News
HAIs remain a significant challenge for U.S. hospitals, says CDC. The Center for Disease Control and Prevention (CDC) published a report in the New England Journal of Medicine on March 26, coordinated with a media briefing presented the same day, in which the agency reported that healthcare-associated infections remain a significant cause of illness and death in American hospitals. CDC representatives noted that “on any given day, about one in 25 hospital patients have an infection caused by their medical care. Almost half of these patients are 65 or older….One in every nine patients who gets an infection will die during hospitalization.”
The most common sites of infection are the bloodstream, the urinary tract, the gut, the site of surgery, and the lungs. The most common causes are Clostridium difficile, staph (including MRSA), Enterobacteriaceae (including CRE) Enterococcus, and Pseudomonas. The CDC reports progress in reducing the rate of infection; during the last five years, for example, the number of bloodstream infections in patients with central lines has been cut nearly in half.
More than 720,000 HAIs and 75,000 deaths were reported in the published survey, which covered some 648,000 patients hospitalized during 2011. A second CDC report, covering nearly 13,000 American hospitals, indicated that hospital-associated infections did decrease in all categories except catheter-associated UTIs.
New Study
New septic shock biomarker test could boost better interventions. In a study published in Critical Care Medicine, researchers at Cincinnati Children’s Hospital Medical Center and the University of Cincinnati report a new blood test that identifies low-risk and high-risk septic shock patients. Based on genome-wide studies, the stratification tool measures five protein biomarkers in the blood that are combined to accurately estimate the risk of mortality and determine which patients should receive experimental therapeutic intervention. The study involved 882 adults in ICUs in medical centers in the United States, Canada, and Finland.
Researchers selected the biomarkers used because of their clear links to infection and inflammation. In addition to biomarkers, the researchers included measurements of patient age, lactate levels, and the number of chronic diseases patients had. They then used a mathematical model to combine the information into a single tool that separates high- and low-risk patients.
The authors report that in general the tool accurately determined that patients who tested positive had a < 50% chance of surviving, while patients who tested negative had a > 90% chance of surviving. More detailed analyses identified patients with a > 98% chance of surviving, and those with a > 75% chance of dying.
Genetics/Genomics
The Society of Gynecologic Oncology has issued new clinical practice statements regarding genetic testing for ovarian and endometrial cancers. The SGO recommends that “women diagnosed with epithelial ovarian, tubal, and peritoneal cancers should be considered for genetic counseling and testing, even in the absence of a family history” and that “women diagnosed with endometrial carcinoma should undergo systematic clinical screening and/or molecular screening for Lynch syndrome.”
The SGO acknowledges the benefits gene panel testing can offer: “The advent of next generation sequencing has led to an era of inexpensive, high throughput DNA sequencing, which is having a major impact on both cancer research and clinical care….Advantages of cancer gene panels include decreased cost and improved efficiency of cancer genetic testing by decreasing the time involved, number of patient visits, and number of tests sent.”
At the same time, the SGO recognizes that “the major drawback of cancer gene panels is the increased complexity of results. For many genes, clear risk reduction strategies for mutation carriers are not established. A major concern is the increased likelihood of identifying results of uncertain clinical significance.” The SGO concludes that “given the increased variety of testing options and potential complexity of genetic results with cancer gene panels, genetic counselors or knowledgeable medical professionals should carefully discuss the pros and cons with patients.”
EHR/EMR
Volume of notifiable disease reporting may double with required electronic lab reporting. Public health departments nationwide are already feeling the strain from budget cuts. But their case report volumes could double when federal requirements for automated electronic laboratory reporting of notifiable diseases go into effect next year, according to a study by researchers from the Regenstrief Institute, Inc., and the Indiana University School of Informatics and Computing.
Notifiable disease reports, required for sexually transmitted diseases, E. coli, tuberculosis, Lyme disease, and other conditions, typically are submitted by hospitals and physicians’ offices to state and county public health departments by fax, phone, or paper mail. Electronic laboratory reporting prevents information from falling through the cracks and improves timeliness of data transmittal. The study authors used data from the Indiana Network for Patient Care to project the national scenario.
Worth Re-quoting
This month’s conversation starter: From the Special Feature “Pre-analytical errors: their impact and how to minimize them” by Nitin Kaushik, MD, MBA, and Sol Green, PhD, FACB (p. 22): “Despite improvements in pre-analytical automation, the pre-analytical phase remains the most error-prone part of laboratory testing due to its complexity, that is, due to the presence of many steps that occur both before and after the specimen reaches the laboratory.” Reactions? Comments? Examples? Suggestions? Share your thoughts at mlo-online.com.
