Crash Cart: Flies Carrying “Super Bugs”

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REAL PHYSICIANS DISCUSS RECENT HEALTHCARE HEADLINES

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Flies carrying “superbugs” 

https://nypost.com/2019/06/25/hospital-flies-are-carrying-antibiotic-resistant-bacteria-study/

Well, if flies in hospitals are carrying dangerous bacteria, hospitals simply need more powerful pesticides. I can’t see a downside!


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Nicholas Genes, MD, PhD

As if it’s not scary enough in the hospital, now we have to worry about the flies too. A study out of the UK showed that over half the bacteria carried by flies in a hospital setting have shown resistance to at least one form of an antibiotic.  This issue is created by the willy-nilly use of antibiotics caused by “sepsis phobia,” and the dogma of core measures in my humble opinion. Possible infection? Get a lactate, blood cultures and give antibiotics within one hour.  Everyone wants to talk about the increase in mortality for every one-hour antibiotics are not given, but what about the flip side…the more antibiotics we give incorrectly, the more resistance we create.

– Salim R. Rezaie, MD

Yes, this is disgusting. I get flashbacks to the Jeff Goldblum scene in the movie The Fly where he vomits on food before he eats it. Bigger question in my mind is where were the bugs picking up the resistant bacteria. Where’s the reservoir? Outside? If so, where? Inside? If so we need to figure out a better way to clean surfaces. Maybe Orkin funded the study. Can’t wait to see the JCAHO safety standards created in response. “All staff shall hereby be required to carry flyswatters and cans of Raid.”


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William Sullivan, DO, JD

Patient data breaches

https://www.nbcnewyork.com/news/local/Quest-Diagnostics-12-Million-People-Data-Breach-510754611.html

So the Qwest breach wasn’t really from Qwest, it was from their billing company, AMCA. And AMCA is now going to rely on a third party for processing payments, to beef up their security. And the Vescepa breach came from a company called PSCW, which runs ConnectiveRx, but they’re denying responsibility and pointing to other players. Sounds like no one’s going to really get in trouble for this breach, except for the patients, which is par for the course. Worth pointing out: doctors and hospital administrators are terrified of accidentally violating patient privacy rules, to the point of adding crazy hurdles to clinical workflows, sticking with obsolete tech like faxing, and routinely inconveniencing patients and families. But the rest of healthcare industry never seems to get penalized when privacy is breached.

Nicholas Genes, MD, PhD

For the most part, there’s no private right of action for HIPAA violations – but maybe there should be. As the law stands now, patients generally can’t sue companies directly for violating HIPAA. They have to complain to the government and hope that the government sues or takes other action. Being able to file class action suits against companies that are flippant with privacy policies would enrich lawyers, but would also probably cause a lot of policies to be implemented that prevent future such data breaches.

William Sullivan, DO, JD

Robocalls overwhelming hospitals

https://www.washingtonpost.com/technology/2019/06/17/robocalls-are-overwhelming-hospitals-patients-threatening-new-kind-health-crisis

The robocall epidemic is really getting bad. And, unlike the email spam epidemic, relying on the end-user to filter out suspicious phone calls is just not an option —especially in work environments. Maybe now that big business (healthcare) is affected, we can hope for some kind of regulatory or law-enforcement response because, of course, the administration didn’t care to act when it was just private citizens being annoyed or scammed.

Nicholas Genes, MD, PhD

This is a big deal. Friends in private practice are having a heck of a time with spam calls. There are some potentially easy fixes, but I don’t share Nick’s optimism that the government is here to help us on this one. Maybe telecommunications companies begin charging a small amount of money per call. Perhaps 5 cents. For most people, that wouldn’t be an issue, but for robocallers who make hundreds of thousands of calls per month, they’d quickly be in a lot of debt. Alternatively, I don’t see why we can’t create a program with some type of verification process. Instead of ringing through upon dialing, create a program that requires some type of input from the caller. Solve a simple math equation. Dial the first four letters of the last name of the person you’re calling. We’ve cut down on spam e-mails by several orders of magnitude. There’s no reason we can’t do the same with spam calls. Oops. Excuse me. I have to answer this call from the IRS.

William Sullivan, DO, JD

New old cure for scabies

https://www.nytimes.com/2019/06/26/health/scabies-treatment-ivermectin.html

The treatment for scabies has historically been pretty straightforward…suspect scabies…write a RX for permethrin cream.  Well a new study looks at topical permethrin cream versus PO ivermectin x2 pills.  After two years of follow up the winner was PO ivermectin with only 4% of patients still having scabies vs. 15% in topical permethrin cream group. More importantly, secondary infections (i.e. impetigo) were also 90% less common after two years with PO ivermectin.  Although this study was done in low income countries, in settings that are quite different than the US, this may be a promising shift in treatment that we may soon be able to offer to patients if the results can be reproduced in settings similar to the ones we work in.

– Salim R. Rezaie, MD

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