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New protocol offers hospitals an option to detect bacterial contamination of duodenoscopes

Categories: Healthcare-associated infections

Michael Bell, MD

Michael Bell, MD

Author: Michael Bell, MD
Deputy Director of CDCs Division of Healthcare Quality Promotion

Combatting antibiotic-resistant infections and protecting patients are national priorities. The President’s FY 2016 Budget invests in efforts to combat and prevent antibiotic resistance, and nearly doubles the amount of federal funding to more than $1.2 billion. The Administration has also issued its National Strategy on Combating Antibiotic-Resistant Bacteria, which outlines steps the U.S. government will take to improve prevention, detection, and control of resistant pathogens.   

Recent outbreaks of CRE (carbapenem-resistant Enterobacteriaceae) related to a type of endoscope called a duodenoscope underscore the importance of quick response to new threats to patient health. In the past when outbreaks related to the use of these scopes have occurred, they have been attributed to failure to follow duodenoscope manufacturer-recommended cleaning protocols. The fact that recent outbreaks have occurred without identified lapses of infection control is a call for action.

With input from healthcare facilities, professional partners and stakeholders, CDC has developed an interim protocol for facilities that want to test their duodenoscopes for contamination with bacteria, including CRE, after the cleaning and disinfection process. The protocol provides a plan to determine how scopes may be sampled and how to test the samples in a lab. This is not a replacement for ongoing training and oversight to ensure that cleaning and disinfection steps are all performed correctly. But it might be a way to detect contamination, whether due to lack of adherence to manufacturer-recommended reprocessing practices or any other reason, and to prompt follow-up action to protect patients if needed.

C. diff survivor and advocate shares her story

Categories: Clostridium difficile, Healthcare-associated infections, Patients

Nancy Caralla

Nancy Caralla

Guest Author: Nancy C Caralla
Founding Executive Director,
President of the C Diff Foundation.

My name is Nancy Caralla, and I know all too much about Clostridium difficile (C. diff).  I am a nurse and contracted C. diff while caring for patients suffering from this horrible infection. Now, I am a C. diff survivor. Tragically, our family lost my father from C. diff, too. I know how fighting a C. diff infection can be exhausting on so many levels. It is a physically, mentally, and financially debilitating infection. It has the ability to steal away a loved one, tear away dreams, create added stress on families, diminish financial nest eggs, eliminate employment opportunities, build geographic mobility limitations, and create tears in even the strongest individuals. All aspects of one’s being are involved in fighting a C. diff infection. This is why I have dedicated myself to “Raising C. diff Awareness” worldwide.

The C diff Foundation was brought to fruition in 2012 with a mission to provide education and advocate for C. diff infection prevention, treatment, and environmental safety worldwide. It provides Antibiotic News, Nutrition Support, Government and private Scientific Research and Development Studies, and a CDF Volunteer program. The C diff Foundation hosts a 24-hour hotline to support patients, families, and health care providers through the difficulties of a C. diff infection (1-844-FOR-CDIF).

Our hotline now gets 20-30 calls a day from individuals impacted by this germ. These are some of the most common questions we get asked: 

Antibiotic Resistance: Urgent Health Threat Jeopardizing Modern Medicine

Categories: Antibiotic use, Antimicrobial Resistance

Estimated minimum 2,049,442  illnesses and 23,000 deaths are caused by antibiotic resistance

Estimated minimum 2,049,442 of illnesses and 23,000 deaths are caused by antibiotic resistance

Antibiotic resistance, the ability of bacteria to resist the effects of drugs, is perhaps the single most important infectious disease threat of our time.  Although some people are at greater risk than others, no one can completely avoid the risk of antibiotic-resistant infections. These infections affect real people and they can be horrible for patients. Infections with resistant organisms are difficult to treat, requiring costly and sometimes toxic alternatives. Resistant infections account for at least $20 billion in excess direct healthcare costs and up to $35 billion in lost productivity due to hospitalizations and sick days each year.

Every year, more than two million people in the United States get infections that are resistant to antibiotics, and at least 23,000 people die as a result. Clostridium difficile (C. diff), a serious diarrheal infection usually associated with antibiotic use, causes about 250,000 hospitalizations and at least 14,000 deaths every year in the United States.

Safe Injection Practices: Establishing the Habit in Residency

Categories: Infection Control, Injection Safety, Pain Management

Aaron Rich Ducoffe, MD

Aaron Rich Ducoffe, MD

Guest Author: Aaron R. Ducoffe, MD
US Department of Health and Human Services

In my first few weeks as a Health Policy and Quality Fellow, I immediately became intrigued with the CDC’s One & Only Campaign and its applicability to my former and upcoming planned specialties.

I have learned in residency that a physician’s best and worst habits develop during training. Therefore, even in the midst of a chaotic hospital day, it is crucial that I maintain a mental checklist for every procedure, especially injections.

A frequent encounter concerns the lidocaine vial. Last year, I performed countless lidocaine injections in the ER for suturing wounds and hematoma blocks for fracture reduction. If the vial was multi-use, I always ensured it was stored appropriately – out of the ER bays in a safe, clean area, avoiding the ever-present improperly stored “leftover” vial. Continuing down the checklist, I always utilized sterile needles and syringes as well as proper aseptic technique for both drawing and injecting the lidocaine. These practices[PDF – 1.35 MB] are not only important for subcutaneous injections, but even more so for intra-articular aspirations and injections, vascular access, and at the depths of other interventional procedures often requiring a sterile IR suite, such as spinal injections.

Not Worth the Risk: Failing to Implement Basic Safe Injection Techniques

Categories: Injection Safety, Pain Management

Andrew Engel, MD

Andrew Engel, MD

Guest Author: Andrew Engel, MD
International Spine Intervention Society

The International Spine Intervention Society supports the Centers for Disease Control and Prevention’s safe injection practices. As a strong proponent of using evidence-based medicine and safe injection practices, the International Spine Intervention Society agrees with the message espoused by CDC’s new Key Standards for Pain Clinics [PDF – 1.35 MB] poster.  Unfortunately, there continue to be rare (although much too frequent) infections during interventional spine procedures that are directly linked to failures of implementing basic safe injection techniques. Fortunately, the evidence is clear that by simply following safe injection practices physicians can reduce the likelihood of their patients developing infections.

While many providers express concern that they are not adequately reimbursed for providing a new single dose vial for every patient, the emotional and economic consequences in the event of an infection or possibly an outbreak clearly make "One and Only" practice the practical choice. Breaches in sterile technique, including the reuse of single dose vials, can facilitate a single infection turning into an outbreak.

Some will reflect on their years in practice, saying that they have not adhered to one or more of the standards of care and have never seen an infection as a result.  While these physicians should consider themselves lucky, sporadic transmission of blood borne pathogens may not be recognized as having resulted from unsafe injections.  Given the severity of the potential complications, a single preventable infection, let alone an outbreak, is one too many.  It’s not worth the risk.

For more information about patient safety and interventional spine procedures, check out the International Spine Intervention Society’s FactFinder series at

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