Feature Channels: Patient Safety

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Loyola University Medical Center achieved a 68 percent decrease in the overall number of central line-associated bloodstream infections (CLABSI) over a 12-month period. A two-year study compared the use of disinfection caps to an intense scrub-the-hub intervention to standard care. Scrub-the-hub refers to cleaning catheter connector hubs and injection ports with alcohol for the recommended 15 seconds before accessing the central line, a catheter placed in a large vein to deliver medicine and liquids during hospitalization.

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Results presented today at the 50th Annual Meeting of the American Society for Clinical Oncology (ASCO) and June 6 at the European Association of Palliative Care Research Conference show that stopping statins for cholesterol management in the late stages of cancer or other terminal illnesses may offer quality-of-life and even life-extending benefits.

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The Centers for Medicare & Medicaid Services (CMS) has certified the Anesthesia Quality Institute’s (AQI’s) National Anesthesia Clinical Outcomes Registry (NACOR) as a Qualified Clinical Data Registry (QCDR) – one of only 40 entities to achieve this designation. Registry participants will select performance measures aimed at improving patient care and safety, and influencing health care legislation.

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Basic science research suggests a promising, if surprising, method to protect against anesthesia-induced developmental neurotoxicity: subclinical carbon monoxide (CO) inhalation, according to a report and accompanying editorial published in the June 2014 issue of Anesthesia & Analgesia, the official journal of the International Anesthesia Research Society (IARS).

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Patients experience fewer postoperative complications when a surgical safety checklist is used by their surgical team, reports the first large-scale review on the subject published in the June issue of Anesthesiology, the official medical journal of the American Society of Anesthesiologists® (ASA®). By following a simple checklist, health care providers can minimize the most common postoperative risks such as wound infection and blood loss.

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The Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit was funded by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) and aims to provide intervention guidelines for healthcare professionals, acute- and long-term-care hospitals and health departments across the country.

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Although it’s present in only a tenth of all patients who are admitted to the hospital, sepsis contributes to up to half of all hospital deaths in the U.S., according to a study presented at the American Thoracic Society’s annual conference here.

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Mount Sinai study shows the socioeconomic status of congestive heart failure patients does not influence hospital rankings for heart failure readmissions.

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In most circumstances, extremely premature babies should not be given a drug to prevent a potentially fatal fungal infection, according to findings by a Duke Medicine-led research team.

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Informed consent programs are somewhat beneficial for improving patient comprehension prior to cardiac revascularization, but many patients still have misconceptions about benefits and outcomes

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Pregnancy affects how drugs are metabolized, which makes it difficult for physicians to prescribe appropriate dosing. A research team at the University of Illinois at Chicago has revealed new details about one particular enzyme that’s responsible for the metabolism of one-fifth of drugs on the market.

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A major new study using data from the National Cancer Data Base details the impact of annual hospital volume on 30- and 90-day mortality rates. Investigators found that major lung surgery has become progressively safer over the last few decades, although higher death rates at low-volume hospitals and an unexpected increase in mortality at 90 days compared to 30 days were observed. The study further suggests that choosing a center that performs major lung surgery regularly can have a strong impact on survival.

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A new approach to handling agitation, aggression and other unwanted behaviors by people with dementia may help reduce the use of antipsychotics and other psychiatric drugs in this population, and make life easier for them and their caregivers.

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Faculty from Rutgers New Jersey Medical School are working to attack the problem of hospital-acquired delirium in the surgical intensive care unit. They are getting valuable assistance from Doctor of Physical Therapy students from Rutgers School of Health Related Professions, who provide physical therapy to patients. Researchers estimate that at least 45 percent of patients in intensive care develop hospital-acquired delirium, a number that can rise above 80 percent when patients have mechanical breathing assistance. Advancing age also puts patients at higher risk. Patients with delirium tend to die more frequently than others during the 12 months after they leave the hospital, and the effects of delirium often linger.

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The fewer the red blood cell transfusions, the less likely patients were to develop infections like pneumonia.

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Researchers at the University of Adelaide have discovered that a commonly used anesthetic technique to reduce the blood pressure of patients undergoing surgery could increase the risk of starving the brain of oxygen.

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Scientists at the Center for Nanotechnology and Nanotoxicology at Harvard School of Public Health have discovered a way to measure the effective density of engineered nanoparticles in physiological fluids, making it possible to determine the amount of nanomaterials that come into contact with cells and tissue in culture.

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Virginia Mason’s commitment to safety and quality is helping to inspire new measures aimed at improving patient safety at hospitals throughout England.

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For patient safety, the U.S. Food and Drug Administration (FDA) should require that clinical data be submitted as part of a more rigorous re-evaluation of medical devices that are modified after approval. According to authors Rita Redberg, MD, UCSF professor of medicine, and UCSF second-year medical student Sarah Zheng, such a requirement could prevent deaths due to insufficiently tested device modifications.

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A new microfluidic method for evaluating drugs commonly used for preventing heart attacks has found that while aspirin can prevent dangerous blood clots in some at-risk patients, it may not be effective in all patients with narrowed arteries. The study, which involved 14 human subjects, used a device that simulated blood flowing through narrowed coronary arteries to assess effects of anti-clotting drugs.

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The College of American Pathologists has developed the first evidence-based guideline to validate all immunohistochemical (IHC) assays. The guideline, “Principles of Analytic Validation of Immunohistochemical Assays, is available in the online edition of Archives of Pathology & Laboratory Medicine.

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UC Davis clinicians and physicists have recommended new strategies to make computed tomography (CT) safer, including adoption of a new metric for dose measurement, ways to manage exposure protocols that differ by CT brand and specific approaches to reduce exposure during needle biopsies. The recommendations are detailed in papers published in the March issue of the Journal of the American College of Radiology (JACR).

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George Washington University Researchers were published today in Academic Emergency Medicine for their paper, "Rising Opioid Prescribing in Adult U.S. Emergency Department Visits: 2001-2010."

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As National Patient Safety Awareness Week kicks off (March 2 – 8, 2014) Cincinnati Children’s Hospital Medical Center is joining forces with children’s hospitals around the country to affirm the critical role patient families play in making hospital stays as safe as possible for their children.

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National survey shows frequent antibiotic use strays from national guidelines

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University of Adelaide researchers have identified a key step for the future prevention of liver failure resulting from taking too much of the everyday painkiller acetaminophen (also known as paracetamol).

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Patients who have had bariatric surgery may need to take dietary supplements and pay closer attention to their nutritional intake, a UT Southwestern Medical Center study suggests.

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Patients feel safer – and likely are safer – when they receive a surgical safety checklist and request that their health care providers use it, suggests a pilot study being presented at the American Society of Anesthesiologists PRACTICE MANAGEMENT 2014.

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An international, multidisciplinary research team has developed an ultrathin membrane that can stick to skin and carry arrays of diagnostic sensors and stimulatory components. The “electronic skin” allows remote patient monitoring and may someday be used to deliver treatments.

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Nurses are well positioned to stop dangerous and costly bloodstream infections caused by the improper placement of catheters in large veins in the neck, chest or groin, according to guidelines released by The Joint Commission, which oversees accreditation for U.S. hospitals, nursing homes and other health facilities. Central line-associated bloodstream infections, or CLABSI, needlessly afflict thousands of patients each year, lengthening hospital stays, boosting hospital readmission rates, and driving up the cost of care.

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Nanosponges that soak up a dangerous pore-forming toxin produced by MRSA (methicillin-resistant Staphylococcus aureus) could serve as a safe and effective vaccine against this toxin. This “nanosponge vaccine” enabled the immune systems of mice to block the adverse effects of the alpha-haemolysin toxin from MRSA—both within the bloodstream and on the skin. Nanoengineers from the University of California, San Diego described the safety and efficacy of this nanosponge vaccine in the December 1 issue of Nature Nanotechnology.

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Among thousands of hospital patients treated for a “mini stroke,” those who were at highest risk for suffering a full-blown ischemic attack were less likely to received optimal care, according to a study led by researchers at Duke Medicine.

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Data from a national registry developed to track patient safety and real-world outcomes finds that the initial use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in high surgical risk and inoperable patients in the United States is safe and effective.

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After cardiac surgery, healthcare-associated infections (HAIs) are common complications associated with increased morbidity, mortality, and use of resources. New study findings reveal the substantial economic impact of HAIs following cardiac surgery and the importance of preventing these infections leading to re-hospitalizations.

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New research from the Cleveland Clinic shows most patients with diabetes and obesity who undergo gastric bypass not only experience remission of their diabetes and lose significant weight, but they also reduce their risk of having a heart attack by 40 percent and their risk for suffering a stroke by 42 percent, over a 10-year time horizon.

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A new study led by Johns Hopkins Children’s Center investigators shows that clinicians can reduce the risk of dangerous bloodstream infections in newborns with central venous catheters by ending use of the device as soon as possible, rather than waiting for signs of infection.

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The Joint Commission (JC) is naming three Johns Hopkins Medicine hospitals as 2012 Top Performers on Key Quality Measures, a designation reserved for accredited hospitals that consistently and at a very high level follow best practices for treating people who require surgery or suffer heart attacks, heart failure, stroke, pneumonia or other serious conditions.

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Highlights • Kidney transplant recipients who discontinue immunosuppressive drugs before conception have a higher rate of live births and a lower rate of birth defects without an increased risk of kidney problems.

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There is an association between the influenza virus and cardiovascular events like heart disease and stroke; those with cardiovascular disease should protect themselves against the flu.

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NYU Langone Medical Center scored number one for overall patient safety and quality among leading academic medical centers (AMCs) across the nation that participated in the University HealthSystem Consortium (UHC) 2013 Quality and Accountability Study.

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Despite major efforts to keep operating rooms sterile, surgical wound infections remain a serious and stubborn problem, killing up to 8,200 patients a year in the U.S. Columbia University Medical Center research published in PLOS ONE suggests that narrow-spectrum UV light could dramatically reduce such infections without damaging human tissue.

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Complications in the recovery room decreased by 58 percent between 1990 and 2010, according to a study presented at the ANESTHESIOLOGY™ 2013 annual meeting. In a previous study completed in the late 1980s, recovery room complications occurred in 23.7 percent of the patients. Today, the complication rate is 9.9 percent. The study also found that less-healthy patients are more prone to recovery room complications.

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Hospital bedsore rates varied widely based on how the data was collected, unfairly making some hospitals appear to fare better or worse than others.

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Simple remedies – from keeping the antibacterial gel dispenser clean to giving health care workers their own hand sanitizer – can help keep patients safe by decreasing contamination in operating and recovery rooms, suggest two studies presented at the ANESTHESIOLOGY™ 2013 annual meeting.

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Driver rehabilitation provides a comprehensive evaluation on whether a patient can safely drive a car. It is intended for elderly patients and patients with stroke, brain injury, Parkinson’s disease, multiple sclerosis, low vision, etc.

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The Children’s Hospital of Philadelphia (CHOP) announced today that it has removed dietary supplements from its formulary, making it the first hospital in the U.S. to discourage patients from using these products without a doctor’s provision as a matter of policy. The hospital said the action was being taken because the Food and Drug Administration (FDA) does not routinely review the manufacturing of dietary supplements, and therefore cannot guarantee their safety and effectiveness.

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In a new paper published early online by the Annals of Surgery, physician-researchers at University Hospitals Case Medical Center describe a new tool called the HARM score that reliably measures quality and clinical outcomes for colon and rectal surgery patients. The name of the tool reflects the data sources used to calculate the score: HospitAl stay, Readmission rate, and Mortality. The paper demonstrates a strong correlation between the HARM score, and the quality of clinical outcomes achieved by surgeons and hospitals for patients having major abdominal surgery.

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Simply replacing the connector in the IV system in patients with central lines could help reduce deadly bloodstream infections, researchers at Georgia Regents University have found.