Study: Understaffing of Nurses Increases Infection Risk

The results of a new study indicate there is a correlation between nurse understaffing and elevated healthcare-associated infection risk.

The study, published in The Journal of Nursing Administration, analyzed multiple data sets gathered over a period of several years from an urban hospital system.

The key finding: When nurse understaffing occurred (defined as below 80% of unit median) on a unit for both shifts (day and night) in a day, patients on those units were much more likely to develop a healthcare-associated infection (HAI) two days later.

The researchers' conclusions include the following: "… a break of continuous care due to nurse understaffing will directly affect patient outcomes. In addition, a continuous unit staff shortage may also indicate an underlying issue with the working environment. Nurse administrators need to implement effective solutions to ensure adequate nurse staffing and provide safe and reliable care to acutely ill hospitalized patients."

The project received approval from Columbia University Medical Center and Weill Cornell institutional review boards.

Expert Council Pushes for Hospital Antibiotic Stewardship Requirement

The Presidential Advisory Council on Combating Antibiotic Resistant Bacteria (PACCARB), which provides recommendations to Health and Human Services (HHS) on federal programs and policies to combat antibiotic resistance, is urging the finalization of a policy that would make antibiotic stewardship programs a requirement for U.S. hospitals.

In an April letter to HHS Secretary Alex Azar, PACCARB states the following: "There is a critical need for mandatory, not voluntary, implementation of antibiotic stewardship programs in our nation's hospitals to curtail the over-prescription of antibiotics — a lead cause in the rise in antibiotic resistance. We urge the immediate finalization of the proposed Centers for Medicare and Medicaid Services (CMS) conditions of participation (CoP) rule, in advance of the upcoming June 2019 deadline. This rule requires the adoption of antibiotic stewardship programs in hospitals, especially critical access hospitals (CAHs), to help reduce the daunting overtreatment of patients with unnecessary broad-spectrum antibiotics and, thereby, improve the care of patients receiving the appropriate antibiotics.

"… The PACCARB believes that requiring hospitals and CAHs to develop and implement antibiotic stewardship programs will have a direct, positive and immediate impact on antibiotic prescribing practices, thus aiding in the fight against antibiotic resistance and preserving of our nation's health in the face of this increasing public health threat."

As a report from the Center for Infectious Disease Research and Policy (CIDRAP), a center within the University of Minnesota, notes, the Centers for Disease Control and Prevention (CDC) recommended in 2014 that all U.S. hospitals have an antibiotic stewardship program and has published guidelines to support such program implementation. The report also notes that while the Joint Commission has a stewardship program requirement, this covers only about 75% of U.S. hospitals.

PACCARB includes human and animal health experts from a variety of fields, including pharmacy, biomedicine, public health, healthcare and epidemiology. It was established in 2015 and is presently chaired by Martin J. Blaser, MD, Henry Rutgers Chair of the Human Microbiome and author of Missing Microbes: How the Overuse of Antibiotics is Fueling our Modern Plagues.

Study: Patient Privacy Curtains Represent Infection Risk

The results of a new study show that patient privacy curtains are commonly contaminated with multidrug-resistant organisms (MDROs), raising the risk of infection and disease transmission.

The study was conducted at skilled nursing facilities by researchers from the University of Michigan Medical Center. They obtained bacterial culture samples from patient body sites and high-touch surfaces in patient rooms on the day patients were admitted and again after 14 days, 30 days, then monthly up to 6 months, according to a report from the Center for Infectious Disease Research and Policy (CIDRAP), a center within the University of Minnesota. The patient population consisted mostly of those on short-stay admissions recovering from acute-care hospitalization.

More than 1,500 samples from 625 rooms were obtained from the edges of privacy curtains — where they are most frequently touched. Analysis of the samples revealed more than one in five cultures taken were contaminated with MDROs. The most frequent MDRO detected: vancomycin-resistant enterococci (VRE). Also detected: drug-resistant gram-negative bacteria (including Acinetobacter baumannii, Klebsiella pneumoniae, and Enterobacter cloacae) and methicillin-resistant Staphylococcus aureus (MRSA). The researchers found that in nearly 16% of sampling visits, patients and their privacy curtains were carrying the same MDRO concurrently. 

The results are concerning, noted lead author Lona Mody, a geriatrician at the University of Michigan Medical Center, because privacy curtains are common in facilities, patients and healthcare personnel frequently touch the curtains and the curtain undergo infrequent cleaning.

"Healthcare textiles and soft surfaces often fly under the radar," she said in the CIDRAP report. "Curtains are an issue because it is really required to touch them in order to move them … and healthcare workers are likely to touch the curtains after they do hand hygiene and before they see the patient."

The researchers' recommendations to reduce the infection risks associated with privacy curtain included the following:

  • Establishment of privacy curtain cleaning guidelines by regulatory agencies.

  • More frequent cleaning of privacy curtains.

  • Explore redesigning privacy curtains.

  • Emphasize the importance of hand hygiene.

The research was presented at the European Congress of Clinical Microbiology & Infectious Diseases in April.

Phenelle Segal to Discuss Dental Infection Prevention at APIC 2019

Phenelle Segal, RN, CIC, FAPIC, founder and president of Infection Control Consulting Services (ICCS), will be presenting at APIC 2019, the annual event hosted by the Association for Professionals in Infection Control and Epidemiology (APIC).

This year's meeting will take place June 12–14 in Philadelphia. It is expected to be the largest gathering of infection prevention professionals in the world.

Phenelle will be presenting on "Breaches in Dental Infection Prevention: Could This Be Your Practice?" on Friday, June 14, from 8:00 AM – 9:00 AM. She will be accompanied by Luci Perri.

The session's description is as follows:

This session discusses a detailed description of findings related to onsite observations at dental practices and oral surgery centers across the continuum of care. Practices were reviewed against the CDC Guidelines for Infection Control and Dental Health-Care Settings and Basic Expectations for Safe Care and current FDA and American Dental Association (ADA) guidelines. Examples of review metrics include but are not limited to cold chemical sterilization, instrument sterilization, dental unit waterlines, safe injection practices, use of PPE, operatory room turnover, and tips about table top sterilizers.

These onsite observations showed that individual practices consistently fall out of compliance, putting patients and employees at risk from the lack of effective disinfection, sterilization, and knowledge of IPC best practices.

This topic is important and much needed since the dental community, including oral surgery, is often overlooked and the risk of blood-borne pathogens from lack of effective disinfection and sterilization is of concern. This concern is well-founded as there have several documented outbreaks of hepatitis and bacterial infections in patients.

Participants will understand the various risk factors that are specific to dental practices and oral surgery centers and learn the steps necessary to remediate deficiencies. In addition, we will address a written dental IPC program and essential resources to enhance best practices.

If you are interested in arranging a meeting with Phenelle, contact ICCS.

Measles Outbreak: 8 Resources for Outpatient Settings

Several outpatient center clients have recently contacted Infection Control Consulting Services (ICCS) regarding the measles epidemic and how outpatient settings should respond.

To help our clients and all outpatient settings, we have compiled a compendium of resources available for free access and download, and can be adopted for use, and shared links to them below. If you are in a high endemic area, start thinking about ways to leverage these and other resources before the outbreak gets out of hand. We have seen an exponential increase in cases in the United States over the course of the past few weeks and believe it's only a matter of time before all states report cases.

By sharing these resources and this guidance, we are not aiming to create the type of "hysteria" witnessed in 2014 concerning Ebola that ultimately did not affect most of the United States. However, the growing numbers of measles cases are cause for concern, as are the increasing number of "anti-vaxxers" in those communities where high rates are seen, thus putting others at risk. It is reasonable to believe that such individuals live in communities throughout the country, so it would be wise for all healthcare providers, including outpatient settings, to be proactive in their efforts to educate their patient communities and reduce the likelihood of new outbreaks.

Measles Resources 

1. Measles web graphics (infographics, button and banner for your website) from the Centers for Disease Control and Prevention (CDC)

2. "Measles Surveillance Toolkit for Healthcare Settings" from the Arizona Department of Health Services (includes numerous resources, including a screening tool, signage, a case tracking form and an exposure event worksheet)

3. "Minimize Measles Transmission in Health Care Settings" two-page booklet from the Minnesota Department of Health

4. "When to Suspect and Test for Measles" poster from the Minnesota Department of Health

5. "Measles Post-Exposure Prophylaxis (PEP) for Non-Symptomatic Susceptible Contacts" booklet from the Minnesota Department of Health

6. "Common Rashes/Illnesses in Children" poster from NYC Health

7. "Preventing Measles in Health Care Settings During an Outbreak" booklet from NYC Health

8. Measles fact sheet from the Maryland Department of Health