February 4, 2017
Sepsis Alliance and HROC Team to Shine Spotlight on National Security Threats Posed by "Superbugs"
The High Reliability Organization Council (HROC) and Sepsis Alliance will work together to raise awareness of the dangers presented by antibiotic resistant bacteria. These efforts aim to show the value of Military-related and other government antibiotic stewardship initiatives to help defend our nation against so-called “superbugs.”
Sepsis Alliance and the High Reliability Organization Counsel (HROC) are joining forces to raise awareness of “superbugs,” or bacteria that are immune to drugs such as antibiotics. This partnership comes on the heels of a recent report by the Centers for Disease Control and Prevention (CDC) of a Nevada patient who recently died from a bacteria that could not be stopped by any antibiotic available in the U.S.
The case in Nevada was not the first detection in the past year. In April, 2016, the Military identified a patient in Pennsylvania with a germ impervious to the antibiotic of last resort. Today, there is new evidence that these bacteria are circulating more widely than reported, and even among people with no signs of infection.
The potential risks to patients and their loved ones cannot be overstated, and historic outbreaks have demonstrated the incredible toll such superbugs can take. For example, the nation's first large scale pandemic, the 1918 Spanish flu outbreak, was estimated to have killed up to 5% of the world's population. To put this in perspective, a mortality rate of 5% using current population numbers would equate to 350 million people globally. In the U.S., a 5% mortality rate would equal more than six times the number of people that died from all causes last year.
Concerns of a pandemic were also just elevated by the CDC’s report in January, 2017 that death rates from influenza and pneumonia are now above epidemic thresholds. Flu and pneumonia are common precursors to sepsis, the body’s overwhelming response to infection that can lead to patient injury, limb amputation, or death. Consequently, treating infection early – and properly -- with effective antibiotics must be a primary mission for healthcare providers.
Currently, the CDC notes drug-resistant bacteria cause 2 million illnesses and 23,000 deaths annually. Given the increase in infections in the past decade, more antibiotic use will be necessary and should be expected. Appropriate antimicrobial use and stewardship in healthcare will be critical, along with the reduced use of antibiotics in farming and the encouragement of new antibiotic development.
Given the risks posed by these superbugs to national security, the United States Army commissioned a new research arm in 2009 to address the global threat of antibiotic overuse and preventable drug-resistant infections. The Multidrug-Resistant Organism Repository and Surveillance Network (MRSN) was designed to improve biosurveillance, and tied to about 100 military facilities around the world.
Pandemic-level diseases such as the flu, Ebola, and other pathogens can spawn epidemics that can then result in sepsis -- the most dangerous of all complications from infection.
Antibiotic-resistant bacteria are considered by experts to be the result of the overuse of antibiotics. To prevent possible infections from worsening, more people are using antibiotics with greater frequency and in stronger doses, given the threat to the elderly and the goal of avoiding severe infections and sepsis (currently a major focus nationwide). The paradox many healthcare providers are finding is that more resistant bacteria can emerge from this increased usage that, in turn, will not be able to be stopped by these antibiotics.
To battle this crisis, one measure currently advocated by the CDC is "antimicrobial stewardship" (AMS). Studies have shown stewardship programs, involving increased monitoring, education within clinical settings, and improvements to antibiotic use, may lower the use of antibiotics by almost 20 percent. Such programs have also been linked to declining infection rates, especially from resistant microbes in a hospital.
Given the presumed “limiting” associated with any stewardship program, a misconception exists that antimicrobial stewardship could make it even harder to fight sepsis, such as by delaying needed antibiotics. Research into another Military-led contribution against the pandemic threat, called the Military Acuity Model (MAM), suggests otherwise.
Balancing the "not too little, not too much" in antibiotic use was key to the research conducted for MAM being applied to antimicrobial stewardship. "We have been doing research into how MAM can help reduce the threat to patients, and the ways reducing task saturation can help with this looming healthcare crisis," said Lieutenant Colonel Jared Mort, an expert on MAM and its implementation. "This strategy relies on people reacting precisely the right way at the right time. This was the reason for HROC's research into ensuring reliability in the proper timing and execution of care tasks."
A study showing how MAM tackles this threat to patients and the public is expected to be published shortly. However, it is not the only research that seems to suggest more attention be focused on improving the means by which healthcare is delivered.
A 2007 New Yorker article written by Atul Gawande quoted patient safety expert Peter Pronovost, M.D., who suggested the fundamental problem with the quality of American medicine is the failure to also view the delivery of health care as a science. Dr. Pronovost noted that the tasks of medical science fall into three buckets: 1. Understanding disease biology; 2. Finding effective therapies; 3. Ensuring those therapies are delivered effectively. "That third bucket has been almost totally ignored by research funders, government, and academia,” Dr. Pronovost said in the article. “It’s viewed as the art of medicine. That’s a mistake, a huge mistake. And from a taxpayer’s perspective, it’s outrageous."
This “Delivery Science" is where HROC and Sepsis Alliance are focusing their joint efforts and research.
In fact, the Bill & Melinda Gates Foundation estimated that $4.5 billion per year is required to protect against pandemic threats -- a key reason HROC and Sepsis Alliance joined the research to halt the rise of these pandemic risks that often lead to sepsis.
The financial impact that health systems may suffer during possible pandemics is also a significant concern. The hospital that had the nation's first Ebola incident in 2014 was criticized for poor adherence to safety protocols, and suffered negative media attention after its mishandling of the Ebola patient. The financial impact of this superbug protocol failure was dramatic. The hospital's revenue dropped 25.6% in the month following the negative press, and continued to be running below normal even months later. Hospitals also have other expenses to consider, including losses from liability to patients and care workers, and costs from extra efforts to prevent the next disaster. Such expenses are so significant that they may force smaller, community-based hospitals to close, which will only exacerbate the issue of preventable fatalities in the event of an epidemic.
"Hospitals that get overwhelmed by patients during a pandemic or superbug outbreak will have too much to do in too little time," notes Terry Rajasenan, HROC's chief scientist for MAM projects. "If teams become more reliable, they don't wait for high acuity patients to reach riskier late stages of infection that consume more staff time and costlier care, such as intensive care units. An example of too urgent is septic shock -- often too late to save patients. Earlier treatment means less fatalities, but it also means more patients to review to properly catch actual infections sooner -- or else it would lead to giving patients antibiotics that weren't needed. Staff with enough 'time to think' can choose this ideal time to treat. In short, timing is critical, and it's adversely impacted by task saturation."
“Combating task saturation brings increased reliability and preparedness to our battle against pandemic risks, which in turn can help stop sepsis in its tracks,” said Tom Heymann, Executive Director of Sepsis Alliance. "All of us stand to benefit in improving antimicrobial stewardship.”
For those interested in learning more about improving antimicrobial stewardship and preventing infections from reaching sepsis in any setting, HROC encourages people to access a special webinar on high reliability organizations, which is free for those qualifying as serving the public interest, such as those helping the Military and VA. More details are online at:About HROC
HROC (http://www.thinkhro.org) is a registered non-profit committed to scientific study and public safety, and serves as a platform for education and collaboration, supporting and assisting in the implementation of High Reliability Organizations (HRO) in healthcare, government, and nonprofit entities. It arose from over 2 years of pro bono work by ProcessProxy Corp. with the U.S. Air Force in a Cooperative Research And Development Agreement. HROC members are clinicians, researchers, veterans, and HRO practitioners on the frontline of educating the public on the need for healthcare to adopt HRO principles in the interest of significantly improving both patient and public safety.About Sepsis Alliance
Sepsis Alliance is the nation’s leading sepsis advocacy organization, dedicated to saving lives by raising awareness of sepsis as a medical emergency. A 501(c)(3) organization, Sepsis Alliance was founded by Dr. Carl Flatley after the sudden, unnecessary death of his daughter Erin to a disease he had never even heard of. Sepsis Alliance produces and distributes educational materials for patients, families and health providers on sepsis prevention, early recognition and treatment. The organization also offers support to patients, sepsis survivors, and family members through its sepsis.org website which receives more than 1 million visits each year. The organization founded Sepsis Awareness Month in 2011, and works with partners to host community outreach events across North America. Since Sepsis Alliance began its mission, sepsis awareness has increased almost threefold, from 19% to 55%. For more information on Sepsis Alliance, a GuideStar Gold-rated charity, please visit http://www.sepsis.org.
https://wwwnc.cdc.gov/eid/article/12/1/05-0979_article. Also see: https://www.cdc.gov/flu/about/qa/1918flupandemic.htm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/ https://www.cdc.gov/drugresistance/about.html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783672/
"Texas Health reports lower margin, higher expenses", Beth Kutscher, April 1, 2015
"Texas Health Resources works to rebuild image after Ebola", Steven Ross Johnson, October 18, 2014