Portion (from a Seattle Times expose) below; whole thing here: http://seattletimes.nwsource.com/html/localnews/2008396215_mrsaday1.html
Repeat offenders
To impede MRSA and other infectious germs, Washington hospitals typically rely on basic strategies — washing hands, isolating patients, sterilizing equipment.
But most of the state's 25 largest hospitals have been cited for unsanitary conditions or failure to adhere to fundamental safety standards, state and federal regulatory reports since 2005 show.
Last year, at Spokane's Holy Family Hospital, state Department of Health inspectors discovered the following:
A nurse entered Room 520 and dropped two packets of pills on the floor. Instead of throwing them out, she scooped up the packets and put them in a paper medication cup. She then pried the pills from the packets, dumped them into the contaminated cup and handed it to the patient.
An hour later, in a different room with an infectious patient, a staff member began to leave without washing hands. A second staffer tried to leave without discarding a contaminated gown. Both were headed for public areas of the hospital before state inspectors stopped them.
That afternoon, inspectors watched a phlebotomist draw blood from an infectious patient. Afterward, she brushed her gloved hands against items in a nearby supply cart — supplies destined for other patients.
In all, the four-day inspection cited seven staff members for violating basic infection-control standards, state records show.
Physicians can be the most lackadaisical about infection control.
In April 2006, doctors at the UW Medical Center carried personal items from home into sterile operating rooms and dropped them on the floor. These items included backpacks and satchels, made of porous materials friendly to germs. Hospital administrators told inspectors this was "common practice."
In November 2006, a physician at St. Joseph Medical Center in Tacoma removed his surgical mask during an operation. He had complained it was uncomfortable. Hospital officials told inspectors the physician was a "repeat" violator and had been warned before to keep his mouth and nose covered.
In hospitals, the most common violation is the failure to wash hands upon entering or leaving a patient's room.
In the worst cases, as few as 40 percent of staff members comply with hand-washing standards. Doctors are the worst offenders, according to confidential hospital records reviewed by The Times.
Even the best hospitals typically boast no better than 90 percent compliance — which means one out of 10 practitioners may have contaminated hands.
Hospitals remedied all violations spotted during the inspections, records show.
But these violations were all the more brazen because hospital officials — benefiting from a new law — knew the exact day that state inspectors were coming.
No surprise inspections
In the past, the state health department conducted surprise inspections to ensure that hospitals adhered to health and safety codes, from patient care to building maintenance.
But in 2002, the Washington State Hospital Association issued a 28-page report: "How Regulations are Overwhelming Washington Hospitals." In it, hospital administrators claimed surprise inspections disrupted patient care.
In Olympia, lawmakers voted unanimously to eliminate surprise inspections starting in July 2004. Today, the Department of Health must provide four weeks' notice — even the exact hour of arrival.
Hospital officials also had complained that some state inspectors were abrupt and unfriendly.
Lawmakers approved a Band-Aid: Hospital officials now can anonymously evaluate state regulators on whether they were polite enough.
The Legislature receives an annual compilation of these critiques. One hospital official wrote that state inspectors could "do a better job of highlighting the positive," instead of just looking for problems.
Washington is the only state that legally empowers hospitals to rate the conduct of regulators, according to the Consumers Union, a nonprofit organization that monitors hospital-related legislation.
"What kind of message does that send?" said Lisa McGiffert, who directs the organization's Stop Hospital Infections project.
Federally commissioned hospital inspectors began surprise inspections in 2004 — the same year Washington eliminated them.
The Joint Commission on Accreditation of Healthcare Organizations sets health-care standards and certifies hospitals to receive federal funding, such as Medicare. For decades, the commission had provided at least a month's notice before inspections.
But dozens of hospitals exploited the advance notice to temporarily hire more staff, cart in rental medical equipment — which was returned when inspectors left — and conduct dramatic makeovers with fresh sheets and pillows, according to inspector general reports at the U.S. Department of Health and Human Services.
Responding to public criticism, the commission stopped giving notice.
In some Washington hospitals, makeovers now take place just before state inspections, three registered nurses told The Times. The hospitals beef up staffs during planned inspections and, in some cases, have hired extra cleaners to disinfect beds and equipment, the nurses said.
The state hospital association recognizes "more needs to be done" to combat MRSA and is pushing to standardize patient-isolation procedures and increase hand-hygiene compliance, association president Leo Greenawalt said.
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