Category Archives: C. diff. prevention

Study Assessed Bezlotoxumab Cost Effectiveness Added To Standard of Care to Prevent rCDI In High-risk Patients From the Spanish National Health System

Abstract

Introduction

Clostridium difficile infection (CDI) is the major cause of infectious nosocomial diarrhoea and is associated with considerable morbidity, mortality and economic impact. Bezlotoxumab administered in combination with standard of care (SoC) antibiotic therapy prevents recurrent CDI.

This study assessed the cost-effectiveness of bezlotoxumab added to SoC, compared to SoC alone, to prevent the recurrence of CDI in high-risk patients from the Spanish National Health System perspective.

Methods

A Markov model was used to simulate the natural history of CDI over a lifetime horizon in five populations of patients at high risk of CDI recurrence according to MODIFY trials: (1) ≥ 65 years old; (2) severe CDI; (3) immunocompromised; (4) ≥ 1 CDI episode in the previous 6 months; and (5) ≥ 65 years old and with ≥ 1 CDI episode in the previous 6 months. The incremental cost-effectiveness ratio (ICER) expressed as cost per quality-adjusted life-year (QALY) gained was calculated. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were performed.

Results

In all patient populations (from 1 to 5), bezlotoxumab added to SoC reduced CDI recurrence compared to SoC alone by 26.4, 19.5, 21.2, 26.6 and 39.7%, respectively. The resulting ICERs for the respective subgroups were €12,724, €17,495, €9545, €7386, and €4378. The model parameters with highest impact on the ICER were recurrence rate (first), mortality, and utility values. The probability that bezlotoxumab was cost-effective at a willingness-to-pay threshold of €21,000/QALY was 85.5%, 54.1%, 86.0%, 94.5%, 99.6%, respectively.

Conclusion

The results suggest that bezlotoxumab added to SoC compared to SoC alone is a cost-effective treatment to prevent the recurrence of CDI in high-risk patients. The influence of changes in model parameters on DSA results was higher in patients  ≥ 65 years old, with severe CDI and immunocompromised. Additionally, PSA estimated that the probability of cost-effectiveness exceeded 85% in most subgroups.

To review article in its entirety, please click on the following link:

https://link.springer.com/article/10.1007/s12325-018-0813-y

It Takes a Team Approach To Break the Chain of Infections and Decrease Infection Rates

Reduce the Risk to Patients, Staff and Visitors

A comprehensive approach to C. diff can break the chain of infection and help to decrease the spread of this organism throughout your hospital. There are many paths of transmission that contribute to the spread of C. diff from infected patients to the hands of healthcare workers, visitors and the environment. Progressive distribution of spores happens through multiple contacts to multiple surfaces and people. Ensure your staff is trained to identify patients exhibiting C. diff symptoms.

To guard against C. diff, follow three key environmental and hand hygiene workflows to help ensure your facility breaks the chain of infection and improves patient outcomes.

  1. Identify and Communicate Risk. Communications remains key to controlling the spread of C. diff during complex interactions and location changes in hospitals. Proper communication protocols better support the tracking and reporting of infections and prevention efforts.
  2. Assess Appropriate and Timely Environmental Hygiene. Implement a strong process to regularly audit the adequacy of room cleaning, so you know before you have an issue. Audits and processes will also help you proactively identify where your staff can improve. Stay ahead of potential outbreaks through proactive daily use of a sporicidal disinfectant with good material compatibility for daily cleaning and disinfection of surfaces.
  3. Implement Hand Hygiene Practices. Hands are the main pathways for germ transmission during healthcare. Practicing good hand hygiene is key to mitigating the spread of C. diff. The ability to accurately monitor hand hygiene in your hospital can drive positive change, decrease the risk of HAIs and improve patient outcomes. With the more stringent interpretation of the hand hygiene policy issued by the Joint Commission in January 2018, immediate citations will be issued for any single instance of a healthcare worker’s non-compliance during a patient interaction.

Transform the way your hospital assesses, communicates, tracks and reports C. diff and other HAIs to drive and sustain better patient outcomes and increase compliance. To learn how to implement these workflows into your hospital program and to gain insightful technology tips, visit www.ecolab.com/healthcareinsightscenter.

 

To read the article in its entirety please click on the following link:

http://www.modernhealthcare.com/article/20180703/SPONSORED/180709972

 

 

Researchers at Boston-based Massachusetts General Hospital, Ann Arbor-based University of Michigan and Cambridge-based Massachusetts Institute of Technology Are Developing Institution-Specific Models That Predict Patient’s Risk Of Acquiring C.diff. Infections

Researchers at Boston-based Massachusetts General Hospital, Ann Arbor-based University of Michigan and Cambridge-based Massachusetts Institute of Technology are developing hospital-specific machine learning models that predict patients’ risk of Clostridium difficile infections much sooner than current diagnostic methods allow, according to a study published in Infection Control & Epidemiology.

“Despite substantial efforts to prevent C. diff infection and to institute early treatment upon diagnosis, rates of infection continue to increase,” co-senior study author Erica Shenoy, MD, PhD, said in a press release. “We need better tools to identify the highest risk patients so that we can target both prevention and treatment interventions to reduce further transmission and improve patient outcomes.”

The study authors noted most previous approaches to C. diff  infection risk were limited in usefulness since they were not hospital-specific and were developed as “one-size-fits-all” models that only included a few risk factors.

Therefore, to predict a patient’s C. diff risk throughout the course of their hospital stay, the researchers took a “big data” approach that analyzed the entire EHR. This method allows for institution-specific models that could be tailored to different patient populations, different EHR systems and factors specific to each facility. 

“When data are simply pooled into a one-size-fits-all model, institutional differences in patient populations, hospital layouts, testing and treatment protocols, or even in the way staff interact with the EHR can lead to differences in the underlying data distributions and ultimately to poor performance of such a model,” said co-senior study author Jenna Wiens, PhD. “To mitigate these issues, we take a hospital-specific approach, training a model tailored to each institution.”

With this machine learning-based model, the researchers looked at de-identified data, which included individual patient demographics and medical history, details on admissions and daily hospitalization, and the likelihood of C. diff exposure. The data was gathered from the EHRs of roughly 257,000 patients admitted to either MGH or to Michigan Medicine over two-year and six-year periods, respectively.

The models proved to be highly successful at predicting patients who would ultimately be diagnosed with C. diff. In half of these infected patients, accurate predictions could have been made at least five days before collecting diagnostic samples, which would allow hospitals to focus on antimicrobial interventions on the highest-risk patients.

The study’s risk prediction score could guide early screening for C. diff if validated in subsequent studies. For patients who receive an earlier diagnosis, treatment initiation could curb illness severity, and patients with confirmed C. diff could be isolated to prevent transmission to other patients.

The algorithm code is freely available here for hospital leaders to review and adapt for their institutions. However, Dr. Shenoy notes facilities looking to apply similar algorithms to their own institutions must assemble the appropriate local subject-matter experts and validate the performance of the models in their institutions.

To read article in its entirety please click on the following link to be redirected:

https://www.beckershospitalreview.com/quality/how-machine-learning-models-are-rapidly-predicting-c-diff-infections.html

Nick Van Hise, PharmD, BCPS Is Welcomed As Chair Of the C Diff Foundation’s Antimicrobial Stewardship and C.diff. Infection Prevention (ASCP) Committee


We are honored to have Nick Van Hise, PharmD, BCPS  Chair the C Diff Foundation’s Antimicrobial Stewardship and C. diff. Infection Prevention (ASCP) Committee and promote the Foundation’s mission worldwide.

 

Nick Van Hise, PharmD, received a Bachelor of Science from Bradley University in Peoria, IL and his Doctorate of Pharmacy from Union University School of Pharmacy in Jackson, TN.

Dr. Van Hise then went on to do an infectious disease residency and become board certified in pharmacoltherapy and infectious disease.  Dr. Van Hise has been published in various scientific journals, includng the New England Journal of Medicine, Clinical Infectious Diseases, and the Journal of Clinical Neuropharmacology.

In addition, Dr. Van Hise is a Member of the Society of Infectious Diseases Pharmacists (SIDP), American Association of Pharmaceutical Scientists (AAPS), and American Pharmacists Association (APhA).

Two New Jersey Health Providers, Virtua and the Deboarah Heart and Lung Center Recognized by New Jersey Hospital Assoc. for Reduced Hospital-Onset CDI

CONGRATULATIONS!!!

Two Burlington County NEW JERSEY health providers, Virtua and the Deborah Heart and Lung Center, were recently recognized by the New Jersey Hospital Association for excellence in quality and community outreach.

Virtua earned the association’s Excellence in Quality Improvement Award for its efforts to reduce the occurrence of hospital-onset Clostridium difficile infection, or C.diff, a bacterium that causes diarrhea and more serious intestinal conditions such as colitis, and education programs to reduce catheter-associated urinary tract infections (CAUTI) in home care.

Deborah was honored alongside Cooper University Health Care in Camden with the Community Outreach Award for its HeroCare program, delivering specialty medical care to active and retired military members.

The awards were presented during the association’s 99th annual meeting at the Hyatt Regency in Princeton on Friday.

To reduce hospital-onset C.diff, infection preventionists and Virtua Memorial in Mount Holly, Virtua Marlton in Evesham and Virtua Voorhees in Camden County put limitations on prescribing the antibiotic fluoroquinolone, which has been known to increase the risk of C. diff, and distributed education materials on the infection to staff.

At Virtua Marlton, which previously had the highest rate of C. diff, the health system instituted mattress covers in targeted units.

As a result of these initiatives over 18 months, hospital-onset C. diff infections were reduced by 32 percent across the system, and by 55 percent at Virtua Marlton.

“Hospital onset C. diff is an issue in hospitals across the country which results in potential harm to patients, increases length of stay, and increased health care costs. At Virtua, we decided to tackle this problem proactively and head on,” said Dr. John Matsinger,

Virtua’s executive vice president and chief clinical officer. “Virtua is honored to be acknowledged for the work by our clinicians to increase the safety of our patients and community. Keeping our patients safe is Virtua’s No. 1 priority.”

Also, Virtua Home Care was recognized for creating educational programs for employees, patients and family caregivers to lower the rate of CAUTI. There are fewer guides to preventing and measuring CAUTI in a home care setting than in acute or residential care.

Virtua Home Care established specific CAUTI education and measurement for its home program, and saw incidents of infection decline by nearly 92 percent. Virtua reported no CAUTI for the first three quarters of 2017.

Deborah, in Pemberton Township, and Cooper University Health Care earned the Community Outreach Award for its joint HeroCare program, which provides specialty medical services to active military members, veterans, National Guardsmen, and the family of all military associated with Joint Base McGuire-Dix-Lakehurst.

“It’s very nice to be recognized by our colleagues and our peers for the work that we’re doing for the program,” Christine Carlson-Glazer, Deborah’s government and community relations liaison, said of the award.

Staff housed at Deborah schedule appointments within 48 hours of requests and offer additional veterans services like post-traumatic stress disorder counseling, mental health or substance abuse help.

In less than a year, over 1,500 appointments have been scheduled.

Deborah is 1.3 miles from the Fort Dix entrance of the joint base, and as a result the two have a close connection, according to Carlson-Glazer. Deborah celebrated its 95th anniversary last year as the former Fort Dix installation recognized its centennial.

“It’s an amazing way for us to give back,” Carlson said. “We’re so proud of that.”

U.S. Food and Drug Administration Released Notice For Hospital Mattress Safety

Health care facilities everywhere have been ramping up their disinfection practices in order to prevent the spread of infectious diseases. However, when it comes to hospital mattresses, one of the biggest vectors for spreading deadly bugs, efforts are still falling short.

With health care workers using chemicals that are intended for dry surfaces, the mattresses are harboring pathogens such as Clostridium difficile (C. diff), and, as Edmond A. Hooker, MD, DrPH, professor in the Department of Health Administration at Xavier University, pointed out at the 5th Annual International C. diff Awareness & Health Expo, regulatory agencies seem to have “turned a blind eye” to the issue.

Until now.

The US Food and Drug Administration (FDA) recently released a notice on how to keep hospital mattress covers safe.

In this notice, the FDA notes safety concerns regarding hospital mattress covers, particularly that over time they can “wear out and allow blood and body fluids to penetrate and get trapped inside mattresses.” They added, “If blood or body fluids from one patient penetrate and get absorbed in a mattress, the fluids can leak out the next time the mattress is used.” If that happens, the next patient runs the risk of coming into contact with these fluids, and thus, becoming infected with pathogens from the bed’s previous occupants.

The FDA reports that this is not the first time they acknowledged these concerns; they released a safety communication in 2013 to make health care workers aware of the issue. However, the problem of contaminated hospital mattresses persists.

“There is no question there has been report after report after report of, ‘We had this outbreak. We killed all these people.’ There was just a report that came out on 18 people who were sick in a French hospital; they were on beds manufactured here in America, and 4 people were killed before they finally realized that it was the mattresses. They took all of the mattresses out of service and stopped the outbreak,” Dr. Hooker told Contagion ® in an exclusive interview.

“There’s a reason that it’s an under reported problem; hospitals don’t want to say, ‘Hey, we just killed a bunch of people. We kill 29,000 people a year with C. difficile infections. Do you hear that? I mean, that’s like crashing a plane every day and we do nothing about it. We just act like it didn’t happen.”

In an effort to address the issue, the FDA has released recommendations based on Centers for Disease Control and Prevention (CDC) guidelines for environmental infection control in health care facilities; they include:

  1. Develop an inspection plan for all hospital mattresses and mattress covers in the facility. Learn the time of life for all mattresses/mattress covers by checking the manufacturer’s guidelines; follow any other recommendations that the manufacturers list. If you have any additional questions, contact the mattress manufacturer.
  2. Inspect each hospital mattress for visible signs of damage, which can include: cuts, tears, cracks, pinholes, snags, or stains. On a routine basis, remove mattress covers and check the inside. With the cover removed, check the mattress for wet spots, staining, or other signs of damage. Be sure to check all sides of the mattress as well as underneath. You will not be able to effectively inspect the mattress with the cover on.
  3. Remove any mattresses that are damaged, appear worn, or are visibly stained and immediately replace any mattress covers that are damaged.
  4. Maintain your mattresses and mattress covers by cleaning and disinfecting them “according to the manufacturer’s guidelines.” DO NOT stick needles into the hospital mattress through the cover, the FDA stresses.

“The FDA notice about mattress failures is an important first step. However, much more needs to be done. Most failures are not being reported to FDA, and the 700 reports that they have represents an industry-wide problem. Up to one-third of hospital mattresses currently in service in hospitals have failed. Also, the ones that have not failed are not being cleaned,”

Dr. Hooker stressed to Contagion ® in a follow-up interview. “These mattresses quickly get fissures and microscopic cracks that allow bacteria to remain on the surface during terminal cleaning. The next patient is then exposed to those bacteria and gets a hospital-acquired infection. The CDC needs to mandate better cleaning practices nationwide, which they can do.

The CDC needs to also mandate inspection of every mattress after every patient. Damaged mattresses should be removed from service immediately.”

 

To review the article in its entirety, please click on the link below to be re-directed:

http://www.contagionlive.com/news/fda-acknowledges-hospital-mattresses-as-hotbed-for-germs-releases-recommendations

The Society for Healthcare Epidemiology of America (SHEA) Releases New Guidance for Infectious Disease Outbreak Preparedness in Hospitals

 

 

New Document Guides Hospitals in Responding to Infectious Disease Outbreaks

Healthcare epidemiologists play key role in emergency preparedness and response

New expert guidance document for hospitals to use in preparing for and containing outbreaks was published today by the Society for Healthcare Epidemiology of America, with the support of the Centers for Disease Control and Prevention. The guide was published in Infection Control and Hospital Epidemiology.

“This guidance details the role of the healthcare epidemiologist as an expert and leader supporting hospitals in preparing for, stopping, and recovering from infectious diseases crises,” said David Banach, MD, co-chair of the writing panel and Assistant Professor of Medicine at the University of Connecticut and Hospital Epidemiologist at UConn Health. “Armed with the resources to develop and support key activities, healthcare epidemiologists can utilize their skills and expertise in investigation and response to infectious disease outbreaks within a hospital’s incident command system.”

SHEA and CDC collaborated in 2016 to form the Outbreak Response Training Program to guide healthcare epidemiologists in how to maximize their facilities’ preparedness and response efforts to combat outbreaks such as Ebola, Zika, pandemic influenza, and other infectious diseases. The new document, Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare Epidemiologists in United States Acute-Care Hospitals, leads epidemiologists through how to apply, use, and interact with emergency response structures, groups, and frameworks from the institutional to the federal levels, and provides an overview of essential resources. The principles in the guidance are intended for acute care hospitals, but may apply to other types of healthcare facilities, such as free-standing emergency departments and long-term care facilities.

According to the guidance document, during a crisis the epidemiologist provides medical and technical expertise and leads infection prevention and control efforts, coordinates with institutional stakeholders, and provides input into internal and external communications.

“We will always be faced with new and re-emerging pathogens,” said Lynn Johnston, MD, co-chair of the writing panel and professor of medicine and infectious diseases at Dalhousie University, Halifax, Canada. “This guidance is part of an ongoing effort to develop tools and strategies to prevent and manage contagious diseases to ensure patient and public safety.”

The document is part of a partnership between SHEA and CDC to prepare for emerging and re-emerging infections by providing training, educational resources, and expert guidance for dealing with outbreaks in healthcare facilities. The program is designed to train U.S. healthcare epidemiologists, who oversee infection control programs, to have the skills, abilities, and tools available to implement infection control practices and provide a leadership voice in responding to infectious threats.

To operationalize the guidance, SHEA will conduct an outbreak response workshop in January, develop and post toolkits based on the recommendations, and provide online training modules and webinars.

 

 

To view article in its entirety please click on the following link:

http://www.shea-online.org/index.php/journal-news/press-room/press-release-archives/555-w-document-guides-hospitals-in-responding-to-infectious-disease-outbreaks