Saturday, April 28, 2007

Weird, glowing substances

There's an episode of Scrubs1 that shows the incidental passing of an infectious agent from medical personnel to patients and visitors and back to medical personnel. The infectious agent is represented by a green, glowing substance that illuminates the hand or mouth or nose as it is transferred by touch from person to person. Of course, Scrubs is a television program played for laughs.

If infectious diseases were actually weird, glowing substances, it might be easier to prevent their inadvertent transmission. We would all see exactly what we’re dealing with. OK, I’m back to one of my favorite subjects2 – hand washing, one of the most important things we can do to prevent harm to our patients.

Getting medical professionals to wash their hands was a struggle 150 years ago. Before the germ theory of medicine was understood, a Hungarian physician by the name of Ignaz Philipp Semmelweis speculated that the unwashed hands of physicians and medical students contributed to the significant infection rates of maternity patients. Puerperal fever (childbed fever) was common in mid-19th-century hospitals and mortality rates ranged from 10% to 35%.

Dr. Semmelweis observed that the mortality of patients who were cared for by physicians and students was up to three times higher than that of patients cared for in midwife wards. When a friend of his died after cutting his finger in a post mortem, Dr. Semmelweis speculated that the source of the disease that killed his colleague was the same as that killing maternity patients. He insisted that medical personnel wash their hands in a chlorine solution before each maternal examination. The result? The death rates of women in Dr. Semmelweis’ hospital dropped from 12% to 1%.3

You would think that Dr. Semmelweis’ dramatic results of the early 1850’s would have prompted widespread hand washing throughout Europe, but hand washing was resisted by the medical establishment. This was in part because Dr. Semmelweis did an inconsistent job of explaining and promoting the practice of hand washing. But it was also because the medical people of that day had a hard time acknowledging their hands were “dirty” and because it would be a decade before Louis Pasteur definitively demonstrated germ theory (and even then, the theory was not immediately accepted).

Today – many generations and many medical advances later – we understand the importance of hand washing. So why is national compliance with hand washing protocols so poor in hospitals across the country?

Last year hand washing compliance at CGH averaged 94.5%. That is excellent, compared with the 50-60% compliance rates reported for hospitals generally.4 But what does it say about the 5.5% of CGH people who do not comply?5 What additional risk does a failure to follow hand washing policy pose for patients, for visitors, for fellow workers – or for our families when we greet them after work?

That is why next Wednesday, May 2, is Hand Hygiene Day at CGH.

At the start of each shift on May 2, members of senior management and I will join Sue Chamberlain, Director of the Infection Control Program, in distributing free hand sanitizers to each employee (and to anyone else!) who enters CGH. It’s a way to promote the importance of hand washing for everyone – no exceptions!

Special thanks to the manufacturer of Purell® for providing CGH with the free supply of product for Hand Hygiene Day.

Because of Drs. Semmelweis, Pasteur, and the other pioneers of medicine, we know how to prevent the spread of infection. Thanks to hand sanitizers, it is easier than ever to do so.

Let’s use Hand Hygiene Day to reach 100% compliance – and stay there.

[1] Scrubs is a half-hour comedy on NBC-TV that focuses on the surreal experiences of a medical resident surrounded by bizarre characters.

[2] I have written before about the importance of hand washing and infection control: “All fish swim in the same water,” March 5, 2005; “Why the obsession about hand washing?” March 19, 2005; “A culture of safety,” July 3, 2005; “Not Halloween masks,” October 29, 2005; “Lowest infection rate in Syracuse,” June 24, 2006; and “A tipping point,” March 18, 2006. I have re-posed excerpts from these letters on the CGH website: Click on “CGH Family Letter” and look for “Excerpts – Letters about Infection Control.”

[3] The sources for this information are: Emerging Infectious Diseases, Vol. 7, No. 2, Mar–Apr 2001, published by the Centers for Disease Control ( and (

[4] On April 13, 2007, Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston, MA, disclosed in his blog that “[a]fter months of intensive effort…our compliance with hand hygiene has risen from 52% on medical-surgical floors to 57%....And some floors remain at or below 40%...The results of one particularly noncompliant floor have prompted one of our Chiefs to write to his physicians: THIS IS ABSOLUTELY INTOLERABLE! It is bad patient care…” (original emphasis) To see Mr. Levy’s blog entry, go to:

[5] CGH hand washing compliance is tracked monthly by staff who make unannounced observations.

Saturday, April 21, 2007

Why we’re in this business

I'd like to share an e-mail I recently received from Lois Sperling, a social worker on our sixth floor. She wrote me on April 12, and it will be obvious why I consider her message important enough to share. I use this message with her permission.

I became an employee of Community General Hospital at the end of December 2006 as the Social Worker for the RHCF [residential health care facility].

In my position, I hear the good and the bad. There are often issues surrounding patient’s care and experiences but most of the input I have been receiving has been positive which is why I am writing to you.

On Wednesday…I heard from three different residents and/or their family about the care on this unit. They used expressions like “wonderful experience”, “very compassionate staff”, and being admitted on the 6th floor as something that was meant to be.

Today I witnessed two aides holding the hands of a dying resident with tears running down their faces. The daughter told them they were like family. The resident has only been here three weeks.

As I sit at my desk typing this email, I hear a resident’s spouse as he passes my office say to a male aide that he makes life worth living! I can’t help smiling almost in disbelief at the impact any of us can have on someone at any given time. That aide was simply being himself and not doing anything out of the ordinary for this person.

I have had very positive experiences in the past at this hospital as a patient and as a family member. Now I am proud to be a part of Community General Hospital and the team that serves the residents on the 6th floor.

Here is my response of April 13

What a wonderful message to receive. Thank you for sharing these thoughts. Life is often difficult for us, for those we love, for those we know. What a privilege it is to make life better, even a little bit, for others. And how thoughtful you are to share this with me.

Saturday, April 14, 2007

The senator and the budget

In December 2002 State Senator John DeFrancisco invited a couple of us to his Albany office to meet with officials of the State Department of Health. The subject was CGH’s application for the Physical Medicine and Rehabilitation Unit (PM and R), which had been stalled in the state’s approval process for a year or longer. The Senator thumped the desk. He looked each official in the eye. He said it was time to call the question, to get moving, to make a decision.

That meeting broke a logjam, and several months later the state officially approved the PM and R unit for CGH. In December 2003 Senator DeFrancisco helped us cut the ribbon at the PM and R opening on 4 East. I have a picture of that event in my office. He arrived here a few minutes before ribbon-cutting and asked me about CGH plans. I told him about the cardiac catheterization laboratory being developed in partnership with St. Joseph’s Hospital Health Center. In his typical way, the Senator asked several blunt questions, then said simply, “I’ll support it.”

Fast forward to the opening of the cardiac cath lab on February 14, 2006. The Senator had not only endorsed the project to the state, he had obtained $500,000 in state funds for it. A plaque outside the cath lab commemorates his assistance in securing that funding.

Two weeks ago the Legislature passed the 2007 state budget after a particularly difficult budget season.[1] As proposed by the Governor, the budget would have cost CGH some $940,000 a year. In the end, some of the proposed cuts were reversed by the Legislature. The new state budget will cost CGH about $440,000 a year. That is a significant reduction in revenue, but it is about a $500,000 improvement over the budget’s starting point.[2]

Two days after budget passage, Senator DeFrancisco called me. He said he had been able to secure in the final budget $200,000 in capital funds for CGH. “I know you can use it,” he said. Needless to say, I expressed appreciation for his assistance.

This was a difficult budget year and, despite the relative improvement for CGH – that is, fewer budget cuts than first proposed – the budget is a problem. All hospitals should have a bottom line of two or three percent a year so they can fund the necessary upgrades in equipment and physical plant.

CGH has been fortunate to have had a positive bottom line in each of the last four years, but in every case it is less than one percent. Enough to get by. But not what we should be earning as we make the longer term investments in patient care. The new state budget does nothing to help. It merely hurts us less than it could have.

In this difficult environment, CGH has had a constant friend in Senator DeFrancisco. He is interested in what we do, he has expressed support when needed, and he has secured additional state funds when it helps.

Thank you, Senator DeFrancisco.

[1] I wrote about the “The worrisome state and federal budgets” in my family letter of March 10, 2007. For a copy, go to

[2] In the weeks since budget passage, there has been a lot of talk in government and health care circles about who won and who lost the budget battle. Health care spending was particularly contentious this year with statewide advertising by SEIU 1199 and Greater New York Hospital Association, as well as advertising by the Governor himself. According to Crain’s Health Pulse, April 12, 2007, the Governor’s campaign manager said the budget includes $1 billion in health care cuts of the $1.3 billion initially proposed, or 77%. The Governor’s office considers the budget battle “a success.”