Bacterium, beware

At a recent meeting of Community General Hospital's Quality Committee, Chairman Dr. David Tyler made the following comment after Sue Chamberlain concluded her report on infection control:

"If I were a bacterium, I would be very scared to see Sue in my neighborhood."

Sue Chamberlain, Community's Director of Infection Control Program at Community General Hospital will be honored November 1 by the Onondaga County Medical Society.

I have written many times about infection rates. Thanks to Sue -- and her colleague Dr. Mitch Brodey, Infectious Disease Officer -- Community's infection rates are well controlled, and our compliance with surgical infection protocols is strong.

The hospital's staff posts immunization rates that are among the best in the county, and compliance with hand washing policies by employees and physicians are consistently well above average.

Sue is routinely consulted for her infection control experience by the Department of Health and by other hospitals -- and now she will be honored by the Medical Society

I thank the Medical Society for recognizing Sue for her expertise and accomplishments.

Today's Legionella announcement

This afternoon Dr. Cynthia Morrow, the Onondaga County Health Commissioner, announced that seven cases of Legionnaires’ disease were reported in the county over the past ten days. This includes four unconfirmed cases that Community General Hospital reported last week.

Obviously, there's a fair amount of news coverage this evening, including The Post-Standard, and Central New York television stations WSYR, WTVH, WSTM, and News10Now.

The Department of Health’s preliminary investigation identified that all of the unconfirmed cases were on or near Onondaga Hill, including at Community General Hospital. The source of this cluster of cases has not yet been determined.

Last week Community supplied the Health Department with water samples from both the hospital and the physicians’ office building cooling towers. In addition, over the course of the past several days, Community has undertaken additional measures involving experts in water treatment to assure disinfection of the cooling towers. Keeping Legionella below detectable levels in cooling towers at all times is practically impossible due to the ubiquitous nature of the bacterium, according to the Association of Water Technologists.

Community has routinely tested the hospital’s cooling tower and water supply. Also, Community has for years been one of the relatively few hospitals that actively tests for Legionella all patients who have pneumonia.

The office building cooling tower did recently test positive for the bacterium. In cooperation with the Health Department, we completely disinfected and sanitized that tower to eliminate the bacterium (even before test results were received).

Dr. Mitchell Brodey, Community’s Infectious Disease Specialist, and Sue Chamberlain, RN,CIC, our Director of the Infection Control Program, have been fully engaged with surveillance and with communications with the Department of Health, as has Community's engineering staff. We are glad to work with the state and county health department professionals, and we will continue to do so.

Our low infection rate

It was great to see Community General Hospital's hard work on reducing infections reported in this morning's Post Standard.

The news story was based on data released today in the New York State Hospital Report Card by the Niagara Health Quality Coalition.

The report included a graph (not available in the newspaper's on-line version), comparing infection rates for intravenous lines and catheters among area hospitals, based on 2006 data. The graph showed the infection rates as percentages.

I think it's difficult to appreciate such differences when small numbers are displayed in a percentage format. How significant is the gap between the highest infection rate (0.686%) and the lowest rate (0.090%)? To me, it's not immediately apparent.

So I changed the newspaper's display to show infection rates for every thousand patients who were discharged from local hospitals (see the graph, above). This makes the difference readily understandable. Specifically, the highest infection rate was 6.86 infections per 1,000. The lowest, 0.90 infections per 1,000.

The difference between the highest and the lowest infection rates was 5.96 patients among every one thousand patients treated at the hospitals.

I'm proud of what Community General Hospital has accomplished in keeping our infection rate below the state average (2.21 per 1,000) and below the rates of other local hospitals.

Congratulations to the doctors, nurses, clinical and support staff for their conscientious efforts in controlling infections! And a special hats off to Mitchell Brodey, MD, infectious disease specialist, and to Sue Chamberlain, RN and her infection control staff.

VHA honors ICU for having no VAP cases

Congratulations to the staff and leadership of the Intensive Care Unit (ICU) at Community General Hospital. Because of their accomplishment, our hospital will receive an award for excellence at the VHA Leadership Conference, May 4, in Philadelphia, PA.

The award recognizes Community for having no cases of ventilator-associated pneumonia (VAP) for 12 consecutive months.

I’d like to acknowledge and thank Dr. Russ Acevedo, [1] ICU Medical Director, and the intensivist physicians who practice with him in the ICU. Appreciation also goes to Sue Kompf, RN, Staff Educator and Acting Manager of the ICU, and her staff. My thanks as well to Dr. Mitchell Brodey, Infectious Disease Officer, and to Sue Chamberlain, RN, Director of the Infection Control Program.

According to the Institute of Health Care Improvement (IHI):

VAP is the leading cause of death amongst hospital-acquired infections, exceeding the rate of death due to central line infections, severe sepsis, and respiratory tract infections in the non-intubated patient. Perhaps the most concerning aspect of VAP is the high associated mortality.

An article in Chest, published by the American College of Chest Surgeons, reports that VAP increases the time an ICU patient spends on a mechanical ventilator, as well as adding to the length of a hospital stay even after a patient is discharged from an ICU.

The Society of Critical Care Medicine among others, has identified a “bundle” of activities that “achieve significantly better outcomes when used together,” including elevating the head of the ICU bed, daily “sedation vacations” and assessments of a patient’s readiness for extubation, as well as prophylactic treatment[2] for peptic ulcer disease and deep venous thrombosis (DVT).

Community was notified of the honor by Curt Nonomaque, President and CEO of VHA, Inc., who said, “This award honors organizations that have differentiated themselves around national performance standards by achieving exceptionally high levels of performance.”

It is our second VHA award. In 2006 Community was honored for excellence in the clinical care of patients with heart failure (at left)

Congratulations on this milestone in quality patient care!

[1] Dr. Acevedo also directs the ICU at Crouse Hospital, and he is the chair of the Respiratory Care Network Steering Committee of the American College of Chest Physicians. Congratulations to Crouse Hospital, which will also be honored by the VHA for having no VAP cases in 12 months.
[2] “Prophylaxis” comes from a Greek word that means guarding against or preventing something. In medicine, a prophylactic treatment is a medical or public health procedure that helps prevent disease or injury.

All fish swim in the same water

Before I began the blog, I wrote weekly messages as short letters to the employees, physicians, volunteers, and auxilians of Community General Hospital – to all the members of the CGH family. Hand washing, infection control, and standard precautions have been consistent themes. Here are excepts of past letters that have not been posted as blog entries.

From “All fish swim in the same water,” March 5, 2005
“If you saw a co-worker or someone from another department fail to wash hands, what do you do? Be embarrassed for them? Bite your tongue and say nothing? I suggest that you say something, such as: ‘Excuse me, did you forget to wash your hands? You must have a lot on your mind – just trying to help.’

“The fact is, hand washing is often done privately. Most of the time there is no one to remind us, just a sign (on the wall)…and that little voice in our heads that tells us to do the right thing. All of us who work in health care share the responsibility for keeping our patients and our co-workers safe. That responsibility starts with hand washing….

“In the aquarium all fish swim in the same water. In our world, we breathe the same air and touch the same surfaces. We touch our patients. Hand washing is not something to take for granted.”

From “Why the obsession about hand washing?,” March 19, 2005
“Nationally, statistics show hospital personnel comply with hand washing requirements only 54% of the time. That is shocking. At CGH our compliance last year averaged 90%. That is almost twice the national rate, but it is not good enough. Even a single instance of noncompliance could put an employee or a patient at risk of infection.”

From “A culture of safety,” July 3, 2005
“Last month the State Legislature passed a bill that will require hospitals to report publicly infection rates for surgical wound infections and for bloodstream infections related to central lines in ICU patients…..

“This particular bill received a lot of attention statewide and across the nation, thanks to publicity generated by the Committee to Reduce Infection Deaths (‘RID’), a non-profit organization that has worked to require the public reporting of hospital infection rates. I wrote to RID earlier this year in support of its efforts…”

From “Not Halloween masks,” October 29, 2005
“As you can see, [hand hygiene] compliance in October is 95%. That sounds great, but consider this as you look around the cafeteria. Of the 99 other people there, who are the five who, on average, fail to wash their hands? When it comes to infection control, we cannot be satisfied with 95% – 100% has to be the goal.”

That's Mitchell Brodey, MD, Hospital Epidemiologist, in the photo, above. Actually, it's a photo of the life-size cutout of Dr. Brodey that makes its way around the hospital to remind everyone at CGH about the importance of hand washing. Dr. Brodey's doppelganger has been "on duty" since September, a companion to the life-size cutout of Sue Chamberlain, RN, CGH's Infection Control Program Director, who has "patrolling" the halls and departments since July.