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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.   

When Antibiotics Lead to Deadly Diarrhea…

Categories: Antibiotic use, Long Term Care (LTC)

Matthew Wayne MD, CMD

Matthew Wayne MD, CMD

Author – Matthew Wayne MD, CMD,
Chief Medical Officer for CommuniCare Family of Companies,
President of the American Medical Directors Association (AMDA)

So, you’ve recently taken antibiotics and you’ve now developed a case of disturbing diarrhea. Should you be concerned? Maybe so…
Antibiotic-associated diarrhea refers to diarrhea that develops in a person who is taking or recently took antibiotics. One of the most serious causes of antibiotic-associated diarrhea is Clostridium difficile (C. difficile) infection – a major cause of acute diarrhea in long-term care facilities. Not only does C. difficile cause discomfort, it actually results in nearly 14,000 deaths every year—90% of these involve people aged 65 or older. People who have recently taken antibiotics are at greatest risk for C. difficile, which is yet another reason we need to use these medications carefully in our nursing homes and long-term care facilities.

Addressing Antibiotic Use in Nursing Homes – It Starts with a Conversation

Categories: Antibiotic use, Long Term Care (LTC)

Nimalie Stone, MD

Nimalie Stone, MD

Author – Nimalie Stone MD,
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention.

As you have read in the posts from our academic and clinical partners, much work needs to be done to impact the systems and behaviors driving antibiotic use in the nursing home setting.

We believe many of the principles of antibiotic stewardship we apply in hospitals would also hold true in other healthcare settings. However, we do not have the same levels of clinical experience and research evidence to implement this activity in our nation’s nursing homes. As an important first step in developing a strategy to promote improved antibiotic use in these healthcare facilities, CDC has reached out to key partners across the nursing home industry to get their input and advice. In fact, today CDC is having face-to-face conversations with these industry stakeholders to discuss and outline next steps towards improved antibiotic use in nursing homes.

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.

Cost of Antibiotic Misuse Too Great to Ignore

Categories: Antimicrobial Resistance

The Society for Healthcare Epidemiology of America (SHEA)

The Society for Healthcare Epidemiology of America (SHEA)

Author - Sara Cosgrove, MD, MS,
Johns Hopkins University School of Medicine

Medical and scientific advances change the way we look at the world. Before penicillin was introduced in 1942, any infection could be a death sentence. Since then, we have been in awe of and dependent on the use of antibiotics as one of the most valuable tools in our medical toolbox. But society as a whole has taken these drugs for granted with use that has allowed the issue of drug resistant infections to creep up on us and grow to be a serious public health threat. Correcting this misuse of antibiotics in our healthcare facilities is necessary to help preserve these drugs; the cost of inaction is too great to be ignored.

One strategy to preserve the use of the antibiotics currently available and reign in resistance is antimicrobial stewardship. These programs and interventions help prescribers know the right drug, at the right time, in the right dose, for the right duration. These programs help to improve the use of antibiotics.

Antimicrobial resistance is becoming an increasing issue in healthcare facilities and communities throughout the country, as evidenced by outbreaks of MRSA and carbapenem-resistant Enterobacteriaceae (CRE). These resistant bugs are associated with increased patient morbidity, mortality and higher healthcare costs spent on useless use of antibiotics and longer, more intense hospital stays.

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