New Options for Fighting Hospital-Acquired Infections

NEWS TRENDS

Hospital-acquired infections are a scourge. Not only do they harm patients, killing as many as 99,000 a year, but they cost $5.5 billion a year to treat. Some payers, including CMS, have had enough and will no longer be covering treatments necessitated by infections caused by prior treatments.

CMS will cease Medicare coverage for four such conditions in October. They are infections associated with urinary catheters, blood lines, heart bypass surgery, and certain elective surgeries. It is proposing to stop paying for treatments of some other infection-related conditions by fall 2009.

This development should accelerate research to find solutions to curb the problem. A number of efforts are already under way, and many of the proposed solutions will require buy-in from medical device manufacturers. One idea in development is a device itself.

Some ideas were passed around at the eighth annual conference of the Multidisciplinary Alliance against Device-Related Infections (MADRI). “One benefit of the conferences is that many relationships have been formed that are resulting in collaborative research,” says Rabih Dariouche, MD, MADRI's founder. He is also director of the Center for Prostheses Infection at Baylor College of Medicine (Houston).

One area being studied is ventilator-initiated pneumonia. Ventilators' endotracheal tubes are the culprits, and they need anti­infective coatings, he says. “We must combine strict infection-control measures with anti­infective technology,” he says. This applies to other implanted devices as well, he adds.

Solutions to the problem need to have two qualities, he explains. First, they must be able to easily achieve a reduced rate of infection. Second, they must be durable. “You can't rely on human rates of compliance when it comes to infection-control measures,” he says. “Once an implant with a truly effective antiinfective is put in the patient, its job is essentially done.”

Gene and Peter Gordon, the founders of Germgard Lighting LLC (Dover, NJ), are tackling the problem from a different angle. They say that not only are current hospital practices inadequate for keeping pathogens out of patients, but that coating devices won't fully solve the problem, either. The main reason is that treating devices doesn't do anything about the pathogens that the caregiver can transmit to the patient.

What is needed, they say, is a way to make caregivers' hands sterile. “Personal protective equipment is a huge part of the infection prevention business, but all it does is protect the worker from the patient,” says Peter Gordon, who is Gene's son. Alcohol rubs kill some germs but not spores. Hand washing removes pathogens but doesn't kill them.

Instead, says Gene Gordon, “We have to figure out a way to sterilize hands within a very short time—seconds—and do it conveniently and with no irritation. So that all the excuses that healthcare workers and hospital administrators make will go down the drain.”

So Germgard is developing several technologies to address that. The closest to fruition is the Glovegard, a gloved-hand sanitizer. It uses Ultraviolet C to sterilize the glove on a caregiver's hand to the tune of a 4 log reduction in pathogens or better.

The Ultraviolet C is emitted through a germicidal tube, in a way that does not cause cancer. It can cause redness of the skin, but that's not an issue on gloved hands. The caregiver sticks his hand into a box and spreads his fingers. The opening is sealed, and the tubes emit the radiation. The sanitizing process at this point takes 3 seconds. Eventually, the Gordons would like to get the process down to 1 second.

Germgard is also developing a bare-hand sanitizer, an air sterilizer, and a surgical instrument sterilizer.

Hospitals have been reluctant to embrace these concepts, the Gordons say, but that could change once they are on the hook financially for treatments of infections contracted at their facilities.

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