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Selected Category: Healthcare-associated infections

Picking a Fight with Multidrug-Resistant Gram-Negative Organisms

Categories: Healthcare-associated infections

Ebbing Lautenbach MD, MPH, MSCE

Ebbing Lautenbach MD, MPH, MSCE

Author: Ebbing Lautenbach MD, MPH, MSCE

Over the last decade, the incidence of multidrug resistance in gram-negative pathogens has steadily increased, yet there has not been any increase in antimicrobial development to address these organisms.  The potential for widespread and rapid transmission of the pathogens is concerning as is the growing prevalence of these organisms in all aspects of patient care – acute care hospitals, long-term acute care hospitals, long-term care and the community .   With their emergence, it has become even more critical to preserve the viability of our current antimicrobials through strong stewardship programs such as those promoted in the recent CDC Vital Signs Report.

Beyond that we need to specifically target Multidrug-Resistant Gram-Negative Organisms or MDROs to create a national and even global response that makes scientific sense to effectively combat this problem.  In the April 2014 special issue of Infection Control and Hospital Epidemiology we published studies that take a critical look at MDROs.  The papers highlighted in this issue provide insights on current practices and raise questions to guide future scientific studies in this research area.   While more research still needs to be done,  these studies help to better define the scope of the problem and understand how different hospitals and healthcare workers approach these organisms including how facilities control the spread of these pathogens.  Applying this research to inform our current practices in order to improve patient outcomes is critical as we wage this battle with MDROs.

Yet with so many areas of Healthcare Associated Infections (HAIs) being interdependent it is impossible to address the issue of MDROs without pairing it with overall good HAI prevention such as antimicrobial stewardship, environmental cleaning, hand hygiene, and more.    It is also careless to only consider this problem in the acute care setting, as the frequent transfer of patients between different healthcare facilities is a crucial element of the problem.  As a healthcare system, we need to promote and develop evidence-based interventions for MDROs and other supplemental infection prevention interventions to defeat MDROs while saving lives and decreasing healthcare costs overall.

Despite Progress, three-quarters of a million infections threaten hospital patients each year

Categories: Antimicrobial Resistance, BSIs, CAUTI, CLABSI, Clostridium difficile, Healthcare-associated infections, Long Term Care (LTC), NHSN, State HAI Prevention

National and State Healthcare-associated Infections Progress Report. This report is based on 2012 data, Published March 2014

National and State Healthcare-associated Infections Progress Report. This report is based on 2012 data, Published March 2014

Despite Progress, three-quarters of a million infections threaten hospital patients each year
National and state data detail threat of healthcare-associated infections and opportunities for further improvements.

CDC released two reports today – one, a New England Journal of Medicine (NEJM) article detailing national healthcare-associated infection estimates, and the other an annual report on national and state-specific progress toward U.S. Health and Human Services HAI prevention goals. Together, the reports show that progress has been made in the effort to eliminate infections that commonly threaten hospital patients, but more work is needed to improve patient safety.

The NEJM article updates the burden numbers for healthcare-associated infections in hospitals.  On any given day, 1 of every 25 patients had 1 or more infections related to their hospital stay.   That means about 722,000 infections a year related to medical care.  One of every 9 patients who gets an infection will die during their hospitalization.

This article sounds the alarm about threats we need to address now.  It tells us that lung infections, gut infections, surgical infections and infection from urinary catheters are harming the most patients.

Some of the top pathogens attacking patients are: 

  • C. difficile, or deadly diarrhea,
  • Staph, including the drug-resistant type known as MRSA,
  • a family of germs known as Enterobacteriaceae, that includes CRE the “nightmare bacteria,”

The second report, CDC’s National and State Healthcare-associated Infection Progress Report, includes national and state-by-state summaries of infection types that are commonly required to be reported to CDC. The Progress Report looked at data submitted to CDC’s National Healthcare Safety Network (NHSN), the nation’s healthcare-associated infection tracking system.   On the national level, the report found a:

  • 44 percent decrease in central line-associated bloodstream infections between 2008 and 2012
  • 20 percent decrease in infections related to the 10 surgical procedures tracked in the report between 2008 and 2012
  • 4 percent decrease in hospital-onset MRSA bloodstream infections between 2011 and 2012
  • 2 percent decrease in hospital-onset C. difficile infections between 2011 and 2012
  • 3 percent increase in catheter-associated urinary tract infections

At the federal and state levels, CDC uses this information to find facilities that need help and target resources where they are most needed.

To access both reports and to see the updated healthcare-associated infection data, see CDC’s website: www.cdc.gov/hai.

Watch a new video on Healthcare-Associated Infections.

C. diff in Our Kids: A Call to Action

Categories: Clostridium difficile, Healthcare-associated infections

Peggy Lillis was the mother of two and a Brooklyn kindergarten teacher.  Peggy lost her battle to C. difficile infection in 2010.  She had only been ill for 6 days.  Learn more about Peggy’s story: http://www.peggyfoundation.org/

Peggy Lillis was the mother of two and a Brooklyn kindergarten teacher. Peggy lost her battle to C. difficile infection in 2010. She had only been ill for 6 days. Learn more about Peggy’s story: http://www.peggyfoundation.org/

Author: Christian John Lillis

My mother loved children. Me and my brother Liam, her 12 godchildren, and the 24 children she taught each year in her kindergarten class. We lost Mom at just 56 years old to a Clostridium difficile infection in April 2010. In response to her death, we started the Peggy Lillis Foundation to raise C. diff awareness.

That is why we are both distressed and pleased by the Centers for Disease Control and Prevention’s new paper on C. diff infections in children. Distressed that so many children are suffering but pleased that the paper explodes a piece of C. diff mythology that persists in our healthcare system, where even some physicians cling to a dangerous notion that children don’t get C. diff.

The CDC finding that 17,000 children contract the disease each year, most outside of healthcare settings, is a call to action for healthcare providers. Clinicians should consider whether symptoms such as fever, loss of appetite, cramping, and painful diarrhea might be indications of C. diff. When prescribing antibiotics to kids, they should ask themselves whether the drug is absolutely necessary, since antibiotic exposure is a key risk factor for C. diff.

This report also alerts parents to ask doctors whether symptoms they can plainly see are severe and out of the ordinary might be signs of a C. diff infection, especially if their child has recently taken an antibiotic. In the presence of such symptoms, especially when initial treatments don’t work, parents should ask about a stool test.

In 2013, the CDC declared C. diff. an "urgent" public-health threat, placing it first on the list of critical dangers to Americans. But many reports of C. diff focus on adults and seniors in long-term care settings, leading to ignorance of its risks to younger patients.

Angela G., a Brooklyn mother, found this out the hard way when her kids were five and two. Spotting symptoms like fever and diarrhea, she took them to a pediatrician who insisted they had a stomach flu. After escalating symptoms, repeated visits, and finally a trip to the emergency room, a test resulted in the proper diagnosis: C. diff.

The Power of Antibiotic Stewardship in Patient Care

Categories: Antibiotic use, Healthcare-associated infections

Don Goldmann, MD

Don Goldmann, MD

Author: Don Goldmann, MD
Chief Medical and Scientific Officer
Institute for Healthcare Improvement
Clinical Professor of Pediatrics
Harvard Medical School
Professor of Immunology and Infectious Diseases, and Epidemiology
Harvard School of Public Health

For the past several years, IHI has been actively engaged in working with a wide variety of acute care hospitals in partnership with the Centers for Disease Control and Prevention (CDC) and other national experts to advance antibiotic stewardship. Our overarching goal is to reduce adverse drug events related to inappropriate antibiotic utilization, the prevalence of antibiotic resistance, the risk of Clostridium difficile infection, and the cost of care.

We developed a framework for reducing inappropriate antibiotic utilization and a set of key practical change concepts and related metrics that caregivers could implement as part of their routine work at the bedside. These recommendations were designed to support hospitals across the US (regardless of size, acuity, or geographic location) in their efforts to curb unwarranted antibiotic utilization. A key learning from initial testing of the framework in a group of pilot hospitals emphasized the power of stewardship when relatively simple practices are incorporated into the everyday work of hospitalists and care teams, preferably in collaboration with pharmacists.

IHI’s upcoming Expedition on Antibiotic Stewardship will spread what we learned in this initial testing to help other hospitals create a more reliable system for sound antibiotic prescribing. The Expedition is designed to support hospitals where they are currently — whether they are just starting to implement stewardship or are hoping to accelerate improvement in their existing programs. Specific interventions that have been particularly successful will be highlighted, including:

  • An “antibiotic time out” — a pause at 48 to 72 hours to review the indication and expected duration of antimicrobial therapy, and make appropriate adjustments or discontinue treatment based on available clinical data; and
  • Use of multidisciplinary rounds to engage all team members in antibiotic stewardship goals, opportunities for improvement, and action.

IHI’s Expedition can help identify and begin improving key processes to optimize antibiotic selection, dose, and duration in their patient care setting and share additional strategies for effectively incorporating antibiotic stewardship into existing patient care processes.

Preserving Antibiotics Key to Protecting Patients

Categories: Antimicrobial Resistance, Healthcare-associated infections

Rear  Admiral Boris D. Lushniak, MD, MPH

Rear Admiral Boris D. Lushniak, MD, MPH

Author: Rear Admiral Boris D. Lushniak, MD, MPH
Acting Surgeon General

Antibiotics are powerful tools for fighting illness and disease, but some of these drugs are being rendered less effective due to overprescribing, misuse, and bacterial evolution.

Many of our advances in medical treatment, such as chemotherapy and transplants, depend on antibiotics’ ability to fight bacterial infections. These drugs also help manage infections that happen as a result of surgery. Unfortunately, bacteria learn in a very short time how to outsmart antibiotics. Resistant bacteria can easily multiply, spread, and share their resistance with other bacteria.

A recent report from the Centers for Disease Control and Prevention found that more than two million people in the U.S. become sick every year with antibiotic-resistant infection. At least 23,000 die as a result. Antibiotic-resistant infections can also add considerable, and many times avoidable, costs to patients and the healthcare system due to longer illness, lost productivity, and more expensive hospital stays.

The President’s budget, which was released on Tuesday, includes $30 million for a domestic initiative to establish a robust infrastructure that can detect antibiotic resistant threats and protect patients and communities.

Antibiotics are among the most commonly prescribed drugs used in human medicine, yet up to 50% of all the antibiotics used in hospitals are not needed or are incorrectly prescribed. Each one of us can help limit antibiotic resistance by changing the way we use antibiotics.

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