Study: High-Risk Antibiotics Linked to Increase in C. Diff Infections

A new study indicates that usage of high-risk antibiotics is connected to increases in hospital-associated Clostridioides difficile (C. diff) infection.

The research, published in Infection Control and Epidemiology, analyzed data from 171 community and teaching hospitals gathered from June 2016 through July 2017. It looked at use of high-risk antibiotics — specifically second-, third- and fourth-generation cephalosporins, fluoroquinolones, carbapenems and lincosamides — and their impact on hospital-associated C. diff.

As a Center for Infectious Disease Research and Policy report notes, the researchers found that for every 100-day increase in the use of these antibiotics, there was a correlating 12% increase in hospital-associated C. diff.

The authors conclude, "High-risk antibiotic use is an independent predictor of hospital-associated C. diff infection. This assessment of poststewardship implementation in the United States highlights the importance of tracking trends of antimicrobial use over time as it relates to C. diff infection.

The 'Licking Challenge' is Another Reason to Switch From Bulk Items

Is your organization still using bulk supplies? Better be careful: They may prove too alluring to be resisted by some people who just "need" to lick them.

In the latest in strange, antisocial behavior, people are being caught opening containers and licking the contents. Examples include a tongue depressor and cartons of ice cream.

While the likelihood of your organization encountering such an individual is low, these incidents serve as a reminder of the risks associated with using bulk items. When bulk supplies are not individually wrapped, such as tongue depressors and cotton balls or gauze pads (in containers for use with refillable alcohol dispensers; see example image), they are a source of hand contamination when healthcare workers reach into the container repeatedly. They are also subject to contamination in other ways, including having their containers knocked over, spilling the contents, and, more recently, the "licking challenge."

Infection Control Consulting Services (ICCS) advises clients and all healthcare organizations still using bulk items to consider switching to individually wrapped. While individually wrapped supplies are likely to be a bit more expensive, the savings captured does not justify the potential contamination risk posed by these items.

OIG Report: ASCs Struggling to Comply With Infection Control Requirements

The HHS Office of the Inspector General (OIG) has issued a new report suggesting many ambulatory surgery centers (ASCs) are coming up short in their efforts to meet infection control requirements.

The report claims that more than three out of every four Medicare-certified ASCs were cited for at least one deficiency during their most recent state-government inspection, and one out of every four had a serious — or "condition-level" — deficiency. Infection control deficiencies were the most frequency cited type of deficiency from fiscal year (FY) 2013 to FY 2017, comprising roughly one-fifth of all violations.

Furthermore, states cited 55% of all nondeemed ASCs with one or more infection control deficiency in these ASCs' most recent certification surveys — easily tops on the list of the types of Conditions for Coverage (CfC) deficiency citations. Coming in second was pharmaceutical services-related deficiencies (37%), with environment deficiencies rounding out the top three at 33%.

Infection control also had the highest percentage of condition-level deficiencies at 12%. The OIG defines a condition-level deficiency as indicating that "… substantial noncompliance with multiple standards of a CfC adds up to pervasive noncompliance, or that noncompliance with one or more standards poses a serious threat to patient health and safety."

Patients also flagged infection control as a significant concern. Between FY 2013 and FY 2017, the most common complaint allegations related to quality of care and treatment (35%). The second most common was infection control (24%), with patient rights coming in third (19%).

The OIG states that it completed its review and report by analyzing state data on ASC certification surveys for nondeemed ASCs and complaints about deemed and nondeemed ASCs from FY 2013 to FY 2017, as provided by Medicare. Using these data, OIG assessed state survey performance against Medicare's requirements and analyzed trends in deficiency citations from state surveys and trends in complaint surveys.

Among its conclusions: The Centers for Medicare & Medicaid Services (CMS) can use the report to help focus its efforts on "… ASCs' recurring challenges in meeting health and safety requirements, especially for infection control."

In need of CMS and/or accreditation survey assistance? Infection Control Consulting Services can help your organization with survey preparation and developing a plan of correction, among many other infection control services.

Study: Surveillance May Miss Many Outpatient Surgical Site Infections

The results of a new study show that surgical site infection (SSI) surveillance systems may omit numerous outpatient surgeries with an expected increased likelihood of an adverse event.

As the study, which was published in the Society for Healthcare Epidemiology of America (SHEA) journal Infection Control & Hospital Epidemiology, notes, surveillance was based on Veterans Affairs Surgical Quality Improvement Program (VASQIP) eligibility criteria, which is defined by clinician determination of invasiveness.

Data for the study came from 31 Veterans Affairs (VA) organizations —  20 freestanding ambulatory surgery centers and 11 inpatient facilities — reports Infectious Disease News. Researchers conducted a retrospective study examining outpatient surgeries performed at these facilities between October 2011 and September 2015.

Researcher Dr. Katherine Linsenmeyer of the VA Boston Healthcare System told Infectious Disease News that the researchers' analysis indicated that more than half of the adverse events identified occurred in low-risk surgeries that did not meet criteria for review under the current VASQIP surveillance processes. These include nearly all skin and soft tissue procedures and nearly half of urologic procedures.

She told the publication, "Our study demonstrates the need to re-evaluate surveillance, particularly for SSIs, in this outpatient setting and to re-think how we classify 'low'- and 'high'-risk procedures — infections are a risk following any invasive procedure and it is important that we think about ways to implement effective inpatient prevention programs in outpatient settings."

This is yet another study raising concerns about effective SSI identification. Duke researchers recently determined that inconsistent methods for calculating SSI rates of some procedures are contributing to underestimates of the rates.

Data Analysis: Some Surgical Site Infection Rates Underestimated

Researchers have found that inconsistent methods for calculating surgical site infections (SSIs) of some procedures are contributing to underestimates of their SSI rates.

The research was published in Infection Control & Hospital Epidemiology and performed by members of the Duke infection Control Outreach Network (DICON). They conducted a retrospective analysis of SSI surveillance data from 11 DICON hospitals over a three-year period (January 2015 through December 2017). The analysis looked at SSI rates of laminectomies and rectal procedures using two different denominators: the current National Health Safety Network (NHSN) definition or only when the laminectomy or rectal procedure was the primary procedure.

Researchers hypothesized that since laminectomies and rectal procedures are commonly performed with "higher-ranking" procedures (fusion procedures and colon procedures, respectively), SSI rates would greatly differ when calculated using the different denominators. More specifically, "… SSIs occurring after combined laminectomy and fusion procedures would be counted as spinal fusion SSIs (but not laminectomy SSIs) and SSIs occurring after combined colon and rectal procedures would be counted as colon surgery SSIs (but not rectal surgery SSIs)," they wrote.

Their hypothesis was correct: The analysis showed significant underestimates of SSI rates for laminectomies and rectal procedures. The researchers wrote, "This analysis showed that the current NHSN method of calculating SSI rates underestimates the SSI rate of procedures, such as laminectomies and rectal surgeries, which are commonly performed alongside higher-ranking procedures."

Dr. Jessica Seidelman, who led the team of researchers, told Infectious Disease News, "If we want to have clinicians and hospitals make informed decisions for their patients, then we need to ensure that the data they use to make those decisions are accurate."

NHSN recently announced it is considering a requirement for hospitals to report ICD-10 or CPT codes when they report SSI denominators. The researchers wrote, "Requiring ICD-10 or CPT codes when reporting SSI data may pave the way for NHSN to further risk-adjust SSI rates based on specific procedure(s) performed. We recommend that the NHSN consider revising their current method for counting SSI denominators by including only primary surgical procedures in denominators when calculating SSI rates and standardized infection ratios."