The March 2019 issue of the ICCS Infection Prevention & Control Newsletter has published.
The issue includes a special report on instructions for use and stories on outpatient surgical guidelines, dental infection compliance, PPE, staph and polymyxins.
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A new study shows that when healthcare workers do not properly remove their personal protective equipment (PPE), the likelihood of bacterial contamination increases significantly.
The study was performed at a tertiary-care teaching hospital. Researchers monitored and evaluated samples taken from 125 healthcare workers — mostly nurses or physicians — in four adult intensive care units caring for patients colonized or infected with a multi-drug resistant organism (MDRO), according to a Society for Healthcare Epidemiology of America (SHEA) news release.
The study's results were published in SHEA's Infection Control and Hospital Epidemiology journal. Findings included the following:
Nearly 40% percent of workers made errors in removing their PPE, including gowns and gloves, when evaluated by Centers for Disease Control and Prevention (CDC) guidelines. This was despite the fact that, as the release notes, a significant majority of the workers had undergone training on appropriate methods for donning and doffing PPE within the past five years.
Following patient contact, 36% of workers were contaminated with an MDRO.
After removing PPE, more than 10% were contaminated on their hands, clothing or equipment.
Workers who made multiple PPE-removal errors were more likely to be contaminated after a patient encounter.
"Based on these findings, we should reevaluate strategies for removing PPE, as well as how often healthcare workers are trained on these methods," said Dr. Koh Okamoto, a lead author of the study, in the release. "An intervention as simple as education about appropriate doffing of PPE may reduce healthcare worker contamination with MDROs."
Two of the top five most commonly cited violations by the Dental Board of California in 2018 concern infection control and prevention, according to a California Dental Association (CDA) report.
The report, which summarizes the findings of the Dental Board of California's 2018 Sunset Review Report to the California Legislature, identifies "failure to follow infection control guidelines" and "failure to comply with bloodborne requirements" as common areas for citation. Rounding out the top five list:
Failure to produce patient records
Grounds for action: Conduct of proceedings
Unprofessional conduct
CDA notes that the number of citations issued by the Dental Board of California is on rise: 47 citations were issued in fiscal year (FY) 2015-16; 56 citations in FY 2016-17; and 64 citations in FY 2017-18.
The findings and increase in citations come as no surprise to Infection Control Consulting Services (ICCS). They are consistent with observations made by ICCS consultants who provide dental infection control services to dental offices and oral surgery centers nationwide.
An international panel of infectious disease and antimicrobial researchers have published new practice guidelines for the clinical use of polymyxin antibiotics.
Polymyxins are a class of antibiotics that have "… assumed an important role as salvage therapy for otherwise untreatable gram‐negative infections, most notably multidrug‐resistant (MDR) and extensively drug‐resistant (XDR) strains of Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacteriaceae," according to the guidelines, which were published in Pharmacotherapy.
The guidelines specifically concern the polymyxin antibiotics colistin (polymyxin E) and polymyxin B. They became available in the 1950s, but their use fell out of favor because of toxicity concerns, according to a news release. However, in the effort to combat superbugs, their clinical use has resurged.
Unfortunately, as the researchers note in the guidelines, "Since their reintroduction into the clinic, significant confusion remains due to the existence of several different conventions used to describe doses of the polymyxins, differences in their formulations, outdated product information and uncertainties about susceptibility testing that has led to lack of clarity on how to optimally utilize and dose colistin and polymyxin B."
The guidelines establish new standards for polymyxins in areas including maximum dosage, treatment strategies and best practice for use in combination with other antibiotics.
"These guidelines represent consensus recommendations from expert clinicians and scientists around the globe to guide polymyxin therapy in gram-negative infections where no treatments appear to exist," said Brian Tsuji, who co-led the panel and is professor of pharmacy practice in the University of Buffalo School of Pharmacy and Pharmaceutical Sciences, in the release.
The guidelines have received endorsements from the American College of Clinical Pharmacy, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, International Society for Anti-infective Pharmacology, Society of Critical Care Medicine and Society of Infectious Diseases Pharmacists.
Timely discontinuation of antimicrobial prophylaxis following outpatient surgery is better achieved in higher complexity organizations with stronger infection prevention and antimicrobial stewardship services and support, according to a new study.
Published in Antimicrobial Resistance & Infection Control, the study examined more than 150,000 outpatient procedures in general surgery, urology, ophthalmology, otolaryngology (ENT) and orthopedics performed in Veterans Health Administration (VA) facilities. The procedures were performed at 70 higher complexity hospital outpatient departments (HOPDs), 41 lower complexity HOPDs and 22 ambulatory surgery centers (ASCs), also considered lower complexity, with complexity defined by the VA. Researchers identified which patients continued to receive antimicrobial prophylaxis lasting more than 24 hours after surgery.
Evidence-based guidelines, as the study notes, recommend discontinuation of antimicrobial prophylaxis within 24 hours after incision closure in uninfected patients. Unnecessary antimicrobial exposure, the researchers note, can lead to increases in postoperative adverse events.
Findings included the following:
About 7,700 patients (5.0%) received antimicrobial prophylaxis lasting more than 24 hours after surgery.
Highest rates were associated with cystoscopies and cystoureteroscopy with lithotripsy (16% and 20%, respectively).
Hernia repair, cataract surgeries and laparoscopic cholecystectomies had the lowest rates (0.2%-0.3%).
Furthermore, the researchers found that organizations with applicable ancillary services (e.g., infectious diseases, infection prevention, antimicrobial stewardship) typically found in higher complexity facilities leads to lower rates of postoperative prophylactic antimicrobial use and more guideline-consistent care compared to lower complexity facilities where such services are not often available or readily accessible.
The researchers conclude, "Lower complexity facilities with limited infection prevention and antimicrobial stewardship resources may be important targets for quality improvement. … Increasing pharmacy, antimicrobial stewardship and/or infection prevention resources to promote more evidence-based care may support surgical providers in lower complexity ASCs and HOPDs in their efforts to improve this facet of patient safety."