Idea #314 for December 29th, 2009: The Link Between Disinfectants And Resistant Pathogens

Misuse of antibiotics has been associated with the rise of resistant strains of pathogens that have plagued hospitals in the US. New research suggests that misuse of disinfectants may also play a role in the spread of superbugs. Researchers examined whether benzalkonium chloride, a common disinfectant, might lead to resistant strains of a certain bacterium known to cause disease in people with weakened immune systems.

Their results showed that the bacteria eventually became resistant to the disinfectant, as well as the antibiotic Cipro. Since the research took place in a lab, we shouldn’t necessarily jump to conclusions about its relevance to real-life situations. However, the scientists behind the research have a few recommendations about household use of disinfectants. For one, they should not be diluted, as that may allow some bacteria to survive and breed other resistant bacteria. Also, ample time should be afforded to let the disinfectants work so that the vast majority of bacteria are killed. Disinfectants shouldn’t be avoided altogether, they should just be used more wisely to avoid contributing to the superbug epidemic.

Read more about this issue here.

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 #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 #242 for October 18th, 2009: Big Bucks or The Cost of Antibiotic Resistant Infections

The dire effects that antibiotic resistance can have on public health have been covered in this blog in the past, but there’s another consequence that is a little fuzzier. The economic impact of antibiotic resistance is difficult to pin down, but researchers have come up with an estimate at one Chicago hospital. The cost: $18,000 to $29,000 per infected patient.

The study looked at data from over 1,000 patients at Cook County Hospital in Chicago and found that patients who had antibiotic resistant infections spent on average 6-13 extra days in the hospital. They estimate that the patients and their families were on the hook for an additional $10-15 million in total, for the cost of treating the infections. Also, they found that the death rate for those patients was 6.5%, which is twice that of other patients.

The authors also extrapolated the costs to estimate what the entire nation is spending to treat antibiotic resistant infections. The number is somewhere between $16-26 billion annually, they say. And that’s a conservative estimate. Further, the authors point out that reducing the incidence of these infections by just 20% would save the nation $3-5 billion a year. We have to keep those numbers in mind when we’re developing ways to fight the problem. If a solution costs us a few billion dollars, politicians and the public will balk, but the cost of doing nothing is far greater, both in money and in our health.

Read more about the study here.

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 #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.

Idea #37 for March 27th, 2009: Steak With a Side of Penicillin or Antibiotics and Livestock

In a future post, I’ll delve into the issue of over-prescribing antibiotics in humans, but for this post I’ll limit the scope to the agricultural world. To compensate for crowded and unsanitary conditions, many farm animals are given antibiotics. A lot of them. An estimated 70% of antibiotics used in US actually go into livestock.

We know that widespread use of antibiotics leads to resistance, and we are more judicious about the use of antibiotics for humans. But in livestock, otherwise healthy animals are given antibiotics throughout their lives, which promotes the growth of bacterial strains resistant to antibiotics. The fact that some of our most effective antibiotics are being used on these animals is even more disturbing, as new superbugs are arising as a result. There is evidence that antibiotic-resistant pathogens in farms have transferred to humans in the past.

Fortunately, legislation introduced by Ted Kennedy in the Senate and Louise Slaughter (yes, that’s her real name) in the House seeks to ban the use of antibiotics for healthy livestock. The bill has actually been introduced multiple times in past years, but has never made it through because of resistance from agribusiness. Other nations have lapped us in this regard: the European Union banned all antibiotics for healthy animals in their agricultural systems a few years ago. And Denmark stopped the practice in 1998, and has seen a significant drop in resistant bacteria in their farm animals.

The USDA and FDA are ostensibly there to protect us, but it seems they prefer to side with businesses doing us harm. We shouldn’t have to put up with cattle lobbyists and others dictating what our food safety standards should be. The massive amounts of antibiotics being used in farms right now is only covering up the underlying problem, which is the overcrowded and squalid conditions much of our livestock exist in. If we implement measures to change this, maybe there will be some cost consequences but that is probably a worthy price to rid ourselves of MRSA-tainted pork.

Further reading: A food industry CEO explains why he hopes the legislation passes and this website has some good resources on the subject.