Medical Device Daily National Editor
NEW YORK – Hospital-acquired infections are in the news like never before, and that focus led Piper Jaffray (Minneapolis) to put together a panel on the topic as part of the program for its 19th annual healthcare investing conference here last week.
The topic drew a considerable crowd to the Grand Ballroom of the Pierre Hotel, and the panelists, who came at the topic from three distinctly different roles, forcefully emphasized the magnitude of the problem
Elizabeth McCaughey, PhD, was the most high-profile member of the panel. A widely-known health policy expert, she is a former lieutenant governor of the state of New York and about a year-and-a-half ago founded the Committee to Reduce Infection Deaths.
McCaughey, who also serves as chair of that committee, set a statistical foundation for the discussion, noting that it is estimated that one out of every 20 hospital patients in the U.S. acquires an infection, totaling some 20 million a year, with about two-thirds of those infections being drug-resistant. Of those 20 million, there are as many as 100,000 die each year.
As daunting as those statistics appear, the news may be even worse.
“A new study reported in the Journal of the American Medical Association in October suggests that it [the volume of such infections] could be much larger,” she said. “The JAMA study said that MRSA [methicillin-resistant Staphylococcus aureus] probably is twice as prevalent as previously reported ... [perhaps] even larger.”
With even the lower previous estimates being mind-boggling, the realization that the incidence of such infections may be underestimated by a factor of two, or even more, was enough to make many in the audience to lean forward in their chairs, as if determined not to miss any of the dialogue emanating from the panelists.
Another panelist, Janet Haas, RN, DNSc, is associate director of infection prevention and control at New York University Medical Center. She noted that one of the reasons for what now are seen as under-stated earlier estimates is that it is “very labor- and time-intensive to gather infection data in hospitals.”
In what amounted to a plea to an audience of investors who might in turn help influence the directions taken by firms into which they put their money, she said: “We need help from our IT partners in including epidemiological information on electronic patient records.”
Panelist Sandra Finley, VP of marketing at diagnostics firm Cepheid (Sunnyvale, California), said that when it comes to surveillance of MRSA, “we need to know who is colonizing it.”
As for how to approach the problem, McCaughey said “the evidence is quite compelling that screening incoming patients for MRSA is essential if we hope to deal with the problem. You cannot control the spread of these bacteria unless you know the source.”
She said the “vast majority” of hospitals take what she characterized as “the tip-of-the-iceberg” approach, “which ignores the vectors of MRSA.” Because those hospitals don’t screen patients, things like stethoscopes and blood pressure cuffs become vectors,” or carriers, of MRSA.
As an example of succeeding in the battle against such infections, McCaughey cited a community hospital in New Haven, Connecticut, that put a program in place for screening patients who were coming into the surgical department, putting strategies in place that reduced the number of hospital-acquired infections by two-thirds.
As another, she said implementation of a patient-screening program for intensive-care units at Brigham & Women’s Hospital (Boston) cut infection rates by 75%.
After Finley cited new Centers for Medicare & Medicaid Services rules for hospital reimbursement that include requirements for dealing with the infections issue, McCaughey gave CMS high marks for “a positive first step,” especially given “Medicaid’s historic indifference to quality.”
She fought – unsuccessfully – to keep the sarcasm from being too obvious in saying that it appears that “most infections will be excluded from the new rule.”
Adding that she was “glad the market is realizing it,” McCaughey said infection identification and resolution efforts “are being legislated and litigated into existence.”
In fact, she forecast that hospital infections “is the next asbestos,” an area of attorney involvement that put thousands of them behind the wheels of new Mercedes.
Haas said, “My job is to prevent infection, and we need to attack it. The goal is to prevent [all] infections, not one bug at a time” – a reference to the appearance that MRSA seems to be getting almost all the attention.
The problem, she said, “is that we have to put the limited resources we have to the most effective use.” That means “we have to pick the low-hanging fruit, as in MRSA screening.”
Of most importance as hospitals turn greater attention – and hopefully more resources – to dealing with such infections, Haas said, “is that we screen for the infections important to our own institutions.”
Touching on the focus-on-MRSA question, Finley noted that in the U.S., “C. difficile is a [considerable] problem.”
Clostridium difficile, whose most outward sign is in symptoms such as diarrhea, is a pathogen that has plagued a number of U.S. hospitals with severe outbreaks.
Both Finley and Haas, representing a diagnostic test maker and someone who mans a frontline battle station against infections, respectively, argued the case for rapid tests for screening and routine testing purposes.
“Molecular tests take 12 to 24 hours,” Finley said. “That’s why rapid tests are so important.”
Noting that “we’ll see more and more pathogens,” she said, “So we need more and more tests that can be easily given.”
It has a lot to do with human behavior, she said. “If we can tell someone, ‘We can tell you within 50 minutes’ whether they have an infection, their eyes light up.”
She added: “Having to call patients back in [the hear test results] is always difficult, so rapid tests are important.”
One point that particularly energized McCaughey was the oft-heard concern by administrators that infection control is a cost center for institutions. “It’s not a cost center,” she said. “It’s a profit center.”
By that she means that “all hospitals are losing their shirts on infection. Patients who contract infections have five times the length of stay, and are twice as likely to die.”
Dealing with infections aggressively can make infection control a matter of profit, McCaughey said. “Many hospitals have experienced a 10:1 payback on their investments in infection control.”
Finley added: “Some hospitals are testing everyone coming in – it’s good community PR.”
She indirectly quoted the CEO of one hospital she had visited recently: “We are a community hospital. I need to protect my community.”