Wednesday, October 15, 2014

Where Hospitals Trip Themselves Up

You’ve been in a hospital either for treatment or to visit a friend or even to volunteer at some activity, I suspect. And you’ve been around a lot of hospital treatment rooms, waiting areas, lavatories and spoken to personnel. The assumption you make is that everything is kept ship shape and all the appropriate infection control rules re being followed and someone is always on the lookout. It seems you would be quite wrong in that assumption and the latest horrific incidents in Dallas regarding Ebola seem to give this statement credibility.

But, you say, you haven’t been in a hospital that is in the midst of an Ebola incident, so you’re okay. Well, let’s look a bit more closely at this and I’ll relate what I’ve noticed and you can add what you’ve noticed and what you’ve read.

The Dallas hospital held a dramatic press conference as soon as they knew they had an Ebola patient, but they were really premature with their information. They either didn’t have all the information or they didn’t look closely enough to get it. Either way, they first blamed a nurse who failed to properly complete an Ebola checklist with Mr. Duncan. Then, they next slid the blame over to software glitches where two different systems didn’t communicate information to everyone involved. So, first it was the nurses (and aren’t they the first to be blamed all the time), then it was that darned technology and now it seems it’s something else.

Watch enough of the TV news and you’ll be able to piece together the following:

1.    there’s a blood test(s) that could be used to identify persons at risk of developing Ebola but there’s not doing this

2.    the protective gear or the procedures used for decontamination is inadequate. The gear used in West Africa is much more sophisticated and was used by the CDC Director Tom Frieden when he visited an African hospital. Not so in Texas. In Texas they had to use duct tape to close the openings on the neck area of their protective outfits because the suits didn’t fit properly.

3.    training to be used in instances of infectious diseases has lagged behind the times

4.    protocols are full of holes, e.g. not keeping track of everyone who could have been exposed from the very first moment a patient came in

5.    a lack of fully qualified medical leadership seems to be lacking. A judge, while willing and intelligent, is no substitute for a medical authority. The CDC has to be “invited” to come into a hospital to help. They are powerless at the moment.

All of this has brought only one thing to the fore and that’s that, in times of serious, potential viral outbreaks, there needs to be a major wake-up call sounded. The bad news, however, isn’t this but that hospitals are sloppy in their daily attention to infection control and cleanliness even without Ebola being present. Allow me to give you a few illustrations of what I’ve noted on cursory and casual observation while in a few major hospitals where interns and residents are trained and which are affiliated with world-class medical centres.

One exam room in an ER (now referred to as the ED) had at least one major breach of infection/sterility control. Tubing to be used in procedures and which was packaged in sealed plastic pouches was stores on a rod on a rack. In order to store it there the packaging was pierced, thereby cancelling any hint of sterile supply. Dust was also noted on cabinets and the floor. The small lavatory next to this room had blood on the wall which had not been cleaned.

On a patient floor, one of the lavatories had feces on the wall. The rooms are turned much like the tables in a coffee shop and thorough cleaning and inspection seemed to be overlooked. In the radiology department, where people with all manner of illnesses are screened, dust bunnies floated under the instrument tables, a layer of dust was on the fire extinguisher and window sills.

The chairs in the capacious waiting room were stained. The CT scan machine, where a patient with a hacking cough had just been scanned, was not cleaned before another patient was to be scanned.

At another hospital, where they do pulmonary function testing, the tubing used by patients to blow into the machine is not changed or cleaned until the end of the day. How is this infection control? I didn’t see a change in the mouthpiece, either, between patients. An enclosed pod-like unit, where other pulmonary testing was performed, had noticeable dust on the interior surfaces. On the interior surfaces where persons with lung conditions were seated!

The door leading to an isolation unit for persons with respiratory disorders had a large sign on it, “To be closed at all times” yet it was latched open for the several hours that I had an opportunity to view it. This happened on the same day that the hospital was having a JCAHO (Joint Commission on Accreditation for Healthcare Organizations) inspection for their continuing accreditation. How did they miss this one? Or were they carefully directed to other areas? Curious.

At a back service door at a major hospital, a body in a bag was strapped on a gurney and no one appeared to be in attendance. Was it a mortuary pick-up and, in any case, why wasn’t someone there with it?

Hospitals are obviously not doing a good job in many areas of sanitation and infection control. Is this the reason that there is such a problem with sepsis infections? How many people are monitoring their infection control at each hospital and are they getting a bit too casual with their protocols? One major example, like that in Dallas, isn’t just a wake-up call, it’s a thundering boom that should be reverberating off the walls of every healthcare organization in this country and the world.

How careful is your hospital when it comes to their procedures? You might want to look around next time you’re there and, perhaps, take a few cell phone photos for the administration.