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Issues & challenges
A N E W DAY...
LATEX ALLERGY
The health care industry has been reeling as a result of escalating costs in the past decade associated with achieving compliance with regulatory mandates ranging from medical waste to occupational safety. Professional organizations have been articulate and persistent in their search for the scientific foundation and the value added per resource expended in meeting these requirements. They have taken repeated opportunities to share their concerns with congressional members. Health care organizations and numerous other industry groups, along with representatives of state and local governments including the National League of Cities and the U.S. Chamber of Commerce, are strongly supporting a legislative initiative to reform the promulgation process of these regulations, which are termed "unfunded mandates." Essentially this reform would require the Congressional Budget Office to estimate the costs of any new federal legislation placing requirements on industry that would require total private sector resources in excess of $200 million. Legislation producing costs lower than this ceiling would not require analysis. This reform forces Congress to determine public and private sector costs and to pay for mandates imposed on state and local governments that cost more than $50 million. This process would apply only to future congressional activity; however, the bill indudes creation of a federal commission to review existing mandates for recommended revision or dimination. [SOURCE: Bureau of National Affairs. Regulation, economics and law text. Washington, DC: BNA, Jan 5, 1995]
Latex allergy currently affects thousands of people who have IgEmediated cutaneous, respiratory, and systemic allergic reactions. In a recent article, Sussman and Beezhold of the Guthrie Foundation for Medical Research summarized the clinical symptoms of latex rubber allergy, provided guidelines for its management, and offered industry-specific recommendations to eliminate latex reactions. The most commonly seen form of latex allergy is nonimmunologic contact dermatitis (type 1V delayed hypersensitivity to rubber additives). Type I responses are less common and indude contact urticaria, rhinoconjunctivitis, asthma, and anaphylaxis. From 7% to 10% of health care workers regularly exposed to latex have a positive skin test reaction to latex proteins, indicative of increased blood levels of IgE antibody. Only about a third of these persons have symptoms of allergy. Systemic anaphylaxis can occur because of mucosal absorption of latex proteins. Current treatment depends heavily on latex avoidance and the use of powderfree latex gloves for persons with inhalant allergic reactions. A reference,
AJIC AM J iNFECTCONTROL1995;23:85-6 Copyright © 1995 by the Association for Professionals in Infection Control and Epidemiology, Inc.
Compendium of Non-Latex Gloves (Medical Devices Bureau, Health Protection Branch, Health Canada, July 1994), provides a comprehensive listing of alternatives. These alternatives include gloves, drains, catheters, dressings, tape, and other equipment for allergic individuals. [SOURCE:Sussman GL. Allergy to latex. Ann Intern Med 1995;122:43-6].
GLOBAL SURVEILLANCE Last year, the Centers for Disease Control and Prevention (CDC) published a national plan, "Addressing Emerging Infectious Disease Threats-A Prevention Strategy for the United States," to address emerging infectious diseases. This report stressed the need to strengthen surveillance networks, applied research, and prevention and control programs at state and local lev85
86
AJIC April 1995
Issuesand Challenges--April 1995
els, and to strengthen the laboratory infrastructure at the CDC, This plan is the culmination of recommendations from multiple expert panels and the recommendations of three recent National Academy of Sciences Institute of Medidne reports indicating that the ability of the U.S. public health system to meet the challenges of emerging infectious diseases is in jeopardy. Together, these reports documented the lack of readiness to recognize, treat, or control the extraordinarily serious microbial disease threats emanating from the tropics (Lassa fever, Ebola virus, cholera, drug-resistant malaria). They also documented the costly, crisis-driven, reactive nature of the public health community today, as opposed to a more cost-effective practice, prevention-driven system, and the crucial need to increase vigilance and enhance response capability through collaboration among federal, state, and local agencies and to establish a leadership role for the CDC in a national and global effort to monitor, prevent, and control emerging infectious diseases. It was estimated that flail implementation of the CDC sentind system would cost $125 million dollars, but for fiscal year 1995 CDC was given $6.7 million. As a result, the CDC is setting up an abridged version of the original plan. Four states, Oregon, California, Connecticut, and Minnesota, will be the first states to begin phasing in the network. All four states will track invasive bacteria such as group A streptococci and analyze unexplained deaths of previouslyhealthy individuals. In addition, each state will conduct special research projects: Oregon will monitor ET5 meningitis, the strain of group B meningitis discovered in Norway and considered responsible for a doubling of Oregon's meningitis morbidity; California will track valley fever, whose incidence has increased 10-fold since 1991; Connecticut will be studying Erlichia and Cryptosporidium; and Minnesota will monitor food-borne illnesses and methods of prevention. [SOURCE:
Associated Press, Washington via America Online, Mercury Center Code N l l l ID:me23054e, 1/3/95]
N E W VIRUS? Researchers at Columbia University believe that they have preliminary evidence to support the theory that Kaposi's sarcoma is linked to a new agent. In Kaposi's sarcoma lesions from patients with AIDS, these researchers found DNA sequences that appear to be from a new herpesvirus. Debate has ensued about the activity of this new agent--either working through a secondary mechanism such as cytokines or actually transforming cells, making them susceptible to growth from secondary factors such as cytokines. Whatever the actual mechanism, this virus is central, and the answers its study provides will go a long way toward solving the decade-old questions related to the incidence of Kaposi's sarcoma in patients with AIDS. [SOURCE: Research news. Science 1995;266:1803-4]
REDIRECTION OF JOINT C O H H I S S I O N SPURRED BY DECLINING C O N F I D E N C E Late last year, the American Hospital Association called for a summit meeting of the five organizations that sponsor the Joint Commission on Accreditation of Healthcare Organizations (American Hospital Association [AHA], American Medical Association, American College of Surgeons, American Dental Association, and American College of Physicians). Fundamental to the summit agenda were discontent with current operations and procedures and the need for a comprehensive reappraisal of the Joint Commission's mission and purpose. In a December press release, the AHA defined the Joint Commission "crisis" as the result of the cumulative impact of chronic performance problems, marketing of too many add-on services, and a fundamental lack of
responsiveness to the needs of hospitals and their medical staffs. According to the statement, the Joint Commission leadership has attempted to address some of these issues, but the response has been "uneven and untimely." The AHA has encouraged the Joint Commission sponsors to address governance, quality, and organizational collaboration, with particular sensitivity to issues of role conflict and consumer focus during the summit. Related to the AHA statement, state level hospital associations also engaged in the debate regarding the Joint Commission's future. Two such groups in California defined their concerns in terms of the Joint Commission's dual role as standards setter and as standards educator and enforcer, which they perceived as creating conflicts of interest. These are, according to the hospital associations, exacerbated by the virtual monopoly the Joint Commission enjoys on facility accreditation services. Further, this group questioned the propriety of the Joint Commission's selling of consultant services and charging of facilities for surveys. These associations suggested the organizational separation of standards and survey functions and encouraged the demonstration of the ability of survey standards to improve health care delivery and outcomes. ]SOURCE: American Hospital Association. Press release. Chicago: AHA, Dec 8, 1994] On January 21, 1995, the Board of Commissioners of the Joint Commission approved an action plan to address the concerns raised by the AHA Board of Trustees. Richard Davidson, president of the AHA, indicated that significant progress had been made but that much work lies ahead. He added that the AHA will convene a special task force to follow and assess developments in the action plan. [SOURCE:American Hospital Association. Press release. Chicago: AHA, Jan 23, 1995] •
LATEX ALLERGY
The health care industry has been reeling as a result of escalating costs in the past decade associated with achieving compliance with regulatory mandates ranging from medical waste to occupational safety. Professional organizations have been articulate and persistent in their search for the scientific foundation and the value added per resource expended in meeting these requirements. They have taken repeated opportunities to share their concerns with congressional members. Health care organizations and numerous other industry groups, along with representatives of state and local governments including the National League of Cities and the U.S. Chamber of Commerce, are strongly supporting a legislative initiative to reform the promulgation process of these regulations, which are termed "unfunded mandates." Essentially this reform would require the Congressional Budget Office to estimate the costs of any new federal legislation placing requirements on industry that would require total private sector resources in excess of $200 million. Legislation producing costs lower than this ceiling would not require analysis. This reform forces Congress to determine public and private sector costs and to pay for mandates imposed on state and local governments that cost more than $50 million. This process would apply only to future congressional activity; however, the bill indudes creation of a federal commission to review existing mandates for recommended revision or dimination. [SOURCE: Bureau of National Affairs. Regulation, economics and law text. Washington, DC: BNA, Jan 5, 1995]
Latex allergy currently affects thousands of people who have IgEmediated cutaneous, respiratory, and systemic allergic reactions. In a recent article, Sussman and Beezhold of the Guthrie Foundation for Medical Research summarized the clinical symptoms of latex rubber allergy, provided guidelines for its management, and offered industry-specific recommendations to eliminate latex reactions. The most commonly seen form of latex allergy is nonimmunologic contact dermatitis (type 1V delayed hypersensitivity to rubber additives). Type I responses are less common and indude contact urticaria, rhinoconjunctivitis, asthma, and anaphylaxis. From 7% to 10% of health care workers regularly exposed to latex have a positive skin test reaction to latex proteins, indicative of increased blood levels of IgE antibody. Only about a third of these persons have symptoms of allergy. Systemic anaphylaxis can occur because of mucosal absorption of latex proteins. Current treatment depends heavily on latex avoidance and the use of powderfree latex gloves for persons with inhalant allergic reactions. A reference,
AJIC AM J iNFECTCONTROL1995;23:85-6 Copyright © 1995 by the Association for Professionals in Infection Control and Epidemiology, Inc.
Compendium of Non-Latex Gloves (Medical Devices Bureau, Health Protection Branch, Health Canada, July 1994), provides a comprehensive listing of alternatives. These alternatives include gloves, drains, catheters, dressings, tape, and other equipment for allergic individuals. [SOURCE:Sussman GL. Allergy to latex. Ann Intern Med 1995;122:43-6].
GLOBAL SURVEILLANCE Last year, the Centers for Disease Control and Prevention (CDC) published a national plan, "Addressing Emerging Infectious Disease Threats-A Prevention Strategy for the United States," to address emerging infectious diseases. This report stressed the need to strengthen surveillance networks, applied research, and prevention and control programs at state and local lev85
86
AJIC April 1995
Issuesand Challenges--April 1995
els, and to strengthen the laboratory infrastructure at the CDC, This plan is the culmination of recommendations from multiple expert panels and the recommendations of three recent National Academy of Sciences Institute of Medidne reports indicating that the ability of the U.S. public health system to meet the challenges of emerging infectious diseases is in jeopardy. Together, these reports documented the lack of readiness to recognize, treat, or control the extraordinarily serious microbial disease threats emanating from the tropics (Lassa fever, Ebola virus, cholera, drug-resistant malaria). They also documented the costly, crisis-driven, reactive nature of the public health community today, as opposed to a more cost-effective practice, prevention-driven system, and the crucial need to increase vigilance and enhance response capability through collaboration among federal, state, and local agencies and to establish a leadership role for the CDC in a national and global effort to monitor, prevent, and control emerging infectious diseases. It was estimated that flail implementation of the CDC sentind system would cost $125 million dollars, but for fiscal year 1995 CDC was given $6.7 million. As a result, the CDC is setting up an abridged version of the original plan. Four states, Oregon, California, Connecticut, and Minnesota, will be the first states to begin phasing in the network. All four states will track invasive bacteria such as group A streptococci and analyze unexplained deaths of previouslyhealthy individuals. In addition, each state will conduct special research projects: Oregon will monitor ET5 meningitis, the strain of group B meningitis discovered in Norway and considered responsible for a doubling of Oregon's meningitis morbidity; California will track valley fever, whose incidence has increased 10-fold since 1991; Connecticut will be studying Erlichia and Cryptosporidium; and Minnesota will monitor food-borne illnesses and methods of prevention. [SOURCE:
Associated Press, Washington via America Online, Mercury Center Code N l l l ID:me23054e, 1/3/95]
N E W VIRUS? Researchers at Columbia University believe that they have preliminary evidence to support the theory that Kaposi's sarcoma is linked to a new agent. In Kaposi's sarcoma lesions from patients with AIDS, these researchers found DNA sequences that appear to be from a new herpesvirus. Debate has ensued about the activity of this new agent--either working through a secondary mechanism such as cytokines or actually transforming cells, making them susceptible to growth from secondary factors such as cytokines. Whatever the actual mechanism, this virus is central, and the answers its study provides will go a long way toward solving the decade-old questions related to the incidence of Kaposi's sarcoma in patients with AIDS. [SOURCE: Research news. Science 1995;266:1803-4]
REDIRECTION OF JOINT C O H H I S S I O N SPURRED BY DECLINING C O N F I D E N C E Late last year, the American Hospital Association called for a summit meeting of the five organizations that sponsor the Joint Commission on Accreditation of Healthcare Organizations (American Hospital Association [AHA], American Medical Association, American College of Surgeons, American Dental Association, and American College of Physicians). Fundamental to the summit agenda were discontent with current operations and procedures and the need for a comprehensive reappraisal of the Joint Commission's mission and purpose. In a December press release, the AHA defined the Joint Commission "crisis" as the result of the cumulative impact of chronic performance problems, marketing of too many add-on services, and a fundamental lack of
responsiveness to the needs of hospitals and their medical staffs. According to the statement, the Joint Commission leadership has attempted to address some of these issues, but the response has been "uneven and untimely." The AHA has encouraged the Joint Commission sponsors to address governance, quality, and organizational collaboration, with particular sensitivity to issues of role conflict and consumer focus during the summit. Related to the AHA statement, state level hospital associations also engaged in the debate regarding the Joint Commission's future. Two such groups in California defined their concerns in terms of the Joint Commission's dual role as standards setter and as standards educator and enforcer, which they perceived as creating conflicts of interest. These are, according to the hospital associations, exacerbated by the virtual monopoly the Joint Commission enjoys on facility accreditation services. Further, this group questioned the propriety of the Joint Commission's selling of consultant services and charging of facilities for surveys. These associations suggested the organizational separation of standards and survey functions and encouraged the demonstration of the ability of survey standards to improve health care delivery and outcomes. ]SOURCE: American Hospital Association. Press release. Chicago: AHA, Dec 8, 1994] On January 21, 1995, the Board of Commissioners of the Joint Commission approved an action plan to address the concerns raised by the AHA Board of Trustees. Richard Davidson, president of the AHA, indicated that significant progress had been made but that much work lies ahead. He added that the AHA will convene a special task force to follow and assess developments in the action plan. [SOURCE:American Hospital Association. Press release. Chicago: AHA, Jan 23, 1995] •