Diary

The dangers of bureaucratic neglect are built into the system

I carefully read Jack’s front page post and this line jumped out at me.

The only way this disease could be a major problem for a significant portion of the US population would be for a lot of people in charge to make some very poor decisions

I provided end user support to the the health care industry until just recently. We can get into more details but lets look at a few of the “bureaucratic” decisions that have already been implemented resulting in an extremely high risk of neglect.

The electronic age. All data is being captured electronically. And in most hospitals the money for hardware to make this possible is an afterthought. Computers do not save lives, drugs, sutures and people do. But the keyboard and mouse, monitor, and a wide range of peripheral devices are ubiquitous. Go into any patient room, procedure room, or treatment room and there are computers, monitors, tv’s, call buttons, speakers, etc. There are tap and go devices, keyboards, mice, band printers, scanners. etc. They get splashed. Procedures are recorded by staff before during and after procedures. They where gloves to protect themselves, of course, but then type on the keyboards. The keyboards are cross contaminated. Then there are the carts. Rolling carts that have laptops or computers built in that doctors and nurses move from room to room. Since ObamaCare there use has increased so that doctors can more quickly review patient information and enter data directly while treating the patient. The most important thing to know is that this equipment is not sterilized between patients. or completely sterilized ever.

Cutting costs in areas that don’t directly effect patient care. Because of cost constraints most of the support for these devices and equipment are contracted out. As is house keeping and sanitation, and many other services. Contractors reduce cost to clean, repair, replace, maintain and dispose of used equipment, materials and supplies. In many cases the money to pay for this is added to the budget as an afterthought, based on available funds rather than needs.

Limited budgets means re-purposing working devices. Keyboards get replaced, sometimes with new Keyboards, not always. Old Computer systems are removed and replaced by new systems in planned or unplanned system upgrades or refresh projects. The working keyboards, mice, monitors, network cables, tap and go readers, fingerprint readers, wrist band printers, label printers are all scavenged for replacement hot spares. They are not sterilized. Many peripheral devices need replacement or adjustment often. Contractors can’t leave the medical staff without a computer, especially in an intensive care, emergency, operating, procedure, treatment, or patient room and at the nurses stations. Likewise If a cart stops working it is urgent it be replaced immediately by a working device. What about TV’s and patients pillow speaker and call buttons? Ask any hospital administrator what is the most important device in a patient room the one that will insure a bad patient experience if it isn’t working and they will tell you the television. So when a call comes to a contract employee is expected to be resolved immediately and cheaply. In many hospitals there is no sanitation discipline to insure that the device being removed is safe, or even that the device being returned is not contaminated. What does get done is good enough for the kinds of risks we typically face. The big contagious diseases like tuberculosis or polio and similar airborne contamination are managed or severally limited. HIV and other blood born diseases less so but still contamination from this is limited overall. The increasing prevalence of treatment resistant bacterial infections shows us the danger of this approach however. We get treatment resistant bacterial infections because the of the bureaucratic decisions that place speed and quantity higher in priority than absolute sanitation. But all things have trade offs and the health care we have in this country is as great as any in the world.

The bureaucracy has decided out of sight is the foundation of safety. The decision to subcontract it out cheap as possible is the result. No money means reuse what you can then dispose of what is left as quickly and cheaply as possible. Not sanitized, hardware gets handled on it’s way to the recycle center by people who have little or no training to identify and handle potentially contaminated devices.

Of course, the same problem applies to the housekeeping staff. Good people that work hard. Contracted employees. Yes they have training, but as someone who spent a lot of time traveling the service halls and service lobby the need for speed has higher priority then sanitation. The focus is on getting the stuff out of the patient area, out of site, not making sure that the service lobby, service hallway, dumpster dock, trash carts or the people handling this stuff are clean and safe. Get the most work done for the cheapest price, and the people doing this work do work hard, really hard, and I suspect are happy to have a decent paying job. They work hard they work fast and that leads to overloaded carts, spills and messes that are not cleaned up at least not right away. The guy on the floor cleaning machine will get it later when that job gets done. Even though it may sit there all day, wheels and boots tracking it up and down the hallway.

So while I agree that the danger of a medical practitioner getting infected is slim. That isn’t the risk. Everyone from the medical assistant to the surgeon understands the risk. But when body fluids get sprayed, splashed, dumped or transferred by contaminated gloves to other things the risk that someone will get something and we won’t know about until lots of people are contaminated comes from this exposure. Whether they are computer things, or carts, halls, doorknobs, elevator buttons, trash containers, power switches, whatever, the danger is that someone could take this contamination home. In the case of door knobs and elevator buttons, it may be someone not even trained to recognize the risks.

Our Medical care system, in spite of the administration’s claims to the contrary is not as pristine and risk free as the TV shows and patient experiences would suggest. Bureaucratic bad decisions have resulted in a system designed to keep the dangers out of site. But with Ebola, that is probably not good enough.

So forgive me if I am an alarmist. I hope I am wrong. In the meantime I am looking for a new IT job that is not in the health care industry.

WmCraig