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Issues & Legislative Committee

October 8, 2009


Group Purchasing / Code of Conduct Principles

Senators probe group purchasing organizations

Health Industry Group Purchasing Association ( HIGPA) leaders say they will provide information to U.S. senators from the committees on finance, judiciary and aging who are investigating group purchasing organizations (GPOs) because they are concerned the GPOs may be inflating the price of goods at the expense of taxpayers, who fund the Medicare program.

Curtis Rooney, HIGPA president, said his organization is reviewing the senators’ letter and looks forward to providing the requested information.  He added that two empirical studies, which came out earlier this year, found that GPOs save the nation between $36 billion and $64 billion, demonstrating the value GPOs deliver. He also noted that the GPO industry is among the most transparent businesses in all health care.

Materials Management in Health Care Sept 2009

Infection Control

X-ray equipment may be crawling with germs
Reuters Health
Thursday, September 3, 2009
By David Douglas

NEW YORK (Reuters Health) - Portable X-ray equipment is implicated in the spreading of drug-resistant bacteria in the intensive care unit (ICU), Israeli researchers report.
Dr. Phillip D. Levin of Hadassah Hebrew University Hospital, Jerusalem and colleagues recently watched technicians perform 173 chest X-rays.

Adequate infection control was practiced only during 2 of these procedures, or only 1 percent, they report, and drug-resistant bacteria were discovered on the surfaces of 12 of 30 X-ray machines, or 39 percent.

Following the observation period, the investigators instituted an educational intervention aimed at the technicians and then evaluated its impact, which was significant.

Adequate infection control was observed in 48 of 113 subsequent X-rays (42 percent) and none of the 29 machine samples yielded drug-resistant bacteria. But the improvement was short-lived.

A follow-up study 5 months later found that only 12 of 120 X-rays (10 percent) were conducted with adequate infection control and 7 of 14 surface samples (50 percent) yielded resistant bacteria.

"To date," Levin told Reuters Health, "no one had looked at the X-ray technicians and their equipment and seen them as a potential link in the network of cross contamination of ICU patients with highly antibiotic resistant bacteria."

"Based on the results of this study," Levin said, "our hospital has instituted a wide-ranging disinfection protocol for all X ray equipment."

SOURCE: Chest, August 2009. http://www.nlm.nih.gov/medlineplus/news/fullstory_88975.html

NIOSH Publication No. 2008-118:

First Responders: Encourage Your Workers to Report Bloodborne Pathogen Exposures

First responders are at risk for occupational exposure to bloodborne pathogens, including hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV).

Exposure incidents may occur through the following:

Some employees are reluctant to report exposure incidents. Encourage your employees to report all exposures.

This way, you can carry out your responsibility to take appropriate post-exposure actions to protect your workers, their families, and the public against infection from bloodborne pathogens.

Why Are Employees Reluctant to Report Exposures?
Although rates of underreporting are difficult to ascertain, studies estimate that high percentages of workers do not report all exposures.
Employees give many reasons for not reporting exposures:

First, reporting exposures to blood or potentially infectious body fluids will help protect your workers, their families, and the public. It allows you to provide appropriate, prompt, medical assessment and treatment.

Second, by documenting exposures, you can identify causes and prevent them from occurring again. This keeps your workers on the job, reducing costs in the long run.

How Can You Encourage Reporting?

Get the word out! Tell your employees about the policy, the steps you are taking to implement it, and how they can help.

Risk and Assurance, Ministry of Health, Wellington & Research Affiliate, Joint Centre for DisasterResearch, School of Psychology / GNS Science, Wellington, New Zealand. sarb@equanimity.co.nz

Those affected by quarantine are likely to report distress due to fear and risk perceptions. This distress can be amplified in the face of unclear information and communication that is common in the initial period of disease outbreaks. This paper outlines recommendations for care of those in quarantine and those working with them, such as helping to identify stressors and normalising their impact as much as possible. This should take place at all levels of response, from public information and communication messages to individual face-to-face advice and support.

http://www.cdc.gov/ncidod/dhqp/hai.html

Estimates of Healthcare-Associated Infections

CDC strives to understand how healthcare-associated infections happen and to develop appropriate interventions. A new report from CDC updates previous estimates of healthcare-associated infections. In American hospitals alone, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year. Of these infections:

http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf

Healthcare-associated infections =direct costs in 1992 dollars is $4.5 billion; adjusted using CPI for all urban consumers= $6.65 billion in 2007 dollars.

Lost/Wages Diminished worker productivity on the job Short term and long term morbidity Mortality Income lost by family members Forgone leisure time Time spent by family/friends for hospital visits, travel costs, home care

INDIRECT COSTS

Psychological Costs (i.e., anxiety, grief, disability, job loss) Pain and suffering Change in social functioning/daily activities

INTANGIBLE COSTS

Fixed Costs Buildings Utilities Equipment/Technology Labor (laundry, environmental control, administration)

DIRECT HOSPITAL COSTS

Variable Cost: Medications Food Consultations Treatments Procedures Devices Testing (laboratory and radiographic) Supplies

DIRECT HOSPITAL COSTS

the direct medical cost of preventable HAIs are comparable to the costs of stroke ($6.7 billion), diabetes mellitus with complications ($4.5 billion), and chronic obstructive lung disease ($4.2 billion).[28]

http://www.cdc.gov/ncidod/dhqp/bp_laundry.html    
 
Although soiled linen may harbor large numbers of pathogenic microorganisms, the risk of actual disease transmission from soiled linen is negligible. Rather than rigid rules and regulations, common-sense hygienic practices for processing and storage of linen are recommended.

Soiled linen should be handled as little as possible and with minimum agitation to prevent gross microbial contamination of the air and of persons handling the linen. All soiled linen should be bagged or placed in containers at the location where it was used and should not be sorted or rinsed in the location of use. Linen heavily contaminated with blood or other body fluids should be bagged and transported in a manner that will prevent leakage. Soiled linen is generally sorted in the laundry before washing. Gloves and other appropriate protective apparel should be worn by laundry personnel while sorting soiled linen.

Commercial laundry facilities often use water temperatures of at least 160°F and 50-150 ppm of chlorine bleach to remove significant quantities of microorganisms from grossly contaminated linen. Studies have shown that a satisfactory reduction of microbial contamination can be achieved at water temperatures lower than 160°F if laundry chemicals suitable for low-temperature washing are used at proper concentrations. In the home, normal washing and drying cycles including "hot" or "cold" cycles are adequate to ensure patient safety. Instructions of the manufacturers of the machine and the detergent or wash additive should be followed closely.

Commercial dry cleaning of fabrics soiled with blood also render these items free of the risk of pathogen transmission.

Clean linen should be handled, transported, and stored by methods that will ensure its cleanliness.

Quality / Medication Errors / Safety Issues

Safety:
“Potency of USP heparin unit changing”
ISMP Medication Safety Alert! September 24, 2009, Vol 14, Issue 19

In response to the heparin adulteration crisis of 2007 and 2008, USP has worked to improve the standards for unfractionated heparin in order to secure the supply of safe heparin and heparin products in the US. As part of the revisions to the heparin sodium monograph, USP has adopted a new potency assay for heparin that manufacturers must use, the chromogenic anti-Factor IIa test. In a statement, USP noted that the high specificity of this assay provides an additional safeguard against potential adulterants that may display heparin-like activity in the current USP plasma-based assay. Transition to the new assay and parallel introduction of a new potency reference standard, USP Heparin Sodium for Assays Reference Standard, has given USP the opportunity to calibrate the new material relatives to the International Standards for unfractionated heparin issued by the World Health Organization. Over the past 30 years, there has been an estimated drift of 10% between the USP heparin unit and the international unit for unfractionated heparin. The calibration of the new USP Heparin Sodium for Assays Reference Standard eliminated this difference since the standard is directly traceable to the International Standard for unfractionated heparin. USP does not anticipate the harmonization with the International Standard will hold clinic significance.

“ISMP Survey helps define near miss and close call”
ISMP Medication Safety Alert! September 24, 2009 Vol 14, Issue 19

An ISMP survey reports that 88% of respondents defined a ‘near miss’ as an error that happened but did not reach the patient. These errors are captured and corrected before reaching the patient, either through chance or purposefully designed system controls that have been put in place. Reporting near misses can help to evaluated whether capture opportunities are functioning poorly or well. Only 3% of respondents defined a near miss as an error that reached the patient but did not result in harm.  – This is closer to a near miss as defined by some state reporting programs and the Agency for Healthcare Research and Quality. According to AHRQ definition, a near miss is an event or situation that does not product patient injury but only because of chance. The good fortune of not harming a patient might reflect how robust the patient is or how fortuitous a timely intervention by the provider may be. The problem with the AHRQ definition is 2 fold – (1) It does not clarify whether the harmless error that reached in the “event” or “situation” reached the patient and (2) it fails to foster ongoing evaluation of system controls that can help capture errors or prevent patient harm once an error has reached the patient. Although near miss appears to be well entrenched in healthcare terminology, we refer to near misses as close counts when feasible in the future to prevent errors.

Supply Chain Standards – GS1/HSCSC

The following is an update on GS1 Standards activities: