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Medical Laboratory Week is an annual celebration to highlight and show appreciation for laboratory professionals. This week highlights the critical and vital role of laboratory professionals in clinical diagnostics, disease prevention and public health surveillance. Although sometimes unrecognized, the work of laboratory professionals saves lives and protects public health. This month we highlight the Oregon State Public Health Lab (OSPHL) team and the achievements that have improved patient care and public health.
In 2023, OSPHL introduced a groundbreaking test, Carba-R, to screen for carbapenemase-producing organisms (CPOs) in rectal swabs. This innovative technology enhances our screening capacity beyond Enterobacterales to include other bacterial groups like Pseudomonas aeruginosa and Acinetobacter baumannii. By reducing turnaround times and expanding in-house testing capacity, we're strengthening our ability to detect and contain antibiotic-resistant bacteria.
Furthermore, the OSPHL Microbiology team conducted a comprehensive genomic analysis for Acinetobacter in Oregon, underscoring the urgency to make resistant strains reportable. Through whole-genome sequencing, we're shedding light on the epidemiology of these pathogens, enabling better surveillance and outbreak investigations.
OSPHL’s decision to adopt more efficient test kits, like STRECK, shows its commitment to advancing laboratory practices. This move streamlines polymerase chain reaction (PCR) testing across all bacterial groups, expands the list of gene variants we can detect, and enhances our ability to identify potential CPOs swiftly and accurately.
Lastly, the implementation of antimicrobial susceptibility testing by Sensititre in January 2024 marks another milestone. Antimicrobial susceptibility testing performed at the state lab is a powerful surveillance tool that provides additional information and a broader profile of antibiotic resistance in the state.
These achievements underscore OSPHL’s commitment to innovation, quality, and public health. As we celebrate Medical Laboratory Week, let's recognize the remarkable dedication and expertise of our laboratory professionals, whose tireless efforts contribute to saving lives and safeguarding communities every day.
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“There is no public health without the impactful work of our public health laboratories, and there is no healthcare team without the interdisciplinary role of medical laboratory professionals”
– CDC ‘s Division of Laboratory Systems.
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Oregon experienced a record number of carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) cases in 2023. This is a 40% increase from 2022.
Oregon CP-CRE Report
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OHA’s Healthcare Associated Infections Program released new screening recommendations for multidrug-resistant organisms. We recommend that Oregon hospitals and ventilator-capable skilled nursing facilities screen for Candida auris and CPOs, in patients who in the past 12 months:
- Spent the night in a healthcare facility (hospital or long-term care), outside of Oregon or
- Had outpatient surgery or hemodialysis, outside the US or Canada.
Testing is provided at no cost to facilities. Contact us to get started.
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New initiative gives Oregon nursing facilities free HEPA units. The Healthcare-Associated Infections Program is providing MedifyAir MA40 Units and replacement filters to licensed nursing facilities, assisted living facilities, and residential care facilities. High efficiency particulate air (HEPA) filters trap small, harmful particles, such as pollen, mold, viruses, smoke, and dust mites. They improve indoor air quality for staff and residents. Check if your facility is eligible and order by April 30th.
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Most healthcare-associated infections (HAIs) at Oregon hospitals in 2022 were lower than predicted, which aligns with hospitals nationally. While HAIs increased in 2021 coinciding with periods of high COVID-19 activity and hospitalizations, this trend does not appear to continue in 2022. Methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA BSI) and Clostridioides difficile infections (CDI) in Oregon critical access hospitals are priority areas for improvement.
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The Society of Infectious Diseases Pharmacists (SIDP) is offering scholarships to complete its Antimicrobial Stewardship Certificate Program for FREE. This opportunity is open to nurses, nurse practitioners, physician assistants, microbiologists, laboratory scientists, or physicians who identify as an underrepresented minority, and who live and practice in the U.S.
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Telehealth Providers: Join the AHRQ Safety Program for Telemedicine: Improving Antibiotic Use! Join this NO-COST program to improve patient safety and antibiotic use in telemedicine. This 18-month AHRQ program starts in June 2024 and offers technical help, coaching, webinars, and practical tools to adapt antibiotic prescribing for telemedicine. Learn more and join here.
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AUR Reporting for the CMS Promoting Interoperability Program. A reminder that Centers for Medicare and Medicaid Services (CMS) will require all hospitals to be in active engagement with the NHSN Antimicrobial Use and Resistance (AUR) module starting in 2024. See NHSN AUR FAQs for more on requirements and deadlines.
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How to talk to residents and families about antibiotics. We know Nurses and Medical assistants who work in long-term care facilities work hard to keep their patients safe from harm. But what about the harms of inappropriate antibiotic use? This activity offers tools and strategies to improve communication around antibiotic use to help avoid inappropriate prescribing. Free continuing education credits are available.
Infectious Insights
Check out the newest @CDCProjectFirstline micro-learn training on what to do when you see blood. Train your team to recognize infection risks and stop the spread of germs.
MicroLearn - Blood
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Washington State reported its first known outbreak of C. auris. The first case was identified through a proactive admissions screening program. Subsequent investigation and testing found three additional cases.
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75% of US facilities that screened on admission for C. auris in the last year found at least one case. 35% found at least 5 cases, supporting the need for targeted admissions screening to stem the spread.
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Antibiotic resistance is a growing threat — is climate change making it worse? Researchers are studying how extreme weather and rising temperatures can encourage the spread of drug-resistant infections.
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MIT and Harvard scientists using AI have developed the first new antibiotics in decades. The team used a deep-learning model “to predict the activity and toxicity” of a new compound against methicillin-resistant Staphylococcus aureus.
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Cosmetic Surgery Linked to 15 Cases of Nontuberculous Mycobacteria Infections Across Nine States. Inadequate infection control was found in an outpatient cosmetic surgery clinic, urging vigilance among health providers.
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More than half of antibiotics prescribed by dentists do not have guidelines supporting their use. The analysis of 92,224 antibiotic prescriptions from 2019 Veterans’ Affairs health record data concluded that improving prescribing by dentists is critical to reaching the national goal of decreasing unnecessary antibiotic use.
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Higher levels of social vulnerability may increase the likelihood of having a drug-resistant pneumococcal infection.
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CSTE Annual Conference on June 9-13, 2024. Early bird registration closes May 2. There is no registration deadline. The event will be held in Pittsburgh.
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Get to know the exceptional members of the Oregon State Public Health Lab team. This quarter, we introduce Karim Morey.
Karim Morey is the Lead Microbiologist and antibiotic resistance subject matter expert at the Oregon Public Health Laboratory (OSPHL) overseeing testing in Oregon performed in the General Microbiology section for CDC’s Antimicrobial Resistance Laboratory Network (ARLN). Karim obtained her B.S. in Microbiology from the Universidad Nacional de Trujillo in Peru and a MS in Applied Biotechnology from the Oregon State University. Karim has been a clinical microbiologist for 27 years, the last eleven working at OSPHL evaluating and validating newer test methodologies, training personnel, and closely collaborating with epidemiologists and key public health stakeholders. One of her main roles is to collaborate with her team to identify potential outbreaks caused by pathogenic bacteria and rapidly inform epidemiologists to implement measures to stop and prevent the spread of diseases.
When she’s not busy detecting outbreaks, Karim spends time with her family and taking long walks with her beloved dog Charlie. She also enjoys reading, traveling, and learning from other world cultures. While growing up in Peru, Karim was a performer of the national dance “marinera” in her hometown of Trujillo. The love for Peruvian traditional dances stays with her to this day.
As a Latina striving and persevering every day in this country to create a more equitable society, she never forgets the power of the phrase “Si se puede”, honoring its creators Dolores Huerta and César Chávez, who believed in creating a society that values and provides its people with equal opportunities to succeed.
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Do you have a question about antimicrobial stewardship? Send it to us, and Liz Breitenstein, PharmD, RPh, Antimicrobial Stewardship Pharmacist, may answer it in a future edition.
Diagnostic tests play a vital role in fighting antimicrobial resistance by helping identify what type of microorganism (bacterium, virus, fungus, or parasite) is causing an infection and whether it's resistant to antimicrobial medicines. Diagnostic tests can help health professionals end guesswork, reduce unnecessary antimicrobial use, and make sure patients receive the right treatment.
But diagnostic tests are not always necessary. For example, performing urine cultures for asymptomatic patients may drive unnecessary use of antibiotics. Suspected urinary tract infection (UTI) is a common cause of inappropriate antibiotic prescribing in the inpatient setting.
Urine culture stewardship is an approach to ensures that urine cultures are:
- Performed only when indications are present (i.e., when antibiotic treatment would be indicated).
- Collected, stored, and processed in appropriately to prevent contamination.
The CDC Urine Culture Stewardship page outlines approaches for patients with and without indwelling urinary catheters.
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Artificial nails are a way to protect natural nails, make them sturdier, and express your personality. Unfortunately, studies have shown they can also harbor bacteria and prevent good hand hygiene. This becomes a concern in healthcare settings. Fungal growth can happen often under artificial nails because of trapped moisture between the natural and artificial nail. It may also be hard to wash your hands well when wearing artificial nails. The fingertips of people wearing artificial nails have a higher number of bacteria when compared to people with natural nails. This is true both before and after washing their hands. Many facilities have created policies to ban artificial nails to prevent the spread of bacteria.
What about gel or shellac polish nails? Is regular nail polish, okay?
UV hardened gel nails may cause concern as well. When nails grow out, a crack is created in the subungual space that may reduce the effectiveness of hand hygiene and pose an infection risk for patients. However, if well-kept and changed before growing out, studies have shown low incidence of bacterial growth with HCW using gel polish on their nails.
Traditional lacquer nail polish can be used if the HCW maintains clean, short, polish nails that are not cracked or chipped. Once cracked or chipped, this again allows for a reduction in hand hygiene effectiveness and can encourage a higher presence of bacteria in these grooves.
A 2018 article found that gel nails do not have the same impact as artificial nails for bacterial growth burden.
Untitled photo of beakers. Twitter, n.d., https://twitter.com/DNA_RNA_Uni/status/1615746406656139266/photo/1. Accessed March 11, 2024.
Enjoy a dose of infectious humor with a HAI-larious joke that's sure to brighten your day! Have a great joke in mind? Send us your jokes and we’ll feature you in one of our upcoming newsletters.
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Oregon Health Authority works to transform the health care system in Oregon by lowering and containing costs, improving quality and increasing access to care to improve the lifelong health of Oregonians. OHA is overseen by the nine-member citizen Oregon Health Policy Board working toward comprehensive health reform in our state.
The HAI program within the OHA Public Health Division is dedicated to preventing and containing healthcare-associated infections (HAIs) and addressing the growing challenge of antimicrobial resistance (AR). Through initiatives such as the Antimicrobial Resistance Laboratory Network (AR Lab Network) and the National Healthcare Safety Network (NHSN), we are bolstering our ability to detect and respond to antibiotic resistance while strengthening the nation's most widely used HAI tracking system. We also focus on antibiotic stewardship to improve the appropriate use of antibiotics, and we provide comprehensive infection prevention and control (IPC) education and training to equip the health care workforce with the necessary skills. Our team further offers IPC consultations to health care facilities throughout the state, providing expert guidance and support in implementing effective infection prevention strategies and responding to outbreaks. Together, we are committed to enhancing patient safety and reducing the impact of HAIs and antimicrobial resistance.
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