Harbor-UCLA Infection Control Deficiencies: A Climate of Disregard

By Peter Laird, MD

Harbor-UCLA medical center made headline news recently for severe public health infection control issues cited in a 55 page report. (here, here)  Reading though this lengthy report reveals a climate of disregard for basic infection control procedures that affected every aspect of medical care throughout the entire hospital. The Federal government responding to these serious deficiencies with a threat of withdrawing Medicare funds should the hospital fail to correct the outcomes of the report. Hospital officials responded to local news blaming the deficicies on the age of the building:

Inspectors: Harbor-UCLA Hospital Unsanitary

Harbor-UCLA executive Delvecchio Finley said the hospital has addressed all the concerns raised by inspectors, according to the Times. Nevertheless, Finley told the Times, issues continue to arise because of the age of the hospital, which was built in 1963.

"It's an old building," he told the newspaper's Anna Gorman. "Because of that, there are certain challenges."

However, despite the fact that some of the deficiencies were related to the infrastructure needs of the hospital, many more were blatant failures to adhere to simple hygiene standards expected of health care professionals. My medical training at Boston City Hospital was in a building over 100 years old, but I learned to wash my hands and scrub properly for surgical procedures, a task that I took seriously not only for the prevention of nosocomial spread of disease to my patients, but also to my own family when my work was completed.  Infection control begins with an attitude of professionalism understanding hygiene standards and caring enough to take the time to perform them with each and every patient, every time.

The inspectors focused mainly on the surgical and in-patient areas, but they also found serious procedural errors in the dialysis unit including failure to respect patient privacy, improper chloramine testing, failure to test for endotoxins since 2007, no policy and procedure for endotoxin testing and no policy for notification by the water utility for changes in chloromine concentrations. All of these irregularities place patients at risk each time they undergo hemodialysis in this unit.

Canada promotes a new climate of infection control through their Stop! Clean Your Hands Day annual promotion. Thousands of patients die each year by the lack of attention to simple and basic concepts by the people they trust with helping and curing their illnesses. Over a hundred and fifty years since Ignaz Semmelweis first showed the benefits of washing your hands between patients, it remains one of the most serious health care issues today. Dr. Semmelweis was ridiculed, insulted and castigated for his suggestions that doctors were causing the deaths of the obstetrical patients attended shortly after they performed autopsies. The fact that Canada has to remind healthcare professionals about the most basic infection control procedure demonstrates the remarkable personal and collective failure of doctors, nurese, lab techs and all of the people employed throughout this industry.

The ghost of Dr. Semmelweis haunts the halls of every hospital throughout the world with the knowledge that many health care professional are still the cause of death to thousands of patients entrusted in their care through a lack of personal handwashing. Until the health care industry develops an attitude of infection control at every level, there remains little hope that this climate of disregard shall ever end. 

Comments

[roberta mikles]

Peter, thanks for posting this. I am particularly interested in such and was aware of this...

I am an appointed member of a legislatively mandated Advisory Committee to the California Department of Public Health's HAI Program --
http://www.cdph.ca.gov/programs/hai/Pages/default.aspx
The above link will go directly to the site, hopefully, whereby, a tremendous amount of information can be obtained on California hospitals, as well as patient education. The committee is comprised of dedicated professionals, myself, and two other patient advocates who work in the area of infection prevention -
Roberta Mikles BA RN
(uncompensated Dialysis Patient Safety Advocate)
Director, Advocates 4 QualitySafePatientCare
www.qualitysafepatientcare.com
San Diego, CA

[roberta mikles]

afterthought ----

I wonder if Harbor UCLA manages this unit or they contract out to manage e.g. with one of the dialysis providers. Considering more than half of the surveys conducted (inspection reports) in California 2010 and 2011, to date, had deficiencies in infection control, this does not surprise me. Shameful, to say the least. What are providers doing? Do they not realize the danger they are placing patient in ?? Who are the RNs running the unit? Don't they know what needs to be done? I just have to shake my head and wonder who is at the running the show? I wonder how many negative outcomes happened that were not picked up in the survey? It is quite interesting that those at the top (providers) area working towards decreasing infections in connection with the QIP reimbursement and connected to infection reporting data --- they all talk a good game as I learned at a meeting in VA .. but what happens at the unit level? Those at the top, talking a good game is all fine and good, but unless there is change at the unit level patients will continue to acquire deadly infections, or infections that cause lengthy rehabilitation with emotional and physical distress
Roberta Mikles RN BA
Dialysis Patient Safety Advocate