16 August 2013

Hospitals Sharing Patients Spreads Bacteria

This isn't funny, but I had to laugh about how ironic this is after having written this blog about hospital greed. With some hospitals now gaming the system, they are creating some of their own problems with bacteria that are antibiotic resistant. Although not part of this study, I now understand why Methicillin-resistant Staphylococcus Aureus (MRSA) is spreading so rapidly and a recent New York City Hospital outbreak became so severe. Maybe hospitals that are gaming the system will pay more dearly and not be able to keep up with the diseases they are spreading.

This study is about the spread of vancomycin-resistant enterococci (VRE) in regional California hospitals (Orange County) and how fast it spreads. Although slower in general than MRSA, it is spreading when hospitals share patients. Maybe it is time for the Centers for Medicare and Medicaid Services (CMS) to investigate and relax their 30-day readmission restriction. This might reduce the speed with which MRSA and VRE are being spread. Then the hospitals could worry more about bringing these back into their own hospitals.

The researchers obtained 2006-2007 patient level admission and transfer data for all 29 adult acute care hospitals (3 children's hospitals were excluded) in Orange County (serving a total population of 3.1 million). Of the 29 hospitals, five are long-term acute care facilities (LTACs), which primarily treat patients who have prolonged high-level medical needs. The data included length-of-stay (LOS), location where patient was admitted from or discharged to, and an encrypted patient identification code that allowed researcher to track patient movement between hospitals. The model was constructed using probabilities generated from this real-world data by calculating hospital-specific proportions of 2006 patients discharged to the community, transferred from each hospital, or readmitted within 365 days.

The full study may be read here. It is studies like this that can poke holes in what CMS does and makes rules harder to cut the number of readmissions to hospitals. Until CMS can get hospitals and other care facilities to increase their safety standards, we will continue to see the spread of more diseases and even more severe resistance to antibiotics. Until hospital boards get on board with safety measures, this will only get worse.

The safety standards are many, but one of the most common is the lack of hand sanitation by doctors, nurses, and other hospital employees. I will not say one group is worst than the other because they are all lax and seldom wash their hands. The next area is the lack of equipment sanitation. I have never seen a stethoscope, a blood pressure cuff, or other piece of equipment that is used patient after patient go through any sanitation or cleaning. I hate to think of the cost involved, but maybe patients will need to start asking to have this equipment be removed from a sealed cellophane container before it can be used.

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