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Success in Controlling Outbreaks in an Intensive Care Unit Using CDC Toolkit Interventions

Categories: Antimicrobial Resistance, Gram negatives, Healthcare-associated infections

Dr. Kyle Enfield

Dr. Kyle Enfield

Guest Author: Kyle B. Enfield, MD,
Assistant Professor of Medicine,
Assistant Hospital Epidemiologist,
Medical Director, Medical Intensive Care Unit,
University of Virginia

Infections due to carbapenem-resistant Enterobacteriaceae (CRE) are on the rise globally. These infections have limited therapeutic options, and invasive infections due to CRE are associated with a mortality rate upwards of 40 percent. A scary statistic for patients!

My institution, the University of Virginia Health System, identified our first case of CRE in August 2007. We had low level transmission with periods of improvement; however, in January 2010 we noted both an increase in CRE transmission among patients in the surgical intensive care unit (SICU), as well as a cluster of infections caused by a nosocomial pathogen new to the unit and our institution – extensively drug-resistant Acinetobacter baumannii (XDR-AB).

It was critical that we address this potential issue head-on in order to ensure positive patient outcomes and do our best to limit our institution’s exposure to CRE. After initial attempts to control these concurrent outbreaks of multidrug-resistant Gram negative pathogens using reinforced standard infection control practices failed, we implemented a bundled set of infection control interventions aimed to assess the prevalence of CRE and XDR-AB colonization or infection in the unit. The collective set of measures we implemented became recommended practice in the Centers for Disease Control and Prevention 2012 Carbapenem-resistant Enterobacteriaceae Toolkit. The interventions were developed by units in collaboration with Infection Prevention and Control and Environmental Services.

Drug Diversion Defined: Steps to Prevent, Detect, and Respond to Drug Diversion in Facilities

Categories: Healthcare-associated infections, Injection Safety

Injection Safety

Injection Safety

Guest Author: Kimberly New, JD BSN RN,
President, Tennessee Chapter of the National
Association of Drug Diversion Investigators

In my last blog, I talked about the impact of drug diversion on hospitals and healthcare facilities. Today, I will be discussing the frequency of diversion within healthcare facilities and what facilities can do to prevent, detect, and appropriately respond to diversion.

There are no reliable statistics about diversion by healthcare providers. This is because diversion is done covertly, and methods in place in many institutions leave cases undetected or unreported. At a facility with a strong diversion program and a nursing staff of about 1,000, I identified 1-2 new cases of staff members diverting each month. Well over 50% of those caught were diverting and using injectable opioids.

Diversion of controlled substances happens at all institutions. Because diversion can’t be stopped entirely, facilities must prevent it to the extent they can, identify cases quickly, and respond appropriately.

The essential elements of a healthcare facility diversion program include

  • Policies to prevent, detect, and properly report diversion,
  • A method of observing processes and auditing drug transaction data for diversion,
  • Prompt attention to suspicious audit results,
  • A collaborative relationship with public health and regulatory officials, and
  • Diversion education for all staff. 

In conjunction with its investigation of a diversion incident, the New Hampshire Department of Health and Human Services observed, “Highly educated and well-trained staff failed to recognize or overlooked behaviors indicative of addiction…or failed to follow established policies to address staff with substance abuse problems.” Ensuring that all staff are aware of the signs of diversion and impairment, and that they know reporting avenues, can facilitate quick recognition and response.

Whenever diversion is identified, healthcare facilities should promptly report to appropriate enforcement agencies and, ideally, obtain complete details from anyone caught diverting.  If injectable medications were diverted and tampering is suspected, facilities should also engage public health officials to assess the need for patient notification.

Drug Diversion Defined: Consequences for Hospitals and Other Healthcare Facilities

Categories: Healthcare-associated infections, Injection Safety

Kimberly New, JD BSN RN

Kimberly New, JD BSN RN

Guest Author: Kimberly New, JD BSN RN
President, Tennessee Chapter of the
National Association of Drug Diversion Investigators

In my last blog, I talked about how drug diversion, or theft of medication, poses a continuous threat to patient safety. In today’s blog, I’ll be discussing the many ways in which drug diversion negatively affects hospitals. It’s hard to believe, but drug diversion occurs in facilities every day.

Hospitals and other healthcare facilities are required to provide care in a safe setting and protect patients from harm. Diversion by personnel in healthcare facilities not only threatens patients, but also places the facility at risk. As a result of a diversion event, the facility can incur civil and regulatory liability, become the subject of negative publicity, and even be placed in “immediate jeopardy” of being shut down.

All healthcare facilities intend to provide good care, but many do not appreciate the frequency with which diversion occurs. They trust their employees to do the right thing. It is unimaginable that an employee’s addiction would go undetected or that a diverter would harm a patient. Facilities may view events as isolated occurrences, and be unsure of what to do once diversion is discovered.

Looking forward to APIC Annual Conference, June 7-9 in Anaheim

Categories: Healthcare-associated infections

Timothy Wiemken, PhD, MPH, CIC

Timothy Wiemken, PhD, MPH, CIC

Guest Author: Timothy Wiemken, PhD, MPH, CIC
Assistant Professor of Medicine
Division of Infectious Diseases
University of Louisville School of Medicine

The 41st Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC) will definitely be the best one yet. Each year more than 2,500 clinical professionals from around the world gather for three days to learn more about infection prevention. This year, the conference is in Anaheim, CA (June 7-9).

The opening plenary sessions will be amazing, with keynote speakers Dr. Jennifer Gardy from the British Columbia Centre for Disease Control and Dr. Greg Poland from the Mayo Clinic. I have had the pleasure of hearing Dr. Gardy speak at IDWeek, and she is incredible. I highly suggest you follow her on Twitter at @jennifergardy. Dr. Poland (@drgregpoland) is internationally renowned for his work in vaccines. This year he will be speaking on a different topic: why healthcare professionals inhibit medical advances.

Drug Diversion Defined: A Patient Safety Threat

Categories: Healthcare-associated infections, Injection Safety

Kimberly New, JD BSN RN

Kimberly New, JD BSN RN

Guest Author: Kimberly New, JD BSN RN
President, Tennessee Chapter of the National Association of Drug Diversion Investigators

You may have seen some recent media reports about drug diversion. Today, I want to break down the issue of drug diversion and provide some details about this serious patient safety threat.

Drug diversion, or theft of drugs, by healthcare personnel poses a continuous threat to patient safety in any healthcare setting in which controlled substances are handled. Although personnel who divert originally went into healthcare to care for patients, they have made poor choices for which they are accountable, including the impact their actions have on others. The longer a healthcare worker is allowed to steal medication, the greater the consequences become. Impaired providers can harm patients by providing sub-standard care, denying medications to patients, or exposing patients to tainted substances.

Tampering is the worst type of diversion. Commonly, the diverter removes medication from a syringe, vial, or other container and injects him- or herself with the medication. The diverter then replaces the stolen medication with saline or sterile water, or another clear medication or liquid. The “replacement liquid” is later used on the patient by an unaware provider. When tampering, the diverter may rarely use sterile technique. Ultimately the patient doesn’t receive the required medication and may be exposed to the diverter’s blood.

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