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How Safe Are Your Injection Practices?

More than 10% of surgical centers are plagued by unsafe injection practices, says the Accreditation Association for Ambulatory Health Care's Institute for Quality Improvement, which flagged safe injection practices as a top concern in its 2015 Quality Roadmap.

Lapses in basic safe injection practices expose patients to needless risk of such bloodborne pathogens as hepatitis B virus and hepatitis C virus.

The report, available for free download at the Institute's website, also found shortcomings in credentialing, privileging and peer review policies at more than 15% of ASCs surveyed by the AAAHC.

On the positive side, the AAAHC found that 100% of the ASCs it accredits excel at providing patient-centered care, which includes treating patients with respect and engaging them in their healthcare decisions.

The report totals up surveyors' findings from more than 1,300 on-site inspections between June 2014 and June 2015. "This report provides analysis of where our nation's ambulatory providers are performing highly, and the areas which should be addressed in ongoing quality improvement initiatives," says Naomi Kuznets, PhD, the Institute's vice president and senior director.

The report's authors speculate that the safety reporting requirements CMS issued in 2014 to raise awareness of cross-contamination risks from reusing syringes and multi-dose vials may explain the greater scrutiny over, and perceived need for improvement in, injection practices.

David Bernard

N.J. Lawmakers Propose Minimum Nurse Staffing Levels

A bill is working its way through the New Jersey legislature that would require the state's hospitals and surgery centers to maintain minimum nurse staffing levels in order to improve patient safety and workplace prevent burnout that leaves facilities understaffed. Opponents of the controversial bill say staffing levels should be up to the judgment of individual facilities.

The bill, which was voted through a committee last week and awaits consideration by the full assembly, would require 1 registered professional nurse for every 6 patients on a medical/surgical unit for the first year after the regulations are adopted, and 1 RN for every 5 patients in subsequent years. It would also require 1 RN for every patient under anesthesia in an operating room, and 1 RN for every 2 post-anesthesia patients in a recovery room or post-anesthesia care unit.

New Jersey would join California in mandating nurse-to-patient staffing ratios.

JNESO, a labor union representing professional healthcare workers in New Jersey, says the vote was a step toward victory for patient safety and quality health care.

The New Jersey Hospital Association opposes the bill. "We believe these types of patient care decisions should be left to nurses and other trained healthcare professionals who provide patient services daily in the caregiving environment, rather than proscribed by lawmakers," says spokeswoman Kerry McKean Kelly.

Officials at the New Jersey Association of Ambulatory Surgery Centers did not immediately respond to a request for comment.

Daniel Cook

The Economic Scourge of C. Diff

Patients with Clostridium difficile infections cost more to treat, have longer hospital stays and are more frequently readmitted than those who don't, a new study suggests.

The study, published in the American Journal of Infection Control, looked at roughly 171,500 patient discharges from approximately 5,000 U.S. hospitals. Researchers found that C. diff. increased hospitals' cost per case by 40%, or an average of $7,285. They also discovered that C. diff. patients had a 55% longer length of stay and were 77% more likely to be readmitted within 30 days.

The majority of the C. diff. cases in the study were associated with concurrent antibiotic use. Because of that, researchers suggest that facilities pay extra attention to how they use these drugs and avoid overprescribing "redundant combinations of IV antibiotics."

"In the last 15 years, C. diff. hospitalizations have increased by more than 200 percent," says Glenn Magee, MBA, lead author of the study. "Although it's commonly known that C. diff. contributes to high costs and less than ideal outcomes, this study is the first to provide a complete look at how much of an impact it has on U.S. hospitals and patients. Efforts focused on preventing initial C. diff. episodes, and targeted therapy to prevent recurrences for vulnerable patients, are essential to decrease this burden."

Kendal Gapinski

InstaPoll: Is Your Staff Receiving a Holiday Bonus This Year?

Is your staff receiving a little (or a lot!) something extra in their paychecks for the holidays this year? Tell us in this week's InstaPoll and track the real-time results.

Most of the 212 respondents to last week's poll are not offended when professional trade publications like Outpatient Surgery Magazine publish photographs that show poor or inappropriate practices. The results:

Should magazines publish photos that show poor practices?

  • No. It sets a bad example of acceptable practices. 43%
  • Yes. Why hide from what's really going on in today's ORs? 57%

Dan O'Connor

News & Notes
  • Citrus scents and stares improve hand hygiene Exposing healthcare providers to the smell of citrus fruits increased their hand hygiene compliance by 50%, while posting a photo of a man's staring eyes above hand sanitizer dispensers boosted compliance by one-third, according to British and American researchers. Their study tested the effects of psychological priming — using "nudges" to affect subjects' behavior without their awareness of the impact — on employees at a Miami teaching hospital.
  • AAOS's new total knee guidelines The American Academy of Orthopaedic Surgeons released the first evidence-based clinical pathway guidelines for adults undergoing total knee arthroplasty due to osteoarthritis. The guidelines — issued in advance of the April 2016 start of CMS's knee replacement bundled payments — advise physicians on reducing patient risk factors, using multimodal pain management, the importance of ambulating after surgery and other common care issues.
  • Female surgeons face gender discrimination Life as a surgeon is full of hardships for females, according to a study in the American Journal of Surgery that found that women must battle gender equality, appropriate mentorship, and accommodations for balancing work and family responsibilities. The survey of 81 female surgeons revealed 18% felt they experienced gender discrimination in medical school, 36% in residency, 12% in fellowship and 41% as staff surgeons. More than half felt that their gender had played a role in the career challenges they faced.