Doctors Told to Stop Prescribing Antibiotics Inappropriately

Doctors are to be told to stop prescribing antibiotics for common ailments such as coughs and colds because their overuse is helping the spread of killer hospital superbugs.

Health secretary Alan Johnson says doctors must adopt "less of a knee-jerk reaction to prescribing" drugs such as penicillin, as they are ineffective against most colds, coughs and flus which are caused by viruses.

The liberal use of antibiotics has led to strains of killer infections such as MRSA becoming resistant to treatment.

As part of a £270 million campaign against hospital infections, the Government will remind doctors and the public that antibiotics should only be used when necessary.

The campaign, called Clean, Safe Care, will also provide an extra £45 million funding for hospitals to spend on specialist staff such as infection control nurses.

Overuse of antibiotics can cause harmful bacteria to develop resistance, making it harder to cure them in future.

If their use is not limited, then doctors could run out of effective treatments against certain infections as bugs become resistant to a wider range of drugs.

Doctors are being told to cut down on antibiotic prescriptions for common illnesses because their overuse helps superbugs become more resistant

Official guidance advises against antibiotic prescriptions for upper respiratory tract infections, sore throats and ear infection.

But in 2000, antibiotics were still being given to 67 per cent of those with respiratory infections, said Dr Andrew Hayward, from University College London.

Professor Kevin Kerr, consultant microbiologist at Harrogate District Hospital said doctors face huge pressure from patients to prescribe antibiotics.

He said: "These campaigns are desperately needed. The focus has been on cleanliness and washing hands, but without closing the circle by tackling prescribing it is only half the battle."

Figures released by the Health Protection Agency in November suggested hospitals in England may be turning the corner on battling the bugs.

Cases of MRSA fell by 10 per cent from April to June 2007 compared with the previous quarter. Cases of C diff. were also down 7 per cent for the same period.

Liberal Democrat health spokesman Norman Lamb said: "The Government has ignored the link between antibiotics and hospital infections for too long.

"Over-prescribing of broad-spectrum antibiotics is very dangerous."

A spokesman for the Department of Health said: "From February 2008, a new nationwide campaign will be launched to remind the public, GPs and other doctors that using antibiotics is not effective on many common ailments.

"The campaign will also highlight that inappropriate use of antibiotics can increase the emergence of antibiotic-resistant strains of infections and that prudent prescribing is therefore required."

Septicaemia Killed Christopher Reeve, Bee Gee Maurice Gibb and Pope John Paul II

Jem Abbott, a healthy 37-year-old, had gone into hospital for a vasectomy, the male sterilisation operation performed on more than 100,000 men every year in Britain.

The operation is routine, yet a little over a week later Jem was dead, the victim of septicaemia.

This vicious bacterial infection of the blood claims 37,000 lives a year, yet has been largely side-tracked as public attention focuses on the newer problem of superbugs - which kill 5,300.

In fact, septicaemia is a leading cause of death, after heart disease and cancer, and claims more lives than breast and bowel cancer combined.

It occurs when an infection in the blood stream causes the body's immune system to go haywire and start attacking the body it is meant to protect.

Among its victims are Superman actor Christopher Reeve, former Bee Gee Maurice Gibb and Pope John Paul II.

Devoted: Jem and Karen before he fell victim to septicaemia

Yet despite the number of lives it claims, its symptoms are often unrecognised by doctors and nurses. As a result the window for effective treatment is missed, with fatal consequences.

Now hospital specialists have launched a campaign to educate medical staff and raise public awareness of the condition - they say that prompt recognition and treatment for all septicaemia cases could halve the death rate at a stroke, saving thousands of lives.

Jem's widow Karen has joined this campaign. Almost four years after his death, and left alone to bring up their two children, Emily, now 15, and Thomas, 12, she remains shattered by the loss.

She says she would do anything to prevent people going through the trauma experienced by her family.

"We had completed our family, we were totally happy," she said.

"For Jem a vasectomy was the right thing to do."

He underwent the operation on a Friday. Doctors advised a couple of days' rest, but said Jem could return to work after the weekend.

"He was told it was a quick, completely routine procedure, and that there might be a bit of pain and swelling but nothing he couldn't handle," Karen said.

Indeed Jem, who was a director of a transport firm in Sutton Coldfield, had returned to work that Monday, but as the week progressed became ill with what the family assumed was gastric flu.

By the Thursday he was vomiting, with diarrhoea and fever, and spent the following day at home in bed. Karen called the family doctor, who recognised a post-surgical infection and prescribed antibiotics.

But it was already too late. The infection was out of control and standard antibiotics were not enough. That Saturday morning, eight days after the operation, Jem woke up delirious, with blue lips and uncontrollable diarrhoea.

Karen called an ambulance, uttering soothing words as her partner of 20 years was taken away, while she followed behind with his nightclothes.

It was to be the last time she spoke to him. By the time she arrived at the hospital she was told her husband had suffered a massive heart attack because of septicaemia.

He had been put on a life-support machine and doctors were battling to save his failing organs.

Karen was warned the circulation was failing in his limbs. She was told to expect amputation of his fingers and toes, which had already been irreversibly damaged.

As her husband's condition worsened over the following two days, the doctors said they would need to remove all four limbs. Karen was also told Jem would be brain damaged.

"I knew he wouldn't want to be alive like that," she said. "He was a proud man, a great water-skier, the life and soul of the party."

But the decision about whether to switch off the life-support machine was made by the doctors the following Tuesday.

They said his heart and other major organs were so damaged by the bacterial invasion that they would not sustain him. Jem died ten days after the vasectomy in March 2004.

"It was so quick, it was impossible to take in," said Karen, who is now 42, and has moved back to her parents' home with the children.

"I had no idea septicaemia could kill young, fit people. I thought only frail hospital patients were at risk.

"We had to wait a year for the inquest. They couldn't tell what the original bacterial infection was because, by the end, he had been given so many antibiotics they masked which bacteria had killed him.

"The coroner said that while septicaemia was the cause of death, there was no way of knowing where it had come from."

Her husband's death was not attributable to any particular wrongdoing. A vasectomy involves making a tiny incision to cut and tie off the ends of the tubes which carry sperm from the testicles.

Jem's fatal infection had apparently been caused by bacteria getting into the wound site, but there was no explanation for how it had happened.

It could not be argued that the family GP had failed in his duty. Septicaemia kills rapidly.

The condition he had observed in Jem showed no outward sign of being a fatal infection, and he had given antibiotics correctly.

There are thousands of similar tragedies every year. Although the frail and sick are at much greater risk, there have been fatal cases in babies and children, and even in people undergoing minor dental procedures.

It's thought that some, like Jem, may simply be genetically more susceptible to bacterial infection.

Gene mapping has already identified one common gene variation which means some people may be at greater risk if they are exposed to an infection.

There are fears that a new wave of infections is being caused by the so-called antibiotic-resistant superbugs like MRSA.

However, microbiologists say infections with varieties of streptococcal bacteria can spread much faster and be more lethal than superbugs.

Although septicaemia, or blood poisoning, is recognised as a major cause of death, it often is not mentioned on death certificates.

Instead doctors simply write more general diagnoses such as pneumonia or perforated bowel because patients have not even been tested for bacterial infection.

According to a new pressure group of worried senior doctors and nurses, called Survive Sepsis, it is this lack of attention which has led to the condition being widely unrecognised.

They are launching education campaigns in hospitals to make doctors and nurses aware of the 'golden hour' before the infection overwhelms the body, and when treatment can still be effective.

They are being urged to perform six key procedures as soon as the patient arrives in hospital, which research has proved will make the difference between life and death.

These elements of extra care include giving oxygen, antibiotics and fluids; taking blood cultures to identify the specific bacteria involved; monitoring blood characteristics and checking urine output.

Although this extra care is sometimes offered in septicaemia cases, there are fears that too often it is not even considered. If Jem had been sent straight to hospital before the fatal weekend, he might not have died.

The Survive Sepsis campaigners are hoping that raising awareness among GPs and the wider public will save lives. So far 12 hospital trusts have sent staff to the Survive Sepsis training course and have implemented the new septicaemia treatment guidelines.

Ron Daniels, an intensive care specialist at the Good Hope Hospital in Sutton Coldfield, and regional co-ordinator for the prevention of infectious diseases in the West Midlands, is spearheading the UK arm of Survive Sepsis, which is part of a 14-nation effort.

Dr Daniels' own hospital team has already proved the effectiveness of rigorously using the six-step plan.

In a three-month investigation of the treatment of 101 infected patients, it was found that almost three-quarters of those who received all six treatment elements survived the infection.

Dr Daniels points out that a similarly diligent application of procedures for treating heart attacks has reduced mortality to one in 20.

If a similar approach was taken to septicaemia, there would be an equally dramatic drop in cases.

"We have a target time of one hour to apply the procedure to prevent sepsis. The international target for the campaign is to reduce sepsis deaths by 25 per cent, but I think it should be possible to save many more - perhaps 10,000-20,000 people a year - by doing these straightforward things," he said.

One of the problems of getting people specialist help in Britain is the lack of intensive care beds.

In terms of population, Britain has only ten per cent of the number of intensive care beds available in America, and half the number available in countries such as Denmark or Germany.

Doctors and nurses are regularly forced to carry out heroic life-and-death struggles to save septicaemia patients under the gaze of general patients on open wards.

A study published three years ago in the British Journal of Anaesthesia said that although critical care and high dependency beds had increased since the millennium, the facilities could still not meet the rising demand.

"There is evidence to suggest that many British surgical patients could benefit from access to a critical care area but are denied it," the report said.

Nor is the problem simply about money. Intensive care doctors say that despite the fact septicaemia is so serious, treatment of it has never been the subject of any NHS target, so hospital managers have no incentive to divert resources to tackle it.

"These are not 'must-do' priorities for hospital administrators," said Richard Beale, the clinical director of perioperative and critical care at Guy's and St Thomas' in London.

"Managers don't know how many of their patients die from sepsis and they are not accountable for it."

Patrick Nee, an intensive care consultant at Whiston Hospital in Liverpool, agrees that part of the problem is there is no national requirement for doctors to collect statistics on septicaemia deaths.

"A lot of them happen in nursing homes as well as on open wards and are never recorded as sepsis, they just get put down to things like pneumonia," he said.

"If every single hospital started following these guidelines we would have a chance of starting to improve survival rates."

This May, the National Patient Safety Congress will hear argument that the Surviving Sepsis guidelines should be applied to all hospitals as a matter of urgency, and that greater funding should be made available for nurses and other staff to attend the training programmes to alert them to the signs.

"There is no question that raising the profile of the problem in this way would make a considerable difference to the way septicaemia is viewed," said Ron Daniels.

"Let's hope that as a result of this meeting and the international initiative, things finally start to move."

"No one wants to see people die needlessly, especially young people," said Karen Abbott.

"The hospital staff tried everything they could to save Jem. The fact is that it was already too late. If more people were aware, they could act sooner.

"I don't want him to have died in vain. I want people to know about this so they can save their loved ones."

Hi-Tech Infection Surveillance

Hospitals Turn to Information Technology Solutions from Cardinal Health to Help Reduce Hospital-Acquired Infections

More than 250 hospitals across the country have turned to Cardinal Health to help prevent, detect, monitor and treat hospital-acquired infections (HAIs), a problem that affects one in every 20 patients across the U.S. and costs the health care industry an estimated $20 billion each year.

The MedMined™ Data Mining Surveillance Service monitors the entire hospital for early signs of an emerging issue and targets improvement efforts where and when they can have the most impact. Using technology similar to that used by credit card companies to monitor purchases for fraud, this patented technology automatically identifies patterns indicative of specific and correctable quality breakdowns without predefined search criteria, user-defined control charts or alerts, or chart review.

The new MRSA Scorecard provides a hospital-wide view of methicillin-resistant staphylococcus aureus (MRSA), allowing infection control practitioners to track the types and locations of MRSA infections throughout the hospital. The MRSA Scorecard allows hospitals to identify patients who have tested positive for the bacteria and distinguish between those who likely acquired the infection in the hospital and those who had an MRSA infection present on admission. Through this real-time view, hospitals can rapidly dispatch resources to limit the spread of MRSA infections that are responsible for an estimated 94,000 life-threatening conditions and 18,650 deaths annually in the U.S.

The MedMined™ Antimicrobial Management Service helps alert clinicians of patients that may be in need of therapy optimization early in the course of infection. In addition, detailed patient histories provide infectious disease physicians, clinical pharmacists and infection control practitioners with a more comprehensive view of clinically significant events.

MedMined™ services were developed to help hospitals produce quality of care improvements and measurable cost savings by providing real-time measurement of data related to HAIs, and clinical, evidence-based practice recommendations that enable immediate interventions to prevent infections from spreading. Electronic infection surveillance enables hospitals to significantly reduce the time necessary for manual data collection and analysis, and redeploy their infection control resources to value-added areas that directly impact patient care, such as clinician education and infection prevention initiatives. The service is also designed for start-to-finish implementation in less than 60 days, with only a minimal resource requirement from the hospital’s information technology department.

“MedMined™ services implementation was swift, utilized our hospital’s existing data and required minimum effort by my IT department,” said Linda Reed, RN, MBA, vice president and chief information officer of Atlantic Health in Morristown, N.J.

Hospitals using MedMined™ services realized more than 13 percent reductions of HAIs on average in the first year and have repeatedly produced an average 300 percent internal rate of return within 12 months. Additionally, MedMined™ services recently received the notable ’Peer Reviewed’ designation from the Healthcare Financial Management Association. Cardinal Health will be showcasing this technology at the Healthcare Information and Management Systems Society (HIMSS) Annual Conference and Exhibition, being held Feb. 24-28 in Orlando.

Additional new Cardinal Health innovations to be highlighted at the HIMSS Conference and Exhibition include:

· Web-based, integrated medication order management and clinical intervention tool: A new system that uses a hospital’s existing fax machines on its nursing units to transmit paper medication orders into a digitized format that is viewable in the hospital pharmacy through a web-based document management system. All orders are queued in a central location and prioritized by urgency, which enables faster and safer reviews of patients’ medication orders. The system also provides detailed metrics such as order volume by line, order turnaround times, number of unapproved abbreviations, duplicate orders, medication error rates, and also tracks clinical consultations and interventions according to safety issues and physician practices.

· Transfusion verification for critical care: The only system currently available that can help protect patients from blood transfusion errors hospital-wide, including those in operating rooms, emergency departments and other critical care areas, where transfusions need to occur rapidly. The new Rapid Infusion feature provides a systematic method of positive patient identification for matching blood components and efficient documentation, even during emergency situations.

· Safer medication management: A single medication management solution that can help clinicians monitor orders for their patients, determine the location of medications, pre-populate parameters for continuous IV infusions, verify the accuracy of medications to be administered and document to the hospital’s existing IT systems. The solution links the workflow across automated medication dispensing technology, infusion safety systems and point-of-care barcode medication administration applications.

· Cardinal Health partnership program: By partnering with health care IT vendors, Cardinal Health’s Alaris®, Pyxis® and CareFusion™ technologies can be interfaced with a wide variety of health care IT products to allow hospitals to maximize their current IT investments when installing one or more of Cardinal Health’s patient safety technologies.

Medicare Says Hospitals Must Pay for Mistakes

By Debbie Gilbert

Talk about adding insult to injury.

Sometimes patients leave the hospital with problems they didn’t have when they first came in. They fall and break a hip, or they get an infection after surgery.

In the worst-case scenario, a hospital employee makes a mistake that causes a patient’s death.

Now Medicare is telling hospitals, if you mess up, you pay up.

As of Oct. 1, the federal agency will no longer reimburse hospitals for eight preventable conditions that occur after the patient is admitted.

"The hospital absorbs the cost of treating the hospital-acquired condition and may not bill the beneficiary for the difference," said Ellen Griffith, spokeswoman for the Centers for Medicare & Medicaid Services.

She said the new rule is part of a legislative mandate in the Deficit Reduction Act of 2005. It’s intended to give hospitals a financial incentive to follow accepted standards of care.

In 1999, the Institute of Medicine estimated that medical errors may cause as many as 98,000 deaths a year. In response to that study, health agencies began looking at ways to reduce the number of "never events," things that should never happen if a hospital is observing the right protocols.

These include operating on the wrong body part, leaving a foreign object inside the patient after surgery and transfusing the wrong blood type.

Medicare has also singled out conditions that are common in hospitals but could be prevented with proper precautions, including patients being injured by falling, urinary tract infections caused by catheters and severe bedsores.

Next year, Medicare plans to expand the list, adding pneumonia in patients who are on ventilators, septic blood infections and blood clots that travel to the lungs.

Hospitals, anticipating the upcoming rule change, are already taking steps to prevent mistakes and to deal with them when they happen.

Last week, the Georgia Hospital Association announced a new statewide billing guideline, encouraging hospitals not to charge patients or private insurers for "serious preventable events."

"Most have not charged in the past," said association spokesman Kevin Bloye. "But we wanted to formalize this policy. It creates an environment of transparency."

Association vice president Vi Naylor said the association began considering such a policy long before the Medicare rule was written.

"We started a program, the Partnership for Health and Accountability, seven years ago," she said.

Though it is possible that patients who are not charged for a hospital’s mistake may be less likely to file a malpractice lawsuit, Bloye said the move has nothing to do with avoiding litigation.

"It’s just an assurance to the patient that, ‘Hey, we’re going to take care of this,’" he said.

Taylor said the association has not calculated how much it will cost hospitals to absorb the unreimbursed charges.

At Northeast Georgia Medical Center in Gainesville, spokeswoman Cathy Bowers said it has been a standard practice for years not to bill the patient for something that the hospital did wrong.

But Lynda Adams, director of performance improvement at the medical center, said it’s inevitable that some of the "events" on Medicare’s list are going to occur.

"It’s easy to say these things shouldn’t happen in the hospital, but they do, and it’s not necessarily always the hospital’s fault," she said.

For example, several items on the list are related to hospital-acquired infections. Employees are supposed to follow strict rules, such as frequently washing their hands, to prevent transmission of germs. But Adams said patients who are already in poor health when they enter the hospital are much more susceptible to developing infections.

Nevertheless, hospitals continue to strive to do the best they can. Adams said the medical center has a patient safety committee as well as subcommittees on specific issues, such as preventing falls and controlling infections.

She said the hospital staff never assumes that only elderly patients get injured in falls.

"Upon admission, every patient is evaluated for their risk of falls," she said. "Even young patients are at risk if they’re on certain medications."

Those deemed at risk are more carefully monitored, Adams said, and sometimes changes are made in the patient’s room to reduce the likelihood of a fall.

Often a small measure of prevention can make a big difference, she said. For example, to help prevent pneumonia when a patient is on a ventilator, the head of the bed is always kept raised.

"Now our ventilator-associated infection rate is almost nonexistent," Adams said.

To prevent urinary tract infections, she said, "We try to remove the (urinary) catheter as soon after surgery as possible. In the old days, patients often remained on a catheter during their entire hospital stay, just because it was convenient."

Adams said preventing pressure sores is one of the toughest challenges for nurses, even when patients are turned frequently and kept on specially cushioned mattresses.

"If a patient’s nutritional status is poor, their skin breaks down easily despite your efforts," she said.

But with bedsores being added to Medicare’s nonreimbursement list, hospitals are expected to focus more aggressively on prevention.

As for the "never events," Adams said no hospital wants the embarrassment of a major mistake such as amputating the wrong limb. So there are numerous safeguards already in place.

"We mark the body part for surgery, with the patient aware and involved in the process," she said. "There’s an extensive list of checks that have to be done before the first incision is made."

As for making sure that a patient gets transfused with the right blood type, Adams said, "we have people in our blood bank whose only job is to ensure blood compatibility."

The medical center is still working on preventing one of the most common errors: giving a patient the wrong drug or the wrong dosage.

"We have a computerized system now for medication administration," Adams said. "That’s not to say we never have errors. We do. But look-alike drugs or ones with sound-alike names are kept in separate places. And both the drug and the patient (via wristband) are bar-coded."

Bowers said besides the financial burden of having to pay for mistakes, hospitals are also at risk for losing their accreditation if they don’t follow safety precautions.

"Any unexpected, serious outcome is called a ‘sentinel event,’" she said. "It must be reported, and it could lead to an investigation."

MDROs a Growing and Dangerous Problem

WASHINGTON, Feb. 13 /PRNewswire-USNewswire/

The following statement is attributable to Kathy Warye, CEO of the Association for Professionals in Infection Control and Epidemiology (APIC):

"APIC is concerned with the increased rate of antibiotic resistant infections -- as high as 70 percent according to recent reports. New strains of MRSA, such as the pUSA03-positive strain, provide evidence that the very nature of these organisms is changing -- producing infections that are increasingly resistant to our strongest antibiotics.

Because of the increasing number of multi-drug resistant organisms (MDROs), APIC promotes a culture of 'zero tolerance' toward non-compliance with measures proven to prevent healthcare-associated infections (HAIs). Furthermore, the association calls upon healthcare institutions to increase efforts to prevent these infections.

Research demonstrates that many HAIs can be prevented through adopting a range of elimination strategies including proper hand hygiene, barrier precautions such as use of gloves and gowns, and equipment cleaning and decontamination.

APIC also urges consumers and health professionals to exercise the prudent use of antibiotics. With a dwindling arsenal of effective drugs and few new compounds on the horizon, healthcare facilities and consumers must stop the misuse and overuse of antibiotics to curb the growth of virulent multi-drug resistant organisms nationwide.

Reducing the rate of HAIs will require adequately resourced infection prevention departments within healthcare facilities. To ensure the safety of patients, APIC stands ready to partner with healthcare professionals, policy makers and consumer groups to provide support and education in this important endeavor."

APIC's mission is to improve health and patient safety by reducing risks of infection and other adverse outcomes. The Association's more than 11,000 members have primary responsibility for infection prevention, control and hospital epidemiology in healthcare settings around the globe. APIC advances its mission through education, research, collaboration, practice guidance, public policy, and credentialing.