Infection Control – There’s a right way, and a wrong way

The quote below was actually spoken by a member of a hospital committee on infection control to the Vice President of a healthcare laundry. The committee had decided that the sign on the gown would be a great way to encourage caregivers to be more diligent in following the hospital's hand washing protocol. An increase in hand washing would absolutely decrease the number of hospital acquired infections. Good job committee, but OMG! Could this methodology be any more demeaning, or cause any more alarm to the patients? Is it a good idea to turn the patient (client/customer) into a billboard for the sake of infection control? Are HAIs so unpreventable that we have, even for a minute completely disconnected the infection from the patient? Where for art thou, "First, Do No Harm"?

“Let’s print our patient gowns with a sign on the chest that says, “Wash Your Hands"!”

Joint Commission, CDC and many other regulatory agencies have been focused on nosocomial infections for many years. Still, today, reducing the number of patients acquiring infections is a major challenge for healthcare institutions. While there has been progress, the statistics remain daunting, with an estimated 1.7 million hospital acquired infections resulting in 99,000 U.S. deaths in 2002 alone. The cost of all U.S. HAIs is estimated at between $35.7 and $45.0 billion per year in 2007 dollars.

Given this huge cost in life and treasure, it makes sense that policies have been put in place for hand-washing, isolation of MRSA and other patients, even brushing patient's teeth and cleaning under their fingernails on a daily basis. Advanced procedures for inserting complicated and expensive central lines, urinary catheters, and other medical devices have been developed to help lower infection rates. More and more difficult- to- enforce policies and procedures are implemented every year. And despite these efforts, the rate of HAIs remains alarmingly high, and the cost of medical care continues to rise.

Although effective to an extent, these new procedures take more clinicians more hours to accomplish. These hours are paid for either in increased labor costs, or in requiring the same number of already overburdened caregivers to accomplish more in the same number of hours each day. Every new policy and procedure added comes with a cost of training, enforcement, and opportunity:  What went out the window to make time for doing "X"?

With Medicare not covering HAIs, and the cost of healthcare in general rising out of control, it is critical that simple, cost effective solutions be applied to the problem of hospital acquired infections immediately. While lowering the statistics is important, the right way to approach it is the way that provides the best experience for the patient.

Inspired to put patients first

One nurse with years of bedside experience thought the same thing. As she administered bedside care in the ICU, she wondered, "Why do we have all these new, sophisticated, expensive devices and complicated procedures which cause the patient more discomfort?  All the I.V.s, drains, central lines, and feeding tubes are hidden under the patient gown, pulling on the dressings at the insertion sites. I can't see them all to make sure they are properly connected, and what I don't see I may not disinfect per hospital protocol. Trying to get the patient walking as soon as possible after surgery could be a lot more comfortable for the patient and care-giving could be faster and more effective for the nurse. Hmmmm...?"

As it happened, right about the time she started thinking this way, the nurse's husband suffered a heart attack and went into the hospital for bypass surgery. She had seen patients' discomfort and indignity for years, but it really came home to roost when her own husband had a telemetry unit hung around his neck in a little cloth pouch. With multiple I.V.s coming up out of the neck of his gown, and his backside in plain view for the world to admire, the normally outgoing, gregarious, 230 pound, talk to everyone man was reduced to a silent, sullen, uncomfortable pincushion. He was depressed.

With that, the nurse became passionate about designing a new patient gown from the perspective of the patient, with the goals and tasks of the caregiver in mind. The right gown would provide comfort and security for the patient instead of being a source of embarrassment. A correctly designed gown could make patient care faster and easier and help to make advanced medical devices more effective, rather than being a source of inefficiency, and a potential contributor to the high rate of infections.

Three years later the ECT Patient Gown was ready for testing, and began to receive positive acclaim.

The nurse and her husband took a sample of the gown into the hospital where he had received his life-saving surgery and it was love at first sight. The gown had a pocket for the telemetry unit, eliminating the need for a separate cloth pouch. The design included snaps on the sleeves to allow I.V. tubes to pass through, allowing I.V. fluid bags to stay attached when the gown needed to be changed. The gown has an additional three fenestrations conveniently located to provide easy access for central lines, feeding tubes, and gastrostomy connectors, while minimizing incision exposure and stress. In addition, there are two utility pockets with inside slits to accommodate drainage devices. And the gown was cut wide enough, with a generous overlap in back to provide most patients coverage with dignity. Because of its most impressive, useful and unique attributes the gown was awarded design and utility patents by the U.S. Patent office. More important than the features was that it did not make matters worse for the patients.

There are goals and then there is THE goal

With all of the pressures to reduce negative trends, rack up better statistics, keep up with targets, lower costs, blah, blah etc. - keeping the actual patient experience positive is being squeezed out of the picture. There is a wrong-headed belief that if a problem is persistent it can only be solved by out-of-the box thinking. Cutting edge research and development, requiring bigger budgets has to produce  more advanced technology so we can have the right tools to fight against these pervasive statistics. We had better get out in front of this HAI epidemic even if it means throwing more money, convoluted policies and more time-consuming procedures at it as fast as we can.

This is not to say that we have made the conscious decision to sacrifice the patient in order to save him; that would be goal-setting turned backwards. But stop a moment and look at what has happened. We have worked so hard, with such a laser focus on the infection reduction goal, that is exactly where we are today - thinking that the patient needs to become a reminder to practice good healthcare. Ridiculous.

In September, 2009 the 16th U.S. Surgeon General, Dr. David Satcher became acquainted with the new  ECT patient gown, and mentioned it to a forum of manufacturers and health system purchasing executives as, "Exactly the kind of product needed to help combat the high cost of healthcare today." Putting the patient first works! There is power to heal within the patient himself that we can harness if we don't bury it under expensive devices, mountains of protocol and hours of procedures. Making it easier for caregivers to provide the best care, comforting patients so they get out of bed to walk, and check out of the hospital in less time is The Goal. Not expensive, not complicated, and not out-of the-box. Simple may be the best solution.