C-Difficile Infection Control and Prevention Strategies

Transcription

1 C-Difficile Infection Control and Prevention Strategies Adrienne Mims, MD MPH VP, Chief Medical Officer 1/18/2016 1

2 Disclosure This educational activity does not have commercial support or sponsorship. Planners and presenters have no conflict of interest and or vested interest with this educational activity. This educational activity has no endorsement of any products, or co-providerships.

3 Objectives Understand infection control and prevention strategies for C-difficile Understand the harm of over using antibiotics

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5 Impact of C. diff

6 Percentage of Clostridium difficile infection (CDI) cases (N = 10,342), by inpatient or outpatient status at time of stool collection and type/location of exposures * United States, Emerging Infections Program, 2010

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9 Risk of getting C. diff

10 Symptoms of C. diff Watery diarrhea Fever Loss of appetite Nausea Abdominal pain and tenderness

11 Treatment of C. diff Eliminate other antibiotics (if possible) Oral course of antibiotics for 10 days Metronidazole mild infections, 1 st reoccurrence vancomycin, or fidaxomicin severe case, additional reoccurrences Fecal transplants multiple reoccurrences (effective but not widely available)

12 Prevention of C. diff Hand washing By the patient after toileting and before eating Family visitors Caregivers pre and post contact with patients Use soap and water or an alcohol-based hand rub Prudent use of antibiotics Carefully clean rooms and medical equipment that have been used for patients with C. diff Use EPA-approved, spore-killing disinfectant (such as bleach)

13 Use Contact Precautions to prevent C. diff from spreading to other patients Patients with C. diff - single room or share only with someone else who also has C. diff Healthcare providers - wear gown and gloves and use separate equipment Visitors - wear a gown and gloves When leaving the room- remove gown and gloves and clean hands (hand sanitizer doesn t kill C. difficile) Patients with C. diff - stay in their rooms as much as possible.

14 Antibiotic Stewardship Adrienne Mims, MD MPH VP, Chief Medical Officer 1/18/

15 Disclosure This educational activity does not have commercial support or sponsorship. Planners and presenters have no conflict of interest and or vested interest with this educational activity. This educational activity has no endorsement of any products, or co-providerships.

16 Objectives Understand the harm of over using antibiotics Learn strategies to promote appropriate antibiotic use

17 A post antibiotic era in which common infections and minor injuries can kill far from being an apocalyptic fantasy, is instead a very real possibility for the twenty-first century, Data from 129 member states to show extensive resistance to antimicrobial agents in every region of the world. Keiji Fukuda, WHO Assistant Director-General for Health Security rary/diseaseagents/img17.jpg pseudomonas

18 Tom Frieden, MD / Director - CDC Each year, in the U.S. 2,049,442 illnesses caused by bacteria and fungi that are resistant to at least some classes of antibiotics, out of those illnesses 23,000 deaths $20 billion each year in additional healthcare spending An additional $35 billion lost to society in foregone productivity.

19 If we are not careful, we will soon be in a post-antibiotic era, And for some patients and for some microbes, we are already there. ~ Tom Frieden, MD, Director - CDC

20 How Antibiotics Can Cause Harm Cause nausea and vomiting Cause diarrhea (C.difficile) Cause secondary infections (Candida) Rash or other allergic reactions Harm kidneys or other organs Create bacterial resistance

21 Infection vs. Colonization Infection Presence of pathogen on culture Organism growth & invasion of host Presence of clinical signs & symptoms Colonization Presence of microorganism on culture No tissue invasion Absence of clinical signs & symptoms

22 Surveillance vs. Clinical Criteria Surveillance Criteria Focused on specificity Applied easily retrospectively Not for case finding Not for diagnostic purposes Not for clinical decision making Facility A Clinical Criteria Focused on sensitivity Applied prospectively Can be for case finding Mrs. Jones

23 Checklist Leadership support Accountability Drug expertise Actions to improve use Tracking: monitoring antibiotic prescribing, use, and resistance Reporting information to staff on improving antibiotic use and resistance Education

24 Antibiotic Stewardship for Nursing Homes Antibiotic prescribing and use policies Documentation of : Dose: including route Duration: start date, end date, and planned days of therapy Indication: which includes both rationale (i.e., prophylaxis vs. therapeutic) and treatment site (i.e., urinary tract, respiratory tract) Culture results Applies to those started in facility or prior to arrival

25 Antibiotic Stewardship for Nursing Homes Establish best practices for use of microbiology testing no test of cure cultures Use guidelines and local susceptibilities to create facility specific treatment recommendations (pneumonia, UTI, skin) Review the antibiotic agents available in the facility (inventory accessible during off hours)

26 Antibiotic Stewardship for Nursing Homes Develop and implement algorithms for the assessment of residents by clinical staff Utilize a communication tool for discussing residents with attending clinicians Develop and disseminate a facility-specific report of antibiotic susceptibility to clinical providers antibiogram Reduce prolonged antibiotic treatment courses for common infections short courses

27 Infection specific interventions to improve antibiotic use Do not treat with antibiotics in asymptomatic bacteriuria Reduce antibiotic prophylaxis for prevention of UTI Clarify when to treat pneumonia in facility vs. transferring Do not use superficial wound cultures

28 Residents and Families who want antibiotics Don t trust the natural healing process Want pain / symptom relief Are confident they know the best treatment Instead Educate on when antibiotics may not be needed Discuss alternative treatments: Increased fluid intake, perineal hygiene, regular toileting / pad change, respiratory therapy Monitor for fever or complications

29 American Geriatrics Society Don t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present. inician-lists/american-geriatricssociety-antimicrobials-to-treatbacteriuria-in-older-adults/

30 6 WAYS TO BE A SAFE PATIENT

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35 This material was prepared by GMCF, for Alliant Quality, the Medicare Quality Innovation Network Quality Improvement Organization for Georgia and North Carolina, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 11SOW-GMCFQIN-C