INFECTION: Stop spread of C. difficile? Methods matter
ENGINEERING: Hospitals increase energy-efficiency with CHP
SAFETY: Atlantic Health earns accolades for security steps
ARCHITECTURE: Patients' design input creates better hospitals
Increased activity to prevent the spread of Clostridium difficile, which is linked to thousands of deaths annually, is failing to reduce infection rates, which have reached historically high levels.
That’s the finding of one recent survey. But another study shows that the person who cleans and disinfects patient rooms and how it is done can make a difference in controlling the deadly bacteria.
According to a recent survey by the Association for Professionals in Infection Control and Epidemiology (APIC), 70 percent of respondents said the hospital in which they work has adopted additional interventions to address the problem of C. difficile infections (CDI).
Yet, only 42 percent witnessed a decline in their CDI rates during that period, while 43 percent did not see a decline, according to APIC’s 2013 CDI Pace of Progress survey conducted Jan. 14-28, 2013. Survey results were presented in March at APIC’s Clostridium difficile Education and Consensus Conference in Baltimore.
While cleaning activity has increased, monitoring the results has not kept pace, the survey reported. While 92 percent of respondents have increased emphasis on environmental cleaning and equipment decontamination, 64 percent said they rely on observation instead of more accurate monitoring technologies to determine cleaning effectiveness. Fourteen percent said that nothing was being done to monitor room cleaning.
Because C. diff spores can survive in the environment for many months and are highly resistant to cleaning and disinfection, environmental cleaning and disinfection are critical to prevent the transmission of CDI, APIC says.
But how it’s done makes a difference, notes a study published in the May issue of Infection Control and Hospital Epidemiology, the journal for the Society for Healthcare Epidemiology of America. The study describes the importance of establishing a rigorous cleaning and monitoring regime to control C. diff.
The study notes that a dedicated daily cleaning crew who uses a standardized process to clean and disinfect rooms contaminated by C. diff can be more effective than other disinfection interventions.
The cleaning crew used fluorescent markers to monitor cleaning effectiveness, an automated ultraviolet radiation device and bleach wipes to augment disinfection after cleaning. A combination of the dedicated cleaning crew and enhanced methods reduced the presence of C. diff in patient rooms by 89 percent during a 21-month study conducted at the Cleveland Veterans Affairs Medical Center.
There are 337,000 hospitalizations for C. diff annually in the United States and C. diff is linked to about 14,000 deaths, adding at least $1 billion in health care costs, according to the Centers for Disease Control and Prevention.
Jennie Mayfield, clinical epidemiologist, Barnes-Jewish Hospital/Washington University School of Medicine, St. Louis, and president-elect, APIC, says science about C. diff’s multiple strains and how the pathogen moves among populations remains a mystery.
“I think until we answer some of those basic questions, hospitals are going to continue to do what seems to work in their individual facilities. It becomes a case of my hospital is doing one thing and the hospital next door may do something else to prevent the spread,” she says.
Mayfield says that experts suspect that patients may remain colonized with C. diff and continue to shed the bacteria for an undetermined period after symptoms evolve.
“Those persons could be a source of new infection if they’re not isolated. So we may need to prolong isolation; we may need to screen people on admission. None of that’s happening right now,” she says.Mayfield is encouraged by ongoing research that shows promise for a vaccine that may prevent infection. Persons who are colonized with a nontoxigenic strain of C. diff don’t get the toxigenic strain, so it’s possible that being colonized protects them from infection. Patients who are admitted or readmitted to the hospital would be vaccinated as a safeguard.
By Jeff Ferenc, senior editor.
The Environmental Protection Agency (EPA) recently recognized two New York City hospitals and a power plant serving several Boston health care facilities for utilizing highly efficient and environmentally friendly combined heat and power (CHP) systems.
Energy Star CHP Award winners include Montefiore Medical Center and New York-Presbyterian/Weill Cornell Medical Center, both in New York City. EPA also recognized Medical Area Total Energy Plant (MATEP), which serves several hospital, teaching and research facilities in Boston.
“These institutions are protecting their critical operations from power outages and protecting our climate from harmful carbon pollution with reliable and more efficient CHP systems," says Gina McCarthy, assistant administrator for EPA’s Office of Air and Radiation.
CHP systems, also known as cogeneration, capture waste heat from electricity generation, and use the heat to generate steam or hot water for both cooling and heating. A single energy source such as natural gas commonly is used in the system.
MATEP’s 46-megawatt CHP system produces steam, chilled water and electricity for the Longwood Medical and Academic Area (LMA). Located in Boston, the 200-acre LMA is home to Boston Children’s Hospital, Brigham and Women’s Hospital and several other health care facilities.
Two natural gas-fired combustion turbines equipped with heat recovery steam generators power the CHP system, producing up to 360,000 pounds of steam per hour and 24 megawatts of electricity. The steam drives turbines to generate an additional 22 megawatts of electricity and also to heat water for space heating and other uses. Several chillers use part of the steam output to produce chilled water for space cooling.
With an operating efficiency of 75 percent, MATEP’s CHP system requires approximately 24 percent less fuel than using electricity from the grid and producing steam with a boiler. The system prevents an estimated 117,500 tons of carbon dioxide emissions annually.
Employing a network of five internal combustion engines and one combustion turbine, Montefiore’s CHP system generates up to 11 megawatts of electricity and produces up to 27,000 pounds of steam per hour utilizing otherwise wasted heat.
The steam is used to meet more than 95 percent of the medical center’s thermal energy demands, including hot water, space heating and cooling.
With an operating efficiency of 69 percent, Montefiore’s CHP system requires approximately 26 percent less fuel than using electricity from the grid and producing boiler steam. The system prevents an estimated 17,900 tons of carbon dioxide emissions per year.
Using a natural gas-fired combustion turbine and heat-recovery steam generator, the CHP system at New York-Presbyterian/Weill Cornell Medical Center generates up to 7.5 megawatts of electricity and produces up to 70,000 pounds of steam per hour.
With an operating efficiency of 72 percent, the system requires approximately 27 percent less fuel than using electricity from the grid and producing boiler steam. The system also prevents an estimated 21,500 tons of carbon dioxide emissions from entering the atmosphere per year.
For more information on the program, log on to www.epa.gov/chp.
The Atlantic Health System, Morristown, N.J., has developed a rigorous safety program called Red Cell, using undercover agents to test for weaknesses in hospital security. The effort has helped to strengthen Atlantic’s protocols, while also earning industry accolades.
Atlantic toughened its security after 9/11 by adding card readers and security cameras. But those measures weren’t always effective in preventing unauthorized persons from entering its facilities.
Atlantic Health brought in former law enforcement officers and security experts in 2009 to identify and prevent potential breaches by working undercover to gain unauthorized access to sensitive areas within system facilities.
During these surveys, the undercover, plainclothes agents test locks and access to equipment, as well as the ability of employees to question or challenge individuals as to whether they are authorized to be in a particular area. The intent is to help the health care system’s managers tighten security where needed.
“The best way to begin to fortify your security is to identify the potential risks,” Alan Robinson, director of protection and security services and emergency management for Atlantic Health System told Health Facilities Management's sister publication Hospitals & Health Networks.
Results of Red Cell have been promising, as Atlantic Health has experienced a noticeable decline in the number of times agents were able to infiltrate hospitals over the past few years -- from 22 percent of the attempts in the first year of the program, down to 5 percent last year.
Last month, Atlantic earned one of CSO magazine’s inaugural CSO40 Awards, honoring security projects “that demonstrate outstanding business value and thought leadership.” The Joint Commission also recognized the Red Cell program last year as an example of security best practices.
U.S. intelligence agencies and others have used Red Cell for decades to obtain insights from persons outside their organizations.
More than $600 million in construction projects either recently completed or under way in four states will feature at least nine new health care facilities built by Mercy, St. Louis, by spring 2015.
To make sure Mercy provides the best possible experience for patients, who better to provide input on new facility design than the patients and community being served?
The health system provides opportunities for patient input on a regular basis by establishing local community advisory groups and other ways to communicate suggestions for each construction project, says Beth Kistner, director, customer experience, at Mercy. More importantly, Mercy has enhanced its facilities by incorporating patients’ ideas, she adds.
“In the last three years or so, there has been an explicit and intentional attempt to bring our patients directly into our projects so that we’re matching up what we’re doing with their needs and expectations,” she says.
For example, Shan Carter, Spencer, Okla., who has a rare form of multiple sclerosis, served on the advisory group for the new Mercy Rehabilitation Hospital Oklahoma City.
Being wheelchair-bound for the past two years enabled Carter to offer insight into something as simple, yet critical, as the size of bathrooms in the rehab facility. Many bathroom doorways are now 6 inches wider and bathrooms are 5 inches bigger for easier maneuvering in wheelchairs due to his input.
Patient input also resulted in changes to the labor and birth suites at Mercy Hospital St. Louis so there is proximity between the baby’s bed and the mother. Other changes included improving the proximity and size of bathrooms, especially to accommodate patients’ using an IV pole, and installing high-end shower jets in patient bathrooms.
Thanks to community input, numerous changes were incorporated at the new neonatal intensive care unit (NICU) in Springfield, Mo. Among them were giving parents the ability to stay with their babies in the NICU and providing a room for family members.
»Alert on medical alarm safety issued by Joint Commission
»CMS proposes sprinkler waiver for long-term facilities
»Joint Commission offers surgical fire prevention advice
»Possible adoption of 2012 Life Safety Code moves forward
The Joint Commission this month issued a "Sentinel Event Alert" urging hospital leaders to take a focused look at the issue of medical device alarm safety and alarm fatigue.
Among the recommendations are preparing an inventory of alarm-equipped medical devices in high-risk areas and for high-risk clinical conditions, establishing guidelines for alarm settings on alarm-equipped medical devices used in high-risk areas and for high-risk clinical conditions and inspecting, checking and maintaining alarm-equipped medical devices to provide for accurate and appropriate alarm settings, proper operation and detectability.
For more, go to www.jointcommission.org/sea_issue_50
The Centers for Medicare & Medicaid Services have proposed a waiver for certain long-term care facilities that are undergoing construction and cannot meet an August deadline for becoming fully sprinklered, according to a March 22 email notice the American Society for Healthcare Engineering sent to its members.
Under current rules, all buildings containing long-term care facilities are required to have automatic sprinkler systems installed throughout by Aug. 13. Under the proposed rule, published on page 9243 of the Feb. 7 Federal Register, long-term care facilities in certain situations would be allowed to apply for an extension.
For more, go to http://www.gpo.gov/fdsys/pkg/FR-2013-02-07/pdf/2013-02421.pdf
The Joint Commission in its March 20 Joint Commission Online e-newsletter issued advice on preventing surgical fires.
Many Joint Commission Environment of Care (EC) standards and associated elements of performance address fire safety, the Joint Commission states, including EC.03.01.01, which calls for staff and practitioners to be familiar with their responsibilities and roles related to the environment of care; EC.04.01.01, which requires staff and practitioners to collect information to monitor conditions in the environment; and related requirements in EC.02.03.01 and EC.02.03.03, which address fire safety in general.
Recommendations include performing a fire-risk evaluation before any procedure and being aware of possible oxygen enrichment under the drapes near the surgical site and in the fenestration as well as a number of technical precautions.
For more, go to www.jointcommission.org/issues/default.aspx?archieve=y
The Centers for Medicare & Medicaid Services (CMS) have moved a step closer to adopting the 2012 edition of the National Fire Protection Association's NFPA 101, Life Safety Code, according to an email notice the American Society for Healthcare Engineering (ASHE) sent to its members on April 11.
“CMS has filed a federal agenda item that indicates the agency will submit a notice of proposed rule-making on the issue later this year,” ASHE reports. “The proposed rule would amend the fire safety standards for hospitals, ambulatory surgery centers, long-term care facilities, and other health care facilities. The proposed rule also would adopt the 2012 edition of the Life Safety Code and eliminate references in CMS regulations to all earlier editions.”
According to ASHE, the proposed rule would have to go through the federal rule-making process, including opportunities for public input.
»Ground broken for rehab hospital in Missouri
»Heart Center and ED expansion started in Illinois
»Contractor selected for Mississippi renovation project
»Groundbreaking held for replacement hospital in Texas
A groundbreaking recently was held for the new Mercy Rehabilitation Hospital Springfield, Mo.
The $28 million, 63,000-square-foot facility will have 60 beds and provide inpatient rehabilitation for patients who are recovering from strokes, brain or spinal cord injuries, amputations, complex orthopedic injuries and other conditions.
Mercy Rehabilitation Hospital Springfield will challenge patients to tackle obstacles they will encounter in everyday life. “Little things like walking on gravel may not seem like a big deal to most of us,” says Dr. Robert W. Steele, president of Mercy Hospital Springfield. “But after a traumatic injury, learning how to navigate various surfaces is a major milestone. We’ll have features that will allow patients to practice that in a safe environment.”
Other unique features will include an apartment where patients and families can practice daily living tasks; gymnasiums featuring high-tech therapy devices and treatments; dedicated rooms for burn patients; a brain injury unit with monitored rooms, specialized beds, patient lifts and dedicated therapy space and dining area; a dedicated stroke unit with specialized equipment; specially-equipped rooms for bariatric patients; private, family friendly rooms with sleeper chairs; and pet therapy and recreation programs.
McCarthy Building Cos. is the construction manager. The project is estimated to take about a year to complete.
Trinity Regional Health System is scheduled to break ground in June on construction of a $61.3 million, 90,000-square-foot expansion of its Heart Center and emergency department at the Trinity Rock Island, Ill., campus.
Located at the front of the hospital the $61.3 million construction expansion is the largest in the facility’s history. The expansion is designed to improve patient safety and privacy, better coordinate care, reduce operational costs and accommodate increased demand.
“The rapidly increasing number of patients in the emergency department, cardiac treatment unit and psychiatric crisis service areas has stretched these units beyond capacity,” says Trinity President and CEO Rick Seidler. “The need is critical. With this vote, the State of Illinois is allowing us to better serve people in the Quad-City region.”
Behavioral health facility closures also add to the capacity issue, according to the hospital.
In addition about 10 percent of ED patients receive cardiac-related diagnoses. Trinity Rock Island’s three cath labs already operate at 80-90 percent capacity on any given day, so there is little room in the schedule to accommodate emergency cases like heart attacks.
Contracting firm Brasfield & Gorrie was recently awarded a multiphase nursing unit renovation project at Baptist Medical Center in Jackson, Miss.
The project will consist of the complete demolition and renovation of approximately 156,000 square feet of existing space.
“We are excited about the opportunity to partner again with Baptist Health Systems on this renovation, and we look forward to expanding that relationship in the Mississippi market,” says Todd Jackson, division manager at Brasfield & Gorrie.
Brasfield & Gorrie will work with Dean and Dean/Associates Architects, The CGM Group, and Jon D. Rice & Associates, all from Jackson, Mississippi.
Groundbreaking recently was held for the $55 million Permian Regional Medical Center replacement hospital in Andrews, Texas.
The 200,000-square-foot facility will be a 34-bed, full-service, acute care hospital with wellness center and physician clinic/offices. It will replace the existing hospital and tie into the medical center's skilled nursing unit.
The project is scheduled to be constructed in multiple phases and complete in 2016.McCarthy Building Cos. will build it.