New Technology
Necrotic fungal infection a risk after disaster Survivors of natural disasters with penetrating wounds may be at greater risk for necrotizing fungal infections, a study found. A case-control study of survivors of a category-5 tornado found that patients with penetrating trauma were at a nearly nine-fold risk for mucormycosis by Apophysomyces trapeziformis infection, according to Benjamin Park, MD, of the CDC, and colleagues. Risk of infection among injured survivors was elevated
twofold for each additional wound with which a patient was afflicted, they wrote online in the New England Journal of Medicine. The authors noted that mucormycosis is a rare infec-
tion by molds – including Apophysomyces trapeziformis – common in soil and decaying wood and with an affin- ity for iron-rich and acidic environments. Infection with these fungi generally only affects immunocompromised patients, but can also occur “after trauma in immuno- competent persons.” Park and colleagues followed 13 patients injured
during a category-5 tornado in Joplin, MO, on May 22, 2011, who had necrotized soft tissue due to mucormy- cosis, and 35 control patients who were injured in the tornado but were otherwise healthy. Wounds were counted, classified as punctures,
lacerations, or abrasions, and categorized as blunt or penetrating. Patients affected with mucormycosis had samples taken, which were cultured or DNA-sequenced to identify the source of infection. All 13 patients tested positive for A. trapeziformis. The authors also noted that “all case patients had been located in the most severely damaged zone.” Patients with mucormycosis “underwent irrigation and
extensive surgical debridement” and received systemic antifungal therapy for the incident wound at a median half-day from time of infection (range 0 to 7 days). Five patients died within 14 days of wound culture
with an active fungal infection. However, “autopsy was not performed in any of the case patients who died, which made it difficult to determine conclusively whether these deaths were primarily due to mucormycosis,” they wrote. Compared with controls, case patients were: More
than seven times more likely to be admitted to the intensive care unit; More likely to have significantly more wounds; More likely to have puncture wounds; More likely to have penetrating trauma; Nearly seven times more likely to die. The elevated odds of dying did not remain significant
when the number of wounds was controlled for. Infec- tion was independently associated with number of wounds and penetrating trauma, the authors noted. They concluded that “increased awareness of fungi as a cause of necrotizing soft-tissue infections after a natural disaster is warranted.” Park and colleagues added that the FDA had, at the time of the study, only approved two anti-fungal agents (amphotericin B and posaconazole) for use against mu- cormycetes, making identification of mold affecting a patient crucial in treatment.
PRODUCTS & SERVICES
Disaster readiness, recovery in the dark?
Supply chains may be schooled, but progress may be relative by Rick Dana Barlow
M
uch of what passes for disaster plan- ning and preparedness these days seems to be nothing more than disas-
ter relief and recovery. Some may blend the concepts, using the
terms interchangeably but a fine line separates the two. Simply, disaster planning and pre- paredness involves the development of proto- cols and investments in technology to maintain routine or close-to-routine operations; disaster relief and recovery involves efforts to rescue people and salvage products to triage opera- tions and set up baseline alternative services. One is normal; the other is the “new” normal for a while.
Hurricane-turned-Superstorm Sandy slammed into the East Coast in late October, flooding parts of New York City and Hoboken, NJ, among other areas, along the way. The weather malady destroyed property, uprooted lives and lifestyles and choked supply lines. Initial shock and awe — despite numerous early warnings to evacuate based on Sandy’s path — gave way to selfless assistance before sliding into impatience and flared tempers as the “getting back to normal” seemed to be taking too long. To their credit, healthcare organizations slapped by Sandy were able to evacuate criti- cal patients, relocating them to other facilities. When the power went out, along with commu- nication lines, they turned to backup genera- tors to keep the lights on, computers running and other equipment functioning. When the backup generators ran out of fuel, however, they were stuck in the dark as floodwaters complicated access to fuel supplies. Since the early 1990s at least, healthcare or- ganizations faced myriad disasters from which to learn how to respond better for successive ones. They include the Mississippi River floodings in 1993 and 2011; North Dakota’s Souris River flooding in 2011; Hurricanes Andrew, Floyd, Isabel, Charley, Katrina and Rita; the Joplin, MO, tornado; earthquakes and mudslides in California; wildfires in Cali- fornia, Colorado and South Dakota; terrorist bombings in Oklahoma City and New York
42 January 2013 • HEALTHCARE PURCHASING NEWS •
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City; shooting rampages in Columbine and Aurora, CO, Blacksburg, VA, and Fort Hood, TX, among others. Through all of these disasters, hospitals and
other healthcare facilities reacted. But key questions remain. What have healthcare organizations really
learned from these disasters, why haven’t they developed and implemented effective proto- cols to maintain order and “routine” to enact when the next disasters strike, and what can they learn from the most recent East Coast’s reaction to Sandy?
Learning lessons History may translate into effective learn- ing experiences unless you blind yourself to hindsight. “Sandy reminded us that backup power for facilities is essential and must be drilled and embedded into the hospital culture,” said Christopher O’Connor, FACHE, President, GNY- HA Services Inc. and Nex- era Inc., and Executive Vice President, GNYHA Ven- tures Inc., New York. “In a post-Sandy world, with changing weather patterns all but guaranteeing that there will be a ‘next time,’
Christopher O’Connor
the location of key supplies and/or equip- ment must be reviewed. Communication is also critical. During the storm and for several days after, phone and cell phone service was spotty at best. Organizations should consider a review of their communications plans, what backup procedures are in place, and if any of those procedures can be improved.” Robert T. Yokl, Chief Value Strategist, Stra-
tegic Value Analysis in Healthcare, Skippack, PA, lost electricity for five consecutive days. As a result, Yokl emphasized the need to develop multi-dimensional over one-dimensional plans that account for myriad variables. “From our own experience with hurricane Sandy, we realized that we not only needed a plan ‘A,’ but we also needed a plan ‘B’ and
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PRODUCTS & SERVICES
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