C Difficile in Exam Rooms, on Equipment…

From Science Direct:

Background

Numerous studies have demonstrated that environmental surfaces in the rooms of patients with Clostridium difficile infection (CDI) are often contaminated with spores. However, less information is available regarding the frequency of contamination of environmental surfaces outside of CDI isolation rooms.

Methods

We performed a point-prevalence culture survey for C difficile in rooms of patients not in isolation for CDI, in physician and nurse work areas, and on portable equipment, including pulse oximetry devices, electrocardiogram machines, mobile computers, and medication distribution carts. Isolates were characterized by assessment of toxin production, polymerase chain reaction (PCR) ribotyping, and PCR for binary toxin genes.

Results

Of 105 nonisolation rooms, 17 (16%) were contaminated with toxin-producing C difficile, with the highest rate of contamination on the spinal cord injury unit (32%). Of 87 surfaces cultured outside of patient rooms, 20 (23%) were contaminated, including 9 of 29 (31%) in physician work areas, 1 of 10 (10%) in nurse work areas, and 9 of 43 (21%) portable pieces of equipment, including a pulse oximetry finger probe, medication carts, and bar code scanners on medication carts. Of 26 isolates subjected to typing, 19 (73%) matched ribotype patterns detected in stool samples from CDI patients and 13 (50%) were epidemic, binary toxin-positive strains.

Conclusion

In the context of a CDI outbreak, we found that environmental contamination was common in nonisolation rooms, in physician and nurse work areas, and on portable equipment. Further research is needed to determine whether contamination in these areas plays a significant role in transmission.

House passes stimulus bill

From Modern Physician:

he Democratic-controlled House approved an $819 billion stimulus bill Wednesday night with spending increases and tax cuts at the heart of the young administration’s plan to revive a badly ailing economy, including more than $80 billion for state Medicaid budgets and more than $20 billion to help doctors and hospitals adopt health information technology.

The vote was 244-188, with Republicans unanimous in opposition despite Obama’s pleas for bipartisan support.

Included is money for traditional job-creating programs such as highway construction and mass transit projects. But the measure tickets far more for unemployment benefits, healthcare and food stamp increases designed to aid victims of the economic downturn.

Charity Care and Non-Profit Status

From the Wall Street Health Blog:

In the latest round of the fight over whether nonprofit hospitals provide enough charity care to justify their tax exemptions, a big Chicago hospital operator is settling a class action suit over what it has charged the uninsured.

Advocate Health Care, which operates a bunch of hospitals in the Chicago area, said today it has agreed to provide charity aid to patients earning up to 400% of the federal poverty level or $82,500 for a family of four, the Chicago Tribune reports. It will provide aid retroactively to people who would have been eligible from November 2000 and on.

Health Reform Pervades Economic Stimulus Bill

From the Wall Street Journal Health Blog:

You might mistake the economic stimulus package slated for a House vote today for a health-reform bill, if weren’t sprinkled with some goodies for other sectors of the economy.

Take a look at the changes to Medicaid policy, in particular, the New York Times reports. If it becomes law, the bill would temporarily allow unemployed workers to qualify for Medicaid regardless of their income or assets. Medicaid is typically for the poor.

The bill also increases federal funding for Medicaid and subsidizes laid-off workers who are paying for Cobra insurance coverage through their former employers, NYT says. Here’s how the paper quotes the Congressional Budget Office on the costs: $87 billion to increase the federal share of Medicaid; $29 billion to subsidize private insurance and $11 billion to fund Medicaid for unemployed workers who wouldn’t otherwise qualify.

Grassley pushes legislation to aid rural access

From Modern Healthcare:

Sen. Chuck Grassley (R-Iowa) has introduced legislation intended to improve Medicare payments to rural doctors, ambulance services and midsized hospitals. The Medicare Rural Health Access Improvement Act of 2009 would also seek to protect access for rural residents to home medical equipment and supplies, as well as continue to lend support to critical-access hospitals, according to a summary of the legislation from Grassley’s office.

In addition, the bill could provide relief to the so-called “tweener” hospitals, which are too large to be designated as critical-access hospitals—having 25 or fewer beds—but too small to be financially viable under the Medicare hospital prospective payment system. Grassley said in a news release that there is “no justification” for Medicare not to recognize the unique role of these facilities.

Most tweener hospitals are designated in the Medicare program as Medicare Dependent Hospitals or Sole Community Hospitals. Specifically, this bill’s provisions would provide temporary and permanent improvements so that payments to these hospitals would better reflect the cost of providing inpatient and outpatient services. Also, the bill would extend and increase rural ambulance payments by 5% for next year. And it would protect rural areas from being affected by the new Medicare competitive-bidding program for durable medical equipment, as rural and metropolitan statistical areas with populations of 600,000 or fewer would be exempt from the bidding process.

ER doctors sue state, say emergency room system near collapse

From the LA Times:

Emergency room doctors filed a lawsuit today against the state, saying that California’s overstressed emergency healthcare system is on the verge of collapse unless they receive additional funding.

California has seen 85 hospital closures in the last decade. An additional 55 facilities have shut down emergency rooms. The state now ranks last in the country in access to emergency care and is last in emergency rooms per capita with only seven per 1 million people. The national average is 20 emergency rooms per 1 million people.

“Patients are suffering every day,” said Irv Edwards, one of the doctors represented in the lawsuit and president of Emergent Medical Associates, which staffs 12 emergency rooms in Southern California. “There are emergency rooms throughout the state where people, we believe, have died. Some have died in the lobby before they were seen. Some have died shortly after being placed in a bed after having waited in the lobby for hours. Are people truly suffering consequences? Absolutely.”

Emergency room physicians say they have been particularly hard hit by the state’s fiscal problems. Unlike other doctors, who can choose not to accept Medi-Cal patients, emergency rooms cannot deny treatment. They provide care for these patients but are reimbursed at rates they say are half the cost of the treatment. California’s reimbursement rate ranks 43rd in the country, state officials said.

“As we go forward, these emergency room doctors, they can’t any longer take on the financial burden of the state’s obligation to its poor and to its elderly,” said attorney Raymond Boucher, who filed the lawsuit in Los Angeles County Superior Court today.  “This isn’t a joke. This isn’t just a power play. They are on life support.”

Emergency room doctors statewide believe they subsidized more than $100 million in services provided to Medi-Cal patients in 2007 alone, according to the lawsuit.

MRSA screening test

From the manufacturer’s website:

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The MicroPhage MRSA screening test identifies methicillin-resistant S. aureus (MRSA) when you need rapid results in a simple-to-use, cost sensible format.

MicroPhage’s bacteriophage amplification technology will provide the performance of molecular results at a price that is more in line with chromagenic culture media. The easy-to-use platform allows for simple, unbatched test starts and rapid batched or unbatched results, perfect for an early morning delivery of hospital-wide results when Infection Control can best use them. The MicroPhage MRSA screening test is ideal for institutions concerned with screening for MRSA in their patients that may not have the capacity for molecular or traditional microbiology.

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