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Selected Category: Healthcare-associated infections

Three Ways the Affordable Care Act Makes a Difference as it Turns 3

Categories: Healthcare-associated infections

Tom Frieden, MD, MPH<br />
Director, Centers for Disease Control and Prevention

Frieden, MD, MPH
Director, Centers for Disease Control and Prevention

Guest Author, Tom Frieden, MD, MPH
Director, Centers for Disease Control and Prevention

Last Saturday marked the third birthday of the Affordable Care Act. We at CDC are in the prevention business. So, in addition to the Act’s provisions to increase health insurance coverage, improve quality, and address cost, I’m especially excited about the potential for prevention—prevention in communities and prevention in health care settings. It’s wonderful to see the difference it’s making three years later.

  1. The Affordable Care Act has eliminated out-of-pocket costs–copays and deductibles—for proven preventive services. Despite proven benefits of preventive tests, screenings, and vaccinations, millions of Americans still don’t get these services. The ACA makes it free for millions of Americans with new private health plans to receive these proven services, including mammograms, flu shots, smoking cessation counseling, and more. Last week, HHS released a study showing that approximately 71 million Americans received expanded coverage for preventive services in 2011 and 2012.

New York Hospital Virtually Eliminates CRE Transmission in ICU Settings

Categories: Antimicrobial Resistance, Healthcare-associated infections

Brian Currie, MD, MPH

Brian Currie, MD, MPH

Guest Author – Brian Currie, MD, MPH
Montefiore Medical Center,
University Hospital and Academic Medical Center for the Albert Einstein College of Medicine

Today I would like to discuss a highly successful patient safety intervention designed to reduce the prevalence of CRE in the ICU units across Montefiore Medical Center (MMC) in the Bronx, N.Y. Funded by AHRQ, this effort used CDC’s infection prevention guidelines to reduce CRE prevalence and was intended to be exportable for replication at other acute care hospitals.

CRE has been widespread in NYC since 2006, including at our medical center. In NYC, CRE has been almost exclusively due to the Klebsiella pneumoniae carbapenemase gene (KPC). At our facilities 40% of the prevalence of KPC was due to patients who were already carrying CRE, prior to their transfer into our facilities from other acute and long term care facilities in the Bronx. My team worked to detect CRE using PCR-based lab tests and protect patients from picking up CRE by rapidly implementing contact isolation precautions for all positive patients.

Our baseline rate was established via weekly peri-rectal swab sampling of all ICU patients (94 beds in 7 units across 3 hospitals) during a four month period. Testing results were not shared with caregivers during the baseline period. However, all health care providers were educated about CRE/KPC and how to stop spread. After roll out, another sampling was initiated for another 4 months that included weekly sampling and sampling all new admissions on arrival on a daily basis. All results were reported within 3 hours of sample pickup and KPC positive patients were immediately placed on contact isolation.

I am thrilled to report that overall our facility reduced KPC in each unit by 53%. The remaining KPC prevalence was almost completely composed of patients who were known to be KPC positive on ICU admission, thus patient to patient transmission was virtually eliminated.
At Montefiore Medical Center, we continue our efforts to protect patients from the threat of CRE and other multi-drug resistant bacteria.

The Beginning of the End of Antibiotics?

Categories: Antimicrobial Resistance, Healthcare-associated infections

Arjun Srinivasan, MD

Arjun Srinivasan, MD

Author – Arjun Srinivasan, MD
Associate Director for Healthcare Associated Infection Prevention Programs
CDC, Division of Healthcare Quality Promotion

Today in CDC’s March Vital Signs, we report on what could be the beginning of the end of antibiotics. Our arsenal of existing antibiotics is being overpowered by lethal germs called carbapenem-resistant Enterobacteriaceae (CRE). These germs affect people who are in or who recently had inpatient medical care. When someone gets a serious (bloodstream) infection from CRE, we have very few or no antibiotics to cure the problem. Up to half of patients will die. Adding to the concern of spread between people, CRE can spread their antibiotic-fighting weapons to other bacteria, potentially creating additional untreatable bacteria. New drugs won’t be here for many years, so we must do everything we can to preserve current antibiotics for as long as possible.

Here are other important facts to know about CRE:

  • About 4% of US short-stay hospitals had at least one patient with a serious CRE infection during the first half of 2012. About 18% of long-term acute care hospitals had one. This totals almost 200 facilities.
  • One type of CRE has been reported in medical facilities in 42 states .
  • The most common type of CRE is also rising rapidly – there has been a seven-fold increase in its presence during the last 10 years.

So how do we stop the rise of these deadly, resistant CRE germs?

First, know that it can be done. CDC has mapped out specific guidelines that, when followed, can halt CRE infections before they become widespread in medical facilities and before they spread to otherwise healthy people in our communities. In fact, medical facilities in several states have reduced or stopped CRE rates by following CDC’s prevention guidelines. As further proof, Israel decreased CRE infection rates in all 27 of its hospitals by more than 70% in one year with a coordinated prevention program.

To learn specific steps tailored to CRE in your state, review CDC’s comprehensive CRE Prevention Toolkit, which provides CRE prevention guidelines for doctors and nurses, hospitals, long-term acute care hospitals, nursing homes, and health departments. The toolkit provides step-by-step instructions for facilities treating patients with CRE and for those not yet affected by it.

The entire medical system must act quickly to halt CRE infections before it’s too late. We cannot afford to miss this window of opportunity. Antibiotics are a shared resource and therefore preserving them is a shared responsibility. Are you doing everything that you can?

Overcoming Education Gaps and Denial: CDC and SIPC Release New Tools to Help Clinicians Ensure Every Injection is Safe

Categories: Healthcare-associated infections, Injection Safety

The Impacts of Unsafe Medical Injections in the U.S.

The Impacts of Unsafe Medical Injections in the U.S.

Author: Centers for Disease Control and Prevention 

Injection safety is part of the minimum expectation for safe care anywhere healthcare is delivered; yet, CDC has had to investigate outbreak after outbreak of life-threatening infections caused by injection errors.  How can this completely preventable problem continue to go unchecked?  Lack of initial and continued infection control training, denial of the problem, reimbursement pressures, drug shortages, and lack of appreciation for the consequences have all been used as excuses; but in 2012 there is no acceptable excuse for an unsafe injection in the United States. 

Eradicating unsafe practices will take a multifaceted approach, and now is the time for action to ensure that no additional patients are harmed through unsafe injections.  Today, the CDC and the Safe Injection Practices Coalition released new materials to make it easier for clinicians and others working in healthcare to learn and train others about following safe injection practices. 

Two Birds with One Stone:  Bloodborne Pathogen Training + Patient Safety – Enhanced PowerPoint

Healthcare providers or training managers who need to keep staff current on bloodborne pathogens training can now use a new presentation:  “Safe Injection Practices:  Protection Yourself and Your Patients – A Bloodborne Pathogens Training Activity.” This training was created to remind healthcare providers that measures they take to protect themselves from bloodborne pathogens and other exposures also protect patients from healthcare-associated infections.  View the training on the One & Only Campaign’s website.   

Inappropriate Antibiotic Use in Nursing Homes: A Systems Problem

Categories: Antimicrobial Resistance, Healthcare-associated infections

Chris Crnich, MD

Chris Crnich, MD

Author – Chris Crnich, MD
Assistant Professor of Medicine in the Division of Infectious Diseases at the University of Wisconsin School of Medicine and Public Health and is the Hospital Epidemiologist at the William S. Middleton VA Hospital.

A significant proportion of antibiotic use in nursing homes is inappropriate. Inappropriate antibiotic use unnecessarily places residents at risk for adverse drug events and is the major driver of antibiotic resistance in nursing homes.

A traditional approach to the problem of inappropriate antibiotic use in nursing homes centers on educating the provider making prescribing decisions. The thinking goes, that if we can get providers to better understand the adverse consequences of antibiotics and increase their knowledge about antibiotic choice and dosing, the problem of inappropriate antibiotic use in nursing homes will go away. Unfortunately, it is not that simple.

Prescribing in nursing homes is unique in that most decisions to initiate antibiotics are made over the phone without the benefit of a clinical exam performed by the prescribing provider. Coupled with the clinical uncertainty created by the atypical presentation of acute illness in the frail elderly and limited access to diagnostic test results creates a perfect environment for overuse of antibiotics. When viewed through this prism, the likelihood of inappropriate antibiotic use is not simply determined by the provider but by the particulars of the resident’s presentation, accessibility to diagnostic tests, features of the nursing home staff primarily responsible for the clinical exam, as well as the quality of communication between providers and facility staff.
Recognizing that inappropriate antibiotic use is an outcome determined more by the nursing home system rather than an individual provider’s decisions and behaviors is an important step towards addressing this problem. With this in mind, future efforts to improve antibiotic use in nursing homes must begin to focus on strategies that: 1) standardize nursing assessments of the resident with suspected infection; 2) enhance the accessibility of clinical information and diagnostic test results, and 3) improve the quality of communication between providers involved in the antibiotic start process.

Implementing these types of interventions in the nursing home environment will not be without challenge but as Albert Einstein once said, “Insanity is doing the same thing over and over again and expecting different results”. Ignoring the important role of the system on antibiotic use will lead to more of the same. We can and must do better.

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