Idea #303 for December 18th, 2009: A Large Chunk Of Change or The Costs Associated With MRSA

Infections resulting from surgery are a major concern in healthcare, and it’s been addressed here several times already. The economic aspect of these infections has been difficult to pin down, though. A new study sought to estimate the per-patient cost of the infections, and the amount is staggering.

The study, which was conducted by researchers at Duke, followed hundreds of patients in the 9o days following surgery. Patients who contracted MRSA infections accrued additional costs of around $60,000 for the three additional weeks of hospitalization they required, on average, to clear the infection. In that same 90 day period, the MRSA infected patients were seven times likelier to die than other patients, the study says. At just the seven hospitals that the study investigated, the MRSA infections accounted for more than $19 million in additional costs. These stats remind us once again that preventing MRSA-related infections in hospitals can save us not only unnecessary deaths, but also significant amounts of money.

Read more about the study here.

Idea #286 for December 1st, 2009: Keep Those Meds To Yourselves or The Problem With Sharing Prescription Drugs

There’s a large problem in the US with people selling prescription medications on the black market for recreational use. But there’s another problem involving people who are sharing their medications with others to provide assistance. Twenty percent of teens admit to have given some of their prescription drugs to friends. They might think they’re just helping out a friend by sharing their prescription, like giving some antibiotic pills, but the results can be more harmful than helpful.

Of the people surveyed who had received medications from another person’s prescription, a quarter experienced some side effects. People who receive the drugs may not be informed of potential interactions or allergies that may come into play. Side effects aren’t the only problems; sharing things like eye drops can spread infections rather than contain them. And misusing antibiotics can contribute to drug resistant bacteria strains like MRSA. Two ways to address this problem are: better informing patients of the risks involved in sharing meds, and increasing access to programs that take back expired and unwanted medications, so that patients do not have to accumulate old medications.

Read more about this issue here.

Idea #280 for November 25th, 2009: Looking Over Your Shoulder or A Simple Way to Boost Hand-Washing Compliance in Hospitals

Proper hand-washing compliance remains a problem across many medical facilities. Not thoroughly washing hands can lead to the spread of pathogens including MRSA. A program recently instituted at UCLA Medical Center, however, has led to dramatic changes in the compliance rate of hand-washing there. It could serve as model for other hospitals in the future.

UCLA has achieved their success with using a simple method: enlisting undergrads to observe hand-washing in the hospital and report on the results. They have seen their compliance with hand-washing guidelines rise from 50% to 93% since the program began. Apparently, simply having people watch over medical staff during washing can make them more careful. It’s something for other medical facilities to keep in mind, especially if they are looking for a low-cost way raising compliance.

Read more about this program in the Wall St Journal.

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 #204 for September 10th, 2009: Hands-On Approach or Joint Commission Takes on Handwashing

The Joint Commission, which serves as an accreditation body for healthcare organizations, will soon be expanding its role in the health system. They will begin rolling out programs to identify and rectify problems in patient safety, in addition to the certifying they already do. The task will be carried out by a new division of the Joint Commission called the Center for Transforming Healthcare.

The first project to be tackled under the new initiative is the Hand Hygiene Project, which aims to increase hand-washing compliance among hospital staffs. Infections kill 100,000 patients a year in hospitals and may cost the nation billions of dollars, and better hand-washing is believed to be the best way to decrease those numbers. The pilot project in eight hospitals used undercover observers to note hand-washing compliance in those facilities. They found that less than half of staff were washing their hands before entering patients’ rooms.

After observing and compiling data on hand-washing, the next step was implementing changes to resolve the issue. At those eight hospitals in the pilot program, improvements were made and the hand-washing compliance jumped to 75% within a few months. Still, that number is below the target of 90%, but it is improvement nonetheless. The fact that the Joint commission is taking a more hands-on role in fixing healthcare is a positive development. If this hand-washing trial is any indication, outcomes could be drastically improved with some minor adjustments.

Read more about this program in the NY Times and Wall St Journal.

Idea #199 for September 5th, 2009: Cleaning Up or Fighting the Spread of MRSA on Medical Equipment

A lot has been made over the spread of MRSA within hospitals and other medical facilities. MRSA is a strain of staph bacteria that is resistant to even the strongest antibiotics, and is responsible for infections that are not easily clear-up. Eradicating MRSA has proven difficult and it continues to be a problem in many places. Researchers in Israel have found an often ignored area that is a potential vector for the spread of drug-resistant pathogens: chest X-ray equipment.

The researchers observed technicians perform nearly 200 chest X-rays and found that proper sanitation protocol was followed only 1% of the time. Drug-resistant bacteria was found on 39% of the X-ray machines. Then, after educating the technicians on correct protocol, the rate of compliance went up to 42%, which is far from perfect, but more importantly none of the machines tested positive for resistant bacteria. The lesson here is that with timely intervention and proper education, a facility can decrease or eliminate the presence of antibiotic resistant bacteria like MRSA on their equipment.

Read more about this research here.

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 #70 for April 29th, 2009: Empty That Pill Bottle or Taking a Full Course of Antibiotics Fights Resistance

If a doctor prescribes you antibiotics for a lingering infection, you may be tempted to quit taking the pills as soon as your symptoms clear up. Doing so, though, can inflict harm not just on yourself, but the general population as well. Antibiotic resistance is a major issue in medicine, and the failure to take a complete course of antibiotics is one of several contributors to the problem.

During the initial period of an antibiotic course, the majority of vulnerable bacteria die, resulting in a marked improvement in the patient’s condition. However, a smaller amount of resistant bacteria may survive the early stages of treatment, only to multiply and return with a vengeance at a later date if the course of antibiotics is abandoned prematurely. At that point, the patient would have to switch to a different antibiotic capable of wiping out the resistant bacteria that is causing the new infection.

The concern over antibiotic resistance doesn’t end with the patient who abandons his treatment early. Such individuals breed resistant bacteria, which puts other people at risk for contracting the resistant strain. This scenario is one contributing factor to the rise of so-called “superbugs” — bacteria that are resistant to even the strongest antibiotics available. Just remember: your doctor prescribed the specific course of treatment for a reason. Abandoning antibiotics early could have devastating impacts on your health, and the health of those around you.

For more about antibiotic resistance, see information from the FDA‘s and the Mayo Clinic’s websites.