Time to Rethink the Traditional White Coat?

January 8, 2014 By Leave a Comment

lab coat protectionIs the physician’s white hospital coat a protection for or a danger to patients?  Years ago, the United Kingdom, concerned that the fabric on the lower sleeve is rife with infectious matter, instituted a bare-below-the-elbows policy to reduce the risk of nosocomial infections (NI).  (Murphy 2007, Kerr 2008, Gray 2008) (To clarify, “bare below the elbows” only applies to the arms, not to a practitioner’s nether regions.)

The United States is taking longer to arrive at such a policy, despite the fact that in June 2009 the American Medical Association (AMA) House of Delegates passed a resolution to encourage the “adoption of hospital guidelines for dress codes that minimize transmission of nosocomial infections (NI).” (AMA 2009) One reason for hesitation:  The UK has not performed definitive studies to demonstrate that its “bare below the elbows” policy actually reduces nosocomial infections.

What is undeniable is that NI are a serious danger in the US.  In 2002 alone, there were 1.7 million nosocomial infections, which resulted in 99,000 deaths in the United States, at an estimated annual cost of $6.7 billion.  (Monina 2007, Graves 2004).  And studies have shown that physicians’ coat sleeves and pockets are often colonized with the types of bacteria that cause NI. (Varghese 1999, Loh 2000, Wong 1991, Amy 2008)

These facts make it imperative to resolve any danger associated with medical uniforms.  “Below the elbows” policies may be a starting point, but the AMA and hospitals should also be investigating other avenues of potential protection, such as novel fabrics that have antimicrobial properties “built into” them.

 

 

Endnotes

AMA, 2009.  “Resolution 720: Hospital Dress Codes for the Reduction of Nosocomial Transmission of Disease.

Amy, MT, AT Kerri et al.  2008.  “Bacterial Contamination of Health Care Workers’ White Coats.” Am J Infect Control 37(2) 101-105.

Graves, N. 2004. “Economics and Preventing Hospital-Acquired Infection.  Emerg. Infect. Dis.

Gray, S. 2007 Sep 17.  “Superbug Fears Kill Off Doctors’ White Coats.”  The Times. [Accessed 19 June 2008]. http://www.timesonline.co.uk/tol/news/uk/health/article2470379.ece

Kerr, C.  2008.  “Ditch that White Coat.” CMAJ 178(9):1127.

Loh, W, VV Ng, and J Holton. 2000. “Bacterial Flora on the White Coats of Medical Students.” J Hosp Infect 45(1):65-68.

Monina, R, and D Klevens, R Jonathan et al. 2007. “Estimates of Healthcare-Associated Infections.”  Public Health Reports 122:160-166.

Murphy, C. 2007 Sep 17.  “End for Traditional Doctor’s Coat.”  BBC News. [Accessed 19 June 2008].

Varghese, D and H Patel.  1999.  “Hand Washing. Stethoscopes and White Coats are Sources of Nosocomial Infection. BMJ 319(7208):519.

Wong, D, K Nye, and P. Hollis P. 1991. “Microbial Flora on Doctors’ White Coats. BMJ 303(6817):1602-1604.

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CRE, Another Antibiotic-Resistant Germ

December 16, 2013 By Leave a Comment

CRECRE, which stands for carbapenem-resistant Enterobacteriaceae, is a family of germs that, like MRSA, is resistant to antibiotics.  Escherichia coli (E. coli) is one example of Enterobacteriaceae, a normal part of the bacteria in the human gut, which can become carbapenem-resistant. Types of CRE are sometimes known as KPC (Klebsiella pneumoniae carbapenemase) and NDM (New Delhi Metallo-beta-lactamase).  KPC and NDM are enzymes that break down carbapenems and make them ineffective. (CDC n.d.)

Healthy people usually do not get CRE infections, which most often afflict people being treated for other conditions.  Patients whose care requires devices like ventilators, urinary catheters, or IV catheters, and patients who are taking long courses of certain antibiotics are most at risk for CRE infections. (CDC n.d.)

Between 2001 and 2011, the percentage of carbapenem-resistant Enterobacteriaceae infections reported by US hospitals rose nearly fourfold, from 1.2% to 4.2%.  Information from the first 6 months of 2102 suggests that the percentage of such infections has gotten slightly higher, at 4.6%.  CDC director Tom Frieden said that it was time to sound an alarm in order to address this threat. (Brunk 2013)  He characterized CRE as a “nightmare” for multiple reasons:  “First, they’re resistant to all or nearly all antibiotics….Second, they have high mortality rates. They kill up to half of people who get serious infections with them. And third, they can spread their resistance to other bacteria such as Escherichia coli and make E. coli resistant to those antibiotics also.” (Brunk 2013)

Endnotes

Brunk, Doug.  2013 Mar. 6.  “’Nightmare’ CRE Infections on the Rise.”  Family Practice News. Retrieved from http://www.familypracticenews.com/news/infectious-diseases/single-article/nightmare-cre-infections-on-the-rise-cdc-says/a0206becb5b1bb3c1e20b4b81a11f78e.html

Centers for Disease Control and Prevention.  (n.d.) Healthcare-Associated Infections.

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Healthcare-Associated Infections

December 3, 2013 By Leave a Comment

Healthcare-associated infections, or HAIs, are infections acquired while receiving treatment for another condition in a healthcare setting.  (HHS.gov [n.d.]).  They include almost every malady that is not part of the admitting diagnosis.  (Wilcox J. 2012)  Although they are sometimes referred to as hospital-acquired infections, they can be contracted anywhere healthcare is delivered, including inpatient settings, outpatient settings, and nursing homes or rehab centers.  HAIs may be caused by any infectious agent, including bacteria, fungi, and viruses.  (HHS.gov [n.d.]).

Risk factors for HAI include

  • Use of bloodstream, endotracheal, and urinary catheters
  • Surgical procedures
  • Injections
  • Contamination of the healthcare environment
  • Transmission of communicable diseases between patients and healthcare workers
  • Overuse or improper use of antibiotics  (HHS.gov [n.d.]).

HAIs are rife.  At any given time, about 1 in 20 inpatients has an infection related to hospital care.  These infections cost the US healthcare system billions of dollars each year. (HHS.gov [n.d.]).  According to one 2010 study, the average length of stay for someone with an HAI is more than 19 days longer than that of someone without an HAI.  On average, each HAI-afflicted patient in a hospital costs $43,000 more than a patient free of HAIs.  In 2007, HAI cost 99,000 lives, the majority of them from pneumonia and bloodstream infections. (–.  The Silver Book (n.d.))

The US Department of Health and Human Services (HHS) has identified the reduction of HAIs as an Agency Priority Goal.  In time, HHS believes that HAIs can be eliminated entirely. (HHS.gov [n.d.]).

 

Endnotes
 HHS.gov (n.d.).  Health Care Associated Infections.  Retrieved from http://www.hhs.gov/ash/initiatives/hai/

(n.d.). The Silver Book:  Healthcare-Associated Infections.  Retrieved from http://www.silverbook.org/uploads/images/SilverBookHAI_FactSheet.pdf

Wilcox, J. (ed.), 2012. Hospital-Acquired Infections.

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Cleanliness is Next to … Infection Control

June 19, 2012 By

In addition to helping create a great first impression and contributing to sustainability ratings, patient satisfaction and staff morale, Environmental Services (ES) teams are increasingly being recognized for their role in improving infection rates.Environmental Services’ role in battling hospital infections

In addition to helping create a great first impression and contributing to sustainability ratings, patient satisfaction and staff morale, Environmental Services (ES) teams are increasingly being recognized for their role in improving infection rates.

Keeping hospital rooms and overall environment clean and ridding them of microscopic germs is essential to controlling infections. Here are some of the best practices we’ve gleaned from several success stories.

Communication and collaboration.

ES should be part of the multidisciplinary team that defines infection program goals and standards and reviews progress toward those goals. ES early and constant participation assures their full buy-in.

Improved cleaning procedures.

ES teams can define more aggressive cleaning procedures, and develop ES staff training to implement them, as well as standards for supervisorial monitoring. For example, teams might increase concentration on high touch areas and use an “all-or-nothing” checklist approach whereby all components of checklist must be completed for room to be considered cleaned. Since staff turnover is often an issue in ES, infection control training may need to be repeated.

Enabling and monitoring compliance.

ES can specify and maintain waterless hand hygiene stations and supplies of personal protective equipment (gloves and masks) at key locations. Adding touchless paper towel dispensers can reduce waste and more importantly improve hygiene and reduce the risk of cross-contamination. ES staff can and should receive training on hand hygiene procedures and help monitor all staff compliance (“see something, say something”).

Improvement is a process, not a project.

Infection control takes constant vigilance and monitoring. That certainly applies to the ES team and continued supervisorial focus. Feedback on the importance and effectiveness of their work in reducing or controlling infection rates can help maintain morale. When the ES teams are part of programs that improve infection rates, their success can be a great motivator and source of pride.

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