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Issues & Legislative Committee

November 12, 2009


Emergency Preparedness / Surge Capacity / Pandemic Flu

Mass Critical Care:
Pediatric Considerations (Disaster Medicine and Public Health Preparedness, http://www.dmphp.org);  a special focus area published in the current issue covered the topic of extending care and rationing care during Public Health Emergencies.  The article goes into the needs and requirements in support of this population, when collated, should account for 20 to 28% of victims, should that be in a disaster, or possibly even Pandemic Flu surges.  The article goes on to discuss general measures of response and also critical care interventions.  The article goes into discussion on the differences of intervention between the use of adult-use equipment and supplies versus those needed for age-specific categories from infants, to children even into adolescents, like ventilation and respiratory equipment/supplies.

At this point the article transitions into the rationing of care during MCC events and what exclusion criteria to use to maximize population outcomes based on intervention. When looking at rationing of care, public belief on the care of children, rationing care and prioritizing care into groups must be addressed.  There appeared to be debate on how to best address and manage not only patient outcomes but also public belief on the allocation of resources.

So, this took me back into my own area here at Ft. Campbell and how prepared are we for an All-Hazards response, that could allow us to respond to either a Mass Critical Care event, Pandemic Flu or even a MASCAL event like what we had down in Ft. Hood.  We may inadvertently assume that our population is of a median age and healthy.  However, based on how we are tied to the surrounding communities that population demographic may change or be influenced by what we have the capability to treat and the capacity to hold.  In either instance, we need to engage the clinicians on how they’ll address and provide care, and engage them on a regular basis. 

Does anyone else have a similar experience or means of engaging their clinicians when looking and assessing their ability to support the organizations preparedness plans?

Pandemic Flu
CDC reported that Flu activity remains high

Infection Control

Test Drug Does Well Against Hospital Infection
By ANDREW POLLACK
Published: November 10, 2008

A new antibiotic being developed by a small San Diego company fared well in a clinical trial, holding promise in treating an intestinal superbug that is commonly spread in hospitals and is becoming more deadly.

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In the trial, the drug developed by Optimer Pharmaceuticals to treat a bacterium, Clostridium difficile, worked better than the only approved drug on the market. The bacterium kills thousands of Americans a year, and that number has been rising sharply, in part because a more virulent strain has emerged. The announcement led Optimer’s stock price to nearly double in after-hours trading; it closed at $8.50, up $3.90, or 84.78 percent.

The results could also represent a significant step in the fight against the superbug, which can cause severe diarrhea and in some cases requires the removal of the colon. “C. difficile, if you look at the numbers, probably far outstrips MRSA as a hospital-acquired problem,” said Dr. Stuart Johnson, an associate professor at Stritch School of Medicine at Loyola University. The usual treatment for C. difficile infection is the generic antibiotic metronidazole. More serious cases are treated with the approved drug, Vancocin, a branded oral version of the antibiotic vancomycin that is sold by ViroPharma.

But more than 20 percent of patients treated with either drug have relapses that often require hospitalization again, said Dr. Johnson, who is a consultant to Optimer and other companies.  In the clinical trial, both Optimer’s drug and Vancocin were nearly 90 percent effective in initially clearing the infection. But only 15.4 percent of those treated with Optimer’s drug, called OPT-80, suffered a relapse within four weeks, compared with 25.3 percent of those treated with Vancocin.

The difference in recurrence rates “is something that has us absolutely ecstatic,” Pam Sears, senior director for biology at Optimer, told analysts on a conference call. The longer-term cure rate, meaning initial cure without recurrence, was 74.6 percent for OPT-80 compared with 64.1 percent for Vancocin.

The study, sponsored by Optimer, involved 629 patients in the United States and Canada. It was a Phase 3 trial, the final stage of testing before a drug is approved. Optimer said it would complete another Phase 3 trial, with results expected late next year, before applying to the Food and Drug Administration for approval to market the drug. Optimer has no drugs on the market yet but has another antibiotic for travelers’ diarrhea that is also in Phase 3 clinical trials.
ViroPharma recorded Vancocin sales of $182.3 million for the first nine months of 2008, up 17 percent from the year earlier, and the drug is responsible for the company being profitable.

ViroPharma, based in Exton, Pa., acquired Vancocin from Eli Lilly & Company in 2004, just as concerns over C. difficile started to rise, then increased the price of the drug 80 percent in its first year of ownership. In after-hours trading Monday, ViroPharma’s stock was down $1.07, to $11.50. C. difficile infection occurs when patients are treated with antibiotics for other problems. The antibiotic treatment disrupts the bacteria in the intestine, allowing C. difficile, which is resistant to many antibiotics, to take over.

Last week, Medarex and the University of Massachusetts said that antibodies they were developing to neutralize toxins produced by C. difficile had been effective in a Phase 2, or midstage, clinical trial.

Quality / Medication Errors / Safety Issues

Quality & Safety:
“Joint Commission initiative targets quality and safety” Materials Management in HealthCare October 2009, pg 6

In September 2009, TJC (Center for Transforming Healthcare) launched an initiative that aims to address quality issues and unsafe practices in the nation’s hospitals and health systems by transforming health care into a very reliable industry.

The first step is targeting hand-hygiene problems to address the issue of health care-associated infections (HAIs). Eight hospitals and health systems that are participating have begun the work to analyze the problem and find solutions.

Early findings indicated that faulty data lulled the health care facilities to believe there was a higher level of hand-washing compliance by caregivers than was actually true.
The eight hospitals determined that on average caregivers washed their hands less than 50% of the time. Among the reasons given for the failure were soap and alcohol gel dispensers being inconveniently located for caregivers. In other situations, caregivers had their hands full when approaching a patient, making them unable to wash their hands before entering the room.

The Center is targeting hand hygiene first because of the personal and financial magnitude of the problems causes by HAIs. Estimates are that about 247 people die in the US every day because of health care-associated infections.

In addition, an estimated 2 million patients a year become seriously ill due to HAIs, which results in annual cost of $28.4 billion to $45 billion to hospitals – according to the CDC.

The Center is also testing efforts to hold clinical and non-clinical staff accountable and responsible for hand washing, using a method to measure performance, real-time performance feedback and developing education to correct hand hygiene for specific disciplines.

The Center’s patient safety efforts will expand to include analyzing injuries caused by medications and wrongful surgery. The goal of the center is to put health care on par with the aviation and nuclear power industries in terms of safety and reliability.

Supply Chain Standards – GS1/HSCSC

Awareness and activity around the adoption and implementation of healthcare data standards is picking up. Following is a list of recent activity and those planned for the near future: