Warm Weather Increases SSI Risk

WARMING TREND SSIs are more common in August and less likely in January.

Make sure your infection control practices are dialed in during the dog days of summer, suggests new research, which says risk of surgical site infections increases when temperatures soar into the 90s.

Researchers from the University of Iowa compared hospital discharges following treatment of SSIs between 1998 to 2011 with monthly temperatures, rainfall totals and wind averages. The findings, published in the journal Infection Control & Hospital Epidemiology, show incidences of post-op infections peaked in August and were lowest in January. There were 26.5% more cases of SSIs in August, according to the study.

The researchers note hospitalizations for treatment of SSIs increased by 2% for every 5-degree increase in average monthly temperature. They say infection risks increased by 29% when temperatures soured above 90 degrees, but jumped by only 4.4% when temperatures dipped below 40 degrees. The association between higher temperatures and increased risk of SSIs was consistent, regardless of the age, sex and gender of patients, the procedure type, and the geographical regional where the surgeries took place.

Although the researchers did not determine why infection risks were higher during warmer months, they say their study could serve as a jumping-off point for further investigations that could identify which patients are at increased risk when the mercury rises.

Daniel Cook

A Most Unusual HIPAA Infraction

PRIVATE PROPERTY The health system reportedly issued a press release containing a patient's PHI — without her consent — to more than a dozen news outlets.

A Texas health system has agreed to pay $2.4 million to the U.S. government to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. The health system's infraction? Disclosing a patient's name in a 2015 press release about an illegal immigrant arrested for using a fraudulent identification card when she checked in for an appointment at a gynecologist's office.

The settlement is just one aspect of a resolution agreement between Houston-based Memorial Hermann Health System and the U.S. Department of Health and Human Services involving the impermissible disclosure of a patient's protected health information (PHI). The September 2015 incident drew national attention.

The patient, Blanca Borrego, 44, was at the Memorial Hermann Medical Group Northeast Women's Healthcare Clinic in Kingwood, Texas, for a gynecology appointment. When Ms. Borrego — a Mexican-born immigrant who had been living illegally in the United States for more than a decade — presented a fake Texas driver's license, staff reported the suspected forgery to the Harris County Sheriff's Office, and deputies arrived soon after to arrest Ms. Borrego.

Two things happened next: First, immigration-rights advocates began staging protests, suggesting Memorial Hermann had overstepped its authority by reporting Ms. Borrego to law enforcement; and second, the HHS Office for Civil Rights began to investigate the incident as a possible violation of Ms. Borrego's patient privacy rights. The agency ultimately determined that the disclosure to law enforcement was permissible under federal law, but there was another problem. The health system allegedly issued a press release to 15 news outlets and reporters that included Ms. Borrego's PHI — including her name in the title of the release — without her consent.

Even though local media outlets had already been reporting on the story, including using Ms. Borrego's name, attorneys specializing in medical privacy say healthcare providers may not do the same unless they first get the patient to sign a consent form.

"Senior management should have known that disclosing a patient's name on the title of a press release was a clear HIPAA privacy violation that would induce a swift [Office for Civil Rights] response," says Roger Severino, director of the HHS Office for Civil Rights, in a statement. "This case reminds us that organizations can readily cooperate with law enforcement without violating HIPAA, but that they must nevertheless continue to protect patient privacy when making statements to the public and elsewhere."

Memorial Hermann, which has admitted to no wrongdoing, has also agreed to adopt a corrective action plan requiring the health system to update its policies and procedures on safeguarding PHI. In addition, the corrective action plan requires all Memorial Hermann facilities — the not-for-profit health system has more than a dozen hospitals in the Houston area — to attest to its understanding of permissible uses and disclosures of PHI, including disclosures to the media.

A spokesperson for Memorial Hermann declined to provide further comment.

Bill Donahue

Elderly Patient Falls off Operating Table During Procedure

MATTHEW CUMMINGS, MD, is accused of being distracted during the case.

A North Carolina surgeon is the target of a revived lawsuit filed by an elderly woman who fell off an operating table during a cardiovascular procedure in 2012.

Matthew Cummings, MD, is accused of failing to monitor and control the body of Marjorie Locklear, who was 75 at the time. The complaint accuses Dr. Cummings of becoming distracted and failing to "position himself in close proximity to [her] body" during the procedure.

Ms. Locklear was "opened up and had surgical tools in her," says the complaint. As a result of the fall, she suffered a concussion, developed double vision, injured her jaw, and was battered and bruised on the left side of her body, she says. She's also repeatedly had nightmares about the incident, she says.

Asby Fulmer, one of Ms. Locklear's lawyers, tells Outpatient Surgery that Ms. Locklear's "leg twitched" while she was under anesthesia, and she simply rolled off a catheterization table.

Initially, the suit, which also names Duke University Health System and Duke University Affiliated Physicians, was dismissed, because Ms. Locklear's lawyers didn't follow North Carolina rules for filing a malpractice case. But in a split decision, an appeals court reinstated it, determining that it was really a case of negligence, even though her lawyers had framed it as one of malpractice.

The question, said the court, was whether the decisions leading to the fall required "clinical judgment and intellectual skill." Had it been a case of medical personnel failing to properly use restraints, it would be medical malpractice, said the majority. But this sounded more like the "type of injury resulting from actions not requiring specialized skill or clinical judgment."

Calls to Dr. Cummings and Duke University Health System were not returned.

Jim Burger

InstaPoll: How Many RNs Work Local Anesthetic Cases?

AORN recommends that there be 2 perioperative RNs assigned to care for the patient if the patient is receiving moderate sedation — one to administer sedation and monitor the patient, and one to perform the circulating role. Do you require both a monitoring RN and a circulating RN for nurse-monitored sedation cases at your facility? Tell us in this week's InstaPoll.

Two-thirds (66%) of the 388 respondents to last week's InstaPoll prefer to use reusable blood pressure cuffs. The results:

Reusable or disposable blood pressure cuffs?

  • reusable 66%
  • disposable 22%
  • both 11%

Dan O'Connor

News & Notes

  • Win a free stay at ORX If you've ever wanted to do Vegas in style, now's your chance. Register for OR Excellence (Oct. 11 to 13 at the Red Rock Casino Resort and Spa) by Memorial Day (Monday, May 29), and you'll be entered into a drawing for great prizes, including spa gift certificates, room upgrades and the grand prize: a complimentary 3-night stay in a Red Rock Signature Suite for ORX. Plus, you'll take advantage of the $100 early-bird price discount and secure your room in the heart of the conference action.
  • Predicting extended length of stays in PACU The use of general anesthesia, longer scheduled case duration, and the presence of conditions such as hypertension and morbid obesity may help to identify patients at higher odds for extended length of stay in the post-anesthesia care unit, according to researchers from the University of California at San Diego. The study, published in Anesthesia & Analgesia, also showed that surgical subspecialties such as otolaryngology, gastroenterology, ophthalmology and plastic surgery had decreased odds for extended length of stay in PACU when compared with the likes of general surgery and gynecology, both of which put the patient at a higher risk of post-operative nausea and vomiting.
  • New weapon against C. diff in development An enzyme in the drug ribaxamase may help protect patients from Clostridium difficile without disturbing the diversity of the gut microbiome. In a randomized clinical trial, the drug reduced the incidence of C diff., by more than 70%, compared with placebo, according to the company developing the compound.