Study: Patients With Dental Infections Receive Excessive CT Scans

The results of a study indicate that emergency settings overorder computed tomography (CT) scans for dental infections.

Published in the Journal of Oral and Maxillofacial Surgery, the study examined 470 adult patients who presented through an emergency department for odontogenic infection evaluation, of which 389 received CT scans.

Researchers set out to determine how many of these scans were unnecessary when considering the effectiveness of history and physical (H&P) examinations to accurately diagnose dental infections before patients undergo the CT scan. Unlike H&Ps, CT scans are expensive and linked to long-term potential for cancer.

The researchers found that nearly 57% of the total ordered scans were unnecessary, meaning patients presented without what researchers labeled as "red-flag" signs at physical examination. This included voice change, elevated floor of mouth, signs of inflammation of deep fascial spaces, periorbital edema, nonpalpable inferior border of the mandible, dyspnea, dysphagia or odynophagia, and trismus. Furthermore, unnecessary scans were found to be most prevalent in those patients with infections classified as low risk, with more than 78% of scans deemed unnecessary. 

In conclusion, the study authors' wrote, "Establishing guidelines to standardize ordering is the first step oral and maxillofacial surgeons can take to decrease unnecessary CT scans. Guidelines, in theory, would decrease the amount of unnecessary scans ordered and standardize ordering practices among providers."

CDC Hoping Chlorhexidine Soap Will Stop Superbug Infections

The Centers for Disease Control and Prevention (CDC) is funding research in California and Illinois hospitals and nursing homes that it hopes will help stop or at least considerably reduce drug-resistant infections, according to an NPR report.

The approach these organizations are taking primarily centers around doctors and healthcare workers washing patients with antimicrobial chlorhexidine soap. CDC provided funding to 50 facilities in the two states, more specifically in Chicago and Orange County, Calif., for the efforts.

NPR reports that in Chicago, researchers are working with nursing home and long-term acute care hospital staff to screen patients for carbapenem-resistant Enterobacteriaceae (CRE) upon admission and then bath them daily with the soap. Efforts also include a handwashing campaign and increased communication concerning CRE among hospitals.

Researchers working in Orange County are collaborating with hospital and nursing home staff to use an antiseptic wash, together with an iodine-based nose swab. The expectation is that these efforts will "prevent new people from getting drug-resistant bacteria and keep the ones who already have the bacteria on their skin or elsewhere from developing infections," according to the report.

Preliminary data from the Orange County project (which concludes in May) show that after 18 months, there was a 25% drop in drug-resistant organisms in nursing home residents, 34% percent in long-term acute care hospital patient and a 9% decline in traditional hospital patients. Results from the Chicago project are pending, with the project ending in September.

Infection Control Requirements Among the Most Challenging for Joint Commission-Accredited Organizations in 2018

The Joint Commission has released its report on the top five most challenging requirements for 2018. These are requirements identified most frequently as "not compliant" during surveys and reviews from Jan. 1, 2018, through Dec. 31, 2018.

Unfortunately, it comes as no surprise to Infection Control Consulting Services (ICCS) that infection control standards hold one or more spots for several of the accreditation organization's programs.

Ambulatory Care Accreditation

For the ambulatory care accreditation program, infection control standards were the most challenging and fourth most challenging. IC.02.02.01 (The organization reduces the risk of infections associated with medical equipment, devices, and supplies.) took the top spot with more than 60% non-compliance. Coming in fourth was IC.02.01.01 (The organization implements infection prevention and control activities.) at nearly 46%.

Office-Based Surgery Practice Accreditation

Office-based surgery practices had similar results. IC.02.02.01 (The practice reduces the risk of infections associated with medical equipment, devices, and supplies.) occupied the top spot with about 64% non-compliance. In fourth was IC.02.01.01 (The practice implements infection prevention and control activities.) at about 29%.

Hospital Accreditation

For the hospital accreditation program, IC.02.02.01 (The hospital reduces the risk of infections associated with medical equipment, devices, and supplies.) took the fifth spot at nearly 71%.

Home Care Accreditation

For home care organizations, IC.02.01.01 (The organization implements the infection prevention and control activities it has planned.) was the second most challenging standard with more than 40% non-compliance.

Nursing Care Center Accreditation

Infection control standards occupy two spots on the nursing care center program's list. Coming in second was IC.02.01.01 (The organization implements its infection prevention and control plan.) with about 39% non-compliance while IC.02.02.01 (The organization reduces the risk of infections associated with medical equipment, devices, and supplies.) occupies the fifth spot with about 29% non-compliance.

Commentary from the Field

These results are consistent with observations made by ICCS consultants during on-site visits in 2018. ICCS serves facility types including ambulatory care, behavioral health, critical access hospitals, acute care hospitals and office-based surgery practices. ICCS services include assisting organizations with survey preparation and complying with infection control requirements from the Centers for Medicare & Medicaid Services (CMS), The Joint Commission, AAAHC, HFAP, DNV and AAAASF.

Study: Improper Personal Protective Equipment Practices Spread Contamination

A new study shows that when healthcare workers do not properly remove their personal protective equipment (PPE), the likelihood of bacterial contamination increases significantly.

The study was performed at a tertiary-care teaching hospital. Researchers monitored and evaluated samples taken from 125 healthcare workers — mostly nurses or physicians — in four adult intensive care units caring for patients colonized or infected with a multi-drug resistant organism (MDRO), according to a Society for Healthcare Epidemiology of America (SHEA) news release.

The study's results were published in SHEA's Infection Control and Hospital Epidemiology journal. Findings included the following:

Nearly 40% percent of workers made errors in removing their PPE, including gowns and gloves, when evaluated by Centers for Disease Control and Prevention (CDC) guidelines. This was despite the fact that, as the release notes, a significant majority of the workers had undergone training on appropriate methods for donning and doffing PPE within the past five years.

  • Following patient contact, 36% of workers were contaminated with an MDRO.

  • After removing PPE, more than 10% were contaminated on their hands, clothing or equipment.

  • Workers who made multiple PPE-removal errors were more likely to be contaminated after a patient encounter.

"Based on these findings, we should reevaluate strategies for removing PPE, as well as how often healthcare workers are trained on these methods," said Dr. Koh Okamoto, a lead author of the study, in the release. "An intervention as simple as education about appropriate doffing of PPE may reduce healthcare worker contamination with MDROs."