Learn Something New Everyday

I learned something new today about the Center for Medicare and Medicaid Services' (CMMS) plan to change reimbursement for some Hospital Acquired Infections (HAI). The new item appears in the Consumers Reports Blog:

"Medicare has listed eight preventable conditions (above) for which it will not reimburse hospitals after Oct. 1, 2008, and is proposing nine more conditions to be added in 2009. The effects could widen as private insurers and state-funded health insurance programs begin to follow Medicare's lead.

Some of the eight have been dubbed "never events" because they should never happen. They include leaving sponges or implements in a patient after surgery and giving the wrong type of blood. Several hospital-acquired infections are also on the list. In 2007, almost 500,000 hospitalized Medicare patients were hurt by the eight preventable events.

While the new rule bars hospitals from passing the bill on to the patient, it addresses only charges accrued in the initial hospital stay. But patients might need continuing treatment that adds up to a bundle. Consumers Union has asked Medicare to clarify that patients who are harmed by these preventable conditions will not be billed for any of the additional care they need."

I didn't realize that the continuing costs of treatment following a hospital acquired condition were not addressed by the legislation. So...stay tuned. When Consumers Reports dot Org receives an update, I will pass it on.

Hand washing just one part of infection control, medical experts say

An excellent common sense approach to the hype surrounding hand washing hygiene. This article is excerpted from the Grand Island Independent, a newspaper published in Nebraska:

"Widespread use of antibacterial hand gels has helped make it easier for healthcare workers to comply with hand hygiene policies, which is especially important during cold and flu season. The gels, which have been proven as effective at killing germs as soap and water, are also less drying to the skin an important quality for those who work in the medical field and may cleanse their hands up to 50 times per day. Recent studies and local experience have proven, however, that increasing compliance to hand-washing policies is not always enough to reduce the rates of hospital-acquired infections. A study published by the University of Nebraska Medical Center this month showed that while use of antibacterial hand gels in two UNMC adult intensive care units helped the units increase their hand-washing rate from 38 percent to 70 percent, there was no corresponding reduction in hospital-acquired infections. But a similar experiment at St. Francis Medical Center has had different results. At St. Francis, the use of hand sanitizer and the creation of a hand hygiene improvement committee has nearly doubled the rate of hand-washing policy compliance for the entire hospital, said Laura Mader, St. Francis infection control coordinator. The hospital's current 76 percent compliance rate is above the national average. It has also led to a decrease in St. Francis' incidence of hospital-acquired infections, Mader said. While UNMC and St. Francis had different results in similar experiments, officials from both facilities agree that hand washing, while highly important, is only one component of infection control. "There are many factors that influence the development of hospital-acquired infection," said Dr. Mark Rupp, professor of infectious diseases at UNMC. "It would be naive to think that a single, simple intervention would fix this problem." The lack of a correlation between increased hand hygiene and lower incidence of infections could be attributed to many factors, including UNMC's already low infection rate in the ICU."

Infection Control professionals fight disease transmission on many fronts. While hand washing has drawn much attention, it is merely one weapon in the arsenal. We believe that a comprehensive approach to infection control should include air disinfection, especially in critical care units.

Hand washing no panacea

I was delighted to hear the ABC song drifting from my bathroom last night.  It meant that my five year old son was following the instructions he learned in school to properly guage the amount of time he should wash his hands with soap and water.  Will he do this everytime? Probably not, but it is important to try.

The situation in my house is much like the situation in many healthcare facilities, according to an LA Tines article on the MRSA Watch blog site:

30 studies show hand washing neglect

Link: Beating the staph superbug - Los Angeles Times.

But, with a few exceptions, hospitals and public agencies have been slow to gear up against MRSA. More than 30 studies have shown, for example, that healthcare workers wash their hands about half as often as they're supposed to, even though washing before and after seeing each patient would drastically cut down on infection rates. Hospital surfaces and equipment aren't cleaned as often as they should be, and careless habits -- like touching potentially contaminated surfaces after hands have been washed but before touching the patient -- contribute to the spread. The first order of business should be to get a clear picture of MRSA. Where is it and how prevalent? An upcoming bill by state Sen. Elaine Alquist (D-Santa Clara) would make MRSA a reportable disease and require hospitals and nursing homes to report their infection rates. In Tennessee, which tracks MRSA, it quickly became the third most common reportable disease in the state, behind chlamydia and gonorrhea. A similar bill was vetoed in 2004 by Gov. Arnold Schwarzenegger, but the recent news from the CDC should make him rethink his position, despite the almost certain opposition of hospitals.

http://tahilla.typepad.com/mrsawatch/2008/01/30-studies-show.html

I bring this to your attention to demonstrate that infection control is dynamic.  There is no silver bullet.  Infection control requires multi-layers and some redundancies.  Our technology, VIGILAIR®, does not replace other sanitary efforts--it complements and enhances them.  Like hand washing, VIGILAIR® is not a cure all.  It is a prudent and effective way to reduce the airborne environmental pathogens within your facility.

Brits love a healthy debate...

From Britain's Telegraph, news on a new government program to reduce antibiotic prescriptions as a way to reduce the superbug cycle. I've included a snippet of the article. It is the responses to the article that are just as interesting. In response to this topic, readers blame doctors, politicians and patients for the problem. These comments show the complexity of the issue and the passion of those seeking a solution. My favorite response is listed below in which the writer tells people to stop being wimps, suck it up and go to the doctor's office less.

Stop giving antibiotics for colds, doctors told

By Rebecca Smith, Medical Editor
Last Updated: 12:09pm GMT 09/01/2008

Doctors are to be told to stop prescribing antibiotics for coughs, colds and sore throats because over-use of the drugs is fuelling the spread of killer hospital superbugs. Alan Johnson, the Health Secretary, says it is time to end the unnecessary use of penicillin and other commonly-prescribed pills, which cost the NHS £1.7 billion a year. Using antibiotics too liberally has led to bugs such as MRSA becoming resistant to treatment with the drugs. Most colds, coughs and flu are caused by viruses, which cannot be treated with antibiotics anyway, Mr Johnson points out. Announcing a £270 million campaign against superbugs, to be launched next month, he says it is vital that doctors adopt "less of a knee-jerk reaction to prescribing". The campaign, called Clean, Safe Care, will also include an extra £45 million for hospitals to spend on infection control nurses or antibiotic specialist pharmacists. All patients going into hospital will be screened for MRSA by 2009.

COMMENTS:

Antibiotics fight "bugs", not viruses, so the basic premise is absolutely correct. Do not give antibiotics merely for colds or flu. BUT post viral conditions such as chest infection, infected sinuses and catarrh (and real sore throats) DO need antibiotics and I hope this will not change under the new guidelines. Perhaps doctors could prescribe a placebo antibiotic to anyone insisting on antibiotics who merely has a viral infection.
Posted by graham wagner on January 9, 2008 9:59 AM

Antibiotics are not the cure for superbugs, cleanliness is - and the hospitals simply aren't clean enough in the UK. Accountability is needed, not money, run a hospital like a fast food joint. "Clean as you go" and it is all staff's responsibilty to clean up, not delegated to the lowest bidder.
Posted by Craig Douglas on January 9, 2008 9:55 AM

So what is Alan Johnson's next big idea? Now wash your hands? Make sure you're wearing your face-mask? Or is he going to go round every surgery and tell the doctors what medicine to prescribe? What a joke! The trouble is this joker is in charge of the health service! That is more frightening than any superbug.
Posted by Pinkie on January 9, 2008 9:27 AM

The best solution for colds and viruses is to stop giving them to everyone else!
If people stayed at home and looked after themselves when they became ill there would be a lot less general illness in the community, rather than battling on and infecting all and sundry.
Surely we all know by now that antibiotics are not given out by GPs for colds - that has been common knowledge for decades - hence the barrage of cold 'cures' on the shelves.
Posted by Annie on January 9, 2008 9:25 AM

I am a GP and we know that we should not give antibiotics in the circumstances described; the patients do not always know this and it does not matter how many times we inform them they will keep coming back until they get them, in these circumstances another approach needs to be adopted and a debate needs to be taken on what this might be.
Posted by Jonathan Allcock on January 9, 2008 8:50 AM

Simple - don't go to your doctor - it's dangerous. I've been telling my patients this for years. The whole ludicrous thing is compounded by several factors: the great unwashed believe it's their god given right to be ill on a regular basis, a health service that is free at the point of delivery (if you offer free beer there's a queue that stretches round the corner and up the road), and a partially educated, disinterested and overpaid workforce.
Posted by Andrew Renaut, Associate Professor of Surgery, Brisbane on January 9, 2008 8:36 AM

The crux of the issue lies in the fact that many people are greedy and want immediate satisfaction. I have wrestled with people who demanded antibiotics for simple viral illnesses. The the patient wants to leave with something in his/her pocket and they are willing to go to any means to acquire it.
There are also legal implications that are caused by the system. If a patient complains of not receiving the desired medication or a rationalized "standard of care", the legal system automatically demonizes the medical practitioner.
I am all for placebo's in this instance.
Posted by James on January 9, 2008 7:51 AM

Yes suck it up. It is called illness. We are made of flesh and blood and mortal. It is normal for people to get sick off and on. You must endure illness sometime. If you find yourself going to the doc everytime you feel unwell then you likely are a mental case ie "nervous nelly". Anxiety /depression are a big reason why folks can't cope w/ minor illnesses. Quick being a wimp
Posted by ER doc on January 9, 2008 6:59 AM

Again the real cause of hospital infection is ignored. Unsustainable bed occupancy ratios, and out- sourcing of hospital cleaning. Blaming GPs is an irrelevant political ploy. Fight the real battle please.
Posted by John Powell on January 9, 2008 6:47 AM

Most experts talk around the Problem of Antibiotic Resistance. Your article headlines should say "ALL COLDS ARE VIRUSES, ANTIBIOTICS DO NOT KILL VIRUSES, THEREFORE YOU(DOCTORS) MUST NOT USE/ ANTIBIOTICS and start from there. Bacteria and viruses are as different as Gold and Lead. It is possible that a virus can make a person sick and that because of a compromised Immune System bacterial Infections can follow which can then require antibiotics to heal, It should also be pointed out that antibiotics tend to kill many neccessary bacterial species in the body and so lead to further problems-(example,life on the toilet) and Candida infections
Posted by declan mansfield on January 9, 2008 6:13 AM

Source: http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/01/09/nbiotic109.xml

A meeting of creative minds

I was privileged last week to attend the evidence based design and a passion for improving the environment of care in health facilities world wide. The Center is known for matching new design technology with progressive hospital administrators who are looking for innovative ways to improve patient care.
Environment Standards Committee (ESC) members volunteer their time to bring evidence based ‘best practices’ to such organizations such as the American Institute of Architects (AIA).
ESC members tend to be recognized leaders in architecture and design who are simultaneously extremely creative and pragmatic. They marry their expertise with a hunger for innovation to produce solutions that are aesthetically, environmentally and economically beneficial.
Following the meeting, we were given a tour of the building. Richard Smith was kind enough to show us the newly designed structure of 1305 York Avenue, a part of the Weill Cornell Medical College. Mr. Smith demonstrated how attention to design details have yielded a significantly better care experience for patients who receive ambulatory outpatient services here.
Many of the innovations stemmed from a patient survey that highlighted patient perceptions about care. Changes in design to floor plans and internal procedures have produced a streamlined admissions process that reduces waiting time, assures HIPPA privacy and eliminates paper records. It would be difficult to review all the innovations of this building, so I will share some images of the tour.

Center For Health Design

Editorial-Pennsylvania's Infection Reporting

Here is an open letter to the editor about the mandatory reporting of HAI's in Pennsylvania hospitals. It accurately reflects our feelings on the issue:

Editor,

Pennsylvania has a rich history of trail blazing in healthcare. The first medical school in America opened in our state in 1765. The first medical school for female students opened here as well, in 1850.

Building on this history of innovation, Pennsylvania is the first state to mandate thorough public reporting of hospital acquired infections (HAIs) for all hospitals within the Commonwealth. Now that the first year’s worth of results are published, hospital officials are justifiably concerned that people will misinterpret the information. As a person who works with hospitals in Pennsylvania to reduce HAIs, I understand their unease.

Under the current reporting rules:

-some honest hospitals that scrutinize and report all HAIs may face an unfavorable comparison with hospitals that are not as diligent in their reporting.

-the types of infections that hospitals were mandated to track changed during the year; these rule changes may’ve caused errors and confusion.

-mortality rates are skewed for hospitals that provide palliative care for terminally ill patients who, by request, do not seek aggressive interventions.

In the hospitals’ defense, defining the source of an infection can be elusive.

Difficulty in finding an infection’s source is reflected in a study published in the November 2006 issue of the American Journal of Infection Control. Researchers reviewed medical reports of more than 1,500 outbreaks of HAIs. In 37% of the outbreaks no source could be identified.

Where does this leave Pennsylvania healthcare consumers? The answer is that we are in a better position than any other state to monitor and improve the quality of medical care. Here are some things to keep in mind as you review the new statistics on HAIs:

-knowledge is power! Some measure of quality is better than none. HAI statistics are certain to evolve with time and become clearer and fairer.

-HAI rates are just one indicator of quality. Speak to your physician, or better yet, speak to a nurse who works in a hospital you’re considering for a procedure. Another great source of hospital information is available on the web through the Joint Commission on Accreditation of Healthcare Organizations (www.jointcommission.org).

-all healthcare is local. Many effective hygiene techniques occur right inside your hospital room. Thanks to HAI awareness, you can prevent infections by insisting on rigorous adherence to hand washing procedures (don’t be shy about asking physicians, nurses and visitors to wash their hands).

In Pennsylvania we should be proud that we are able to gather and view information on HAIs. In many other states political pressure has prevented citizens from having access to this important data. We must be aware that infection control is dynamic—numbers can only tell part of the story. But at least we are telling the story here in Pennsylvania and we are beginning a dialogue on how to break the chain of pathogen transmission within hospitals.

Once again Pennsylvania is a pioneer in healthcare.