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UN declares drug resistance a global threat to humanity

The fight against antimicrobial-resistant (AMR) infections has become a hot topic in 2016, and the United Nations (UN) has now joined the fray. This year, The Joint Commission and CMS making antimicrobial stewardship programs (ASP) mandatory for all healthcare facilities. At the World Economic Forum in Davos, 74 drug makers, 11 diagnostic test manufacturers, and nine industry groups signed “The “Declaration on Combating Antimicrobial Resistance.” Two different disease strains were found to be resistant to the “last-resort” antibiotic colistin.

During the 71st session of the UN General Assembly in New York City last week, the world’s governments discussed the increasing dangers posed by AMR infections and doubled down on the need for national and international AMR action plans. This makes AMR infections the fourth health issue in history to be taken up by the U.N. General Assembly after HIV, noncommunicable diseases, and Ebola.

“Antimicrobial resistance threatens the achievement of the Sustainable Development Goals and requires a global response,” said H.E. Peter Thomson, president of the 71st session of the UN General Assembly, in an address to delegates. “Member states have today agreed upon a strong political declaration that provides a good basis for the international community to move forward. No one country, sector, or organization can address this issue alone.” [more]

Joint Commission’s 2017 antibiotic stewardship standards

In the wake of a CMS ruling that will make antibiotic stewardship programs (ASP) mandatory, The Joint Commission recently announced that it will roll out a similar standard. Effective January 1, 2017, the new Medication Management standard requires facilities to create an effective ASP. The standard applies to:

The Joint Commission released the standard a month after attending the White House Forum on Antibiotic Stewardship, which focused on implementing changes over the next five years to slow the emergence of antibiotic-resistant bacteria, detect resistant strains, promote stewardship of existing antibiotics, and prevent the spread of resistant infections. Representatives from 150 retailers, food organizations, healthcare organizations, and animal health organizations were in attendance.

Only 40% of U.S. hospitals have an antibiotic stewardship program and an estimated 30% to 50% of prescribed antibiotics are unnecessary or inappropriate.  In the U.S., drug-resistant diseases cause 23,000 deaths and 2 million illnesses each year. That number is expected to increase exponentially in the upcoming decades. 

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CMS releases list of proposed rules, makes antibiotic stewardship mandatory

Last week, CMS published a list of proposed rule changes for hospitals and laboratories.  One of the more notable proposals would make antibiotic stewardship programs [ASP] mandatory. ASPs are viewed by many as a way to prevent antibiotic misuse and the spread of drug-resistant disease.

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“We propose to change the introductory paragraph [in Infection Control Condition of Participation §482.42] to require that a hospital’s infection prevention and control and antibiotic stewardship programs be active and hospitalwide for the surveillance, prevention, and control of HAIs and other infectious diseases, and for the optimization of antibiotic use through stewardship,” according to the proposed rule.

Only 40% of U.S. hospitals have an antibiotic stewardship program and an estimated 30% to 50% of prescribed antibiotics are unnecessary or inappropriate.  In the U.S., drug-resistant diseases cause 23,000 deaths and 2 million illnesses each year.

The document also changed included changes to patient rights, restraint usage, physician assistants, medical records, diet orders, periodic evaluations, and several more. To see the full list of changes, click here.

Healthcare professionals can comment on the proposed rules until 5 p.m. on August 15, 2016. Comments can be sent by traditional mail to CMS or done online.

 

Joint Commission approves new antimicrobial stewardship standard

In the wake of a CMS ruling that will make antibiotic stewardship programs [ASP] mandatory, The Joint Commission recently announced that it will roll out a similar standard. Effective January 1, 2017, the new Medication Management standard requires facilities to create an effective ASP. The standard applies to hospitals, critical access hospitals, and nursing care centers.

The new standard can be viewed in the July issue of Joint Commission Perspectives.

CMS proposal would make antibiotic stewardship programs mandatory

Healthcare professionals have 60 days to comment on a proposed CMS rule to make antibiotic stewardship programs (ASP) mandatory for all hospitals and critical access hospitals.

“We propose to change the introductory paragraph [in Infection Control Condition of Participation §482.42] to require that a hospital’s infection prevention and control and antibiotic stewardship programs be active and hospital-wide for the surveillance, prevention, and control of HAIs and other infectious diseases, and for the optimization of antibiotic use through stewardship,” according to the proposed rule.

Only 40% of U.S. hospitals have an antibiotic stewardship program and an estimated 30% to 50% of prescribed antibiotics are unnecessary or inappropriate.  In the U.S., drug-resistant diseases cause 23,000 deaths and 2 million illnesses each year.

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. 

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.

Teaching hospitals struggle with C. diff; infection rates higher than national average

Despite strong efforts to reduce hospital acquired infections, some of the best teaching hospitals in the U.S. have seen a rapid rise in Clostridium difficile (C. diff) infections. In 2014 alone, 101,074 patients contracted C. diff at a hospital, a 4% increase from the previous year. C. diff infects 450,000 people annually and plays a role in 29,000 deaths.

A Consumer Reports study examined C. diff rates in 3,200 American hospitals and found that at least a third of them had C. diff rates higher than the national average. Some of the worst performers included 24 of the nation’s largest teaching hospitals, including:

  • Baylor University Medical Center, TX
  • Brigham and Women’s Hospital, MA
  • Cleveland Clinic, OH
  • John Hopkins Hospital, MD
  • Massachusetts General, MA
  • Mount Sinai Hospital, NY
  • VCU Medical Center, VA
  • Yale-New Haven Hospital, CT

“Teaching hospitals are supposed to be places where we identify the best practices and put them to work,” Lisa McGiffert, director of Consumer Reports’ Safe Patient Project, said in a news release. “But even they seem to be struggling against this infection.”

All 24 teaching hospitals have at least 500 beds and over 200,000 patient days a year. Representatives from several of the larger hospitals in question have said that the higher infection rates might be because they treat a higher ratio of sicker patients than non-teaching hospitals or that they may be better at detecting and testing for C. diff.

The report suggests better hygiene and antimicrobial stewardship is needed to fight C. diff infections. Antibiotics can kill off the “good” bacteria in a patient’s stomach that normally keep C. diff at bay, and antibiotic misuse is thought to be one of the main causes in growing C. diff rates. The bacteria is also able to live outside the body for weeks, making hand hygiene and sanitation a high priority.

Only 28% of hospitals received top scores in C. diff prevention, four of which were large teaching hospitals; Mount Sinai St. Luke’s, Maimonides Medical Center, Maine Medical Center, Harris Health System.

Click here to see the Consumer Reports interactive map to see how your local hospital did on the report. 

Report: Vaccines the key to reducing superbugs

Developing new antibiotics is a notoriously difficult task and the rampant misuse of existing antibiotics have made them ineffective against many types of diseases, known as superbugs. Superbugs have become a global health concern, with governments and drug makers joining forces to tackle the problem.

Suggested solutions have included behavioral changes to how doctors prescribe antibiotics, increased collaboration between medical researchers and no longer giving antibiotics to livestock.

The United Kingdom’s Review on Antimicrobial Resistance (RAR), which hosts the industry’s “Declaration on Combating Antimicrobial Resistance” on its website, issued a new report on February 11 saying increasing the use and spread of vaccines can drop the number of superbug cases.

“Vaccines prevent infections and so reduce the need to use antibiotics,” wrote RAR Chairman Lord Jim O’Neill in the report. “This is true for vaccines that prevent bacterial infections, and it is also true for vaccines that prevent viral infections, such as the flu, which should not be treated with antibiotics but often are anyway.”

The report urges governments and drug makers worldwide to increase the distribution of existing vaccines, as well as develop new vaccines for common ailments. O’Neill singled out the pneumococcal conjugate vaccine, which treats Streptococcus pneumonia, as an example. The vaccine is widely used in parts of the world. O’Neill wrote that global coverage could prevent 800,000 annual deaths of children under five and reduce antibiotic usage.

“Universal coverage by a pneumococcal conjugate vaccine could potentially avert 11.4 million days of antibiotic use per year in children younger than five, roughly a 47% reduction in the amount of antibiotics used for pneumonia cases caused by S. pneumonia,”the report states.

The RAR’s report estimates that antimicrobial resistance could kill 10 million people per year and cost up to $100 trillion by 2050 if not brought under control.

Click here to read the full RAR vaccine report.