Safety - Medical Errors #2

Course Sample

Safety

Sample of Course Material

Introduction

Preventable Medical Errors is one of the biggest concerns presently affecting US healthcare. Preventable Medical Errors include such things as adverse events (AEs), adverse drug events (ADEs), fatal drug events, misdiagnosis, incorrect treatment or surgery, failure to treat, treating the wrong patient, and preventable infections and deaths. These outcomes occur in clinics and institutions due to error and neglect. According HealthGrades, a leading third party evaluator of hospitals and resource for health professionals, nearly 1 million patient-safety incidents occurred in US hospitals between 2006-2008. The cost of preventable medical errors in hospitals is about $9 billion annually. Adverse drug events are the most common health problem with as many as 1.5 million ADEs occurring in the US annually.

Infectious Disease Control

Health care providers are exposed to a host of pathogens on a daily basis. Both resident and transient microorganisms occupy the surface of our skin and hair. Many of the microorganisms living on the surface of our body are capable of causing disease or infection if they penetrate deeper into underlying tissue and our immune system fails to fight them off.

Protecting ourselves and our patients is crucial to a safe and healthy clinical environment. Healthcare providers must be concerned with preventing transmission and cross-contamination. The Occupational Safety and Health Administration has established Universal Precautions for this purpose. All healthcare providers need to understand the mechanisms of transmission and prevention of infectious diseases. Some primary routes of transmission are given below:

Airborne—via aerosol and air droplets. Examples include:

Tuberculosis
Influenza
Common cold
Streptococcus
Mononucleosis

Direct contact—via transfer by hands, hair, countertops, etc. Examples include:

Staphylococcus
Methicillin Resistant Staphlyococcus Aureus (MRSA)

Bloodborne—via blood, seminal fluids. Examples include:

Hepatitis A
Hepatitis B
Hepatitis C
Human Immunodeficiency Virus (HIV)

Food or water borne- via contaminated food or water. Examples include:

Hepatitis E
Escherichia coli
Clostridium difficile

All healthcare providers should also be aware of nosocomial infections. Nosocomial infections are acquired in the hospital or clinical setting. They are a serious medical issue responsible for 20,000 deaths annually, and some reports indicate they can be responsible for as many as 99,000 deaths annually. Nosocomial infections are commonly caused by opportunistic pathogens such as:

Enterococcus spp.
Escherichia coli
Pseudomonas spp.
Staphylococcus aureus

Acupuncturists must be aware of the transmission risks of these pathogens and exercise caution to prevent cross-infection and transmission. During new patient intake, be certain to conduct a thorough health history. The best method to prevent nosocomial infections is to practice hand hygiene and to clean work surfaces.

Hepatitis and HIV Summary of Disease Characteristics

1. Hepatitis A (HAV)

15 – 45 days Incubation

Bloodborne, fecal contaminated food and water

Abrupt Onset

Vaccine Available

Not Chronic, common with children and young adults

2. Hepatitis B (HBV)

50 – 180 days Incubation

Bloodborne

Insidious (slow) Onset

Vaccine Available

Chronic 5 – 10% of cases

3. Hepatitis C (HCV)

20 -90 days Incubation

Bloodborne

Insidious Onset

No Vaccine

Chronic 50% of cases

4. Hepatitis E (HEV)

30 – 40 days Incubation

Waterborne

Abrupt Onset

No Vaccine

Not Chronic, more prevalent in developing countries

5. Human Immunodeficiency Virus (HIV)

2 weeks – 10 years Incubation (50% of cases develop within 10 years; some occur in as much as 20 years from initial exposure)

Bloodborne

Asymptomatic or symptomatic; symptoms can resemble other common diseases like mononucleosis or a common cold

No Vaccine

Chronic can lead to Acquired Immune Deficiency Syndrome (AIDS)

Preventing Diseases and Infections

To prevent diseases and infections, we also need to know the difference between autogenous infections and cross-contamination.

Autogenous Infections

Infections acquired from pathogens already on the individual (both resident and transient microorganisms).

Resident bacteria reside on the body surface, are persistent and make up the microflora of the skin, hair, and outer membranes. They cannot easily be washed off. Most of the time resident bacteria do not cause us any harm. However, when they are allowed to penetrate the surface of the skin such as through cuts or abrasions, resident microorganisms become opportunistic and can result in serious infections.

Transient microorganisms temporarily reside on the skin and can be washed off. In contrast to resident microorganisms, transient microorganisms are short lived—usually hours to days. Transient microorganisms include bacteria, fungi, and viruses. Transient microorganisms spread in a linear fashion. For example, transient microbes may progress from fingers to palm to the wrists, and the mouth and nose when a person touches his or her face. Transient microorganisms, obviously, can spread autogenously or through cross contamination and can also result in serious infection.

The single most effective means to prevent infections is to practice proper hand sanitation. The hands must be cleaned before and after each patient treatment. Gloves are recommended in cases where contact with blood or other contaminants is possible. The World Health Organization recommends hand washing and hand hygiene as follows:

Hand Washing – when the hands are soiled

Apply soap over entire hands and between fingers

Lather the hands for 40 – 60 seconds

Rinse running warm water

Dry with a clean towel or air dry

Hand Hygiene – when the hands are not soiled

Apply sanitizing products, such as an alcohol-based cleaner

Rub for 20 – 30 seconds

Air dry

Cross-contamination and transmission

Cross-contamination involves actively managing biohazards and preventing passing of pathogens from person-to-person. Cross contamination occurs when diseases are spread from person-to-person or via contaminated materials such as sharps, needles, instruments, soiled gowns, etc. Transmission occurs when an individual is directly exposed to pathogens. Blood-to-blood contact is the most common route of transmission for the bloodborne pathogens HBV and HIV. In the acupuncture setting, the typical route of infection for these diseases is percutaneously (i.e., through needlesticks).

The Occupational Safety and Health Administration requires all healthcare professionals to practice universal precautions to prevent the spread of bloodborne pathogens. Employers are required to have an Exposure Control Plan and to train employees at initial hiring and annually on implementation of the plan’s procedures.

Universal Precautions Review – The purpose of universal precautions is to reduce the occupational risk of infection. Healthcare workers must assume all patients are potential carriers HBV or HIV and take precautions to protect themselves and prevent the transmission of these diseases. Healthcare workers should review the universal precautions and components of their employer’s Exposure Control Plan annually.

“RULE OF THUMB: APPLY UNIVERSAL PRECAUTIONS TO ALL PATIENTS.”

Use universal precautions when exposed to:

Blood (or visible blood in body fluids)
Body fluids (such as semen, vaginal secretions, tissues, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, and amniotic fluid)

The Centers for Disease Control recommend that all healthcare workers protect themselves from possible infections by taking several steps:

Practice hand hygiene before and after direct patient contact, or immediately after gross contamination.

Wear the appropriate personal protective equipment (i.e., gloves, gowns, protective eyewear) with the risk of exposure.

Gloves should be worn whenever there is a risk of direct contact with blood or body fluids, and the hands washed after removing the gloves.

Masks should worn whenever there is a risks of splattering blood (i.e., when bloodletting) or with a patient who has active tuberculosis.

Use protective barriers, such as plastic-lined paper tray covers.

Dispose of sharps in the appropriately labeled or color coded sharps disposal container. Never overfill sharps containers.

Disinfect treatment room surfaces daily.

Clean and sterilize equipment contaminated with blood or body fluids, or use disposal equipment.

To clean blood or body fluid spills, use a 1:100 solution of sodium hypochlorite or bleach (1/4 cup bleach in 1 gallon of water) to clean smooth surfaces. Discard any bleach solutions over 24 hours old and prepare fresh solutions daily.