Barriers to Primary Care Doubled, Prompting More ED Visits

A shortage of primary care may lead to ever-increasing rates of emergency department use, even for people who have health insurance, according to a study in the Archives of Internal Medicine. 

"Coverage does not equal access," said Sandra Schneider, M.D., president of the American College of Emergency Physicians. "People come to the ER because it's the only place they are guaranteed to get the help they need. It's time to recognize the tremendous value that people place on having access to emergency care. And that it's not a realistic objective to prevent emergency visits — at least for the foreseeable future — not only because of physician shortages, but because of the nation's growing elderly population. It's time to start focusing on new ways of providing medical care in the United States. For example, emergency departments are fully staffed 24/7, and the marginal costs of caring for a nonurgent patient are actually the same as a visit to a primary care physician."

Researchers analyzed National Health Interview Survey data of approximately 317,000 adults across the United States from 1999 to 2009. They found that people with one or more barriers to primary care are more likely to visit the emergency department and that barriers to primary care have doubled over the past decade. Those barriers include limited physician office hours, wait times for appointments, difficulty in getting in touch with a primary care physician's office to make an appointment and transportation issues.

In 1999, 6.3 percent of adults reported at least one barrier to primary care.  By 2009, that number had risen to 12.5 percent. Among adults with at least one emergency department visit, the prevalence of having at least one barrier to primary care increased from 12 percent to 18.9 percent during that decade.

"Emergency medical care consumes just 2 percent of all health care spending in this country while treating an ever-growing population of patients," said Schneider. "Emergency medicine is critical at any hour of the day. It must be there when you need it."

Hospital Uniforms Contain Dangerous Bacteria Most of the Times

More than 60 percent of hospital nurses' and doctors' uniforms tested positive for potentially dangerous bacteria, according to a study published in the September issue of the American Journal of Infection Control, the journal of APIC–the Association for Professionals in Infection Control and Epidemiology.  

A team of researchers led by Yonit Wiener-Well, M.D,. from the Shaare Zedek Medical Center in Jerusalem, Israel, collected swab samples from three parts of the uniforms of 75 registered nurses and 60 physicians by pressing standard blood agar plates at the abdominal zone, sleeves' ends and pockets. 

The researchers at this 550-bed, university-affiliated hospital found that exactly half of all the cultures taken, representing 65 percent of the RN uniforms and 60 percent of the MD uniforms, harbored pathogens. Of those, 21 cultures from RN uniforms and six cultures from MD uniforms contained multi-drug resistant pathogens, including eight cultures that grew methicillin-resistant Staphylococcus aureus (MRSA). Although the uniforms themselves may not pose a direct risk of disease transmission, these results indicate a prevalence of antibiotic resistant strains in close proximity to hospitalized patients.

"It is important to put these study results into perspective," said APIC 2011 President Russell Olmsted, MPH, CIC. "Any clothing that is worn by humans will become contaminated with microorganisms. The cornerstone of infection prevention remains the use of hand hygiene to prevent the movement of microbes from these surfaces to patients."

Posters Can Help Increase Hand Hygiene in Health Care Settings

A study by Kansas State University shows posters can make a difference when it comes to increasing hand hygiene in a health care setting. The research, based on observations of more than 5,000 patrons at a hospital-based cafeteria, shows that an evidence-based informational poster can increase attempts at hand hygiene. The study appeared in the American Journal of Infection Control, and was funded by One Health Kansas, a project supported by the Kansas Health Foundation.

Over a five-week period, a poster intervention with an accessible hand-sanitizer unit was deployed to improve hand hygiene at the entrance to a hospital cafeteria. An anonymous researcher was able to observe hand hygiene attempts from the adjacent dining area. The study included baseline, intervention and follow-up phases, with each consisting of three randomized days of observation for three hours at lunchtime.

Gains were modest. During the 27 hours of observation, 5,551 participants were observed, with hand hygiene attempts increasing from 3.16 percent to 6.17 percent.