Study: Glucocorticoids Raise Infection Risk for Joint Replacement Patients With RA

The results of a new study show that glucocorticoid use significantly increased the risk for infection for patients with rheumatoid arthritis (RA) undergoing joint replacement surgery.

The retrospective cohort study, which was published in Annals of Internal Medicine, examined claims data on nearly 11,000 surgeries — specifically primary or revision hip or knee joint replacement surgery in adults with RA — performed over a nearly 10-year period.

Researchers from the University of Pennsylvania Hospital found that while the risks for hospitalized infection, prosthetic joint infection and readmission following arthroplasty were similar across biologics, glucocorticoid use — particularly when dosages exceeded 10 mg/d — nearly doubled risk for adverse outcomes.

As a news release on the study noted, "According to the researchers, these findings suggest that limiting glucocorticoid use should be a focus of perioperative management."

New York Considering Bill Requiring Infection Prevention Certification

Lawmakers in New York have sponsored a bill that, if passed, would require infection preventionists to be certified in infection prevention and control if they want to practice in New York hospitals, according to a news release from the Association for Professionals in Infection Control and Epidemiology (APIC).

The bill stipulates that infection preventionists in a general hospital would be required to meet one of the following:

• Pass an exam from a nationally accredited infection prevention and epidemiology accrediting organization and hold and maintain certification in infection prevention and control.

• Provide evidence of employment as an infection preventionist for one year or more within four years of the bill's passage.

• Be a student or intern performing the functions of an infection preventionist (within the scope of the student's or intern's training) while serving under direct supervision of appropriately licensed or certified healthcare professional.

If an infection preventionist fails to meet at least one of these requirements, the individual would have three years from the date of hire to obtain an infection preventionist credential.

The bill, A. 3705/S. 5186, is sponsored by Assemblywoman Aileen Gunther (D) and Senator Jen Metzger (D). Gunther previously held an infection control position at Catskill Regional Medical Center. In the release, she is quoted as saying, "I am proud to lead an effort that will enhance patient safety in New York hospitals by ensuring that infection preventionists have appropriate credentials. I hope other states follow this example."

The bill includes a clause to account for hospitals that are unable to contract with an individual(s) who meets the requirements.

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.