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Division of Infectious Diseases

UNMC ID Fellowship Coordinator Sandy Nelson TAGME-certified!

It is with great pleasure that we announce that our UNMC Infectious Diseases Fellowship Coordinator, Sandy Nelson has passed her examination administered by the National Board for Certification: Training Administrators of Graduate Medical Education (TAGME) and has earned the designation C-TAGME.

C-TAGME is available to individuals who have served as a program coordinator for two years and successfully completed 15 hours of education credits. C-TAGME is earned by individuals after successful completion of a rigorous examination that covers multiple content areas such as recruitment, ACGME/AOA policies and procedures, and overall Fellowship Program Management. Sandy’s successful completion of the certification demonstrates her ability to find the correct answer for these and many other areas, rather than a focus on instant recall, a philosophy of TAGME.

We appreciate Sandy’s commitment to the Infectious Diseases Fellowship with her achievement of this distinguished certification, and her tireless contributions to the success of the Fellows and the program over the last 3 years.  Please join us in congratulating Sandy on this substantial accomplishment!

For more information about the UNMC Infectious Diseases Fellowship click here

Practice Makes Perfect – Drills with the Nebraska Biocontainment Unit

The Nebraska Biocontainment Unit (NBU) is one of ten Regional Ebola and other Special Pathogen Treatment Centers (RESPTC) in the United States that has the capacity to care for patients with a highly hazardous communicable disease. As part of ongoing preparedness efforts the NBU coordinated a 2 day exercise on October 12 & 13, 2017 that included county and state public health officials, the Nebraska Public Health Lab, Midwest Medical Transport, Omaha Fire Department, CHI Health Creighton University Medical Center Bergan Mercy and Children’s Hospital and Medical Center, the UNMC rapid response institutional review board and multiple supporting ancillary departments within Nebraska Medicine.

In this recent exercise, the NBU tested multiple processes including the transfer of patients from local assessment hospitals, admitting both an adult and a pediatric patient into the NBU and activating the rapid response IRB for protocol review as well as the administration of a recognized experimental medication for Ebola virus disease. Once both of the simulated patients’ had been admitted, the NBU team comprised of physicians, nurses, respiratory therapists, and patient care technicians completed 6 hours of care interventions using established NBU protocols. The emphasis during this full scale exercise was on optimizing care coordination for two patients who required multiple interventions. These interventions included obtaining labs, containing body fluid spills, and the administration of an experimental drug therapy which required obtaining informed consent by the appropriate physicians.

The focus of the exercises conducted in the NBU is to enhance practices that will provide safe and effective patient care while providing optimal protection for the providers. The staff members that comprise the NBU team are dedicated professionals who seek to advance preparedness for highly hazardous communicable diseases. The NBU continually strives to advance these efforts by routinely holding structured trainings and coordinating exercises to test protocols and incorporating best practices.

 

Dr. Angela Hewlett and Dr. Ted Cieslak obtain informed consent for an experimental medication.

Dr. Angela Hewlett communicates with Kate Boulter, Nurse Manager, NBU.

Dr. Angela Hewlett observes Dr. Jim Sullivan preparing to place a central line in the NBU simulator.

Photo Credit: Taylor Wilson, Nebraska Medicine and Jeff Peters, RN, Nebraska Medicine Bellevue

Written content courtesy of Angela Vasa and Dr. Angela Hewlett.

ID Journal Club – Highlights C. difficile Infections

Content and review by Dr. Trevor Van Schooneveld

C. difficile infection (CDI) is a difficult to control pathogen and the contribution of aggressive infection control practices and antibiotic stewardship have generally been assessed in single hospitals over short periods of time. This study evaluated the impact of advanced infection control practices and an aggressive national antimicrobial stewardship program on the incidence of CDI in the Grampian region of Scotland, which represents 11% of that regions population. The authors found that infection control measures had little impact on CDI rates.  Interestingly, the implementation of an antibiotic stewardship program that decreased the use of macrolides, clindamycin, broad-spectrum cephalosporins, fluoroquinolones, and amoxicillin-clavulanate 50% was associated with major changes in both CDI epidemiology and prevalence.  Declining use of the targeted antibiotics predicted near elimination of the R001 and R027 multidrug resistant CDI phenotypes.  CDI rates declined 68% in hospitals and 45% in the community during the stewardship intervention.

This study had a number of interesting findings.  First, the infection control measures did not improve CDI rates.  Whole genome sequencing data from the UK suggest that the majority of CDI is not acquired from other CDI cases in the hospital and thus the advanced measures implemented there would not be effective.  Second, there may be a threshold effect for antibiotic use that when use of the high risk agents drops below a certain level epidemic multidrug resistant strains lose their advantage and disappear.  Third, while use of the targeted agents declined, use of alternative agents including carbapenems increased and increasing carbapenem use was associated with increased CDI risk.  These findings strongly suggest antimicrobial stewardship strategies are essential to controlling CDI.  Additionally, the targeting of high-risk agents may be beneficial beyond their general influence of decreasing antibiotic exposure and may have profound effects on CDI epidemiology.  An unanswered question if the exclusion of the targeted agents altered the clinical outcome of various infectious syndromes such as pneumonia, UTI, and skin/soft tissue infection.

Read the full article here.


 

Global Efforts in Education in Lagos

Education is critical in prevent of infection and UNMC and Nebraska Medicine continue their global efforts.

A team recently traveled to Lagos, Nigeria – a city of 20 million people for such a purpose. They visited the 68 Nigerian Army Reference Hospital, Yaba in Lagos with two days of workshops/education with various leaders and clinical staff from the Army hospital.  Education efforts touched on various topics such as infection prevention and control; PPE; waste management; our Nebraska Biocontainment Unit among other topics.  Attending were Shelly Schwedhelm, MSN, RN, NEA-BC; Dr. Dele Davies, MD, MHCM; and Dr. John Lowe, PhD from UNMC.  Others attending included USAMRIID infectious disease physicians, an infectious disease MD from Singapore who shared their SARS experience and one from South Korea who shared details of their MERS experience.

Learn more about education efforts here.


 

Fantastic Presentation by Guest Speaker Dr. Bearman on “Hospital Infection Prevention: Processes, Pragmatisim, and Controversies”.

The UNMC ID Division was pleased to host Dr Gonzalo Bearman, MD, MPH as a visiting professor 10/19/17-10/20/17.  Dr Bearman, who is a Professor of Medicine, ID Division Chief  and Medical Director of Hospital Epidemiology at Virginia Commonwealth University, gave an insightful and thought provoking grand rounds presentation on 10/20/17 entitled: “Hospital Infection Prevention: Processes, Pragmatisim, and Controversies”.

Dr. Bearman’s research focus is on the epidemiology of hospital-acquired infections with multiple articles in peer-reviewed publications. He is also passionate about education and dissemination of medical information and in addition to lectures in the College of Medicine and School of Public Health, launched an online magazine called the Medical Literacy Messenger and a blog discussing issues in Infection Prevention and Control and Hospital Epidemiology.

In his presentation, Dr Bearman expanded the concept of “Satisfice” a combination of satisfy and suffice, initially coined by Nobel prize winner Herbert Simon, to the field of Infection Prevention.  To satisfice we need to find satisfactory solutions in a pragmatic manner for complex problems  – not perfect solutions that are not practical.  Dr Bearman is a proponent for Horizontal Infection Prevention solutions – interventions that cut across the board and impact all of our patients – examples include hand hygiene, standard infection control measures, antiseptic bathing, standardized methods to insert and care for indwelling lines and catheters.

During the session he described various approaches that his institution has implemented to decrease the rates of hospital-acquired infections.  The most intriguing was the concept of healthcare provider attire and their bare below the elbows (BBE) approach. This non-mandated approach suggests that healthcare providers put away the white coat, wear short sleeved clothing such as team scrubs, team vests, and avoid wearing watches, bracelets or rings.  In a survey to assess healthcare worker perception of this practice, Dr. Bearman’s team found that many providers laundered their white coats infrequently and most viewed the white coat as a potential source of bacterial transmission.  Despite the BBE approach being non-mandatory, 2/3 of healthcare workers were compliant to this attire suggestion, and as part of a multi-faceted approach that included the BBE attire recommendations, Dr. Bearman’s team noted a significant decrease in hospital-acquired infections. This approach is very promising (and cheap), but requires a substantial paradigm shift and culture change as of course, the white coat has been a long-standing symbol of tradition in medical education.

After Grand Rounds, Dr. Bearman had some time to sit with members of our Infection Prevention and Control and Antimicrobial Stewardship teams for some small group discussion.  He gave some advice to one of our PhD students working in Infection Prevention and Control, and discussed strategies for reducing hospital-acquired infections with our Infection Prevention nurses.

Dr. Bearman’s top 3 infection prevention pearls from our small group discussion:

  • The science is better: while we cannot prevent ALL infections, we know more now what to do to prevent infections in the hospital
  • Look for practical solutions to real life implementations
  • Learn to be nimble –if it doesn’t work, be open to making a change! Human beings don’t always function in linear function in systems that are chaotic.

To learn more about Dr. Bearman’s research click here. Thank you Dr. Bearman for visiting us, we enjoyed your talks and hope you can visit again!

 

At Nebraska Medicine, we strongly adhere to the concept of Horizontal Infection Prevention interventions.  Click here to learn more about Nebraska Medicine horizontal infection prevention efforts.

Content courtesy of Drs. Rupp and Marcelin.

BBE photo courtesy Dr. Bearman 


 

Happy Respiratory Care Week!

It is our great pleasure to celebrate Respiratory Care Practitioners this week! They are critical to the excellent care of our patients and in the prevention of ventilator associated events such as ventilator associated pneumonia – so say congratulations and thank them for their efforts this week!

To help kick off the week, Dr. Cawcutt and Joleen Strohsahl spoke to our respiratory care practitioners on the algorithms of ventilator associated events, bundled care, workflows and how infection control defines and reports these rates. There was an excellent conversation on ways we can continue to improve the care of our patients every day.

Prevention of all Healthcare Associated Infections is truly a team effort and we are grateful to have such fantastic colleagues as part of our multidisciplinary teams.


 

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

CDC has designated November 13-19, 2017 as Antibiotic Awareness Week.  Formerly known as Get Smart About Antibiotic Week, the goal of this one-week observance is to raise awareness of appropriate antibiotic use in the United States.

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

  • Highlight US Antibiotic Awareness Week on your website
  • Use Antibiotic Awareness Week to kickoff your stewardship program
  • Issue a press release
  • Distribute educational materials on appropriate antibiotic use to the general public
  • Distribute tools and guidelines to healthcare professionals
  • Host local events
  • Deliver presentations to interested parties
  • Post social media messages and participate in the annual Twitter chat
  • Share information with your organization’s membership through email or newsletters
  • Include content in employee materials

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

During the Antibiotic Awareness Week, a collaborative blog post from UNMC ID/ASP and Nebraska ASAP will be published each day between November 13 and 17.  The list of blog post topics will include:

  • Monday, 11/13: Introduction to antimicrobial stewardship program and Nebraska Medicine/UNMC/ASAP accomplishments that will be highlighted in subsequent blog posts
  • Tuesday, 11/14: Antimicrobial stewardship in hospitals
  • Wednesday, 11/15: Antimicrobial stewardship in long-term care facilities
  • Thursday, 11/16: Antimicrobial stewardship in critical access hospitals and role of pharmacists
  • Friday, 11/17: Antimicrobial stewardship in outpatient clinics

We at Nebraska ASAP and UNMC ID/ASP are excited about the upcoming Antibiotic Awareness Week during November 13 to 19.  We hope you and your facility will fully participate in activities promoting appropriate antibiotic use.

Links to UNMC ASP and Nebraska ASAP are listed below:

UNMC ASP

Home

Content courtesy of Phil Chung, the Nebraska ASAP and UNMC ID/ASP.


 

 

ANTIBIOTIC-ASSOCIATED ADVERSE DRUG EVENTS IN HOSPITALIZED PATIENTS

Phil Chung and the Nebraska ASAP have provided another excellent journal article review, here is a snippet,  but we encourage you read his whole review here.

Antibiotics are life-saving medications that make modern medical care such as surgical procedures, organ transplantation, cancer chemotherapy possible.  Unfortunately, their use can be associated with a number of adverse drug events (ADE).  In a study by Tamma et al (Tamma PD, et al. JAMA Intern Med 2017;177:1308-15), investigators found antibiotic-associated ADE occurred in 20% of study patients and the risk of developing an ADE increased by 3% for every 10 days of antibiotic therapy.

Nebraska ASAP team is also maintaining an email distribution list for website users who would like to get an email alert for important new postings on the website. Healthcare personnel can join the distribution list by sending an email to Nebraska ASAP Community Network Pharmacy Coordinator Phil Chung, PharmD, MS, BCPS at pchung@nebraskamed.com.

To learn more about ASAP and the ASAP website, visit https//asap.nebraskamed.com.

Content courtesy of Phil Chung and the Nebraska ASAP. 

Superheroes Armed with Hand Sanitizer

 

Superhero or infection preventionist? Maybe both. To celebrate National Infection Prevention Week, our very own infection preventionists donned superhero costumes and paid a visit to the inpatient floors of the Fred & Pamela Buffett Cancer Center Oct. 16. There, they asked nurses to touch two of their props and then used a special light to demonstrate the germs that transferred to their hands. After using hand sanitizer, the nurses’ hands were examined again for any remaining germs. It’s a great reminder to practice hand hygiene and how to do it properly. The team plans to visit the inpatient units at Nebraska Medical Center and Bellevue as well as nearby clinics.

Even better? These superheroes are EMPOWERING OTHERS to practice great hand hygiene by giving away 1oz. bottles of hand sanitizer to healthcare workers. Be a hero, wash your hands!

  

Content courtesy of Terry Micheels and Kara Haworth. 


 

New Faculty Spotlight – Dr. Marcelin

Tell us about the position you are starting? My current roles are Assistant Professor of Medicine and Associate Medical Director of Antimicrobial Stewardship.  In my clinical practice I will be seeing patients on the General Infectious Disease hospital service. This means patients admitted to the hospital (who do not have transplants or malignancies) who have infections. Common conditions include skin/soft tissue infections, respiratory tract infections, and patients who are very ill from an overwhelming infection requiring ICU admission.  In the outpatient clinic, I will be seeing primarily HIV-infected patients at the Specialty Care Center. Finally, in my role as the Associate Medical Director of the Antimicrobial Stewardship Program, I will be part of the team that reviews antimicrobials and their use for infections, educating patients and healthcare professionals on the importance of appropriate antimicrobial use, and from a big-picture viewpoint, helping to try to reduce the number of resistant microorganisms present in our institution, country and the world by preserve the antibiotics we do have for responsible use when needed.

Background: I was born in the Caribbean on the Nature Island of Dominica and spent my teenage years and early adulthood on another island, Antigua.  I completed my undergraduate education at St. Mary’s University in Halifax, Nova Scotia and returned to Antigua for medical school at American University of Antigua College of Medicine. I completed my Internal Medicine Residency and Infectious Diseases Fellowship at Mayo Clinic in Rochester, Minnesota before joining the faculty in the Division of Infectious Diseases at University of Nebraska Medical Center.

Why UNMC? Having done all of my postgraduate training at an academic medical center, I knew I wanted to stay in academics for my career. One of the things that drew me to this institution was the immensely collegial environment. I felt welcomed on every visit, and everyone I spoke to was happy here. I love that the faculty is strongly supported by the division in academic, educational and clinical pursuits, and that there are opportunities for junior faculty to be very involved in any of these ventures if they desire.

What about ID makes you excited? I have always been interested in mysteries and detective work. In medical school I realized that I enjoyed taking care of patients with diagnostic dilemmas rather than focusing on one organ system, so Internal medicine made sense as an initial choice. During residency I further realized that I was most excited about patients with potential infectious causes of their diagnostic dilemmas and Infectious diseases was the one rotation that never felt like “work” to me. I love that infectious diseases is both consistent and ever-changing; both old-fashioned and new-fangled, and while we have made so many life-changing advances in diagnosis and therapy like the microscope and penicillin, there is still so much discovery and change in the horizon, like HIV cure or finding ways to prevent multi-drug resistant organisms. Finally, in infectious disease, I can be both a consultant that manages specific conditions, as well develop long-term relationships with my HIV-infected patients. One of the most rewarding things about Infectious diseases is the ability to cure disease; even if disease cannot be cured such as with HIV, it is humbling to be able to care for a person who is extremely ill at diagnosis and journey with them to a place where they can live a near-normal life such that visits become less about the HIV infection itself, and more about non-infectious issues such as heart disease, cholesterol and diabetes.

Something interesting about me not related to medicine: I speak conversational (but not quite medical) French creole. I was on the track team in college. I have travelled to almost every island in the Eastern Caribbean

See more about the UNMC ID Division here.


 

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