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Is Healthcare Attire an Infection Risk?

No more white coats? New recommendations aimed at limiting the cross-transmission of pathogens could spell the end of a traditional symbol of healthcare professionalism.

New guidance published in the journal Infection Control and Hospital Epidemiology says common attire worn by healthcare professionals, including white coats, stethoscopes and neckties, could serve as vehicles to carry bacteria between patients.

While healthcare facilities must focus on known ways to prevent infection, such as hand hygiene and proper environmental cleaning, infection control efforts should also address what healthcare professionals are wearing, says Mark Rupp, MD, chief of the division of infectious diseases at the University of Nebraska Medical Center in Omaha and an author of the recommendations.

The recommendations suggest facilities implement the following practices:

  • Ensure caregivers wear short sleeves and no wristwatches, jewelry or neckties when treating patients.
  • Frequently launder any apparel that comes in contact with patients or patients' environments. If home laundering is allowed, ensure apparel is washed in hot water with bleach and mechanically dried or ironed.
  • Disinfect, replace or eliminate the use of lanyards, ID tags, cell phones and pagers that come into direct contact with patients.
  • Ensure all footwear has closed toes, low heels and non-skid soles.
  • Clean shared equipment, including stethoscopes, between patient uses.
  • When white coats are required, ensure wearers have 2 or more available at all times and convenient access to a laundering service. Place hooks in clinical areas so wearers can remove the coats before caring for patients.

Dr. Rupp says following these measures should be voluntary until they're proven effective with additional clinical research. He adds that healthcare providers and the general public may need to re-evaluate their perceptions of medical cultures and traditions as facilities aim to balance professional appearance, comfort, and practicality with infection control concerns.

Daniel Cook

Why You Should Let Patients Participate in Surgical Safety Checklists

Surgical teams are more likely to use safety checklists when patients know about them and ask those teams to be sure to follow them, say researchers at Tulane University Hospital and Clinic in New Orleans.

Their study, presented at the American Society of Anesthesiologists' conference, compared conduct during 104 procedures as secretly monitored by students who were observing the cases. In 43 cases, patients were told about the World Health Organization's surgical safety checklist; in 61 others, they were not. When patients were aware of the checklist's existence, compliance was higher on all 26 checklist items.

The differences were significant among 19 of the 26 items. For example, the percentage of teams that reviewed sponge and instrument counts rose from 19% when they were operating on uninformed patients to 87% when their patients knew there was a safety checklist to follow.

Only 35% of the informed patients said they'd previously heard of the WHO checklist, but they all said that their existence made them feel more comfortable going into surgery.

Jim Burger

Seattle Hospital's SPD Under Scrutiny

Reprocessing practices at Seattle Children's Hospital are under review by state health authorities after an in-house investigation late last year revealed the inadvertent use of contaminated flexible endoscopes.

While no incidents of cross-contamination illness have been reported to date, the hospital has disclosed that 106 patients were exposed to the improperly cleaned instruments. It has offered blood tests for hepatitis B and C and HIV to patients at risk of infection.

According to news reports, a sterile processing technician discovered bioburden in a reprocessed endoscope's channel in November. A few days later, the residue was found in another scope.

"At that point in time we stopped all colonoscopies and performed an investigation and identified that we had a lapse in our cleaning processes," said Danielle Zerr, MD, MPH, the hospital's medical director of infectious disease.

Dr. Zerr attributed the dirty instruments to a breakdown in staff training. "We feel that we didn't have good systems in place to ensure training of new technicians who were coming into our system," she said.

The scopes' manufacturer has since inspected and re-evaluated the hospital's reprocessing procedures to ascertain their compliance with its cleaning guidelines. The hospital has retrained 20 staffers and has opened its doors to investigation by Washington's health department.

"This is an isolated occurrence that happened," says Dr. Zerr, "but of course that makes you think about where else you might have vulnerabilities."

David Bernard

InstaPoll: Is IV Saline Solution in Short Supply?

Amid widespread reports of a nationwide shortage of IV saline solution, triggered by manufacturing issues and an increased demand by hospitals that's potentially related to the flu season, we want to know if you're able to keep IV saline on hand at your facility. Tell us in this week's InstaPoll, then check back next week for the results.

The 2 most common never events respondents to last week's poll have experienced are retained objects (21%) and wrong-site surgery (20%). The results, based on 372 responses:

Which of these never events have you had at your facility?

  • Surgery on the wrong site: 20%
  • Surgery on the wrong patient: 2%
  • Retained foreign object: 21%
  • Wrong surgical procedure: 2%
  • We've never had a never event: 55%

Dan O'Connor

News & Notes
  • ASA on sedation technology The American Society of Anesthesiologists released a guidance document for facilities that will use Sedasys, the new computer-assisted personalized sedation system from Ethicon Endo-Surgery. Among its recommendations, the ASA suggests anesthesia professionals remain "immediately available" to assist or consult as needed, which could mean creating a code team or rapid response team that includes at least 1 anesthesiologist.
  • How safe is your water? Water from faucets fitted with aerators is likely to contain up to 10 times more infectious pathogens than water from elsewhere in a facility's plumbing system, says a study published in the February issue of the journal Infection Control and Hospital Epidemiology. "Aerators are a reservoir for drug-resistant bacteria and a source of infection for patients at risk," say researchers at the University of Genova in Italy.
  • Tonsillectomy care quality varies widely After tonsillectomy procedures, some children's hospitals see patient revisit rates as high as 12.6%, while others' are as low as 3%, according to a study published online in the journal Pediatrics. The study notes that many hospitals with high revisit rates fail to follow current guidelines for tonsillectomy care, including administering antibiotics and dexamethasone, and concludes that shared data can improve quality across the specialty.