‘Superbug’ scourge spreads as U.S. fails to track rising human toll • Hacker News Board

Re: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

#131

Post by sqeaky » Thu, Sep 08, 2016, 10:52 PM UTC

trhway wrote: post #99

sqeaky wrote: post #93

Earlier quoted context omitted.

I would much rather pay 1% more for my food than 10% more for may healthcare. For many there will be no amount that can be paid to keep up with antibiotic resistant bacteria, it will kill people. I am sure that farmer's would rather risk their livestock than risk their children or grandchildren. I think the only way this practice can exist is when people do not understand or are coerced into doing it. Many of the lar…

>I am sure that farmer's would rather risk their livestock than risk their children or grandchildren. you're kidding right? sure economical impact today vs. theoretical risk to grand/children tomorrow - Nov 8 will show how many people and of what demographics what choice would make, and I'm somehow sure what choice the farmers would make :)

I am not kidding. I am in one of those red states at the moment and most people doing the farming literally do not believe or accept anthropogenic global warming.

When the discussion is calm enough, they do largely agree that they wouldn't do anything harmful to their children or their farm's legacy. The just don't think global warming is real so their low mpg cars don't contribute to harming their farm.

Combine this with the fact that people defending a stance often become emotionally entrenched and likely they will continue to believe global warming is not real until they can no longer plant corn. Then once that emotionally devastates them, or some similarly life shattering cognitive dissonance destroying event occurs, they can take a look with fresh eyes.

EDIT - I know this is mostly about glbobal warming and the original discussion related to antibiotic resistance, but largely the resistance is from uneducated super-conservative people with a fundamental religion and a fundamental distrust of science. I really see these two problems as two sides of the same coin.

Re: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

#132

Post by apathy » Thu, Sep 08, 2016, 11:25 PM UTC

thr0waway1239 wrote: post #123

apathy wrote: post #103

Earlier quoted context omitted.

Or (perhaps more likely) Medicare/Medicaid and/or private insurers might start penalizing the ones that are screwing it up (by renegotiating contracts and reimbursements). I know of one center where executive laziness led to a $2 million fine (completely unjustified) for a line infection in an immunosuppressed patient. Which was cleared up in hours, probably didn't come from the line to begin with, and got said execu…

Sorry, I am a little confused. Why was it a happy ending? Because the VP was just a titular post? Also, looking at your comment, it reads like the problem went away not because the hospital improved, but because the data stopped being reported. This does not look like a happy ending either. And if the line infection was cleared up in hours, how did it also "probably didn't come from the line to begin with"?

The VP was a douche and the "line infection" was almost certainly not from a line in the first place. The patient was on IST, so calling any random opportunistic infection a central line infection is (at best) irresponsible.

Reporting incorrect data can be worse than reporting nothing at all. Here are the guidelines: http://www.cdc.gov/nhsn/pdfs/faqs/faqs-v-6_clabsi.pdf

CLIs are only supposed to be reported when the central line can reasonably be implicated as the vector and the blood is the primary infection site. Neither was established.

As far as cleaning up procedures, there will always be room for further improvement, but that's no reason to accept a $2 million fine (which still had to be paid) as a cost of doing business when the "root cause" was incorrect reporting.

Re: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

#133

Post by chmaynard » Sun, Sep 11, 2016, 1:10 PM UTC

maxerickson wrote: post #22

anonymfus wrote: post #20

Earlier quoted context omitted.

Non-native speaker here, I would probably express my condolence in the same way ("I'm sorry for your loss"). What is so wrong with these words that they deserve WTF?

chmaynard decided to retract what they had said earlier.

That's correct. I realized my remarks were insensitive after several readers downvoted them.

Re: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

#134

Post by daveloyall » Tue, Sep 13, 2016, 9:18 PM UTC

daveloyall wrote: post #64

Hello. I work for public health. My job is to support the computer systems that allow epidemiologists to track 'superbugs' (and regular ones). Deathcerts is an interesting dataset. It's not the only one. Even if death-by-MSRA isn't tracked, I assure you that MSRA itself is tracked. There's a specific class of lab test called "antibiotic susceptibilities". The results report includes a bunch of numbers that represent…

Update... I asked around the office and learned more about this. TL;DR: I'm less right than I thought.

Specifically regarding tracking cause of death:

Not every disease or condition is "reportable". Each state maintains a list of reportable diseases. When a hospital/lab (hereafter: facility) encounters a disease on the list, then they are required to report it.

State health departments will open investigations in various circumstances. You've seen events like e. coli outbreaks in the news--those always precipitate an investigation. There are also investigations associated with individual infections, i.e. every case of tuberculosis.

If a patient involved in an investigation dies, public health will find out.

But, if a patient dies from (because of) an infection that wasn't on the reportable list, then public health won't know the cause of death unless it is on the death certificate. Just like the article says!

Regarding tracking the susceptibility of bacteria to antibiotics (superbugs):

Any sample that is tested for antibiotic susceptibility is reportable. The results of that testing generally include the specimen source, but don't include why the test was ordered (i.e. because some person has sepsis and might die) and certainly there's no (deliberate) relation between this data and cause of death.