Tag: OR

Germs. The Pseudoscience of Quality Improvement


No one wants a hospital-acquired infection—a wound infection, a central line infection, or any other kind.  But today, the level of concern in American hospitals about infection rates has reached a new peak—better termed paranoia than legitimate concern.

The fear of infection is leading to the arbitrary institution of brand new rules. These aren’t based on scientific research involving controlled studies.  As far as I can tell, these new rules are made up by people who are under pressure to create the appearance that action is being taken.

Here’s an example.  An edict just came down in one big-city hospital that all scrub tops must be tucked into scrub pants. The “Association of periOperative Registered Nurses” (AORN) apparently thinks that this is more hygienic because stray skin cells may be less likely to escape, though there is no data proving that surgical infection rates will decrease as a result.  Surgeons, anesthesiologists, and OR nurses are confused, amused, and annoyed in varying degrees.  Some are paying attention to the new rule, and many others are ignoring it.  One OR supervisor stopped an experienced nurse and told to tuck in her scrub top while she was running to get supplies for an emergency aortic repair, raising (in my mind at least) a question of misplaced priorities.

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When a Fire Breaks Out In the Operating Room

Summary: It
is hard to imagine fire engulfing a patient on the operating
table. But it does happen—even at highly respected medical
centers. An electrical device is turned on while the patient is
receiving oxygen . . . Or, electricity meet an alcohol-based solution
that was used to clean a patient’s skin before making an incision .

Rarely is a patient  severely burned in an OR. Although
the Cleveland Clinic experienced six surgical fires last year,  only
three patients were hurt and they suffered minor burns. Yet
it is amazing that there were six surgical fires at the widely
respected Cleveland Clinic –and that the Clinic didn’t report the fires.
In Ohio, as in many other states, hospitals are not required to tell
anyone about these adverse events. And patients who
receive compensation are often asked to sign confidentiality agreements.
(To be fair, when Medicare inspectors came in March, the Clinic
voluntarily talked about the fires that had occurred over
the previous 12 months. It is not at all clear that the Clinic was
trying to bury the information. It just didn’t have anyone to tell. That
is the problem. )

Surgical fires, like many accidents that hospitals
call “adverse advents” could be prevented. If more errors
and accidents were made public, medical professionals could analyze
causes and publish guidelines that would make patients safer, not only
at one hospital, but nationwide.

Under the new reform legislation, regulation is all
about transparency. Medicare will insist that hospitals report infection
rates. And my guess is that more and more states are going to require
that hospitals publicly disclose accidents and errors.

Meanwhile, groups such as the Empowered
Patient Coalition
and the Consumers Union Safe
Patient Project
providing new channels for patients to report these accidents.


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