Archive for the ‘Infection control’ Category

West Nile Virus is Back in D.C. -Things You Should Do to Stop the Spread

Wednesday, October 12th, 2011

Last week, the D.C. Department of Health confirmed this year’s first case of West Nile Virus (WNV). WNV is a bird disease. However, infected mosquitoes can transmit the virus to humans. Otherwise, this disease cannot be transmitted directly from a human or a bird.  Persons infected with the West Nile Virus may experience severe headaches, fever, nausea, vomiting, muscle aches, pain, and stiffness.

While the risk of a WNV infection is low, individuals who are immunocompromised should be particularly careful and seek medical attention if symptoms are present. Individuals with weak or suppressed immune systems include the elderly, young children and those prone to infections (e.g., HIV/AIDS patients).  The key is to implement measures to reduce exposure to mosquitoes. Individuals at risk should wear long-sleeved shirts and pants. Mosquito repellent should be used as well.

Every year, the Department of Health conducts WNV testing throughout the District, particularly in areas where infections have been reported. If you live in an affected area, you might receive additional information from the Department. Larvicide may be sprayed in your neighborhood. Should you require additional information about WNV, feel free to contact the D.C. Department of Health.

In the meantime, while mosquitoes are still flying around, here are a few things you could do stop the spread of the WNV:

1.  Dispose of cans, bottles and open containers properly.  Store items for recycling in covered containers.
2.  Remove discarded tires. Drill drainage holes in tires used on playground equipment.
3. Clean roof gutters and downspouts regularly.  Eliminate standing water from flat roofs.
4. Turn over plastic wading pools, wheelbarrows, and canoes when not in use.
5. Cover waste containers with tight-fitting lids; never allow lids or cans to accumulate water.
6. Flush bird baths and potted plant trays twice each week.
7. Adjust tarps over grills, firewood piles, boats or swimming pools to eliminate small pockets of water from standing   several days.
8. Re-grade low areas where water stands; clean debris in ditches to eliminate standing water in low spots.
9. Maintain swimming pools, clean and chlorinate them as needed, aerate garden ponds and treat with “mosquito dunks” found at hardware stores.
10. Fix dripping water faucets outside and eliminate puddles from air conditioners.
11. Store pet food and water bowls inside when not in use.

Please share this information with your friends and neighbors.

Week in Review: (July 2 – July 9, 2011) Eye Opener Health, Law and Medicine Blog

Saturday, July 9th, 2011

Eye Opener’s Week in Review

From the guest editor:         Good morning! I was hoping that you would take a break from making your “to do” list to stop by and check in with us. As usual, we have been busy blogging. And practicing law. And getting ready for trial. And in trial! Needless to say, we have been pushing it to the limits. In truth, we wouldn’t have it any other way. Before we get back to trial preparation, lets take a step back and look at the past week.

–Jason Penn, guest editor

Litigating for the Sake of Litigating: A Temptation to Be Resisted

By Jon Stefanuca

What do you do when your opposing counsel forgets that the practice of law is a profession and not a blood sport? What do you do when the phase “zealous representation” gets confused with “obnoxious obstructionist behavior?” When faced with similar frustrations, Jon Stefanuca broke out his keyboard and explained what we litigators deal with on a day to day basis. Being a lawyer is a very rewarding profession, but like any other, it has its share of frustrations. Don’t take my word for it, read more…

Can Copper Surfaces and Duct Tape Reduce Hospital Infections and Deaths?

By Sara Keogh

Germs are in your kitchen.  They are in your bathroom and your bedroom.  They are on your fingertips and even on your tongue.  And everyone knows that there are going to be germs in hospitals. Even the best hospitals have to work to keep the patients, rooms and visitors clean and safe.  Sara Keogh reported on news that may make keeping hospitals and other health care environments less germy in the future. Two simple solutions, copper and duct tape, might have a major impact on infection control.  Read more…

Sneak Peak of the Week Ahead:

The Eye Opener and its writers are excited about the week ahead too!  Here’s a sneak peak of what’s in store for you:

  • Service dogs for children:  more than just a pet
  • Legal Boot Camp is back in session and Part IV of our Cerebral Palsy tutorial.
  • And more!

Images courtesy of:

www.lifehack.org

www.mountainpulse.blogspot.org

 

Can Copper Surfaces and Duct Tape Reduce Hospital Infections and Deaths?

Thursday, July 7th, 2011

Image from medgadget.com

How many times have you heard about someone entering the hospital healthy, or relatively so, and developing a dangerous infection while hospitalized? What about the number of times that you may have visited your own doctor’s office or your child’s pediatrician’s office and wondered whether the cold you got a few days later was coincidence or the result of having been in the waiting and exam rooms following other sick patients? Have you ever considered what cleaning procedures are done in hospital rooms when one patient is discharged before another takes their place?

In the past, Brian Nash and the other legal bloggers here at Eye Opener have written posts and made mention of the importance of hospital cleanliness and sterility, see the related posts below. We have been involved in cases involving the devastating results of infections. However, everyone knows that there are going to be germs in hospitals. Even the best hospitals have to work to keep the patients, rooms and visitors clean and safe.

Well, there is news that may make keeping hospitals and other health care environments less germy in the future. Two recent articles have focused on seemingly simple solutions, copper and duct tape, that may have major impacts on infection control.

Copper Surfaces Dramatically Reduce Infections by Killing Bacteria

A Reuters’ article reports that a recent study “presented at the World Health Organization’s 1st International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland” shows that “replacing the most heavily contaminated touch surfaces in ICUs with antimicrobial copper will control bacteria growth and cut down on infection rates.” According to the Reuters’ article:

[a]ntimicrobial copper surfaces in intensive care units (ICU) kill 97 percent of bacteria that can cause hospital-acquired infections, according to preliminary results of a multisite clinical trial in the United States. The results also showed a 40 percent reduction in the risk of acquiring an infection.

This news could have a profound impact on health-care costs, disease spread, and most importantly lives lost. If hospitals are able to replace some of their current surfaces with copper surfaces, at least in the parts of the hospital that are most frequently the source of infections, there could be a dramatic improvement in hospital-acquired infections.

Hospital-acquired infections (HAIs) are the fourth leading cause of death in the United States behind heart disease, strokes and cancer.

According to estimates provided by the Centers of Disease Control and Prevention, nearly one in every 20 hospitalized U.S. patients acquires an HAI, resulting in 100,000 lives lost each year.

From Reuters

Perhaps even more infections could be prevented if these changes could be made outside of just ICUs. For instance, perhaps copper surfaces could replace highly touched surfaces on sink handles, the doors to hospital rooms, hospital bed rails, or in out-patient surgery centers and long-term care facilities that are not housed within hospitals.

Duct Tape Warnings Keep Others Far Enough Away from Infected Patients

Image from ducttapesales.com

An article from Medicalnewstoday reports that some hospitals are using plain duct tape – just colored red – to achieve a reduction in infection rates from highly infectious patients without having to deal with the hassle and expense of all visitors or hospital personnel who enter the room having to rescrub and use new gowns every time they enter the room of an infected patient. The study looked at highly infectious diseases like C. diff that require isolation of patients and very careful hand washing to avoid spreading the infection. So how does duct tape help?

The Association for Professionals in Infection Control and Epidemiology (APIC) commissioned a study to corner off a three foot perimeter around the bed of patients in isolation. Medical personnel could enter the room unprotected if they stayed outside the perimeter. Direct patient contact or presence inside the perimeter meant a redo of the cleansing process. The concept, called “Red Box” employs red duct tape, a color used as it provides a strong visual reminder to those who enter the room to be aware.

The study found that 33% of all who entered the rooms could do so without the addition of gowns and gloves, saving the environment, hospital and patient costs, and time without compromising the patient or the medical personnel.

From Medicalnewstoday

How Else Can We Reduce Infections?

What ideas do you have for the use of copper surfaces? Do you think that copper surfaces or duct tape could make a dramatic difference in the safety of hospital admission? What about the cost? Do you think that hospitals would pay the upfront costs of replacing surfaces with copper to be able to dramatically cut infection rates? What about other low cost solutions like duct-tape around the perimeter of the bed? Can you think of other low-cost solutions that could minimize infections and maximize safety?

Related Posts:

New federal study finds ‘lax infection control’ at same-day surgery centers

FDA warning to healthcare professionals: use sterile prep pads!

Diseases of Summer: Ticks and Lyme Disease

Thursday, June 30th, 2011

family-time2

Summer is heating up, and there are lots of outdoor activities in which to participate. Along with the thermostat, however, there is also a rise in the deer tick population! This equates to an increase in Lyme disease, the most commonly reported vector-borne illness in America! Maryland, Virginia, Pennsylvania, Delaware and New Jersey all all “hotbeds” for this disease, comprising 5 of the top  12 states comprising 95% of all Lyme disease cases nationwide.

According to a recent post by Roberta Seldon in Boomer Health and Lifestyle, the deer tick population is a “bumper crop” this year, partly due to the wet winter in the Midatlantic and Northeast United States. Tick activity peaks in June and July, and this correlates to rates of illness as reported by the Centers for Disease Control (CDC). The CDC also reported 2009 as the second-highest incidence of disease cases, following 2007; with the estimated increase in the deer tick population, 2011 might go down in the record books as the highest year ever since the beginning of recording/reporting lyme disease (1995). The Maryland Department of Health and Mental Hygiene (DHMH) breaks down the jurisdictions even further into cases per County, with the top two counties being Baltimore and Anne Arundel, with Howard, Harford and Carroll counties being right in the mix.

What is a deer tick and what does it look like?

The deer tick, as it is commonly called, is really the black-legged tick or Ixodes scapularis. This is NOT the same as the dog tick; it is a much-smaller version with different coloration. The Canadian Lyme Disease site provides an excellent pictoral description and differentiation of the various types of ticks and relative sizes. The deer tick, especially in the nymph stage, is so very tiny and nearly impossible to see, and it is this very pinpoint little bug that causes most of the infections.

The CDC website (one of my favorites for all kinds of information related to infectious diseases and other public health topics) details the disease transmission process and prevention, diagnosis and treatment information. The site discusses many myths about the tick, its removal, the disease, its symptoms and long-term sequellae.

Did you know that the tick itself does not cause the disease? The tick carries a bacteria called Borrelia burgdorferi that has to be transmitted through the saliva during feeding. It takes at least 24 hours, if not 36 to 48  hours, of tick attachment and feeding in order to transmit the bacteria. Thus, besides various prevention techniques with appropriate clothing and wearing bug spray with DEET, it is critical to perform (or have someone else perform) a “tick-check” after being in wooded areas or areas known to have deer activity. The best way to remove this little critter is by using tweezers and grasping the head while applying gentle traction in the opposite direction of attachment. Even if you are not the environmental type but you have a dog, be sure to apply tick-prevention remedies to your pet since they can bring these critters into your home.

What are some common symptoms of Lyme disease?

The most common symptom, and the one classically associated with Lyme disease, is the bulls-eye type rash (called erythema migrans) that develops at the site of the infection/tick bite.

There is a central area of redness, and over several days, the red ring starts to migrate peripherally, followed by an area of clearing; it clearly resembles a bulls-eye target. According to the CDC, approximately 68% of those infected report this rash. The next most common symptom is joint pain that can involve one or more joints and typically migrates to various joints. Other more serious presentations include paralysis of the facial nerve (Bell’s palsy), meningitis or encephalitis, and even heart block or problems with the electrical conduction system of the heart leading to irregular heart rhythms.

The Maryland DHMH just released a video on Lyme Disease in Maryland. Dr. Katherine Feldman describes the disease.  It is a 7-minute and 23-second video with lots of good information. Please, click the link to watch and learn!

Other tick-borne illnesses:

Lyme disease is not the only disease transmitted by ticks. Ticks live on the blood of the hosts on which they feed. They can transmit a variety of pathogens via their bite and/or saliva that have been acquired from other hosts. Some of these infections include anaplasmosis, babesiosis, ehrlichiosis and Rocky Mountain Spotted Fever (RMSF). As an aside, don’t let the Rocky Mountain part fool you! North Carolina has one of the highest incidence rates of RMSF nationwide!

QUESTION: Do you know someone who has had Lyme Disease? Were there any unusual circumstances surrounding the diagnosis? Share your story so others can be more aware!

Images courtesy of:

(c) L. Gerlach on Blisstree.com

Cancer: HIV/AIDS Patients At Increased Risk

Monday, June 27th, 2011

It is estimated that there are more than a million people in the U.S. infected with HIV.  In 2009 alone, there were roughly 50 thousand new HIV cases. There are approximately 16-18 thousand AIDS-related deaths in the U.S. each year. Although medical advancements have enabled many HIV/AIDS patients to live a relatively normal life, the truth is that the HIV/AIDS epidemic has been and continues to be a public health disaster of astronomic proportions.

As if life with HIV/AIDS is not difficult enough, researchers have also found that HIV/AIDS patients are also more prone to developing various malignancies when compared with the non-infected population. In fact, cancer is one of the leading causes of mortality in the HIV/AIDS  population. It is estimated that 30%-40% of HIV patients will develop some type of cancer during their life time.

The types of cancer that affect HIV patients can be generally divided into two groups: AIDS defining cancers and opportunistic cancers. An HIV positive patient who develops a cancer defined by the Center for Disease Control and Prevention as AIDS defining is considered to have AIDS.  These AIDS defining cancers include: Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and invasive cervical cancer. Other cancers are generally categorized as opportunistic.

Researchers have found that HIV/AIDS patients have a 2-to-3 fold increase in the overall risk of developing opportunistic cancers. Not only are HIV/AIDS patients more likely to develop cancer but the cancer prognosis is worse when compared with that of non-infected patients. HIV/AIDS patients also present with more advanced cancers at the time of diagnosis and, on average, they develop cancers at a younger age.

So, why is the risk for developing cancer higher in the HIV/AIDS population? It remains unclear whether the actual virus has a direct impact on the development of malignancies. It is believed, however, that the increased incidence of cancer is due to the fact that HIV/AIDS patients have a compromised immune system, which can lead to an impaired ability to produce antibodies or inflammatory responses.

Needless to say, if you are an HIV/AIDS patient or you know someone who is, please be aware of the increased risk for developing cancer. Be proactive and pursue proper and timely cancer screening. If you are experiencing unusual symptoms, don’t automatically attribute them to having HIV/AIDS (e.g., unusual fatigue). Unfortunately, they might just be symptoms of cancer.

 

Related posts:

H.I.V. treatment advances, but what are the implications of terminating research early?

 

 

Week in Review: (May 29 – June 4, 2001) Eye Opener Health, Law and Medicine Blog

Saturday, June 4th, 2011

From the Editor:

We didn’t get to post as many blogs as usual this past week due to the simple fact that our lawyers/blawgers were spread around the country doing depositions and meetings, in court and getting ready for some major trials coming up very soon.

Sometimes the real practice of law (which is what we do when we’re not on WordPress blawging away) just gets in the way (read – big smiley face).

Brian Nash

 

Here’s what our blawgers wrote this past week. We hope you enjoy! Oh – thanks for stopping by too.

Summer Vacation Checklist: Add Vaccination to Your List

By: Theresa Neumann

Ahhh, summer vacation is coming. Passport? Airline tickets? Three 1oz containers? Zipper-lock bag? Sunblock? Camera? Vaccination status?

Summer is typically the busiest time for vacationers to explore new territories, or even old ones. Granted, the economy has replaced some travelers’ grand plans with much more modest ones, but many are still planning trips to Mexico and other foreign destinations. The summer is also a big time for missionary groups to head to under-served areas to provide assistance and medical care. The events of September 11th have forever changed travel for the United States and countries all over the world. There is now a new concern…..your vaccination status! Read more

The Grief of Losing an Unborn Child

By: Mike Sanders

For parents who have lost an unborn child, the sense of grief is no different than if the child had been born and then died. Unfortunately, our society seems less sympathetic to the loss because there is no infant that we have seen and gotten to know. We all recognize the agony of losing an older child. Even if we haven’t experienced it ourselves, we can at least try to understand how sickeningly awful it must be. We can then offer our support and love and condolences to those who have experienced it. With an unborn child, however, it’s different. We have a tendency to minimize the grief associated with losing an unborn child, as if the fact that the child wasn’t yet born makes him or her less real. Even medical providers are guilty of this. I’ve had women tell me that their doctors tend to treat miscarriage or stillbirth as a medical condition, not the loss of a loved one. For the parents of such children, however, the loss is deep and real and long-lasting. Read more

Legal Boot Camp: The Story of Mark and Susan – Common Law Marriage in Maryland

By: Jason Penn

Mark and Susan had been living together in a small apartment in Baltimore for 12 years. Both of their names were on the lease and they share a used car to commute back and forth to their jobs. Both names appeared on the utility bills and although they never had an actual “ceremony,” they always considered themselves to be husband and wife. Mark and Susan always assumed that the state of Maryland would consider their relationship to be a “common law marriage.” Ten months ago, Susan began experiencing unfamiliar stomach pains. Her doctor assured her that she was fine and that no follow-up examinations were necessary. Six months ago, Susan was diagnosed with an aggressive form of cancer. Tragically, Susan died last week. Mark is certain that Susan was the victim of medical malpractice and wants to file an action for medical malpractice. Mark is now concerned that his common law marriage might not be valid.  Is it? Read more

Home Births: Increasingly Popular But Are They Safe?

By: Sarah Keogh

Many little girls grow up fantasizing about what they want to be when they grow up; perhaps they want to be the President, or an artist, or a doctor, or an architect. Others might be daydreaming about being a princess or an astronaut. However, I do not know of many little girls who grow up dreaming about how they would like to bring a child into this world. Yet once these girls grow up into adults, many of them feel strongly about having a birth plan that is just as magical as all of their other dreams. Images of a comfortable labor or a display of womanly strength may play a role; perhaps they want music or a particular image available to them. Some want as few interventions as possible, while others would prefer an epidural at the hospital door. No matter what vision of childbirth a woman has, the desired end result is almost universally a healthy child. Read more ….

Sneak Peak of the Week Ahead

  • Two Sessions (yes, it’s almost summer) of our Legal Boot Camp Series –
  • Parents of children with Cerebral Palsy – Part II
  • Loss of Consortium – some things about this claim you need to understand
  • ….AND even more….

Have a Great Weekend, Everyone!

Summer Vacation Checklist: Add Vaccination to Your List!

Monday, May 30th, 2011

Photo from guardian.co.uk

Ahhh, summer vacation is coming. Passport? Airline tickets? Three 1oz containers? Zipper-lock bag? Sunblock? Camera? Vaccination status?

Summer is typically the busiest time for vacationers to explore new territories, or even old ones. Granted, the economy has replaced some travelers’ grand plans with much more modest ones, but many are still planning trips to Mexico and other foreign destinations. The summer is also a big time for missionary groups to head to underserved areas to provide assistance and medical care. The events of September 11th have forever changed travel for the United States and countries all over the world. There is now a new concern…..your vaccination status!

According to the Centers for Disease Control, the United States is experiencing its largest outbreak of measles in 15 years! USA Today reported a record 118 cases of confirmed measles in the USA between January 1 and May 20 of this year, mostly acquired abroad by unvaccinated individuals and brought back to the States. Measles was reported to have been “eradicated” from the USA as of the year 2000 due mostly to the efforts of immunization, but measles is still prevalent in other parts of the world.

Over 42,000 cases were diagnosed in an outbreak among young adults in Brazil in 1997! Third-world countries are not the only ones affected; over 7,500 cases have been diagnosed in France between January and March of this year, according to the CDC! And the outbreaks continue across most countries of Europe. Failure to vaccinate and receive periodic “booster shots” to provide immunity allows the virus to infect that individual who then gets sick. Since the virus is spread via respiratory droplets (coughing and sneezing), public modes of transportation allow for contact with infected individuals.

Measles is NOT just a rash!

According to the Associated Press, 2 of every 5 of these 118 patients required hospitalization; none died, but measles can have deadly consequences. Worldwide, measles causes nearly 800,000 deaths annually, mostly in small children. Some of the bad consequences include encephalitis characterized by vomiting, seizures, coma and even death; of those who survive this, approximately one-third are left with permanent neurologic deficits.

Once the spots are gone…

Interestingly, there is a late complication of measles infection, called subacute sclerosing panencephalitis (SSPE), that occurs from 5 to 15 years after the acute infection; the virus causes a slow degeneration of the brain and central nervous system long after the initial infection. Measles can also cause bronchiolitis or bronchopneumonia, and it can be associated with secondary bacterial infections due to the depleted immune system that occurs while fighting the virus.

Measles is NOT the only vaccine-preventable disease available for infection!

There have been recent outbreaks of mumps, another viral disease that has potential complications of pancreatitis, orchitis and even meningitis and encephalitis.

There have been outbreaks of Bordetella pertussis (part of the DPT vaccine), otherwise known as “whooping cough.” Pertussis can severely affect young children under 2 years, but it affects adults as well. Since the vaccine does not impart lifelong immunity, adults become a reservoir for this disease, unless a booster shot is given, and the adults spread the disease to unvaccinated children.

Haemophilus influenza type B, known as HIB, can cause typical cases of upper respiratory infections, sinusitis and otitis media (common ear infection); it can also cause epiglottitis, a potentially fatal infection of the epiglottis. The epiglottis is a flap of tissue that acts like a valve, protecting our airway when we eat and swallow food. This “valve” swells up so large from the infection that it can totally obstruct the airway and prevent a child from breathing; it is a medical emergency that can require emergent tracheostomy! An HIB vaccine has been available for years, and this infectious culprit had nearly been eradicated, as well, in the USA. The anti-vaccine movement has produced many children, adolescents and even young adults who have never received this vaccine  - et voila….there is a resurgence of HIB and Haemophilus epiglottitis.

Hepatitis B is a virus (HBV) for which a vaccine has also been available for over 20 years. It is a 3-shot regimen, but it also requires that titers be drawn after vaccination to prove immunity. HBV can be transmitted through sexual contact or any exchange of body fluids, including contaminated food in rare instances. Although the human body can fight some cases of HBV, other cases become chronic and lead to liver failure and/or liver cancer. Wouldn’t you know it? May is “Hepatitis Awareness Month” for the CDC!

There are plenty more vaccines available for a multitude of viral, bacterial and other infectious agents. Additionally, there are immunoglobulin shots that can address other infectious conditions and act as prophylaxis during your time abroad.

The Moral of the Story

Check your own vaccination status first. If you are not sure, your doctor can do blood tests to determine if you are immune to specific infectious agents…even the chicken pox virus! Secondly, take the time to check the CDC website (www.cdc.gov) for infections endemic to the area to which you are traveling. Follow guidelines offered for disease prevention and possible vaccines, medications or immunoglobulins available.

Be aware and be prepared! Protect yourself and those near and dear to you!

 

The New Enron? Are Hospitals Cooking the Books?

Thursday, April 28th, 2011

Tax season is over. Well, it is over if you filed your return in a timely fashion. Don’t let this blog stop you from stashing away your W-2’s and 1040-G’s for safekeeping. I hope you never need them. But, if you will, indulge me for just a second and leave your calculator out. No, I don’t need you to calculate the ever-increasing cost to fill-up your gas tank. Let’s take a quick look at a few health care statistics. Before you cringe, declare that you ‘hate math!’ and click-back to Facebook, let me share this with you: medical errors occur 10 times more than previously thought. Maybe that wasn’t hard hitting enough. Let me try again. How about this: mistakes occur in one out of every three hospital admissions!

Yes, seriously.

It’s Hard To Measure Without a Yardstick

Despite all of their education and training, medical professionals make mistakes. You know it, I know it, and certainly they know it. I hope that we can also all agree that it is unrealistic to expect for our health care providers to be perfect. What is reasonable, however, is to require an accurate accounting of the mistakes that occur in a health care setting. Believe it or not, there is no uniform method for a hospital to classify, track and otherwise determine what is or is not a medical mistake. A negative outcome at Hospital X in Baltimore might be considered a mistake, and yet if the same negative outcome occurred at Hospital Y in Washington D.C., it would not be considered a mistake. How so?

I don’t want to bog you down with the myriad measures that hospitals use to come up with the numbers but suffice it to say that at any hospital in the United States, its administration could utilize the: Agency for Healthcare Research and Quality’s Patient Safety Indicators or the Utah/Missouri Adverse Event Classification technique, or an approach developed by the Harvard Medical Practice Study, or the Institute of Healthcare Improvement’s Global Trigger Tool, or they can do their own analysis of the records and score themselves (self-reporting.)

That was a mouthful. Essentially, a yardstick for measuring the safety of care in hospitals does not exist. Or, at least, a yardstick has not been agreed upon. The two most common methods used, however, are voluntary reporting and the Agency for Healthcare Research and Quality Patient Safety Indicators. And according to a recent study, those two methods are awful. Before you conclude that I am being too harsh, let’s take a look.

The Good, the Bad, and the Ugly

The study, conducted by David C. Classen, and published in journal Health Affairs, utilized the Institute for Healthcare Improvement’s Global Trigger Tool. The Global Trigger Tool uses specific methods for reviewing medical charts. Patient charts are analyzed methodically, analyzing discharge codes, discharge summaries, medications, lab results, operation records, nursing notes, and physician progress notes to determine whether or not a “trigger” exists. A notation of a trigger leads to further investigation into whether or not an adverse event occurred. Here is how the tools stack up:

Self Reporting (Commonly Used Method #1): 4 adverse events detected

Safety Indicators (Commonly Used Method #2): 35 adverse events detected

Global Trigger Tool: 354 adverse events detected

The Global Trigger Tool is overwhelmingly more sensitive and picked-up many, many more adverse events. Overall, the Global Trigger Tool discovered that adverse events occurred in 33.2 percent of hospital admissions or 91 events per 1,000 patient days. That number is staggering.

What kind of “adverse events” are being missed? Medication errors, surgical errors, procedure related errors, infection, pressure ulcers, device failures and patient falls. All very serious and potentially injurious to a patient. The study indicates that the error detection tool being utilized by Hospital ABC in Yourtown, USA is probably woefully inadequate.

Why Accurate Error Detection Is Important

Error detection is essential to error correction. A hospital cannot identify the areas that need improvement if it is unable to identify the areas where it is falling down on the job. Failure to utilize an adequate error detection tool ensures that the same mistakes will continue to happen time and time again. I think the results certainly beg the question: why not adopt a nationwide standard? The Global Trigger Tool or another sensitive measuring matrix strikes me as a reasonable place to begin.

Certainly, there is a financial aspect to this discussion. Extensive chart reviews and lengthy inquiries into negative outcomes are costly and time intensive. Also, what motivation, besides error prevention, does a hospital have to discover its errors? As I wrote about here before, when errors are discovered, hospitals are penalized. If a hospital’s main concern is its bottom line and not patient safety, why not continue to “self-report” or use the Agency for Healthcare Research and Quality Patient Safety Indicators and leave the adverse events undetected?  Makes sense if you want to avoid the penalties…

It doesn’t say “leave a response” down below for nothing. Feel free to let us know YOUR thoughts.

QUESTION: Have you ever had a negative outcome at a hospital? Where you told that a mistake was made or were you told otherwise?

 

Week in Review: Miss our posts this past week? Catch-up now!

Saturday, April 16th, 2011

From Eye Opener’s Editor, Brian Nash: Another week gone by – where does the time go? Our bloggers this past week, Theresa Neumann, Jon Stefanuca, Jason Penn, Mike Sanders and Sarah Keogh, were – in addition to practicing law – busy on the keyboard blogging away. In case you missed any posts during the week of April 10th through the 15th, here’s your opportunity to catch-up.

The “Medical Home” – find out what it is and why you should have one!

This past week, Sarah wrote two blogs on a concept that frankly I had not heard of before – the Medical Home. Her follow-up piece on how parents in particular are using emergency departments and clinics was posted yesterday, Friday, April 15th.

In her first piece, Sarah discussed a key issue about continuity of medical care for all of us but particularly our children. While there’s no doubt that there are times when taking your child to an emergency room is the only way to go in a true emergency, is it really the right place for a child to receive primary care? You see a physician or a medical specialist such as a physician’s assistant on a one-time basis. What do they really know about your child’s complete medical history? Do they really address key issues of general health care that is essential to your child’s overall health?

Her second post addresses specifically the topic of how many in this country are using facilities such as in-store clinics and emergency rooms for minor, non-emergency care. While there is no doubt that ED’s and clinics serve a vital role in the providing of healthcare in the United States, are they being used the right way? Are clinics often the only place where many in our country can obtain care for their children? Read Sarah’s posts on What is a medical home? Do your children have one? and her follow-up piece Clinics and Emergency Rooms: Helpful or Barriers to Good Pediatric Care.

A Disturbing Report on Some Area Hospitals and their Complication Rates

Earlier in the week, the new member of our legal team, Jason Penn, wrote about a recent report from the Maryland Health Services Cost Review Commission regarding a continuing failure of several local Maryland and DC hospitals to lessen the number of patients who suffer from complications while in these institutions. P.G. Hospital Center won the dubious distinction of being first in class. Jason reports that this institution, which services many of the area’s population, was fined by the state of Maryland for the number of “complications that are unlikely to be a consequence of the natural progression of an underlying disease.” The “list” includes specified complications such as “bed sores, infections, accidental punctures or cuts during medical procedures, strokes, falls, delivery with placental complications, obstetrical hemorrhage without transfusion, septicemia, collapsed lungs and kidney failure.” For information as to how the local jurisdictions deal with these hospitals in the pocketbook and who made the list, read Jason’s blog post entitled Report Card on Failing Hospitals: Prince George’s Hospital Center Tops “Complications” List.

Learn More about Medicine and Your Health

Theresa Neumann, an in-house medical specialist in our firm, posted Spinal Stroke: An atypical cause of back pain this past week. It’s one thing to have lawyers who live and breath medicine and the law write about medical conditions; it’s quite another to have real medical specialists like Theresa educate all of us on medical matters that affect the lives of so many. Theresa brings to the public’s awareness the signs, symptoms, risks and potential treatment alternatives to a catastrophically disabling condition that many just don’t know about – until it’s too late for them.

We’ve all – unfortunately – heard about or know someone who has suffered a stroke in their brain. Well, as Theresa reports, there’s an equally devastating form of stroke that can hit our spinal cord, which can render the victim paralyzed, without control of bowel or bladder, incapable of feeling sensation and a host of other life-altering consequences. We’re always appreciative of the wonderful, educational pieces Theresa brings to our blog. This piece is no exception.

The War against Super Bugs – MRSA and CRKP – are we losing the fight?

There was a time many months ago where we all became aware of the super bug infection known as MRSA. It was in the news over and over again. Have you heard much about it lately? Silence by news media might make one think that our medical institutions have won the war and the threat of this deadly infection is over. As Mike Sanders tells us – not so quick! In his blog of this past week, Deadly Super Bugs on the rise, Mike tells us who’s winning the MRSA war to and about a newcomer in the Super Bug family – CRKP.

The news is simply not good! See what seems to be working against MRSA and don’t miss the update at the end of Mike’s post about a new prevention method using honey.

Law and Medicine

Well we are lawyers – so why not a piece about our specialty area – representing patients and families of patients against healthcare providers? This past week, Jon Stefanuca wrote what we consider to be a very important piece entitled Should you sue a healthcare provider? Some guidelines to help you decide.

Some may just be surprised about the advice Jon gives in this posting. It is not a call to arms against the medical profession or even a call to our law firm so you can sue the b*****ds! Jon offers some very important advice to those who have been through an experience with a healthcare provider and are considering whether or not they have a potential lawsuit for the injuries they have suffered.

We believe this post encapsulates in large part some principles we have been advocating for a long time. Not every bad outcome means malpractice has occurred. However, how would you – as a lay person – be able to make the distinction between what is and what is not a real medical malpractice case? In addition to Jon’s sage advice, this post links to a White Paper we did on Choosing a Lawyer – a Primer. We hope if you have unfortunately found yourself faced with this issue of whether you should sue or not that you will find this blog by Jon informative and helpful in making your decision.

A Sneak Peak of the Week Ahead

As you can see, our bloggers were quite busy last week. Well, this coming week will be no different. The days ahead will be consumed with representing our clients in depositions, investigations, filing pleadings and court appearances….and writing and posting some interesting, important blogs on aneurysms (did you know they can present as back pain?), laughing gas coming back for moms in labor, sleep deprivation for nurses (and how well that plays out in your healthcare) and some other good stuff our writers are busy working on this weekend and during the week ahead.

Stay tuned – stay informed! Read the Eye Opener and tell your friends about us too! …and don’t forget to join our social networking communities on Facebook and Twitter.

Deadly Super Bugs on the rise.

Wednesday, April 13th, 2011

Health scares are common and are many times overblown. However, the evolution of bacteria that are resistant to antibiotics (dubbed Super Bugs) is a very real and growing danger. Yahoo Health is reporting that two especially dangerous bacteria – MRSA and CRKP – are becoming resistant to all but the most advanced antibiotics, which is posing a major health threat.

Klebsiella is a common type of gram-negative bacteria that are found in our intestines (where the bugs don’t cause disease). MRSA (methacillin-resistant staphylococcus aureus) is a type of bacteria that live on the skin and can burrow deep into the body if someone has cuts or wounds, including those from surgery.

The reason for this new resistance is likely over-use (which includes mis-use) of antibiotics by health care providers (with likely some contribution from use of antibiotics in animals). For a few years now, there has been a growing recognition that doctors are over-prescribing antibiotics, i.e., routinely prescribing antibiotics when they are not necessary. For example, in 2005, U.S. News reported a Harvard study that revealed that doctors routinely prescribed antibiotics for sore throats in children when they were not indicated. A 2007 study indicated that Dutch doctors (whom are generally considered more careful in their use of antibiotics) routinely prescribed antibiotics for respiratory tract infections when they were not indicated.

The Problem with “Overuse”

The danger this poses is that antibiotics – even effective ones – typically leave some bacteria alive. These tend to be the stronger or more resistant bacteria, which then leads to the development of more and more resistance. This occurs in a single individual body in which a patient may have less response to an antibiotic after earlier use of that same antibiotic, but because of the easy spread of bacteria in our world, it also occurs on a global scale. For certain strains of bacteria, doctors are becoming hard-pressed to treat these infections.

CRKP – worse than MRSA?

Thankfully, MRSA is still responsive to several antibiotics so it is still considered a treatable infection. CRKP, however, is of more concern because it is only responsive to Colistin, which can be toxic to the kidneys. Therefore, doctors have no good options when treating CRKP. While so far, the risk of healthy people dying from MRSA and CRKP remains very low, the most vulnerable of us (the elderly and the chronically ill) remain at risk because of their lowered immune system and because the elderly are in nursing homes or other long-term care facilities where infections tend to spread more easily than in the general community.

CRKP has now been reported in 36 US states—and health officials suspect that it may also be triggering infections in the other 14 states where reporting isn’t required. High rates have been found in long-term care facilities in Los Angeles County, where the superbug was previously believed to be rare, according to a study presented earlier this month.

It is essential that we rein in the casual use of antibiotics before we are left with infections that have no cure. Doctors must be better trained to know when antibiotics are necessary and when they are not. For example, antibiotics are useless against viruses (such as the common cold), but how many of you have been given an antibiotic by a doctor “just in case” or because your symptoms have gone on slightly longer than a typical cold would last? It is unfortunately a more common occurrence than we realize. The past success of antibiotics has naturally led doctors to want to give them to patients to relieve suffering. No one wants to turn down a patient who is seeking relief.  However, it makes no sense to give antibiotics to a patient who has no bacterial infection or whose illness will clear up on its own.

Patient Awareness is key

The problem, however, is more than just educating doctors. Patients share some blame too. We – the public – need to learn that antibiotics are not always needed, which can be a difficult lesson to learn when we’re sick. Everyone knows that antibiotics are a quick and effective remedy against common bacterial infections. Antibiotics have saved countless lives over the years and have relieved untold human suffering. So naturally, when we are sick (or our child is sick) and we go to the doctor, we want to see results. We want something that will alleviate the pain and symptoms, not simply be told to wait for the illness to run its course. Sometimes, however, that is the best course when you consider the side-effects of antibiotics and the dangers of over-use. That being said, who wants to hear that when you’re in pain and want relief? It is very easy to demand of doctors that they use all available means to treat a sick child. Doctors need to be able to stand-up to patients and educate them on why antibiotics are not necessarily the best course of treatment in a specific situation.

Don’t kill the good ones!

Doctors also have to teach patients that antibiotics are not targeted killers.  The body contains a lot of good bacteria that are vital to our body’s functioning.  Antibiotics kill those bacteria as well, which some researchers believe can adversely affect health by allowing harmful bacteria to proliferate.  (If you have seen “probiotocs” advertised on certain food products – like yogurt – that is an attempt to introduce good bacteria back into your body.).

Some basic steps to take

In order to protect yourself (or a loved one), good hygiene remains the most effective method of remaining infection-free.  Thankfully, neither MRSA or CRKP are transmitted through the air.  They are typically transmitted through person-to-person contact, or else through hospital equipment such as IV lines, catheters, or ventilators.  If you have a loved one in a hospital or nursing home, be vigilant with your hand-washing and those of the healthcare providers caring for your loved one.

Also, if you are a patient who has been prescribed antibiotics, follow your pharmacist’s orders scrupulously and take the medication in the proper dosage and for the proper amount of time.  Stopping antibiotics too soon can leave bacteria alive, which contributes to the evolution of more resistant bacteria.  You may feel better and want to stop the medication, but it is important to take the full dose.

So – now that you know the risks of over-using antibiotics, are you willing to forego antibiotics when you are sick in order to do your part for the greater good?

UPDATE: (Editor – Brian Nash) Within an hour of posting Mike Sander’s blog on MRSA (and CRKP), I came across a tweet about Manuka Honey is being used for dressings to fight the spread of Super Bugs – particularly MRSA.

Researchers now believe that it can also put a stop to the rates at which superbugs are becoming resistant to antibiotics.

Anyone know of this practice being used in your area hospital or clinics? Does anyone know if this really works? If so, most interesting and useful. Here to spread the word – how about you spreading it too?