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Division of Infectious Diseases

Resistant CMV – Research Aimed at the Cure

 

Infections due to Cytomegalovirus(CMV) remain a significant problem for patients undergoing various types of transplants, including both hematopoietic stem cell transplants and solid organ transplant, particularly since these groups both require the use of potent immunosuppressive chemotherapy. Although the currently available systemic anti-cytomegalovirus agents are usually effective, their use is limited by their toxicities, especially in transplant recipients, who receive ongoing immunosuppressive medications to prevent organ rejection or graft-versus-host disease, and who receive other potential nephrotoxic therapies. The population of hematopoietic stem cell transplant and solid organ transplant recipients, whose CMV infections are increasingly refractory to available antiviral treatment, is an area of high unmet medical need as currently there are no approved treatment for resistant cytomegalovirus infections.

To help discover ways to meet this need, here at UNMC, Dr. Florescu and her research team are leading a study in transplant recipients of a drug for the treatment of CMV infections, including those resistant or refractory to standard of care.

Learn more about ID research at UNMC here.

Content courtesy of Dr. Diana Florescu. 


 

Dr. Rupp Setting the Record Straight on Transmission of Organisms via the Floor

Dr. Mark Rupp debated Curtis Donskey today regarding the role of the hospital floor in transmission of resistant pathogens. According to several in attendance, this was a great discussion! Key Point  Dr. Ashraf took away from this debate : Even though it is important to thoroughly clean floors, we need to remember that transmission of pathogens is more likely to happen due to lack of hand hygiene or not paying attention to high touch surfaces.

Content courtesy of the ID Division attendees at IDWeek. 

Follow IDWeek online via Twitter @UNMC_ID and #IDWeek2017

IDWeek Pre-Meeting – Seminar on Best Practices in Antimicrobial Stewardship

Excellent pre-meeting Seminar on Best Practices in Antimicrobial Stewardship where numerous national experts presented.  The picture shows Dr.  Arjun Srinivasan from the CDC presenting on national compliance with Stewardship Core Measures. Dr. Trevor Van Schooneveld fromUNMC also presented during this session on Syndromic Stewardship: Combining Interventions to Improve Care.

Follow IDWeek events on Twitter @UNMC_ID and #IDWeek2017

Content courtesy of Dr. Van Schooneveld.

Do What You Do and Get Published, Too – Key Take Home Points!

 

This morning, a fantastic Faculty Development panel was held to a full house of attendees,  focused on how to maximize your productivity within your career and life. Our Division is incredibly productive and this is reflected in that two of the three panelists were from within our ranks: Dr. Hewlett and Dr. Scarsi were joined by Dr. Schenarts in providing insight and expertise in this area.

Missed the session? Here are a few of the key suggestions from that session:

  • Decide when and where you want to write – Where can you focus? What time of day are you productive?
  • Schedule the time – Block your calendar
  • Close the door
  • Find your team AND bring others up to your level when you can. Ask junior colleagues or trainees to work with you and delegate roles.
  • Set deadlines for when this will be done.
  • Do not forget downtime. It is critical to rest.
  • Write down possible research ideas to bring for possible future use.
  • Be an opportunist. When you have an experience that can teach others, capitalize on that.
    • Building a new clinical model? Write it up! If you do not, someone else will.
  • Sometimes the practical and simple clinical questions are well worth printing.
  • Choose a way to write and edit documents as a team IN ADVANCE so that roles are very clear.
  • Consider editing live together as opposed to constant track changes if possible as then your final draft will be done once and in real-time.
  • Not sure if you can publish your project because you hadn’t planned on it at the onset? Perhaps it was a quality improvement project? Call the IRB and ask. This is usually not an insurmountable situation.
  • Consider WHO you think will want to read this and submit to that journal.
    • “Not everything has to be a RCT published in The Lancet”
  • How do you get the expertise to do this?
    • Find a good mentor.
    • Reach out beyond your division.
    • Consider a national course or masters program for additional training.
    • Send your publication/grant/proposal to your WORST critic to focus on improvement.

 

Interested in learning more about faculty development opportunities at UNMC? Read more here.


 

IDWeek 2017 – The Official UNMC ID Guide of Where We Will Be!

IDWeek is upon us and we want to be sure YOU know where to find us! Below is the list of faculty presentations and posters from our Division. Please come visit us at IDWeek –  We would LOVE to meet you! 

Content courtesy of Sandy Nelson and the entire UNMC ID Division. 

 

Tuesday Oct 3

10:15-10:45 a.m.   Van Schooneveld TC.  Best Practices for Antimicrobial Stewardship Programs – Syndrome-specific interventions: Combining Interventions to Improve Care

4:10 p.m. Friefeld A. Transplant Infections. *at Vincent T. Andriole Board Review Course

Wednesday October 4

1:30-3:30 p.m.  Rupp ME. Controversies in Infection Prevention: Pro/Con

Thursday October 5

12:30-2:00 p.m.   Rupp ME, Olson C, Cavalieri RJ, Lyden E, Carling P. How Clean are the Clinics?

Assessment of Environmental Cleanliness in Ambulatory Care. Poster 481

12:30-2:00 p.m. Fitzgerald T, Nailon R, Tyner K, Beach S, Drake M, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. Infection Control in Long-Term Care Facilities: Frequently Identified Gaps in Infrastructure, Surveillance and Safety. Poster 413

12:30-2:00 p.m. Tyner K, Nailon R, Beach S, Drake M, Fitzgerald T, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. Environmental Cleaning and Disinfection in Long-Term Care Facilities: Opportunities for Improvement. Poster 485

12:30-2:00 p.m. Chung P, Nailon R, Tyner K, Beach S, Bergman S, Drake M, Fitzgerald T, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Van Schooneveld, T, Ashraf MS. Frequently Identified Gaps in Antimicrobial Stewardship Programs in Critical Access Hospitals. Poster 701

12:30-2:00 p.m. Chung P, Nailon R, Tyner K, Beach S, Bergman S, Drake M, Fitzgerald T, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Van Schooneveld, T, Ashraf MS. Frequently Identified Gaps in Antimicrobial Stewardship Programs in Long-Term Care Facilities. Poster 702

12:30-2:00 p.m. Uriel Sandkovsky, Michelle Schwedhelm, Shonelle Grayer, Emily Adelgren, and Mark E. Rupp. Small Changes Make a Big Difference in the Fit of N95 Respirators. Poster 435

 

Friday, October 6

12:30-2:00 p.m.  Green Hines A, Zwiener J, Stec R, Heybrock B, Hegemann L, Simonsen K. Cost Analysis of an Antimicrobial Stewardship Program (ASP) Protocol for Adherence to the 2014 American Academy of Pediatrics (AAP) Palivizumab Prophylaxis Recommendations in a Freestanding Children’s Hospital. Poster 1608

12:30-2:00 p.m. Bares SH and Sandkovsky U. Development and Assessment of an HIV-focused E-learning Flipped Classroom Curriculum in an Infectious Diseases Fellowship Program. Poster 1446

12:30-2:00 p.m. Tyner K, Nailon R, Beach S, Drake M, Fitzgerald T, Lyden E, Rupp ME, Schwedhelm M, Tierney M, Ashraf MS. Frequently Identified Infection Control Gaps Related to Hand Hygiene in Long-Term Care Facilities. Poster 1322

 

Saturday October 7

12:30-2:00 p.m.  Rupp ME, Tandon HK, Danielson PW, Cavalieri RJ, Sayles H. Peripheral Intravenous Catheters – “They Don’t Get No Respect”. Poster 2160

12:30 -2:00 p.m.  Uriel Sandkovsky, Fang Qiu, Andre C. Kalil, Ada Florescu, Natasha Wilson, Christa Manning, and Diana F. Florescu. Risk factors for development of cytomegalovirus resistance in solid organ transplantation: a retrospective nested case control study. Poster 2448

12:30 -2:00 p.m.  Uriel Sandkovsky, Fang Qiu, Andre C. Kalil, Adriana Weinfeld-Massaia, Joong Kwon, Cynthia Schmidt, and Diana F. Florescu. Epidemiology of Bloodstream Infections in Kidney Transplant Recipients: A Systematic Review and Meta-analysis. Poster 2375

12:30 -2:00 p.m.  Signorelli J, Liewer S, Zimmer A, Freifeld AG Incidence of Febrile Neutropenia in Autologous Hematopoietic Stem Cell Transplant (HSCT) Recipients on Levofloxacin Prophylaxis at a Single Center Midwest Cancer Center Poster 2390

12:30 -2:00 p.m.  Richard Hankins, Denisa Majorant, , R Jennifer Cavalieri, , Elizabeth Lyden, Paul D. Fey, Mark E. Rupp,  and Kelly Cawcutt, Microbial Colonization of Intravenous Luer Lock Connector During Active Infusions Among Hospitalized Patients Poster 2155

 

Find us on Twitter @UNMC_ID; #UNMCID


 

Twitter Here We Come!!

Thank you for ALL of the AMAZING support for our blog! We are thrilled to continue our venture into social media to provide more content, and commentary, on what is happening in the world of Infectious Diseases – particularly here at UNMC. With that goal in mind, we have officially launched our Twitter account @UNMC_ID. We encourage you to join us on Twitter and engage in the conversations, particularly given the increasing utilization of Twitter for academic medicine,  faculty development, promotion of publications, access to journal articles via links and Twitter chats and the opportunity to engage in conversations with colleagues both near and far. IDWeek is almost here(October 4-8th) and is a great time to get involved! Tag #IDWeek2017 AND #UNMCID to follow the conference virtually.

See you on Twitter!


 

 

Welcoming Our New Fellows – Focus on Dr. Hankins

Tell us about the position you are starting?

I think it’s a little difficult to fully describe the position that I am starting.  I don’t fully know all the ins and outs of what the Infectious Disease fellow does, but I’m excited to get into the position and learn.

Tell us about your background?

When people ask me where I’m from, I always find that to be a difficult question to answer.  I was born in the south, where most of my family is from, and my extended family still lives, but grew up in Omaha, so I usually answer that partly from Nebraska and partly from Mississippi.  After finishing high school in Nebraska I went to Ole Miss for undergrad, before returning to Nebraska for medical school.

Why UNMC?

I have ended up staying at UNMC for both internal medicine residency and infectious disease fellowship.  When ever I have thought about leaving UNMC, I seem to be drawn back to how much I enjoy working with the people here.

What about ID makes you excited?

I’m excited to be able to start focusing on just treating infections.  I noticed as I was going through residency that it always seemed the patient’s that had infections were the most interesting to me.  I was always astounded how quickly and much people can improve from getting anti-microbial therapy. I’m also excited about the interesting differentials that occurs in patients being seen by the infectious disease service, and the history and clues that contribute to the infectious disease work up.

Tell us something about yourself UNRELATED to medicine? 

Outside of medicine, I have found that I really enjoyed Mock Trial, an activity that I was able to compete in during high school and college, and that since I have been in Omaha have been able to coach a collegiate team.

Learn more about the UNMC Division of Infectious Diseases and ID fellowship here.


 

What’s Hot in Infection Control?

Here are some fantastic take-home points from our Infection Preventionists who attended APIC 2017 – the national meeting of the Association for Professionals in Infection Control and Epidemiology. 

Water management Legionella  – Building water safety & Management

Legionella is endemic to overall water systems, not just the cooling towers, therefore infection control programs need to be concerned about the sporadic nosocomial risk, not just outbreak risk. Even portable risks, such as patients bringing in personal equipment that may have biofilm due to poor cleaning and disinfection at home.

Urine antigen test is inadequate for water related testing as only one serotype is detected, therefore Legionella cultures are required instead.

When is Legionella considered a nosocomial infection?  At  >10 days, but 2-10 days may still be nosocomial, so think about performing an environmental investigation. Finally, don’t necessarily chase zero;  zero legionella contamination is not the goal and may be impossible in some cases, zero patient cases is the goal. There are MANY waterborne pathogens with potential risk of infection. A water safety & management plan is the key component, not focus on mitigation and eradication of a single pathogen.

 

Central Line Insertion Site Assessment (CLISA Score)

There is a lot of focus on insertion, but maintenance is critical. Standardize criteria & expectations for early risk detection. At what point of site assessment, can you intervene and prevent a CLABSI? Beyond asking if you need the line, assess the site for signs of erythema and if progressing beyond 3mm radius of erythema, documentation of the scoring would prompt providers to starting looking toward removing the line BEFORE a CLABSI occurred.  Multidisciplinary approach – daily site assessment & documentation, communication with providers when results warrant further assessment/intervention. Read more here.

 

Disinfectants used in the hospital and what should we use? Are we thoughtful enough in our choices?

There are many critical pieces of information to consider when choosing a disinfectant, but one piece that often has been overlooked is the consideration of the end-user – are we also considering the patients, nursing and environmental service staff?

 

3 Fatal Flaws – Hand Hygiene

The three Fatal Flaws of Bias are: 1) Sampling bias; 2) Observer bias; 3) Hawthorne Effect.  Many Hand Hygiene programs across the country suffer from these Fatal Flaws. Due to lack of resources and competing priorities many Hand Hygiene programs are based on individual observations.

A successful Hand Hygiene program needs appropriate resource allocation, as well as an elevated design and reporting process. Particular attention needs to be given to the statistical design of the program to ensure meaningful data is shared across the organization.  The design must highlight the link between clean hands and a reduction of all hospital-acquired infections. The most successful programs are embraced by each layer of leadership; linking hand hygiene scores to leadership goals/rewards have been successful to garner appropriate support and resources

 

Learn more about Infection Prevention and Control at UNMC here.

Content courtesy of Terry Micheels, Kim Hayes and Joleen Strosahl.


 

New Faculty Spotlight – Dr. El-Ramahi

Background:

I am Jordanian but grew up in Riyadh, Saudi Arabia where my dad used to work. I moved back to attend medical school at the Jordan University of Science and Technology. After graduation, I worked in Jordan for two years before moving to the United States. We recently moved to Omaha and before that we lived in Tucson, Arizona for more than 6 years.

Why UNMC:

I decided during my training that I wanted to work in an academic institution because I wanted to teach and be a part of educating our medical students and residents/fellows. I also realized that working in a tertiary referral center offers the clinician the opportunity to take care of a variety of disease processes and a good number of intriguing cases. The other appealing quality is that there is a lot of support for research.

UNMC is well-renowned for offering high quality patient care and medical education along with exceptional research opportunities. The infectious diseases division here is unique in that it offers different service teams tailored to different patient populations which I believe enables the ID physicians to focus their interests and provide better care for the patients.

What about ID makes you excited?

When evaluating patients as infectious diseases physicians we are doing a detective’s work trying to gather as many clues as we can. What is also appealing to me is that it is a very intellectual specialty rather than procedure-driven. In addition to using our infectious diseases analytical skills, we also utilize a lot of our internal medicine knowledge trying to decide if what is making the patient sick is an infection or not. What is rewarding at the end of this hard work and after identifying a specific infection, is that we get to see patients improve and feel better with the treatment(s) we provide.

Something interesting about me not related to medicine:

I like outdoor activities such as hiking and riding my bike. I recently started to learn how to play the piano.

See more about the UNMC ID Division here.


 

Dr. Paul Fey on “Why I Love Clinical Microbiology”

 

Dr. Paul Fey on “Why I Love Clinical Microbiology:

“I love clinical microbiology because each pathogen that invades a human host has a different strategy. Our job is to determine how these processes occur mechanistically but also practically utilize this information to find new diagnostic strategies for our patients and clinical colleagues. ”

 

See more about UNMC Clinical Microbiology here.

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