QUALITY: Betsy Lehman redux, patient safety crisis continues

I was gobsmacked when I heard this on the local news today. A patient at San Mateo Medical Center (San Mateo is the small county immediately south of San Francisco and north of Silicon Valley/San Jose) died after being given 10 times the correct chemotherapy dose. We all know that medical errors are a problem that still exists, but this error was exactly the same as that which killed Betsy Lehman, the health columnist of the Boston Globe at Dana Farber cancer center in 1994. Betsy’s death was part of the groundswell that ended up 5 years later in the IOM “to Err is Human” report.

Nearly five years after the report and ten years after the tragedy in Boston, it’s clear that this is still a frequent occurrence. San Mateo Medical Center will hold an enquiry, but it’s almost certain that a miscommunication between the nursing, medical and pharmacy staff, without adequate process or technology back-up systems, is to blame. And there’s been plenty of time for the health care system to call attention to that, but as Michael Millenson says it’s mostly been silence.

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  2. (WHH)
    Blasts of Dry Air Eradicate Lice
    Parents around the world breathed a sigh of relief when the cure for lice was finally reported by medical researchers. According to “Pediatrics” and other reliable medical journals the method proven most effective is to blast the hair from the roots up with dry air. The method is similar to common hair dryers, only more air and less heat. About a half hour of dry air dessicates the lice and continued bi-weekly sessions keeps hair free of lice, without chemicals, pain or tears. A study outlining dry-air blasting was published in the November 2006 issue of the journal “Pediatrics” as reported by Dale Clayton, a University of Utah biology professor who led the research.
    Each of the six treatment methods took 30 to 35 minutes and used air at about 140 degrees Fahrenheit at air pressure and speeds up to twice that of the common handheld hair dryer. Apparently, long blasts of warm dry air eliminates lice and nits (eggs) by drying them out, not by heating them.
    A note of caution, Clayton urges untrained parents not to use hot hair dryers to try to kill head lice. “We don’t want kids getting burned by parents who think it’s the heat” that kills lice, he says. Devices used were actually cooler than a hair dryer, but used twice as much air flow.
    Dry-air blasting requires that the base of the hair around the roots be thoroughly exposed to the blasts of warm, dry air. Since it is difficult to coordinate hand held dryers and combs and efficiently blast all the lice and nits with enough dry air, special dryers, air funnels and combs were used.
    Clayton conducted the study with Brad Goates, a University of Utah medical student who wrote his master’s thesis about dry-air lice cleaning; and Joseph Atkin, Kevin Wilding, Kurtis Birch and Michael Cottam, all of whom worked in Clayton’s lab as undergraduates; and Sarah Bush, who is Clayton’s wife and co-directs the Center for Alternate Strategies of Parasite Removal, a state-funded Center of Excellence working to commercialize the method. Clayton, Atkin and Wilding co-invented the devices used.
    A dry air fan with twice the air pressure of handheld dryers was used. In the best result, a plastic hose and hand piece with 10 coarse teeth (not like fine-toothed nit combs) was attached to the end of the dryer and raked through hair while hot air blew the opposite direction. All areas of the scalp were raked and exposed to hot air for at least 30 seconds. The handpiece killed 80 percent of hatched lice – a larger proportion than any of other methods tried – and 98 percent of louse eggs(nits).
    The hose and comb method not only had an immediate 80 percent result, the blasts of dry air also prevented remaining lice from breeding – possibly due to stress or sterilization – so virtually all lice were gone when examined one week following that treatment, the scientists reported.
    Here are other dry-air blasting methods tried, from least to most effective:
    — Air hoses from two bonnet-style hair dryers fed air into one bonnet doubling total air flow. This method killed 10 percent of hatched lice and 89 percent of eggs.
    — A handheld blow dryer was used to apply diffuse heating. Each child’s hair was divided into ten sections using hair clips, and the base of each section was heated three minutes while the dryer was moved to ensure even heating. This method killed 21 percent of lice and 97 percent of eggs.
    — A handheld blow dryer was used to apply directed heating. Hair clips were used to divide each child’s hair into 20 sections. The dryer was held still for 30 seconds to heat one side of each section, then held still another 30 seconds to heat the other side. This method killed 55 percent of lice and 98 percent of eggs.
    — A hose was attached to a wall-mounted blow dryer like those in public restrooms. The dryer was put on a table, and the hose used to treat hair divided into 20 sections. The method’s larger air volume killed 62 percent of lice and 97 percent of eggs.
    — With the hair divided into 14 to 20 sections, a double strength air flow hair dryer without a hand piece was used to treat each section with diffuse heat for 60 seconds. Air speed was similar to the restroom hand dryer. This technique killed 76 percent of lice and 94 percent of eggs.
    No problems were reported from stray lice that were blasted into the work area surrounding the children during treatments. Head lice cannot survive more than 24 hours off a host’s head.
    Children and their parents reported none of the treatments had adverse effects. Kids reported less discomfort from the dry-air blasting than from any other method. (WHH)
    Link to University of Utah report on treating lice with dry air.

  3. A health journalist takes on lice issues and gets them right. Happens way too infrequently so this is a news item to keep. Here’s link and a few paragraphs from it.
    Bear in mind that head lice are an annoyance, not a public health crisis. They rarely cause direct harm, and are not known to transmit infectious agents from person-to-person. However, since the head lice is closely related to Pediculus humanus humanus, the body louse, which does transmit such diseases as typhus, it is wise not to ignore the pathogenic possibilities of head lice.
    According to the Harvard School of Public Health, the basic reproduction number (a measure that defines the number of secondary infections arising from an index case) is far lower for head lice than for infections due to cold or flu viruses. This opens up the topic of the so-called no-nits policies that are in place in many school districts.
    On the one hand, if a child is barred from school for having nits, the condition can be easily cleared up within a day or two. On the other hand, some authorities drift toward political correctness by condemning such policies only because they SEEM to hearken back to lice-related ethnic prejudices of the past. Moreover, they claim that such policies are ineffective, conveniently ignoring the extreme difficulty in obtaining meaningful data on human diseases, especially those whereby treatment efficacy is almost completely dependent on parent effort. Clearly, if there are no nits in the school, there will be no cases of head lice!
    Finally, I can’t help but think that those against no-nits may harbor their own prejudices about putting public health into the hands of the public, and not esteemed authorities such as themselves.
    Lice are a nuisance, not a cause for panic, unless toxic remedies are brought to bear. Given enhanced means of communication, and the public’s continuing interest in good health, we should be able to vastly reduce the incidence of this parasite.
    Michael D. Shaw
    Exec VP
    Interscan Corporation