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UPMC employees risk steep penalties for violating guidelines

About Luis Fábregas
Picture Luis Fábregas 412-320-7998
Medical Editor
Pittsburgh Tribune-Review

Luis Fábregas is an award-winning reporter who specializes in medical and healthcare issues as a member of the Tribune-Review’s investigations team.

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By Luis Fábregas

Published: Tuesday, Feb. 1, 2011

Administrators at UPMC Presbyterian are threatening to fine doctors $1,000 and send workers home if they don't wash their hands or follow other infection control guidelines after an outbreak of hard-to-treat bacteria in the Oakland hospital.

"We want people to know that we will hold you responsible if you choose to be reckless or to follow risky behaviors," said Tami Minnier, chief quality officer at UPMC. "This is important. These are patients' lives that we're responsible for."

During routine surveillance in mid-January, infection control workers noticed a spike in the number of patients harboring an antibiotic-resistant bacteria called acinetobacter. The hospital typically counts two or fewer acinetobacter infections a month, but workers identified five infected patients, said Dr. Carlene Muto, chief of infection control at UPMC.

"Once we felt a pulse that something is not right, we jumped on it immediately," Muto said. "We decided we would implement some extra measures just to be sure that we're doing everything possible not to transmit to other patients."

Keeping hands clean is the best way to prevent the spread of germs and reduce hospital-acquired infections, experts said. Although it is a relatively simple action, compliance has been a problem among health care workers for years, said Marcia Patrick, a registered nurse and board member of the Association for Professionals in Infection Control and Epidemiology, a leading infection prevention group.

"Wow, talk about getting your attention," Patrick said about the measures UPMC imposed.

Patrick said she had not heard of such drastic disciplinary measures, but UPMC officials said some hospitals throughout the country are taking similar steps.

Acinetobacter is a hardy bug that typically infects the sickest patients, such as those in intensive care or trauma units, said Dr. Alex Kallen, a medical officer at the Centers for Disease Control and Prevention. It can live on the skin and survive on bed rails and table surfaces for days, he said.

"It's one of those bugs that because it affects generally people who are very ill, mortality rates tend to be high," Kallen said, noting the bacteria is associated with infections in wounded soldiers fighting in Iraq and Afghanistan.

UPMC administrators, who encountered an acinetobacter outbreak in 2006, placed workers in selected areas at Presby to monitor nurses and doctors as they go in and out of patient rooms. If they see someone who doesn't use a hand sanitizer or doesn't clean equipment according to standards, the monitor will intervene and show them how to follow hygiene guidelines. If they refuse, penalties kick in.

Workers could be sent home on the spot, without pay. On their next scheduled shift, they will be asked if they understand the precautions, and their infraction will be noted on their permanent employee record. The fine on physicians is not as steep for residents and fellows, who would pay $250. No one has been disciplined since the rules took effect Jan. 20, said Holly Lorenz, UPMC's chief nursing officer.

"We've had 100 percent complete cooperation," Minnier said. "No one wants to do the wrong thing. That's one of the things about health care that makes me the proudest: Very, very rarely when you point something out to somebody, they say, 'I don't care what you think.'

"They all want to do the right thing. The staff have responded tremendously well. I think they've done an amazing job."




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