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 no data prove 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.
The Joint Commission, of course, loves nothing more than to make up new rules, based sometimes on real data and other times on data about as substantial as fairy dust.
A year or two ago, another new rule surfaced, mandating that physicians’ personal items such as briefcases must be placed in containers or plastic trash bags if they are brought into the operating room. Apparently someone thinks trash bags are cleaner.
Now one anesthesiology department chairman has taken this concept a step further, decreeing that no personal items at all are to be brought into the operating room–except for cell phones and iPods. That’s right, iPods, not iPads. This policy (of course) probably won’t be applied uniformly to high-ranking surgeons or to people like the pacemaker technicians who routinely bring entire suitcases of equipment into the OR with them.
What’s particularly irrational about this rule is that cell phones likely are more contaminated with bacteria than briefcases or purses, even if they’re wiped off frequently. And I have to ask how an iPhone 6+ meets eligibility criteria while the barely-larger iPad mini doesn’t. Again, please show me the data demonstrating that this will reduce infection rates, unless someone is making it a habit to toss briefcases and iPads onto the sterile surgical field.
Show me the money
I wish I could say that the driving force behind hospitals’ fear of infection is simply the wish for patients to get well. Unfortunately, it’s probably driven as much by financial motives as benevolent ones. Today, Medicare won’t pay for care related to surgical site infections, and it fines hospitals whenever too many patients need to be readmitted within 30 days of discharge. In 2014, a record 2610 hospitals–including 223 in California–were penalized, and will receive lower Medicare payments for all patients over the next year, not just those who were readmitted.
What does this mean at the grassroots level?