Idea #296 for December 11th, 2009: Food Fight or Improving Food Safety In School Lunches

Considering that many American children rely on school lunches on a daily basis, we should expect that this government-subsidized program delivers a quality product. That’s why it’s disheartening and surprising to hear that meat used by school lunch programs is not even up to the standards of fast-food restaurants, in some cases. Jack in the Box, for instance, sets the acceptable level of bacteria in their beef ten times lower than the USDA does for school lunch meat. And the type of chicken used in school lunches is deemed sub-standard by KFC and Campbell’s Soup. In fact, this type of chicken is normally reserved for pet food.

If not properly cooked, the meat in school lunches could contain enough bacteria to cause food poisoning. Tougher standards don’t have to come at a high cost. The safety changes that Jack in the Box implemented only added a fraction of a penny to the cost of a pound of beef. That’s trivial compared to the cost of treating children sickened by E. coli or salmonella from tainted meat. At the very least, school lunch programs should strive for the level of quality demanded by the fast food industry.

http://www.usatoday.com/news/education/2009-12-08-school-lunch-standards_N.htm

Idea #279 for November 24th, 2009: Unwelcome Visitors or Fighting The Rise in Community-Acquired MRSA

MRSA, the antibiotic resistant pathogen we often hear about in the news, is usually thought of as a problem that only occurs in hospitals. New data suggests that a growing number of patients are picking up MRSA in the community and then bringing the pathogen into hospitals, rather than the other way around. The incidence of MRSA in outpatient units has grown rapidly. This is dangerous because doctors often travel between outpatient and inpatient units, potentially spreading the bacteria that’s carried into the hospital during outpatient visits.

Strains of MRSA that originate outside of hospitals are considered less dangerous than the deadly ones often cited in the media. That doesn’t mean the threat should be ignored, though. Hospitals now have to concentrate not only on containing and eliminating MRSA from their inpatient units, but also must contend with battling strains that are introduced by new patients. Healthcare facilities will probably require more resources to fight the outside waves of MRSA now. They will also need to increase surveillance and find better diagnostic tools to ensure that their response can be rapid.

Read more about this story in the LA Times.

Idea #247 for October 23rd, 2009: Erasing Germs or Rethinking One-Use Markers in Hospitals

Occasionally a piece of news comes up that turns some aspect of conventional medical thinking on its head. Today, there’s a story about the role Sharpie pens may or may not play in the spread of germs in hospitals. Generally, when hospital staffs want to write on patients prior to surgery, they use either Sharpies or special one-use pens with an anti-fungal agent. When they use Sharpies, they discard them after one use out of fear that the pens may spread bacteria from one patient to another.

It seems to make sense: the moist felt tip of the marker sounds like an ideal place for bacteria to be picked up and grown. But it’s not true at all. Doctors in Canada conducted a study that assessed the amount of bacteria that remains on the tips of Sharpies hours and days after writing on a patient. The amount detected was always zero. It turns out that Sharpies contain alcohol, and at a high enough concentration to kill microbes that it contacts. Meanwhile, the special one-use pens with anti-fungals do not kill bacteria and must be thrown out after each use.

The effect that this can have on healthcare is relatively minor. It may save hospitals thousands of dollars a year if they decide to re-use their Sharpies. It’s not earth-shattering, but reducing unnecessary spending anywhere in healthcare is a step in the right direction.

Read more about the study in the LA Times.

Idea #240 for October 16th, 2009: An Endless Battle or Keeping Antibiotic Resistance Under Control

Antibiotic resistance is a huge concern in healthcare, with strains of bacteria like MRSA especially troublesome. Despite our efforts, we cannot expect the issue of antibiotic resistance to ever go away completely. Instead, we have to consider ways to lessen its effect, says a new report. The American Academy of Microbiology report makes the point that we can’t expect to win a battle against trillions of microbes and the forces of evolution, but we can employ better ways of managing the inevitable.

The report outlines several suggestions that can reduce the threat of antibiotic resistance. For one, if we have better diagnostic tools available, patients can be treated more promptly with the correct antibiotics, reducing the amount of mis-prescribed medications. The scientists recommend more comprehensive surveillance to ensure we have accurate data on the spread of resistant bacteria. They also want more research into the role that ubiquitous antimicrobial agents found in household products like soap are playing in the rise of resistant strains. And they believe that more time and resources be spent trying to develop new antibiotics that will keep us one step ahead of the bacteria. These methods won’t solve the problem of antibiotic resistance, but they could give us our best chance of keeping it under control.

Read the report from the American Academy of Microbiology here.

Idea #237 for October 13th, 2009: Dirty Needles or The Case of The Contaminated Syringes

In late 2007, there were over 150 cases of bloodstream infections from the bacterium S. marcescens in nine different states. The culprit was contaminated syringes pre-filled with heparin and saline, produced by a company operating in violation of safety guidelines. The failures that led to the contamination and the difficulty in tracking down the parties responsible have caused some to rethink the ways these kinds medical products should be tracked.

After determining the source of the outbreak, agents discovered that proper protocol consistent with the FDA’s Good Manufacturing Practices was not being followed, which led to the contamination. But an even bigger problem was the difficulty in identifying the source. The syringes themselves did not have the manufacturer’s name on them, but names of subsidiaries instead. Further complicating the matter was the large number of middlemen that stand between the manufacturer and healthcare providers. The FDA should devise rules to ensure that manufacturers of medical supplies can be easily identified during a crisis like this, when time is critical. It may take more funding or staff, but it’s essential that sources of outbreaks be uncovered promptly in the future.

Read more about this story in the Atlanta Journal Constitution.

Idea #209 for September 15th, 2009: Prescription For Trouble or Online Drug Sales Contribute to Antibiotic Resistance

Antibiotics resistance is a big problem in healthcare. Over-prescription of antibiotics and patients’ reluctance to take the drugs for the full course of treatment both contribute to the problem. Another major factor is the growing industry of internet-order antibiotics, which is done without a prescription from a doctor and is illegal. Researchers scouring the internet found that about a third of sites selling prescription drugs did not actually require a prescription to complete an order.

When antibiotics are readily available without a prescription, patients will misuse the drug, which contributes to the rise of resistant strains of bacteria. Not only that, but researchers found that the mean delivery time for internet-order antibiotics was eight days, which means infections have already worsened or cleared up by the time the buyer receives the shipment.

Beyond the internet, it’s estimated that 30% of migrant workers are buying antibiotics without prescriptions from corner stores that are trafficking them illegally. There needs to be a larger crackdown on illegal sales of these drugs if we want to preserve the effectiveness of existing antibiotics. If researchers can easily buy prescription antibiotics online from multiple sources, then clearly not enough has been done to deter the sellers from continuing the practice.

Read about this issue further in this news story.

Idea #180 for August 17th, 2009: Washing Up or Encouraging Proper Hand-Washing in Hospitals

The act of hand-washing is more important than many realize, and that is especially true in medicine. A study in 2000 by the Institute of Medicine claimed that, of all the hospital-related errors that lead to death, the spread of bacterial infections was one of the top causes. Insufficient hand-washing may be partly to blame for that stat.

Cedar-Sinai came up with an interesting way to make sure more doctors were washing their hands. At the time, only about 65% of the doctors were washing their hands to the degree that it was compliant with JCAHO standards. So a team of staff there began handing out Purell bottles to doctors in the parking lot, as well as giving Starbucks giftcards to doctors who they found washing up properly. Soon the rate of compliance jumped to 80%, which was an improvement, but still not acceptable.

Then came the idea that changed the culture of hand-washing at Cedar-Sinai forever. Hospital leadership decided to take handprints on petri dishes of some of the doctors and culture those prints to show the bacterial colonies. The results were visually striking, displaying forests of bacteria in the outline of a hand. One such image was then used as the standard screen-saver for all computers at the hospital, and staff were confronted with it frequently. Hand-washing compliance rose to nearly 100%, where it still is today. It’s a fascinating way of getting a message across, and that type of non-standard methodology could be used in other locations that suffer from the same problem.

Read about this story in the NY Times.

Idea #142 for July 10th, 2009: Sweetening the Deal or Preventing Toddler Tooth Decay

Outside of the common cold, dental cavities are the most widespread health ailment in the US. The majority of people who have cavities received their first one before the age of five. The habits of baby bottle feeding are thought to be a major cause. Sugars in milk or fruit juice promote growth of bacteria that eventually cause tooth decay. It may seem unimportant to care about cavities in baby teeth; after all, they are just temporary teeth. However, tooth decay in baby teeth can lead to health problems, and also affect the development of adult teeth later on.

Researchers have found an interesting way to battle this problem that plagues many babies: giving them the sugar-substitute xylitol, a naturally occurring sweetener. Giving babies xylitol syrup daily, it was found, can lead to a 70% reduction in tooth decay incidence. That doesn’t mean substituting other sugars with xylitol, but rather giving a supplemental amount of the syrup every day. Xylitol seems to attract bacteria, but the bacteria cannot survive on the chemical and thus die off, lowering the number of decay-causing bacteria on teeth. Since children born into poverty are more likely to suffer tooth decay, this can be a great low-cost solution for those families in the fight against cavities and their related health problems.

Read more about this in healthnews.com

Idea #24 for March 14th, 2009: Medical Moonshine or Hand Sanitizers

An easy way for everyone — not just healthcare professionals — to help reduce the spread of disease is to use alcohol-based hand sanitizers. Alcohol kills bacteria and fungus and can deactivate viruses like influenza and the common cold. These sanitizing gels are better choices than products containing antibacterial compounds, which actually promote the emergence of resistant strains of bacteria. In fact, the CDC points out that no known bacterium has ever been shown to be resistant to alcohol.

Unlike hand-washing, applying hand sanitizers doesn’t require a sink or running water, making it convenient for use anywhere. One caveat to be aware of is alcohol strength. Any sanitizer that contains under 60% alcohol is not considered effective, according to the FDA (though they could  have meant effective enough to put in their coffee). Also, they should be kept away from children. Those issues aside, anybody who often finds themselves shaking hands with cold-sufferers would be well-advised to carry some hand sanitizer with them. It’s easier than carrying a sink.

For more on hand sanitizers, see this New York Times story.