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Guidance on HCP Attire to Prevent Infections

Guidance on HCP Attire to Prevent Infections

Healthcare personnel (HCP) attire is an aspect of the medical profession steeped in culture and tradition, according to Gonzalo Bearman, MD, MPH. “Apparel and appearance of HCPs have been linked with significant symbolism and professionalism, but we’ve recently increased our awareness of the potential role of attire in the transmission of healthcare- associated infections (HAIs).” HCP apparel can be contaminated with potential pathogens, but the role of clothing in the transmission of these microorganisms to patients has not been established. This has made it challenging to create generalizable, evidence-based recommendations on attire for non-operating room HCP. The Society for Healthcare Epidemiology of America (SHEA) recently analyzed available data on this topic and issued a guidance paper with reasonable recommendations for HCP attire. “The SHEA recommendations should not be viewed as a consensus guideline or as a standard of care,” explains Dr. Bearman, who was lead author of the paper and is a member of SHEA’s guidelines committee. “Instead, it’s intended to help acute care hospitals develop or modify policies relating to HCP attire.” The SHEA article evaluated and summarized the literature around the perception of both patients and HCP regarding attire in relation to professionalism and the potential risk for transmitting microorganisms. It also assessed the evidence for contamination of HCP attire and the potential for it to contribute to the transmission of pathogenic microorganisms in hospitals. In addition, a survey of the SHEA membership and SHEA Research Network was conducted to learn more about the policies related to HCP attire that are currently in place in members’ institutions. “Bare Below the Elbow” & White Coats The concept of...
Getting Third Parties Out Of The Exam Room

Getting Third Parties Out Of The Exam Room

Any physician, especially primary care physicians, can tell you that they are frequently forced to make a decision based on a third party’s opinion. Most often, this will be an insurance company denying a prescribed medication or test; the discussion in the exam room evolves into a discussion of what is covered by the patient’s health plan—and what is not. The goal of providing the best medical care is often overruled by some of those decisions. Of course, the insurance company will tell you that they are not making medical decisions, and the patient can pay out of pocket if they would still like the medication or the diagnostic test. Most patients will chose to go with what their plan covers, either for financial reasons, or they feel they are paying an insurance premium, and their insurer should be paying for their medical care. All too often, I find myself playing the appeals game with the insurance companies in order to get appropriate care for my patients. For example, I recently saw a young asthmatic patient who was controlled on a certain inhaler for many years. They had tried others, but those had all failed to relieve the asthmatic symptoms. The insurance company decided that the patient would have to fail on a trial of one of the inhalers they had already failed on in the past before covering the current inhaler. Well, patients can end up in the ER or even die from an exacerbation of asthma. Clearly, this was not in the patient’s best interest. Why should third parties not be allowed in the exam room? *...
Updating Adult Vaccination Recommendations

Updating Adult Vaccination Recommendations

Research has shown that current vaccination rates for adults are low. “There are 14 different infectious agents for which vaccines are recommended for adults, but vaccination rates are low for a number of reasons,” says Carolyn B. Bridges, MD. “There is limited public awareness about the need for vaccines for adults besides influenza. Also, patients rely on recommendations about vaccines from their providers, but many providers don’t routinely assess vaccination status and follow with recommendations for the vaccines their patients need.” Each year, the Advisory Committee on Immuni­zation Practices (ACIP) reviews and updates its recommended immunization schedule for adults aged 19 and older. Each February, the schedule is updated on the CDC website (www.cdc.gov/vaccines). The schedule provides a brief summary of ACIP recommendations using figures and footnotes to describe which patients are recommended to receive each vaccine and a table that describes the primary contraindications and precautions for each vaccine. Strategies for Improvement A number of strategies can help incorporate adult vaccinations into clinical practice, including systems changes so that vaccines are routinely assessed and offered. Other strategies include using reminders for healthcare providers (HCPs), such as prompts in electronic health records, using protocols or standing orders for office staff, and sending reminders to patients about needed vaccines. According to Dr. Bridges, one of the most important elements in improving vaccination rates is making sure patients hear from their provider about which vaccines they need. The CDC has partnered with many organizations to update the Standards for Adult Immunization Practice. The standards are a call to action for providers to: – Assess vaccination needs among patients in every clinical...
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