Hospital-acquired infections and central line infections have been a significant focus within healthcare of late, with health systems undertaking myriad approaches to reduce or eliminate them, in turn bringing down costs and improving patient satisfaction and , seemingly, outcomes. But is the fear overblown?
Karen Sullivan Sibert, MD a Los Angeles anesthesiologist, seems to think so, suggesting that the focus on stemming such infections is bordering on more “paranoia than legitimate concern.” In a blog post, she argues that “the fear of infection is leading to the arbitrary institution of brand new rules.”
For example:
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“An edict just came down in one big-city hospital that all scrub tops must be tucked into scrub pants. The “Association of periOperative Registered Nurses” (AORN) apparently thinks that this is more hygienic because stray skin cells may be less likely to escape, though there is no data proving that surgical infection rates will decrease as a result. Surgeons, anesthesiologists, and OR nurses are confused, amused, and annoyed in varying degrees.”
In one instance, she said, an experienced OR nurse was told to tuck it in while she was rushing to prepare for an emergency aortic repair, raising, in her mind, “a question of misplaced priorities.”
In that same vein, a new rule has emerged from the Joint Commission that mandates all physician’s personal items, like briefcases, have to be stored in plastic trash bags, while another hospital anesthesiology department has now limited items allowed in the OR to smart phones and tablets.
Unsurprisingly, the heightened focus is likely about finance given the reimbursement environment for hospitals.
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“I wish I could say that the driving force behind hospitals’ fear of infection is simply the wish for patients to get well. Unfortunately, it’s probably driven as much by financial motives as benevolent ones. Today, Medicare won’t pay for care related to surgical site infections, and it fines hospitals whenever too many patients need to be readmitted within 30 days of discharge. In 2014, a record 2610 hospitals–including 223 in California–were penalized, and will receive lower Medicare payments for all patients over the next year, not just those who were readmitted.”
Sibert notes that progress has been made in reducing central line-associated bloodstream infections, to the tune of a 44 percent reduction between 2008 and 2012, according to the CDC.
“But other initiatives aren’t based on this type of solid science, with sound methodology and careful tracking of results over time.
A widely circulated study from the American Journal of Infection Control that showed hand hygiene within hospitals was lacking, Sibert argues, was also misleading and caused perhaps unwarranted consternation among germiphobes.
“The hand-washing study ignored the fact that the anesthesia practitioner who is directly administering anesthesia is caring for only one patient at a time, not going from patient to patient without appropriate hand hygiene. The study involved observation of only 10 surgical cases, and did not report whether or not any of the patients developed a surgical site infection or any other postoperative infectious complication. Most important, it did not address the fundamental question of whether bacterial counts in the anesthesia work area, which is physically separated by sterile drapes from the surgical field, have any bearing on the real issue of patient well-being.”
Update: A previous version of this article incorrectly referred to a hygiene study from the World Health Organization. The study was from the American Journal of Infection Control.
