Volume 5, Number 2

MRSA Poses Tough Decisions for Hospital Administrators; Studies Mixed on Benefits of Universal Screening To universally screen or not to universally screen? That is the question many hospital healthcare professionals are pondering in their fight against MRSA (methicillin-resistant Staphylococcus aureus). Unfortunately, a clear answer may not be available anytime soon.

Initial studies on the value of universal MRSA testing show conflicting results. A study in the Journal of the American Medical Association (JAMA) released in March showed little benefit in widespread screening at a Swiss hospital.1 Yet that same month a study published

in the Annals of Internal Medicine detailed how one community health system in Illinois cut its MRSA infection rates by 70 percent with universal testing.2

“The medical evidence [on universal screening] is not definitive yet,” said Nancy Foster, vice president for quality

and patient safety policy for the American Hospital Association (AHA).

Foster said that while evidence for universal testing is insufficient, medical evidence support-ing the practice of screening high-risk individuals is clear. “We are encouraging hospitals to know the prevalence of MRSA in their communities so that they can take the appropriate action,” Foster said.

In the JAMA study, Swiss researchers screened surgery patients admitted to the University of Geneva Hospitals over a two-year period; a control group of surgery patients was admitted without MRSA screening. Patients who tested positive for MRSA were put in isolation,

continued on p. 2

Also in This Issue:

Home Care Happenings ...........2

Legislative Corner ...................... 3

Mark Your Calendar .................. 4

Upcoming Trade Shows ............ 4

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home care services, delivering a mix of news and trends in healthcare

and up-to-date information about our clinical programs and services

HC Spectrum®

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Initial studies on the value of universal MRSA testing show conflicting results.

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scrubbed with disinfectants, and given antibiotics. Despite those interventions, the rates of hospital-acquired MRSA infections between the tested group of patients and the control group of untested patients were not significantly different.

Quite different results were reported in a study in the Annals of Internal Medicine. Researchers monitored MRSA infection rates at Evanston Northwestern Healthcare’s three hospitals in Evanston, Ill. All three hospitals practice universal testing. During the two-year study period, the hospitals reduced MRSA infection rates by 70 percent.

Whether universal or selective, the issue of MRSA screening has crept its way into the legislative arena with proposals to mandate screening and infection reporting. Last year, Illinois became the first state to enact a law requiring hospitals to test all at-risk patients for MRSA.*

David Allen, associate director of media relations for the AHA, said the association is careful to remind the public that screening—universal or selective—is just one weapon in the MRSA-fighting arsenal. Appropriate use of antibiotics, hospital hygiene, controlled ventilation systems, and other measures are equally important. “Active surveillance is not a silver bullet. It is just one of many tools at a hospital’s disposal for controlling MRSA,” Allen said.

* For information about MRSA-related legislation in your state, visit the web site of the Association for Professionals in Infection Control & Epidemiology (APIC) at www.apic.org and click on the legislative map under the Public Policy section. Allen, David. Telephone interview April 28, 2008.Foster, Nancy. Telephone interview April 30, 2008.

Home Care Happenings USP Revisions to Sterile Compounding Standards Now in Effect It’s official. Six months after the U.S. Pharmacopeia (USP) released its revisions to chapter 797 on sterile compounding, the revised chapter became official June 1. Among the changes, the new version of chapter 797: • Describesthatthischapterisintendedtoapplytoallpersonswhopreparecompoundedsterile preparations (CSPs) and all practice settings where CSPs are prepared • PlacesgreateremphasisonindividualtrainingandevaluationofthoseinvolvedinCSPs • Recognizesthenewcategoryofimmediate-useCSPandoutlinesthecriteriathatmustbemetfor waiving low-risk-level CSP requirements • Makesanallowanceforfacilitiesunabletolocatelaminarairflowworkbenchesorbiologicalsafety cabinets in a class 7 buffer area, as defined by the International Organization for Standardization • Outlinessignificantnewregulationsonthehandlingofhazardoussubstancessuchaschemotherapy medications

The revised chapter is available for purchase at www.usp.org.

Walgreens-OptionCare Receives ACHC Accreditation Moving forward with its post-acquisition consolidation, Walgreens-OptionCare in April received national accreditation with the Accreditation Commission for Health Care, Inc. (ACHC). Paul Mastrapa, executive vice president of Home Care, said the accreditation is a testament to the company’s ongoing commitment to clinical excellence in patient care. “We’re especially proud that this national accreditation was attained with no deficiencies,” Mastrapa said.

HC Spectrum

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MRSA (continued from p. 1)

©2008 Walgreen Co. All rights reserved. Volume 5, Number 2

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The ACHC accreditation went into effect April 16, 2008, and applies to all Walgreens- OptionCare facilities. “We are pleased to share that through the consolidation process, policy and procedure review, and ACHC survey preparation, we achieved accreditation without any lapse in our status,” said Dorinda Belcher, co-director of Accreditation.

ACHC is a private, not-for-profit corporation that is certified to ISO 9001:2000 standards and was developed by home care and community-based healthcare providers to help companies improve business operations and quality of patient care.

Legislative Corner Medicare Approves Home Sleep TestingAfter months of review, the Centers for Medicare & Medicaid Services (CMS) in March approved home sleep tests for the diagnosis of obstructive sleep apnea. The coverage details have yet to be worked out, but the approval paves the way for less expensive diagnostic testing. Home testing devices cost about 35 percent less than an overnight test at a sleep clinic. Some private insurers already cover at-home testing but more may follow suit in the wake of CMS’s approval.

FDA News•PeoplewithCrohn’sdiseaseandthephysicianswhotreatthemcannowaddCimzia® to their biologic therapy options. The Food and Drug Administration (FDA) in April approved Cimzia for the treatment of adults with moderate to severe Crohn’s disease who have not responded to conventional therapies. Developed by UCB, Inc., Cimzia requires an injection every two weeks for the first three injections. Once benefit has been established, Cimzia is administered once every four weeks. Common side effects include headache, upper respiratory infections, abdominal pain, injection-site reactions, and nausea. •TheFDAinMayapprovedthefirstroom-temperaturehemophiliatreatmentformulation. NovoSeven® RT, developed by Novo Nordisk, is a recombinant product available at room temperature for the treatment of bleeding episodes in patients with hemophilia with inhibitors. In addition to not requiring refrigeration, Novo Seven RT is also highly concentrated for lower infusion volumes and quick administration. The medication will be available in August. •In the Pipeline - A new medication for the prevention of respiratory syncytial virus (RSV) is showing early promise as a more potent alternative to Synagis®. Numax® (motavizumab) is a third-generation anti-RSV product developed by MedImmune and AstraZeneca. Like Synagis, Numax is a monoclonal antibody administered by intramuscular injection. In phase III clinical trials, however, Numax has shown greater efficacy. In one phase III trial, Numax had a lower incidence of RSV hospitalizations. Although the incidence rate was low for both groups (Numax 1.4 percent, Synagis 1.9 percent), the difference was statistically significant. MedImmune and AstraZeneca filed a biologics license application for Numax in January and expect a response by November 2008.

Currently, Synagis is the only anti-RSV medication approved by the FDA for the prevention of RSV in high-risk infants. Walgreens-OptionCare provides Synagis prophylactic services throughout the nation with our RSV Prevention Program. The program offers two convenient options: medication delivery to the prescriber for Synagis administration in the office or to a patient’s home for administration by one of our nurses. With a committed team of pharmacists, nurses, patient care coordinators, and insurance specialists, we deliver an exceptional level of care. Ask your account executive for more information about our RSV Prevention Program.

3©2008 Walgreen Co. All rights reserved. Volume 5, Number 2

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To initiate a referral, contact your local Walgreens-OptionCare. You can also refer to us through the ECIN online

referral service or email homecare@walgreens.com. For general information about Walgreens-OptionCare programs

and services, email homecare@walgreens.com.

Editorial Board

Editor Gail Murphy Consultant Linda Lampinen; Tom Rout, RPh; Lisa Siefert, RPh Designer Maria Perez

Brand names are the property of their respective owners.

Articles in HC Spectrum may be reprinted only by clients, or respective agent(s) of clients, of Walgreens-OptionCare. Please attach the following statement: Reprinted with permission. ©2008 Walgreen Co. All rights reserved.

©2008 Walgreen Co. All rights reserved. Volume 5, Number 14 HC8661A-0608

HC Spectrum

Mark Your Calendar For a list of this year’s national observances, visit the National Health Information Center’s website at www.healthfinder.gov/library/nho.

Look for Us at These Trade Shows American Association of Heart Failure Nurses (AAHFN) 2008 Oley Conference

June 26 – 28 Boston, Mass.

Westin Boston Waterfront www.aahfn.org

June 26 – 30 San Diego, Calif.

Marriott Mission Valley www.oley.org

3rd Annual ACMA Georgia Chapter Conference 5th Annual ACMA Florida Chapter Conference

July 19 Atlanta, Ga.

Emory Crawford Long Hospital – Glenn Auditorium www.acmaweb.org

July 31 – August 1 Orlando, Fla.

Renaissance Orlando Hotel Airport www.acmaweb.org

American Association of Respiratory Care Forum CMSA Houston Chapter Annual Educational Conference

July 9 – 14 Phoenix, Ariz.

Pointe Hilton Tapatio Cliffs Resort www.aarc.org

September 10 Houston, Texas

George R. Brown Convention Center www.cmsahouston.com

For a full list of upcoming trade shows, go to WalgreensHomeCare.com and view the Trade Show Calendar.

References 1. Harbarth S, Fankhauser C, Schrenzel J, et al. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA. 2008;299:1190-1192.

2. Robicsek A, Beaumont JL, Paule SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med. 2008;148:474-476.

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