Tag Archives: Infection control

The Society for Healthcare Epidemiology of America (SHEA) Issued Contact Precautions Guidelines On Multidrug-resistant Infections and C. difficile Infections

The Society for Healthcare Epidemiology of America (SHEA) January 2018 issued guidelines on how long hospitals should continue contact precautions for multidrug-resistant infections and Clostridium difficile infections to avoid the spread of potentially deadly organisms through hospitals.

“Because of the virulent nature of multi-drug resistant infections and C. difficile infections, hospitals should consider establishing policies on the duration of contact precautions to safely care for patients and prevent spread of these bacteria,” said David Banach, MD, MPH, an author of the study and hospital epidemiologist at the University of Connecticut Health Center in Farmington, in a society news release. “Unfortunately, current guidelines on contact precautions are incomplete in describing how long these protocols should be maintained. We outlined expert advice for hospitals to consider in developing institutional policies to more effectively use contact precautions to safely care for patients.”

Dr Banach and members of the SHEA Guidelines Committee, which includes experts in infection control and prevention, studied available evidence and practical considerations and surveyed SHEA members to develop the updated guidance document. The available evidence, however, is insufficient to issue a formal guideline.

The recommendations were published online January 11 in Infection Control & Hospital Epidemiology.

The guidance, which covers methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and carbapenem-resistant Enterobacteriaceae, as well as C difficile, emphasizes the need for clinicians to consider the amount of time since the last positive sample. Specific recommendations include:

  • For patients not receiving antibiotics with activity against methicillin-resistant S aureus ((MRSA), the committee recommends using negative screening cultures to decide when to stop contact protocols. The optimal number of negative cultures is unclear, but 1 to 3 are often used. Hospitals may want to extend contact precautions for high-risk patients with chronic wounds and those from long-term care facilities. The ideal length of extension is unknown, but 6 months is common.
  • For highly resistant Enterobacteriaceae, such as carbapenemase-producing carbapenem-resistant Enterobacteriaceae, or Enterobacteriaceae with few treatment options, hospitals should maintain contact precautions indefinitely.
  • For C difficile infections, contact precautions should be continued for at least 48 hours after the resolution of diarrhea, and clinicians should consider extending precautions if C difficile infection rates remain high despite appropriate prevention and control measures.
  • With cases of vancomycin-resistant enterococci (VRE)  infection, negative stool or rectal swab cultures should be used to determine when to discontinue precautions. One to three negative cultures at least 1 week apart are commonly used.

The authors note that there was insufficient evidence to formally recommend use of molecular testing to help guide decisions on length of contact precautions. However, they said they assume that polymerase chain reaction tests have better sensitivity compared with culture.

Hospitals should carefully gauge their own risks, priorities, and resources when adopting policy on duration of precautions, as costs and practicality of implementation differ, the authors note. In addition, guidance should be reevaluated by infection control leadership, especially when there are outbreaks.

“The duration of contact precautions can have a significant impact on the health of the patient, the hospital, and the community,” coauthor Gonzolo Bearman, MD, MPH, from the Division of Infectious Diseases at Virginia Commonwealth University, Richmond, said in the news release. “This guidance is a starting point, however stronger research is needed to evaluate and optimize the use.”

The guidance was endorsed by the Association for Professionals in Infection Control and Epidemiology, the Society of Hospital Medicine, and the Association of Medical Microbiology and Infectious Disease Canada.

This study was supported in part by the SHEA Research Network. Various coauthors report ties to Springer Nature for book and journal editing and grants from the National Institutes of Health, the Agency for Healthcare Research and Quality, Veterans Affairs’ Health Services Research and Development, the Centers for Disease Control and Prevention, Medimmune, Nanosphere Inc, Techlab, The Children’s Hospital of Philadelphia, Premier EHEC and CHRO-Magar 0157, Pfizer, and the University of Louisville. Coauthors also report consultant roles or fees with Xenex/Clorox, Ecolab and Gilead.

 

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

https://www.medscape.com/viewarticle/891242

C diff Infection Control and Hospital Epidemiology Initiative Helps Reduce CDI Rates in VA Facilities

A significant decrease in rates of clinically confirmed long-term care facility onset Clostridium difficile infection (CDI) at 132 Veteran’s Affairs facilities coincided with implementation of a nationwide prevention initiative, researchers report in a new study in Infection Control and Hospital Epidemiology.

The initiative for prevention of CDI in VA long-term care facilities (LTCFs) was implemented in February 2014 following implementation in VA acute care facilities in July 2012. The initiative, which emphasizes environmental management, hand hygiene, contact precautions, and institutional culture change, was extended and tailored to VA LTCFs because they are often linked to VA acute care facilities, where CDI has become the most common healthcare-associated infection. To evaluate the impact of the initiative, the researchers analyzed quarterly CDI trends from the first 33 months of the program and compared them with the 2 years prior to implementation.

The analysis found that there were 137,289 admissions, 9,288,098 resident days, and 1,373 clinically confirmed LTCF-onset CDI cases from April 2014 through December 2016.

The nationwide number of clinically confirmed LTCF-onset CDI cases did not change in the 2 years prior to implementation of the prevention initiative but decreased by 36.1% over the 33-month analysis period.

The results mirror the experience in VA acute care facilities, which saw a 15% drop in hospital-acquired CDI cases over the first 33 months of the prevention initiative, and the authors note that this may have had an impact on their findings, along with strong leadership from the VA Central Office and individual facility accountability.

“The exact reason for the decrease in cases within the VA LTCFs is not known,” they write. “Given the large number of facilities involved and the long observation period, we were not able to collect data on individual facility activities or sustainability of activities; hence, we cannot report a ‘magic bullet’ responsible for the declining trend.”

Study shows substantial burden of primary, recurrent C diff

In another study on CDI, researchers with Merck’s Center for Observational and Real World Evidence estimated the healthcare resource utilization (HCRU) and costs attributable to primary CDI and recurrent CDI (rCDI).

In the retrospective observational study, published in Clinical Infectious Diseases, the researchers analyzed administrative claims data from two commercial databases representing nearly 50 million individuals with private health insurance.

To obtain hospitalized days and costs attributable to primary CDI, patients without CDI were matched 1:1 by propensity score to those with primary CDI but no recurrences. To obtain hospitalized days and costs associated with rCDI, patients with primary CDI but no recurrences were matched 1:1 to those with primary CDI plus one recurrence.

A total of 55,504 CDI patients were identified from July 2010 through June 2014, and among those patients 24.8% had a recurrence. Compared to those patients without CDI, the cumulative hospitalized days and healthcare costs attributable to primary CDI were 5.20 days and $24,205. Compared to those patients with primary CDI only, the cumulative hospitalized days and healthcare costs attributable to rCDI were 1.95 days and $10,580.

“In conclusion, the HCRU and economic burden associated with primary and rCDI are quite substantial,” the authors write. “Better prevention and treatment of CDI, especially rCDI, are needed.”

To read article in its entirety please click on the following link:  http://www.cidrap.umn.edu/news-perspective/2018/01/stewardship-resistance-scan-jan-22-2018

 

Medical Mattresses; Healthcare-acquired Infections and How Hospital Bedding Is Involved

Our guests Dr. Edmond Hooker, MD with Bruce Rippe, CEO of Trinity Guardion and  J. Darrel Hicks, BA, Master REH, CHESP joined us on C. diff. Spores and More Global Broadcasting Network live broadcast –August 1st  to  discuss Healthcare – associated Infections (HAIs ) and how they lead to more than 720,000 illnesses and 75,000 deaths a year. In fact, more people die from HAIs each year than from automobile accidents. Furthermore, HAIs are a huge financial burden, adding $30 billion to annual healthcare costs. The American-made Trinity Patient Protection System gives hospitals the solution they need to reduce and eliminate HAIs.

Launderable, reusable, cost-effective and eco-friendly, the Trinity System’s fluid-proof covers fit around beds, pillows, stretchers and physical therapy tables. Unlike typical disinfectant agents designed for hard surfaces, the Trinity System keeps bacteria off the porous surface of the mattress, as well as, the bed deck. When laundered to CDC standards, the Trinity System removes 99.99% of bacteria and has been proven to reduce C. diff infection rates by about 50%.

 

www.trinityguardion.com

 

To learn more, from these leading topic-experts, about Medical Mattress Contamination and how bedding is involved in healthcare-associated infections.

Listen to the podcast available and part of the C.diff. Spores and More living library.

https://www.voiceamerica.com/episode/100501/healthcare-acquired-infections-and-how-hospital-bedding-is-involved

Hand Washing aka Hand Hygiene While On a Journey

washhands2

“Spring Break” is upon us and it’s the perfect time for a road-trip!

 

Traveling is one of the most important times to pay close attention to “infection prevention.”

Being prepared can help.

During a recent journey along the east coast, in the USA, a few of the Foundation members had the opportunity to visit an array of public restrooms along the way.

As we are aware, public restrooms can be a challenge and a real eye-opening experience. Many of the facilities fell short in monitoring their supplies along with the monitoring of over-all cleanliness of their restroom.

During the road trip, along various interstates, back roads, and local towns, we began to assess the establishment’s public facilities based on the following criteria:

* Cleanliness.

* Supplies offered.

* Electronic hand drying devices vs traditional supplies.

* Cleaning/Room monitoring log.

As the journey continued the restroom grading system became the topic of conversation discussing the vast ways establishments can maintain a safe, clean, and friendly environment for their visitors.  There were also discussions on how a traveler can be prepared by carrying supplies to ensure their own safety when utilizing public facilities.

The following is a list of a few supplies easily kept in a small bag during travel times:

* A small container of liquid soap (preferably one without the anti-bacterial ingredients).

* A few paper towels dampened with bleach or pack a EPA Registered cleaning product to clean the commode and high-touch areas.  It is good safety practice to store the paper towels in a sealed plastic container.  Other cleaning (Germicidal/Disinfectant) product wipes should remain in their original container or sealed separately in a plastic container.   Never mix two cleaning wipes/products together or store in the same container.

* Sheets of T.P. or a small roll.

* Sheets of dry paper towels to turn off water faucets and dry hands.

*  Attempt to open the restroom door with an elbow or use a dry paper towel to pull the door handle open in order to keep hands clean and not re-introduce germs onto the hands.

Was there a favorite rest stop/establishment along the way?  Yes.

McDonalds restrooms were found to be acceptable and met the needs of the travelers. Their establishments focus on cleanliness, offered an adequate supply of soap with automated towel dispenser or hand dryers, and facility monitoring logs in place. Their organization also displayed signs over the sinks promoting hand hygiene, a public safety announcement for both staff, and visitors.

The public restrooms at rest-stops along I-95 were impressive with their focus on cleanliness, adequately filled soap containers, and hand dryers available in each restroom with the elimination of a main door to enter/exit the facility.  Once the hands are washed/dried the reintroduction to harmful germs upon exiting the public area from a door handle is eliminated.

There were a number of unacceptable facilities located in local discount stores, some food stores, food chain eateries, and quick-mart stations.  Their sinks were not automated with motion sensors and many with two handles, empty paper towel dispensers and automatic hand drying equipment unavailable. Many restrooms were without cleaning monitoring logs promoting safety and cleanliness to the staff (food handlers), and visitors alike.

We appreciate the availability and use of public restrooms during  long commutes, when on vacations, and time away from home.  Most establishments offer adequate supplies to eliminate, and  prevent the spread of harmful germs, however;  it is always best to be prepared.  The next time a journey is planned, do not forget to pack the supplies needed for a public restroom visit that will keep you and your family safe.

The journey and hand-washing experiences become part of the adventure.  Take the opportunity to report negative experiences to the management and help change a negative into a positive for the next person visiting.

Remember to take that twenty second hand-washing break before exiting a restroom, before/after eating, before/after entering a patient’s room, after changing diapers, before/after handling food, and during the day.   Let’s stop giving germs a free ride.

Here’s to everyone’s good health!

Below you will find links available for Public Restroom locators offered by Charmin, one app for an iPhone, and an app for an Android Phone. 

http://www.charmin.com/find-public-restrooms.aspx?utm_source=msn&utm_medium=cpc&utm_campaign=Charmin_Search_Desktop_Lifestyle_SoS+App&utm_term=restroom%20app&utm_content=SvExifYv_restroom%20app_p_2095916800&sctp=ppc&scvn=bing&scsrc=bing_search&sckw=na

* App For iPhone

https://itunes.apple.com/us/app/restroom-bathroom-toilet-finder/id311896604?mt=8

* App For Android

https://play.google.com/store/apps/details?id=com.bto.toilet

Healthcare Disinfecting Cell PhoneSoap System

PHONESOAP_CELL_PHONE_CHARGER_UV_SANITIZER_003Cell Phone Soap

Click on the link below to be directed to the PhoneSoap website and learn more about this Cell Phone Disinfecting System Available:

https://www.phonesoap.com/product/healthcare-sanitizing-and-disinfecting/

 

 

PhoneSoap’s UV products are used in hospitals throughout the country

 

UV-C light is already being used in hospitals and clean rooms throughout the world because it has been proven to effectively penetrate and disarm bacteria. The light will sanitize any surface it touches. PhoneSoap has adapted this technology to be portable and accessible to the average health care provider.

 

Hand-washing (aka hand-hygiene) Helps Stop The Spread Of Germs

HAVE YOU TAKEN A 20 – 30 SECOND HAND-WASHING BREAK?

Correct hand-washing technique keeps you and others safe:

 

  • Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
  • Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.
  • Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  • Rinse your hands well under clean, running water.
  • Dry your hands using a clean towel or air dry them

WHEN TO WASH YOUR HANDS:

  • Before, during, and after preparing food
  • Before eating food
  • Before and after patient care in any setting
  • Before and after treating a cut or wound
  • After using the toilet and before exiting the restroom
  • After changing diapers or cleaning up a child who has used the toilet
  • After blowing your nose, coughing, or sneezing
  • After touching an animal, animal feed, or animal waste
  • After handling pet food or pet treats
  • After touching garbage
  • After visiting an outpatient setting (Physicians office/Dentist office/Clinic)
  • After shopping
  • Before and after handling food
  • After traveling on public transportation
  • Any any time hands are soiled

 

What is the difference?
Hand hygiene . A general term that applies to either
handwashing, antiseptic handwash, antiseptic hand rub, or
surgical hand antisepsis.
Handwashing . Washing hands with plain (i.e., non-antimi-
crobial) soap and water.
Guideline for Hand Hygiene in Health-Care Settings
Recommendations of the Healthcare Infection Control Practices
Advisory Committee and the HICPAC/SHEA/APIC/IDSA
Hand Hygiene Task Force
Vol. 51 / RR-16
Activity of Antiseptic Agents Against
Spore-Forming Bacteria
The widespread prevalence of health-care–associated diarrhea                                                            caused by Clostridium difficile and the recent occurrence
in the United States of human Bacillus anthracis infections                                                                    associated with contaminated items sent through the postal
system has raised concern regarding the activity of antiseptic
agents against spore-forming bacteria. None of the agents
(including alcohols, chlorhexidine, hexachlorophene,
iodophors, PCMX, and triclosan) used in antiseptic handwash
or antiseptic hand-rub preparations are reliably sporicidal
against Clostridium spp. or Bacillus spp. (120,172,224,225).
Washing hands with non-antimicrobial or antimicrobial soap
and water may help to physically remove spores from the sur-
face of contaminated hands. HCWs should be encouraged
to wear gloves when caring for patients with
C. difficile – associated diarrhea (226). After gloves are removed, hands
should be washed with a non-antimicrobial or an antimicro-
bial soap and water or disinfected with an alcohol-based hand
rub. During outbreaks of C. difficile-related infections, washing                                                              hands with a non-antimicrobial or antimicrobial soap and
water after removing gloves is prudent. HCWs with suspected
or documented exposure to B. anthracis-contaminated items also should be encouraged to wash their hands with a non-antimicrobial or antimicrobial soap and water
cdiffhandwashingbreakposter

Evaluation of a Pulsed Xenon Ultraviolet (PX-UV) Disinfection System for Reduction of Healthcare-Associated Pathogens in Hospital Rooms

“Evaluation of a Pulsed Xenon Ultraviolet (PX-UV) Disinfection System for Reduction of Healthcare-Associated Pathogens in Hospital Rooms”

A study conducted by Dr. Curtis Donskey, and a team of researchers with the objective to determine the effectiveness of pulsed xenon ultraviolet (PX-UV) disinfection device for reduction in recovery of healthcare-associated pathogens was recently published in Infection Control & Hospital Epidemiology (ICHE).

Michelle M. Nerandzica1 c1, Priyaleela Thotaa2, Thriveen Sankar C.a2, Annette Jencsona1, Jennifer L. Cadnuma2, Amy J. Raya2a3, Robert A. Salataa2a3, Richard R. Watkinsa4 and Curtis J. Donskeya2a3a5

a1 Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio

a2 Case Western Reserve University School of Medicine, Cleveland, Ohio

a3 Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio

a4 Akron General Medical Center, Akron, Ohio

a5 Geriatric Research, Education and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio

Abstract

OBJECTIVE To determine the effectiveness of a pulsed xenon ultraviolet (PX-UV) disinfection device for reduction in recovery of healthcare-associated pathogens.

SETTING Two acute-care hospitals.

METHODS We examined the effectiveness of PX-UV for killing of Clostridium difficile spores, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE) on glass carriers and evaluated the impact of pathogen concentration, distance from the device, organic load, and shading from the direct field of radiation on killing efficacy. We compared the effectiveness of PX-UV and ultraviolet-C (UV-C) irradiation, each delivered for 10 minutes at 4 feet. In hospital rooms, the frequency of native pathogen contamination on high-touch surfaces was assessed before and after 10 minutes of PX-UV irradiation.

RESULTS On carriers, irradiation delivered for 10 minutes at 4 feet from the PX-UV device reduced recovery of C. difficile spores, MRSA, and VRE by 0.55±0.34, 1.85±0.49, and 0.6±0.25 log10 colony-forming units (CFU)/cm2, respectively. Increasing distance from the PX-UV device dramatically reduced killing efficacy, whereas pathogen concentration, organic load, and shading did not. Continuous UV-C achieved significantly greater log10CFU reductions than PX-UV irradiation on glass carriers. On frequently touched surfaces, PX-UV significantly reduced the frequency of positive C. difficile, VRE, and MRSA culture results.

CONCLUSIONS The PX-UV device reduced recovery of MRSA, C. difficile, and VRE on glass carriers and on frequently touched surfaces in hospital rooms with a 10-minute UV exposure time. PX-UV was not more effective than continuous UV-C in reducing pathogen recovery on glass slides, suggesting that both forms of UV have some effectiveness at relatively short exposure times.

Infect Control Hosp Epidemiol 2014;00(0): 1–6

(Received July 11 2014)

(Accepted October 14 2014)

To access the report in its entirety please click on the following link:

http://dx.doi.org/10.1017/ice.2014.36