Becker's Hospital Review

76 CMO / CARE DELIVERY Arkansas VA Hospital Under Review for Not Updating Surgical Equipment Cleaning Processes By Brian Zimmerman T he Veterans Health System of the Ozarks in Fayetteville, Ark., failed to follow manufacturer updates regarding proper cleaning procedures for equipment used in eye surgery, according to the Northwest Arkansas Democrat Gazette. Hospital officials identified the lapse in device cleaning proce- dures Sept. 25. The hospital has not learned of any infections among patients related to the issue and is working to deter- mine how long the outdated cleaning processes were used. "[A] routine program inspection found that eye instrumen- tation had not been processed following the manufacturers correct instructions for use," said the hospital in a statement obtained by the Democrat Gazette. "Immediately, the facility implemented a pause in operations to implement standard operating procedures and rescheduled future appointments in accordance with manufacturer instructions." The VA center issued requests to both the National Sterile Pro- cessing Officer for the U.S. Department of Veterans Affairs and the department's Infectious Disease Office to review the case. Investigators will visit the facility Oct. 23 to assess the hospital's processing procedures and compliance. n Hospital Food Can Carry MRSA, VRE By Anuja Vaidya A new study, published in Infection Control & Hospital Epidemiology, examined the role of hospital food in transmission of methicillin-re- sistant Staphylococcus aureus and vancomycin-resis- tant enterococci. Researchers conducted a prospective cohort study from May 2011 to July 2012 at Barnes-Jewish Hos- pital in St. Louis. For the study, 149 patients collect- ed 910 samples from their meals in sterile specimen cups. They handed over the samples to researchers. Additionally, researchers collected data from patient interviews, chart reviews and medical informatics queries, including MRSA and VRE clinical laboratory results from one year before study enrollment to one year after enrollment. The study shows one or more food specimens sub- mitted by 17 patients were positive for MRSA; similar- ly one or more food specimens from 17 patients were positive for VRE. MRSA was cultured from 29 speci- mens (3.2 percent) in all, and VRE was cultured from 22 specimens (2.4 percent). More than one positive specimen was collected from some patients. n Viewpoint: Pressure to Reduce Readmissions Can Hinder Care Quality, Patient Safety By Mackenzie Bean W hile CMS' Hospital Readmission Reduction Program successfully reduces readmissions, the pro- gram may also produce unintended care consequences that threaten patient safety, ac- cording to an op-ed published in the Journal of the American College of Cardiology. Gregg Fonarow, MD, director of the Ah- manson-UC Los Angeles Cardiomyopathy Center; Marvin Konstam, MD, chief phy- sician executive of The CardioVascular Center at Boston-based Tufts Medical Cen- ter; and Clyde Yancy, MD, chief of cardi- ology at Evanston, Ill.-based Northwestern University's Feinberg School of Medicine penned the article. e physicians argue pressure to reduce re- admissions, particularly among heart failure patients, may encourage inappropriate care strategies and shi hospitals' focus away from meaningful quality improvement efforts and patient safety considerations. e physicians cited a study published July 18 in JAMA, which found a weak, but sta- tistically significant, correlation between reductions in 30-day readmissions and reductions in 30-day mortality rates aer discharge. However, hospitals with stable or increasing readmission rates demonstrated increases in 30-day post-discharge mortal- ity. e same study showed 30-day risk-ad- justed post-discharge mortality in Medicare patients with heart failure increased from 7.9 percent in 2008 to 9.2 percent in 2014. e Hospital Readmission Reduction Pro- gram took effect in 2012. "It is interesting that the declines in 30-day readmission aer [Hospital Readmission Reduction Program] implementation are accepted as evidence of the success of the program, but the reversal in more than a decade of declines in 30-day mortality for [heart failure] is dismissed," the authors wrote. "No level of reduction in readmis- sions or cost savings should be considered adequate justification for this level of poten- tial harm." e physicians acknowledged there is no proof of a causal relationship between in- creasing mortality rates and the Hospital Re- admission Reduction Program. "Our concerns, if corroborated, should prompt immediate consideration for reas- sessment and revision of the HRRP. If harm has been the consequence of the [Hospital Readmission Reduction Program], we are obliged to exercise appropriate due dili- gence," they concluded. n

• Cover