Category Archives: C. diff. prevention

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

 

C. diff. Infections Related to Dental Care and the Unnecessary Use of Antibiotics

During the annual ID Week2017— an annual meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA) and the Pediatric Infectious Diseases Society (PIDS)— researchers presented findings that suggest that the prevalence of Clostridium difficile is likely caused by the unnecessary prescription of antibiotics by dentists.

“Dentists have been overlooked as a source of antibiotic prescribing, which can potentially delay treatment when doctors are trying to determine what is causing a patient’s illness,” Stacy Holzbauer, DVM, MPH, lead author of the study and career epidemiology field officer for the CDC and MDH, said in a statement. “It’s important to educate dentists about the potential complications of antibiotic prescribing, including C. diff.

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

https://www.rdmag.com/article/2017/10/dentists-overprescribing-antibiotics-overlooked-cause-superbug-infection

“Dentists write more than 24.5 million prescriptions for antibiotics a year,” she added. “It is essential that they be included in efforts to improve antibiotic prescribing.”

C. diff is a deadly bacterial infection that causes severe and possibly fatal diarrhea. Taking antibiotics can put patients at an increased risk for developing the infection.

“Research has shown that reducing outpatient antibiotic prescribing by 10 percent could decrease C. diff rates outside of hospitals by 17 percent,” Holzbauer said. “Limiting the use of inappropriate antibiotics in dentistry could also have a profound impact.”

For the study, the Minnesota Department of Health tracked community-associated C. diff infections—patients who did not have an overnight stay in a hospital or nursing home—in five Minnesota counties.

For the study, the researchers interviewed 1,626 people with community-associated C. diff between 2009 and 2015, 57 percent of which reported they had been prescribed antibiotics.  The researchers also found that patients that were prescribed antibiotics for tended procedures tended to be older and likely received the medication ….   clindamycin.

The six-year study shows that 15 percent of those with the infection had taken antibiotics prescribed to them from dental procedures, one-third of which had a medical chart that did not list dental procedure-related antibiotics, highlighting the apparent disconnect between dental care and medical care.

Another study conducted by the MDH found that 36 percent of dentists prescribed antibiotics in situations that were generally not recommended by the American Dental Association.

“It is possible some dentists aren’t aware of the updated recommendations or are being asked by other healthcare providers to continue preventive antibiotics despite the change,” Holzbauer said.

Hand-Washing aka Hand Hygiene Patient Education Proves Successful To Reduce C.diff. Infections

HandHygiene #1 Prevention

Hand-Washing aka hand hygiene Remains #1 In Infection Prevention In Every Setting.

“Despite evidence to suggest that [hand hygiene] is important in preventing infection, hospitalized patients are often not provided the opportunity to clean their hands,” due to mobility and cognitive obstacles as well as lack of education, investigators wrote.

Education on patient hand hygiene significantly reduced the incidence of Clostridium difficile infection at University of Pittsburgh Medical Center Mercy Hospital.

First, they conducted baseline surveys to assess patient hand hygiene, which showed patients needed more opportunities to wash their hands. Then nurse educators provided staff with an educational presentation on the importance of patient hand hygiene for preventing infection, which included specific times they should encourage and assist patients with hand hygiene. Staff then provided education and assistance to newly admitted patients, and researchers conducted additional surveys after implementation of this intervention.

During the first phase of the study involving just four medical-surgical nursing units, patient hand hygiene education increased significantly after the intervention (P < .0001). Overall, 97 follow-up surveys showed the proportion of those who received hand hygiene education increased from 34% to 64%, the opportunities provided for hand hygiene increased from 60% to 86%, and the average number of times hand hygiene was performed daily increased from 2.7 to 3.75.

After expanding the intervention to the whole hospital in the second phase of the study, 189 follow-up surveys showed that patient hand hygiene education increased from 48% to 53%. Meanwhile, overall opportunities for hand hygiene remained unchanged from 68%, and daily frequency of patient hand hygiene did not change significantly (mean, 2.4 vs. 2.6 times per day).

Notably, CDI rates dropped significantly during the 6 months following hospital-wide implementation.

“[Standardized infection ratio] P values for Q2 and W3 (0.0157 and 0.0103, respectively) were significantly lower than expected (P .05),” investigators wrote. “The Q4 SIR, however, showed an increase to 0.3844 over the 2 preceding quarters.”

They concluded that these findings showed patient hand hygiene “should be considered a potential addition to CDI prevention measures in hospitalized patients.” – by Adam Leitenberger

Source:  https://www.healio.com/gastroenterology/infection/news/online/%7B0ea95c50-ddec-4259-a229-5979fde9d8af%7D/patient-handwashing-cuts-c-difficile-rate-in-hospital

Study Show 9% Fewer Antibiotics Prescribed

The use of antibiotics among Americans with commercial health insurance has decreased during the past several years, according to a new analysis that nevertheless
shows lingering variations for different ages and in different parts of the country.

The study released provides the latest evidence of how doctors and patients have begun to heed warnings that excessive antibiotic use breeds dangerous drug resistance and “superbug” bacteria.

The analysis is based on 173 million insurance claims from people under age 65 with Blue Cross Blue Shield coverage
who filled prescriptions
between 2010 and 2016.

 

It is a sequel of sorts to research by the federal Centers for Disease Control and Prevention, which found a smaller decline and comparable age and geographic variations.

The CDC reported a 5 percent decrease overall between 2011 and 2014 in antibiotic prescriptions written in outpatient settings such as doctors’ offices, clinics and hospital emergency rooms.

The study by the Blue Cross Blue Shield Association found that 9 percent fewer antibiotics prescribed in outpatient settings were filled in 2016, compared with 2010.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Blue Cross Blue Shield Study:

https://www.bcbs.com/the-health-of-america/reports/antibiotic-prescription-rates-declining-in-the-US?utm_source=social&utm_medium=linkedin&utm_content=&utm_campaign=hoa-antibiotics

 

To read more of this article please click on the link provided below:

https://www.washingtonpost.com/news/to-your-health/wp/2017/08/24/fewer-antibiotic-prescriptions-are-being-filled-a-new-analysis-finds/?utm_term=.d30b61b8fae7