Are Your Hands Clean?

     It can be hard to own up to a mistake, especially a major one, but in the articles that make up this month's cover report, two veteran EMS providers admit to just that-- medical mistakes that caused harm to their patients.

     In We Don't Mean to Hurt Patients on page 52, Mike Taigman discusses how a medication error led to the death of a 68-year-old man whom Mike and his partner had at first managed to successfully resuscitate from ventricular fibrillation. In Fallible Medicine on page 57, Steve Whitehead relates how an unidentified misplaced endotracheal tube led to a series of errors both in the ambulance and at the hospital that resulted in his patient suffering a serious burn.

     Mike and Steve are not alone. Research indicates there are more than 41,000 instances of medical harm in U.S. hospitals every day, which amounts to 15 million mistakes each year. The nonprofit Institute for Healthcare Improvement has identified five areas where mistakes could be prevented. These include using science-based guidelines for prevention of pressure ulcers and implementing infection-control practices to reduce MRSA (staph) infections. While these recommendations were made for the hospital environment, a recent study shows they could be just as relevant in the prehospital arena. According to a report published in the Apr-Jun edition of Prehospital Emergency Care, nearly half of 21 ambulances in a single fleet tested positive for MRSA contamination. Five specific areas within each ambulance were tested, suggesting the need for decontamination of the interior surfaces of the ambulance, as well as stretchers.

     The CDC reports that the main method of transmission of MRSA is by hand contact. If your ambulance was tested today, would it pass with flying colors or would bacteria show up on the swabs? If your hands were tested, would they be found clean or dirty? Are your hands killing the patients you think you are healing?

     A few weeks ago, I spoke to a regular contributor to EMS Magazine who told me that when he first became an EMT, he rarely, if ever, cleaned his stethoscope. Ironically, the first article I ever wrote for EMS Magazine in the August 1995 issue detailed a study on stethoscope hygiene, or the lack thereof. Little seems to have changed in 12 years, but in an increasingly litigious society, you may be saving your career, as well as saving your patients, if you choose to pay heed to this information.

     I welcome your comments on this topic. E-mail nancy.perry@cygnusb2b.com.