Hospitals keep disease at bay

One of Canada’s largest hospitals has taken effective measures to prevent the spread of contamination and ensure secure access to pharmaceuticals.

Hospitals present unique security challenges for staff and patients. Not only are there issues of access control, but patients and staff must be kept safe and secure. Two areas that pose challenges are bio contamination and drug security.

Dr. Serge Jothy is chief of the department of laboratory medicine at St. Michael’s Hospital in Toronto, Canada. Because labs often house dangerous chemicals and potentially infectious agents, keeping them secure begins with access control.

“Access is limited to staff with a keyless swipe card,” says Dr. Jothy. Once inside the labs, staff must take steps to protect themselves from potentially harmful agents – and to ensure they do not transport those agents into the hospital beyond.

Dressed to deal with disease

“In the microbiology lab, cultures of microbes are kept for a few days and then discarded,” Dr. Jothy says. For samples that post an infection risk, such as tuberculosis, laboratory staff is protected by wear full body suits, including double clothing and proper face masking.

“All equipment that would be used to examine those specimens would then be discarded according to strict procedures,” says Dr. Jothy. In the case of the most dangerous specimens, such as Creutzfeldt-Jakob disease, all tools used to process and handle the material are destroyed after a single use. Proper ventilation in labs is also essential. Healthcare workers only handle high-risk specimens in a negative pressure environment.

Beyond the laboratories, hospitals must also take the steps necessary to prevent the spread of infections to patients and staff. Proper sanitation is key.

“There are things that are not particularly high technology but that are still highly effective, such as proper hand washing,” Dr. Jothy says.

Stopping SARS

Following an outbreak of Severe Acute Respiratory Syndrome (SARS) in Toronto in 2003, Canadian hospitals moved quickly to implement measures to reduce the spread of the potentially deadly illness. Today, those prevention measures have become standard practice.

At St. Michael’s Hospital, patients admitted for treatment are first tested for any infectious disease. Even those with mild symptoms are kept in isolation rooms within the hospital and all healthcare staff who work with them are properly masked.

“This is an improvement over even five to ten years ago,” says Dr. Jothy. “In the last few years, in various parts of Canada, there were sites with significant problems of Clostridium difficile infections. Because of that, these measures were taken.”

The SARS outbreak of 2003 prompted hospitals to universally apply safety standards that were already well known.

“This did not call for new technology. It was about making sure there was an immediate implementation of these measures,” he explains. “Things can happen extremely rapidly as we have seen and learned and it’s part of the challenging aspect of education to refresh staff about the mundane things from hand washing, to locking doors.”

Another area where hospitals are implementing best practices to ensure patient safety and security is in the safe distribution and storage of pharmaceuticals.

Lock on pharmaceuticals

As with the laboratories of St. Michael’s Hospital, keeping the hospital pharmacies secure begins with access control.

“That’s the brick and mortar piece of it,” says Dr. Janice Wells, Director of the Department of Pharmacy at St. Michael’s Hospital. “We use a keyless card access system to control who gets in and out of the pharmacy.”

When it comes to monitoring the individual drugs, storage and movement are captured through an inventory control system.

“We use a system called Smart Stream,” says Dr. Wells. “It is a procurement and a financial system, but it also lets us monitor drug movement.”

All drugs are labeled with a barcode. As in many hospitals, St. Michael’s employs a high degree of automation to order, package and dispense medications. When a doctor enters an electronic order for a medication, that order arrives at the pharmacy for assessment and validation. Medication is dispensed largely by an automated system and then provided to the nurses, who use a medication administration system to match the barcode on the medication to a barcoded wristband worn by each individual patient.

“We have systematized a complex process to prevent medication errors and give the nurses the tools they need to do their jobs,” says Dr. Wells. “Drug tracking and security is a nice bonus of this system, but patient care is the driving force.”

Unlike a retail pharmacy where a patient will receive multiple doses of a prescribed medication and take charge of administering it on their own, hospitals such as St. Michael’s work on a ‘unit dose’ dispensing system. Only the amount of medication required by a patient within a 24-hour period is dispensed from the hospital pharmacy.

“With the unit dose system, the nurse is provided with the drug in as close as possible to a ‘ready-to-administer’ dosage form,” says Dr. Wells.

The robust tracking system has helped St. Michael’s Hospital oversee the safe administration of up to four million doses of medication given to patients each year.

“With the use of barcodes we have really decreased the opportunities for error and given our nurses the tools to identify potential errors before the drugs even reach the patient,” Dr. Wells says.

By Rachel Sa