http://www.baltimoresun.com/news/nation/ba...0,3478186.story
I was listening to this on C-SPAN radio today and found this interesting. Something I didn't really know about, but maybe you all have. I don't keep up with the news that well, just whoever is talking on C-SPAN radio on the way home.

People were speaking on the radio about how bacteria is just floating around in hospitals because of lack of thorough cleaning. Guidelines don't require inspections to check for bacteria on surfaces, and doctors say they don't change their lab coats even if they know they are infected. They people on the radio that were speaking in the committee meeting on this said MRSA infections have gone from 8,000 5 years ago to 100,000 last year, and that only accounts for 8% of all bacteria infections supposedly.

Story:

The federal government isn't doing enough to protect patients from getting infected at hospitals, endangering tens of thousands of lives and costing billions of dollars, congressional researchers reported yesterday.

The government has not established sufficient standards for hospitals to follow or prodded hospitals to follow those standards to reduce infections, the Government Accountability Office reported. Private groups representing doctors and hospitals demand more from hospitals, including simple steps like requiring doctors and nurses to wash their hands.

About 90,000 Americans die after contracting infections at hospitals every year, and 1.9 million more are sickened by the bacteria, says Consumers Union, an interest group that has been advocating for more action to prevent hospital-associated infections. The deaths alone add an estimated $5 billion in health care spending.

"Safety needs the equivalent of a polio campaign," said Dr. Peter J. Pronovost, medical director of Johns Hopkins' Center for Innovation in Quality Patient Care, who testified before the House Oversight and Government Reform Committee yesterday on the issue.

Patients often get the infections through intravenous tubes, catheters and ventilators they're hooked up to. Bacteria, often antibiotic-resistant types such as methicillin resistant staph or MRSA, contaminate the blood, urinary tracts and surgical sites...

...Medicare has established too few standards for hospitals, and they tend to be vague, the GAO said. Meanwhile, the Centers for Disease Control and Prevention has failed to give hospitals direction about which of the 1,200 practices it recommends are the most important to follow, strongly recommending 500.

"It feels like you're trying to walk through mud when you get volumes of recommendations," said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. Industry and physician associations offer more specific guidelines, such as requiring hospitals to offer flu vaccinations to staff, the GAO said.

Having worked in hospitals, and nursing homes, I always suggest you get in and out as soon as possible. Nowadays, every patient and visitor needs to be vigilant that universal precautions are practiced. Good health care facilities train and practice what the industry calls "universal precautions".

If you are in a hospital, have people visit you. The more eyes and ears the better. Care seems to improve for patients who have a connection to family and visitors.Wash your hands, wash your hands, wash your hands. For invasive procedures or any action that releases fluids, or exposes open wounds, make sure staff and those around the patient are washing hands. Staff know to wash hands and if gloves are indicated, reglove between patients. Visitors need to read posted infection signs on their loved ones door and adhere to the protocol. Many infections are passed to family members, and then that visitor neglects to follow guidelines. Takes a gift home or to the office to share, not good.

Has to be a team effort, germs do not stop and say, "Oh, you are not a nurse or hospital employee, I won't cling onto you."

I got sick in January after visiting my mom who was in isolation. I am in the health care field and knew better. But Dad kept harping when i put the robe and gloves on. I did not use the robe or gloves and I may of picked up a bug. Developed a mild infection but luckily it was easily controlled. Trying to save you the pain and grief. For me, it was embarrassing explaining to my doctor I had been so careless. But then there was Dad. You know how it goes.....Family

Also, read up on your hospital of choice for elective procedures, there are surveys outlining infractions.

You can google infection survey information. I recall one that contains performance measures. Bottom-line research is a good thing, then you can make an informed choice. .....Information, information, information......You will be more relaxed, less stressed and ready to heal if you have peace of mind.
http://quality.mdhospitals.org

The govt can establish guidelines, but we the people need to wash our hands. And look around to ensure staff is doing the right thing. Not closing their eyes like in Vegas.

I am from Nevada, and worked in hospitals there. Nurses out there are now in shock by the horrific & needless spread of hepatitis from used needles, and recycled tubing. Thankfully that is an extremely rare example.

http://lasvegas.about.com/od/governmentciv...atitisscare.htm

Good grief! Do not have a heart attack at WCh.

Consider the average age of those who use WCH. These aren't middle-aged stock brokers having their first heart attack. They're a high percentage of them elderly folks who've been waiting to kick the bucket for some time.

You've got to take outcome figures with a grain of salt. WCH's community includes an unusual high percentage of elderly folks.

BMIC--most hospitals I have ever been to have a high % of elderly persons. They use the most health care, so they are the higher percentage of patients, in ALL HOSPITALS..

I was talking about Washington COUNTY not the hospital. I believe that Wash Co has a high percentage of elderly compared to many other areas, and thus your average cardiac patient from Wash Co will be older and more likely to have a poor outcome.

The influence of the community demographics on health outcome measures is well understood. For example, in certain parts of FL you would think they have absolutely HORRIBLE health care if you didn't realise that the communities served by certain hospitals are chock full of elderly folks.

So, basically you are saying Wash Cty is dying--we have only old people--not many youthful persons residing here? I thought once you got to be 65 or so, you had to go to FL or AZ..

http://quickfacts.census.gov/qfd/states/24/24043.html

In 2006, 13.7% were over 65 yrs. old.

http://factfinder.census.gov/servlet/QTTab...id=05000US24043

Median age is 37.4. (half the population is below that age, half is above)

Doesn't look like an "old" county to me.

for the U.S. as a whole: 65 years and over: 12.6% (male 15,858,477; female 21,991,195)
http://en.wikipedia.org/wiki/Demographics_...e_United_States

BTW, in Florida 16.8% were 65 or older in 2006.
http://quickfacts.census.gov/qfd/states/12000.html

I'm disappointed B, usually you back up your statements with cites. (just kidding!)

The recent HM report shows WCH lagging other area hospitals in several areas of quality, including areas where population age is not a factor. But the WCH rep interviewed made excuses about the age of the hospital having an influence, though building age clearly did not affect several of the criteria WCH was rated low on.

Excuses will not drive improvements. There are obvious things WCH can and should change, and proven ways to do it, but, like in manufacturing, the desire to improve quality must come from the top. Many of the improvements are not rocket science level, so studying a hundred pages of studies is not needed to know what to do. They just gotta wanna do it.

I usually do when I feel srongly about something. But this one I am simply ambivalent about. My only intention was to add a note of caution to those who may just take the health outcome data at face value.

Were I to have any serious cardiac problems I would probably want to be treated at Washington Hospital Center myself. But I seriously doubt that WCH is really significantly worse than most rural hospitals.

When was the last time you were in the ER? Last month they had an average of 6hr wait time..

Excellent point Snoopy: Hospital administrators and the corporations or govt entities funding them know what needs to be done. It is an age old issue affecting hospitals nation wide. Their are clearly demonstrated strategies that work. The problem is acting on them with consistency.

Like many have said, it is germs and too many people. Easily addressed but tedious if your in the trenches, or over zealous families. I for sure would want to be with my loved one. Universal precautions go a long way to prevent the problem. Surfaces used for lab work, patient procedures, and shared areas need to be cleaned repeatedly. There are countless in-services and information on the topic. Frequency for cleaning in between patients and their families/friends is sometimes a variable.

Sadly, care goes up when one has regular visitors.
Perhaps the number and behavior could be monitored. Some visitors follow universal precautions and help eliviate the problem. Others do not. Like in many situations, courtesy and precautions go a long way.

Around the country, there are good hospitals, and those that struggle. Definitely, be an informed consumer.

One of the first things they could do is only allow 1 person to accompany a person to the hospital--people carry germs and diseases--and they wonder where MRSA came from? Years ago children were not allowed to come to the hospital unless they were a patient...and only a few people could visit the patient...this kept down the chaos & the germs...

When a place is short-staffed, and WCH definitely is in that category the first step to get rid of unnecessary time wasters...such as the 2 people at the front to 'assess the patient' and the many chairs in the waiting room...

In January, I waited 6 hours, continuously vomiting, and incredible pain. Not life threatening but my doctor and urgent care ordered me to the ER. I had waited and was seen and referred by Urgent Care. Fun.

All the chairs were full and those around the corner. I thank god for the chair. The crowds were huge that night. Of course, having worked in hospitals I was thinking about the crowds and germs but realized I was no prize that night. I can not remember who checked me in, there was a fuzzy group up front. One was the money lady, "How you gonna pay?" and the other was medical, the nurse. Two different jobs. I did sit in the lab chair by admissions and fell asleep while I waited for the blood lady. I know that chair was germy. It is right next to the money lady and nurse desk, so that may be why it looks congested. I even put my head down on that common lab chair. i dozed until they came for blood. UGH.

I never get sick. I woke up on the back bench, figure that out. I was close to the last person called. Guess everyone else was sicker. Once seen, the care was fine. So that was one plus and not being deemed sicker than others.

Thank Goodness for good health. Happier days are here this Spring.

Sounds like about the norm nationwide. Of course if you go in with a truly life-threatening condition you won't wait at all. Hence, you shouldn't be using the ER for non-life-threatening conditions.

The national average is 3.7hrs in er waiting time.

And if I sit in any waiting room for more than about an hour I have to ask myself :"WTH am I doing here?"

I could not move unassisted. I did think What the heck? But I could not physically move on my own. And where would I go? Thus the 6 hour wait. Sometimes there are no choices. I guess dying but that was not on my top five preferences. So waiting seemed like a good option.
Like I said, one behind the magical curtain, my care was good, no complaints on that.

Dumb question but I just don't know because all of my doctors priviledges are at FMH and Frederick is more convenient to me than Hagerstown: doesn't Wash Co. have any Urgent Care centers? My experience with them (admittedly limited) is that they are far better than hospital ERs for anything that's not immediately life-threatening. But maybe Wash Co is just behind the times.

As I stated, I was transferred from the urgent care after being treated there. My care and wait at urgent care totaled three hours. Then the fun came, I went to the ER. I saw 2 people from the urgent care that nite, sitting near me. They too were educated and medically insured. They got sick, very sick. It happens on a Saturday nite near a holiday, it gets crowded.

My primary care doc and urgent care demanded I go to the ER. How else can I slice it? I had no choice. I am not a frequent flyer at ERs. That was my first visit as a patient. Going home was not an option.
I am a responsible, educated and medically insured individual.
It was a busy night all over the area, it happens.

Yeah, the urgent care has no x-ray capacity and it routinely sends the patients to the hospital. Why since they do this routinely there is no chain of command to by-pass some of the ER bottleneck, I have never understood. Ran into the same thing when DS had appendicitis...by the time he was taken to have his surgery, we had been waiting a total of 10 hours between the Urgent Care & the ER. 1 hr UC, 4 hrs in ER, then back in ER for 4+ more hours while they decided he needed surgery and tests..

OK then it sounds like the Urgent Care center is poorly equipped. They definitely need to do something about that. For heaven's sake even my family doctor's office has an x-ray machine.

BMIC--you are right on the money! When they told me that about my DS I wanted to scream!

YUP, one would think you would get some credit for being at Urgent Care for three hours. The transition or turfing (dumping) is weird. Arriving at the ER after UC and going to the back of the line was numbing. Now I laugh, it was a cartoon. I would end up here and there. A bad movie.

Opps, just remebered, at the Urgent Care on Penn Ave, the new one, they had an x ray. It is at the sylvania Center up near Maugins Ave/Longmeadow, on RT 11. I got a chest x ray & labs, it did not turn up anything. The care was pretty good. The doctor, nurse and tech were sweet, and conscientious. But I needed a long lasting IV due to dehydration. They were not allowed to do it. I guess there are certain guidelines, when you hit a threshold, you are sent to the ER.

Also, they close at 7:00 pm. I think that was a factor but it was never mentioned.

It was curious. When I got to the ER, I saw two other patients from the same Urgent Care.

I think it's funny that some people go to urgent care for little things that they would usually go to a doctor for (cold, flu, stomache ache) but it's called URGENT care. Maybe those people just don't have doctors. The one time I was there a lady had a fishing hook stuck in/through her hand. Ugh.

Many of them do not. That's a huge problem for both Urgent Care Centers and Regular ERs. People using them for primary care because they don't have a regular doctor and/or don't have insurance. The whole triage process is designed to put them at the far end of the line so that those who really NEED emergency or urgent attention get it.

Unfortunately sometimes the ER or Urgent Care place needs to adjust their triage rules, because they can vary from place to place. Usually chest pain gets you seen immediately anywhere you go. But for example abdominal pain will get you seen immediately at some places but not at others.