MDS Alert

Published on Tue Jan 05, 2010 PDF

CMS recently announced its decision to pay for HIV screening for Medicare beneficiaries at increased risk for the infection.

That includes Medicare beneficiaries who request the screening without disclosing any high-risk personal behaviors. Many people think of HIV as a younger person's disease, but the statistics say otherwise. "Almost onefourth of all people with HIV/AIDS in this country are age 50 and older," states an article on HIV posted on the National Institute on Aging Web site.

The article points out that even more cases may exist. "One reason may be that doctors do not always test older people for HIV/AIDS and so may miss some cases during routine check-ups," the article states.

For additional information about the new HIV screening coverage, go to www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=229.

MDS coding tip: Whether the facility should code a diagnosis of HIV on the MDS is up to the individual state, says Joan Brundick, RN, state RAI coordinator for Missouri.

Thus, the facility MDS staff should check with their state RAI coordinator, she suggests.

If you're using Negative Pressure Wound Therapy (NPWT) devices (i.e., wound vacs), be aware of a new preliminary public health warning from the U.S. Food and Drug Administration. The "FDA has received reports of six deaths and 77 injuries associated with NPWT systems over the past two years," the agency reports in a Nov. 13 health notice. Most of the deaths and serious injuries related to NPWT systems occurred in the home or in long-term care facilities, the FDA says.

Bleeding represented the most serious wound vac-related complication, which was associated with six deaths and 17 injuries. "Extensive bleeding occurred in patients with blood vessel grafts in the leg, breastbone and groin wounds, those receiving medication for blood clots, and during removal of dressings attached to the tissues."

Twenty-seven reports involved "worsening infection from original open infected wounds or from pieces of dressing that remained in the wound," states the alert

(www.fdagov/MedicalDevices/Safety/AlertsandNotices/PatientAlerts/ucm190476htm).

Watershed study findings warn of bacterial biofilms in showerheads. The place where people go to get clean may actually be teeming with pathogenic bacteria. University of Colorado-Boulder researchers have discovered that some showerheads appear, in particular, to be home to Myobacterium avium, which can cause a non-tuberculosis type pulmonary infection, especially in people with impaired immunity. When turned on, the showerheads spew the organisms into the air. Using special molecular testing, the researchers found that 30 percent of about 50 showerheads in apartment buildings, homes and public places in several states appeared to shelter the bacteria in "slimy biofilms," according to a press release. The study appeared in Proceedings of the National Academy of Sciences (PNAS).

One of the researchers used bleach to combat Mycobacterium gordonae in a showerhead. Several months later, the showerhead showed the microorganisms had increased three-fold, according to the release.

"Metal showerheads load up with biofilm less than plastic, from our limited anecdotes," lead researcher for the study, Norman Pace, PhD, at the University of Colorado-Denver, tells Eli.

"The real problem, however, is the showerhead per se [because] it generates aerosols with particles sufficiently fine to penetrate the deep airways, and the bugs also are in the municipal waters,"

Pace adds. "To avoid aerosols take a bath or use a tube shower. The goal is to reduce generation of aerosols." Pace noted in the release that the affected showerheads probably don't pose a threat to people with healthy immune systems. "But it's like anything else -- there is a risk associated with it."

Next step: "The health risk associated with showerhead microbiota needs investigation in persons with compromised immune or pulmonary systems," state the authors in an abstract of their study in PNAS: www.pnas.org/content/early/2009/09/11/0908446106.abstract.