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July 20, 2016
Norovirus strikes the Republican National Convention
A terrifying word circulated Tuesday at the Republican National Convention: norovirus. A dozen staffers in the California delegation who had arrived
in Cleveland early have fallen ill with the extremely contagious virus, California GOP chairman Jim Brulte said.
The virus causes extreme vomiting and diarrhea and has been known to spread explosively through people in closed places, such as cruise ships,
schools and nursing homes, according to the Centers for Disease Control and Prevention.
Brulte said that, so far, no delegates or alternates have shown symptoms. He said his delegation will continuing to attend the convention at Quicken
Loans Arena, where the Californians sit next to the Maryland delegation.
Brulte said he believes one staffer brought the virus to Ohio from California and then passed it to the staffer's spouse. Soon, 12 of the 36 staffers
were sick.
The infected individuals first began showing symptoms on Thursday, and Erie County health officials have taken fecal samples for analysis, the Plain
Dealer reported.
State party officials alerted the delegation Monday morning to the norovirus outbreak and briefed attendees again Tuesday. They also informed Ohio
health officials.
They have instructed delegates to wash their hands frequently, use sanitizers, and avoid shaking hands (something, as it happens, that Donald
Trump has long been loath to do). They also should not share food and have been told to stay off delegation buses to the convention arena if they
exhibit any symptoms of norovrius.
Visit the Washington Post for the story.
ACS NSQIP data helps hospital develop a quality improvement assessment tool for reducing UTI rates
A systematic program for analyzing processes associated with catheter placement and removal for surgical patients decreased urinary tract
infections (UTI) for all hospitalized patients.
These results are believed to be the first report of a quality improvement effort in surgery to benefit an entire institutional patient population. The
program may serve as a model for hospitals to generate their own institution-specific best practice catheter management guidelines.
It was described by physicians from the University of Texas MD Anderson Cancer Center, Houston, at the 2016 American College of Surgeons
National Surgical Quality Improvement Program (ACS NSQIP) Conference.
UTI is commonly associated with the placement of urinary catheters. The Centers for Disease Control and Prevention established guidelines for
preventing catheter-associated UTI (CAUTI) in 2010. ACS NSQIP published best practice guidelines for preventing CAUTI in 2009.
Based on assessment of their initial outcomes data, a postoperative UTI reduction program was the first surgical quality improvement initiative
undertaken by MD Anderson Cancer Center after joining ACS NSQIP in 2011. ACS NSQIP is the leading nationally validated, risk-adjusted,
outcomes-based program to measure and improve the quality of surgical care in hospitals.
From a sample of 1,000 surgical cases at MD Anderson Cancer Center in the NSQIP data base, the researchers identified UTIs in 3 of every 100
patients, which was a higher overall rate than expected.
A surgical quality improvement team first developed a system to evaluate factors that could be contributing to the UTI rate and bundled them
together in an analytical framework that would single out weak points in catheter management.
Their S.T.O.P. UTI program evaluated four categories of catheter management processes and screening for infection: Sterile placement, Timing of
removal, Optimal positioning, and Proper sampling.
UTI cases were reviewed to determine whether providers were maintaining sterile conditions during placement of urinary catheters, removing
catheters according to recognized time frames, positioning catheters so they would not create potential reflux back into the bladder, and obtaining
clean, uncontaminated urine samples to validate the diagnosis of UTI.
The surgical quality improvement team partnered with nursing staff and pharmacy as well as frontline personnel, such as advance practice providers
and trainees, along with infection control physicians to collect, evaluate, and regularly report data to the surgical faculty.
The S.T.O.P. UTI quality assessment tool identified a specific subset of processes that could be contributing to UTIs. The subsequent targeted
quality improvement program reduced the infection rate by 66 percent within 18 months. In total, since program initiation the rate has fallen six-fold,
from 2.9 percent down to 0.46 percent. These reductions were estimated to result in 450 fewer UTIs per year and save more than $1 million annually
for surgery cases alone.
Interestingly, the best practices put in place in the surgical environment appear to have crossed over to impact the CAUTI rate across the entire
hospital, as nonsurgical CAUTI rates have now dropped by half.
Visit American College of Surgeons for the report.
Sometimes tiny is just the right size: ‘Microhospitals’ filling some ER needs
Eyeing fast-growing urban and suburban markets where demand for healthcare services is outstripping supply, some healthcare systems are
opening tiny, full-service hospitals with comprehensive emergency services but often fewer than a dozen inpatient beds.
These “microhospitals” provide residents quicker access to emergency care, and they may also offer outpatient surgery, primary care and other
services. They are generally affiliated with larger healthcare systems, which can use the smaller facility to expand in an area without incurring the
cost of a full-scale hospital. So far, they are being developed primarily in a few states — Texas, Colorado, Nevada and Arizona.
“The big opportunity for these is for health systems that want to establish a strong foothold in a really attractive market,” said Fred Bentley, a vice
president at the Center for Payment & Delivery Innovation at Avalere Health. “If you’re an affluent consumer and you need services, they can fill a
need.”
SCL Health has two microhospitals operating in the Denver metropolitan area and another two in the works. Microhospitals “are helping us deliver
hospital services closer to home, and in a way that is more appropriately sized for the population compared to larger, more complex facilities,” said
spokesman Brian Newsome.
The concept is appealing, and some people suggest they should be developed in rural or medically underserved areas where the need for services
is great.
Small hospitals, even tiny ones, with robust outpatient services could be a real boon for people who live far from major metro areas.
“Right now they seem to be popping up in large urban and suburban metro areas,” said Priya Bathija, senior associate director for policy
development at the American Hospital Association. However, “we really think they have the potential to help in vulnerable communities that have a
lack of access.”
Analysts liken microhospitals to standalone emergency departments, which have been cropping up in recent years in fast-growing metropolitan
areas where people are often well-insured and waits at regular hospital emergency departments may be long. Both can handle many emergencies
and are equipped with lab, imaging and some diagnostic capabilities.
Unlike standalone EDs, microhospitals are fully licensed hospitals with inpatient beds to accommodate people admitted from the emergency room.
They may have other capabilities as well, including surgical suites, a labor and delivery room, and primary care or specialist services on site or
nearby.
The growing interest in microhospitals can be linked to the shift toward providing more care in outpatient settings, said Bathija. In addition to the
emergency department, the facilities can include medical home services and other outpatient services.
Between 2010 and 2014, the annual number of inpatient hospital admissions declined by more than 2 million to 33.1 million, according to figures
from the American Hospital Association. Meanwhile, the total number of outpatient hospital visits increased to 693.1 million in 2014 from 651.4
million four years earlier.
Visit Kaiser for the report.
HSCA statement on JAMA generic drug approval report
Healthcare Supply Chain Association (HSCA) President and CEO Todd Ebert, R.Ph., released the following statement on the new Journal of the
American Medical Association (JAMA) report Generic Drug Approvals Since the 1984 Hatch-Waxman Act, which concludes that the number of
generic alternatives to a brand-name drug affects prices:
“Robust competition in the generic market has driven down costs for patients and providers alike. However, the JAMA report affirms that competition
is essential for preventing price spikes. The report specifically finds that at least four generic competitors are needed to ensure healthy markets.
Many treatment fields fall short of this threshold – for example, only two-thirds of cancer drugs have at least one generic.
“While we are pleased that the U.S. Food and Drug Administration (FDA) prioritizes abbreviated new drug applications (ANDAs) for generic drugs
with only one manufacturer – sometimes referred to as ‘sole source’ products – more must be done to increase competition in the generic market
and safeguard access to essential medications. HSCA encourages Congress to mandate that FDA expand their priority review to include generic
drugs with two or fewer manufacturers, particularly in the generic injectable market. Generic injectables are the workhorses of acute care facilities –
often used in cases of emergency – and bring tremendous value to healthcare providers and the patients they serve.
“The JAMA report underscores the urgent need for Congressional and FDA action to expand priority review beyond sole source products. Doing so
will help foster a robust generic drug marketplace that keeps prices in check and preserves patient and provider access to essential medications.”
The Healthcare Supply Chain Association (HSCA) represents the nation’s leading healthcare group purchasing organizations (GPOs).
Visit HSCA for the statement.
Hänel storage systems publishes Florida Hospital Case study
Hänel Storage Systems has announced the publication of a new customer case study featuring Florida Hospital in Altamonte Springs, FL. The study
details Florida Hospital’s successful implementation of several Hänel Rotomat vertical storage carousels.
Since installing five Rotomats, the system features inventory management that allows the staff to track items to ensure proper supply levels are
maintained, and that items do not expire.
The Florida Hospital Rotomats also protect items from all kinds of contamination, because they are kept fully enclosed inside the units and maintain
sterility until they are needed in the OR. The Rotomat is used to store surgical instruments in sterile containers to protect them from all kinds of
contamination. The retrieval of these containers takes place at the optimum ergonomic height
The highlight of the installation is a 26-foot tall Rotomat that stores approximately 850 wraps and containers in 60 square feet of floor space. The
unit was installed in a shaft with the depth of 18 feet, into the floor below.
Visit Hänel for the study.
Crosstex/SPSmedical named FY16 McKesson Medical-Surgical McKesson Brands Supplier of the Year
Crosstex/SPSmedical, an infection prevention products and solutions supplier, was named "FY16 McKesson Medical-Surgical McKesson Brands
Supplier of the Year" by McKesson's Medical-Surgical business at McKesson's National Sales Conference in Grapevine TX, May 24th-26th.
The McKesson Medical-Surgical McKesson Brands Supplier of the Year award acknowledges medical suppliers and vendors for their commitment to
collaboration, high service levels, supply chain efficiency and ultimately driving sales and customer value.
Crosstex/SPSmedical achieved high ratings in key areas of product fulfillment. Highlights include: a 99% customer fill rate; a 20% growth rate, and a
#1 manufacturer rating at the recent McKesson New Generation ASC training meeting in Tampa.
Visit Crosstex/SPS for the release.
HLAC to expand 'process monitoring' section of its accreditation standards with ATP testing, textile bioburdens
The board of directors of the Healthcare Laundry Accreditation Council (HLAC) has approved funding for application development and field testing of
two process monitoring tools - adenosine triphosphate (ATP) for hard surfaces and bioburden testing for soft surfaces.
These monitors respectively quantify the effectiveness of internal surface cleaning procedures e.g. carts, shelves, etc., and the total accumulated
bioload present on textiles up to the point of use.
The new standards will become another important element of HLAC's process-based approach, and will help laundries to enhance their ongoing
quality control efforts, according to John Scherberger, board president.
The standards will focus on ATP testing of contact surfaces and extraction of textiles for bioburden, including enumeration of total spore formers.
Spore formers represent a class of pathogenic organisms including Clostridium Difficile (C. difficile) that are known to be extremely hard to kill. The
tools will be beta tested, piloted and formalized over the summer and fall. They will be implemented in 2017.
"Adding these two additional process monitoring tools is another step towards patient safety and superior outcomes," Scherberger said. "It enhances
ongoing quality control within HLAC-accredited laundries; and it provides their hospital customers with new data - and peace of mind - about their
healthcare laundry."
Visit HLAC at www.hlacnet.org for more information.
AHA statement on commonly used drugs may cause, worsen heart failure
Commonly used medications and nutritional supplements may cause or worsen heart failure, according to the first American Heart Association
scientific statement on avoiding drug-drug or drug-condition interactions for people with heart failure.
The statement provides comprehensive information about drugs and “natural” remedies that may have serious unintended consequences for heart
failure patients.
Heart failure patients have an average five or more separate medical conditions and take seven or more prescription medications daily, often
prescribed by different healthcare providers.
“Since many of the drugs heart failure patients are taking are prescribed for conditions such as cancer, neurological conditions or infections, it is
crucial but difficult for healthcare providers to reconcile whether a medication is interacting with heart failure drugs or making heart failure worse,”
said Robert L. Page II, Pharm.D., M.S.P.H., chair of the writing committee for the new statement published in the AHA journal Circulation.
Healthcare providers should talk to heart failure patients during every visit about all prescription and over-the-counter medications they’re taking, as
well as nutritional supplements and herbs, Page said.
Non-steroidal anti-inflammatory drugs, including commonly used painkillers such as ibuprofen, can trigger or worsen heart failure by causing sodium
and fluid retention and making diuretic medications less effective. Over-the-counter heartburn medications and cold remedies may also contain
significant amounts of sodium, which is usually restricted in patients with heart failure.
Many supplements in complementary and alternative medicines can be dangerous for people with heart failure, including products containing
ephedra (which raises blood pressure) and others that interfere with one or more commonly used heart failure medication, including St. John’s wort,
ginseng, hawthorn, danshen and green tea.
The statement also notes that nutritional supplements, herbs and other “natural” remedies should not be used to treat or manage heart failure
symptoms.
Visit AHA for the statement.