Overprescribed antibiotics under CDC’s microscope
As Ebola ravaged areas in West Africa this summer, medical experts around the world tried to calm fears that the deadly virus would spread to other countries.
An Ebola outbreak is unlikely in places like the United States, Japan or Switzerland that have strong healthcare response capabilities.1 There is, however, another global health threat sickening two million people each year in the United States alone and killing at least 23,000 of them—antibiotic-resistant bacteria known as superbugs.
Infectious disease experts point to the overuse and misuse of antibiotics as the major cause of superbugs. The Centers for Disease Control and Prevention (CDC) warns that immediate action must be taken before life-saving antibiotics are no longer effective. Last year, the CDC reported about half of antibiotics prescribed by doctors in the United States went to people who didn’t actually need them.2 Overuse and misuse of health treatments and services are two problems affecting healthcare quality and cost.
At a July press conference, CDC Director Thomas Frieden said the agency will isolate superbugs in medical facilities and eliminate them through more thorough tracking systems and tougher safety methods.
"We always want to be part of the solution, but sometimes in health we’re part of the problem," Frieden said.3
Too much of a good thing?
While antibiotics should be used to treat bacterial infections, they are not effective against viral infections responsible for the common cold, most sore throats and the flu, according to the CDC.4
A July 2014 Medscape survey of doctors showed physicians commonly prescribe antibiotics when they are unsure of an infection’s cause. Medical providers, on average, reported prescribing unnecessary antibiotics 20% of the time.5
Doctors reported increased pressure to meet patients’ expectations, and that their pay and performance may be linked to patient satisfaction. Though the extent is unknown, some clinicians said patients expect and demand antibiotics.
"It is very hard to get a patient out the door of the ED [emergency department] without a prescription for an antibiotic," said an emergency medicine clinician surveyed.
Another emergency medicine practitioner said, "Prescribing unnecessary antibiotics is quicker than taking the time to explain properly, and customers who don’t get antibiotics are much more likely to complain. Good medicine is taking a back seat to the ‘customer is always right’ mentality now prevalent in healthcare."
Several clinicians revealed they lost their jobs following complaints from patients who didn’t receive antibiotics.
One clinician responded, "I am in the waning days of employment at a privately owned urgent care center. One of the reasons cited for my departure was my reluctance to provide antibiotics ‘on demand.’ I was told that I was not responsible for antibiotic overuse and resistance. Needless to say, I am leaving, in no small part due to the emphasis on patient satisfaction over standards of care in this and other matters."
Antibiotic resistance costs the U.S. healthcare system $20 billion a year and it becomes more difficult to stop the longer it persists, Frieden said.6
"We talk about the pre-antibiotic era and the antibiotic era; if we’re not careful we will soon be in the post-antibiotic era," he said. "And, in fact, for some patients and some pathogens we’re already there."7
The World Health Organization recently reviewed how well antibiotics performed in 114 countries. In some places, antibiotics no longer work for half of all people being treated for common diseases.8
"Antibiotics are a natural resource, just like fossil fuels," said Ramanan Laxminarayan, a director at the Public Health Foundation in India. "Finding new ones will be hard and expensive. Penicillin costs pennies. Newer antibiotics may cost hundreds or even thousands of dollars."9
Restore development pipeline
It would seem another alternative solution is to create stronger antibiotics. But many drug makers are reluctant to develop new antibiotics.10
"From a strictly business standpoint, the terrible thing about antibiotics is they cure people," Frieden said. "That’s not a model for a highly lucrative pharmaceutical product—you want a product that has to be taken for a long, long time."11
During the 1970s, drug developers focused on noninfectious health problems, such as cancer and heart disease. In the past 30 years, no new types of antibiotics have been developed.
Systems to reduce misuse
In July, the CDC launched a new system that allows hospitals to track the antibiotics dispensed and obtain real-time patterns of antibiotic resistance so doctors can determine which antibiotics are most likely to work.12
As the healthcare system works to change its antibiotics-prescribing practices, researchers around the world are developing alternative methods to fight superbugs:
- A ward at Glasgow Royal Infirmary’s intensive care unit in Scotland is piloting the use of high-intensity narrow spectrum light to kill superbugs. The light is powerful enough to kill superbugs and poses no health risk to patients.13
- An engineering team at the University of California in San Diego is developing biocompatible, biodegradable nanosponges that soak up superbug toxins in the bloodstream.14
- Microbiologists at Victoria University of Wellington, New Zealand, are bio-synthesizing antibiotics. The microbiologists are rearranging the enzymes that comprise a specific antibiotic so the resistant bacteria won’t recognize it.
Biotechnologist David Ackerley, who oversees the research at Victoria University, likened the war against superbugs to an arms race that requires the constant development of new ammunition and weapons.
"If you’ve got rifles and your opponent suddenly develops tanks, you’re going to need armor-penetrating bullets," he said.15
by Megan Schmidt,
- Arthur Caplan, "Bioethicist: Why Americans Should Really Worry About Ebola," NBC News, Aug. 4, 2014, http://tinyurl.com/lhtf7c5.
- Esther Landhuis, "Superbugs: A Silent Health Emergency," Student Science, June 10, 2014, http://tinyurl.com/n9ldr58.
- Hoai-Tran Bui, "Antibiotic Resistance Could Be ‘Next Pandemic,’" USA Today, July 22, 2014, http://tinyurl.com/q2y7oqk.
- "Antibiotic Resistance Questions and Answers," Centers for Disease Control and Prevention, http://tinyurl.com/8azr73c.
- Laura A. Stokowski, "Can We Stop Overprescribing Antibiotics? Readers Speak Out," Medscape, July 17, 2014, www.medscape.com/viewarticle/827888_4.
- Bui, "Antibiotic Resistance Could Be ‘Next Pandemic,’" see reference 3.
- Ferdous Al-Faruque, "CDC Director Warns of ‘Post-Antibiotic Era,’" The Hill, July 22, 2014, http://tinyurl.com/pyceayb.
- Landhuis, "Superbugs: A Silent Health Emergency," see reference 2.
- Michaeleen Doucleff, "Last-Resort Antibiotics in Jeopardy as Use Rises Globally," NPR, July 9, 2014, http://tinyurl.com/ogkovla.
- Al-Faruque, "CDC Director Warns of ‘Post-Antibiotic Era,’" see reference 7.
- Alistair Grant, "Scots Hospital Ward in Anti-Superbug Light Trials," The Scotsman, July 31, 2014.
- Rebecca Jacobson, "Nanosponges Soak Up Superbugs and Even Snake Venom in Your Blood," PBS News Hour, May 2, 2014, http://tinyurl.com/lqgv9u5.
- Matt Stewart, "Scientists in Race to Beat Superbugs,"stuff.co.nz, July 22, 2014, http://tinyurl.com/kzdjwem.
Who’s Who in Q
NAME: Beth Cudney.
RESIDENCE: St. Louis.
EDUCATION: Doctorate in engineering management from Missouri University of Science and Technology in Rolla.
INTRODUCTION TO QUALITY: Cudney’s father was an industrial engineer, and she learned a lot about the impact of quality and quality engineering by watching him and listening to him talk about his work. Her first job out of college was as a quality engineer for the Spicer Axle Division of Dana Corp.
CURRENT JOB: Associate professor in the engineering management and systems engineering department at Missouri University of Science and Technology. Her research focuses on quality engineering, pattern recognition and healthcare systems.
OTHER NOTEWORTHY JOBS: Cudney served as a Six Sigma Black Belt and manufacturing manager at Jacobs Vehicle Systems, headquartered in Bloomfield, CT, where she led numerous lean implementations and kaizen events. She also developed a graduate-level Six Sigma course as an adjunct professor at the University of Hartford in West Hartford, CT. Doing this training and teaching led to her desire to become a professor and lead research in quality engineering.
ASQ ACTIVITIES: Cudney serves as editor of Quality Approaches in Higher Education, an online journal published by ASQ’s Education Division. She was the 2007 recipient of ASQ’s Feigenbaum Medal. Cudney also holds eight ASQ certifications.
ACTIVITIES/ACHIEVEMENTS: Cudney is president of the American Society for Engineering Management (ASEM). She is the past president of the Rotary Club of Rolla and has received the following honors: the Society of Manufacturing Engineer’s Outstanding Young Manufacturing Engineer Award, ASEM’s Outstanding Dissertation Award and the Institute of Industrial Engineer’s Lean Teaching Award. She is also a member of the International Academy for Quality.
PUBLISHED WORKS: Cudney has written four books on topics such as lean, hoshin kanri and Six Sigma. She also has contributed eight chapters to other books, authored 39 journal articles and written 68 conference papers.
RECENT HONORS: Cudney was part of the 2013 class of ASQ fellows.
PERSONAL: Married 16 years to Brian. They have two children.
FAVORITE WAYS TO RELAX: Spending time with family and watching the children’s activities.
QUALITY QUOTE: Quality is not a destination; it is a continuous journey to meeting and exceeding ever-changing customer requirements.
Study: Medication Safety Improves
While medication safety has improved, hospital-acquired infection rates are still troublesome, a new study of U.S. hospitals concluded.
The report from the healthcare watchdog group, Leapfrog, says the use of computerized physician order entry, an approach proven to reduce medication errors, has climbed. Some problems with performance of the systems persist, however, such as failure to alert potentially fatal medication errors.
Other findings from the Leapfrog report included:
- Dramatic improvement in areas of maternity care, especially in reducing early elective deliveries, with the average rate of early elective deliveries declining from 11.2% in 2012 to 4.6% in 2013.
- Better compliance with intensive-care unit physician staffing standards, shown to decrease mortality by as much as 40%. Notably, 41.7% of reporting hospitals fully meet this standard in 2013, compared to 39% in 2012.
For more from the report, visit http://tinyurl.com/nmbqlmd.
ISO 45001, which sets requirements for occupational health and safety management systems, has now reached committee draft stage. This draft standard, inspired by OHSAS 18001, is designed to help organizations ensure the health and safety of the people who work for them. For more information, visit http://tinyurl.com/k4ac4g8.
THE GOVERNMENT OF Prime Minister Narendra Modi in India proposed a sweeping change to ensure product quality and that substandard goods be automatically withdrawn from the marketplace, according to a recent report in the Economic Times, an Indian newspaper. The proposed change would allow the Bureau of Indian Standards to evolve as a national standards body for goods and services, with an emphasis on self-certification and market surveillance instead of inspection. To read the full story, visit http://tinyurl.com/pnhdh56.
NOMINATIONS FOR THE 2015 Harry S. Hertz Leadership Award are now being accepted by the Baldrige Foundation. The award is named for the long-time director of the Baldrige Performance Excellence Program, who retired in 2013. A description of the award, the award criteria and nomination process, and names of members of the selection committee can be found at http://tinyurl.com/pcx6tt5.
New Foundation Leader Named
Al Faber, president and CEO of the Partnership for Excellence in Columbus, OH, has been named the president and CEO of the Baldrige Foundation.
Faber will assume overall responsibility for the operation of the Baldrige Foundation, including all philanthropic, strategic and day-to-day functions. The foundation’s mission is to ensure the long-term financial growth and viability of the Baldrige Performance Excellence Program and to support organizational performance excellence in the United States and throughout the world.
The foundation’s board unanimously approved the appointment of Faber to the board and to his role as president and CEO.
Monréal, Former ASQ
El’as Monréal, an ASQ senior member and a former member of ASQ’s Board of Directors, died in late July. He was 41.
An ASQ member since 2000, Monréal served on the board from 2011-2013. He also served as ASQ Tucson-Old Pueblo Section chair, vice chair of the Section Affairs Council, Region 7 director and ASQ’s Measurement Quality Division membership chair. In addition, Monréal spent four terms as an examiner for the Arizona Quality Alliance’s state quality award.
Monréal, who worked as a quality engineer at Industrial Tool, Die and Engineering in Tucson, AZ, had been selected as one of QP’s "40 New Voices of Quality" (http://tinyurl.com/op73rb9) in a 2011 feature on up-and-coming individuals who would help shape the future of the profession.
Visit http://tinyurl.com/qjpl6oh for a full obituary.
Panel Disciplines Exam Proctor
ASQ’s Certification Board Ethics Subcommittee has disciplined an exam proctor who violated the nondisclosure agreement (NDA) the individual had signed.
In April, the subcommittee considered the case of the person who was performing duties as an ASQ exam proctor during the same period of time the person was teaching both ASQ certification refresher courses and refresher courses for alternative certifications that mirrored ASQ certifications. This action is in direct violation of the NDA signed by proctors, the subcommittee concluded.
As a result, the subcommittee barred the person from proctoring ASQ exam administrations permanently. The individual’s extant ASQ certifications also have been canceled, and the person is not allowed to sit for ASQ certification exams for five years.
UPDATED CASE STUDY ASQ’s Knowledge Center has updated a case study on the Wisconsin school district that received a Malcolm Baldrige National Quality Award last year. The case study, originally published in 2008, describes the Pewaukee School District and its 10-year journey, which culminated in the Baldrige honor in 2013. Visit http://tinyurl.com/p3pl6us to read the entire case study.
MEDAL RECIPIENT Manu Vora, an ASQ fellow, was named this year’s recipient of the Harrington/Ishikawa Medal, which recognizes individuals who contribute to the advancement of quality in the Asia-Pacific region. The Asia Pacific Quality Organization will present the medal to Vora at its conference in November in Kuala Lumpur, Malaysia.