The April 2019 issue of the ICCS Infection Prevention & Control Newsletter has published.
The issue includes stories on Joint Commission top challenging standards, duodenoscopes, knee replacement, sharps injuries, outpatient prescribing of antibiotics, rotator cuff surgery and much more.
Access the latest issue of our infection prevention newsletter.
Receive the free ICCS Newsletter by signing up here.
A study reveals that a significant percentage of antibiotic prescriptions are unnecessarily prescribed to outpatients.
The study, published in the American Journal of Infection Control (AJIC), the journal of the Association for Professionals in Infection Control and Epidemiology (APIC), assessed nearly 1,100 outpatients at the Veterans Affairs Western New York Healthcare System over a several-month period in 2017.
Researchers found that outpatient providers inappropriately prescribed antibiotics to 40% percent of patients — higher than the figure seen in prior studies.
An electronic alert following prescription was used to determine common causes of inappropriate antibiotic use. Findings include the following:
Urinary tract infections, bronchitis, skin structure infections and sinusitis were common causes of inappropriate antibiotic use.
Azithromycin was prescribed unnecessarily most often. It was followed by ciprofloxacin, amoxicillin/clavulanate and cephalexin. Together, they accounted for 80% of all unnecessary outpatient prescriptions.
Compared to patients in outpatient clinics, those seen in emergency departments were twice as likely to receive an antibiotic only when needed.
Researchers note that outpatient prescriptions comprise 60% of antibiotic use.
In an APIC news release on the study, APIC President Karen Hoffmann is quoted as saying, "Antimicrobial stewardship programs are common in inpatient scenarios, but this research reinforces the point that there continues to be a significant need to build momentum for such initiatives in the outpatient setting."
Concerning antibiotic misuse, the Centers for Disease Control and Prevention note, "Patients who are unnecessarily exposed to antibiotics are placed at risk for serious adverse events with no clinical benefit. The misuse of antibiotics has also contributed to the growing problem of antibiotic resistance, which has become one of the most serious and growing threats to public health. Unlike other medications, the potential for spread of resistant organisms means that the misuse of antibiotics can adversely impact the health of patients who are not even exposed to them."
CDC estimates more than two million people are infected with antibiotic-resistant organisms, resulting in approximately 23,000 deaths annually.
A study has identified the most important risk factors for developing severe infection following knee replacement surgery.
The research, which was published in The Lancet Infectious Diseases, involved analysis of more than 679,000 primary knee replacements, of which nearly 3,700 were revised for an indication of prosthetic joint infection. Researchers from the Musculoskeletal Research Unit at the University of Bristol determined that the following were the notable risk factors:
patients under 60 years of age;
males;
those with a pre-existing history of chronic pulmonary disease, diabetes, liver disease, connective tissue or rheumatic disease, or peripheral vascular disease; and
those with a higher body mass index.
The researchers conclude, "Some of these factors are modifiable, and the use of targeted interventions or strategies could lead to a reduced risk of revision for prosthetic joint infection. Non-modifiable factors and the time-specific nature of the effects we have observed will allow clinicians to appropriately counsel patients preoperatively and tailor follow-up regimens."
The results of a new study show that the off-label use of a variety of products by endoscopists contribute to reprocessing failures, raising the risk of infection.
The study, published in the American Journal of Infection Control, examined reprocessed endoscopes from several hospitals. Visual inspections detected different types of residue on and in the scopes. Researchers found that microbial cultures were positive for at least half of the endoscopes. Hospital personnel reported the off-label use of simethicone, cooking spray, silicone spray and tissue glue during endoscopy.
As the researchers note, these products are insoluble and cannot be removed by reprocessing technicians, thus potentially affecting reprocessing effectiveness.
The researchers conclude: "Infection preventionists should determine whether these products are used in their institutions and evaluate methods for removing them. New policies may be needed to support procedural success and effective endoscope reprocessing."
Surveys of healthcare workers indicate a troubling trend: The number of sharps injuries is increasing.
The EXPO-S.T.O.P. (EXPOsure Survey of Trends in Occupational Practice) 2016 and 2017 surveys were conducted by the Association of Occupational Health Professionals in Healthcare (AOHP), with their results published in the AOHP Journal.
An Infection Control Today report covering the surveys and their results noted that "EXPO-S.T.O.P. is an electronic survey designed to ascertain the incidence of sharps injuries and mucocutaneous blood exposures among healthcare workers in U.S. healthcare facilities." The 2016 survey included facilities in 37 states, while the 2017 survey — AOHP's largest to date — included 224 hospital participants.
The 2016 and 2017 surveys' results point to a significant increase in blood exposure incidence over the 2011 results and continue this trend, which was witnessed in the 2015 survey. Furthermore, the 2017 sharps injuries rate is almost back to the 2001 rate. That was the year that the Needlestick Safety and Prevention Act was enacted, which contributed to a substantial decrease in sharps injuries in the years that followed, according to the report.