Healthcare Triage: The 2017 Flu Killed 80,000 in the US. Get a Flu Shot!
Influenza killed 80,000 people last year in the United States. That is the highest number of deaths since the CDC started keeping records in the 1970s. Help protect yourself and those around you. Get a flu shot!
Duluth, Minn.-based Essentia Health rolled out a mandatory flu shot policy last year, and the health system will continue the program this year.
Under the program, employees had until Nov. 20, 2017, to receive a flu shot, obtain a medical/religious exemption or face termination. Essentia reported more than 99.5 percent compliance with the program.
For 2018, Essentia will continue its mandatory flu shot program, which also applies to students who train and vendors who operate at the health system’s facilities, as well as people who volunteer through Essentia programs.
To ensure there is plenty of time to review medical/religious exemptions before this year’s Nov. 20 compliance deadline, Essentia moved up the deadline to submit exemption requests.
“The first year [is] the most difficult because everyone [is] doing first-time medical and religious exemption requests,” said Rajesh Prabhu, MD, infectious disease and chief patient quality and safety officer for the system. “Those granted medical exemptions last year still [have their medical exemptions] in place. For religious exemptions, they just have to confirm their belief hasn’t changed from last year.”
He expects compliance to increase this year since fewer people need to request medical exemptions for the first time. Essentia now has 14,700 employees and began its flu shot campaign Oct. 2.
Dr. Prabhu encouraged other systems or hospitals considering a mandatory flu shot program to focus on the reasoning behind beginning the program.
“It’s not just a technical change. You have to get everyone to feel why this is important for not only our employees but [also] the patients we serve. We focus a lot of efforts on that end,” he said.
Dr. Prabhu said support from leadership helped make the first year of Essentia’s mandatory flu shot program a success.
“We had support from our CEO and everyone in leadership,” he said. “[They had] direct, in-person communication with some of those hesitant to get vaccinated because sometimes it’s good to talk to people to understand their concerns and barriers.”
Lessons learned
Essentia announced its mandatory flu shot program in September 2017 and some employees felt they didn’t get enough notice to comply. However, Dr. Prabhu said he believes some employees would not have complied with the program even if they were given more time.
“No matter how much lead time you give, I don’t think it will change the minds of people who are resistant to get the influenza vaccine,” he said.
Essentia’s flu shot policy encountered opposition from unions as well. The Minnesota Nurses Association and some other labor groups that represent Essentia employees continue to challenge the flu shot policy. In July, an arbitrator sided with Essentia over the United Steelworkers Union regarding the policy.
Despite the opposition and a few challenges in the initial rollout, Dr. Prabhu said Essentia needed the policy. He said the system was not going to get to where it wanted to be with its previous voluntary policy, which had 82 percent compliance. And, after evaluating the first year, Essentia decided it was necessary to continue the policy into the 2018-19 flu season.
2018-19 flu season
For this flu season, the CDC recommends everyone 6 months and older receive a flu vaccine by the end of October. Nasal spray FluMist was not recommended last season, but it is recommended for 2018-19 as an option for flu vaccination of nonpregnant individuals age 2 to 49.
It’s unclear how severe the 2018-19 flu season will be. Last year’s flu season was particularly severe, with about 900,000 people hospitalized and about 80,000 people dead due to the virus.
Dr. Prabhu said the flu season hasn’t hit the Duluth area yet, but Essentia is trying to do everything possible to prevent the spread of the virus among patients and staff.
Phyllis Petruzzelli spent the week before Christmas struggling to breathe. When she went to the emergency department on Dec. 26, the doctor at Brigham and Women’s Faulkner Hospital near her home in Boston said she had pneumonia and needed hospitalization. Then the doctor proposed something that made Petruzzelli nervous. Instead of being admitted to the hospital, she could go back home and let the hospital come to her.
As a “hospital-at-home” patient, Petruzzelli learned, doctors and nurses would come to her home twice a day and perform any needed tests or bloodwork.
A wireless patch would be affixed to her skin to track her vital signs and send a steady stream of data to the hospital. If she had any questions, she could talk via video chat anytime with a nurse or doctor.
Hospitals are germy and noisy places, putting acutely ill, frail patients at risk for infection, sleeplessness and delirium, among other problems. “Your resistance is low,” Petruzzelli said the doctor told her. “If you come to the hospital, you don’t know what might happen. You’re a perfect candidate for this.”
So Petruzzelli, who is now 71, agreed. That afternoon, she arrived home in a hospital vehicle. A doctor and nurse were waiting at the front door. She settled on the couch in the living room, with her husband, Augie, and dog, Max, nearby. The doctor and nurse checked her IV, attached the monitoring patch to her chest, and left.
When David Levine, the doctor, arrived the next morning, he asked Petruzzelli why she had been walking around during the night. Far from feeling uncomfortable that her nocturnal trips to the bathroom were being monitored, “I felt very safe and secure,” Petruzzelli said. “What if I fell while my husband was out getting me food? They’d know.”
After three uneventful days, she was “discharged” from her hospital-at-home stay. “I’d do it again in a heartbeat,” Petruzzelli said.
Brigham Health is one of a slowly growing number of health systems that encourage selected acutely ill emergency department patients to opt for hospital-level care at home.
In the couple of years since Brigham Health started testing this type of care, hospital staff who were initially skeptical have generally embraced it, Levine said. “They very quickly realize that this is really what patients want, and it’s really good care.”
This approach is quite common in Australia, Britain and Canada, but it has faced an uphill battle in the United States.
A key obstacle, clinicians and policy analysts agree, is getting health insurers to pay for it. At Brigham Health, the hospital can charge an insurer for a physician house call, but the remainder of the hospital-at-home services are covered by grants and other funding, Levine said.
Insurers don’t have a position on hospital-at-home programs, said Cathryn Donaldson, a spokeswoman for America’s Health Insurance Plans, an industry trade group.
“Overall, health insurance providers are committed to ensuring patients have access to care they need, and there are Medicare Advantage plans that do cover this type of at-home care,” Donaldson said in a statement.
Levine, a clinician-investigator at Brigham and Women’s Hospital and an instructor at Harvard Medical School, was the lead author of a recently published study comparing patients who received either hospital-level care at home or in the hospital in 2016.
The 20 patients analyzed in the trial had one of several conditions, including infection, heart failure, chronic obstructive pulmonary disease and asthma. The trial found that while there were no adverse events in the home-care patients, their treatment costs were significantly lower — about half that of patients treated in the hospital.
Why? For starters, labor costs for at-home patients are lower than for patients in a hospital, where staff must be on hand around the clock. Home-care patients also had fewer lab tests and visits from specialists.
The study found that both groups of patients were about equally satisfied with their care, but the home-care group was more physically active.
Brigham Health is conducting further randomized controlled trials to test the at-home model for a broader range of diagnoses.
Bruce Leff began exploring the hospital-at-home concept more than 20 years ago, conducting studies that found fewer complications, better outcomes and lower costs in home-care patients.
Hospitals, accustomed to the traditional business model that emphasizes filling hospital beds in a bricks-and-mortar facility, have been slow to embrace the idea, however.
There are practical hurdles, too.
“It’s still easier to get Chinese food delivered in New York City than to get oxygen delivered at home,” said Leff, a professor of medicine and director of Johns Hopkins Medical School’s Center for Transformative Geriatric Research.
Since the seven-hospital Mount Sinai system in New York launched its hospital-at-home program, more than 700 patients have chosen it. And they have fared well on a number of measures.
The average length of stay for acute care was 5.3 days in the hospital vs. 3.1 days for home-care patients, while 30-day readmission rates for home-based patients were about half of those who had been hospitalized: 7.8 percent vs. 16.3 percent.
Begun with a $9.6 million federal grant in 2014, Mount Sinai’s program initially focused on Medicare patients with six conditions, including congestive heart failure, pneumonia and diabetes. Since then, the program has expanded to include dozens of conditions, including asthma, high blood pressure and serious infections such as cellulitis, and is now available to some privately insured and Medicaid patients.
Mount Sinai has also partnered with Contessa Health, a company with expertise in home care, to negotiate contracts with insurers to pay for hospital-at-home services.
Among other things, insurers are worried about the slippery slope of what it means to be hospitalized, said Linda DeCherrie, clinical director of the mobile acute care team at Mount Sinai.
Insurers “don’t want to be paying for an admission if this patient really wouldn’t have been hospitalized in the first place,” DeCherrie said.
At Some California Hospitals, Fewer Than Half Of Workers Get The Flu Shot
How well are doctors, nurses and other workers at your local hospital vaccinated against the flu?
That depends on the hospital.
According to data from the California Department of Public Health, flu vaccination rates among health care staffers at the state’s acute care hospitals range from a low of 37 percent to 100 percent.
Overall, flu vaccination rates among hospital workers climbed significantly in the past several years — from an average of 63 percent during the 2010-11 influenza season to 83 percent during the 2016-17 season, according to the California Department of Public Health. Vaccination rates for the current season won’t be determined until later this year.
But that general increase masks some big variations. Monrovia Memorial Hospital in Los Angeles, Los Robles Hospital and Medical Center, East Campus and Thousand Oaks Surgical Center in Ventura each reported that fewer than 40 percent of their health care workers received the flu vaccine last year. Representatives from those hospitals did not return repeated calls for comment.
On the other end of the spectrum, Rady Children’s Hospital in San Diego reported that every single person working there got the vaccine.
California’s flu vaccination policies for hospital workers, and those of many other states, are far from uniform or ironclad. In various states, health care workers have legally challenged hospital requirements for vaccination on religious and seculargrounds. And some unions in California and elsewhere oppose a legal mandate, partly for civil rights reasons.
Public health officials themselves have different takes on the legal requirements for hospital workers. The Centers for Disease Control and Prevention lists California and Massachusetts among the handful of states where the flu vaccination is mandated for health care workers. But the states’ laws allow health care workers to opt out by signing a form declining the vaccine. For that reason, officials from those two states said they do not actually consider the vaccine mandatory.
Colorado law requires hospital health care workers to provide proof of immunization or a doctor’s note providing for a medical exemption, and requires that non-immunized workers wear masks. Hospitals that achieve a 90 percent or higher flu vaccination rate are exempt from these rules, however.
In California, state law requires that hospitals offer the vaccine free of charge. Many hospitals offer vaccines to personnel in the cafeteria, and during day and night shifts. “The key to getting more people vaccinated is to make it more easily accessible for people,” said Lynn Janssen, chief of the California Department of Public Health’s associated infections branch.
She also said many California counties and hospitals have required health care workers to either get the flu vaccine or wear a mask, which can help prevent spreading illness to others.
Partly as a result, nearly a third of the state’s hospitals now have flu vaccination rates above 90 percent.
Vaccination rates vary significantly among different categories of hospital workers, however. Hospital employees had an average vaccination rate of 87 percent statewide in 2016-17, while licensed independent practitioners — including some physicians, advance practice nurses and physician assistants who do not receive paychecks from the hospital — had a rate of just 67 percent.
The CDC recommends that health workers get one dose of influenza vaccine annually, and cites data showing the vaccine in recent years has been to up 60 percent effective — though it was far less so this year. Dr. Bill Schaffner, an infectious diseases professor at Vanderbilt University School of Medicine in Nashville, Tenn., says there are three principal reasons to get vaccinated: to prevent workers from infecting patients, to keep them healthy in order to care for patients and to spare them a bout with the flu.
A 2017 Canadian study, however, suggests that the benefits of health care worker vaccinations have been overstated.
In any case, just because experts say health care personnel should get the vaccine doesn’t mean they will choose to do so.
“In the studies, and also in our experience, it turns out — to everyone’s great surprise — that health care workers are human beings,” Schaffner said. “Some are too busy, some don’t think the flu vaccine is worth it, some don’t like shots. Some are not convinced they can’t get flu from the flu vaccine.” (Experts say they can’t.)
Because of this, Schaffner said, it’s up to hospital leadership to push staffers to get vaccinated. At Vanderbilt University Medical Center, vaccination rates increased from 70 percent to 90 percent once leaders there effectively made the flu vaccine “mandatory,” he said, requiring noncompliant hospital personnel to present vaccine exemption requests to a hospital committee.
Health officials also encourage patients to ask whether their caregivers are vaccinated.
Jan Emerson-Shea, spokeswoman for the California Hospital Association, said her organization would like the flu vaccine to be mandatory for all health care personnel. Independent physicians have proven an especially challenging group to motivate, she said, since hospitals hold little sway over them.
“I, for the life of me, can’t imagine why a physician wouldn’t want to be vaccinated,” she said. “But they make that choice.”
Yet the California Nurses Association strongly opposes making flu vaccines mandatory, said Gerard Brogan, a registered nurse and spokesman for the union.
He said the union does recommend that providers get the vaccine, but it objects to making vaccination a condition of employment. He said some employees have religious issues or safety concerns about the vaccines and “we think that should be respected as a civil rights issue,” he said.
He also called rules requiring unvaccinated providers to wear a face mask “punitive.”
“It’s almost like the scarlet letter to shame you,” he said.
He said the masks can frighten patients — a contention made by a New York union as well. In any case, he said, wearing the masks is not especially effective in stopping the spread of flu (although some researchers say otherwise). Instead, he said, employees should be encouraged to wash hands and to stay home when they are sick.
Too often, he said, nurses are asked to come in to work when they are ill. He said he was not able to find any nurses willing to discuss their decision not to get the flu shot.
https://khn.org/news/infection-lapses-rampant-in-nursing-homes-but-punishment-is-rare/
Basic steps to prevent infections — such as washing hands, isolating contagious patients and keeping ill nurses and aides from coming to work — are routinely ignored in the nation’s nursing homes, endangering residents and spreading hazardous germs.
A Kaiser Health News analysis of four years of federal inspection records shows 74 percent of nursing homes have been cited for lapses in infection control — more than for any other type of health violation. In California, health inspectors have cited all but 133 of the state’s 1,251 homes.
Although repeat citations are common, disciplinary action such as fines is rare: Nationwide, only one of 75 homes found deficient in those four years has received a high-level citation that can result in a financial penalty, the analysis found.
“The facilities are getting the message that they don’t have to do anything,” said Michael Connors of California Advocates for Nursing Home Reform, a nonprofit in San Francisco. “They’re giving them low-level warnings year after year after year and the facilities have learned to ignore them.”
Infections, many avoidable, cause a quarter of the medical injuries Medicare beneficiaries experience in nursing homes, according to a federal report. They are among the most frequent reasons residents are sent back to the hospital. By one government estimate, health care-associated infections may result in as many as 380,000 deaths each year.
The spread of methicillin-resistant Staphylococcus aureus (MRSA) and other antibiotic-resistant germs has become a major public health issue. While Medicare has begun penalizing hospitals for high rates of certain infections, there has been no similar crackdown on nursing homes.
As average hospital stays have shortened from 7.3 days in 1980 to 4.5 days in 2012, patients who a generation ago would have fully recuperated in hospitals now frequently conclude their recoveries in nursing homes. Weaker and thus more susceptible to infections, some need ventilators to help them breathe and have surgical wounds that are still healing, two conditions in which infections are more likely.
“You’ve got this influx of vulnerable patients but the staffing models are still geared more to the traditional long-stay resident,” said Dr. Nimalie Stone, the CDC’s medical epidemiologist for long-term care. “The kind of care is so much more complicated that facilities need to consider higher staffing.”
The Centers for Medicare & Medicaid Services (CMS), which oversees inspections, has recognized that many nursing homes need to do more to combat contagious bugs. CMS last year required long-term care facilities to put in place better systems to prevent infections, detect outbreaks early on and limit unnecessary use of antibiotics through a stewardship program.
But the agency does not believe it has skimped on penalties. CMS said in a statement that most infection-control violations have not justified fines because they did not put residents in certain danger. For instance, if an inspector observed a nurse not washing his or her hands while caring for a resident, the agency said that would warrant a lower-level citation “unless there was an actual negative resident outcome, or there was likelihood of a serious resident outcome.”
Vaccination is underway for the 2017-2018 seasonal flu, and next year will mark the 100-year anniversary of the 1918 flu pandemic, which killed roughly 40 million people. It is an opportune time to consider the possibility of pandemics – infections that go global and affect many people – and the importance of measures aimed at curbing them.
The 1918 pandemic was unusual in that it killed many healthy 20- to 40-year-olds, including millions of World War I soldiers. In contrast, people who die of the flu are usually under five years old or over 75.
The factors underlying the virulence of the 1918 flu are still unclear. Modern-day scientists sequenced the DNA of the 1918 virus from lung samples preserved from victims. However, this did not solve the mystery of why so many healthy young adults were killed.
I started investigating what happened to a young man who immigrated to the U.S. and was lost during World War I. Uncovering his story also brought me up to speed on hypotheses about why the immune systems of young adults in 1918 did not protect them from the flu.
Certificates picturing the goddess Columbia as a personification of the U.S. were awarded to men and women who died in service during World War I. One such certificate surfaced many decades later. This one honored Adolfo Sartini and was found by grandnephews who had never known him: Thomas, Richard and Robert Sartini.
The certificate was a message from the past. It called out to me, as I had just received the credential of certified genealogist and had spent most of my career as a scientist tracing a gene that regulates immune cells. What had happened to Adolfo?
To follow up, I posted a query on the “U.S. Militaria Forum.” Here, military history enthusiasts explained that the Army Corps of Engineers had trained men at Camp A. A. Humphreys in Virginia. Perhaps Adolfo had gone to this camp?A bit of sleuthing identified Adolfo’s ship listing, which showed that he was born in 1889 in Italy and immigrated to Boston in 1913. His draft card revealed that he worked at a country club in the Boston suburb of Newton. To learn more, Robert Sartini bought a 1930 book entitled “Newton War Memorial” on eBay. The book provided clues: Adolfo was drafted and ordered to report to Camp Devens, 35 miles from Boston, in March of 1918. He was later transferred to an engineer training regiment.
While a mild flu circulated during the spring of 1918, the deadly strain appeared on U.S. soil on Tuesday, Aug. 27, when three Navy dockworkers at Commonwealth Pier in Boston fell ill. Within 48 hours, dozens more men were infected. Ten days later, the flu was decimating Camp Devens. A renowned pathologist from Johns Hopkins, William Welch, was brought in. He realized that “this must be some new kind of infection or plague.” Viruses, minuscule agents that can pass through fine filters, were poorly understood.
With men mobilizing for World War I, the flu spread to military installations throughout the U.S. and to the general population. It hit Camp Humphreys in mid-September and killed more than 400 men there over the next month. This included Adolfo Sartini, age 29½. Adolfo’s body was brought back to Boston.
His grave is marked by a sculpture of the lower half of a toppled column, epitomizing his premature death.
The quest to understand the 1918 flu fueled many scientific advances, including the discovery of the influenza virus. However, the virus itself did not cause most of the deaths. Instead, a fraction of individuals infected by the virus were susceptible to pneumonia due to secondary infection by bacteria. In an era before antibiotics, pneumonia could be fatal.
Recent analyses revealed that deaths in 1918 were highest among individuals born in the years around 1889, like Adolfo. An earlier flu pandemic emerged then, and involved a virus that was likely of a different subtype than the 1918 strain. These analyses engendered a novel hypothesis, discussed below, about the susceptibility of healthy young adults in 1918.
Support for this hypothesis was seen with the emergence of the Hong Kong flu virus in 1968. It was in “Group 2” and had severe effects on people who had been children around the time of the 1918 “Group 1” flu.Exposure to an influenza virus at a young age increases resistance to a subsequent infection with the same or a similar virus. On the flip side, a person who is a child around the time of a pandemic may not be resistant to other, dissimilar viruses. Flu viruses fall into groups that are related evolutionarily. The virus that circulated when Adolfo was a baby was likely in what is called “Group 2,” whereas the 1918 virus was in “Group 1.” Adolfo would therefore not be expected to have a good ability to respond to this “Group 1” virus. In fact, exposure to the “Group 2” virus as a young child may have resulted in a dysfunctional response to the “Group 1” virus in 1918, exacerbating his condition.
What causes a common recurring illness to convert to a pandemic that is massively lethal to healthy individuals? Could it happen again? Until the reason for the death of young adults in 1918 is better understood, a similar scenario could reoccur. Experts fear that a new pandemic, of influenza or another infectious agent, could kill millions. Bill Gates is leading the funding effort to prevent this.
Flu vaccines are generated each year by monitoring the strains circulating months before flu season. A time lag of months allows for vaccine production. Unfortunately, because the influenza virus mutates rapidly, the lag also allows for the appearance of virus variants that are poorly targeted by the vaccine. In addition, flu pandemics often arise upon virus gene reassortment. This involves the joining together of genetic material from different viruses, which can occur suddenly and unpredictably.
An influenza virus is currently killing chickens in Asia, and has recently killed humans who had contact with chickens. This virus is of a subtype that has not been known to cause pandemics. It has not yet demonstrated the ability to be transmitted from person to person. However, whether this ability will arise during ongoing virus evolution cannot be predicted.
The chicken virus is in “Group 2.” Therefore, if it went pandemic, people who were children around the time of the 1968 “Group 2” Hong Kong flu might have some protection. I was born much earlier, and “Group 1” viruses were circulating when I was a child. If the next pandemic virus is in “Group 2,” I would probably not be resistant.
It’s early days for understanding how prior exposure affects flu susceptibility, especially for people born in the last three to four decades. Since 1977, viruses of both “Group 1” and “Group 2” have been in circulation. People born since then probably developed resistance to one or the other based on their initial virus exposures. This is good news for the near future since, if either a “Group 1” or a “Group 2” virus develops pandemic potential, some people should be protected. At the same time, if you are under 40 and another pandemic is identified, more information would be needed to hazard a guess as to whether you might be susceptible or resistant.
A new study suggests that healthcare professionals should heed their own advice: Stay home when sick.
Some four in 10 healthcare professionals work while experiencing influenza-like illness, according to findings published in the November issue of the American Journal of Infection Control, the journal of the Association for Professionals in Infection Control and Epidemiology.
As in all workplaces, contagious employees risk infecting others when they turn up for work. But with higher concentrations of older patients and individuals with immunosuppression or severe chronic diseases in healthcare facilities, flu-like transmission by healthcare workers naturally presents a public health hazard.
The research pointed to an earlier study showing that patients who are exposed to a sick healthcare worker are five times more likely to get a healthcare-associated infection.
The annual study, conducted via a national online survey, collected data from from 1,914 professionals during the 2014-2015 flu season. Respondents self-reported influenza-like illness, defined as the combination of a fever and cough or sore throat, and listed factors that prompted them to turn up for work.
The survey assessed a variety of health occupations across multiple institutions: physicians; nurse practitioners and physician assistants; nurses; pharmacists; assistants/aides; other clinical pros; nonclinical pros; and students. Four types of work settings were assessed: hospitals, ambulatory care or physician offices, long-term care facilities and other clinical settings.
Of the 1,914 professionals surveyed, 414 reported flu-like illness. Of these, 183 — or 41.4 percent — reported working for a median duration of three days while experiencing flu-like symptoms.
Hospital-based healthcare professionals had the highest frequency of working with flu-like illnesses (49.3 percent), compared to those at long-term care facilities (28.5 percent). Clinical professional healthcare workers were the most likely to work with the flu (44.3 percent), with pharmacists (67.2 percent) and physicians (63.2 percent) among those with the highest frequency.
The survey found that assistants and aides (40.8 percent), nonclinical workers (40.4 percent), nurse practitioners/physician assistants (37.9 percent), and other clinical workers (32.1 percent) worked while sick.
The most common reasons for healthcare professionals to opt from taking sick leave included feeling that they could still perform their job duties; not feeling “bad enough” to stay home; feeling as if they were not contagious; sensing a professional obligation to be present for coworkers; and difficulty finding a coworker to cover for them. Among the workers who felt they could still perform their job duties, 39 percent sought medical attention for their symptoms, as did 54 percent of those who didn’t think they were contagious. Almost 50 percent of workers in long-term care settings who reported for work when sick reported doing so because they couldn’t afford to lose the pay.
Healthcare professionals with self-reported flu symptoms missed a median number of two work days. Of those, 57.3 percent visited a medical provider for symptom relief; 25.2 percent were told they had influenza. The Centers for Disease Control and Prevention recommends that anyone with such symptoms wait 24-hours after a fever breaks before returning to work.
Previously published results from the survey showed that only 77.3 percent of respondents reported getting a flu shot.
http://www.medpagetoday.com/hospitalbasedmedicine/generalhospitalpractice/65825
Most outbreaks preventable with properly designed and maintained water systems.
Most of the country has seen cases of Legionnaires’ disease associated with healthcare facilities, CDC officials said Tuesday.
This is “a concerning finding,” a CDC statement said, because of the illness’s increased severity when contracted in hospitals and long-term care facilities. The fatality rate for definite healthcare-associated Legionnaires’ disease was 25% in a new CDC analysis.
Surveillance data from 20 states and one large city identified 2,809 Legionella infections.
Although the analysis found that only 3% of confirmed cases were definitely acquired in healthcare institutions, officials said they believe that a much larger fraction were contracted in such facilities but were diagnosed only after discharge. The CDC’s Vital Signs report indicated that another 17% of infections were suspected to have originated in healthcare facilities, in that the patients had been in such a facility within 10 days of symptom onset.
During a press call with reporters, CDC Acting Director Anne Schuchat, MD, said the study highlights the important work that hospitals and long-term care facilities must do with regard to their water systems. Legionella organisms live in water and outdated systems allow them to spread.
Proper water management “could have prevented four out of five Legionnaires’ disease outbreaks,” Schuchat said. “This means tending to the buildings’ water infrastructure,” she added, particularly in older facilities.
The chief of CDC’s respiratory diseases branch, Cynthia Whitney, MD, MPH, noted on the press call that the agency has developed a water-management toolkit for hospitals and other facilities to minimize Legionnaires’ disease. As important as having a program, she emphasized, is assigning “a dedicated team to execute the program.”
Whitney and Schuchat also said they believe many, perhaps most, Legionnaires’ cases go undiagnosed. Whitney said it’s vital that patients with symptoms consistent with the condition undergo specific testing for Legionnaires’ disease, so that outbreaks can be curtailed at their outset.
The incidence of Clostridium difficile infections rose by 43% from 2001 to 2012, while the incidence of multiple recurring CDI rose by 189% over the same period.
Multiple recurring Clostridium difficile infections are becoming more common in the nation’s hospitals and researchers aren’t sure why. In an analysis of a large, nationwide health insurance database, researcher’s at the University of Pennsylvania’s Perelman School of Medicine found that the annual incidence of multiple recurring C. difficile (mrCDI) increased by almost 200% from 2001 to 2012.
During the same period the incidence of ordinary CDI increased by only about 40%. The study results were published this week in the Annals of Internal Medicine.
Related: C. Diff Infection Raises Hospital Costs by 40% per Case The reasons for the sharp rise in mrCDI incidence is unknown.
Researchers said the finding points to an increased burden on the healthcare system, including increased demand for new treatments for recurrent CDI. The most promising of these new treatments, fecal microbiota transplantation—the infusion of beneficial intestinal bacteria into patients to compete with C. difficile—has shown good results in small studies, but hasn’t yet been thoroughly evaluated. “The increasing incidence of C. difficile being treated with multiple courses of antibiotics signals rising demand for fecal microbiota transplantation in the United States,” said study senior author James D. Lewis, MD, professor of gastroenterology and senior scholar in the Center for Clinical Epidemiology and Biostatistics.
Related: Intractable C. Diff Infection Linked to Multiple Care Settings “While we know that fecal microbiota transplantation is generally safe and effective in the short term, we need to establish the long term safety of this procedure.” In their analysis of CDI trends, the researchers examined records on more than 40 million patients enrolled in private health insurance plans. Cases of CDI were considered to have multiple recurrences when doctors treated them with at least three closely spaced courses of CDI antibiotics.
Hospital floors and sinks may pose infection risks, ones that could be overlooked when trying to control the spread of disease.
The floors in patient rooms may be contaminated by bacteria like methicillin-resistant Staphylococcus aureus (MRSA) or Clostridium difficile, according to a new study published in the American Journal of Infection Control. These pathogens, which can cause potentially deadly infections, can be spread when items are dropped on the floor, the researchers noted.
The research team swabbed a number of surfaces, including the floors, clothing, call-buttons and other high-touch items, in 159 rooms at five Cleveland hospitals, according to the study. The study included C. difficile-isolated rooms, and researchers found floors were often tainted by bacteria, most commonly with MRSA, C. difficile and vancomycin-resistant enterococci (VRE). The researchers also found that in 41% of these rooms, at least one high-touch object came in contact with the floor.
The study team said it hopes the results bring more attention to the infection risk posed by floors, which are not often considered in the conversation on infection control.
“Although healthcare facility floors are often heavily contaminated, limited attention has been paid to disinfection of floors because they are not frequently touched,” lead study author Abhishek Deshpande, M.D., Ph.D., an internal medicine physician for the Cleveland Clinic, said in an announcement. The results of our study suggest that floors in hospital rooms could be an underappreciated source for dissemination of pathogens and are an important area for additional research.”
Another recent study noted that hospital sinks may frequently host drug-resistant superbugs like MRSA or VRE. The research, which was published in Applied and Environmental Microbiology, set up five identical sinks in a lab that replicated sinks at the University of Virginia’s hospital in Charlottesville. The researchers then contaminated the sinks with E. coli bacteria, and though colonization began in drain pipes, it inched toward sink strainers before water spread it in the sink.
“This type of foundational research is needed to understand how these bacteria are transmitted, so that we can develop and test potential intervention strategies that can be used to prevent further spread,” Amy Mathers, M.D., an associate professor of medicine at pathology at University of Virginia, told HealthDay.
HENRY KOTULA 