RSSAll Entries in the "CDC" Category

CDC updates SSI prevention guidelines

For the first time in 18 years, the Centers for Disease Control and Prevention (CDC) has updated its surgical site infection (SSI) prevention guidelines. In its previous iteration, the guidelines were based on expert opinion rather than evidence-based practices on preventing SSIs.

“Unfortunately, in many cases the authors make no recommendation with respect to support or harm if the level of the evidence was low or very low or if they were unable to judge tradeoffs between harms and benefits of the proposed intervention because of lack of outcomes,” wrote Pamela A. Lipsett, MD, MHPE, MCCM, in the accompanying editorial. 

The CDC said it was heeding the call of healthcare professionals who said that guidelines needed to be based on evidence rather than opinions from 1999. The agency condensed thousands of studies into 170 high-quality trials to issue the following recommendations:

  • Patients should shower or bathe (full body) with soap (antimicrobial or nonantimicrobial) or an antiseptic agent on at least the night before surgery.
  • Antimicrobial prophylaxis should be administered only when indicated and timed such that a bactericidal concentration of the agents is established in the serum and tissues when the incision is made.
  • Skin prep in the OR should be done with an alcohol-based agent unless contraindicated.
  • For clean and clean-contaminated procedures, additional prophylactic antimicrobial agent doses should not be administered after the surgical incision is closed in the OR, even when a drain is being used.
  • Topical antimicrobial agents should not be applied to the surgical incision.
  • During surgery, glycemic control should be implemented using blood glucose target levels less than 200 mg/dL.
  • Normothermia (i.e., normal body temperature) should be maintained in all patients.
  • For patients with normal pulmonary function undergoing general anesthesia with endotracheal intubation, increased fraction of inspired oxygen should be administered during surgery and immediately after extubation in post-op.
  • Blood transfusions should not be withheld from surgical patients as a means to prevent SSIs.

Joint Commission and CDC team up on ambulatory infection prevention

The Joint Commission and the Centers for Disease Control and Prevention (CDC) are working on a new initiative to improve infection control in ambulatory care settings. The Adaptation and Dissemination Outpatient Infection PrevenTion (ADOPT) project will promote existing CDC infection prevention (IP) guidance while also making updates and alterations. The collaboration will involve:

•    Evaluating organizations’ infection prevention and control guidelines and materials to find gaps between what’s done in practice and what’s in the CDC materials.
•    Finding new ways and opportunities to raise awareness of IP guidance.
•    Adapting model infection control plans for outpatient-focused professional organizations.
•    Developing new ways of disseminating these materials and models to healthcare organizations to increase their reach, uptake, and adoption in outpatient settings.

There are 12 outpatient-focused professional organizations and 11 ambulatory healthcare systems participating in ADOPT. Other healthcare organizations or state health departments interested in learning more can reach out to Barbara Braun, PhD, at bbraun@jointcommission.org.

For examples of CDC ambulatory-focused infection prevention and control guidance, check out the following links:
•    CDC Guide to Infection Prevention for Outpatient Settings:  Minimum Expectations for Safe Care
•    CDC Outpatient Settings Policy Options for Improving Infection Prevention
•    CDC Basic Infection Control and Prevention Plan for Outpatient Oncology Settings
•    The CDC One and Only Campaign
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New antibiotic stewardship playbook meshes NQF, CDC, and Joint Commission guidelines

Released late last month, the National Quality Forum’s (NQF) Antibiotic Stewardship in Acute Care: A Practical Playbook is broken into five core elements focused on proper antibiotic usage: Leadership commitment, accountability, drug expertise, action, tracking.

Currently, only 40% of U.S. hospitals have an antibiotic stewardship program. The book was created by experts from the NQF, Centers for Disease Control and Prevention (CDC), and the Hospital Corporation of America and is based on the CDC’s Core Elements of Hospital Antibiotic Stewardship Programs. The playbook also aligns with upcoming Joint Commission standards.

Read the full article on the NQF playbook at HealthLeaders Media. 

How many will adopt the new CDC opioid guidelines?

After several months of debate, the Centers for Disease Control and Prevention (CDC) have finally published its Guideline for Prescribing Opioids for Chronic Pain on March 15. The agency’s recommendations are aimed towards primary care physicians, since family physicians alone account for 15.3 million opioid prescriptions annually. Currently, 44 Americans overdose and die each day after abusing prescription painkillers and the CDC hopes its recommendations can noticeably reduce the use of opioids in pain care.

However, the Guideline for Prescribing Opioids for Chronic Pain are voluntary and some question how many in the healthcare sector will adopt them.  Several healthcare professionals and patient groups protested the guidelines after their first draft was unveiled for comment, claiming they were too restrictive on pain care. The outcry was enough that the CDC had to organize an extra review process for the guidelines back in January.

Now it’s up to healthcare facilities, including those who protested the guidelines, to decide if they will follow the CDC’s recommendations and to what extent.  The guidelines consist of 12 recommendations total, including:

  1. Using non-pharmacologic and non-opioid therapy for chronic pain whenever possible.
  2. Establishing treatment goals before starting long-term opioid therapy. Physicians should only continue to prescribe opioids if there is “clinically meaningful improvement” that outweighs safety risks.
  3. Discussing the risks and benefits of opioids with patients before prescribing them.
  4. Using short-acting opioids instead of extended-release, long-acting drugs to treat chronic pain.
  5. Prescribing opioids in their lowest effective dosage.
  6. Using short-term opioid treatments instead of long-term treatments for acute pain care. Usually three days’ worth of opioids will be enough, though up to seven days is sometimes permissible.
  7. Patients should be evaluated within one to four weeks of beginning opioid therapy for chronic pain and be reevaluated at once every three months afterwards to assess the pros and cons of continued treatment.

Click here to read The Joint Commission’s “Facts about Pain Management” page and view its Sentinel Event Alert 49, dealing with safe use of opioids in hospitals.

 

Drug-resistant bacteria on the rise

First, the good news. Between 2008 and 2014 there was a 50% and 9% drop in central line-associated bloodstream infections at short-term care (STC) facilities and long-term acute care (LTAC) facilities, respectively. Surgical site infection rates are also down by 17% in STC facilities, while LTAC facilities saw a 11% decline in catheter-associated urinary tract infections.

Now the bad news. Even as hospitals reduce hospital-acquired infections (HAI), there have been more cases of antibiotic-resistant (AR) bacteria. A new Vital Signs report released by the Centers for Disease Control and Prevention (CDC) found that one in seven HAIs at a STC facility is caused by an AR infection. At LTAC facilities, there’s a one in four chance that an HAI is caused by a AR infection.

“The good news is that we are preventing healthcare-acquired infections, which has saved thousands of lives,” said Patrick Conway, MD, CMS deputy administrator and chief medical officer said in a statement. “The challenge ahead is how we help to prevent antibiotic resistance, as well as infections. We are using incentives, changes in care delivery, and transparency to improve safety and quality for patients.”

Two million Americans contract AR infections annually, with 23,000 dying because of their infections. There are six bacteria causing the most concern, with a significant percentage of each becoming drug-resistant:

  1. 6% of Acinetobacter species are multidrug-resistant
  2. 9% of Staphylococcus aureus isolates are methicillin-resistant
  3. 5% of Enterococci are vancomycin-resistant
  4. 8% of Enterobacteriaceae are extended-spectrum β-lactamase-producing.
  5. 9% of Pseudomonas aeruginosa are multidrug-resistant
  6. 6% of Enterobacteriaceae are carbapenem-resistant

“For clinicians, prevention means isolating patients when necessary,” said report author Clifford McDonald, MD, in the release. “It also means being aware of antibiotic resistance patterns in your facilities, following recommendations for preventing infections that can occur after surgery or from central lines and catheters placed in the body, and prescribing antibiotics correctly.”

The CDC encourages the healthcare community to continue to focus on preventing HAIs by stronger adherence to existing best practices.  The agency has also come up with a new web app that allows users can make customizable, interactive maps and tables with regional, state and national on HAIs caused by AR bacteria.

 

CDC releases new antibiotic stewardship app

On March 7, the Centers for Disease Control and Prevention (CDC) the release of a new web app; Antibiotic Resistance Patient Safety Atlas (AR Atlas).

With the AR Atlas app, users can make customizable, interactive maps and tables with regional, state and national on healthcare-associated infections (HAI) caused by antibiotic resistant (AR) bacteria.

With the AR Atlas app, users can make customizable, interactive maps and tables with regional, state and national on healthcare-associated infections (HAI) caused by antibiotic resistant (AR) bacteria. Users will be able to see and study antibiotic resistance patterns in HAIs by filtering the data by geographical area, time period, event type, and patient age. The app includes resistance data on 31 different AR strains, including:

• Methicillin-resistant Staphylococcus aureus (MRSA)
• Carbapenem-resistant Enterobacteriaceae (CRE)
• Multidrug-resistant Pseudomonas aeruginosa

The AR Atlas includes information from 2011-2014 and data collated from 3,676 acute care hospitals, 506 long-term acute care hospitals and 221 inpatient rehabilitation facilities. Click here to learn more about the app and its uses.

CDC: No more antibiotics for the common cold

The use of antibiotics and the rise of antibiotic-resistant diseases have been an increasing concern for public health. Studies have shown that the misuse of antibiotics is decreasing their effectiveness against new strains of infection. The Centers for Disease Control and Prevention (CDC) estimates that half the antibiotics currently prescribed for acute respiratory tract infections (ARTI), including bronchitis and the common cold, are unnecessary.

In response, the CDC and the American College of Physicians (ACP) released new guidelines for the use of antibiotics for ATRIs in the Annals of Internal Medicine on January 19. The new guidelines explain when it’s appropriate to give antibiotics to ARTI patients and what steps are needed to make that decision.

“Overuse of antibiotics contributes to the spread of antibiotic resistance, which has led to approximately 2 million people developing antibiotic-resistant illnesses and 23,000 associated deaths in the United States each year,” lead study author Aaron M. Harris, MD, MPH, LCDR, said during an interview with Medscape Medical News. “Furthermore, antibiotics are a leading reason for emergency room visits for drug side effects, responsible for one of every five visits.”

Bronchitis

Don’t start antibiotic therapy unless pneumonia is suspected. Bronchitis symptoms can instead be treated with cough suppressants, expectorants, antihistamines, decongestants, and β-agonists.

Group A Streptococcus

Only give antibiotics to patients once streptococcal pharyngitis is confirmed. Test using a rapid antigen detection test and or/culture if a patient has the symptoms of group A streptococcal pharyngitis.

If patients complain of a sore throat, reassure them that it will typically it will go away in less than a week and recommend that they take analgesics such as aspirin or acetaminophen to ease the pain. Explain that unnecessarily prescribing antibiotics can cause several side effects.

Acute Rhinosinusitis

Only give antibiotic treatment for acute rhinosinusitis patients if:

  • Their symptoms last more than 10 days
  • They experience an onset of severe symptoms
  • They have a temperature higher than 39°C/102.2°F
  • They have purulent nasal discharge or facial pain that lasts at least three consecutive days
  • They develop worsening symptoms after a typical viral illness that lasted five days and had begun improving (double sickening).

The common cold

Never prescribe antibiotics for the common cold.

Instead, explain to patients that symptoms can be treated with other methods and that unnecessarily prescribing antibiotics can cause several ill side effects. Tell each patient to follow up with a physician if symptoms last more than two weeks or worsen.

The full study can be read here.