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Industry to Brainstorm About Hospital-Acquired Infections

Beginning in October, CMS will no longer pay for treatments of certain infections acquired by patients while they were in a hospital or other healthcare facility. (More about this topic appears in the September issue of MD&DI.) The infections on the list include line sepsis and catheter-associated urinary-tract infections.

That means that medical device companies who sell catheter-based products will have to be very careful about how they are designed. Leaders from the device industry and other stakeholders in the healthcare system will meet in October to discuss how to prevent line sepsis. Cook Group is one company that treats catheters with antibiotics to prevent line sepsis. (In Cook's case, the antibiotic is not coated on the catheter but embedded within it.) It will send representatives to the summit. What follows are the thoughts of Dr. Charles McIntosh, its vice president and chief medical science and technology officer, about the upcoming summit. He provided them exclusively to MD&DI. "Preventable medical errors that occur during or after hospitalization are estimated to cost about $1.5 billion a year, according the Agency for Healthcare Research and Quality. Beginning Oct. 1, 2008, CMS will no longer pay hospitals for several conditions deemed preventable when following evidence-based guidelines, including several hospital-acquired infections (HAIs) such as line sepsis and catheter-associated urinary-tract infections (UTIs). Recently, questions have been raised by the media and medical professionals about treatment for line sepsis and other HAIs. Such questions include the effectiveness of the treatment, as well as the validity of the research supporting the treatment. Despite the scrutiny, effective treatment options are necessary if and when an infection occurs. However, greater attention must be paid to preventing line sepsis. Line sepsis develops when bacteria enter a patientâEUR(TM)s bloodstream through a central venous catheter (CVC). CVCs are universally employed in the intensive care unit as key medical devices to deliver frequent and/or continuous injections of fluids and medications. But they inherently carry a substantial risk of infection, either from the device itself or from contaminated medical supplies. Of the estimated 1.7 million HAIs in the United States annually, the CDC estimates at least 250,000 of these cases are line sepsis. With an associated attributable mortality rate of 12-25%, this infection is the second-leading cause of death associated with HAIs, second only to pneumonia. Line sepsis can lead to acute respiratory-distress syndrome, kidney failure, shock and other potentially fatal ailments. Additional treatment costs for line sepsis average about $35,000 per infection. Clearly, preventing sepsis must be a major priority to protect patient lives and help corral rising health care costs. From the insertion of the CVC, to administering injections, to providing bedside care to a patient with a CVC, bacteria are often easily transmitted through improper hand hygiene at all levels of the healthcare system. In response, the CDC specifies that healthcare workers wash their hands before and after contact with each patient, change gloves when moving from a contaminated site to a clean site on the same patient and use full barrier sterile precautions when inserting devices such as CVCs. The CDC also recommends the use of chlorhexidine over betadine prep, as it has shown to be more effective in reducing infections. Investigators have found that process alone will not consistently eliminate the risk of infection, particularly in high-risk patients. Technology, however, can help close the gap. For example, a new generation of catheters impregnated with the antibiotics minocycline and rifampin has been proven to reduce the risk of CRBSI. In October, thought leaders from the nationâEUR(TM)s leading healthcare and quality organizations and hospitals, including the CDC, CMS, the Association for Professionals in Infection Control and Epidemiology, and Johns Hopkins University Hospital, will meet in Washington, DC to discuss the increased accountability regarding line sepsis. At the âEURoeLeadership Strategy for the Prevention of Line SepsisâEUR summit, the group will formulate standardized recommendations on how hospitals and medical practitioners can employ evidence-based process measures and technology to reduce the occurrence of line sepsis to as close to zero as possible. Healthcare professionals have always been committed to improving patient care, and so a solid commitment must be made to not just treating HAIs, such as line sepsis, but preventing them. Adherence to infection prevention best practices recommendations by the âEURoeLeadership Strategy for the Prevention of Line SepsisâEUR summit looks to be a major step in reducing the occurrence of preventable infections and providing patients with a safer hospital stay."

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