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Welcome to Stacy Severin – Transplant Infectious Diseases Clinical Study Associate

Tell us about the position you are starting?

I am starting as a research nurse coordinator in infectious disease, solid organ transplant division.

Tell us about your background?

I have been an RN for the last 9 years, with the last 4 in research.  I have always worked in the Oncology field prior to this position. My first nursing position was here at Nebraska Medicine on the Oncology/Hematology Special Care Unit. (OHSCU). Before coming back to UNMC,   I was working as an Oncology Research Nurse coordinator with CHI Health Bergan Mercy Creighton Medical Center.

Why UNMC?

I chose to come to UNMC because I was looking for a new challenge and an opportunity to learn and expand my nursing research knowledge. I feel that UNMC will grant me the opportunity to further not only my research education, but also my academic education.

What about ID makes you excited?

I chose Infectious disease because I find the different types of infections and treatments very interesting.  I am looking to expand my experience outside of oncology and felt this field would be fascinating.  I look forward to working in clinical trials with transplant patients and I am excited at the opportunity to offer these patients potential new treatments.

Tell us something about yourself UNRELATED to medicine?

Outside of work, I am married and have two beautiful daughters ages 19 and 17. We love animals and have 3 dogs. I love to travel and try and to visit a new city or country every year!

HIV Clinic Nurse Case Manager Receives a Community Award

Precious Davis, BSN, MSN received the “Field of Medicine Award” on Saturday, August 26th from the Omaha Section of the National Council of Negro Women (NCNW).  This organization recognizes individuals in the community for outstanding achievement. Each year individuals are recognized for excellence in medicine, education, leadership, community involvement, embodiment of the Mary McLeod Bethune Legacy and youth in excellence.

Precious is a Nurse Case Manager in the Nebraska Medicine HIV Clinic, and the clinic staff are very proud of her.  The award was presented at the annual Mary McLeod Bethune Award Luncheon on Saturday, August 26th . The community was invited to attend this important event.

The keynote speaker was Shawntal M. Smith Esq. Human Resources and Talent Development Leader for Omaha Home for Boys. Smith is also a social justice attorney. The theme was “Extraordinary Women: Breaking Barriers, Rising above Challenges, Transforming Lives.” The Omaha Section of the NCNW advocates for women of African descent as they support their families and communities. It fulfills its mission through research, advocacy and national and community based services and programs on health, education, and economic empowerment.

Congratulations, Precious!

 

Content courtesy of Dr. Swindells. 

Widespread use of chlorhexidine in hospitalized patients does not promote resistance in Staphylococcus aureus

Content courtesy of Dr. Rupp.

Investigators from the University of Nebraska Medical Center (UNMC) Division of Infectious Diseases recently published reassuring data indicating that use of chlorhexidine (CHG) to bathe hospitalized patients does not lead to CHG-resistance in S. aureus.  (Marolf CT, et al Infection Control and Hospital Epidemiology 38:873-75, 2017).

CHG is a very effective disinfectant that has been successfully utilized to prevent the spread of multi-drug resistant organisms (eg. MRSA) and prevent healthcare associated infections such as central-line associated bloodstream infections (CLA-BSI).  Unfortunately, there is concern that widespread use of CHG will promote resistance- particularly in staphylococci in which it has been observed that multi-drug efflux pumps encoded by qac A/B genes lead to low-level CHG resistance.

At UNMC, over a 7.5-year period, CHG was used to bathe patients in two distinct periods that were separated by over a year when CHG was not in use.  This served as a terrific “natural experiment” to see if use of CHG led to decreased susceptibility.  The research team tested strains of S. aureus clearly responsible for invasive nosocomial infections (bloodstream infections) for susceptibility to CHG.  Reassuringly, no emergence of resistance (decreased susceptibility) was observed.  In fact, the level of resistance was higher in the baseline period (when CHG was not in use) than during the study periods.

The results of this study provide reassurance that CHG can be used broadly in hospitalized patients without selecting for CHG-resistance in S. aureus.  However, these results do not exclude the emergence of resistance in the future and continued vigilance is warranted.

Read the entire study at:  https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/susceptibility-of-nosocomial-staphylococcus-aureus-to-chlorhexidine-after-implementation-of-a-hospitalwide-antiseptic-bathing-regimen/776D48E0315B4C44D2E161FD3C9B4E59

 

P.S. It should be noted that this research effort was largely conducted by an UNMC medical student!

 


 

Infectious Diseases Interest Group Kicks Off the Year with an Upcoming Panel!

The Infectious Diseases Interest Group here at UNMC will be hosting a panel of ID physicians covering a range of sub-specialties within ID. Our goal is to provide an introduction to incoming students about the many opportunities in ID and allow physicians to share their passion for the field. Additionally, students will be able to ask the faculty any questions they might have. Lunch will be provided for the first 50 attendees.

The event is scheduled for Thursday, September 7th at noon in MSC 2010 – Mark you calendars to attend!

Content courtesy of Jonathan Seaman and the IDIG. 

For further information regarding this group or how to join it, please email: idig@univnebrmedcntr.onmicrosoft.com


 

UNMC Clinical Microbiology Fellowship Program Welcomes Dr. Arryn Craney!

Content courtesy of Dr. Paul Fey and Dr. Arryn Craney.

UNMC’s Department of Pathology and Microbiology in collaboration with Nebraska Medicine sponsors a Clinical Microbiology Fellowship Program that is accredited by the Committee on Postgraduate Educational Programs (CPEP) of the American Academy of Microbiology.  This two year training program provides the trainee hands-on experience in the basic disciplines of clinical microbiology.  Upon successful completion of the Clinical Microbiology Fellowship Program, the Fellow will be eligible to sit for the examination as the next step to certification as a diplomate by the American Board of Medical Microbiology (D [ABMM]).  Our new fellow is Dr. Arryn Craney.  Dr. Craney received her PhD from McMaster University in Canada and most recently finished a post-doctoral fellowship at the Scripps Research Institute in San Diego where she studied the type I signal peptidase as a potential antibiotic target.

See more about the Clinical Microbiology Fellowship here.


 

Welcoming our new ID fellows – Focus on Dr. Karnatak

We are thrilled to welcome Dr. Karnatak as a new fellow in our Infectious Diseases program! Read on to learn a little more about him…

Tell us about the position you are starting?
I am starting infectious diseases fellowship at UNMC. I plan to do two years of specialization in infectious diseases followed by one year in critical care medicine.
Tell us about your background? 
I  finished medical school from the Himalayan Institute of Medical Sciences in India and further training in cardiac critical care at the All India Institute of Medical Sciences in New Delhi. I did my Internal Medicine residency at the Brookdale University Hospital in Brooklyn, New York. Post residency I have been practicing academic internal medicine from last three and half years. 
Why UNMC?
Omaha is second home for my wife. She always wanted to come back to Omaha. I was well aware of great training environment at UNMC as my wife did part of her residency and fellowship training here at UNMC. During my fellowship interview I realized infectious disease fellowship program at UNMC is designed to create a great learning environment for fellows and help fellows to grow in their career irrespective of whatever they want to achieve.  
What about ID makes you excited?
Infectious diseases is very exciting due to its complexity. During my practice I often noticed when I needed an specialist experienced in complexity I would call ID!! Infectious disease in today’s era is incredibly important due to crisis of multi-drug resistance, growing number of immunosuppressed oncology and transplant population, international travel related infections, infection control and need for expertise in health care epidemiology. According to a recent CDC report health care infections costs around 26-33 billion annually. In 2013 “Infectious Diseases Specialty Intervention is Associated with Decreased Mortality and Lower Healthcare Costs”,  study by Steven K. Schmitt, MD and Daniel McQuillen, MD provided data when ID specialists were involved early  less patients died in the hospital and after discharge and when ID docs were involved patients had 5.1% shorter ICU stays and had fewer readmissions within 30 days discharge from the hospital. ID physicians reduced costs by estimated 6%. Infectious disease is consistently changing and unpredictable as seen by recent emergence of infections like Ebola to  MERS to bioterrorism. For me, choosing infectious disease after finishing internal medicine residency was simply right thing to do.
Tell us something about yourself UNRELATED to medicine?
Apart from medicine I enjoy spending time with my family. My wife and I both have our families back in India. We chat with our folks almost every day. We both love cooking and travel. We both grew up in northern India close to Himalayas and love mountains and lakes!!! In the future, I want own a boat and take it to lake every weekend to go fishing!! 
See more about the UNMC Infectious Diseases Fellowship here.


 

Advancing Healthcare and Antimicrobial Stewardship in Nebraska

Content courtesy of Phil Chung and the Nebraska ASAP. 

The Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) is funded by the Nebraska Department of Health and Human Services, Healthcare-Associated Infection Team through a CDC grant.  It is closely affiliated with the nationally recognized Antimicrobial Stewardship Program (ASP) at Nebraska Medicine and Division of Infectious Diseases at University of Nebraska Medical Center. The ASAP program employs a full-time ID trained pharmacist, ID trained medical directors as well as infection control and research nurses, all with extensive experience in establishing and running successful stewardship programs.

Nebraska ASAP has recently launched a completely revamped website.  The purpose of the website is to stimulate and support antimicrobial stewardship activities in a variety of healthcare settings.  The website offers a number of ASP tools, templates and guidance documents developed by Nebraska ASAP team in addition to providing links to other available resources. These resources will help hospital and long-term care facility administrators, healthcare providers, infection preventionists, pharmacists and other healthcare personnel working on promoting appropriate use of antibiotics in establishing or improving their own institutional antimicrobial stewardship program.

In addition, a blog will regularly post news and study highlights related to antimicrobial stewardship and antimicrobial therapy.  Recorded ASAP antimicrobial stewardship educational webinars geared toward hospitals and long-term care facilities will also be posted on the website in the future.

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.

 


 

Are contact isolation precautions (CP) necessary when caring for patients infected or colonized with endemic MRSA or VRE?

Researchers from the University of Nebraska Medical Center Division of Infectious Diseases and Nebraska Medicine Department of Infection Control and Epidemiology recently published results from a two-year observational study indicating that routine use of contact isolation precautions (CP) are not needed in caring for patients with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). (Rupp ME, et al.  Infection Control and Hospital Epidemiology 38:1005-1007, 2017).

The CDC has long recommended use of CP (i.e. private room, gowns and gloves, limitation of potential fomites) when caring for patients colonized or infected with multi-drug resistant pathogens (MRSA, VRE).  However, some studies have indicated that CP adversely influence provider behavior (fewer and shorter provider-patient interactions) and may result in delays in patient admissions and transfers, excess adverse events, and psychologic harm.

In the UNMC two-year quasi-experimental before-after study, it was noted that the rate of infection due to MRSA or VRE did not change in the yearlong period after CP were discontinued compared to the previous year.  However, it was also noted that the discontinuation of CP was conducted in an institution with excellent horizontal infection control interventions in place [hand hygiene (>90%), careful attention to environmental cleanliness (>90% clean rate on high-touch surfaces) and a practice of routine patient bathing with chlorohexidine].

This recently published paper adds additional support for re-examining the need for CP in the routine care of patients colonized/infected with endemic MRSA or VRE.

Read the article at:  https://www.cambridge.org/core/product/905595BFE67B3D41CF603C2D497EE517

Content courtesy of Dr. Mark Rupp. 

See more from the UNMC ID Division here.


 

Cephalexin with or without TMP-SMX Showed Similar Clinical Cure Rates for Uncomplicated Cellulitis

Content courtesy of Philip Chung, PharmD, MS, BCPS

The Infectious Diseases Society of America recommends use of antimicrobial agent active only against streptococci (e.g., cephalexin) for management of cellulitis in patients without systemic signs of infection, penetrating trauma, evidence of MRSA, and injection drug use.  Despite this recommendation, healthcare providers frequently prescribe additional antimicrobial agents with anti-MRSA activity (e.g., cephalexin plus trimethoprim-sulfamethoxazole).

A recent multicenter, double-blind, randomized, controlled trial evaluated the efficacy of cephalexin alone or in combination with trimethoprim-sulfamethoxazole (TMP-SMX) for treatment of acute uncomplicated cellulitis in the outpatient setting.  Clinical cure rates were similar between the combination therapy arm (83.5%) and the monotherapy arm (85.5%).  Adverse event rates and secondary outcomes (including overnight hospitalization, recurrent skin infections, and similar infection in household contacts) were not different between treatment arms.

For additional details, please read Moran GJ, et al. JAMA 2017;317(20):2088-96.


 

THINK FUNGUS – Fungal Disease Awareness Week!

Welcome to the first Fungal Disease Awareness Week sponsored by the CDC and partners! In Infectious Diseases, we truly to see lives saved by thinking about possible fungal diseases and we treat them often. Interested in learning more about Fungal Diseases? Check out the CDC video and the website here.

Share the post to help the CDC increase awareness of these important infections!

Site content and images from CDC link above. 


 

 

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