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Infections

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In a Q&A with TBR News Media, Carol Gomes, interim chief executive officer at Stony Brook University Hospital, discusses a variety of topics including patient safety, quality control and curbing infections. Here is what she had to say. 

1. Being the interim chief executive officer at the hospital, how important is patient safety and  quality control to the day-to-day operations?

Stony Brook Medicine physicians and staff are committed to providing high-quality, safe patient care.

SBU Hospital CEO Carol Gomes discusses what the hospital is doing to reduce infection potential. Photo from SBU Hospital

Quality and patient safety is priority number one, and we focus on safe patient care every day. The Stony Brook Medicine team convenes a safety huddle that is part of the day-to-day operations in every area, which includes critical leaders from all over the hospital.

We start the day with approximately 35 care team members from nursing leadership, physician leadership and operational leadership who report on important safety or quality opportunities.  Our huddles are highly structured meetings that allow the hospital to focus on process changes with direct follow-up. This drives accountability to help ensure that adequate safety measures are in place for our patients at all times. 

2. Interim SBU President Michael Bernstein mentioned to us that you were making an effort to curb infections at the hospital among other things. Could you discuss some of the initiatives you’ve been implementing to improve in that area?

Stony Brook University Hospital has three primary strategic quality priorities — clinical outcomes, patient safety and the patient experience.

Proactively, Stony Brook works to provide safe and effective care to every patient via our patient safety work groups. These groups analyze processes, review relevant data and implement process changes to enhance patient safety and prevent patient harm.

The vast majority of projects and improvement efforts are aimed at reducing hospital associated infections. There are teams that implement best practices for CLABSI, or central line associated bloodstream infections; hand hygiene; CAUTI, or catheter-associated urinary tract infections; C. diff, or Clostridium difficile infections; SSI, or surgical site infections; and sepsis. 

Working groups incorporate real-time data to implement best practices to ensure hospital units continue to drive improvement efforts in achieving patient safety goals.

3. In general could you talk about the threat of infections to patients at hospitals? Most people view hospitals as a place of recovery and necessarily don’t think of other germs, sick people around them. Can you speak on that and the challenges you and others face?

As a matter of standard practice, the hospital adheres to rigorous infection control guidelines every day to ensure a clean environment for patients, staff and visitors. These practices are especially important during the flu season.

Being within the close quarters of a hospital, there is an increased incidence of transmission for infections. Many patients have recent surgical wounds, IVs and other catheters placing them at higher risk of infection. These risks may be enhanced by the acquisition of an infection from a visitor.

Family members and other visitors who suspect they may have the flu or other viruses are advised to not visit the hospital.

To lessen the spread of the flu virus, hand hygiene and attention to reducing the effects of droplets from respiratory illnesses such as the flu can enhance patient safety.

Hand washing prevents infection. It is one of the most important actions each of us can implement before and after every encounter with a patient.

The goal is to minimize that transmission while the patient is in the hospital.

4. Other practices/guidelines at the hospital?

The flu virus most commonly spreads from an infected person to others. It’s important to stay home while you’re sick, not visit people in the hospital and to limit close contact with others.

Visitors should wash their hands before entering a patient room and after seeing a patient, whether or not there is patient contact. 

As added protection, patients who have been identified as having infections are isolated appropriately from other patients in order to prevent accidental spread.

Therefore, if a patient has the flu or flulike symptoms, the hospital will place them in respiratory isolation. Likewise, a patient with measles or chicken pox is kept in appropriate isolation.

Visitors may be asked to wear masks on certain units.

5. How do patient safety grades affect how the hospital looks to improve
its quality? 

Stony Brook University Hospital supports the public availability of quality and safety information about hospitals. We are constantly looking for ways to improve and ensure the highest quality of care.

There is a wide variation of quality reports with different methodologies and results.

Clinical outcomes define our success as a hospital. Better clinical outcomes means we’re taking better care of our patients. Stony Brook Medicine initiated a major initiative to improve clinical outcomes. We have multidisciplinary groups improving outcomes in the following areas:

  Increasing our time educating patients prior to their discharge in order to prevent hospital readmissions.

  Improving the care of our patients receiving surgery to reduce postoperative complications.

  Enhancing the diagnosis and care of patients with diabetes.

  Improving the speed of diagnosis and treatment of sepsis.

In short, great effort is expended in identifying opportunities for improvement with a detailed and focused approach on enhancing patient outcomes.

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We worry about infections regularly. The last thing people want is a cold right before they go on a summer vacation, before they see a newborn, or before they are about to give a presentation half way around the world to a group of people who might approve their work for the next three years.

And, yet, there are some types of infections, or infectious behavior, that have the opposite effect, making us stronger, purging our system of toxins and giving us the extra energy to work harder, to be more patient with traffic around us and to smile when someone accidentally insults us.

Laughter fits that bill. TV producers certainly understand this when they add laugh tracks to their shows. It allows people to feel as if they are not alone, as they laugh with others they can’t see, even if they are alone in front of their TV.

A late family friend used to become so caught up in funny stories that his quick breaths and high-pitched squeals kept him from speaking. The tale, however, became irrelevant as his performance more than compensated for the lack of a narrative, allowing the rest of the room, particularly those who knew him well, to share his laughter.

I can still hear the laughter from my late aunt, whose giggles would often end with joyous tears.

I recently spent a few days with my brothers to celebrate summer birthdays. We sailed, ate well and hit baseballs on a hot, airless field at Gelinas Junior High School.

I stood in right field, as one brother pitched and the other sent bombs deep into the outfield. My sister-in-law patrolled near second base, scooping up grounders and acting as a relay.

My brother crushed a hard grounder directly at his wife. I immediately shouted, “Field it to the side. Move out of the way.”

My brothers started laughing, slowly at first, at advice that was so contrary to the suggestions I had made when I coached baseball and softball over the last decade.

“Yes,” I acknowledged, “but I don’t want her to get hurt. I’d rather she missed a ball that hit a rock or took a crazy bounce than have it slam into her.”

“Sure, sure,” they teased. “You really don’t know anything about this game, do you?”

Then, it occurred to me to go with it.

“Well,” I shrugged, “I’m actually trying a new technique.”

“Oh yeah?” they asked dubiously.

“Yes, I’m going to tell the kids, ‘Take your eyes off the ball and make sure you have absolutely no idea what to do with the ball when it comes to you.’”

After a few snickers, the four of us shared the kinds of things you’d never tell kids on a baseball field, which ramped up the laughter. Things such as “Yes, it is all your fault” and “No, you’re not that good at this sport.”

The laughter somehow  made the heat of the afternoon more bearable.

Later, my younger brother was in the middle of a salad when he offered something so uproariously funny that his lips could barely contain the food, even as he couldn’t possibly swallow. With great effort, he slowed his laughter and swallowed.

I’m not sure what was so funny, but I know the value of laughter. Yes, of course, one movie after another tells us about the power of love, which drives people to incredible achievements and affirms the value of our connections.

Along the way, however, laughter helps fill our tank, soothes the frustrations of the day and puts a broad infectious smile on our faces that can spread, like a beneficial virus, delivering feelings of goodwill that can cascade through a crowd.