One of the main topics in current hospital management is about risk management and specifically risks dedicated to infections.

The main point in managing this risk is that all employees have a stake in managing this risk. Secondly, systems or tools can help to reduce the risk, but a system can not eliminate the risk nor held responsible for the risk.

"Essential facts: 1. Infections contracted in hospitals are the fourth largest killer in America. Every year in this country, two million patients' contract infections in hospitals and an estimated 103,000 die as a result, as many deaths as from AIDS, breast cancer, and auto accidents combined. " (1)

The uniqueness of the hospital as a company unlike many others is of course the production process where patients are subject to a service often the operation) offered by a large number of medical professionals and cared by even more nursery professionals. It is this intervention process where the infection becomes a danger.

Another unique feature of hospitals is that it is open to the public. There is no one at the door who prevents people with flu to enter the area.

"The Major Problem: Poor Hygiene... ... physicians and other caregivers ("often") break the most fundamental rule of hygiene by failing to clean their hands before treating patients...
...
Cleaning hands is essential, but it's only the first step....("they") put on gloves, and then reach up and pull open the privacy curtain to see the next patient. That curtain is seldom changed, and it is frequently full of bacteria. The result? Caregivers' gloves are soiled again...

People management is the hardest job in overall business management. Especially if these "people" are highly qualified professionals that operate with a certain amount of autonomy... It is this autonomy that makes that the individual professional not easily accepts central rules and principles.

Yet as states in the beginning, all professionals have a stake in the risk and compliance to the central rules will determine the overall success of the hospital, which is in this case an infection free area. Solving an infection requires much more effort than preventing it to happen.

But there is more to a hospital than the professionals that cure and care patients...

Human resources make up the most significant part of a hospital and amongst them, the medical professionals dominate the number of employees.

Yet, a hospital is a more and more a capital intensive organization, where information systems, medical equipment and infrastructure determine the overall success of the company.
It is this combination of human resources and systems and its specific configuration that make a hospital both efficient and effective.

Sterilization is one of the most important central processes in a hospital. All tools and equipment must be sterilized before re-use. Then, the operating room is full of medical equipment.

Last but not least is an infrastructural element that is literally invisible: (clean) air. For this last there are new developments - like the virus buster (2) - that makes it possible to sterilize the air by using UV light.

This latter is an example where tools and systems may offer support in reducing the risk. The virus buster will clean (sterilize) the air and will help to reduce the chance on infections, but the system on itself will not solve the infection, nor will it be responsible. Responsibilities for risks are always assigned to employees or managers.

So in managing the risk the focus will be distributed on: measures and guidelines on human interaction (the organizational element), purchase and implementation of extra tools (the system element) and cleaning time (the business element).

Successful risk management is achieved by focusing on the organization; what's the follow-up rate on hygiene procedures and does the organization change to be more hygiene-conscious? It is partly achieved by investment in new tools and equipment (automatic doors and virus busters, etc). Yet while investing in these tools, there is a negative effect on the organizational awareness. Although systems cannot be held responsible, people imagine that with automatic doors the infection problem will be solved. Tools and equipment make the organization "lazy" which increases the risk.

Finally the business process is the part that can be measured by the risk manager. When cleaning times (to sterilize the operation rooms after an operation) decrease because of the pressure to increase the availability of operating space, the risk manager should ring a bell.

Bottom line: managing the risk of infections requires attention to people, procedures which can be summarized by: (more) discipline. The investment in tools and equipment will only give a one-time effect, similar like the "Da Vinci Inside (3):" having the latest robot technology doesn't automatically upgrade the hospital to one of the best. The same hospital may face the risk of an infection as any other. Only people (management) can prevent such a drama.

Affordable health care is becoming a concern to many Americans nowadays. Many companies are now increasing the charges, for providing this service to their workers or cutting back on the level of cover. This situation happened to me not that long ago at the company I work for when every employee's health benefits were reduced. Last fall, out of the blue, we were informed that our health care provider was going to be switched to a cheaper alternative.

They said it was necessary if all their employees were to have the same level of health care. I suppose some people are better off and perhaps I shouldn't sound ungrateful. The new insurance company may be cheaper for the company but it isn't for me because to have my husband and daughter in the plan costs double what it did with the previous provider. This means, that for my company to provide a health plan to all of the employees, it is no longer affordable for us.

I suppose my health care plan is still good but this new company is not as good as the old one. Many workers saw their paychecks reduce when this new affordable health care scheme come into force. You see, four years ago, I gave birth to a little girl and of course my old insurance paid for the whole of my hospital stay. I sat and worked out the cost of this new plan and if I were to stay in hospital now and have a baby it would cost around 4,000 dollars out of my own pocket.

This figure does not take into account additional amounts I must pay out of my salary. Luckily there are more and more affordable health care programs being created to help those that do not have any coverage. Some people are even able to get free health care, also single mothers or families where an employment scheme isn't available are having the opportunity to join low cost plans. The problem is when a small number of people take advantage of a system that was designed for those that needed it most.

Those less well off are in need of these affordable health care schemes but they are also used by those who are intent on living of the state and do not actually contribute to society. We all have a responsibility to help those less fortunate but those who abuse the system put extra financial pressure on the rest of us. My employer definitely found advantages in finding a lower cost health plan provider for their employees! All too often this happens where the only one that really benefits is the company, who seem quite happy that many of their employees will take home less. In the long term we really need to do something in America to help those in need find affordable health care.

Let us say that you have someone in the nursing home or in a rehab and care center, and you have detected something incorrect or wrong or just something that needs to be changed. Your first instinct might be to tell the nurse or aid that is in the room or on duty right there. Most times, these workers will instruct you to go to the nurses station. And, since you are usually agreeing to almost anything that sounds reasonable, you go to the nurses station and you present your problem, question or critic right there at the nurses station.

Do not do it. You heard correct. When the aid, worker or doctor instructs you to go to the nurses station with the problem, do not do it. Well, you can go there, and find out which nurse or staff member is in charge of that particular issue or problem that you wish to speak about , for example, food, or clothing or medicine. Find out which worker is in that department. Once you are directed to the proper nurse, do not speak with her about the issue at the nurses station at all. Why ?

1. If the issue is something that is likely to annoy the nurses or make more work for nurses, then all the nurses or workers that are hanging out at the nurses station will have their ears open to what you are saying. So, instead of having your privacy and the resident's privacy, now every single person sitting or hanging out at the nurses station is now listening to what you are saying.
2. Since everyone is listening, and since the issue might be one that is annoying or probably to cause the nurses more work, most likely, some will interject with their own remarks, opinions or sly remarks regarding the issue EVEN though they have no authority to rectify or change the problem and even though it is not their department. They will feel free to enter into the conversation. This puts you at a loss. Have you ever tried to converse with five people who are disagreeing with you or who might be upset that your observation or problem might be causing them to have more work every day? Trust me with this one. Whenever you want to speak with staff, never speak with the nurse who is sitting behind the nurses station. Tell her that you need privacy in conversation and ask to speak with her aside somewhere. There is no reason why she should not oblige you. After all, the HEPA laws guarantee patient privacy do they not?
3. It is your right to refrain from discussing patient's, resident's or family members issues or problems or questions in the hallways of facilities or in any public areas of the nursing home. That is the law. And any employee, no matter what their job, who insists that you discuss private things in the public areas of the nursing home is breaking the law. But most employees will not tell you this. So, learn the laws yourself and save yourself lots of time and trouble.
4. Speaking with one staff member while five or six others are watching and listening protects the facility but does not protect you or the resident. Why? They are protected because they can back each other up and say what you said, even if you did not say it. This has happened many times in unscrupulous rehabilitation and care centers across America and across the world.

So, protect yourself and protect the family member, resident or patient by not discussing anything personal at all at any nurses station or in any public area of any nursing home, physical rehabilitation and care center or in any medical building, lab or hospital. Protect yourself from unscrupulous workers. If a worker is innocent and honest, that worker will want to talk with you in private, not in any public hallway and not in the public nurses station. So beware of ANY employees that wish to discuss personal things at the nurses station. Yes, they need to take a little time to come to the room or to bring you to an area of the place that is not public. But that they must do. They just will not tell you that.

One family member I know approached the nurses station to discuss a private matter and the matter --to be resolved--would mean extra and more work for the staff, so naturally, they did not want it resolved. The family member made the mistake of mentioning the problem at the nurses station. While five or six nurses were sitting around, seemingly doing nothing, their ears were spread wider than a happy face smile and they listened intentively. Then one by one, each interjected their own opinion, remarks and angry-looking expressions at the matter, even though they had no authority in the matter, no business in the matter and no power to resolve the problem. This family member learned the lesson the hard way. Then he had six nurses looking at him in disgust, just because they did not want to do their jobs, a little more work.

Moral of the experience, discuss everything in private, not in public, even if the staff wants to discuss it out in the open, never listen to the staff. They are out to protect themselves from more work and from other things. So protect yourself, and listen to your own inner instinct. Have private discussions in private.

FIRE THESE NURSES!

So, exactly which nurses are we talking about when we suggest, fire these nurses?

Okay, so that might be harsh. Instead of firing these nurses, let us just transfer them to different parts of the hospitals and nursing homes. Let us give them the harder jobs and then perhaps they will not be just hanging out at the nurses station minding everyone else's business.

Why do we say hanging out? This reason-- whenever you approach a nurse at a facility, most times they are busy , correct? Right. No problem. They are doing the job that they came there to do and they are doing the job they are being paid to do. However, there are some nurses that instead of doing the job that is their own assignment, will be listening with both ears to your conversation when you are obviously speaking to another nurse. As soon as they begin listening to you, instead of doing the job they are stationed there for, they are now hanging out instead of working. So you do not need them there.

You are speaking with one nurse, and that one nurse barely has time for you, so how in the world do you think that two or three or four nurses who just happen to be in the nurses station at the time, have time also--to listen to your conversation when you are not even speaking with them. They do not. So every moment they spend eavesdropping on your conversation with Nurse A, that nurse is not doing her own job since she is not Nurse A. Nurse B has stopped her own job and is now listening to you speaking to Nurse A , and then Nurse B enters her opinion when she is not being asked her opinion.

I say, transfer Nurse B to another part of the hospital where she will not have the opportunity to hang out and listen to other conversations that are not her business. Clear? Yes, clear. Transfer Nurse B--and problem solved.

So now you are informed! Keep your personal business private and keep it out of public areas in any facility.

This article is about people who do not need to medically wear diapers. This is NOT about anyone who medically needs to wear diapers. Anyone who is incontinent and needs to wear diapers should wear diapers. But those adults who have been taught to be lazy and pee and poop in their diapers just because it is easier for nurses and doctors to handle that ---these are the patients that this article is addressed to. (See disclaimer at the end of this article).

All over the world, at this very moment, there are nurses, staff and attendants who are trying to convince fully healthy, continent individuals to wear diapers when they do not medically need to wear diapers. All over this is happening. And this is making the patient more and more unhealthy.

Here is why it is important that your family member or you do not wear diapers inside a nursing home or inside a physical rehabilitation and care center:

* Once you begin wearing diapers, you will become in the habit of just pooping and peeing whenever you want to simply because you have a diaper on and because your clothing will not get wet or soiled. The diaper will protect your clothing. You are told to go in your diaper because that is what they are for. So, you begin to get accustomed to pooping whenever you feel like it. Wow. Think about it. You do not even have to get out of bed. No more nighttime trips. You just poop and pee whenever you want to do so. But what is happening to your body while you do this? Here is what happens. Eventually, you will lose control of those muscles that you are not using and you will make yourself incontinent. Yes, you, yourself, with the help of nurses and staff who are being paid good money, are helping you lose your muscles. Soon you will not be able to control your muscles and then you will indeed be incontinent. If you do not use those muscles to hold it in, you will lose the power those muscles still have. So you are actually making yourself sick. You are making yourself to have signs of being an invalid, when you came into the place a healthier person who was fully able to urinate and defecate in a toilet bowl. But for the convenience of staff, imagine that, for the convenience of staff, you become more ill and more dependent on the staff in a nursing home or in a hospital.

* Now, if you are in such a mind that you think this is okay, think again. You are in the nursing home or in the rehab and care center --only temporarily. Yes, you are there temporarily, and after you leave there you will go home to your family. What happens when you get home? You will be there and you will be dependent on your family and also on temporary home care -to change your diapers. What if your family does not agree to changing diapers on you ---because you put yourself in diapers when it was not necessary? What happens if your family tells you that they will not change your diapers because you put yourself in that condition? (Of course this will be settled long before you leave the nursing home or rehab center). But I am trying to give you some ideas, some brainstorming of what your future might look like. Your future looks different if you are in or out of diapers, very different.

* Once you are at home now, and you are still in diapers, you will be sitting in soaked diapers for long times, just like in the nursing home. Since you are in diapers no one has to change you immediately. Get the picture? You wait. And yes, you wait. You might be under the impression that you will soil a diaper and wet a diaper and then someone will come immediately to change you --but you are mistaken. Once your family knows that you did this to yourself, once they know that you could have avoided being incontinent, do you think that they are going to drop everything they do and run to change your diaper? Do you think that you will have your diaper changed any quicker than the nurses will do it? Perhaps it will take longer, since there are many nurses and great number of staff but perhaps only one or two family members. Yes, you will wait. And you will wait in a soiled diaper or wet diaper, just the same way that you waited in the hospital . No one says that the minute you pee or poop that someone must or someone will imediately come running to change your diaper. Your family member might be in the tub or they might be out to work or to school or to a volunteer job, and if that is the case --that they are out, you will wait for them to return. And upon their return, they will have to catch their breath, sit a few minutes and then when they are able to change your diaper , then they will change it.
* So, you sit there smugly thinking that your home care attendant will change you promptly because that is what she is being paid for? Take the smug grin off your face and welcome yourself to reality and to the real world. When you have a home care attendant, you will have that person in your home only for short periods of time. You will not have someone there 24/7 . They work their own hours. So if they are there they can change your diaper. But what if you have a home-care attendant who hates her or his job? What if they are not happy people? What if they are not good workers? If this is the case, you can wait, yes , hours and hours to have your diaper changed, if at all. Your family member might say, that the attendant will be here soon to change the diaper and you might wait and then they might call in sick or not show up at all. And, there you sit in a messy, uncomfortable diaper until someone can change you. Remember, now, you put yourself in this position by volunteering to go in diapers when you did not need diapers. When I say volunteer, I mean that you did not insist that you be taken to the restroom but happily let the attendants put diapers on you when you were not medically incontinnet. You did this to yourself with the help of highly-paid staff at nursing homes and at physical rehabilitation and care centers.

* What about depression? If you are a patient who has ever been depressed in your lifetime, once you submit to wearing unnecessary diapers, your depression will come back to you and worsen. You are making yourself more unhealthy by submitting to unnecessary diapers. Depression is banished most times, by action. And when you sit all day in a diaper, to even a normal human being who has no depression that is depressing. There is no one that can honestly tell you that sitting in soiled diapers , soaked diapers, diapers with diareahh is not depressing. So by making yourself more physically unhealthy, you are also making yourself more emotionally unhealthy. Depression comes and comes back and worsens when a person is wearing diapers if they do not need to medically wear diapers.

Wearing diapers is a comfort ONLY to those who NEED to medically wear the diapers. They are not a comfort to continent people. Do not let any staff convince you otherwise. Do not let any staff scare you with the threat of falls or scare you with the threat of "accidents". Insist on your rights if you are not medically incontinent.

The bottom line is that once you PUT yourself in diapers when you are not medically incontinent, you are putting yourself in a world that you have never known and you are making more problems for yourself and even making more medical problems for yourself. How? Well, as you sit in dirty and soaked diapers, you might begin to develop rashes, or problems or sores, especially if you are diabetic or especially if you have a skin problem to begin with. Everyone knows that diapers bring rashes sometimes. And most likely you will have your share of diaper rashes in your lifetime when you choose to be in diapers.

Now all these things are only possibilities, that is all, but they are possibilities that you have not thought of, correct? But they are all possibilities, depending on the staff, home attendants and the families, and depending on their attentiveness and their availability. What I am trying to say to you is that your life will be so much easier for you if you just grow up and keep yourself out of diapers when you are medically able to not wear diapers.

When you put yourself in diapers and you do not medically need to be in diapers, you are killing a part of yourself, you are humiliating yourself for no good reason. If you are a person that is not incontinent, and if you are a person that does not medically need to wear diapers, then you should make the decision yourself and demand to be out of diapers immediately. If you do not medically need to wear diapers, there is no reason for you to wear diapers.

What about the doctors and nurses in diapers? Here is what about them. Think about this:

When a surgeon or nurse needs hospitalization, or when a lawyer or judge or someone of high importance needs hospitalization or a nursing home or rehab stay, do you think that these dignified people would allow anyone to put them in diapers for the convenience of the staff? Probably not. No lawyer, judge, or doctor or surgeon or nurse would permit themselves to poop and pee in a diaper for the mere convenience of the staff of a facility.

They would protest. They would demand that the staff do their job and they would insist that no one put a diaper on them. So that is why you will not see lawyers in diapers any more than you would see doctors, surgeons or nurses in diapers. Why? This is why:

* It is not medically necessary --in their cases.
* It is an embarrassment even though staff insists it is not embarrassing. Sure, it is not embarrassing to them because it is not their bare but that is being wiped of poop. It is only embarrassing to the patient that is all. And staff spends time to reassure the patient that this is not embarrassing. Lie!
* Lawyers, doctors and nurses have more recourse to argue the point and the staff knows that they had better not go against a surgeons words if that surgeon is insisting on NOT wearing diapers.
* The nurses know that it will come out to the public, if not to the news stations when a surgeon is put in diapers unnecessarily because that surgoen will do everythying in his power to stay out of diapers.
* That is why you do not see surgeons, doctors, lawyers or nurses in diapers. You will only see those patients who have been hoodwinked into thinking that they need diapers just in case or so they do not fall. It is all a lie. No healthy , continant patient needs diapers, EVER!

What about falls?

This is a big argument that staff has. Staff will insist that you have a diaper so you do not fall. Everyone knows that falls are dangerous. The fall is not the result of wearing a diaper or not wearing a diaper. You will not fall more if you do not wear diapers. You will only fall if you insist on net getting help to and from the bathroom. You will only fall if the staff is negligent and not paying attention and not coming when the bell rings. You will only fall if the staff ignores you.

So there you go, you have the fall situation solved. Your staff where you are should be attentive and should come when you call them. There is no excuse for negligence in any nursing home or rehab facilitiy. Do not worry about falling if you follow instructions.

To Avoid Falls do This:

Always ring the bell and do not get out of bed unatttended.

Always ask for help and get help.

This solves the fall problem.

And here is the biggy. If you are in a place where the staff is negligent and is not attending to you, you have many legal recourses and many organizations that will help you solve these problems. But the solution is not to wear a diaper for the convenience of the staff.

And yes, at this moment as I type and as you read this, hundreds if not thousands of patients are being forced into diapers just for the convenience of the staff. I wish Geraldo Rivera would do some kind of investigation into this diaper mess because it is a really big diaper mess. What are your thoughts?

I created this article on May 25, 2008. DISCLAIMER: I am not a doctor, nurse or any other type of medical practitioner. If you need medical advice or professional advice you should call your own doctor, lawyer or other professional for that advice. This article is for basic social information and for basic behind-the-scenes information that the public should be aware of. Do not do anything that is not safe for you to do and before making any medical or professional changes,consult your doctors, lawyers or professionals. Never ask your attending nurse/ or attendant if you should be in diapers because most will tell you yes, and most times they are saying that for their own convenience. Consult your medical doctors, lawyers and other professionals.

It is a myth that it is easier for nurses to bring someone to the restroom than it is for them to change messy diapers on grown adults. Most people figure that it would be less work for them and much easier to bring someone to the rest room than to clean up a person and change a diaper on a person.

Reality is this--nurses, cna, any person who is responsible for cleaning a person or bringing a person to the restroom has an EASIER time just changing that person's diaper. That is why there are some attendants or nurses aids' who prefer to have their patients in diapers even when the patient does not medically need to be in a diaper. The diaper is to save the staff time and work and effort. Here are the fact and the reasons why.

Staff Want Continent Patients To Wear Diapers When the Resident Does Not Medically Need to Wear Diapers Because:

1. When a person is wearing a diaper, they do not have to attend to that person immediately because the person is wearing a diaper. They know and tell the person to just "go in the diaper; that is what the diaper is for". So they tell people --who are not incontinent to begin just peeing and pooping in the diaper instead of calling them to bring that person to the restroom.
2. When a person in a diaper does call for the staff, they do NOT come right away because they know the person is wearing a diaper and they know that if the person can not hold it in, only the diaper will be messed, not the sheets and not the clothing. So staff is very comfortable letting diapered patients wait and wait and wait till they finally just give up and poop and pee in the diapers. Then they do not need to be taken to the restroom.
3. Patients can sit in wet diapers and dirty diapers for hours and the staff does not have to come to them immediately since -- resident is wearing a diaper.
4. So, a patient wearing a diaper might need only to be attended to once a day or twice a day, whereas a patient not wearing a diaper might ask to go to the restroom six or seven times a day or eight, depending on the person. (Sometimes a person thinks they need to go and then gets to the restroom and does not have to go to the restroom. So that makes a few extra trips sometimes).
5. Staff feels that when a patient wears diapers that lessons falls in the facility. This is not a good reason to have a person wear a diaper but staff convinces residents and families that this is a good reason. It is not a good reason and not a valid reason for someone to be in diapers when they are not medically needing diapers. Falls can be prevented OTHER ways besides keeping residents in diapers.

Reasons Why Staff Wants Healthy, Continent People Wear Diapers:

1. When the patient is not wearing a diaper, the staff must and should come immediately when the patient rings the bell for help. They must come immediately; they cannot tell the patient, wait a half-hour , or wait an hour , or wait four hours, like they do and have done when the patient is in diapers. They must attend and help that patient transport to the restroom.
2. They must wait there for some patients while they go. If the patient is not allowed to be left in the restroom by themselves, they must wait there for them until they are finished going. They must see that the patient washes their hands afterwards --to prevent infection. All of this takes time, lots of time out of the staff's schedule. And time, to any staff is very precious. If they do not wait with the patient, they have to come back immediately to get the patient out of the restroom. (Why must they go immediately? If they hesitate too much or make the patient wait, the patient might decide to help him or herself back and they might have a horrible fall that can cause injury or even death. That staff member will be responsible for that accident if they are not there with the patient.
3. They must spend time --and sometimes this takes lots of time-- helping the patient in and out of the bed just to get to the restroom. So when the patient is finally done,they must help them back.
4. After going to the restroom, any patient can ask to go again, maybe hour or so later or even sooner and the staff has to do this all over again. All of this takes up time. And the staff feels they do not have this kind of time. This is why staff sometimes puts people in diapers even though they are not incontinent and even though they do not need to medically be in diapers. Fully continent patients are kept in diapers when the staff wants this to happen.

Now after reading this you might thing it is good for a patient to be in diapers but that is the furthest thing from the truth. It is horrible for healthy, continent people to lay in diapers in nursing homes and in physical rehabilitation centers. It is a most horrible, horrible thing that affects their life in a very embarrassing, negative and life-changing way. I will write about all the downfalls of keeping patients in diapers --patients who are not medically needing diapers-- in another article.