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Digital Issues

Employees Practice Better Hand Hygiene When Among Co-Workers

Peer pressure may be one way to improve hand hygiene among healthcare workers, a new study suggests.

The study, published in October's issue of Infection Control and Hospital Epidemiology, found that workers who were in close proximity to peers practiced proper hand hygiene at a 7% higher rate.

Researchers at the University of Iowa's Carver College of Medicine used a custom-built, badge-based system to estimate hand hygiene compliance and opportunities as well as the location and proximity of healthcare workers. The study examined the medical intensive care unit at the hospital over a 10-day period for 24 hours a day. During that time, there were more than 47,000 hand hygiene opportunities recorded.

When a worker was alone, the adherence rate for hand hygiene was around 21%, while 28% complied when a co-worker was nearby. Additionally, the results showed that adherence increased as the number of nearby healthcare workers increased, but only up to a certain point.

"Social network effects, or peer effects, have been associated with smoking, obesity, happiness and worker productivity," says Philip Polgreen, MD, an author of the study. "As we found, this influence extends to hand hygiene compliance, too."

Kendal Gapinski

Nursing Continuity, Experience Boost Bottom Line

Good, experienced nurses are worth every penny — and more, a recent study finds, especially when they work in familiar environments with equally experienced teammates.

"The key finding is something intuitive: When we have teams working together, the quality of care on the unit is better," co-author Patricia Stone, PhD, RN, of the Columbia University School of Nursing in New York City, tells MedPage Today. "Trust gets developed, people know how to function, know whom to ask questions of — everything gets done more smoothly."

The study, which involved more than 900,000 patients in 76 VA hospitals between 2002 and 2006, examined the link between the length of patients' hospital stays and RN staffing data — including increases and decreases, tenure, new hires, departures and vacations.

For RNs, each year spent on a specific unit was associated with a 1.33% reduction in mean length of stay, say researchers at the Columbia Business School. To illustrate the potential significance, the authors say that raising the average RN unit tenure from 2.25 years to 6.55 years would raise the cost of wages and benefits for a facility by $18,196, but save 7.88 bed days per month. Pegging each bed day at $2,531, the overall net savings would be $1,748 monthly, or $20,976 yearly.

Additionally, the study, which appears in the American Economic Journal: Applied Economics, found that care was negatively affected when nursing teams were disrupted by vacations, new additions and/or replacing staff nurses with contract nurses.

Jim Burger

Hospitals Wasting Billions on Insurance Bureaucracy

A new study in the journal Health Affairs calls out insurance bureaucracy for filling a quarter of U.S. hospital budgets with unneeded administrative costs and diverting resources from patient care.

The analysis of 2011 hospital finances in the U.S., Canada, England, Scotland, Wales, France, Germany and the Netherlands revealed spending on administrative costs in American hospitals was the highest at $667 per capita compared with $158 per capita, the lowest amount, in Canada. Administrative spending in the U.S. rose nearly 2% to 25.3% since 2000, while spending in Canadian hospitals dropped slightly during the same span. For-profit hospitals in the U.S. shell out the most on administrative costs, according to the study, which notes the increased spending had no positive impact on quality of care.

Study co-author David Himmelstein, MD, a professor at the CUNY/Hunter College School of Public Health in New York City and lecturer at Harvard Medical School, says hospitals waste $150 billion pushing papers, and $300 billion more in costs related to insurance overhead.

Administrative costs have soared because hospitals deal with numerous insurers, not to mention varying payment rates and documentation requirements, all of which demand investments in computer software and consultants to help navigate these complex payment systems. Hospitals also face pressure to accumulate profits or surpluses for spending on marketing to attract profitable patients and services.

"Only a single-payor reform can squeeze out the bureaucratic waste and use the money to give patients the care they need," says Dr. Himmelstein. "Instead, we're layering on more bureaucracy in insurance exchanges and accountable care organizations."

Daniel Cook

InstaPoll: Does Joan Rivers's Death Justify Scrutiny on For-Profit Surgery Centers?

Joan Rivers's death has put the safety of ambulatory surgical centers under the public's microscope, again. Is this scrutiny warranted? Tell us in this week's InstaPoll, and check back next week for the results.

There is little debate: Surgeons should apologize after committing a medical error, according to the overwhelming majority of the 654 respondents to last week's poll. The results:

Should surgeons say "I'm sorry" after an error?

  • Yes 94%
  • No 6%

Dan O'Connor

News & Notes

  • Is antibiotic overuse costing you? Inappropriate or duplicative antibiotic use not only risks patients' safety and the efficacy of the drugs, it also wastes a lot of money, say researchers from the Centers for Disease Control and Prevention and the Premier Safety Institute. They've calculated antibiotic overuse's cost to healthcare at $163 million over a recent 3-year period, a figure that doesn't include such associated expenses as supplies, labor, or treating patients' side effects or complications. Their study, which appears in the October issue of the journal Infection Control and Hospital Epidemiology, points out that antimicrobial stewardship can provide safer, more effective outcomes.
  • Are you sure your endoscopes are clean? There are at present no national recommendations for monitoring the quality of flexible endoscope reprocessing, but there is science that allows such surveillance. In the September issue of the journal GIE: Gastrointestinal Endoscopy, technology researchers from the American Society for Gastrointestinal Endoscopy review the state of such emerging technology as microbial culturing, bioburden assays and ATP bioluminescence testing, and their practical ability to rapidly assess your facility's compliance with reprocessing's stringent steps.
  • Could ICD-10 make you less safe? The conversion to the ICD-10 coding system could skew the accuracy of hospital safety reporting, and consequently the public's impression of a facility's safety, warn researchers from the University of Illinois at Chicago. According to their analysis, published online by theJournal of the American Medical Informatics Association, not every diagnosis translates the same way from ICD-9, which could affect data results and facilities' previously established safety records.