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November 25, 2015 Download print version

Paris doctors describe war-like effort to save lives following terrorist attacks

How data can help with hand hygiene compliance

AAMI Foundation releases compendium to help hospitals with alarm management goal

New CDC estimates underscore the need to increase awareness of a daily pill that can prevent HIV infection

Are doctors prescribing generic drugs often enough? This group says no

Bacteria resistant to colistin discovered

U.S. system to detect bioterrorism can't be counted on, government watchdog finds

Uber delivers flu shots in 36 cities, in one-day experiment

Healthcare Purchasing News wishes you a Happy Thanksgiving!


Daily Update Archives


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December 2015

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Paris doctors describe war-like effort to save lives following terrorist attacks

A group of Paris doctors have offered a chilling account of how their medical teams responded in the wake of the deadly attacks broke out across Paris on Nov.13.

Published Tuesday in The Lancet, the report described “the civil application of war medicine” as doctors focused on maintaining blood pressure, ensuring consciousness, and treating victims with medication and tourniquets.

Paris’ public health system, the Assistance Publique-Hôpitaux de Paris (APHP), mobilized 40 hospitals, nearly 100,000 staff members and 200 operating rooms within minutes of the first attack.

Beginning just before 9:30 p.m. Paris time, three suicide bombers struck near the Stade de France in Saint-Denis, followed by suicide bombings and mass shootings at cafés and restaurants, and a hostage taking at the Bataclan concert hall.

“Never before had such a number of victims been reached and so many wounded been operated on urgently,” one of the author’s wrote.

The attackers killed 130 people, including 89 at the Bataclan theatre. More than 360 people were injured, including more than 90 who were seriously injured. Seven of the terrorists also died, and authorities continue to search for a remaining fugitive believe to be in Brussels.

The accounts are written from the anonymous perspective of an emergency physician, an anesthesiologist, and a trauma surgeon and detail how 45 medical teams were deployed to the six attack sites.

“15 were kept in reserve, since we did not know how and when this nightmare would end,” the author wrote. Medical teams focused on treating patients at the scene and controlling the “damage” as much as possible as most of the injuries were bullet related. The need for tourniquets was so high that medical teams came back without their belts, according to the report.

The report also noted the Paris public hospital system had been bracing for a terrorist attack since January, when gunmen killed 12 people at the offices of the satirical newspaper Charlie Hebdo.

The anesthesiologist said following the attacks that the number of patients admitted to hospital was “far beyond” what any of the staff imagined they could treat.

Medical teams worked continuously through the night on the injured, and by Nov. 15, the hospital’s usual services resumed.

A review by staff on Nov.16 found one common observation was that all but one of the victims admitted to hospital were less than 40 years old and all patients suffered from “high-energy ballistic trauma.”

“What happened strengthens our belief that size can be combined with speed and excellence,” the authors said. “As terrorism becomes more lethal and violent, nothing will prevent the medical community from understanding, learning, and sharing knowledge to become more effective in saving lives.”

Visit Global News for the story.

How data can help with hand hygiene compliance

In a 2012 study, Gojo measured the rate of hand washing at John Peter Smith Hospital in Fort Worth, TX by pairing traffic-monitoring activity counters with sensor-laden soap and sanitizer dispensers. These sensors were installed in medical, surgery, and infectious disease units throughout the hospital. The company later crunched the results via Microsoft Azure, the company’s cloud computing service. The results were revealed last week at a Microsoft event in New York City.

At the beginning of the study, the system collected baseline figures over 10 days, tabulating a hand washing compliance rate of 16.5%. That’s the percentage of times that healthcare workers sanitized themselves versus how many opportunities they had to do so.

Then, over the next 80 days, workers, patients, and even hospital visitors were informed of the study, in the hopes that people would consciously choose to scrub up as much as possible. Over that period, compliance rates jumped to 31.7%. Over the final 50 days, a post-study assessment tracked how much people cleaned up, even though they were no longer being reminded. It seems the lesson stuck, because the compliance rate wound up at 25.8%.

The system was able to detect 90,000 handwashing opportunities, a number that human auditors would have a hard time matching. Applied across more hospitals, this could have a huge impact on sanitization in hospitals, potentially reducing the number of infections. But even just in this one instance, hand washing soared 92% during the study period. In human terms, that means fewer infections — and quite possibly some lives saved.

Visit Time for the article.

AAMI Foundation releases compendium to help hospitals with alarm management goal

The AAMI Foundation has synthesized the knowledge, experience, and advice of leading practitioners into a toolkit designed to help healthcare organizations meet The Joint Commission’s National Patient Safety Goal on clinical alarms.

Starting Jan.1, The Joint Commission will expect hospitals to establish and implement policies and procedures for managing clinical alarms, as this is when surveyors will start documenting noncompliance to the second phase of the goal.

“Noncompliance will be a direct finding, and the organization will have to submit a plan for corrective actions. Noncompliance also will be posted on Quality Check,” said Ronald Wyatt, MD, medical director of healthcare improvement for The Joint Commission. The Quality Check website provides detailed information about an organization’s performance and accreditation.

To assist in developing the necessary policies and procedures, the AAMI Foundation’s complimentary Clinical Alarm Management Compendium provides specific tips and outlines practices already being used by leading institutions.

In addition to outlining ways to implement these ideas, the compendium provides a set of default alarm parameters that could be used to benchmark alarm system settings. These parameters were developed from information reported in a survey conducted by the AAMI Foundation, and they represent responses from 17 of the 25 hospitals and healthcare system members of the National Coalition for Alarm Management Safety.

To learn more about the best practices and comprehensive initiatives of healthcare systems and hospitals featured in the compendium, visit AAMI.

New CDC estimates underscore the need to increase awareness of a daily pill that can prevent HIV infection

A new Vital Signs report estimates that 25 percent of sexually active gay and bisexual adult men, nearly 20 percent of adults who inject drugs, and less than 1 percent of heterosexually active adults are at substantial risk for HIV infection and should be counseled about PrEP, a daily pill for HIV prevention.

PrEP for HIV prevention was approved by the Food and Drug Administration in 2012. When taken daily, it can reduce the risk of sexually acquired HIV by more than 90 percent. Daily PrEP can also reduce the risk of HIV infection among people who inject drugs by more than 70 percent.

However, according to recent studies, some primary healthcare providers have never heard of PrEP. Increasing awareness of PrEP and counseling for those at substantial risk for HIV infection is critical to realizing the full prevention potential of PrEP.

While PrEP can fill a critical gap in America’s prevention efforts, all available HIV prevention strategies must be used to have the greatest impact on the epidemic. These include treatment to suppress the virus among people living with HIV; correct and consistent use of condoms; reducing risk behaviors; and ensuring people who inject drugs have access to sterile injection equipment from a reliable source.

PrEP is one of four focus areas in the July 2015 Update to the National HIV/AIDS Prevention Strategy. Other key elements of the Strategy and CDC’s high-impact prevention approach are:

·         Widespread HIV testing and linkage to care that enables early treatment;

·         Broad support for people living with HIV to remain engaged in comprehensive care, including support for treatment adherence;

·         And universal viral suppression

CDC has published resources to educate and advise providers – including 2014 clinical guidelines, step-by-step PrEP checklists and interview guides – and supports a hotline to answer providers’ questions about when and how to offer PrEP.

Visit CDC for more information.

Are doctors prescribing generic drugs often enough? This group says no

Doctors should more diligently prescribe generic medicines whenever possible, both to help contain rising prescription drug costs and to improve the chances that patients will adhere to their therapies, a top physicians group said Monday.

Generic drugs now account for roughly 88 percent of prescriptions in the United States, even though they amount to less than a third of the more than $325 billion Americans spend each year on prescription drugs. But the American College of Physicians says doctors should be using generics even more often than they already do.

"While the use of generic drugs has increased over time, clinicians often prescribe more expensive brand-name drugs when equally effective, well proven and less expensive generic versions are available," Wayne J. Riley, president of the American College of Physicians, said in a statement.

Researchers detailed several reasons in a paper published Monday in the group's journal, Annals of Internal Medicine.

One key hurdle is that some patients -- and even some doctors -- perceive lower-cost generic drugs as inferior and associate them with lower effectiveness, despite evidence that most work just as well as their brand-name counterparts. In addition, the report found many physicians still refer to drugs by their original brand name, even long after generic versions become available, which can result in them inadvertently prescribing of more expensive drugs.

Some doctors also reported prescribing brand-name drugs rather than existing generics because a patient requested it. "The likelihood of this behavior was significantly higher for physicians who also reported that they received industry-provided food and samples or who met with [brand name] representatives," wrote the authors, who studied years of past research on the topic.

They said the consequence of such practices likely amounts to billions in lost savings. For instance, they cited a study of Medicare beneficiaries with diabetes, which found that 23 percent to 45 percent of prescriptions, depending on drug class, involved brand-name drugs for which identical generics existed. That rate was far higher than for similar patients treated by the Veterans Affairs system, which has a centrally managed formulary that encourages greater generic-drug use.

The recommendations come at a time when the high cost of prescription drugs has become a topic of national interest. The Obama administration had an all-day gathering on the topic last week, presidential candidates have floated ideas of how to rein in high prices, and a Senate committee plans to hold a hearing on the issue soon.

The authors of Monday's study excluded any evaluation of "biosimilars," which are copycat versions of complex biologic drugs. Only one biosimilar drug has received approval in the United States -- a cancer treatment approved earlier this year -- but the Food and Drug Administration has received a growing number of biosimilar applications.

Visit the Washington Post for the story.

Bacteria resistant to colistin discovered

Chinese scientists have reportedly identified a gene that makes Enterobacteriaceae, a family of gram-negative bacteria, resistant to “last-resort” drugs known as polymyxins. The polymyxins (colistin and polymyxin B) were the last class of antibiotics in which resistance was incapable of spreading from cell to cell. These have become known as “last resort” antibiotics, increasingly used to treat infections that resist every other kind.

“Although now confined to China, MCR-1 is likely to emulate other resistance genes… and spread worldwide”. This gene was found on a piece of bacterial DNA that can be transferred between bacteria.

Should bacteria become completely resistant to treatment, it could plunge the world into what the BBC refers to as “the antibiotic apocalypse”, a period in which common infections could be fatal because medicine proves ineffective, and surgeries and cancer treatments requiring antibiotic use would be placed in jeopardy.

“These are extremely worryingly results”, said Liu Jian-Hua, a professor at China’s Southern Agricultural University and co-author of the study. (It’s encouraging that such a project exists.) They say they first perceived a colistin-resistant E. coli in 2013, in a pig from an intensive farm near Shanghai, and then noted increasing colistin resistance over several years.

This prompted the researchers to collect bacteria samples from pigs at slaughterhouses across four provinces and from pork and chicken sold in 30 open markets and 27 supermarkets across Guangzhou between 2011 and 2014. On further examination, the researchers also found mcr-1-containing plasmids in E. coli and Klebsiella pneumoniae isolated from a small number of patients in hospitals in Guangdong and Zhejiang provinces. The MCR-1 gene was also found in E. coli collected from 78, or 15 percent of 523 samples of raw meat and 166 or 21 percent of 804 live animals.

Professor Laura Piddock, from the campaign group Antibiotic Action, said the same antibiotics “should not be used in veterinary and human medicine“. So the development of resistance to colistin may have affected the bacteria discovered by the team in China in other ways – ways that are more harmful to the bacteria than beneficial.

The World Health Organization (WHO) classified Colistin in 2012, as the most broadly used polymyxin and the most important for human health.

The lower infection rate among humans suggests the resistant bacteria passed from animals to people, the study found.

Worse still, MCR-1 enables the bacteria to spread easily from one strain or species to another, according to the study by the researchers which was published in the respected medical journal Lancet Infectious Diseases.

Chinese scientists identified bacteria in a position to shrug off the drug – colistin – and livestock.

Visit Rapid News for the story.

U.S. system to detect bioterrorism can't be counted on, government watchdog finds

The nation’s main defense against biological terrorism — a $1-billion network of air samplers in cities across the country — cannot be counted on to detect an attack, according to a new report by the Government Accountability Office.

The BioWatch system, introduced with fanfare by President George W. Bush in 2003, has exasperated public health officials with numerous false alarms, stemming from its inability to distinguish between harmless germs and the lethal pathogens that terrorists would be likely to unleash in an attack.

Timothy M. Persons, the GAO’s chief scientist and lead author of the report, said health and public-safety authorities "need to have assurance that when the system indicates a possible attack, it’s not crying wolf." U.S. Homeland Security officials cannot credibly offer that assurance, he said.

The Department of Homeland Security, which oversees BioWatch, has repeatedly touted the system's effectiveness while seeking to upgrade it with new technology.

The GAO report challenges the department's central claims about BioWatch. It also illuminates the nation's vulnerability to biological terrorism at a time of heightened concern about the reach and resourcefulness of Islamic State and other extremist groups.

The 100-page document, scheduled for release Monday, says that Homeland Security "lacks reliable information" about BioWatch's "technical capabilities to detect a biological attack." The Los Angeles Times obtained a copy of the report.

The government has never defined the minimum capabilities, or "performance requirements," needed for BioWatch to alert authorities to a deliberate release of deadly pathogens and not be fooled by similar but benign bugs that are pervasive in the environment, according to the report.

BioWatch relies on about 600 air-collection units stationed atop buildings, in transit stations and in other public places in more than 30 urban areas. Mobile units are deployed at some major spectator events, such as the Super Bowl.

Each of the units, about the size of a small refrigerator, sucks in air and blows it over a disposable filter. Once every 24 hours, a technician removes the filter and delivers it to a public health lab for analysis. Lab personnel look for a DNA match with anthrax or any of four other pathogens considered likely to be used in a biological attack.

BioWatch was developed by U.S. national laboratories and government-hired contractors. Its deployment was accelerated after anthrax-laced letters were sent through the U.S. mail in the fall of 2001, infecting more than 20 people and killing five. The letters were ultimately traced to a U.S. Army scientist, Bruce E. Ivins, who committed suicide in 2008 as authorities prepared to seek an indictment against him.

The GAO study was requested by members of Congress after a 2012 Los Angeles Times investigation identified serious shortcomings in BioWatch, including the many false alarms and doubts about whether the system could be relied on to detect an actual attack.

Visit the Los Angeles Times for the report.

Uber delivers flu shots in 36 cities, in one-day experiment

For four hours last week, people in Boston and 35 other cities had the opportunity to summon a nurse to their doorstep to give them a flu shot.

This experiment in “on-demand healthcare,” which involved the use of hundreds of Uber drivers, heralds what some consider the wave of the future: bringing healthcare to the people, instead of waiting for them to come and get it.

The project, dubbed UberHEALTH, was the brainchild of John S. Brownstein, a researcher at Boston Children’s Hospital and Harvard Medical School who develops technologies that track and promote public health.

“The concept of bringing on-demand services…bringing physicians and nurses to people has so many opportunities,” Brownstein said. Startup companies are enabling people to order home visits from medical professionals, he said. For example, PediaQ, available in four Texas communities, provides an app parents can use to summon a pediatric nurse practitioner to their homes during evenings and weekends.

The Uber project is an outgrowth of Brownstein’s HealthMap Vaccine Finder, a website that provides a list of recommended vaccines, tailored to the individual, and locations nearby where the vaccine can be obtained.

But no matter how easy it gets, most healthy young adults can’t be bothered getting a flu shot, with only 30 percent of 18- to 49-year-olds getting vaccinated.

The demand proved greater than the supply of vaccine, and many customers were disappointed, Brownstein said. Still, more than 2,000 got vaccinated in that 2014 pilot. In a survey afterward, 78 percent of respondents said having the vaccine delivered was important to their decision to get the shot.

Uber expanded the one-day flu-shot program to 36 cities, including Philadelphia, Houston, Des Moines, and Los Angeles, where the service was available from 11 a.m to 3 p.m. Thursday. It was offered only for a short time because of limited resources and the need to gauge patient demand, Brownstein said. Uber declined to say whether it would offer the service again.

“UberHEALTH” was one of the options at the bottom of the Uber app. An ad popped up, saying, “Get one $10 wellness pack and a registered nurse will offer free flu shots for up to 10 people.” The “wellness pack” is a bag with trinkets such as hand sanitizer and a water bottle. When someone clicked to order it, the driver receiving the request gave the information to a nurse, who called to confirm the request and ask if the customer also wanted a flu shot.

Upon arrival, the driver waited in the car, while the nurse went inside to handle paperwork and administer the shot at no additional charge. Up to 10 people could be vaccinated at each site; workplaces were among the sites visited. The nurses were employees of Passport Health, a national company that specializes in running immunization clinics and providing vaccines. Epidemico, a public health data-mining company that Brownstein helped found, bought the vaccines and shared the operational costs with Uber.

Visit the Boston Globe for the story

Healthcare Purchasing News wishes you a Happy Thanksgiving!

The HPN staff wishes you all a wonderful and blessed Thanksgiving with your own families and friends. I know my staff at HPN has special plans with their families this Thanksgiving and I (Kristine Russell) was blessed with a new grandson this last Sunday and will enjoy spending time with him and my daughter and son-in-law this weekend.

I hope you all have the same opportunity to do something wonderful with the ones you love. We will be back with the Daily Update on Monday, November 30.