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Division of Infectious Diseases

Antimicrobial Stewardship in Long-Term Care Facilities – The Time is Now!

Antibiotic use is common in long-term care facilities (LTCF) with 70% residents receiving at least one course of systemic antibiotic every year. A significant proportion of the antibiotic use (40% to 75%) in nursing homes has been found to be unnecessary or inappropriate. The prevalence of multi-drug resistant organisms and C. difficile infections are already a significant problem for the post-acute and long-term care facilities. As these facilities are now providing care to more medically complex individuals with increasing numbers of post-acute care (Medicare) admissions, these problems may continue to amplify unless new interventions are introduced to promote appropriate antibiotic use in this setting. Antibiotic stewardship programs have demonstrated effectiveness in reducing inappropriate antibiotic use in long-term care facilities. The Center for Medicare and Medicaid Services (CMS) revised the condition of participation for LTCF in October 2016 and mandated LTCF to develop antibiotic stewardship program as a part of their infection prevention and control program.

Dr. Ashraf and other national speakers spoke on the topic of antimicrobial stewardship in long-term care facilities at 2017 Illinois Summit on Antimicrobial Stewardship. They discussed the strategies for implementation of such a program and introduced the participants to the free resources, which they can use to develop a program at their facilities.

If you would like to learn more about the talk and the available resources, the slides of the presentation are available at the following link:

http://www.dph.illinois.gov/sites/default/files/publications/antimicrobial-stewardship-long-term-care-ashraf-frentzel-mahajan-072617.pdf

 

Content courtesy of Dr. Ashraf. 

Pharmacist-Driven Intervention Improves Care of Patients with Staphylococcus aureus Bacteremia

Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality.  Previous studies have shown Infectious Diseases (ID) consultation for patients with SAB optimizes care and reduces mortality.  A recent study highlights outcomes of a pharmacist-driven intervention to encourage adherence to SAB quality-of-care measures and ID consultation in an Ohio medical center.  The study investigators found that these interventions significantly increased compliance to SAB quality-of-care measures from 69% to 92% and ID consultation from 76% to 95%.  Although not statistically significant, all-cause mortality reduced by 6-fold, from 15.6% to 2.6%, after implementation of these interventions.  For additional details, please read Wenzler E, et al. Clin Infect Dis 2017;65(2):194-200.

Content courtesy of Philip Chung, PharmD, MS, BCPS

 

Microbiology and Infectious Diseases – The Ghostbusters of Medicine

 

Medicine is a team sport, there is no denying that, but together the Microbiologist and Infectious Diseases(ID) specialists create a powerhouse of for diagnosis and treatment. Detect, Identify and Destroy.

Infectious Disease physicians are called in to start the investigation – does the patient have an infection? What do we think is the most likely infection? What tests do we need to determine what it is and how to treat it? Do we need to isolate the patient for risk of spreading infection?

Then the tag-team starts and we order tests to look for different germs (bacteria, viruses, fungi) to figure out what infection the patient may have. Our amazing microbiology colleagues run the tests, try to identify and if possible, grow the germ, and sometimes can even tell us which medicines are the best for treating it. They can tell us if it is one of the “superbugs” that some antibiotics no longer work against. Sometimes, the work is more dangerous and requires special precautions if it could be contagious! They really are the scientists with all the technology and expertise we rely on for this critical information.

Tag! Back to the ID team to review those results and help decide if the patient needs treatment, and if so, what it may be.

ID relies on everyone in microbiology to do our job well EVERY DAY.

We ain’t afraid of no bugs. Who you gonna call?????

 

Content courtesy of Dr. Paul Fey and Dr. Kelly Cawcutt. 


 

 

Dr. Sue Swindells on “Why I Love ID”

Dr. Sue Swindells on “Why I Love ID”: 

“So, I found myself in a fancy maternity hospital in San Francisco not too long ago, while my daughter was having a baby.  The nurses there were very excited to have an Infectious Diseases doctor in the room.  I had thought they might be a bit nervous about my presence, but they were very happy to have me because they had lots of questions.  More than one of them said that they thought Infectious Diseases doctors were amongst the smartest, and that we are really good at solving difficult patient problems.  Mostly they had personal questions like whether going to Brazil on honeymoon was a good idea or not, in light of the ongoing Zika epidemic.  That one was pretty easy to answer.

It was very rewarding to be thought of as a “smart” doctor, and I do believe that many Infectious Diseases doctors that I know are very wise and thoughtful people.  This is important in a discipline where we are mostly paid to think, rather than to do procedures or operate on people.  I have now been an HIV doctor for more than 30 years, and can say that this disease has entirely shaped my career.  It was unheard of when I was in medical school, and only discovered when I was a very junior doctor.  The disease still fascinates me and I learn new things every week.  Every year I also get Christmas cards from patients who credit me with saving their lives – there are very few professions where you actually get to save lives.  At the risk of sounding sappy, I can honestly say I view this as a privilege.”

 

See more about Dr. Swindells and the UNMC HIV team here.


 

Lisa Hill, NP on “Why I Love ID”

Lisa Hill, Nurse Practitioner with Transplant Infectious Diseases on “Why I Love ID”

“ID is like a puzzle. You are looking at each piece trying to see how it fits in the big picture.  Sometimes the edges are clear and sometimes pieces are missing. It is our job to look at all the details to take the best care of each person and their family.  No two days or situations are the same. I love the variety.”

 

See more about UNMC ID here.


 

Hope is Not a Plan – Preparing for Public Health Emergencies.

Dr. Hewlett presented her talk “Hope is Not a Plan” for the SHEA/CDC Outbreak Response Training Workshop(ORTP) in Philadelphia in June. The workshop was geared towards Hospital Epidemiologists and focused on hospital preparedness for public health emergencies. Dr. Hewlett specifically spoke on key steps in preparing for a high-consequence pathogen infection, travel and screening tools for locations and risks, multi-drug resistant organisms and the facilitators/barriers for preparing for emerging infections.

If you would like to learn more, there is addition online training available and listings for future workshops here.

 

Content courtesy of Dr. Hewlett. 


 

Dr. Alison Freifeld on “Why I Love ID”

Dr. Freifeld on “Why I Love ID”: 

“My 30+ year career in managing infections in the most vulnerable immunosuppressed cancer patients has been an incredible journey and one I would choose again! Infectious complications in this population are often complex and life-threatening, but work of diagnosing and managing those problems (and often there are multiple infectious problems involving viral, fungal and/or bacterial pathogens) is both challenging and rewarding because it so often allows patients to continue their cancer treatments despite these complicating infections. I especially love working in concert with a wonderful team of oncologists and other practitioners in the field to provide the best patient care and to improve the lives of people living with cancer. ”

 

See more about Dr. Freifeld and the rest of the UNMC ID division here.

Courage and Heroism in the Face of Ebola – Dr. Martin Salia Honored at Nebraska Medical Center

Dr. Martin Salia was a healthcare hero in his native Sierra Leone. He strove to provide excellent, quality healthcare to patients in Freetown, the capital city of Sierra Leone, as the Ebola epidemic continued to spread. It was during his selfless determination to care for his patients, that Salia contracted the Ebola virus. He was evacuated and arrived at the Nebraska Biocontaminent Unit, but despite aggressive efforts, he died less than 2 days after his arrival.

On July 12th, Dr. Salia’s wife, children, friends and medical staff gathered to honor him. A plaque now hangs in the Nebraska Biocontainment Unit in honor of Dr. Salia. His wife was also present with a brick engraved with ” In honor of Dr. Martin Salia, courage and heroism” that will placed in the pathway of the healing gardens at the hospital.

To see more about Dr. Salia and the celebration of his life and sacrifice, please see:

http://www.omaha.com/livewellnebraska/doctor-who-died-in-ebola-outbreak-honored-for-courage-and/article_2fd0b072-6764-11e7-9279-3b51085ec9ab.html

http://www.3newsnow.com/news/local-news/unmc-honors-doctor-who-died-from-ebola-virus

 

For more about the Nebraska Biocontainment Unit, click here.


 

 

Interested in Common Infections in the Elderly? Listen and Learn at UNMC!

Common Infections in the Elderly
July 13, 2017
Location: UNMC Eppley Science Hall – Amphitheater

In this presentation, Dr. Muhammad Salman Ashraf, Associate Professor, Department of Internal Medicine – Infectious Diseases, will discuss why older adults are at increased risk of infections. He will also identify common infections in the elderly and present management issues related to these infections.

**No need to pre-register. Registration will be available on-site. Also available via live video stream.

HIV prevention – Are you PrEPared?

HIV pre-exposure prophylaxis (PrEP) is the strategy of administering antiretrovirals to HIV uninfected, at-risk individuals in order to prevent HIV infection. Tenofovir-emtricitabine (Truvada) was approved for HIV PrEP by the FDA in 2012 and is over 90% effective in preventing HIV infection when taken as directed.

UNMC’s HIV clinic has been offering HIV PrEP for a few years and demand is steadily increasing, but patients often arrive too late. Recently, we saw a patient with newly diagnosed HIV who had unsuccessfully tried to obtain PrEP from his primary care provider just months before his diagnosis.

Although no single intervention is going to end the HIV epidemic, we have a chance at changing the course of the epidemic and significantly reducing the number of new HIV infections with PrEP.

Providers from UNMC’s HIV team are eager to teach others how to prescribe and monitor patients on PrEP and partnered with University of Nebraska Omaha, the Nebraska Department of Health and Human Services and the Nebraska AIDS Project to provide educational seminars across the state in the months of May and June.

Did you miss the seminars? Find additional resource to learn about PrEP here and here. Look for mini modules to update your HIV knowledge in general? Try these!

 

Content courtesy of Dr. Bares and Sara Weber. Learn more about the UNMC HIV clinic here.


 

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