Nearly 100,000 patients were put at increased risk of surgical site infections in a 12-month period because prophylactic antibiotics weren't administered at the right time, were misprescribed or weren't stopped at the appropriate time following surgery, according to a Consumers Union study.

The study analyzed surgical cases that took place between July 1, 2007, and June 30, 2008, through data posted on the U.S. Department of Health and Human Services' Hospital Compare Web site.

Nearly 10% of all surgical patients didn't receive antibiotics within 1 hour before surgery, a critical window in preventing surgical site infections, says the study. Nationwide, 445 hospitals, or 14%, had a low compliance rate (defined by the study as less than 79% compliance) with regards to this measure. In Washington, D.C., for example, 43% of hospitals showed low compliance.

While 95% of all patients received the appropriate antibiotic, treatment did not stop within 24 hours of surgery for 13% of patients, as recommended by the Centers for Medicare and Medicaid Services.

"Too many hospitals are not protecting their patients by following these proven infection control practices consistently," says Lisa McGiffert, director of Consumer Union's "Stop Hospital Infections" program. "As a result, patient experiences can vary widely within each state depending on where they have surgery."

Kent Steinriede

Medication errors due to improper reconciliation are relatively common in hospitals, a recent study shows, but providers can significantly reduce such errors by using automated solutions and standardizing their medication tracking processes.

"It turns out that we commit about 1.5 errors per patient either for the admissions orders in the hospital or, much more commonly, in the discharge orders, which is kind of appalling," says Jeffrey Schnipper, MD, MPH, of Brigham and Women's Hospital and Harvard Medical School. His Boston-based research team sought to improve the rate of medication errors at 2 hospitals by testing a new process that relies on a computerized medication reconciliation tool and standardized surveillance by doctors, nurses and pharmacists.

According to the results, published in the April 27 issue of the Archives of Internal Medicine, the intervention group had a 28% lower rate of medication errors with the potential for patient harm (1.05 per patient) than the group receiving the usual care (1.44 per patient). Noting that one of the hospitals fared significantly better with the automated tool than the other, the study authors caution that "software integration issues are likely important for successful implementation of computerized medication reconciliation tools."

Dr. Schnipper says that with the new system in place, error rates have continued to drop in each of the study hospitals to about "half an error per patient." Matthew Grissinger, a medication safety analyst at the Institute for Safe Medication Practices, says the key to the system's success was standardization. "Standardizing the process of who is going to do what in regard to medication reconciliation in hospital admission and discharge is really the biggest challenge organizations have."

Irene Tsikitas

Spurred on by last year's hepatitis C outbreak at a Las Vegas endoscopy center, Nevada lawmakers have introduced 2 bills aimed at increasing scrutiny over the state's ambulatory facilities.

Senate Bill 70 and Assembly Bill 123 would require facilities to obtain a permit from the state's health division before offering general anesthesia, conscious sedation or deep sedation.

In addition, AB 123 states that facilities performing ambulatory surgery would need to maintain current accreditation by a nationally recognized accrediting agency approved by the Nevada Board of Health. Finally, the Nevada Health Division would be required to conduct annual, unannounced inspections of surgical facilities licensed by the division. The inspections would focus on a facility's infection control practices and procedures.

A budget proposed by Nevada Gov. Jim Gibbons adds 14 staff positions to Nevada's Bureau of Health Care Quality and Compliance, the organization currently responsible for inspecting the state's surgical facilities every 3 years, according to a published report, which notes that the bureau's staff believes the additional positions would let them inspect surgical facilities every 18 months.

State health officials shut down the Endoscopy Center of Southern Nevada in Las Vegas last year while investigating 6 hepatitis C cases allegedly contracted at the center. They discovered that the center had reused syringes, single-use vials of anesthesia and scope-cleaning solution.

Daniel Cook

More than three-fourths (78%) of the 40 readers who answered last week's online poll said they don't let their staff launder their scrubs at home. Only 22% of respondents let their staff home-launder their scrubs and wear them to and from the facility.

This week's poll wants to know what type of adverse event last occurred at your facility. Go to our front page to participate in the poll and view real-time results.

Dan O'Connor