This Just In

Nosocomial Infections
Docs' Cell Phones May Spread Hospital Infections
Mobile phones used by healthcare personnel in the hospital can spread dangerous infectious agents, according to investigators in Israel. Researchers randomly screened 124 hospital personnel for the germ Acinetobacter baumannii, a frequent cause of nosocomial infections and a cause of severe primary infections in immunocompromised people. They found that 12 percent of healthcare providers' cell phones were contaminated with the germ.

A. baumannii has the propensity to develop resistance to almost all available antibiotics. It is especially dangerous because it can survive on dry surfaces such as cell phones for a long time without the addition of serum. Researchers found the bacteria um not only on phones, but also on one-fourth (24 percent) of the hands of the people they tested, including 71 physicians and 53 nurses.

"You can wash your hands correctly, as the guidelines recommend, but 'autoinfestion' commonly occurs" when cell phones are used by medical personnel in the hospital, the investigator says. Cell phones have completely replaced traditional pagers among physicians and nurses in many facilities.

Response to this study is cool. "If you started checking for growth on pens, briefcases, shoelaces and name badges, you could also find a wide array of bacteria. Also, eliminating cell phones is almost impossible in practice. Cell phones for physicians have become an extension of their office practice," says Marlene Brunswick, RN, the director of nursing at Findlay Surgery Center in Ohio.

Others emphasize sticking to the basics. "Infection control experts have argued for years that nosocomial infections can be greatly reduced with one small simple thing: better enforcement of proper handwashing technique. Before running off to alarm the masses that cell phones are harboring dangerous germs, why don't these people initiate a strong and stringent handwashing program? If the staff is compliant, the infection risk is greatly reduced," says Diana Procuniar, RN, BA, CNOR, the nurse administrator at the Winter Haven Ambulatory Surgery Center in Winter Haven, Fla.

HealthSouth Accounting Fraud
CEO Scrushy to Face Criminal Charges
U.S. prosecutors announced this month an indictment against former HealthSouth Corp. Chief Executive Richard Scrushy that contains 85 criminal counts. The charges against Mr. Scrushy include money laundering, conspiracy, securities, mail and wire fraud, and making false statements. The government seeks more than $278 million in forfeiture from Mr. Scrushy's personal property.

HealthSouth, the Birmingham, Ala.-based operator of rehabilitation and outpatient surgery centers, has been accused by federal officials of inflating earnings and assets by about $2.5 billion since 1994.

Mr. Scrushy, who founded HealthSouth, has denied that he helped inflate earnings or had any part in the accounting fraud. He has blamed the scandal on underlings. Fifteen former HealthSouth executives have pleaded guilty to a variety of fraud-related charges.

Inside the Numbers
Inside the Numbers

• 19.6 million Number of U.S. surgical procedures in 1981.
• 47.5 million Projected number of U.S. surgical procedures in 2004.
• 80% Percentage of surgical procedures performed in hospital inpatient setting in 1981.
• 19% Projected percentage of surgical procedures performed in hospital inpatient setting in 2004.
• 18% Percentage of surgical procedures performed in HOPD in 1981.
• 43% Projected percentage of surgical procedures performed in HOPD in 2004.
• 1% Percentage of surgical procedures performed in freestanding ASCs in 1981.
• 17% Projected percentage of surgical procedures performed in ASCs in 2004.
• 1% Percentage of surgical procedures performed in physician offices in 1981.
• 21% Projected percentage of surgical procedures performed in physician offices in 2004.

Locum Tenen Staffing
Top Ten Temporary CRNA States
North Carolina has the greatest demand for locum tenen CRNAs, according to a recent review of temporary CRNA staffing trends conducted by Staff Care, Inc. North Carolina leads the nation both in surgical days on which nurse anesthetists are requested (20,324) and days on which CRNAs are actually used (17,176). Here are the top 10 states by usage days:

• North Carolina 17,176
• California 12,859
• Texas 12,695
• Pennsylvania 9,524
• Louisiana 7,167
• New Mexico 7,090
• Missouri 7,024
• Indiana 6,980
• South Carolina 6,892
• Wisconsin 6,859

Accreditation Compliance
JCAHO Clarifies Hand-hygiene Policy
The Joint Commission recently clarified its hand-hygiene policy spelled out in its 2004 national patient safety goals, which has led to more confusion that conformity. Among the major issues:

• JCAHO expects compliance with all category I recommendations in the CDC guidelines, including bans on artificial nails for staff who care directly for high-risk patients. Category II recommendations, such as keeping natural nails less than one-quarter inch long, are suggested but not required.
• Facilities are not required to use alcohol-based hand rubs. Rather, they are suggested as an alternative to soap and water for hands that aren't visibly soiled.
• If your facility must perform a root-cause analysis of an adverse event due to a nosocomial infection, JCAHO expects not just an identification of the infection as the cause but also of specific facility-wide systems and practices that can be redesigned to minimize infection risks.

Plastic Surgery Reimbursement
Survey: Abdominoplasty Brings Highest Cosmetic Fees
Abdominoplasty draws on average the highest fees per patient, according to an analysis of a surgeon survey conducted by the American Academy of Cosmetic Surgery. The data spans 30 cosmetic surgery procedures performed on 859,858 patients in 2002. The data includes not only the facility fee, but pre-operative consultation, anesthesia and all other billable services and materials. Here are the average fees last year for seven high-volume cosmetic procedures:

• Abdominoplasty $6,041
• Botox $424
• Breast Augmentation $4,685
• Laser Resurfacing $3,121
• Rhinoplasty $4,280
• Liposuction $3,728
• Hair Transplant/Restoration $3,984

OIG's 2004 Plan
New Safe Harbors Highlight Agenda
CMS will provide several new physician-ownership safe-harbor exemptions from the federal anti-kickback statute, according to the Office of Inspector General's (OIG) recently released 2004 work plan. Other key work-plan items:

• OIG plans to "review several aspects" of the hospital outpatient prospective payment system, most notably HOPD payments for multiple procedures performed during a single operative session.
• OIG will investigate "vulnerabilities related to hospital charges" for Medicare outlier patients to determine whether CMS "appropriately reimburses providers as intended."
• OIG pledges to "review the costs and charges reported by ambulatory surgery centers and provide CMS with information for determining whether reimbursement rates for these centers are reasonable or need revision." The plan states that, according to MedPAC, the current ASC rates are still based on the 1986 cost survey, although the most recently completed cost survey was done in 1994-95.
• OIG will examine CMS' oversight of and cooperation with JCAHO, which accredits 82 percent of the 6,200 hospitals that participate in Medicare.

FDA APPROVES NEW GYN PROCEDURE
Microwave Endometrial Ablation (MEA) has received FDA clearance. The system, owned by Microsulis Americas, is used to treat benign but excessive menstrual bleeding in pre-menopausal women who have completed childbearing. The procedure uses microwave energy to heat the lining of the uterus, permanently removing the tissue that produces excessive menstrual bleeding without damaging other tissue, according to the company.

The physician uses a wand-like device to uniformly apply thermal energy to the uterine lining. A built-in computer link lets the physician monitor and control the procedure. The treatment takes about three-and-a-half minutes and can be performed in the office, ASC or hospital setting.

ANESTHESIOLOGIST INVENTS POST-OP SUNGLASSES
After anesthesiologist Steve Marcum, MD, underwent LASIK, he was dissatisfied with the conventional post-op sunglasses he was given. As an alternative, he designed his own less bulky wrap-around, roll-up model called SportEYZ. Now available in bulk for outpatient facilities, they're geared toward patients who enjoy active outdoor lifestyles. For information, go to www.sporteyz.com or call 916.736.9167.

A NEW PROPOFOL FORMULATION
Manhattan Pharmaceutical and NovaDel Pharma are jointly developing a lingual spray formulation of propofol. The drug will be indicated for diagnostic and minor surgical procedures for which sedation is desired but IV catheter usage is not, particularly in the office setting.

According to the manufacturers, clinical testing should begin in early 2004, and the time lapse until it is available to facilities should be short. Because the product is not a new chemical entity, it does not require a New Drug Application. Thus, it will only require two to three studies to show that the lingual spray is safe, delivers the drug and brings the expected sedative effects with drug levels in the established therapeutic window.

WHERE THERE'S SMOKE
Nursing students are four times likelier to be smokers than medical students, according to a study published in the October issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP). Moreover, nearly twice as many nursing students are former smokers. The study also found that the smoking rate among medical students has significantly decreased in the last decade and that medical students who do smoke are less nicotine-dependent than their nursing counterparts. According to the study's lead author Ashwin A. Patkar, MD, physicians and nurses can significantly influence health-related behavior of patients, but healthcare professionals who smoke are at a particular disadvantage when attempting to educate their patients about smoking-related pathologies.