tag:blogger.com,1999:blog-81763968315710998552024-03-14T02:11:47.852-04:00Getting to ZeroA Campaign to Reduce Healthcare-Associated InfectionsRonhttp://www.blogger.com/profile/12298292710222455199noreply@blogger.comBlogger112125tag:blogger.com,1999:blog-8176396831571099855.post-14701767437155933382011-11-28T13:20:00.001-05:002011-11-28T13:27:48.304-05:00Hospital adopts new technology to monitor hand-washingHospitals use various methods to monitor hand-washing by staff; some methods measure the volume of soap and disinfectant hand gel used while others employ "secret shoppers" to observe hand-washing activities. <br />
<br />
North Shore University Hospital in Manhasset, N.Y. is the first hospital to adopt a new video monitoring technology to track hand-washing. The video monitor technology is made a by Arrowsight. The technology relies on a network of sensors that monitor entrance activity around doors and a series of cameras mounted on ceilings above sinks and hand sanitizing stations both in and outside patient rooms. Arrowsight employees monitor the footage to track whether staff wash their hands within 10 seconds of passing through the door.<br />
<br />
The rates are published daily on large L.E.D. displays in the hallways
and serve as a constant reminder to the staff. The nurse manager also
gets e-mail messages throughout the day with detailed information
about hand-washing rates.
<br />
<br />The new video monitoring technology was implemented in the surgical
and medical intensive care units (ICUs). ICUs typically have the
lowest hand-washing rates because the staff there are the most harried
due to large volume of patients and that most patients in ICUs are in
serious medical conditions. Since adopting the technology three years
ago, both ICUs have achieved and sustained better results than before. The medical ICU in particular, improved its hand-washing rates from 6.5% three years ago to over 80%.<br />
<br />
Read the article in <a href="http://opinionator.blogs.nytimes.com/2011/11/24/an-electronic-eye-on-hospital-hand-washing/" target="_blank">The New York Times</a><br />
<br />
<a href="http://cid.oxfordjournals.org/content/early/2011/11/18/cid.cir773.abstract%20" target="_blank">Abstract</a> to North Shore's study published in Clinical Infectious DiseasesUnknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-71533524344974447232011-09-22T10:19:00.004-04:002011-09-22T10:19:40.207-04:00New York State publishes 4th HAI report<!--[if gte mso 9]><xml>
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New York State published the 2010 Hospital Acquired
Infection Rate report this week.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>In 2005, New York became one of the first
states to mandate reporting of HAIs to the state’s public health department.<span style="mso-spacerun: yes;"> </span>In 2009 it became the first state to mandate
reporting of inpatient adult and pediatric laboratory-confirmed <i style="mso-bidi-font-style: normal;">C. difficile</i> cases using the new NHSN
reporting protocol.<span style="mso-spacerun: yes;"> </span>Public reporting of
HAIs began in 2005 and the first HAI report was published in 2007.<span style="mso-spacerun: yes;"> </span>Over 170 hospitals in New York State reported
their HAI rates.<span style="mso-spacerun: yes;"> </span>The 2010 report found
that since 2007, the rate of CLABSIs and SSIs has fallen 37% and 15%
respectively, saving more than $15 million because of shorter hospital stays
and preventing the need for additional treatment.<span style="mso-spacerun: yes;"> </span>The decline in HAI rates can be attributed to
better surveillance methods and higher adoption of best infection prevention
practices at hospitals.</div>
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<br /></div>
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<a href="http://www.health.ny.gov/statistics/facilities/hospital/hospital_acquired_infections/2010/docs/hospital_acquired_infection.pdf">Full report</a> </div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-52679565702822806942011-08-29T10:16:00.001-04:002011-08-29T10:17:02.323-04:00Marketing hand hygiene to the public – what works?<br />
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A recent study published in this month’s American Journal of
Infection Control evaluated the effectiveness of hand hygiene posters placed in
a hospital’s cafeteria. The study was conducted over a 5 week period
and had three phases which tracked hand hygiene compliance before, during, and
after a poster has been placed next to the hand sanitizer stand. The study found that hospital visitors used
sanitizers significantly more frequently during and after the poster was put up
than before, suggesting that the poster was effective at inducing people to
change behavior. </div>
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In the article’s conclusions, the author described key
characteristics of the poster design. The
poster was large and highly visible to visitors, it had bright graphics, a
persuasive message that highlights the benefits of hand hygiene, and offered
practical advice. Unpleasant images,
passive training, and reminder messages were not included in the design.</div>
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To see the actual poster, please go to the<a href="http://www.ajicjournal.org/article/S0196-6553%2810%2900986-7/abstract"> article link</a></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-47006086199759241312011-08-10T13:17:00.000-04:002011-08-10T13:18:49.599-04:00Strategies for Increasing Influenza Vaccine Acceptance by Employees<strong>Face-Mask Mandate Improved Flu Vaccination Rates Among HCWs </strong>
<br />
<br />An influenza vaccination campaign that included a face-mask mandate for all unvaccinated health care workers (HCWs) led to a vaccination compliance rate of 95 percent at Geisinger Medical Centers in Pennsylvania during 2009, researchers report in Infection Control and Hospital Epidemiology. "Establishing a tough and enforceable requirement that any unvaccinated individuals wear a mask for the entire flu season not only produced the vaccination compliance rates we wanted, but avoided unnecessary legal challenges and inspired an amazing amount of team spirit," said Dr. Lisa M. Esolen of Geisinger Health System. The analysis of the health system's vaccination campaign, implemented during the 2009-2010 flu season, included 12,363 HCWs employed at Geisinger Health System throughout the state. Unvaccinated employees were instructed to wear a surgical mask when they were within six feet of a patient during their shift. The campaign also included a vaccination effort that included increased vaccination hours, vaccination stations at HCW entrances and outside the cafeteria, and recruiting 150 "flu team captains" to decentralize vaccine supplies with vaccination kits. Compared with vaccination compliance rates of 47 percent in 2007 and 61 percent in 2008, vaccination compliance rates among HCWs were 95 percent during 2009 and 92 percent during 2010.
<br />
<br /> From "Face-Mask Mandate Improved Flu Vaccination Rates Among HCWs"
<br /> <i> Pediatric Supersite (06/22/2011)</i>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-17137946487294287842011-07-12T11:57:00.003-04:002011-07-12T12:38:06.830-04:00Crying Wolf about Infectious Diseases<!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:trackmoves/> <w:trackformatting/> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:donotpromoteqf/> <w:lidthemeother>EN-US</w:LidThemeOther> <w:lidthemeasian>X-NONE</w:LidThemeAsian> <w:lidthemecomplexscript>X-NONE</w:LidThemeComplexScript> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> <w:splitpgbreakandparamark/> <w:dontvertaligncellwithsp/> <w:dontbreakconstrainedforcedtables/> <w:dontvertalignintxbx/> 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mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} </style> <![endif]--> <p class="MsoNormal"><span style="font-size:11.0pt;">A well-known public health expert is often asked to be a keynote speaker at infection management seminars.<span style="mso-spacerun:yes"> </span>I happened to hear him present at two different infection control gatherings about a year apart.<span style="mso-spacerun:yes"> </span>They were both emotional speeches about the modern day dangers cause us all to face.<span style="mso-spacerun:yes"> </span>During the first speech he talked about how he lay awake nights worrying about his daughters and their survival chances in a world of anthrax.<span style="mso-spacerun:yes"> </span>In the next speech he talked about how he lay awake nights worrying about his daughters and their survival chances in an age of <span style="mso-spacerun:yes"> </span>Avian Flu. Clearly he was talking about the disastrous infection of the moment.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;"> </span></p> <p class="MsoNormal"><span style="font-size:11.0pt;"><span style="mso-tab-count: 1"> </span>So what’s wrong with this picture?<span style="mso-spacerun:yes"> </span>Link to the following for the answer: <a href="http://2.bp.blogspot.com/_a9OgLbIsBns/TMpEWB-eabI/AAAAAAAAALg/gaQHkVlSf1o/s1600/sky+falling+in+cartoon.jpg">http://2.bp.blogspot.com/_a9OgLbIsBns/TMpEWB-eabI/AAAAAAAAALg/gaQHkVlSf1o/s1600/sky+falling+in+cartoon.jpg</a>.<span style="mso-spacerun:yes"> </span></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;"> </span></p> <p class="MsoNormal"><span style="font-size:11.0pt;"><span style="mso-tab-count: 1"> </span>I believe that the public and healthcare providers are suffering from a disaster fatigue.<span style="mso-spacerun:yes"> </span>There are too many infections to worry about them all.<span style="mso-spacerun:yes"> </span>Worse yet, many of the dire scenarios painted by the media (with the help of some public health officials) have not occurred.<span style="mso-spacerun:yes"> </span>It is becoming more and more difficult to know what is real and what to do about it</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;"> </span></p> <p class="MsoNormal"><span style="font-size:11.0pt;"><span style="mso-tab-count: 1"> </span>At the same time the public has come to view health care facilities as death houses where patients are discharged in worse condition than when they were admitted.<span style="mso-spacerun:yes"> </span>Public reporting has reinforced this perception.<span style="mso-spacerun:yes"> </span>I think that the fact that reporting is legally required is more frightening than the actual contents of the reports. If it must be reported, it must be really bad.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;"> </span></p> <p class="MsoNormal"><span style="font-size:11.0pt;"><span style="mso-tab-count: 1"> </span>Certainly, there are serious infections occurring in various places throughout the world. The recent E. coli outbreak was a sobering event.<span style="mso-spacerun:yes"> </span>Our job as IPs is to place these events in perspective and to help people understand their personal risks of contracting a serious infectious disease.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;"> </span></p> <p class="MsoNormal"><span style="font-size:11.0pt;"><span style="mso-tab-count: 1"> </span>When everyone was worried about avian flu I was asked to make several presentations about it.<span style="mso-spacerun:yes"> </span>I used humor to try to deflate the audience’s anxiety.<span style="mso-spacerun:yes"> </span>I showed pictures of houses built above duck ponds and asked “Does this look like your house?”</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;">I showed pictures of people taking dead geese to market on the backs of mopeds, etc.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;">I think my efforts were successful in bringing listeners back to reality where they could plan rationally.<span style="mso-spacerun:yes"> </span></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;"> </span></p> <p class="MsoNormal"><span style="font-size:11.0pt;"><span style="mso-tab-count: 1"> </span>The humor was not intended to make light of the issue. Rather it was intended to reduce the level of anxiety in the audience so that we could discuss the actual threats and possible responses. </span></p> <p class="MsoNormal"><span style="font-size:11.0pt;"> </span></p> <p class="MsoNormal"><span style="font-size:11.0pt;"><span style="mso-tab-count: 1"> </span>I think it is important to use a variety of techniques balance the scales of concern. <span style="mso-spacerun:yes"> </span>In some cases stories about personal concerns are appropriate.<span style="mso-spacerun:yes"> </span>But we must consider ourselves to be <span style="mso-spacerun:yes"> </span>Panic Preventionists as well as Infection Preventionists.<span style="mso-spacerun:yes"> </span>This is no easy challenge to bring people back to earthly sights when everyone else is screaming “Watch out for the birds”! </span></p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-34492950419188526162011-07-12T11:24:00.004-04:002011-07-12T12:27:51.753-04:00The future of the flu vaccine?<style>
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Flu vaccines today have two major problems: they need to be administered every year, and are only effective against a small subset of flu strains. Basically, the vaccine makers make an educated guess about which will be the most prominent strains in a given year, and then manufacture the vaccine based on that prediction. Since different strains become prevalent in different years, this means that each new vaccine must be given when it’s developed each year. </div>
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Damian Ekiert and Ian Wilson, along with Robert Friesen and Jaap Goudsmit from Crucell (a Dutch biopharmaceutical company), recently published a paper in <i style="mso-bidi-font-style: normal;">Science Express</i> that details their efforts to prevent and treat influenza infection using antibodies, which would avoid the problems of traditional flu vaccines. </div>
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The project was started several years ago, when Goudsmit and other researchers at Crucell discovered an antibody that bound to a functionally important structure on the flu virus which exists in many different strains. The antibody, CR6261, worked to both prevent and treat infections by about 50% of influenza viruses, including H1 viruses. Crucell is about to begin early clinical trials of CR6261, according to the Scripps Research Institute.</div>
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To complement this, Crucell’s team began to search for another similar antibody that would be effective against other flu viruses, including H3 and H7 subtypes. They discovered CR8020, an antibody which binds close to the viral membrane. CR8020 appears to work by preventing the conformational changes that occur when a flu virus is taken up by a host cell, thereby blocking the release of the virus DNA into the host. </div>
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As Ekiert et al. note in the publication, influenza A viruses responsible for human pandemics have come from very different strains. In accordance with this, a near-universal therapy for influenza should protect against all these strains, if possible. Though it is unknown how the antibodies will fare in clinical trials, a mixture of antibodies such as CR6261 and CD8020 is a potentially promising treatment for people who have contracted the flu. Despite the challenges in developing the antibody mixture into a vaccine, there is now more hope that a “universal” vaccine can be developed.</div>
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<i style="mso-bidi-font-style: normal;">Science Express</i> paper: <a href="http://www.sciencemag.org/content/early/2011/07/06/science.1204839">http://www.sciencemag.org/content/early/2011/07/06/science.1204839</a></div>
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Calibri","sans-serif"; font-size: 11pt; line-height: 115%;">Infection Control Today</span></i><span style="font-family: "Calibri","sans-serif"; font-size: 11pt; line-height: 115%;"> article: <a href="http://www.infectioncontroltoday.com/news/2011/07/discovery-of-natural-antibody-brings-universal-flu-vaccine-a-step-closer.aspx">http://www.infectioncontroltoday.com/news/2011/07/discovery-of-natural-antibody-brings-universal-flu-vaccine-a-step-closer.aspx</a></span> Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-32881256710202052622011-06-13T10:10:00.001-04:002011-06-13T12:27:31.004-04:00Reasons to question Consumer Report’s report on hospital performance<!--[if gte mso 9]><xml> <o:officedocumentsettings> <o:relyonvml/> <o:allowpng/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:trackmoves/> 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Grid 3 Accent 6"> <w:lsdexception locked="false" priority="70" semihidden="false" unhidewhenused="false" name="Dark List Accent 6"> <w:lsdexception locked="false" priority="71" semihidden="false" unhidewhenused="false" name="Colorful Shading Accent 6"> <w:lsdexception locked="false" priority="72" semihidden="false" unhidewhenused="false" name="Colorful List Accent 6"> <w:lsdexception locked="false" priority="73" semihidden="false" unhidewhenused="false" name="Colorful Grid Accent 6"> <w:lsdexception locked="false" priority="19" semihidden="false" unhidewhenused="false" qformat="true" name="Subtle Emphasis"> <w:lsdexception locked="false" priority="21" semihidden="false" unhidewhenused="false" qformat="true" name="Intense Emphasis"> <w:lsdexception locked="false" priority="31" semihidden="false" unhidewhenused="false" qformat="true" name="Subtle Reference"> <w:lsdexception locked="false" priority="32" semihidden="false" unhidewhenused="false" qformat="true" name="Intense Reference"> <w:lsdexception locked="false" priority="33" semihidden="false" unhidewhenused="false" qformat="true" name="Book Title"> <w:lsdexception locked="false" priority="37" name="Bibliography"> <w:lsdexception locked="false" priority="39" qformat="true" name="TOC Heading"> </w:LatentStyles> </xml><![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}</style> <![endif]--> <br /><div class="MsoNormal">Consumer Reports published new hospital ratings recently.<span style="mso-spacerun: yes;"> </span>One of the key measures in the report was CLABSI and SSI rates.<span style="mso-spacerun: yes;"> </span>The report obtained CLABSI and SSI rates from states with mandatory reporting and from the independent reporting agency, the Leapfrog Group.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal">One conclusion in the report is that large teaching hospitals perform poorly in preventing CLABSIs.<span style="mso-spacerun: yes;"> </span>According to the report, 3 teaching hospitals got the lowest rating in preventing CLABSIs and 64 teaching hospitals got the second lowest rating.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal">APIC has issued a letter to the infection prevention community to bring attention to the findings in this report.<span style="mso-spacerun: yes;"> </span>APIC pointed to several reasons why findings from the report may not tell the whole story.<span style="mso-spacerun: yes;"> </span>Patient demographics vary widely between teaching hospitals and small community hospitals.<span style="mso-spacerun: yes;"> </span>Many teaching hospitals serve as Level 1 trauma centers that treat patients with more serious illness than those treated at community hospitals.<span style="mso-spacerun: yes;"> </span>Patients with serious illnesses have a higher risk of becoming infected<span style="color:red;"> </span>than others.<span style="mso-spacerun: yes;"> </span>Another reason that the report may not be reliable is due to the robustness of the infection prevention program in place at each institution examined.<span style="mso-spacerun: yes;"> </span>Hospitals with strong infection prevention practices may identify more cases of HAIs than hospitals without good practices.<span style="mso-spacerun: yes;"> </span>As a result the facility that actively tracks HAIs may appear to have worse rates than those which do track HAIs closely.</div><div class="MsoNormal"><br /><p style="margin-bottom: 0in">While APIC encourages the public to use the information to initiate conversations with healthcare providers to learn more about a hospital’s infection prevention program, the organization emphasizes that the public should not base their decisions and opinions solely on this report. </p><br /></div><div class="MsoNormal"><a href="http://www.consumerreports.org/health/doctors-hospitals/hospital-ratings.htm">Link</a> to Consumer Reports' Hospital Rating</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><!--[if gte mso 9]><xml> <o:officedocumentsettings> <o:relyonvml/> <o:allowpng/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> 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mso-bidi-theme-font:minor-bidi;}</style> <![endif]--> </div><div class="MsoNormal"><a href="http://news.consumerreports.org/health/2011/06/teaching-hospitals-not-always-best-for-patient-safety.html">Article</a> on teaching hospitals having worse HAI rates than other hospitals</div><div class="MsoNormal"><br /></div><div class="MsoNormal"> </div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-35072534748389576062011-06-09T15:21:00.000-04:002011-06-09T15:23:41.195-04:00Handwashing and the Law of Diminishing Returns<!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:trackmoves/> <w:trackformatting/> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:donotpromoteqf/> <w:lidthemeother>EN-US</w:LidThemeOther> <w:lidthemeasian>X-NONE</w:LidThemeAsian> 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style="mso-tab-count: 1"> </span>IPs spend a lot of time monitoring and educating about handwashing.<span style="mso-spacerun:yes"> </span>There are continuous debates about what the consequences should be for staff who are “caught” not washing their hands.<span style="mso-spacerun:yes"> </span>One question that rarely is raised in Infection Control Committee meetings is whether there is an upper limit beyond which hand hygiene will no longer play a major role in HAI prevention.<span style="mso-spacerun:yes"> </span>The answer<span style="mso-spacerun:yes"> </span>can have profound effects on the amount of time and energy devoted to this one particular part of the IP role.</span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span>Two recent articles have questioned the relationship between increasing handwashing compliance and reduction of health care infections.<span style="mso-spacerun:yes"> </span>Biggs, Shepherd and Kerr (2008) performed a mathematical analysis of the transmission of Staph by healthcare workers’ hands that became contaminated by patient contact.<span style="mso-spacerun:yes"> </span>They concluded that a compliance levels (or imperfect hand hygiene) <50% were sufficient to stop outbreaks.<span style="mso-spacerun:yes"> </span>They also concluded that the rate of increase in hand hygiene compliance was not associated with a similar decrease in infection transmission</span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span>Silvestri, Petros, Sarginson, et al (2005) conducted a literature review of 9 studies that looked at the relationship between hand hygiene compliance levels and actual infection rates.<span style="mso-spacerun:yes"> </span>They concluded that [poor] handwashing can only account for 40% of transmission in intensive care units.</span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span>Why do these studies make sense in a time when hand washing is the first commandment of health care delivery?<span style="mso-spacerun:yes"> </span>Both the literature and everyday observation provide some answers.<span style="mso-spacerun:yes"> </span>First, glove use is becoming a universal practice.<span style="mso-spacerun:yes"> </span>There are few studies that test how much hand contamination occurs with the use of gloves.<span style="mso-spacerun:yes"> </span>Second, think of all of the environmental surfaces and healthcare equipment becomes contaminated and is used without cleaning.<span style="mso-spacerun:yes"> </span>Stethoscopes, phones (both patient and clinician), bath basins, computer screens and on and on have been found to be contaminated.<span style="mso-spacerun:yes"> </span>How effective are clean and gloved hands if contaminated equipment is used between patients without cleaning in between.<span style="mso-spacerun:yes"> </span>I recently conducted a study in which we found that pens became contaminated within a single work shift.<span style="mso-spacerun:yes"> </span>How many staff take pens into patients rooms, mark dressings and put the pen back into a pocket?</span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span>I think the time has come to take a harder look at housekeeping surfaces.<span style="mso-spacerun:yes"> </span>I have found that most housekeepers want to do a good job but are hampered by a workload that allows only the most cursory of cleaning.<span style="mso-spacerun:yes"> </span>It is about time that we stopped using precious resources on hand hygiene compliance and use them to provide more housekeepers with better equipment.</span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt">Beggs, C.B, Shepherd, S.J., and Kerr, K.G. (2008).<span style="mso-spacerun:yes"> </span>Increasing the frequency of </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span>handwashing by healthcare workers does not lead to commensurate reductions</span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span></span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span><span style="mso-spacerun:yes"> </span>in staphylococcal infections in a hospital ward.<span style="mso-spacerun:yes"> </span><i style="mso-bidi-font-style:normal">British Medical Journal of </i></span></p> <p class="MsoNormal"><i style="mso-bidi-font-style:normal"><span style="font-size:10.0pt"> </span></i></p> <p class="MsoNormal"><i style="mso-bidi-font-style:normal"><span style="font-size:10.0pt"><span style="mso-tab-count:1"> </span>Infectious Disease,</span></i><span style="font-size:10.0pt">8, 114.<span style="mso-spacerun:yes"> </span>Available at:<span style="mso-spacerun:yes"> </span>http:/www.biomedcentral.com/1471-<span style="mso-tab-count:1"> </span></span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span>2334/8/114.</span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt">Silvestri, L., Petros, A.J., Sarginson, R.E., de la Cal, M.A.,Murray, A.E. and Saene, H.K.</span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span>(2005). Handwashing in the intensive care unit: a big measure with modest effects.</span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span><i style="mso-bidi-font-style:normal">Journal of Hospital Infections,</i> 59(3), 172 – 179.</span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-34917949539498364422011-06-06T21:48:00.000-04:002011-06-06T21:48:03.389-04:00Adoption of infection surveillance technology linked to better infection control practices<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div class="MsoNormal">A recent study published in the American Journal of Infection Control looked at the relationship between the use of automated surveillance technology (AST) and the depth of implementation of evidence-based infection prevention and control practices.<span style="mso-spacerun: yes;"> </span>The study analyzed survey responses from 241 acute care hospitals in California on questions related to the adoption of AST, the breadth and depth of implementation of HAI and process specific infection control practices.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The study found a positive relationship between AST adoption and the adoption of infection control practices.<span style="mso-spacerun: yes;"> </span>Although it’s unclear whether adoption of AST leads to better implementation of infection control practices or vice versa, it is clear that hospitals using AST are doing a better job implementing evidence-based infection control practices compared with hospitals that still rely on manual surveillance.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><a href="http://www.ajicjournal.org/article/S0196-6553%2811%2900088-5/abstract"><span>Link to full article</span></a></div><div class="MsoNormal"><span> </span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-84752272488586718762011-05-24T11:24:00.005-04:002011-05-24T11:30:50.150-04:00Using Google to Track MRSA<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/-X7R6UoS1lVw/TdvO9Gi_3MI/AAAAAAAABFs/-GGDxQS9YjE/s1600/mrsa-epi1.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 320px; height: 245px;" src="http://1.bp.blogspot.com/-X7R6UoS1lVw/TdvO9Gi_3MI/AAAAAAAABFs/-GGDxQS9YjE/s320/mrsa-epi1.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5610305309944831170" /></a><br />It’s hard to believe it’s been nearly 3 years since Google launched its <a href="http://googleblog.blogspot.com/2008/11/tracking-flu-trends.html">Flu Trends</a> site. Flu Trends uses Google search queries to forecast outbreaks of influenza. The simplest example is trending total queries for "flu" over time to see if there are patterns indicating an outbreak. Google’s results found strong correlation between its search-based forecasts and CDC’s actual surveillance data.<br /><br />Now, a group of out of University of Chicago has used the same approach to <a href="http://www.wired.com/wiredscience/2011/05/google-mrsa/">forecast MRSA outbreaks</a>. Google search terms for “MRSA” and “staph” were used to predict MRSA hospitalization rate. Like Flu Trends, the MRSA predictor showed strong correlation between predicted and actual outcomes. If subsequent validations hold, Google search trends could be used as a proxy for hospital-reported data to support MRSA surveillance.Ronhttp://www.blogger.com/profile/12298292710222455199noreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-7999938655626793022011-05-23T09:46:00.003-04:002011-05-23T16:07:32.909-04:00Biotech fills Pharma gap<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-uSiDHpRug0A/Tdpk_ixPRUI/AAAAAAAAABY/pg58I1eBhC0/s1600/antibiotics_2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="antibiotics" title="antibiotics" src="http://1.bp.blogspot.com/-uSiDHpRug0A/Tdpk_ixPRUI/AAAAAAAAABY/pg58I1eBhC0/s320/antibiotics_2.jpg" border="0" height="253" width="320" /></a></div><div style="text-align: center;"><br /></div><br />A recent article in <i>Bloomberg Business Week</i> says that only two of the top 6 drugmakers (as determined by market value) are developing antibiotics. As IPs and pharmacists, many of our readers are already well aware of this neglected area of development. The void in the market has created an opportunity for sufficiently innovative competitors, and biotechnology companies are getting into the business as a result.<br /><br />Big pharma has been getting out of the antibiotics business because the revenue potential for antibiotics is significantly lower than for medications used to treat chronic illness. Antibiotics are used in limited courses for several weeks at a time, as opposed to medicines that are used to treat chronic conditions over long periods. Additionally, as <i>Bloomberg Business Week</i> notes, doctors are advised to limit use of antibiotics because of concerns that overuse can cause resistance. Both these factors have a negative effect on antibiotic sales, removing the motivation for big pharma companies to develop new antibiotics. (It's worth noting that the concern about drug resistance is a well-founded one; drug-resistant bacteria cost the US healthcare system more than $34 billion and 100,000 lives last year, according to the Infection Disease Society of America, as cited by <i>Bloomberg Business Week</i>.)<br /><br />We’ve previously written about the shortage of new antibiotic development on this blog, particularly <a href="http://vecnamed.blogspot.com/2010/08/mrsa-infections-down-but-new-threat-on.html">as relates to NDM-1</a>, and it’s comforting to know that some companies are trying to fill the general void. <i>Bloomberg</i> mentions Optimer Pharmaceuticals Inc. as an example of a biotech company developing an antibiotic. Optimer’s Dificid, developed to treat Clostridium difficile infections, could potentially be approved by the FDA by the end of this month. If so, it would be the first drug approved to treat C. diff in 25 years.<br /><br />Other companies mentioned in the article are Trius Therapeutics, The Medicines Co., Paratek Pharmaceuticals Inc., Cubist Pharmaceuticals Inc., and Durata Therapeutics. All are in final testing of antibiotics that would be submitted for FDA approval in the next two to three years. While it’s certainly good to develop new lines of attack for bugs that are resistant to current antibiotics, it definitely does not diminish the need for vigilance when prescribing the currently existing drugs.<br /><br />Article in <i>Bloomberg Business Week</i>: <a href="http://www.businessweek.com/news/2011-05-17/drug-resistant-germs-lure-biotechs-to-create-new-antibiotics.html">http://www.businessweek.com/news/2011-05-17/drug-resistant-germs-lure-biotechs-to-create-new-antibiotics.html</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-71336492363386593612011-05-13T12:44:00.003-04:002011-05-13T12:57:56.038-04:00The Tyranny of Zero Tolerance<!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:trackmoves/> <w:trackformatting/> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> 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style="font-size:10.0pt">Think about the most complicated infection control patient you have ever had. My worst patient was admitted with necrotizing fasciitis that had eroded almost the full circumference of of her trunk and spread to her perineal area. Naturally, she had an indwelling urinary catheter and several central lines.<span style="mso-spacerun:yes"> </span>Her wounds were constantly draining and she was able to spend, at most, an hour a day out of bed.<span style="mso-spacerun:yes"> </span>Our goal was to keep her from acquiring both a BSI and an SSI.<span style="mso-spacerun:yes"> </span>She was with us about 2 months before she acquired each type of infection.<span style="mso-spacerun:yes"> </span></span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span>Zero tolerance is generally accepted as the mantra for demonstrating commitment to reducing HAIs.<span style="mso-spacerun:yes"> </span>According to APIC zero tolerance generally means that no one on a healthcare team believes that even one HAI is acceptable.<span style="mso-spacerun:yes"> </span>The assumption is that zero tolerance will eventually result in zero HAIs.<span style="mso-spacerun:yes"> </span></span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span>The zero tolerance approach represents a shift from believing HAIs as a normal risk of hospitalization.<span style="mso-spacerun:yes"> </span>Certainly no one wants to go back to that way of thinking. <span style="mso-spacerun:yes"> </span>But is zero tolerance realistic? Does it support the culture of blame that many quality officers are trying to eliminate?<span style="mso-spacerun:yes"> </span></span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span>We all know that healthcare is a complicated service compounded by the fact that peoples’ bodies break down, including their immune systems.<span style="mso-spacerun:yes"> </span>Was it realistic to think we could prevent our patient from getting HAIs given the massive assault on her body from her first infection?<span style="mso-spacerun:yes"> </span>Good nursing care during her admission resulted in a reduction of her initial wounds to about half of their original size.<span style="mso-spacerun:yes"> </span>Unfortunately, the initial infection was not treatable and it spread to other sites despite aggressive care. It was at the time of that spread that the other infections occurred.</span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span>If I had strictly ascribed to the zero tolerance policy, my course of action would have been to conduct quality analyses and try to determine which staff performed poorly and/or what they had done that was wrong. That would have been followed by remedial actions including the possibility of staff discipline.</span></p> <p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span>But in this case I believed that the concept of zero tolerance was not appropriate.<span style="mso-spacerun:yes"> </span>There seemed no point in discussing the infection prevention strategies that might have been breached.<span style=""> The staff were familiar with prevention strategies. </span>They were devastated when the HAIs developed.<span style="mso-spacerun:yes"> Reviewing prevention strategies or threatening punishment would have been viewed as a punishment and, I believe, a disincentive for future prevention efforts.<br /></span></span></p><p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-spacerun:yes">The question was whether, given this patient's underlying condition, any prevention strategies would have been successful? The answer was probably not.</span></span><span style="font-size:10.0pt"> So I wondered what the teachable moment would be directed toward. I wondered if there was anything positive that could be taken from this situation.<span style="mso-spacerun:yes"> </span>It occurred to me that, given the massiveness of the patient's initial infection, what the staff had done was to prevent HAIs for a relatively extended period of time. <span style="mso-spacerun:yes"> </span>They had taken the necessary infection control precautions that were successful until the patient’s immune system was overwhelmed.</span> </p><p class="MsoNormal"><span style="font-size:10.0pt"> </span></p> <p class="MsoNormal"><span style="font-size:10.0pt"><span style="mso-tab-count: 1"> </span>Is there a place for zero tolerance?<span style="mso-spacerun:yes"> </span>Yes, but not as an inviolate goal.<span style="mso-spacerun:yes"> </span>To hold that belief without allowing different perspectives may be detrimental to prevention efforts. Sometimes we must give ourselves credit for keeping patients infection-free for as long as possible given the forces that both patients and staff are fighting against.<span style="mso-spacerun:yes"> </span>Supporting staff even in the face of failure can be an effective way to reinforce good practice for the many other patients whose conditions will challenge our best efforts.</span></p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-9706683647537127932011-04-28T16:30:00.002-04:002011-05-23T09:47:03.970-04:00Watch out for Armadillos!<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-IYD8s4NCCrQ/TbnLqEMvlHI/AAAAAAAAABU/j34WPX5OG9U/s1600/armadillo.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" alt=armadillo" height="206" src="http://1.bp.blogspot.com/-IYD8s4NCCrQ/TbnLqEMvlHI/AAAAAAAAABU/j34WPX5OG9U/s320/armadillo.bmp" width="320" /></a></div><br />
<br />
Research released today in the <i>New England Journal of Medicine</i> points to what many leprosy researchers have suspected for years: that armadillos can likely transmit leprosy to humans. <br />
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Leprosy, also called Hansen ’s disease, is caused by <i>Mycobacterium leprae</i>. The bug likes cooler temperatures than are found at the cores of human bodies, which is why it infects our extremities and skin. Armadillos have a low core body temperature, about 89 degrees Fahrenheit, which <i>Mycobacterium leprae</i> finds quite comfortable. <br />
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How did armadillos, of all creatures, get leprosy? Humans gave it to them. Richard Truman, the study’s first author, tells NPR health blog “Shots” that leprosy was brought to the New World by European settlers. It’s not known exactly how or when we gave it to the armadillos, but now about 15% of them carry the disease. <br />
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The study looked at the genetics of the bacterial strains found in leprosy patients in the southern U.S., and compared them with the genetics of the bacteria from wild armadillos living in the same area. A majority of both the patients and the armadillos carried the same strain of bacteria, and this strain hasn’t been reported anywhere else in the world. The conclusion is that the patients got leprosy from the armadillos.<br />
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Truman tells NPR that the risk of contracting leprosy from brief contact with an armadillo is low, so how did they give it to us? In some southern states, barbecued armadillo and armadillo chili are folk favorites. That’s right; the humans got leprosy from eating armadillo. Fortunately, if treated early with antibiotics, the bacteria are eradicated from the body and people become healthy again. Nonetheless, I don’t think you’ll catch me ordering up an armadillo burger anytime soon. <br />
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<i>New England Journal of Medicine</i> article: <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1010536">http://www.nejm.org/doi/full/10.1056/NEJMoa1010536</a><br />
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NPR "Shots" blog post: <a href="http://www.npr.org/blogs/health/2011/04/28/135740951/mysterious-leprosy-cases-linked-to-armadillos">http://www.npr.org/blogs/health/2011/04/28/135740951/mysterious-leprosy-cases-linked-to-armadillos</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-51979316148216022322011-04-25T10:29:00.000-04:002011-04-25T10:29:19.178-04:00FDA warns makers of hand sanitizers on false claimsThe FDA sent warning letters to four manufacturers of over-the-counter hand sanitizer products that claim to prevent infection from MRSA, H1N1, and <i>E. coli</i>. The FDA found insufficient data to support the claims made by these companies regarding their products and considers their labeling a violation of federal law.<br />
<div class="MsoNormal"> </div><div class="MsoNormal">The four companies and their products are:</div><ul><li>Tec Laboratories for Staphaseptic First Aid Antiseptic/Pain Relieving Gel</li>
<li>JD Nelson and Associates for Safe4Hours Hand Sanitizing Lotion and Safe4Hours First Aid Antiseptic Skin Protectant</li>
<li>Dr. G.H. Tichenor Antiseptic Co. for Dr. Tichenor’s Antiseptic Gel</li>
<li>Oh So Clean, Inc dba CleanWell Company for CleanWell All-Natural Foaming Hand Sanitizer, CleanWell All-Natural Hand Sanitizer, CleanWell All-Natural Hand Sanitizing Wipes, and CleanWell All-Natural Antibacterial Foaming Handsoap</li>
</ul><div class="MsoNormal">Major concerns cited in FDA's letters were:</div><div class="MsoNormal">1. The manufacturer's claims about the effectiveness of the products fall under the FDA drug category. FDA defines drugs as anything that cures, mitigates, treats or prevents disease. None of the products have been approved by FDA as drugs. <br />
2. Some products are defined as new drugs because the combination of ingredients included in the product do not match any similar product that has been approved by FDA as a drug. <br />
3. Several do not have sufficient details about the ingredients. FDA requires that the name, quantity and proportion of each ingredient be listed on the label. The lists must match all product marketing materials. <br />
4. One citation indicated that a product has a combination of ingredients that have not been tested by FDA in combination. That is, each ingredient has been found safe alone but not in combination with other ingredients. However, a troubling citation is a citation for a product that contains Triclosan. Triclosan has not yet received FDA widespread approval for safety. The other products contain ingredients that are probably harmless, if not effective, but this product may contain ingredients that are harmful. <br />
5. Three of the four manufacturers have been notified that they need to respond to the FDA within 15 days of the letter with plans to come into compliance. In some cases, formal requests for FDA approval are necessary. However, in others only re-labeling may be necessary. <br />
6. FDA has ordered the manufacturer of CleanWell All Natural Foaming Hand Sanitizer to stop producing their product(s). This company was cited in 2010 for FDA violations and their response has not been approved by FDA. Their response included "technology" briefs intended to show scientific proof of efficacy. These have been denied by FDA. Finally, this company was cited for lack of quality control of the manufacturing process and states that the product may be subject to adulteration because of this.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"> So what to look for in a sanitizer? We recommend a sanitizer that contains at least 61% alcohol and has been approved by the FDA. Also, look for sanitizers with lotion in them since alcohol alone makes the skin very dry. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm252127.htm">Full FDA press release</a> </div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-3282526604446900312011-04-22T10:09:00.001-04:002011-04-22T10:10:54.357-04:00Updates from NHSN<!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:trackmoves/> <w:trackformatting/> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:donotpromoteqf/> <w:lidthemeother>EN-US</w:LidThemeOther> <w:lidthemeasian>X-NONE</w:LidThemeAsian> <w:lidthemecomplexscript>X-NONE</w:LidThemeComplexScript> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> <w:splitpgbreakandparamark/> 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mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} </style> <![endif]--> <p class="MsoNormal" style="text-align: center;" align="center">Updates from NHSN about HAI Reporting</p> <p class="MsoNormal" style="text-align: center;" align="center"> </p> <p class="MsoNormal"> </p> <p class="MsoNormal"><span style=""> </span>I recently returned from the SHEA conference where I attended as many sessions as I could that dealt with NHSN’s thoughts about current or future reporting. You will be happy to know that someone has heard IP’s cries of pain when it comes to the amount of time that we spend on data collection!<span style=""> </span>Here are some of the specific messages from the forums I attended.</p> <p class="MsoNormal"> </p> <p class="MsoNormal"><span style=""> </span>The overall theme was that NHSN has a mandate (that they call their Action Plan) to reduce the time, effort and money spent on surveillance.<span style=""> </span><span style=""> </span><span style=""> </span>They spoke several times about the need to (a) provide definitions that will track the effects of interventions, (b) will have clinical as well as surveillance meaning, and (c) will give IPs more time on clinical <span style=""> </span>units helping patients and staff to improve care.</p> <p class="MsoNormal"> </p> <p class="MsoNormal"><span style=""> </span>They will be issuing a new SSI form as soon as OMB approves it.<span style=""> </span>They have changed the form so required data is more relevant to specific surgeries.<span style=""> </span>For instance, information about implants will be required for orthopedic procedures but not for hysterectomies.<span style=""> </span></p> <p class="MsoNormal"> </p> <p class="MsoNormal"><span style=""> </span>NHSN is currently having consensus meetings to finalize the criteria for VAP.<span style=""> </span>They expect to have a statement by mid-summer.<span style=""> </span>It will then take them some time to develop the software for NHSN submission.<span style=""> </span>They expect that VAP reporting will become “mandatory” no sooner than January 1, 2013.</p> <p class="MsoNormal"> </p> <p class="MsoNormal"><span style=""> </span>The biggest changes they are considering <span style=""> </span>related to the definition of VAP include:</p> <p class="MsoNormal"> </p> <p class="MsoNormal"><span style=""> </span>- making the chest x-ray a confirmatory finding rather than a key <span style=""> </span>criterion of the definition,</p> <p class="MsoNormal"> </p> <p class="MsoNormal"><span style=""> </span>-specifying PEEP settings and FiO2 readings as the specific <span style=""> </span><span style=""> </span>indicators for worsening gas exchange, and</p> <p class="MsoNormal"> </p> <p class="MsoNormal"><span style=""> </span>- specifying the time on a vent at 4 or more days before <span style=""> </span><span style=""> </span>considering pneumonia as a possibility.</p> <p class="MsoNormal"> </p> <p class="MsoNormal"> </p> <p class="MsoNormal"><span style=""> </span>The SHEA forums with NHSN content were very satisfying.<span style=""> </span>For the first time in memory the phrase “I’m the government and I’m here to help” wasn’t the introductory joke of the sessions.</p> <p class="MsoNormal"> </p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-21140383556662652262011-04-22T10:07:00.000-04:002011-04-22T10:07:29.080-04:00"I Watch the Line" selected to be shown at the APIC Film FestivalThe APIC Film Festival committee notified us yesterday that Ron's music video, "I Watch the Line," has been selected to be shown at the APIC Film Festival. The Film Festival will take place during the Annual APIC Conference from June 27 to June 29 in Baltimore, MD.<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/zMyJEOu4zoI?feature=player_embedded' frameborder='0'></iframe></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-81368104595102701262011-04-18T08:59:00.000-04:002011-04-18T08:59:08.902-04:00New Partnership for Patients aims to improve care, reduce cost<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div class="MsoNormal">The federal government took a step towards sustainable healthcare this month by launching a new initiative to reduce preventable errors in hospitals.<span> </span>The Partnership for Patients: Better Care, Lower Costs aims to achieve $10 million in health care savings over the next three years.<span> </span></div><div class="MsoNormal"><br />
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</style> <![endif]--> </div><ul><li>Keep patients from getting injured or sicker by reducing preventable hospital-acquired conditions by 40% by 2013.<span> </span>Achieving this goal would mean approximately 1.8 million fewer injuries to patients and more than 60,000 lives saved over three years.</li>
<li>Help patients heal without complications by reducing hospital readmissions by 20% by 2013.<span> </span>Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.</li>
</ul><div class="MsoNormal">The partnership will bring together leaders from hospitals and state and federal governments to devise strategies to achieve these objectives.<span> </span>The details of the partnership are still being worked out so stay tuned!</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><a href="http://www.healthcare.gov/center/programs/partnership">Read more about the Partnership</a></div><div class="MsoNormal"><br />
</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-59256163405336744172011-04-10T22:39:00.007-04:002011-04-11T10:01:38.313-04:00Likely outcomes of public HAI reportingAs mandatory healthcare-associated infection (HAI) reporting takes hold, and as NHSN data becomes available publicly on CMS Hospital Compare, what are the likely outcomes?<br /><br /><span style="font-style:italic;">Will healthcare consumers become more savvy?</span><br /><br />Let’s take a look at existing international reporting systems as analogues. University of Exeter performed a <a href="http://www.ncbi.nlm.nih.gov/pubmed/10770149">study</a> in 2000 on seven health reporting systems. The study found that consumers and purchasers rarely sought out publicly available information, and did not understand the data when it was found. AHRQ similarly <a href="https://www.talkingquality.ahrq.gov/content/tools/arg1.aspx">makes the case</a> that public reporting does not affect consumer behavior. ARHQ’s Talking Quality web site states: 1) that information is not used, 2) quality data can be misleading, and 3) quality data can be difficult to understand. <br /><span style="font-style:italic;"><br />Will infection rates decrease?</span><br /><br />While public reporting may not affect consumer behavior, it still holds the potential to positively affect health outcomes and quality improvement. The same University of Exeter study found that hospitals tended to be the most responsive to publicly reported data with some correlation between public performance data and quality of care improvement. Another <a href="http://www.annals.org/content/148/2/111.abstract">2008 study</a> published in the Annals of Internal Medicine similarly states that “publicly releasing performance data stimulates improvement activity at the hospital level.” <br /><br />Let’s hope this holds true for the latest iteration of public reporting in the US. Perhaps self-scrutiny (rather than consumer pressure) will be part of the solution.Ronhttp://www.blogger.com/profile/12298292710222455199noreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-12353726670404369722011-04-01T05:46:00.000-04:002011-04-01T05:46:57.335-04:00Meet the bloggers at SHEARon, Joan, and I will be attending <a href="http://www.shea2011.com/">SHEA</a> in Dallas this weekend. You can find us at booth #302. We will be posting throughout the conference.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-39564046976109586962011-03-28T16:31:00.000-04:002011-03-28T16:31:18.883-04:00East Liverpool City Hospital in Ohio successfully reduces incidences of hospital-acquired VAP and CLABSIs<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div class="MsoNormal">East Liverpool City Hospital began using prevention bundles several years ago to reduce hospital-acquired ventilator-acquired pneumonia (VAP) and central line-associated bloodstream infections (CLABSIs).<span> </span>The hospital has not had a case of hospital-acquired VAP in 3 years or 1,291 ventilator days and has not had a case of CLABSI in 19 months or 2,448 central line days.<span> </span>These are remarkable accomplishments and the hospital attributes its success to the consistent use of bundles, nursing-physician collaboration, and streamlined processes.<span> </span></div><div class="MsoNormal"><br />
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</div><div class="MsoNormal"><u>VAP bundle </u></div><ol><li>Keep the head of the patient’s bed raised between 30 and 45 degrees, unless other medical conditions prevent this</li>
<li>Check the patient’s ability to breathe on his or her own every day so that the patient can be taken off the ventilator as soon as possible</li>
<li>Clean their hands with soap and water, or an alcohol-based hand rub before and after touching the patient or ventilator</li>
<li>Clean the inside of the patient’s mouth on a regular basis</li>
<li>Clean or replace equipment between use on different patients</li>
</ol><u>CLABSI prevention bundle</u><br />
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<ol><li>Washing hands with soap and water, or an alcohol rub</li>
<li>Wearing sterile clothing and taking barrier precautions such as wearing a mask, gloves, and hair covering, and fully covering the patient with sterile drape, except for a very small hole where the line is inserted</li>
<li>Cleaning the patient’s skin with chlorhexidine when the line is inserted</li>
<li>Finding the best vein to insert the line</li>
<li>Checking the line for infection each day</li>
</ol><a href="http://www.reviewonline.com/page/content.detail/id/542411/City-Hospital-winning-fight-against-infections.html?nav=5002">Further reading</a><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif";}</style> <![endif]--><br /><div class="MsoNormal">Last month, the Mayo Clinic Proceedings published the first of a 15-part series, “Symposium on Antimicrobial Therapy.”<span> </span>The purpose of this series is to educate practicing physicians on the key concepts and best practices in antimicrobial therapy and stewardship.<span> </span>An introduction to the series written by Dr. Zelalem Tamasgen can be found <a href="http://www.mayoclinicproceedings.com/content/86/2/86">here</a> </div><div class="MsoNormal"><br /></div><div class="MsoNormal">The February article titled “General Principles of Antimicrobial Therapy” is a useful overview of important principles in determining appropriate antimicrobial therapy in relation to clinical diagnoses, microbiology lab results, and patient history while taking into consideration drug characteristics and special circumstances.<span> </span>I am highlighting some 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mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif";}</style> <![endif]--> Use narrow spectrum antibiotics as soon as possible</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 0in;">The use of broad spectrum antibiotics is often necessary in situations where the patient is critically ill and that therapy is required before microbiology lab testing results are known.<span> </span>The optimal therapy should take into consideration the site of infection, the most probable organism, organism colonization history in the patient, and resistance patterns from the hospital’s institutional antibiogram.<span> </span>Once microbiology results are known, narrow spectrum antibiotics should replace broad spectrum antibiotics as soon as possible to prevent the emergence of antimicrobial resistance in the community.</div><div class="MsoListParagraphCxSpMiddle"><span> </span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 0in;"><u><b><br />Infection site is important for AST interpretation</b></u></div><div class="MsoNormal">Antimicrobial susceptibility testing (AST) is the lab test used to predict the effectiveness of an antibiotic against an organism.<span> </span>Labeling the site of the specimen is important because different antibiotics have different penetration capabilities in various body sites.<span> </span>By knowing the specimen site the lab can test antibiotics that are likely to have good bioactivity at the site.<span> </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><u>Combination therapy is most appropriate for infections that may be caused by organisms that have shown multidrug resistance in the past.<span> </span></u></b> </div><div class="MsoNormal">These include hospital acquired infections, HIV, and TB.<span> </span>Providing multiple drugs helps assure that one will be effective in suppressing the infection until actual susceptibilities are known</div><div class="MsoListParagraph" style="margin-left: 0in;">Avoid “one size fits all” approach</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><u>The condition of the patient must be considered when prescribing antibiotics.</u></b><span><b><u> </u></b> </span> </div><div class="MsoNormal">Some critical factors are kidney and liver function, age, genetics, allergies, pregnancy, and history of recent antibiotic use.</div><div class="MsoListParagraphCxSpFirst" style="margin-left: 0in;"><br /></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 0in;"><u><b>Common misuses of antibiotics:<span> </span></b></u></div><ul><li>Prolonged antimicrobial treatment without clear evidence of infection</li><li>Treatment of a positive clinical culture in the absence of disease</li><li>Failure to narrow antimicrobial therapy when a causative organism is identified</li><li>Prolonged prophylactic therapy </li><li>Excessive use of certain antimicrobial 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</style> <![endif]--> </div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">Joan asked me post this on her behalf because she is traveling this week. </div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"> </div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">Once upon a time histograms, bar charts, and line graphs were the most important tools for displaying infection control data.<span> </span>We used them to show differences between events and to track changes over time.</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span></span>Now someone has decided that control charts are essential tools for measuring success in healthcare.<span> </span>We spend a lot of time constructing charts that show upper and lower confidence limits.<span> </span>We faithfully plot our own results on them and hope that we will not meet the criteria for being “out of control”.<span> </span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span></span>We have rules for what it means to be out of control:<span> </span>one spike above two standard deviations, a series of X in a row above or below the central line, or a series of ups and downs.<span> </span>How many of us have been called to task because a dreaded spike has appeared in our data.</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span></span>Would it surprise you to know that control charts are business tools?<span> </span>They were not introduced into health care by epidemiologists.<span> </span>They were adopted by people in healthcare who had business backgrounds.<span> </span>We have adopted them because they seem like better tools than our old stand-bys.</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span></span>What are we really comparing ourselves to when we use control charts?<span> </span>The goal of control charts is to keep a process average.<span> </span>The center line represents average performance and, in business, the goal is to keep it there.</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span></span>In healthcare we are always striving to be better.<span> </span>In most cases this means that we <u>want </u>the lines to move steadily up or down.<span> </span>We want to have more of what is good and less of what is bad.<span> </span>So why are we caught up in control charts?</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span></span>This month I am linking you to a business consulting website that explains control charts.<span> </span>Being a business site, the explanations are about applying control charts to the production of widgets.<span> </span>Notably absent are recommendations to use control charts to measure complex healthcare processes that involve not just machinery, but the unpredictability of people (both patients and workers).</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span></span>I think it is time that we move away from the model of infection prevention as a business.<span> </span>A big step in doing so is to use statistics that correctly show what we really are all about.</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span></span>Please let me know if there are any questions I can answer about these articles.</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
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</style> <![endif]--><span style="font-size: 12pt;">Individual control charts:<span> </span>different types of control charts, what they tell us and when to use them.<span> <a href="http://www.spcforexcel.com/individuals-control-charts">Available here.</a></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
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</style> <![endif]--><span style="font-size: 12pt;">An <a href="http://www.spcforexcel.com/example-misuse-spc-health-care">example</a> of misuse of statistical process control in healthcare.<span> </span></span><span style="font-size: 12pt;"><span> </span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
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</style> <![endif]--><span style="font-size: 12pt;">An <a href="http://www.spcforexcel.com/overcontrolling-process-funnel-experiment">example</a> of overcontrolling a process:<span> </span>Over-reacting to points on a control chart that are above or below a confidence level.</span><span style="font-size: 12pt;"><span> </span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div>Unknownnoreply@blogger.com5tag:blogger.com,1999:blog-8176396831571099855.post-64074263988715684862011-03-11T14:08:00.000-05:002011-03-11T14:08:53.181-05:00Vaccinated vs. unvaccinated children – the realitySome of you might remember the previous post here titled “<a href="http://vecnamed.blogspot.com/2011/01/thanks-andrew-wakefield.html">Thanks, Andrew Wakefield</a>,” talking about the anti-vaccine movement and its negative consequences on infectious disease rates. Lately, according to <a href="http://scienceblogs.com/insolence/">Orac</a> over at <a href="http://scienceblogs.com/">ScienceBlogs</a>, anti-vaccine activists have been demanding a study of vaccinated versus unvaccinated children. As pointed out, a randomized, double-blind study of vaccinated vs. unvaccinated children would be highly unethical given that vaccines are already proven to reduce disease among the vaccinated. <br />
<br />
In response, some anti-vaccine activists have taken to demanding an <i>observational</i> study rather than an experimental one – a study where the differing rates of infection in vaccinated vs. unvaccinated children are merely observed, rather than controlling who is vaccinated or not. Never mind that there are a large number of confounding factors that would make it difficult to conduct such a study (subjects would have to be matched for age, sex, socioeconomic group, geographic location, urban vs. rural vs. suburban setting, race), and that there are only approximately 50,000 unvaccinated children ages 3-6 in the U.S.; this observational study is apparently the way to go. <br />
<br />
“Fine,” said a study just reported in <i>Deutsches Ärzteblatt International</i>. Roma Schmitz and colleagues from the Robert Koch Institute reviewed results from the German Health Interview and Examination Survey for Children and Adolescents, double-checking the responses against medical records for accuracy. Schmitz and her co-authors compare the occurrence of infections and allergies in vaccinated vs. unvaccinated German children and adolescents – exactly the kind of observational study requested by anti-vaccine activists. The authors even specifically state that they did the study because of the anti-vaccine movement.<br />
<br />
The findings shouldn’t be surprising – the only difference between the vaccinated vs. unvaccinated children was in the incidence of vaccine-preventable infectious disease. In other words, vaccines work, and if your child isn’t vaccinated, they are more likely to get the disease that the vaccine would have prevented. <br />
<br />
However, the controls that the authors used in the study are extremely interesting; they looked at incidence of infectious disease in general between the two groups, as well as incidence of allergies and immune dysfunction. They found that unvaccinated children were <i>just as likely</i> to have other infectious diseases, were <i>just as likely</i> to have allergies, and were <i>just as likely</i> to have immune system dysfunction as the vaccinated children. I.e., vaccinated children aren’t at any higher risk of developing some of the negative consequences that anti-vaccine activists are so worried about.<br />
<br />
The study doesn’t measure prevalence of autism, because, as explained by Orac, “there were only 94 unvaccinated children, which makes it impossible to compare autism and ASD [Autism Spectrum Disorders] prevalence with the vaccinated cohort, because the expected prevalence of autism is only approximately 1 in 100 anyway, which means that on average less than one autistic child would be expected in such a cohort. To look at differences in autism prevalence between the groups, many times more than 13,000 subjects would be needed.”<br />
<br />
So, the study shows that vaccines work, and don’t cause any harm (as measured in the study). Ironically, the study was just what anti-vaccine activists said they wanted, though they most likely won’t like the results.<br />
<br />
<i>Deutsches Ärzteblatt International</i> paper: http://www.aerzteblatt.de/int/article.asp?id=80869<br />
<br />
Orac’s post on ScienceBlogs, a good discussion of the paper: http://scienceblogs.com/insolence/2011/03/for_the_anti-vaccinationists_out_there_t.phpUnknownnoreply@blogger.com2tag:blogger.com,1999:blog-8176396831571099855.post-35014372094273427792011-03-07T10:17:00.000-05:002011-03-07T10:17:06.255-05:00CDC study shows decreasing CLABSIs in hospitals<div style="font-family: Arial,Helvetica,sans-serif;"><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> </div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">Some encouraging news came out of the CDC last week on CLABSI rates.<span> </span>The CDC calculated the total central line days in the U.S. in 2001 and 2009 and estimated the total number of CLABSIs that occurred during the same time period.<span> </span>The results showed a 58% CLABSI rate reduction from 2001 to 2009.<span> </span>This reduction represents 25,000 fewer incidences of CLABSIs in 2009 than in 2001, and translates into 3,000-6,000 lives saved and $414 million of excess healthcare costs.<span> </span>The reduction in CLABSIs was greatest for <i>Staphylococcus aureus</i> CLABSIs which showed a 73% reduction.<span> </span><span> </span></div><div style="font-family: Arial,Helvetica,sans-serif;"> <span style="font-size: 11pt; line-height: 115%;"> </span></div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 11pt; line-height: 115%;">The CDC credits this significant drop in CLABSI rates to collaborative efforts among federal, state, and regional agencies and cited a couple notable examples in the Pittsburgh Regional Healthcare Initiative (<a href="http://www.prhi.org/">http://www.prhi.org/</a>) and the Michigan Keystone Project (<a href="http://www.mhakeystonecenter.org/">http://www.mhakeystonecenter.org/</a>).<span> </span>Both initiatives involve a combination of regional mandate on CLABSI reporting and broad dissemination of prevention education and best practices.<span> </span></span></div><div style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 11pt; line-height: 115%;"><span><a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6008a4.htm?s_cid=mm6008a4_w">Link to full report</a> </span></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8176396831571099855.post-28219705732475077222011-02-28T09:44:00.000-05:002011-02-28T09:44:39.075-05:00Maryland ties payment to hospital performance on hospital-acquired conditionsResults from a state-wide hospital-acquired conditions reporting program were published last week by the state of Maryland. Hospitals were required to report data in 49 categories of potentially preventable complications including HAIs. Of the 45 hospitals that submitted data, 9 hospitals had higher rates than the state's target. <br />
<br />
Maryland is currently the only state that ties payment to hospital performance on dealing with hospital-acquired conditions. The state sets target rates for each reportable condition and payments to hospitals are tied to meeting the state's targets. <br />
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In 2008, Maryland's hospitals collectively had approximately 53,000 cases of hospital-acquired conditions out of a total of 800,000 inpatients and these conditions amounted to approximately $500 million in potentially preventable hospital payments. The initiative was put in place in 2009 in an effort to address hospital-acquired conditions and to improve the quality of care for patients. <br />
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More info can be found at the Maryland Health Services Cost Review Commission <a href="http://www.hscrc.state.md.us/init_qi_MHAC.cfm%20">website</a>Unknownnoreply@blogger.com0