Division of Infectious Diseases

Nichole Regan on “Why I Love ID”

Nichole Regan, APRN, NP-C on “Why I Love ID”

“I love ID because each patient is a blend of history, exam, laboratory and other results, tied to a very personal human story. We have algorithms to guide us, and cutting-edge research to challenge us to do better. The ID team at Nebraska Medicine is the icing on the cake—some of the most brilliant and resourceful people I have ever had the pleasure to work with!”

See more about the UNMC ID division here and the UNMC HIV clinic here.


 

Ebola Case Confirmed – Are you Ready? National Ebola Training and Education Center

Earlier this Month, WHO confirmed a case of Ebola related death in the Democratic Republic of the Congo. Although there is not a known widespread outbreak, such confirmations raise questions of  preparedness. Are you ready if there is another outbreak of Ebola or another highly contagious infectious disease? If you are not prepared, or unsure, training is available.

The National Ebola Training and Education Center (NETEC), leverages the expertise of three institutions that have safely and successfully treated patients with Ebola.  The National Ebola Training and Education Center has worked diligently to share its knowledge with other health care facilities and public health jurisdictions.

ROLE OF THE NATIONAL EBOLA TRAINING AND EDUCATION CENTER (NETEC)

In coordination with ASPR (Assistant Secretary for Preparedness and Response) and CDC (Centers for Disease Control and Prevention), the NETEC conducts site visits which can include direct training, readiness assessment, and technical consultation to assist healthcare facilities prepare for Ebola and other special pathogens.

READINESS ASSESSMENT
NETEC offers on site hospital readiness assessment to assist facilities in validating Ebola and other special pathogen preparedness plans. Readiness assessments generally consist of a team of faculty from the three NETEC institutions spending at least one day on site to help hospitals validate plans from pre-hospital arrival to patient discharge.

TECHNICAL ASSISTANCE/EDUCATION

NETEC faculty provide targeted technical assistance to hospitals through on-site individualized exercise training programs focusing on key topics such as management of the deceased, PPE, and infection control (to name a few). This assistance can also be provided utilizing distance learning technology depending on the needs of the requesting site.

TRAINING/EXERCISE DEVELOPMENT

Independently, or in conjunction with a readiness assessment, NETEC offers significant resources for emergency management exercise planning and development.  NETEC faculty can provide technical assistance while serving as on site evaluators/observers during an actual exercise and can act as subject matter experts during the planning phase of exercise development.  

NETEC also has HSEEP compliant exercise templates available online at www.netec.org that include essential components for a successful exercise.


 

Dr. Hankins on “Why UNMC ID?”

Dr. Hankins on “Why UNMC ID”  

When I started residency I had no idea what I wanted to do afterwards.  Soon I realized as an intern that every patient I saw in which we were treating for an infection, suddenly became the patients I was most interested in.  I was amazed at how quickly patient’s with blood stream infections could go from almost dying to appearing perfectly healthy in just 24 hours.  I found myself excitedly running down to the micro lab at the VA to personally follow up on rare blood cultures.  I chose UNMC because of how much I like all of the staff.  I’ve rotated through the ID service multiple times and enjoyed working with all the different providers on the service.  I think that UNMC provides a variety of ID exposures, and I thought that it would be great to learn with the staff that I really enjoy working with.

 

 

– Dr. Richard Hankins, incoming Infectious Disease fellow

See more about the Infectious Disease fellowship here.


 

ID Journal Club on HPV Vaccination

What Are You Reading?

 

 

At the last Infectious Diseases Journal Club, I reviewed “Quadrivalent HPV Vaccination and the Risk of Adverse Pregnancy Outcomes”, a comprehensive review published in the March 30th, 2017 issue of The New England Journal of Medicine that examined adverse pregnancy outcomes between women who received the quadrivalent HPV vaccine during pregnancy and those who did not.  I trained in both internal medicine and pediatrics and studies like this one pique my interest as the implications span across the fields.  The HPV vaccine is recommended for all women ages 9-26 years, but few data exist regarding the vaccine during pregnancy.  The study’s data showed that the children born to women vaccinated with the quadrivalent HPV vaccine during pregnancy did not have a significantly higher rate of major birth defects compared to children born to women who were not vaccinated with the quadrivalent HPV vaccine during pregnancy.  Also, the number of spontaneous abortions, preterm births, infants with low birth weight, infants who were small for gestational age, and stillbirths were not higher in the vaccinated cohorts than in the unvaccinated cohorts.  This data therefore supports the safety of HPV vaccines if they are inadvertently given in pregnancy.  For me, this study highlights the need for vaccine studies to include pregnant women who until recently were classified as a “vulnerable population” by the Common Rule, the ethical framework that guides biomedical research in humans in the United States.

– Content courtesy of Dr. Andrea Green


 

Infection Prevention and Healthcare Associated Infections

It is difficult to overstate the importance of healthcare associated infections (HAI).  Approximately 4% of patients who enter hospitals in the United States develop an infection related to their hospital care.  Although 4% may not sound like a big number, when you multiply 4% by the tens of millions of admissions to U.S. hospitals, it equates to 1-2 million infections per year resulting in billions of dollars of excess cost and approximately 100,000 deaths.  This is one of the leading causes of death in the United States!

The Infection Prevention team at Nebraska Medicine coordinates a multi-faceted approach to minimize a patient’s risk for HAI.

  • First, we stress standard infection control measures- hand hygiene is the cornerstone, and our surveillance program, with over 118,000 opportunities for hand hygiene observed, documents overall compliance of ~90% (although we are not satisfied with this level of hand hygiene and our target is 100%, it is much better than compliance cited in most of the published literature).
  • We also stress appropriate isolation precautions for patients with some types of infections due to antibiotic-resistant pathogens.
  • We know a clean environment is important and we use an invisible UV-tagged marking gel to ensure that our housekeepers are thorough in their cleaning and disinfection of patient rooms and the healthcare environment- they do a terrific job and their numbers prove it! In addition, for rooms potentially contaminated with antibiotic-resistant pathogens or environmentally hardy spores, we disinfect the rooms with an UV-irradiation robot!
  • Furthermore, in our fight against pathogen acquisition and transmission, all of our patients are bathed daily with an antiseptic soap called chlorhexidine. This intervention has been proven to prevent bloodstream infections and stop the transmission of antibiotic-resistant pathogens.
  • Because medical devices such as urinary catheters and intravenous lines can put patients at risk of infection, we stress careful insertion and care procedures, and protocols are in place to remove devices as soon as they are no longer needed. Intravenous catheters are further protected with chlorhexidine-impregnated dressings and the hubs are covered with an alcohol-containing passive port protector.
  • Another robust program to prevent infections is our respiratory etiquette program and our yearly healthcare worker influenza vaccination campaign. We are proud to note that over 90% of our bedside providers are vaccinated each year.

These are just some of the efforts that are in effect, largely “behind the scenes” to keep our patients safe from infection.  We recognize that infection prevention is a team sport and we are all part of the team.

– Content from Dr. Mark Rupp, Professor and Chief, Division of Infectious Diseases; Medical Director, Department of Infection Control & Epidemiology


 

Let’s Talk About…HIV and Stigma

Recently, Nikki Regan, APRN at the Nebraska Medicine Specialty Care Clinic, was a guest speaker for the Healthy Lifestyles curriculum at her alma mater, Ridge View Middle School (formerly Schaller-Crestland), in Early, IA.

Regan led a discussion about HIV and stigma for a group of approximately sixty (very curious) 8th graders. They talked about HIV basics, like how it is transmitted and, more importantly, how to prevent transmission, as well as the stigma associated with the disease. The sub-title of the presentation was Caring for Yourself and Caring for Others. “My goal was for these adolescents to know the facts. With the facts, they can protect themselves, and also treat those already impacted by HIV with respect and compassion, because they are no longer fearful”, states Regan.

The students had plenty of great questions. On a pre-survey of the class, 60% of them had reported they thought they would become HIV positive at some point in their life. “They were afraid they would acquire HIV from casual contact. They didn’t quite understand that HIV doesn’t just ‘happen’, so we talked a lot about how it has to be transmitted from a HIV-positive person, and ways that can occur”, Regan said.

Regan added, “I am very passionate about taking care of our patients at the HIV clinic, but I am just as passionate about educating the next generation about HIV, so they don’t become one of my patients. HIV is 100% preventable, and hopefully after today, these kids are prepared to protect themselves by avoiding high-risk behaviors.”

 

-Content from Nikki Regan, APRN


 

Dr. Zimmer on “Why I Love ID”

Dr. Zimmer on “Why I Love ID”: I love the diversity and complexity of the field and especially enjoy working with immunocompromised populations. Seeing a variety of challenging cases and working with multiple different teams makes every day interesting.

Learn more about Dr. Zimmer and the UNMC ID Division here.