Tag Archives: Infection Prevention Nursing

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 Foundation Welcomes Linda Jablonski, MS, BSN, RN-BC – Director Of Nursing

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WELCOME

We are pleased to welcome Linda Jablonski, MS, BSN, RN-BC, to the C Diff Foundation.   Linda presides as the Director of Nursing of the C Diff Foundation’s Global Community Education & Outreach Program

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Linda Jablonski has been in the Nursing profession for over 22 years. A Graduate from Fairleigh Dickinson University and Masters at Kean College of New Jersey. Linda was a Special Education Instructor and Counselor prior to entering Nursing and her Thesis was on Preventing Violence Through Education or PTE. The major component of her thesis was Community Outreach. Linda worked her way through school as a Certified Nurses Aide and Home Health Aid which developed the experience and passion in the Home Care setting. Today Linda is a Director of Nursing for a Home Health agency and works at providing quality care, continued education to staff, and speaking to community groups to provide education in Infection Prevention (C.diff., MRSA & Superbugs) and Antibiotic Resistance Awareness and Stewardship Programs.