Survey finds risky use of syringes and needles

By Michael C. Cohen, president of the Institute for Safe Medication Practices

A survey of 5,446 health-care practitioners published last week reveals alarming lapses in how some of them use syringes, needles, drug vials, and solutions to flush intravenous tubings.

While most nurses and others report following good practices, some put patients at risk for blood-borne diseases, the study in the American Journal of Infection Control found.

At issue is reusing injection equipment on more than one patient. The survey found:

Nearly 1 percent of respondents admitted to sometimes or always reusing a syringe on more than one patient after only changing the needle.

Six percent admitted to sometimes or always using single-use vials for multiple patients. These vials lack preservatives, so they can support growth of contaminants between uses.

Fifteen percent reported using the same syringe to re-enter a multiple-dose vial numerous times; of this group, about 7 percent reported saving these multiple-dose vials for use with other patients. If a contaminated syringe is used, the solution is contaminated.

Nine percent sometimes or always use a common bag or bottle of IV solution as a diluting agent for drugs for multiple patients or to clear IV tubing. These solutions also lack preservatives and can become contaminated if used for multiple patients.

Each practice has been linked to spreading disease and is explicitly prohibited in the government recommendations.

This shows there is a general lack of awareness regarding safe infection control practices as well as numerous misconceptions.

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Ariz. ends Medicaid coverage for transplants

By Robert Field, a law and public health professor at Drexel University

Remember the dire warnings about the future of health care under reform? That rationing and death panels would come between you and your doctor? Well, the future has arrived three years before Obamacare fully takes effect. And lifesaving care is being rationed not by the federal government but by the red state of Arizona.

Faced with a serious budget shortfall, Arizona opted to save about $4.5 million a year by terminating Medicaid coverage for transplants, including those of the heart, lung, pancreas, and bone marrow.

Transplants are already rationed because of the limited supply of organs. The procedure is used based on such factors as the patient's health and likelihood of doing follow-up care. Arizona's plan, by contrast, rations transplants just to save money.

Transplants are a treatment of last resort. The alternative is death. About 100 Medicaid patients are on Arizona's transplant waiting lists, and have no medical alternative.

The cuts were signed into law by Gov. Jan Brewer, a Republican, after a state review questioned the effectiveness of transplants for saving lives. Most physicians would be surprised by this conclusion. Transplants have added decades to the lives of countless patients.

To be fair, the cost pressures on Arizona are real. And health-care rationing based on finances is not new.

Access to many kinds of care is routinely denied to those who lack insurance. What is different in Arizona is that the government is turning aside people who had previously been covered.

Arizona may yet relent.

But note that rationing arose not from a particular ideology but from exploding health costs and limited options for controlling them. What we need now is not more scare stories but a serious debate over how to resolve the cost dilemma.