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DAILY UPDATE

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October 24, 2014   Download print version

New York City physician tests positive for Ebola

HHS Secretary announces $840 million initiative to improve patient care, physician access to information and lower costs

Blood of Ebola survivors tested as short-term treatment option 

Some U.S. hospitals weigh withholding care to Ebola patients

WHO says Ebola outbreak continues to spread in West Africa

Kimberly-Clark sterilization wrap first to receive FDA clearance for all standard sterilization methods in North America

Older antibiotic still works against staph infections, study finds

You need to wash your towels more often than you think. Here's why.

 
 
 


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New York City physician tests positive for Ebola

A New York physician who recently returned from the front lines of the Ebola epidemic in West Africa has tested positive for the deadly virus, according to two U.S. government officials. The man, identified as Craig Spencer by New York City Councilman Mark Levine, is in isolation at Bellevue Hospital in Manhattan. Spencer, who had been treating Ebola patients in Guinea with Doctors Without Borders, returned to New York this month.

He becomes just the fourth person diagnosed with Ebola in the United States -- and the first diagnosed outside of Texas.

The New York City health department, which did not identify Spencer, said in an earlier statement that he had returned to the United States "within the past 21 days from one of the three countries currently facing the outbreak of this virus." On Thursday, the statement said, Spencer "presented a fever and gastrointestinal symptoms" and was transported from a residence in Harlem to the hospital in Manhattan.

A federal official said the Centers for Disease Control and Prevention is readying a team of specialists for epidemiology, infection control and communications to travel to New York on Thursday night. CDC officials declined to comment.

The New York lab that conducted the preliminary Ebola test is a part of the Laboratory Response Network, a group of facilities designed to coordinate quickly with the CDC in response to public health threats. The CDC has "high confidence" in the results and is unlikely to repeat the test, the federal official said.

On Sept. 18, Spencer published a photo of himself on Facebook wearing personal protective equipment. In an accompanying post, he wrote: "Off to Guinea with Doctors Without Borders (MSF). Please support organizations that are sending support or personnel to West Africa, and help combat one of the worst public health and humanitarian disasters in recent history."

A spokesman for Doctors Without Borders confirmed that someone who had worked with the organization had recently returned to New York from an Ebola-affected country and notified the organization's office Thursday morning about developing a fever.

Hours before the positive diagnosis, the city health department's statement said that a team of disease detectives had already begun "to actively trace all of the patient’s contacts to identify anyone who may be at potential risk."

"We can safely say it has been a very brief period of time that the patient exhibited symptoms," New York Mayor Bill de Blasio said at a news conference Thursday evening. "The patient is in good shape and has gone into a good deal of detail with our personnel with regard to his actions in the last few days."

Physicians volunteering with Doctors Without Borders follow strict protocols as they return from the Ebola zone. They first travel through Europe and are debriefed in Brussels. Doctors can remain in the field for a maximum of four to six weeks; upon returning to the United States, they are told to follow CDC guidelines. Those without any known exposure to Ebola are told to monitor their health for a 21-day incubation period, according to the organization.

Emergency officials received a call just before noon Thursday for a sick person in Harlem, a fire department spokesman said. The patient met Ebola risk criteria, so a special hazardous EMS unit was sent to the apartment with personnel who were fully covered in personal protective equipment. The vehicle was immediately decontaminated, said New York City EMS union president Israel Miranda.

In its statement, the city health department noted that Bellevue Hospital "is designated for the isolation, identification and treatment of potential Ebola patients by the City and State." Earlier this month, New York Gov. Andrew M. Cuomo (D) designated Bellevue as one of eight hospitals in the state that could care for potential Ebola patients.

According to Spencer’s public LinkedIn profile, he has worked as a doctor at NewYork-Presbyterian/Columbia University Medical Center, not far from where he lives, since July 2011. Visit the Washington Post for the story.

 

 

HHS Secretary announces $840 million initiative to improve patient care, physician access to information and lower costs

Health and Human Services Secretary Sylvia M. Burwell today announced an initiative that will fund successful applicants who work directly with medical providers to rethink and redesign their practices, moving from systems driven by quantity of care to ones focused on patients’ health outcomes, and coordinated healthcare systems. These applicants could include group practices, healthcare systems, medical provider associations and others. This effort will help clinicians develop strategies to share, adapt and further improve the quality of care they provide, while holding down costs. Strategies could include:

·         Giving doctors better access to patient information, such as information on prescription drug use to help patients take their medications properly;

·         Expanding the number of ways patients are able communicate with the team of clinicians taking care of them;

·         Improving the coordination of patient care by primary care providers, specialists, and the broader medical community; and

·         Using electronic health records on a daily basis to examine data on quality and efficiency.

“The administration is partnering with clinicians to find better ways to deliver care, pay providers and distribute information to improve the quality of care we receive and spend our nation’s dollars more wisely,” said Secretary Burwell. “We all have a stake in achieving these goals and delivering for patients, providers and taxpayers alike.”

Through the Transforming Clinical Practice Initiative, HHS will invest $840 million over the next four years to support 150,000 clinicians. With a combination of incentives, tools, and information, the initiative will encourage doctors to team with their peers and others to move from volume-driven systems to value-based, patient-centered, and coordinated health care services. Successful applicants will demonstrate the ability to achieve progress toward measurable goals, such as improving clinical outcomes, reducing unnecessary testing, achieving cost savings and avoiding unnecessary hospitalizations. 

“This model will support and build partnerships with doctors and other clinicians across the country to provide better care to their patients. Clinicians want to spend time with their patients, coordinate care, and improve patient outcomes, and the Centers for Medicare & Medicaid Services wants to be a collaborative partner helping clinicians achieve those goals and spread best practices across the nation,” said Patrick Conway, M.D., deputy administrator for innovation and quality and CMS chief medical officer.

By participating in the initiative, practices will be able to receive the technical assistance and peer-level support they need to deliver care in a patient-centric and efficient manner, which is increasingly being demanded by healthcare payers and purchasers as part of a transformed care delivery system. Participating clinicians will thus be better positioned for success in the healthcare market of the future - one that rewards value and outcomes rather than volume.

HHS encourages all interested clinicians to participate in this initiative. For more information on the Transforming Clinical Practice Initiative visit here.

 

 

Blood of Ebola survivors tested as short-term treatment option 

ANTWERP, Belgium – An international research consortium led by the Institute of Tropical Medicine in Antwerp (ITM) will assess whether treatment with antibodies in the blood of Ebola survivors could help infected patients to fight off the disease. If proven effective, this straightforward intervention could be scaled up in the short term and provide an urgently needed treatment option for patients in West Africa. 

The researchers will receive € 2.9 million of European Union (EU) funding to evaluate the safety and efficacy of treatment with blood and plasma made from the blood of recovered Ebola patients. A World Health Organization (WHO) expert meeting in September recommended convalescent blood therapies as one of the most promising strategies meriting urgent evaluation as treatment of Ebola disease. As a result of the current outbreak, there are also substantial numbers of survivors to prepare Ebola plasma.

ITM’s Johan van Griensven, the project’s coordinating investigator, said, “Blood and plasma therapy are medical interventions with a long history, safely used for other infectious diseases. We want to find out whether this approach works for Ebola, is safe and can be put into practice to reduce the number of deaths in the present outbreak. Ebola survivors contributing to curb the epidemic by donating blood could reduce fear of the disease and improve their acceptance in the communities.” 

Blood and plasma from recovered Ebola patients has been used in a limited number of patients previously. For example, during the 1995 Ebola outbreak in Kikwit, in the Democratic Republic of the Congo (DRC), seven out of eight patients receiving convalescent whole blood survived. However, whether this was due to the transfusions or to other factors is unclear. There is an urgent need to evaluate this therapy in carefully designed studies according to the highest ethical and scientific standards. 

EU Research, Innovation and Science Commissioner Máire Geoghegan-Quinn said in the funding announcement that it is urgent to step up medical research on Ebola and the selected projects ”enlist the best academic researchers and industry to take the fight to this deadly disease.” 

The project, which will start in Guinea in November 2014, is supported and guided by the WHO and the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC). The Wellcome Trust will provide additional support, enabling unparalleled international collaboration across the public, private and not-for-profit sectors to tackle the Ebola emergency. Visit the Institute of Tropical Medicine for more information.

 

 

Some U.S. hospitals weigh withholding care to Ebola patients

The Ebola crisis is forcing the American healthcare system to consider the previously unthinkable: withholding some medical interventions because they are too dangerous to doctors and nurses and unlikely to help a patient.

U.S. hospitals have over the years come under criticism for undertaking measures that prolong dying rather than improve patients' quality of life.

But the care of the first Ebola patient diagnosed in the United States, who received dialysis and intubation and infected two nurses caring for him, is spurring hospitals and medical associations to develop the first guidelines for what can reasonably be done and what should be withheld.

Officials from at least three hospital systems said they were considering whether to withhold individual procedures or leave it up to individual doctors to determine whether an intervention would be performed. Ethics experts say they are also fielding more calls from doctors asking what their professional obligations are to patients if healthcare workers could be at risk.

U.S. health officials meanwhile are trying to establish a network of about 20 hospitals nationwide that would be fully equipped to handle all aspects of Ebola care.

Their concern is that poorly trained or poorly equipped hospitals that perform invasive procedures will expose staff to bodily fluids of a patient when they are most infectious. The U.S. Centers for Disease Control and Prevention is working with kidney specialists on clinical guidelines for delivering dialysis to Ebola patients. The recommendations could come as early as this week.  

The possibility of withholding care represents a departure from the "do everything" philosophy in most American hospitals and a return to a view that held sway a century ago, when doctors were at greater risk of becoming infected by treating dying patients.

"This is another example of how this 21st century viral threat has pulled us back into the 19th century," said medical historian Dr. Howard Markel of the University of Michigan.  

Because the world has almost no experience treating Ebola patients in state-of-the-art facilities rather than the rudimentary ones in Africa, there are no reliable data on when someone truly is beyond help, whether dialysis can make the difference between life and death, or even whether cardiopulmonary resuscitation (CPR) can be done safely with proper protective equipment and protocols.

Such procedures "may have diminishing effectiveness as the severity of the disease increases, but we simply have no data on that," said Dr. G. Kevin Donovan, director of the bioethics center at Georgetown University.

Donovan said he had received inquiries from fellow physicians about whether hospitals should draw up lists of procedures that would not be performed on an Ebola patient. "To have a blanket refusal to offer these procedures is not ethically acceptable,” he told the doctors.

Nevertheless, discussions about adopting policies to withhold care in Ebola cases are under way at places like Geisinger Health System, which operates hospitals in Pennsylvania, and Intermountain Healthcare, which runs facilities in Utah, according to their spokesmen.

Dr. Nancy Kass, a bioethicist at Johns Hopkins Bloomberg School of Public Health, said healthcare workers should not hesitate to perform a medically necessary procedure so long as they have robust personal protective gear.

So far, only two U.S. hospitals have used kidney dialysis: Texas Health Presbyterian Dallas, which treated Liberian patient Thomas Duncan and where two nurses became infected, and Emory University Hospital in Atlanta, which has treated four Ebola patients at its biocontainment unit without any healthcare workers becoming infected.

Although it is not yet clear how the Dallas nurses became infected, health officials have questioned both the lack of adequate training in the use of protective gear and the decision to perform invasive procedures.

The American Society of Nephrology and CDC are now working on new dialysis guidelines for Ebola patients, whose kidneys often fail. In some cases, dialysis can help a patient get through the worst of the illness until their own immune system can fend off the virus.

Nephrologist Dr. Harold Franch said the new guidelines will consider both whether the procedure is medically necessary and whether the hospital can do it safely. "Most academic medical centers and many good private tertiary care hospitals will be able to do this," he said. Yet he thinks many hospitals may not offer the service, since “it takes a lot of money and time to train people.”

At University of Chicago Medicine, questions of taking last-ditch measures were discussed early in the hospital's Ebola planning, said Dr. Emily Landon, a bioethicist and epidemiologist. Landon views dialysis as a "no brainer" for Ebola patients, and believes the risks are fairly low to the well-trained nursing staff who have volunteered for the hospital's isolation ward. But putting in a breathing tube and putting them on a ventilator is more controversial. Visit Reuters for the article.

 

 

WHO says Ebola outbreak continues to spread in West Africa

Ebola is racing ahead of efforts to contain its spread, according to the World Health Organization. There are nearly 10,000 reported cases – a tally that underestimates the true scope of the epidemic as overwhelmed health workers fall behind in their record-keeping the WHO says. About half have died.

Ebola has now reached every district in Sierra Leone and all but one district in Liberia, with "intense transmission" in these countries' capital cities, according to the WHO.

Some experts worry that Ebola is poised to spill over the borders to other African countries, such as Ivory Coast. Of the eight districts in Guinea and Liberia that border Ivory Coast, all but one have reported Ebola cases. In August, Ivory Coast closed its borders with Ebola-affected countries and temporarily suspended flight.

Two of the four parts of Guinea with new Ebola cases this week are near the border with Ivory Coast, a country of 20 million people, according to the WHO. With a metro area population of more than 7 million, Ivory Coast's economic capital, Abidjan, is the second largest city in West Africa, behind Lagos, Nigeria.

"There is no magic boundary at the border," says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "We shouldn't be surprised if we see cases."

Osterholm notes that farmers often leave home in the fall, as they finish harvesting their crops, and migrate to other countries looking for work. He fears that these seasonal migrations could help spread Ebola across Africa.

Experts have blamed Ebola's spread through West Africa on poverty, lack of education and crumbling public health systems, which were battered during years of conflict. Although the first Ebola case apparently occurred in Guinea in December, local health officials didn't realize they were dealing with an Ebola outbreak until March, when there were already nearly 50 cases.

At a press conference Thursday, WHO officials addressed rumors that Ebola had been detected in other West African countries.

"At WHO, we hear about many rumors of cases in different countries. Most of these turn out to be negative," said Keiji Fukuda, the WHO's assistant director-general for health security and environment, following an emergency meeting on Ebola.

"Ebola is one of these things that is really hard to cover up," Fukuda said. "There is reasonable confidence that we are not seeing widespread transmission into neighboring countries. . . . We think it would be very difficult to miss."

West Africa today is nowhere close to goals set by the United Nations' to get the outbreak under control, according to the WHO.

Even with the modest goal of meeting only 70% of the region's needs by Dec. 1, affected countries would need at least 16 more labs, to help medical staff quickly diagnose patients; 230 more "dead body management teams," to bury or cremate bodies in ways that doesn't spread Ebola; 4,388 more hospital beds; and 20,000 contract tracers, to help find and isolate potential cases.

The WHO is working to prepare Ivory Cost and 14 other countries with borders or strong travel ties to the Ebola-affected nations. The WHO will stage simulation drills, for example, and provide other types of technical assistance.

Even Doctors Without Borders, which has been on the ground fighting Ebola since March, has had to suspend taking care of women and children at one of its hospitals in Sierra Leone, which once admitted more than 10,000 people per year. The organization's overwhelmed staff can no work maintain "flawless infection control" in that hospital, putting staff lives at risk.

"It is our intention to resume our activities…as soon as possible, but for that we need to first put all of our energy in fighting Ebola," said Brice de le Vingne, director of operations at Doctors Without Borders. "We really hope that in a few months, we'll be able to focus once again on treating mothers and children."

Visit USA Today for the article

 

 

Kimberly-Clark sterilization wrap first to receive FDA clearance for all standard sterilization methods in North America

Kimberly-Clark Health Care, soon to be Halyard Health, announced it is the first and only manufacturer to receive 510(k) clearance from the U.S. Food and Drug Administration (FDA) for use of their sterilization wrap portfolio with all standard sterilization modalities.

The KIMGUARD ONE-STEP and QUICK CHECK family of sterilization wrap is now the most validated sterilization wrap on the U.S. market, with comprehensive FDA clearance for use with low temperature Sterrad sterilization systems, STERIS sterilization systems, pre-vacuum steam, ethylene oxide (EO) and gravity steam.

“Providing innovation in sterilization technology has been a longtime priority at Kimberly-Clark Health Care and we will continue to invest in innovation as we transition to Halyard Health,” said Lon Taylor, Marketing Director, Surgical and Infection Prevention, Kimberly-Clark Health Care. “Securing FDA clearance for use of our market-leading Sterilization Wrap with each and every sterilization modality supports our ongoing mission to help clinicians prevent infections and protect patients.”       

In November 2014 Kimberly-Clark Health Care will become Halyard Health, an independent medical technology company focused on preventing infection, eliminating pain and speeding recovery. Visit Atlanta Business Chronicle for the article.

 

 

Older antibiotic still works against staph infections, study finds

An older antibiotic called vancomycin is still effective in treating dangerous Staphylococcus aureus bloodstream infections, a new study finds. The findings show that doctors should keep using vancomycin to treat Staphylococcus aureus infections even though there are several newer antibiotics available to do the job, University of Nebraska researchers said.

They analyzed the outcomes of nearly 8,300 cases of Staphylococcus aureus bloodstream infections in the United States and several other countries. The overall death rate was 26 percent. The researchers concluded that vancomycin is still a safe and effective treatment in such cases.

Their findings were published in the Journal of the American Medical Association.

"The study provides strong evidence that vancomycin remains highly useful," study leader Dr. Andre Kalil, an infectious diseases specialist and a professor in the internal medicine department, said in a university news release. "The prevention of a rapid switch to newer drugs has another great benefit to our patients -- less unnecessary exposure to these drugs, which will translate into less development of antibiotic resistance," Kalil said. (HealthDay) Visit NIH for the report.

 

 

You need to wash your towels more often than you think. Here's why.

We're always on the hunt for ways we can keep our homes germ-free, and we landed on one particularly nasty vessel of ick: towels. If you're drying silverware with a kitchen towel, for instance, chances are you're drying it with germs. A 2014 study from the University of Arizona found that 89 percent of kitchen rags carried coliform bacteria, the stuff found in both animal and human digestive tracts that's used to measure water contamination. Twenty-five percent tested positive for E. coli.

A deep dive into the particulars of towel cleaning looked at how often you should wash the various kinds of towels used on a daily basis? It turns out you should wash all your towels more often than you probably think. For bath towels, the experts we spoke with recommend washing after about three uses to remove millions of dead skin cells and avoid that musty scent. Kitchen rags should ideally be dipped in diluted bleach between uses, according to a University of Arizona germ expert. And face towels should really be replaced after every use if you don't want to reintroduce bacteria to your pores, says a dermatologist.

Recommendations include:

Kitchen towels

Kelly Reynolds, a researcher at the University of Arizona’s Zuckerman College of Public Health says you should launder your kitchen towels after each use. A next-best option though is to dip your towels in a diluted bleach solution between uses, and let them dry. Reynolds recommends filling your sink with water and a bit of bleach – two teaspoons per gallon of sink water will do the trick and prolong the time you're able to use your towels between washes. At least weekly, launder them in your washing machine (on an antibacterial or sanitizing cycle, if possible).

Bath towels

That musty smell isn't your imagination -- because bath towels are extra-thick, they lock in moisture and harbor odors more quickly. When you wash them, use vinegar in place of fabric softener, says laundry expert Mary Marlowe Leverette. "Fabric softener residue traps odors," she explains. "The vinegar strips it away." Leverette recommends running your bath towels through the washing machine as normal, but with no soap and just one cup of vinegar. Then, wash again with regular detergent. Mary Gagliardi – aka Clorox's "Dr. Laundry" expert – says to give them a "second rinse," if your washer has that option. Dry immediately to prevent mustiness.

Face towels and washcloths

"Dirt and bacteria have a way of getting caught in the fabric on a washcloth," says Dr. Eric Schweiger, of New York's Schweiger Dermatology. "When you wash or dry your face with a dirty washcloth, you're reintroducing that dirt and bacteria back into the skin."

Face towels and wash clothes should be washed after every use. And while that's the ideal frequency with which you want to wash your face and body cloths, it's really about how much you use it. If you're only using a towel to pat your face dry, Schweiger says, it's okay to use it a few times between washes. But if you're removing makeup, a real-deal laundering is necessary. He recommends a regular, hot-water wash cycle, using fragrance-free detergent to avoid irritating your skin.

Visit the Huffington Post for the article.