ECRI: Infection Risks, Antimicrobial Stewardship Top Patient Safety Concerns

Challenges concerning antimicrobial stewardship, sepsis and peripheral intravenous (PIV) catheter infections appear on the ECRI Institute's "2019 Top 10 Patient Safety Concerns for Healthcare Organizations" report.

Coming in second on the list is "Antimicrobial Stewardship in Physician Practices and Aging Services." In an executive brief, Sharon Bradley, senior infection prevention and patient safety analyst/consultant with ECRI Institute, notes, "Antibiotic stewardship does not mean withholding necessary treatment. But we have casually and cavalierly handed around the candy dish of antibiotics without a second thought as to how we may be harming our patients."

Coming in eighth is "Early Recognition of Sepsis across the Continuum." In the brief, ECRI notes, "Healthcare workers throughout the continuum of care must be able to recognize sepsis. Certified nursing assistants can be trained to use screening tools, and physician practices can screen for sepsis both in the exam room and on the phone. Simulation and skills practice can help workers recognize sepsis and communicate their concerns."

Ninth on the top 10 list is "Infections from Peripherally Inserted IV Lines." The brief notes, "Often, PIVs are inserted upon admission as a matter of course, in case the patient needs IV therapy at a later point. However, PIVs can expose patients to a significant risk of infection — one that is underreported, underrecognized and often ignored…"

ECRI states that it creates the annual list of patient safety concerns to support healthcare organizations to proactively identify and respond to safety threats. The list is compiled using data on adverse events and concerns gathered by ECRI and "expert judgment."

The top patient safety concern for 2019 is "Diagnostic Stewardship and Test Result Management Using EHRs." Rounding out the top three is "Burnout and Its Impact on Patient Safety."

CDC: Nearly 20,000 People Died From Staph Infections in 2017

Staphylococcus aureus (staph) infections remain a significant threat, and efforts to reduce them appear to be stalling, according to a Centers for Disease Control and Prevention (CDC) report.

More than 119,000 people suffered from staph infections in the United States in 2017, with nearly 20,000 people dying from them.

Furthermore, while hospital infection control efforts successfully reduced rates of serious staph infections in the United States by about 17% each year from 2005-2012, recent data show that this success is trailing off. The recent rise in staph infections may be linked, in part, to the nationwide opioid epidemic. Nearly 1 in 10 serious staph infections in 2016 occurred in people who inject drugs, such as opioids.

As the report notes, "Despite significant reductions in healthcare–associated methicillin-resistant S. aureus (MRSA) infections, progress is slowing. Methicillin-susceptible S. aureus (MSSA) infections have not decreased as much in hospitals and might be increasing in the community." 

According to CDC, the risk for serious staph infection is greatest when people:

• stay in healthcare facilities or have surgery;

• have medical devices placed in their body;

• inject drugs; and

• come into close contact with someone who has already staph.

To better protect patients from staph, CDC advises healthcare organizations to:

• make staph prevention a priority;

• follow CDC recommendations, including contact precautions (gloves and gowns), to prevent the spread of staph;

• consider additional interventions (e.g., screening, decolonizing high-risk patients);

• treat infections appropriately and rapidly; and

• educate patients about how to avoid infection and spread, and about early signs of sepsis.

Study: Electric System Change Drastically Cuts Unnecessary UTI Tests

A simple change to how physicians order urine tests can reduce unnecessary urinary tract infection (UTI) tests by nearly half without compromising the identification of patients requiring treatment, according to research by a team at Washington University School of Medicine in St. Louis.

The study, published in Infection Control and Hospital Epidemiology, measured the effectiveness of changing the electronic ordering system used by physicians. The first option presented in the system for ordering urine tests was culture test alone. Researchers changed the default to urine dipstick test followed by a bacterial culture test. Clinicians could still order a culture test alone but were required to open an additional screen.

The rationale behind this change is that it encourages physicians to check for signs of a UTI before testing urine for bacteria, thus reducing over-testing, unnecessary prescribing and use of antibiotics and cost.

Researchers compared all urine culture tests ordered at Barnes-Jewish Hospital in the 15 months prior to the intervention to the 15 months after. Before the intervention, physicians ordered nearly 16,000 urine cultures. After the intervention, they ordered about 8,800 cultures — about 45% fewer. There were 125 diagnosed catheter-associated UTIs in each time period.

"Ordering tests when the patient needs them is a good thing," said senior author and infectious diseases specialist David Warren, MD, a professor of medicine, in a news release. "But ordering tests when it's not indicated wastes resources and can subject patients to unnecessary treatment. We were able to reduce the number of tests ordered substantially without diminishing the quality of care at all."

Study: Surgical Gloves Before Surgical Gown Decreases Infection Risk

A study conducted by members of Duke University Medical Center's Department of Orthopaedic Surgery showed that putting on surgical gloves before putting on a surgical gown has a significant impact on sleeve contamination.

The study, which was published in The Journal of Arthroplasty, compared the differences in gown contamination between three different gown and glove donning techniques. The participants — Duke surgeons of varying experience levels — covered their hands with ultraviolet light disclosing lotion and then put on surgical gown and gloves using their preferred technique and the proposed technique in a randomly assigned order. Gowns were removed and analyzed under ultraviolet light for distance and quantity of sleeve contamination.

The finding: Gloving first demonstrated zero contamination in all samples, which researchers said was significantly less than both closed and open staff-assisted techniques.

The researchers' conclusions include the following: "We strongly recommend considering the use of this glove and gown donning technique as opposed to the currently accepted closed and open techniques in an effort to reduce gown contamination."

Speaking to Orthopedics This Week, Colin Penrose, MD, Duke University Medical Center orthopedic surgery resident and co-author, said, "Something so simple as putting on gloves, and it is easy to learn this new technique, could potentially have a significant positive impact on the surgical outcome."

Study: MRSA Infection Risk Greatly Reduced By Home Decolonization

The results of a new study indicate that decolonization efforts at home can significantly reduce the likelihood of infection for hospitalized patients harboring methicillin-resistant Staphylococcus aureus (MRSA).

A trial — called "Changing Lives by Eradicating Antibiotic Resistance (CLEAR) — randomly divided more than 2,100 adult hospital patients with colonized MRSA into one of two groups. One group received post-discharge hygiene education. The other received this education plus a decolonization protocol. Decolonization involved the use of chlorhexidine mouthwash; baths or showers with chlorhexidine; and nasal mupirocin by patients for five days repeated twice per month over six months. Participants were followed for 12 months following discharge.

Among the findings of the study, which was published in the New England Journal of Medicine: The decolonization group experienced 30% fewer MRSA infections and 17% fewer infections of any kind. Decolonization group patients who fully adhered to the regimen (i.e., did not miss any decolonization doses) experienced 44% fewer MRSA infections and 40% fewer infections overall.

As a press release noted, the Centers for Disease Control and Prevention (CDC) has shown that MRSA carriers discharged from hospitals are at high risk of serious disease from MRSA in the year following their discharge. Approximately 5-10% of hospitalized patients are MRSA carriers.

In the release, Dr. Mary Hayden, professor of internal medicine and pathology, chief of the division of infectious diseases and director of the division of clinical microbiology at Rush University Medical Center, said, "Our goal was to understand whether removing MRSA from the skin, nose and throat was better than hygiene education alone in reducing MRSA or other infections and associated hospitalizations. … With an issue this large, we wanted to find best practice strategies to prevent these infections and associated hospitalizations. This large clinical trial helped determine that there is a way to help prevent infections after patients go home and it can prevent readmission."