Variety of medical
scopes pose the risk of serious infection
A doctor reported in December that a medical scope commonly used to examine
patients' lungs had infected 14 people with a superbug that kills half its
Yet another type of scope, used to see inside the bladder, sickened three
patients with a different bacteria in March, according to a nurse. The
device was sent to the manufacturer, which found "foreign substances" inside
And in November, a nurse manager reported that seven patients were infected
with an often lethal bacteria known as clostridium difficile from a
device used for colonoscopies.
The three outbreaks are among dozens of injury reports in a federal database
that detail how the risk of serious infection from contaminated scopes is
far broader than a specialized device that recently sickened patients at
UCLA, including three who died.
Regulators have blamed the intricate design of that device â€” a duodenoscope
â€” for being especially hard to clean. But in the last three years, patients
have also been exposed to bacteria â€” and to human tissue and dried blood â€”
left inside a variety of scopes commonly used to examine the lungs, the
colon, the bladder and the stomach, according to the reports.
Infection experts have been warning for years in speeches and research
papers that many types of endoscopes can remain dirty after cleaning â€” only
to have their concerns mostly ignored by doctors performing the procedures.
Federal regulators say they don't know how many patients have been sickened
by the scopes, which as a group are used tens of millions of times each
year. There are no numbers to quantify the risk because few of the
scope-caused infections get reported. The government's injury reporting
system, which keeps names of hospitals and clinics secret, is mostly
The cases reported to the Food and Drug Administration show a repeated
story: The scope transferred bacteria among patients even though medical
staff believed it had been disinfected. And in many cases, multiple patients
were sickened before doctors recognized that the scope harbored bacteria
inside its long narrow channel or delicate mechanisms.
As the scopes snake through a patient's throat, intestine and other
cavities, they are contaminated with mucus, blood and millions of microbes.
But the delicate devices can't be sterilized like a surgeon's knife because
intense heat would destroy them.
Instead the scopes are brushed, washed with disinfectants, rinsed and dried
according to manufacturers' instructions, a process performed by technicians
that may require a hundred steps.
In 2010, the Palomar Health system in San Diego County notified 3,400
patients that they may have been exposed to tainted scopes after workers
continued for months to use a disinfectant that was past its expiration
Scope manufacturers have said they often find that hospitals reporting
infections did not properly clean or maintain the device.
For example, Olympus told the FDA that the bronchoscope that had potentially
infected 14 patients with CRE, or carbapenem-resistant enterobacteriaceae,
in December had been sent to an unregulated company for repair.
That case was the third reported outbreak suspected to be caused by an
Olympus bronchoscope in less than three weeks. In one of those outbreaks, a
nurse reported that three people were sickened by another often deadly
Even when the recommended disinfection guidelines are followed correctly,
it's sometimes not enough. Biofilms can form inside the scopes, making them
extremely hard to clean.
Only after the UCLA outbreak was revealed in February did the FDA take
action. In March, the agency began requiring manufacturers asking for
regulatory approval of a new scope to provide studies proving that it can be
disinfected. The agency had proposed the rules four years ago, but did not
approve them until news of the deadly Los Angeles outbreak raised public
The new rules don't apply to devices already on the market. That means
hospitals will continue to use current scopes for years. The rules also do
not cover cystoscopes, used to examine the bladder, and gastroscopes, used
to look inside the stomach. According to the FDA's injury database, those
devices have also been found to be dirty after cleaning.
Jennifer Dooren, an FDA spokeswoman, said the agency believes the scopes
currently on the market are safe. She said it took the agency four years to
finalize the rules because it had received hundreds of comments on the
proposal, including some raising key scientific issues. She noted the agency
had warned hospitals about improperly cleaned scopes in 2009. The FDA is
continuing to monitor reports of scope-related infections, Dooren said, to
see if it should do more.
In May, some members of an expert panel created to advise the FDA on
improving the safety of duodenoscopes expressed alarm about the even broader
danger from the other types of scopes.
Visit the Los Angeles Times for the report.
CDC funding helps
states address infectious disease threats
The Centers for Disease Control and Prevention (CDC) announced awards of
nearly $110 million to help states and communities strengthen their capacity
to track and respond to infectious diseases. The awards represent an
increase of about $13 million over fiscal year 2014 funding, with increases
going to vaccine-preventable-disease surveillance, foodborne-disease
prevention and advanced molecular detection, among other projects.
The funding is allocated through the Epidemiology and Laboratory Capacity
for Infectious Diseases Cooperative Agreement (ELC), with a goal of helping
states fight infectious disease outbreaks more quickly and develop better
interventions to protect the publicâ€™s health. Of the nearly $110 million,
$51 million is provided through the Affordable Care Actâ€™s Prevention and
Public Health Fund.
â€śIn the last year alone, states were hit with emerging diseases, like
chikungunya and respiratory infections from enterovirus D-68, while also
responding to outbreaks of measles, foodborne illness, and other threats.
These awards lay the foundation for those on the front lines â€“ state and
local health departments â€“ to act quickly to prevent illness and deaths,â€ť
said Beth P. Bell, M.D., MPH, director of CDCâ€™s National Center for Emerging
and Zoonotic Infectious Diseases.
This yearâ€™s funding includes:
$6 million to establish local, state and territorial health coordinators to
track vaccine-preventable diseases like measles and pertussis.
$17.4 million for foodborne disease prevention and tracking â€“ a $4 million
increase over fiscal year 2014 funding. This includes increased support for
the PulseNet surveillance system and outbreak response and for the
Integrated Food Safety Centers of Excellence to establish a new Northeast
More than $2 million to help states build their capacity for advanced
molecular detection, an emerging field that combines next-generation genomic
sequencing with bioinformatics to more quickly identify and respond to
Approximately $1.5 million to help states fight Lyme and other tickborne
diseases. CDC research shows that Lyme disease has been spreading
geographically in recent years and CDC estimates that it affects about
300,000 people per year.
Approximately $9.2 million to aid state, local, and territorial health
departments in building and maintaining disease detection, surveillance, and
prevention programs to reduce the number of human infections with West Nile
virus and other mosquito- and tick-borne arboviruses.
Resources to help states on the U.S.-Mexico border prepare for and respond
to potential outbreaks of the mosquito-borne chikungunya virus. Chikungunya
surfaced in the Western Hemisphere for the first time in late 2013 and last
year infected more than 1.5 million people throughout the Caribbean, Mexico
and Central America.
For more information on CDCâ€™s ELC cooperative agreement and the breakdown of
FY15 funding, please
Visit CDC for the release.
Half of nationâ€™s
hospitals fail again to escape Medicareâ€™s readmission penalties
Once again, the majority of the nationâ€™s hospitals are being penalized by
Medicare for having patients frequently return within a month of discharge â€”
this time losing a combined $420 million, government records show.
In the fourth year of federal readmission penalties, 2,592 hospitals will
receive lower payments for every Medicare patient that stays in the hospital
â€” readmitted or not â€” starting in October. The Hospital Readmissions
Reduction Program, created by the Affordable Care Act, was designed to make
hospitals pay closer attention to what happens to their patients after they
Since the fines began, national readmission rates have dropped, but roughly
one of every five Medicare patients sent to the hospital ends up returning
within a month.
Some hospitals view the punishments as unfair because they can lose money
even if they had fewer readmissions than they did in previous years. All but
209 of the hospitals penalized in this round were also punished last year, a
Kaiser Health News analysis of the records found.
The fines are based on readmissions between July 2011 and June 2014 and
include Medicare patients who were originally hospitalized for one of five
conditions: heart attack, heart failure, pneumonia, chronic lung problems or
elective hip or knee replacements. For each hospital, Medicare determined
what it thought the appropriate number of readmissions should be based on
the mix of patients and how the hospital industry performed overall. If the
number of readmissions was above that projection, Medicare fined the
Medicare is penalizing hospitals that see patients return to the hospital
too soon after being discharged. Medicare reduces what it pays each hospital
per patient, per stay.
Medicare Readmission Penalties By Hospital (.pdf)
Medicare Readmission Penalties By State (.pdf)
The fines will be applied to Medicare payments when the federal fiscal year
begins in October. In this round, the average Medicare payment reduction is
0.61 percent per patient stay, but 38 hospitals will receive the maximum cut
of 3 percent, the KHN analysis shows. A total of 506 hospitals, including
those facing the maximum penalty, will lose 1 percent of their Medicare
payments or more.
Overall, Medicareâ€™s punishments are slightly less severe than they were last
year, both in the amount of the average fine and the number of hospitals
penalized. Still, they will be assessed on hospitals in every state except
Maryland, which is exempt from these penalties because it has a special
payment arrangement with Medicare.
Most of the 2,232 hospitals spared penalties this year were excused not
because Medicare found readmissions to be sufficiently infrequent, but
because they were automatically exempted from being evaluated â€” either
because they specialized in certain types of patients, such as veterans or
children, because they were specially designated â€ścritical accessâ€ť
hospitals, or because they had too few cases for Medicare to accurately
Visit Kaiser Health for the story.
CVS of overcharging for generic drugs
CVS deliberately overcharged some pharmacy customers for generic drugs by
submitting claims to their insurance companies at inflated prices, according
to a lawsuit filed on Thursday in federal court in San Francisco. The suit
says those inflated prices led to higher co-pays for customers that exceeded
what they would have paid for the drugs if they had no insurance and
participated in a CVS discount program.
â€śWeâ€™ve seen people who pay $20 for a 30-day supply as their copayments on a
drug that was $11.99 for a 90-day supply had they been in the (discount
program),â€ť said Kristen Broz, an attorney with the firm that filed the suit.
The lawsuit seeks class action status, a court order prohibiting CVS from
engaging in the behavior and unspecified damages.
Broz estimated that hundreds of thousands of people may have been affected
At issue in the lawsuit is CVSâ€™s â€śHealth Savings Passâ€ť program, which offers
discounts to customers who do not have insurance or choose not to use
insurance on hundreds of generic prescription drugs, including generic
versions of the antibiotic Penicillin and the anti-depressant Prozac,
according to the suit. Instead of presenting insurance companies with that
discounted price, CVS reported the higher price that a normal retail
customer not in the Health Savings Pass would pay, the lawsuit alleges.
Customers were then charged co-pays according to those higher prices.
Visit WFLA for the story.
SMI releases new
executive briefing on the impact of RFPs in the healthcare supply chain
The Strategic Marketplace Initiative (SMI) released a new executive briefing
for the healthcare supply chain industry entitled â€śRFP Activity: A
Contributor to Industry SG&A Costsâ€ť. This document is available, at
no-charge, on the SMI website at
and is designed to help increase awareness of the impact that RFPs
contribute to industry SG&A costs as well as promote industry actions that
could potentially lower SG&A costs for providers and suppliers.
This comprehensive document was developed by a team of SMI members, all
healthcare supply chain executives, who set out to identify â€śimprovement
opportunitiesâ€ť that the industry could explore to lower the sales, general,
and administrative (SG&A) costs in the healthcare industry. While there are
many behaviors and practices that contribute to high SG&A costs, the SMI
Team identified the industryâ€™s approach and utilization of the request for
proposal (RFP) process, as an area worth exploring.
This briefing is a culmination of research and survey data collected by the
SMI team that shows how RFP volumes and the supplier costs to respond to
these RFPs have increased over the past 12 months. The briefing also
includes information obtained from supplier interviews and how one supplier
was able to reduce their RFP response time by 28%.
Dennis Orthman, SMI Senior Director said, â€śThrough publication of this
briefing, this SMI team hopes to increase overall industry awareness of the
costs associated with RFP activities, while also encouraging both buyers and
sellers to take actions that may reduce and control these costs better
through more efficient practices.â€ť
This resource, along with 29 other downloadable tools and solutions are
available on the SMI website, and are designed to help industry
professionals address real supply chain issues and challenges.
Drones might fly
blood samples to clinics, study finds
Johns Hopkins University researchers found that common and routine blood
tests were not affected when blood samples spent up to 40 minutes traveling
on hobby-sized drones.
The findings from test flights in the United States are promising news for
patients in areas with poor road networks. Drones could give isolated
medical clinics quick access to lab tests required to diagnose and treat
health problems, the researchers said.
After this successful proof-of-concept study, the next step would be to test
the use of drones in Africa where health care clinics are sometimes 60 miles
or more away from testing labs, the researchers said.
"A drone could go 100 kilometers [about 62 miles] in 40 minutes," study
author Dr. Timothy Kien Amukele, a pathologist at the Johns Hopkins
University School of Medicine in Baltimore, said in a university news
release. "They're less expensive than motorcycles, are not subject to
traffic delays, and the technology already exists for the drone to be
programmed to 'home' to certain GPS coordinates, like a carrier pigeon," he
Amukele pointed out that drones have already been tested as carriers of
medicines to clinics in remote areas. The U.S. National Institutes of Health
has more about blood tests. (HealthDay)
Visit US News for the article.
IBM Watson Health
now counts CVS Health as a partner
IBMâ€™s data service for the healthcare industry, Watson Health, now has CVS
Health as a partner, joining Apple, Medtronic, and others.
The pharmacy chain now joins the ranks of other Watson Health partners,
including Apple, Johnson & Johnson, and Medtronic, which are using Watson to
build their own healthcare services on top of.
The goal of the partnership is to make Watsonâ€™s number-crunching technology
available for healthcare professionals working at CVS Health, which operates
roughly 7,800 drugstores. Ultimately, CVS Health wants to use Watson to
analyze patient data and improve patient care.
With pharmacies having access to boatloads of healthcare data, like health
records and medical claims information, IBM claims that Watson technology
could help them better understand a patientâ€™s overall health.
The partnership will also address patients with declining health â€śwho may
benefit from proactive, customized engagement programsâ€ť created by
healthcare providers with the help of Watson, according to the announcement.
The announcement is the latest in IBMâ€™s plans to make its Watson data
analytics technology a viable business. The company does not currently share
exactly how much revenue Watson is contributing to IBMâ€™s bottom line.
Visit Fortune for the release.
patient safety often at risk in ER to inpatient handoff
Physicians report that patient safety is often at risk during the emergency
department admission handoff process due to ineffective communication.
Christopher J. Smith, M.D., from the University of Nebraska Medical Center
College of Medicine in Omaha, and colleagues surveyed resident, fellow, and
faculty physicians directly involved in admission handoffs from emergency
medicine and five medical admitting services at a 627-bed tertiary care
academic medical center.
Based on responses from 94 admitting and 32 emergency medicine physicians,
the researchers found that admitting physicians reported that vital clinical
information was communicated less frequently for all content areas (P <
0.001), compared to emergency medicine physicians. Nearly all (94 percent)
of emergency medicine physicians felt defensive at least "sometimes."
Just under one-third of all respondents (29 percent) reported
handoff-related adverse events, most frequently related to ineffective
communication. Sequential handoffs were commonly reported for both emergency
medicine and admitting services, and 78 percent of physicians reported that
these handoffs negatively impact patient care. (HealthDay)
Visit Medical Express for the report.