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'Superbugs' create new challenges for hospital supply chain

Though antibiotic-resistant bugs aren’t new, their rise in U.S. healthcare institutions is leading hospitals to stock up on supplies.

Opportunities are opening up for hospitals' supply chain and materials management executives to add to their institutions' superbug battle-gear, particularly when it comes to infection prevention and detection.Opportunities are opening up for hospitals' supply chain and materials management executives to add to their institutions' superbug battle-gear, particularly when it comes to infection prevention and detection.

Though antibiotic-resistant "superbugs" aren't new, their rise in U.S. healthcare institutions is leading hospitals to stock up on supplies to combat them.

The White House held a summit in June about combating antibiotic-resistant bacteria with a focus on reducing the use of antibiotics in livestock. This followed President Obama's Executive Order this past fall, on detecting, preventing and controlling antibiotic resistance through strategic and sustained efforts; and the administration's subsequent plan to fight the spread of antibiotic-resistant microbes over the next five years.

Many hospitals and clinicians already have established infection prevention policies for key resistant organisms that are based on national standards, said Kristi Kuper, clinical pharmacy manager for VHA Inc., the largest member-owned healthcare company in the country. Antibiotic stewardship programs also have been put in place, led by pharmacists and physicians, to help improve appropriate use of antimicrobials, she adds, though they vary in degree from being partial or informal implementations to full-scale, formal efforts.

[Also: Tackling superbugs, 'crisis of this generation']

Equally important is that opportunities are opening up for hospitals' supply chain and materials management executives to add to their institutions' superbug battle-gear, particularly when it comes to infection prevention and detection.

"There are unique infection prevention devices out on the market today such as ultraviolet light robots or machines that aerosolize different liquids that then dry on the surfaces and kill bacteria," Kuper said. UV light or hydrogen peroxide devices can come into use in patient rooms, operating rooms, ICUs and burn units. But they represent a significant capital investment, she said, so hospitals must first decide how such devices will be incorporated into hospital policies, procedures, workflow and training processes.

Supply chain transactions may also soon incorporate orders for medical devices that should be less susceptible to harboring deadly bacteria. Some existing medical devices have been shown to be the source of outbreaks of drug-resistant bacteria. Duodenoscopes, which diagnose and treat problems in the pancreas and bile ducts, have been linked to superbug outbreaks at facilities including UCLA's Ronald Reagan Medical Center and Seattle's Virginia Mason Medical Center.

"The design of these scopes are complex, which is great because they can do more for clinicians, but it's a very labor-intensive process to clean them prior to disinfecting or sterilizing them, or those steps are not as effective," said Lise Moloney, director of business development, healthcare, at Sciessent. "Even following the manufacturer's instructions for cleaning and reprocessing, the risk of a technician missing a step or misinterpreting what scrubbing hard means is high. The human factor is always an issue."

[Also: 'Superbug' infections sicken four patients at Cedars-Sinai]

Sciessent is working closely with medical device manufacturers to incorporate antimicrobial additives into products like duodenoscopes and other invasive devices, such as central venous catheters. It's also targeting non-invasive patient monitoring systems that travel from room to room, potentially taking drug-resistant bacteria with them. In all these cases, this provides a second line of defense against superbugs beyond manual cleaning and reprocessing.

"From a supply chain standpoint, you are looking at potentially higher costs to buy devices with antimicrobial additives," Moloney said. "But hospitals need to think of what having a new way of preventing antibiotic-resistant infections can save them." In the best case, affected patients survive but stay longer and cost more to treat, and CMS won't pay for certain types of infections caused by drug-resistant organisms such as MRSA if patients contract them while they're at the facility. 

Kuper also thinks it is likely that hospital CFOs and VPs of supply chain will get more involved in the battle against superbugs when they start to hear microbiology labs making business cases to invest in rapid diagnostic testing equipment that can identify bacteria within a very short timeframe.

"We are seeing more and more interest in acquiring this technology, and the government has even incentivized manufacturers to develop new technology with the award of a $20 million dollar prize [for fostering private-sector innovation in the area]. This is definitely an area of high impact from a financial perspective," she said.

[Also: 'Superbug' scopes lacked FDA clearance]

Using this technology, doctors can avoid prescribing broad spectrum antibiotics when they're really not warranted--which reduces the risk that brings of breeding bacteria that's later resistant to first-line treatments. Again, this can be a pricey proposition, anywhere from $10,000 to a quarter of a million dollars, depending on the equipment.

"It's very powerful, because getting patients on the appropriate antibiotics upfront is significant and can save lives," Kuper said.

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The reasons to look more closely at such preventive and detective technologies seem prudent particularly in light of the fact that pharmaceutical companies aren't spending as much money on research and development of new antibiotics as they used to. The return on investment simply isn't there as compared to developing treatments for chronic conditions, for example.

"Fewer new antibiotics are coming out with novel mechanisms of action," said Ron Hartmann, senior vice president, pharmacy, at healthcare performance improvement company MedAssets. "There haven't been many major breakthroughs when it comes to treating some resistant infections."

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