Infection Preventionists: Innovative Approach to Age-Old Problem

By Michael Anne Preas, RN, BSN, CIC
Infection Prevention and Control

Editor’s Note: A December Associated Press article on infection preventionists, which focused on the University of Maryland Medical Center, received widespread coverage. In the Q&A below, Michael Anne Preas (pictured at right with UMMC’s infection prevention and control team), one of UMMC’s infection preventionists, provides more information on what she and her colleagues are doing to keep our patients safe, and steps you can take to reduce your infection risk.

What is an infection preventionist?

At the University of Maryland Medical Center, I am one of 4 preventionists (IPs) who each have areas of responsibility throughout the hospital to keep hospital-acquired infections to a minimum. We partner with the front-line staff — nurses, physicians, patient care technicians, environmental services staff and others — to ensure that every aspect of a patient’s experience in the hospital is as safe as possible.

Each IP is paired with a hospital epidemiologist — a physician trained in the study of how diseases are transmitted. This pairing offers a unique opportunity to have a hands-on influence to infection prevention partnered with a scientific expert to address complex healthcare-associated infection issues.

Although we each cover a specific area and provide education, we rely on a close partnership with the front line nursing staff and physicians to ensure that the best infection prevention measures are followed.

What do we do?

• Teach best practices to reduce infection risk to patients and staff.
• Set goals for reductions in infection rates within the hospital.
• Collect and report infection data both publicly and internally.
• Collaborate with public health officials when there are outbreaks.

What do our healthcare workers do to reduce the patient’s infection risk while in the healthcare setting?

• Wash hands frequently, always before and after patient encounters.
• Let patients and families know what they can do to prevent infections.
• Let the patient know that it is OK for them to ask anyone who has contact with the patient to “please clean your hands.”
• Manage indwelling catheters safely — this means “scrubbing the hub” or wiping the IV catheter hub with a disinfectant such as an alcohol wipe before giving intravenous medications.
• Collaborate to remove invasive devices such as urinary drainage catheters, central venous catheters, and ventilator tubes as soon as they are determined to be unnecessary for patient care.

What can hospital visitors and patients do to reduce their infection risk while in the hospital?

• Be informed about your treatment plan. Ask questions like: How long do I need this catheter or urinary drainage device?
• Remember that all staff should clean their HANDS frequently and often and always before having contact with you or your loved one. And it is OK for you to ask!
• The most important principle of infection prevention we have all learned in kindergarten: WASH YOUR HANDS!

Honoring the Legacy of Henrietta Lacks

More than 750 people attended one of two events on February 11 to honor the legacy of Henrietta Lacks. The events were hosted by the University of Maryland Medical Center and the professional schools of the University of Maryland.

Mrs. Lacks was an African-American Baltimore woman who died of cervical cancer more than 60 years ago. But her cells, known as HeLa, continued to reproduce in the laboratory and eventually became one of the most important contributions to medicine because of their usefulness in developing vaccines, drugs and other therapies. Her family was unaware of her contributions for decades.

The day event was a symposium that looked into the medical, ethical, social, legal and economic lessons that can be learned from the scientific contributions of Ms. Lacks (See videos of the day event.). One guest speaker was Rebecca Skloot, author of the bestselling “The Immortal Life of Henrietta Lacks.”

High school sophomore Hayley Warren, though, stole the show with a moving speech about how Ms. Lacks’ story and cells have inspired her to find a cure for cancer. Ms. Warren, who got to know about the HeLa cells in a paper she wrote about their impact in medical research, was warmly greeted by many members of the Lacks family in attendance after her speech.

The evening event featured spoken and artistic tributes to Ms. Lacks and her family, more than 30 of whom were in attendance.

UMMC Employees Celebrate Leapfrog Recognition

This one-minute video showcases footage from the Leapfrog celebration held on Wednesday, January 5, 2011 to honor the Medical Center being recognized as a Leapfrog Group “Top Hospital of the Decade.” UMMC was one of only two hospitals in the U.S. to receive this honor, which it earned as a result of being named as one of the nation’s best hospitals for patient safety and quality of care for the fifth year in a row. The celebration gave employees the opportunity to be photographed with the Leapfrog award and frog, as shown in the slideshow below.

Related Information:

Hospital of the Decade an Honor Worth Celebrating

By Chris Lindsley
Blog Editor

UMMC Receives Leapfrog Top Hospital of the Decade Honor
UMMC CEO Jeffrey Rivest (far left) and COO Herbert Buchanan (second from right) with the Leapfrog Top Hospitals of the Decade and Top Hospitals 2010 awards presented last night. Also pictured are Leapfrog CEO Leah Binder (far right) and Leapfrog Board Chair David Knowlton.

Talk about having a reason to celebrate!

Last night at the Leapfrog Group’s 10-Year Anniversary Gala in Washington, DC, the University of Maryland Medical Center was recognized as a Leapfrog “Top Hospital of the Decade” for patient safety and quality of care, one of only two U.S. hospitals so honored.

This award recognizes UMMC’s inclusion on the Leapfrog Top Hospitals list every year since its inception in 2006, including in 2010.

So what makes this award meaningful to consumers and the medical community?

The Leapfrog Group’s national survey measures hospital performance in a range of areas, including patient care outcomes, use of best practices and patient safety initiatives and measures of efficiency. It is the only national, public comparison of hospitals on key issues, including preventing medication errors and infections and standards for performing high-risk procedures. Each year, Leapfrog adds new, more stringent performance measures and expands the criteria for hospitals to meet its standards.

How credible is the Leapfrog recognition?

“Leapfrog has a great amount of credibility because it is founded on evidence-based practices and on actual clinical processes and patient care data, rather than relying substantially on opinions and reputations,” said UMMC president the CEO Jeffrey Rivest. “It is for that reason that we are especially proud of this national recognition.”

How we became a “Hospital of the Decade” is quite a story. View the short video below to find out.

Related Information:

UMMC Patient Advocates Take Proactive Approach to Identifying and Meeting Patients’ Needs

By Odetta James-Harlee
Supervisor, Patient Advocacy

The Patient Advocacy Department, previously known as the Patient Representative Department, was formed in 1988 in response to state regulations requiring that all Maryland hospitals have a formal program for addressing patient complaints.  Since that time, the Joint Commission and CMS have implemented more standards requiring formal complaint mechanisms and have focused on greater attention to patient rights.  Even without mandates, a patient advocacy process is beneficial to improving public image, improving quality of care, improving service and reducing risk.

Under the previous system, two patient representatives responded to all patient concerns in the Medical Center’s inpatient units as well as outpatient clinics. The patient representative operated more on a reactive basis and was known as the Medical Center’s “firefighter” instead of one who could educate staff about preventing these “fires.”  In 2002, the Medical Center recognized the need for change and the Patient Advocacy Department was formed as a result of new customer service initiatives.  We were finally able to take a more proactive approach to identifying any patient or family need.

Patient Advocacy functions have evolved somewhat since the establishment of the department; however, primary objectives and responsibilities have always been to provide prompt response to patient concerns, investigate these concerns by channeling information about patient care issues to appropriate departments and services so that corrective action can be taken and changes in policies and procedure can be made when indicated, and trend and report this data to senior leadership.  The patient advocate has always been able to serve as that neutral link between the patient and the Medical Center.  With assistance from physicians, nursing, and department managers, we are able to resolve concerns that include lack of communication, rude behaviors, long wait times and missing belongings.

In 2006, two medical interpreter positions were added to the Patient Advocacy Department.  We currently have one Spanish interpreter who provides interpretation services to help providers communicate with their non-English and Limited English Speaking patients and are recruiting for the second open position.

Since the department has grown, in addition to working with patients to resolve concerns, we are able to assist patients and families with their requests for hotel accommodations, obtain consents from living related kidney donors for recognition on the Wall of Honor located in the Medical Center, serve on the UMMC Commitment to Excellence’s Patient Experience Team, the Shock Trauma Patient Education committee and Surgical Intensive Care Unit Supportive Care Initiative committee.  Advocates rotate coverage of the interpretation pager, carrying it 24 hours a day to ensure that our deaf and LEP patients receive the sign and language interpretation they need.

To contact a patient advocate, please call:

  • 410-328-8777 or 410-328-7536 for main hospital, outpatient clinic, and general concerns
  • 410-328-1531 for Shock Trauma concerns
  • 410-328-2131 for Adult/Pediatric Emergency Room concerns
  • 410-328-2337, id # 8255 for interpretation requests

Building for the Future

The University of Maryland Medical Center is starting construction of a $160 million, nine-floor trauma/critical care building that will significantly expand its renowned Shock Trauma Center. The 140,000-square-foot building at the corner of Penn and Lombard streets will house 10 state-of-the-art operating rooms and 64 new and replacement critical care beds.

Take an animated tour of the new facility, which is scheduled to open its doors in 2013:

Watch an interview with Leonard Taylor, UMMC’s vice president of facilities who is the project executive for the new building.

“Great Catch” Award Recognizes Staff for Patient Safety Efforts

By Fe Nieves-Khouw
Director, Quality Improvement

Raylyn Miller and Jonathan GottliebEven the best policies and systems to protect patient safety still rely on alert staff members to make a “great catch” when they notice something that could result in an error.

The University of Maryland Medical Center has consistently encouraged staff to report concerns that affect safety and quality. The “Great Catch” Award is an extension of this commitment and rewards staff for “catching” an error before it can affect the patient.

“Sometimes, the only thing standing between a patient and an adverse event is an alert employee who takes action to avert a potential disaster – a ‘great catch,’ ” says Jonathan Gottlieb, M.D., a UMMC senior vice president and its chief medical officer, who created the award and gives it out (above and below).

Seemingly minor errors can have major consequences for a patient, Gottlieb says. “The purpose of the award is to increase our focus on timely recognition and intervention to protect a patient from potential harm,” Gottlieb says. “Themes or patterns learned from these reports will provide another source of evidence from which to draw ways to improve quality and safety.”

The first two “Great Catch” winners are nurses in the Medical Intensive Care Unit: Raylyn Miller, (above, left), withheld an insulin injection that had been ordered by a physician and dispensed by the pharmacy when she noticed the patient was already receiving an insulin infusion.

Thea Epple and Jonathan GottliebThea Epple, (left), stopped a physician leaving the room of a patient with C. difficile colitis when she saw him use only an alcohol-based hand sanitizer, which in most cases would be sufficient. But hand sanitizers don’t reliably kill this particular bacterium.

“She stopped the physician and said, ‘You have to wash your hands with soap and water,’ ” Gottlieb said. “And the reason I know this is that the physician was me.”

The Nominating Process

Any UMMC employee may nominate someone (including oneself) for a Great Catch Award by describing an occurrence involving the care of the patient where harm or potential harm was prevented or averted.

Paired Kidney Exchange: A Major Breakthrough in Kidney Transplantation

By Matthew Cooper, M.D.
Director of Kidney Transplantation

Transplantation is about opportunity. The hardest part about choosing a career in transplantation is knowing the limits of perhaps the most ‘valuable’ valuable resource on this earth – lifesaving organs for those that desperately need them. Every day people die on the waiting list as that opportunity never comes, and the numbers of those added to that list grows exponentially.

We can never allow ourselves to think that there is no room for growth in transplantation. We can never be comfortable with the status quo and must continually reach for that next breakthrough, the next discovery, the next opportunity. The University of Maryland’s Division of Transplantation prides itself on being the place where people come for answers when others leave them with questions.

The University of Maryland has always been a leader in both surgical innovation and opportunities for patients in transplantation. Paired kidney exchange (PKE) is yet another opportunity we offer.  The program is designed for patients that have a living donor that is otherwise healthy and suitable for donation but incompatible with their intended recipient.  In years past we were forced to tell both the donor and the recipient that the only option was to wait an expected 3-5 years for a deceased donor transplant, knowing many would never see that day.

As more and more pairs were found to be incompatible we knew we had to find another opportunity.  Through paired kidney exchange we’ve turned ‘no’ into ‘yes’ and are excited about the possibilities. We’ve invested significant resources —  including designated clinical nurse coordinators — to maintain this specialty program and multiple assistants in our office to facilitate such procedures.

In recent months we’ve performed a four-way kidney exchange, involving eight people from four states, a two-way kidney exchange with a hospital in Minnesota and a third exchange involving a patient at Johns Hopkins, and we have more lifesaving kidney exchanges in the works.

The paired exchange program is an opportunity not all centers are able to offer, in part due to the complexity of the organization necessary to plan these procedures either within the institution or with other medical centers.   This may require flying an organ to another part of the country or operating very early in the morning or late at night to minimize the time the organ is waiting to be transplanted.   Also, there needs to be an institutional commitment, especially with the operating room, to provide space for these multiple transplants and/or odd timing for an operation.  We set high expectations for this transplant program, eliminate barriers for patients, and open the door for many to receive the Gift of Life.

This new program has brought great energy to the transplant division.  We’re seeing patients who either because of blood type incompatibility or high levels of antibodies to their donor now are finding matches after long years of waiting.  We’re seeing their intended donors (most of them close family members) excited about the chance to not only see their loved one free from dialysis but also having the opportunity to help another.  The ‘trickle down’ effect is a miracle itself.  Patients are now coming with potential donors for the PKE program that they never considered because of previous knowledge of blood type incompatibility.  Everyone is now an ‘opportunity’ for one another.

We take living donation very seriously.  We are bound by the principle of “Do No Harm” first and foremost.  Our standards of evaluation and safety of living donation are the highest in the country.  We place great value on the trust not only of the donor but of the recipient and their families who look to us to care for their Hero who comes offering this gift of new life.

We believe our standards must be even higher for donors in the PKE program, as they most often have never met the intended recipient of their donated kidney.  Ethically, while we maintain the privacy of all those involved in the exchange, we still demand the informed consent of all donors and recipients and answer all questions until it is clear and understandable.

We will continue to look for new and better answers for patients seeking to avoid the effects of end-stage renal disease.  We can no longer look at incompatibility with a living donor as an excuse to deny kidney disease patients the Gift of Life.  Paired kidney exchanges will become the standard of care across major transplant centers and will be a regular activity here at the University of Maryland, where we are committed to doing all we can to advance the state of the art in kidney transplantation for our patients.

Radiation Therapy and Patient Safety

By William F. Regine, M.D.
Chief of Radiation Oncology

Editor’s Note: In response to an article in the New York Times on January 24, 2010, about radiation injuries to patients, Dr. William F. Regine provided the following comment. Dr. Regine is chief of radiation oncology at the University of Maryland Marlene and Stewart Greenebaum Cancer Center and professor and Isadore and Fannie Schneider Foxman chair of radiation oncology at the University of Maryland School of Medicine.

An article in the New York Times highlights several cases of radiation over-exposure in cancer patients in several New York hospitals in 2005. We are concerned that the article could make some patients fearful of receiving radiation therapy. This would be disastrous, since radiation therapy is by far one of the safest and most effective forms of cancer treatment.

We want to reassure all of our patients that their safety is our number one priority. In fact, our hospital has been recognized as one of the nation’s best hospitals for patient safety and quality of care for the past four years in a row by the Leapfrog Group, a national public assessment of hospital safety and quality performance. We strictly follow the highest standards of quality assurance in providing radiation therapy to patients.

Radiation therapy actually has an extremely low rate of errors, due to the many checks currently in place to ensure patient safety. As noted in the article, an estimated 35 million treatments were administered last year on equipment made by Varian Medical Systems alone, with about 70 instances of mistakes that affected or nearly affected patient care. While this is a very low rate, even assuming significant under-reporting, even one such mistake is too many.

The errors described in the article were associated with the lack of quality assurance processes. At our center, we strictly follow a comprehensive set of safety rules. These include: 1) machine-related QA checks, including a daily check of the beam output and monthly physics checks of all equipment; 2) secondary calculations to verify the accuracy of the radiation dose calculated by our treatment planning systems; 3) a review of all treatment plans by medical physicists; 4) quality assurance checks of Intensity Modulated Radiation Therapy (IMRT) plans prior to treatment; 5) review by the therapist staff to verify agreement between the radiation dose in the treatment plan and the treatment console; and 6) verification of the physician’s written directive, the prescribed dose and the patient’s identity.

Since 2005, when the events described in the New York Times article occurred, two national-level professional meetings have taken place to specifically address errors in radiation therapy. A member of our faculty in the Department of Radiation Oncology was selected to serve on a special task force launched by the American Association of Physicists in
Medicine (AAPM)
to study safety processes in radiation oncology. Both the AAPM and the American Society for Radiation Oncology (ASTRO) continuously work to strengthen training, quality assurance and safety in radiation oncology.

All treatments pose risks, and patients should discuss them with their doctors. Our staff is committed to the very highest standards in the delivery of radiation therapy to our patients. Please feel free to discuss your treatment plan and our quality assurance processes with your radiation oncologist or with any member of our staff.

What is Leapfrog?

By Ellen Beth Levitt
Director of Public Affairs and Media Relations

Ever since 2006, I have asked dozens of people if they have heard of Leapfrog. The response has almost always been, “Isn’t it a children’s game?” Maybe. But to a hospital, and people who may need hospital care, Leapfrog has a different meaning. If you are a Leapfrog hospital, you are among a small group recognized as having key patient safety measures in place to provide the safest, highest quality care. UMMC was just named for the fourth year in a row to the Leapfrog list—among only 45 hospitals nationwide.

The current Health Care Reform debate has raised our awareness of the quality issue — and getting value for the health care dollar. As we become more educated health care consumers, I believe more of us will recognize that Leapfrog is more than just a children’s game.

To learn more about the Leapfrog Group, what this patient safety and quality award means for UMMC and its patients and more, watch this interview with UMMC Chief Medical Officer Dr. Jonathan Gottlieb.