Burnt-Out Nurses Linked to More Hospital Infections

HealthDay – 1 hr 50 mins ago TUESDAY, July 31 (HealthDay News) -- Burnout among nurses is linked to an increase in hospital infection rates, researchers have found.

In addition, job-related exhaustion among nursing staff costs millions of health care dollars each year, according to the study from the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

In conducting the study, the researchers analyzed data from the Pennsylvania Health Care Cost Containment Council and the American Hospital Association Annual Survey. They also examined a 2006 survey of more than 7,000 registered nurses from 161 Pennsylvania hospitals that provided insight into their job-related attitudes, including feelings on depersonalization and personal accomplishment. The survey also revealed the nurses' levels of emotional exhaustion, which is a key factor in burnout syndrome.

The study showed that among nurses caring for an average of 5.7 patients, for every additional patient they were assigned there was roughly one additional catheter-associated urinary tract infection per 1,000 patients. This translates to 1,351 more infections every year, according to study co-author Jeannie Cimiotti of the New Jersey Collaborating Center for Nursing and Rutgers School of Nursing in Newark, N.J., and her colleagues at the University of Pennsylvania School of Nursing.

Each 10 percent increase in a hospital's high-burnout nurses was associated with almost one more catheter-related infection and two more surgical site infections for every 1,000 patients each year, the investigators noted in a news release from the Association for Professionals in Infection Control.

Catheter-related urinary tract infections cost an average of $749 to $832 each, and surgical site infections can cost up to $29,443. Based on those figures, the researchers projected that 4,160 infections could be prevented and hospitals could save $41 million by reducing rates of nursing staff burnout to 10 percent from an average of 30 percent.

"Health care facilities can improve nurse staffing and other elements of the care environment and alleviate job-related burnout in nurses at a much lower cost than those associated with health care-associated infections," Cimiotti and colleagues concluded. "By reducing nurse burnout, we can improve the well-being of nurses while improving the quality of patient care."

The study was published in the August issue of the American Journal of Infection Control.

While the study uncovered an association between nursing staff burnout and infections among patients, it did not prove a cause-and-effect relationship.

More information

The U.S. Centers for Disease Control and Prevention has more about health care-related infections.

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Capri scooter spill leaves ex-French PM in Rome hospital

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U.S. commander accused of stalling Afghan hospital abuse probe

Reuters – 22 mins ago WASHINGTON (Reuters) - A top U.S. general in Afghanistan sought to stall an investigation into waste, abuse and mismanagement at a U.S.-funded hospital in Kabul for political reasons, a former U.S. military official will tell Congress on Tuesday.

Retired Colonel Gerald Carozza, who served as an adviser to the U.S. campaign in Afghanistan, will accuse Lieutenant General William Caldwell, then head of U.S. and NATO efforts to train Afghan security forces, of delaying a military investigation into allegations of corruption and patient abuse at the Dawood National Military Hospital.

"The evidence is clear to me that General Caldwell had the request (for a probe into the hospital) withdrawn and postponed until after the (November 2010 U.S. congressional) election and then, after the election, tried to intimidate his subordinates into a consensus that it need not move forward at all," Carozza said in testimony submitted ahead of Tuesday's hearing.

Carozza and others who say they sought to bring problems at the U.S.-funded hospital to light will testify before a subcommittee of the House of Representatives Oversight and Government Reform Committee, which will examine allegations that military officials blocked or delayed the hospital probe.

Colonel Wayne Shanks, a military spokesman, said Caldwell "would welcome the opportunity to respond to any inquiry and I'm confident that once the facts are presented and examined, all allegations will be proven false."

Last month, Republican Representative Jason Chaffetz sent Defense Secretary Leon Panetta a letter on behalf of the Oversight Committee and asked the Defense Department to examine whether military leaders had sought to cover up reports of abuse at the hospital in 2010.

U.S. lawmakers began looking into the hospital last year after The Wall Street Journal reported abuse and neglect of Afghans receiving medical treatment there.

Lawmakers have voiced concerned not only by the allegations that a probe may have been blocked but that mismanagement and fraud were widespread at the hospital, just the latest case raising questions about the U.S. effort to rebuild Afghanistan and ensure stability as most foreign forces withdraw in coming years.

The Pentagon has acknowledged problems at the hospital and has said that "investigations and corrective action" were underway.

Caldwell, who is now a senior Army official in the United States, was not invited to testify at Tuesday's hearing.

Schuyler Geller, another retired colonel who served in Afghanistan, accused the U.S. leadership in his prepared testimony of "providing half-truths" in the hospital case, including about widespread corruption in the Afghan government.

After over a decade of Western aid efforts in Afghanistan, which have cost tens of billions of dollars, rampant corruption remains a major concern.

(Reporting By Missy Ryan; Editing by Eric Beech)

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Berlin hospital suspends circumcisions after court ruling

"A baby is blessed by a group of Jewish priests belonging to his family in 2004 during a circumcision ceremony. Berlin's Jewish Hospital will suspend circumcisions after a German court ruled this week that performing the procedure on religious grounds is unlawful, a hospital spokesman said Friday. (AFP Photo/Menahem Kahana)" title

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Rare Drug-Resistant Bacteria Spotted in U.S. Hospital

HealthDay – 4 hrs ago THURSDAY, June 21 (HealthDay News) -- A rare type of deadly bacteria was found in two patients in a Rhode Island hospital in 2011, but swift treatment and infection control measures stopped any further spread, a new government report shows.

The bacterium -- called New Delhi metallo-beta-lactamase (NDM)-producing Klebsiella pneumoniae -- is highly resistant to antibiotics and easily spread. It is rare in the United States, but more common in areas including India, Pakistan, Cambodia and other Asian countries.

"These people had the bacteria in their body, but fortunately it was not causing an infection anywhere," said lead researcher Dr. Leonard Mermel, medical director of the department of epidemiology and infection control at Rhode Island Hospital, in Providence.

The bacteria were isolated in one patient's urine sample and in another patient's fecal sample, but nowhere else in their body.

Infections with this strain of bacteria, however, can be deadly and there are few treatment options, Mermel said.

Where the bacteria is endemic, its growth is spurred on by several conditions, he said.

"In many parts of the developing world, you can just walk into a pharmacy and get antibiotics without a prescription, so there is widespread antibiotic use," Mermel said.

This ease of getting antibiotics coupled with poor sanitation promotes bacteria growth and creates a "perfect storm" for the development of resistant strains of bacteria, he said.

The report was published in this week's issue of Morbidity and Mortality Weekly Report, a publication of the U.S. Centers for Disease Control and Prevention.

The first patient was hospitalized in Rhode Island, after being hospitalized in her native Cambodia and treated with antibiotics. In the U.S. hospital, infection was discovered and she received a wide range of antibiotics. However, only partial infection control measures were taken. Eventually, the infection spread to another patient in the same ward.

At that time, stronger infection control measures were taken and no other patients were infected.

Dr. Marc Siegel, an infectious disease expert and associate professor of medicine at NYU Langone Medical Center in New York City, said that "this is not an epidemic, but it is eyebrow-raising. This bacteria is very problematic and highly resistant to antibiotics."

So far, this hasn't become epidemic, he said. "These are isolated cases," he said. "This is another resistant bacteria -- an ultra-resistant bacteria."

Siegel doesn't expect to see this bacteria become common in the United States.

"I don't think it's going to take hold here," he said. "I am concerned more about the importing of this bacteria. We are going to be seeing more cases."

The goal is to control the bacteria with infection precautions, including patient isolation, Siegel said.

This case drives home several points, he noted. "We need better sanitation in hospitals. We need to be vigilant in searching for these types of bacteria. We really could use more antibiotics. There have been almost no new antibiotics in the past decade."

It's the tip of the iceberg, Siegel said. "The iceberg is the developing of resistant bacteria, but this bacteria is not likely to spread in the near future, but it is of concern."

The overuse of antibiotics adds to the creation of these resistant strains, he added.

More information

For more on drug-resistant bacteria, visit the U.S. Centers for Disease Control and Prevention.

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Interpreters may help shorten hospital stays

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Patients leaving hospital against advice fare worse

Reuters – 14 hrs ago NEW YORK (Reuters Health) - Hospital patients who leave against medical advice may have an increased risk of being readmitted or dying within a month, a study at one New York medical center finds.

In the U.S., about 500,000 hospital patients a year sign themselves out against medical advice.

Studies have suggested that decision can be unwise: patients hospitalized for asthma, HIV or a heart attack, for example, have been found to have an increased risk of readmission when they leave contrary to doctors' recommendations.

But the new study, reported in the American Journal of Medicine, suggests patients are also at increased risk of dying within 30 days of leaving against medical advice.

Researchers found that of 84,000 patients treated at their medical center, those who left against doctors' advice were more likely be readmitted within the next month: one-quarter of them ended up back in the hospital, versus 11 percent of patients who went home after a planned discharge.

They were also twice as likely to die: 1.3 percent died during the month after leaving the hospital, compared with 0.7 percent of patients with a planned discharge.

"That's the really sobering finding," said lead researcher Dr. William N. Southern, of Montefiore Medical Center and Albert Einstein College of Medicine in New York.

"These patients are not only at greater risk of readmission," he said, "they are also more likely to die in the next 30 days."

The exact reasons are not certain, Southern told Reuters Health.

Patients who signed out against medical advice tended to have a shorter hospital stay than patients with a planned discharge.

"So it may be that they aren't staying long enough to complete a course of treatment," Southern said in an interview. "But it may also be that they are not getting the follow-up care they may need."

The bottom line, according to Southern, is that people should be aware of the risks of leaving the hospital early.

That does not mean they have to follow "doctor's orders."

"Refusal of care is a patient's fundamental right," Southern said.

But, he added, patients do not always sign out because they don't want treatment. Often, it's for a personal obligation like work or caring for a family member.

The findings are based on 84,000 patients treated at Montefiore Medical Center between 2002 and 2008. That included 3,544 patients who signed out against medical advice.

Patients who checked out early were different from their counterparts in other ways too. For example, they were more likely to have a history of substance abuse or psychiatric conditions or to be on Medicaid, the government health insurance program for the poor.

But even when the researchers accounted for those differences, as well as factors like age and race, patients who left the hospital against advice still had twice the risk of dying.

Of course, the specific risks to any one person would depend on the illness being treated, overall health and other factors. "Our findings suggest that whatever your baseline (death) risk is -- whether it's high or low -- it would be twice as high if you leave the hospital against medical advice," Southern said.

A limitation of the study, though, is that it reflects a single medical center -- one located in a high-poverty area of New York. Southern said it's not known whether the results would be the similar at all hospitals.

But he said the findings do give hospital staff something to communicate to patients. Until now, it had not been clear whether discharge against medical advice was associated with death risk specifically.

"Now we know that it is," Southern said.

SOURCE: http://bit.ly/JcvCbG American Journal of Medicine, online April 17, 2012.

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