INS 2011

Posted on by Greg Dennis

The annual meeting of the Infusion Nurses Society attracted hundreds of nurses from all over the  world for  its May gathering in Louisville, Ky.  With Medicare no longer reimbursing for hospital-acquired infections such as  Central-line associated bloodstream infections (CLABSI’s), nurses were especially interested in new technologies to reduce these potential deadly infections.

One of the technologies drawing considerable attention was SwabFlush, from Excelsior Medical (a Dowling & Dennis client). SwabFlush combines the SwabCap disinfection cap for needleless IV Connectors with a flush syringe. More information at www.swabflush.com.

Video of Tony Saia (VP of Global Marketing for Excelsior) demonstrating SwabFlush during INS:

Study Shows Promise of Disinfection Cap as Weapon in the War on Infections

Posted on by Greg Dennis

For years, efforts to reduce central-line associated bloodstream infection (CLABSI) rates have focused on relatively complex initiatives – including “bundles” of evidence-based practices and technologies that together create multi-layered protection against infections. Now, the early results of a prospective, peer-reviewed clinical trial suggest that the use of a simple but ingeniously designed device can contribute to improved disinfection and allow for reduced CLABSIs.

That device – SwabCap® by Excelsior Medical – is also known as a disinfection cap. SwabCap supplements manual disinfection of IV connectors, long thought to be a weak point in CLABSI prevention because the method is subject to variation and noncompliance. The study results were recently reported at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA).

Early results of the prospective, peer-reviewed clinical trial demonstrated that SwabCap® improved disinfection and allowed for reduced central-line associated bloodstream infection rates of more than 79%. Those improvements were seen in the four-hospital NorthShore University HealthSystem (Evanston, Ill.) after SwabCap was implemented for use on all central lines.

Notably, the gains were made even though the hospitals already had a low rate CLABSI rate of 1.95 per 1,000 catheter days before SwabCap was tried.

NorthShore also studied the device’s effectiveness a second way: it compared the density of colony-forming units (CFUs) of bacteria in blood samples when SwabCap was used to CFUs in samples when it wasn’t. During the SwabCap phase of the research, contaminated samples were 75% less dense with bacteria.

The new data is the most extensive ever gathered on SwabCap. The device is in use at multiple institutions, sometimes allowing for a drop in infection rates that is even more dramatic than at NorthShore. More at http://www.swabcap.com.

IV Connectors: Younger Nurses May Be More Diligent Cleaners

Posted on by Greg Dennis

We often think of young people as rebels and their elders as better at following rules. But the opposite is true in American hospitals, a new study says – at least when it comes to disinfecting IV connectors.

Recent graduates of nursing school were more likely “to consistently use optimal disinfection techniques” than were more experienced nurses, according the study, in the May-June issue of the Journal of Infusion Nursing,.

The research examined whether younger or more experienced nurses adhered more closely to the “scrub-the-hub” manual method for disinfecting connectors. The method requires nurses to scrub the connector hubs with alcohol for up to 10-15 seconds and then wait up an additional 30 seconds for the alcohol to dry before accessing the line.

This protocol is widely recommended by infection control experts, but it must be performed meticulously to have any chance of being effective. The method’s several steps mean that variation is common, and busy nurses are known to sometimes skip disinfection altogether. The consequences of variation or noncompliance are great because incomplete disinfection increases the risk for sometimes deadly central line-associated bloodstream infections (CLABSIs).

The study found that nurses just out of school were more likely to perform the protocol exactly as it was taught – a good thing. The more experienced nurses, conversely, rated higher than younger nurses in such qualities as autonomy and “self-efficacy” (essentially, belief in one’s own competence). One can assume from this that more experienced nurses felt more free to stray from the protocol – not a great idea in this case and one that put patients in danger.

The findings may point toward one reason hospitals should be using a disinfection cap such as SwabCap® to supplement manual disinfection. SwabCap, from our client Excelsior Medical, is ingeniously designed to eliminate variation and noncompliance.

By prolonging the hub’s contact with alcohol, it may also increase the bacteria kill over manual methods, especially when compliance with the manual method is not optimal.

Considering what’s at stake, it seems to us that using the cap is a no-brainer – even if a nurse just graduated magna cum laude.

– END –

Vascular Access Group on LinkedIn

Posted on by Greg Dennis

LinkedIn is a tremendous information resource for professionals. But for the most part those in nursing – especially professionals with an interest in infusion therapy and vascular access – have been underrepresented on LinkedIn.

No more! We’ve just established a new forum for vascular access professionals on LinkedIn. It’s open to anyone interested in the field, who wants to read or post about issues and questions pertaining to vascular access.

We hope you’ll consider joining the group. To do so, go to http://www.LinkedIn.com. Join LinkedIn if you are not already a member, then search the “Groups” function for the phrase “vascular access.”

Thanks, and we hope to see you over on LinkedIn soon.

Healthcare IT’s Failings: Even the Onion Has Noticed

Posted on by Greg Dennis

How far behind is healthcare in the full and efficient use of information technology?

So far behind that even The Onion has noticed.

The satirical newspaper and website normally focuses on “stories” such as Joe Biden’s fascination with hot babes and his muscle car. Recently, though, The Onion took aim at the shortcomings of healthcare IT with an article titled “Quick-Lube Shop Masters Electronic Record Keeping Six Years Before Medical Industry.” Written in typical Onion style that makes it seem like an actual news report, the article quotes a fictitious garage owner:

‘We figured that a basic database would help us with everything from scheduling regular appointments to predicting future lubrication requirements,’ said the proprietor of the local oil-change shop, Karl Lemke, who has no special logistical or programming skills, and who described his organizational methods, which are far more advanced than those of any hospital emergency room, as ‘basic, common-sense stuff.’

‘We can even contact your insurance provider for you to see if you’re covered and for how much, which means we can get to work on what’s wrong without bothering you about it. The system not only saves me hundreds of thousands of dollars per year, but it saves my customers a bundle, too.’

And here’s the part that really hurts: “Lemke added that he also routinely and politely inquires about his customers’ health and well-being, which puts him roughly 145 years ahead of the medical industry.”

Of course things aren’t nearly as bad as The Onion makes them out to be.

Thanks to the efforts of cloud computing pioneers such as eMix and others, things are in fact getting better. And hundreds of millions of federal stimulus dollars are flowing into healthcare to get MDs’ office online and to computerize and interconnect hospitals’ records through PACS and other technology.

But as one wag said about The Onion story to blogger Neil Versel, the current status of medical industry It is “so pathetic that a bunch of young joke writers in NYC who almost never go to the doctor have noticed.”

CMS Gets Tough on Infection Reporting

Posted on by Greg Dennis

Ushering in the new year in its own way, the Centers for Medicare and Medicaid Services (CMS) has dropped a hammer on hospitals. A new rule requiring hospitals to report certain central line-associated bloodstream infections (CLABSIs) went into effect last month.

Specifically, the rule states that hospitals must now report the number and rate of adult patients in their intensive care units who get CLABSIs — or the hospitals’ Medicare payments will be reduced by two percent.

We first wrote about this rule in our October 27, 2010 post and you can read the rule’s details there. Part of the rule requires the infection data to be publicly reported on the government’s website, HospitalCompare.hhs.gov. That part of the rule will go into effect later this year.

At Dowling & Dennis, we applaud CMS’ report-or-pay approach. In fact, we think they should carry it a little farther. For instance, the rule only concerns patients in ICUs. We think it should apply hospitalwide.

Even at this point, though, we think this national incentive will be a useful supplement to the patchwork of state reporting laws. There are 27 states that make infection reporting mandatory, with two more that require confidential reporting, and three that have voluntary reporting systems. We expect that the CMS rule will push most hospitals across the country to divulge their infection data.

After all, two percent of Medicare payments is real money.

We’ve learned how important the CLABSI issue is because several of our current or former clients — including Excelsior Medical (SwabCap), Johnson & Johnson (Biopatch), RyMed Technologies (InVision-Plus), and Venetec International (StatLock) – produce medical devices shown to reduce CLABSI risk. Much of our effort the past several years has been to promote the use of these safer technologies.

Where these devices have been implemented, CLABSIs have generally gone down – dramatically. CLABSIs still kill 31,000 U.S. patients per year – in part, because hospitals aren’t adopting such devices fast enough, as many infection control experts have testified.

The CMS rule has several things going for it. For one thing, the data that hospitals report to HospitalCompare will be based on objective, CDC-defined criteria. That isn’t always the case with some state reporting requirements, so that when a consumer compares Hospital A’s infection rate to Hospital B’s, they’re actually comparing apples to oranges. The CMS rule should get us close to apples-to-apples comparisons.

Also, many consumers who have to be hospitalized are likely to go to HospitalCompare to find the safest facilities. You would think all institutions will want a presence in that online system – a presence that includes a low CLABSI rate. This is CMS’s hope, and ours.

Contaminated Alcohol Swabs: One More Reason to Use Disinfection Cap

Posted on by Greg Dennis

There were already real concerns about the use of alcohol swabs to disinfect needleless IV connectors. Now here comes another one: The pads themselves can be a source of potentially deadly contamination.

The FDA announced Jan. 5 that Triad Group, a Hartland, Wis. manufacturer, was voluntarily recalling all lots of its alcohol prep pads, alcohol swabs, and alcohol swab sticks because they might be contaminated with the organism Bacillus cereus. Use of any of these products, if contaminated, “could lead to life-threatening infections, especially in at-risk populations, including immune-suppressed and surgical patients,” the FDA’s press release said.

Triad products are widely used in the healthcare marketplace, not just under the Triad name but also as private-labeled products for corporate customers. In addition, various companies include them in their medical product packages – which is why corporations such as Bayer and Genentech are informing their customers about the recall and warning them not to use the Triad alcohol products packaged with their medicines.

Even before this brouhaha, many infection control professionals worried about the use of alcohol swabs to disinfect IV connectors. Hospitals generally require that connectors be disinfected before a clinician accesses an IV line for a blood draw or to inject nutrients or medication. The traditional method involves scrubbing the port with an alcohol swab for 10-15 seconds and then waiting for the alcohol to dry before accessing the line.

Even if the swabs are sterile, this somewhat complicated, time-consuming method is prone to variance and noncompliance, which increases the chances of a potentially fatal bloodstream infection.

“Alcohol prep pads are only as good as the person using them. Prep pads are rarely used long enough or with enough friction to cover all surface areas,” says Nancy Moureau, vascular access specialist with PICC Excellence (Hartwell, Ga.)

The best way to avoid the pitfalls of alcohol scrubbing – not to mention contaminated swabs – is to use a disinfection cap such as SwabCap (Excelsior Medical, a client of Dowling & Dennis). SwabCap twists onto the threads of the connector. Its patent-pending design keeps the entire port bathed in alcohol, an ideal disinfection scenario.

Because it is left on between line accesses, it also protects against contamination of the port during that time, something that even meticulous scrubbing can’t do. Variation in technique – a recognized source of infection risk with alcohol pads — is virtually impossible, because the cap twists on one way, like a nut onto a bolt. Compliance is simple to verify. If the bright orange cap is attached to the port, compliance has occurred. No wonder we’ve seen bloodstream infection rates plummet at one hospital after another when they adopt the device.

Hospitals that use alcohol swabs to scrub connectors are busy emptying their shelves of Triad alcohol products if they stocked them. But they still have to fret about variation in technique, noncompliance with the alcohol-pad protocol, and contamination between line accesses.

Hospitals that use disinfection caps like SwabCap, by comparison, know they have an extra measure of protection and disinfection.

Patient Safety Gets a Certification Program — At Last

Posted on by Greg Dennis

More than a decade after patient safety hit the national agenda with the publication of the Institute of Medicine’s “To Err Is Human” report, someone is finally putting together a certification program for professionals involved in ensuring patient safety.

The leading group in this field, the National Patient Safety Foundation (NPSF), has just launched the certification program. It’s designed to standardize a curriculum, elevate the profession and share best practices.

“Patient safety is a top priority for our healthcare system,” said Dr. Lucian L. Leape, chair of the Lucian Leape Institute at NPSF. “But we will not be able to truly move the needle until those who are involved in the practice have the knowledge base necessary to do the job. The certification program is an essential element in that quest.”

Dr. David Shulkin attempted as far back as the late 1990s to highlight the profession through creation of the Patient Safety Officers Society. PSOS got some early traction but hasn’t been active for several years. Dr. Shulkin is now president of Morristown (N.J.) Memorial Hospital and vice president of its parent, Atlantic Health.

This time around, NPSF reports, membership in the American Society of Professionals in Patient Safety is open to professionals whose primary responsibility is patient safety as well as others across the healthcare disciplines.

Our view: The patient safety field represents the essential nexus of numerous healthcare fields, and NPSF’s new initiative represents a major step forward in better protecting patients. More details at http://npsf.org/pr/pressrel/2010-12-22.php.

 

Social Media As Personal Health Record

Posted on by Greg Dennis

People share a lot about themselves on Facebook and other social media — so much so that social media can even be a lifesaver. See this account of a recent case where doctors were able to save the life of a comatose woman with whom they couldn’t communicate — because she had recorded her health problems on her Facebook page: http://aol.it/gQH9WP.

We’ve heard a lot about teens and others who “overshare” on Facebook. But this woman’s postings probably saved her life.

Reporting this case, Newt Gingrich and a neurosurgeon who authored the article said: “A personalized system that puts the individual at the center and helps us make decisions based on the needs of the individual will become even more accessible — and more important — as the digital world expands in ways that can save lives and save money.”

We can all hope that with individuals “at the center,” though, there’s still plenty of room for knowledgeable clinicians to bring their expertise and technology to bear on individuals’ health problems.

Informed patients clearly will play a much greater role in the healthcare of the future. Regarding the social media part of that equation, the always interesting HISTalk blog on healthcare information technology (http://histalk2.com) comments:

“Since Facebook is taking over the world, maybe it makes sense to create a PHR (personal health record) add-on for it since Microsoft and Google aren’t getting anywhere with theirs. … After all, a new survey shows that 72% of adults in England check Facebook in bed right before they go to sleep.”

Patient Safety and Cloud Computing

Posted on by Greg Dennis

There are loads of advantages to cloud-based sharing of medical data, but bottom-line, it’s about patient safety, says radiologist Murray Reicher, M.D.

Writing in the latest issue of Patient Safety & Quality Healthcare (“Riding the Cloud to Improve Patient Safety,” November/December 2010), Reicher says that sharing data via the cloud makes it possible to move information much faster than old methods. This can save patients from unnecessary procedures and radiation – and in emergency cases, potential injury from delayed treatment. (Full article at http://psqh.com/novemberdecember-2010/684-information-exchange.html.)

Dr. Reicher is the founder and chairman of DR Systems, which created eMix, one of the first of the new cloud-based medical information sharing services. He’s also a practicing radiologist.

In the article, Dr. Reicher describes a number of common scenarios that can harm patients because the conventional ways of sharing data – such as burning files to CDs and sending them by express mail – are too slow and clumsy. For instance, if doctors assigned to an emergency patient need to see a prior CT scan from another facility before starting treatment, the patient’s condition could worsen while they wait. In other circumstances, facilities might re-image a patient whose files can’t be obtained in time, which exposes the patient to extra radiation.

Cloud-based data-sharing such as eMix addresses all these situations because it moves data quickly on the Internet, which also overcomes the hurdle of incompatible, proprietary IT systems at different facilities. It is also secure, trackable, and affordable because it is priced on a low, per-use basis without any software or hardware purchase. It is versatile, too. Besides medical institutions, the files can be pushed to patients’ computers, doctors offices, and other remote locations.

“The limitation is no longer the technology itself but simply the speed of adoption,” Reicher writes. The rest of the business world is catching on – 20 million businesses and more than a billion people use cloud-based services, he says, citing a Microsoft claim. His gentle nudge to his own industry: Get with the program!

Full article — http://psqh.com/novemberdecember-2010/684-information-exchange.html.