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This week is the first annual Fungal Disease Awareness
Week! CDC and partners are highlighting the importance of recognizing serious
fungal diseases early enough in the course of a patient’s illness to provide
life-saving treatment. Visit the Think Fungus webpage
for more information about fungal diseases and why they pose a public health problem.
The HAI unit at MDH conducts surveillance in Hennepin and
Ramsey Counties for candidemia (bloodstream infections with Candida species), which is one type
of serious fungal disease. We conduct surveillance for candidemia to track
disease incidence, monitor trends, and identify areas where prevention and
intervention strategies can be focused. Candida
is a type of yeast that is normally found on the skin and in the
gastrointestinal tract of healthy people, but in people
with certain underlying conditions, Candida can cause serious invasive infections. Most
cases of candidemia are HAIs, and candidemia is among the most common types of
HAI bloodstream infections. These infections can be difficult to treat due to
the growing threat of antifungal resistance in Candida species.
August is National Immunization Month and with students
coming in for back-to-school vaccinations, it’s a great time to review safe
vaccine preparation technique. Always follow these guidelines:
- Use aseptic technique, starting with hand hygiene, even if you are going to wear gloves.
- Inspect the vial to verify you have the correct vaccine and the correct age-appropriate formulation.
- Examine the vaccine for discoloration and precipitate. Do not use if you notice either.
- Use a new sterile needle and new sterile syringe for each patient.
- Disinfect the rubber septum with alcohol before entering the vial.
- Dispose of a single-dose vial immediately after withdrawing a dose, even if there is serum left in the vial.
- Enter a multi-dose vial with a new sterile needle and a new sterile syringe. Never re-enter the vial with a used needle and syringe, even if it is for the same patient.
Learn more from the MDH How to
Administer Injections factsheets.
Since 2013, nine cases of varicella have been reported in
persons who worked at LTC or assisted living facilities. Four of these cases
are known to have had contact with residents who had shingles.
One case involved a 25-year-old man who was previously
healthy. He was out of work for three weeks and hospitalized twice during that
period due to complications. He had no history of disease or vaccination.
CMS does not require LTC facilities to have proof of
immunity to varicella, but does recommend that health care workers be protected
against varicella. Find out more at CDC’s
Recommended
Vaccines for Health Care Workers webpage. If health care personnel are
exposed to varicella or zoster, follow the steps outlined on the Preventing
Varicalla-Zoster Virus Transmission in Health Care Settings webpage.
If insurance does not cover vaccine for these workers, there
are sites throughout the state that provide free or low cost vaccines for
qualifying adults. You can find a list of these locations at the Vaccination
Clinics Serving Uninsured and Underinsured Adults webpage.
The Minnesota
2017 CHAIN Fall Conference will be held on Wednesday, Sept. 27 from
1:00-4:30PM at the Earle Brown Heritage Center in Brooklyn Center. Learn about
the latest evidence-based approaches for reducing and preventing
healthcare-associated infections (HAIs) in Minnesota. Winners of the CHAIN
Award for Excellence will be recognized at the conference.
The Wisconsin Surgical
Site Infection Prevention Summit V: Collaboration as a Pathway to Improving
Patient Outcomes is Friday, Sept. 29 in Madison, Wisconsin. Dr.
Darrell A. Campbell, Jr., director of the Michigan Surgical Quality
Collaborative and professor emeritus at the University of Michigan Medical
School, will be the keynote speaker. Registration
closes Sept. 15. Contact Heidi Brittnacher at surgeryevents@mcw.edu or
414-805-9427 for more information.
The South Dakota Infection Control Council will be hosting
the Hunting
for New Ways to Prevent Infections Conference Oct. 5-6 in Sioux Falls,
South Dakota. Registration to the conference is free this year.
Have you been struggling with how to implement an
antimicrobial stewardship program in a small or critical access hospital? Do
you feel like CDC’s Core Elements for Acute Care Hospitals are nice, but not
realistic for your facility? If so, CDC recently published a document that
might help you: Implementation
of Antimicrobial Stewardship Core Elements at Small and Critical Access
Hospitals.
If you are interested in a plain-language description of why
antimicrobial stewardship is important; current antimicrobial use in the U.S.
and how it varies by region or setting; or if you would like a comprehensive summary
of activities geared to improving antimicrobial use, you might like CDC’s
recent Antibiotic
Use in the United States, 2017: Progress and Opportunities report.
An opinion piece recently published in JAMA, titled Diagnostic
Stewardship—Leveraging the Laboratory to Improve Antimicrobial Use,
describes a strategy aimed at improving appropriate use of antimicrobials. Diagnostic
stewardship strategies designed to reduce false-positive infection diagnoses
include modifications to test ordering, specimen collection and processing, and
result reporting. These false-positives may lead to unneeded antibiotic
treatment but could also serve to obscure or delay a correct diagnosis for
symptoms like delirium due to a non-infectious cause. Therefore, these practice
changes could improve health care quality more generally.
The article includes an informative table summarizing
possible interventions for commonly ordered diagnostic tests for infections,
e.g., urine cultures, blood cultures and certain molecular detection tests. It
also includes a description of potential limitations and the necessity of
monitoring for unintended consequences of diagnostic stewardship interventions.
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