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Carbapenem-resistant Enterobacteriaceae (CRE) are a subgroup of Enterobacteriaceae that are resistant to commonly used antibiotics. They are a serious threat to public health. A new study just released by the CDC describes carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) from less common genera identified through reference testing at CDC and surveillance at the Minnesota Department of Health and Public Health Laboratory.
Read more: MMWR: Notes from the Field: Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae from Less Common Enterobacteriaceae Genera — United States, 2014–2017; CDC
 Get the resources and training that your facility needs to run a robust antibiotic stewardship program by joining a free, 12-month national project.
Beginning in December 2018, the AHRQ Safety Program for Improving Antibiotic Use provides participating long-term care facilities with antibiotic use guidelines, expert coaching, online education, improvement tools, patient education materials, and more to help you prevent harms associated with antibiotics, such as Clostridium difficile.
Participants also have the opportunity to earn continuing education credits. This program is funded and guided by the Agency for Healthcare Research and Quality and is led by Johns Hopkins Medicine and NORC at the University of Chicago.
Learn more: The AHRQ Safety Program for Improving Antibiotic Use: A National Program for Antibiotic Stewardship
Efforts to cut patient safety risks such as Central Line-Associated Bloodstream Infections, Clostridium difficile Infections, Surgical Site Infections, Ventilator-Associated Pneumonia, and other Hospital Acquired Conditions or falls saved 8,000 lives and $2.9 billion between 2014 and 2016, according to the Agency for Healthcare Research and Quality's National Scorecard on Hospital-Acquired Conditions. AHRQ estimates 350,000 hospital-acquired conditions were avoided in that time period, reducing the rate of such adverse events by 8 percent.
Read more: AHRQ: Decline in hospital-acquired conditions saved 8,000 lives and $2.9B; Fierce Healthcare
When we think about how hepatitis C is transmitted we often think about drug abuse and sharing used needles on the street. There is another situation that in which needles are reused that often goes undetected, that is within healthcare facilities, where drugs are passed every day. Drug diversion is an issue in and of itself, but it becomes even more serious when it happens in healthcare facilities.
A true story
This case really underscores how important it is to provide training to staff on injection safety and provider diversion training.
"The nurse trainee said when she worked with Henry, residents complained of pain even after Henry gave them their medication. But when training with other nurses, the trainee said the same residents were not complaining of pain after receiving pain medication."
The nurse-trainee reported the provider who diverted drugs. An investigation showed that instead of giving residents scheduled doses of hydrocodone or Percocet, Henry was giving them Tylenol."
Read more: Nursing home worker accused of drug theft; Leader-Telegram
Facilities need to assess their organizational awareness and assume that if you have controlled substances, you will have diversion. Train your staff to recognize signs of diversion.
Table top exercises
The New Jersey Department of Health has created drug diversion tabletop exercises for ambulatory surgery centers and acute care facilities. Their facilitator guides are complete with scenarios to stimulate a discussion of drug diversion and to review existing policies related to the topic
If your facility hosts any exercises, please let us know at health.hai@state.mn.us
Read more: New Jersey News and Events; One and Only Campaign
 Recently there has been a dramatic shift in health care delivery from hospitals to the outpatient setting. Without outpatient infection control programs, the opportunities for health care–acquired infections in these settings will increase. New resources developed specifically for outpatient settings provide guidance for developing an infection prevention and control program.
The Joint Commission and Center for Disease Control's Adaptation and Dissemination of Outpatient Infection Prevention Guidance team (ADOPT), have developed two new infection prevention guides for outpatient settings to be released in 2018. The two infection prevention guides will focus on combined orthopedics/pain management settings and guidance focused on podiatric settings.
Learn more: Joint Commission, CDC Collaborating on Ambulatory Infection Prevention Project
Infectious Disease Society of America (IDSA) also provides guidance. A review by Steinkuller et al. describes a step-by step approach for implementing an outpatient infection control program, highlighting some of the common pitfalls and high-priority areas.
Read more: Outpatient Infection Prevention: A Practical Primer; Open Forum Infectious Diseases
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Do you work in a medical or dental ambulatory care setting?
Are you interested in improving antibiotic stewardship?
In Fall 2018, Minnesota Department of Health will gather an advisory group to share insights on stewardship needs in ambulatory care, identify priorities for resource and tool development, and help promote awareness of stewardship resources.
If you are interested in joining us, contact health.stewardship@state.mn.us.
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Members of the Minnesota One Health Antibiotic Stewardship Collaborative (MOHASC) will be at the 2018 State Fair to discuss the problem of antibiotic resistance, how antibiotic stewardship can make an impact, and what everyone can do to combat resistance.
We encourage you to find us in the Eco Experience Building, learn more about our unique Stewardship Collaborative, and participate in our stewardship pledge!
The Minnesota State Fair runs August 23 through September 3, 2018.
Learn more: Minnesota State Fair
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Over 2,500 nursing homes have enrolled and reporting Clostridium difficile events in the National Healthcare Safety Network (NHSN). Comparison of nursing home data indicates that the burden of CDI is NOT equally distributed across the US nursing homes. Clustering of CDI events may be a flag for action.
You can report CDI in NHSN and compare your nursing home with others in the nation. The data is now available to drive action. The Minnesota Department of Health provides support for facilities interested in NHSN enrollment, CDI reporting and analysis for long-term care facilities. Contact health.hai@state.mn.us or 651-201-5414 for more information about enrolling in NHSN.
Learn more: National Healthcare Safety Network (NHSN)
New NHSN Educational Roadmap
The roadmap is divided by component or protocol, each one will provide you with a guided tour of training materials. Your journey begins with basic level learning events and guides you to more advanced content.
Learn more: NHSN Educational Roadmaps; CDC
NHSN Interactive Self-paced Trainings – Updated for 2018
Updated 2018 self-study training courses are now available on the NHSN website. Individual training courses will include: Introduction to Device-associated module, CLABSI, CAUTI, PNEU, CLIP, MRSA Bacteremia and CDI LabID Event Reporting, Introduction to Procedure-associated module, and SSI.
Learn more: NHSN Continuing Education; CDC
Analysis Quick Learn Resources: 5-15 Minute Trainings
The NHSH Analysis Series covers everything you need to know about entering your facility’s data and creating and modifying reports in NHSN.
Learn more: NHSN Analysis; CDC
This year's workshop will focus on providing knowledge and experience to attendees to create novel research related to antimicrobial stewardship across the healthcare continuum.
The workshop agenda is focused on how to define and scope out antimicrobial stewardship research to create best practices and improve patient outcomes. Register before September 27th to get the early-bird special.
Learn more: SHEA Antimicrobial Stewardship Research Workshop Agenda| SHEA Antimicrobial Stewardship Research Workshop Registration
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