hand hygiene
hand hygiene
By Robert P . Lee
One Patient ’ s Challenging Journey Through the Healthcare System
“ By all rights I shouldn ’ t be here ,” said my close colleague . A routine colonoscopy went from bad to worse in a hurry . When considering any medical or surgical procedure , how do you choose what facility and what physician will perform the procedure ? I would imagine that most of us just accept the physician and site to which we are referred by our primary-care physician . As it is often said , we are more careful from whom we purchase an automobile than how we assess our physician ( s ) and site of care ; however , it can make a difference . Let ’ s examine some of these considerations based on my colleague ’ s experience .
My colleague did his homework , as an experienced and careful individual with more than 40 years of healthcare provider experience . He considered the following factors :
●Hospital website featured positive news ●Word of mouth reflected that the facility was well-respected in the community ●Quality scores from The Leapfrog Group indicated an “ A ” rating ●CMS / Medicare database indicated no penalties for infection outcomes and no penalties for adverse outcomes ●Surgeon / specialist performance data indicated an excellent performance
What began as a routine colonoscopy was complicated by a perforated colon which rapidly resulted in sepsis and required surgical intervention . I immediately traveled to support my colleague and provide some guidance / patient advocacy during the early days of his hospitalization . Prior to the colonoscopy , my colleague ’ s weight was 205 pounds , but during these events it had dropped to 135 pounds and he was in critical condition . Fortunately , after a second surgery , his condition normalized . What followed was clearly not a surgical failure but complications that were potentially preventable and resulted in a lengthy hospitalization and two surgeries to address the complications , including a Pseudomonas infection and a decubitus ulcer requiring skin grafting .
In a conversation with the surgeon , he noted , “ I did my job , but how can I be let down by the quality of care post-operatively .” This is an important question , as excellent surgery must be supported by excellent pre- and post-operative care to avoid the many potential complications , such as sepsis and decubiti .
So , what were my observations ? As a trained consultant and biologist , I think I understand what should have been done or what could have been done to potentially prevent some of the complications in this case . I observed the following :
●Quality Processes : Hand hygiene compliance ? ●Environmental Services : How clean is the patient room ? ●Nursing Staff : Who and how many times nursing attended to the patient ? ●Infection Prevention : Any visits ? Communications with family ? ●Nursing Management : Any visits ? Communications with family ?
Because of the lack of attention for this patient , a professional patient advocate was deployed to provide 24 / 7 coverage . The patient advocate was instructed to monitor patient activity and advise the family of key events . Additionally , I instructed the advocate to provide the following on each visit : cleaning and sanitizing of all high touch surfaces with disinfectant , monitor and note hand hygiene compliance ( both ungloved and gloved ) and note when personnel entered and exited the patient space . What conclusions did I draw from my visit ?
●Hand hygiene compliance was suboptimal . Having a great deal of experience in this area , I was particularly critical of where , when and how hand hygiene was completed . An estimate during my presence at the bedside was less than 25 percent .
●Gloves were used to replace hand hygiene ; I did not observe personnel performing hand hygiene prior to or after donning gloves .
●In the three days I was present , environmental services personnel never visited or cleaned my colleague ’ s room .
●Regarding staff attention to detail , there were several medication errors noted by family and the patient advocate .
●It was alarming that the surgeon expressed concern about the post-op care of the patient .
●The staff relied too much on technology ; my colleague ’ s bed was equipped with sensing technology designed to prevent pressure ulcers , but more hands on treatment and assessment may have made a difference .
●There were no visits by personnel from nursing management , Infection prevention or administration .
The following letter was written to the CEO at this facility : “ I want to congratulate you and the team on your facilities , staff and commitment to excellence . Achieving ‘ A ’ Leapfrog scores should be recognized and applauded . I recently had the opportunity to visit your facility for a colleague of mine and spent three days caring for my friend . At the same time , I had the opportunity to observe what an A-rated Leapfrog hospital does in practice when nobody is observing . So , I did a three-day consulting review . I would welcome the opportunity to share with you my observations . Being the best is always wanting to be better , and I know you and your team want to be the best . Advise and thank you .” There was no response . In conclusion , I advise the following :
●Do your homework – what you read is not always what you get . ●If feasible , find a way to avoid a stay in an acute care setting , and , if required , get out as fast as possible . ●Ask your surgeon about outcomes , especially infections . ●Depending on your unit , do not be afraid to ask about infection rates . ●Ask to see the hand hygiene compliance data of your caregivers . ●Create your own quality check list . ●Signage for staff , visitors , and everyone , asking them to “ wash their hands ”
●Ask the staff questions that make you comfortable : ask them to show you that they washed their hands , cleaned your room , and sanitized high touch surfaces . ●Find an effective patient advocate .
The good news is that the patient is fully recovered and doing well and is back up to 180 pounds .
If you have any questions or needs , you can always reach out to me directly medicaldatamanagement @ gmail . com
Robert P . Lee , BA , the CEO and founder of MD-Medical Data Quality & Safety Advisors , LLC , is the senior biologist and performance improvement consultant . MD-MDQSA is the home of The IPEX - The Infection Prevention Exchange , a digital collaboration between selected evidence-based solutions that use big data , technology , and AI to reduce risk of HAIs .
24 • www . healthcarehygienemagazine . com • october 2024