While most hospitals have policies in place to prevent health care-associated infections, clinicians often fail to follow evidence-based guidelines established to prevent these infections, according to research from Columbia University School of Nursing published in the February issue of the American Journal of Infection Control. The study, the most comprehensive review of infection control efforts at U.S. hospitals in more than three decades, found lax compliance even in intensive care units, where patients are more likely to be treated with devices linked to preventable infections—such as central lines, urinary catheters, and ventilators.
A team led by Patricia Stone, PhD, MPH, RN, FAAN, Centennial Professor of Health Policy at Columbia Nursing, investigated compliance with evidence-based policies to prevent infection in 1,653 ICUs at 975 hospitals nationwide. The study focused on three of the most common preventable infections: central line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections. Despite decades of research establishing best practices for prevention of these infections, approximately one in 10 hospitals lack checklists to prevent bloodstream infections, and one in four lack checklists to help avoid pneumonia in ventilator patients. Even worse, these checklists are followed only about half of the time, the study found.
“Hospitals aren’t following the rules they put in place themselves to keep patients safe,” says Stone, who has published extensive research on health care-associated infections and has contributed to prevention guidelines issued by the Joint Commission, which oversees accreditation for U.S. hospitals, nursing homes, and other health facilities. “Rules don’t keep patients from dying unless they’re enforced.”
Health care-associated infections kill an estimated 100,000 Americans a year and create approximately $33 billion in excess medical costs. The U.S. Centers for Disease Control and Prevention first linked infection rates to prevention programs in the 1970s. Research since then has shown that checklists and other targeted infection-control practices can make a significant dent in infection rates—but only if compliance rates among clinicians are high.
Compliance could be improved through two approaches most hospitals aren’t using: electronic monitoring systems and staff certified in infection control. The study found that only about one-third of the ICUs have an electronic surveillance system to track compliance with infection-prevention policies at the clinician level. Previous research has found that electronic monitoring systems that provide report cards on compliance are effective at getting clinicians to follow the rules and lowering infection rates. At the same time, more than one-third of hospitals also failed to employ a full-time clinician certified in infection prevention to supervise compliance, the study found.
“Every hospital should see this research as a call to action. It’s just unconscionable that we’re not doing every single thing we can, every day, for every patient, to avoid preventable infections,” Stone says.
For central line-associated bloodstream infections, or CLABSI, the study found that more than 90 percent of ICUs had checklists for sterile insertion but the policies were followed only about half of the time. Catheters, also known as central lines, deliver life-saving medicines and nutrition. Without proper insertion, utilization, and maintenance, catheters can also transmit deadly infections to the bloodstream. Simple infection-prevention measures include handwashing before handling the catheter and immediately changing the dressing around the central line if it gets wet or dirty.
Compliance rates were no better for preventing ventilator-associated pneumonia, or VAP, the study found. Overall, three out of four ICUs had checklists for protecting against infections linked to ventilators, machines that force air into the lungs of patients unable to breathe on their own. The ICUs followed their own checklists just half the time. Keeping patients elevated in bed, with the head higher than the feet, is one simple precaution that can help prevent pneumonia.
Patients with urinary catheters fared even worse, the study found. Guidelines to prevent catheter-associated urinary tract infections, or CAUTI, are newer, and there are not yet universally accepted checklists to follow at the bedside. About one-third of hospitals had no prevention polices in place to prevent these infections. Even at hospitals that did establish guidelines, the measures were followed less than 30 percent of the time.
“We’ve come a long way in understanding what causes health care-associated infections and how to prevent them,” Stone says. “This study shows we still have a long way to go in compliance with well-established, life-saving, and cost-saving measures that we know will lower infection rates.”
Watch a video of Patricia Stone discussing the findings.
This article originally appeared on the Columbia University School of Nursing website.
WASHINGTON – Today, First Lady Michelle Obama joins U.S. Department of Agriculture Secretary Tom Vilsack to announce proposed guidelines for local school wellness policies. The bipartisan Healthy, Hunger-Free Kids Act of 2010 mandated that the USDA set guidelines for what needed to be included in local school wellness policies in areas such as setting goals for nutrition education and physical activity, informing parents about content of the policy and implementation, and periodically assessing progress and sharing updates as appropriate. As part of local school wellness policies, the proposed guidelines would ensure that foods and beverages marketed to children in schools are consistent with the recently-released Smart Snacks in School standards. Ensuring that unhealthy food is not marketed to children is one of the First Lady's top priorities; that is why it is so important for schools to reinforce the importance of healthy choices and eliminate marketing of unhealthy products.
"The idea here is simple—our classrooms should be healthy places where kids aren't bombarded with ads for junk food," said First Lady Michelle Obama. "Because when parents are working hard to teach their kids healthy habits at home, their work shouldn't be undone by unhealthy messages at school."
This action comes after the White House Summit on Food Marketing to Children last fall where Mrs. Obama called on the country to ensure children's health was not undermined by marketing of unhealthy food.
"The food marketing and local wellness standards proposed today support better health for our kids and echo the good work already taking place at home and in schools across the country. The new standards ensure that schools remain a safe place where kids can learn and where the school environment promotes healthy choices. USDA is committed to working closely with students, parents, school stakeholders and the food and beverage industries to implement the new guidelines and make the healthy choice, the easy choice for America's young people," Secretary Vilsack said.
To help schools with the implementation of the school wellness policies, the U.S. Department of Agriculture has launched a new "School Nutrition Environment and Wellness Resources" website, which includes sample wellness policy language for school districts and a dedicated page of resources for food marketing practices on the school campus.
These new resources will complement a second announcement which highlights the nationwide expansion of a successful program that was piloted in 11 states with the goal of ensuring children who are in need of nutritious meals are receiving them. Beginning July 1, 2014, more than 22,000 schools across the country—which serve primarily low-income students—will be eligible to serve healthy free lunches and breakfasts to all students. This will help as many as 9 million American children eat healthy meals at school, especially breakfast, which can have profound impacts on educational achievement. Research shows that kids who eat breakfast in the classroom preform over 17% better on math tests and have fewer disciplinary problems.
For more information, go to http://www.fns.usda.gov/school-meals/
MINNEAPOLIS/PRNewswire-USNewswire/ -- The Minnesota Dental Association (MDA) has serious concerns about the inconclusive nature of findings in a report issued by the Minnesota Department of Health on the early impact of dental therapists on the delivery of and access to dental services. This report, issued in conjunction with the Minnesota Board of Dentistry, was mandated by the 2009 Minnesota Legislature when dental therapists were first authorized to be licensed in Minnesota, but is based on small numbers of practicing dental therapists and the patients they have served.
To date Minnesota has licensed 32 dental therapists, with only 26 currently practicing, a virtually insignificant number compared to the over 17,000 licensed dental professionals in our state. Such small numbers shed serious doubt on the findings in the report, which claims that practicing dental therapists have had a pronounced impact on underserved populations, from reduced travel times and wait times for appointments to increased productivity and improved patient satisfaction. This study is not only premature in terms of its validity, but it also utilizes much anecdotal evidence that is reported as fact.
In particular, the MDA is concerned that the MDH report provides little conclusive evidence of the impact of dental therapists on access to dental care or their economic impact.
Only four clinics of the 15 surveyed are in rural Minnesota, where access to dental care is a greater challenge.
Some benefits attributable to dental therapists include cost savings and increased dental team productivity, but were reported anecdotally and not substantiated.
Of the 6,338 patients served by dental therapists, 84% were enrolled in public programs. Because public program reimbursement rates are the same for dentists and dental therapists, the addition of the mid-level practitioner to the dental workforce results in no savings for the state.
"While the report fulfills the legislature's mandated requirements, it is by no means a complete picture," stated Dr. Michael Perpich, MDA President. "Conclusions are based upon the experiences of seven full time equivalent employees or FTE's. It would be unrealistic to suggest that the experiences of seven FTE's can determine trends for an entire health care profession in the state of Minnesota."
While dental therapists may be a viable dental team member in certain settings, their continued licensing and employment will require ongoing assessment to truly understand what, if any, impact they will have on delivering quality dental care to underserved populations in Minnesota.
CINCINNATI--(BUSINESS WIRE)--Oral-B® will introduce its interactive electric toothbrush – the world’s first of its kind with Bluetooth 4.0 connectivity – at Mobile World Congress 2014 beginning Monday, February 24. As an essential element to the well-connected bathroom, the product will be showcased in the GSMA Connected City exhibition space, a realistic city environment showcasing cutting-edge mobile products and services for the increasingly connected life. Available for purchase in limited quantities this spring, the product is poised to set a new standard in personal oral care.
This new innovation gives you unprecedented control over your oral care, and in turn, the outcome of your dental appointments. Via Bluetooth 4.0 technology, the interactive electric toothbrush connects to the Oral-B App that provides real-time guidance while you brush, and records brushing activity as data that you can chart on your own and share with dental professionals, helping to create smarter and more personalized brushing routines.
Features & Benefits of the Oral-B App
Utilizes Two-Way Communication: Not only does that app receive brushing data and report it back to you, but you can also program the app so that it communicates with the brush for personalized brushing.
Delivers Expert Guidance with Focused Care: The purpose of this new technology is not to outsmart dental professionals, but to work hand-in-hand with them. Dental professionals can program patients’ brushing routines in the app to help improve their brushing behaviors and focus on problem zones within the mouth.
Programs Personal Brush Settings: You can use your smartphone as a “remote control” to customize your brush to your needs, including setting your target session length and selecting your preferred modes.
Stores Your Data: It is not always convenient or easy to remember to have your smartphone in the bathroom while you brush, so the Oral-B interactive electric toothbrush handle can store up to 20 brushing sessions. The data is transferred the next time the app is connected to the toothbrush, updating your records.
Fosters Better Brushing: The app and interactive electric toothbrush help drive patient compliance, which determines a large part of the success of dental appointments.
Helps You Stay Informed: The app helps maintain your attention and motivation while brushing with news, weather and oral care tips.
Available for free on iOS and Android
Additionally, pre-tests of the app have shown that when connected, brushing time increases from less than 60 seconds with a manual toothbrush to two minutes and 16 seconds with an electric toothbrush, surpassing the dental professional-recommended two-minute per session.
“Oral-B has been a leading innovator in oral care for more than 60 years, and we’re proud to introduce this new interactive electric toothbrush with Bluetooth 4.0 connectivity, which was developed in conjunction with leading dental experts around the globe,” said Wayne Randall, Vice President, Global Oral Care at Procter and Gamble. “It provides the highest degree of user interaction to track your oral care habits to help improve your oral health, and we believe it will have significant impact on the future of personal oral care, providing data-based solutions for oral health, and making the relationship between dental professionals and patients a more collaborative one.”
Oral-B’s participation in the GSMA Connected City marks the first time an oral care brand has debuted its mobile capabilities at Mobile World Congress, the largest and most premier exhibitor in mobile developments.
“The GSMA Connected City was created to showcase the most innovative developments in mobile technology and demonstrate how they will have a positive impact on people’s lives. So we are delighted to welcome Oral-B,” said Michael O’Hara, Chief Marketing Officer, GSMA. “The progress of connected devices and machine-to-machine communications continues to grow at an incredible pace, shaping the world around us and we hope that visitors to the City will be inspired by what they see this year.”
The Bluetooth 4.0 technology will be available in a variety of Oral-B electric toothbrushes, including the new sophisticated and elegant Oral-B SmartSeries.™
Features & Benefits of the New SmartSeries with Bluetooth Connectivity 4.0
Bluetooth 4.0 connectivity: Links electric toothbrush to smartphone app via low-energy Bluetooth
Oscillating-rotating-pulsating technology: Removes up to 100 percent more plaque than a regular manual toothbrush
Six different cleaning modes: Daily Cleaning, Deep Clean, Whitening, Gum Care, Sensitive, Tongue Cleaning
Compatible with six different brush heads: CrossAction, Precision Clean, 3D White, Sensitive, Floss Action, TriZone
Pressure sensor: Signals and decelerates the speed when the user is brushing too hard
Travel accessories: Protects the brush and charger during travel
The new Oral-B interactive electric toothbrush with Bluetooth 4.0 connectivity and the Oral-B App will be available in limited quantities in Germany this spring, with a global rollouts – including the SmartSeries – launching in June 2014. The new Oral-B App will be available in iOS in May, and in Android in August.
For more information on the new SmartSeries and other Oral-B electric toothbrushes with Bluetooth 4.0 connectivity, visit connectedtoothbrush.com.
The American Association of Dental Office Managers (AADOM) is offering a free webinar called Goof Proof Insurance and Collections, presented by Lois Banta, at 1 pm EST on Wednesday. It is approved for 1 CE toward the AADOM fellowship program.
Participants will learn which systems to have in place for reviewing key collections and insurance systems, which reports are crucial, letters to develop and send to “use remaining dental benefits” and strategic planning for the next year.
-Key Collections Systems
-Collections and Insurance Strategies
-Narratives that Work
-Do it Right…Not Over Helpful Tools
-How to Inspect what you Expect
Click here to register.
This webinar will have a handout. Please be sure to have the handout prior to the start of the webinar.
The handout can be found in the webinar registration link above.
CHICAGO – The Chicago Dental Society (CDS) is scheduled to honor NASCAR Star Greg Biffle on Feb. 20 for his involvement with the American Dental Association’s (ADA) national Give Kids A Smile® program. Biffle will be honored with the George H. Cushing award, which is given to an individual or group that has raised public awareness of oral health issues.
“Biffle, NASCAR driver of the #16 3M ESPE Dental car, for the last three years has been working in conjunction with ADA on their Give Kids a Smile Day program,” said Dr. Phil Schefke, the 2014 Chair of the Chicago Dental Society’s Communications Committee. “He has been helping deliver the message about the benefits of healthy habits like brushing, flossing, visiting the dentist and making smart food choices to children around the country at NASCAR events.”
Biffle was unable to attend the ceremony, which took place at Chicago’s Midwinter Meeting, because he is in Daytona, Fla., this week preparing with his team for the upcoming Daytona 500.
The namesake of the George H. Cushing award was a prominent Chicago dentist in the mid- 1800s who served as the CDS president for five terms and was a strong advocate of dental health education. Past recipients of the George H. Cushing award have included Surgeon General Dr. David Satcher and the Shriver Family.
In his fourth year encouraging children to “Brush with the Biff,” Biffle re-joins ADA’s Give Kids A Smile, 3M ESPE Dental, the ADA Foundation, Henry Schein, Inc. (NASDAQ:HSIC), CareCredit℠, Church and Dwight, Oral Health America and Biffle to deliver healthy mouth messages to children such as brushing for two minutes twice a day, flossing, visiting the dentist regularly and making smart food choices.
The yearlong ADA Give Kids A Smile education program, now in its 12th year, includes a national public service announcement featuring Greg Biffle and ongoing outreach to parents and children through dental offices, community events and media. Throughout the year, more than 1,500 Give Kids A Smile events will be held around the country, providing dental services to approximately 350,000 underserved children.
For more information, visit www.3MESPE.com/givekidsasmile to create a photo with Greg Biffle. For dental tips, visit www.2min2x.org, www.MouthHealthy.org and www.Facebook.com/GiveKidsASmile.
Hatfield, PA -- DEXIS is pleased to announce the introduction of CariVu, a compact, portable caries detection device that uses unique, patented transillumination technology. This exciting new product provides the ability to easily detect a range of carious lesions (occlusal, interproximal, secondary/recurrent,) and cracks, and yields an easily interpreted image that is stored with the patient’s other images. Incorporating easily into current workflow, CariVu serves as a valuable adjunct tool for the identification of tooth decay when used with clinical and radiographic examinations.
CariVu embodies a modern version of transillumination technology that has been evolving for over a decade and has been shown, in some cases, to both find lesions earlier than with X-ray, as well as represent the lesion’s structure very accurately. Also, design improvements have led to a product where the light source and other electronics needed for image capture are housed sleekly in a light-weight handpiece that can interact with the DEXIS software. The system also utilizes flexible, autoclavable tips. This improved usability speaks to the hallmarks of DEXIS imaging solutions of ease-of-use and patient comfort.
This new system employs near-infrared light which, in images, turns the natural tooth transparent and the caries dark similar to radiographs, and thus, in a view that is familiar to clinicians. Not only are CariVu images easy to read and understand, they are captured andstored with the patient’s other images.Since all intra-oral X-rays, camera and CariVu images for the select tooth appear side-by-side, the clinician can quickly compare them to make a diagnosis and decide on a course of treatment. These images can be shared with patients so that they may better understand the need for preventive or restorative care.
The technology behind CariVu offers an advantage in diagnosis of caries over systems that rely on fluorescence reactions which is typically denoted by colors or numeric values. In laboratory testing on the comparison of these two technologies, this new transillumination device showed that the view of the lesions on the images correlated well with their actual physical conditions.Thus, with CariVu, the dentist gains a more accurate view of the actual carious lesion’s shape and size, not just an indication of the presence of decay.
CariVu Indications for Use: The DEXIS CariVu is designed exclusively to support the identification of open or incipient carious lesions above the gingiva and for monitoring the progress of such lesions. Indications: Detection of smooth surface caries, detection of occlusal caries, detection of proximal caries, detection of initial caries, detection of secondary caries and detection of cracks
This influenza season was particularly hard on younger- and middle-age adults, the Centers for Disease Control and Prevention reported in Thursday’s Morbidity and Mortality Weekly Report. People age 18-64 represented 61 percent of all hospitalizations from influenza—up from the previous three seasons when this age group represented only about 35 percent of all such hospitalizations. Influenza deaths followed the same pattern; more deaths than usual occurred in this younger age group.
A second report in this week’s MMWR showed that influenza vaccination offered substantial protection against the flu this season, reducing a vaccinated person’s risk of having to go to the doctor for flu illness by about 60 percent across all ages.
“Flu hospitalizations and deaths in people younger- and middle-aged adults is a sad and difficult reminder that flu can be serious for anyone, not just the very young and old; and that everyone should be vaccinated,” said CDC Director Tom Frieden, M.D., M.P.H. “The good news is that this season's vaccine is doing its job, protecting people across all age groups."
U.S. flu surveillance data suggests that flu activity is likely to continue for a number of weeks, especially in places where activity started later in the season. Some states that saw earlier increases in flu activity are now seeing decreases. Other states are still seeing high levels of flu activity or continued increases in activity.
While flu is responsible for serious illness and death every season, the people who are most affected can vary by season and by the predominant influenza virus. The currently circulating H1N1 virus emerged in 2009 to trigger a pandemic, which was notable for high rates of hospitalization and death in younger- and middle-aged people. While H1N1 viruses have continued to circulate since the pandemic, this is the first season since the pandemic they have been predominant in the U.S. Once again, the virus is causing severe illness in younger- and middle-aged people.
Approximately 61 percent of flu hospitalizations so far this season have occurred among persons aged 18-64 years. Last season, when influenza A (H3N2) viruses were the predominant circulating viruses, people 18 to 64 years accounted for only 35 percent of hospitalizations. During the pandemic season of 2009-2010, people 18 to 64 years old accounted for about 56 percent of hospitalizations.
Hospitalization rates have also been affected. While rates are still highest among people 65 and older (50.9 per 100,000), people 50 to 64 years now have the second-highest hospitalization rate (38.7 per 100,000), followed by children 0-4 years old (35.9 per 100,000). During the pandemic, people 50 to 64 years also had the second-highest hospitalization rate. Note that hospitalization rates are cumulative and thus will continue to increase this season.
Influenza deaths this season are following a pattern a similar to the pandemic. People 25 years to 64 years of age have accounted for about 60 percent of flu deaths this season compared with 18 percent, 30 percent, and 47 percent for the three previous seasons, respectively. During 2009-2010, people 25 years to 64 years accounted for an estimated 63 percent of deaths.
"Younger people may feel that influenza is not a threat to them, but this season underscores that flu can be a serious disease for anyone," said Dr. Frieden. "It's important that everyone get vaccinated. It's also important to remember that some people who get vaccinated may still get sick, and we need to use our second line of defense against flu: antiviral drugs to treat flu illness. People at high risk of complications should seek treatment if they get a flu-like illness. Their doctors may prescribe antiviral drugs if it looks like they have influenza."
People at high risk for flu complications include pregnant women, people with asthma, diabetes or heart disease, people who are morbidly obese and people older than 65 or children younger than 5 years, but especially those younger than 2 years. A full list of high risk factors and antiviral treatment guidance is available on the CDC website. More information about flu vaccine and how well it works also is available.
Flu Vaccine Best Tool Available
In the flu vaccine effectiveness (VE) study, CDC looked at data from 2,319 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness (Flu VE) Network from December 2, 2013 to January 23, 2014. They found that flu vaccine reduced the risk of having to go to the doctor for flu illness by an estimated 61 percent across all ages. The study also looked at VE by age group and found that the vaccine provided similar levels of protection against influenza infection across all ages. VE point estimates against influenza A and B viruses by age group ranged from 52 percent for people 65 and older to 67 percent for children 6 months to 17 years. Protection against the predominant H1N1 virus was even slightly better for older people; VE against H1N1 was estimated to be 56 percent in people 65 and older and 62 percent in people 50 to 64 years of age. All findings were statistically significant.
The interim VE estimates this season are comparable to results from studies during other seasons when the viruses in the vaccine have been well-matched with circulating influenza viruses and are similar to interim estimates from Canada for 2013-14 published recently.
While flu vaccine can vary in how well it works, vaccination offers the best protection currently available against influenza infection. CDC recommends that everyone 6 months and older get an annual flu vaccine.
“We are committed to the development of better flu vaccines, but existing flu vaccines are the best preventive tool available now. This season vaccinated people were substantially better off than people who did not get vaccinated. The season is still ongoing. If you haven’t yet, you should still get vaccinated," said Dr. Frieden.