Categories: Healthcare-associated infections, Hemodialysis, Long Term Care (LTC), NHSN, Outpatient Care
June 29th, 2010 2:30 pm ET -
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Dr. Daniel Pollock
— Dr. Daniel Pollock
Head of CDC’s National Healthcare Safety Network
A colleague began a recent presentation by asking the audience, “How many of you have had a colonoscopy?”
The majority of participants raised their hands.
Then he asked, “How many of you assumed that the instruments used during your procedure were truly clean?”
All raised their hands again.
Then, he asked, “How would you feel if you found out two weeks, or even a year later, that you may have contracted a severe illness because the tools used were contaminated?”
Silence…
No one expects that receiving healthcare will make them sicker instead of well.
Healthcare-associated infections (HAIs) are a significant concern that affects all types of patients in all kinds of settings including hospitals, surgery centers, dialysis clinics, community clinics, long-term care facilities and more. While we know that the financial cost and, more importantly, the emotional and physical toll of these infections is huge, HAIs were historically accepted as part of routine care. Certainly, not many people outside of the medical and public health communities knew much about what we now know are largely preventable infections.
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Categories: HICPAC, Healthcare-associated infections, NHSN
June 17th, 2010 1:08 pm ET -
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PJ Brennan, M.D.
— PJ Brennan, M.D.
Chief Medical Officer
Division of Infectious Diseases, University of Pennsylvania Health System
Chair of the Healthcare Infection Control Practices Advisory Committee (HICPAC)
At my first meeting of the Healthcare Infection Control Practices Advisory Committee (HICPAC) in October of 2003, the Committee heard reports on guidelines in development for Sterilization and Disinfection and Isolation Precautions. Both of those important documents had been years in development by 2003 and were still years away from public release. HICPAC’s challenges in bringing those documents to conclusion and release led to the adoption of a more efficient and rigorous evidence evaluation process. Our new methods now posted on the HICPAC homepage have been the result of new thinking, new resources and significant investments and will serve HICPAC and its constituencies well for years to come.
As the Committee worked to finish the Sterilization and the Isolation Precautions guidelines a movement was already afoot that would radically alter our landscape. At my second HICPAC meeting in March 2004, I made an oral presentation on the public reporting of healthcare associated infections (HAIs). Two states, Illinois and Pennsylvania, had recently passed laws requiring the disclosure of HAI data. Outside of those states there was little awareness among professionals that as far as the public reporting of HAIs was concerned the train was leaving the station. By the summer of 2004, two more states had mandates and HICPAC was hard at work on a guidance document. Six years later nearly half the hospitals in the United States are participants by mandate in the CDC’s National Healthcare Safety Network – more than a seven fold expansion in its base. It has become the de facto national public reporting system. The early apprehensions and occasional acrimony that characterized the discussion of this issue have largely been replaced with the realization that all stakeholders – patients, hospitals, doctors and nurses and payors have benefitted from the attention and effort. I am proud of the role that DHQP and HICPAC played in fostering better methods of surveillance and reporting of HAIs and in the leadership it displayed in the early months of this national movement.
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Categories: CAUTI, HICPAC, Healthcare-associated infections
June 15th, 2010 12:58 pm ET -
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Jeffrey Hageman, MHS
— Jeffrey C. Hageman, M.H.S.
CDC Epidemiologist and Executive Secretary of HICPAC
CDC’s Division of Healthcare Quality Promotion
Each morning when I review news headlines about the latest medical research identifying a new cure or danger, questions pop into my head. Was the research study designed correctly? Was the information collected accurately? Does this new research finding mean the older recommendations don’t need to be followed? Fortunately, there are groups of experts who review the evidence, ask these questions, and develop recommendations so that clinicians have the best information available to practice safe care.
One important group that advises the Centers for Disease Control and Prevention (CDC) and the Secretary of Health and Human Services (HHS) is the Healthcare Infection Control Practices Advisory Committee (HICPAC). HICPAC is a federal advisory committee composed of 14 external infection control experts who come from a variety of medical fields such as infectious diseases, nursing, surgery, critical care medicine, and public health. HICPAC also has a consumer advocate representative, as well as representation from both other federal agencies and professional organizations. HICPAC’s primary function is to issue recommendations in the form of guidelines for the prevention of healthcare-associated infections. Guideline topics range from how to prevent catheter-associated urinary tract infections (CAUTIs) and surgical site infections (SSIs) to how personnel should clean medical equipment and rooms between patients.
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Categories: Healthcare-associated infections, Outpatient Care
June 9th, 2010 8:04 am ET -
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Dr. Melissa Schaefer
— Dr. Melissa Schaefer, Medical Officer
CDC’s Division of Healthcare Quality Promotion
When patients seek care in any setting, they should feel confident that their healthcare providers are following basic infection control practices. Ambulatory surgical centers (ASCs), or outpatient surgery centers, are one setting where there has been significant growth in recent years both in number and in the type and complexity of procedures performed. Ensuring patient safety in all settings is a priority for CDC as a whole, and something I take very seriously in my own work.
As part of efforts to better define infection control practices in ASCs and target prevention efforts, CDC and the Centers for Medicare & Medicaid Services (CMS) recently piloted an infection control audit tool during almost 70 ASC inspections in three states. This week, my colleagues and I reported findings from these inspections in study published in the Journal of the American Medical Association (JAMA). The bottom line is that we identified infection control lapses in two-thirds of the pilot facilities.
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Categories: Antibiotic use, Healthcare-associated infections
June 8th, 2010 12:44 pm ET -
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Neil Fishman, M.D.
— Neil Fishman, M.D.
Antimicrobial resistance is one of the most pressing problems and greatest challenges that we will confront during the coming decade. As bacteria and other micro-organisms are becoming more resistant to antimicrobials, our current therapeutic options are dwindling and research and development of new antibiotics is lagging. For the first time since the discovery and introduction of penicillin in the 1940s, we are dangerously close to a return to the pre-antibiotic era.
I believe that antimicrobial stewardship is the best way to improve antibiotic use. The goals of antimicrobial stewardship are to ensure the proper use of antibiotics in order to reduce or stabilize resistance, to optimize clinical outcomes, and to decrease the risk of adverse events. SHEA and IDSA published Guidelines for Antimicrobial Stewardship Programs in 2007, but there are many simple steps practices and hospitals can take to improve antibiotic use without a complex infrastructure. For example:
- Never treat viral syndromes such as acute bronchitis with antibiotics, even when patients demand therapy.
- Use fluoroquinolones cautiously. Not only is fluoroquinolone resistance rising at an alarming rate, but this group of drugs causes resistance to many other antibiotics and is associated with the new more virulent strain of C. difficile we are seeing in the United States.
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