By Paul Roberts, author of the new book The End of Food. Find it here.
(H/t to indefatigable animal activist Karen Dawn, author of Thanking the Monkey, for the link!)
22 August 2008
Not-reimbursing hospitals for MRSA: The reaction
You'll remember that early in the summer we talked about the proposal by the Center for Medicare and Medicaid Services to cease reimbursing hospitals for the additional care of a patient that is required when a hospital gives a patient a nosocomial infection. CMS has been debating whether to include several types of hospital-acquired infection in the 2009 iteration of its "never event" no-reimbursement list. (CMS has not announced its final choices.)
Healthcare's reaction has been, hmmm, not positive. At The New Health Dialogue, Joanne Kenen captures the reactions, many of which run along the lines of "infections are inevitable because patients are so sick." But she's also found a marvelous (and appalling?) argument that goes, more or less, "Preventing infections will be more costly, not less, because hospitals will introduce additional procedures to protect themselves."
This recalls the intriguing and dismaying suggestion in JAMA a few weeks ago that "search and destroy" active surveillance is driven less by wanting to halt in-hospital transmission and more by hospitals wanting to build a case that patients brought the infection with them.
Healthcare's reaction has been, hmmm, not positive. At The New Health Dialogue, Joanne Kenen captures the reactions, many of which run along the lines of "infections are inevitable because patients are so sick." But she's also found a marvelous (and appalling?) argument that goes, more or less, "Preventing infections will be more costly, not less, because hospitals will introduce additional procedures to protect themselves."
This recalls the intriguing and dismaying suggestion in JAMA a few weeks ago that "search and destroy" active surveillance is driven less by wanting to halt in-hospital transmission and more by hospitals wanting to build a case that patients brought the infection with them.
News round-up
I'm deep into writing again and therefore slipping on posting; apologies to regular readers! But here are some items of importance from the past week:
- Wednesday (Aug. 20) marked the first anniversary of Illinois' signing and immediately enacting the MRSA Screening & Reporting Act, the first state law to mandate that hospitals screen all ICU and other high-risk patients for MRSA colonization and to isolate and treat them until they are clear. This law would never have been passed without the extraordinary advocacy of MRSA survivor Jeanine Thomas, founder of the MRSA Survivors Network (site here and in the blogroll).
- Also as of Wednesday, California came within one step of passing its own MRSA laws, SB 1058 and SB 158. They await the signature of Gov. Arnold Schwarzenegger — but with California's budget in a $15.2 billion deficit freefall, new legislation there may be held hostage until a budget deal is agreed. Important addition: SB 1058 is also called "Nile's Law," after Nile Calvin Moss, who died of MRSA in April 2006. His parents Carole and Ty have pushed relentlessly for a MRSA law in his memory.
- Plus, a great find thanks to Carole Moss: The Washington State Department of Health has put together an excellent pamphlet, Living with MRSA, that explains MRSA infection, colonization, decolonization and infection-control care at home in excellent everyday language.
- And finally, another blog worth knowing about: GERMblog, written by Dr. Harley Rotbart, professor and vice-chair of pediatrics at University of Colorado School of Medicine and author of Germ Proof Your Kids: The Complete Guide to Protecting (Without Overprotecting) Your Family from Infections. I interviewed Dr. Rotbart recently for a magazine story and his advice was clear, science-based and sensible. His blog is now in the blogroll.
14 August 2008
Surveillance to stop MRSA: Where, when, how costly, how much?
My colleague Joanne Kenen — longtime health policy correspondent for Reuters, now a staff member at the New American Foundation, and a Henry J. Kaiser Family Foundation Media Fellow with me in 2006-07 — very kindly invited me to guest-blog at the New Health Dialogue. Most of the post is reproduced below, but please be kind and visit them so they can record the hits!
Stopping the spread of MRSA in hospitals is one of the most contentious topics in infectious disease policy right now. A small sample of the, umm, highly divergent views on the subject filled up the letters pages of the Journal of the American Medical Association last week. Community-associated MRSA has grabbed the public's attention over the past year, but hospital-acquired MRSA remains a huge problem — so much so that the Center for Medicare and Medicaid Services has proposed treating it as a medical error and declining to reimburse hospitals for the extra care that must be given to a patient when it occurs.
Within health care, there is vociferous debate over how to control MRSA. Because MRSA can live on the skin, nostrils and other body sites for a long period of time before causing an infection — either in the person colonized by the bug or in someone else who acquired it from the colonized person — many hospitals espouse a program of checking new patients who are most likely to be carriers, including patients in high-risk units such as ICUs, new admits from long-term care facilities, and people who have had MRSA infections on the past. But a small set of institutions are pursuing a more aggressive program, variously called "active surveillance and testing," "universal screening" or "search and destroy," that checks every inpatient for MRSA colonization and confines them to isolation until the bug has cleared.
"Search and destroy" was the topic of an important JAMA paper and editorial last March that decided the effort wasn't worthwhile. (A simultaneously published paper in the Annals of Internal Medicine completely disagreed.) The five letters in JAMA tear the topic apart, examining definitions, methodology, cost-effectiveness, adherence to infection control and more. The most intriguing suggests that "search and destroy" contains a hidden agenda: That if hospitals can demonstrate patients were carrying MRSA on admission, they may be able to make a case for any subsequent infections not being their fault — and so escape the lowered reimbursement rates that CMS proposes.
Stopping the spread of MRSA in hospitals is one of the most contentious topics in infectious disease policy right now. A small sample of the, umm, highly divergent views on the subject filled up the letters pages of the Journal of the American Medical Association last week. Community-associated MRSA has grabbed the public's attention over the past year, but hospital-acquired MRSA remains a huge problem — so much so that the Center for Medicare and Medicaid Services has proposed treating it as a medical error and declining to reimburse hospitals for the extra care that must be given to a patient when it occurs.
Within health care, there is vociferous debate over how to control MRSA. Because MRSA can live on the skin, nostrils and other body sites for a long period of time before causing an infection — either in the person colonized by the bug or in someone else who acquired it from the colonized person — many hospitals espouse a program of checking new patients who are most likely to be carriers, including patients in high-risk units such as ICUs, new admits from long-term care facilities, and people who have had MRSA infections on the past. But a small set of institutions are pursuing a more aggressive program, variously called "active surveillance and testing," "universal screening" or "search and destroy," that checks every inpatient for MRSA colonization and confines them to isolation until the bug has cleared.
"Search and destroy" was the topic of an important JAMA paper and editorial last March that decided the effort wasn't worthwhile. (A simultaneously published paper in the Annals of Internal Medicine completely disagreed.) The five letters in JAMA tear the topic apart, examining definitions, methodology, cost-effectiveness, adherence to infection control and more. The most intriguing suggests that "search and destroy" contains a hidden agenda: That if hospitals can demonstrate patients were carrying MRSA on admission, they may be able to make a case for any subsequent infections not being their fault — and so escape the lowered reimbursement rates that CMS proposes.
01 August 2008
Oh no they *didn't*...
The Environmental Protection Agency will allow apple growers in Michigan to spray the human antibiotic gentamicin on apples to control an apple-tree disease, fire blight.
This because the disease had already become resistant to a previously used, different human antibiotic, streptomycin.
The Infectious Diseases Society of America tries to get them to see reason:
The decision in the Federal Register here. The original EPA proposal here. A Clinical Infectious Diseases article about human antibiotic use in plant agriculture here. And somewhere in the immediate vicinity, me clutching my head and wandering away muttering.
This because the disease had already become resistant to a previously used, different human antibiotic, streptomycin.
The Infectious Diseases Society of America tries to get them to see reason:
"At a time when bacteria are becoming increasingly resistant to many of our best antibiotics, it is an extremely bad idea to risk undermining gentamicin's effectiveness for treating human disease by using it to treat a disease in apples." (IDSA President Donald Poretz, MD in a press release.)Gentamicin is used against staph and against a range of Gram-negative bacteria, and is an important drug for bloodstream infections in newborns. In a bizarre irony, the EPA bans its use on imported fruits/vegetables — because of fears of fostering resistance.
The decision in the Federal Register here. The original EPA proposal here. A Clinical Infectious Diseases article about human antibiotic use in plant agriculture here. And somewhere in the immediate vicinity, me clutching my head and wandering away muttering.
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