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CDC launches new website for preventing infections in long term care

Categories: Healthcare-associated infections, Long Term Care (LTC)

Nimalie Stone, MD

Nimalie Stone, MD

Author: Nimalie Stone, MD
Medical Epidemiologist
CDC’s Division of Healthcare Quality Promotion

The past few years have brought heightened awareness of the important role of infection prevention programs and activities in long-term care settings, including nursing homes and assisted living. Navigating all the information available on infection prevention in healthcare facilities can be overwhelming, and it can be particularly difficult to locate available resources that are specific to long-term care settings. To address this need, my CDC colleagues and I have worked to redesign and expand our web-based tools and resources for this important healthcare setting.

Today, we are excited to unveil CDC’s Infection prevention website for long-term care facilities! This site organizes existing infection prevention guidance and resources into sections for clinical staff, infection prevention coordinators, and residents. Facilities can also directly access the new infection tracking system for long-term care facilities in CDC’s National Healthcare Safety Network, and the innovative infection prevention tools and resources developed as part of the partnership between CDC and the Advancing Excellence in America’s Nursing Homes Campaign (AE). AE is a well-established quality improvement campaign, supported by national nursing home partners. The partnership between CDC and AE grew tremendously through our joint effort to develop and launch the Infection goal to prevent C. difficile infections in nursing home residents. By cross-promoting the AE infection resources on the CDC website, we hope to bring a new audience to the AE campaign while also exposing the campaign’s participants to even more CDC tools to support their local infection prevention activities.

Public gets early snapshot of MRSA and C. difficile infections in individual hospitals

Categories: Healthcare-associated infections

MRSA and C. difficile

MRSA and C. difficile

New data posted yesterday and gathered through the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN) gives patients a first look at how their local hospitals are doing at preventing Clostridium difficile infections (deadly diarrhea) and methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections.  This information, as well as other hospital performance measures, is collected as part of the Centers for Medicare & Medicaid Services’ (CMS) Hospital Inpatient Quality Reporting (IQR) Program and is publicly available on the Hospital Compare website.

The numbers represent only the first quarter of 2013; measurements of how hospitals are doing will be more precise and provide a more complete picture as more information is collected over time.  The next update, which will represent six months of data, is scheduled for April 2014.

“Sunlight is a great disinfectant, and public reporting of hospital infections is the sunlight the public has asked for and deserves when it comes to their health and safety,” said CDC Director Tom Frieden, M.D., M.P.H.  “Hospitals understand the importance of reporting, and their leaders are using this information to prevent infections and keep their patients safer.”

For more information about this important CDC and CMS collaboration to advance public reporting of hospital quality indicators, read the full press release at: http://www.cdc.gov/media/releases/2013/p1212-mrsa-cdifficile.html

Sometimes the Safest Prescription is “Wait and See”

Categories: Antibiotic use, Antimicrobial Resistance

Adam L. Hersh, MD, PhD

Adam L. Hersh, MD, PhD

Guest Author – Adam L. Hersh, MD, PhD
Assistant Professor of Pediatrics
Division of Pediatric Infectious Diseases
University of Utah

Get Smart About Antibiotics Week is a great opportunity to call attention to a priority that we all share: preserving the effectiveness of antibiotics for the future. Doctors and other practitioners on the front-lines of ambulatory care may become frustrated when they hear the way they practice medicine is partly to blame for the urgent threat of antibiotic resistance.

For those of us working in ambulatory care settings, it is a really busy and demanding job, and for many patients with upper respiratory tract infections (URIs), it’s hard to know who has a bacterial infection and who doesn’t. This year, Get Smart About Antibiotics Week is featuring the publication of Principles of Judicious Antibiotic Prescribing for Pediatric Upper Respiratory Tract Infections in the journal Pediatrics. It discusses the importance of diagnostic certainty and reviews the clinical criteria practitioners should use when determining the likelihood of a bacterial infection.

There are established and stringent clinical criteria that should be applied to justify an antibiotic prescription for the key URIs in pediatrics that are potentially caused by bacteria. Many bacterial URIs will resolve on their own without antibiotic treatment. And the serious and justifiably feared complications of URIs (such as mastoiditis as a complication of otitis media) usually cannot be prevented by early antibiotic therapy anyway. All of this is important to consider as our understanding continues to grow about the harms antibiotics can cause.

Antibiotic overuse not only contributes to increased resistance but also avoidable adverse drug events including serious allergic reactions, cardiovascular problems and chronic conditions such as eczema, asthma, inflammatory bowel disease and obesity. Doctors want to do what is safe and in their patients’ best interests. When there is a considerable degree of uncertainty regarding the diagnosis for patients with URIs, sometimes the safest thing to do is to “wait and see.”

Good Infection Prevention Habits Don’t Just Happen

Categories: Hand Hygiene, Healthcare-associated infections

Elaine Larson, RN, PhD, CIC, FAAN

Elaine Larson, RN, PhD, CIC, FAAN

Guest Author – Elaine Larson, RN, PhD, CIC, FAAN
Associate Dean for Research and Anna C. Maxwell Professor of Nursing Research
Columbia University School of Nursing
Editor, American Journal of Infection Control

Over the past few decades, especially since the ‘antibiotic era’ and the advent of increasingly technologic and sophisticated interventions, there has been less and less attention paid to simple hygiene measures in the curriculum of healthcare professionals.  In fact, I recall in the 1980s reading that the age of infections was coming to an end because we had conquered germs.  Confident that the ‘battle against germs’ was won, hand hygiene, isolation practices, and personal protective equipment took a back seat to fancier therapies.  Educators of physicians and nurses seemed to assume either that everybody knows how to wash their hands (or perhaps that it wasn’t really that important?).  Hence, because many effective barrier practices are also rather simple, they have received little, if any, attention in healthcare curricula.

In the September issue of The American Journal of Infection Control, Gould and Drey reported on student nurses’ experiences with infection prevention and control during their clinical placement.  Almost 500 students from England, Wales, Scotland, and Northern Ireland responded to a survey placed on the website of The Royal College of Nursing.  More than three-fourths reported that they had seen clinicians failing to perform hand hygiene before patient contact, and more than half reported deficiencies in other infection prevention practices such as ‘sharps’ disposal, changing personal protective equipment between patients, or failure to apply isolation precautions.

Even though the study was biased by a low response rate and by the fact that nursing students who respond to such surveys may have characteristics and attitudes different than those who do not respond, the findings are very consistent with what others have reported from both nursing and medical students.  That is, when students observe infection prevention practices, they can and do identify frequent breeches in themselves and others. 

So what do these findings mean for educators and for clinicians working with ‘newbies’?  Clearly, the problem does not seem to be lack of knowledge, since students can identify deficiencies.  But we know that infection prevention practices and habits don’t just happen, even when people know what to do!  Having students be observant of practice increases their mindfulness and can help translate the ‘book learning’ into actual practice.  Such ‘mindfulness’ ultimately is what will be required of all staff members to build the kind of safety and patient-oriented culture for which we are striving.  So, we need to support students and staff to increase their mindfulness and take ownership of their own infection prevention practices.

The Value of an Infectious Diseases Specialist

Categories: Antimicrobial Resistance, Clostridium difficile, Healthcare-associated infections

Steven Schmitt, MD, FIDSA

Steven Schmitt, MD, FIDSA

Guest Author – Steven Schmitt, MD, FIDSA
Chair of the Infectious Diseases Society America’s Clinical Affairs Committee and infectious diseases physician at Cleveland Clinic

We’re all well aware that infection is a major problem among hospitalized patients, sometimes arriving with infection as a reason for admission and sometimes developing infection in the hospital.  In either case, infection is among the top causes of death in the hospital and hospital-acquired infections affect one in 20 patients. Many of these infections are resistant to antibiotics, making them extremely difficult to treat. So what is the answer?  Get patients the type of care they deserve – in this case, treatment provided by physicians who are experts in infectious diseases.  A recent study published in Clinical Infectious Diseases– based on Medicare data from nearly 130,000 hospitalized patient cases – provides strong evidence that infectious diseases expertise is invaluable. 

To quantify the value of ID physicians, we studied the records of patients who had at least one of 11 common types of infections, including Clostridium difficile, which the CDC recently named as one of the top three urgent threats in its landmark antibiotic resistance report.  Other infections included: bacteremia, central line associated bloodstream infections (CLABSI), bacterial endocarditis, HIV/opportunistic infections, meningitis, osteomyelitis, prosthetic joint infections, septic arthritis, septic shock and vascular device infections. Matching patient characteristics, we compared the outcomes of those who had seen an ID physician and those who had not. 

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