ECRI: Sterile Processing, Antimicrobial Stewardship Top Patient Safety Concerns

Challenges concerning sterile processing and antimicrobial stewardship appear on the ECRI Institute's "Top 10 Patient Safety Concerns for Healthcare Organizations 2020" report.

Coming in fifth on the list is "Device Cleaning, Disinfection and Sterilization." In an executive brief, ECRI states that sterile processing failures can lead to surgical site infections (SSIs). Furthermore, "Incidents involving improperly reprocessed instruments can potentially result in devastating effects on patients, damage to organizational and provider reputations, citations and fines from regulatory bodies, prompt review by accrediting agencies and lawsuits."

Coming in eighth is "Antimicrobial Stewardship," which also appeared on last year's list (as "Antimicrobial Stewardship in Physician Practices and Aging Services"). In the brief, ECRI notes, "Despite the increased focus on the importance of antimicrobial stewardship in healthcare, and increased recognition among healthcare workers and patients alike, antibiotics are still being prescribed unnecessarily, when no longer needed, in the wrong dose and with the wrong indication—any of which can increase antimicrobial resistance. Many of these antibiotics are being prescribed in care settings such as long-term care organizations, urgent care centers and dentist offices."

ECRI states that it creates the annual list of patient safety concerns to help healthcare organizations proactively identify and respond to safety threats. The list is compiled using data on patient safety events and concerns and on the "judgment of interdisciplinary patient safety experts from inside and outside ECRI."

The top patient safety concern for 2020 is "Missed and Delayed Diagnoses." Rounding out the top three are "Maternal Health Across the Continuum" and "Early Recognition of Behavioral Health Needs."

KHN: Nursing Homes Struggling With 'Basic Infection Prevention Protocols'

A Kaiser Health News (KHN) report highlights the struggles of many nursing homes around the country — including some that have received the highest government rating for overall quality — with following "basic infection prevention protocols."

A KHN federal records analysis revealed that more than 9,000 nursing homes — or about 61% of all such facilities — were cited for one or more infection-control deficiencies.

Furthermore, the analysis showed that since the beginning of 2017, government health inspectors cited more nursing homes for failing to ensure workers follow infection prevention and control rules than any other type of violation. KHN notes that inspection reports indicate many of the infection prevention and control errors cited are attributable to lapses in following fundamental best practices, such as workers not washing their hands as they move between patients and failing to don masks, gloves and gowns when in rooms with isolated, contagious patients. Violations were also more common at homes employing fewer nurses and aides than those with higher staffing levels.

Patricia Hunter of the Washington State Long-Term Care Ombudsman Program, which advocates for residents of nursing homes, adult family homes and assisted-living facilities, told KHN, "It's all these little things that are part of infection-control practices that when they are added up can create an environment for an infection outbreak."

Of those nursing homes with the maximum government overall quality rating (five stars), KHN noted that 4 in 10 have been cited for an infection-control lapse. This includes the Life Care Center in Kirkland, Wash., where several residents have succumbed to the coronavirus. One publication has described the nursing home as the "national epicenter of coronavirus."

Unfortunately, nursing homes are likely to continue struggling with infection prevention and control. As KHN notes, these facilities are challenged by frequent staff turnover, new workers less likely to know facility protocols, keeping potentially infected workers at home (in part due to low pay and limited time-off benefits) and finding replacement staff.

On Wednesday, March 4, the Centers for Medicare & Medicaid Services (CMS) announced several actions it hopes will limit the spread of COVID-19. These include the following:

• Issuing a call to action to healthcare providers nationwide to ensure they are implementing and maintaining infection control procedures.

• Directing state survey agencies and accrediting organizations to focus facility inspections exclusively on issues related to infection control and other serious health and safety threats, beginning with nursing homes and hospitals.

• Outlining a survey regime that focuses on infection control and other emergent issues, including COVID-19.

CMS Administrator Seema Verma stated,. “All healthcare providers must immediately review their procedures to ensure compliance with CMS’ infection control requirements, as well as the guidelines from the Centers for Disease Control and Prevention (CDC).” 

WHO: PPE Shortage Could Increase Health Worker Risk From COVID-19

The World Health Organization (WHO) is warning of increased risk for health workers of exposure to COVID-19 and other infectious diseases due to the growing shortage of personal protective equipment (PPE).

As WHO notes, disruption to the global supply of PPE has been caused by "rising demand, panic buying, hoarding and misuse" of PPE, including medical masks, respirators, gloves, gowns and aprons. As a result, health workers are increasingly finding themselves ill-equipped to care for patients, including those with or believed to have the new coronavirus.

WHO is calling on industry to increase manufacturing of PPE by 40% and governments to incentivize such production, including easing restrictions on export and distribution of medical supplies.

"We can't stop COVID-19 without protecting health workers first," said WHO Director-General Dr. Tedros Adhanom Ghebreyesus.