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Preserving Antibiotic Effectiveness: Everybody’s Responsibility

Categories: Antibiotic use, Antimicrobial Resistance

Ramanan Laxminarayan, PhD.

Ramanan Laxminarayan, PhD

Guest Author – Ramanan Laxminarayan, PhD
Director, Center for Disease Dynamics, Economics & Policy

To many, antibiotic resistance may seem like an evergreen issue that reappears in the news cycle periodically. However, recent reports of the emergence and spread of carbapenem-resistant Enterobacteriaceae, described in CDC’s March 2013 Vital Signs Report remind us that we stand at the threshold of the post-antibiotics era and that we have a responsibility to bring broader attention to this serious public health threat.

In November of last year, a group of 26 organizations came together to sign the Joint Statement on Antibiotic Resistance, an agreement that put forth bold principles for protecting our current supply of working antibiotics while urging the development of new ones. Among the goals listed is the need for continued efforts to educate a wider audience about the looming danger of running out of effective antibiotics.

Last week, Extending the Cure released an animated video that explains in clear and engaging terms how antibiotic resistance emerges, what it costs to society, and why antibiotics must be conserved as a communal resource, like water and trees.

The Role of the Healthcare Environment: Challenges and Opportunities in Reducing Healthcare-Associated Infections

Categories: Healthcare-associated infections

Kerri A. Thom, MD, MS

Kerri A. Thom, MD, MS

Guest Author – Kerri Thom, MD
Assistant Professor of Medicine
Division of Epidemiology and Public Health
University of Maryland School of Medicine

As leaders in infection control and prevention, healthcare epidemiologists and infection preventionists must work to educate other healthcare professionals, from the C-Suite to the frontline, on the need to incorporate comprehensive environmental cleaning and disinfection strategies to reduce HAIs. At the University of Maryland, we look to use data to demonstrate how evidence-based strategies can reduce environmental contamination. For example, using methods like fluorescent dye to capture the rate of high-touch surface disinfection, we are able to provide immediate feedback to frontline staff and to report data back to hospital management highlighting the frequency of cleanliness of these surfaces.

The Society for Healthcare Epidemiology of America’s (SHEA) Spring Meeting puts a spotlight on the impact of the healthcare environment in the spread of bacteria responsible for healthcare-associated infections. Healthcare environment research identifies the role of the healthcare environment to contaminate the hands of healthcare professionals, hospital surfaces and medical equipment. The goal of the meeting is to educate professionals in healthcare epidemiology and infection prevention on evidence-based research and policies in this area.

Three Ways the Affordable Care Act Makes a Difference as it Turns 3

Categories: Healthcare-associated infections

Tom Frieden, MD, MPH<br />
Director, Centers for Disease Control and Prevention

Frieden, MD, MPH
Director, Centers for Disease Control and Prevention

Guest Author, Tom Frieden, MD, MPH
Director, Centers for Disease Control and Prevention

Last Saturday marked the third birthday of the Affordable Care Act. We at CDC are in the prevention business. So, in addition to the Act’s provisions to increase health insurance coverage, improve quality, and address cost, I’m especially excited about the potential for prevention—prevention in communities and prevention in health care settings. It’s wonderful to see the difference it’s making three years later.

  1. The Affordable Care Act has eliminated out-of-pocket costs–copays and deductibles—for proven preventive services. Despite proven benefits of preventive tests, screenings, and vaccinations, millions of Americans still don’t get these services. The ACA makes it free for millions of Americans with new private health plans to receive these proven services, including mammograms, flu shots, smoking cessation counseling, and more. Last week, HHS released a study showing that approximately 71 million Americans received expanded coverage for preventive services in 2011 and 2012.

New York Hospital Virtually Eliminates CRE Transmission in ICU Settings

Categories: Antimicrobial Resistance, Healthcare-associated infections

Brian Currie, MD, MPH

Brian Currie, MD, MPH

Guest Author – Brian Currie, MD, MPH
Montefiore Medical Center,
University Hospital and Academic Medical Center for the Albert Einstein College of Medicine

Today I would like to discuss a highly successful patient safety intervention designed to reduce the prevalence of CRE in the ICU units across Montefiore Medical Center (MMC) in the Bronx, N.Y. Funded by AHRQ, this effort used CDC’s infection prevention guidelines to reduce CRE prevalence and was intended to be exportable for replication at other acute care hospitals.

CRE has been widespread in NYC since 2006, including at our medical center. In NYC, CRE has been almost exclusively due to the Klebsiella pneumoniae carbapenemase gene (KPC). At our facilities 40% of the prevalence of KPC was due to patients who were already carrying CRE, prior to their transfer into our facilities from other acute and long term care facilities in the Bronx. My team worked to detect CRE using PCR-based lab tests and protect patients from picking up CRE by rapidly implementing contact isolation precautions for all positive patients.

Our baseline rate was established via weekly peri-rectal swab sampling of all ICU patients (94 beds in 7 units across 3 hospitals) during a four month period. Testing results were not shared with caregivers during the baseline period. However, all health care providers were educated about CRE/KPC and how to stop spread. After roll out, another sampling was initiated for another 4 months that included weekly sampling and sampling all new admissions on arrival on a daily basis. All results were reported within 3 hours of sample pickup and KPC positive patients were immediately placed on contact isolation.

I am thrilled to report that overall our facility reduced KPC in each unit by 53%. The remaining KPC prevalence was almost completely composed of patients who were known to be KPC positive on ICU admission, thus patient to patient transmission was virtually eliminated.
At Montefiore Medical Center, we continue our efforts to protect patients from the threat of CRE and other multi-drug resistant bacteria.

Understanding and combating CRE bacteria in Chicago

Categories: Antimicrobial Resistance

Michael Lin, MD, MPH

Michael Lin, MD, MPH

Guest Authors - Michael Y. Lin, MD MPH and
Mary K. Hayden, MD

Rush University Medical Center
CDC, Chicago Antimicrobial Resistance and Infection Prevention Epicenter

Increasingly, certain kinds of bacteria are causing serious infections that are difficult or impossible to cure because the bacteria are resistant to all or nearly all antibiotics. Carbapenem-resistant Enterobacteriaceae, or CRE, are one of the most feared group of these extremely drug-resistant bacteria; they are spreading worldwide, with few treatment options.

CRE are not equal opportunity bacteria; rather, they typically affect the sickest patients. These patients are cared for at a whole range of inter-connected healthcare facilities, from traditional hospitals to long-term care facilities.

In Chicago, CRE were not known to exist prior to 2007. When an increase in healthcare-associated CRE was detected in 2010, we partnered with CDC to develop a plan to combat CRE infections in our region.

Many questions exist regarding how to best control CRE, especially when it affects a whole region of healthcare facilities. The CDC, via its Prevention Epicenters program, has supported coordination of effort between local scientists such as ourselves and public health officials to try to understand how to best prevent the spread of CRE in Chicago so that lessons can be applied to other areas confronting CRE.

Through support from CDC, we are studying control strategies that fight the spread of CRE in facilities that care for the most vulnerable of our patients. Such control programs include region-wide efforts that combine proven strategies for infection control, such as (1) actively identifying and providing special precautions for patients who carry CRE, (2) improving healthcare worker hygiene practices, and (3) improving patient skin hygiene and applying a protective antiseptic. We will be analyzing the results of the program in late 2013.

In order to monitor the regional effects of the program, we are improving surveillance of CRE through active search strategies, such as periodically checking patients in Chicago intensive care units for CRE. We are also harnessing the power of communication, by growing public health information systems to promote timely sharing of infection control information between healthcare facilities.

In Chicago, we see a tremendous spirit of cooperation among healthcare facilities that is necessary to combat the common CRE threat.

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