Cheers for Lisa McGiffert

Lisa McGiffert Makes Modern Healthcare’s “100 Most Influential People in Healthcare”

Lisa McGiffert, Director of Consumers Union’s Safe Patient Project, was recognized in Modern Healthcare’s “100 Most Influential People in Healthcare” 2015 list. Consumer Reports couldn’t be more proud of Lisa and her accomplishments.

“This recognition is well-deserved and long overdue,” said Consumer Reports President & CEO Marta Tellado.

“Lisa has been a tireless leader in the fight to reduce deadly hospital infections and medical errors. Her work has helped save countless lives by shining the spotlight on this preventable epidemic and by mobilizing patients and their families to hold hospitals accountable for improving the care they provide. Lisa’s partnership with patient safety activists across the country has demonstrated how much impact ordinary citizens can have by joining together and working for change.”

Lisa joined Consumers Union, the policy and advocacy arm of Consumer Reports, in 1991, working on a full array of health issues in Texas before launching the national Stop Hospital Infections campaign in 2003. Through this campaign, Consumers Union was instrumental in helping to pass legislation in 30 states requiring hospitals to publicly disclose their patient infection rates. Our success in the states helped prompt the federal government to establish a national hospital infection public reporting program in 2011.

As Director of CU’s Safe Patient Project, Lisa has been a tenacious advocate on a number of other patient safety issues, including working to eliminate preventable medical errors and to improve the safety of physician care and medical devices. She lobbies on national and state patient safety legislation and regulations to improve accountability and expand public disclosure about medical harm. Lisa provides a strong voice for consumers at conferences, with the media and when serving on state and national advisory committees, including current positions on the National Quality Forum Patient Safety Committee, the Measures Application Partnership (advises the Center for Medicare and Medicaid Services on quality measures for public reporting and pay for performance programs), and CDC’s Healthcare Infection Control Practices Advisory Committee.

She has led the development of a national patient safety activist network through collaboration with individuals who have personal experiences with medical harm, providing technical support and training for their work on state legislation and regulations.

Here’s what some Safe Patient Project activists had to say about Lisa’s award:

So good to see you, Lisa, on this list!! It shows what a strong leader of this movement you are and how our work is being heard and our voice is powerful.

Congratulations, Lisa!! We are honored to know you and to have been working with you to save more lives.

This is well deserved recognition for all you do in patient safety around the nation, and especially with the advocates and other people you touch every day! You are just getting started!

We believe that Lisa’s work has made a real difference in the way that American health care is delivered, and her work opens minds and commands attention. From Suzanne Henry, Safe Patient Project Policy Analyst: 

“Lisa influences the way leaders in healthcare approach their work when it comes to patient safety. She has led the charge to quantify patient safety measures, specifically hospital infections. And after ten years of passing laws to require reporting of hospital infections, the guessing game is over. Hospitals can now tell a story about their efforts to prevent infections. Patients can know if hospitals are reducing their infection rates. And reducing infections results in lives saved. Medical harm is the third leading cause of death in the U.S., a statistic that might have gone unnoticed and unchanged without Lisa’s work.”

Passwords--they may as well help us

I was in a meeting last week and Morgan shared an interesting thought process for creating passwords. I believe we all have trouble remembering so many passwords and constantly trying to create new ones when we are prompted to do so. Morgan was kind enough to distribute Mauricio Estrella's article to a few of us so I am sharing it.. It really is a great way to handle the dreaded password syndrome. 

How a Password Changed My Life

Mauricio Estrella 

Posted: 07/08/2014 11:32 am EDT Updated: 09/07/2014 5:59 am EDT

"How could she do something like this to me?" said a voice in my head. All the time. Every day.

Back in 2011, when everything had gradients, iOS icons made sense, and people used deodorants, I was stuck in middle of a pretty bad depression due to my divorce.

Thankfully, I think I was smart enough (and had great people around me) so I managed my way out.

One day I walk into the office, and my day begins at my computer screen. It was all great, until I saw this message:

Your password has expired.
Click 'Change password' to change your password.

No shit. I thought clicking 'Change password' was gonna do something else.

I read this dumb message in my mind with angry grandpa voice: The damn password has expired.

At my workplace, the Microsoft Exchange server is configured to ask thousands of employees around the planet to change their passwords. Every 30 days.

Here is the horseshit: The server forces us to use at least one UPPERCASE character, at least one lowercase alphabetic character, at least one symbol and at least one number. Oh, and the whole damn thing can't be less than eight characters. And I can't use any of the same passwords I've used in the last three months.

I was furious that morning. Tuesday, 9:40 a.m. It was so hot that my torso was already sweaty even though I just got to work. I was late. I was still wearing my helmet. I think I forgot breakfast. Something tastes like cigarette in my mouth. I need to get shit done before my 10 a.m. meeting and all I have in front of me is a huge waste of my time.

So there it was... this input field with a pulsating cursor, waiting for me to type a password that I'll have to re-enter for the next 30 days. Many times during the day.

Then, letting all the frustration go, I remembered a tip I heard from my former boss.

I'm gonna use a password to change my life.

It was obvious that I couldn't focus on getting things done with my current lifestyle and mood. Of course, there were clear indicators of what I needed to do -- or what I had to achieve -- in order to regain control of my life, but we often don't pay attention to these clues.

My password became the indicator. My password reminded me that I shouldn't let myself be victim of my recent break up, and that I'm strong enough to do something about it.

My password became: "Forgive@h3r"

I had to type this statement several times a day. Each time my computer would lock. Each time my screensaver with her photo would appear. Each time I would come back from eating lunch alone.

In my mind, I went with the mantra that I didn't type a password. In my mind, I wrote "Forgive her" every day, for one month.

That simple action changed the way I looked at my ex wife. That constant reminder that I should forgive her, led me to accept the way things happened at the end of my marriage, and embrace a new way of dealing with the depression that I was drowning into.

In the following days, my mood improved drastically. By the end of the second week, I noticed that this password became less powerful, and it started to lose its effect. A quick refresh of this 'mantra' helped me. I thought to myself I forgive her as I typed it, every time. The healing effect of it came back almost immediately.

One month later, my dear exchange server asked me again to renew my password. I thought about the next thing I had to get done.

My password became Quit@smoking4ever

And guess what happened. I shit you not. I quit smoking overnight. This password was a painful one to type during that month, but doing it helped me to yell at myself in my mind, as I typed that statement. It motivated me to follow my monthly goal.

One month later, my password became Save4trip@thailand

Guess where I went three months later. Thailand. With savings.

Thank you, password.

So, I learned that I can truly change my life if I play it right. I kept doing this repeatedly month after month, with great results.

Here is an extract of what some of my passwords have been in the last two years, so you get an idea of how my life has changed, thanks to this method:

Forgive@her ← to my ex-wife, who started it all.
Quit@smoking4ever ← it worked.
Save4trip@thailand ← it worked.
Eat2times@day ← it never worked, still fat.
Sleep@before12 ← it worked.
Ask@her4date ← it worked. I fell in love again.
No@drinking2months ← it worked. I feel better.
Get@c4t! ← it worked. I have a beautiful cat.
Facetime2mom@sunday ← it worked. I talk with my mom every week.

And the one for last month:

Save4@ring ← Yep. Life is gonna change again, soon.

I still await very anxiously each month so I can change my password into something that I need to get done.

This method has consistently worked for me for the last two years, and I have shared it with a few close friends and relatives. I didn't think it was a breakthrough in tiny habits but it did have a great impact in my life, so I thought to share it with you all.

Try it yourself! Write these statements with the right mindset and attitude, and you'll change your life. Let me know how it works for you!

Remember, for added security, try to be a bit more complex with the words. Add symbols or numbers, or scramble a bit the beginning or the ending of your password string. S4f3ty_f1rst!

Pass the tip to those who might need it.

Updated on Jun 21, 2014: She said yes.

Mauricio Estrella is currently based in Shanghai, working as the Associate Creative Director at EF, Education First. This post first appeared on Medium.

Follow Mauricio Estrella on Twitter: www.twitter.com/manicho

MORE:PasswordsChanging BehaviorBREAKING UPHabitsGood HabitsMarriage ProblemsChanging HabitsNew HabitsBad Habits

National Dog Day

Be extra good to your dog today!

My husband would say every day is Dog Day...when will it be Husband Day?

Should you get vaccinated at a pharmacy?

Consumer Reports

Here’s what to know before you go
Published: July 14, 2015 06:00 AM

You’re picking up a few household items at the pharmacy and spot a sign for on-site vaccinations. Would getting vaccinated at a pharmacy be a reasonable move? Yes. It’s a safe, convenient way to keep up to date on your immunizations, and may save you a trip to the doctor. What’s more, pharmacists are trained in immunization technique and practice giving shots regularly.

CVS, Rite Aid, Walgreens, and other chains, as well as some independents, offer more than the flu shot – they also administer Centers for Disease Control and Prevention-approved vaccines, including hepatitis A and B, pneumonia, polio, shingles, Tdap (tetanus, diphtheria and pertussis), and varicella (chickenpox). And many also offer travel immunizations for meningitis, typhoid, yellow fever, and other diseases.

While many pharmacies require no appointment and only ask that you complete a consent form (which includes questions about your medical history and authorizes the release of your health care provider and insurers), rules and vaccine availability vary by state—so call ahead before you drop in.

As at your doctor’s office, most pharmacies will file with your insurance, and under the Affordable Care Act, insurers are required to cover most immunizations for adults and children, so you probably won’t be charged. When in doubt, you or your pharmacist should check first with your insurer. Note, too, that your insurance plan may have age limitations, for example, most plans will not cover the shingles vaccines for adults under age 60. If you’re paying out-of-pocket, know that prices vary depending on the pharmacy, just as they do at your doctor’s office. For example, you’ll pay $85 for the pneumonia vaccine at CVS and Target, but just $73 at Costco pharmacies. And the dual Hepatitis A and B vaccine costs $169 at Target, and $114 at Walmart. Ask your pharmacist to forward information about your vaccinations to your doctor's office so that it can be added to your medical record.

An added perk for getting vaccinated at the pharmacy: CVS, Walgreens, and other chains offer loyalty programs (it’s free to sign up) that earn you rewards for each vaccination you get, and those reward points add up to discounts on other store purchases. Sign up online or at the pharmacy counter.

If you are uninsured or paying out-of-pocket, many of the same statewide free health clinics and community health centers that provide preventative care offer free or low-cost vaccinations. Find a clinic near you.

—Ginger Skinner

National Story Contest Creates Collaboration in Order to Provide Best Care at Lowest Cost

KSLA News: Posted: Aug 19, 2015 3:57 AM EDT

Boston, MA (PRWEB) August 19, 2015

Clinician Led Non-Profit ‘Costs of Care’, the Healthcare Financial Management Association, Yale New Haven Health System and Strata Decision Technology Launch ‘The Best Care, The Lowest Cost: One Idea at a Time.’

Costs of Care, a clinician led non-profit, has partnered with a number of leading stakeholders to launch The Best Care, The Lowest Cost: One Idea at a Time, a National Story Contest inviting patients, clinicians and hospital administrators to share real stories of successes and failures in pursuit of affordable healthcare. According to a New York Times/CBS Poll, half of Americans have identified the affordability of basic medical care as a hardship. The National Story Contest seeks to highlight key insights into clinician and administrator partnerships across the country.

“Over the years, Costs of Care has demonstrated that those of us on the frontlines of healthcare delivery see routine opportunities to make healthcare more affordable every day. I’m thrilled by this opportunity to bring patients, nurses, physicians, financial administrators, and others, into a common conversation,” said Neel Shah, M.D., Executive Director at Costs of Care and an Assistant Professor at Harvard Medical School.

Supported by leading organizations representing patients, clinicians, administrators and technology, the National Story Contest will collect stories from individuals or small teams, in writing or via video. The focus is experiences that illustrate the challenges and opportunities to make healthcare more affordable. The contest deadline is Sept. 28, 2015.

“While both clinicians and hospital administrators want to and need to address this waste and bend the cost curve, it is a daily struggle to keep healthcare costs down while trying to deliver high quality care,” stated Tom Balcezak, MD, MPH, Chief Medical Officer at Yale - New Haven Hospital, the lead academic medical center partner for this initiative. “While progress is being made, the challenge is that those ideas and experiences aren’t being shared. It’s time to change that.”

The Healthcare Financial Management Association (HFMA), the nation’s largest group for healthcare finance leaders with over 40,000 members, is also a key supporter in this initiative and a valuable partner for the contest. "At HFMA, we believe that now is the time to bring all stakeholders to the table to share knowledge and best practices, and to identify opportunities to collaborate to deliver more value. This contest couldn’t come at a more critical time for our industry," said Joseph J. Fifer, FHFMA, CPA, President and Chief Executive Officer of HFMA.

Five thousand dollars in prizes will be awarded to the winning entry determined with the help of five judges:

• Tara Montgomery, Director of Health Impact at Consumer Reports
• Tom Balcezak, MD, MPH; Chief Medical Officer at Yale - New Haven Hospital
• Joseph J. Fifer, FHFMA, CPA; President and Chief Executive Officer at HFMA
• Neel Shah, MD, MPP; Founder and Executive Director at Costs of Care
• Dan Michelson, MBA; Chief Executive Officer at Strata Decision Technology

The winner will be officially announced at the 2015 Strata Decision Summit in Chicago on Nov. 3, 2015. In addition, the winner and other top contest entries will be highlighted in a new open source e-book that will be shared for free with healthcare leaders across the country. Preference will be given to stories and videos that best articulate real-world experiences and to simple yet innovative ideas that can become part of the solution to the cost crisis. Contest submissions should be submitted on the Costs of Care website at http://www.costsofcare.org/story.

“Finance and clinicians haven’t consistently collaborated to reduce costs, or even to discuss the problem,” said Dan Michelson, CEO at Strata Decision Technology. “The data is now there to take action and open sourcing this conversation represents an incredible opportunity for our industry to drive and deliver value.”

For more information on the contest or Costs of Care, please visithttp://www.costsofcare.org/story.

ABOUT COSTS OF CARE
Costs of Care is a nonprofit that has become one of the nation’s most powerful voices for physicians, nurses and patients to share their experiences on personal impact of the cost of healthcare. Led by Dr. Neel Shah, an Assistant Professor at Harvard Medical School, and a practicing physician, Costs of Care sources, curates, and disseminates ideas from the frontlines of healthcare delivery that can drive better care at lower cost. http://www.costsofcare.org

ABOUT YALE NEW HAVEN HEALTH SYSTEM
Yale New Haven Health System, through its Yale-New Haven, Bridgeport, Greenwich and Northeast Medical Group Delivery Networks, provides comprehensive, cost effective, advanced patient care characterized by safety and clinical and service quality. Yale New Haven Health System, in affiliation with the Yale School of Medicine and other universities and colleges, educates health professionals and advances clinical care. In all of its work, YNHHS is committed to the communities it has the privilege of serving. http://www.ynhhs.org

ABOUT THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION
With more than 40,000 members, the Healthcare Financial Management Association (HFMA) is the nation's premier membership organization for healthcare finance leaders. HFMA builds and supports coalitions with other healthcare associations and industry groups to achieve consensus on solutions for the challenges the U.S. healthcare system faces today. Working with a broad cross-section of stakeholders, HFMA identifies gaps throughout the healthcare delivery system and bridges them through the establishment and sharing of knowledge and best practices. We help healthcare stakeholders achieve optimal results by creating and providing education, analysis, and practical tools and solutions. Our mission is to lead the financial management of health care. http://www.hfma.org/

ABOUT STRATA DECISION TECHNOLOGY
Strata Decision Technology provides an innovative cloud-based financial analytics and performance platform that is used by healthcare providers for financial planning, decision support and continuous cost improvement. Founded in 1996, the Company's customer base includes 1,000 hospitals and many of the largest and most influential healthcare delivery systems in the U.S. The Company’s StrataJazz® application is a single integrated software platform that includes modules for capital planning, contract modeling, cost accounting, cost management, decision support, financial forecasting, management reporting, operational budgeting and performance improvement and strategic planning. The Company's headquarters are in Chicago, IL. For more information, please visit http://www.stratadecision.com.

Contact:
Neel Shah, MD, MPP, (617) 841-8581, neel(at)costsofcare(dot)org
Steve Allegretto, (203) 688-5593, Stephen.Allegretto(at)ynhh(dot)org
Karen Thomas, (708) 492-3377, kthomas(at)hfma(dot)org

For the original version on PRWeb visit:http://www.prweb.com/releases/2015/08/prweb12909676.htm

Information contained on this page is provided by an independent third-party content provider. WorldNow and this Station make no warranties or representations in connection therewith. If you have any questions or comments about this page please contact pressreleases@worldnow.com.

How your hospital can make you sick

Consumer Reports’ new Ratings of more than 3,000 U.S. hospitals show which do a good job of avoiding MRSA, C.diff, and other deadly infections

www.consumerreports.org / Published: July 29, 2015

In the ongoing war of humans vs. disease-causing bacteria, the bugs are gaining the upper hand. Deadly and unrelenting, they’re becoming more and more difficult to kill. You might think of hospitals as sterile safety zones in that battle. But in truth, they are ground zero for the invasion.

Though infections are just one measure of a hospital’s safety record, they’re an important one. Every year an estimated 648,000 people in the U.S. develop infections during a hospital stay, and about 75,000 die with them, according to the Centers for Disease Control and Prevention (CDC). That’s more than twice the number of people who die each year in car crashes. And many of those illnesses and deaths can be traced back to the use of antibiotics, the very drugs that are supposed to fight the infections.

Terry Otey appears to be one casualty in that ongoing battle. Three years ago, a few weeks after an overnight stay for back surgery at Providence Regional Medical Center in Everett, Wash., he went to the emergency room vomiting, dizzy, and with excruciating back pain. Bacteria known as MRSA (methicillin-resistant staphylococcus aureus) had taken hold in his surgical incision and quickly spread to his heart. He died in the hospital about three months later, following a cascade of serious health problems. “He just wanted to ease his back pain enough to play golf,” says his sister, Deborah Bussell.

Kellie Pearson, 49, a farmer in northern California, says she encountered a different kind of bug after having heart surgery last April. Her doctors prescribed an antibiotic in the hopes that it would prevent a postsurgical infection. Instead the drug killed off healthy bacteria in her body, and another germ, C. diff (clostridium difficile), swooped in, causing diarrhea so severe that she had to stay in the hospital an additional five days until doctors could rein in the potentially deadly infection.

She recovered but soon realized that she wasn’t the only patient suffering. “When I was able to walk down the hall in the hospital,” she says, “I was horrified to see room after room with C. diff caution signs on their doors warning that the patients inside, like me, had been infected.”

In the danger zone

“Hospitals can be hot spots for infections and can sometimes amplify spread,” says Tom Frieden, M.D., director of the CDC. “Patients with serious infections are near sick and vulnerable patients—all cared for by the same health care workers sometimes using shared equipment.”

Making the situation even more dangerous is the widespread, inappropriate use of antibiotics that’s common in hospitals, which encourages the growth of “superbugs” that are immune to the drugs and kills off patients’ protective bacteria.

It’s “the perfect storm” for infections to develop and spread, says Arjun Srinivasan, M.D., who oversees the CDC’s efforts to prevent hospital-acquired infections. “We’ve reached the point where patients are dying of infections in hospitals that we have no antibiotics to treat.”

But there’s hopeful news: Some hospitals are taking steps to reduce infections and end inappropriate antibiotic use. “But others have made little effort,” Srinivasan says.

'Be your own advocate'

Kellie Pearson recovered from a life-threatening case of C. diff caused by antibiotics she got in the hospital. But shortly after, she says, her doctor wanted to prescribe a broad-­spectrum antibiotic to prevent infection in her incision. “I was shocked because that could trigger the C. diff all over again,” she says. Her takeaway: “You have to be your own advocate.”

Red flags for bad bacteria

Methicillin-resistant staphylococcus aureus (MRSA)

We are focusing on C. diff and MRSA for two important reasons.

First, the infections are common and deadly. More than 8,000 patients each year are killed by MRSA; almost 60,000 are sickened by the infections. The bacteria often find their way into patients’ bodies through the lines and tubes that doctors use to deliver medication and nutrition to patients, or via surgical incisions, as happened to Terry Otey.

C. diff is an even bigger concern. Kellie Pearson is one of the 290,000 Americans sickened by the bacteria in a hospital or other health care facility each year. She was lucky: At least 27,000 people in the U.S. die with those infections annually.

Second, poor MRSA or C. diff rates can be a red flag that a hospital isn’t following best practices in preventing infections and prescribing antibiotics. That could not only allow C. diff and MRSA to spread but also turn the hospital into a breeding ground for other resistant infections that are even more difficult to treat.

For example, as dangerous as MRSA is, an infection can be cured if it is treated promptly with vancomycin, long held out as an “antibiotic of last resort.” But, in part because that drug is now so often used in hospitals, another resistant strain of bacteria—vancomycin-resistant staphylococcus aureus, or VRSA—is emerging. “VRSA infections pose special challenges; they can be even more difficult to treat than MRSA,” Srinivasan says.

Hospitals that rate well

Clostridium difficile (C. diff)

To earn our very top rating in preventing MRSA or C. diff, a hospital has to report zero infections—an admittedly high bar. Still, 322 hospitals across the country were able to achieve that level in our MRSA ratings, and 357 accomplished it for C. diff, showing that it is possible. (Experts say some hospitals might game the system. Read more about how hospitals fudge the numbers, and help us identify those that might not accurately report infections.)

More hospitals were able to earn either of our two highest ratings—indicating that they reported either zero infections or did much better than predicted compared with similar hospitals: more than 623 hospitals received high marks for MRSA, and 917 did so for C. diff.

Hospitals really begin to distinguish themselves when they earn high ratings against both infections: 105 hospitals succeeded in that. Even better, some hospitals excel against not only MRSA and C. diff but also other infections that the CDC tracks and that are in our hospital Ratings. Those include surgical-site infections and infections linked to urinary catheters or central-line catheters, large tubes that provide medication and nutrition.

“Hospitals that do well against infections across the board have figured something out and deserve special mention,” Peter says. Only nine hospitals in the country—those featured in the “Highest-Rated in Infection Prevention” chart earned that high honor. (Note that some of hospitals listed in that chart differ from those in the September 2015 issue of Consumer Reports magazine because new data was released by the federal government after the magazine went to press.)


And hospitals that don't

You won’t find any familiar, big-name hospitals on that top-performing list. In fact, several high-profile hospitals got lower ratings against MRSA, C. diff, or both, including the Cleveland Clinic in Cleveland, Johns Hopkins Hospital in Baltimore, Mount Sinai Hospital in New York City, and Ronald Reagan University of California Los Angeles Medical Center.

Those are all large teaching hospitals in urban areas, which in our analysis did not do as well as nonteaching hospitals of similar sizes in similar settings. That could be because teaching hospitals may do a better job of reporting infections. Or, as a representative for Ronald Reagan UCLA Medical Center told us, they may see sicker patients or have more patients undergoing complex procedures.

Although the CDC adjusts the data to account for some of those factors, teaching hospitals tend to perform worse. For example, only 6 percent of teaching hospitals received one of our two top scores against C. diff, compared with 14 percent of similar nonteaching hospitals.

“Yes, teaching hospitals face special challenges. But they are also supposed to be places where we identify best practices and put them to work,” says Lisa McGiffert, director of the Consumer Reports Safe Patient Project. “Obviously, that is not happening as well as it should.”

Larger hospitals also tended to do worse in our Ratings. That could be because patients in smaller hospitals are less likely to be exposed to infections. But some larger hospitals managed to do a good job avoiding infections. Case in point: Harlem Hospital Center in New York City earned high ratings against MRSA and C. diff. Or consider Northwest Texas Healthcare System in Amarillo, Texas. It made it onto our list of top hospitals in the prevention of all of the infections included in our Ratings.

What safe hospitals do

Good hospitals focus on the basics:

Use antibiotics wisely

Almost half of hospital patients are prescribed at least one antibiotic, Srinivasan says, but “up to half the time the drug is inappropriate.” To combat antibiotic misuse, many good hospitals have “antibiotic stewardship” programs, often headed by a pharmacist trained in infectious disease, to make sure that patients get the right drug, at the right time, in the right dose.

Such programs often monitor the use of broad-spectrum antibiotics. Doctors at some hospitals use three times more of those all-purpose bug killers than others. Reducing broad-spectrum prescriptions by 30 percent would “cut hospital rates of C. diff by more than 25 percent, plus reduce antibiotic resistance,” says Clifford McDonald, M.D., a CDC epidemiologist.

Keep it clean

C. diff and MRSA can live on surfaces for days and can be passed from person to person on hospital equipment or the hands of health care workers. To prevent that, hospitals must be kept scrupulously clean. “Infection control is all about the basics, starting with hand hygiene,” says Christine Candio, president and CEO of St. Luke’s Hospital in Chesterfield, Mo., which earned higher Ratings against both MRSA and C. diff.

She reminds patients, “it’s your right to ask” staff to wash up. In fact, fastidious hand washing slashes rates of C. diff, MRSA, and other infections. St. Luke’s also “prioritizes cleanliness,” in some cases exceeding infection-control guidelines—cleaning the rooms of C. diff patients twice daily, for example, and replacing curtains between patients.

What more needs to be done

Steps such as those, plus federal mandates for some public reporting of infections data, have already led to reduced rates of certain infections. Still, McGiffert says hospitals need to do more:

• Consistently follow the established protocols for managing superbug infections, such as using protections including gowns, masks, and gloves by all staff.
• Be held financially accountable. Already, hospitals in the bottom 25 percent of the government’s data at preventing certain complications now have Medicare payments docked 1 percent. But they should also have to cover all costs of treating infections patients pick up during their stay.
• Have an antibiotic stewardship program. That should include mandatory reporting of antibiotic use to the CDC.
• Accurately report how many infections patients get in the hospital. And the government should validate those reports.
• Be transparent about infection rates. For instance, Cleveland Clinic acknowledges its below-average performance in C. diff prevention on its website. “That’s refreshingly candid,” Peter says.
• Promptly report outbreaks to patients, as well as to state and federal health authorities. Those agencies should inform the public so that patients can know the risks before they check into the hospital.

Germ warfare: Protect yourself against superbugs

First step: Check our Ratings to see how hospitals in your community compare in preventing infections and other measures of hospital safety. 

But bad things can happen even in good hospitals. For example, Terry Otey developed his infection after a 2012 surgery in a hospital that now gets one of our higher ratings against MRSA. Our experts say there are several things you can do when you’re in the hospital and after you’re discharged to minimize your risk and spot symptoms of possible infection early:

In the hospital

Consider MRSA testing. A nasal swab can detect low levels of MRSA and allow medical staff to take precautions, such as having you wash with a special soap before your procedure.

Insist on cleanliness. Ask to have your room cleaned if it looks dirty.

Take bleach wipes for bed rails, doorknobs, and the TV remote. Insist that everyone who enters your room wash his or her hands.

Keep your own hands clean, washing regularly with soap and water.

Question antibiotics. Make sure that any anti­biotics prescribed to you in the hospital are needed and appropriate for your infection.

Watch out for heartburn drugs. Medications such as Nexium and Prilosec increase the risk of developing C. diff symptoms by reducing stomach acid that appears to help keep the bug in check. So ask whether the drug is needed and request the lowest dose for the shortest possible time.

Ask every day whether ‘tubes’ can be removed. The risk of infection increases the longer items such as catheters and ventilators are left in place. If you’re not able to ask, be sure a friend or family member does.

Say no to razors. If you need to be shaved, use an electric hair remover, not a razor, because any nick can provide an opening for infection.

At home

If you’ve been in the hospital, “assume you’ve been exposed to potentially dangerous bacteria,” says Lisa McGiffert, director of the Consumer Reports Safe Patient Project. Here’s what to do when you get home to keep yourself and your family safe:

Watch for warning signs. They include fever, diarrhea, worsening pain, or an incision site that becomes warm, red, and swollen. People at particular risk include adults older than 65 as well as infants, anyone on antibiotics, and people with a compromised immune system.

Practice good hygiene. If you or someone you live with receives a diagnosis of a hospital-acquired infection after being discharged from the hospital, take extra precautions to make sure that it doesn’t spread. Steps you should consider take include cleaning frequently touched surfaces with 1 part bleach mixed with 10 parts water and reserving a bathroom for the infected person. If that’s not possible, use the bleach solution to disinfect surfaces between uses. And don't share toiletries or towels; use paper towels rather than cloth hand towels.

Editor's Note:
This article also appeared in the September 2015 issue of Consumer Reports magazine.

Note that there are some differences between the print and online versions of the story because new data was released by the federal government after the issue went to press.

Whooping cough alert

Whooping cough alert: Get a booster before school starts
Pertussis remains a major problem, so make sure your child is protected

Reprinted from consumerreports.org
Last updated: August 06, 2015 08:45 AM

The words “whooping cough” conjure up a bygone era of gravely sick babies and desperate parents hoping their feverish, hacking children make it through the night. The devastating disease, called pertussis, is characterized by several weeks, or even months, of low-grade fever and incessant bouts of rapid coughing that have a "whoop" sound (you can listen to it here) as the child tries desperately to expel thick throat mucus. At its worst, the disease can bring on pneumonia and, due to lack of oxygen during the coughing spells, even seizures and death.

Well, it’s back. Last year, there were 17,873 cases of pertussis reported to the national Centers for Disease Control and Prevention. And so far in 2015 there have been 10,209 cases reported. In fact, the number of pertussis cases has been steadily rising since the 1980s, hitting a 50-year high of 48,277 in 2012. Why would a disease that had nearly been wiped out after a highly effective vaccine was introduced in the 1940s now be making a comeback?

Experts aren’t entirely sure, but point to a variety of causes, including more parents choosing not to vaccinate their children. That failure, in turn, has allowed for the extremely contagious Bordetella pertussis bacteria to circulate more freely.

The vaccine’s effectiveness also appears to wane over time. A 2015 review of studies in the journal Pediatrics concluded that the vast majority of children who had been vaccinated in their first years of life were no longer protected against pertussis by the time they received their scheduled Tdap booster in their teens. One possible explanation for this loss of immunity is that new strains of B. pertussis may have developed since the current vaccine was first introduced in 1991.

The CDC is now analyzing data from around the country to see if it should change recommendations for how often people need to be vaccinated or receive booster shots.

In the meantime, our advice remains unchanged: All children should have the entire five-shot series of DTaP (diphtheria, tetanus and pertussis) vaccinations between the ages of 2 months and enrollment in kindergarten. Adolescents, adults, and pregnant women (ideally between 27 and 36 weeks) should get a Tdap booster shot if they’re unsure if they’ve had one—unless, of course, they’ve previously had a severe (and extremely rare) allergic reaction.

If your child develops pertussis, antibiotics remain the treatment of choice. But while the antibiotics long used to treat confirmed cases of pertussis continue to work well, some pockets of antibiotic-resistant strains of B. pertussis have been reported. (Read more about the rise of antibiotic-resistant bacteria.)

It doesn't really matter whether you get vaccinated at your doctor's office or at your local pharmacy. The important thing is to just get vaccinated.

—Chris Hendel

Tribute to Frank Gifford

What a beautiful tribute, and an awesome testimony. A testament to Lord's faithfulness and everlasting power. A must watch.

Its great that the Today Show and NBC allowed Kathie to share her strong testimony without interruption and not afraid that it might offend a group.

Thank you Kathie lee for sharing your faith without reserve and with great joy!

Today Show

"I want to thank everybody for your love, and your texts and your tweets. Just just the outpouring has been extraordinary," Kathie Lee Gifford said.http://on.today.com/1E0S34F

Trazodone: Common sleep drug is little-known antidepressant

Consumer Reports (August 2015)
http://www.consumerreports.org/cro/2012/04/trazodone-common-sleep-drug-is-little-known-antidepressant/index.htm

What are the top prescribed drugs for insomnia—Ambien? Lunesta? Yes, but there's another: a three-decade-old generic antidepressant called trazodone, which causes drowsiness as a potentially useful side effect. A recent U.S. study in the journal Sleep found it to be one of most commonly used medications to treat sleeplessness.

Trazodone was first approved by the Food and Drug Administration in 1981 as an antidepressant. Though doctors can legally prescribe trazodone (and all drugs, for that matter), for any treatment, the drug is actually not approved to treat insomnia. Today, there's no branded form of trazodone—you can only get it as a generic—but there is a long-acting version available called Oleptro.

In a few studies, trazodone is reported to improve sleep during the first two weeks of treatment. But the drug has not been studied for longer than six weeks, so little is known about how well it works or its safety past that point. Also, an effective dose range has not been studied.

There's very little clinical trial evidence on whether it's effective as a sleep aid when a person does not have depression, and only modest evidence when there is. Treatment guidelines from the American Academy of Sleep Medicine recommend trazodone for chronic insomnia without depression only when drugs like Ambien and Lunesta have failed.

But numerous doctors are convinced, based mainly on their own experience, that trazodone is an appropriate sleep medication for many people, even when there's no depression. Here's why trazodone has become so popular—and what to do if your doctor suggests you try it.

Trazodone: Risks and benefits

While trazodone is rarely used to treat depression alone any more, it's widely prescribed, off-label, at lower doses for treating insomnia, for several likely reasons.

First, trazodone has one distinct advantage—and possibly a few others. It's generic, so it's considerably cheaper than many of the other widely prescribed sleep medications—about $3 for a week's supply. That's compared to other sleep drugs like generic zolpidem (Ambien), generic eszopiclone (Lunesta) or generic Sonata (zalepon) that run about $15 for a week's supply. And while some of the insomnia drugs are classified by the FDA as controlled substances that require doctors and pharmacists to take additional steps before they're prescribed or dispensed; trazodone is not a controlled substance, so doctors can prescribe it without those constraints.

In addition, many physicians apparently believe that trazodone is safer than other frequently prescribed sleep medications. But because there are not studies that actually show it is safer, whether or not that is true remains unknown.

It's true that the other drugs approved to treat insomnia can impair your ability to recall new experiences, and may even—although rarely—cause you to walk, eat, have sex, or drive a car while still essentially unconscious. We could find no evidence to date of those problems having been reported with trazodone. Moreover, many doctors seem to believe that trazodone is less likely than even the newer sleep drugs to cause dependency and, when discontinued, renewed insomnia. Yet there's little evidence to prove or disprove those ideas.

And, trazodone has certain risks of its own. In particular, it's more likely than the newer sleep drugs, particularly the short-acting ones, to leave you feeling drowsy the next day, which increases the chance of accidents. It can also cause abnormally low blood pressure and, in turn, dizziness or even fainting, particularly in seniors.

Trazodone can also cause heart-rhythm disorders. It might possibly weaken the immune system. And some evidence suggests it can cause priapism, or persistent erection, a medical emergency that may require surgery and can lead to impotence if not treated promptly. Moreover, a black-box warning in the package insert notes that trazodone, like other antidepressants, can increase the risk of suicidal thoughts and behavior in children and adolescents.

Trazodone: Should you take it?

For the average person who has occasional brief bouts of insomnia, making certain changes to your lifestyle may help, including: avoiding big meals, alcohol, smoking and exercising late at night or working or watching TV in bed. (See sidebar for a full list.) If those don't work, our medical advisors recommend first trying an inexpensive over-the-counter drug containing an antihistamine such as diphenhydramine (Benadryl, Nytol, Sominex, and generic) or doxylamine (Unisom Nighttime Sleep-Aid and generic)—but only use those for a few nights.

If your insomnia last longer than a few nights and this continues for several weeks, you should see your doctor to determine if other conditions or drug side effects could be disturbing your sleep. If those are ruled out—or if your insomnia persists despite treatment of the underlying problem—nondrug sleep treatments such as cognitive behavioral therapy appear to yield better, more lasting results than medication. If possible, try that before resorting to medication, which can undermine your motivation to make the behavioral changes.

If your doctor recommends sleeping pills for more than a temporary bout of insomnia without mentioning nondrug therapy, you should mention it yourself. For more on such treatment, see our Best Buy Drug report on drugs to treat insomnia.

Of course, medication is sometimes needed for persistent insomnia—when nondrug treatment is refused, unavailable, or ineffective, or when the sleep disturbance is affecting your ability to carry out your daily activities. Here are the main considerations for using drug trazodone to treat insomnia:

• Insomnia without depression. Because there's so little supporting evidence, sleep experts generally recommend trazodone for insomnia only after the newer sleep drugs have failed. Trazodone may improve sleep initially, as found in one small study, but that effect could fade after several weeks. Researchers theorize that this could be due to residual sleepiness in the daytime, so a person is less physically active , which may contribute to the ability to sleep well at night.
• Insomnia with depression. Some conditions, such as depression, have a complex and intertwined relationship with insomnia, and the best treatment for these two issues together has not been determined. If you have both, discuss the options with your doctor, based on the severity of the depression, the nature of your sleep problem, your medical history and susceptibility to side effects, any possible drug interactions, and, of course, your personal preferences.  

Usually, the most important consideration is managing the depression, which should be treated separately with a more effective antidepressant medication, counseling, or both. A separate drug can then be prescribed for the insomnia—either a newer sleep medication or low-dose trazodone. Studies have suggested that trazodone plus another antidepressant can improve sleep in these cases. Alternatively, trazodone might be taken alone, at a higher, antidepressant dose, to treat both problems.

Although trazodone may improve sleep at first, the effect may not continue past several weeks. Taking trazodone may also worsen sleepiness during the daytime, and morning grogginess. Plus, the side effect of sedation may not actually improve depression or insomnia.

Precautions to take

• Because trazodone may not work well to treat insomnia after a few weeks, check in with your doctor periodically to discuss how or if it's still working.
• If you have trouble getting to sleep, take it several hours before you go to bed; if you have trouble staying asleep, take it within 30 minutes before bedtime.
• Avoid trazodone if you're recovering from a heart attack. Inform your doctor if you have abnormal heart rhythms, weakened immunity, active infection, or liver or kidney disease. Use it cautiously if you have heart disease.
• Watch for adverse effects. That's especially important for people over age 55 or so since they're more susceptible to falls caused by dizziness or drowsiness and to abnormal heart rhythms. Close monitoring is also crucial if you're taking trazodone with another antidepressant.
• As with any sleep medication, never mix trazodone with alcohol, and use it cautiously if you're taking other sedating medications or antihypertensive drugs. Ask your doctor or pharmacist about other possible drug interactions.
• If you develop an erection that is unusually prolonged or occurs without stimulation, discontinue the drug and contact your physician. Also call your doctor if you develop fever, sore throat, or other signs of infection while taking trazodone.

Poor sleep habits and how to correct them

 

Watching TV in bed	Don't. TV viewing is not conducive to calming down.
Computer work in bed	Don't work on a computer at all for at least an hour before going to bed.
Drinking alcoholic or caffeinated drinks at night	Don't drink either for at least 3 hours before going to bed.
Taking medicines late at night	Many prescription and nonprescription medicines can delay or disrupt sleep. If you take any on a regular basis, check with your doctor about this.
Big meals late at night	Not ideal especially if you are prone to indigestion or heartburn. Allow at least 3 hours between dinner and going to bed.
Smoking at night	Don't smoke for at least 3 hours before going to bed. (Better yet: quit!)
Lack of exercise	Just do it! Regular exercise promotes healthy sleep.
Exercise late at night	A no-no. Allow at least 4 hours between exercise and going to bed. It revs up your metabolism, making falling asleep harder.
Busy or stressful activities late at night	Another no-no. Stop working or doing strenuous house work at least 2 hours before going to bed. The best preparation for a good night's rest is unwinding and relaxing.
Varying bedtimes	Going to sleep at widely varying bed times -- 10:00 p.m. one night and 1:00 a.m. the next -- disrupts optimal sleep. The best practice is to go to sleep at around the same time every night, even on the weekends
Varying wake-up times	Likewise, the best practice is to wake up around the same time every day (with not more than an hour's difference on the weekends).
Spending too much time in bed, tossing and turning	Solving insomnia by spending too much time in bed is usually counter-productive; you'll become only more frustrated. Don't stay in bed if you are awake, tossing and turning. Get up and do something else until you are ready to go to sleep.
Late day napping	Naps can be wonderful but should not be taken after 3:00 pm. This can disrupt your ability to get to sleep at night.
Poor sleep environment	Noisy, too hot, uncomfortable bed, not dark enough, not the right covers or pillow -- all these can prevent a good night's sleep. Solve these problems if you have them.

Editor's Note: 

This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).