New Jersey Issues New Infection Control Recommendations for LTC

The N.J. Department of Health (DOH) has issued new policy recommendations for infection control at long-term care (LTC) facilities.

They come in response to an adenovirus outbreak last year at a pediatric facility in the state that led to 11 deaths and dozens of cases.

The DOH is recommending all LTC facilities with pediatric and adult ventilator beds have an infection control plan that "allows for separation of sick and well residents — and the staff caring for them — as quickly as possible and monitoring of staff and residents for illness," according to a DOH news release.

One of the most significant recommendations is for these LTC facilities to have an outbreak plan that addresses the following:

  • policies for patient and staff notification;

  • availability of lab testing;

  • protocols to assess visitor wellness;

  • protocols to identify/exclude sick staff from the facility; and

  • separation of sick and well patients at the outset of an outbreak to prevent spread of illness.

The report also includes recommendations for amending state regulations to require such facilities to:

  • implement protocols to ensure parents and guardians of residents are immediately notified when outbreaks occur;

  • employ a full-time infection control professional;

  • have an agreement in place to consult with an infectious disease specialist during an outbreak; and

  • provide all staff with training in the facility's infection control policies — including protocols for identifying employees and visitors showing signs of illness — every six months.

Other recommendations touch on areas including response to outbreak by local health departments, development of a respiratory virus outbreak preparedness checklist and funding for staff dedicated to respiratory virus surveillance.

Since some of the recommendations call for policy changes, the N.J. Senate and Assembly Health committees have introduced legislation to address them. 

Study: Most Antibiotics Prescribed Before Dental Procedures Unnecessary

The results of a new study show that more than 80% of antibiotics prescribed for infection prophylaxis prior to dental procedures are unnecessary.

The retrospective cohort study, published in JAMA Network Open, examined about 168,000 dental visits from 2011-2015 involving about 91,000 patients who received antibiotic prophylaxis. Appropriate antibiotic prophylaxis was defined as "a prescription dispensed before a dental visit with a procedure that manipulated the gingiva or tooth periapex in patients with an appropriate cardiac diagnosis."

Researchers noted that nearly 91% of the visits had manipulation of the gingiva or tooth periapex, but only about 21% of patients had a cardiac condition at the highest risk of adverse outcome from infective endocarditis. They therefore determined that 80.9% of antibiotic prophylaxis prescriptions were "discordant with guidelines."

Their conclusions include the following: "While antibiotic prophylaxis is appropriately prescribed for indicated dental procedures in patients with cardiac conditions, most antibiotic prophylaxis is prescribed to patients in whom guideline-identified risk factors are not present. Although prescribing is slowly improving, the high proportion of antibiotics that were found to be unnecessary in our study is worrisome. Implementing antimicrobial stewardship efforts in dental practices is an opportunity to improve antibiotic prescribing for infection prophylaxis."

The researchers note that dentists prescribe about 10% of all antibiotic prescriptions in the United States and are also the top prescriber of clindamycin in the United States. Furthermore, they note that antibiotics prescribed by dentists for infection prophylaxis have been associated with community-associated C difficile infection.

May 2019 Issue of Infection Prevention & Control Newsletter Published

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

The issue includes stories on ophthalmology devices, patient privacy curtains, measles, TB, antibiotic stewardship requirement and a New York bill on infection prevention certification.

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