Posts Tagged ‘HAI’

To Decolonize, or Not to Decolonize

June 5th, 2013

…  that is the question- at least when it comes to whether to take standard measures to decolonize intensive care patients with antibiotic ointments in their nose to remove Staphylococcus bugs.  Hospital associated infections are a critical public health and healthcare cost problem.  While we’re losing ground in our fight against obesity- we’re making progress toward reducing healthcare associated infections both here in AZ and across the country. 

A study published in the New England Journal of Medicine this week found that that “universal decolonization” of intensive care patients can reduce MRSA infections by up to 37% and other  bloodstream infections by 44%.  This was a big study (about 74,000 patients in 43 hospitals), meaning that these results carry a fair amount of statistical weight.  This study will provide additional information to the infectious disease practitioners in AZ as they craft and implement hospital infection control plans. 

We’re making it a priority to prevent hospital associated infections by maintaining our HAI Program and by licensing and inspecting healthcare facilities across the state.  We also facilitate a multidisciplinary HAI Advisory Committee that identifies and addresses priority areas for Arizona.  This dedicated group of partners has collaborated continuously since 2009 to coordinate prevention efforts across the state. The partnerships and open dialogue help us improve surveillance, report and prevent hospital associated infections, which support our Strategic Map goal of reducing healthcare associated infections and re-admissions.

Preventing Healthcare Associated Infections: An AZ Winnable Battle

January 4th, 2013

Healthcare-associated infections are a critical public health challenge in Arizona and in the US. Healthcare associated infections (HAIs) are acquired during healthcare treatment and can be devastating and even deadly- and they’re largely preventable. You may have seen the article in last week’s Republic about dirty needles and their link to transmission of viruses and drug-resistant superbugs. The article mentions a recent Arizona incident in which unsafe injection practices at a pain management clinic- which had been investigated by our disease detectives in AZ’s public health system and summarized in an MMWR article last Summer.

Arizona’s public health system takes a layered approach to preventing HAI’s in our state.  It starts with our Licensing team- who regulates the healthcare institutions where care is given.  Our regulations set the standards that prevent infections and our teams of surveyors do routine checks and complaint investigations to make sure facilities are in compliance with our standards.  We already have solid infection control regulations for hospitals and nursing homes…  but our current Rulemaking for healthcare institutions will be establishing new infection control standards across the board that’ll be applied consistently across all health care institutions in the second half of 2013.

At another level, our Medical Facilities Licensing team and our HAI Program collaborate to ensure the safety of patients in Arizona by jointly providing technical assistance and guidance to licensed healthcare facilities in response to identified infection control breaches. Through our HAI Program and our HAI Advisory Committee– we generate guidance documents for all healthcare facilities and promote best practices for infection control and injection safety like materials produced through the CDC’s One and Only Campaign and our No Place Like Home initiative which is Arizona’s approach to the national Partnership for Patients: Better Care, Lower Costs project.

The next layer is our network of public health disease detectives.  Our Healthcare-Associated Infections Program and the counties conduct  epidemiologic investigations when we get reports of unsafe injection practices affecting multiple patients. For example…  last year we investigated 3 separate instances of unsafe injection practices- exposing 327 people to disease and resulting in 3 infections.  Each of the investigations identified unsafe injection practices like: 1) Re-inserting a used syringe into a medication vial; 2) Using a single-dose vial for more than one patient; 3) Diluting medicine beyond the manufacturer’s recommendations; 4) Improper use of personal protective equipment prior to spinal/lumbar injections; and 5)  Illegal contamination of needles/syringes and injectable reagents.

Many of the gaps in infection control have roots at the national level.  A national drug shortage on many reagents and medications (including appropriate concentrations and single-use vial sizes) has compelled some healthcare practitioners to search for alternate solutions to ensure availability and to use medications as economically as possible. Some practices, like using single-dose vials for multiple patients, may be considered an industry standard in some fields and may still be taught and practiced, despite CDC injection safety guidelines inclusion in Standard Precautions since 2007. Many of these challenges can be safely addressed through medication repackaging into single-dose vials by a licensed compounding pharmacy appropriately applying the U.S. Pharmacopeia standards.

In short- healthcare associated infections remain a public health problem nationally and in Arizona- but by continuing to effectively use our licensing survey teams, effectively using the network of disease detectives we have in our county and state public health system, and by leveraging the work of our HAI Advisory Committee, the One and Only Campaign, and Arizona’s No Place Like Home Initiative- preventing healthcare associated infections remains a Winnable Battle.


ADHS’ Disease Detectives

July 25th, 2012

Awhile back, our epidemiology and licensing team of disease detectives including Jason Lempp, Cara Christ, Vinita Oberoi, Jessica Rigler, Ken Komatsu, Kathy McCanna, Connie Belden, Ken Komatsu, and Shoana Anderson learned of a severe case of a Methicillin-resistant Staphylococcus aureus  (MRSA) through our 24-hour disease reporting system.  Our team quickly contacted the county public health department which immediately began an investigation into the cause.  

Their investigation quickly uncovered more people with the infection who had been seen the same day.  The detectives also found that a single-dose vial of solution used for pain meds was diluted and used for more than one patient.  Medication shortages often push health-care providers to search for solutions to provide comparable care using limited supplies- which is what looks like happened in this case.  

Our work with the county led to an improvement in the clinic’s practices through discontinued use of mixed products; appropriate use of single dose vials; using personal protective equipment, such as face masks, during medication preparation and injections procedures; education of all staff on infection control practices; and the development of a plan to report further suspected infections.  This Arizona investigation was written up in this week’s CDC Feature Article and has added to the national picture on injection safety best practices. 

Note: Health-care-associated infections (HAI) affect nearly 100,000 people every year and result in over $30B in unnecessary health-care costs (HHS).  Our HAI Program works with partners across the state to rapidly identify and help prevent these infections. Traditionally, the focus of preventing HAIs has been in hospital settings, but more and more people are being identified outside of hospital settings.  They can happen at any health-care facility, but simple steps can help protect patients.

New Healthcare Associated Infections Toolkit

April 15th, 2011

Healthcare-associated infections are a critical challenge to public health in Arizona.  Healthcare associated infections are acquired during healthcare treatment and can be devastating and even deadly- importantly, they’re preventable.  At any given time, about 1 in 20 patients have an infection while receiving healthcare treatment in U.S. hospitals, causing up to $33B in excess medical costs every year.  For example, a single central-line associated bloodstream infection can result in an estimated $16,550 in excess medical costs. The Association of State and Territorial Health Officials recently developed a handy new toolkit called “Eliminating Healthcare Associated Infections: State Policy Options” which provides ways to use legal and policy interventions as tools to implement a comprehensive HAI prevention program.

Healthcare Associated Infections Report

March 7th, 2011

Good news this time.  The number of bloodstream infections in intensive care unit patients with central lines decreased by 58% over the last 10 years according to a new CDC Vital Signs report. This decrease saved 27,000 lives and $1.8B in excess health care costs. Bloodstream infections in patients with central lines can be deadly, killing as many as 1 in 4 patients who gets one.

Most hospital Infectious Disease Committees follow central line infections very closely these days. Back in the day (about 10-15 years ago), it was common practice to put in central lines at the bedside with only a pair of sterile gloves. Now most hospitals require full gowning, face mask, and cap, along with full sterile draping of the patient. This is even required now in many ORs for central lines put in patients right before surgery.

You can check out our website dedicated to preventing Healthcare Associated Infections.   We also help facilitate communication through the hospital association for facilities that are participating in the national collaborative “On the Cusp” to prevent blood stream infections.  Part of our strategic initiatives for 2011 is to help address blood stream infections in hemodialysis units so our prevention efforts will be extending beyond acute care hospitals.

By the way- a “central line” and a simple “IV” are different things.  Central lines are inserted into large veins  and are pretty big because they need to handle a large volume.  Simple IV’s usually go into veins.  IV’s have a much lower risk of infection.

Handwashing Report

March 3rd, 2011

A recent report in Surgery News found that a six-month “process improvement project” that added a simple hand-washing question to the daily ICU checklist decreased the rate of central line-associated bloodstream infections in a surgical ICU.

Infection Prevention in AZ

October 22nd, 2010

Healthcare-associated infections claim more lives in Arizona every year than auto accidents or influenza.  Surprised?  That’s why the Governor issued a proclamation making this week as Infection Prevention week in Arizona- providing us with an opportunity to call attention to one of the CDC’s Winnable Battles–  defeating Healthcare-Associated Infections.  We had a news conference (along with hospital partners) this week to talk about our statewide efforts reduce these unnecessary and preventable infections.  These infections don’t just claim lives, they’re real expensive too, on my blog in March, I talked about a study in the Annals of Internal Medicine outlining just how expensive these infections are.

New numbers from the just released 2009 Vital Statistics report talk about one of these infections called C.diff.  In 2009, about 2,500 Arizonans were hospitalized with intestinal inflammation from Clostridium difficile, a bacterial inflammation of the intestines. This disease is of growing public health concern because it is sometimes acquired in hospitals and other health care institutions with long-term patients as residents. In 2009, 161 Arizonans died from intestinal inflammation (enterocolitis) due to Clostridium difficile. Those 65 years or older accounted for about 90% of the deaths.

We’ve got to work smart to get rid of healthcare-associated infections, educating both providers and the public.  Our Licensing division works with all healthcare and long term care facilities to make sure they use best practices.  Some of the most effective interventions are the most simple and low-tech:  good hand washing by all healthcare professionals, doing a quick nasal swab before surgery and using a different cleanser on the skin before surgery.  Simple steps like these and a long term plan can make a difference in protecting those in hospitals.

We’re also working a different angle to educate the public; we are holding a contest asking the public to make a video to teach the rest of the folks and there’s a $500 prize (paid for by an association control specialists in the state). Even though staff and family can’t win, be sure to let your friends know – we really want a creative answer to teach the public.  More details are on our website:

5 “Winnable Public Health Battles” Infection Control

May 24th, 2010

I was in Atlanta a couple of weeks ago for new health officer orientation and was able to meet with Dr. Frieden (the new head of the CDC) a couple of times.  Each time that we met he referred to a general theme that the CDC will be using over the next 3 years to drive public health policy- it’s called Public Health’s “Winnable Battles”.  CDC will be increasingly  focusing its strategic planning on public health and policy interventions to help win the 5 “Winnable Battles”.  There’s not much on the CDC’s website yet on the new strategy- but moving forward you’re sure to hear about them.  I’ll introduce them to you this week:

1. Infection Control

This one is probably the most winnable “Winnable Battle” in the short run.  Healthcare-associated infections are  acquired when being treated for something else in a healthcare setting. They’re one of the top-10 leading causes of death in the US.  We’ve developed a Healthcare-Associated Infection (HAI) and Antibiotic Resistance resource page to help healthcare providers to develop and implement better plans to reduce healthcare associated infections.

Unlike the problems of teen pregnancy, smoking, and obesity- interventions to reduce healthcare acquired infections can have an impact even in the short run.  The CDC’s Infection Control website also has information to help providers do better in this area.


March 3rd, 2010

Post-surgery infections cost a fortune.  Health care–associated infections cause 1.7 million extended hospitalizations each year.  A study published last week in the Archives of Internal Medicine looked at the clinical and economic costs from these infections which are poorly understood.  The researchers looked at national hospital discharge records to find sepsis (blood borne infections) and pneumonia cases- specifically excluding community-acquired infections.

They found that the average extra hospital stay from sepsis after an invasive surgery was about 11 days, costs were about $33,000 extra each, and about 20% of the folks who contracted sepsis died.  For pneumonia, the average extra stay was 14 days, cost $46,400, and  11% of patients with pneumonia died.

You can read more in the report and, don’t forget, our final report contains an assessment of infection control activities in AZ and highlights a series of recommendations to improve AZ’s track-record for controlling infections that occur in health care settings.