Isolation Gown Testing | Top 10 Patient Safety Concerns | Changes in Aging Services

Paul Anderson: Hi, and welcome to ECRI Now, a show about healthcare insights from the experts. I'm your host, Paul Anderson. Today we'll talk about the changing face of the aging services industry and look ahead to the top 10 patient safety concerns facing healthcare in 2023. To get us started, we'll visit the ECRI lab and Karen Haberland, a senior project officer with our device evaluation team who's been testing isolation gowns, a critical piece of safety equipment that can be easy to overlook. Medical protective gowns are a critical piece of equipment to keeping the healthcare workforce safe and helping them provide safe care. But we know that organizations may not always test them, especially things like disposable isolation gowns to make sure they're doing the job that's expected. We're here in the ECRI lab with our senior project officer, Karen Haberland, to talk about testing that we've been doing of those isolation gowns. Karen, what is an isolation gown?

Karen Haberland: So broadly, medical protective gowns are just a group of protective equipment that provide a barrier of protection to prevent cross- contamination between a healthcare worker and the patient. Isolation gowns specifically are tested to a standard called AAMI PB70. They are tested to one of four levels, level one through four, depending on their level of fluid barrier protectiveness. So how much risk you can be exposed to of fluid hitting you.

Paul Anderson: So when we talk about testing, what kind of things are we testing for? Is this a question of tears and punctures? Is it that barrier protectiveness? What sort of things are we looking at?

Karen Haberland: Yeah, we test a lot of things. So ECRI's doing an evaluation right now on disposable isolation gowns. So we're running a pretty big gamut of physical testing. So we are looking at a bunch of fluid barrier properties and also durability tends like strength and tearing properties. And then we're also doing a human factors evaluation. So we have active clinicians coming in who volunteered to try out our gowns through a range of activities, what they would be doing on a day- to- day basis, and seeing how comfortable they are wearing them.

Paul Anderson: With some of those tests you were describing, Karen, what are the real world equivalents of those? So if we're testing for tensile strength, where might that be challenged during the course of a person's shift, for example?

Karen Haberland: It's usually for tensile testing, that's looking at the movement of the wear going around their tests. So say they have to roll a patient that might pull on a gown, or if you're looking at tear, does it get caught on a cart or the bed and is it going to tear really easily or is it going to move with you? Because if it tears, that's going to break your fluid barrier and now you could be contaminated. So for the fluid barrier testing, spray impact is really looking at that quick spray. We've all been there. Hydrostatic pressure is really looking at, say you're rolling a wet patient or washing a patient, you're getting that harder contact of fluid against you. If you're leaning on a bed this wet, it might make it easier for the fluid to get through.

Paul Anderson: So the other piece of this, I'm thinking besides there's the individual wearer, the individual user piece, there's testing. How about purchasing? So I'm imagining that for disposable gowns, an organization must go through huge quantities of these things. What are some purchase considerations they should be thinking about?

Karen Haberland: Yeah, there are quite a few. Really, you want to make sure first and foremost that you vet your suppliers. Make sure when you're looking at different suppliers, have they been on the market for very long? Do they have that history or did they start making gowns during the pandemic? Ask what testing they do on their gowns, and if they do testing, can you see it? Did they do their testing in- house or did they send it out to a certified testing lab who has data to back that up? That's really critical. When you're making those decisions, when you're looking at the range of gowns, that should be a really big conversation. That should include risk management, that should include infection preventionist, and it should include some of the wearers that will be using these from day to day. That should be a conversation about every procedure that these are going to be used in, what is the risk of fluid exposure in that procedure and what gown makes sense for that? And then again, those users that are wearing it, they should be trained. They should understand what their exposure risk is for each activity that they're doing, and should they be wearing a different gown for one procedure versus a different one. And if they have strikethrough, that's not normal. Scrub soilage is not a good thing that should be reported. That should be a conversation. Like, is this not the best gown to be using for this procedure? And really make sure that the risk and what you're doing in that procedure really aligns with what you're wearing.

Paul Anderson: Karen, thanks so much for being with us today. Yeah,

Karen Haberland: Thank you.

Paul Anderson: To learn more about the work our device evaluation team is doing, check out our ECRI lab tour webcasts. Every year, ERCI identifies the top 10 patient safety hazards facing healthcare organizations. Over the years, we've looked at topics like staffing shortages, diagnostic error, and the effects of COVID- 19. For this year, we spoke with Laura Stone, a risk management analyst at ECRI, about how we developed the list and how organizations can implement it. Every year, ECRI produces a list of the top 10 patient safety challenges facing healthcare organizations. We're here with Laura Stone, a risk management analyst at ECRI to talk about how we identify items to be on that list, how organizations can use it to tackle their patient safety challenges and how the list has evolved over the years. So Laura, there are obviously a lot of patient safety hazards in the world. Every year, we put out a list of the top 10. How do we identify those 10? Are they just the most reported things to ECRI patient safety organizations, something like that?

Laura Stone: Sure, Paul. So we do look at the patient safety data, but that's certainly not the only way that we get this information. It's truly a collaborative effort across all of ECRI and ISMP employees. So what happens is every year all ECRI and ISMP staff are asked to nominate patient safety concern that might be important to them. They might have discovered this through reading scientific literature, through member queries, root- cause analyses results, or anything that's been reported to ECRI or ISMP databases. And so one of the really cool things that we've done this year is we've added icons. So you can see where on the healthcare continuum, this concern might manifest. So they could be any combination of a hospital, an ambulatory surgery center, physician practice, an aging services organization, or home care. So look for that. We then are asked to vote, and then a select committee picks the top 10 and then they will rank them.

Paul Anderson: So it's more than just accounting exercise.

Laura Stone: Correct.

Paul Anderson: In other words, we're evaluating things from all those sources. How important do you think that that interaction that we have with our actual clients than representing their real lived experience down into the list?

Laura Stone: Oh, that's so important Paul. And I think that that's one of the things that we do really well is we listen to our clients, we see what are their pain points, and then we try to help them.

Paul Anderson: One of the things we really like about our top 10 list is that it's not just a list of things that can go wrong. We offer recommendations about what an organization can do about it, and we really always try to emphasize especially the role of the patient in that why is that so important?

Laura Stone: Engaging patients in their care is really important, Paul. It gives patients a sense of autonomy. It also leads to better adherence to their care. So one of the things that we are really focusing on in this is not just helping the healthcare workers and giving recommendations to them, but really how can they engage those patients and also their caregivers as well.

Paul Anderson: So we've been doing the top 10 list for almost a decade, and obviously things have fallen off the list over the years. Is that an indication that healthcare by and large has sort of solved those challenges, things around diagnostic challenges or fall prevention, things like that, are they basically better now?

Laura Stone: I think they might in some cases be better. I think in some things we've made improvements definitely. I wouldn't go so far as to say they're completely solved, and I think just because something isn't on our list doesn't mean it's not important. It's just these are the top 10 things that really this year maybe we should be paying a little bit more attention to and trying to address.

Paul Anderson: Last year, in our 2022 list, the lead item was about staffing shortages. And I know that is not all fixed now in here in 2023. How do we see something like that that maybe isn't called out individually in a future list? Does it still sort of pop its head up in other ways?

Laura Stone: It does. So it's not explicitly an item in this list this year. Like you said, we devoted the number one last year to it, but it does still show up in some of the ones this year. It might have been a contributing factor or it might be something that people need to address in order to overcome current concerns for this year.

Paul Anderson: Again, we've done this list for a long time and this is really be our third full list in what I'll call the COVID era. How do we see the influence of that in some of these topics?

Laura Stone: Yes, absolutely. So without giving away any of the items on the list, I will say that considerations around the COVID virus or the pandemic really does show itself in a lot of our topics this year. It could have been a contributing factor to some of them, or it's something that you need to think about while you're addressing some of these issues because it is our new reality.

Paul Anderson: Laura, thanks so much for your time.

Laura Stone: Thank you, Paul.

Paul Anderson: Be sure to check out ecri. org for the release of our annual top 10 patient safety concerns list coming during patient safety week beginning March 12th. As the US population ages and retires, the elder care industry is evolving to fit its growing needs. I spoke with Vic Rose, the executive director of Aging and Ambulatory Care at ECRI, to see how some of those changes have taken place and where things might be going next. Vic, what are a couple of the big ways that the long- term care industry has changed over the last, let's say, a decade or so?

Vic Rose: Paul, that's a really important question. And all of healthcare right now, there's a lot of forces at play affecting how we care for our older adults, who's caring for our older adults. If I had to say the number one force having an influence on how we deliver care for our older adult folks in the country today, it's staffing and scheduling. But there's other challenges too that we're paying attention to. They range from financial challenges, reimbursement challenges, greater regulatory expectations, increased expectations from family members and residents themselves, but also from staff and how we keep our staff safe. And finally, there's other care delivery systems emerging. One of the biggest being care at home. We don't know today exactly how that's all going to play out. What we do know is it's going to continue to change how we deliver care in almost every existing setting and where we'll be in the future.

Paul Anderson: So Vic, you mentioned risks that emerge as we go through changing acuity regulation, staffing, all of that. What are one or two of the things that we think really people maybe aren't paying as much attention to as they ought to be?

Vic Rose: It's a great question, and you almost cannot have this conversation right now without talking about the pandemic and the influences that the pandemic had on our care delivery systems. Identifying opportunities for performance improvement in how we care for older adults and frankly people all across the continuum of care. One of the risks that really drew out for us is infection prevention and control. And again, these are conversations now that are taking place that talk about visitor management, outbreak management for residents and outbreak management for staff. As one emerging area of risk in an area that we need to continually develop in when it comes to IPC, there's some of the most catastrophic challenges we saw in care delivery systems where an outbreak settled into a resident population, increasing the resident care workload overnight as more positive cases came. And then at the same time, we had an outbreak occur in the staffing population who was caring for that. So you get this spike in care at the same time, your very capability to meet those needs is dropping. And so it's taught us to think a little bit differently from a systems perspective about how these different elements of our care delivery systems influence each other, what risks come out of that. And frankly, the kind of environments that we create that either act to prohibit adverse events or in some cases, they actually can proliferate them depending on the behavior of that care delivery system 24/7, 365 days.

Paul Anderson: You mentioned the pandemic, and obviously one of the other big storylines through the pandemic was supplies-- supply chains and shortages and purchasing. And broadly speaking, in the aging services industry, are they set up the same way we think of more established acute care organizations to be thinking about their purchasing programs and their purchasing assurance?

Vic Rose: So it's really been a hidden area of focus and frankly, something we haven't always paid attention to in the non- acute care aging services part of the care delivery system or the continuum of care. And it's something at ECRI, we're really focused on right now. ECRI's made huge impact when it comes to procurement, purchasing and supporting safety and cost- effectiveness in healthcare through some of our services. And we're pivoting, not stopping our focus in acute care, but realizing that a lot of our providers across other continuums, the whole continuum, other care settings, need that same support. For us, cost- effectiveness and safety with the right focus on procurement and purchasing, you can support both in a very unique way. And again, it's an all stakeholder approach, knowing which masks and what PPE to use for visitors when they come in, as well as staff, as they're caring for folks and at times for the residents too, who are interacting can do a few things. You understand the shortages that can come out of it, how to react to those shortages when they happen to standardize products being used across your systems to support continuity of care, especially if you have multiple units or multiple locations, but also that cost- effectiveness element. And in today's world, we talked about our staffing shortages and those impacts. Certainly, if we can find ways to be more cost- effective, better stewards of our resources, including financial, identify and capture savings and reallocate those to some of the other operating challenges we're facing light staffing, yeah, that's a win- win for everyone. And then if you do it right, you can also support your safety measures at the same time by selecting and comparing products and equipment that really help you achieve your quality and safety goals.

Paul Anderson: Build a real virtuous cycle supporting it, reinforcing itself.

Vic Rose: 100%.

Paul Anderson: Thanks so much for being with us today.

Vic Rose: Truly my pleasure, Paul.

Paul Anderson: To learn more about how ECRI can support aging services providers in responding to these evolving challenges, visit us at ecri. org. Thanks for watching ECRI Now. To find future episodes, visit us at ecri. org. Until next time, I've been your host, Paul Anderson.