Tuesday, May 31, 2011

Infections at the VA. Good News and Bad News


An interesting juxtaposition of news releases turned up today in an email called the “Critical Care SmartBrief.” One story described a significant reduction in infections at a Texas VA hospital, which had instituted a policy of swabbing the nose of every admitted patient looking for MRSA. The hospital’s program was part of a larger study published in the New England Journal of Medicine.

The other article described a problem of poor hygiene in VA hospitals in five states which has necessitated warnings to 13,000 veterans. Among other issues, a dentist was found to have used unsterile equipment. He also did not change dirty gloves between patients. So far, 61 patients have tested positive for hepatitis and 8 for HIV.

These two anecdotes raise some important issues. Although some health care quality gurus would have you believe that all errors are due to system failures, I believe that most are caused by humans. How could a 21st century dentist, presumably a graduate of an accredited school, use unsterile equipment and dirty gloves? You could ask, was he operating in a vacuum and should other personnel have noticed his poor technique? Can the VA ever improve its image? Is it possible to eradicate all mistakes in a complex environment like a hospital?

In the words of the late Roseanne Rosannadanna, “It’s always something!”

5 comments:

TS said...

I'd be interested to hear your take on

http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html

Although I suspect I know what you'll say

Skeptical Scalpel said...

Thanks for posting the link. I'm only glad I didn't have to sit through it at a graduation exercise. I have nothing against checklists. I use them myself. Of course, he did write a book about them.

Now we're moving on to pit crews. I think I'm going to retire to my medical home.

Libby said...

I agree with you, human error (and ignorance, apathy, stupidity) cause errors like the ones you stated. Not changing gloves between patients? Isn't that dental school lesson 1? Geesh, even in first aid we teach CHANGE GLOVES BETWEEN working with casualties! Unsterile equipment? That is just stupidity. It has been, what, 151 years since Lister figured it out that keeping yourself and stuff clean prevented the spreading of germs?
You can use checklists up the ying-yang and still someone CHOOSES not to do something. It doesn't get missed, it is a choice not to wash hands, equipment, site or whatever.
Should the other staff say something? Sure, and maybe endure the biting sarcastic wrath of the "boss" (and loose a much needed job?). Maybe something had been said/done and to no avail. He chose not to follow what is now common knowledge--keep germs from spreading by washing yourself & the stuff you use. Simple, but he CHOSE not to do it.
Is is possible to eradicate all errors in a complex environment? No, because humans are involved (and computers) there will be mistakes. But if people took responsibility of their own actions there would be less stupid ones like the ones you cited. "Gee I didn't know I should be changing my gloves between patients or using sterile equipment" just doesn't cut it. He probably didn't wash his hands either. And laying blame on cost cutting doesn't cut it either. Cough up for the gloves and a working autoclave VA!
just sayin' like it is, just like Roseanne Rosannadanna always did.

Chris Porter MD said...

The VA image - tough to overcome. A sketchy event in one clinic or hospital tarnishes the system of 520 facilities. Size of the system almost guarantees negative branding that lasts. Smaller systems like Mayo (70) or Kaiser (35) have time (and resources) to rebuild an image between events.

Skeptical Scalpel said...

@Libby

Agree. Does the checklist now have to include "Change gloves now and then"?

@Chris

Agree. This is why the VA will never fix its image.

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