Monday, July 19, 2010

Hospital Infection Deaths Caused by Ignorance and Neglect

Hospital infection deaths caused by ignorance and neglect, survey finds

By N.C. Aizenman
Washington Post Staff Writer
Tuesday, July 13, 2010; A03

Deadly yet easily preventable bloodstream infections continue to plague American hospitals because facility administrators fail to commit resources and attention to the problem, according to a survey of medical professionals released Monday.

An estimated 80,000 patients per year develop catheter-related bloodstream infections, or CRBSIs -- which can occur when tubes that are inserted into a vein to monitor blood flow or deliver medication and nutrients are improperly prepared or left in longer than necessary. About 30,000 patients die as a result, according to the Centers for Disease Control and Prevention, accounting for nearly a third of annual deaths from hospital-acquired infections in the United States.

Yet evidence suggests hospital workers could all but eliminate CRBSIs by following a five-step checklist that is stunningly basic: (1) Wash hands with soap; (2) clean patient's skin with an effective antiseptic; (3) put sterile drapes over the entire patient; (4) wear a sterile mask, hat, gown and gloves; (5) put a sterile dressing over the catheter site.

The approach also calls for clinicians to continually reconsider whether the benefits of keeping the catheter in for another day outweigh the risks and to use electronic monitoring systems that allow them to spot infections quickly and assemble a rapid response team to treat them.

A federally funded program implementing these measures in intensive-care units in Michigan hospitals reduced the incidence of CRBSIs by two-thirds, saving more than 1,500 lives and $200 million in the first 18 months. Similar initiatives across the country helped bring the overall national rate of these and related bloodstream infections down by 18 percent in the first six months of 2010, according to the CDC.

"Our research shows that the cost of implementing [such programs] is about $3,000 per infection, while an infection costs between $30,000 to $36,000," said Peter Pronovost, a professor at Johns Hopkins University School of Medicine who led the program. "That means an average hospital saves $1 million."

So why aren't hospitals leaping to adopt these best practices?

The survey released Monday, which was conducted by the Association for Professionals in Infection Control and Epidemiology and funded by Bard Access Systems, a maker of catheters, pointed to ignorance and neglect at the top.

More than half of the 2,075 respondents, most of whom were infection control nurses employed by hospitals, reported that they use a cumbersome paper-based system for tracking patients' conditions that makes it harder to spot infections in real time. Seven in 10 said they are not given enough time to train other hospital workers on proper procedures. Nearly a third said enforcing best practice guidelines was their greatest challenge, and one in five said administrators were not willing to spend the necessary money to prevent CRBSIs.

Pronovost said part of the problem was that many hospital chief executives aren't even aware of their institution's bloodstream infection rates, let alone how easily they could bring them down.

When hospital leaders decide to create a culture in which preventing infections is a priority, he added, nurses feel empowered to remind physicians to follow the checklist when inserting catheters, physicians are provided antiseptic soaps as part of their catheter kits and infection control personnel have the best tools to monitor patients.

"If anyone in that chain of accountability doesn't work, you won't get your [infection] rates down," he said. "But it's the hospital's senior leadership that is ultimately responsible."

Doctors Okay with Industry Gifts

MDs OK @industry gifts
Posted by medconsumers on July 19, 2010

One thing that adds to the inefficiency of our medical care system is the distorting influence of the pharmaceutical industry’s marketing techniques. A new survey of 600 doctors, surgeons, and medical students found that most have positive attitudes towards the marketing activities of the drug companies. Unfortunately, most seem to miss the fact that marketing is all about getting them to prescribe the most expensive drugs.

The most disturbing finding in this survey, published in Archives of Surgery, is the 58% of respondents who said they believe that drug samples improve patient care. Free drug samples to doctors—one of the pharmaceutical industry’s most effective marketing strategies—are all about increasing the sales of brand-name drugs. They tend to be the newest, most expensive drugs, offered to patients in this way, “Try this free drug sample and see how you do.” The patients who do just fine continue with the expensive drug, which might very well have a less expensive alternative that is just as good…or safer. So far, no one has come up with any good evidence that free samples improve patient care.

The pharmaceutical industry would have us believe that the free drugs go to low-income patients, but that didn’t hold up once researchers took a hard look. They found that the people most likely to receive free drug samples from their physicians are the financially well off and the insured. (Click here) Another study showed that the people who get free samples wind up with significantly more out-of-pocket expenditures than those who don’t.

Three-fourths of the doctors in the new survey believe that accepting free gifts and free lunches did not influence their own prescribing practices, but 52% said other doctors are likely to be swayed by such marketing tactics.

I think we can safely assume that the pharmaceutical marketing pros know exactly what works in terms of gifts to doctors, be it a free mug with drug company logo or a lavish dinner at the local French restaurant. One anti-drug industry documentary featured a former drug saleswoman turned whistle-blower. She said that her company could clock an uptick in drug prescriptions after something as seemingly minor as bringing a $10 take-out Chinese lunch for each person on the doctors’ staff.

You have no way of knowing how much marketing influences your own doctor’s prescribing behavior. A doctor too ready to prescribe the newest drug is a bad sign. So is the doctor whose waiting room often includes a well-dressed drug sales representative (usually female) and/or an office that is heavy on the industry-generated posters, pens, mugs, and brochures. One friend noticed the place she was expected to place her feet on the scale in her doctor’s office had a paste-on ad for Meridia, the weight-loss drug.

Revealing as this survey is, it centers on marketing tactics that are small potatoes compared to what’s happening at academic medical centers and is largely hidden from public view. It’s the fact that half of all continuing medical education is funded by industry. It’s the large consulting fees paid to key opinion leaders to “educate” their peers about the latest drugs. (For the definitive article describing how this works, click here.) Things have gotten so bad that medical students at Harvard are reportedly asking hard questions about which of their professors are paid consultants for the pharmaceutical industry (click here).

Reforms are on the way but still relatively new. Under a new federal law, drug and device companies will soon have to disclose, on a publicly accessible website, the names of doctors who accept speaking fees, as well as the value of all gifts. We already know that this will have an immediate effect. Vermont is one of three states that already put this law into practice in 2002. Early this year, the attorney general of Vermont release data showing that total payments to doctors dropped 13% in 2009 to $2.6 million. Vermont now plans to improve its law with an outright ban on most gifts, including food, which amounts to $800,000 of the 2009 total.

Several years from now we can look forward to another survey to see how doctors react to the new federal law.

Maryann Napoli, Center for Medical Consumers©