The Spread of Superbugs

superbugs on the riseThe U.S. Centers for Disease Control and Prevention has just published a first-of-its-kind assessment of the threat the country faces from antibiotic-resistant organisms.

And the news is not good.  In fact it’s downright scary. The agency’s overall conservative assessment of the problem includes frightening statistics such as:

  • Each year, in the U.S., 2,049,442 illnesses caused by bacteria and fungi that are resistant to at least some classes of antibiotics
  • Each year, out of those illnesses, there are 23,000 deaths
  • Each year, those illnesses and deaths result in $20 billion of additional healthcare spending
  • Each year, an additional $35 billion lost to society in foregone productivity.

The report marks the first time the agency has provided hard numbers for the incidence, deaths and cost of all the major resistant organisms. It also represents the first time the CDC has ranked resistant organisms by how much and how imminent a threat they pose, using seven criteria:

  • health impact
  • economic impact
  • how common the infection is
  • how easily it spreads
  • how much further it might spread in the next 10 years
  • whether there are antibiotics that still work against it
  • whether things other than administering antibiotics can be done to curb its spread

antibiotic resistant bacteriaOut of that matrix, their top three “urgent” threats they identified were:

multi-drug-resistant-pseudomonas-aeruginosa-horizontal-galleryIn addition, the CDC identified 12 resistant bacteria and fungal infections which the agency dubs “serious” i.e., requiring “prompt and sustained action.”  They include the hospital-acquired infections  Acinetobacter, Pseudomonas aeruginosa, and Vancomycin-Resistant Enterococcus (VRE) ; the foodborne organisms CampylobacterSalmonella and Shigella; MRSACandida and TB.

The last category, “concerning” i.e., requiring “careful monitoring and prevention” includes rare but potent vancomycin-resistant staphylococcus aureus  (VRSA), as well as strains of streptococcus resistant to two different categories of drugs.

For each organism, the report explains why it is a public health threat, where the trends are headed, what actions the CDC is taking, and what it is important for health care institutions, patients and their families, and states and local authorities to do to help.

Commenting on the report, Ed Septimus MD, professor of internal medicine at Texas A&M Health Sciences Center in Houston says “It’s up to us to make the recommendations in this report happen. If we do nothing but say, ‘Here’s the problem,’ then the problem will continue to grow.”

Well said Doctor, well said.

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Infection control controls costs

Aside from blogging, SRxA duties, and volunteering as an EMT, once a month I teach infection control to Fire and Rescue personnel.  During classes I stress the importance of the basics – training, hand-washing, good hygiene While most students probably forget the more scientific aspects of my lectures, they all remember the advice “if it’s wet, sticky and it’s not yours, don’t touch it!”

I was therefore interested, but not altogether surprised, to read a new study published in the September 2011 issue of Health Affairs, which showed that simple infection control measures could save thousands of lives and billions of dollars.

According to the U.S. Department of Health and Human Services at any given time, one of every 20 hospital patients has a hospital-acquired infection. This leads to an estimated 99,000 deaths in the U.S. each year and up to $33 billion in preventable health care costs.

The study, undertaken by researchers at the University of North Carolina at Chapel Hill, tested three interventions aimed at preventing and reducing hospital acquired infections.

The first intervention was strict enforcement of hand hygiene practices. All health care workers were expected to wash their hands with soap and running water or an alcohol-based rub on entering and leaving a patient’s room, before putting on and after removing gloves, and before and after any task that involves touching potentially contaminated surfaces or body fluids.

The second intervention was aimed at preventing ventilator-associated pneumonia and included measures such as elevating the head of the patient’s bed while the patient was on a ventilator, giving the patient daily breaks from sedation to assess whether or not the patient is ready to come off the ventilator, and providing daily oral care (teeth brushing, mouth washes, etc.) with a long-lasting antiseptic.

The final intervention was ensuring compliance with guidelines for the use and maintenance of central-line catheters. Examples included using sponges impregnated with an antiseptic, using catheters impregnated with antibiotics whenever possible, and performing two assessments per day of whether patients with central-line catheters still needed them.

Results showed that patients admitted after these interventions were fully implemented got out of the hospital an average of two days earlier, their hospital stay cost about $12,000 less and the number of patient deaths were reduced by two percentage points.

The costs for implementing these measures were modest – less than $22 / patient/day. However, adoption of the three interventions could potentially save thousands of lives and billions of dollars each year and improve the care of all patients.  Proving once again, it’s sometimes the simple things in life that are the most effective.

Hospital errors affect 1:3 patients

How common are hospital errors?

A shocking new study suggests that the number of “adverse events” befalling patients in U.S. hospitals may be 10 times higher than previous estimates.

If the authors are correct, this would mean that medical mistakes affect one in three people hospitalized  in the US. The study, published in the journal Health Affairs involved a review of almost 800 patient charts at three U.S. hospitals. Using a review technique known as the “global trigger tool,”  researchers detected a whopping 354 adverse events. Scarier still,  that figure might actually understate the enormity of the problem as it was based on potentially incomplete medical records rather than on direct observation in real time.

Dr. David C. Classen of the University of Utah believes his study gives a more reliable tally of hospital errors than other studies, including a 1999 landmark study from the Institute of Medicine entitled To Err is Human showing that hospital errors caused up to 98,000 Americans each year.

So what sorts of events were uncovered in the new review? According to Classen, there were three big ones:

The question many are now asking: is the new estimate accurate?

It is hard to know that to make of the trigger tool,” admits Dr. Peter J. Pronovost, a Professor in the Johns Hopkins University School of Medicine (Departments of Anesthesiology and Critical Care Medicine, and Surgery) and Medical Director for the Center for Innovation in Quality Patient Care.

However, “Far too many patients suffer preventable harm in the U.S.” he added.

Other recent studies appear to confirm Classen’s findings.

Earlier this month the US government released data for the first time, showing how often patients are injured by certain medical errors in hospitals.  However, only eight types of serious, preventable errors were included in the comparison.

They were: air in the bloodstream, falls, bedsores, transfusions with the wrong blood type, urinary tract infections, blood infections, uncontrolled blood-sugar levels and foreign objects left in the body after surgery.

Other serious events, including wrong-site surgeries and medication errors, were not included.

And late last year, the Office of Inspector General for the U.S. Department of Health and Human Services said 180,000 Medicare recipients die each year from hospital mistakes. That’s more people than are killed every year in car crashes, or from diabetes or pneumonia.

Without doubt, health care has improved over the past decade, but it’s clear that there is still a great deal of work to do in order to achieve a health care system that safe, effective, patient-centered, efficient, timely, and devoid of disparities based on race or ethnicity.

Until then, SRxA’s Word on Health advises that if you think something is amiss or wrong with your hospital care, speak up.