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TECHNOLOGY FOR PATIENT SAFETY 

AT VETERANS HOSPITALS 

JOINT HEARING 

BEFORE THE

SUBCOMMITTEE ON RESEARCH AND TECHNOLOGY 

& 

SUBCOMMITTEE ON OVERSIGHT 

COMMITTEE ON SCIENCE, SPACE, AND 

TECHNOLOGY 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

JUNE 26, 2014 

Serial No. 113–83 

Printed for the use of the Committee on Science, Space, and Technology 

( 

Available via the World Wide Web: http://science.house.gov 
(II) 

COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY 

HON. LAMAR S. SMITH, Texas, Chair 

DANA ROHRABACHER, California 

RALPH M. HALL, Texas 

F. JAMES SENSENBRENNER, JR., 

Wisconsin 

FRANK D. LUCAS, Oklahoma 

RANDY NEUGEBAUER, Texas 

MICHAEL T. MCCAUL, Texas 

PAUL C. BROUN, Georgia 

STEVEN M. PALAZZO, Mississippi 

MO BROOKS, Alabama 

RANDY HULTGREN, Illinois 

LARRY BUCSHON, Indiana 

STEVE STOCKMAN, Texas 

BILL POSEY, Florida 

CYNTHIA LUMMIS, Wyoming 

DAVID SCHWEIKERT, Arizona 

THOMAS MASSIE, Kentucky 

KEVIN CRAMER, North Dakota 

JIM BRIDENSTINE, Oklahoma 

RANDY WEBER, Texas 

CHRIS COLLINS, New York 

BILL JOHNSON, Ohio 

EDDIE BERNICE JOHNSON, Texas 

ZOE LOFGREN, California 

DANIEL LIPINSKI, Illinois 

DONNA F. EDWARDS, Maryland 

FREDERICA S. WILSON, Florida 

SUZANNE BONAMICI, Oregon 

ERIC SWALWELL, California 

DAN MAFFEI, New York 

ALAN GRAYSON, Florida 

JOSEPH KENNEDY III, Massachusetts 

SCOTT PETERS, California 

DEREK KILMER, Washington 

AMI BERA, California 

ELIZABETH ESTY, Connecticut 

MARC VEASEY, Texas 

JULIA BROWNLEY, California 

ROBIN KELLY, Illinois 

KATHERINE CLARK, Massachusetts 

SUBCOMMITTEE ON RESEARCH AND TECHNOLOGY

HON. LARRY BUCSHON, Indiana, Chair 

STEVEN M. PALAZZO, Mississippi 

MO BROOKS, Alabama 

RANDY HULTGREN, Illinois 

STEVE STOCKMAN, Texas 

CYNTHIA LUMMIS, Wyoming 

DAVID SCHWEIKERT, Arizona 

THOMAS MASSIE, Kentucky 

JIM BRIDENSTINE, Oklahoma 

CHRIS COLLINS, New York 

BILL JOHNSON, Ohio 

LAMAR S. SMITH, Texas 

DANIEL LIPINSKI, Illinois 

FEDERICA WILSON, Florida 

ZOE LOFGREN, California 

SCOTT PETERS, California 

AMI BERA, California 

DEREK KILMER, Washington 

ELIZABETH ESTY, Connecticut 

ROBIN KELLY, Illinois 

EDDIE BERNICE JOHNSON, Texas 

SUBCOMMITTEE ON OVERSIGHT

HON. PAUL C. BROUN, Georgia, Chair 

F. JAMES SENSENBRENNER, JR., 

Wisconsin 

BILL POSEY, Florida 

KEVIN CRAMER, North Dakota 

BILL JOHNSON, Ohio 

LAMAR S. SMITH, Texas 

DAN MAFFEI, New York 

ERIC SWALWELL, California 

SCOTT PETERS, California 

EDDIE BERNICE JOHNSON, Texas 
(III) 

C O N T E N T S 

June 26, 2014 

Page 

Witness List ............................................................................................................. 2 

Hearing Charter ...................................................................................................... 3 

Opening Statements 

Statement by Representative Larry Bucshon, Chairman, Subcommittee on 

Research and Technology, Committee on Science, Space, and Technology, 

U.S. House of Representatives ............................................................................ 6 

Written Statement ............................................................................................ 7 

Statement by Representative Dan Maffei, Ranking Minority Member, Subcommittee on Research and Technology, Committee on Science, Space, and 

Technology, U.S. House of Representatives ....................................................... 8 

Written Statement ............................................................................................ 9 

Statement by Representative Paul Broun, Chairman, Subcommittee on Oversight, Committee on Science, Space, and Technology, U.S. House of Representatives ........................................................................................................... 11 

Written Statement ............................................................................................ 13 

Statement by Representative Lamar S. Smith, Chairman, Committee on 

Science, Space, and Technology, U.S. House of Representatives ..................... 13 

Written Statement ............................................................................................ 14 

Witnesses: 

Dr. Chetan Jinadatha, Chief, Infectious Diseases, Central Texas Veterans 

Health Care System 

Oral Statement ................................................................................................. 17 

Submitted Biography ....................................................................................... 19 

Dr. Elaine Cox, Professor of Clinical Pediatrics, Director of Infection Prevention, Director of Pediatric Antimicrobial Stewardship, Riley Hospital for 

Children 

Oral Statement ................................................................................................. 20 

Written Statement ............................................................................................ 22 

Dr. Trish M. Perl, Professor of Medicine and Pathology, Johns Hopkins School 

of Medicine; Professor of Epidemiology, Bloomberg School of Public Health; 

Senior Epidemiologist, Johns Hopkins Medicine 

Oral Statement ................................................................................................. 25 

Written Statement ............................................................................................ 27 

Mr. Jeff Smith, President, Electro-spec, Inc. 

Oral Statement ................................................................................................. 36 

Written Statement ............................................................................................ 38 

Mr. Morris Miller, Chief Executive Officer, Xenex Disinfection Services 

Oral Statement ................................................................................................. 54 

Written Statement ............................................................................................ 56 

Discussion ................................................................................................................. 100

Appendix I: Answers to Post-Hearing Questions 

Dr. Chetan Jinadatha, Chief, Infectious Diseases, Central Texas Veterans 

Health Care System ............................................................................................. 82 
Page

IV 

Dr. Elaine Cox , Professor of Clinical Pediatrics, Director of Infection Prevention, Director of Pediatric Antimicrobial Stewardship, Riley Hospital for 

Children ................................................................................................................ 98 

Dr. Trish M . Perl, Professor of Medicine and Pathology, Johns Hopkins 

School of Medicine; Professor of Epidemiology, Bloomberg School of Public 

Health; Senior Epidemiologist, Johns Hopkins Medicine ................................. 105 

Mr. Jeff Smith, President, Electro-spec, Inc. ......................................................... 110 

Mr. Morris Miller, Chief Executive Officer, Xenex Disinfection Services ........... 119 

Appendix II: Additional Material for the Record 

Prepared statement by Representative Eddie Bernice Johnson, Ranking Member, Committee on Science, Space, and Technology, U.S. House of Representatives ........................................................................................................... 128 

Articles submitted by Subcommittee Representative Larry Bucshon, Chairman, Subcommittee on Research and Technology, Committee on Science, 

Space, and Technology, U.S. House of Representatives .................................... 130 

Supporting documents submitted by Dr. Trish M . Perl, Professor of Medicine 

and Pathology, Johns Hopkins School of Medicine; Professor of Epidemiology, Bloomberg School of Public Health; Senior Epidemiologist, Johns 

Hopkins Medicine ................................................................................................. 150 
(1) 

TECHNOLOGY FOR PATIENT SAFETY AT 

VETERANS HOSPITALS 

THURSDAY, JUNE 26, 2014 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON RESEARCH AND TECHNOLOGY AND

SUBCOMMITTEE ON OVERSIGHT, 

COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY, 

Washington, D.C. 

The Subcommittees met, pursuant to call, at 9:06 a.m., in Room 

2318 of the Rayburn House Office Building, Hon. Larry Bucshon 

[Chairman of the Subcommittee on Research and Technology] presiding. 
2 
3 
4 
5 
6 

Chairman BUCSHON. The joint hearing of the Subcommittee on 

Research and Technology and the Subcommittee on Oversight will 

come to order. 

Good morning, everyone, and welcome to today’s hearing titled 

‘‘Technology for Patient Safety at Veterans Hospitals.’’ 

In front of you are packets containing the written testimony, biographies and Truth in Testimony disclosures for today’s witnesses. 

Before we get started, since this is a joint hearing involving two 

Subcommittees, I want to explain how we will operate procedurally 

so all Members understand how the question-and-answer period 

will be handled. We will recognize those Members present at the 

gavel in order of seniority on the full Committee and those coming 

after the gavel will be recognized in order of arrival. I now recognize myself for five minutes for an opening statement. 

This morning’s hearing will focus on an important public health 

issue: the problem of patients contracting dangerous infections 

while in the hospital. This problem has been in the news lately due 

to disclosure of unfavorable information about some Veterans Administration hospitals, including high rates of hospital-acquired infections, or HAIs. 

We want the highest quality of care and the highest standards 

of patient safety in all VA hospitals. Big variations among VA hospitals are a cause for concern. 

However, as a former cardiothoracic surgeon, I am well aware 

that HAIs are not a problem unique to the VA Health Care System. Also, it is important to realize that hospital-acquired infection 

rates will never be zero, but can and should be aggressively minimized. 

Rates of hospital-acquired infections appear to have declined in 

recent years. During the 1990s, estimates hovered around 2 million 

per year. The CDC’s most recent estimate is 1.7 million hospitalacquired infections happen annually. The CDC also calculates this 

works out to about a one in 25 chance of contracting a serious infection while in the hospital. 

The idea a hospital patient, on average, only has a one in 25 

chance of getting an infection is certainly not a good thing. Many 

infections that patients suffer from while hospitalized originate 

from their own flora—their own bacteria, for non-medical people— 

i.e., the skin, respiratory, or intestinal bacteria for example, that 

comes to the hospital with the patient. 

That said, research has shown it is possible to prevent a large 

fraction of hospital acquired infections. For example, simple things 

like isolating patients who have serious infections, and doctors and 

nurses washing their hands between each patient, can go a long 

way toward controlling the spread of potentially lethal infections. 

One hundred percent adherence to all these best practices by 

health care personnel won’t solve the problem. Hand washing and 

hand sanitation is just as important for family members and other 

hospital visitors, too, as they often are unknowingly responsible for 

spreading bacteria and viruses. Some types of viruses, for example, 

can survive for months on a tray, a door frame or other surface. 

Most people take for granted that antibiotics can ultimately cure 

all but the most exotic types of infections. Until a few decades ago, 

antibiotics were, for the most part, an effective backstop against 
7 

most hospital-acquired infections. The evolution of antibiotic-resistant superbugs is voiding the assumption that medicine can cure 

every infection. More than one dozen types of pathogens have developed resistance to most types of antibiotics. In some cases, just 

one class of antibiotics is still effective, and in a few instances, 

there are literally no antibiotics that are effective against certain 

bacteria. Antibiotic overuse and inappropriate use are significantly 

responsible for the growing number of antibiotic resistant 

superbugs. 

As a personal side note, I believe tort issues surrounding the 

practice of medicine is partly responsible for this issue and needs 

reform. Another problem is the slow pace at which new antibiotics 

are being developed, due to the costly and lengthy approval process. 

According to the Infectious Disease Society of America, just one 

organism, methicillin-resistant Staph aureus, better known as 

MRSA, kills more Americans each year than the combined total of 

emphysema, HIV/AIDS, Parkinson’s disease, and homicide. 

The Food and Drug Administration recently approved a new antibiotic for MRSA infections, but that is just one type of bacteria, 

and the odds are that resistance to the new medicine will develop. 

The better news is that there are some promising new, non-pharmaceutical innovations that can help to reduce hospital-acquired 

infection rates significantly, innovations that don’t seem to carry 

the possibility of eventual antibiotic resistance. These innovations 

have been developed from research in several scientific fields, including nanotechnology, robotics, computer science, and biology. 

We are fortunate to have with us three physicians who are national experts in infectious diseases and the prevention of hospitalacquired infections and two witnesses will describe the anti-infection innovations their companies have brought forward. I look forward to this morning’s testimony on this important subject. 

[The prepared statement of Mr. Bucshon follows:] 

PREPARED STATEMENT OF THE SUBCOMMITTEE ON RESEARCH AND TECHNOLOGY

CHAIRMAN LARRY BUCSHON

This morning’s hearing will focus on an important public health issue—the problem of patients contracting dangerous infections while in the hospital. This problem 

has been in the news lately due to disclosure of unfavorable information about some 

Veterans Administration hospitals, including high rates of hospital acquired infections, or HAI’s. 

We want the highest quality of care and highest standards of patient safety in 

all VA hospitals. Big variations among VA hospitals are a cause for concern. However, as a former cardio-thoracic surgeon, I am well aware that HAIs are not a problem unique to the VA Health Care System. Also, it is important to realize that HAI 

rates will never be zero, but can and should be aggressively minimized. 

Rates of hospital-acquired infections appear to have declined in recent years. During the 1990’s, estimates hovered around 2 million per year. The CDC’s most recent 

estimate is 1.7 million HAIs annually. The CDC also calculates this works out to 

about a one in 25 chance of contracting a seriousinfection while in a hospital. 

The idea a hospital patient, on average, has ‘‘only’’ a one in 25 chance of getting 

an infection is certainly not a good thing. Many infections that patients suffer from 

while hospitalized originate from their own flora (ie skin, respiratory, or intestinal 

bacteria for example.) 

That said, research has shown it is possible to prevent a large fraction of hospital 

infections. For example, simple things like isolating patients who have serious infections, and doctors and nurses washing their hands between each patient, can go a 

long way toward controlling the spread ofpotentially lethal infections. 
8 

One hundred percent adherence to all best practices by health care personnel 

won’t solve the problem. Hand washing and hand sanitation is just as important for 

family members and other hospital visitors, too, as they often are unknowingly responsible for spreading bacteria and viruses. Some types of viruses can survive for 

six months on a tray, a door frame or other type of surface. 

Most people take for granted that antibiotics can ultimately cure all but the most 

exotic kinds of infections. Until a few decades ago, antibiotics were an effective 

backstop against most hospitalacquired infections. 

The evolution of antibiotic-resistant superbugs is voiding the assumption that 

medicine can cure infections. More than one dozen types of pathogens have developed resistance to most types of antibiotics. In some cases, just one class of antibiotics is still effective. And in a few instances, there is literally no antibiotic that 

works. Antibiotic overuse and inappropriate use are significantly responsible for the 

growing number of antibiotic resistant superbugs. As a personal side note, I believe 

tort issues surrounding the practice of medicine is partly responsible for this issue 

and needs reform. Another problem is the slow pace at which new antibiotics are 

being developed, due to a costly and lengthy approval process. 

According to the Infectious Disease Society of America (IDSA), just one organism—methicillin-resistant Staphylococcus aureus, better known as MRSA—kills 

more Americans each year than the combined total of emphysema, HIV/AIDS, Parkinson’s disease, and homicide. 

The Food and Drug Administration recently approved a new antibiotic for MRSA 

infections. But that’s just one type of bacteria, and the odds are that resistance to 

the new medicine will develop. 

The better news is that there are some promising new, non-pharmaceutical innovations that can help to reduce HAI rates significantly, innovations that don’t seem 

to carry the possibility of eventual antibiotic resistance. 

These innovations have been developed from research in several scientific fields, 

including nanotechnology, robotics, computer science, and biology. 

We’re fortunate to have with us three physicians who are national experts in infectious diseases and the prevention of HAIs and two witnesses will describe the 

anti-infection innovations their companies have brought forward. I look forward to 

this morning’s testimony on this important subject. 

Chairman BUCSHON. I now yield to the Ranking Member, Mr. 

Maffei. 

Mr. MAFFEI. Thank you very much, Chairman Bucshon. I also 

want to thank you for holding this hearing and I also want to 

thank Chairman Broun, who is the Chairman of my Subcommittee, 

the Subcommittee on Oversight, and I of course want to thank 

Chairman Smith, the Chairman of the full Committee, and all the 

Members for being here. This is an important hearing on the technology for patient safety at Veterans Hospitals. 

Health care-associated infections are a serious and potentially 

deadly threat to anyone who spends time in a hospital, any hospital. In fact, overall, not just the VA but all hospitals, there is an 

average of 200 individuals who die every day as a result of health 

care-associated infections. This amounts to an estimated 75,000 

people a year. Another 650,000 patients become infected each year 

during their hospital stays, and it can cost as much as $45,000 per 

patient to treat these infections. Health care-associated infections 

in the United States alone cost as much as $45 billion a year. 

I would stress that these infections are not unique to the Veterans Administration’s hospitals. I know that health care-associated infections and medical mishaps do not stop at the door of the 

VA, however. Unfortunately, they are prevalent in all health care 

facilities, and the tools to combat these infections and to prevent 

medical errors are the same regardless of where the care is given. 

I look forward to hearing from our witnesses today about both 

proven methods and new technologies that can help play a role in 

addressing this serious issue. I am particularly interested in hear-
9 

ing from Dr. Trish Perl from Johns Hopkins University, who brings 

a wealth of experience and expertise to the area of infectious diseases and the role that technology can play in their prevention. She 

has firsthand experience implementing new technologies to combat 

hospital infections, some that worked successfully and some that 

actually increased the rate of infection. I look forward to hearing 

from her about the possible benefits and potential downsides to implementing unproven technologies in the hospital settings. 

Mr. Chairman, I must confess, though, I do have concerns about 

the testimony of one of our witnesses, however, and that is simply 

that it wasn’t submitted at all in a clear contradiction of this Committee’s rules and practices. It is the standard practice of the 

House Committee on Science, Space, and Technology to have advanced written testimony from witnesses before they testify. Today, 

the Majority has taken the opposite approach and is willing to sit 

a witness from the Veterans Administration that has provided no 

written testimony in advance of this hearing. I am concerned that 

Majority staff knew about this problem and did not rectify it in a 

timely manner and agreed to sit this witness without having written testimony prior to the hearing several days ago rather than 

postponing the hearing or moving forward without this witness. 

My understanding is that the failure to have testimony is not the 

failure of the witness, Dr. Jinadatha, so I apologize to you. I am 

sorry you are caught in the middle of this. I know that you have 

provided—you prepared your testimony and it was an approval 

process that was the issue, but still, I did want to voice these concerns because I do think it is very, very important that we don’t 

set a precedent in this Committee that we do not want to set, that 

we will have—particularly with the Oversight Subcommittee, that 

we will have witnesses testifying without having submitted in advance for everybody on the Committee to look at, peruse, develop 

questions on written testimony. 

So with those concerns stated, Mr. Chairman, I yield back. 

[The prepared statement of Mr. Maffei follows:] 

PREPARED STATEMENT OF THE SUBCOMMITTEE ON RESEARCH AND TECHNOLOGY

RANKING MINORITY MEMBER DAN MAFFEI

Chairman Bucshon, Chairman Broun thank you both for holding this important 

hearing today on ‘‘Technology for Patient Safety at Veterans Hospitals.’’ 

The recent disclosures of mismanagement at the VA are deeply troubling. I represent nearly 50,000 veterans in Central New York and I want to ensure they receive the best care possible. Last month, as a result of these revelations about the 

VA, I personally called for the Secretary of the VA, Eric Shinseki to step down so 

that the VA could move forward with new management. 

But nothing about the substance of this hearing, focused on the threat of 

Healthcare Associated Infections (HAIs) and potential methods to successfully address them, is isolated to the VA. 

Healthcare Associated Infections are a serious and potentially deadly threat to 

anyone who spends time in a hospital—any hospital. By this time tomorrow 200 individuals at U.S. hospitals will have died as a result of healthcare associated infections. This amounts to an estimated 75,000 people per year. Another 650,000 patients become infected each year during their hospital stay. 

It can cost as much as $45,000 per patient to treat these infections. Healthcare 

Associated Infections in the U.S. alone cost as much as $45 billion per year. 

I would stress that these infections are not unique to Veterans Administration 

(VA) hospitals. My home District in Syracuse, New York includes one VA hospital 

and six public and private hospitals. I know that Healthcare Associated Infections 
10 

and medical mishaps do not stop at the door of the VA. Unfortunately, they are 

prevalent in all healthcare facilities. And the tools to combat these infections and 

to help prevent medical errors are the same regardless of where the care is given. 

The good news is that a recent report released by the Centers for Disease Control 

and Prevention (CDC) shows steady progress at the national level against 

Healthcare-Associated Infections. The report found a 44 percent decrease in central 

line-associated bloodstream infections between 2008 and 2012; a 20 percent decrease 

in infections related to 10 major surgical procedures between 2008 and 2012; and 

a 4 percent decrease in hospital-onset MRSA (Methicillin-resistant Staphylococcus 

aureus) bloodstream infections between 2011 and 2012. 

But combatting healthcare associated infections is still difficult, often deadly and 

very costly. 

Technologies can help, but I doubt there is a single silver bullet available in this 

fight to eradicate these troubling and pervasive infections. Simple steps like proper 

hand-hygiene, appropriate training and clear communication can also have a major 

impact on the spread of these healthcare associated infections. 

I am looking forward to hearing from our witnesses today about both proven 

methods and new technologies that can help play a role in addressing this serious 

issue. I am particularly interested in hearing from Dr. Trish Perl from Johns Hopkins University, who brings a wealth of experience and expertise in the area of infectious diseases and the role that technology can play in their prevention. She has 

first-hand experience implementing new technologies to combat hospital infections, 

some that worked successfully and some that actually increased the rate of infection. I look forward to hearing from her about the possible benefits and potential 

downsides to implementing unproven technologies in the hospital setting. 

Chairman BUCSHON. Thank you. I would also like to comment on 

that. Rule 3, Section C says insofar as is practical, no later than 

48 hours in advance of his or her appearance, each witness who is 

to appear before the Committee or any Subcommittee shall file a 

printed copy in electronic form or written statement of his or her 

proposed testimony and a curriculum vitae. In this situation, we 

had some difficulty with the process through the VA getting the 

written testimony final approval and we felt that the testimony of 

this witness was very valuable and it was not practical to get the 

testimony in in time. The delay was unexpected due to the process 

needing approval and therefore I feel that the witness’s testimony 

is valuable and in no way would prejudice the discussion at this 

hearing and therefore should be allowed. 

Mr. MAFFEI. Would the Chairman yield? 

Chairman BUCSHON. I will yield. 

Mr. MAFFEI. Mr. Chairman, I appreciate those comments, and I 

certainly—that is why I would not object to Mr. Jinadatha being 

a witness here because I do believe that he has a lot of important 

things to say, but my understanding is that the Majority staff did 

know about this in enough advance notice to have done something 

about it. So while I appreciate that at this point of course it 

couldn’t be avoided, there was a point where it could have been, 

and that is my concern. 

The Chairman of my Subcommittee, Mr. Broun, has pressured 

the Administration many times about the—— 

Chairman BUCSHON. I take back my time. Thanks for that opinion. I appreciate it. We don’t like the situation either but again, 

feel that the testimony of the witness is very valuable to the context of this hearing, and at this point we will proceed ahead with 

the hearing. 

Chairman SMITH OF TEXAS. Mr. Chairman, could I just add a 

comment here? 

Chairman BUCSHON. I yield to the Chairman of the full Committee, Mr. Smith. 
11 

Chairman SMITH OF TEXAS. Thank you. I do want to reassure the 

Ranking Member, Mr. Maffei, that we actually did try to get the 

written testimony and we share his sentiments completely. I am as 

frustrated as anyone else, and I have been frustrated both in this 

Committee and other Committees when we have had witnesses 

who because of various governmental rules have not been able to 

give us the written testimony that we all would like to see ahead 

of time. So I think we made a good-faith effort to try to get it over 

the last several days. 

I also want to say to the Ranking Member, I very much appreciate his measured remarks, measured comments, and because 

they were measured, they even have a greater impact than he 

might think, and we will try to make sure that, as he suggested, 

this is very much the exception to the rule and not the rule. 

Mr. MAFFEI. Would the Chairman yield just so I can thank the 

gentleman? 

Chairman BUCSHON. I will yield. 

Mr. MAFFEI. I do want to thank the Chairman of the full Committee and of course, you, Mr. Chairman, for hearing me out on 

this, and I will just stick with, I just don’t want this to be the 

precedent of the Committee. But thank you very much for hearing 

us out. 

Mr. BROUN. Mr. Chairman? 

Chairman BUCSHON. Mr. Broun, I yield. 

Mr. BROUN. Thank you, Mr. Chairman. 

I just want to remark to my dear friend, good friend, my coworker on our Oversight Committee, that as he stated in his remarks, it has been something I have been very concerned about 

and I am extremely concerned just like my friend, Mr. Maffei, is 

about this very issue, and I would be objecting tremendously except 

for I think this is an extremely important witness that can give us 

some insight into the VA, and his testimony has been approved by 

the VA, from my understanding. It is just some other parts of the 

Administration that have delayed or dragged their feet, and let me 

assure my friend, Mr. Maffei, that the staff on this side have been 

very, very diligent in trying to get this written testimony approved. 

His oral testimony—in his oral testimony, he can read his written testimony, and that is okay with the VA. And so what we are 

trying to do is prevent deaths, and I think this is an emergent situation or I would be objecting very vehemently myself, I assure you, 

and I don’t want this to be a precedent any more than my friend 

wants it be a precedent. We must have written testimony, but in 

this case, because of life-threatening situations, I think it is prudent for us to go ahead and hear from the witness, and I appreciate 

my friend’s comments and I agree with wholeheartedly and I appreciate us being able to go forward, and I thank you very much. 

At this point I will yield back. 

Chairman BUCSHON. I will reclaim my time and then with that, 

I will now recognize the Chairman of the Subcommittee on Oversight, the gentleman from Georgia, Mr. Broun, for his opening 

statement. 

Mr. BROUN. Thank you, Dr. Bucshon. I thank all the witnesses 

for being here today and going through this little necessary dialogue between us, and I look forward to hearing from you all today. 
12 

For those of you all who are not from the South ‘‘you all’’ is singular and plural, so I appreciate all of you all being here. 

As both a medical doctor as well as a U.S. Marine, it is deeply 

troubling to me to hear reports of poor care given to veterans in 

my home State of Georgia as well as across this country. In January of this year, I returned to Augusta for an oversight visit to the 

Charlie Norwood VA Medical Center with some of my colleagues. 

During the trip, I was extremely saddened to see the cavalier attitude expressed by the VA, and the potential implication for hospital-associated infections, or HAIs, and preventable deaths. A recent Wall Street Journal article on VA hospitals cited specifically 

that, ‘‘at Augusta, the in-hospital death rate was 120 percent above 

that of the best facilities.’’ This kind of negligence is intolerable 

and I won’t stand for it. 

The principal function of our federal government under the Constitution is to provide for our national defense, and it is imperative 

that we take care of the men and women who so bravely served our 

country with dignity and pride. We made promises to veterans, and 

we must fulfill those promises for those who have sacrificed for all 

us to keep us free as a nation. Our veterans should receive the best 

care available anywhere in the country, and there is no question 

about that. 

The Centers for Disease Control and Prevention states that ‘‘approximately 1.7 million HAIs occur in United States hospitals each 

year, resulting in up to 99,000 deaths and an estimated $20 billion 

in healthcare costs.’’ Contributing to these numbers is a wide variation in medical care at VA hospitals with substantially more HAIs 

and preventable deaths at certain VA hospitals. However, since the 

VA does not publicly disclose comprehensive details on each of 

their facilities, it is hard for veterans and their families to receive 

fair warning that they are walking into a potentially life-threatening situation when they are requesting medical care from those 

VA facilities. 

What is additionally astounding is that the infection rates at 

some VA hospitals exceed the rates at private sector hospitals by 

ten times or more. On top of that, the Wall Street Journal article 

I mentioned earlier notes that, ‘‘VA senior management suspended 

a long-standing program that had sent teams of doctors and monitors to its worst-performing hospitals to try to improve them.’’ As 

the Chairman of the Oversight Subcommittee, I consider this lack 

of oversight, accountability, and due diligence to be totally inexcusable and intolerable. 

The treatment of veterans is not only a moral issue, but a national security issue as well. If the federal government fails to fulfill the promises it has made to our veterans, how are we going to 

recruit the finest men and women to come into the military and 

stay to be senior NCOs, senior officers, or flag officers? It just will 

not happen. 

I look forward to hearing from our witnesses about technologies 

that can save veterans from preventable infections and deaths. I 

also encourage everyone at the VA listening to this hearing today 

to renew their commitment to our veterans by doing everything in 

their power and as soon as possible to ensure that our Nation’s heroes are given the care that they deserve and have earned. 
13 

I thank you, Chairman Bucshon, Dr. Bucshon, my good friend 

and medical colleague, for holding this very important hearing, and 

I yield back the balance of my time. 

[The prepared statement of Mr. Broun follows:] 

PREPARED STATEMENT OF THE SUBCOMMITTEE ON OVERSIGHT

CHAIRMAN PAUL BROUN

Thank you, Chairman Bucshon, and thank you to all of our witnesses for being 

here today. I am looking forward to hearing from you all on this very important 

matter. 

As both a medical doctor and a U.S. Marine, it is deeply troubling to hear reports 

of poor care given to veterans in my home state of Georgia as well as across this 

country. In January, I returned to Augusta for an oversight visit of the Charlie Norwood VA Medical Center with some of my colleagues. During the trip, I was extremely saddened to see the cavalier attitude expressed by the VA, and the potential 

implication for hospital-associated-infections—or HAIs—and preventable deaths. A 

recent Wall Street Journal article on VA hospitals cited specifically that, ‘‘at Augusta, the in-hospital death rate was 120% above that of the best facilities.’’ This 

kind of negligence is intolerable. 

The principle function of our federal government under the Constitution is to provide for our national defense and take care of the men and women who have so 

bravely served our country with dignity and pride. We have made promises, and we 

must fulfill those promises for those who have sacrificed for us. Our veterans should 

receive the best care—there is no question about it. 

The Centers for Disease Control and Prevention states that ‘‘approximately 1.7 

million HAIs occur in U.S. hospitals each year, resulting in up to 99,000 deaths and 

an estimated $20 billion in healthcare costs.’’ Contributing to these numbers is the 

wide variation in medical care at VA hospitals with substantially more HAIs and 

preventable deaths at certain VA hospitals. However, since the VA does not publicly 

disclose comprehensive details on each of their facilities, it is hard for veterans to 

receive fair warning that they are walking into a potentially life-threatening situation when requesting medical care. What is additionally astounding is that the infection rates at some VA hospitals exceed the rates at private sector hospitals by 

ten times or more. 

On top of that, the Wall Street Journal article I mentioned earlier notes that, ‘‘VA 

senior management suspended a long-standing program that had sent teams of doctors and monitors to its worst-performing hospitals to try to improve them.’’ As the 

Chairman of the Oversight Subcommittee, I consider this lack of oversight, accountability, and due-diligence to be inexcusable. 

The treatment of veterans is not only a moral issue, but a national security issue 

as well. If the federal government fails to fulfill the promises it has made to our 

veterans, how are we going to recruit the finest men and women to come into the 

military and stay to be senior NCOs, senior officers, or flag officers? It won’t happen! 

I look forward to hearing from our witnesses about technologies that can save veterans from preventable infections and deaths. I also encourage everyone at the VA 

listening to this hearing today to renew their commitment to our veterans by doing 

everything in their power, as soon as possible, to ensure our nation’s heroes are 

given the care that they deserve and have earned. 

Thank you again Chairman Bucshon for holding this very important hearing, and 

I yield back the balance of my time. 

Chairman BUCSHON. Thank you, Dr. Broun. I now recognize the 

Chairman of the full Committee, Mr. Smith, for an opening statement. 

Chairman SMITH OF TEXAS. Thank you, Mr. Chairman. 

The long delays and unacceptable quality of VA health care for 

tens of thousands of our veterans has recently become public. Following up on a series of letters to the VA Inspector General and 

others, I recently met with Acting VA Secretary Gibson at the 

Audie Murphy Memorial Hospital in my district in San Antonio. I 

was reassured that he sincerely wants to fix the problems facing 
14 

our veterans but we need swift action and strong resolve to fix such 

a broken system at the VA. 

Veterans who live in the 21st Congressional District of Texas and 

across our country should have the best health care America can 

provide. American veterans have made tremendous sacrifices to 

protect and defend our freedoms. They deserve the best health care 

possible, as soon as possible. 

Today’s hearing will enable us to understand more about patient 

safety and how scientific research and new technology can boost efforts to prevent patients from contracting serious infections while 

they are hospitalized. 

A number of VA hospitals are among the worst in the United 

States in terms of inflicting preventable infections on their patients. Hospital-acquired infections are a serious public health 

problem that affects patients in hospitals all across the country. In 

the worst-performing hospitals, which includes some VA hospitals, 

up to ten percent of patients are harmed by such infections. 

A few years ago, a state agency in Pennsylvania analyzed millions of hospital records and found that the in-hospital mortality 

rate among patients who contracted infections was about five times 

higher than among patients who were not infected. Research has 

shown that most of these infections are preventable if hospitals and 

medical personnel adhere to systematic prevention measures. This 

starts with essential steps such as thorough, repeated hand-washing and isolation of infected patients. However, hand hygiene and 

other commonsense measures have been only partially successful. 

We are fortunate to have with us this morning three physicians 

who are experts in the field of preventing hospital-acquired infections. As far as that goes, we have three doctors who are Members 

of these two Subcommittees this morning, and they are experts in 

their own right. We also have representatives from two companies 

that have developed new tools and technologies to prevent infections in hospitals. I look forward to learning more about the science 

behind fighting harmful hospital-acquired infections, and I am particularly interested in how the VA health care system, the largest 

integrated health care system in America, could deploy scientifically proven technology and practices with the goal of setting the 

highest standard of patient safety in all of its hospitals. 

Thank you, Mr. Chairman, and I will yield back. 

[The prepared statement of Mr. Smith of Texas follows:] 

PREPARED STATEMENT OF FULL COMMITTEEE

CHAIRMAN LAMAR S. SMITH

The long delays and unacceptable quality of VA health care for tens of thousands 

of our veterans has recently become public. 

Following up on a series of letters to the VA Inspector General and others, I recently met with Acting VA Secretary Gibson at the Audie Murphy Memorial Hospital in my district in San Antonio. I was reassured that he sincerely wants to fix 

the problems facing our veterans. But we need swift action and strong resolve to 

fix such a broken system at the VA. 

Veterans who live in the 21st Congressional District of Texas and across our country should have the best health care America can provide. American veterans have 

made tremendous sacrifices to protect and defend our freedoms. They deserve the 

best health care possible, as soon as possible. 
15 

Today’s hearing will enable us to understand more about patient safety and how 

scientific research and new technology can boost efforts to prevent patients from 

contracting serious infections while they are hospitalized. 

A number of VA hospitals are among the worst in the United States in terms of 

inflicting preventable infections on their patients. 

Hospital-acquired infections are a serious public health problem that affects patients in hospitals all across the country. In the worst-performing hospitals, which 

includes some VA hospitals, up to 10% of patients are harmed by such infections. 

A few years ago, a state agency in Pennsylvania analyzed millions of hospital 

records and found that the in-hospital mortality rate among patients who contracted 

infections was about five times higher than among patients who weren’t infected. 

Research has shown that most of these infections are preventable if hospitals and 

medical personnel adhere to systematic prevention measures. This starts with essential steps such as thorough, repeated hand-washing and isolation of infected patients. 

However, hand hygiene and other common-sense measures have been only partially successful. We are fortunate to have with us this morning three physicians 

who are experts in the field of preventing hospital-acquired infections. We also have 

representatives from two companies that have developed new tools and technologies 

to prevent infections in hospitals. I look forward to learning more about the science 

behind fighting harmful hospital-acquired infections. 

I’m particularly interested in how the VA health care system, the largest integrated health care system in America, could deploy scientifically proven technology 

and practices, with the goal of setting the highest standard of patient safety in all 

of its hospitals. 

Chairman BUCSHON. Thank you, Chairman Smith. 

At this time I would like to introduce our witnesses. Our first 

witness is Dr. Chetan Jinadatha—how did I do—very well—the 

Chief of Infectious Disease Section at the Central Texas Veterans 

Health Care System in Temple, Texas. Dr. Jinadatha is also an Assistant Professor of Medicine at Texas A&M University Health 

Science Center. He is the President of the Texas Infectious Disease 

Society. Dr. Jinadatha is board-certified in infectious disease. He is 

also an active researcher in hospital-acquired infections, the role of 

environment in hospital-acquired infections, and the evaluation of 

no-touch disinfection technologies. Dr. Jinadatha completed his 

medical degree in India and his master’s in public health at Texas 

A&M. Welcome. 

Our second witness is Dr. Elaine Cox, Professor of Clinical Pediatrics. Dr. Cox trained at Indiana University School of Medicine 

and has been on the faculty in the section of pediatric infectious 

disease since 1995. She is currently serving as the Medical Director 

of Infection Prevention, Medical Director of the Pediatric Antimicrobial Stewardship, and a Safety Officer for Riley Hospital for 

Children at IU Health. In addition to these and other clinical duties, Dr. Cox has spent much time working on legislation that impacts children’s health in the State of Indiana. Dr. Cox earned her 

undergraduate degree in biochemistry from Indiana University and 

her medical degree from Indiana University School of Medicine. 

Welcome. 

Our third witness is Dr. Trish Peri. Did I get that right? 

Dr. PERL. Perl. 

Chairman BUCSHON. Perl. My eyes. I should have put my glasses 

on, I guess. Dr. Perl is a Professor at the Department of Medicine 

and Infectious Diseases and Pathology at Johns Hopkins University School of Medicine and in the Department of Epidemiology at 

the Johns Hopkins Bloomberg School of Public Health. She is a 

Senior Epidemiologist for the Johns Hopkins Hospital—John Hopkins Medicine. Dr. Perl received her bachelor of arts and medical 
16 

degree from the University of North Carolina at Chapel Hill and 

a master’s of science degree from McGill University in Montreal. 

She completed her residency in internal medicine at McGill University and a fellowship in infectious diseases and clinical epidemiology at the University of Iowa in Iowa City. 

I now recognize Representative Todd Young from Indiana to introduce our fourth witness. 

Mr. YOUNG. Thank you, Mr. Chairman. It is an honor to be here 

with you today. I would just like to say, you are a person of professional competence, high personal integrity and a good friend, so 

thank you so much for allowing me to introduce our witness, Jeffrey D. Smith, a Hoosier, a resident of Indiana’s 9th Congressional 

District and President and CEO of Electro-spec, which is located in 

Franklin, Indiana. 

Mr. Smith and I had an opportunity to visit briefly yesterday, 

and it was clear during that brief visit that he cares as deeply as 

I do about the health of our Nation’s veterans and preventing hospital-acquired infections in our Nation’s Veterans Hospitals. 

He has been with Electro-spec since 1994 and held positions of 

increasing responsibility beginning as Vice President in 1994. Mr. 

Smith is also President and CEO of Steriplate LLC, an Indiana corporation he formed in 2013. It focuses on the design, development 

and implementation of antimicrobial finishes for medical and commercial applications. In May of 1997, Mr. Smith purchased the 

business from former owner David Yates and assumed the position 

of CEO and President at that time. 

I want to thank you for your presence here today and your testimony about your promising work on potential veteran-saving technology. Thank you, sir. 

I yield back. 

Mr. BROUN. Would the gentleman yield? 

Mr. YOUNG. Indeed. 

Mr. BROUN. As a fellow Marine, I would like to correct a statement that you made. There is no such thing as a former Marine. 

Once a Marine, always a Marine. 

Mr. YOUNG. I agree with the gentleman’s comments. If the gentleman will yield? 

Mr. BROUN. Certainly. Thank you. 

Mr. YOUNG. I am told the taxonomy is, there is no such thing as 

an ex-Marine. There may be a couple of exceptions out there. But 

whatever. I am proud to be a Marine with you, and thank you. 

Duly corrected by the senior gentleman on the panel. 

Mr. BROUN. Semper fi. 

Mr. YOUNG. Semper fi. I yield back. 

Chairman BUCSHON. Thank you. I now recognize the Chairman 

of the full Committee, Mr. Smith, to introduce our final witness. 

Chairman SMITH OF TEXAS. Thank you, Mr. Chairman. 

Mr. Chairman, I am happy to welcome Morris Miller from San 

Antonio, who is going to be testifying today. 

As CEO of Xenex, Mr. Miller is responsible for the company’s 

business strategy and oversight of day-to-day operations. Under his 

guidance, the company has grown and established itself as the 

world leader in UV room disinfection. After starting his career as 

an attorney, Mr. Morris served as co-founder and President/CEO of 
17 

Rackspace Hosting Inc., which now has over $1 billion in annual 

revenue and a market cap in excess of $5 billion. He is an alumnus 

of Phillips Exeter Academy, the University of Texas at Austin, and 

the Dedman School of Law at Southern Methodist University, as 

am I. 

Mr. Chairman, I yield back, and we welcome Mr. Miller. 

Chairman BUCSHON. Thank you, Mr. Chairman. 

As our witnesses should know, spoken testimony is limited to 

five minutes each after which the Members of the Committee have 

five minutes each to ask questions. 

It is the practice of the Subcommittee on Oversight to receive 

testimony under oath. Does anyone have a problem with taking an 

oath? Then if you would please stand and raise your right hand. 

Do you solemnly swear or affirm to tell the whole truth and nothing but the truth, so help you God? Let the record reflect that all 

the witnesses participating have taken the oath. 

And at this point I will now recognize Dr. Jinadatha for five minutes for his testimony. 

TESTIMONY OF DR. CHETAN JINADATHA, 

CHIEF, INFECTIOUS DISEASES, 

CENTRAL TEXAS VETERANS HEALTH CARE SYSTEM 

Dr. JINADATHA. Good morning, Chairman Dr. Bucshon, Chairman Dr. Broun, Chairman Smith, Ranking Member Maffei and 

Members of the Subcommittee. I thank you for the opportunity to 

participate in this important discussion today. My name is Chetan 

Jinadatha, and I am the Chief of Infectious Diseases at the Central 

Texas Veterans Health Care System and an Assistant Professor in 

the Department of Medicine at Texas A&M University Health 

Science Center. 

I currently serve as the President of Texas Infectious Disease Society. My area of research interest is reduction of hospital-acquired 

infections using technology including the effectiveness of ultraviolet 

disinfection. 

It is reported that hospital-acquired infections cause 1.7 million 

infections and 100,000 deaths annually within the United States, 

costing health care systems $30 billion to $40 billion. Methicillinresistant Staph aureus-related hospital-acquired infections alone 

cost $9.7 billion annually. It is hard to predict the percentage of 

preventable hospital-acquired infections but most facilities aim for 

zero hospital-acquired infections. 

Patients may harbor resistant organisms prior to admission and 

not have any signs or symptoms. However, the same patient may 

develop an infection from the organism that they came with or acquire a new organism during their hospital stay, thus resulting in 

a hospital-acquired infection. 

The hospital environment includes surfaces in the patient room, 

equipment or the hands of health care workers who acquire it from 

touching other patients or surfaces. An estimated 20 to 40 percent 

of hospital-acquired infections in the United States have been attributed to cross-contamination by a health care personnel hands, 

either by direct patient or by touching contaminated environmental 

surfaces. 
18 

Recent literature has indicated that supplementing manual 

cleaning with disinfection technologies such as hydrogen peroxide 

systems or UV light technology systems decreased microbial burden on high-touch surfaces such as bed rails, call buttons, toilet 

seats in patient rooms. 

Although the systems add cost and time to the disinfection process, the bacterial load reduction after using these systems effectively complements manual cleaning. Preliminary evidence suggests from a single center study showed a 52 percent reduction of 

Clostridium difficile hospital-acquired infection with the implementation of UV-based protocol. A federally funded, multi-center study 

in private setting is currently underway to evaluate the effectiveness of UV in reducing hospital-acquired infections. 

Similarly, several studies that have shown decreased multi-drugresistant organism acquisition and reduction in hospital-acquired 

infection rates after implementation of hydrogen peroxide system 

across hospitals. In comparing the hydrogen peroxide system to 

that of an ultraviolet system, hydrogen peroxide requires prolonged 

exposure time and ventilation system modification for aeration but 

disinfects better than UV. UV technology disinfection time is shorter than hydrogen peroxide but it has lower bacterial reduction on 

surfaces. 

Hence, technologies such as ultraviolet or hydrogen peroxide 

have the potential to have an impact on transmission of pathogens 

in the hospital environment and possibly prevent life-threatening 

infections. A federally funded study is currently underway to evaluate the effectiveness of UV on hospital-acquired infection rates in 

four Veterans Affairs Medical Centers, one of which is mine. 

In 2013, the Central Texas Veterans Health Care System initiated several patient safety initiatives to decrease the risk of developing hospital-acquired infection including the deployment of ultraviolet disinfection system after manual cleaning. 

Reducing hospital-acquired infection requires a multi-prolonged 

approach. Interventions or technologies such as ultraviolet or hydrogen peroxide do not decrease the importance of rigorous handwashing, isolation of appropriate patients, and other measures to 

prevent the spread of pathogens in hospitals. New technologies for 

prevention do not obviate the need for manual cleaning or antimicrobial stewardship. Health care professionals must work together with the patients to prevent the spread of antibiotic-resistant organisms in health care settings. 

Meanwhile, further research is needed to ascertain the generalized ability of our studies and define the specific role of new technologies in hospital-acquired infection prevention. Emergence and 

spread of antibiotic-resistant bacteria is a significant public health 

threat. In addition to basic infection prevention and control practices such as hand hygiene and the use of isolation precautions, 

good antibiotic stewardship and use of supplemental technologies 

may provide effective and improved strategies to prevent the 

spread of health care-associated infections and create a safer environment for our patients. 

Mr. Chairman, this concludes my testimony. I welcome any questions from the Committee. 

[The prepared statement of Dr. Jinadatha follows:] 
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Chairman BUCSHON. Thank you, Doctor. 

I now recognize our second witness, Dr. Cox, for five minutes. 

TESTIMONY OF DR. ELAINE COX, 

PROFESSOR OF CLINICAL PEDIATRICS, 

DIRECTOR OF INFECTION PREVENTION, 

DIRECTOR OF PEDIATRIC ANTIMICROBIAL STEWARDSHIP, 

RILEY HOSPITAL FOR CHILDREN 

Dr. COX. Good morning. On behalf of Riley Hospital for Children 

at IU Health, I want to thank all of you here for your continuing 

commitment to patient safety by focusing on hospital-acquired infections in all patients. Riley Hospital is a self-standing children’s 

hospital with an 85-year history. We see about a quarter of a million patients a year and we are part Indiana University School of 

Medicine, which gives us a lot of opportunity for research and development of technologies. 

So we have heard a lot of statistics this morning: nearly 2 million 

infections, 100,000 deaths, one in 25 of our hospitalized patients 

every day having a hospital-acquired infection. This results in 

about 7.5 million excess hospital days in our country every year, 

increasing our length of stays by about three to ten times over the 

expected. 

When you look at cost, conservative cost measurements for direct 

cost are about $5 billion to $6 billion, and when you add in total 

costs, it is certainly upwards of $30 billion. 

But I don’t think that these statistics necessarily clarify the entire picture of personal cost. So I work in a children’s hospital and 

I will share with you that recently we had a baby, a newborn, in 

for heart surgery. Now, that takes two weeks to get out of the ICU 

and 4 weeks to get out of the hospital, minimum. This family had 

a 3-year-old at home that they were away from all these weeks. 

They finally promised their son they would be home for the weekend and they would spend time with him when the baby acquired 

a central-line-associated bloodstream infection, or a CLABSI. This 

set that baby’s recovery back 6 to 8 weeks and devastated a 3-yearold at home. I think the personal costs suffered by these families 

that encounter these infections go far beyond the event itself and 

is not reflected in our statistics. 

You know, fighting infection has always relied on prevention, 

whether it is from vaccination or the development of the bundle, 

which we now all use to prevent infections, as the Chairman said. 

We have used it at Riley. We have cut our CLABSI rate by 65 or 

70 percent. But the question is, is that enough? Is that enough for 

any of our patients, our veterans all the way to our babies? 

I think the other problem is that we have plateaued. What are 

our other strategies? Well, certainly we have a reaction position we 

can take. We can treat with antibiotics. That is kind of the horse 

already being out of the barn. By then, infection is already set up. 

You know, antibiotics have changed the face of infectious-disease 

treatment in America, which has been great, but it has also led to 

the development of resistance. This is accelerating in our time, and 

it is directly due to antibiotic overuse and use, and there is no antibiotic we have currently that is impervious to the development of 
21 

resistance. These are important players in HAIs. They occur in 

about 16 percent of the events, and over infections that have susceptible organisms they increase length of stay by an additional 20 

percent and cost by an additional 30 percent. 

We use antimicrobial stewardship, we use isolation and we have 

slowed the development and spread of resistance but we haven’t 

eradicated it, and CDC just recently came out and said that infection with these multi-drug-resistant organisms is an emerging 

threat to health care in the United States. 

In light of all that, I think we do need to look at new technologies. We have used some things in the environment. Can we 

expand that? Can we get beyond 55 to 65 percent safe for our patients? I think we have known the effects of metals for years. Why 

can’t we expand their use in the environment? And can we look at 

the patient level? Can we coat things like orthopedic rods and 

ventriculoperitoneal shunts and cardiac implants so that we can 

prevent infections at the patient level? 

We have known about the germ theory since the mid-19th century. We have the Institute of Medicine report, ‘‘To Err Is Human,’’ 

on patient safety since 1999 and yet we are still struggling. We are 

still only 55 to 65 percent safe for the patients in our environment 

who trust us to care for them. 

The impact financially on the health care budget is severe and 

negative, and I think if we could whip this problem as much as 

possible, we could turn those resources to other initiatives for patient safety and patient quality of care and, above all, do no harm, 

as is our oath. 

I thank you for this hearing. 

[The prepared statement of Dr. Cox follows:] 
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Chairman BUCSHON. Thank you. 

I now recognize Dr. Perl for your testimony. 

TESTIMONY OF DR. TRISH M . PERL, 

PROFESSOR OF MEDICINE AND PATHOLOGY, 

JOHNS HOPKINS SCHOOL OF MEDICINE; 

PROFESSOR OF EPIDEMIOLOGY, 

BLOOMBERG SCHOOL OF PUBLIC HEALTH; 

SENIOR EPIDEMIOLOGIST, JOHNS HOPKINS MEDICINE 

Dr. PERL. I will start by turning on the microphone. 

Chairmen Bucshon and Broun, Chairman Smith, Ranking Members Maffei and Lipinski, and distinguished Members of this Subcommittee, thank you for the opportunity to appear today. 

I will share lessons learned from hospital attempts to integrate 

technology into clinical care and highlight the importance of using 

scientific assessment to ensure hospitals make cost-effective and 

evidence-based decisions to improve patient outcomes. 

I am a Physician and a Professor at Johns Hopkins University 

and their Senior Epidemiologist, and I am also the former President of the Society of Health Care Epidemiology of America, which 

is the professional society that works around health care-associated 

infections and multi-drug-resistant organisms. 

That aside, my job has allowed me to study novel technologies including no-touch technologies and to investigate outbreaks associated with new products and devices, i.e., in other words, the unintended consequences of using these devices in the health care environment. 

The Committee should be aware that I am doing a large research 

study that is partially funded by the VA, and my husband is employed by the University of Maryland and the VA. 

Health care-associated infections, as everyone has mentioned, are 

common and actually cause about half of the untoward events that 

occur in health care affect approximately four percent of all patients. As we have heard, they are costly to patients and to the 

health care system, and to prevent these health care-associated infections, we encourage hand hygiene, vaccination, isolation, and 

more and more integrating technology. Many novel technologies are 

introduced into the market every year. It is commonly difficult to 

determine the merit of each device or idea without independent, 

well-designed studies that look at their efficacy. 

I would actually like to review two personal experiences of why 

we need to be thoughtful about using technology and how we need 

to approach our efforts to protect patients. Approximately eight 

years ago, we began a study at our institution and looked at a technology that vaporized hydrogen peroxide, an excellent disinfectant, 

into the environment. The goal is to disinfect surfaces that were 

potentially contaminated with bacteria despite terminal cleaning. 

The technology was intriguing and expensive yet there were unknowns including around patient safety and the impact on our 

other expensive equipment. Ultimately, we developed a study, and 

after testing in our intensive care units, we significantly decreased 

the risk of acquiring a multi-drug-resistant organism in the patients in those units. No risk to patients, damage to equipment or 
26 

the facility was identified. Hence, our recommendation to our leadership was to continue using this technology, and it was based on 

scientific evidence. We have subsequently showed that we can use 

this technology to disinfect surfaces of supplies that are in these 

rooms, they can be reused, and it leads to cost savings that help 

pay for this technology. 

Another story is in mid-October 2004, our institution introduced 

a new mechanical valve needleless device, which is used on IV tubing. These are devices that decrease needle sticks among health 

care personnel. By April of 2005, approximately six months later, 

the catheter-associated bloodstream infection rate in our children’s 

hospital had increased by 60 percent. Using fluorescent dye, we determined that these devices could not be cleaned using standard 

techniques. When we removed the device from our institution, our 

rate returned to normal. What seemed to be a very benign introduction of a nursing product turned into significant patient safety 

issue for our patients. 

So in summary, health care-associated infections are a significant challenge for health care despite strides to date, there are 

huge opportunities to improve patient safety and we should begin 

and insist upon the basic infection prevention. However, there is a 

role for technology that can improve our processes and protect patients. This technology, while often tantalizing, can have unexpected consequences and we must be vigilant in our approach to its 

introduction. 

Congress should continue its long history of supporting science, 

and this is an area where science needs to guide decisions so we 

are thoughtful about how to introduce and use technology. The 

health care community should develop standards to measure the effectiveness of new technologies like this new touch disinfection that 

are being discussed today so we can measure their efficacy in a 

standard fashion. Congress should consider funding learning labs 

or centers of excellence to evaluate these exciting products in the 

context of patient care using trained scientists. These labs consider 

the multiple issues that impact patients to assure we do not do 

harm. There is not a one-size-for-all solution, and this effort needs 

the expertise that will translate science into effective patient care. 

Thank you. 

[The prepared statement of Dr. Perl follows:] 
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Chairman BUCSHON. Thank you, Dr. Perl. 

I now recognize Mr. Smith for five minutes to present his testimony. 

TESTIMONY OF MR. JEFF SMITH, 

PRESIDENT, ELECTRO-SPEC, INC. 

Mr. SMITH. Thank you, Chairmen Bucshon, Broun and Smith, 

Members of the Committee, and Congressman Young for that nice 

introduction. I am not nearly as eloquent as my doctors are on the 

panel so I might sneak a ‘‘y’all’’ into my testimony. We will see. 

I am President of Electro-spec and Steriplate. What we do, we 

specialize in high reliability and highly functional electroplating of 

devices for the military, aerospace, medical and automotive industries, and the reason I am here today is to talk about a new technology that we have developed called Steriplate. Steriplate was designed specifically for medical applications, antimicrobial situations 

hopefully to make a dramatic impact in the transmission of HAIs. 

But first I want to draw kind of an analogy to what the statistics 

that were shared with you previously. Imagine a Boeing 737 crashing every single day in the United States with 200 people on board 

and there are no survivors. Can you imagine what the general public would be? Can you imagine what the FAA would be dealing 

with? That is what we are dealing with with HAIs, just to put 

things in perspective. The Department of Health and Human Services has made this an agency priority goal for HAIs. They have new 

metrics in place with goals hopefully to be achieved by the year 

2020. So it is a big issue obviously. Copper and copper alloy as well 

as antimicrobial metal coatings are the one continuous, sustainable 

method for reducing the bacterial burden that you have on surfaces, whether they are in body or out of body. Our Steriplate process, which I have some examples here for you, employs copper as 

one of the metals as well as another antimicrobial metal in the 

process, and it is designed specifically for again antimicrobial 

functionality but also by alloying in other metals, we designed a 

metal that has more tarnish resistance, corrosion resistance and 

wear resistance than traditional copper. The antimicrobial testing 

that we have done thus far specifically on the traditional HAI bacteria, E. coli, for example, we had a 99.9998 percent reduction. 

With MRSA, we had a 99.998 percent reduction, and similar results against C. diff and B. subtilis bacteria. 

Another aspect of Steriplate that we have designed is using 

nanotechnology in the process to impart hydrophobic or hydrophilic 

surface. The hydrophilic surface is designed to provide an antimicrobial that is on touch surfaces outside the body. We are currently using this technology for surfaces that typically can be contaminated by touch or translocation as well. The hydrophobic aspect of Steriplate really was designed for in body, and what we are 

trying to do is repel typical solution in terms of blood, urine, cerebral fluid, whatever it may be, and the applications that we are 

working on right now in terms of implantable devices are everything from VP shunts to Baclofen pumps for cerebral palsy, scoliosis rods, access ports for dialysis, just to name a few, the traditional types of devices that have a high rate of infection associated 

with them. 
37 

Another aspect of this is also to potentially have a surface that 

is antithrombotic to prevent clotting as well, so an antimicrobial 

and antithrombotic surface. 

But to summarize today for you, the time, cost and complexity 

associated with developing this technology is huge. You know, we 

are geared specifically to try to provide an answer to not just the 

Veterans Hospitals but hospitals across the United States. We are 

a small company. We have 85 employees. But we have reinvested 

about 30 percent of our net profit back into developing this technology. So it is really critical for us to be able to be here today to 

present our technology to share with you our findings as well as 

hopefully be able to solicit help from federal agencies like NIH, 

CDC, National Science Foundation, Veterans Affairs as well or any 

other federal agencies that might be able to help us continue to develop the technology behind Steriplate and hopefully antimicrobial 

surfaces in general. 

Thank you very much. 

[The prepared statement of Mr. Smith follows:] 
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Chairman BUCSHON. Thank you very much, Mr. Smith. 

I now recognize Mr. Miller for five minutes to present his testimony. 

TESTIMONY OF MR. MORRIS MILLER, 

CHIEF EXECUTIVE OFFICER, 

XENEX DISINFECTION SERVICES 

Mr. MILLER. Good morning. Thank you, Chairman Smith, Chairmen Broun and Bucshon and other distinguished Committee Members. It is an honor to be here today. Every year, HAIs cost $20 billion and kill 100,000 Americans, 

more than breast cancer, auto accidents and HIV combined. This 

is a devastating problem, so I wanted to share some good news 

with the Committee. Hospitals that use our germ-zapping robot kill 

pathogens and drug-resistant superbugs and their infection rates 

have dropped more than 50 percent. I am joined today by Dr. Mark 

Stibich, who along with his Xenex co-founder, Julie Stachowiak, 

both hold Ph.D.’s in epidemiology from Johns Hopkins. They founded Xenex to stop hospital-associated infections. 

Just two years ago, scientists were unsure the role of the environment in the passage of the infections from patient to patient. 

Over the past two years, we know without a doubt that these 

pathogens and superbugs exist on bed rails, remote controls, nurse 

call buttons, telephone handsets. These superbugs are microscopic. 

We have spent—I have spent a lot of time with housekeepers over 

the past two years. These are some of the hardest-working Americans you have ever met. They cannot do the task that is assigned 

to them in the time that they have. They clean but they cannot disinfect every surface, and they never know whether they have eliminated the microscopic superbugs. Now in our hospitals, they clean 

and then they use our Xenex robots. We call them housekeeping 

heroes. 

My written testimony has every detail of our proven, peer-reviewed outcome studies in journals like American Journal of Infection Control. To summarize, we have seen a sustained 53 percent 

reduction in C. diff infections. We have seen a sustained 56 percent 

reduction in MRSA, also known as staph infections. Just this week, 

two VAs told us, Muskogee, 50 percent drop in overall infections, 

Iowa City, 30 percent drop in C. diff. This is the only technology 

of its kind that has shown this ability to impact rates. 

Now, since 1901, we have known that we can use ultraviolet 

light put out by low-intensity narrow-spectrum mercury bulbs to 

disinfect things like water. In the hospital where room turnover 

time is critical, they are too slow. The Xenex robot uses full-spectrum, high-intensity pulsed xenon bulbs to create UV light and destroy the DNA of bacteria in four ways. The light is 25,000 times 

brighter than sunlight. Disinfection takes about five minutes. The 

pathogens have no defense. 

At the end of 2013, more than 200 hospitals including 26 VA 

Hospitals now utilize the technology. How do we know the results 

that have been peer-reviewed and published? Because our customers purchase the devices, they achieve the results. They were 

so excited that they decided to publish them. 
55 

Just recently, a new customer, an infection preventionist from a 

California hospital, came to me. They had an outbreak in their 

labor and delivery suites. Sixty mothers and their newborns, didn’t 

ask for it, all got MRSA. They were fighting it. They were following 

all of the CDC guidelines. They couldn’t stop it. In desperation, 

they called us. We sent over one of our employees. The employee 

began disinfecting the rooms. Within three days, the outbreak 

stopped. There have been no more infections since. 

So the next logical question I would think is, well, what is the cost of technology like this? It is about $1 per patient day. And the 

return on the investments for a 36-month use of the robot, the hospitals tell us it pays for itself in about four months. 

So one of the questions you asked was, what can Congress do? 

On Hospital Compare, which is a Web site that you all insisted on 

sharing data, insist on more data, specifics on MRSA, C. diff, VRE 

and the other infection rates that we know are preventable. To the 

extent that you can, don’t pay for preventable infections, and a little bit outside the box, incentivize hospitals. If you gave them $1 

to $1.50 per patient day that they could bill through to use this advanced disinfection, this would give patients the disinfection they 

need and don’t know to request. 

In 1968, Congress mandated that automakers install seatbelts. 

In 2012, seatbelts saved over 12,000 lives. If Congress mandated 

the proper disinfection of these hospital rooms, we could save that 

many lives in two months. 

I feel pressure every day because 5,000 Americans are infected 

and 273 die. We have the technology to save them. If you or a loved 

one ever has to go to a hospital, you would like to know that your 

hospital or procedure room would not make you sick. 

Let us work together to prevent millions of infections and save 

50,000 lives a year. Our veterans, their families and all Americans 

deserve no less. 

Thank you. 

[The prepared statement of Mr. Miller follows:] 
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66 

Chairman BUCSHON. I would like to thank the witnesses for their 

testimony, and reminding Members that the Committee rules limit 

questioning to five minutes. At this point the Chair will open the 

round of questions. I recognize myself for five minutes. 

I want to start with Dr. Perl because one of my areas—I mean, 

I was a cardiovascular and thoracic surgeon, and other than 

orthopedists, probably the most infection-averse people in the hospital. It is obviously a disaster when it happens. 

I have always been interested in when people come in how to, 

you know—what the patient themselves are bringing into the hospital and what the effect not just on hospital-based antibiotic use 

but outpatient antibiotic use as on the development of resistant 

bacteria, and I can say this because I have four kids and they have 

all kinds of ear infections and everything, and I have parents who 

are seniors who get antibiotics for all kinds of things that they 

probably shouldn’t. Can you just discuss a little bit about maybe 

some of the things we might do in training infectious-disease professionals or internists about really how to manage that on an outpatient basis because I do think that has a significant impact on 

inpatient hospital infection. 

Dr. PERL. Yes. Thank you for the question, and I think you are 

absolutely correct. The reality is that we don’t have all the answers 

but what we can tell you is, even actually after one dose of antibiotics, you can develop resistant organisms. It has been best studied actually in the perioperative surgical setting where they have 

looked at that. So the challenge really is to really make sure that 

we use antibiotics appropriately, and to do that, we really have to 

enhance diagnostics. When we can differentiate whether somebody 

has a bacterial infection versus a viral infection, you can direct 

your therapy much more appropriately to limit the use of antibiotics, to define duration, course durations, and also to make sure 

that we simplify the antibiotic and really use one that we don’t go 

more broadly than we need to. 

So in terms of what we can do in the outpatient setting, it is almost like it is really common sense. Just make it simple. Make 

sure it is for the right thing and—— 

Chairman BUCSHON. And I think, don’t you also think that it is 

a public education process? I mean, how many—every practicing 

physician has had a patient come in and they clearly have a viral 

infection but it keeps going and they just have a hard time believing that it is not something that needs to be treated with antibiotics. It is probably a multipronged approach, right? I mean, all 

of us that practice medicine know that phenomenon, right? And 

what happens is, the patient will ultimately get antibiotics from 

someone, and so how do we solve that problem? Maybe we can— 

is there a way we can bring this more to the public attention than 

we already are? 

Dr. PERL. I don’t have all of the answers but I would certainly 

tell you that there have been very effective public health campaigns that we could look to. I mean, we have been able to reduce 

smoking. We have been able to get people to use car seats. We have 

been able to get people to use seatbelts. So I think that there are 

clearly examples out there but it requires directed, concerted effort 
67 

from multiple groups, as you know, not only directed at health care 

professionals but also, as you point out, the public. 

Chairman BUCSHON. Thank you. That is a big problem to solve. 

Dr. Cox, are there different or more significant risks resulting 

from hospital-acquired infections at pediatric hospitals, such as IU 

Health, comparing children to adult hospitals? Is there a difference? 

Dr. COX. So there is a difference. Children are not just short 

adults, certainly, but I think it is sort of interesting if you look at 

the two ends of the spectrum, sort of what you have at this end 

of the table, very young infants and very elderly patients. Their immune systems do not function quite as well as they do in the peak 

times of their life and so they are both at risk. I also think when 

you look at self-standing children’s hospitals, there is a lot of referral patients, the very complicated problems. They require a lot of 

instrumentation. So you are a cardiovascular surgeon. All cardiovascular open hearts who have been on the pumps require a lot of 

instrumentation, no matter your age, and those are the risks that 

occur everywhere, even beyond children. 

Chairman BUCSHON. Okay. Thank you. 

And are there—at Riley, what is your review process you identify 

a hospital-acquired infection and do you think—has that morphed 

over time to change or improve the process to try to retrospectively 

find out why exactly that happened? Do you have information on 

that? 

Dr. COX. We do. So I think it is pretty typical, I think, of what 

is becoming the norm across the country. So it used to be nobody 

worried about this, it is just a little bit of extra antibiotic, until 

that became clear that that is not appropriate, and so now what 

hospitals do, including ours, is we have a standardized work flow. 

Every single infection in our hospital that is hospital-acquired is 

investigated. There is a form. Our nursing staff, our clinical nurse 

specialists who are advanced practitioners, sort of lead the information gathering. We review the chart. We interview everybody who 

took care of the patient in that 48 hours prior to the onset of the 

infection. Then we sit down as a multidisciplinary group, RTs, 

physical therapists, nurses, doctors, everybody, pharmacists, that 

we can get and we look at every piece of that puzzle. 

What has happened over time is initially we had all these aha 

moments, right—oh, this shouldn’t have happened, we should have 

used this technique, we didn’t do that. I think over time as we have 

gotten better, we have sort of picked that low-hanging fruit, if you 

will, and we have cleared up those things that are easily done and 

so we have seen our infection rates go down. What becomes the 

challenge then, right, as we review these cases, the solutions get 

harder and harder and so we need to come up with new strategies 

that don’t replace what we have always done but just augment 

them. 

Chairman BUCSHON. Thank you very much, and my time is expired so I will recognize Mr. Swalwell for his questioning. 

Mr. SWALWELL. Thank you, Chair, and good morning to our witnesses. 

I wanted to start by first comparing our VA Hospitals to non-VA 

Hospitals across the country, and I just want to go witness by wit-
68 

ness. Yes or no, to your knowledge, is there any known difference 

in any studies that you are aware of or anecdotally in hospital-acquired infections at VA Hospitals as compared to non-VA Hospitals. I will start with Dr. Jinadatha. Yes or no? 

Dr. JINADATHA. No. 

Mr. SWALWELL. Dr. Cox? 

Dr. COX. No. 

Mr. SWALWELL. Dr. Perl? 

Dr. PERL. No. 

Mr. SWALWELL. Mr. Smith? 

Mr. SMITH. No. 

Mr. SWALWELL. Mr. Miller? 

Mr. MILLER. Don’t know. 

Mr. SWALWELL. And Dr. Jinadatha, are you aware of any studies 

underway or in your own experience working with patients in central Texas who are veterans with regard to HAIs? 

Dr. JINADATHA. Yes, sir. As I mentioned in my testimony, we 

have a multicenter study where we are looking at how does implementation of UV technology affect outcomes such as hospital-acquired infections so we have two intervention sites and two control 

sites so we are comparing standard practice versus enhanced cleaning to see if that makes a difference. 

Mr. SWALWELL. Great. And certainly in the last six months, we 

have learned a lot about Veterans Hospitals. Over the last four to 

five years, we have learned a lot about the veterans’ claims disability backlog and most on this panel, I assume, would agree and 

most of my colleagues would agree that what we promise our veterans and how we treat our veterans is not matching up and that 

we promised them that we will take care of them and right now 

we have unacceptable backlogs in the care in some of these hospitals that have been highlighted like in Phoenix, for example, is 

outrageous and not what they deserve. 

However, I am concerned that by having this hearing, we may 

be alluding to or implying that a problem exists that does not exist, 

and we could further hurt confidence that our veterans have in our 

health care system by implying that HAIs exist or occur at a greater rate at VA Hospitals than they do elsewhere, and so Dr. 

Jinadatha, is it your experience that you are not seeing at least in 

the central Texas system anything that would exceed your area, 

community or private hospitals? 

Dr. JINADATHA. We are a very small facility, sir. We have 90 operating beds. So our infection rates when we compare it to our hospitals of our similar size, we are at national average or below national average on some of the measures. 

Mr. SWALWELL. And Mr. Smith called for to study this not just 

for our Veterans Hospitals but for non-Veterans Hospitals additional federal funding for the CDC, for the NIH, for the National 

Science Foundation, and just going again across with the witnesses, would you agree that when we are making our budgeting 

priorities we should be increasing funding for those programs or 

cutting funding? So would you say increase or cut, Dr. Jinadatha? 

Dr. JINADATHA. Since I am a researcher, increase. 

Mr. SWALWELL. Okay. And Dr. Cox? 

Dr. COX. Increase. 
69 

Mr. SWALWELL. And Dr. Perl? 

Dr. PERL. Increase. 

Mr. SWALWELL. Mr. Smith? 

Mr. SMITH. Yeah, definitely increase. 

Mr. SWALWELL. And Mr. Miller? 

Mr. MILLER. Increase with incentives. 

Mr. SWALWELL. And actually I am glad you brought up those incentives because Dr. Perl, starting this fall Medicare is set to impose penalties on hospitals that have poor infection control rates as 

an incentive to improve quality of care. Do you believe that this is 

a reasonable policy that will help reduce hospital infection rates? 

And then Mr. Miller, if you could follow up on that? 

Dr. PERL. I am not a public policy researcher but I think that if 

it does go ahead, and in your opinion, that is the way the country 

should go, that we absolutely need to make sure that we don’t have 

untoward consequences as a result of that. I mean, I think the risk 

is that we lose resources that may be supporting some of the practices that all of us have been talking about. 

Mr. SWALWELL. Great. And Mr. Miller, is that an incentive you 

would support, and could you give us examples of others that you 

might support? 

Mr. MILLER. So I think the—I am in support of including more 

in Hospital Compare data and increasing the penalties on valuebased purchasing, making sure that things like MRSA, C. diff, 

VRE, Gram-negative staph, that those are all included in there so 

that the hospitals absolutely know they are not going to make 

money by making the patients sick. Is that responsive? 

And then the second thing is, the other idea is, that’s the stick, 

and then providing them with an incentive that enables them to 

say okay, I have got 20,000 patient days coming up, I can afford 

to buy the technology that is going to save you 20 to one on your 

spend, that is more direct. 

Mr. SWALWELL. Thank you, Mr. Miller, and Mr. Chair, I yield 

back the balance of my time. 

Chairman BUCSHON. I want to take a personal privilege and just 

comment briefly on what has happened at hospitals when Medicare 

decides not to pay for infections, for example, in cardiovascular surgery when you have a sternal wound infection. They decide not to 

pay for it. Now the hospitals that I have worked at now culture everybody when they come into the hospital and it is flooding our 

microbiology labs with nasal swab cultures and others to try to 

prove that indeed the infection came to the hospital with the patient. So your comment on unintended consequences of public policy is well taken. 

I now recognize Dr. Broun for five minutes. 

Mr. BROUN. Thank you, Dr. Bucshon. 

By the way, Mr. Swalwell, there are some studies that show that 

some VA hospitals have higher infection rates than others, so there 

is data. 

Back to my question. Dr. Jinadatha, as I alluded to in my remarks, the Veterans Health Care Administration executives in 

Washington apparently have access to detailed information about 

quality care and patient safety at individual VA hospitals all across 

the system but a lot of this information is not available to the pub-
70 

lic. As the Chairman of the Oversight Subcommittee, I am a huge 

proponent of transparency and accountability. So when I hear that 

some VA hospitals exceed the infection rates of private-sector hospitals by 10 times or more, it seems especially important to alert 

veterans to the kind of medical treatment that they should expect 

to receive. 

So why isn’t the VA more forthcoming in providing objective information and data about individual patient outcomes in VA hospitals? 

Dr. JINADATHA. Mr. Chairman, I am a frontline clinician and I 

usually focus on what I can do for the veteran that is at my hospital. Unfortunately, I will have to take it for the record and see 

what I can get back. 

Mr. BROUN. Well, if you would, please, because I think it is imperative that patients know what the infection rates are, et cetera, 

as well as all patient outcomes at various hospitals. 

I will ask all witnesses this. If the two technologies represented 

here today were implemented properly at all VA hospitals, how 

much would that improve current conditions? In addition to highlighting technologies that can help improve vet infections and 

death, what more can Members of this Committee, Members of 

Congress do to improve care for our veterans? And Mr. Miller, I 

know you offered some suggestions in your testimony so let us start 

over here on the other side with Dr. Jinadatha. 

Dr. JINADATHA. Generalizing one center experience and applying 

it across all VAs, I don’t know whether it will decrease or not because I believe every hospital is different. The patient population 

is different. The procedure done is different. The culture is different. So I don’t know whether that will solve the problem. It 

might help some institutions and it may hurt some institutions, depending on the local conditions. 

Dr. COX. You know, it is a difficult thing. I think first and foremost, people should know the kind of care they are entitled to get 

and what they should expect. I think accountability comes from 

knowledge, and I think educating the consumer as well to the role 

that they pay is critically important. We don’t need an antibiotic 

for everything, and you know, you don’t need a line in longer just 

because it is more convenient, and we need to consider how we prepare the entire care team, which includes not only the hospitalbased personnel but the patient and family themselves, and I think 

that can go a long way. I think all of these strategies can augment 

it. The question is, are we ever going to get to zero, and I think 

that is a question we think probably not but can we be closer. 

Mr. BROUN. Dr. Perl, if you would answer quickly, I have got 

some more questions and I want to go forward so I am about to 

run out of time in another minute and a half. 

Dr. PERL. Well, just to sort of add to what has been said, we actually don’t know. There have been not been any head-to-head 

studies, and I think this Committee needs to really recognize that 

there are incremental potential benefits or incremental potential 

detriments with any of these technologies, and they must be studied in a very rigorous way so that we make good choices. 
71 

Mr. BROUN. Thank you. And I will just—Mr. Smith, if you don’t 

mind, I have got another question that I would like to ask Dr. Cox 

and Dr. Perl. 

Both of you referred to the concept of the bundle and you referenced that in your testimony. It is an approach that appears to 

have helped in you all’s own hospitals to decrease infection rates 

significantly. So what specifically does the bundle entail, and do 

you see this is something that can be implemented in the VA Hospitals? Dr. Cox? 

Dr. COX. Yes. So the bundle is just a series of very easy things— 

wash your hands, scrub the hub, let it dry, access with aseptic 

technique, review every day if you need this device in place, and 

it is tweaked a little from device to device but that is the basic 

premise, and the beauty of it is, it is very inexpensive and it is very 

quick and it is very easy to do, and it should be able to be done 

not only in all hospitals and VA hospitals but in resource-limited 

countries as well. 

Mr. BROUN. Dr. Perl, any addition to that? 

Dr. PERL. No, I would agree with what the witness said. I would 

just add that actually there have been some data in VA hospitals 

looking at implementation of these bundles that have actually 

shown they are effective. So they are device-specific but they can 

actually give people very structured processes that facilitate good 

care. 

Mr. BROUN. Thank you all. 

Mr. Chairman, if I may take a point of personal privilege? 

Chairman BUCSHON. Sure. 

Mr. BROUN. As a family-care doctor, I just want to state that 

something I fought my whole medical career is overutilization of 

antibiotics in patients, and I have had patients come to my office, 

as all primary-care physicians do, for every earache, for every child 

or every sore throat, every cough, even bronchitis, most of these are 

due to viral illnesses or allergies, and antibiotics are not appropriate in that treatment modality for taking care of those patients. 

Patients have to be responsible too. 

I have spent a career trying to educate my patients and my patients’ moms and dads that antibiotics are not the solution to every 

fever, and whatever we can do, whatever you can do, whatever the 

medical community can do to try to help stop this overutilization 

of antibiotics is something that I focused upon my whole medical 

career and it is absolutely imperative that we continue to do that. 

And one other final comment, Mr. Chairman, is that these hospital-acquired infections just—they are a whole plethora of things, 

whether it is a nosocomial pneumonia, as you very well know, 

whether it is Legionella that develops from a faulty air conditioning system, whether it is a catheter or an IV set or anything 

else or whether it is a heart valve, the problem has a whole wide 

variety of potential causes and so it is not a very simple thing to 

say the bundle is going to protect our patients from infections, and 

it is just absolutely—I thank you or helping us put together this 

hearing, and I yield back. I thank you for the leeway. 

Chairman BUCSHON. Thank you, Mr. Broun. I now recognize the 

Chairman of the full Committee, Mr. Smith. 
72 

Chairman SMITH OF TEXAS. Thank you, Mr. Chairman, and let 

me direct my initial questions to Mr. Miller. 

Mr. Miller, in your oral testimony today, you gave us the good 

news that on the whole, you felt like your device, your technology 

has reduced infections by about 50 percent, sometimes a little bit 

more, sometimes a little bit less. That is a phenomenal drop and 

has incredible consequences if you can reduce the infections by 

half. To take it to the next step, that means you are saving a lot 

of lives as well. 

My question is merely—I would like for you to expand a little bit 

more on how effective your technology is in creating a bacteria-free 

environment, particularly compared to other methods that are 

used. 

Mr. MILLER. Thank you. So I think this also responds to Dr. 

Broun as well. Before we ever released the product, we did testing 

at M.D. Anderson, and at M.D. Anderson, comparing post-cleaning 

rooms versus rooms that were cleaned with Xenex, we found that 

the cleaning didn’t make a statistically significant difference. In 

other words, whether you clean the room or didn’t clean the room, 

if you ran the robot, there ended up being 20 times less bacteria. 

This is on a colony-per-square-inch count at the end of the day, and 

where manual cleaning could never get rid of VRE in the environment, the robot was able to basically because it doesn’t miss surfaces. It is always hitting it with its high-intensity UV light, and 

as a result of having a less bacterial count in the room, then the 

patient isn’t subject to getting infection even if perhaps somebody 

forgets to wash their hands, maybe they won’t infect the patient 

anyway. So getting that bacterial load way down, 20 times lower, 

is part of the key of the success of the device. 

Chairman SMITH OF TEXAS. And Mr. Miller, also, what impediments have you encountered in trying to persuade others to use 

your technology and have a wider spread use of your technology? 

Mr. MILLER. Overwhelmingly, the primary objection is, they say 

well, we just don’t have enough budget to do that, we understand 

the benefit to the patients but we just can’t afford it. 

Chairman SMITH OF TEXAS. You said it paid for itself, I believe, 

in four months. How did you calculate that? 

Mr. MILLER. That is what the hospitals report back to us, so our 

very—one of our very first hospitals said they got a 50 to 1 payback 

on the investment. They saved almost 1,100 patient days just after 

starting to use it in their ICUs. 

Chairman SMITH OF TEXAS. What is the typical cost of this device? 

Mr. MILLER. It costs about $104,000 for the device and then it 

can treat somewhere between 30 and we have hospitals treating as 

many as 65 patient rooms per day, so on a per-room basis, it ends 

up being somewhere between $2 and $3.50 on the discharge of that 

patient. 

Chairman SMITH OF TEXAS. That is amazing, and I appreciate 

your putting that in the record. 

My next question is, what kind of obstacles have you encountered 

in developing even new processes or new technology? 
73 

Mr. MILLER. We are working as fast as we can. Dr. Stibich 

spends the Majority of his time thinking about what is the next 

iteration. 

Chairman SMITH OF TEXAS. Have there been any regulatory 

problems that you have encountered? 

Mr. MILLER. Not so far. 

Chairman SMITH OF TEXAS. Okay. I am glad to hear that. I 

thought maybe you had. Okay. 

The other question I have is, are there any other similar products like yours available on the market? 

Mr. MILLER. As Dr. Perl referred to, there is hydrogen peroxide 

gas. It can absolutely work. It takes about three and a half to four 

hours including sealing the room, disinfecting it, but it does a good 

job. There is also the—there is devices that are built on mercury 

bulbs, and if you had two and a half hours, approximately two 

hours and fifteen minutes to disinfect a hospital room, those work 

as well. So basically it is a time difference, four hours, two hours 

and fifteen minutes, or about ten minutes. 

Chairman SMITH OF TEXAS. Okay. Thank you. 

And let me ask whatever panelist might be the best one to answer this question, and that is, is there any danger that bacteria 

will develop a resistance to these types of methods that are trying 

to create a bacteria-free environment? Mr. Miller, if you want to respond first, it looks like you are eager to. 

Mr. MILLER. Yeah. We know of a—there is a recent study that 

showed that the bacteria do not develop a resistance to this kind 

of treatment. 

Chairman SMITH OF TEXAS. Let me just see if any of the doctors 

on the panel have a comment on that as well. Is there any danger 

that bacteria would develop a resistance to this type of technology? 

Dr. JINADATHA. We in central Texas evaluated the risk of developing resistance to mercury-based and xenon-based technologies, 

and in our preliminary report—and I want to disclose that it is not 

peer-reviewed yet. We did present this data at the APIC meeting 

that there was no development of resistance in our experiment. 

Chairman SMITH OF TEXAS. That sounds to me like more good 

news, not only for you all but, more importantly, for patients in the 

hospitals themselves. 

Thank you, Mr. Miller. Thank you all for your expert testimony 

today, and Mr. Chairman, I will yield back. 

Chairman BUCSHON. Thank you, Mr. Smith. At this point I will 

ask unanimous consent to introduce the Wall Street Journal investigative articles about VA health care into the record, and note that 

in those articles, within the VA system itself, there does appear to 

be a wide variance on the incidence of hospital-acquired infections. 

[The information appears in Appendix II] 

Chairman BUCSHON. At this point I will recognize Mr. Lipinski 

for five minutes. 

Mr. LIPINSKI. Thank you Mr. Chairman. I want to thank you and 

all the chairmen for holding this hearing. Although the issues we 

are talking about today are not unique to VA hospitals, we do owe 

it to our veterans to do all we can to take care of them for what 

they have given to us, for us, the sacrifices they have made. So I 

want to thank of our witnesses for coming to testify today. 
74 

The first thing I wanted to ask is, I wanted to ask Dr. Perl, I 

just wanted to get your thoughts—I know you are not an expert on 

the specific technology but the Xenex’s pulse xenon ultraviolet technology, do you believe this technology has been proven or do you 

believe more research is needed to test its potential benefits for reducing the rate for infections? 

Dr. PERL. So I would actually say that there is preliminary evidence suggesting that it does decrease the microbial contamination 

in the environment. There is limited evidence that is not as rigorous as we would like looking at the impacts in the clinical setting—does it actually decrease infections—and that is really that 

translation that is needed. 

Mr. LIPINSKI. Okay. I just wanted to get clarification there. 

Something else I wanted to bring up. I know it has been discussed a little bit, and it was also in written testimony. Dr. Perl, 

I think many of us would like to think that there is a single solution for this problem; if only we adopted the right technology, 

health care-associated infections would be eliminated, and I am not 

talking just specifically on this issue but on all issues that we get 

here, that we discuss here in Committee. We are looking for that 

one breakthrough that is going to solve everything, and we know 

it is more complicated than that, especially an issue that I talk 

about very often here on this Committee is the aspect of human behavior. We could have the best technology in the world, if it not 

being used correctly or may be not used at all or we are just doing 

things that are bad, that human behavior can undermine the best 

technology that we have in place. 

So Dr. Perl, can you speak of the importance of low-tech applications or processes such as training, clear communication and proper hand hygiene that would help in efforts to eliminate infections? 

Before you go, I just want to say everyone on the Committee knows 

I am always talking about the importance of having research in behavioral sciences, and behavior—we need to understand people’s 

behavior or else the best technology is not going to do us any good. 

So what can you add on that? 

Dr. PERL. I think you have actually really stated the big challenge. Human factors, which is really this behavior is a huge challenge for us in health care. We are asking people to do multiple 

tasks with critically ill patients commonly, and including a lot of 

different things simultaneously, and so what you are always challenged with is making sure that people are doing everything that 

they need to do and that you facilitate those kinds of behaviors. So 

we could have all of the technology in the world but if people don’t 

know how to use it or how to integrate it into their work flow or 

they don’t have time to integrate it, then we are back to square 

one. So this whole issue of not only bringing in the technology but 

actually figuring out how to operationalize it once we know what 

works is going to be critical, and having done clinical trials in this 

arena, I can just tell you, it is much more difficult than it looks 

at face value. So it is a huge challenge as well as issue to think 

through. 

Mr. LIPINSKI. Would you like to add something, Mr. Miller? 

Mr. MILLER. Just two things. We agree with that. As part of a 

bundle, we never just deliver a robot. There is always robust train-
75 

ing that goes to the people. That is number one. And then number 

two, three of the studies out of the six that I have shown you are 

actually outcome studies showing the reduction peer-reviewed in 

the published journal so not just showing reductions in pathogens 

in the environment. 

Mr. LIPINSKI. Thank you. I will yield back. 

Mr. JOHNSON. [Presiding] I thank the gentleman for yielding 

back. The Chairman has stepped out for a minute, and I have 

taken his place, so I will yield myself five minutes, Representative 

Bill Johnson from Ohio, and first of all, Dr. Jinadatha, thank you 

for being here today, and the entire panel. I recognize that you specifically did not have—you are not the reason why we didn’t get 

written testimony. It was the bureaucracy, and quite honestly, I 

must state for the record that that is exactly what is causing so 

many Members here and so many Americans across the country 

concern is the bureaucracy in the VA that is not looking out for the 

best interest of our veterans, and I am not speaking about you specifically. But clearly, we have some major issues, and this attitude 

of, we will get to you when we get to you, and a lack of sense of 

urgency in addressing the concerns of the voice of the American 

people, which is the United States Congress, that is very, very concerning to me, but I do want to thank you for being here today. 

And with that, let me ask just a few basic questions. What suggestions do you—and this is for the entire panel and we will just 

go left to right if that is okay. What suggestions do you have to prevent the outbreaks and the spread of diseases, for example, such 

as Legionnaire’s? 

Dr. JINADATHA. My belief is, it is about people, process and products, and I think if we master all the three, we probably could prevent a lot of our infections including Legionella. 

Mr. JOHNSON. Okay. Dr. Cox? 

Dr. COX. I think you have to go both from an environmental approach, particularly for things like Legionella. I think you have to 

take what Dr. Perl said and get rapid diagnostics so that you can 

intervene earlier because outcomes will be better, and then I think 

you have to keep looking at the individual patient level, what can 

you do there as well. 

Mr. JOHNSON. Okay. Thank you. Dr. Perl? 

Dr. PERL. You have asked actually a very loaded question, and 

it really requires a comprehensive approach, and I think we have 

identified the people issues. There are technologic solutions but 

there is also implementation that is critical in all of this, and it has 

got to be multidisciplinary and really involve everyone from frontline staff to leadership to really be effective. 

Mr. JOHNSON. Thank you. Mr. Smith? 

Mr. SMITH. Yeah, my belief is really, is it kind of two things. It 

is mindset, getting people to understand that HAIs are not inevitable, they are preventable. That is the big thing initially. The second thing, as Dr. Perl said, implementation or practice, and it is 

a collaborative effort. There is no one specific solution. It is going 

to take a collaborative effort of multiple technologies to be able to 

make the impact that we all want. 

Mr. JOHNSON. Okay. Mr. Miller? 
76 

Mr. MILLER. And what we have seen is when the hospital administration makes a concrete commitment to patient safety, it is 

amazing what you can see. 

Mr. JOHNSON. It kind of starts at the top, doesn’t it? 

Mr. MILLER. Absolutely. 

Mr. JOHNSON. And we see that in many instances. That seems 

to be the key. 

Dr. Jinadatha, do you know if the VA has specifically implemented any procedures to prevent Legionnaire’s outbreaks like the 

one that happened in Pittsburgh? Has Legionnaire’s been addressed specifically within the VA? 

Dr. JINADATHA. I will start with my facility. We have a water 

safety Committee, and the chair is led by the top leaders from the 

front office, and we take every precaution to do whatever we can 

within our powers to make sure our veterans are safe from the Legionnaire’s perspective at our facility. 

As to the VA, I am not sure. I probably can get back to you. But 

I know it is a concentrated effort that is going on to do whatever 

we can to take care of that. 

Mr. JOHNSON. Shifting gears just a little bit, kind of a different 

subject. You know, we have read stories about millions of dollars 

in performance bonuses paid to VA hospital managers even as patient wait times for appointments and other problems including 

HAIs festered. Should the VA explicitly and primarily base performance pay to health care managers on objective measures of 

care that our veterans receive? I would just like your opinions, and 

we will go left to right again. Dr. Jinadatha, do you have an opinion? 

Dr. JINADATHA. No, sir. 

Mr. JOHNSON. You don’t have an opinion, or your answer is ‘‘no’’? 

Dr. JINADATHA. I don’t have an opinion. 

Mr. JOHNSON. Okay. Dr. Cox? 

Dr. COX. I think with all the benchmarking data that we have 

now and accountability, I think that performance measures can be 

instituted in a lot of varieties including for bonuses. 

Mr. JOHNSON. Okay. Dr. Perl? 

Dr. PERL. I think there is a risk, and you have to really actually 

decide what you are looking for. The risk is that if it is a performance-related measure, that there is strategy to game the system, 

and so perhaps if you include those, you also want to have process 

measures that are a little bit harder to game, so I think that is the 

risk, and there are people who are much smarter than I that are 

thinking about those things. 

Mr. JOHNSON. Got you. Mr. Smith? 

Mr. SMITH. As a small-business owner, my life revolves around 

risk-reward and accountability, and so while I can’t specifically 

comment to your question, in any situation, reward and accountability, I think, is a good thing. 

Mr. JOHNSON. Mr. Miller? 

Mr. MILLER. And I am cognizant of what Chairman Bucshon said 

earlier about unintended consequences. On the other hand, in all 

the companies that I have grown, we have 6,000 employees, there 

is nothing like incentives that are properly put in place to get them 

focused on what the administration of that entity wants to see hap-
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pen, and then you measure it and then you re-measure it and then 

you adjust the incentives constantly. 

Mr. JOHNSON. Well, thank you all, and as a 26–1/2-year veteran, 

I can tell you that I am concerned about the care that our veterans 

get. I appreciate the edification on this particularly interesting and 

critical subject that you brought to us today, and I agree, there is 

no such thing as a former Marine. Semper fi. I am Air Force, but 

thank you for your service. I yield back to the Chairman. 

Chairman BUCSHON. I yield now to Ms. Esty for five minutes. 

Ms. ESTY. Thank you, and I want to thank the Chairman again 

for holding this important hearing today, and I want to thank all 

our witnesses. We certainly all have a shared commitment to serving those who have served us, and some of the issues we have seen 

are a microcosm of what we see more broadly in hospitals. As one 

whose father sat in a prominent university hospital in 2005 where 

he had a staph infection induced in the hospital that greatly accelerated his demise, this is of particular concern to me and something I am aware of the consequences that happens. 

A couple of things just at the outset. I think we have heard over 

and over again, and as I serve on the Transportation and Infrastructure Committee as well and on the Rail Subcommittee and I 

live in Connecticut, the importance is a safety culture because this 

has to do with human element of any of these technologies, any of 

these procedures are ultimately going to depend on human beings 

to implement them and so we are going to need to create a safety 

culture at each and every institution and we also need to frankly 

make it easy for people to do the right thing, and that is to be able 

to use the technology well for everybody involved in the situation 

to be able to do the right thing most easily and not force them to 

adapt to what we think they ought to do but actually recognize the 

reality of human behavior. So that being said, I think the best 

technology in the world, as we would all agree, is not going to do 

any good if people won’t use it properly. 

So to that end, I wanted to turn to you, Dr. Perl, to talk about 

how we do currently test technologies because in order to have appropriate testing, you want to reduce the number of variables but 

at the end of the day, we also have to look at human behaviors. 

Could you talk a little bit about that? 

Dr. PERL. So I probably recognize one end of that spectrum, but 

in general, there are different kinds of technologies and what happens for drugs, for example, may be different than what happens 

for devices and could be different than some of the disinfectants 

that are being talked about and actually the current technology 

that has been discussed today as far as I understand is somewhat 

unregulated and there are no standards. So in general, there is a 

process that is usually run at the government level where the device or the drug is regulated. What happens in the FDA is a little 

different than what will happen in, say, the EPA for disinfectants. 

Once that goes through that process, then products are generally 

brought into the marketplace and commonly people will approach 

you and say I have this new device, I would like you to look at it, 

or I have this new product I would like you to look at it, and then 

how you approach it will be very different. What I do may be different a little bit than what Dr. Cox does, and we try and look at 
78 

the technology not only from a safety point of view but from an infectious risk point of view, from an engineering point of view, and 

if we think it is interesting, you can either pilot it or commonly you 

may say look, there are some risks and benefits and we would actually like you to go ahead—we would like to do a study, and then 

you try and determine sources of funding to go ahead and do these 

kinds of studies. Sometimes these are done under the rubric with 

IRBs, or institutional review boards, and sometimes they are actually done as quality projects. So that is in general the process. 

It has been relatively difficult for us to get funding to test this 

kind of technology in a much more what I would call rigorous scientific way. 

Ms. ESTY. And I can follow up on exactly that point, who currently is funding the research on these technologies, and if you 

have thoughts about who ought to be, whether we need a dedicated 

federal funding stream to deal with technologies. Obviously we do 

in the drug category. We have separate ones for medical devices. 

Is this something, given the importance of HAIs, that we ought to 

be looking at a funding stream dedicated to that in and of itself? 

Dr. PERL. So I think that funding for HAIs has actually been— 

it has been greatly underfunded, given its importance, and we really do not have a good home. The NIH will say this is really not 

our area. They might fund resistance at a very basic science level. 

The CDC really does not have that much research funding, and 

what they have is minimal. Traditionally, we haven’t gone a lot to 

the EPA, et cetera, and AHRQ has not been necessarily quite as 

interested in technologies but more implementation science. So 

there is not a good home, and I think that—I am not sure that another infrastructure needs to be created but certainly there needs 

to be an infusion into this arena to assure that we are studying 

things appropriately. 

Ms. ESTY. And if I may, could I ask all five you if I can follow 

up afterwards, if you have thoughts about just deciding a home. I 

agree with you, it makes no sense to create a new agency. That 

would be foolish. But someone needs to take ownership of this issue 

clearly. It makes no sense to have no dedicated stream, given the 

expense, the mortality, the human expense, as well as the cost to 

our system. Someone needs to wrap their arms around this, take 

ownership, start developing metrics and have a funding stream 

that it gets the respect and resources it deserves. 

Thank you all very much. 

Chairman BUCSHON. I would agree with that. 

I now recognize Mr. Collins for five minutes. 

Mr. COLLINS. Thank you, Mr. Chairman. 

Dr. Jinadatha, as Chief of Infectious Diseases, do you run your 

own blood testing lab and so forth in your hospital? 

Dr. JINADATHA. We have our own pathology, microbiology and hematology lab, and of course, I have my own research lab. 

Mr. COLLINS. So using PCR and molecular diagnostic equipment? 

If a patient comes in, you will do your own blood tests? 

Dr. JINADATHA. Yes, we have. 

Mr. COLLINS. Now, one thing I have been concerned about is— 

and I know you are not in Buffalo, but in Buffalo, our VA hospital 

was—it was discovered by the IG a year and a half ago. They were 
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reusing insulin pens. A very basic, you can’t make this stuff up, 

reusing insulin pens. We had to test many thousands of patients 

to see if they had contracted HIV or hepatitis through the refuse 

of these insulin pens. We just discovered through a whistleblower 

that they were not properly sterilizing their instrumentation, I 

mean, not just by a little bit, and so the whistleblower contacted 

the Office of Special Counsel and now it just came out two days ago 

about instrumentation within the hospital not being sterilized, almost, again, something you can’t imagine. 

So what I really discovered is, coming out of the private sector, 

best practices are the heart and soul of quality, but in many cases, 

that means benchmarking. We have three great hospital systems 

in western New York: the Kaleida Health System, Catholic Health 

System and Erie County Medical Center. The VA was not 

benchmarking with any of them, and I can only use the word ‘‘arrogance.’’ The arrogance of the VA system was, we are the best, we 

are the biggest. Well, they are anything but, and if you don’t 

benchmark, how do you know what others are doing? Because, you 

know, not to say for sure but I can assure you, the other systems 

weren’t reusing insulin pens on several patients. They were sterilizing their instrumentation. 

So a real quick question. Do you do and do you have someone 

that does proficiency programs testing out your technicians on your 

molecular diagnostic equipment? 

Dr. JINADATHA. We have a certification process, the CAP, which 

is the—— 

Mr. COLLINS. College of American Pathology? 

Dr. JINADATHA. Yes. 

Mr. COLLINS. So CAP is running your program? 

Dr. JINADATHA. They come and inspect us, so does, I believe, IG 

and—— 

Mr. COLLINS. So with CAP, they are sending you the samples two 

or three times a year, influenza, whatever, and then they are scoring you? 

Dr. JINADATHA. Yes. I believe we undergo CAP certification. 

Mr. COLLINS. How is your score? 

Dr. JINADATHA. Since that is not something I run, I don’t know 

but—— 

Mr. COLLINS. Well, I am glad because that is an outside agency. 

CAP does a very good job. 

Dr. JINADATHA. They kept us working, so I believe we are good 

on their benchmarks. 

Mr. COLLINS. So does your system benchmark? I mean, are you 

making sure you have got best practices? 

Dr. JINADATHA. We have a national infectious disease office that 

is located in Cincinnati, and we get directives, we get handed down 

best practices that we should be implementing, some of the examples that have been alluded by the panelists are MRSA bundle, the 

MDRO program. We have a CLABSI reduction program and an 

antimicrobial stewardship program. 

Mr. COLLINS. But is that coming down from on high to you or is 

your hospital reaching out to the others even in your area just to 

share information? 
80 

Dr. JINADATHA. Absolutely, sir. One of that would have been an 

example of how we instituted UV disinfection technology at our facility. So in our facility, which I can speak for, we do both. We take 

some of the best practices that are given to us from the national 

office. We also initiate on our own some best practices that I follow 

the literature and bring it into—try to bring it into practice. 

Mr. COLLINS. Again, in Buffalo, I just don’t—I wonder if any 

other panelist has a comment, not as a physician, but how could 

you reuse insulin pens? How could they be doing that? Or in the 

case of instrumentation, not sterilizing it. And it was really—the 

technicians didn’t seem to care. They were going through the motions. I mean, does anyone else—it is almost rhetorical. Mr. Smith? 

Mr. SMITH. Just a quick comment. You know, one of the questions before was practice, implementation, training people and so 

forth, and again, it is going to take a collaborative effort to have 

the favorable impact that we all want. 

With our technology, it is not—it does not require training people. It is just simple implementation, whether it is in the touch surfaces outside the body or potentially inside the body. So this is a 

continuous type of technology that does not require training. And 

so thankfully, you take the human element out of that, the decision 

making—the poor decision making out of that aspect. 

Mr. COLLINS. Thank you. I just would conclude by saying it is obvious our veterans deserve the best care. It has been very disappointing in the Buffalo area with a very large hospital, we have 

not delivered the best care, and I go back to—you know, I have 

sensed a level of arrogance within the VA that they just know best, 

and then when you show them they don’t, they still say they know 

best. 

So anyway, thank you, Mr. Chairman. 

Chairman BUCSHON. Thank you. We need to bring this more to 

the public’s attention. It does get out there some into the mass 

media. When we discuss funding for a lot of medical research, obviously there is a disparity between different disease processes within the funding stream, many of which is related to, in my view, for 

political reasons and for the fact that some things are on the front 

page and some things are not. This is one area that we have heard 

today that the dramatic impact on the people that we take care of 

in health care and how it most likely is very clear that we need 

more research and more public awareness of this problem because 

the impact, I think, can be dramatic. 

So I would like to at this point thank all the witnesses for their 

valuable testimony and the Members for their questions. The Members of the Committee may have additional questions for you, and 

we will ask you to respond in writing. The record will remain open 

for two weeks for additional comments and written questions from 

the Members. 

At this point the witnesses are excused and this hearing is adjourned. Thank you. 

[Whereupon, at 10:49 a.m., the Subcommittees were adjourned.] 
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Appendix I 

ANSWERS TO POST-HEARING QUESTIONS
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ANSWERS TO POST-HEARING QUESTIONS

Responses by Dr. Chetan Jinadatha 
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Responses by Dr. Elaine Cox 
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Responses by Dr. Trish M . Perl 
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Responses by Mr. Jeff Smith 
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Responses by Mr. Morris Miller 
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Appendix II 

ADDITIONAL MATERIAL FOR THE RECORD
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PREPARED STATEMENT OF FULL COMMITTEE RANKING MEMBER EDDIE BERNICE

JOHNSON
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ARTICLES SUBMITTED BY SUBCOMMITTEE CHAIRMAN LARRY BUCSHON
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DOCUMENTS SUBMITTED BY DR. TRISH M. PERL
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