Influenza Vaccines For the 2016-17 Season

September 23, 2016

by David J. Weber, MD, MPH

This summary is based on the just released CDC/ACIP statement “Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States,

David J. Weber
David J. Weber

2016–17 Influenza Season (http://www.cdc.gov/mmwr/volumes/65/rr/rr6505a1.htm).

Influenza viruses typically circulate widely in the United States annually, from the late Fall through early Spring. Although most persons who become infected with influenza viruses will recover without sequelae, influenza can cause serious illness and death, particularly among older adults, very young children, pregnant women, and those with chronic medical conditions. During 31 seasons from the 1976–77 through the 2006–07 season, estimated influenza-associated deaths ranged from approximately 3,300 to 49,000 annually. Annual influenza vaccination is the primary means of preventing influenza and its complications. A variety of different types of influenza vaccine are available. Routine annual influenza vaccination for all persons aged ≥6 months who do not have contraindications has been recommended by CDC and ACIP since 2010.

Primary changes and updates in recommendations are included in the CDC/ACIP statement.  Routine annual influenza vaccination of all persons aged ≥6 months without contraindications continues to be recommended. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended product is otherwise appropriate. Updated information and guidance in this document includes the following: Read More →

The Joint Commission: Review Procedures for Cleaning, Disinfecting and Sterilizing Reusable Medical Devices

September 23, 2016

by William A. Rutala, MPH, PhD

bill-rutala2
William A. Rutala

In September 2015, the Centers for Disease Control and Prevention (CDC) and U.S. Food and Drug Administration (FDA) alerted healthcare providers and facilities about the public health need to properly maintain, clean, and disinfect or sterilize reusable medical devices.1 Recent infection control lapses due to non-compliance with recommended reprocessing procedures highlight a critical gap in patient safety.  There are at least 8 outbreaks of duodenoscope-related infections of MDROs without reprocessing breaches.2   Additionally, there has been a Senate investigation that reported these outbreaks were not isolated incidents.  Between 2012 and spring 2015, closed-channel duodenoscopes were linked to at least 25 different incidents of antibiotic-resistant infections that sickened at least 250 patients worldwide.3  Healthcare facilities (e.g., hospitals, ambulatory surgical centers, clinics, and doctors’ offices) that utilize reusable medical devices are urged to immediately review current reprocessing practices at their facility to ensure they (1) are complying with all steps as directed by the device manufacturers, and (2) have in place appropriate policies and procedures that are consistent with current standards and guidelines.1

In 2016, The Joint Commission (TJC) has concentrated on reprocessing instructions for semicritical items when they conduct their triennial review.  Below is a list of recommendations for a healthcare facility in North Carolina when TJC surveyors visited each of >30 areas reprocessing semicritical items. Read More →

Healthcare Outbreaks Associated With a Water Reservoir and Infection Prevention

September 23, 2016

By Hajime Kanamori, MD, PhD, MPH, Division of Infectious Diseases, University of North Carolina

Hajime Kanamori, MD, PhD
Hajime Kanamori, MD, PhD

We reviewed outbreaks of waterborne healthcare-associated infections as well as prevention strategies and control measures for each water reservoir (Table).

  • Hospital water sources may serve as a reservoir of healthcare-associated pathogens.
  • The common waterborne pathogens were bacteria, including Legionella and other gram-negative bacteria, and nontuberculous mycobacteria.
  • These waterborne pathogens caused a variety of infections, including bacteremia and invasive and disseminated diseases, particularly among immunocompromised hosts and critically ill adults as well as neonates.
  • Waterborne outbreaks occurred in healthcare settings with emergence of new reported reservoirs, including electronic faucets (Pseudomonas aeruginosa and Legionella), decorative water wall fountains (Legionella), and heater-cooler devices used in cardiac surgery (Mycobacterium chimaera).
  • With emergence of reservoirs and pathogens that have been unrecognized so far, waterborne healthcare-associated outbreaks and infections continue to occur and affect patients’ health and safety.
  • Advanced molecular techniques are useful for achieving a better understanding of reservoirs and transmission pathways of waterborne pathogens.
  • It is important for healthcare personnel to understand reservoirs of waterborne pathogens for developing prevention strategies and control measures of healthcare-associated infections.

See summary of key issues and infection prevention strategies: Read More →

Successful Reduction in Healthcare-Associated Infections at University of North Carolina (UNC) Hospitals over the Last Decade

September 23, 2016

By Hajime Kanamori, MD, PhD, MPH, Division of Infectious Diseases, University of North Carolinaunc-health-care

“You go to the hospital to get well, right? Of course, but did you know that patients can get infections in the hospital while they are being treated for something else?”, according to the Centers for Disease Control and Prevention (CDC) website. http://www.cdc.gov/HAI/patientSafety/patient-safety.html

Infections which patients may get in the hospital during their stay are generally called healthcare-associated infections (HAI). A recent survey estimated that at least 1 HAI occurred in 4% of inpatients in U.S. acute care hospitals which resulted in an estimated 720,000 HAI in the U.S. HAI are still one of the top 10 leading causes of death in the U.S. HAI cost the U.S. more than $30 billion and in the state of North Carolina more than $100 million each year. At UNC Health Care, the Department of Hospital Epidemiology is working hard to reduce infections in our hospital and to prevent patients from being infected via other patients, healthcare personnel, or medical devices. Read More →

Playbook for Antimicrobial Stewardship in Hospitals

September 23, 2016

by Kristen Pridgen, MPH, CHES

antimicrobial stewarship playbookDecades of overprescribing and misuse of antibiotics have contributed to an increase in drug-resistant bacteria. CDC reports that antibiotic resistant bacteria cause 2 million illnesses and 23,000 deaths in the United States annually. CDC, National Quality Forum’s National Quality Partners (NQP), and the Hospital Corporation of America (HCA) collaborated with professional societies and national stakeholders to publish a practical guide for hospitals to improve antibiotic use within their facilities. “Antibiotic Stewardship in Acute Care: A Practical Playbook” is based on CDC’s Core Elements of Hospital Antibiotic Stewardship Programs and provides guidelines to establish new antibiotic stewardship programs and strengthen existing programs within acute care settings. The playbook can be found here: http://ow.ly/MoZI302qDCT.

 

Antibiotic Use in Outpatient Settings

September 23, 2016
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image from The Pew Charitable Trusts

by Kristin Pridgen, MPH, CHES

The Pew Charitable Trust recently published the first in a series of reports on antibiotic use in outpatient settings. A panel of public health and medical experts, including representatives from the CDC, analyzed current outpatient antibiotic prescribing habits in the United States, determined targets for reducing inappropriate prescribing, and identified steps needed to reach these targets. At least 30% of the outpatient antibiotic prescriptions written each year are unnecessary.

The panel set a 2020 goal of 50% reduction of inappropriate antibiotic use, or 23 million fewer prescriptions. This would require decreasing outpatient antibiotic prescribing by 15% overall. The majority of this reduction would come from eliminating unnecessary antibiotic prescribing for acute respiratory conditions. To read the report, go to: http://www.pewtrusts.org/en/research-and-analysis/reports/2016/05/antibiotic-use-in-outpatient-settings.

CRE Sentinel Site Surveillance

September 23, 2016
heather-dubendris2
Heather Dubendris

by Heather Dubendris, MSPH

Enterobacteriaceae are a normal part of gut bacteria. Carbapenem-resistant Enterobacteriaceae (CRE) are bacteria that are resistant to nearly all antibiotics and cause over 9,000 healthcare-associated infections each year. The mechanism of resistance among CRE currently of greatest public health concern is production of Carbapenemase enzymes. CRE producing carbapenamases are known as Carbapenemase producing CRE or CP CRE. Beginning March 1, 2015, NC DPH implemented a sentinel surveillance system to characterize CRE infections and colonization among patients admitted to seven of the state’s largest medical centers and to assess the prevalence of specific mechanisms of resistance.

As of March 31, 2016, 212 cases have been identified; 118 (56%) of which were identified through surveillance cultures. The most common infections were urinary tract (n=31, 33%), bacteremia (N=16, 17%), and pneumonia (n=13, 14%). Among patients from whom CRE were isolated, the median age was 56 years, and half were female (54%).

The majority of patients had recent healthcare exposures including hospitalizations, indwelling devices and a recent history of antibiotics. We identified the predominance of CRE isolates (n=110, 52%) to be carbapenamase-producing. These results will be used for future antimicrobial resistance prevention activities and program planning as we consider incorporating CRE as a reportable condition in NC.

DPH Welcomes CDC/CSTE Applied Epidemiology Fellow

September 23, 2016
Katie Steider2
Katie Steider

The NC Division of Public Health SHARPPS Program is pleased to welcome our new HAI CSTE Applied Epidemiology Fellow, Katie Steider! Katie graduated with her MPH from the Department of Infectious Diseases and Microbiology at the University of Pittsburgh Graduate School of Public Health and is Certified in Public Health (CPH) by the National Board of Public Health Examiners. Prior to joining NCDHHS, Katie was a phone interviewer for the Behavioral Risk Factor Surveillance System survey with the Evaluation Institute for Public Health at the University of Pittsburgh and worked extensively with the Allegheny County Health Department to analyze animal exposure and rabies testing data. Katie’s email address is katie.steider@dhhs.nc.gov and her direct office number is (919) 715-6733. Please join us in welcoming Katie!

New SPICE program assesses, improves infection control practice

September 23, 2016

Welcome to SPICE nurse consultants, Julie Hernandez, Wanda Lamm and Heather Ridge, who are conducting comprehensive infection control assessments in a variety of health care settings through March 2018. The primary focus of this project is to address the lack of comprehensive infection control training and oversight in hospital and non-hospital healthcare facilities across the state and to enhance

Lamm3
Wanda Lamm, R.N., C.I.C.
Ridge2
Heather Ridge, R.N., C.I.C.
Hernandez
Julie Hernandez, R.N., C.I.C.

the ability of public health to work with all facilities to prepare for and mitigate existing or emerging infectious disease threats. Federal funding through Centers for Disease Control and Prevention (CDC) has enabled DPH to contract with SPICE to carry out the infection control assessments in nursing homes, hospitals, outpatient practices, and dialysis centers. Analysis of the data, submitted to the CDC in aggregated and anonymous format, will reveal gaps in infection control practice and guide the development of educational programming. In addition to conducting the infection control assessments, NC DPH Communicable Disease Branch is contracting SPICE to develop a comprehensive database of all NC healthcare facilities. Facilities not participating in the on-site assessments will be encouraged to complete an on-line assessment of their infection control practices. To sign up for a visit and/or learn more about this program, by clicking on the following link: http://spice.unc.edu/icar/