Study Finds Bacteria Can Live on Airplane Surfaces for Days

By Kim Smiley

With many bodies packed into a tight space and seemingly stale air, airplanes tend to bring out the inner germaphobe in many of us.  And the latest research, especially if you just read the headlines, isn’t going to help. Researchers at the University of Auburn found that Methicillin-resistant Staphylococcus aureus (commonly known as MRSA) and E. Coli can live for days on airplane surfaces.

The experiment involved sterilizing six surfaces found on airplanes (seat pocket, arm rest, leather seat, window shade, tray table and toilet handle), introducing MRSA and E. Coli bacteria to them and then measuring how long the bacteria survived.  Typical conditions inside an airplane were stimulated and the bacteria were suspended in three different solutions (saline, simulated seat and simulated saliva) to replicated the environment inside an airplane. The survival times ranged from 8 to 2 days.  This is a little scary, especially since an estimated 1-2 percent of people in the US may be carriers of these dangerous bacteria.

The good news, and there is good news, is that the surfaces where the bacteria lived the longest, the more porous surfaces such as the seat pocket, are the least likely surfaces to actually spread the contamination.  The study also didn’t look into how much bacteria remained after the typical cleaning  by airlines between flights, but the researchers plan to look into this in the future.

So what can you do to reduce the risk of illness if you have plans to travel on an airplane soon?  The simplest thing you can do to protect yourself is to frequently wash your hands with soap or use hand sanitizer as well as avoid touching your face as much as possible.  If you feel the need to take additional precautions, you can clean the areas around your seat with a disinfectant when you board the plane.

Airline cleaning procedures can also significantly impact the spread of illness.  So the question is, how much do you trust the thoroughness of the cleaning performed by the airline?  I think I may invest in a travel-size hand sanitizer before my next flight.

To see a high level Cause Map of this issue, click on “Download PDF” above.

Lethal injection fails to quickly kill prisoner

By ThinkReliability Staff

While the use of the death penalty remains highly controversial, there is general agreement that if it is used, it should be humane.  The execution of a prisoner in Oklahoma on April 29, 2014 did not meet those standards.  The inmate died 43 minutes after the drugs were injected.  (Typically death takes 5-6 minutes after injection.)  According to Jay Carney, the White House Spokesperson, “We have a fundamental standard in this country that even when the death penalty is justified, it must be carried out humanely – and I think everyone would recognize that this case fell short of that standard.”

The details surrounding this case can be captured in a Cause Map, or visual root cause analysis, to examine the causes and effects of the issue.

The problem being evaluated is the botched execution of an inmate in the Oklahoma State Penitentiary. The execution began at 6:23 pm on April 29, 2014.  An important difference in this execution, compared to other executions, is that it was the first time the state had used the drug midazolam as part of the three-drug injection protocol.  The protocol, when originally developed in 1977, called for sodium thiopental, followed by pancuronium bromide and potassium chloride.

The safety goal was impacted in this case because of the failed execution.  The public service goal can be considered to be impacted as the execution was called off (after all three drugs were administered; the prisoner later died of a heart attack.)  The schedule goal is impacted because all future executions have been called off.  The state planned a two-week postponement of the next execution (scheduled for later the same day) in order for a review of this investigation to be completed, but at the time of this writing, that execution has not yet been scheduled.  Executions across the country have been appealed or stayed and none have taken place since April 29th.  The labor/ time goal is also impacted due to the investigation into the execution, which has not yet been published.

These goals were impacted due to the failure of the lethal injection.  The process intended to be used for this lethal injection is detailed on the downloadable PDF.  However, from the start things didn’t go smoothly.  Instead of using two IVs, one in each arm, only one IV was able to be connected, in the patient’s groin.  Because sodium thiopental is no longer available (drug companies will no longer provide it for use in lethal injections), the drug midazolam was used instead.  However, the protocol for using that drug is disputed.  In Florida, five times the amount of midazolam is used.  In Oklahoma, midazolam is used along with hydromorphone.  Because of the debate about lethal injection, most states don’t divulge their suppliers, so the efficacy of the drugs used cannot be verified.  In addition, there is generally at least one doctor present to oversee the executions, but these doctors are not usually identified and may not participate in the actual administration of the drugs because many medical organizations ban doctors from participating on ethical grounds.

At this point, it’s unclear what will happen at future executions.  The investigative report being prepared by the state of Oklahoma may give some suggestions as to how to make lethal injections more humane in the future, or this may tilt the scales towards ending lethal injection, or executions altogether.

To view the Outline, Cause Map, and Process Map, please click “Download PDF” above.

Two Los Angeles area nurses are stabbed the same morning at different hospitals by different attackers

By ThinkReliability Staff

The stabbing of a nurse that took place in a Los Angeles County, California hospital on April 20th, 2014, resulted in the serious injury of a nurse.  The danger of increasing violence and attacks within hospitals was demonstrated by this and an unrelated incident at another Los Angeles County hospital that happened later that same morning.  Both involved stabbings to nurses, though in the first case, the attacker used a knife after he bypassed security and in the second case, the attacker stabbed a nurse with a pencil.

By performing a root cause analysis of just one demonstrative case, solutions that can prevent similar issues (like the one that happened later that very day as well as many other recent cases of hospital violence) can be developed.  We will use Cause Mapping, a visual diagram of cause-and-effect relationships, of this case as an example of hospital violence.

The first step in the Cause Mapping process is to describe the what, when, and where of an incident, and define the impacts to an organization’s goals.  In this case, the employee safety goal is impacted by the serious injury to a nurse.  The patient safety goal is impacted by the potential for injury to a patient.  The patient services goal is impacted by the fact that a violent attacker was able to bypass a weapons screening area.  It’s unclear from the information available whether other goals were impacted in this case.  Once that is determined the “?” can be replaced with the actual impacts to the goals, or “none”.

It can be helpful to determine the frequency of a type of incident.  Clearly, since about seven hours passed between two stabbings of nurses within the same county in California, the frequency of these types of attacks is much too high.

Next, cause-and-effect relationships are determined by beginning with an impacted goal and asking “Why” questions.  In this case, the injury to the nurse was caused by multiple stabbings.  The stabbings resulted from the nurse encountering a violent attacker and were impacted by the response time.  (In this case, security was searching for the man after he bypassed the weapons screening and was alerted to his presence when the attacked nurse began to scream.)   It is unclear how the man was able to bypass the weapons screening station, but ideally improvements that would decrease the possibility of entrants bypassing it in the future will be implemented.

Violence within hospitals has been increasing over recent years, believed to be due to a number of factors.  In addition, nurses and other hospital personnel have noted the difficulty in determining the potential for an escalation of violence in patients and other visitors.  According to the President of the Emergency Nurses Association, Deena Brecher, R.N.,”You need to be able to recognize when things are starting to escalate.  We know our behaviors can help escalate a situation, not intentionally.”

Many nurses are calling for establishment of workplace violence plans that would provide nurses and other hospital workers tools to identify and de-escalate potentially violent behavior, as well as provide additional protections against these types of attacks.  Some hospitals have begun using a mobile distress system, such as a help button worn around the neck that allows a worker to request backup in a situation that feels unsafe.

These solutions bring up an interesting discussion about prevention and blame.  The solutions listed above all require action by the part of nurses or hospital workers.  Many organizations attempt to determine the person to “blame” for a situation, and then assign corrective actions accordingly.  Clearly, nobody is trying to imply that hospital workers are at fault for these violent attacks (blame) but are rather trying to provide tools within their sphere of control to reduce the risk of worker injury (prevention).  Preventing all people prone to violence from entering a hospital, while theoretically more effective at solving the problem, is neither practical nor possible.  Thus it is hoped that providing hospital workers additional tools will result in reduced injuries from hospital violence.

To view the Outline and Cause Map, please click “Download PDF” above.  Or view the Workplace Violence Prevention for Nurses course offered by the Centers for Disease Control and Prevention (CDC).

The Future Is Now?: Building a Neurobridge

By Kim Smiley

A chip was recently inserted into the brain of a man paralyzed from the chest down with the goal of allowing him to move his hand.  The tiny microchip is part of a system, called a Neurobridge, which uses a computer and a sleeve that fits around the patient’s arm in addition to the chip to allow the patient to communicate with his limb by bypassing his damaged spinal cord.  If the procedure works, the patient will be the first paralyzed person who has used his own thoughts to control a limb.  It will be a few weeks before the success of the procedure can be verified, but this is already an exciting development with the promise of amazing future applications of this type of technology.

So how does this Neurobridge work?  An article by The Washington Post “Ohio surgeons hope chip in man’s brain lets him control paralyzed hand with thoughts” by Jim Tankersley discussed the procedure in detail.  The patient’s brain was mapped prior to the surgery using a functional magnetic resonance imaging (MRI) machine.  The patient was shown pictures of hands moving and the areas of his brain that showed activity while he imagined moving his hand were recorded.  Once the surgery began, a portion of the patient’s skull was removed to allow access to his brain.  Electric pulses were fired into the area of the brain believed to control hand movement.  The patient was unable to move his hands, but did have movement of his upper arms so the team watched for a response in his upper arms to verify that the correct location was identified to insert the chip.

Once the chip was inserted into the brain, it was connected by wire to a transmitter port at the skull.  This transmitter port is connected by cable to a computer.  The signal from the brain then travels through the cable into the computer where it is run through an algorithm that mirrors the brainwaves that are present when a person is thinking about moving.  The signal now mimics brainwaves and is sent to a sleeve wrapped around the arm.  The sleeve has tiny electrodes that are used to stimulate the muscles to make the hand move.

It’s an ambitious project that if successful could help not only paralyzed patients, but others with limited motor function like stroke victims.   And as amazing as a Neurobridge sounds, it’s just one of many types of brain implants being actively researched and some of the ideas sound more like science fiction than plain old science.

The Neurobridge process can be illustrated by building a Process Map.  A Process Map visually shows the steps and is generally easier to read than the same information written in paragraph form.  To see a high level Process Map of this procedure, click on “Download” PDF above.

New Federal Rule Limits Level of Coal Dust Allowed

By Kim Smiley

On April 23, 2014, federal officials announced changes to the regulations governing dust-control practices in coal mines.  These changes are the most significant since the Coal Mine Health and Safety Act of 1969 and are intended to curb the increasing number of black lung cases.

Black lung is a potentially deadly disease that occurs when coal dust accumulates in a person’s lungs.  The coal dust slowly destroys parts of the lungs and blood vessels resulting in breathing problems, coughing and even death if the lungs are unable to adequately function.  As discussed in a previous blog, there is evidence that the number of black lung cases has been increasing in recent years.  Many believe that changes to the mining industry, such as modern high-speed mining equipment that produces high levels of dust and longer shifts, are increasing the risks to miners, in at least some mines.

The bad news is that there is no way to remove the dust once it has settled into the lungs and black lung disease is irreversible, but the good news is that it can be prevented by limiting the coal dust a person inhales and this is exactly what the new federal regulations are hoping to do.

The new regulations attempt to reduce the number of black lung cases by reducing the amount of coal dust exposure that is allowed during a shift by 25% (1.5 milligrams per cubic meter from 2.0).  Better monitoring of dust levels will also be required.  Miners regularly exposed to high levels of coal dust will be required to wear monitors that continuously track coal dust levels.  If dust levels are found to be above the limit, immediate actions to lower the dust limits will be required (such as slowing production) and respirators will be required to be available to miners working in the high dust areas.

The changes, first proposed in 2010, have been a long time coming and many in the mining industry have opposed them.  Some plan to continue fighting against the new regulations like Murray Energy Corp who have stated their intention to file a lawsuit against the U.S. Department of Labor saying the new rules are flawed, have no scientific support and are unachievable. As with any new regulation, only time will tell how smoothly the new changes can be implemented and how effective a solution they will be.