Safe Healthcare

Hosted by CDC’s Division of Healthcare Quality Promotion

Add this to...
Añadir en...
Favorites
Delicious
Digg
Google Bookmarks

NDM-1: New Route, Same Destination – Untreatable Infections

Categories: Antimicrobial Resistance, Gram negatives, Healthcare-associated infections

September 17th, 2010 3:24 pm ET - .

Brandi Limbago, PhD

Author – Brandi Limbago, PhD
CDC’s Division of Healthcare Quality Promotion

You’ve likely seen the news over the last couple of weeks warning people about “The [so-called] New Superbug NDM-1,” a newly discovered gene that makes bacteria resistant to last-resort antibiotics called beta-lactams or carbapenems. NDM stands for New Delhi Metallo-beta-lactamase, and in this case the NDM gene rendered antibiotics useless in three cases of infection with carbapenem-resistant Enterobacteriaceae (CRE). CDC discovered NDM-1 in the United States this year and reported it through the MMWR in June. Is it concerning? Absolutely; and we are working closely with healthcare providers and health departments to stop transmission of these bacteria.

That said, I’d like to point out that the story shouldn’t be solely about these bacteria being new or imported from other countries; the story should be about the whole group of CRE and untreatable infections they cause. In reality, these are not the first CRE cases we’ve seen in the United States. Not even close. NDM-1 is actually just one type of CRE and represents a larger antibiotic resistance issue that we already have, right now, in this country. CDC has been working with partners to prevent a type of CRE known as KPCs (carbapenemase-producing Klebsiella pneumonia). The KPC gene also makes Enterobacteriaceae bacteria resistant to beta-lactam/carbapenem antibiotics, just in a different way than NDM-1. KPCs have been reported in about 35 states and are associated with high mortality – 40 percent in one report. It may be in the other 15 states as well, but has not been reported to CDC. So, let’s not wait for NDM-1 in order to take action.

16 Comments - Read more

Sharing Successes and Challenges of Preventing CLABSIs in Dialysis

Categories: CLABSI, Healthcare-associated infections, Hemodialysis

September 10th, 2010 8:04 am ET - .

Healthcare Professionals

Author – Barbara Bond, RN
Senior Quality Improvement Advisor
Delmarva Foundation

Each year, healthcare-associated infections (HAIs) cause substantial illness, hospitalization and, even, death in hemodialysis patients. From 1994 to 2007, rates of hospitalization for infection among this patient population have increased by nearly 38%. As infection rates have increased, so has our need to respond and implement measures that help reduce infections in hemodialysis. That is why we became a part of the Centers for Disease Control and Prevention’s (CDC) collaborative.

The CDC sponsors this collaborative to assist hemodialysis organizations in their efforts to reduce and prevent central line-associated blood stream infections (CLABSIs). It is my job to help support those activities and to work toward answering those nagging questions that we in the healthcare community are often too scared to ask.

5 Comments - Read more

Preventing CLABSIs in Dialysis

Categories: CLABSI, Hemodialysis, NHSN

August 25th, 2010 3:06 pm ET - .

dialysis brochure

Author – Priti Patel, MD, MPH
Medical Officer
CDC’s Division of Healthcare Quality Promotion

Reducing central line-associated bloodstream infections (CLABSIs) is a national priority. We all know about the incredible efforts dedicated to preventing these infections in intensive care units and other inpatient units – but what about settings outside of acute care?

Since 2009, CDC has partnered with interested dialysis providers, infection preventionists, health departments, and others to prevent CLABSIs in chronic hemodialysis patients. Over the last year, this group has teamed up to develop a set of interventions that are being implemented in participating facilities. In the process, they are setting new standards for what can be achieved through infection prevention in hemodialysis facilities.

Monthly conference calls offer educational opportunities to the collaborative participants and serve as a forum for discussion of common challenges and potential solutions. Participants have regular access to CDC subject matter experts and other stakeholders who offer support and assistance. Participating facilities enter data into the dialysis module of CDC’s National Healthcare Safety Network (NHSN). Using NHSN data, the participants can compare their rates with the rest of the group and can use this information to influence decisions in their facility; NHSN data also allows us to follow the impact of the collaborative over time.

14 Comments - Read more

Decline In Most Serious MRSA Infections, More Work To Be Done

Categories: Antimicrobial Resistance, Healthcare-associated infections, MRSA, NHSN, State HAI Prevention

August 12th, 2010 6:40 am ET - .

Alexander J. Kallen, MD, MPH

Author — Alex Kallen, MD, MPH
Medical Epidemiologist
CDC Division of Healthcare Quality Promotion

Few people would disagree with me that reducing the number of devastating healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections continues to be important. We now have some encouraging results from CDC’s Emerging Infections Program/Active Bacterial Core Surveillance system (ABCs) that MRSA infections acquired in the healthcare setting are on the decline. This important laboratory-based surveillance system has tracked rates of serious invasive MRSA infections since mid-2004 in nine diverse metropolitan areas in the U.S.

A recent analysis of data has shown about a 28% decrease in invasive MRSA infections that had onset in the hospital from 2005 through 2008. Decreases in infection rates were even larger for the subset of patients with bloodstream infections. Even more interesting to me, was a 17% drop over the same time period in invasive MRSA infections that had onset in the community but occurred in people with recent exposures to healthcare settings.

Although the reduction of these invasive infections was substantial, the reasons behind the decreased rates are not completely clear. The fact that rates fell more in hospitals than outside of hospitals might argue that at least some of the drop was due to MRSA prevention activities that are going on in those facilities. As most of the infections captured by this surveillance system were bloodstream infections, device-specific prevention activities like the implementation of CDC Healthcare Infection Control Practice Advisory Committee (HICPAC) evidence-based central line insertion practices could explain some or all of this decrease.

13 Comments - Read more

CMS Rule: Shining the spotlight on hospital acquired infections – Part 5

Categories: Clostridium difficile, Healthcare-associated infections, MRSA

August 9th, 2010 6:40 am ET - .

Lisa McGiffert

Guest Author — Lisa McGiffert
Director, Consumer’s Union Safe Patient Project

Is your hospital doing a good job protecting patients from developing infections during treatment? For years, patients have been left in the dark about this important indicator of hospital safety even though these infections are associated with nearly 100,000 deaths annually.

Nancy Oliver, of Cincinnati, Ohio, wished she had known more about her hospital’s infection rates. Nancy’s father was expected to make an excellent recovery following heart surgery but ended up developing a MRSA infection in his surgical site. Later he acquired a C-difficile infection, went into septic shock and died. “We miss my Dad every day,” says Oliver who has become an active patient safety advocate.

Next year, consumers across the country finally will be able to start checking their hospital’s infection prevention track record thanks to new regulations adopted as part of the landmark health care reform law.

The regulations build on the successful efforts of patient safety advocates working with Consumers Union over the past seven years to push states to adopt hospital infection reporting laws. Twenty seven states have done so and 19 have issued reports so far that disclose this critical information to the public.

Consumers can already check the Hospital Compare web site to find out how well hospitals follow procedures proven to reduce surgical site infection risks. But soon the public in all 50 states will be able to see whether their hospital’s prevention efforts are working.

The new regulations will make central line associated bloodstream infection rates in intensive care units, including neonatal intensive care units, available on Hospital Compare next year and surgical site infection rates in 2012. That’s a good start but it should be just the beginning.

Patients have a right to know about other hospital-acquired infection rates, including those caused by MRSA and C.difficile, and urinary tract infections. These additional infections are targeted for improvement by a federal healthcare-associated infection action plan. The public should be able to see if the action plan’s prevention targets for these infections are being met.

Armed with infection rate information, consumers will be able to make more informed decisions about where to go for the care they need. And disclosing this information to the public is a powerful motivator for hospitals to improve care and keep patients safe.

For Nancy Oliver and the countless others who have lost loved ones to hospital-acquired infections, making infection rates public is long overdue.

___________
Lisa McGiffert is the Director of Consumers Union’s Safe Patient Project. Follow the campaign on Twitter @CUSafePatient Consumers Union is the nonprofit publisher of Consumer Reports.

2 Comments - Read more