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6 PATIENT SAFETY PRIORITIES IN 2017 10 Top Patient Safety Issues for 2017 By Heather Punke and Brian Zimmerman T he Becker's Infection Control & Clinical Quality editorial team chose the following 10 patient safety issues for providers to pri- oritize in 2017, presented below in no particular order, based on news, study findings and trends reported in the past year. Health equity. In 2001, the Institute of Medicine established six aims for improvement in healthcare: to make it safe, effective, patient-cen- tered, timely, efficient and equitable. While great strides have been made toward the first five, progress on health equity has lagged, ac- cording to the Institute for Healthcare Improvement. IHI called health equity the "forgotten aim" in a 2016 whitepaper. Health equity, per the IHI, is defined as "when everyone has the oppor- tunity to attain their full health potential." When access to health isn't equitable, it can lead to poor health outcomes for patients. For instance, black people have much lower life expectancies compared to white peo- ple in the U.S., and people in households with lower incomes have higher relative risk of mortality than those with higher incomes. While social determinants play a large role in health outcomes, health- care organizations have a big part to play in improving health equity in their communities. e IHI, the CDC and other organizations have made resources available to show hospitals and physicians how to make health equity a strategic priority, decrease institutional racism and devel- op partnerships with other organizations in their community. Growth of antibiotic resistance. Bacteria and fungi continue to grow more resistant to antimicrobials, even last-resort antibiotics like carbapenem and colistin. CDC Director Tom Frieden, MD, told e Washington Post in May that "the end of the road isn't very far away for antibiotics — that we may be in a situation where we have patients in our intensive care units, or patients getting urinary tract infections for which we do not have antibiotics." Hospitals can do their part to stymie the growth of antibiotic resis- tance by implementing antibiotic stewardship programs. e CDC and the National Quality Forum released "Antibiotic Stewardship in Acute Care: A Practical Playbook," in May to help hospitals set up such pro- grams, which are so vital to stopping the growth of antibiotic resistance that the Joint Commission added an antimicrobial stewardship stan- dard to its accreditation process for 2017. Patient care transitions. Patient handoffs are always a risky mo- ment in a patient's care journey, whether the move is from care team to care team or from acute care to post-acute care or to home. A study published in JAMA in December further solidified that truth, finding the end-of-rotation transition between resident care teams was asso- ciated with a significantly higher risk of in-hospital patient mortality. Fortunately, several patient handoff tools and checklists exist to strengthen this process, and an analysis of such protocols published in November 2016 in Human Factors: e Journal of the Human Factors and Ergonomics Society showed those protocols do help. It found "good evidence for the general benefit of using handoff protocols, regardless of setting or protocol type." Sterilization and reprocessing issues. Problems in the sterile processing department can put patients at risk of contracting various infections via surgical tools and medical devices. Hospitals and clinics continued to encounter problems cleaning, reprocessing or sterilizing reusable medical instruments in 2016. Some of the challenge stems from instrument design. A study pub- lished in October 2016 in Infection Control & Hospital Epidemiology found removing all contamination from robotic surgical instruments is close to impossible, for instance. Experts have also called duodeno- scopes — which have been linked to outbreaks of multidrug-resistant organisms — "almost impossible to clean correctly." Other issues arose due to lack of training for SPD staff. For example, a state investigation into Detroit Medical Center in fall 2016 found a lack of a "robust, consistent, repeatable, comprehensively documented and well-maintained training system" for central sterile processing employ- ees was one of numerous issues that exposed DMC surgery patients to infections. Hospitals can stymie this problem by ensuring staff are trained proper- ly on the latest sterilization procedures and making it as easy as possi- ble for staff to follow manufacturers' cleaning instructions. Quality data transparency. In 2016, CMS moved forward with its controversial Overall Hospital Quality Star Rating program, which assigns hospitals a performance rating ranging from one to five stars. CMS touted the ratings as a way to "help millions of patients and their families learn about the quality of hospitals, compare facilities in their area side by side, and ask important questions about care quality when visiting a hospital or other healthcare provider." However, the star ratings did not come without criticism. Several stake- holders spoke out about the shortfalls in CMS' program, including in- adequate risk adjustment for data that makes larger hospitals that treat more complex patients less likely to receive a high star rating. Other critics can paint CMS' star ratings as one more voice in an al- ready conflicting crowd of rankings and ratings. A JAMA viewpoint published in November noted "virtually no agreement among the rat- ing systems identifying 'better' or 'worse' hospitals. Hospital ratings systems offer conflicting information, as they rarely agree on which hospitals are top performers and which are poor performers." Some systems have taken quality data transparency into their own hands. For instance, Meridian Health in New Jersey started displaying performance reports for its hospitals online so patients can see more current data and make comparisons to other facilities in the area. "We own it, and put it into a format we believe would be easier for folks in our community to understand, and it's more current," Marty Scott, co-chief quality officer of Hackensack Meridian Health, told Becker's in an interview. Contaminated water. In 2016, hospitals faced a myriad of patient safety challenges related to contaminated water. e spread of Legio- nella bacteria, which incites a type of pneumonia, was especially prom- inent. For instance, in September, five patients at University of Wash- ington Medical Center in Seattle contracted Legionnaires' disease. Two of the patients died. e infections may have contributed to the deaths. A subsequent investigation detected Legionella bacteria in an ice ma- chine and two sinks in UW Medical Center's cardiac unit. In October, STAT examined the unintended consequences of having more sinks in hospitals. While installed to encourage better hand hy- giene, the splashing of sinks has the potential to aerosolize contaminat- ed water droplets and therefore infect patients nearby. e article cited a number of cases in which hospital sinks were linked to patient infec-