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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.

Helping Cancer Patients Prevent Infections this Winter

Categories: Healthcare-associated infections, Outpatient Care, Patients

Alice Guh, M.D, MPH

Alice Guh, M.D, MPH

Author:   Alice Guh, M.D., M.P.H.
Medical Officer, CDC’s Division of Healthcare Quality Promotion

When you are battling cancer, the last thing you want to get is an infection.  This is one of the reasons why I am involved in Preventing Infections in Cancer Patients,  a program focused on providing information, action steps and tools for cancer patients, their families and healthcare providers to reduce the risk of developing potentially life-threatening infections during chemotherapy treatment.

With flu season peaking, I thought it was an appropriate time to answer some questions about how cancer patients can take action to protect themselves against the flu and other serious infections this winter.

Why are cancer patients at greater risk for infection from the flu?

Cancer patients who are receiving chemotherapy are vulnerable to infections when their white blood cell count is low. It’s important for cancer patients to understand how to prevent infections year-round, and especially during flu season.

In the winter months, cancer patients face an additional infection risk: influenza or flu. Like other infections, flu is more likely to cause serious complications in cancer patients because of their   weakened immune systems. These complications can include pneumonia, a disruption to their chemotherapy schedules, hospitalization and death.

Engineering Safe Healthcare: Why CDC Needs Business Partnerships

Categories: Healthcare-associated infections

Business Pulse: How CDC protects the health of your business

Author: Dr. Michael Bell
Deputy Director, CDC’s Division of Healthcare Quality Promotion

Working at CDC, I see how our country is doing at protecting patients during medical care.  While we’ve made some solid progress, I am still shocked when we uncover outbreaks or infection control breaches that are simple and unacceptable lapses in basic safe care. 

Every day, one in every 20 hospital patients has an infection caused by their medical care.  Imagine this from a business perspective – the last thing you want is for your employees to be sick or unable to work.  If your employees get an infection on top of whatever problem leads them to seek care, the consequences can be devastating.  For example, bloodstream infections alone can extend hospital stays for up to one month and cost up to $40,000 extra per person.  And today, we have the risk of infections that are drug-resistant as many bacteria are outsmarting our best antibiotics.

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