I’m sure the first reaction to this title is, it’s an April Fool’s joke. This is not that. I know, I don’t really write on any deep clinical topics, for various reasons. First, I’m not qualified clinically (I read to stay B.S. proof and to help my wife’s work – clinical compliance). Second, my only clinical training is the decades I’ve spent listening and learning from the clinicians I have worked with. I’ve schooled myself sufficiently that I know the drugs (common), lots of medical terminology, and the abbreviations common to medical/clinical charting.
Today, I’m straying just a bit because I came across this JAMA article in my reading and it fits a theme, I have long harped on to SNF operators, Medical Directors, and clinicians – polypharmacy and unnecessary drug use in the elderly creates problems beyond just excess cost. One such major problem in all of institutional care is the development of resistant bacteria, not sensitive to drug therapy (antibiotics).
From the article: Antimicrobial resistance threatens global health. Compared with antimicrobial-susceptible organisms, infections due to multidrug-resistant organisms (MDROs) are more difficult to treat with increased morbidity, mortality, length of hospitalization, and health care costs. Moreover, the emergence of MDROs continues to outpace the development of new antimicrobials, contributing to increasing infections without effective treatments. With limited therapeutic options, action is warranted to mitigate MDRO burden and spread, especially in health care settings. There is a high prevalence of MDROs in long-term care, reaching 40% to 65% in nursing homes (NHs) and 80% in long term acute care hospitals (
LTACHs). These levels exceed the typical hospital prevalence of 10% to 15%, and most cases of
MDRO colonization are unknown due to resource constraints that preclude routine screening and limited communication about MDRO status from transferring facilities. Furthermore, this high prevalence fuels spread as patients colonized with MDROs are shared among NHs, LTACHs, and hospitals. Thus, coordinated action across regional health care facilities is needed to reduce MDRO burden and interrupt transmission.
The full article is available here: Reducing Hopsitalizations and Multidrug Resistant Organisms
With basic infection prevention techniques/interventions such as chlorohexidine bathing and nasal rinsing, significantly lowered MDRO prevalence and in turn, costs of care, hospitalizations, complications and deaths.
Hospital Acquired Infections (non-COVID) non-responsive to antibiotics produced approximately 90,000 deaths per year. The older the patient, the greater the number of comorbidities, the greater the risk that an infection will lead to death. This was proven true with COVID, even despite vaccination status.
Sepsis, life-threatening organ dysfunction secondary to infection, contributes to at least 1.7 million adult hospitalizations and at least 350,000 deaths annually in the United States. CDC Sepsis in Acute Care Hospitals
Without going out too far on my non-clinical limb, getting a handle on infections in healthcare, practicing novel infection prevention techniques that are low in cost, monitoring antibiotic use with effective stewardship programs particularly in SNFs and other senior living environments, has immediate, tangible benefits for health, reduced hospitalizations, lower costs, and reduction in death.
I hope readers enjoy this little excursion into the clinical realm. I promise not to go too far astray from my health policy, economics, and business focus – mostly out of self-preservation.