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Amid calls to rein in antibiotics, APIC and SHEA want a seat at the table

March 18, 2012 – 8:01 pm | By Gary Evans | No comments yet

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With the misuse and overuse of antibiotics driving drug resistance in general and emerging Clostridium difficile in particular, infection preventionists and health care epidemiologists want to have a greater role in antimicrobial stewardship programs. It may seem surprising that this point even has to be made, but for too often and too long there has been something of a disconnect between prescribing physicians and their infectious disease colleagues. A wide variety of multidrug resistant organisms (MDROs) have emerged under selective pressure of massive antibiotic misuse – a lot of it in the outpatient setting -- with the very real threat of a “post-antibiotic” era underscored time and again. More recently, C. diff has driven discussions of reining in drug use, as antibiotic therapy can clear a niche for the now widespread virulent NAP-1 strain of the spore-forming bacillus to set up in the patient’s gut. What can infection preventionists and health care epidemiologists bring to the table? Plenty, says the Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA). In a joint position paper they emphasize that they are the professional organizations with the historical focus, expertise and credibility in articulating and implementing best practices in antimicrobial stewardship and infection prevention and control. Specific contributions they can make to multidisciplinary drug stewardship programs include: - Identification of MDROs detected among the population served by a health care facility - As part of surveillance, the monitoring and reporting of trends over time involving MDROs - Oversight of the use of standard and transmission-based precautions aimed at preventing cross transmission of pathogens - Compliance with hand hygiene - Use of surveillance data to inform risk assessment and planning for prevention of infection - Education of clinicians on prudent and appropriate use of antibiotics - Development of clinical algorithms for treating infections - Audit, analysis and reporting of data on HAIs - Implementation of strategies aimed at prevention of infection and elements involving prescribing and therapeutic use of antimicrobials, (e.g., guidelines, decision support involving order/entry, de-escalation) To get the lastest advice and tips on preventing C. diff infections tune in to for our upcoming educational progam: Clostridium difficile Colitis: Prevention and Management on Thursday, March 22 from 12:00 - 1:30pm. In this 90-minute streaming webinar, Infection Prevention Consultant Leah Frederick MS, RN, CIC, will give you practical tips to protect your patients. The experienced IP will discuss the characteristics and transmission of CDI, monitoring these infections, and recommended practices for prevention and control. Learning Objectives: • Discuss 2 features of the microorganism C. diff which make transmission difficult to control in the healthcare setting • List the elements of a program to recognize and prevent CDI and transmission in the healthcare setting • Discuss the importance of hand hygiene and environmental cleaning in prevention of transmission of C. diff • Describe resources for controlling CDI in the healthcare setting Credits: 1.5 CNE Credits Course Level: All Levels Registration: Only $299 to attend Priority Code: 10T12407/EM02235 Meet Your Expert Leah Frederick has successfully developed Infection Prevention and Control Programs for new hospitals, and led organizations in improving existing programs. She specializes in leading organizations to decrease and prevent healthcare-acquired infections and providing the most up-to-date information on regulatory compliance. For questions or comments call Customer Service at 800-688-2421 or 404-262-5476

Posted in Multi-drug Resistant Organisms (MDROs) | Tagged , , , ,

Smartphones and ingenious disease: A tale of transmission

March 14, 2012 – 6:42 am | By Gary Evans | No comments yet

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“Technology causes problems as well as solves problems. Nobody has figured out a way to ensure that, as of tomorrow, technology won't create problems. Technology simply means increased power, which is why we have the global problems we face today.”--Jared Diamond, author of Guns, Germs and Steel. The power of the smartphone can be wielded for good or evil it appears, thwarting disease transmission or aiding and abetting it. Let’s begin with the good news. The Kenya Ministry of Health, along with collaborating researchers from the Centers for Disease Control and Prevention, found that smartphone use was cheaper than traditional paper survey methods to gather disease surveillance information, after the initial set–up cost. Moreover, survey data collected with smartphones also had fewer errors and were more quickly available for analyses than data collected on paper, according to a study presented Tuesday at the International Conference on Emerging Infectious Diseases in Atlanta. Researchers compared survey data collection methods at four influenza surveillance sites in Kenya. At each site, surveillance officers identified patients with respiratory illness and administered a brief questionnaire that included demographic and clinical information. Some of the questionnaires were collected using traditional paper methods, and others were collected using HTC Touch Pro2 smartphones using a proprietary software program called the Field Adapted Survey Toolkit (FAST). “Collecting data using smartphones has improved the quality of our data and given us a faster turnaround time to work with it,” says Henry Njuguna, M.D., sentinel surveillance coordinator at CDC Kenya. “It also helped us save on the use of paper and other limited resources.” But the marriage between technology and public health has a short honeymoon -- if there ever was one. On the downside, we must also report that similar smartphone technology is suspected of somewhat literally increasing transmission of syphilis in Sacramento, CA. According to an article by the Sacramento Bee, local doctors diagnosed 41 cases of primary and secondary syphilis in the 1st half of 2011. In the 2nd half, they identified 65 cases, an increase of 60%. Taken together, the 106 new cases in 2011 were twice as many as Sacramento saw the year before, and the county's highest annual total in at least a decade. A Sacramento County communicable disease investigator quoted in the article suspects a surprising culprit for the recent rise: smartphones. Though the evidence cited is strictly anedoctal, the general perception is that social networks and smartphones have made it easier for people seeking casual sex to find willing partners. Some GPS-powered apps enable people to broadcast their location to others seeking "hookups" in their vicinity, the paper reported. "It's been going on for a while, but I think a lot of people are having more access to computers, and the creation of the smartphone definitely has made an impact on quick access to partners," the investigator said.

Posted in Uncategorized | Tagged , , ,

C. diff no longer a mystery meat: Healthcare is the battleground

March 13, 2012 – 8:45 am | By Gary Evans | No comments yet

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One finding that slid under the radar recently in a CDC report on the surging epidemic of Clostridium difficile was that 94% of the infections were linked to health care. That’s logical enough, you may well note, but consider that not that long ago there was increasing suspicion of retail meat and other sources to explain the historical picture that some 20% of C. diff infections are of unknown origin. In one study, C. diff was found in a wide variety of retail meats, and then came the disturbing corollary: cooking does not necessarily kill the hardy bug. Now, as surveillance systems are being refined to capture more of these high-priority infections, we can see that C. diff links to the food chain and other unusual sources likely account for a very small percentage of cases. That means more than ever that health care settings will be the battleground if C. diff is to be stopped from a rampant rise that is generally attributed to the absolute dominance of the highly virulent NAP1 strain. To get the lastest advice and tips on preventing C. diff infections tune in to for our upcoming educational progam: Clostridium difficile Colitis: Prevention and Management on Thursday, March 22 from 12:00 - 1:30pm. In this 90-minute streaming webinar, Infection Prevention Consultant Leah Frederick MS, RN, CIC, will give you practical tips to protect your patients. The experienced IP will discuss the characteristics and transmission of CDI, monitoring these infections, and recommended practices for prevention and control. Learning Objectives: • Discuss 2 features of the microorganism C. diff which make transmission difficult to control in the healthcare setting • List the elements of a program to recognize and prevent CDI and transmission in the healthcare setting • Discuss the importance of hand hygiene and environmental cleaning in prevention of transmission of C. diff • Describe resources for controlling CDI in the healthcare setting Credits: 1.5 CNE Credits Course Level: All Levels Registration: Only $299 to attend Priority Code: 10T12407/EM02235 Meet Your Expert Leah Frederick has successfully developed Infection Prevention and Control Programs for new hospitals, and led organizations in improving existing programs. She specializes in leading organizations to decrease and prevent healthcare-acquired infections and providing the most up-to-date information on regulatory compliance. AHC Media | 3525 Piedmont Road, Building 6, Suite 400 | Atlanta, GA 30305 For questions or comments call Customer Service at 800-688-2421 or 404-262-5476

Posted in Centers for Disease Control and Prevention (CDC), Clostridium Difficile (C. diff), Uncategorized | Tagged , , , , ,

Are you certifiable? Ok, don’t answer that, but CIC makes a difference

March 9, 2012 – 8:16 am | By Gary Evans | No comments yet

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With the increasing transparency regarding all things infection prevention, we foresee a roadside billboard with two or three health care professionals standing strong, looking like they are not interested in taking any prisoners. “The Bug Stops Here: Our Board Certified Infection Preventionists make sure all patients are safe at North Side Center,” the billboard proclaims. An endorsement accented in cursive writing on the sign says, “With one certified infection preventionist for every 75 beds, North Side is so safe I recommended it to my mother!” Gary Evans, Editor, Hospital Infection Control & Prevention. OK, technically, I have not discussed this endorsement deal with my mother, but I’m sure I would recommend family care at a place that touted its certified infection preventionists as an asset. It wasn’t always that way, and it fact it is still not that way, but one can almost taste the wine after so years in the vineyard. No longer the hospital’s best-kept secret, the IP will emerge as a marketable strength flashing the academic badge: Certified in Infection Control (CIC). In that regard, hospitals whose infection prevention and control programs are led by a director who is board certified in infection prevention and control have significantly lower rates of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) than those that are not led by a certified professional, according to a new study published in the March issue of the American Journal of Infection Control, the official publication of APIC - the Association for Professionals in Infection Control and Epidemiology. A team of researchers from the Columbia University School of Nursing surveyed infection prevention and control departments of 203 acute care hospitals in California to determine if there is an association between structure and practices of their programs, and frequency of infections caused by antibiotic-resistant bacteria. MRSA bloodstream infection data for 91 of these hospitals were analyzed to see if there were factors that were associated with frequency of this infection. Presence of a board certified director and participation in a multifacility performance improvement project were associated with significantly lower MRSA BSI rates. This is one of the first studies that found an association between specific infrastructure elements, patient care practices, and rates of healthcare-associated infections.

Posted in Heathcare Associated Infections (HAIs), Infection Preventionist, patient safety | Tagged , , , ,

C. diff infections move beyond the hospital

March 7, 2012 – 9:51 am | By Gary Evans | No comments yet

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Clostridium difficile is moving beyond its traditional stronghold in the hospital to cause infections in long term care and ambulatory settings, the Centers for Disease Control and Prevention reports. While many health care-associated infections, such as bloodstream infections, declined in the past decade, C. diff infection rates and deaths climbed to historic highs. The infection is linked to about 14,000 U.S. deaths every year. Those at highest risk are people who take antibiotics and also receive care in any medical setting. Almost half of infections occur in people younger than 65, but more than 90% of deaths occur in people 65 and older. Previously released estimates based on billing data show that the number of U.S. hospital stays related to C. diff remains at historically high levels of about 337,000 annually, adding at least $1 billion in extra costs to the health care system. However, the CDC reports that these hospital estimates may only represent one part of the overall impact. According to the CDC, 94% of C. diff infections are related to medical care. About 25% of infections first show symptoms in hospital patients; 75% first show in nursing home patients or in people recently cared for in doctor’s offices and clinics. Although the proportion of infection onset is lower in hospitals, these facilities remain at the core of prevention since many patients with C. diff infections are transferred to hospitals for care, raising risk of spread within the facility. The report notes that half of C. diff infections diagnosed at hospitals were already present at the time the patient was admitted (present on admission), usually after getting care in other facilities. The other half were related to care given in the hospital where the infection was diagnosed.

Posted in Clostridium Difficile (C. diff), patient safety, Uncategorized | Tagged , , , ,

Working with sterilizing agents raises miscarriage rate

March 5, 2012 – 11:52 pm | By Gary Evans | No comments yet

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The use of sterilizing agents to prevent infections from being transmitted to patients via instruments and equipment may come at the price of the unborn child of a health care worker. Despite workplace protections, pregnant nurses may still be at risk from exposure to chemotherapy and sterilizing agents like glutaradehyde. An analysis of information from almost 7,500 pregnant nurses in the Nurses’ Health Study found a significantly higher risk of spontaneous abortion in the first trimester among nurses who handled antineoplastic drugs and in the second trimester among nurses who worked with sterilizing agents. “The women exposed to anti-neoplastic drugs had twice as high of risk as those who did not report that [exposure],” says Christina Lawson, PhD, epidemiologist with the National Institute for Occupational Safety and Health (NIOSH) in Cincinnati. There was a similar two-fold increase related to sterilizing agents, including ethylene oxide, formaldehyde and glutaraldehyde. “We caution women that if something is termed a carcinogen, it’s probably also a reproductive hazard,” says Lawson. “Generally, you should stay away from carcinogens during pregnancy.” The study is significant because it didn’t ask nurses only about known exposures, such as spills, says Martha Polovich, PhD, RN, AOCN, director of clinical practice at the Duke Oncology Network in Durham, NC. “They merely asked the nurses to report the number of hours they worked with these chemicals,” she says. “Nurses working with the chemicals had a higher rate of miscarriage.” --Michelle Marill

Posted in Health Care Workers, Uncategorized | Tagged , , ,

And the award for the top HAI on the patient misery index goes to… C. Diff! Again!

March 2, 2012 – 10:20 am | By Gary Evans | No comments yet

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If there is a healthcare associated infection (HAI) higher on the patient misery index than Clostridium difficile please submit a nomination, but we give the default award to this nasty opportunist that can go from benign gut dweller to explosive diarrhea, colitis and a life-threatening cascade beyond. Increasing C. Diff infections are being driven in large part by the highly virulent strain dubbed North American Pulse Field type 1 (NAP1), which orginally struck adult patients and now is moving into pediatric populations. Knowlege is power, so make a patient happy and tune in for an upcoming educational progam: Clostridium difficile Colitis: Prevention and Management on Thursday, March 22 from 12:00 - 1:30pm. In this 90-minute streaming webinar, Infection Prevention Consultant Leah Frederick MS, RN, CIC, will give you practical tips to protect your patients. The experienced IP will discuss the characteristics and transmission of CDI, monitoring these infections, and recommended practices for prevention and control. Learning Objectives: • Discuss 2 features of the microorganism C. diff which make transmission difficult to control in the healthcare setting • List the elements of a program to recognize and prevent CDI and transmission in the healthcare setting • Discuss the importance of hand hygiene and environmental cleaning in prevention of transmission of C. diff • Describe resources for controlling CDI in the healthcare setting Credits: 1.5 CNE Credits Course Level: All Levels Registration: Only $299 to attend Priority Code: 10T12407/EM02235 Meet Your Expert Leah Frederick has successfully developed Infection Prevention and Control Programs for new hospitals, and led organizations in improving existing programs. She specializes in leading organizations to decrease and prevent healthcare-acquired infections and providing the most up-to-date information on regulatory compliance. AHC Media | 3525 Piedmont Road, Building 6, Suite 400 | Atlanta, GA 30305 For questions or comments call Customer Service at 800-688-2421 or 404-262-5476

Posted in Clostridium Difficile (C. diff), Uncategorized | Tagged , , ,

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