What's in a Name? Reducing False Positive Blood Cultures by Making Care Truely ‘Accountable’ (original) (raw)
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Journal of Hospital Infection, 2019
Background: Blood culture contamination (BCC) increases length of stay (LOS) and leads to unnecessary anti-microbial therapy and/or hospital-acquired conditions (HACs). Aim: We sought to quantify the magnitude of the additional LOS, costs to hospitals and society as well as the harm to patients attributable to BCC. Methods: A retrospective matched survival analysis was performed involving hospitalized patients with septicaemia-compatible symptoms. BCC costs, hospital-acquired conditions (HACs), and potential savings were calculated based on the primary LOS data, a modified Delphi process, and published sources. The cost analysis compared standard care to interventions for reducing BCC, and estimated annual economic and clinical consequences for a typical hospital and for the entire U.S. Findings: Patients with BCC experienced mean prolonged hospital stays of 2.35 days (p=0.0076). Avoiding BCCs would decrease costs by 6,463(6,463 (6,463(4,818 from inpatient care, of which 53% was from reduced length of stay, and 26% was from reduced antibiotic use). Annually, in a typical 250- to 400-bed hospital, employing phlebotomists would save 1.3millionandprevent24HACs(including2C.difficilecases);basedonclinicalefficacyevidence,usingthestudiedInitialSpecimenDiversionDevice(ISDD)wouldsave1.3 million and prevent 24 HACs (including 2 C. difficile cases); based on clinical efficacy evidence, using the studied Initial Specimen Diversion Device (ISDD) would save 1.3millionandprevent24HACs(including2C.difficilecases);basedonclinicalefficacyevidence,usingthestudiedInitialSpecimenDiversionDevice(ISDD)wouldsave 1.9 million and prevent 34 HACs (including 3 C. difficile cases). In the United States, the respective strategies would prevent 69,300 and 102,900 HACs (including 6,000 and 8,900 C. difficile cases) and costs of 5and5 and 5and7.5 billion. Conclusion: Costs and clinical burdens associated with false-positive cultures are substantial and can be reduced by available interventions, including phlebotomists and ISDD use.
C: Mandatory Influenza Vaccine for ALL Health Care Workers
2005
Health care workers (HCWs) who have contact with patients have an increased risk of exposure to vaccinepreventable diseases and of spreading those diseases to vulnerable patients. Maintenance of immunity against vaccine-preventable diseases is an essential part of disease-prevention and infection-control programs [1]. Influenza is the most common vaccine-preventable disease, and nosocomial transmission is frequently identified in health care facilities; yet, voluntary vaccination policies permit HCWs to put patients at risk of influenza, despite the availability of a safe and effective vaccine. Together, influenza and pneumonia are the seventh leading cause of death overall in the United States. Deaths due to influenza and pneumonia greatly exceed the death toll from AIDS, and these illnesses rank in the top 10 causes of death for every decade of life. Annual epidemics of influenza result in ∼40,000 deaths and 1200,000 hospitalizations in the United States [2, 3], accounting for the winter increase in US mortality rates [4]. The greatest toll is on persons у65 years of age and those with underlying chronic illnesses-precisely the population in our hospitals, intermediate care facilities, and long-term care facilities. Vaccination is the primary means of preventing influenza. Inactivated influenza vaccine is safe and effec
Nudges or mandates? The ethics of mandatory flu vaccination
According to the CDC report for the 2012–2013 influenza season, there was a modest increase in the vaccination coverage rate among healthcare workers from 67% in 2011–2012, to 72% in 2012–2013 to the current 75% coverage. This is still far from reaching the US National Healthy People 2020 goal of 90% hospitals vaccination rates. The reported increase in coverage is attributed to the growing number of healthcare facilities with vaccination requirements with average rates of 96.5%. However, a few other public health interventions stir so much controversy and debate as vaccination mandates. The opposition stems from the belief that a mandatory flu shot policy violates an individual right to refuse unwanted treatment. This article outlines the historic push to achieve higher vaccination rates among healthcare professionals and a number of ethical issues arising from attempts to implement vaccination mandates. It then turns to a review of cognitive biases relevant in the context of decisions about influenza vaccination (omission bias, ambiguity aversion, present bias etc.) The article suggests that a successful strategy for policy-makers and others hoping to increase vaccination rates is to design a " choice architecture " that influences behavior of healthcare professionals without foreclosing other options. Nudges incentivize vaccinations and help better align vaccination intentions with near-term actions.
To Be or Not to Be Vaccinated? The Ethical Aspects of Influenza Vaccination among Healthcare Workers
International Journal of Environmental Research and Public Health, 2019
Influenza is a highly contagious airborne disease with a significant morbidity and mortality burden. Seasonal influenza (SI) vaccination has been recommended for healthcare workers (HCWs) for many years. Despite many efforts to encourage HCWs to be immunized against influenza, vaccination uptake remains suboptimal. Sometimes there is a significant sign of improvement, only if numerous measures are taken. Is ‘the evidence’ and ‘rationale’ sufficient enough to support mandatory influenza vaccination policies? Most voluntary policies to increase vaccination rates among HCWs have not been very effective. How to close the gap between desired and current vaccination rates? Whether (semi)mandatory policies are justified is an ethical issue. By means of a MEDLINE search, we synthesized the most relevant publications to try to answer these questions. Neither the ‘clinical’ Hippocratic ethics (the Georgetown Mantra: autonomy, beneficence, non-maleficence, and justice), nor the ‘public health’...
Ethical Concerns Regarding Mandatory Influenza Vaccination in Healthcare Practitioners
Applied ethics: from bioethics to environmental ethics, 2018
An escalating international geographical mobility enhances and facilitates the promptness of infectious disease spreading across large regions. The transmission of influenza to healthcare practitioners, as a result of nosocomial influenza outbreaks, has been well documented. Consequently, healthcare institutions have devoted extensive efforts to the large-scale prevention of nosocomial transmission of influenza through vaccination programmes of healthcare personnel. Nevertheless, despite well-aimed endeavours of voluntary vaccination, sustained augmented-level annual immunization percentages are low. Moreover, many ethical challenges regarding vaccination are still very much present.