Friday, February 20, 2015

Endoscopes and Drug Resistant Bacteria

There has been significant coverage of infections due to drug resistant bacteria related to the use of an endoscope.  One example of this coverage comes from from the Wall Street Journal.

The gist of the situation is this.  A medical device is used to help get a view of specific internal organs as a diagnostic procedure.  The device can have bacteria from the gut on it when it is removed from the patient.  There are directions for cleaning and sterilization that, if followed correctly, can make the device clean for use for the next patient.  However, at least a part of the standard procedure is performed manually and it has to be done meticulously and absolutely correctly in order to make the device completely safe for the next patient.

When the cleaning is not done correctly and the bacteria from the gut (where they can live safely for the person) end up someplace else, it causes an infection.  The bacteria are drug resistant as they create enzymes that break down the antibiotics.

How does this relate back to health care financing?

Someone has to make an assessment of the value of the device.  The device must be purchased and then it is use and its use is reimbursed.  This is part of the value proposition.

However, if the FDA, and other regulatory bodies, recognize the danger and can structure payment system incentives that make it costly to clean the device incorrectly that will help to limit the misuse of the device.  Potential penalties can also create an incentive or innovation with respect to the device or with respect to its post-use processing.  Anyone who can figure out how to make the device safer and commercialize that change can make a substantial amount of money.

Not using the device does not seem like a good option given that the Wall Street Journal article describes it as being used to diagnose diseases of the liver, bile ducts, and pancreas.

Thus, it will be interesting to see how strongly the FDA warns providers and patients against the use of this device and then to observe whether the manufacturer or users (as UCLA is said to have already gone beyond what the manufacturer recommends for cleaning and decontamination) are the first to find a way to innovate and improve the outcomes associated with this device.  

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