Becker's Hospital Review

60 CMO / CARE DELIVERY Nearly 200 Employees, Patients Potentially Exposed to TB at Seattle Hospital By Heather Punke H arborview Medical Center of- fered free tuberculosis tests to 45 patients and some hospital staff members who may have been ex- posed to TB at the Seattle-based facility. According to The Seattle Times, about 150 staff members were potentially exposed. A patient was diagnosed with active TB, but the diagnosis was delayed because the patient — whose name and gender have not been released — has several health conditions and didn't show tradi- tional symptoms of TB infection, accord- ing to a hospital statement. The patient visited the hospital on three occasions between December and Jan. 20, according to the hospital. Once clinicians suspected the patient had TB, they placed the patient in iso- lation and started treatment. The hospital contacted all potentially exposed patients and staff and offered free TB tests, even though the likeli- hood of transmission to others is "rela- tively low," according to the statement. TB is caused by Mycobacterium tu- berculosis and, if left untreated, can be deadly, according to the CDC. The bacteria spread in the air when some- one with an active TB infection coughs, speaks or sings. TB is not easily spread — it typically takes repeated prolonged exposure to pass on the bacteria. Ten drugs are approved by the Food and Drug Administration for treating TB, and the regimen lasts six to nine months. The patient in this case is in satisfactory con- dition, according to Harborview. TB is becoming more common in the U.S. — the number of TB cases in the nation increased over the previous year in 2015 after having declined yearly from 1993 through 2014. n New Sepsis Treatment Guidelines: 5 Things to Know By Heather Punke T he Surviving Sepsis Guidelines were first published in 2004, with updates issued in 2008 and 2012. In January, the newest updates were released and pub- lished in Critical Care Medicine and Intensive Care Medicine. e new guidelines were written by a com- mittee of 55 experts representing 25 inter- national organizations. ey provided 93 recommendations on early management of sepsis and septic shock. Here are five things to know about the major changes in the new update. 1. e most important changes came in the areas of antibiotic therapy and initial resusci- tation, according to a January JAMA article. 2. e new initial resuscitation guidelines now recommend using hemodynamic as- sessment for further fluid administration as well as for determining the type of shock if the clinical diagnosis does not lead to clear diagnosis. Previously, initial resuscitation guidelines were based on early goal-directed therapy, which is no longer recommended. 3. New guidelines recommend using dy- namic over static variables to predict fluid responsiveness. "is is a significant change," according to the JAMA article. "e guide- lines moved from a protocolized, quantitative resuscitation strategy to a more patient-cen- tered resuscitation approach guided by he- modynamic assessment including dynamic variables for fluid responsiveness and ongoing reevaluation of the response to treatment." 4. e updated guidelines call for antibiotics to be administered as soon as possible within one hour, as studies show delay in antibiotic treatment can lead to increased risk of death. 5. e new guidelines also address combination therapy, or using two different classes of anti- biotics to cover a pathogen sensitive to both. Doing so is not recommended for routine treat- ment of neutropenic sepsis, but it can be done with patients who are in septic shock. n 10k Patients Die Each Year Within 7 Days of Leaving a Hospital ER, Study Finds By Heather Punke M ore than 10,000 Medicare patients die each year within a week of leaving a hospital emergency room, according to a new study published in The BMJ — and typ- ically they were released from a rural hospital or a hospital with low inpa- tient admission rates. Researchers examined Medicare claims data covering ER visits from 2007 through 2012, looking at a na- tionally representative 20 percent sample of Medicare fee for service beneficiaries. They found 0.12 percent of studied patients died within seven days of discharge from a hospital ER, which translates to 10,093 deaths annually. Hospitals in the lowest fifth of rates of inpatient admission from the ER had the highest rates of early death (2.7 percent), which was 3.4 times higher than hospitals in the highest fifth (0.08 percent). "Hospitals with lower admission rates, lower costs and lower patient vol- umes had significantly higher rates of death after discharge, despite serving healthier overall patient populations," the study authors wrote. Ziad Obermeyer, MD, an emergency medicine physician and professor in Boston, told STAT it's likely not provider error causing these high- er rates of early death, but instead pointed to other factors like limited staffing and poorer hospitals and lack of transportation for rural pa- tients to get to follow-up care. n

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