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

April 2019 Issue of Infection Prevention & Control Newsletter Published

The April 2019 issue of the ICCS Infection Prevention & Control Newsletter has published.

The issue includes stories on Joint Commission top challenging standards, duodenoscopes, knee replacement, sharps injuries, outpatient prescribing of antibiotics, rotator cuff surgery and much more.

Access the latest issue of our infection prevention newsletter.

Receive the free ICCS Newsletter by signing up here.

Study: Outpatient Providers Prescribe Excessive Antibiotics

A study reveals that a significant percentage of antibiotic prescriptions are unnecessarily prescribed to outpatients.

The study, published in the American Journal of Infection Control (AJIC), the journal of the Association for Professionals in Infection Control and Epidemiology (APIC), assessed nearly 1,100 outpatients at the Veterans Affairs Western New York Healthcare System over a several-month period in 2017.

Researchers found that outpatient providers inappropriately prescribed antibiotics to 40% percent of patients — higher than the figure seen in prior studies.

An electronic alert following prescription was used to determine common causes of inappropriate antibiotic use. Findings include the following:

  • Urinary tract infections, bronchitis, skin structure infections and sinusitis were common causes of inappropriate antibiotic use.

  • Azithromycin was prescribed unnecessarily most often. It was followed by ciprofloxacin, amoxicillin/clavulanate and cephalexin. Together, they accounted for 80% of all unnecessary outpatient prescriptions.

  • Compared to patients in outpatient clinics, those seen in emergency departments were twice as likely to receive an antibiotic only when needed. 

Researchers note that outpatient prescriptions comprise 60% of antibiotic use.

In an APIC news release on the study, APIC President Karen Hoffmann is quoted as saying, "Antimicrobial stewardship programs are common in inpatient scenarios, but this research reinforces the point that there continues to be a significant need to build momentum for such initiatives in the outpatient setting."

Concerning antibiotic misuse, the Centers for Disease Control and Prevention note, "Patients who are unnecessarily exposed to antibiotics are placed at risk for serious adverse events with no clinical benefit. The misuse of antibiotics has also contributed to the growing problem of antibiotic resistance, which has become one of the most serious and growing threats to public health. Unlike other medications, the potential for spread of resistant organisms means that the misuse of antibiotics can adversely impact the health of patients who are not even exposed to them."

CDC estimates more than two million people are infected with antibiotic-resistant organisms, resulting in approximately 23,000 deaths annually.