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SHEA Publishes New Guidance for Infectious Disease Outbreak Response

The Society for Healthcare Epidemiology of America (SHEA) has published new guidance for hospitals to assist with preparing for and containing infection disease outbreaks.

The document, titled "Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare Epidemiologists in United States Acute-Care Hospitals," was developed with support of the Centers for Disease Control and Prevention (CDC) and published in Infection Control and Hospital Epidemiology.

It's intended to provide healthcare epidemiologists in acute-care hospitals with an overview of incident management for outbreaks and help prepare them to work within an emergency response framework.

In a news release, David Banach, MD, co-chair of the writing panel (i.e., the authors) and assistant professor of medicine at the University of Connecticut and hospital epidemiologist at UConn Health, stated, "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. 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."

Topics addressed in the document include the following:
  • incident management organizational structures;
  • stakeholders in preparedness and response;
  • communication strategies;
  • legal, ethical and regulatory requirements;
  • leadership role, activities and responsibilities of the healthcare epidemiologist in incident management;
  • role of the healthcare epidemiologist in coordination with stakeholders;
  • equipment and supplies for management of an emerging pathogen outbreak;
  • role of the healthcare epidemiologist in experimental vaccines, therapeutics and clinical research during an emerging pathogen outbreak; and
  • role of infection prevention staff and direct care healthcare professionals.
While the document is intended for healthcare epidemiologists working in acute-care hospitals, the authors noted that its principles may be applicable to other types of facilities, such as freestanding emergency departments, urgent care centers, long-term care and nontraditional acute-care settings.

SHEA indicated that to operationalize the new guidance document, the organization intends to conduct an outbreak response workshop in January, develop and share toolkits based on the recommendations and provide online training modules and webinars.


7 Tuberculosis Trends to Know

The Centers for Disease Control and Prevention (CDC) recently released a new report on tuberculosis (TB) cases in the United States.

TB is the leading cause of death from infectious disease worldwide.

Here are seven trends to know about TB, according to the report.

1. The rate of decline in the United States remains too slow to achieve TB elimination in this century. As CDC notes, eliminating TB will require interrupting TB transmission as well as major efforts to address latent TB infection (LTBI). In 2016, a total of 9,272 TB cases were reported in the United States. This represents a 2.9% decrease from 2015. The national incidence rate was 2.9 cases per 100,000 persons (3.6% decrease from 2015).

2. TB was reported in all 50 states. Nine states, the District of Columbia (D.C.) and New York City reported incidence rates above the national average. TB case counts were highest in California, Texas, New York (including New York City) and Florida. These four states accounted for just over half of the total cases in the United States.

3. CDC estimated that about 14% of U.S. TB cases with genotype data are attributed to recent transmission.

4. The percentage of drug-resistant TB cases has remained stable for the last 20 years. TB is typically treatable and curable, but TB bacteria sometimes become resistant to the drugs used to treat the disease. In 2016, the most common form of primary resistance was isoniazid (INH) monoresistance or INH-only resistance. INH-only resistance occurred in 577 cases (8.7% of cases with drug susceptibility results).

5. The number of persons who died of TB decreased. In 2015, the most recent data available, 470 deaths were attributed to TB. That's down from 774 cases reported in 2014.

6. Incidence rates decreased for all racial and ethnic groups. Minority populations continue to disproportionately bear the burden of TB disease. Asians have the highest number of TB cases (18) per 100,000 persons. Native Hawaiians and other Pacific Islanders come in second with 13.9 TB cases per 100,000 persons, followed by Blacks or African Americans with 4.9 TB cases per 100,000 persons.

7. TB disease in the United States is most common among people who travel to or who were born in countries with high rates of TB. In 2016, a total of 68.5% of reported TB cases in the United States occurred among non-U.S.-born persons.

CDC noted that current efforts to rapidly diagnose and treat TB disease are essential but insufficient to eliminate the disease. CDC made the following recommendations:

"The United States needs to implement major new efforts to address LTBI to accelerate progress toward TB elimination. New essential programs consist of a surveillance system to monitor progress, scale-up of screening for LTBI in at-risk populations, increased adoption of short-course treatment regimens, engagement of affected communities and medical providers who serve those communities, and increased public health staffing for implementation and oversight. Such an effort would benefit greatly from the development of new tools, such as improved tests that indicate TB reactivation risk, and even shorter LTBI treatment regimens than currently exist.

"The United States must implement increased LTBI-related activities concurrently with sustained, effective programs to diagnose and treat patients with TB disease and protect communities. This will require continued engagement with existing and new partners to better reach high-risk groups, conduct TB testing, and connect persons with LTBI or TB disease to care in order to prevent future TB cases."

Access the TB report, titled "Reported Tuberculosis in the United States, 2016," by clicking here.


New Approach to Tracking Superbugs Could Improve Containment

Researchers from Rush University Medical Center and the University of Michigan Medical School have developed a new method of tracking the spread of antibiotic-resistant bacteria, according to a news release.

The research was supported by funding from the Centers for Disease Control and Prevention’s Prevention Epicenters Program, the National Institutes of Health and the National Science Foundation.

Here are three things to know about the approach.

1. It was developed through analysis of data from the 2008 outbreak of carbapenem-resistant Klebsiella pneumoniae in the Chicago area along with modern genetic analysis techniques.

2. The research team was able to model and predict how the organism spread between and within healthcare facilities. The approach was able to identify where the outbreak began and if the bug was spreading within a facility (hospital, nursing home or long-term acute care hospital) or if a patient transferred from another facility brought it to the facility.

3. This approach identifies the full superbug DNA from infected patients, making it is possible to use changes in the DNA to track the spread within and between healthcare facilities.

The researchers hope that the approach may enable interventions that would prevent the transfer of drug-resistant organisms among healthcare facilities.

This research was published in Science Translational Medicine. Access it here.


Study: 4 in 10 Healthcare Professionals Go to Work Sick

The results of a new study indicate that more than 40% of healthcare professionals (HCPs) work while sick.

The study's findings were published in American Journal of Infection Control, the journal of the Association for Professionals in Infection Control and Epidemiology (APIC).

According to an APIC news release, researchers conducted a national online survey during the 2014-2015 influenza season, gathering data from more than 1,900 HCPs. Respondents were asked to self-report influenza-like illness (ILI), which is defined as the combination of a fever and cough or sore throat. The survey assessed a range of occupations across multiple types of organizations. This included physicians, nurse practitioners, physician assistants, nurses and pharmacists in hospitals, ambulatory care, physician offices, long-term care facilities and other settings.

Survey findings included the following:
  • More than 400 HCPs reported ILI. Of these, more than 41 reported working for a median duration of three days while experiencing influenza-like symptoms.
  • Hospital-based HCPs had the highest frequency of working with ILI at more than 49.
  • Clinical professional HCPs were the most likely to work with ILI at more than 44%, with pharmacists at more than 67% and physicians at more than 63% among those with the highest frequency.
  • Among the HCPs reporting ILI who felt they could still perform their job duties, 39% sought medical attention for their symptoms, as did 54% percent of those who did not think they were contagious.
  • Nearly 50% of HCPs in long-term care settings who reported for work when sick reported doing so because they couldn't afford to lose the pay.
"The statistics are alarming," said lead researcher Sophia Chiu, MD, MPH, a medical officer at the CDC's National Institute for Occupational Safety and Health, according to the release. "At least one earlier study has shown that patients who are exposed to a healthcare worker who is sick are five times more likely to get a healthcare-associated infection. We recommend all healthcare facilities take steps to support and encourage their staff to not work while they are sick."

As noted in the study's conclusion, "To reduce HCP-associated influenza transmission, interventions should target HCP misconceptions about working while ill and consider the influence of paid sick leave policies."

Access the study here.


Antibiotic Awareness Week Puts Antimicrobial Stewardship in the Spotlight

November 13–19 marks U.S. Antibiotic Awareness Week. The objective of this annual observance is to raise awareness of antibiotic resistance and the importance of appropriate antibiotic prescribing and use, in part through antimicrobial stewardship program development and implementation.

The Centers for Disease Control and Prevention (CDC) report that each year, at least 2 million people in the United States become infected with bacteria resistant to antibiotics. At least 23,000 people die as a direct result of these infections. Many more people die from other conditions that were complicated by an antibiotic-resistant infection.

The use of antibiotics is the most important factor leading to antibiotic resistance. Antibiotics are among the most commonly prescribed drugs used for people. However, up to 50% of all the antibiotics prescribed are not needed or optimally effective as prescribed.

As part of the kickoff efforts for U.S. Antibiotic Awareness Week, the CDC has released "Be Antibiotics Aware: Smart Use, Best Care." This is a national educational effort designed to help combat antibiotic resistance and protect patients from unnecessary side effects. It provides resources to support healthcare professionals and patients in their efforts to practice safe antibiotic use.

Prescribing the right dose of the right antibiotic at the right time, and for the right duration helps fight antibiotic resistance, protects patients from unnecessary side effects from antibiotics and helps make sure life-saving antibiotics will work when needed.

The observance of marks U.S. Antibiotic Awareness Week is an international collaboration, coinciding with:

For assistance with developing and maintaining an antimicrobial stewardship program, contact Infection Control Consulting Services (ICCS). ICCS is a national consulting firm providing services to healthcare facilities including hospitals, ambulatory surgery centers, nursing homes, physician practices and veterinary clinics.


New Guidance on Pediatric Infection Prevention and Control in Ambulatory Settings Issued by AAP

The American Academy of Pediatrics (AAP) has issued new guidance providing recommendations for infection prevention and control in pediatric ambulatory settings.

The new policy statement, published in Pediatrics, is AAP's first update on these issues since 2007.

AAP makes the following recommendations:
  • Written policies and procedures concerning infection prevention and control should be developed, incorporated into the ambulatory practice safety program, available at all times to office staff and reviewed at least every two years.
  • Educational programs for staff concerning infection prevention and control should be implemented, reinforced and evaluated on a regular basis. All staff should be required to review the policies at the time of employment.
  • Annual influenza immunization should be mandatory for staff as well as immunization or documentation of immunity against other vaccine-preventable infections (including pertussis, measles, mumps, rubella, varicella, and hepatitis B) that can be transmitted in an ambulatory care setting.
  • All healthcare personnel should perform hand hygiene using an alcohol-based hand rub or hand washing with soap and water before and after patient contact or contact with the patient’s immediate environment.
  • Standard Precautions should be used in every interaction with a patient.
  • In waiting rooms of ambulatory care facilities, the use of respiratory hygiene and cough etiquette should be encouraged for patients and accompanying people, especially those with suspected respiratory infection,
  • Patients with potentially contagious diseases and immunocompromised children should be promptly triaged. Contact between contagious children and uninfected children should be minimized. Policies to deal with children who present with highly contagious infections (such as varicella, measles, pertussis, influenza, mumps and TB) should be devised and implemented; travel, immunization and exposure history is key to identify patients who may be at increased risk for such infections.
  • Alcohol is preferred for skin antisepsis before immunization and routine venipuncture. Skin preparation for incision, suture and collection of blood for culture requires either 2% CHG in 70% isopropyl alcohol–based solutions (for children older than 2 months) or iodine (1% or 2% tincture of iodine, 2% povidone-iodine). Most skin preparation agents must be allowed to dry before surface bacteria are killed.
  • Physicians should be aware of requirements of government agencies, such as OSHA, as they relate to the operation of ambulatory facilities.
  • Needles and sharps should be handled with great care. Safer needle-disposal units that are impermeable and puncture-proof should be available next to the areas used for injection or venipuncture. The containers should be used only until filled to three quarters of capacity and should be kept out of reach of young children. Procedures should be established for the removal and incineration or sterilization of contents. Needle devices with safety features should be evaluated periodically with input from staff members who use needles, and the use of devices that are likely to improve safety should be implemented.
  • A written bloodborne pathogens exposure control plan that includes written policies for the management of contaminated sharp object injuries should be developed, readily available to all staff and reviewed annually.
  • Standard guidelines for sterilization, disinfection and antisepsis should be followed.
  • Policies and procedures should be developed for communication with local and state health authorities regarding reportable diseases and suspected outbreaks.
  • A policy for communicating with other  healthcare facilities when referring potentially contagious patients should be established.
  • Policies should be established for communicating with patients and families in case of infectious disease outbreaks, emergencies and seasonal increases of infections (such as influenza or respiratory syncytial virus).
  • Antimicrobial agents should be used appropriately, and Standard Precautions should be observed to limit the emergence and spread of antimicrobial-resistant bacteria.

The policy statement was developed by AAP's Committee on Infectious Diseases. Access it here.

Infection Control Consulting Services (ICCS) is a nationally renowned firm providing expert infection prevention services to organizations including ambulatory surgery centers and outpatient care facilities. Learn more about ICCS infection prevention consulting.


CDC Issues Awards to Help Combat Antibiotic Resistance

The Centers for Disease Control and Prevention (CDC) has announced the awarding of more than $9 million to support efforts to develop solutions and explore knowledge gaps about antibiotic resistance.

The money will go to 25 different investigator institutions, which include Infectious Diseases Society of America, Medical Research Analytics & Informatics Alliance, Cleveland VA Medical Research and Education Foundation, and a number of colleges and universities.

The awards are part of the CDC's Antibiotic Resistance Solutions Initiative. They are intended to expand the agency's approaches to combat antibiotic resistance related to areas including healthcare settings. As the CDC notes, antibiotic-resistant infections can be deadly and represent a growing threat jeopardizing modern medicine and the healthcare, veterinary and agriculture industries.

CDC noted it will work with investigators to:
  • Discover and evaluate new strategies that protect patients from resistance threats in healthcare settings and improve healthcare quality.
  • Investigate the human microbiome and pinpoint effective prevention strategies that protect people, their microbiomes and the effectiveness of antibiotics.
  • Examine the impact of antibiotic resistance elements in environmental settings , like surface water and soil, to determine potential downstream impacts on human health.
CDC said data from this work will also help protect people through initiatives such as detecting reservoirs of resistant germs, informing outbreak response and preventing future infections.

For additional information about antibiotic resistance and developing an antimicrobial stewardship program, read the following reports:
Have questions about starting or improving an antimicrobial stewardship program? Contact Infection Control Consulting Services.