Division of Infectious Diseases

Celebrating Antibiotic Awareness Week in Nebraska!

Antibiotic Awareness Week Proclamation Signing Ceremony

CDC has designated November 18 to 24 as US Antibiotic Awareness Week.  Antibiotic Awareness Week is an annual observance in the United States and around the world to promote the importance of using antibiotic appropriately as a mean to minimize unwanted effects from antibiotic therapy (e.g., adverse reactions, Clostridioides difficile infections) and antibiotic resistance.

In recognition of this annual observance, Governor Pete Ricketts signed a proclamation on November 4, 2009 in the State Capitol designating November 18 to 24 Antibiotic Awareness Week in Nebraska.  Dr. Maureen Tierney, the head of the Healthcare Associated Infections and Antimicrobial Resistance (HAI-AR) Team within Public Health at the Nebraska DHHS, delivered a brief statement during the signing ceremony.  She remarked that antibiotics are critical and life-saving tools for combating common and serious infections but at least 30% of outpatient antibiotics are prescribed unnecessarily (contemporary estimates suggest that more than half of antibiotics prescribed in the outpatient setting are inappropriate).

Dr. Tierney explained that a number of different partners in Nebraska are improving the way healthcare professionals, farmers, veterinarians and other professionals in the livestock and agricultural industries are using antibiotics.  These partners include the Nebraska Infection Control Assessment and Promotion Program (ICAP), Nebraska Medicine, CHI, Great Plains Quality Innovation Network, Nebraska Pharmacist Association, Nebraska One Health, and the Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP).

Follow us for more content throughout this week celebrating Antibiotic Awareness!

Content courtesy Phil Chung, PharmD

Photos courtesy Sue Beach

Antibiotic Awareness Week Is Coming! How Will YOU Raise Awareness??

CDC has designated November 18-22, 2019 as US Antibiotic Awareness Week!  We are joining the CDC and many organizations around the world recognizing and promoting awareness for appropriate antibiotic use.

During #AntibioticAwarenessWeek, collaborative blog posts from UNMC ID/ASP and Nebraska ASAP will be published between November 18 and 22.

Check out these videos supporting the Antibiotic Awareness Week message, from our UNMC ID archives!

  • Dr. Jasmine Marcelin (UNMC ID specialist and Associate Medical Director of Antimicrobial Stewardship) and her General ID consult team sharing their reasons to #BeAntibioticsAware
  • Dr. Catherine Liu (ID specialist and visiting Grand Rounds speaker from University of Washington) sharing antimicrobial stewardship initiatives in immunocompromised patients
  • Dr. Trevor Van Schooneveld (UNMC ID specialist and Medical Director of Antimicrobial Stewardship) sharing his top reasons for choosing antimicrobial stewardship as a career (video courtesy Infectious Diseases Society of America)
  • Dr. David Khan (Allergy specialist and visiting Grand Rounds speaker from UT Southwestern) sharing how to deal with antibiotic allergies (which impact antimicrobial stewardship)
  • Dr. Jasmine Marcelin (UNMC ID specialist and Associate Medical Director of Antimicrobial Stewardship) sharing why antimicrobial stewardship is important (video courtesy Infectious Diseases Society of America)

The CDC has suggested a list of activities and an informative toolkit to promote appropriate antibiotic use which include:

  • Highlight US Antibiotic Awareness Week on your website
  • Use Antibiotic Awareness Week to kickoff your stewardship program
  • Distribute tools and guidelines to employees, healthcare professionals, and the general public
  • Post social media messages and participate in the global Twitter Storm on Monday November 18 between 9:00-10:00 AM EST using the hashtag #USAAW19
  • Share information with your organization’s membership through email or newsletters

Which of these activities will your facility adopt during Antibiotic Awareness Week? Need ideas? Check out this post from our Nebraska ASAP team and the CDC partner toolkit for links to resources!

We at UNMC ID/ASP and Nebraska ASAP and are excited about the upcoming Antibiotic Awareness Week during November 18-22. We hope you and your facility will fully participate in activities promoting appropriate antibiotic use.  Get more information about UNMC ASP and Nebraska ASAP


 

Are you ever involved with prescribing antibiotics in the hospital? We want to hear from you!

The Nebraska Medicine Antimicrobial Stewardship Program (ASP) invites you to participate in a research survey entitled: Use of Oral Antibiotic Therapy (OAT) for Definitive Treatment of Uncomplicated Bloodstream Infections (uBSIs): Opportunities for Antimicrobial Stewardship.

There are several studies describing successful use of oral antibiotics to treat bloodstream infections, but are clinicians actually using oral antibiotics for bacteremia? The purpose of this study is to evaluate clinician’s use of oral antibiotics in bloodstream infections. This study has been evaluated by the UNMC IRB and deemed exempt (IRB # 488-19-EX).

You are eligible to participate in this research study because you may be a physician, pharmacist, advanced practice provider, or other clinician caring for hospitalized patients who may receive antibiotics.

If you are ever involved with prescribing antibiotics for hospitalized patients, you are eligible to complete this 5 minute survey.

The primary physical location of this study is Nebraska Medicine, but has been expanded to include clinicians outside of Nebraska Medicine using social media/digital dissemination.  You do NOT have to be employed by Nebraska Medicine to complete this survey.

Your participation in this survey is voluntary and your responses will be confidential and anonymous. There are no known risks to completing this survey. If you agree to participate, please fill out this survey, which should take less than 5 minutes to complete.

Survey Link: (https://unmcredcap.unmc.edu/redcap/surveys/?s=DDWHLKWNNL). This survey link can be forwarded, so feel free to forward this invitation to as many of your colleagues as possible (but please only take the survey once). 

For questions about the survey, contact Principal Investigator, Dr. Jasmine Marcelin (jasmine.marcelin@unmc.edu).

Thank you for participating!


 

UNMC Global Center for Health Security opens new National Quarantine Center

The UNMC Global Center for Health Security (GCHS) has expanded its capability and national role in quarantine care through the establishment of a 20-bed quarantine unit located within the Davis Global Center for Advanced Inter-professional Learning.

The National Quarantine Center, funded in October 2016 by a $20 million dollar award from the Assistant Secretary of Preparedness and Response (ASPR), officially opened on October 1, 2019, and is the only dedicated quarantine space in the United States for individuals exposed to highly hazardous communicable diseases.

The Davis Global Center also houses a Biocontainment Training Unit, which consists of a six-bed simulated biocontainment unit, a laboratory, autoclave, advanced control rooms, and debriefing rooms that will be used to train healthcare workers from across the country, including National Disaster Medical System members and UNMC/Nebraska Medicine staff.

For more information go to the GCHS website or check out the recent Center for Preparedness Education newsletter featuring the GCHS.

Content provided by Dr. Angela Hewlett (Medical Director of the Nebraska Biocontainment Unit). Photo with permission from James Horacek (GCHS)

EMR Order Set Speeds Time to Antibiotic Treatment in Musculoskeletal Infections

The UNMC contingent at the 2019 Musculoskeletal Infection Society, from right to left: Nurse Practitioners Dan Cramer and Tiffany Kalin, Dr. Angela Hewlett (Orthopedic Infectious Diseases), Dr. Curtis Hartman (Orthopedic Surgery). Dr. Hewlett moderated a scientific abstract session and served as a panelist for a prosthetic joint infection clinical case presentation session.

Dr. Angela Hewlett spends her time at UNMC not only studying Ebola but also working to prevent and manage musculoskeletal infections.  In addition to publishing this year’s update on “What’s New in Musculoskeletal Infection,” she collaborated with orthopedic surgeons, trauma surgeons, and emergency physicians to design and implement a new order set in the UNMC electronic medical record system to streamline antibiotic initiation in the setting of fractures.  Previously, physicians would have to build an antibiotic regimen for each of their patients, frequently resulting in ID consultation to determine the appropriate medication and dose.  By constructing an order set in the EMR, the authors hypothesized that providing clear and easily accessible instructions would lead to faster initiation of appropriate antibiotics in the emergency department.

The order set contains guidelines for fracture classification and recommended antibiotic strategies based on contamination, patient allergies and condition, and bacterial colonization. There are also direct links for providers to request an ID consult.

The results of their performance improvement project, published in the Journal of the American Academy of Orthopaedic Surgeons, were powerful.  Patients whose physicians used the new order set were evaluated sooner and received antibiotics faster compared to those whose physicians did not use the order set.  The order set has been rolled out at all UNMC/Nebraska Medicine sites and is available in the supplemental resources in their paper.

 


 

Medical Student Musings from #UNMCHIV2019

This year, the UNMC HIV Update for Care Providers and Educators on October 10, 2019 brought approximately 100 attendees to Omaha again to learn about new drugs, management approaches, and patient experiences with HIV. The CME conference was funded by the Nebraska AIDS Education & Training Center (AETC), [a local partner of the Midwest AETC], and the Nebraska Department of Health & Human Services. One of our medical students, Brandon Lew, attended and shared his thoughts about the conference here. 

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Every year, health professionals involved in the care for patients with HIV get together at the UNMC HIV Care Update Symposium. With the successes of antiretroviral therapy, HIV treatment has been one of the major healthcare successes of recent history. However, there is still progress to be made and the treatment for patients with HIV is continually improving.

This year the symposium took place on October 10, and I had the pleasure of attending the conference. It was a full day of talks organized by the UNMC ID healthcare professionals who staff the HIV Specialty Care Center. The talks began with UNMC physician Dr. Sara Bares, who set the stage in what’s new in HIV care. She established how HIV still impacts hundreds of thousands of lives, and discussed the hopes for making HIV a disease of the past with initiatives such as the Ending the HIV Epidemic. She then turned to the audience and asked what they thought the biggest barrier to ending the HIV epidemic in Nebraska was. Free responses were submitted through our phones and immediately a word cloud was generated using the audience’s answers. This was not only a super cool way of making the presentations interactive and engaging, but also highly impactful seeing professional consensus that 1) lack of education and 2) stigma were major barriers to HIV care.

The day went on with keynote speaker Dr. Timothy Wilkin (from Cornell) sharing about advances in antiretroviral therapies and Dr. Josh Havens speaking about the current state of Pre-exposure prophylaxis (PrEP), that is, medication for HIV prevention. In going to scientific conferences, these were the talks I was expecting and excited to see, learning about the state-of-the-art therapies and scientific studies. However, I was also pleasantly surprised by the number talks that did not revolve around the science and medical jargon.

Dr. Nada Fadul, MD, Precious Davis, MSN, RN, and Tommy Young-Dennis presented on connecting patients in a talk entitled “Meeting Them Where They Are: Strategies to Engage Black MSM in HIV Care and Prevention Services.” Their passion for not just treating, but truly caring for patients and their lives was striking. They advised to engage the patient and learn about their struggles, “keep it real,” and be mindful your own of verbal and nonverbal communication. Interestingly there were also talks which did not centrally focus on HIV, including presentations on current trends in illegal drug use in Omaha, and how to have a dialogue with refugee populations living around Omaha. These patient focused discussions and locally driven information were especially impactful because they were not jargon filled lectures, but rather topical information on subjects that are important for patient care.

One of the recurring and most impactful discussions for me was around “U=U”. I had learned of the phrase during a preceptorship at the Specialty Care Center, and as a medical student, I immediately identified it as a great learning tool. In medical school, there is so much to memorize, and acronyms become ubiquitous for learning. So when I learned that Undetectable = Untransmittable, or U=U, I identified it as an important educational tool not only for myself, but also in patient education. I knew that this phrase was effectively helping address one of the major barriers to HIV care, the lack of education.

However, what I did not realize is how U=U also addresses that second audience-identified barrier to HIV care, the stigma surrounding HIV. This discussion was the final topic of the symposium, and was the most impactful part of the day for me. Three patients with HIV spoke about their stories with HIV and their perspectives on HIV care, and the message of U=U. The stigma they had experienced throughout their lives due to HIV was heart breaking, describing denigration and isolation due to their diagnosis. They then described how the message of U=U was freeing from that stigma. Undetectable = Untransmittable; that is, NO risk of transmitting HIV through sexual contact. And for the patients, eliminating that risk of transmission can in turn eliminate the unending concern that one might transmit HIV to someone they love, or the isolation that some patients may feel in being labeled as HIV positive. Put in much better words by one of the panelists: “I am liberated from the cloud over me.

Ultimately the symposium opened my eyes to what it means to care for patients with HIV. I learned about the cutting-edge advances in antiretroviral therapies and the current state of PrEP for HIV prevention. But importantly, I also learned that care for patients with HIV is much more than a viral load and CD4 count. It’s also about meeting them where they’re at, overcoming barriers to care, and addressing the stigma around HIV.

Happy National Pharmacy Week!

We LOVE our UNMC ID Pharmacists! This week is National Pharmacy Week and we want to share our appreciation and thanks for the hard work and invaluable contributions of our pharmacists at UNMC ID. Our pharmacists are not only exceptional clinicians giving us the clinical advice we need on antimicrobials and drug interactions, but they are also published national experts in Antimicrobial Stewardship and HIV, experienced educators in both the College of Pharmacy and College of Medicine, and phenomenal colleagues all-around. Our division would not function as well as it does without these individuals, and we do not thank them enough.

Meet our UNMC ID Pharmacists:

(TOP ROW L-R):

Josh Havens, PharmD, BCPS: Pharmacy Coordinator of the UNMC Specialty Care (HIV) clinic, PI on several clinical studies, coordinator of our Pre-exposure Prophylaxis (PrEP) clinic, and HIV clinic pharmacy rotation preceptor.

Kimberly Scarci, PharmD, MS, FCCP, BCPS-ID: Clinical Pharmacist at UNMC Specialty Care clinic, HIV clinic pharmacy rotation preceptor, HIV principal investigator with many collaboration on AIDS Clinical Trials Group (ACTG) studies and recipient of several research awards. She is also a College of Pharmacy representative on the UNMC Faculty Senate and member of the HIV Medicine Association (HIVMA) board of directors.

Phil Chung, PharmD, MS, BCPS, BCIDP: Antimicrobial Stewardship pharmacist and Pharmacist coordinator of the Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP). He coordinates the outreach stewardship programs and participates in several clinical studies relating to this.

(BOTTOM ROW L-R):

Anthony Podany, PharmD: Clinical Pharmacist at UNMC Specialty Care clinic, HIV clinic pharmacy rotation preceptor, and HIV researcher with many collaboration on AIDS Clinical Trials Group (ACTG) studies.

Andrew Watkins, PharmD: PGY2 ID Pharmacy Resident

Bryan Alexander, PharmD, BCIDP, AAHIVP: Clinical and Antimicrobial Stewardship Pharmacist and coordinator of Outpatient Parental Antimicrobial Therapy (OPAT) program.

Scott Bergman, Pharm.D., BCPS, FIDSA: Antimicrobial Stewardship Pharmacy Coordinator, ID Pharmacy Residency Program Director, Pharmacy residency ID rotation education coordinator and preceptor, education award recipient

 

#IDWeek2019: An infectious air of inclusion, knowledge, and empowerment

This year, our ID division was well represented at IDWeek, with several residents and students attending (and presenting) for the first time. One of our third year Internal Medicine/Pediatrics residents interested in Infectious Diseases, Dr. Joe Wang, wrote about his experiences, published last week on Doximity. We are very proud of him and share his IDWeek recap below:

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IDWeek is the seminal event for Infectious Diseases (ID) occurring annually in October. During this week-long event, current and future ID specialists from all over the world converge to share their latest research, cases, experiences, and stories of the past year. This event fosters a multinational, interdisciplinary, collaborative approach and the continued dissemination of scientific and social knowledge across the world. Perhaps more importantly, this event gives the opportunity for old friends, colleagues, and mentors/mentees to reunite and for new connections to be made.

Dr. Wang with his mentors, Dr. Marcelin (top) and Dr. Cawcutt (bottom)

This year, as a third year Internal Medicine/Pediatrics resident, I had the privilege to attend my first IDWeek in Washington D.C. and presented two scientific posters to the ID community. Let me tell you, for all the hype there was beforehand, it did not disappoint. From day one, attendees could sense an infectious air of inclusivity, knowledge, and empowerment throughout the convention center. The entire community embraced all of us first-timers and support for all of us from our home institution and well beyond was unparalleled.

The knowledge and science found at ID Week was beyond anything I had imagined. Multiple lectures on challenging cases in all areas of ID as well as novel approaches and research to clinical conundrums dotted the program. There were updates on the Ebola outbreak, flanked by updates in the world of prosthetic joint infections, HIV, diarrheal illnesses, excited discussions about the new community-acquired pneumonia guidelines — the list goes on and on. Thousands of amazing posters were presented by trainees and faculty, across multiple professions, from all reaches of the world, providing insight and innovation into every conceivable area of ID and then some.

The convergence of a major scientific community on the capital of the United States was also not lost amidst the scientific rigor of the conference. From lectures on healthcare and career disparities in our field to infectious diseases amongst refugees (and how international travelers carry more risk for disease spread and transmission than refugees), to the importance of vaccination, particularly as we see resurgence of vaccine-preventable diseases, IDWeek made sure to rise as a singular voice against discrimination, prejudice, and inequality. With an ever-present voice in the Twitterverse, ID is taking up the mantle for change within the medical community.

Vaccines and vaccine-preventable diseases (particularly measles) have been making recent headlines, and IDWeek took up the cause without hesitation. The NIH director Dr. Francis Collins and TIME Magazine Person of the Year and computational genetics expert Dr. Pardis Sabeti opened up the meeting with a fantastic plenary on outbreaks and genomics. For anyone who thinks ID docs don’t know how to have fun, think again! Social media from that day was flooded with video clips and images of Dr. Collins (wearing a “Vaccines cause Adults” t-shirt) and Dr. Sabeti rocking out with Dr. Collins’ band the Affordable Rock & Roll Act. Later in the week, during a plenary on vaccine hesitancy, ID specialists flooded social media with a #WhyIVaccinate Twitterstorm. A “Plague Doctor” visited IDWeek to call attention to recent outbreaks of vaccine-preventable diseases. Almost 5,000 unique tweets about vaccination posted during IDWeek sent a loud and clear message that vaccines work, period.

I left IDWeek with a newfound sense of pride in the field of medicine that I plan to pursue and that has embraced me from day one. From cutting edge research into antimicrobial resistance to the fight against healthcare and career disparities, IDWeek has left this young physician in training with a stronger sense of purpose and affirmed that I have chosen the right career. IDWeek has left me eager to see what we as an ID community can bring to the table to change not only ID but also the world. I also left IDWeek with something I never thought I would have: a Twitter account (@JoeWangDO)! In the days since IDWeek, #IDTwitter has not disappointed and is something I look forward to checking up on every day. You could say I caught the “Twitter bug” at #IDWeek2019.

IDWeek is an amazing opportunity to meet your fellow ID enthusiasts and to connect with those across the nation and across the world. If you’re interested at all in ID, meet me in 2020 in Philly! From the way it looks, it’s going to be a great time!

Celebrating Global Handwashing Day!

Established by the Global Handwashing Partnership in 2008, Global Handwashing Day is celebrated each year on October 15 as a way to increase awareness and understanding of the benefits of handwashing with soap. Global Handwashing Day is an opportunity to get involved in creative ways to encourage people to wash their hands with soap at critical times.

The Infection Control & Epidemiology team took the opportunity to promote hand hygiene with our front line staff.  We prepared bags of cheery stickers saying “I cleaned my hands” and life saver candies.  The CDC “Life is better with clean hands” picture was enclosed in each sticker/candy bag with the following phrase:  Thank you for being a “Life Saver” at Nebraska Medicine”.

We asked our Leadership team to round in clinical areas and catch our front line staff/providers performing hand hygiene.  Our Dr. Linder, our CEO and Mr. Cory Shaw, COO also took bags of stickers and vowed to round in clinical areas.  When caught in the act, leaders thanked the staff member for being a “lifesaver” by performing hand hygiene, gave them a sticker and a life saver candy.  Many managers captured fun poses of their staff and shared them with Infection Control.

 

It was gratifying to see the teams have fun with it.  It was such a simple way to have fun at work but raise awareness about the importance of hand hygiene.

Written by Terry Micheels, MSN, RN, CIC; Manager of Infection Control & Epidemiology, UNMC/NM

Why I Love ID – Dr. Nicolas Cortes-Penfield

What about ID makes you excited?

I love a good medical mystery or diagnostic challenge.  Infectious disease specialists are often the experts other physicians turn to when they’re stumped by a patient’s seemingly inexplicable symptoms – a persistent fever, a perplexing rash, abnormal bloodwork that hints at inflammation in the body no one can seem to track down.  As a kid who grew up listening to Car Talk on NPR and wondering at how the two hosts could make diagnoses over the phone that other mechanics had missed in person just by getting a good story, that aspect of the job really resonates with me. I still find making tough diagnoses that have frustrated patients and their doctors immensely satisfying.

I also appreciate that Infectious Diseases gives me the opportunity to move though all of the different domains of medicine.  By that, I mean that the ID team may be called to see patients in the Emergency Room, on the post-operative surgical ward, in the ICUs, in Labor & Delivery, or anywhere else, sometimes all in the same day.  We get to interact with all of the various other types of clinicians – hospitalist, medical and surgical specialists, radiologists, pathologists, laboratory microbiologists, pharmacists, nurses, etc – and rather than focusing on a single organ system and a handful of diseases we’re challenged to consider the whole patient and the full spectrum of medical illness.

Finally, I love that the keys to challenging ID cases are often in the social history – that is, in asking the patient the sorts of questions about their lives that are too often curtailed in the bustle of modern medicine. That means that part of doing my job well is spending the time to uncover the unique and more interesting sides of my patients and having the opportunity to develop a bit of a relationship.  Do you volunteer at the zoo and clean the cages in the rodent house?  Did you live in the Middle East for a year overseeing an oil pipeline construction project? Did you vacation in the rainforests of Borneo and sleep outside on the dirt?  Did you eat raw bear meat, unpasteurized cheese, or a live snail?  Please, tell me all about it!