Improving Patient Safety

In recent years a primary concern for patients being admitted to hospital has been the risk of contracting methicillin-resistant Staphylococcus aureus, commonly known as MRSA.

Many cases of MRSA arise from the transfer of germs from patient to patient due to lack of good hygiene. To address this, hospitals have revised their hygiene practice. Measures have included the introduction of hand-sanitising kits and tougher visitor regulations to reduce the risk of infections being brought in from outside. However, the concern over post-operative infections lingers.

The Royal College of Surgeons Ireland (RCSI) is introducing a Surgical Development Initiative for trainee surgeons which will focus on maximising patient safety and preventing infections following surgery. The RCSI initiative is being launched this month to the new group of surgical trainees who commence their basic surgical training in July. It has been developed specifically for trainees to improve practice in the areas of hand hygiene, the optimal use of antimicrobial prophylaxis, the care of wound sites after surgery and the prevention of bloodstream infection that can result from infected intravascular devices.

The RCSI’s new project is in line with the World Health Organisation’s (WHO) recent prioritisation of patient safety, to prevent healthcare-associated infection (HCAI) and its ‘Safe Surgery Saves Lives‘ initiative which is endorsed by RCSI.

In tackling post-operative infections, WHO has recently published it’s WHO Surgical Safety checklist. The 19-point checklist has shown improved compliance with standards and a decrease in complications from surgery in the eight pilot hospitals where it was used for evaluation. It demonstrated a decrease in mortality from 1.5 per cent to 0.8 per cent and a drop in surgical site infection (SSI) rates from 6.2 per cent to 3.4 per cent.

As someone who has battled against serious post-operative infections (MRSA, cellulitis and osteomyelitis), I welcome any initiative which will reduce the risk of surgical site and healthcare-associated infections.

The WHO surgical safety checklist is an essential aide to patient safety. This video demonstrates how the checklist is used at Great Ormond Street Hospital…

Information Source:  The Irish Times

12 Responses to Improving Patient Safety

  1. Nancy says:

    Hi Steph,

    We have the same problem here with hospital infections.We all stay away from hospitals as much as we can.

    Is it possible that these medical giants have never heard of Dr. Ignaz Semmelweis? In 1847 he was the first doctor to consider washing his hands between autopsies and obstetrical examinations.The mortality rate went to almost zero AFTER the medical staff was persuaded to wash their hands…

    From Wikipedia:

    “In an effort to reduce childbed fever
    Semmelweis discovered that cases of puerperal fever, a form of septicaemia also known as childbed fever, could be cut drastically if doctors WASHED THEIR HANDS in a chlorine solution before gynaecological examinations, but could not explain why, as his discovery was prior to the germ theory of Louis Pasteur (published 1861).

    While employed as assistant to the professor of the maternity clinic at the Vienna General Hospital in Austria in 1847, Semmelweis introduced hand washing with chlorinated lime solutions for interns who had performed autopsies. This immediately reduced the incidence of fatal puerperal fever from about 10 percent (range 5–30 percent) to about 1–2 percent. At the time, diseases were attributed to many different and unrelated causes. Each case was considered unique, just as a human person is unique. Semmelweis’s hypothesis, that there was only one cause, that all that mattered was cleanliness, was extreme at the time, and was largely ignored, rejected or ridiculed. He was dismissed from the hospital for political reasons and harassed by the medical community in Vienna, being eventually forced to move to Pest.”

    Naturally, because of Dr. Semmelweis’ radical procedures, they were forced to commit him to a mental institution where he died of an INFECTION!

    Cousin Nancy

    • Steph says:

      Nancy

      I have indeed heard of Semmelweis. It was no coincidence that he was forced to move to ‘Pest’ 😉

      You’re on the ball with observations by Semmelweis…

      A recent audit carried out in an Irish teaching hospital, has shown that while everybody knows about hand hygiene BEFORE a procedure, in no cases was hand hygiene actually performed AFTERWARDS as is recommended.

      As is so often the case in infection control, it only takes minor changes in practice to make a BIG difference.

  2. Annb says:

    After a series of expensive audits, the HSE can now affirm the hand washing is recommended. They should have just listened to their Mammy- it would have been a lot cheaper!

    • Steph says:

      Annb – It always amazes me how the conclusions from so many of these expert reports/audits requested by the HSE, end up being so blindingly obvious that even a child could’ve told them what was needed!

      Come to think of it… I’ve seen/heard plenty about the HSE cutting hospital budgets which directly impacts on patient care and yet I’ve not seen/heard any mention of a moratorium on expert reports? 😐

      When you consider the millions wasted on reports which have never been acted upon and are gathering dust in the bowels of the HSE, surely this is an obvious area where savings could be made which do NOT impact on patient care?

  3. Nancy says:

    Steph,

    We just returned from a family cruise to New England/Canada.

    Every time you entered or left the dining room or any place where there was food and drink,a crewman was at the entrance to pour hand sanitizer over your hands.
    I never saw one person refuse the sanitizer because we have all heard of sickness raging through a large ship and the trip having to be cancelled because of illness to the passengers and crew.

    We had a wonderful time and no one got sick..

    • Steph says:

      Lucky you! Nancy

      Your story sounds like a clever solution to an otherwise expensive libel suit!

      Next time you’re planning a cruise, if you’ve any room in your suitcase, please spare a thought for Cousin Steph!

      And whatever you do, don’t tell Grannymar! 😉

  4. mike says:

    Hi Steph
    It was interesting to see that doctor in the itube clip describing and bringing to life all of the things on the checklist, as developed by Atul Gawande and his team, and which has only been made public by WHO as recently as January 2009. As you know, AG published his ‘The Checklist Manifesto – How to get things right’ only this year. It’s amazing to think that such a simple procedure (of running through a checklist) hasn’t existed in most operating theatres in the past, and how it has been resisted, often by the surgeons, when hospitals have attempted to introduce it. And, as AG describes in his book, the airline and construction (where for example high skyscrapers are being built) industries have had these kinds of checklists for decades.

    • Steph says:

      Mike – Perhaps I should have clarified that Atul Gawande was the leader of the WHO Surgical Safety Checklist project.

      I think many surgeons resisted using the checklist at first as they considered it too basic. Gawande quotes in his book… “About 20 percent of surgeons were strongly against using the checklist. They said, ‘This is a waste of my time, I don’t think it makes any difference.’ And then we asked them, ‘If you were to have an operation, would you want the checklist? 94 percent said YES.”

      Many of the key points in the checklist are more personal than medical, such as spending time before an operation to allow each member of theatre team to speak up and introduce themselves. The checklist is designed to promote effective teamwork and improve team communication.

      Gawande says…”There’s tremendous hierarchy in an operating room, and when people get a chance to say their name out loud, it actually changes the likelihood that they will speak up later when they have a problem or have any doubts.”

      I think the hierarchal nature of medicine has a lot to do with why it’s taken so long to implement a checklist system. Doctors find it hard to admit to weaknesses. It’s amazing when you consider that lives can actually be saved and postoperative complications reduced simply by consistently getting the basics right. A simple list has made a BIG difference.

  5. Baino says:

    I’m shocked actually I would have thought this was standard procedure for any medic.

    • Steph says:

      Baino – It is indeed amazing but like so many things in life, it’s the simple things that really make a difference.

      In recent years, I’ve noticed that when being ‘prepped’ for surgery, there has been a huge shift in the amount of ‘box ticking’ carried out to confirm patient data. Details are checked, then re-checked and finally triple checked before any patient goes under anaesthetic. To a novice patient, this could easily be misinterpreted as inefficiency but in fact, it’s to ensure that mistakes do not happen. It’s good to know that the surgical team now carries it’s own checks in theatre before proceeding with any surgery.

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