Septic Arthritis Outbreak Linked to Infection Prevention Violations

An investigation into an outbreak of septic arthritis at an outpatient facility in New Jersey identified multiple breaches of recommended infection prevention practices.

The results of the investigation were published in Infection Control & Hospital Epidemiology (ICHE), the journal for the Society for Healthcare Epidemiology of America (SHEA).

As the ICHE article — "Bacterial septic arthritis infections associated with intra-articular injection practices for osteoarthritis knee pain—New Jersey, 2017" — notes, the N.J. Department of Health received reports of multiple patients who developed septic arthritis following intra-articular injections for osteoarthritis knee pain provided at the same private outpatient facility.

An infection prevention assessment of the facility's practices found 41 patients with septic arthritis associated with intra-articular injections and identified "multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices and poor cleaning and disinfection practices."

A SHEA news release notes that of the 41 patients identified, 33 required surgical removal of damaged tissue.

The outbreak was costly, with the release noting that for just 31 affected Medicare patients, charges claimed for treatment surpassed $5 million.

The outpatient facility, which voluntarily stopped performing procedures following the initial septic arthritis reports as well as complaints, was advised by state officials to follow recommendations in the Centers for Disease Control and Prevention’s 2016 Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. It was also recommended that the facility work with an infection prevention consultant on improvements. No additional cases were identified after infection prevention recommendations were implemented.

Study: Healthcare-Acquired Infections Account for 16% of Medical Errors

The results of a new study indicate that healthcare-acquired infections (HAIs) are associated with nearly one in six incidents of preventable patient harm.

The research, published in The BMJ, examined 70 previously published studies covering more than 337,000 patients. Researchers concluded that about one in 10 patients are harmed when receiving care, and around one in 20 patients experience preventable harm. The proportion of severe preventable patient harm causing permanent disability or death was 12%. 

The researchers found that drug management incidents (25%) and other therapeutic management incidents (24%) accounted for the highest proportion of preventable patient harm. They were followed by incidents related to surgical procedures (23%), healthcare infections (16%) and diagnosis (16%).

The study was international, but Maria Panagioti, lead author and a senior lecturer at the University of Manchester, told NBC News that its findings would be applicable to the United States.

The researchers conclude, "Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm. Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective."

Ebola Outbreak in Congo Declared Global Emergency By WHO

The World Health Organization (WHO) has declared the Ebola outbreak in the Democratic Republic of Congo (DRC) as a "public health emergency of international concern."

As a WHO news release notes, the declaration follows recent alarming developments concerning the outbreak, including the first confirmed case in Goma, the capital of North Kivu province located in the eastern DRC. About two million people reside in Goma, which is on the border with Rwanda and is described by WHO as "the gateway to the rest of DRC and the world."

WHO released a statement that included a series of recommendations for affected countries, neighboring countries and all countries.

Despite the declaration, WHO acknowledged that the risk of Ebola spreading beyond the affected area is presently low. During a press conference, WHO Director-General Dr. Tedros Adhanom Ghebreyesus is quoted as stating, "Our risk assessment remains that the risk of Ebola spread in DRC and the region remains very high, and the risk of spread outside the region remains low."

The latest Ebola outbreak in DRC was declared in August 2018. As of July 15, 2019, WHO reports the total number of confirmed Ebola cases in the DRC at more than 2,400 and nearly 1,600 confirmed deaths.

Study: Efforts to Reduce Catheter-Induced Infections Coming Up Short

The results of a new study show that despite awareness of the infection risks posed by indwelling urinary and vascular catheters, barriers remain that contribute to reduced effectiveness in decreasing these infections.

For the study, conducted by the University of Michigan and published in the American Journal of Critical Care, researchers interviewed a group of nurses, physician assistants, nurse practitioners and physicians, according to a news release. The interviews addressed problems associated with monitoring and communicating among teams about patients' indwelling catheters. As the release notes, indwelling devices like catheters have been shown to cause about 25% of all hospital infections.

Those interviewed noted that factors such as poor communication between physicians and nurses; workflow misalignment between clinicians; issues with electronic medical records and pagers; and strained relationships between clinicians and hierarchies all helped stifle efforts to decrease catheter use and misuse.

The study results indicate that 60% to 90% of intensive care unit (ICU) patients and 10% to 30% of patients outside the ICU have urinary catheters, many of which are unnecessary or remain in patients for too long.

Study: Patients Who Experience Joint Infection 3X More Likely to Suffer Future Infection

The results of a new study show that patients who experience a prosthetic joint infection following primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) are at three times higher risk of suffering another such infection if they undergo another TKA.

The study, published in The Bone and Joint Journal and conducted by researchers from Mayo Clinic, examined 95 patients (undergoing 102 primary TKAs) who were treated between 2000 and 2014 and had a history of prosthetic joint infection in another TKA or THA. Of these patients, 27% were on chronic antibiotic suppression. 

In addition to identifying the three-fold higher risk of prosthetic joint infection, researchers found that the risk was 15 times higher for those patients on chronic antibiotic suppression.

Infection Control Consulting Services (ICCS) has experienced an increase in the number of requests to conduct observations at facilities that perform prosthetic joint replacement surgeries because of concerns about or reports of infections attributable to various organisms. Our highly skilled team of certified infection control consultants works with the surgical staff of these organizations, including surgeons, to determine likely causes and implement mitigation strategies.

Joint infections are complex, and it takes a team approach to conduct an in-depth workup. At times, the potential cause(s) is not obvious and there are often several factors that play a role in joint infections. We can proudly report that we have had tremendous success with assisting in the reduction or elimination of joint infections, particularly when we are able to determine what processes and/or products, devices and equipment contribute to the infections.