Tag Archives: Infections

Healthcare – Associated Infections (HAI’s) Patient Safety Addressed by Vice-President Joe Biden

Vice-President Joe Biden targets patient safety at hospitals

“Up until now, our health care system – in my humble opinion – hasn’t sufficiently linked quality … with safety,” the Vice President said.

“Up until now, our health care system — in my humble opinion — hasn’t sufficiently linked quality … with safety,”  the Vice President said.

Hospitals need to focus more on reducing preventable errors and infections and the government must create more economic incentives to improve patient safety, Vice President Joe Biden said at a conference in Irvine, Calif. over the weekend.

“Up until now, our health care system – in my humble opinion – hasn’t sufficiently linked quality … with safety,” he said. “Not enough time has been focused on keeping bad things from happening.”

But Biden said the paradigm is starting to change. Hospitals are now penalized for unnecessary re-admissions and new technology alerts nurses of possible problems and reduces the reliance on handwritten doctors’ orders.

Gains have been made in improving hand hygiene and reducing central line infections, he said. And a recent government report by the Agency for Healthcare Research and Quality found that 1.3 million fewer hospital-acquired conditions occurred – and 50,000 fewer deaths – in 2013 compared to 2010.

“This is the time to double down on your commitment to patient safety,” he told the crowd of doctors, nurses, hospital executives and patient advocates. “We’ve gone from accepting the inevitable to showing what’s absolutely within our wheelhouse to be able to change.”

The conference was sponsored by the Patient Safety Movement, an organization aimed at reaching “zero preventable patient deaths by 2020.” There were panels on patient involvement, on lessons learned from Ebola and on measuring hospital efforts to improve safety.

Alicia Cole, who attended and spoke at the conference, has spent years recovering from multiple hospital-acquired infections. She went into a Burbank hospital in 2006 for a simple surgery to remove small fibroid and ended up with a staph infection, sepsis and flesh-eating disease.

“Instead of getting better I deteriorated,” Cole said. She has had numerous additional surgeries, had to stop working and still sees a doctor weekly. “My life completely changed.”

Jim Bialick, president of the Patient Safety Movement Foundation, said it’s critical to bring together patients, doctors and technology companies to create solutions. “Traditional methods aren’t working,” he said.


Bialick said he appreciates the government’s renewed focus on the issue. For instance, its Partnership for Patients program is working with 3,700 hospitals across the nation to reduce preventable infections and re-admissions.

Much of the discussion at the conference focused on sepsis, a blood infection that costs the health care system more than $20 billion annually and has a mortality rate of up to 50 percent. Several hospitals, including UC San Francisco, have programs aimed at identifying victims early.

Chris Fee, associate professor of emergency medicine at UCSF, said reducing sepsis deaths is about recognizing symptoms in patients and getting treatment started as soon as possible. Technology can be key in alerting hospital staff of abnormal vital signs and lab tests he said.


“We have to remember that patients can be very ill and look quite well,” Fee said.

The UCSF project started as a pilot and has since expanded to the entire hospital. Fee said it is credited with reducing mortality from 18 percent in 2012 to 12 percent in 2014 and saving more than 100 lives.

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Case Western Reserve University in Cleveland; Good Bacteria Helps Protect Against Harmful Effects of Antibiotics

Researchers from Case Western Reserve University in Cleveland have discovered that populating the gastrointestinal (GI) tracts of mice with Bacteroides species producing a specific enzyme helps protect the good commensal bacteria from the harmful effects of antibiotics. Their research is published ahead of print in Antimicrobial Agents and Chemotherapy.

Antibiotics are powerful weapons against pathogens, but most are relatively indiscriminate, killing the good bacteria  along with the bad. Thus, they may render patients vulnerable to invasion, particularly by virulent, antibiotic-resistant pathogens that frequently populate hospitals.

The novel aspect of the research is that the enzyme produced by these bacteria, beta-lactamase, is a major cause of antibiotic resistance  says first author, Usha Stiefel. Interestingly, the enzyme is not only protecting the bacteria that produce it but also the rest of the bacteria making up the intestinal microbiome.

In the study, the investigators established populations of beta-lactamase producing Bacteroides in some mice, but not others. They then gave all the mice ceftriaxone, a beta-lactam antibiotic, for three days and then oral doses of vancomycin-resistant enterococcus, or Clostridium difficile, both of which are virulent GI pathogens.

The mice that had been populated with Bacteroides maintained their diverse species of commensal gut bacteria, free of pathogens, while the control mice saw their commensals decimated by  antibiotics  enabling establishment of the pathogens.

“When patients in the hospital or nursing home setting receive antibiotics, it is doubly dangerous when they lose their native colonic bacteria, because healthcare settings are full of resistant or particularly  virulent bacteria,  and so patients are especially vulnerable to acquiring these bacteria within their intestinal tracts,” says Stiefel.

Since the Bacteroides, which comprise roughly one quarter of the intestinal microbiome, are absent elsewhere in the body, the investigators believe that the beta-lactamase will not interfere with treatment of infections in other organ systems, such as in the respiratory tract, or the blood, explains Stiefel.

“The results of our study are exciting because they show how it might be possible to take antibiotics without suffering from the loss of your colonic microbiome and then becoming colonized by virulent pathogens,” says Stiefel. For example, beta-lactamase enzymes could be given orally as drugs, to protect the  gut bacteria from systemic antibiotics. Alternatively, as with the mice, patients’ GI tracts might be populated with antibiotic-degrading  bacteria.

One weakness of the strategy is that while it could protect against acquiring a GI infection, C. difficile, for example, it could not be used to combat such an infection.

“The recognition of the importance of an intact and diverse microbiome has probably best been demonstrated by the successful treatment of Clostridium difficile colitis by fecal microbiota transplantation, or ‘stool transplant,'” says Stiefel.

“If you have an intact intestinal microbiome, you simply are going to be resistant to acquiring many types of infection.”

“If we can find ways to preserve the microbiome in hospitalized patients who are receiving antibiotics, we are on our way to preventing a large proportion of hospital-acquired infections,” says Stiefel.

More information: The manuscript can be found  online – The final version of the article

is scheduled for the August 2014 issue of Antimicrobial Agents and Chemotherapy.