Boston Scientific Receives CE Mark, FDA 510(k) Clearance for WallFlex Fully Covered Esophageal Stent

Boston Scientific Corp. has received 510(k) clearance from the U.S. Food and Drug Administration and CE Mark approval to market its WallFlex Fully Covered Esophageal Stent for the treatment of malignant esophageal strictures caused by tumors in patients with resectable or non-resectable esophageal cancer, according to a Boston Scientific news release.

Patients with obstructions due to esophageal cancer may have difficulty swallowing, resulting in severely limited quality of life, and complete blockages of the esophagus can prevent liquid consumption, according to the release. The WallFlex Esophageal Stent allows physicians to re-establish patency of the esophagus, enabling resumption of oral intake.

The WallFlex Fully and Partially Covered Stents employ a proprietary Permalume silicone covering designed to prevent tumor ingrowth, seal concurrent esophageal fistulas and help reduce food impaction, according to the release. The stents’ progressive-step, flared ends are designed to reduce the risk of migration and may assist in anchoring the fully covered stent within the esophageal lumen. The multiple wire-braided construction is engineered to allow the stent to adjust to forces within the esophagus such as peristalsis and strictures. The WallFlex Fully Covered Stent may be reconstrained up to 75 percent deployment.

Read the Boston Scientific release about the WallFlex Fully Covered Esophageal Stent.

Virginia State Health Commissioner Rejects Plans for Virtual Colonoscopy Clinics

Karen Remley, MD, Virginia state health commissioner, has rejected plans for three virtual colonoscopy clinics, which would have allowed patients to receive both traditional and CT colonoscopies, according to a report in theFredericksburg Free Lance-Star.

Dr. Remley rejected proposals for clinics in Manassas, Loudoun County and Fredericksburg, saying that the clinics were “costly, ineffective and unneeded,” according to the report.

Douglas Harris, the adjudication officer who provided an analysis of the projects for Dr. Remley, said in his report that providing office-based colonoscopies would be convenient and cost-effective for patients, but that bringing a new CT scanner into areas that have unused CT capacity would be unnecessary, according to the report.

Read the Free Lance-Star’s report on Virginia virtual colonoscopy.

8 Top Hospital and Health System Trends of the Past Decade

1. Loosened cost controls. HMOs in the late 1990s had successfully slowed growth in healthcare spending, but by the end of that decade they had come to be regarded as heartless conservators of the bottom line. Managed care’s tight controls began to loosen and “the negotiating power slipped back into the hands of the providers,” says Dick Clarke, president of the Healthcare Financial Management Association. Healthcare costs again began increasing faster than the general rate of inflation. “It’s not clear yet how much of that will change if providers come under more pressure to contain prices,” he says. 

2. Healthcare IT. Healthcare information technology, still rough around the edges in 2000, became a major force in hospital operations by the end of the decade, says Michael Rowan, COO and executive vice president of Catholic Health Initiatives in Denver. Innovations like computerized physician order entry and electronic medical records have been shown to improve safety as well as efficiency. Now, thanks to billions of dollars in incentives in the 2009 HITECH legislation, healthcare IT holds the promise of becoming virtually universal in the next few years. But Mr. Rowan reports that HITECH funds will pay for only about a quarter of the cost of the new technology. 

3. Patient safety movement. At the start of the decade, hospitals were just beginning to hear word of one of the most influential reports in the history of U.S. healthcare: “To Err Is Human: Building a Safer Health System,” published in Nov. 1999 by the Institute of Medicine. It concluded that from 44,000- 98,000 people die annually — the equivalent of 10 fully loaded 757 commercial airliners crashing each week, the report stated — due to errors in inpatient hospital treatment.

As a result, “hospitals started to get much more serious about quality and safety,” says Mr. Clarke at HFMA. The industry embraced continuous quality improvement, adds Thomas Dolan, president and CEO of the American College of Healthcare Executives. “Everybody realized that we have to constantly improve quality and it actually lowers costs because it reduces waste,” he says.

4. Physician entrepreneurialism. Many physicians became entrepreneurs, investing in ASCs, imaging centers and specialty hospitals as a way to supplement declining income due to lack of increases in reimbursements and become more efficient. The trend, however, put physicians into conflict with hospitals, who were concerned about losing market share to the leaner, physician-run organizations. By the end of the decade, it seemed that hospitals and regulators had blunted the trend.

“The ban on physician-owned hospitals in the health reform legislation signals the decline of the entrepreneurial physician,” says Nicholas Wolter, MD, a former MedPAC commissioner and CEO of the Billings (Mont.) Clinic. However, ASCs seem to have become a permanent fixture in U.S. healthcare, offering discounts too big for payors to pass up. 

5. Healthcare consumerism. “The future of market-oriented health policy and practice lies in ‘managed consumerism,’ a blend of the patient-centric focus of consumer-driven healthcare and the provider-centric focus of managed competition,” declared Jamie Robinson, a professor of health economics at the University of California, Berkeley, School of Public Health, in 2005 in the journal Health Affairs.

With the decline of HMOs, consumer-driven healthcare became a new way to contain costs. High deductible plans, with or without tax-free health savings accounts, would make patients cost-conscious consumers. Ratings of doctors and hospitals, from HealthGrades to CMS’ Hospital Compare site, would aid patients in choosing the best providers. Retail clinics opened to serve these new consumers. Hospitals developed a new fascination with patient satisfaction surveys. Brand-new hospitals lavished spending on patient-friendly design features, such as single rooms, sunlit atriums and concierge services, and these features seemed to shift market share. 

6. Shortages of healthcare personnel. In July 2007, the American Hospital Association reported 116,000 open positions for registered nurses in hospitals, and the existing RN workforce was aging. Mr. Rowan at Catholic Health Initiatives observes that the recession has erased the shortage for now, at least, as RNs were forced back into the workforce or into full-time work as family income fell.

Physician shortages also emerged. In a dramatic about-face at the beginning of the decade, the federal Council on Graduate Medical Education abandoned its long-held forecast of a physician surplus and predicted a shortage of 85,000 physicians by 2020. Since then, medical schools have been substantially increasing class sizes, but Congress has not removed a cap on the number of Medicare-funded graduate medical education positions for physicians that has been in place since 1997.

“Current evidence suggests that the United States is headed toward an aggregate shortage of physicians,” the Association of American Medical Colleges declared in 2009. “Given the extended time required to increase U.S. medical school capacity, and to educate and train physicians, the nation must begin now to increase medical school and GME capacity to meet the needs of the nation in 2015 and beyond.”

7. Accountable health organizations. While entrepreneurial physicians continued to spin off from hospitals throughout the decade, Dr. Wolter, the former MedPAC commissioner, says an opposing trend also emerged. Many young physicians were eagerly becoming employees. Accountable health organizations such as Mayo Clinic, the Cleveland Clinic and Geisinger Health System thrived by closely aligning hospitals and doctors to make care more efficient and effective.

Mr. Rowan at Catholic Health Initiatives says accountable health organizations seemed to be taking a lesson from the ASC playbook. Incentivizing physicians can make healthcare more efficient. But he adds that the trend is not easy for hospitals. “Many hospitals have no expertise in running practices,” Mr. Rowan says. “We’re hospital people, not group management people.” Hospitals used to hire doctors merely to generate business. Now, he says, “hospitals want doctors to take financial responsibility for outcomes.”

8. Recession. “The decade will be known for the financial turmoil that came at the end,” says Mr. Clarke of HFMA. In March 2009, Thomson Reuters reported that the median profit margin of U.S. hospitals has fallen to zero percent. Hospitals tightened their belts and many of them ended the decade solidly in the black. But the numbers of non-paying patients are still high and many leaders like Clarke believe we are entering an era of having to do more with less.

Leveraging Technology, Data in Surgery Centers to Deliver Better Patient Outcomes

ASCs are under increasing pressure to capture, track and report key quality indicators (QI) and outcomes data. As evidence of this, one need look no further than CMS and leading ASC accreditation bodies.

CMS had previously called for ASCs to begin submitting quality data in 2009 as part of a congressionally mandated pay-for-performance system. Though that requirement was eventually tabled, the agency has gone on the record that its “clear intention is to implement ASC quality reporting in the future.”

Quality indicators and outcomes data also play a greater role in achieving accreditation from the Joint Commission. In fact, beginning in 2010, the Joint Commission will require ASCs to collect data on infections and post-operative complications for 30 days after all procedures and one year after any procedures involving implantable devices. AAAHC, laboratory and other accreditation bodies are also placing more emphasis on quality data.

Benefits beyond compliance
Looming federal mandates and more stringent accreditation standards are not the only impetus for ASCs to put a priority on quality and outcomes data. Professional societies are also stepping up their interest in tracking a broader array of quality measures to expand national benchmarks and position ASCs for the arrival of pay-for-performance reimbursement models.

Many associations offer benchmarks that allow ASCs to compare their data with national performance statistics on clinical outcomes, staff indicators and billing performance, as well as annual surveys that revolve around compensation, revenue and expenses, which many ASC administrators utilize when auditing practice performance.

Though these initiatives are voluntary, they are excellent starting points for ASCs interested in reaping the clinical and operational rewards that can be derived from measuring quality and outcomes data. Doing so can reveal how an ASC is performing against its competition in such areas as infection rates, hospital admissions, etc., all of which can play a significant role in gaining and maintaining market share and negotiating higher reimbursement rates.

Further, tracking operational measures such as supply costs, days in accounts receivable, etc., against national benchmarks can identify areas for operational improvements when they show significant variances between comparable ASCs.

ASCs can also benchmark against internal data to validate clinical and operational efficacy or identify areas for improvement.

This was the case for Central Bucks Specialists, a hospital-owned outpatient GI lab in Bucks County, PA. After deploying an EHR and documentation system, the practice began tracking indicators to determine the cause of inconsistent room turnover that was creating scheduling problems, patient frustrations and overall operating inefficiencies. In doing so, the ASC identified several inconsistent practice patterns that could benefit from adjustments.

For example, one of the ASC’s six physicians averaged a scope-in to scope-out time that was significantly shorter than his peers. This was determined to be a practice preference, and the physician ultimately opted to slow his scope withdrawal to ensure greater consistency and better adhere to identified GI best practices.

Capturing data is critical challenge
Despite the demonstrated benefits that can be realized from tracking QI and outcomes data, many ASCs have been slow to jump on the bandwagon. The problem is not reluctance; it is the ability to effectively and accurately capture structured, compliant data. This is due in large part to the fact that 82 percent of ASCs do not utilize an EHR and 74 percent utilize dictation and transcription to generate physician procedure notes.

In a paper-based environment, data must be manually gathered from patient charts, a time-consuming and error-prone process. Exacerbating the problem, once the data has been collected, there is no efficient means for querying discreet elements to generate the types of reports necessary to effectively benchmark performance indicators and measure quality and operational outcomes. Because of this lack of automation, many ASCs feel they derive little value from the time spent tracking QI data.

The good news is that many of these hurdles no longer exist. A growing number of health technology vendors now provide software and systems that are capable of capturing, tracking and analyzing a full range of QI and outcomes data and are designed specifically for ASCs.

Technology edge
The emergence of specialty-specific automated procedure documentation solutions for ASC-based services help drive structured and compliant data capture for quality initiatives, benchmarking and other reporting statutes.

Menu-driven documentation processes enable fast, easy capture of compliant data at the point of care, without the need for manual manipulation or intervention. The software automatically captures discreet data elements for each procedure, which can then be automatically uploaded to a central repository.

Built-in reporting and analytics tools further simplify quality reporting, clinical research and audit preparation with pre-built reports or customized query-writing capabilities that enable every captured data element, including free text, to be queried, exported and submitted in appropriate formats.

Automation eliminates some of the most significant challenges provider organizations have faced when attempting to participate in quality-based initiatives, such as the Physician Quality Reporting Initiative. Among those were technical and coding problems that resulted in non-payment for thousands of physicians who made a good faith effort to report data.

When ASC-specific EHRs are added to the technology mix, the opportunities to track QI and outcomes data expand exponentially — as do the uses for that data to improve operational and clinical performance. For example, the EHR is an important tool to help ASCs comply with increasingly stringent Joint Commission and AAAHC care standards. It can generate safety alerts, record safety measures taken and significantly streamline the gathering of data and documentation should an audit occur.

By leveraging the EHR’s comprehensive data tracking capabilities, such as scope withdrawal time, adenoma detection rate and rate of cecal intubation, ASCs are able to identify areas for practice improvements.

Conclusion
There is a great deal for ASCs to gain from the capture and tracking of key QI and outcomes data. Internal and external benchmarking can reveal areas for clinical and operational improvements that can directly impact quality of care and the bottom line health of an ASC.

With quality transparency gaining traction as consumers become more familiar with publicly reported data, meaningful benchmarking against local and national competitors and the ability to validate clinical efficacy will play a greater role in gaining and maintaining market share.

Deploying the right technologies, such as automated procedure documentation and coding software and ASC-specific EHRs, eliminates the drain on resources and the potential for human error that can plague QI and outcomes data collection and reporting in a paper-based environment. In doing so, it can help ASCs improve operational and clinical effectiveness and efficiencies and position them for future federal mandates and performance-based payment initiatives.

Mobile technology should enhance work of human providers

MODERN LIFE is a blur of motion and activity, with people constantly communicating on the run. Traditionally slow to change its ways, healthcare is far from the cutting edge of mobile technology, but it’s making strides to close the gap.

“The opportunity for mobile technology to change the way we deliver healthcare is enormous, but the current state of affairs leaves a lot to be desired,” says Joseph C. Kvedar, MD, Director of the Boston-based Center for Connected Health. The Center, a division of Partners HealthCare, seeks to apply consumer-ready technologies, such as cell phones or digital cameras, to enhance the patient-physician relationship. “On the bright side, the time to make it happen is now, for two reasons: Payment reform is taking shape, and employers are fed up. Payment reform affects physician behavior, and employers affect employee behavior. When those two forces are aligned, big things can happen.”

For healthcare executives, the key is to not get caught up in the technology itself, but to view it as a means of improving human performance in—and satisfaction with—the healthcare experience. In other words, mobile technology should enhance the work of human providers, rather than seek to replace them.

“Mobile devices that can document and view vital signs, ECG strips, pain scores, medication data, lab results and nurses assessments, can give a bigger picture of what is going on so the physician can make the right decision quickly,” says Veronica Carr, nursing information coordinator with Shands Healthcare, a not-for-profit system affiliated with the University of Florida.

Best of all, mobile technology is exactly that: mobile. Savvy healthcare veterans don’t limit its role to a healthcare facility, but extend it out into the community to ensure its impact is felt by as many people as possible.

REMIND ME AGAIN

The first hurdle to using mobile devices in a community outreach program is finding technologies that the target population has access to and is willing to use. Studies have shown that more than half of all U.S. physicians own some type of smart phone, but they aren’t common in the general population.

“While it would be great if a doctor could remotely see your blood pressure or blood glucose readings on your BlackBerry, there just aren’t enough of those devices in use yet,” Dr. Kvedar says. “That’s why we look for the ‘lowest common denominator’ technologies. We do a lot with text messaging, because almost everyone with a mobile phone can send and receive them. It reaches a broad audience but still can deliver a powerful message.”

The center has two major text-message-based initiatives underway, each of which targets a highly vulnerable population. The first sends texts to remind pregnant teens to come in for their prenatal visits, and the other sends texts to substance abusers who are enrolled in addiction programs as a reminder to come in for their visits.

But even though 70% to 80% of the people in those two groups have mobile phones with text messaging capability, getting the reminder to them is only half of the battle. The other half is getting them to act on it, and who the message comes from is almost as important as the message itself, Dr. Kvedar says.

“It makes a big difference when the reminder comes from the patient’s own healthcare provider, as opposed to a vendor or even a health plan,” he says. “If you want your acceptance rate to go up, have a doctor or nurse recommend the service directly.”

FREE FLOW OF INFORMATION

Since the earliest days of organized healthcare, the basic layout of a hospital has revolved around a central nurses’ station, which acts as a communications hub for the entire floor. In years past, nurses shuttled information from the nurses’ station to patient rooms. Today, nurses and other clinicians are just as mobile as their predecessors, but in a completely different way. They aren’t moving patients’ information; they’re moving the actual patients from one room to another, and they need access to information everywhere.

“Patients today are very mobile, even within the walls of a hospital, so the nurses and clinicians who treat them need to be able to move as well,” says Edward Cuellar, CIO of San Antonio, Texas-based Methodist Healthcare, the city’s largest care provider with eight hospitals among its two dozen facilities. “Wireless communication plays an integral role in getting information to clinicians at the right time and in the right place, helping to speed clinical decision-making and deliver exceptional patient care throughout the continuum of care.”

Cuellar should know a thing or two about mobile technology. Earlier this year, Methodist entered into an agreement with two third-party vendors to develop a converged wireless system for six hospital sites. The deployment, which will provide voice and data services across an area spanning nearly 2 million square feet, includes an integrated wireless platform that will run on more than 800 wireless phones carried by physicians, nurses, administrators and staff.

Shands also has undertaken a project to keep patient data accessible to clinicians throughout its facilities, deploying an electronic charting program for nurses via laptop computers on mobile carts. Technology that people won’t use has little value, so while it was important to get multiple opinions during the planning stages of the project, it’s equally important to select a standard quickly to facilitate consistency and increase adoption, according to Erik Stielow, Shands’ manager of technical projects.

“Getting the buy-in of the end users is essential to a successful rollout,” he says, “but it’s also important to standardize relatively soon on a vendor for your hardware. Not everyone will be happy with available options or features but in the long run, end users are most satisfied when there is a consistent device experience and a high standard of up-time.”

Having multiple vendors and multiple platforms increases the need for end user training and limits IT’s ability to respond to hardware downtime, he says.

THE HUMAN EXPERIENCE

More than any other industry, the focus must remain on the human experience, whether a provider’s or patient’s. There is no room for “technology for technology’s sake.”

“In healthcare, you are faced daily with the human element,” Stielow says. “You see the frustration and the ache in people when they are sick, and their joy and jubilation during the birth of a child or the news that they are healed. We must never forget that we are here to serve our community, and all that we do as a business must support that goal.”

And that goes for getting a technology project approved and funded, according to Cuellar. When dealing with various decision makers, check the technical jargon at the door and focus on the practical results.

“Even as a CIO, if someone comes to me and wants to talk about this great new healthcare technology, I don’t want to hear about bits and bytes,” he says. “It should start with people, and that means workflow. The focus of technology should always come back to enhancing and improving the delivery of care.”

MedPAC Proposes Increases for Hospitals, Physicians; 0.6% Payment Increase for ASCs

Medicare Payment Advisory Commission is proposing that Congress give hospitals that perform at higher levels in CMS’ the pay-for-performance program a payment update of 2.4 percent in fiscal year 2011, based on the market basket index. Hospitals that don’t perform well on P4P would not get the payment update, a MedPAC official says.

However, the commission is also proposing another adjustment to hospitals’ payments to offset increases caused by coding improvements, the official says. These reductions, of up to 2 percent in fiscal years 2011-2013, would mean an aggregate inpatient update of 0.4 percent in fiscal 2011 for high performers in the P4P program, the official says.

Don May, vice president of policy at the American Hospital Association, stated that that the AHA was “disappointed” with MedPAC’s hospital payment recommendation, noting that CMS, which already has authority to apply an offset, had suggested using a “less aggressive” transition.

The exact wording of the MedPAC recommendations for hospitals is as follows:

Recommendation 1: “The Congress should increase payment rates for the acute inpatient and outpatient prospective payment systems in 2011 by the projected rate of increase in the hospital market basket index, concurrent with implementation of a quality incentive payment program.”

Recommendation 2: “To restore budget neutrality, the Congress should require the Secretary to fully offset increases in inpatient payments due to hospitals’ documentation and coding improvements. To accomplish this, the Secretary must reduce payment rates in the inpatient prospective payment system by the same percentage (not to exceed 2 percentage points) each year in 2011, 2012, and 2013. The lower rates would remain in place until overpayments are fully recovered.”

MedPAC’s recommendations also include a 1 percent payment update for physicians in fiscal year 2011. The commission reiterated its support for increased payments for primary care. Since overall physician payments would need to be budget-neutral, this increase would translate into a decrease in payments for specialists, the official said.

The exact wording of the MedPAC recommendation for physicians is as follows:

Recommendation: “The Congress should update physician payments for physician services in 2011 by 1.0 percent.”

MedPAC also recommended a  0.6 percent payment increase for ASC services in fiscal year 2011, but only for centers that submit cost and quality data to the CMS.

MedPAC and other policymakers are questioning whether the consumer price index, the factor now used to set ASC payments, is the best choice or whether the hospital outpatient market basket might be better, the official says.

Kathy Bryant, president of the ASC Association, says the recommendation is consistent with MedPAC’s past recommendations.

“The ASC Association continues to recommend that future ASC inflation updates be based on the market basket,” says Kathy Bryant, president of the ASC Association. “The ASC Association is continuing to work with MedPAC to improve its recommendations to Congress.”

The exact wording of the MedPAC recommendation for ASCs is as follows:

Recommendation: “The Congress should implement a 0.6 percent increase in the payment rates for ASC services in calendar year 2011 concurrent with requiring ASCs to submit cost and quality data.”

The commission recommended no payment updates for inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities and home health providers.

MedPAC’s recommendations will be included in its report to Congress in March.

Southeast Missouri Hospital Named as One of Top 10 GI Hospitals in the State

Southeast Missouri Hospital in Cape Girardeau, Mo., has been named as one of the top 10 hospitals for gastroenterology surgery procedures in the state of Missouri and received recognition from the American Society of Gastrointestinal Endoscopy, according to a report in the Southeast Missourian.

The hospital received the first honor from HealthGrades, which ranked the hospital based on outcomes data compiled from The Twelfth Annual HealthGrades Hospital Quality in America Study, according to the report. Patient mortality and complication rates for patients undergoing GI procedures were significantly below the national average, earning Southeast a five-star rating for 2010.

Southeast was one of 134 hospitals receiving the ASGE award and the only hospital in southeast Missouri and southern Illinois to be designated, according to the report.

The hospital was presented with the awards on Jan. 12, 2010.

Read the Missourian’s report on Southeast Missouri Hospital.

California Hospital’s Decision to End Eye Surgery Outrages Community

The decision by the Sierra View District Hospital in Porterville, Calif., to stop performing eye surgery in its ambulatory services department met with public outcry against the decision at a recent meeting with the hospital’s Board of Directors, according to a report in The Porterville Recorder.

The board decided to stop its ophthalmology services in an Oct. 27 meeting in order to make room for expanded endoscopy services in the ambulatory services department, according to the report. Officials said that the hospital needed to free up six inpatient beds currently used by endoscopy patients and to reduce back-up in the PACU.

Board officials also cited an outdated microscope used for ophthalmology, which would require a $133,000 investment to replace, according to the report. This claim was denied by ophthalmologists working at the center. Retina specialist Shashi Ganti, MD, promised to donate a $40,000 laser and other equipment if the board reversed their decision so he could perform retina surgery at the hospital.

Supporters of the board’s decision said that moving endoscopy would allow the hospital to see the most patients possible, according to the report.

Read the Recorder’s report about SVDH’s decision to end eye surgeries.

AAAHC Surveyor Gayle Lowe Discusses Industry Emphasis on Patient Safety Initiatives, New Prevention Programs

Gayle Lowe, an AAAHC surveyor, discusses patient safety initiatives and increased efforts on the part of healthcare providers to implement practices and policies that further increase patient safety.

Q: Several healthcare accreditors, including AAAHC, revised their patient safety criteria for accreditation for 2010. Do you think this reflects an increased emphasis on patient safety by the industry overall?

Gayle Lowe: Healthcare has always had an emphasis on patient safety. However, healthcare has been in the forefront of the news in 2009 through political agendas as well as many discrepancies in the way patient safety has been compromised. There certainly have been many opportunities for improvement identified in our healthcare systems that have reached the public’s notice such as flu prevention, procedural safety, medication safety and infection control. 

Q: What are some things AAAHC has done to further emphasize patient safety in its accrediting processes?

GL: AAAHC identified that in order to clarify and delineate patient safety issues in 2010, a chapter of the AAAHC’s Handbook for standards has been dedicated and focused on patient safety and infection control. Even though these issues have always been addressed by AAAHC, the emphasis on newly identified best practices and evidence-based procedures have been incorporated into the standards.

Q: What are some initiatives or processes that you have observed within ASCs that can further improve patient safety within facilities?

GL: One of the more impressive changes seen in centers is the improvements in education for staff, patients and leadership, with an emphasis on basic processes for infection control, such as handwashing. Infection control programs in the centers have been established, reevaluated and improved to ensure the program is designed to prevent, control and investigate infections and communicable diseases.

Having infection control programs is a condition for participation in the Medicare program. Medicare goes on to require, as does AAAHC, that infection control must include prevention aspects and that the centers have implemented nationally-recognized infection control guidelines.

Q: How has requiring ASC to implement nationally-recognized control and prevention guidelines affected ASCs?

GL: The centers have had to reevaluate what they have been doing and now must ensure that their processes meet nationally recognized guidelines. They must have a designated infection control professional (ICP) to assume the leadership of the program. This person should have the training in infection control and qualifications to organize, implement and monitor the program. The ICP must be delegated or appointed by the facility’s governing body to ensure they have the overall responsibility of the program. Benefits of these programs are evident in safe outcomes for patients, staff and visitor.

The first drawback you hear from centers is, of course, the time element for implementation and continuation for monitoring a successful program. I have tried to encourage centers to work “smarter” by looking for best practices of implementation and monitoring by sharing information with successful infection control programs.

Learn more about AAAHC at www.aaahc.org.

Keratitis in the News

Keratitis is an inflammation or irritation of the cornea, often characterized by a cloudiness or loss of luster in the transparent membrane covering the iris and pupil.

Keratitis, recently made headline news with reports from the CDC that contact lens solutions might be a culprit to isolated outbreaks of keratitis.  Surveying all of the information in the world wide web, in regards to outbreaks, it was further realized that certain manufacturers of contact lens solutions were being investigated for outbreaks.

Keratitis can strike any individual but many outbreaks frequent the individual that wear contact lenses.

As a by standing observer of a contact lens wearer and hoping not to get into trouble with my dear wife, I would like to present a few scenarios that maybe the readers should consider to avoid a keratitis outbreak.

My top ten reasons for many a Keratitis outbreak.  Number….

10) Recycling lens solution, topping off

9)  Extra Contact lens case that has lived in suitcase for 5 years

Rinsing off contacts under tap water, from around the world

7) Spraying hair spray while contact lens bathes in open contact lens case

6) Wearing disposable contact lens beyond recommended life

5) Not cleaning hands before placing contact lens into eye

4) Forgetting contact lens case while traveling and hosting contacts in two glasses of tap water over night

3) Contact lens dislodged in eye, found/retrieved to be pulled and clean in mouth and replaced into eye

2) Submerging in hot tub at any hotel/motel of choice while contact lenses are present in eyes

And the 1) reason,………….. falling asleep back at home with your contacts “in” after visiting your favorite smoke filled nightclub!

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