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CME: An Update for Preventing MRSA

CME: An Update for Preventing MRSA

In 2008, the Society for Healthcare Epidemiology of America and Infectious Diseases Society of America—partnering with the American Hospital Association, Association for Professionals in Infection Control and Epidemiology, and the Joint Commission—published the “Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals,” a collection of recommendations focused on common hospital-acquired infections. With new research emerging and the need for up-to-date information, the organizations recently released an update to the compendium. As part of the compendium, updated recommendations were made on the prevention of MRSA infection and transmission. Getting to the Basics Published in Infection Control and Hospital Epidemi-ology, the recently updated compendium recommendations provide a roadmap for prioritizing and implementing strategies to help prevent MRSA infection and transmission. These strategies are broken down into basic practices (Table 1) and special practices. “Based on evidence, expert opinion, and experience, the basic practices are recommended for all hospitals, regardless of the burden of MRSA,” explains lead author David P. Calfee, MD, MS. “These are good, basic infection control practices. Many would be useful in preventing a wide variety of healthcare-associated infections (HAIs) and preventing transmission of various pathogens, including MRSA.” When considering MRSA control practices, conducting a risk assessment is important. This should include an analysis of infection rates, the basic practices that have and have not been implemented already, and whether implemented practices are adhered to consistently, according to Dr. Calfee. “Writing a policy and making sure it’s actually being followed are two different things,” he adds. “A good understanding of the epidemiology of MRSA within your facility is really the first step.” He notes that all providers...
An Update for Preventing MRSA

An Update for Preventing MRSA

In 2008, the Society for Healthcare Epidemiology of America and Infectious Diseases Society of America—partnering with the American Hospital Association, Association for Professionals in Infection Control and Epidemiology, and the Joint Commission—published the “Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals,” a collection of recommendations focused on common hospital-acquired infections. With new research emerging and the need for up-to-date information, the organizations recently released an update to the compendium. As part of the compendium, updated recommendations were made on the prevention of MRSA infection and transmission. Getting to the Basics Published in Infection Control and Hospital Epidemi-ology, the recently updated compendium recommendations provide a roadmap for prioritizing and implementing strategies to help prevent MRSA infection and transmission. These strategies are broken down into basic practices (Table 1) and special practices. “Based on evidence, expert opinion, and experience, the basic practices are recommended for all hospitals, regardless of the burden of MRSA,” explains lead author David P. Calfee, MD, MS. “These are good, basic infection control practices. Many would be useful in preventing a wide variety of healthcare-associated infections (HAIs) and preventing transmission of various pathogens, including MRSA.” When considering MRSA control practices, conducting a risk assessment is important. This should include an analysis of infection rates, the basic practices that have and have not been implemented already, and whether implemented practices are adhered to consistently, according to Dr. Calfee. “Writing a policy and making sure it’s actually being followed are two different things,” he adds. “A good understanding of the epidemiology of MRSA within your facility is really the first step.” He notes that all providers...
Bronchitis in the ED: Analyzing Antibiotic Use

Bronchitis in the ED: Analyzing Antibiotic Use

Although antibiotics are often used in patients with common bacterial causes of acute bronchitis, current guidelines recommend against this practice, especially for cases of uncomplicated acute bronchitis, as most are viral in etiology. Fever, purulent sputum, shortness of breath, the presence of comorbid conditions, and a provider age of 30 or younger are factors that increase the likelihood of prescribing antibiotics for acute bronchitis. Better characterization of prescribing practices in the ED is needed in order to guide efforts to reduce the inappropriate use of antibiotics. A Closer Look at Antibiotic Use My colleagues and I had a study published in the Journal of Emergency Medicine that reviewed antibiotic and bronchodilator prescribing practices of emergency physicians at two EDs in patients with acute bronchitis. The investigation aimed to characterize key factors that were associated with antibiotic prescribing practices. Specifically, we looked at the frequency of antibiotic prescriptions, the class of antibiotic prescribed, and related factors, including age, gender, chief complaint, duration of cough, and comorbid conditions. In our analysis, antibiotics were grossly overprescribed in acute bronchitis, with 74% of adults receiving these therapies. Of those who were prescribed these medications, most (about 77%) received broad-spectrum antibiotics. Prescribing practices for acute bronchitis did not decrease significantly from what has been shown in prior studies. Patients aged 50 and older and those who smoked were more likely to be prescribed antibiotics, but no other factors appeared to increase antibiotic prescribing practices. Among patients without asthma, nearly half were discharged without a bronchodilator, and more than 90% were discharged without a spacer device. Impact on Patient Care for Acute Bronchitis Although there...

Antimicrobial Stewardship Programs: A Call to Action

Over the past 30 years, many multidrug-resistant organisms have emerged across healthcare settings in the United States. At the same time, there has been a dramatic drop in the development and approval of new antibiotics. “The antimicrobial armamentarium has been depleted,” explains Neil Fishman, MD. “As a result, our ability to treat infectious diseases has been severely compromised. Resistant infections are increasing morbidity and mortality while simultaneously increasing healthcare costs.” Research has shown that a multifaceted approach is required to prevent, detect, and control the emergence of antimicrobial-resistant organisms. This includes ensuring that effective and appropriate therapeutic agents are available and that healthcare settings have the diagnostic capacity to rapidly and reliably detect specific pathogens and their antimicrobial susceptibilities. Promoting better infection prevention and control practices and antimicrobial stewardship programs is important in reducing the burden of infectious diseases, Dr. Fishman says. More healthcare facilities nationwide are launching antimicrobial stewardships because they have the potential to reduce the emergence and transmission of resistant pathogens and decrease antimicrobial resistance. A Joint Position Statement on Antimicrobial Stewardship In the April 2012 issue of Infection Control and Hospital Epidemiology, the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) published a joint position paper focusing on the need for public policy around the issue of antimicrobial stewardship. SHEA, IDSA, and PIDS have been at the forefront of addressing the need for antimicrobial resistance programs for many years, says Dr. Fishman, co-author of the position paper. “Great efforts are needed to improve prevention and control practices throughout the country.” Key Recommendations...

IDWeek 2012: Reducing Bloodstream Infections in the ICU

The Particulars: Many infections in ICUs are caused by increasingly antibiotic-resistant bacteria that live on the skin and in the nose. Although these infections are often preventable, they can cause serious complications, prolong hospital stays, and increase costs and mortality. Data Breakdown: More than 40 hospitals participating in a study were randomized to one of three interventions. The first was to continue routine care, screen ICU patients for MRSA, and isolate those who carried it. The second group screened and isolated patients carrying MRSA and bathed them in chlorhexidine soap and applied nasal mupirocin ointment. The third group treated all ICU patients with a daily chlorhexidine bath and 5 days of nasal mupirocin ointment. Among patients randomized to the third group, the number of ICU patients carrying MRSA decreased nearly 35%, compared with no change among the other two groups. Additionally, the rate of bloodstream infections decreased from 6.1 to 3.6 per 1,000 patient days in the hospital in the third group. Take Home Pearl: Treating all ICU patients with antimicrobial soap and ointment appears to significantly decrease their risk of developing bloodstream infections during...
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