Multi-drug Resistant Organisms (MDROs) and Clostridium difficile (C.diff) Infections Are Focus in December Pennsylvania Patient Safety Advisory

Data and analysis promote guidance for reducing inappropriate antibiotic use and infections in hospitals and long-term care facilities (LTCFs)

16 Dec, 2015, 08:00 ET from Pennsylvania Patient Safety Authority

HARRISBURG, Pa., Dec. 16, 2015 /PRNewswire-USNewswire/ -- Data shows that 19% of hospital infections in Pennsylvania were caused by MDROs and 17.1 % by C. diff; in LTCFs 1.9% of infections were associated with MDROs and 7.3% with C. diff., according to the December Pennsylvania Patient Safety Advisory article released today.

Events reported from April 2014 through March 2015 were analyzed by the Authority to determine the most common healthcare-associated infections (HAIs) and the rates of infection caused by epidemiologically significant organisms in Pennsylvania facilities.

"Inappropriate antibiotic use contributes to the increasing frequency of MDRO infections and C. diff infections," JoAnn Adkins, BSN, RN, CIC, infection prevention analyst for the Pennsylvania Patient Safety Authority said. "By giving a snapshot of Pennsylvania infection data in hospitals and nursing homes, we can take the next steps to promote programs and guidance to reduce them."

Adkins said that during the 12-month period, Pennsylvania hospitals reported 24,145 HAIs. The predominant types reported were surgical-site infection, gastrointestinal infection (GI), urinary tract infection (UTI), bloodstream infection (BSI), and pneumonia.

In hospitals, 4,594 of the reported infections were caused by MDROs and 4,121 by C. diff.

"For the twelve-month period, in Pennsylvania hospitals, this would average about twenty-three new antibiotic-associated infections occurring every day; twelve by MDROs and eleven by C. diff," Adkins explained.

For the same 12-month period, LTCFs reported 29,108 HAIs to the Authority. The predominant type of infections was respiratory tract infections (39.7%). Of those HAIs, 1.9% (n=545 of 29,108) were associated with MDROs. The most common MDRO was methicillin-resistant Staphylococcus aureus or MRSA.

Adkins said while C. diff accounted for 7.3% (n=2,109 of 29,108) of the total number of nursing home infections, 54% (n=2,109 of 3,908) of GI infections were associated with C. diff.

"Part of the solution in reducing MDROs and C. diff infections is to encourage responsible use of antibiotics," Adkins said. "The development of an antibiotic stewardship program, improving prescribing practices and the use of tools, such as an antibiogram, can help in this effort."

The antibiogram is a facility-specific, cumulative antimicrobial susceptibility data report that provides valuable information to guide antibiotic prescribing practices in both hospitals and LTCFs. Regular distribution of the current antibiogram provides useful information to help prescribing clinicians (1) select the most appropriate agents for initial empirical antimicrobial therapy, (2) improve outcomes among patients with infections, and (3) reduce inappropriate antibiotic use.

"Antibiograms are inexpensive, easily accessible and help identify changes in facility or unit resistance patterns," Adkins said. "Steps to plan, develop and implement antibiograms include engaging team members who have knowledge and understanding of culturing practices and infection control."

"There are numerous opportunities in the prescribing decision process to stray from the best practices," Adkins added. "For example, if ordering antibiotics for a patient with asymptomatic bacteriuria, a positive urine culture does not by itself mean there's an infection. But these types of decisions may not be tracked so clinicians should refer to the best practices associated with optimal antibiotic use for guidance."

For more information about antibiotic use best practices and how to prevent MDROs and C. diff infections, go to the December Pennsylvania Patient Safety Advisory article, "Strategies to Turn the Tide against Inappropriate Antibiotic Utilization," at www.patientsafetyauthority.org.

Other highlights of the 2015 December Advisory include the following:

  • Addressing the Rise in Neonatal Abstinence Syndrome: A Multifaceted Approach: With the rising incidence of neonatal abstinence syndrome (NAS) in the last decade, helping newborns through withdrawal requires correct diagnosis and collaboration among the healthcare professionals who contribute to treatment. Families also play a key role in learning how to interact with their newborn, whose symptoms may include irritability, inconsolable crying, vomiting and poor feeding. Consumer tips are also available for this article on the Authority's website.
  • Patient Flow in the Emergency Department: Phase III—after Disposition Decision through Departure: Authority analysts identified four key vulnerabilities in events occurring during phase III of the patient's emergency department (ED) care: gaps in care unrecognized by ED personnel, delays, insufficient oversight, and lack of prompt transition.  Care delivery and coordination may be enhanced through awareness of these vulnerabilities and implementation of risk reduction strategies and best practices in patient flow. An educational toolkit is also available with this article on the Authority's website.  
  • Medication Errors Involving Overrides of Healthcare Technology: Users can bypass many of the safety features incorporated in medication-use technologies that provide warnings about possible unsafe conditions or errors. Of the 583 event reports related to the use of overrides, the most commonly mentioned technology was automated dispensing cabinets (77%), followed by computerized prescriber order entry (8.2%) and bar-code medication administration devices (7.5%). The most common classes of medications cited were antibiotics (12%), opioids (12%) and anticoagulants (7.4%); and 26.4% of the reports involved at least one high-alert medication. This article contains risk reduction strategies for organizations to consider.

Other Advisory features include: "Prolonged Prone Positioning for Patients with Acute Respiratory Distress Syndrome" and "Simulation Can Improve the Healthcare Systems We Work Within."

To view the complete 2015 December Pennsylvania Patient Safety Advisory, go to www.patientsafetyauthority.org.

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SOURCE Pennsylvania Patient Safety Authority



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