CDC investigates deadly bacteria's link to doctors' offices

The Centers for Disease Control is raising a red flag that a potentially deadly bacteria may be lurking in your doctor's office. The bacteria, C. difficile, is typically found in hospitals, but a study reports a substantial number of people contracted the bug who hadn't been in a hospital, but had recently visited the doctor or dentist. The bacteria can cause deadly diarrhea, according to the CDC, with infections on the rise. The new report shows nearly half a million Americans infected in various locations in one year, with 15,000 deaths directly attributed to C. diff.

In a 2013 study, researchers found C. diff present in six out of seven outpatient clinics tested in Ohio, including on patients' chairs and examining tables. The CDC is so concerned that they're starting a new study to try to assess nationally whether people are getting C. diff in doctors' offices.

In the meantime, patients should wash their hands after visiting the doctor's office -- with soap and water, because alcohol-based gels don't get rid of C.diff.

Johns Hopkins safety expert Dr. Peter Pronovost recommends asking your doctor if you really need an antibiotic, if there's a less powerful one that will treat your infection, and if you're being prescribed the antibiotic for the shortest time possible.

The CDC study, published Wednesday in The New England Journal of Medicine, said 150,000 people who had not been in the hospital came down with C. diff in 2011. Of those, 82% had visited a doctor's or dentist's office in the 12 weeks before their diagnosis. The CDC is hoping its new study will help determine cause and effect, because it's possible the patients had C. diff to begin with and went to the doctor to get help. It's also possible that antibiotics prescribed during the doctor's visit, and not microbes at the doctor's office, caused the infection.

Johns Hopkins safety expert Dr. Peter Pronovost recommends asking your doctor if you really need an antibiotic, if there's a less powerful one that will treat your infection, and if you're being prescribed the antibiotic for the shortest time possible. Visit CNN for the report.

Fewer Americans have problems with medical bills

The percentage of people under age 65 living in a household reporting problems paying medical bills in the past year decreased from 21.3% (56.5 million) in 2011 to 17.8% (47.7 million) in 2014, according to a CDC report. The figures came from the National Health Interview Survey and were reported by the National Center for Health Statistics. Conducted continuously, the survey involves some 35,000 households nationwide each year. Estimates for 2014 were from data collected during the first 6 months of the year.

Among the questions asked: "In the past 12 months did [you/anyone in the family] have problems paying or were unable to pay any medical bills? Include bills for doctors, dentists, hospitals, therapists, medication, equipment, nursing home, or home care."

The percentage of children under 18 in households reporting such problems decreased from 23.2% to 19.0% during that time period.

Non-Hispanic blacks were the most likely to live in households with bill-paying difficulties in 2014 (23.8%), followed by Hispanics (20.5%), non-Hispanic whites (16.3%), and non-Hispanic Asians (8.0%).

Each year, females were more likely than males to have been in a household with problems paying medical bills (18.5% versus 17.0% in 2014). Those who were uninsured most commonly had trouble paying bills in 2014 (31.2%), followed by those with public insurance (24.2%), and then private insurance (12.4%). For all types of insurance coverage, percentages decreased from 2011 to 2014.

"Near poor" persons (those with incomes of 100% to less than 200% of the poverty threshold) were most likely to live in households with bill-paying difficulties (28.0%). A total of 27.1% of those with incomes below the poverty level lived in such households, compared to 12.6% of "not poor" people who had incomes that were 200% of the poverty threshold or greater. Visit MedPage Today for the report.

NIH announces $41.5 million in funding for the Human Placenta Project

The National Institutes of Health has dedicated $41.5 million for an initiative to understand and monitor the development of the human placenta during pregnancy. The funding will support the development of new technologies to assess the health of the placenta as it grows and matures, with the ultimate goal of improving the health of mothers and children.

“The placenta is a lifeline that gives us our start in the world,” said Alan E. Guttmacher, M.D., director of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, which is leading the research effort. “It influences the health of mother and child not just during pregnancy, but for the rest of their lives. However, despite its important role, the placenta has received comparatively little attention.”

Problems with the placenta may lead to negative pregnancy outcomes for mother or fetus, such as preeclampsia (a disorder of high blood pressure in pregnancy), gestational diabetes, preterm birth, and stillbirth. Placental problems have also been linked to a higher risk of heart disease later in life, for both mother and child.

Until now, most studies of the placenta have been limited to ultrasound exams, blood tests, and the examination of placental tissue after delivery. These studies have provided important foundational knowledge, Guttmacher said, but many questions remain about normal placental development and function and the organ’s role in health and disease.

The initiative seeks to spur new technologies or innovative applications of existing technologies, such as imaging tools or sensors, that would allow practitioners to safely track placental functioning during pregnancy. Such technologies might gauge how blood and oxygen flow through the placenta, how it attaches to the uterine wall, and how it conveys nutrients to the fetus.

The latest funding announcement for the Human Placenta Project, its third and largest to date, also requires applicants to address the effects of environmental factors — such as air pollution, medications, and maternal diet — on the placenta during pregnancy.

“The placenta is a fascinating organ, but it’s one of the least understood,” said Dr. Guttmacher. “For researchers who want to apply their skills in an area of medicine that isn’t being looked at as much as both scientific opportunity and human health warrant, this is a wonderful chance.”

For more details visit NIH.

High rate of shopping and switching in Obamacare plans is a good sign

For most customers returning to the Obamacare marketplaces this year, it really paid to shop around. New data shows that a large number of them did. That bodes well for those shoppers and the future offerings of the insurance marketplaces. More than half of people who bought insurance on HealthCare.gov last year explored their options before choosing a 2015 plan, according to a report from the Department of Health and Human Services. Of those 2.2 million who shopped, more than half switched to a new health plan.

Those high rates of shopping and switching are unusual in public insurance marketplaces. Other government programs that allow customers to shop for health plans have had switching rates close to 10 percent. Indeed, a key policy feature of the marketplace this year was an automatic renewal process, which kept people who did nothing enrolled in the same plan from last year.

There are clear advantages for some people in staying in the same insurance plan from year to year — mainly that you can stick with the same doctors and hospitals. But an Upshot analysis of data from the McKinsey Center for U.S. Health System Reform found that people who bought the most popular plans last year often faced substantial premium increases if they stayed put.

It’s not clear from the government’s report how many people who switched saved money by doing so. But the administration has said that more than 70 percent of all customers could save money by switching, so it’s likely that most of the switchers ended up in a cheaper plan. There may be other reasons to switch, of course — maybe some people didn’t like their plan.

The high switching rate, a surprise, remains a bit of a mystery to experts who study insurance markets. There are a few possible reasons more people than expected may have shopped. One is that Health and Human Services worked hard to encourage people to look again at other options. The customers shopping for insurance in the Obamacare marketplaces also tend to have lower incomes than those in previous public insurance markets, and insurance premiums make up a larger proportion of their incomes. Those factors may have made them more price sensitive and motivated to find the best deal.

Studies have shown that drug plans sold to Medicare patients, who rarely switch, tend to substantially increase in price over time. The pricing patterns for last year and this year may point to a similar pricing strategy — the lowest-cost providers from 2014, which captured large shares of the market, tended to raise their prices more than the market average.

If most repeat customers are looking at their options every year — and a substantial number are willing to change plans — that is likely to encourage insurers to compete on both price and features and improve consumers’ options. Visit the New York Times for the story.

German nurse convicted of murder in life-and-death game

At a hospital in northern Germany, he was once dubbed a “bad luck charm” since so many of his patients required resuscitation. What doctors and nurses there didn’t know was that he was overdosing patients with cardiovascular medication because he got a strange satisfaction from bringing them back to life. But he wasn’t always successful.

Prosecutors accused the 38-year-old male nurse — known only as “Niels H.” because of Germany’s strict privacy laws — of three murders and two attempted murders between 2003 and 2005 at Delmenhorst Hospital in northern Germany. They said he was bored with his job and wanted to sharpen what he called his “excellent” resuscitation skills, so he pumped excessive amounts of heart medication into patients’ hearts to create medical emergencies. Then he could revive them and become a hero.

On Thursday, the nurse, who has confessed to killing 30 patients and nearly killing 60 others, was sentenced to life in prison, court spokesman Daniel Moennich told the Associated Press.

At one point during trial, Niels H. told the court, “It was the clinical daily routine which failed to challenge me,” according to the German newspaper Deutsche Welle. This life-and-death game, he said, gave him a high that lasted days.

Court-appointed psychiatrist Konstantin Karyofilis told the newspaper Niels H. was not mentally ill, but wanted to earn the respect of his colleagues as well as recognition from his patients and their families. Eventually, Karyofilis said, he stopped seeing his patients as people.

Niels H. had worked with patients at other hospitals as well as at a nursing home. He was a part-time paramedic. And he had been in trouble before, the Guardian reported. In 2008, he was sentenced to more than seven years in prison for attempted murder after another nurse caught him in the overdose act. Since then, the prosecution has faced criticism for failing to uncover his other crimes.

Now, investigators are looking into more than 200 deaths that occurred among the nurse’s patients. The first eight bodies are set to be exhumed next month, followed by more than 100 potential others, Deutsche Welle reported. Visit the Washington Post for the story.

A new council has been formed to rid the world’s operating environments of surgical plume

Surgical smoke plume is a hazardous byproduct of operative procedures known to contain harmful gases, minute particles, and microorganisms. Inhalation of this plume by clinicians and patients has been well documented as a hazard to their health and well-being.

Internationally many standards and mandates exist to protect medical staff and patients from exposure to these plumes. However, in many countries including the United States, adherence to these standards remains at unacceptable levels. The need for further studies, lack of education, and dissemination of the educational information that already exists are some of the causes for the lack of full compliance.

A new non-profit council has recently formed with a mission to finally rid the world’s operating environments of surgical smoke plume once and for all. With the participation of key clinical stakeholders, clinician based organizations, industry partners, and standard setting bodies, this new consensus body is known as the International Council on Surgical Plume (ICSP). The charter of this Council is to provide education, aid in the creation of new clinical studies, drive regulatory reform, and advocate enforcement of existing mandates related to surgical plume throughout the world.

With the formation of the ICSP, surgical stakeholders can join in one voice to advocate for clearer mandates, better dissemination of existing studies, construct meaningful new studies that resonate with those not yet advocating for plume management, and review of new and existing clinical information for scientific credibility.

Individual clinicians, clinical organizations, educators, safety advocates, standard setting bodies, and other surgical team members are encouraged to join in this effort to rid surgical environments of the hazards associated with plume inhalation. To learn more about the ICSP and how you can help, please visit www.plumecouncil.com.

UnitedHealth tightens rules covering hysterectomies

UnitedHealth, the largest U.S. health insurer, said Thursday it is tightening its coverage rules on hysterectomies. The company says it will require healthcare professionals and facilities and providers to notify it in advance if they plan to perform some types of hysterectomies. UnitedHealth said in a notice to providers it won't approve the procedure if it concludes that the operation isn't medically necessary.

UnitedHealth Group Inc. says the changes are based on recommendations from the American Congress of Obstetricians and Gynecologists, which said vaginal hysterectomies are recommended over abdominal procedures and "keyhole" laparoscopic procedures. It quoted from recommendations ACOG issued in 2009 that said vaginal procedures are associated with better outcomes and fewer complications.

The Minnetonka, MN-based company said the guidelines will take effect April 6. Vaginal hysterectomies performed on an outpatient basis won't have to be approved ahead of time.

Based on reports from the early 2000s, the Centers for Disease Control say about 600,000 hysterectomies are performed every year in the U.S. In November the Food and Drug Administration issued a stronger warning on a once-popular device used in laparoscopic hysterectomies, saying the product shouldn't be used in the "vast majority" of cases because it can spread undetected cancers. The device is called a laparoscopic power morcellator, and it is used to remove uterine fibroids or the entire uterus in less-invasive surgeries. (Associated Press) Visit the Miami Herald for the story.

Your soap has bacteria in it, but it still gets you clean

As long as the bacteria keep their numbers small, there's nothing wrong with them living in soap. But every once in a while it's a problem, like last week when Gilchrist & Soames recalled seven products, including shampoos and shower gels, because of possible contamination with the bacteria Psuedomonas aeruginosa and Enterobacter gergoviae.

This isn't the first time the very tools we use to fight bacteria have succumbed to an invasion. In 2009, the FDA even recalled one brand of hand sanitizer because it was likely to contain bacteria.

"Everyone assumes that soap is clean," says Jim Arbogast, a vice president of hygiene sciences and public health advancements at GOJO Industries, a company in Akron, Ohio, that makes Purell hand sanitizer and other products. "Any cosmetic product in the U.S. in a public setting or a home setting, it's going to have some normal bacteria that's not going to cause any illness."

When you wash your hands you're not trying to rid them of all bacteria, explains John Heinze, a former senior research microbiologist for the Dial Corp. who now works for KellenAdams, a Washington, D.C., public affairs firm. Bacteria grow everywhere, Heinze says, even in alcohol. While at Dial, Heinze authored a study showing that even though bar soap contains bacteria, it still cleans hands effectively.

"You need to make sure that microbes won't take advantage of the situation and proliferate," says Dave Shumaker, a microbiologist at GOJO Industries. To that end, most products have antimicrobial agents built into the recipe, even if they aren't labeled as antibacterial. Soap- and shampoo-makers call these agents the soap's preservation system. Without a preservation system, bacteria would munch on the surfactants and lipids.

Soap and shampoo companies employ someone like Shumaker to make sure that the preservation system works and that an unopened product will last three years on the shelf. To test that system, he might use bioluminescence to detect any metabolic products — signs that some sort of organism is converting nutrients into energy. Or he might dilute the sample and culture it on a petri dish to count how many bacteria colonies form.

The FDA has set upper limits for bacteria in cosmetics and hygiene products. A product used around the eyes must contain fewer than 500 colony-forming units per milliliter, a standard measure of how many bacterial cells are living in a substance. A product for use elsewhere on the body must contain fewer than 1,000 colony-forming units per milliliter.

Another common test involves adding bacteria to products to see how the preservation system fights back. After all, there are lots of bacteria in the home that could contaminate a product at any time, especially in the bathroom. But as long as the antimicrobial agents are working, bacteria in the soap shouldn't increase in number.

Occasionally a company will find more serious bacteria in its products, such as Staph and Pseudomonas species that cause skin infections, or the bacteria that cause strep throat. The FDA doesn't allow any trace of these bacteria in hygiene products. Visit NPR for the story.