Free Case Study On E. Coli Outbreak At Good Health Hospital

Good Health Hospital has suffered an outbreak of E. coli with six cases currently reported. The Center for Disease Control (CDC) has recommended the investigation start in the hospital kitchens since E. coli is commonly transmitted through ingestion of contaminated vegetables and delicatessen meats. After discovering the current suppliers of vending services cannot verify sanitation protocols for their products, the hospital has received a recommendation that alternative vending services be found ss a precaution due to the severity of the cases and the potential for further spread. In addition, hospitals operating in the Tampa Bay area have reports of E coli contamination. The County Health Department has determined there is a need for further investigation.
An analysis of hospital records reveals the number of reported nosocomial infections in the past year. The findings are categorized pertaining to gender, age, ethnicity, and other factors. The health care administrator at Good Health Hospital was questioned concerning issues with potential lawsuits, and an implementation plan based on her answers is complete. Departmental recommendations prompted the design of a safety protocol itinerary for placement in the public access areas of the hospital. As the social science researcher at a regional hospital, the author has undertaken a complete investigation of the E. coli outbreak at Good Health Hospital.

Analysis of Hospital Records

The present case numbers at Good Health hospital stand at 6. All the cases have been on Ward 10, which is medical/surgery floor. The patients include 4 men between the ages of 15 and 36; the 2 women are ages 21 and 42. The admitting diagnoses ranged from a lacerated eyelid for the teen to a hysterectomy of the older of the females. There does not appear to be any correlation between age, gender, occupation, admitting diagnosis, or any other demography to the E. coli outbreak. On admission, none of the patients demonstrated an active or incubating infection; it would appear the infections were contracted after hospital admission.
An analysis of Good Health Hospital’s nosocomial infections reported over the last year is included in Figure 1.The parameters of age, type of infection, and location within the hospital were evaluated and determined not to be a factor until the current outbreak.
Figure 1. Analysis of Nosocomial Infections for 2014 for Good Health Hospital
Investigation into the Candida cases July through September were traced to the lack of protective hygiene by a temporary staff worker on a specific floor during that time. Otherwise, the reported cases of nosocomial infections in Good Health Hospital are unremarkable. The single Staphylococcus report was related to urinary catheter care on a 89 year-old male admitted for decubitus care; indications were the patient came in with the infection due to previous reporting by his physician’s office. Similarly, the E. coli report in March was unclear whether the 21-year-old female had contracted the infection prior to hospitalization since she was admitted with the symptoms of E. coli. The influenza reports during the cold season were seen throughout the hospital and there was no determination as to source. The evaluation of demographics yielded no correlations.

Questions for Health care Administrator

A meeting with the Joe Wellborn, the health care administrator at Good Health Hospital, resulted in six questions concerning the possibility of litigation in the E. coli cases.
According to Breathnach (2005), 1 in 10 patients will acquire a nosocomial infection. However, most are probably caused by the patient’s own bacterial flora. When infection prevention and hygiene becomes a priority, nearly all infections acquired at the hospital are preventable. Therefore, assuming you are in a court of law, can you state with all certainty Good Health Hospital enforces hygiene measures for hands and other prevention practices, including the availability of adequate sinks?
There are a few hospitals in the United States that have almost eliminated Staphylococcus (MRSA) and other drug-resistant infections by routinely testing patients on admission for Methicilling-resisant bacteriums. This is a frequent focus of lawsuits filed against a care facility. Does Good Health Hospital perform this type of testing on patients coming into the care environment?
Attorneys for patients pursuing litigation against a hospital find it difficult to determine if an infection was brought into the hospital or was acquired once the patient was admitted. In court, the plaintiff for the patient must prove not only that the hospital was negligent with procedures to prevent infection, but also that this negligence caused the infection. However, problems with diagnosing and treating the infections can be proven with enough evidence. Infectious patients can spread disease to other patients through contact or air transmission. What is the Good Health Hospital policy for appropriate isolation?
Antibiotics are commonly prescribed as a preventative measure on admission to the hospital in many cases. It has been found that when antibiotics are not used prudently, resistance to infection decreases. Does Good Health Hospital have a policy addressing the prescribing of antibiotics when no infections are present? Three of the cases of E. coli on Ward 10 were started on different antibiotics on admission and this aspect may arise in the event of a lawsuit.
Inadequate wound care or attention to an IV site must be documented in the patient’s chart. Lack of documentation for treatment or for hours when the patient should have had his vital signs checked will be brought into court. Does Good Health Hospital have a Compliance Team to educate, reinforce, and audit the activities of the staff in relation to this type of infection prevention?
After the meeting with Mr. Wellborn, the issue of litigation with one of the patients specifically may require further information for determination of whether he was symptomatic with E. coli prior to admission. Referral to the admission notes will determine if he was complaining of the symptoms of abdominal cramping and diarrhea. Food poisoning is suspected in the current reports secondary to the symptoms of nausea, vomiting, cramps, watery diarrhea, and fever MayoClinic.org, 2015).

Implementation Plan for Target Audience

The target audience at Good Health Hospital are any patients, staff, or visitors. Of particular interest are those people eating food prepared from the hospital kitchen. The four primary steps useful in a final implementation plan include:
Proceed with testing of equipment on Ward 10 (Medical/Surgical) including confirmation of proper sterilization of instruments, packages for catheter insertion, needles and intravenous kits, and so on.
2. Evaluate hygiene procedures, adherence to hospital policies addressing infection
prevention, and availability of handwashing stations between patients.
3. Conduct testing of the appliances, cooking utensils, staff, and food in the hospital kitchen
for potential E. coli presentation. In addition, evaluation is needed concerning proper
techniques for hygienic food preparation.
4. Testing of the staff on Ward 10, including employees visiting the floors from other
departments, to determine a potential source of the infections. In addition, testing of any
visitors to the infected patients may reveal the source of contamination and demand
evaluation of patient-to-patient possibility.

Recommendations for the Department Head of the County Health Department

Based on the steps taken in the implementation plan, five recommendations were made to the department head. They are
1) Conduct an audit of the area’s clinics and hospitals in an effort to determine if the
outbreak is confined to Good Health Hospital. Administrators should be notified of the
possibility of an E.coli outbreak in other areas of the city and proper procedures
implemented for prevention.
2) Conduct an audit of the vending services and other suppliers of food to the hospital to
determine if the source is coming from outside the facility. If the source of the E.coli
transmission is a particular supplier, steps should be taken to halt the distribution of the
product.
3) Air public service announcements concerning symptoms of E. coli infection will
provide population protection in the event the source is a particular contaminated food.

If the provider is not detected, this will allow the general population the ability to avoid

the suspicious food type and evaluate members of their households for possible
symptoms. In the event they suspect E. coli infection, they are encouraged to contact
their doctor immediately.
4) Should E. coli be found in a specific food, the County Health Department needs to take
the steps necessary to recall the food from stores, homes, restaurants, schools, and
other locations of distribution.
5) It is recommended the County Health Department undertake the follow-up procedures
for the patients and their families and visitors to guarantee the outbreak is confined to
the hospital and has not spread to the general public.

Safety Protocol Itinerary

Based on the approved recommendations, a safety protocol itinerary has been designed and will be placed in public access areas of Good Health Hospital. The itinerary was based on the information concerning the E. coli outbreak and its source.
The final conclusion by investigators was that the infection originated in the hospital’s dietary kitchens from spoiled food. The food was not contaminated when it was brought into the facility, and the E. coli resulted from mayonnaise left out of refrigeration past the period of safety. The reason the patients on Ward 10 were the only ones affected in the hospital was due to the use of the last remnants of a jar that had been left out too long waiting for use in sandwich preparation.
The staff of the hospital kitchen was instructed in the procedures for refrigeration of specific products. In addition the Compliance Team will perform routine inspections of kitchen storage procedures and food preparation techniques. Signs have been posted in the food preparation areas concerning the recognition and prevention of possibly contaminated foods. Emphasis was placed on the following protocols:
Physical aspects of the preparation area. The areas must be secure from visitors. Regular inspections are necessary to guarantee a pest-free environment.
Handwashing facilities. Sufficient areas for hand washing with cleaners and provisions for hand drying is mandatory. In addition, separate areas for washing food is necessary.
Procedures for sanitation. Proper hand washing techniques are to be taught and reinforced by the Compliance Team and posted signs. Hand washing is to be performed prior to leaving the restroom. Pump sanitizers will be placed on the walls beside doorways for convenient and frequent use.
Food sources. Perishable foods are to be secured from a reliable source and promptly inspected, labeled for dates, and stored appropriately. Cold foods should be kept cold at 40 degree Fahrenheit or below. Refrigerators required regular inspections for accurate temperatures and cleanliness. The inspections are to be documented.
Food temperature. In addition to cold foods remaining cold until just before serving, hot foods must remain at 165 degree Fahrenheit or above. If the hot food has been cooled and stored, but must be brought to the proper temperature prior to serving.
Proper clean up. All surfaces, equipment, and utensils should be cleaned and sanitized prior to storage. The following procedure is required for cleaning: after removing food, wash with soapy water and rinse in clean water, then sanitize in a dilute bleach solution of one tablespoon bleach per gallon of water. Material can be left to air-dry after this final rinse with additional rinsing. If this procedure conflicts with those recommended by the County Health Department, follow their instructions.

References

Breathnach, A. (2005). Nosocomial infections. Medicine, 33(3), 22-26.
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Inweregbu, K. (2005). Nosocomial infections. Continuing Education In Anaesthesia, Critical
Care & Pain, 5(1), 14-17. doi:10.1093/bjaceaccp/mki006
Local Health Department Roles in Food Safety. (2015). Retrieved 26 January 2015, from
http://www.naccho.org/topics/environmental/foodsafety/upload/Local-Health-Department-Roles-
in-Food-Safety-2-2.pdf
Mayoclinic.org. (2015). Food poisoning Symptoms - Diseases and Conditions - Mayo Clinic. Retrieved
26 January 2015, from http://www.mayoclinic.org/diseases-conditions/food- poisoning/basics/symptoms/CON-20031705
O’Connor, C., Powell, J., Finnegan, C., O’Gorman, A., Barrett, S., & Hopkins, K. et al. (2014).
Incidence, management and outcomes of the first cfr-mediated linezolid-resistant
Staphylococcus epidermidis outbreak in a tertiary referral centre in the Republic of
Ireland. Journal Of Hospital Infection. doi:10.1016/j.jhin.2014.12.013
WNEP. (2015). Food Safety Protocol for Food Preparation. Retrieved 26 January 2015, from
http://www.uwex.edu/ces/wnep/files/FoodSafetyProtocol2009.pdf