Do Medicare's Penalties Affect Performance?

Four years after the Centers for Medicare and Medicaid Services stopped reimbursing facilities for the treatment of preventable healthcare-associated infections, a team of researchers has raised doubts that the action has had a demonstrable impact on infection rates.

While the infection rates they tracked have fallen, they were not able to correlate them to Medicare's enactment of its financial penalties, according to their study, published in the Oct. 11 issue of the New England Journal of Medicine.

Examining data from 398 hospitals and health systems regarding patients treated between January 2006 and March 2011, researchers from the Harvard Medical School, Institute for Healthcare Improvement, Centers for Disease Control and Prevention and other organizations compared outcomes involving central catheter-associated bloodstream and catheter-associated urinary tract infections (which are included in Medicare's no-pay list) and ventilator-associated pneumonia (which is not).

"We observed decreasing secular trends for both targeted and nontargeted infections long before the policy was implemented," they write, but "[w]e found no evidence that the 2008 CMS policy to reduce payments for central catheter-associated bloodstream infections and catheter-associated urinary tract infections had any measurable effect on infection rates in U.S. hospitals."

The study's findings, which were not affected by a facility's size, ownership, percentage of Medicare patients, or whether its state required infection reporting, point to the importance of determining which regulatory processes have an actual impact on infection rates, say the researchers.

David Bernard

Antibiotic Injections More Effective than Eyedrops for Post-Cataract Care

Cataract surgery patients are traditionally prescribed a regimen of antibiotic eyedrops to ward off the risk of post-op infection. But ophthalmic surgeons at Kaiser Permanente in northern California have determined that injecting antibiotics at the close of surgery is a much more effective method.

For the study, published online in the Journal of Cataract and Refractive Surgery, the researchers calculated the incidence rate of endopthalmitis following more than 16,000 cataract cases performed between 2007 and 2011.

During the baseline year of 2007, cataract patients were administered post-op eyedrops only. The endopthalmitis rate was 3.1 per 1,000 cases. "Antibiotic eyedrops applied to the surface of the eye must penetrate inside the eye to reach the site where pathogens can take hold and cause infection," notes Neal Shorstein, MD, the study's lead author.

Administering antibiotics directly into the anterior chamber boosted the effect, however, as seen in 2008's and 2009's cases, in which an injection of cefuroxime was added to the eyedrop regimen. In those cases, the endopthalmitis rate was 1.43 per 1,000 cases.

What's more, in 2010 and 2011, when every cataract patient received an injection of cefuroxime, moxifloxacin or vancomycin, the rate dropped to 0.14 per 1,000 cases, a rate 22 times lower than in 2007.

David Bernard

A Use for Rejected Donor Corneas

Donor corneas that aren't suitable for transplanting might do a better job covering glaucoma shunts than traditional pericardium grafts do, according to researchers at the University of Alabama at Birmingham. In the Journal of Glaucoma, they write that the cornea tissue is more durable and potentially safer for protecting patients' shunts from eroding or becoming infected.

The UAB researchers studied cornea tissue obtained from eye banks. In patients undergoing tube implantation for the first time, they found the cornea grafts are less likely to thin or erode over time than grafts from pericardium, leaving patients at lower risk for infection or subsequent repairs. It also provides a superior cosmetic result, says Christopher A. Girkin, MD, chair of UAB's department of ophthalmology and the study's senior author.

"Some of the corneas donated to eye banks for transplant into patients with cornea disease are not optically clear enough … for that task," says Christine Curcio, PhD, professor of ophthalmology at UAB and director of Birmingham-based Global Sight Network, a non-profit consortium of eye banks. "However, this research indicates that they are suited for use as patch grafts for glaucoma patients, providing for very efficient utilization of this valuable tissue resource."

It's the first study to directly compare glycerol-preserved corneal tissue to another patch graft material in glaucoma shunt surgery. The results could further boost the standing of glaucoma procedures in outpatient surgical facilities.

Stephanie Wasek

InstaPoll: The Easy Way to Improve Hand Hygiene Compliance

It's difficult enough to get your surgeons, anesthesia providers and staff to perform proper hand hygiene. Don't make things worse by not having enough dispensers and bottles of hand sanitizer in your facility. Or by not keeping them filled. Tell us in Outpatient Surgery Magazine's InstaPoll if you keep enough sanitizer on hand for your staff's hands.

There's so, so much that a surgical facility manager has to know, both in and out of the operating room. Last week we asked What do you wish you knew more about or were better at in your job? The results, based on 258 responses:

  • It was an isolated incident, and I'll continue to use my compounding pharmacy. 32%
  • I'll only use a compounding pharmacy to obtain drugs that are in short supply. 27%
  • Now I'll never use a compounding pharmacy. 12%
  • This news is making some of our pain management patients cancel. 15%
  • Doesn't affect me one way or the other. 14%

Dan O'Connor

News & Notes
  • Compounding pharmacy guidance In the wake of the fungal meningitis outbreak originating from a Massachusetts compounding pharmacy, the American Society of Health-System Pharmacists has made available its guidelines for facilities who are considering outsourcing their drug compounding services and a checklist for assessing potential contractors.
  • Lessons learned from C. diff According to the Mayo Clinic, incidents of Clostridium difficile are increasingly common and severe among the oldest and the youngest patients, largely due to the overuse of the antibiotics developed to fight the bacteria. The Agency for Healthcare Research and Quality, in conjunction with the CDC and several major hospitals, has drafted a guide promoting antibiotic stewardship to stem this trend.
  • MHAUS hotline turns 30 The emergency hotline connecting ORs in crisis to malignant hyperthermia experts is (like 36 vials of dantrolene) one of those things you're thankful for the existence of, even if you hope you never have to use it. Did you ever wonder how it got started, or how it's presently staffed? In a recent blog post, MHAUS President Henry Rosenberg, MD, explains its origins on the occasion of its 30th anniversary.