Sunday, November 28, 2010

First large study in a decade finds little progress on patient safety in hospitals

Researchers from Brigham and Women’s Hospital undertook the largest study on patient safety since 1999. The results showed little progress on patient safety in hospitals. The study looked at cases of medical harm at ten hospitals in the State of North Carolina - a state that has shown a high level of engagement to improve patient safety relative to other states, as measured by the hospitals’ enrollment rates in national patient safety initiatives.

The study found 588 cases of medical harm for 10,415 patient-days or 25.1 injuries per 100 admissions. The top three causes of medical harm were procedures (186), medications (162), and hospital acquired infections (87). Patients in 42.7% of the cases required extra time in the hospital, 2.9% of the cases resulted in permanent injury, and 2.4% of the cases contributed to patient death.

One interpretation of the study results is that, in spite of years of efforts to improve patient safety, evidence-based safety practices are still rare in practice. Some hospitals have made significant strides in certain areas of care, such as in the adoption of electronic medical records and computerized physician ordering systems, but these improvements are often made independently of other areas, usually lacking coordination and an overarching strategy.

The last large scale study on patient safety was conducted in 1999 by the Institute of Medicine. The results of that study brought patient safety into the national spotlight. Results from this new study will hopefully lead to more concerted efforts to reduce medical harm through better utilization of resources, collaboration, and adoption of evidence-based practices.

Full text of the study in the New England Journal of Medicine

Tuesday, November 23, 2010

A Holistic Approach to Managing Urinary Catheterization

Although the article in Healthcare Informatics is titled “Intervening on Preventable Infections with IT,” it’s a whole lot more than IT. The article addresses using an EMR system to either remind a nurse to check if a urinary catheter should still be in place, or to place an automatic stop order by default. The clinician can only override the stop order when the patient meets specific criteria to leave the catheter in place.

Dr. Jennifer Meddings of the University of Michigan Health System digs deeper and describes the solution more broadly. In addition to alerts and automatic stop orders, the solution requires the political empowerment of nurses to issue stop orders, strong considerations for usability and workflow in the system, and understanding the root causes for clinicians to place urinary catheters in the first place.

One problem area is with regards to who receives alerts. Sometimes, alerts are produced in an EMR system and not delivered to appropriate decision makers or those responsible for catheter placement. The article also mentions combining high-tech solutions with low-tech, such as attaching a sticker to a catheter bag requiring the person placing the bag to indicate the specific reason for placing the catheter.

These issues serve as a great reminder that technology is never a panacea and that whole solutions for infection prevention need to take into consideration people, process, and technology.

Healthcare Informatics: Intervening on Preventable Infections with IT

Monday, November 22, 2010

CDC considers rule change for pricing of antibiotics

The annual number of antibiotics introduced to the market has been falling around the world. Between 2003 and 2007, only 5 new antibiotics were approved by the FDA in the US. In an effort to encourage the research and development of new antibiotics, the CDC launched a campaign on November 15th to stop the overuse of antibiotics. Key to the campaign is a proposed change in the pricing of these medicines. Currently, pharmaceutical companies have little incentive to develop new antibiotics because new antibiotics are likely to be used only sparingly at first in order to stave off the emergence of resistance. Conservative use of new antibiotics means less profit for the pharmaceutical company, which means it is unlikely to recoup the upfront investment within the fixed patent protection period.

The new solution proposed by the CDC would compensate companies for the true value of the antibiotic. Under the new proposal, new antibiotics will no longer be subjected to the traditional patent period; instead, payment for new antibiotics would be conditioned on meeting conservation and resistance targets set by the CDC. One example could be the rate of emerging resistance. If the company's antibiotic meets the target then it would maintain its market exclusivity. The government hopes that the proposed plan will give incentive to drug companies to develop new antibiotics under the new proposal.

The development of new antibiotics is important because there is an overwhelming number of outbreaks of hospital acquired infections, like MRSA, which could be controlled and treated with these drugs. Among the other diseases that could be targeted by new antibiotics are malaria, anthrax, and tularemia.

New York Times article
Boston Global article

Tuesday, November 16, 2010

A song on best infection prevention practices

Ron uses his singing talent to teaching others about good infection prevention practices.

Monday, November 15, 2010

State of HAIs in Canada

I recently read that the Women’s College Hospital in Toronto has banned magazines in patient waiting rooms in an effort to control the spread of germs (Article). Then over the weekend, it was announced that the Peterborough Regional Health Centre stopped admitting patients to one of its units because of an “uncommon” outbreak of C. diff., MRSA, and VRE (Article). Looks like our neighbor up north are having bad luck with infections.

Canada has ~200,000 HAIs per year, of which 8,000 result in death. An article published in April of this year found that the overall incidence of both MRSA colonization and MRSA infection increased 17-times in Canadian hospitals from 1995-2007 (Article).

A study published in 2003 concluded that infection control departments in Canada are significantly under resourced. Of the 172 hospitals surveyed in the study, 42% of the hospitals had fewer than 1 infection preventionist (IP) per 250 beds (the average in the U.S. is ~ 1 IP per 150 beds). The chart below shows how Canadian IPs were spending their time during the survey period. You can compare these percentages to those of U.S. IPs in an earlier post

% of IP Time
Teaching infection control to others
Writing or reviewing policies
Attending meetings
Managing epidemics/outbreaks
Regional infection control activities
Evaluation of products
Other (Consultations, construction, clerical, research)

Tuesday, November 2, 2010

Scientists confirm the roots of Europe’s plagues

Separate teams of scientists studying the origins of Europe’s historical plagues confirmed in a study published last week that the plagues were caused by bacterium Yersinia pestis.

Europe experienced three great plagues in its history, the Justinian Plague in the 6th century, the Black Death from 1347 to 1349, and the Great Plague of London from 1665 to 1666.  Amongst the three, the Black Death was the deadliest and is estimated to have killed 30%-60% of Europe’s population.  The Great Plague of London killed an estimated 100,000 people (~20% of London’s population), and the Justinian plague, which was the first great plague, struck the Byzantine Empire from 541 to 542 AD, killing around 100 million people. 

The three plagues were caused by three different strains of the bacterium Yersinia pestis.  By comparing the genetic makeup of the bacteria from mass burial grounds across Europe in which the dead were interred to the genetic variations in living strains of Yersinia pestis, scientists conclude that the three strains shared a common ancestor and most likely originated from China.  However, the killing of humans by Yersinia pestis is likely an "accident" as scientists believe that the natural hosts of the bacterium are various species of rodents, and that it has no interest in people. 

This map shows how the bacterium might have spread from China to the rest of the world

New York Times Article on the Great Plagues

Monday, November 1, 2010

Illinois Hospital Association launches new campaign to combat HAIs

The Illinois Hospital Association, representing over 200 hospitals in the state of Illinois, launched the "Raising the Bar" campaign last week through the newly established Quality Care Institute (QCI).  This new campaign has several objectives including:

  • Reduce 30-day hospital readmission rates for congestive heart failure, heart attack, and pneumonia.
  • Reduce hospital-acquired conditions and infections such as MRSA, C Diff, CLABSI, CAUTI, SSI, and deep vein thrombosis and pulmonary embolism following certain orthopedic procedures.

QCI hopes to make Illinois a national leader in quality care and patient safety