Tag Archives: Antibiotic Stewardship

Preventing Healthcare-Associated Infections (HAI’s) and the War On Superbugs

Many hospitals have made impressive strides in preventing health care-associated infections; some have seen a 70 percent reduction in the rate of bloodstream infections, thanks to safeguards such as checklists of steps to take before and during medical procedures and stepped-up hand-washing. But the problem continues to worsen. Now the White House has asked Congress for $1.2 billion to fund an effort to cut the rate of dangerous infections in half by 2020. The plan includes steps to prevent and slow the spread of infection, improve surveillance of resistant bugs, develop better diagnostic tests and new antibiotics and curb the misuse of currently available drugs – the main driver of drug resistance.

This is no fleeting crisis. Experts warn that the loss of antibiotics would roll back medical progress by 70 or 80 years. Without them, people could die of everyday dental abscesses and strep throat. Just inserting an IV could have lethal consequences. “Medical practice developed in a way that presumes the ability to treat infection in order to allow other things to be done like major surgery, cancer chemotherapy, transplants and joint replacement,” says James Johnson, senior associate director of the Infectious Disease Fellowship Program at the University of Minnesota in Minneapolis.

In terms of their power and importance, “almost nothing else in medicine comes close,” says Brad Spellberg, chief medical officer and professor of clinical medicine at the Los Angeles County and USC Medical Center. He is also the author of “Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them.”

The trouble is that “any time we use antibiotics, we’re contributing to their future ineffectiveness,” Johnson says. It’s natural for an organism to eventually become resistant to that drug. And too often, bowing to the demands of patients, doctors prescribe antibiotics when they’re not needed; the drugs aren’t effective against viral illnesses.

Another problem: Because it takes time to determine precisely which organism is the culprit, doctors frequently prescribe “broad spectrum” antibiotics that work against a wide range of bacteria when a more targeted drug would do. “The consequence,” Johnson says, is that “we’re using our last-reserve antibiotics with increasing frequency.” The CDC estimates that at least 50 percent of antibiotic use in humans is unnecessary or inappropriate.

At the same time, 80 percent of antibiotics in the U.S. are used in livestock feed to prevent or control infection and promote growth, which fuels outbreaks of drug-resistant organisms such as Salmonella, E. coli and Campylobacter that spread through the environment. The end result: “There are patients in hospitals in the U.S. today suffering and dying from infections for which doctors have no antibiotics to give,” says Arjun Srinivasan, associate director for Healthcare Associated Infection Prevention Programs for the CDC. “They are completely resistant to all therapies.” Experts agree that no single intervention will solve the problem – and are exploring a number of needed solutions:

Under the president’s plan, hospitals would establish antibiotic stewardship programs to focus doctors on “prescribing the right antibiotic at the right time at the right dose for the right duration,” says Ann McIntyre, clinical associate professor in internal medicine at Nova Southeastern University and director of the infectious diseases fellowship program at Palmetto General Hospital in Florida. Only about half of hospitals currently have such programs. But the Centers for Medicare and Medicaid Services is expected to make them a requirement for eligibility for reimbursements by 2017. Typically led by a multidisciplinary team – infectious disease doctors, pharmacists, microbiologists or epidemiologists and nurses – stewardship programs involve keeping careful control over how the drugs are dispensed. They include such strategies as frequently reviewing patients’ status to make sure they still need an antibiotic, and if so, reassessing the drug, dosage and type of delivery (switching from IV to oral antibiotics, for instance, eliminates a potential source of additional infection), and restricting the use of certain broad spectrum antibiotics until an antibiotic expert weighs in. “Physicians are used to practicing for the patient in the moment and not having to think about all patients globally,” says Neil Fishman, an infectious disease specialist and chief patient safety officer at the University of Pennsylvania Health System. That, he says, has to change.

 

To read article in its entirety click on the link below:

http://health.usnews.com/health-news/patient-advice/articles/2015/10/14/the-new-war-on-superbugs

 

Stop the Spread of Antibiotic Resistance and C. difficile Infections

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Antibiotic-resistant germs cause more than 2 million illnesses and at least 23,000 deaths each year in the US.

Up to 70% fewer patients will get CRE over 5 years if facilities coordinate to protect patients.

Preventing infections and improving antibiotic prescribing could save 37,000 lives from drug-resistant infections over 5 years.

Problem:  Germs spread between patients and across health care facilities.

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Antibiotic resistance is a threat.

 

  • Nightmare germs called CRE (carbapenem-resistant Enterobacteriaceae) can cause deadly infections and have become resistant to all or nearly all antibiotics we have today. CRE spread between health care facilities like hospitals and nursing homes when appropriate actions are not taken.
  • MRSA (methicillin-resistant Staphylococcus aureus) infections commonly cause pneumonia and sepsis that can be deadly.
  • The germ Pseudomonas aeruginosa can cause HAIs, including bloodstream infections. Strains resistant to almost all antibiotics have been found in hospitalized patients.
  • These germs are some of the most deadly resistant germs identified as “urgent” and “serious” threats.
C. difficile infections are at historically high rates.
  • C. difficile (Clostridium difficile), a germ commonly found in health care facilities, can be picked up from contaminated surfaces or spread from a healthcare provider’s hands.
  • Most C. difficile is not resistant to antibiotics, but when a person takes antibiotics, some good germs are destroyed. Antibiotic use allows C. difficile to take over, putting patients at high risk for deadly diarrhea.
Working together is vital.
  • Infections and antibiotic use in one facility affect other facilities because of patient transfers.
  • Public health leadership is critical so that facilities are alerted to data about resistant infections, C. difficile, or outbreaks in the area, and can target effective prevention strategies.
  • When facilities are alerted to increased threat levels, they can improve antibiotic use and infection control actions so that patients are better protected.
  • National efforts to prevent infections and improve antibiotic prescribing could prevent 619,000 antibiotic-resistant and C. difficile infections over 5 years.

 

  • “Patients and their families may wonder how they can help stop the spread of infections,” says Michael Bell, M.D., deputy director of CDC’s Division of Healthcare Quality Promotion. “When receiving health care, tell your doctor if you have been hospitalized in another facility or country, wash your hands often, and always insist that everyone have clean hands before touching you.”

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Antibiotic-resistant germs, those that no longer respond to the drugs designed to kill them, cause more than 2 million illnesses and at least 23,000 deaths each year in the United States. C. difficile caused close to half a million illnesses in 2011, and an estimated 15,000 deaths a year are directly attributable to C. difficile infections.

 The report recommends the following coordinated, two-part approach to turn this data into action that prevents illness and saves lives:

  1. Public health departments track and alert health care facilities to drug-resistant germ outbreaks in their area and the threat of germs coming from other facilities, and
  2. Health care facilities work together and with public health authorities to implement shared infection control actions to stop the spread of antibiotic-resistant germs and C. difficile between facilities.

“Antibiotic resistant infections in health care settings are a growing threat in the United States, killing thousands and thousands of people each year,” said CDC Director Tom Frieden, M.D., M.P.H. “We can dramatically reduce these infections if health care facilities, nursing homes, and public health departments work together to improve antibiotic use and infection control so patients are protected.”

The promising news is that CDC modeling projects that a coordinated approach—that is, health care facilities and health departments in an area working together—could prevent up to 70 percent of life-threatening carbapenem-resistant Enterobacteriaceae (CRE) infections over five years. Additional estimates show that national infection control and antibiotic stewardship efforts led by federal agencies, health care facilities, and public health departments could prevent 619,000 antibiotic-resistant and C. difficile infections and save 37,000 lives over five years.

During the next five years, with investments, CDC’s efforts to combat C. difficile infections and antibiotic resistance under the National Strategy to Combat Antibiotic Resistant Bacteria, in collaboration with other federal partners, will enhance national capabilities for antibiotic stewardship, outbreak surveillance, and antibiotic resistance prevention. These efforts hold the potential to cut the incidence of C. difficile, health care CRE, and MRSA bloodstream infections by at least half.

The proposed State Antibiotic Resistance Prevention Programs (Protect Programs) would implement this coordinated approach. These Protect Programs would be made possible by the funding proposed in the President’s FY 2016 budget request, supporting work with health care facilities in all 50 states to detect and prevent both antibiotic-resistant germs and C. difficile infections. The FY 2016 budget would also accelerate efforts to improve antibiotic stewardship in health care facilities.

 

Two leading CDC Physicians discuss current issues focused on C. difficile infections (CDI) and Antibiotic usage, Tuesday, May 5th on C. diff. Spores and More, C diff Radio

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C. diff. Spores and More”

UPCOMING SHOW:  Tuesday, May 5th: 

Two leading CDC Physicians discuss current issues focused on C. diff.Infections and Antibiotic usage.

 

Join us as we learn from our guests;

Dr. Clifford McDonald, MD, Senior Advisor for Science and Integrity, Division of Healthcare Quality Promotion at the CDC with main interests in epidemiology and prevention of Healthcare-Associated Infections, especially Clostridium difficile infections, and the prevention of antimicrobial resistance,

AND
Dr. Arjun Srinivasan, MD, Associate Director for Healthcare-Associated Infection prevention programs in the Division of Healthcare Quality Promotion at CDC’s National Center for Emerging and Zoonotic Infectious Disease. Listen in as these two stellar Physicians discuss the topics of Clostridium difficile infections and Antibiotic usage, two important issues with potential solutions facing the citizens on a global level.

Guest Bio’s:

Dr. Clifford McDonald, MD, graduated from Northwestern University Medical School, completed his Internal Medicine Residency at Michigan State University and an Infectious Diseases Fellowship at the University of South Alabama, following which he completed a fellowship in Medical Microbiology at Duke University.  Past positions have included Associate Investigator at the National Health Research Institutes in Taiwan and Assistant Professor in the Division of Infectious Diseases at the University of Louisville. Dr. McDonald is a former Epidemic Intelligence Service officer and former Chief of the Prevention and Response Branch in the Division of Healthcare Quality Promotion at the Center for Disease Control and Prevention (CDC), where he currently serves as the Senior Advisor for Science and Integrity.  He is the author or co-author of over 100 peer-reviewed publications with his main interests in the epidemiology and prevention of healthcare-associated infections, especially Clostridium difficile infections, and the prevention of antimicrobial resistance.

Dr. Arjun Srinivasan, MD, is Associate Director for healthcare-associated infection prevention programs in the Division of Healthcare Quality Promotion at the Center for Disease Control and Prevention’s National Center for Emerging and Zoonotic Infectious Diseases. Dr. Srinivasan is also a captain in the US Public Health Service. An infectious disease doctor, Dr. Srinivasan oversees several CDC programs aimed at eliminating healthcare-associated infections and improving antibiotic use. For much of his CDC career, Dr. Srinivasan ran the healthcare outbreak investigation unit, helping hospitals and other healthcare facilities track down bacteria and stop them from infecting other patients. Today, Dr. Srinivasan leads CDC’s work to improve antibiotic prescribing and works with a team of CDC experts researching new strategies to eliminate healthcare-associated infections.

 

http://www.voiceamerica.com/show/2441/c-diff-spores-and-more

 

C. diff. – New CDC Study – National Burden of Clostridium difficile (C. diff.) Infections

Nearly half a million Americans suffered from Clostridium difficile (C. diff.) infections in a single year according to a study released today, February 25, 2015, by the Centers for Disease Control and Prevention (CDC).

• More than 100,000 of these infections developed among residents of U.S. nursing homes.
Approximately 29,000 patients died within 30 days of the initial diagnosis of a C. diff. infection. Of these 29,000 – 15,000 deaths were estimated to be directly related to a
C. diff. infection. Therefore; C. diff. is an important cause of infectious disease death in the U.S.
Previous studies indicate that C. diff. has become the most common microbial cause of Healthcare-Associated Infections found in U.S. hospitals driving up costs to $4.8 billion each year in excess health care costs in acute care facilities alone. Approximately
two-thirds of C. diff. infections were found to be associated with an inpatient stay in a health care facility, only 24% of the total cases occurred in patients while they were hospitalized. The study also revealed that almost as many cases occurred in nursing homes as in hospitals and the remainder of individuals acquired the
Healthcare-Associated infection, C. diff., recently discharged from a health care facility.

 

This new study finds that 1 out of every 5 patients with the Healthcare-Associated Infection (HAI), C. diff., experience a recurrence of the infection and 1 out of every 9 patients over the age of 65 diagnosed with a HAI – C. diff. infection died within 30 days of being diagnosed. Older Americans are quite vulnerable to this life-threatening diarrhea infection. The CDC study also found that women and Caucasian individuals are at an increased risk of acquiring a C. diff. infection.

 

CDC Director, Dr. Tom Frieden, MD, MPH said, “C. difficile infections cause immense suffering and death for thousands of Americans each year.” “These infections can be prevented by improving antibiotic prescribing and by improving infection control in the health care system. CDC hopes to ramp up prevention of this deadly infection by supporting State Antibiotic Resistance Prevention Programs in all 50 states.”

 
The Agency for Healthcare Research and Quality (AHRQ) has developed a toolkit to help all hospitals begin antibiotic stewardship programs to reduce C. diff. infections.
Based on the National Plan to Prevent Healthcare – Associated Infections: Road Map to Elimination, new 2020 national reduction targets are being established for C. diff. and all hospitals participating in the Centers for Medicare & Medicaid Services (CMS) Hospital Inpatient Quality Reporting Program have been reporting C. diff. infection data to the CDC’s National Healthcare Safety Network since 2013. The baseline data allows for continued surveillance for C. diff. infections to monitor progress in prevention.

 
Improve the use of antibiotics in preventing C. diff. infections:
150,000 of the half a million C. diff. infections – the new study revealed that they were community-associated and had no documented health care exposure. A separate recent CDC study found that 82% of patients with community-associated C. diff. infections reported exposure to outpatient health care settings (e.g., physicians or dentist office) within twelve weeks before being diagnosed with a C. diff. infection. Through this finding confirms the need for infection control in these settings as well and the need for improved antibiotic use. Another recent CDC study showed a 30% decrease in the use of antibiotics lined to a C. diff. infection in hospitals could reduce newly diagnosed infections by more than 25% in hospitalized and recently discharged patients. A new retrospective study being conducted at a Canadian hospital found that a 10% decrease in overall antibiotic usage through different wards was related to a 34% decrease in newly diagnosed C. diff. infections. A third CDC study among patients without a recent hospitalization or nursing home stay (i.e. community-associated cases) found that a 10% reduction in the use of all antibiotics in outpatient settings could reduce newly diagnosed            C. diff. infections by 16%. In recent years England has seen a reduction of newly diagnosed          C. diff. cases by 60% largely due to improvements in antibiotic prescribing.

 
C. diff.; Different strains? The North American pulsed-field gel electrophoresis type 1 (NAP1) strain was more prevalent among healthcare-associated than community-associated infections. Changes in the epidemiology of C. difficile infections have occurred since the emergence of this strain in 2000, which has been responsible for widespread dispersed hospital-associated outbreaks. The NAP1 strain was first detected in Pittsburgh, PA and Montreal and is now global. It is causing the majority of infections in communities and healthcare settings. 30% detected in the study and increase seen in healthcare facilities as it is more easily transmitted. “All organisms producing toxins, all infections – must be looked upon with seriousness.”                          Dr. Michael Bell, MD and Dr. Clifford McDonald, MD both concurred.

 
The diagnosing and detection of a C. difficile infection is at the transition point in how this infection is being diagnosed. There is a need to use better methods of testing and who gets tested and a combination of clinical symptoms and laboratory tests. The Enzyme assay may not be sensitive enough and the PCR is more readily used, is more sensitive, and was used in this study with 50% laboratory producing a C. diff. diagnosis.
The care involved treating a patient with a C. difficile infection begins as a short-term treatment and can develop into a long-term illness with many recurrences.

 
Dr. Michael Bell, MD shared a brief C. diff. infection possible scenario:
• The patient may have been on an antibiotic within 90 days and develops diarrhea, then the individual should see a medical physician and get tested for a C. diff. infection.
• If the test result is positive for a C. diff. infection then treatment begins with a prescribed oral antibiotic.
• It may take multiple rounds of a oral antibiotic to suppress a C. diff. infection.
• There is a challenge treating a C. diff. infection as the antibiotic continually disturbs the bacteria in the bowel.
• Toxic forming C. diff. can put one’s life at risk as leaks develop in the bowel allowing bacteria to enter the blood stream (bacteremia).
• The infection may progress and the physicians may have to perform a surgical procedure and remove part or the entire colon (colectomy).
• Or the progression of a C. diff. infection leads the patient diagnosed with a C. diff. infection into becoming a surgical patient which will change their life through a diversion of the bowel (colostomy).
Ways to prevent C. diff. infection recurrences:
Do not take antibiotics unless absolutely necessary and diagnosed with a infection that a antibiotic will be effective. The use of an antibiotic treating symptoms caused by a virus is not effective. (Antibiotic stewardship).
Make the clinician aware that a antibiotic has been taken to treat a infection.
Antibiotics are lifesaving medications and need to be prescribed correctly to avoid antibiotic-resistance.
Healthcare facilities must implement and maintain Hand-washing (hand-hygiene) programs – Infection control.
Probiotics – are found in foods (e.g., Kefir, Yogurt) and are sold as a nutritional supplement, (1) “The U.S. Food and Drug Administration (FDA) has no definition of probiotics and regulates them based on whether they fall into one of the existing regulated product categories,” says Hoffmann, who along with faculty members from the University of Maryland School of Medicine’s Institute for Genomics Sciences, the University of Maryland School of Pharmacy and the University of Maryland Carey School of Law, investigated how probiotics are being regulated
(1) See more at: http://www.thedailysheeple.com/fda-to-change-regulations-for-probiotics_102013#sthash.4IGLf8aE.dpuf

 

C. diff. spores and outpatient settings: There were C. diff. spores found in outpatient settings. A study done at outpatient clinics found that patients who had recently been treated for a C. diff. infection in a hospital, and discharged continued shedding C. diff. spores from weeks to months after recovering from the infection. Clostridium difficile (C. diff.) spores were found on the exam table and in the clinic exam areas. Based on this information it is beneficial to continue disinfecting hard non-porous surfaces utilizing EPA registered disinfecting products, with C. diff. kill claim, in home-care and within healthcare facilities to continue decreasing the spread of        C. diff. spores and maintain infection control. There are Infection programs ongoing with the CDC with continued monitoring/studies.

 

Preventing C. difficile is a National Priority

Based on the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination, new 2020 national reduction targets are being established for C. difficile, and all hospitals participating in the Centers for Medicare & Medicaid Services’ (CMS) Hospital Inpatient Quality Reporting Program have been reporting C. difficile infection data to CDC’s National Healthcare Safety Network since 2013. Those baseline data will allow continued surveillance for C. difficile infections to monitor progress in prevention.

The State Antibiotic Resistance Prevention Programs that would be supported by the funding proposed for CDC in the President’s FY16 budget would work with health care facilities in all 50 states to detect and prevent both C. difficile infections and antibiotic-resistant organisms. The FY 16 budget would also accelerate efforts to improve antibiotic stewardship in inpatient and outpatient settings. During the next five years, CDC’s efforts to combat C. difficile infections and antibiotic resistance under the National Strategy to Combat Antibiotic Resistant Bacteria will enhance national capabilities for antibiotic stewardship, outbreak surveillance, and antibiotic resistance prevention. These efforts hold the potential to cut the incidence of C. difficile infections in half.

For more information please click on the link provided below:

http://content.govdelivery.com/accounts/USCDC/bulletins/f3c509?reqfrom=share

North Carolina Get Smart Partner – Antimicrobial Stewardship Campaign

North Carolina Get Smart 

Antimicrobial Stewardship Campaign

Antibiotics Awareness Week November 17 – 23, 2014

The goal of the NC Get Smart Campaign is to reach all 100 North Carolina counties’ public and provider audiences with the CDC Get Smart Antimicrobial awareness message. Antimicrobial drugs are lifesavers and a vital resource to be preserved. The overuse of antibiotics has led to increased resistance of known infections.  The NC Get Smart Campaign for NC begins on November 17, 2014 and completes on June 30, 2015.

Get Smart About Antibiotics Week logo web button

This webpage contains resources that you can utilize  to promote awareness of antimicrobial drug overuse.

 

 

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NC Get Smart Partners

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Antibiotic checklist to improve Antibiotic Prescribing

Through the Centers for Disease Control and Prevention and their new Vital Signs report, the main focus remains on the use of antibiotics and raising awareness of antibiotic therapy.

A statement from CDC Director, Dr. Tom Frieden, MD, MPH, “Improving antibiotic prescribing can save today’s patients from deadly infections and protect lifesaving antibiotics for tomorrow’s patients.”   “Healthcare facilities are an important part of the solution to drug resistance and every hospital in the country should have a strong antibiotic stewardship program.”

Through the National Healthcare Safety Network, healthcare – associated infection (HAI) tracking system the CDC provides facilities, states, regions, and the nation data needed to identify problem areas, the measurable progress of prevention efforts being made with constant interventions and goal to eliminate HAI’s across the board.

The CDC recommends every hospital implement a Stewardship program that includes the following seven key elements:

Accountability: Appoint a single leader responsible for program outcome. Physicians have proven successful in this role.

Act: Take at least one prescribing improvement action, such as requiring reassessment of prescriptions within 48 hours to check drug choice, dose, and duration.

Drug Expertise: Appoint a single Pharmacist leader to support improved prescribing.

Educate: Offer education about antibiotic resistance and improve prescribing practices.

Leadership Commitment: Dedicate the necessary human, financial, and IT resources.

Report: Regularly report prescribing and resistance information to clinicians.

Track: Monitor prescribing and antibiotic resistance patterns.

The CDC stresses the importance of communicating and working with other health care facilities in the area to prevent infection transmission, and resistance from occurring.

To read the Vital Signs report in its’ entirety please click on the following link:

http://www.prnewswire.com/news-releases/improving-antibiotic-prescribing-in-hospitals-can-make-health-care-safer-248400031.html

 

The CDC Antibiotic Stewardship Program:  Save money with antibiotic stewardship

 

Antibiotic stewardship programs and interventions help ensure that patients get the right antibiotics at the right time for the right duration. Numerous studies have shown that implementing an antibiotic stewardship program can not only save lives, but can save significant healthcare dollars.   Inpatient antibiotic stewardship programs have consistently demonstrated annual savings to hospitals and other healthcare facilities of $200,000 to $400,000.

A University of Maryland study showed one antibiotic stewardship program saved a total of $17 million over 8 years.   Antibiotic stewardship helps improve patient care and shorten hospital stays, thus benefiting patients as well as hospitals.

According to a University of Maryland study, implementation of one antibiotic stewardship program saved a total of $17 million over 8 years at one institution.  * After the program was discontinued, antibiotic costs increased over $1 million in the first year (an increase of 23 percent) and continued to increase the following year.

  • In a study conducted at The Johns Hopkins Hospital, it was demonstrated that guidelines for management of community-acquired pneumonia could promote the use of shorter courses of therapy, saving money and promoting patient safety.
  • Targeting certain infections may decrease antibiotic use. For example, determining when and how to treat patients for urinary tract infections, the second most common bacterial infection leading to hospitalization, can lead to improved patient outcomes and cost savings.
  • Why we must act now: The way we use antibiotics today or in one patient directly impacts how effective they will be tomorrow or in another patient; they are a shared resource.  Antibiotic resistance is not just a problem for the person with the infection. Some resistant bacteria have the potential to spread to others — promoting antibiotic-resistant infections. Since it will be many years before new antibiotics are available to treat some resistant infections, we need to improve the use of antibiotics that are currently available.
  • Healthcare facility administrators and payers can – Make appropriate antibiotic use a quality improvement and patient safety priority.  Focus on reducing unnecessary antibiotic use, which can reduce antibiotic-resistant infections, Clostridium difficile infections, and costs, while improving patient outcomes.   Emphasize and implement antibiotic stewardship programs and interventions for every facility – regardless of facility setting and size.  Monitor Healthcare Effectiveness Data and Information Set (HEDIS®) performance measures on pharyngitis, upper respiratory infections, acute bronchitis, and antibiotic utilization.

For more information regarding the CDC Antibiotic Stewardship information please click on the following link:

http://www.cdc.gov/getsmart/healthcare/learn-from-others/factsheets/antibiotic-use.html

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