the precise opposite. A recent Los Angeles Times article surveys a few recent instances in which technological errors that were not corrected have lead to death.

The more heartbreaking of these incidents was the story of newborn Genesis Burkett, who was killed when a pharmacist technician incorrectly entered data into the hospital's computer system. Burkett, who was born prematurely but was otherwise doing well, was administered a lethal dose of intravenous sodium chloride, over 60 times what the doctor had ordered. Burkett's parents are in the process of a lawsuit, although the hospital is pushing for a settlement.

Although cases like those of baby Genesis are indeed rare, they spotlight the need for additional oversight. One of the biggest problems with health IT cited has been the lack of communication among various groups that operate within a hospital. Despite hospitals working to create bridges between each area of the hospital, often communication errors occur as a result of a simple data entry mistake.

While there is no doubt that technology is pushing the healthcare system into a realm of greater efficiency, privacy, and, in some ways, safety, healthcare cannot afford to become an unquestioning champion of cyber-utopianism. There is too much at risk, and even a few lives lost is a few too many.

Author Bio:

This guest post is contributed by Leslie Johnson, who writes about health, green living, parenting related articles at masters in health administration.

Key results from the study, which evaluated the SurgiCount Safety-Sponge® System, include:

•         Prior to implementation, a retained surgical sponge occurred at the institution on average every 64 days. During the study, 87,404 procedures were performed over 18 months using 1,862,373 data matrix bar code sponges and none were retained.  
•        Use of the data matrix bar code sponge counting system caused no workflow disruption or increase in case duration.
•        Staff satisfaction with the data matrix bar code sponge counting system was acceptable with a high degree of trust in the system.
•        The data matrix bar code sponge counting system was found to be highly reliable and cost-effective.

Doyle writes:  "Without access to infection data from previous years, consumers won't be able to adequately assess a hospital's performance in preventing infections, consumer advocates say. Specifically, the policy of the Department of Health and Senior Services makes it difficult to review how hospitals have performed over time and whether they perform consistently above or below the national average."

This decision to purge data has stirred a heated political, legal and social debate regarding public health records. 

Rep. Rob Schaaf, R-St. Joseph, a family-practice physician who pushed the infection bill in the Legislature is quoted as saying, "It's pretty sad to me that the (health) department can't give you a trend to show that a hospital is getting better or worse. It shows that the department doesn't really care,"

Senator Sarah Steelman, one of the original bill's sponsors, said "I'm surprised at the agency. The job of the health department is to protect people. It makes no sense at all to eliminate data after one year."

Ken Bunting, executive director of the National Freedom of Information Coalition, weighed in on the topic by stating, "It sounds like they're violating the spirit if not the letter of the law, If it's being posted online, they don't need to take it down."

To read Doyle's entire article please visit "Missouri Purges Data From Infection Records".

The Medicare program, which also serves as the model for private health insurance, will begin to hold providers at increased financial risk for errors they make in the course of providing care, including when patients acquire preventable infections or have to be readmitted to the hospital due to poor care during the initial stay.

There will also be a host of quality measures for which hospitals will be held accountable in "pay for performance" programs. 

Hospitals have already begun newly seeking methods to improve the safety, quality and efficiency of their care in preparation for the health care payment reform that is coming from both the public and private sectors.  One private-sector example is Prometheus Payment, Inc. which has a series of pilots underway. 

Arrowsight is uniquely positioned to help hospitals improve care, reducing the likelihood they will suffer financially as a consequence of providing unreliable care.  Careful measurement and feedback to clinical staff on their compliance with key patient safety protocols can dramatically improve and help to sustain a high-level of performance long term.  Arrowsight looks forward to being an important partner to hospitals as they work to position themselves to succeed as the new law is implemented over the next several years.

The updated report, replete with tools to improve safety, draws on new evidence published since the last report was issued in 2009.