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Selected Category: Healthcare-associated infections

New Guideline to Reduce Unexpected Disease Transmission Through Organ Transplantation

Categories: Healthcare-associated infections, Organ and Tissue Safety

Matthew J. Kuehnert, MD

Matthew J. Kuehnert, MD

Author – Matthew J. Kuehnert, MD
Director, Office of Blood, Organ, and Other Tissue Safety
CDC Division of Healthcare Quality Promotion

This week, the U.S. Department of Health and Human Services (HHS) released a new guideline to improve patient safety by reducing disease transmission through organ transplantation.  This guideline updates the 1994 U.S. Public Health Service (PHS) guideline for preventing transmission of human immunodeficiency virus (HIV) through organ transplantation, and adds guidance for reducing unexpected transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) through organ transplants. 

Disease transmission from infected donors has been reported in heart, lung, liver, kidney and pancreas recipients.  From 2008 to 2011, the Centers for Disease Control and Prevention (CDC) participated in more than 200 investigations of suspected, unexpected disease transmission through transplants.  Of these, there were 15 instances in which HIV, HBV or HCV infection was confirmed to have been transmitted from the organ donor to the recipient.

The 2013 PHS Guideline for Reducing Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Transmission through Organ Transplantation, published in Public Health Reports, recommends the use of more sensitive tests so that patients can be protected from infections transmitted from a transplanted organ, and be informed of risks to the greatest extent possible.

The major changes from the previous 1994 PHS guideline are:

What to tell patients when things go wrong (Part 2 of 2)

Categories: Healthcare-associated infections

Abbigail Tumpey, MPH CHES

Abbigail Tumpey, MPH CHES

Author – Abbigail Tumpey, MPH CHES
Associate Director for Communications Science
CDC, Division of Healthcare Quality Promotion

In my last blog, I discussed some of the emotions that patients may feel when they are notified that they were potentially exposed to an infectious disease during medical care – fear, anxiety, anger, loss of trust, and lack of control. Given this mix of strong emotions, how does a healthcare facility representative break the bad news to a patient?  How do you balance being transparent and with retaining the trust of your patients?  The answer is in proven risk communication concepts that ensure we address patients’ concerns and feelings, while giving them the ability to take back control of the situation (and their health and healthcare).

Risk or crisis communication literature identifies four factors that determine whether the public will perceive a messenger as trusted and credible.  To maintain trust, a healthcare facility representative must express:

  1. Empathy and caring
  2. Honesty and openness
  3. Dedication and commitment
  4. Competence and expertise

For example, a spokesperson could say, “We realize that you turn to Dr. Smith’s Medical facility to get better.  This event is intolerable to us as well, and we want to work with you to resolve the situation and ensure your safety and well-being.  We are taking steps to ensure that this event never occurs again in our facility.”  Then, the healthcare facility needs to follow through on these steps and work to prevent such incidents in the future.

What to Tell Patients When Things Go Wrong (Part 1 of 2)

Categories: Healthcare-associated infections

Couple reading a letter

Author – Abbigail Tumpey, MPH CHES
Associate Director for Communications Science
CDC, Division of Healthcare Quality Promotion

Imagine this – the phone rings, you hear a voice on the other end, “Hi, Mrs. Tumpey….I’m calling from Dr. Smith’s office.  You had medical care at our facility a couple of months ago.  We are calling to inform you that during the procedure an unacceptable practice may have occurred that could have put you at risk for hepatitis or HIV infection.  Although the risk is low, we want to ask you a series of questions and request that you come in to our offices to be tested.”

What are you feeling at that moment?  Most likely, you are not really listening to what the caller is saying.  Immediately, you are thinking, “How could this happen to me?”  You are probably overwhelmed with a mix of emotions – fear, anger, sadness, and anxiety.  This is similar to the type of phone call or letter that tens of thousands of patients have received in the past decade.  Last year alone, nearly 14,000 patients were notified that they may be at risk for fungal meningitis or another fungal infection after contaminated medication was sent from an individual compounding pharmacy to 23 states.  Recently, several thousand patients were notified in Oklahoma after unsafe practices occurred for many decades in a dental facility.

The 1980s: Defining the Infection Prevention and Control Profession.

Categories: Healthcare-associated infections

Barbara M. Soule RN, MPA, CIC, FSHEA

Barbara M. Soule RN, MPA, CIC, FSHEA

Author – Barbara M. Soule, RN, MPA, CIC, FSHEA
Practice Leader, Infection Prevention Services
Joint Commission Resources/Joint Commission International
Oak Brook, Illinois
Editor-In-Chief, The APIC Curriculum, 1983

“Infection prevention through the decades” will take center stage at the Association for Professionals in Infection Control and Epidemiology (APIC) 40th Annual Conference June 8-10 in Fort Lauderdale, Fla. The conference leads off with a plenary session highlighting the milestones of infection prevention over the last 40 years.

Along with my esteemed colleagues, Marguerite Jackson and Julie Gerberding, I will be highlighting the decade of the 1980s, when the infection prevention and control profession was still very young. In the 1980s, the science was evolving but was not yet comprehensive. Professionals in the field, both healthcare epidemiologists and infection control practitioners (now infection preventionists), were using the available science and guidance, and common sense approaches to reduce infection risks in patients and health care workers. Concurrently they also grappled with existing and new issues such as the Staphylococcal outbreaks in nurseries, challenges in isolation practices, the role of the environment in transmitting infections, and AIDs.

In the early 1980s, the infection prevention and control profession had no consistent structure so standardization of methods was often lacking. Training programs and the science that was available came mostly from the CDC in their guidelines and from a few forward-thinking hospital epidemiologists, infection control practitioners, and scientists who were interested in the field of infection prevention and control were willing to “push the envelope.” At about the same time, the American Hospital Association convened a technical panel of experts to advise hospitals on infection prevention and control with carefully considered recommendations.

Making Infection Prevention “Simple”

Categories: Antimicrobial Resistance, Healthcare-associated infections, MRSA

Susan Huang, MD, MPH

Susan Huang, MD, MPH

Guest Author – Susan Huang, M.D., M.P.H
Lead author of the REDUCE MRSA study
Associate Professor, UC Irvine School of Medicine
Medical Director of Epidemiology and Infection Prevention, UC Irvine Health

For years, we have searched for new strategies to turn the tide against antibiotic-resistant pathogens in healthcare facilities.

In particular, Methicillin-resistant Staphylococcus aureus (or MRSA) has become a common threat to patients. MRSA is spreading in both community and healthcare settings and can cause severe disease, particularly among patients in intensive care units.  Patients who have MRSA on their bodies are at increased risk of developing a MRSA infection and healthcare personnel can spread the bacteria from them to other patients. 

Today, I would like to share with you the exciting results from a study known as the REDUCE MRSA trial. The study, published in today’s New England Journal of Medicine, was conducted at 43 hospitals within the Hospital Corporation of America health system. The REDUCE MRSA trial was carried out by a multidisciplinary team from the University of California, Irvine; Harvard Pilgrim Health Care Institute; Rush University; Stroger Hospital of Cook County; Washington University in St. Louis; HCA; and CDC. The trial was federally funded by and conducted through research programs at the Agency for Healthcare Research and Quality (AHRQ) and the CDC’s Prevention Epicenters program

The intervention involved nearly 75,000 patients and more than 280,000 patient days in 74 adult ICUs located in 16 states. The study randomized hospitals to the following three prevention strategies:

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