The August 2019 issue of the ICCS Infection Prevention & Control Newsletter has published.
The issue includes stories on hepatitis A, duodenoscopes, a new long-term care law, total knees, antibiotic use, immunization schedules and C. diff.
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The results of a nationally representative survey of nursing homes reveal noteworthy improvements in the development of antibiotic stewardship programs.
The 2018 survey of more than 860 nursing homes analyzed antibiotic stewardship program "comprehensiveness" as well as issues such as infection preventionist training and participation in Quality Innovation Network-Quality Improvement Organization (QIN-QIO) initiatives. Survey results were published in the American Journal of Infection Control.
Comprehensiveness was evaluated based upon a nursing home's number of reported antibiotic stewardship program policies based on the Centers for Disease Control and Prevention's (CDC) core stewardship elements, reports the Center for Infectious Disease Research and Policy (CIDRAP).
Of the nursing homes participating in the survey, about a third had what was defined as "comprehensive" antibiotic stewardship program policies (six or more policies based on CDC core stewardship elements), about 41% had "moderately comprehensive" antibiotic stewardship program policies (4-5 policies) and about a quarter had "not comprehensive" antibiotic stewardship program policies (three or fewer policies).
The survey also revealed that more than 91% of nursing homes reported collecting data on antibiotic use, but just 19% reported restricting the use of specific antibiotics. Also, while the number of nursing home infection preventionists trained in infection control had increased, gaps remain.
CIDRAP noted that a 2013-2014 national survey found that only about half of nursing homes certified by the Centers for Medicare & Medicaid Surveys (CMS) collected antibiotic use data, and less than half had written antibiotic initiation guidelines. In October 2016, CMS finalized a rule requiring nursing homes to have an antibiotic stewardship program, which likely contributed to the increase in the development of more comprehensive programs.
New Jersey has passed a new law requiring some long-term care (LTC) facilities to submit outbreak response plans to the state's department of health (DOH).
The legislation was prompted in response to a 2018 adenovirus outbreak at an LTC facility for severely ill children in Haskell, N.J., that killed 11 patients.
As a press release from N.J. Governor Phil Murphy notes, the law — A5527 — requires certain LTC facilities to develop and submit an outbreak response plan to the N.J. DOH within 180 days after the bill's effective date. These plans should include protocols for isolating infected and at-risk patients in the case of an outbreak, policies for notification of family and staff and additional requirements for containing outbreaks.
The legislation also requires facilities like the one in Haskell that provide care for particularly vulnerable, ventilator-dependent residents to submit a more detailed response plan for review.
"Breaches in infection control practices are a major contributing factor in the spread of disease in healthcare facilities," said Acting Health Commissioner Judith Persichilli, in the release. "Outbreak response plans help facilities remain aware of the need to contact and work with public health to implement practices to minimize further spread of disease."
The Centers for Disease Control and Prevention (CDC) has issued a report on antibiotic use in the United States.
The report — Antibiotic Use in the United States: Progress and Opportunities, 2018 Update —is an update to the antibiotic stewardship report CDC issued in 2017.
Below are some of the key takeaways from this year's report.
1. Outpatient antibiotic prescribing remains a problem, although some improvement has been made. According to 2016 outpatient antibiotic prescribing data, about 47 million antibiotic courses are prescribed in doctors' offices and emergency departments annually for infections that do not require antibiotics. That's about 30% of all antibiotics prescribed. Some good news: Outpatient antibiotic prescribing has improved a bit, with a 5% national decrease from 2011 to 2016.
2. Hospitals are more committed to antibiotic stewardship. According to 2017 hospital antibiotic stewardship program data, the number of hospitals reporting an antibiotic stewardship program meeting all of CDC's "Core Elements of Hospital Antibiotic Stewardship Programs" almost doubled from 2014 to 2017. Slightly more than three out of every four acute-care hospitals reported uptake of all seven core elements. While that's encouraging, significant work remains: The national goal is 100% by 2020.
3. Urgent care centers are a significant source of unnecessary antibiotics for respiratory illnesses. A study of antibiotic prescribing for respiratory illnesses by four outpatient settings — urgent care centers, emergency departments (EDs), retail health clinics and traditional medical offices — found that urgent care centers prescribed antibiotics unnecessarily 46% of the time. This compared to 25% in EDs, 17% in medical offices and 14% in retail health clinics.
4. Fluoroquinolones prescribing remains problematic. A study found that fluoroquinolones are routinely and unnecessarily prescribed for urinary tract infections (UTIs) and respiratory conditions. About 5% of all fluoroquinolone antibiotics prescribed for adults in medical offices and EDs in 2014 were unnecessary; furthermore, about 20% of all fluoroquinolone prescriptions in these settings were not the recommended first-line treatment.
Fluoroquinolones are not the recommended first-line treatment for UTIs or sinusitis. Yet, these conditions accounted for an estimated 6.3 million prescriptions in 2014. Fluoroquinolones were the most commonly prescribed antibiotic for UTIs. Colds and bronchitis, which should never be treated with antibiotics, led to an estimated 1.6 million unnecessary fluoroquinolone prescriptions in medical offices and EDs.
5. A majority of antibiotic courses for sinus infections are longer than expected. A study found that nearly 70% of antibiotic courses for sinus infections were longer than recommended. Guidelines advise 5-7 days of antibiotic treatment for most sinus infections in adults. However, almost 70% of antibiotic prescriptions for sinus infections are for 10 days.
6. There is significant opportunity for improvement in antibiotic selection for children. A study found that azithromycin, a commonly prescribed antibiotic in children, is often prescribed when not recommended or when not the recommended first-line drug by clinical guidelines.
Several national gastroenterology (GI) societies have issued a joint statement that challenges points raised in a recent article in The New York Times.
This article, as we previously wrote, primarily focused on the difficulty healthcare providers face in sterilizing duodenoscopes.
A letter to the editor, as well as a longer statement, written by the GI societies acknowledged the importance of pursuing solutions to eliminate infection risks associated with duodenoscopes, but pushed back on the article, saying that it "largely understates the value of duodenoscopes and the procedure they are used for: endoscopic retrograde cholangiopancreatography (ERCP)."
The societies argue for the importance and value of ERCP, stating that patients who undergo the procedure are often very ill and that the infection risks associated with sterilizing duodenoscopes do not outweigh the benefits of ERCP. Nearly 700,000 patients undergo ERCP annually, the statement notes.
Furthermore, the GI societies acknowledge that while they are working with the Food and Drug Administration (FDA) and industry to "identify and properly vet potential solutions," withdrawal of duodenoscopes in the meantime is "simply not feasible."
The letter is signed by the presidents of the American Society for Gastrointestinal Endoscopy (ASGE), American College of Gastroenterology (ACG), American Gastroenterological Association (AGA) and Society of Gastroenterology Nurses and Associates (SGNA).