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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. 

Program to Prevent Infections in Cancer Patients Hits Home

Categories: Healthcare-associated infections, Patients

Lisa Splitlog

Lisa Splitlog

Guest Author – Lisa Splitlog  
Director, CDC Value Communications
CDC Foundation

As a CDC Foundation staff member, I’m always proud to share with my family and friends how we help advance the Center for Disease Control and Prevention’s (CDC) lifesaving work through public-private partnerships that help protect our nation’s health security and contribute to a healthy economy. It’s exciting and fulfilling to work for an organization that makes a difference in the lives of so many.

Over the last few months, though, one of our partnerships with Amgen focused on preventing infections in cancer patients has really hit home for me. I was recently diagnosed with Stage III breast cancer and am currently undergoing eight rounds of chemotherapy, which will be followed by surgery and radiation. It has been an overwhelming diagnosis that has impacted virtually every area of my life—from the wig I wear to cover my bald head to the fatigue and loss of appetite that I typically experience after each round of chemo. Someone compared chemo to “being hit by a bus,” and that’s exactly what it feels like.

APIC promotes “Infection Prevention and You”

Categories: HAI Guidelines, Healthcare-associated infections

Infection Prevention and You banner

Guest Author – Vicki G. Allen, MSN, RN, CIC
Manager of the Infection Prevention and Control Department
CaroMont Regional Medical Center

This year APIC is marking International Infection Prevention Week (IIPW), October 20-26, by launching a multiyear campaign themed "Infection Prevention and You.” The focus is to engage everyone — patients, families, and healthcare personnel — in infection prevention, as well as to promote a voice and a partnership toward receiving quality and safe patient care.

APIC’s new Infection Prevention and You APIC’s new “Infection Prevention and You” website will be continually updated and revised to reflect the most current information. For example, we recently added a page on preventing infection in the locker room. One section of the website is geared to patients and families, and the other is geared to healthcare personnel who are not necessarily infection preventionists. The resources are aimed at helping everyone understand their role in infection prevention and patient safety. The website includes tips and tools including a new infographic [PDF - 1.25 MB] that depicts how patients and families [PDF - 554 KB] can play an active role, what healthcare-associated infections [PDF - 491 KB] are, and what infection preventionists do to keep patients safe.

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