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DAILY UPDATE

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November 21, 2014 Download print version

Ebola response in Liberia is hampered by infighting

Class I Recall: Respironics California, Esprit V1000 and V200 Ventilators

J&J seeks billions in trial over decade-old bidding war

CDC shelves workplace obesity website after complaints

To stop Ebola, trust in healthcare workers is crucial

3M earns USDA Certified Biobased Product Certification and Label

Deaths from heart disease down, up for blood pressure, irregular heartbeat

Nebraska Methodist Hospital safeguards soft surfaces with bacteria-resistant privacy curtains

 

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Self Study Series:
November 2014

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Self Study Series:
November 2014

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Ebola response in Liberia is hampered by infighting

The global response to the Ebola virus in Liberia is being hampered by poor coordination and serious disagreements between Liberian officials and the donors and health agencies fighting the epidemic, according to minutes of top-level meetings and interviews with participants.

Even now, three months after donors began pouring resources into Liberia, many confirmed cases still go unreported, countries refuse to change plans to erect field hospitals in the wrong places, families cannot find out whether their relatives in treatment are alive or dead, health workers sent to take temperatures sometimes lack thermometers, and bodies have been cremated because a larger cemetery was not yet open.



The detailed accounts of high-level meetings obtained by The New York Times, the most recent from Monday, lift the veil on the messy and contentious process of running the sprawling response to Liberia’s epidemic, one that now involves more than a hundred government agencies, charities and donors from around the world.

Despite these problems, with help from donors, Liberia, one of the three most afflicted West African countries, and the one with the highest death toll, has seen new cases drop to about 20 a day from about 100 a day two months ago. Experts attribute that to fearful Liberians touching one another less, more safe burials of bodies and distribution of protective gear to health care workers. But they also warn that cases are now holding steady and could explode again.

Participants in the meetings of the Incident Management System — which replaced the National Ebola Task Force — said the atmosphere in the meetings in the Liberian capital, Monrovia, should not be characterized as chaotic or bogged down in bickering, instead calling them “collegial” and “effective,” although one who spoke on condition of anonymity described “showmanship and political posturing.” Senior officials of the Centers for Disease Control and Prevention who attended — Dr. Frank J. Mahoney and Dr. Kevin M. De Cock — said in an email that there were “differences of opinion — accompanied by passionate discussions.”

At the meeting on Monday, Dr. De Cock cited serious logistics problems, including regular hospitals that cannot separate out Ebola patients, counties with no ambulances and temperature takers with no thermometers.

On Nov. 12, the representative of the United Nations secretary general complained that “hundreds” of vehicles had been made available but there was always a shortage. Asking where they are, he added: “The recipient also has to be accountable, just as the donor.”

Also, the support documents with the minutes indicate that there is no national plan for Ebola survivors — either for reuniting them with their families or for using them to do nursing tasks because they are thought to be immune.

A report on the issue reads: “The current and planned work presented by the partners and government for survivors can be characterized as fragmented and lacking in scope, scale, comprehensiveness, evidence base and survivor-driven programming.”

American military helicopters ferrying doctors to remote areas were forbidden to fly back not only patients but even blood samples; recently samples from a village had to be walked to a road four hours away. At Monday’s meeting, according to the minutes, Dr. De Cock called this “unacceptable,” adding, “This has to change this week.”

Dr. Hans Rosling, a Swedish epidemiologist and consultant to Liberia’s Health Ministry, said that the helicopter order came “from somewhere in America.” In an interview, he cited problems not listed in the minutes: one Asian and two European donor countries are insisting on building new Ebola field hospitals in Monrovia, where hospitals have empty beds, rather than in remote counties where beds are desperately needed; they insisted because they announced those plans two months ago, he said.

The national case count was not reported for two days recently because the government employee compiling it went unpaid and stopped working. The minutes of the Incident Management System were made available along with PowerPoint files and other documents by an expert who said the disorganization of the Ebola effort should be made public.

The meetings are usually led by Tolbert Nyenswah, the deputy health minister, and include representatives from the Centers for Disease Control, the World Health Organization, the World Bank, the United Nations Mission for Ebola Emergency Response, numerous United Nations agencies, the United States Agency for International Development, the United States Army, Doctors Without Borders and medical, aid or military representatives from many other countries. Dr. Nyenswah and other ministry officials could not be reached for comment; Dr. Rosling has worked with the ministry since October.

The minutes make it clear that accuracy of the national case count is shaky.

In the minutes, Liberian officials regularly complain about the donors, and the donors argue back. On Nov. 12, James Dorbor Jallah, the task force’s deputy manager, said: “People will sit in D.C. or Geneva and want to direct what is happening here.”

The health minister, Dr. Walter T. Gwenigale, backed him up, complaining that “the U.N. and other agencies got their money before the ink was even dry,” while, he said, a group run by a Liberian pastor to teach rural people about Ebola “has not gotten one cent.”

On Sunday, President Ellen Johnson Sirleaf replaced Dr. Gwenigale without explaining why, but said he would remain an adviser. Dr. Emmanuel T. Dolo, Johnson Sirleaf’s youth adviser, complained that the donors were “showing a level of disrespect” by judging Liberian community groups by “harsh standards” and “Western standards.”

At the same meeting, Nyenswah, the deputy health minister, pointed to his government’s “team leaders” and warned, “Partners in the room have not been engaging them and involving them in strategy — but you have to.”

Visit the New York Times for the story.

 

 

Class I Recall: Respironics California, Esprit V1000 and V200 Ventilators

Respironics California Inc. has initiated a recall of Esprit V1000 and V200 Ventilators, Model V1000 and V200, installed with 3rd Generation Power Supplies, and 3rd Generation Power Supply Repair Part Kits. These devices were manufactured and distributed from December 21, 2012 to July 9, 2014.

The 3rd Generation Power Supplies are installed in Esprit V1000 and V200 Ventilators and are also sold as 3rd Generation Power Supply Repair Kits. A part in the 3rd Generation Power Supply may prevent the ventilator from using AC power (electricity from a wall socket) or may fail and prevent the ventilator from switching back to AC power after using battery power. Additionally, if a battery is not present or is used up, the ventilators will not work.

Failure of the power supply may cause the ventilator to shut off, which may result in too much carbon dioxide in a patient’s blood, not enough oxygen in the blood, or death.

There have been no reports of death or serious injury related to this potential problem.

A Philips field service engineer, trained service provider, or distributor will contact customers to schedule a replacement of the recalled 3rd Generation Power Supply with a 3.1 Power Supply on all Esprit V1000 and V200 ventilators, and all 3rd Generation Power Supply Repair Part Kits. Visit the FDA for the notice.

 

 

J&J seeks billions in trial over decade-old bidding war

Johnson & Johnson (JNJ) asked a federal judge to award it $7.2 billion over its failed decade-old effort to acquire heart device-maker Guidant Corp.

J&J claims Boston Scientific Corp. (BSX) owes it that amount, in damages and interest, for a broken contract in a case that went to trial in Manhattan federal court. J&J alleges that Guidant violated their merger agreement to pursue a more lucrative offer by Boston Scientific.

“What J&J is trying to do here is hold Guidant accountable for its willful breach,” Harold Weinberger, J&J’s lead attorney, said in his opening statement.

The suit threatens Boston Scientific, which has a market capitalization of $17.1 billion, with additional costs tied to an acquisition that has been called one of the worst in history. The company, which took on $10 billion in debt to buy Guidant, wrote down $2.7 billion tied to the deal in 2008. Boston Scientific shares have lost 40 percent since it took over the device-maker.

J&J’s damages from the failed transaction are $4.35 billion plus interest, for a total of $7.2 billion, Weinberger told U.S. District Judge Richard Sullivan, who is hearing the trial without a jury.

William Ohlemeyer, a lawyer for Guidant, argued that the company didn’t violate the agreement with J&J and that the world’s biggest seller of healthcare products is better off without Guidant. The deal “would have resulted in a multibillion-dollar loss for J&J,” he told Sullivan.

The first witness, former J&J chief executive officer William Weldon, testified that he didn’t believe his company came out ahead by losing the acquisition opportunity.

Negotiations that started in 2004 led to a merger agreement in which J&J agreed to pay $63 a share, or about $21.5 billion, for Guidant. Boston Scientific then made an unsolicited offer for $72 a share, or $25 billion.

Boston Scientific eventually won the bidding war, buying Guidant for $27.5 billion, with Guidant paying J&J a $705 million termination fee. Boston Scientific also sold Guidant’s heart stent business to Abbott Laboratories (ABT) to avoid antitrust issues the merger would otherwise have caused.

J&J sued in September 2006, claiming Guidant, based in Marlborough, MA, broke their merger agreement by disclosing confidential business information to Abbott.

Abbott and Boston Scientific were also accused by J&J of improperly interfering with its deal with Guidant. The following year, a federal judge in Manhattan dismissed Abbott from the case and narrowed J&J’s claims to a breach-of-contract dispute.

The case is scheduled to run through Nov. 25, then resume Dec. 15.

Visit Bloomberg for the story.

 

 

CDC shelves workplace obesity website after complaints

The CDC has taken down a website that offered an “obesity cost calculator” to help American bosses tally financial losses linked to their overweight employees, a spokeswoman for the agency confirmed Tuesday.

Called Lean Works!, the federal program drew recent criticism from some nutritionists and advocates for overweight Americans who claimed the site and its obesity calculator fueled workplace discrimination and perhaps even led some companies to fire fat people. NBC News first reported those concerns Nov. 2.

Brittany Behm, a spokesperson for the U.S. Centers for Disease Control and Prevention, said via email that content once at Lean Works! “is under review,” adding: “The calculator is also under review and will be potentially updated with new information, technology.”

“The recent attention to the LEAN Works! program caused us to put this part of the website at the top of the list for review, hence why it is currently down,” Behm wrote. “… The potential misuse of this information is something we will certainly consider in our upcoming content review.”

Joanne P. Ikeda, nutritionist emeritus at the University of California, Berkeley called the move a “victory” for people who are “committed to ending discrimination based on body size.”

Visit NBC News for the story.

 

 

To stop Ebola, trust in healthcare workers is crucial

To stop the current Ebola outbreak and prevent future ones from becoming so large, it's crucial for healthcare volunteers to build trust in the communities where the disease can spread, well before a crisis starts, experts say.

Without such trust, it is hard to get people within those communities to accept and follow public health advice, which can allow an outbreak to spiral out of control, according to a recent study.

"It's not a simple, easy thing to tell a mother that she can't touch her sick child if [the child] has a fever," said Timothy Roberton, of the Johns Hopkins School of Public Health, who conducted the research and presented it at the American Public Health Association Meeting. "We've got to remember that what we're asking people to do has profound implications."

In the study, researchers interviewed Red Cross volunteers in Guinea during a two-week period in July. They found that part of the reason why the Ebola outbreak escalated so dramatically is because people in the some parts of the country were reluctant to adhere to advice from healthcare workers regarding how to stop the disease's spread.

For example, people in some villages did not believe that an Ebola outbreak existed, and some were hostile to volunteer healthcare workers, Roberton said, during his presentation. Some people believed that the Ebola outbreak was a hoax, and a way for the government to raise money. There were also rumors that the Red Cross volunteers had made up the disease to steal body parts.

The recommendations to prevent Ebola also interfered with the local customs of preparing the body for burial, so some villagers would not allow Red Cross volunteers to safely bury the bodies of the dead, Roberton said.

To overcome resistance from villagers, Red Cross volunteers contacted community leaders, such as regional and political leaders, to get everyone on the same page as to what needed to be done to stop the spread of Ebola, Roberton said.

In addition, when someone died from Ebola, the Red Cross volunteers began allowing family members to put on protective equipment and watch the burial, and pray over the body from a distance, Roberton said. Visit Live Science for the article.

 

 

3M earns USDA Certified Biobased Product Certification and Label

3M has earned the USDA Certified Biobased Product Label for its 3M Avagard Gel Instant Hand Antiseptic and 3M Avagard Foaming Instant Hand Antiseptic. The USDA Certified Biobased Product Label verifies that the product’s amount of renewable biobased ingredients meets or exceeds levels set by USDA. Biobased products are finished or intermediate materials composed in whole or in significant part of agricultural, forestry, or marine ingredients.

“3M develops sustainable solutions and product platforms to help our customers – and us – manage environmental footprints,” said Andrea Albrecht, Global Marketing Manager, 3M Infection Prevention Division. “We’re honored to receive the USDA Certified Biobased Product Label, which solidifies Avagard Instant Hand Antiseptics as another valuable solution in the sustainability journey.”

All biobased amount claims are verified by independent labs and monitored by the USDA. Consumers may feel secure in the accuracy of the biobased amount and be empowered in making better informed purchasing decisions.

For more information about Avagard Instant Hand Antiseptic Products, please visit go.3m.com/Avagard.

 

 

Deaths from heart disease down, up for blood pressure, irregular heartbeat

Deaths from heart disease are dropping, but deaths related to high blood pressure and irregular heartbeats are on the rise, a new government study finds. From 2000 to 2010, the overall death rate from heart disease dropped almost 4 percent each year, the U.S. Centers for Disease Control and Prevention, researchers found. At the same time, death rates linked to high blood pressure-related heart disease increased 1.3 percent a year, according to the study. The researchers also found that deaths tied to irregular heartbeats rose 1 percent a year.

"While we are continuing to improve in the overall heart disease death rate, we still have considerable work to do," said lead researcher Matthew Ritchey, a CDC epidemiologist. "During this 11-year period, more than 7 million heart disease-related deaths still occurred, including 600,000 deaths in 2010, making heart disease the leading cause of death in the United States," he said.

Heart disease is a broad term for a number of conditions affecting the heart. Coronary heart disease, which is caused by plaque build-up in the blood vessels, is one type of heart disease. Congestive heart failure is another type, and generally occurs when the heart muscle isn't strong enough to pump blood efficiently. Heart disease from the strain of high blood pressure is another type of heart disease, according to the study.

"Despite declines, coronary heart disease remains the leading cause of heart-disease-related death," Ritchey said. "In 2010, it accounted for about 64 percent of all heart-disease-related deaths," he said.

Heart disease also includes abnormal heartbeats (arrhythmias). The normal beating of the heart relies on electrical impulses progressing in a particular pattern. When these impulses do not occur in the correct order, heartbeats become irregular.

Ritchey said the increase in deaths from arrhythmias might be due to the aging population and people living longer with heart failure, kidney disease and high blood pressure.

Although this study didn't report death rates based on the type of arrhythmia, another study found that the rates of ER visits for a common type of arrhythmia called atrial fibrillation increased by 24 percent from 2006 to 2011.

The reasons for the increase in deaths linked to high blood pressure are unclear, but Ritchey thinks that uncontrolled blood pressure and obesity are the likely culprits.

According to the report, deaths associated with high blood pressure increased among whites. For blacks, the rate remained the same, but overall was still higher than the rate in whites.

In 2010, high blood pressure was a leading cause of heart-related death (12 percent) among people 35 to 54 years old, as well as for those in the 55 to 74 age group (6.7 percent), according to the study. In people 75 and older, heart failure was the leading cause for heart-related death at 12 percent, the researchers found.

The study was published in the Nov. 19 issue of the Journal of the American Medical Association.

Visit HealthDay for the report.

 

 

Nebraska Methodist Hospital safeguards soft surfaces with bacteria-resistant privacy curtains

X-STATIC Antimicrobial Technology has been chosen by Nebraska Methodist Hospital to elevate its standard of care for fabrics in the healthcare environment. The facility will install bacteria-resistant Arc-Com privacy curtains powered by X-STATIC in the Post Anesthesia Care Unit (PACU) of its new surgery center. 

Terry Micheels, MSN, RN, CIC, and the Service Leader of the Epidemiology Department at Nebraska Methodist Hospital explained, “We have things we do to address soft surface fabric risk in the facility already. However, we felt a better solution was needed for the new PACU, which would contain a number of cubicle curtains for patient privacy needs.”   

A 2012 study published in the American Journal of Infection Control concluded that privacy curtains are rapidly contaminated, with 92 percent showing contamination within one week. Micheels evaluated antimicrobial solutions and determined a technology which is permanently integrated into the product was optimal next to a temporary topical solution. The durability of X-STATIC, certified at 200+ commercial launderings, was a critical decision-making factor. 

Peg Luebbert, MS, MT (ASCP), CIC, CHSP and Founder of Healthcare Interventions, LLC., offered suggestions for anyone evaluating soft surface fabric solutions: “I suggest  you pay close attention to any kill claims made by antimicrobial fabric manufacturers and ensure those claims are backed by the appropriate approvals. For example, a fabric that claims it “kills MRSA” needs to have a public health claim approved by the Environmental Protection Agency (EPA). To my knowledge, there are no soft surface fabrics currently available that have the ability to make the kill claim.”

For more information, visit www.infectionpreventiontextiles.com/.