Political Versus Epidemiological Correctness

2007 ◽  
Vol 28 (05) ◽  
pp. 589-593 ◽  
Author(s):  
Barry M. Farr
Keyword(s):  
Staphylococcus Aureus ◽  
Infection Control ◽  
Nosocomial Infections ◽  
Task Force ◽  
Position Statement ◽  
Healthcare Facilities ◽  
Control Approach ◽  
Vancomycin Resistant ◽  
Healthcare Epidemiology ◽  
Active Detection

In the March issue of the journal, the Joint SHEA and APIC Task Force indicates that the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology (APIC) support the use of active detection and isolation (ADI) for controlling nosocomial infections due to methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) “in appropriate circumstances, as recommended in previously published guidelines”1(p250) (those published by SHEA and the Healthcare Infection Control Practices Advisory Committee [HICPAC]), but that SHEA and APIC oppose the use of legislation for mandating any infection control approach, including this one as tried in 2006 in Illinois and Maryland. Both supporters and opponents of controlling MRSA and VRE with ADI probably will agree that legislation is not the optimal way to control nosocomial infections in general, but this position statement undoubtedly will please the latter more than it does the former because the SHEA/APIC Task Force argues that ADI is not ready for routine use throughout all healthcare facilities, directly opposing the position of the original SHEA guideline. As an author of that SHEA guideline, I would like to comment. First, the new position seems politically correct (since most infection control professionals have not yet bothered using ADI to control MRSA and VRE), but many of the planks of the SHEA/APIC Task Force position statement are misleading.

scholarly journals Quantifying the Exposure to Antibiotic-Resistant Pathogens Among Patients Discharged From a Single Hospital Across All California Healthcare Facilities

2015 ◽  
Vol 36 (11) ◽  
pp. 1275-1282 ◽  
Author(s):  
Rupak Datta ◽  
Shawn Brown ◽  
Vinh Q. Nguyen ◽  
Chenghua Cao ◽  
John Billimek ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Nursing Homes ◽  
Hospital Readmissions ◽  
Time Dependent ◽  
Antibiotic Resistant ◽  
Total Exposure ◽  
Healthcare Facilities ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

OBJECTIVETo assess the time-dependent exposure of California healthcare facilities to patients harboring methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase (ESBL)–producing Escherichia coli and Klebsiella pneumoniae, and Clostridium difficile infection (CDI) upon discharge from 1 hospital.METHODSRetrospective multiple-cohort study of adults discharged from 1 hospital in 2005–2009, counting hospitals, nursing homes, cities, and counties in which carriers were readmitted, and comparing the number and length of stay of readmissions and the number of distinct readmission facilities among carriers versus noncarriers.RESULTSWe evaluated 45,772 inpatients including those with MRSA (N=1,198), VRE (N=547), ESBL (N=121), and CDI (N=300). Within 1 year of discharge, MRSA, VRE, and ESBL carriers exposed 137, 117, and 45 hospitals and 103, 83, and 37 nursing homes, generating 58,804, 33,486, and 15,508 total exposure-days, respectively. Within 90 days of discharge, CDI patients exposed 36 hospitals and 35 nursing homes, generating 7,318 total exposure-days. Compared with noncarriers, carriers had more readmissions to hospitals (MRSA:1.8 vs 0.9/patient; VRE: 2.6 vs 0.9; ESBL: 2.3 vs 0.9; CDI: 0.8 vs 0.4; all P<.001) and nursing homes (MRSA: 0.4 vs 0.1/patient; VRE: 0.7 vs 0.1; ESBL: 0.7 vs 0.1; CDI: 0.3 vs 0.1; all P<.001) and longer hospital readmissions (MRSA: 8.9 vs 7.3 days; VRE: 8.9 vs 7.4; ESBL: 9.6 vs 7.5; CDI: 12.3 vs 8.2; all P<.01).CONCLUSIONSPatients harboring antibiotic-resistant pathogens rapidly expose numerous facilities during readmissions; regional containment strategies are needed.Infect. Control Hosp. Epidemiol. 2015;36(11):1275–1282

ASID/ACIPC position statement – Infection control for patients with Clostridium difficile infection in healthcare facilities

2019 ◽  
Vol 24 (1) ◽  
pp. 32-43 ◽  
Author(s):  
Rhonda L. Stuart ◽  
Caroline Marshall ◽  
Glenys Harrington ◽  
Louisa Sasko ◽  
Mary-Louise McLaws ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Infection Control ◽  
Clostridium Difficile Infection ◽  
Position Statement ◽  
Healthcare Facilities

The Best Hospital Practices for Controlling Methicillin-Resistant Staphylococcus Aureus: On the Cutting Edge

2002 ◽  
Vol 23 (2) ◽  
pp. 69-76 ◽  
Author(s):  
Meredith S. Arnold ◽  
Jane M. Dempsey ◽  
Marlene Fishman ◽  
Patricia J. McAuley ◽  
Cynthia Tibert ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infection Control ◽  
Rhode Island ◽  
Task Force ◽  
Chief Executive ◽  
Scientific Data ◽  
Methicillin Resistant ◽  
Department Of Health ◽  
Hospital Infection Control ◽  
Hospital Practices

Objective:A performance improvement task force of Rhode Island infection control professionals was created to develop an epidemiologic model of statewide consistent infection control practices that could reduce the spread of methicillin-resistant Staphylococcus aureus (MRSA).Design:This model encompasses screening protocols, isolation techniques, methods of cohorting positive patients, decolonization issues, postexposure follow-up, microbiology procedures, and standardized surveillance methodologies. These “best practice guidelines” include three categories of recommendations that define priority levels based on the availability of scientific data.Setting:From 1995 through 2000, several Rhode Island hospitals experienced a fivefold increase in nosocomial acquisition of MRSA.Participants:Rhode Island infection control professionals are a highly interactive group in the unique position of sharing patients and ultimately experiencing similar trends and problems.Intervention:The task force collaborated on developing the best hospital infection control practices to prevent and control the spread of MRSA in Rhode Island.Results:The task force met with local infectious disease physicians and representatives from the Rhode Island Department of Health, the Hospital Association of Rhode Island, and Rhode Island Quality Improvement Partners. Discussions identified numerous and diverse MRSA control practices, issues of consensus, and approaches to resolving controversial methods of reducing the spread of MRSA The guidelines regarding the best hospital practices for controlling MRSA were finalized 8 months later.Conclusion:These guidelines were distributed to all chief executive officers of Rhode Island hospitals by the Rhode Island Department of Health in December 2001. They were issued separate and apart from any regulations, with the intent that hospitals will adopt them as best hospital practices in an attempt to control MRSA.

Survey of Long-Term-Care Facilities in Iowa for Policies and Practices Regarding Residents With Methicillin-Resistant Staphylococcus aureus or Vancomycin-Resistant Enterococci

2005 ◽  
Vol 26 (10) ◽  
pp. 811-815 ◽  
Author(s):  
Trisha Kreman ◽  
Jianfang Hu ◽  
Jean Pottinger ◽  
Loreen A. Herwaldt
Keyword(s):  
Staphylococcus Aureus ◽  
Infection Control ◽  
Long Term Care ◽  
Term Care ◽  
Methicillin Resistant ◽  
Vancomycin Resistant Enterococci ◽  
Care Facilities ◽  
Vancomycin Resistant ◽  
Policies And Practices

AbstractObjectives:To identify infection control policies and practices used by long-term-care facilities (LTCFs) in Iowa for residents with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE), and to estimate the prevalence of residents known to have these organisms.Design:Survey.Setting:LTCFs in Iowa from December 2002 through March 2003.Results:Of the 429 LTCFs in Iowa, 331 (77%) responded to the survey. The estimated prevalence of residents known to have MRSA was 13.4 per 1,000 and that of residents known to have VRE was 2.3 per 1,000. Facilities owned by the government or those with an average of more than 86 occupied beds were more likely to have residents known to have MRSA and VRE (P = .002 and .007, respectively). Of the responding facilities, 7.3% acknowledged that they refused to accept individuals known to have MRSA and 16.9% acknowledged that they refused to accept those known to have VRE. Facilities in large communities (population, > 100,000) were least likely to deny admission to an individual known to have either MRSA or VRE (P = .05). Most facilities reported adhering to the national guidelines, but fewer than half (44.7%) of the respondents had heard of the Iowa Antibiotic Resistance Task Force's guidelines regarding residents with MRSA or VRE.Conclusions:Many LTCFs in Iowa care for residents known to have MRSA or VRE, but some refuse to admit these individuals. Infection control personnel and public health officials should work together to educate LTCF staff so that residents receive proper care and resistant organisms do not spread within this setting.

Legislative Mandates for Use of Active Surveillance Cultures to Screen for Methicillin-ResistantStaphylococcus aureusand Vancomycin-Resistant Enterococci: Position Statement From the Joint SHEA and APIC Task Force

2007 ◽  
Vol 28 (3) ◽  
pp. 249-260 ◽  
Author(s):  
Stephen G. Weber ◽  
Susan S. Huang ◽  
Shannon Oriola ◽  
W. Charles Huskins ◽  
Gary A. Noskin ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Task Force ◽  
Position Statement ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infections ◽  
Vancomycin Resistant Enterococci ◽  
Surveillance Cultures ◽  
Vancomycin Resistant ◽  
State And Local ◽  
Healthcare Associated

Legislation aimed at controlling antimicrobial-resistant pathogens through the use of active surveillance cultures to screen hospitalized patients has been introduced in at least 2 US states. In response to the proposed legislation, the Society for Healthcare Epidemiology of America (SHEA) and the Association of Professionals in Infection Control and Epidemiology (APIC) have developed this joint position statement. Both organizations are dedicated to combating healthcare-associated infections with a wide array of methods, including the use of active surveillance cultures in appropriate circumstances. This position statement reviews the proposed legislation and the rationale for use of active surveillance cultures, examines the scientific evidence supporting the use of this strategy, and discusses a number of unresolved issues surrounding legislation mandating use of active surveillance cultures. The following 5 consensus points are offered. (1) Although reducing the burden of antimicrobial-resistant pathogens, including methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistant enterococci (VRE), is of preeminent importance, APIC and SHEA do not support legislation to mandate use of active surveillance cultures to screen for MRSA, VRE, or other antimicrobial-resistant pathogens. (2) SHEA and APIC support the continued development, validation, and application of efficacious and cost-effective strategies for the prevention of infections caused by MRSA, VRE, and other antimicrobial-resistant and antimicrobial-susceptible pathogens. (3) APIC and SHEA welcome efforts by healthcare consumers, together with private, local, state, and federal policy makers, to focus attention on and formulate solutions for the growing problem of antimicrobial resistance and healthcare-associated infections. (4) SHEA and APIC support ongoing additional research to determine and optimize the appropriateness, utility, feasibility, and cost-effectiveness of using active surveillance cultures to screen both lower-risk and high-risk populations. (5) APIC and SHEA support stronger collaboration between state and local public health authorities and institutional infection prevention and control experts.

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