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CDC Makes Significant Investment to Combat Antibiotic Resistance

The Centers for Disease Control and Prevention (CDC) recently announced it was providing $77 million to help state and local health departments fight antibiotic resistance.

CDC is investing in every state to combat antibiotic-resistant foodborne infections and infections in healthcare facilities and communities.

"More than 23,000 people in the United States die each year from infections caused by antibiotic resistance," said CDC Director Brenda Fitzgerald, MD, in a press release. "CDC is committed to helping states and cities strengthen their ability to combat antibiotic resistance, and these funds will help state efforts to keep people safe."

As part of the investment, CDC is making enhancements to its Antibiotic Resistance Laboratory Network (AR Lab Network). The investment is aimed at improving the detection of known and emerging antibiotic resistance threats. CDC states that data generated by the AR Lab Network can help improve infection control in healthcare facilities and enable more rapid and effective responses to outbreaks.

The 2017 funding enhances current AR Lab Network activities by doing the following:
  • Increasing nationwide testing for Candida. This includes the emerging drug-resistant Candida auris fungi. C. auris can cause invasive and often deadly infections that are resistant to multiple antifungal drugs.
  • Strengthening national tuberculosis surveillance and infrastructure. This will be made possible by the addition of a new national laboratory equipped to perform DNA sequencing of Mycobacterium tuberculosis gathered from newly diagnosed patients in the United States.
  • Enhancing detection of drug-resistant gonorrhea threats using whole genome sequencing. Enhanced gonorrhea surveillance will identify when and how drug-resistant strains emerge and spread. This information could lead to more rapid outbreak response, and help stop antibiotic-resistant gonorrhea from spreading further. It will also help clinicians make more accurate treatment decisions for patients.
CDC made the public health program investments through its Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement.

For assistance with development of an antimicrobial stewardship program, contact Infection Control Consulting services (ICCS) by clicking here. ICCS is a leading, national consulting firm that provides expert infection prevention and control services to healthcare facilities and organizations.



American Nurses Association Publishes Antibiotic Stewardship White Paper

The American Nurses Association (ANA) has published a white paper focused on nurses' role in antibiotic stewardship efforts.

The white paper is titled, "Redefining the Antibiotic Stewardship Team: Recommendations from the American Nurses Association/Centers for Disease Control and Prevention Workgroup on the Role of Registered Nurses in Hospital Antibiotic Stewardship Practices."

It offers suggestions for how nurses can optimize antibiotic use and provide safer patient care in response to four key questions:
  • What are the roles that bedside nurses can and should play in working to improve antibiotic use?
  • What education and training resources are needed to help nurses perform these roles?
  • How can we engage nurses more (at both a national and hospital level) and encourage them to participate in antimicrobial stewardship programs?
  • What can we do to engage nursing leaders in stewardship efforts?
The white paper is broken down into three parts. The first part reviews antibiotic stewardship programs (ASPs) and the current state of antibiotic resistance. The second part summarizes the workgroup's discussions on current barriers to full nurse participation in ASPs, gaps in nurse knowledge and education about antibiotic stewardship, and the use of antibiotics in the 21st century. The third part examines opportunities for nurses to add their expertise to ongoing stewardship efforts and provides recommendations for future nursing education.

On the importance of nursing involvement in antimicrobial stewardship, the white paper states, "The urgent need to improve appropriate, evidence-based antibiotic use cannot be overstated. With the current worldwide expansion of multidrug-resistant organisms, the question is not whether to involve nursing in antimicrobial stewardship, but how. ... With an estimated 3.6 million workforce, nurses represent a powerful voice and cohort by which to mold interdisciplinary ASPs, enhancing patient safety and minimizing the spread of antibiotic resistance."

To access the white paper, click here. Learn more about ANA here.


CDC Releases New Antibiotic Stewardship Core Elements Guide for Small and Critical Access Hospitals

The Centers for Disease Control and Prevention (CDC) has released a new resource for small and critical access hospitals (CAHs) on antibiotic stewardship.

The resource, titled "Implementation of Antimicrobial Stewardship Core Elements at Small and Critical Access Hospitals," is designed to provide guidance on practical strategies to implement antibiotic stewardship programs in these organizations. 

The core elements are categorized as follows:
  • Leadership Commitment/Accountability
  • Drug Expertise
  • Action
  • Tracking
  • Reporting
  • Education

As the CDC notes, antibiotic use has unintended consequences, including Clostridium difficile and other adverse events, with C. diff infections affecting more than 500,000 patients and are associated with more than 15,000 deaths in the United States each year.  Antibiotic use is a contributor to the growing crisis of antibiotic resistance in the United States.  Programs focused on improving antibiotic use or antibiotic stewardship programs have proven to be effective in mitigating these and other threats.

While CDC notes that small and CAHs likely face challenges in implementing the core elements, due to limitations in staffing, infrastructure and resources, antibiotic stewardship is no less important: "Patients in small and CAHs have not been spared the problems of antibiotic resistance and C. diff. However, small and critical access hospitals also have some factors that can support improvements in care, as they are often tight-knit communities where collaboration is the norm."

The resource uses the "CDC Core Elements of Hospital Antibiotic Stewardship Programs" as a framework for initiating and/or expanding antibiotic stewardship activities. It was developed as a collaboration between CDC, The American Hospital Association, The Federal Office of Rural Health Policy and The Pew Charitable Trusts.

The resource is the fourth addition to the "Core Elements" series that provides recommendations for antibiotic stewardship programs and practices in hospitals, nursing homes and outpatient facilities.

Download a PDF version of "Implementation of Antimicrobial Stewardship Core Elements at Small and Critical Access Hospitals" by clicking here.

Note: Organizations looking for assistance with developing antimicrobial stewardship programs can contact Infection Control Consulting Services (ICCS) by clicking here. ICCS assists facilities across the spectrum of care with the development of such programs in accordance with guidelines, standards and regulatory requirements.


Endoscopy Equipment Not Thoroughly Disinfected Puts Maryland Hospital Patients at Risk

Kaiser Permanente's Largo Medical Center in Upper Marlboro, Md., has reported a possible exposure of 23 patients who underwent a colonoscopy/upper endoscopy as a result of a piece of equipment that "had a defect that might have kept it from being thoroughly disinfected," according to local reports.

The organization released a statement assuring that all patients who may have been affected are being contacted and that this is an “extremely isolated incident." It is believed that the risk to patients of illness as a result of this breach is minimal. Patients are being offered screening tests.

Over the course of the past few years, endoscopes, namely the duodenoscope, have been implicated in several resistant organism-related infections and outbreaks at various healthcare centers. This prompted officials to release a 2016 update to a multisociety guideline on reprocessing flexible GI endoscopes.

The federal government has taken a great interest in infection control, including reducing infection risks associated with medical equipment. In partnership with Medscape, the Centers for Disease Control and Prevention (CDC) is offering a video series addressing the key issues surrounding infection prevention in healthcare facilities. The latest part in the series is on "Recognizing Infection Risks in Medical Equipment."

This free continuing education opportunity covers the following:
  • How to recognize infection risks associated with medical equipment
  • How infection risk assessment may be incorporated into purchasing decisions
  • How to develop an action plan to mitigate infection risk related to the clinical environment

Access the activity by clicking here.

Infection Control Consulting Services (ICCS) is a national provider of infection prevention services that include working with hospitals and ambulatory surgery centers on maintaining sterile processing compliance and following evidence-based best practices. The ICCS team has extensive experience in mastering the steps for pre-cleaning, high-level disinfection, sterilization, monitoring of processes and environmental monitoring in the sterile processing department. Find out more by contacting ICCS.



CMS Issues Facility Requirements to Prevent Legionella Infections

The Centers for Medicare & Medicaid Services (CMS) has released a memorandum requirement intended to help reduce legionella risk in healthcare facility water systems and prevent cases and outbreaks of Legionnaires' disease.

The requirement is directed at hospitals, critical access hospitals and long-term care facilities. Specifically, CMS expects such Medicare-certified facilities to "develop and adhere to policies and procedures that inhibit microbial growth in building water systems that reduce the risk of growth and spread of legionella and other opportunistic pathogens in water."

Legionella disease, a severe and sometimes fatal pneumonia, occurs when persons inhale aerosolized droplets of water contaminated with the bacterium legionella. A recent review of outbreaks in the United States between 2000-2014 report that 19% of outbreaks were associated with long-term care facilities and 15% with hospitals.

The rate of reported cases of legionellosis, which comprises both Legionnaires' disease and Pontiac fever (a milder, self-limited, influenza-like illness) has increased 286% in the United States during that time period, with approximately 5,000 cases reported to the Centers for Disease Control and Prevention (CDC) in 2014. Approximately 9% of reported legionellosis cases are fatal.

Those at risk include persons who are at least 50 years old, smokers or those with underlying medical conditions such as chronic lung disease or immunosuppression. Outbreaks have been linked to poorly maintained water systems in buildings with large or complex water systems, including hospitals and long-term care facilities. Transmission can occur via aerosols from devices such as showerheads, cooling towers, hot tubs and decorative fountains.

Healthcare facilities identified in the memo should expect surveyors to review policies, procedures and reports documenting water management implementation results to verify that organizations perform the following:
  • Conduct a facility risk assessment to identify where legionella and other opportunistic waterborne pathogens could grow and spread in the facility water system.
  • Implement a water management program that considers the ASHRAE industry standard and the CDC toolkit, and includes control measures such as physical controls, temperature management, disinfectant level control, visual inspections and environmental testing for pathogens.
  • Specify testing protocols and acceptable ranges for control measures.
  • Document the results of testing and corrective actions taken when control limits are not maintained.

Infection Control Consulting Services (ICCS) assists facilities, including hospitals and long-term care facilities, with maintaining CMS and accreditation compliance. To learn more about ICCS survey preparation, plan of correction and other services, contact ICCS today.


Study: Warmer Weather Increases Likelihood of Surgical Infections

A new study indicates that warmer temperatures are tied to an increase in surgical site infections (SSIs).

The study is titled "The Seasonal Variability in Surgical Site Infections and the Association With Warmer Weather: A Population-Based Investigation" and published in Infection Control & Hospital Epidemiology. It examined hospital discharges with a primary diagnosis of SSI from 1998 to 2011 extracted from the Nationwide Inpatient Sample (this database is maintained as part of AHRQ's Healthcare Cost and Utilization Project and contains data from a 20% stratified sample of nonfederal acute-care hospitals).

The study also used data from the National Climatic Data Center to estimate monthly average temperatures for hospital locations.

The researchers determined that, "SSI incidence is highly seasonal, with the highest SSI incidence in August and the lowest in January. During the study period, there were 26.5% more cases in August than in January."

The odds of a primary SSI admission increased by roughly 2% per 5°F increase in the average monthly temperature. The highest temperature group of greater than 90°F was associated with a nearly 30%  increase in the odds of an SSI admission compared to below 40°F.

The researchers concluded the following: "At population level, SSI risk is highly seasonal and is associated with warmer weather."

Note: Infection Control Consulting Services (ICCS) consultants frequently deal with issues in surgery suites that relate to temperature and humidity control, particularly in hot and humid climates such as Florida. Several ambulatory surgery centers, often situated in older buildings, have reached out asking whether portable air conditioning units and dehumidifiers can be placed in the operating rooms. ICCS advises clients to follow nationally recognized guidelines and standards, including AORN, ASHRAE and ANSI/AAMI, when making decisions that will or have the potential to effect patient care and safety. 



CDC Report: Number of Detected Superbug Candida Auris Cases Surges

The Centers for Disease Control and Prevention (CDC) has issued a field report in the Morbidity and Mortality Weekly Report outlining the rapid increase in the number of identified Candida auris superbug cases in the United States.

C. auris is a type of yeast — an emerging, and often multidrug-resistant, fungus — that causes severe illness in hospitalized patients. It can enter the bloodstream and spread throughout the body, causing serious invasive infections. C. auris often does not respond to commonly used antifungal drugs, making infections difficult to treat. CDC notes that patients who in an intensive care unit for an extended period of time or those with a central venous catheter placed in a large vein, and have previously received antibiotics or antifungal medications, appear to be at the highest risk of infection.

In June 2016, CDC released a clinical alert about this superbug and later reported the first seven U.S. cases of infection through August 2016. As of May 12, 2017, a total of 77 U.S. clinical cases of C. auris had been reported to CDC from seven states: New York (53 cases), New Jersey (16), Illinois (4), Indiana (1), Maryland (1), Massachusetts (1), and Oklahoma (1).

Screening of close contacts of these patients identified an additional 45 patients with C. auris — 24 in New Jersey, 17 in New York and four in Illinois — resulting in a total of 122 patients from whom C. auris has been isolated. Most cases were in chronically ill patients with long stays at high-acuity skilled nursing facilities

Current recommendations for C. auris-colonized or infected patients include the following, according to CDC:
  • Use standard precautions and contact precautions.
  • House the patient in a private room.
  • Perform daily and terminal cleaning of a patient's room with a disinfectant active against Clostridium difficile spores.
  • Notify receiving healthcare facilities when a patient with C. auris colonization or infection is transferred.

Specialized laboratory methods are needed to accurately identify C. auris. Conventional laboratory techniques could lead to misidentification and inappropriate management, making it difficult to control the spread in healthcare settings.