For Duke University Health System, cleaning up may help keep costs down for patients.
Last month, several Consumer Reports National Research Center surveys showed that 4 percent of patients and 28 percent of nurses saw problems with hospital cleanliness. DUHS infectious disease specialist Dr. Deverick Anderson recently published a study showing a lack of cleanliness can be costly for patients.
Data from seven Triangle-area hospitals found that patients who contracted post-surgical infections faced almost $60,000 in additional charges from readmission and an increased length of stay. The Duke University Health System is working to improve cleanliness.
“Until recently, there weren’t many ways to objectively determine how well hospitals were cleaned, with most inspections consisting of a cursory glance as employees did rounds or other tasks,” Anderson said. “Duke recognized it as an issue and implemented a number of methods to assess the cleanliness of its clinics and operating rooms.”
Duke already had a program through which hospital staff would leave invisible liquid dots on surfaces and return with an ultra-violet light to check whether the surfaces were adequately cleaned, Anderson noted.
He added that like the six other hospitals he studied, Duke is successful at preventing surgical site infections, as only 1 to 2 percent of patients develop them. Still, problems with hospital cleanliness revealed a seven-fold increase in mortality rates and a total cost of $19 million dollars for the seven hospitals examined, so Anderson said he believes an intervention would be cost-effective.
“Duke does pretty well in preventing surgical site infections,” Anderson said. “That was somewhat the point of my article, that even at these well performing hospitals you add it all up and it’s $19 million dollars.”
According to HealthGrades, a health care ratings company, and the Agency for Healthcare Research and Quality, Duke is rated average among the national standard for lack of infections acquired at hospitals.
Associate Chief Nursing Officer Yvonne Spurney said hand-washing is an issue in hospitals. Unlike procedures that are trained, such as sterilizing medical equipment, she said hand-washing is sometimes forgotten because it is so common.
According to the Consumer Reports survey, 26 percent of nurses reported that hospital staff would sometimes not wash their hands.
Director of Nursing Practices Judy Prewitt said hand-washing is affected by unpredictable patient interactions.
“You have that patient with partial hypertension who’s a little woozy and needs to be helped,” Prewitt said.
These unexpected interactions are sometimes forgotten and hands are not washed, she added.
Hospitals are utilizing a number of basic methods to reduce incidents of contamination. They are also employing new technologies to keep vulnerable patients in a safe, pathogen-free environment.
“We are using a UV-light emitting device that we can wheel into rooms and we can turn on and [use to] disinfect the room after initial cleaning,” Anderson said, adding that the device will be used after hours in areas with high traffic.
Prewitt said places like children’s play rooms should receive special attention because they are filled with germs that can cause infections.
Other ideas that are currently being considered include Radio Frequency Identification wristbands that alert the wearer when he forgets to wash his hands after interacting with a patient.
“Although technology can definitely help by acting as a memory aid, we can’t entirely rely on technology,” Spurney said. “Sometimes working together and keeping an eye out for each other works just as well.”
Prewitt said she believes that assessing past incidents and working on ways to improve procedures could be more beneficial and cost-effective.
“We’ve done a huge amount of work on catheter-associated infections and we’ve cut that down substantially,” she said. “When you start looking at how that translates, that’s money. It’s also patient lives.”
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