Dentist Infection Control

Infection Control Consulting Services Blog


Burkholderia Cepacia Linked to Bloodstream Infections

Burkholderia cepacia (B. cepacia), formerly known as Pseudomonas cepacia, is a ubiquitous organism found in soil and water with relatively low pathogenicity in the immunocompetent population.

People at risk for pneumonia and other infections related to this organism include those with weakened immune systems and cystic fibrosis patients. B. cepacia, like many other bacteria, has the tendency to develop antimicrobial resistance, and can spread from person to person in the healthcare setting.

Outbreaks ranging from contamination of intravenous fluids, contaminated medicines and devices have been reported during the course of the past couple of decades. Of note is an outbreak of pneumonia-like illness in several states related to mouthwash in 2005.

The most recent report of serious bloodstream infections across five states (Delaware, Maryland, New Jersey, New York and Pennsylvania) includes approximately 149 cases, with six deaths to date. This outbreak is linked to contaminated prefilled saline flushes marketed for use in long-term care facilities.

As reports of this nature continue, they further emphasize that ubiquitous organisms, especially those that are "water-loving," continue to cause significant morbidity and mortality. Proper infection prevention and control practices are imperative as even a small breach in protocol while compounding, preparing and/or packaging medications as well as medical devices can have disastrous outcomes.

Infection Control Consulting Services (ICCS) is a national provider of infection prevention and infection control services, including development of individualized infection prevention risk assessment. A risk assessment is conducted to identify real and potential risk factors that create a threat for patients to develop healthcare-associated infections, such as the use of contaminated saline flush syringes.


'Get Smart About Antibiotics Week' Puts Spotlight on Antimicrobial Stewardship

The Centers for Disease Control and Prevention (CDC) has dedicated the week of November 14–20 as "Get Smart About Antibiotics" for the purpose of raising awareness in the United States about the use and misuse of these powerful drugs. Note: World Antibiotics Awareness Week is held during the same time period.

Less than two months ago, the United Nations reached out globally for assistance in fighting antimicrobial resistance across many sectors. The incidence of resistant organisms arising in the community and institutionalized patients is occurring at an alarming rate, and immediate action needs to be taken by prescribers in order to reduce morbidity and mortality. In addition, misuse of antimicrobials can result in the often deadly gastrointestinal infection Clostridium difficile.

Inappropriate antibiotic prescribing takes place across the continuum of care, with outpatient care reporting the highest incidence of antibiotic prescribing and use. CDC reports that approximately 154 million visits each year to outpatient facilities result in antibiotic prescription. In addition, at least 30% of antibiotics prescribed in doctor's offices, emergency departments and hospital clinics are unnecessary. This equates to 47 million unnecessary prescriptions written in those settings. Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die as a direct result of these infections.

Hospitals have been developing and maintaining antimicrobial stewardship (AMS) programs for at least the past five years, with approximately 48% of all hospitals in 2015 having instituted a program. In March 2015, the White House issued a "National Action Plan to Combat Antibiotic-Resistant Bacteria," which included a goal of 100% of hospitals establishing an AMS program by 2020. CDC developed "Core Elements of Hospital Antibiotic Stewardship Programs in 2014," which is widely used by many hospitals nationwide.

Ambulatory care has become an important arena in the fight against injudicious use of these medications. The antibiotics National Action Plan called for a 50% reduction in antibiotic usage in outpatient settings by 2020.

The Agency for Healthcare Research and Quality (AHRQ) recently released a "Nursing Home Antimicrobial Stewardship Guide." AHRQ had previously released a toolkit for reduction of Clostridium difficile infections through antimicrobial stewardship.

CDC's "Get Smart: Know When Antibiotics Work" website has a vast array of resources for patients and healthcare professionals.

Facilities, including hospitals, nursing homes and outpatient settings such as ambulatory surgery centers, should continue efforts to comply with federal requirements for antibiotic use and prevention of adverse outcomes.

Healthcare infection control consultant Phenelle Segal, RN, CIC, president and founder of Infection Control Consulting Services, is a stakeholder and member of the U.S. Department of Health and Human Services' (HHS) steering committee established to involve the federal government in the prevention and reduction of healthcare-associated infections (HAIs). She has served on the committee as an advisor for the HAI elimination action plan and also coordinated an antimicrobial stewardship program for The Health Care Improvement Foundation in 2012-2013. Phenelle played a clinical role and was responsible for developing outcome and process measures for participating healthcare facilities in Southeastern and Central Pennsylvania.

Phenelle and the ICCS team of infection prevention consultants assist healthcare organizations with the development of AMS programs as part of the ongoing effort to preventing infections. Contact ICCS to learn more about how ICCS can help your organization.


CDC to Host Free Webinar on Outpatient Antibiotic Stewardship

The Centers for Disease Control and Prevention (CDC) will be hosting a free webinar on outpatient antibiotic stewardship.

Recent reports have shown that at least 30% of antibiotics prescribed in U.S. outpatient settings are unnecessary, and only half of patients are receiving the right antibiotic.

The program, which also offers free continuing education, will take place Tuesday, November 15, 2016, from 1:00-2:00 PM EDT.

It will feature CDC's Dr. Katherine Fleming-Dutra, medical epidemiologist with the Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion. She will discuss the following:
  • The importance of antibiotic stewardship in outpatient settings.
  • The four core elements of antibiotic stewardship across various outpatient settings.
  • Evidence-based examples of how to implement these core elements into your practice.

To learn more and register, click here.

CE is available for physicians, physician assistants, nurse practitioners, registered nurses, health educators, pharmacists, pharmacy technicians, medical residents, epidemiologists, laboratorians and administrators.


"The Role of Personal Protective Equipment in Infection Prevention History" by Phenelle Segal

Infection Control Consulting Services (ICCS) President Phenelle Segal, RN, CIC, has contributed a new column on personal protective equipment  (PPE) to Infection Control Today.

In the article, she discusses a wide range of topics, including the following:
  • Early and current use of PPE
  • Guidelines
  • Evolution across the continuum of care
  • Special circumstances for PPE use
  • Recent controversies in the surgery setting

Access the article by clicking here.

Have questions about PPE or other infection prevention and control issues? Contact ICCS by clicking here.


Healthcare-Associated Infections Update from Health and Human Services

In 2009, U.S. Health and Human Services (HHS), through the Office of Disease Prevention and Health Promotion (ODPHP), released a plan called the "National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination" (HAI Action Plan). The action plan addressed acute care, ambulatory surgery centers, end-stage renal disease facilities and long-term care. In 2013, the HAI Action Plan went through a substantial update, and included a section for increasing influenza vaccination of healthcare personnel.

This week, the ODPHP announced "ambitious new targets for the national acute-care hospital metrics" for the HAI Action Plan. It used 2015 data as a baseline to replace targets that expired in 2013. The goal for these measures is to primarily track HAIs at a national level.

The measures include the following goals:

There are a few other important developments associated with this update:
  • ODPHP eliminated the Surgical Care Improvement Project (SCIP) process measure due to major compliance and widely accepted practice.
  • Antibiotic stewardship is gaining major momentum, with HHS developing an "Agency Priority Goal" for combating antibiotic resistant bacteria. 

Infection Control Consulting Services (ICCS) is a national provider of healthcare infection control consulting services to a wide range of facilities, including hospitals, ambulatory surgery centers, outpatient care facilities, dentists and nursing homes. Services include development of comprehensive, compliant infection prevention programs; infection prevention risk assessment; accreditation and CMS survey preparation; and infection education.


Dental Infection Control Special Report on Pulpotomy, Mycobacteria in Children

Infection Control Consulting Services (ICCS) has published a new special report concerning dental infection prevention and control practices.

The report examines recent outbreaks of Mycobacterium abscessus odontogenic infections in children following pulpotomy procedures ("child root canal").

As the report notes, "... the water that was used during the pulpotomy treatment allowed bacteria growing in the water to be trapped in the tooth when it was capped after the procedure was completed. ... Dental waterlines are a challenge as bacteria grow biofilm which adheres to the plastic tubes and is very difficult to eradicate."

Read the ICCS special report on dental infection control.


Nurse Assist Initiates Recall of IV Flush Syringes Due to Infections

Nurse Assist, a Texas-based medical device manufacturer primarily for hospitals and long-term care facilities, has announced the initiation of a voluntarily recall of all unexpired lots of IV flush syringes due to a potential link to Burkholderia cepacia bloodstream infections.

To date, infections have been reported in four states:

As the U.S. Centers for Disease Control and Prevention (CDC) notes, symptoms of B. cepacia infection vary widely, ranging from no symptoms at all to serious respiratory infections, especially in patients with cystic fibrosis. B. cepacia can also be resistant to many common antibiotics.

The recall applies to flush syringes with 3ml, 5ml and 10 ml fills across four product codes. These lots were distributed between February 16 and September 30 of this year.

To return recalled product for credit, contact Nurse Assist customer service at (800) 649-6800 ext. 10.