Dentist Infection Control

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Hospitals Increasingly Requiring Influenza Vaccine for Staff

A new study reveals a significant surge in the number of hospitals requiring healthcare personnel (HCP) to receive influenza vaccines.

The study, published in JAMA Network Open, examined more than 1,000 survey responses from infection preventionists at Veterans Affairs (VA) and non-VA hospitals between 2013 and 2017.

During this time, required influenza vaccinations among HCP rose from 37.1% to 61.4%, driven by increases at non-VA hospitals.

The study authors note that while mandating influenza vaccinations leads to increased HCP vaccination coverage, other strategies, such as education, free and easily accessible vaccinations, campaigns and data sharing, can also help encourage greater vaccination.

It is important to note that this study concluded prior to a September 2017 directive stating that that all VA HCP were expected to receive the annual influenza vaccination. Those HCP unwilling or unable to do so are required to wear masks throughout the influenza season.



Hospital-Acquired Conditions Decline 8%, Saving Thousands of Lives

From 2014 to 2016, rates of hospital-acquired conditions (HACs) fell by 8% percent, according to new data from the Agency for Healthcare Research and Quality (AHRQ). This decline translated to saving about 8,000 lives and $2.9 billion in healthcare costs.

Examples of HACs include adverse drug events, catheter-associated urinary tract infections (CAUTIs), central-line associated bloodstream infections (CLABSIs), pressure injuries and surgical site infections (SSIs).

The "AHRQ National Scorecard on Hospital-Acquired Conditions" estimates that 350,000 HACs were avoided during the 2014 to 2016 period. This builds on previous gains made between 2010 and 2014, during which an estimated 2.1 million HACs were avoided.

The most significant percentage declines from 2014 to 2016 were seen in ventilator-associated pneumonias (-32%), CLABSIs (-31%), post-op venous thromboembolisms (-21%) and adverse drug events (-15%). Despite these improvements, and the impressive overall improvement, there were some concerning trends. Pressure ulcers and CAUTIs increased from 2014 to 2016 at rates of 10% and 4%, respectively. SSIs remained unchanged.

The Centers for Medicare & Medicaid Services (CMS) has established a goal of reducing HACs by 20% percent from 2014 through 2019. If the reduction goal is met, AHRQ projects that during 2015 through 2019, there would be 1.8 million fewer patients with HACs, which would result in 53,000 fewer deaths and $19.1 billion in healthcare cost savings.


Study: ASC Infection Rates Following Colonoscopy and Endoscopy Higher Than Believed

A new study indicates that rates of infection following colonoscopies and upper-GI endoscopies performed at ambulatory surgery centers (ASCs) is much higher than previously expected, according to a news release.

The researchers analyzed 2014 data from an all-payer claims database, specifically focusing on six states: California, Florida, Georgia, Nebraska, New York and Vermont. They examined infection-related emergency room visits and unplanned inpatient admissions within seven and 30 days after a colonoscopy or upper-GI endoscopy, knows as esophagogastroduodenoscopy (EGD), was provided at an ASC.

What they found was greater-than-expected risk of bacterial infections, including E. coli and Klebsiella, according to the release. The lead researcher stated that while post-endoscopic infection rates were previously believed to be about one in a million, the new research indicated that the rate of infection seven or fewer days after the procedure was slightly higher than 1 in 1,000 for screening colonoscopies and about 1.6 per 1,000 for non-screening colonoscopies. For EGDs, rates of infection within that timeframe were more than 3 per 1,000.

Other observations:
  • At an even greater risk of infection: patients hospitalized before undergoing one of the procedures. The researchers found that almost 45 in 1,000 patients hospitalized within 30 days prior to a screening colonoscopy went to a hospital with an infection within a month. Using those same time parameters, the rate of infection-related hospitalization for EGDs was more than 59 patients per 1,000.
  • Among ASC post-procedure infections, rates were slightly higher for diagnostic versus screening procedures.
  • ASCs with the highest volume of procedures had the lowest rates of post-endoscopic infections.
  • Infection rates at some ASCs were more than 100 times higher than expected.
The study, titled "Rates of infection after colonoscopy and osophagogastroduodenoscopy in ambulatory surgery centres in the USA," was led by a Johns Hopkins researcher, with its results published in the British Society of Gastroenterology's journal Gut.

Does your surgery center need assistance with infection prevention and control? Learn about ICCS's services for ASC infection prevention.


Updated Guidance Issued for Management of Hep C

The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) have issued updated guidance on the management of hepatitis C (HCV), according to a news release.

The new guidance was posted to, a website developed by AASLD and IDSA that provides recommendations for testing, managing and treating HCV.

The guidance reflects new testing and management recommendations specifically for pregnant women, people who inject drugs, men who have sex with men and people who are incarcerated.

The new recommendations are summarized as follows:
  • All pregnant women should be tested for HCV infection, ideally at the start of prenatal care.
  • Annual HCV testing for people who inject drugs and have never been tested for the virus, annual testing for people who have previously tested negative for the virus but continue to use injection drugs and several other recommendations for people who inject drugs.
  • For men who have sex with men, at least annual (or more often, based on risk) testing for HCV antibody for those who have never been exposed to the virus and HCV RNA testing for those who were treated for or spontaneously cleared HCV infection.
  • Jails and prisons should implement opt-out testing for incarcerated individuals and several other recommendations for people in correctional institutions.
Learn more about these updated recommendations here.


Article Examines Surgical Safety Checklist History, Encourages Greater Adoption

A British Journal of Surgery (BJS) article examines the impact of the surgical safety checklist introduced by the Safe Surgery Saves Lives Study Group at the World Health Organization (WHO).

The WHO Surgical Safety Checklist was launched in June 2008 at the PanAmerican Health Organization headquarters. Containing 19 items, it was intended to improve team communication and consistency of care while hopefully reducing complications and deaths associated with surgery, according to a news release.

The BJS article examined studies from the past decade that evaluated the checklist's impact and difficulty of implementation.

While the authors conclude that use of the checklist as part of safe surgical system can support better practices, including surgical infection prevention, there remains opportunity for improvement. These include the following:
  • ensuring box-checking does not overshadow the importance of the communications and process assurance aspects of the checklist;
  • increasing use of the checklist, supported through advocacy and education, in low and middle human development index (HDI) countries;
  • identifying and removing barriers to successful adoption, such as lack of infrastructure, equipment and trained personnel; and
  • not expecting mandated use of the checklist, on its own, to achieve positive results.
According to the release, co-author Dr. Thomas Weiser said, "Use of a surgical checklist has moved from a good idea to standard of care, yet this seemingly simple safety tool is remarkably difficult to implement. This is particularly true in settings with poor resources and weak management systems; however, those hospitals are the ones that could potentially benefit the most. Many people are working to promote its appropriate adoption and use worldwide."


Ebola Claims More Than 25 Lives in Congo; Vaccination Campaign Underway

An outbreak of Ebola has now claimed the lives of 27 people in the Democratic Republic of the Congo, according to the latest figures released by the World Health Organization (WHO).

As of May 21, there were 58 total likely cases of Ebola: 28 confirmed (which includes the 27 deaths), 21 probable and nine suspected.

In an effort to control the outbreak, high-risk populations are receiving an experimental "ring vaccination." As the WHO reported, more than 7,500 doses of the rVSV-ZEBOV Ebola vaccine have been deployed to the northwestern Equator Province of the Congo.

As an ABC News report notes, ring vaccination is an approach used to control smallpox in the 1970s. The first batch of vaccines will go to healthcare workers caring for infected patients, followed by people who know someone with an infection. The vaccine will then go to individuals who know those people, continuing outward in this "ring" fashion.

The vaccine was demonstrated to be highly protective against Ebola in a major trial in 2015 in Guinea. More than 5,800 people who came into contact with patients who had confirmed cases of Ebola received the vaccine. No Ebola cases were recorded nine days or more after vaccination. The rVSV-ZEBOV vaccine is awaiting review by regulatory authorities.

In 2014, an Ebola outbreak in West Africa ended with more than 28,600 cases and 11,325 deaths, according to the Centers for Disease Control and Prevention (CDC).


Hospital Reduces Hysterectomy SSIs With Prevention Bundle

A Connecticut hospital significantly decreased surgical site infections associated with hysterectomies through the use of a multi-step prevention bundle, according to a study published in Obstetrics & Gynecology and Medscape report on the research.

The bundle included the following components:
  • chlorhexidine-impregnated preoperative wipes provided to patients;
  • standardized aseptic surgical preparation of the abdomen, vagina, and perineum;
  • standardized antibiotic dosing before and during surgery;
  • maintenance of intraoperative normothermia;
  • surgical dressing maintenance 24 to 48 hours postoperatively; and
  • provision of direct feedback from peers to physicians and other staff when the protocol was breached.
Hospital staff received education about the bundle prior to its implementation.

During the 33-month study period, Yale New Haven Hospital in New Haven, Conn., performed 2,099 hysterectomies. There were 61 SSIs (4.51%) prior to implementation of the full bundle and 14 SSIs (1.87%) following implementation of the full bundle.

According to the Medscape report, the authors concluded the following: "Although additional analyses are needed to further elucidate the relationships among adherence rates, specific bundle components, hysterectomy routes, length of hospital stay and [SSI] reduction and overall surgical costs, we believe that a multidisciplinary, gynecology-specific approach to implementation and maintenance of the SSI prevention bundle serves patients well and will become a mainstay of gynecologic surgical care."