The California Nurses Union (CNU/NNOC) reached a settlement announcing a landmark agreement for establishing a national standard on containing the spread of pandemics such as H1N1, better known as the "swine flu."
Originally set to strike on October 30 because of issues with protecting nurses from the H1N1 virus, CNU/NNOC called off the strike last week. The strike would have involved more than 13,000 registered nurses in 32 hospitals in the San Francisco-based Catholic Healthcare West (CHW) hospitals in California and Nevada.
"With this historic agreement, we are charting a new course for limiting the spread of not only swine flu, but all other dangerous pandemics that are yet to come," said Rose Ann Demoro, CNA/NNOC executive director in an official statement.
Using a system-wide task force, CNA/NNOC RNs and hospital representatives will focus on the declaration of pandemic emergencies with the help of facility infection control teams. The task force will monitor the full implementation of federal, state, and local guidelines. The task force will also set up standards in regards to checking the availability of property safety protective, communication and training policies for all hospital personnel, and consideration of off-site emergency triage and treatment.
"This is a huge breakthrough that should go a long way to making our hospitals safer and better prepared for containing the spread of H1N1 and stop the unnecessary exposure of fragile patients, their family members, or nurses and other staff to the virus," said Carol Koelle, RN, at St. Bernardine Medical Center in San Bernardino in an official statement.
Under the settlement, all CHW facilities need an employer agreement to comply with the Centers for Disease Control and California Occupational Safety and Health Administration, and those rules set in the CNA/NNOC contract. All CHW nurses will be provided the proper equipment and attire to prevent further spread of any virus when available, and the facility will provide each staff member with the proper training and information on communicable diseases they may have been exposed.
Along with setting a national model for H1N1 hospital safety, the CNA/NNOC and CHW also settled issues on assuring adherence to safe staffing standards, reducing the practice of "floating," which is when nurses are assigned to areas outside of their clinical expertise, and proposals to reduce nurses' healthcare coverage.
CNA continues to receive information from nurses at other hospitals across the nation about the lack of H1N1 protection that nurses are receiving and the lack of hospital readiness. Other hospitals are lagging in isolating contagious patients, distributing N-95 masks, re-use of the masks, informing staff when they have been potentially exposed, and training staff members on the best policies and procedures.
Forty-eight states have now reported widespread flu activity, as the death toll from the H1N1 virus in the United States has climbed over 1,000 cases, including more than 100 children. Thirty million doses of the vaccine have gone out to health departments, doctors’ offices and other providers, with hopes of delivering 120 million in the near future.
Many Americans are nervous about the security of their personal health information in a digital interoperable healthcare system—and for good reason. It seems like there is a new headline every week about a data breach involving personally identifiable patient information. Healthcare isn't exactly known for being the most advanced when it comes to data security. The industry still has a long way to go when it comes to securing electronic data. Unlike a paper-based health system, criminals don't need to break-in to a physical location to gain access to personal health information in a digital world.
So it's understandable that some people are a bit anxious about allowing their personal health information to be stored and shared in electronic health records and health information exchanges. But it is important for the health industry to demonstrate the value of electronic health records, build trust, and encourage the community-at-large to opt in and allow their information to be exchanged, because managing populations of patients is a key factor to realizing the value of electronic medical records (see "Unlock Value," October 2009).
Managing populations of patients with chronic illnesses, using de-identified data for genomics research, and tracking disease outbreaks are just a few examples of how providers will be able to use information stored in EHRs to control costs and improve quality of care in the future.
If people can see the value of capturing digital health information, they are more likely to take some risk and allow providers access to their personal medical information—especially if the data is de-identified and proper security precautions are taken.
The Centers for Disease Control and Prevention and GE Healthcare's recent announcement that they are partnering to monitor H1N1 and seasonal influenza activity may be just the opportunity needed to generate widespread support of EHRs from the public. Under the agreement, GE Healthcare will submit real-time information on the status of influenza activity from its Medical Quality Improvement Consortium, an electronic health record repository that uses de-identified data and meets HIPAA guidelines.
Participating physicians contribute patient data to the MQIC each day through the normal use of GE's Centricity electronic medical record. Information collected during the patient visit is fed to a data repository where the information is de-identified while still onsite at the provider location. After the data is de-identified, it is automatically transferred to GE's MQIC database every 24 hours.
The MQIC, which includes nearly 14 million patient records, enables the CDC to track clinical symptoms, such as fever, nausea, and chills, as well as variables like pregnancy and patient age, within 24 hours of being documented.
"The speed of which we are doing this can't happen in a paper world," says Mark Dente, MD, chief medical informatics officer for GE Healthcare. Traditionally, the CDC would rely on insurance claims data, which has a much longer lag time, to track diseases.
Dente says three benefits of the system are:
Speed. Data are collected on a 24-hour cycle that can be used to monitor events like H1N1 or a salmonella outbreak.
Standardization. Researchers can query a condition like hypertension and the database will include all variations of that nomenclature like HTN or high blood pressure in the results.
Analytics team. To help identify unique occurrences, GE has a team of statisticians and epidemiologists helping identify any thing unusual so that the CDC can get a baseline as quickly as possible—within hours versus weeks.
The health industry is already treating high volumes of patients who are flooding into doctor offices and emergency departments concerned about H1N1 and the health of their children and loved ones. If this partnership and its use of EMR data to track outbreaks of H1N1 can better prepare regions to treat the needs of its community, it stands to reason that people who have reservations about having their personal health information online may change their view. Of course if the EMR data doesn't really change the response time to an outbreak or prove to be more effective than traditional avenues, the opposite may hold true.
"There isn't a better use case out there, but I'm not sure if we're using it the right way," Dente admits. "We are not best at marketing sometimes."
The intent of the program is more about alerting providers earlier in the process that there is a spike of H1N1 in their region so they have more time to prepare rather than communicating outbreaks to the public, explains Dente. "Do we have enough beds available? Do we need to get more resources in the area?"
Getting the general public on board with having their personal health information collected digitally and used for population-based studies is something that should probably be focused on a bit more, Dente says. "People may not understand the nuance in de-identified aggregated clinical information and that is something that we need to make folks aware of." When monitoring an outbreak, 36-hours could make a significant difference, he says.
"Here is a perfect example of how truly de-identified data can be used from a public health perspective and show how quickly information can be shared rather than the traditional methods that would take weeks," says Dente. "It is just intuitive that someone could see the value in it."
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One of the biggest criticisms of any health reform package, particularly the latest one from the House, is the lack of concrete cost containment provisions.
However, a read through the bill's 1,990 pages finds a number of novel proposals that seek to test new ways of measuring and monitoring care.
With these projects, the secretary of Health and Human Services, perhaps through the granting of Medicare waivers, would try out a few ideas that might make the healthcare system not only produce better outcomes, but also become more cost-efficient.
"There's a lot of interesting ideas and pilot projects" in H.R. 3962 says Robert Laszewski, president of Health Policy and Strategy Associates of Washington, D.C. He adds the administration is proposing many such programs "because we're really not sure yet what is going to work."
Here are five such demonstration or pilot projects—most set up for only two or three years—geared to contain costs:
Post-Acute Care Services Payment Reform Plan and Bundling Pilot program. This program is designed to reduce hospital readmissions by "bundling" payments to skilled nursing facilities, inpatient rehabilitation facilities, long-term care hospitals, hospital-based outpatient rehabilitation facilities, and home health agencies that care for a patient after hospital discharge. Many of the specifics, however, have yet to be defined.
Accountable Care Organization Pilot Program. This project would test ways to incentivize providers, perhaps through monetary awards, to physicians to provide quality care, more efficiently, and at a lower cost.
Medical Home Pilot Program. Under this provision, states would be entitled to apply for pilot project grants to give comprehensive care and case management to patients with chronic illnesses, including medically fragile children and high-risk pregnant women. This program also could be used to test wireless technologies that allow practitioners to communicate directly with their patients in managing chronic illness and thereby reduce expensive, acute hospitalizations.
National Independent Monitor Pilot Program. This project is perhaps the most novel and bold. The administration would appoint an independent monitor to "oversee" large chains of skilled nursing facilities for some defined period of time.
These companies would submit applications to the administration if they wanted to be included, but their selection would be approved when "evidence suggests that one or more facilities of the chain are experiencing serious safety and quality of care problems" presumably those that result in a decline in quality and an increase in cost of that care.
These participating companies would, by contract, allow an independent monitor to "conduct periodic reviews and prepare root-cause quality and deficiency analyses of a chain to assess if facilities of the chain are in compliance with applicable laws. The reviews would be published.
Independence at Home Demonstration Program. This project would test a way of rewarding physician, nurse practitioner, and pharmacist teams to visit the homes of severely ill patients with chronic diseases on a 24/7 basis. The goal would be to improve health outcomes and keep patients from rushing to the emergency room.
The teams would be paid a set rate per beneficiary, but would be rewarded with any savings they achieve, not unlike a capitated model.
Those teams selected for such a pilot demonstration project would also use electronic health information systems and remote monitoring, as well as mobile diagnostic technology, all of which can function more efficiently and less expensively than the traditional acute care setting.
Though these five programs are in the latest House health reform bill, many critics have charged there still isn't enough concrete cost savings in the legislation. Plus, many questions remain:
If the bill passes with these proposals intact, which will be picked for these short-run demonstration projects?
Who will decide if they actually work?
How much will it cost to test them and will those involved be strong enough to admit when they have failed?
If the projects do work, how can they be effectively expanded, and who will have the authority to decide?
Adding weight to the belief that we are in a jobless recovery, a new report Monday showed that online job listings decreased slightly across many employment sectors nationally, and that healthcare was one of the casualties.
The Conference Board's Help Wanted OnLine Data Series report, which tracks more than 1,000 online job boards across the United States, found that online advertised vacancies across all occupations fell by 83,200 listings in October, for a total of 3.2 million.
"The September and October numbers are a further indication that, thus far, the recovery is weak," says Gad Levanon, senior economist at The Conference Board. "Labor demand is a leading indicator of employment, and the numbers indicate that employment is not likely to rise for the rest of this year."
Healthcare practitioners and technical occupations, the largest category in terms of volume, dropped 68,900 in October to 535,600. Labor demand for healthcare support occupations also declined in October, down 9,400 to 104,400, the report said.
Levanon says healthcare is a broad field, and the relative tightness of the labor market varies substantially from the higher-paying practitioner and technical jobs to the lower-paying support occupations.
In September, the last month for which unemployment data are available, the study found that for every unemployed person looking for work in a healthcare practitioner or technical occupation, there were 2.7 advertised vacancies and the average wage in these occupations was $32.64/hour. In healthcare support occupations, however, where the average wage was $12.66, there were more than two unemployed for every advertised vacancy.
In the overall economy, while layoffs have slowed, overall the labor market remains anemic. "The gap between the number of unemployed and the number of advertised vacancies is about 11.8 million, with 4.5 unemployed for every online advertised vacancy," Levanon says.
Bureau of Labor Statistics show that the healthcare sector is one of the few areas in the economy that has seen monthly job growth throughout the recession, although that growth has slowed considerably in 2009.
Among the top 10 occupations in October with online advertised vacancies, sales and related occupations, which have remained relatively flat over the last six months, saw the largest gain, rising 46,100 in October, the Conference Board reports.
The Bureau of Labor Statistics is expected this week to report that the nation's unemployment rate is at 10% or higher.
Healthcare industry leaders told members of the Health IT Standards Committee's implementation work group that a lack of common standards is hindering health data exchange efforts. As a result, the work group is gathering information on how to standardize data exchange systems. The implementation work group plans to submit its recommendations to HHS, which will consider the input as it works to hammer out a final definition for "meaningful use."
I am writing this from the perspective of a college professor who teaches mental health nursing, transcultural nursing, and pharmacology math. I also continue to practice as a nurse in the clinical setting, most recently in acute care on pulmonary step-down, adult psychiatry, and geropsychiatry units. It truly is a marvelous existence because I am fortunate enough to work with my former students while refreshing and maintaining the clinical skills I worked so hard to obtain all those years ago. My clinical practice often permits me to easily assess the effectiveness or, at least, retention of my teaching efforts and those of my peers as I observe our students' transitions from academia into beginning clinical practice.
We faculty consciously endeavor to instill a strong sense of professional pride and accountability along with the nursing knowledge. I'd even go so far as to admit nursing educators do indeed try to cultivate students who feel guilt or shame when their nursing performance fails to meet the quality thresholds fixed by our professional standards and practice guidelines.
My clinical role allows me to witness the interminable challenges my new professional peers daily confront. And I see a long-recognized disconnect arise: the one between what is taught and "real-world" pragmatism.
That incongruity, it seems to me, is even more conspicuous in these days due to an increased reconsideration of care delivery methods. Providers are reshaping delivery methods to be congruent with the Institute of Medicine's Six Aims of High-Quality Health Care (IOM, 2006). The Aims assert care should be:
Safe
Effective
Patient-centered
Timely
Efficient
Equitable
I would like to focus our present discussion on effective care. The IOM describes effectiveness in part as being evidence-based, meaning interventions for which there is objective empirical support. Effectiveness also includes avoiding continued use, or at least questioning the use, of interventions lacking scientific confirmation. Let's consider a clinical example.
For many years, nurses and respiratory therapists have instilled small amounts of sterile normal saline into tracheostomy or endotracheal tubes prior to suctioning. The purpose was to loosen thick secretions and aid airway clearance. It seemed a good idea at the time but research hadn't been done. The practice continues. In one descriptive comparative study (Sole, Byers, Ludy & Ostrow, 2002), 95 nurses and 37 respiratory therapists working in adult critical care units at four different sites were surveyed regarding their suctioning techniques. Thirty percent of all nurses and 78% of respiratory therapists reported routinely instilling saline prior to suctioning.
Is this practice supported by evidence? One very recent randomized clinical trial (Caruso, Denari, Ruiz, Demarzo, & Deheninzelin, 2009) using 264 subjects in a single surgical intensive care unit of an oncologic hospital found instilling saline before tracheal suctioning decreased the microbiology proven incidence of ventilator-associated pneumonia (VAP). In the results discussion, the investigators do wonder if the effect was in any way due to shallow sedation levels that permitted the saline to produce sputum clearing coughs (think "water-boarding" here). Also, the authors agree that there was no difference in suspected VAP rates between the intervention group patients who received saline instillation and the control patients who didn't. The researchers urge further studies before recommending saline instillation as a regular step in the suctioning procedure.
The preponderance of the evidence, however, suggests routine saline instillation can be harmful and ought to be avoided. Pedersen, Rosendahl-Nielson, Hjermind, and Egerod (2008) reviewed the available literature regarding endotracheal suctioning. The authors searched literature from 1962 through the present. A total of 77 papers were included in the final review, four studies describing patient personal experiences, 19 literature reviews, two meta-analyses, and 52 clinical trials. Their analysis findings include recommending nurses should suction only when necessary, use a catheter occluding less than half of the lumen of the endotracheal tube, use the lowest possible suction pressure, and avoid saline instillation.
At this point, envision one of my graduates being directed by a nurse mentor during orientation to squirt 5 or 10 mL of sterile normal saline into the tracheostomy tube before suctioning. The student recalls being taught differently and remembers the evidence, but often abjectly yields to confident assertions of the mentor: "I've been doing this for 26 years and it works." The outmoded, unsupported, and potentially harmful practices continue.
Saline instillation is merely an illustration of a more pervasive problem. There are similar current nursing practice versus evidence-based practice conflicts. So, here are some questions for us all. How can nursing educators in colleges and healthcare systems create an environment that fosters the introduction of evidence-based practice? How can we empower new graduates to feel confident and assertive about what they've learned while being respectful of their professional 'elders'? How can we convince, co-opt, or even coerce long-time nurses to quit unsafe and ineffective interventions? Any suggestions?
References
Caruso, P., Denari, S., Ruiz, S., Demarzo, S., & Deheinzelin, D. (2009). "Saline instillation before tracheal suctioning decreases incidence of ventilator-associated pneumonia." Critical Care Medicine 37(1): 32-38.
Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press.
Pedersen, C., Rosendahl-Nielsen, M., Hjermind, J. & Egerod, I. (2008). "Endotracheal suctioning of the adult intubated patient—What is the evidence?" Intensive and Critical Care Nursing 25(1): 21-30.
Sole, M., Byers, J., Ludy, J. & Ostrow, L. (2002). "Suctioning techniques and airway management practices: Pilot study and instrument evaluation." American Journal of Critical Care 11(4): 363-368.
Richard Freedberg, RN, MSN, MPA, is professor of mental health nursing at Lansing Community College in Lansing, MI. He continues to practice in a clinical setting, and has experience that includes staff nursing and management roles in medical-surgical and mental health acute-care settings, home-care nursing, and medical intermediate care.
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The phrase "simulation modalities" may conjure up a variety of images. For example, some nursing staff development professionals think of a sophisticated training mannequin that produces computer-generated EKG printouts, responds to intubation efforts, and virtually behaves in ways similar to an actual patient. Others may think of an IV arm used solely for learning how to start IVs.
The point is, there is a wide range of simulation modalities, but many staff development specialists know of only a few, and still more are as of yet unaware of the vast potential for providing education via simulation.
Low-fidelity simulation modalities
Low-fidelity simulations are described as those that feel the least real to the learner (Holtschneider, 2009; Mt. Hood Community College, 2009). These simulations can be paper- or computer-based and are generally static models that allow for very little learner interaction within the simulation. Examples include computer- or paper-based tasks, mannequins that do not have the capability for providing feedback (e.g., a Resusci Anne that only offers computer printouts that evaluate the accuracy of breaths and compressions), or an IV arm that allows students to practice IV insertion techniques without feedback devices (Holtschneider, Mt. Hood Community College).
Low-fidelity simulation modalities are relatively easy to implement and transport and less expensive to implement than more sophisticated modalities. However, they are the least real of the modalities and therefore do not provide learners with the experience or the feeling of actually working in real-life settings.
High-fidelity simulation modalities
Also referred to as a high-fidelity human patient simulators (HPS), these are often the first thing people think about when we say simulation. When using an HPS, educators can implement a variety of scenarios that they can tape and play back for debriefing or guided reflection, as well as create blended simulations, incorporating actors assuming the role of patients with low-fidelity task trainers.
HPS is usually dependent on some type of computerized mannequin that allows the re-creation of the physical patient in a realistic physical clinical environment. Mannequin-based simulators have become increasingly common in areas such as the OR, emergency department, and critical care units, where life-threatening situations that require recognition and treatment often occur. Some simulators can even mimic the effects of various drugs, track the distribution of the drug in the body, and determine the exact effects that a specific amount of the drug will have on the human body.
The costs associated with these types of simulation generally increase with the level of sophistication of the simulator. Complex simulators may also be more of a challenge to set up and transport than more simple simulation techniques. However, the level of realism introduced by high-fidelity simulation modalities truly brings the learner into an interactive, genuine work environment.
Standardized patient educators
A tactic that adds to the high-fidelity simulation modalities is the use of standardized patient educators (SP). SPs are educators who are specially trained to portray patients, family members, and, at times, even members of the hospital staff.
Using SPs lets learners engage in mock conversations with patients, deal with family members who are frightened and questioning, and cope with colleagues who may not be acting professionally.
SPs are used in a variety of academic settings, such as medical and nursing schools. However, their use is now becoming more common in clinical environments because they add another dimension of reality. However, they also add to the cost. Organizations hiring these educators must screen them carefully and hire only those persons qualified to assume such roles.
Serious gaming
The term "serious gaming" involves the use of video game technology to add another dimension to the learning process. Learners function within specific rules and guidelines while playing interactive computer-based games. These games generally present a complex healthcare situation (e.g., multiple casualties from a terrorist attack arriving at an emergency department) that requires the learner to intervene appropriately.
Although the game format is viewed as a fun way to learn, the games offer deadly serious scenarios. Serious gaming is an increasingly popular training mechanism.
Video and computer games can be developed fairly quickly and can simulate functional entities in various clinical settings. However, they can be expensive to develop and learners must have appropriate training in their use. In addition, they require the availability of adequate equipment for learners.
Desktop simulations and virtual worlds
Desktop simulations and virtual worlds can be run on a desktop computer and only need a screen, mouse, and audio inputs and outputs. The learner can view data, see the patient via animation, perform diagnostic or treatment interventions, and interact with the patient by typing or, in some cases, actually speaking with the patient.
An advanced approach to this type of simulation allows several participants to participate in a virtual world simultaneously. Learners can interact with each other, the patient, and others in this world. A distinct advantage of this type of simulation is the ability to interact with various healthcare team members as well as the patient and family.
Virtual reality and visualization
Virtual reality is a computer-generated world that allows the learner or group of learners to experience various stimuli, often in a 3-D presentation. Learners typically wear head-mounted displays to receive visual and auditory cues. They can interact in the computer-generated world from various sites or be in a physical space in which they can interact with others.
Virtual reality is a rapidly developing field and gives a true sense of realism. However, the creation of a complex virtual patient and treatment setting can be time-consuming and expensive. It requires a complete computer model of the patient environment; a way to track visual, audio, and touch fields; adequate hardware for all sensory modalities; and hardware to compute all models, track inputs, and produce outputs in real time.
Mt. Hood Community College (2009). "Fidelity simulators." Retrieved October 1, 2009, from www.mhcc.edu/pages/493.asp.
National Nursing Staff Development Organization (2008). "Collaborative efforts across organizations: Building a simulation alliance." Journal for Nurses in Staff Development 24(6): 303–304.
This article was adapted from one that originally appeared in the November 2009 issue ofThe Staff Educator, an HCPro publication.
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If your organization doesn't employ any clinical nurse leaders, perhaps it's time you did.
Units with CNLs have been shown to have shorter length of stay and readmission rates, improvements in quality and patient safety such as decreased fall and infection rates, and lower RN turnover.
In fact, these master's degree-prepared nurses have been shown to have such a positive effect on patient care and the healthcare environment that the VA has committed to having a minimum of three CNLs at every one of its facilities by 2016.
"These individuals take the evidence that's out there in the literature and help to improve practice, as well as to evaluate patient outcomes," says James L. Harris, DSN, APRN-BC, MBA, CNL, FAAN, deputy chief nursing officer in the office of nursing services at the Veterans Health Administration. "CNLs are individuals who can coordinate care and break down barriers. They can eliminate fragmentation in healthcare."
The CNL role has only been around for a few years, but it is growing at an impressive rate. The position allows nurses to advance professionally while staying in the clinical environment. According to the American Association of Colleges of Nursing, CNLs are responsible for patient outcomes by applying evidence-based practices. They design, implement, and evaluate patient care by coordinating, delegating, and supervising the care provided by the healthcare team.
In the hospital and health system setting, the CNL role should explode as the graduate degree gains popularity and the opportunities presented by this role become better understood. Adding CNL positions prepares organizations to meet quality improvement initiatives and deliver on these goals. CNLs are also uniquely positioned to plan and coordinate care across entire patient populations or service lines, working with the multidisciplinary healthcare team across the care continuum, and helping organizations reduce length of stay and prevent readmissions.
The VA recognized the value of the role five years ago, began encouraging nurses to pursue the degree by offering scholarships, and has seen such good results that it expects to easily meet its 2016 goal.
Harris advises that administrators not think of the CNL role as a replacement position, but rather as one that can be added to an environment to provide a higher level of clinical expertise.
"I see them as the clinical person who keeps the patient processes moving along, freeing up the nurse manager to be able to manage and develop the staff and really be a manager," says Harris.
Karen M. Ott, RN, MSN, director for clinical practice at the office of nursing services at the Veterans Health Administration, says that CNLs drive quality improvement processes and provide the clinical expertise that is desperately needed by bedside caregivers.
"Clinical leadership is really a full time job and the management part is really a full time job and for someone to try and do both doesn't work effectively," says Ott. "The nurse manager has ideas for outcomes he or she wants to see on that unit and the CNL is the person who makes that happen. The two of them together set goals for the unit."
To understand the effect that CNLs can have on an organization, Ott recommends hiring a CNL for a turbulent unit and seeing what happens. She believes when an organization has one CNL, it will soon want more, and a good place to start is on an inpatient unit—such as a busy med-surg unit—with many admissions and discharges. "A unit where bedside nurses are consumed with tasks all day is ripe for a CNL who can come in and provide leadership," says Ott.
"The key to growth will be when the private sector sees the outcomes that these individuals have," notes Ott. "We're firmly supportive of continuing to implement this role in the VA."
There are roughly 900 certified CNLs in the country right now, and the numbers should rise as healthcare embraces a genuinely new role in nursing. CNLs can raise the bar of clinical experience on a unit and thereby improve the quality of care delivered to patients.
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Eileen Dohmann, RN, VP of nursing for Mary Washington Hospital in Fredericksburg, VA, explains the difference between responsibility and accountability, and offers strategies for getting staff to make and keep commitments.
An uncommon type of MRSA called USA600 appears much more lethal when it infects the bloodstream than more common strains of methicillin-resistant Staphylococcus aureus.
That's the finding from a preliminary study presented Saturday at the Infectious Disease Society of America's annual meeting in Philadelphia.
Infectious disease researcher Carol Moore, PharmD, said her study examined a sample of 80 patients hospitalized with MRSA at Henry Ford Hospital in Detroit over the last three years. Of the 80, 16 had USA600 in their bloodstream. Of those, eight, or 50%, died within 30 days. Of the remaining 64 who had bloodstream infections with other types of MRSA, seven, or 11%, died within 30 days.
"These are obviously very preliminary results in a small number of patients, but it indicates we may have a serious problem with this strain," Moore says. "We need to increase awareness of it, and continue research with larger studies and more analysis to determine what factors are important with this bacteria."
In general, she says, more common types of MRSA infections of the bloodstream have an average 20% to 30% mortality rate within 30 days.
Moore says the 16 patients who were infected with USA600, did tend to be slightly older and sicker than those with other types of MRSA, "but that doesn't fully explain" the increased mortality, Moore says. "We've studied older patients with MRSA in the bloodstream in the past, but we've never seen mortality rates this high."
The average age of patients with USA600 was 64 while the average age of patients with other MRSA strains was 52.
What should also concern healthcare providers is that USA600 appears more likely to be passed on within healthcare settings. Of the 16 USA600 patients, 15 (94%) had a prior tie to a healthcare setting, such as a nursing home, dialysis center or had recently been treated in an acute care hospital, Moore says. In contrast, 42 of the 64 patients with other types of MRSA (65%) had a prior connection with a healthcare setting.
At the Centers for Disease Control and Prevention, health communication specialist Rosa Herrera says USA600 "are still quite rare in the nation." She adds that of all MRSA samples tested by the CDC, "fewer than 1% were USA600."
"It's on our radar, but it's something that still looks to be relatively rare," Herrera says, adding "it is something that needs to be studied further."
At Henry Ford, Moore says the USA600 is only partially resistant to the first line antibiotic for MRSA infections, vancomycin. However, it is more resistant to that antibiotic than most other MRSA bacteria.
According to CDC statistics, the estimated number of people developing a serious MRSA infection in 2005 was about 94,360 and approximately 18,650 persons died during a hospital stay related to that infection.
Moore says her study was launched after hospital officials noticed that among a small number of patients with this strain of MRSA, 60% had died within 30 days. "That was so much higher than what we had seen with other strains," she says.
She says the hospital is conducting research to determine if the bacteria have some identifiable characteristics of virulence.
"We are conducting other studies to see if there is a toxin that may be causing this, but this study doesn't answer that."
Cheryl Clark is a senior editor and California correspondent for HealthLeaders Media Online. She can be reached atcclark@healthleadersmedia.com.
