Hes spring '16 final by Downing and Associates

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Environmental solutionsnews Covering Infection prevention, medical waste management & sustainable practices

VOL. XII NO. 1

www.HealthcareEnvironmentalSolutions.com

SPRING 2016

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War on Drugs Includes Battle Over Disposal Options

By P.J. Heller

eidi Sanborn and her colleagues can’t fathom why there is such a hodgepodge of city/county/state/ federal guidelines and rules concerning how people should dispose of prescription and nonprescription/over-the-counter drugs. Especially troubling, she says, is the Food and Drug Administration’s recommendation to flush some unused, expired and unwanted medications down the sink or toilet. Sanborn, executive director of both the National Stewardship Action Council and its affiliated organization, the California Product Stewardship Council, is not alone in her concern about the effect of pharmaceuticals entering waterways. More than 100 environmental and health organizations, agencies, activists and state legislators signed on to a letter to the FDA urging it to end its “flush list” recommendations. “ We c a l l o n t h e F DA t o e n d i t s recommendation that certain medications be disposed by flushing, and to clarify that secure medicine take-back programs provide the best disposal method for leftover household medications,” said the letter to FDA Acting

Commissioner Dr. Stephen Ostroff. “. . . The time has come for FDA to align its medicine disposal guidance with that of federal, state and local agencies who seek to protect both the public’s health and our water quality.” In place of the assortment of rules and regulations being considered or crafted by governmental agencies at all levels, Sanborn and others recommend a single national disposal system for pharmaceuticals, to be funded by the industry similar to take-back programs such as those for electronics manufacturers. A mandatory, industry-funded takeback program is vehemently opposed by the pharmaceutical industry. Drug take-back programs run and funded by pharmaceutical and related companies already exist in other countries, including Canada, Mexico, Spain, Brazil, Belgium and Portugal. In Canada, for example, people can return their unused and expired medications to any pharmacy any day of the year. “They do it in these other countries and they’re fighting like hell here,” she says.

Continued on page 3

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HEALTHCARE ENVIRONMENTAL SOLUTIONS news

SPRING 2016

Healthcare Environmental Solutions news

healthcare

Environmental solutionsnews Covering Infection prevention, medical waste management & sustainable practices

PUBLICATION STAFF Publisher / Editor Rick Downing Contributing Editors / Writers P.J. Heller Sandy Woodthorpe Production & Layout Barb Fontanelle Christine Pavelka Advertising Sales Rick Downing Subscription / Circulation Donna Downing Editorial, Circulation & Advertising Office 6075 Hopkins Road Mentor, OH 44060 Ph: 440-257-6453 Fax: 440-257-6459 Email: downassoc2@oh.rr.com For subscription information, please call 440-257-6453. Healthcare Environmental Solutions news (ISSN #1557‑6388) is published quarterly by Downing & Associates. Reproductions or transmission of Medical Waste Management, in whole or in part, without written permission of the publisher is prohibited. Annual subscription rate U.S. is $19.95. Outside of the U.S. add $10.00 ($29.95). Contact our main office, or mail-in the subscription form with payment. ©

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War on Drugs Includes Battle Over Disposal Options Continued from page 1

Sanborn pooh-poohs the argument by drug manufacturers that the cost of such take-back programs would be expensive and result in higher prices for drugs, noting that where such programs are in effect drug costs are actually lower than in the U.S. “In Canada they do it very efficiently and do a great job,” she says. “But that’s where we get our cheaper drugs. So they can’t make the claim that the cost of the program is killing the budget. “What it’s going to cut into is CEO pay . . . ” and commercial advertising, she says. In the U.S., Sanborn estimates a takeback program would cost the industry only 1 cent extra for every $10 prescribed; to run the program in California would cost $42 million a year, she estimates. That’s a drop in the bucket compared to the average 30 percent profit margin realized by drug companies. Sanborn points to people like Martin Shkreli, who as chief executive officer at Turing Pharmaceuticals generated outrage and prompted a congressional hearing into his plans to raise the price of a life-saving drug by more than 5,000 percent. Shkreli expected to make $1 billion on the drug price hike. As You Sow, an activist organization that promotes environmental and social corporate responsibility through shareholder advocacy, has filed shareholder resolutions at major pharmaceutical companies asking them to take responsibility for the safe collection and disposal of unused and expired drugs. “We believe the companies that put medications on the market and profit from them should be primarily responsible for financing take-back systems,” Conrad MacKerron, senior vice president at As You Sow, said in a news release. “We are concerned that the pharmaceutical industry has opposed such responsibility.” While the Pharmaceutical Research and Manufacturers of America (PhRMA) is against a mandated industry-funded take-back program, at least one national retailer in the U.S. has launched such an effort. Walgreens, one of the nation’s largest drugstore chains, announced in February that it plans to install safe medication disposal kiosks in more than 500 drugstores in 39 states and Washington, D.C., primarily at locations open 24 hours. The bins will allow the public to dispose of unwanted, unused or expired prescriptions, including controlled substances and over-the-counter medications, at no cost. In announcing the program, Richard Ashworth, Walgreens president of pharmacy and retail operations, noted that the company was “leading the way in retail pharmacy’s fight against prescription drug abuse. We understand the challenges our communities face, and we SPRING 2016

stand ready to help our patients and customers lead healthier lives. When the stakes are this high, the solutions must be comprehensive.” Those stakes include prescription drug abuse; a national survey two years ago reported that 6.5 million Americans misused a prescription drug in 2014. And the Centers for Disease Control and Prevention reported a total of 47,055 drug overdose deaths, which include prescription and illicit drugs, during the same year. Marcia Lee Taylor, president and chief executive officer of Partnership for Drug-Free Kids, calls prescription drug abuse an epidemic among American teens. The FDA’s suggestion that some unused, unwanted and expired medications be flushed down the toilet or sink runs counter to suggestions by other agencies, environmental groups and others. The U.S. Environmental Protection Agency points to studies that have documented the presence of various pharmaceutical active ingredients and metabolic by-products in surface waters and groundwater in the United States. “The phar maceuticals entering the environment, through flushing or other means, are having a negative effect on aquatic ecosystems and on fish and animal populations,” it says. An Associated Press investigation published in 2008 reported that “tests have detected minute concentrations of pharmaceuticals in the drinking water supplies of at least 46 million people in two dozen major American metropolitan areas . . . The federal government does not regulate prescription drugs in water.” Sanborn points to the current drinking water contamination crisis in Flint, Mich. — caused by lead in the water and not drugs — as an example of why the public needs to demand action to protect its waterways from harmful substances. “I think the public trust of government to protect their water is pretty much at an all time low,” she says. “If we cannot get these meds out of the water, why on earth would we put it in there intentionally,” Sanborn asks. “So let’s stop it and let’s use the precautionary principal and say, ‘If we can’t get it all out, it shouldn’t go in. If we can cost-effectively keep it out, let’s do that.” The way to accomplish that goal, she says, is to create a national drug take-back program designed and paid for by the industry in collaboration with local governments. Such an effort, she says, will be a paradigm shift on how waste is handled. “Are we going to subsidize it and let companies put whatever they want on the market and walk away and leave the government holding the bag and then claim the government doesn’t

Continued on page 4

HEALTHCARE ENVIRONMENTAL SOLUTIONS news

Healthcare Environmental Solutions news

War on Drugs Includes Battle Over Disposal Options

Continued from page 3

do anything right, it’s too big, it’s inefficient,” she asks. “Or are we going to go the way the rest of the world is going, towards a producer-responsibility model where they [manufacturers] have a fair sharing of the responsibility and they even get to design it. “It‘s not a command-and-control program,” Sanborn says. “For me, coming from government seeing the flaws in having government decide how a program runs . . . it makes a lot more sense to me to leave it in the private sector to design and run it and fund it, and then have the government do oversight and make sure it’s transparent and make sure it works. It’s the best of both worlds.” The Pharmaceutical Research and Manufacturers of America, however, opposes any mandated take-back programs. An ordinance adopted three years ago by Alameda County, Calif. — the first in the nation to hold pharmaceutical companies responsible for the safe collection and disposal of unused medications from the public — went all the way to the U.S. Supreme Court, which in 2015 denied the industry’s request to review a lawsuit filed against the measure. Three industry trade groups had filed the lawsuit arguing the local law was unconstitutional. “We will continue to actively work with all relevant stakeholders to educate consumers on the appropriate use of medicines, including providing information about safeguarding medicines in the home and promoting safe, secure and effective methods for disposal,” PhRMA said after the Supreme Court refused to review the case. “Ensuring the safe and secure disposal of unused medications is a top priority for our industry,” a PhRMA spokesperson said. “The biopharmaceutical industry supports proper in-home disposal as the first-line option for the safe and effective removal of medicines from the household.” The organization, which represents the nation’s leading biopharmaceutical researchers and biotechnology companies, points to the FDA website for suggestions on how to dispose of medicines. The FDA says community-based drug take-back programs offer the best option, and failing that, “almost all medicines can be thrown in the household trash.” It also has a “flush list” of drugs that it says can go down the sink or toilet. “There is a small number of medicines that may be especially harmful and, in some cases, fatal with just one dose if they are used by someone other than the person for whom the medicine was prescribed,” the FDA says on its website. “To prevent accidental ingestion of these potentially

dangerous medicines by children, or pets, it is recommended that these medicines be disposed of quickly through a medicine take-back program or by transferring them to a DEA-authorized collector. If these disposal options are not readily available, it is recommended that these medicines be flushed down the sink or toilet as soon as they are no longer needed.” PhRMA notes that many biopharmaceutical companies have participated in voluntary take-back events and activities nationwide, but insists mandating such programs is not the answer. “There is no need to mandate new, costly and redundant take-back programs when in-home disposal in your household trash has repeatedly been shown to be effective, ecologically sustainable, secure, more convenient and less costly for patients,” it says. It also contends that mandated take-back programs “place a far greater burden on the environment because individuals have to travel to drop-off sites and somebody has to pick up and dispose of those drugs. “While our industry does not oppose voluntary take-back programs, the fact remains that mandatory local, state or national take-back programs are not a solution,” it adds. “Studies have shown that only a relatively small percentage of consumers use take-back programs, which means most unused medicines never reach collection sites. Proper in-home disposal, particularly in conjunction with public education programs, promises much higher compliance rates and widespread participation.” Despite that, Sanborn remains optimistic that the industry will come around. She describes the battle over drug disposal as the “perfect storm issue,” encompassing areas including drug abuse, law enforcement, water and the environment. “No matter which angle you come from, you care about this issue,” she says. Sanborn says the pharmaceutical industry needs to develop and fund its own take-back drug plan or face more and varied ordinances from governmental agencies at all levels, which she describes for the industry as “death by a thousand cuts.” “Get ahead of it. That’s all you have to do,” she advises. “If you come up with a plan, I don’t know of a legislature in the country that would force a law down on you when you’ve got a program that’s working. Nobody wants to go there. But you haven’t done anything. You can’t sit around and then complain [about a patchwork of laws] now that you’re getting death by a thousand cuts. We warned you that it was coming but you just don’t want to pay for it, so here we are.”

Industry Remembers John L. Hall, Co-owner of San-I-Pak, Pacific Inc.

ohn L. Hall, born November 11, 1937, of Tracy, California passed away on Sunday, January 3, 2016, in his home, surrounded by family. Born in Waldport, Oregon to John Lester Hall Sr. and Doris Johnson-Hall, John’s first professional endeavor would be a 25 year stint as a King Crabber in the Alaskan Bering Sea. He began with his uncle Clifford Hall on the F/V Tiffany, and then became partners with Wilburn and Vern Hall in the F/V King & Winge. Later they built the F/V Provider which John managed and ran as captain. He is credited with inventing and developing numerous fishing vessel safety features, most notably the wheel watch alarm system and the first ship central alarm system; these were the beginnings of automated vessel safety features. In 1975 John was invited to speak to Congress about the decimation of overfished sea life and the need for a resource management limit. The hearing led to Congress passing the 1976 Fishery Conservation and Management Act, still relevant today. In his post King Crab days, John became co-owner of San-I-Pak, Pacific Inc. in Tracy, California, a manufacturer of on-site healthcare waste treatment systems with over 600 installations in the United States and abroad. John again used technology, brilliance, experience and innovation to change the paradigm of an industry. While he undoubtedly would have made many more valuable contributions to the world we live in, his legacy will live on through his employees, partners, family and friends, who meant the world to him.

HEALTHCARE ENVIRONMENTAL SOLUTIONS news

SPRING 2016

News Briefs

Needle Stab Accidents at Kaiser Hospital Brings Cal/ OSHA Fines

allejo, CA – Multiple incidents of needle stabs at Kaiser Hospital in Vallejo have resulted in citations by the state occupational safety agency, Cal/ OSHA, according to a healthcarefinancenews. com article. Cal/OSHA inspectors learned that three employees were injured by improperly discarded needles during routine emptying of the hospital’s biowaste collection receptacle. The employees deposited used needles through a hinged slot on a metal box resembling a postal mailbox. The needles dropped into an inner disposal box designed to contain biomedical waste, and then employees would transfer the contents into a larger disposal container for collection by the hospital’s waste hauling contractor. The needle stick accidents occurred over a three-year period when the receptacle was filled to the point of overflowing. Hospital administration corrected the problem, replacing the collection box with two larger disposal units. The units are now monitored every 30 minutes. Cal/OSHA investigators also learned that the needle collection box was typically cleaned using a broom and dustpan, but when those tools proved inadequate, employees would reach into the box to remove the waste, even though needles were often deposited without a protective cap. All three of the injured employees were given preventive medication to ward off any health consequences, and corrective actions were taken following the inspection. In all, Kaiser was cited for five workplace safety violations of the bloodborne pathogens standard, which requires employers to protect workers from coming into contact with blood or other disease-carrying bodily fluids. Two of those violations were classified as “willful serious” -- meaning evidence showed the hospital was aware of an issue, but essentially did nothing to rectify it. Cal-OSHA fined the hospital $149,900 and has since put safeguards in place to prevent further incidents. According to Kaiser Permanente media relations specialist, Deniene Erickson, “Kaiser Permanente Vallejo was already actively addressing this matter, including purchasing larger and better designed kiosks for the safe storage and disposal of sharps collected from the public. We have since taken further action to protect our staff, including providing employees with additional training and replacing their protective gear.” Erickson said no injuries have been reported since the installation of the new kiosks.

CMS Fines More Than 750 facilities for Hospital-acquired Infections

altimore, MD – According to a Centers for Medicare and Medicaid Services report, 758 hospitals are being penalized by the agency for not meeting 2015 targets for reducing their rates of hospital-acquired infections. The hospitals will see a one percent payment cut to all Medicare discharges applied to claims between October 1, 2015 and September 30, 2016. The reduction saves CMS an estimated $364 million, the agency said. Of a total 3,308 providers covered by the program, the 758 that were found to be deficient in decreasing the rates of HAI represent those in the worst performing quartile. The 75th percentile score cutoff for fiscal year 2016 was 6.75, compared to 7.0 in fiscal year 2015, according to CMS, because more hospitals earned poor scores. Approximately 53.7 percent of those with deficient 2015 performance levels did not show improvement in the next quartile. In the FY 2016 HAC Reduction Program, hospitals with a Total HAC Score greater than 6.7500 are subject to a payment reduction. Overall, mean patient safety and central line-associated bloodstream infection rates showed improvement. The mean catheter-associated urinary tract infection standardized infection ratio increased slightly, while the mean surgical site infection standardized infection ratio was 0.95 in 2016, the first year the measure was used in the program.

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HEALTHCARE ENVIRONMENTAL SOLUTIONS news

News Briefs

Hand Washing Compliance Assisted by New Observational Tools

akbrook Terrace, IL – Data from a recently completed study conducted at Memorial Hermann Health System (MHHS) in Houston suggest that high rates of hand hygiene compliance are the key to preventing hospital-acquired infections (HAI), according to a Hospimedica.com article. The study authors noted that procedure-specific processes to reduce infections related to devices such as central lines or ventilators or others, such as urinary catheters, may not achieve extremely low rates of infection unless they are accompanied by proper hand washing. A new compliance tool developed by the Joint Commission Center (JCC) for Transforming Healthcare (JCC) was used by the MHHS researchers. The web-based Targeted Solutions Tool (TST) for hand hygiene was implemented in 150 inpatient units in 12 system hospitals in 2010, followed by a system-wide process improvement project that was carried out from October 2010 through December 2014. The Targeted Solutions Tool (TST) provides data on an organization’s actual performance in HAI prevention, identifies barriers to excellent performance, and directs them to proven solutions customized to address their particular barriers. For hand hygiene compliance, the TST describes a minimum number of times a health care worker should conduct hand hygiene when entering and exiting a patient’s room, defined as “wash in/wash out” phase. According to the study report, published in the JCC’s January issue of its Journal on Quality and Patient Safety, TST methodology engages anonymous secret observers who hold unbiased positions and are able to observe hand hygiene compliance. These observers (whose identities are completely unknown to the individuals being observed) do not interfere with the caregivers’ work. Their role is to observe and collect data.

To ensure reliability, selected MHHS staff members were trained on accurate data collection. Clinical staff and nonclinical staff, including environmental services, dietary, plant operations, and chaplains were eligible to participate as secret observers and “Just in Time” (JIT) coaches. Only secret observers’ data were used to calculate rates of noncompliance. When a JIT coach observed a noncompliant individual, he or she intervened to identify contributing factors and root causes for noncompliance and briefly educated the individual about hand hygiene protocol. At project completion, the researchers collected and analyzed data on rates of intensive care unit (ICU) central line associated bloodstream infection (CLABSI) and ventilator associated pneumonia (VAP) events throughout the time period. The results showed that based on 31,600 observations during the initial phase (October 2010 to May 2011), the MHHS system-wide hand hygiene compliance baseline rate averaged 58.1 percent; during the improvement phase (June 2011 to November 2012), compliance averaged 84.4 percent. During the control phase (December 2012 to December 2014), compliance increased to 94.7 percent in the first 13 months, while compliance climbed to 95.6 percent in the final 12 months of the program. Adult ICU CLABSI and VAP rates decreased by 49 percent and 45 percent, respectively. “The TST enabled MHHS to measure compliance rates, identify reasons for noncompliance, implement tested interventions provided by the TST, and sustain the improvements,” concluded lead authors M. Michael Shabot, MD, of MHHS, and Mark Chassin, MD, MPP, MPH, of the JCC, and colleagues. “MHHS substantially improved hand hygiene compliance in its hospitals and sustained high levels of compliance for 25 months following implementation.”

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HEALTHCARE ENVIRONMENTAL SOLUTIONS news

SPRING 2016

News Briefs

picture of a man’s intense staring eyes, along with a clean citrusy smell, have been found to substantially improve hand-washing and so cut the risk of hospital infections, according to a new study. According to the latest research, effective hand hygiene is the single most important procedure in preventing hospital acquired infections, which can lead to disease and even death for vulnerable patients, and also increase costs for healthcare systems. Yet the number of staff washing hands is often startlingly low in clinical environments. Ivo Vlaev, of Warwick Business School, Dominic King and Ara Darzi, of Imperial College London, and Maureen Fitzpatrick, Ruth Everett-Thomas and David Birnbach, of the University of Miami, used insights from behavioural science -- often called nudges -- to improve rates of handwashing in a study at one hospital. They found that posting a picture of a man’s eyes resulted in a third more people washing their hands, while a citrus smell boosted handwashing by almost 50 percent. Professor Vlaev said, “Appropriate hand hygiene is considered to be essential practice in clinical environments to prevent healthcare-associated infections. Yet low rates of hand-washing are widely reported and this was reconfirmed in this study, where only 15 percent of staff and visitors to an intensive care unit were observed to use the hand-washing station.” In the paper ‘Priming’ Hand Hygiene Compliance in Clinical Environments, published in Health Psychology, the researchers experimented with psychological priming, which is the process where exposure to certain cues -- for example words, smells, or images -- alters behaviour without the person being aware of the impact of the cue on their behaviour. A trial was set up in a surgical intensive care unit at a teaching hospital in Miami, Florida. A total of 404 healthcare workers and visitors were observed to see if they washed their hands by using the hand sanitizer next to the door before entering a patient’s room. In the control group, of 120 visitors just 18 washed their hands (15 percent). Men on the whole seemed far sloppier with only five out of 54 (9.26 percent) washing their hands, compared to 13 out of 66 women who washed their hands (19.70 percent). A total of 124 visitors were exposed to a visual cue of a pair of eyes positioned above the alcohol hand gel dispenser. When exposed to a photograph of male eyes there was a statistically significant increase in hand-washing of 33.3 percent. However, when the photograph was of female eyes even less, 10 percent, washed their hands. Again males tended to comply with hand hygiene far less than their female counterparts with 21 women influenced by the male or female eyes and only five men, with just one man motivated by the female eyes to wash his hands. Professor Vlaev said, “This may be because male eyes cue different feelings, thoughts, or emotions than female eyes. In many previous studies examining gender differences in exerting social influence more generally, men have been found to exert more influence than women and this may explain the differences seen. However, it is important to clarify the male eyes showed used more facial musculature, often perceived as anger or threat, so this could have influenced the observed individuals.” There were 160 individuals observed who were exposed to a citrus smell and they were significantly more likely than the control group to wash their hands, with 46.9 percent using the alcohol hand gel dispenser. The citrus smell seemed to spur more men into action with 35 out of 83 males observed to wash their hands (42.17 percent). Females again complied more often, however, with 40 out 77 (51.95 percent) complying. “Based on these preliminary findings, we believe that further research in this area should be performed in order to better determine whether priming interventions could be a powerful tool in encouraging handwashing to improve infection rates,” added Professor Vlaev.

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News Briefs

U.S. Capability for Treating Ebola Outbreak Appears Sufficient but Limited (New Survey Finds Increased Capacity Since 2014 Outbreak)

EW YORK – The United States has sufficient capacity for treating another outbreak of the Ebola virus, but financial, staffing and resource challenges remain a hurdle for many hospitals and health systems attempting to maintain dedicated treatment centers for highly infectious diseases, according to a new study published online in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America (SHEA). “In the past year, the United States saw an intense effort across the country to rapidly expand the capacity for high-level isolation patient care,” said John Lowe, PhD, a lead author of the study. “Our study shows an unprecedented increase in the number of high-level isolation beds across the country and found a variety of approaches to achieving this capability.” Following the 2014 U.S. outbreak, which killed one patient and sickened two healthcare workers, the Centers for Disease Control and Prevention designated 55 sites to treat Ebola Virus Disease, including nine regional centers in major metropolitan areas, with total capacity of approximately 120 beds. Prior to this, the vast majority of hospitals were inadequately prepared to care for patients with suspected or confirmed Ebola. Under the direction of CDC, sites have expanded their capabilities, yet remain “limited” in overall capacity. The study recommends further investigation of whether the U.S. has dedicated sufficient resources, proper staffing and training to manage a potential outbreak. Researchers from the University of Nebraska Medical Center, Harvard Medical School, Emory University, New York-Presbyterian Hospital and Indiana University School of Public Health surveyed the capabilities and capacity of all the designated Ebola treatment centers and received responses from 47 or 85 percent. The researchers found that while the development of the centers heightened nationwide preparedness levels, challenges remained in providing the necessary treatment, and often strained an institution’s capacity, especially in key areas such as waste

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disposal, staffing and pediatric care: •Waste disposal: Responses highlight the extremely high cost of disposing of large quantities of highly infectious waste that is generated by even a single Ebola patient. The costs associated with the installation of proper onsite waste disposal equipment, including incinerators, is approximately $100,000 and only 11 institutions reported having this capability; the remaining centers must transport the waste for disposal offsite and would have to spend millions of dollars to do so, while also increasing the risk of exposure of the pathogen to staff during the packaging and transportation process. •Staffing: Large numbers of staff are needed to care for an individual patient due to the intensity of treatment, the extended need for personal protective equipment, and the necessity to limit work shifts in the patient room to 2-4 hours to combat physical and mental fatigue. Because staff participation in Ebola treatment centers is voluntary, scheduling and backfill issues become complicated, as does the question of how to sustain a fully-trained team when a treatment unit is unoccupied. •Patient populations: To date, no pediatric patients with Ebola have been treated in the U.S. Because of this, not much is known on the level of resources and staffing that would be needed. Additionally, survey responses show the majority of centers have much more capacity to handle adult patients and do not plan care for pediatric patients, highlighting the need to distinguish capacity for each population. “We have strengthened our nation’s ability to properly contain a highly unlikely outbreak of Ebola. However, the ability to treat outbreaks of other infectious viruses which are airborne, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) would be challenging,” said Lowe. Nearly all off the centers surveyed have also volunteered to participate in a U.S. Highly Infectious Disease Network to continue to advance this field through peer review and consensus efforts to further develop the national capacity for high-level isolation care. Source: Jocelyn Herstein, Paul Biddinger, Colleen Kraft, Lisa Saiman, Shawn Gibbs, Aurora Le, Philip Smith, Angela Hewlett, John Lowe. “Current Capabilities and Capacity of Ebola Treatment Centers in the United States.” Web (December 9, 2015) www.shea-online.org.

Companies Invest Billions to Meet Value-Based Healthcare Challenges

alamazoo, MI – Medical device, diagnostic services and supplies companies have been consolidating as a way to stay competitive in a tough climate of healthcare cost control, reports a Bloomberg. com article. The Affordable Care Act has made an impact on purchases by hospitals and other healthcare facilities, and according the Bloomberg article, this has been a driver in many of the more than 590 deals announced or completed in the medical devices sector over the past year. Bloomberg analysts have tallied buyouts worth about $82 billion, including acquisitions by Stryker Corp., Abbott Laboratories and Medtronic Plc.: • Stryker Corp., through its purchase of Sage Products LLC for $2.78 billion cash picks up a line of surgical items that help prevent hospital acquired infections. Sage makes orthopedic devices used in artificial hips and knees. • Abbott Laboratories, which makes heart stents, is purchasing diagnostic testing developer, Alere Inc. for $5.8 billion, in a move intended to strengthen Abbott’s position in point-of-care testing. • Medtronic, pioneer of heart pacemakers bought Covidien Ltd., a developer of minimally invasive therapies last year in a cashand-stock transaction valued at approximately $49.9 billion. The investment advances Medtronics’ strategy to offer therapy innovation, globalization and economic value.

News Briefs

First Zika Virus Cases Reported in U.S.

tlanta, GA – A rare sexually transmitted case of Zika virus has prompted the Centers for Disease Control and Prevention to publish a set of interim prevention guidelines and action by blood collection agencies to impose wait periods for donations, according to a BBC.com report and the CDC.gov website. Carried by the Aedes mosquito, the Zika virus has been linked to thousands of babies being born with underdeveloped brains, a condition known as microcephaly. Zika infections are short, mild and pose a significant threat only in pregnancy. South American countries, particularly Brazil, have been the hardest hit, though cases have been reported in Australia and the UK. A number of Zika cases related to foreign travel were reported in Texas, and in February, one case in that state was documented as sexually transmitted. Concerns that cases of sexual transmission could lead to an outbreak prompted the World Health Organization (WHO) to declare the disease linked to the virus a global public health emergency. In a statement to Reuters news agency, WHO spokesman Gregory Hartl said, “We certainly understand the concern. This needs to be investigated to understand the conditions and how often or sexual transmission is likely, and whether or not other body fluids are implicated.” WHO has warned European countries to make preparations once the Aedes mosquitoes become active on the continent during the spring and summer months. WHO’s Europe Director Zsuzsanna Jakab is urging countries to act in a coordinated way to conduct mosquito control and public educational programs, as well as to increase research to understand

the disease and develop vaccines. In February, the CDC issued its Interim Guidelines for Prevention of Sexual Transmission of Zika Virus for the United States. The document describes three cases where men developed symptomatic illness, but indicated that it is unknown whether infected men who never develop symptoms can transmit Zika virus to their sex partners. Sexual transmission of Zika virus from infected women to their sex partners has not been reported. The CDC urges prevention through consistent and correct use of latex condoms, along with a period of abstinence for men who reside in or have traveled to areas with active Zika virus transmission (http://wwwnc.cdc. gov/travel/notices/) and their sex partners. While the CDC is updating its recommendations for men with both pregnant and non-pregnant sex partners, the agency is also recommending Zika virus testing to establish a diagnosis of infection in some groups, such as pregnant women. “At present, Zika virus testing for the assessment of risk for sexual transmission is of uncertain value, because current understanding of the incidence and duration of shedding in the male genitourinary tract is limited to one case report in which Zika virus persisted longer than in blood. At this time, testing of men for the purpose of assessing risk for sexual transmission is not recommended. As we learn more about the incidence and duration of seminal shedding from infected men and the utility and availability of testing in this context, recommendations to prevent sexual transmission of Zika virus will be updated.”

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News Briefs

Canadian Scientists Seek Way to Control Superbug Gene

Study Shows Infection Control for Bloodborne Pathogens Deficient

innipeg, Manitoba, Canada – Researchers at the Public Health Agency of Canada (PHAC) National Microbiology Laboratory are investigating a gene that makes bacteria resistant antibiotics, according to a GlobalNews.ca article. In an effort to head off emergence of Superbugs, the team has been looking for the MCR-1 gene in bacterial samples. The presence of the gene in antibiotic-resistant bacteria was reported by Chinese scientists late last year. Their discovery is significant because the gene makes E. coli and some other bacteria resistant to Colistin, the drug of last resort for treating certain infections and diseases. Of most concern is evidence that the gene can be passed between different types of bacteria, leading to a cascade effect of antibiotic resistance. The PHAC lab designed a test to detect the gene, which the team has used to screen more than 1,000 bacterial samples collected from hospitals and provincial public health labs. The gene was found in E. coli from an Ottawa patient who had been treated for an intestinal disorder in 2011 and two E. coli samples from beef sold in Ontario in 2010. Gerry Wright, director of the Institute for Infectious Disease Research at McMaster University in Hamilton said, “What we want to be able to do, now that we know this gene is here and it’s a potential threat to human health, we want to be able to see if we can find a molecule that blocks MCR-1’s activity,” he said. “If we can find such a molecule, then we’ll be able to combine it with Colistin so you could still use that drug.” That drug resistance has developed in large part because of inappropriate and widespread use of antibiotics to fatten up beef cattle, pigs and chickens for consumption — an agricultural practice that Wright said should be banned.

ew York, NY – Study findings published in the January issue of the American Journal of Infection Control showed that less than one in five nurses adhered to established standards for preventing the spread of bloodborne infectious diseases. The behavior, despite guidelines and negative health consequences of noncompliance, raises concerns about actual practices in healthcare settings, the authors noted. Conducted by Northwell Health system, the “Factors Influencing Nurse Compliance with Standard Precautions” study consisted of surveying 116 outpatient care nurses whose work exposes them daily to blood and body fluids possibly carrying hepatitis B virus, hepatitis C virus (HCV), and HIV. The nurses were asked to complete a questionnaire designed to assess their knowledge of transmission, treatment, disease progression, and exposure risks related to bloodborne disease, as well as their (self-reported) compliance with nine accepted protocols for preventing infectious disease. The nine standards are: 1. Regard all patients as possibly contagious. 2. Do not put foreign objects on hands. 3. Wear gloves when it is expected hands could be exposed to bodily fluids. 4. Wash hands after removing gloves. 5. Wash hands after providing care. 6. Wear a facemask when exposure to air-transmitted pathogens is expected. 7. Do not recap needles. 8. Do not dismantle a used needle from a syringe. 9. Dispose of used sharp materials in sharps containers. The Northwell study found that hand and face barriers constituted the highest percentage of compliance – 92 percent of the nurses reported always wearing gloves, and 70 percent said they always wear a facemask. More than half of participants (63 percent) said they always wash their hands after removing gloves, and 82 percent said they always wash their hands after providing care. The investigators applied the Health Belief Model (HBM) in designing the study. HBM assumes an individual will engage in a recommended health action if he or she believes that a negative health condition can be avoided and that the presence of illness has at least a moderate threat to some aspect of his or her life. Of the nurses surveyed, 26 percent incorrectly believed hepatitis C (HCV) is spread only through sexual contact, 14 percent erroneously believed the virus causes early death, 12 percent were unaware virus antibodies can be present despite no infection, and 11 percent did not know multiple virus genotypes exist. The average age of the nurses in the study was 50 ± 10 years (range, 24-70 years). Average years practicing as a registered nurse was 25 ± 12 years (range, 1-45 years). Forty-four percent of participants had a bachelor’s degree in nursing, 24 percent had a master’s degree in nursing, and 12 percent graduated from a diploma program. About 97 percent were women and predominantly white (69.8 percent). The study investigators said that because the data was self-reported, participants may have overstated their actual compliance. The surveys contained questions related to two infectious diseases, staphylococcus (SP) and HCV. Those two diseases were chosen for the inquiry because more than 5 million people in the United States and 200 million worldwide are infected with HCV, making it one of the greatest public health threats faced in this century, the authors said. “Exposure to blood and body fluids and healthcare associated infections are serious problems that threaten the safety of both patients and health care workers, including nurses. Contracting an infection can result in serious morbidity and mortality. Acute infection leads to chronic infection in 60 percent to 80 percent of cases, 20 percent to 50 percent develop cirrhosis in two to three decades, and 11 percent to 50 percent will develop liver cancer. Chronic hepatitis C virus (HCV) is one of the most frequent indications for liver transplantation in the United States. Understanding reasons for noncompliance will help determine a strategy for improving behavior and programs that target the aspects that were less than satisfactory to improve overall compliance. It is critical to examine factors that influence compliance to encourage those that will lead to total compliance and eliminate those that prevent it,” the authors concluded.

Antiseptic Baths to Prevent Infections Deemed Effective for Long-Term Use

EW YORK – Long-term use of antiseptic soap in bathing critically ill patients to prevent healthcare-associated infections (HAIs) did not cause high levels of resistance in bacteria on the patients’ skin, according to a new study published online in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America (SHEA). “There has been concern in the healthcare community about the impact of routine, daily chlorhexidine (CHG) bathing on fostering the spread of bacteria resistant to this agent,” said David Warren, MD, MPH, lead author of the study and Associate Professor of Medicine in the Division of Infectious Diseases at Washington University School of Medicine and Hospital Epidemiologist at Barnes-Jewish Hospital in St. Louis. “We did not see sustained increase in MRSA resistant to CHG. Based on studies that showed that CHG used for daily body washing decreases MRSA infections, this practice has become widespread in hospitals. However, the long-term effects of the daily bathing on the prevalence of the qacA/B genes that lead to resistance to CHG in MRSA isolates is largely unknown. Researchers conducted a retrospective cohort study of patients admitted to the ICU at Barnes-Jewish Hospital in St. Louis, Missouri from 2005 through 2012. They reviewed more than 500 randomly selected isolates of MRSA from surveillance cultures to determine drug resistance. The prevalence of CHG-resistant MRSA isolates fell from 6.2 percent in the year CHG bathing began to zero to 1.5 percent from 2006 to 2009. The prevalence spiked to 16.9 percent in 2009 and 2010 before subsiding to 4.6 and 7.7 percent in 2011 and 2012. The authors note that increased prevalence of resistant MRSA isolates at certain points in the study period likely stemmed from patients entering the ICU already colonized with that organism prior to CHG exposure. This allowed the research team to rule out the daily baths as a factor for the increase in CHG-resistant MRSA and the hospital continued to use CHG bathing as a strategy to prevent HAIs. 10

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