Infection Control Today

JUN 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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26 ICT June 2019 www.infectioncontroltoday.com N ew research released in March by the Centers for Disease Control and Prevention (CDC) indicate that more than 119,000 people suffered from bloodstream Staphylococcus aureus infections in the U.S. in 2017, and nearly 20,000 died. The fi ndings show that hospital infection prevention and control efforts reduced rates of serious staph infections, however, data also show that this success is slowing, and staph infections still threaten patients. The new data refl ect rates for all Staphylococcus aureus infections: methi- cillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA). According to electronic health record data from more than 400 acute-care hospitals and population-based surveillance data from CDC's Emerging Infections Program, MRSA bloodstream infections in healthcare settings decreased nationally by approximately 17 percent each year between 2005 and 2012. These reductions have recently started to stall, and the CDC reports an almost 4 percent increase in MSSA infections that originated outside of a healthcare setting each year from 2012 to 2017. The rise in staph infections in the community may be linked to the opioid crisis. As reported by CDC last year, 9 percent of all serious staph infections in 2016 happened in people who inject drugs — up from 4 percent in 2011. Patients presenting with recurring staph infections should prompt healthcare providers to consider whether injection drug use could be the cause. To decrease staph infections in people who inject drugs, healthcare providers should link patients to drug-addiction treatment services and provide information on safe injection practices, wound care, and how to recognize early signs of infection. Healthcare providers can protect patients by making staph prevention a priority. This includes implementing CDC recommendations, including the use of Contact Precautions (gloves and gowns), continually reviewing their facility infection data available from CDC's National Healthcare Safety Network (NHSN), and considering other interventions if they are not meeting infection reduction goals. While Staph Infections Still a Threat, Decolonization May Provide a Solution Based on the facility, additional prevention measures could include screening patients at high risk, or decolonization at high risk periods or for certain types of procedures. "We know infection prevention and control works but it's not one-size-fi ts-all. Additional strategies, including decolo- nization, for example, may be needed in certain circumstances and patients, to ensure optimal prevention and the best outcome for the patients," says Athena Kourtis, MD, PhD, MPH, associate director for data activities in CDC's Division of Healthcare Quality Promotion. For example, the U.S. Department of Veterans Affairs medical centers reduced staph infections by 43 percent between 2005 and 2017 by implementing a multi- faceted MRSA prevention program. The program included MRSA screening, use of Contact Precautions, and an increased emphasis on hand hygiene and other infection prevention strategies. In a recent study, MRSA infections and hospitalizations after hospital discharge were reduced by 30 percent in patients known to carry the bacteria on their body by a treatment that cleansed the bacteria from their skin or in their noses, according to new research funded by the Agency for Healthcare Research and Quality (AHRQ). Patients were treated with a combination of an over-the-counter antiseptic for bathing or showering, plus prescription antiseptic mouthwash and antibiotic nasal ointment. The study, published in the New England Journal of Medicine, included more than 2,000 patients with MRSA who were discharged from Southern California hospitals between 2011 and 2014. Patients in one group received an educational binder with recommendations for preventing infections via personal hygiene, laundry, and household cleaning. A second group received the same educational materials, but for six months also took steps to remove MRSA from their skin and noses with chlor- hexidine antiseptic for bathing, chlorhexidine mouthwash, and the nasal antibiotic ointment mupirocin. The participants were adults who were able to bathe or shower (either by themselves or with caregiver assistance), had been hospitalized in the previous 30 days, and tested positive for MRSA while in the hospital or 30 days before or afterward. (California mandates MRSA screening at hospital admission in high-risk patients). In the overall treatment group, the 30 percent reduction in MRSA infections was accompanied by a 17 percent reduction in all infections, according to the study results. Of note, participants who followed the treatment completely had a 44 percent reduction in MRSA infections and a 40 percent reduction in all infections. "It is estimated that MRSA causes more than 80,000 invasive infections each year in the U.S.," says AHRQ director Gopal Khanna, MBA. "The results of this study show that focused attention on removing MRSA can reduce infections and make a measurable difference in the lives of patients. We're pleased that this work adds signifi cantly to the Agency's track record of supporting vital research to improve the safety of healthcare." Side effects were minimal among patients who used the decolonization treatment, the researchers report. About 2 percent of patients reported mild side effects to the antiseptic for bathing, while 1 percent reported mild side effects to the mouthwash or nasal ointment. About 40 percent of those who experienced side effects from a product opted to continue their use. "Protecting the health of patients after discharge is an important part of care," says Susan Huang, MD, MPH, professor of medicine in the Division of Infectious Diseases and medical director of epidemiology and infection prevention at the University of California Irvine, School of Medicine. "But not enough is known about how to help patients avoid infections, including those patients who harbor highly antibiotic-resistant pathogens. This study represents an important step toward keeping patients safe." The Project CLEAR Trial was conducted through longstanding collaborations between the University of California Irvine, Los Angeles feature

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