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Issues & Legislative Committee Reports

October 11, 2007

The Joint Commission

This month TJC added "non-accredited" facilities to its Quality Check website (www.qualitycheck.org).  TJC Annual Conference will be November 12-14 in Chicago.

Infection Control

Flu Shots
The American College of Physicians have recommended that every health care worker get a flu vaccine if they are involved with direct patient care.  It has been documented that only 36% of health care workers actually get vaccinated.  There is also evidence to suggest that 70% of health care workers continue to work when they are ill, which leads to transmission of the virus to patients and fellow workers.  Influenza currently infects about 20% of the population, hospitalizes 200,000 people and kills 36,000 per year.

The Boston Globe published an article discussing the reluctance of health care workers to get flu vaccines.  Nearly 60% of US health care workers, including physicians, do not get vaccinated against the flu.  There are misconceptions, such as the one that one’s body develops immunity since they have been exposed many times.  There is also a concern that when one gets a flu shot, one is sick the following day.  There are studies that suggest that there are connections between sick clinicians and hospital flu outbreaks.

The FDA has approved the use of nasal flu vaccine, FluMist, for children between the ages of 2 and 5.  The CDC recommends that all children between 6 months and 59 months receive a flu vaccine.  Up until now, there have only been two vaccines indicated for children:  Fluzone for the ages of 6 months and older, and Fluvirin, for children 4 years and more.

Unlike previous years, there is enough flu vaccine to go around.  The Washington Post reports that there are ample supplies and stable efficient distribution, with “more manufacturers, more doses and more choices” (Julie L. Gerberding, Director, CDC).  The concern remains that not enough people get vaccinated; all doses should be used.

E. Coli
Per HPN Daily Update, as of 10/4/2007, there were 9 children being treated for E. Coli 0157:H7 at Kosair Children’s Hospital in Indiana.  This is the most virulent type of E. Coli today.  Seven of these children were in kidney failure and on dialysis.  These children were all students at Galena Elementary School in Floyds Knob, IN.  Investigators do not know the cause of the outbreak, and as of publication, the school remained open.

Infection Rates
The journal Clinical Infectious Disease, an on-line journal, has reviewed the incidence of MRSA from 1998-2003, and has documented that there has been a 7% increase, with a concomitant financial expense of 12%.  They have also noted that mortality due to hospital acquired staphylococcus has dropped 5% each year, and they are attributing this to more stringent infection control programs.

Handwashing
Per HPN Daily Update, the Associated Press has reported on a study documenting that far fewer men than women washed their hands after using the bathroom.  It was found that one-third of men versus 12 percent of women neglected to do so.  Handwashing is the single best thing a person can do to avoid getting sick.

Medical Protective Equipment
Kimberly Clark is ramping up its capacity to product protective equipment.  This is primarily due to the demand for their new nitrile glove.  They will also be increasing production on their face masks; their N95 masks will be increased by 25% and their Fluidshield face masks will be increased by 50%.

Sources:
HPN Daily Update, “American College of Physicians recommends flu vaccination for health care workers”.  10/4/2007.
HPN Daily Update, “Indiana E. coli cases holding at 8; all have worst type of bacteria, children being treated for kidney failure”.  10/4/2007.
HPN Daily Update, “US hospitals report infections increasing in frequency and cost”.  9/26/2007
HPN Daily Update, “FDA approves nasal influenza vaccine for use in children”.  9/20/2007.
HPN Daily Update, “Providers in good shape to fight flu: plentiful supplies of vaccine received”.  9/20/2007.
HPN Daily Update, ”Study sees rise in men not washing hands”.  9/18/2007.
HPN Daily Update, “Kimberly-Clark Healthcare ramps up manufacturing capacity for production of medical protective equipment.”  10/2/2007
Smith, Stephen, “For the sake of the patients, doctors need flu shots”.  The Boston Globe:  10/8/2007.
Healthcare Purchasing News Online:  “WHO:  International spread of disease threatens public health security”.  8/26/07
Healthcare Purchasing News Online:  “Study finds environmental tests help predict hospital-acquired Legionnaire’s disease”.  8/26/07
Healthcare Purchasing News Online:  “CDC identifies two new norovirus strains”.  8/26/07
Healthcare Purchasing News Online:  “Screenings for staph are now the law in Illinois: state first to apply mandatory testing.”  8/26/07
Infection Control Today:  “Study confirms limited human-to-human spread of avian flu virus in Indonesia in 2006”.  8/28/07

Quality / Medication Errors / Safety Issues

More Patient Deaths from Luer Misconnections
A recent FDA article in “Safe Practices in Patient Care” highlighted the serious errors that continue to occur when different devices that use Luer fittings are mistakenly connected to each other. Some of these incidents occurred when tubing from a portable blood pressure monitor was mistakenly connected to the patient’s IV line, causing fatal air emboli. In another case, an air supply hose from a pneumatic compression device was inadvertently hooked up to a needless IV tubing port.
JCAHO Sentinel Event Alert recommendations to prevent these kinds of mistakes include:

Source:  http://www.safe-practices.org/SafePractice8.pdf

 

WHO Warns About Fatal Errors with Vincristine
The World Health Organization (WHO) is alerting health professionals that despite repeated warnings, patient deaths continue to occur when the chemotherapy drug vincristine, which is intended for IV use, is accidentally given intrathecally. Patients on the receiving end of these accidents have died slowly and painfully.
WHO recommends developing a ‘gold standard’ to prevent these errors with a lock-and-key design for needles, syringe, catheters, tubing and bags. This can prevent medications intended for IV use from being administered intrathecally and vice versa. In the absence of a lock and key system, WHO recommends the diluting of vincristine and administering it only in minibags, via IV. WHO also says that vincristine labels should include the warning “For intravenous use only. Fatal if given by other routes.”
Source:  http://www.who/int/medicines/publications/drugalerts/Alert_115_vincristine.pdf

UPN Issues / Data Standards Issues

Healthcare Supply Chain Standards Coalition
AHRMM’s representative and staff continue to participate in HSCSC subcommittee meetings to advance the standardization movement. The HSCSC met most recently in Chicago on September 13. The Oversight Committee co-chairs gave an update on the HSCSC activities, financials, and relationship with NAHIT.

The Organizational Identifier Subcommittee recommended the GS1 GLN standard at the meeting and the Data Synchronization Subcommittee recommended the GS1 GDSN / GTIN standards. Both recommendations were voted on and approved by the Oversight Committee. The Education and Enablement Subcommittee distributed a press release announcing the HSCSC’s approval of the GS1 standards, has launched a web site, and continues to work on retention and recruitment of members. Since the July meeting two distributors, Cardinal and Owens and Minor, have joined the HSCSC finally getting the distributor point of view at the table.

The next Oversight Committee meeting will be December 6, 2007.