My View

My view: Observations in health care operations

June 18, 2014 

The following is based on personal observations and dialog with health care workers in five states – Georgia, Tennessee, Kentucky, North and South Carolina – to gain public awareness and action to reverse the growing rate of patient and worker contraction of infectious illness.

The question: Why are so many people re-admitted to hospitals for infection related maladies within weeks of being discharged from an unrelated condition at a hospitalization?

In addition to being admitted for medically needed corrective intervention, many of us access clinics, medical offices and hospitals as visitors, volunteers, employees or support service providers.

We expect medical facilities to be hygienically clean. Think about human interaction pathways followed by micro organisms rather than routine dust, grime and dirt.

In support of cleanliness expectations, health care facilities are closely regulated. Professional designations and certifications are required. Please note: Same-day ambulatory treatment clinics, elderly care and residential facilities, dental, optical, re-habilitation and therapy providers are all included, based on hands-on treatment of clients.

Overshadowing the effort to improve our quality of life, health care providers at all levels are so focused on patient care and safety that many routine behaviors endanger clients and themselves. Don’t be shocked. The regulatory process by federal Food and Drug Administration mandates how things are to be done. To police and verify facilities, supplies, equipment, procedures and work performance, private organizations certify the FDA rules are met.

What appears to be seriously overlooked is the enforcement of health care worker safety. According to the Federal Department of Labor, Bureau of Labor Statistics, the health care industry classification has one of the highest occupational health and safety related lost time records. Going beyond the stress related to lifting patients, or accidental hypodermic needle sticks, shouldn’t health care be one of the safest employment arenas?

Let’s look at one common infection – pneumonia. How can we explain the emergency room treatment and discharge of an athlete’s broken leg, no broken skin, who contracts pneumonia within a week?

You are a hospital nurse working on the obstetrics floor and contract pneumonia three times in one year. Each time you lose a couple day’s work. You visit your family doctor, get a prescription and are back to normal with in a couple of days. Is this viewed as an occupational illness or a personal health issue? Does any one look at the record? Worker pneumonia, three times in one year, working with normally considered healthy patients? Sure, there are lots of hand sanitizing stations all over, but think about this:

In visiting the cafeteria in three hospitals, patrons included a mix of visitors, general employees and medical staff. Several wore scrubs or lab coats, including surgical masks hanging under their chins. Many had stethoscopes around their necks. Assuming all washed their hands before entering the room, what’s the big deal? For starters, scrubs, beside evolving into a status symbol, were intended to be a, easy-on, easy-off pajama wardrobe to facilitate prevention of cross contamination from areas occupied by the sick to areas for the healthy. These same scrubs are worn when going home, maybe with a grocery store stop on the way. Then, after time in the home laundry hamper, into the wash with the family items. These clothes, the cafeteria furnishings, the employees car, home kitchen and pre-post washing uniforms can be tested for microorganisms type and quantity using an electronic meter, or swabs sent to a laboratory for incubation and analysis. Would you want to sit next to a person in scrubs on a bus or carpool from a health care center? By the way, home laundry products and equipment are not designed to sterilize the wash.

Many health care regulations indicate any apparatus that comes into contact with individual patients “shall be sanitized” or equipped with disposable contact surfaces. Sure, they wear disposable gloves, but have you ever seen a medical professional sanitize the stethoscope head before checking you?

How would you like to be assigned to clean three to four hospital or clinic patient rooms between occupancies, in one hour? At best, that’s 20 minutes each. Having tried it, knowing a microorganism count was taken of selected areas prior to, and following my effort, I felt guilty. Directed to use a bleach like general disinfectant disposable cloth and a common mop bucket, it was clear only top, easy access areas, floors and room furnishings had been contacted in my cleaning effort. Privacy drapes, bed controls, wall mounted apparatus, rolling bed-table underside, night stand interior, TV remote, were all overlooked. Germ counts prove it – no defense. How many staff came in contact? The cure: Reasonable expectations of human capabilities and process supplies-equipment for starters.

Long lasting, low-cost, safe, easily applied surface disinfection methods abound. Effectiveness of these normal light activated systems have been witnessed in hospital operating rooms, child care facilities and retirement enclaves showing disinfecting prowess months after application. When interviewed, hospital directors of infection control and patient safety all voiced the same concern. In most health care facilities I encountered, those charged with infection control leadership accountability lack the authority to implement surface disinfection applications. The general health care institutional leadership focus is most likely to be on patient care as specified by FDA regulation or Joint Commission mandate. Employees, staff workers and visitors continue to be at risk for hospital acquired infections.

Fred Freiberger of Rock Hill is a consulting international occupational health engineer and has been conference leader as a member of the International Speakers Network. Designated an authorized outreach trainer-adviser by the Occupational Safety & Health Administration, OSHA, Freiberger is a member of the University of North Carolina, Occupational Safety & Health Education Research Center.

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