Division of Infectious Diseases

Ebola Case Confirmed – Are you Ready? National Ebola Training and Education Center

Earlier this Month, WHO confirmed a case of Ebola related death in the Democratic Republic of the Congo. Although there is not a known widespread outbreak, such confirmations raise questions of  preparedness. Are you ready if there is another outbreak of Ebola or another highly contagious infectious disease? If you are not prepared, or unsure, training is available.

The National Ebola Training and Education Center (NETEC), leverages the expertise of three institutions that have safely and successfully treated patients with Ebola.  The National Ebola Training and Education Center has worked diligently to share its knowledge with other health care facilities and public health jurisdictions.

ROLE OF THE NATIONAL EBOLA TRAINING AND EDUCATION CENTER (NETEC)

In coordination with ASPR (Assistant Secretary for Preparedness and Response) and CDC (Centers for Disease Control and Prevention), the NETEC conducts site visits which can include direct training, readiness assessment, and technical consultation to assist healthcare facilities prepare for Ebola and other special pathogens.

READINESS ASSESSMENT
NETEC offers on site hospital readiness assessment to assist facilities in validating Ebola and other special pathogen preparedness plans. Readiness assessments generally consist of a team of faculty from the three NETEC institutions spending at least one day on site to help hospitals validate plans from pre-hospital arrival to patient discharge.

TECHNICAL ASSISTANCE/EDUCATION

NETEC faculty provide targeted technical assistance to hospitals through on-site individualized exercise training programs focusing on key topics such as management of the deceased, PPE, and infection control (to name a few). This assistance can also be provided utilizing distance learning technology depending on the needs of the requesting site.

TRAINING/EXERCISE DEVELOPMENT

Independently, or in conjunction with a readiness assessment, NETEC offers significant resources for emergency management exercise planning and development.  NETEC faculty can provide technical assistance while serving as on site evaluators/observers during an actual exercise and can act as subject matter experts during the planning phase of exercise development.  

NETEC also has HSEEP compliant exercise templates available online at www.netec.org that include essential components for a successful exercise.


 

Dr. Hankins on “Why UNMC ID?”

Dr. Hankins on “Why UNMC ID”  

When I started residency I had no idea what I wanted to do afterwards.  Soon I realized as an intern that every patient I saw in which we were treating for an infection, suddenly became the patients I was most interested in.  I was amazed at how quickly patient’s with blood stream infections could go from almost dying to appearing perfectly healthy in just 24 hours.  I found myself excitedly running down to the micro lab at the VA to personally follow up on rare blood cultures.  I chose UNMC because of how much I like all of the staff.  I’ve rotated through the ID service multiple times and enjoyed working with all the different providers on the service.  I think that UNMC provides a variety of ID exposures, and I thought that it would be great to learn with the staff that I really enjoy working with.

 

 

– Dr. Richard Hankins, incoming Infectious Disease fellow

See more about the Infectious Disease fellowship here.


 

ID Journal Club on HPV Vaccination

What Are You Reading?

 

 

At the last Infectious Diseases Journal Club, I reviewed “Quadrivalent HPV Vaccination and the Risk of Adverse Pregnancy Outcomes”, a comprehensive review published in the March 30th, 2017 issue of The New England Journal of Medicine that examined adverse pregnancy outcomes between women who received the quadrivalent HPV vaccine during pregnancy and those who did not.  I trained in both internal medicine and pediatrics and studies like this one pique my interest as the implications span across the fields.  The HPV vaccine is recommended for all women ages 9-26 years, but few data exist regarding the vaccine during pregnancy.  The study’s data showed that the children born to women vaccinated with the quadrivalent HPV vaccine during pregnancy did not have a significantly higher rate of major birth defects compared to children born to women who were not vaccinated with the quadrivalent HPV vaccine during pregnancy.  Also, the number of spontaneous abortions, preterm births, infants with low birth weight, infants who were small for gestational age, and stillbirths were not higher in the vaccinated cohorts than in the unvaccinated cohorts.  This data therefore supports the safety of HPV vaccines if they are inadvertently given in pregnancy.  For me, this study highlights the need for vaccine studies to include pregnant women who until recently were classified as a “vulnerable population” by the Common Rule, the ethical framework that guides biomedical research in humans in the United States.

– Content courtesy of Dr. Andrea Green


 

Infection Prevention and Healthcare Associated Infections

It is difficult to overstate the importance of healthcare associated infections (HAI).  Approximately 4% of patients who enter hospitals in the United States develop an infection related to their hospital care.  Although 4% may not sound like a big number, when you multiply 4% by the tens of millions of admissions to U.S. hospitals, it equates to 1-2 million infections per year resulting in billions of dollars of excess cost and approximately 100,000 deaths.  This is one of the leading causes of death in the United States!

The Infection Prevention team at Nebraska Medicine coordinates a multi-faceted approach to minimize a patient’s risk for HAI.

  • First, we stress standard infection control measures- hand hygiene is the cornerstone, and our surveillance program, with over 118,000 opportunities for hand hygiene observed, documents overall compliance of ~90% (although we are not satisfied with this level of hand hygiene and our target is 100%, it is much better than compliance cited in most of the published literature).
  • We also stress appropriate isolation precautions for patients with some types of infections due to antibiotic-resistant pathogens.
  • We know a clean environment is important and we use an invisible UV-tagged marking gel to ensure that our housekeepers are thorough in their cleaning and disinfection of patient rooms and the healthcare environment- they do a terrific job and their numbers prove it! In addition, for rooms potentially contaminated with antibiotic-resistant pathogens or environmentally hardy spores, we disinfect the rooms with an UV-irradiation robot!
  • Furthermore, in our fight against pathogen acquisition and transmission, all of our patients are bathed daily with an antiseptic soap called chlorhexidine. This intervention has been proven to prevent bloodstream infections and stop the transmission of antibiotic-resistant pathogens.
  • Because medical devices such as urinary catheters and intravenous lines can put patients at risk of infection, we stress careful insertion and care procedures, and protocols are in place to remove devices as soon as they are no longer needed. Intravenous catheters are further protected with chlorhexidine-impregnated dressings and the hubs are covered with an alcohol-containing passive port protector.
  • Another robust program to prevent infections is our respiratory etiquette program and our yearly healthcare worker influenza vaccination campaign. We are proud to note that over 90% of our bedside providers are vaccinated each year.

These are just some of the efforts that are in effect, largely “behind the scenes” to keep our patients safe from infection.  We recognize that infection prevention is a team sport and we are all part of the team.

– Content from Dr. Mark Rupp, Professor and Chief, Division of Infectious Diseases; Medical Director, Department of Infection Control & Epidemiology


 

Let’s Talk About…HIV and Stigma

Recently, Nikki Regan, APRN at the Nebraska Medicine Specialty Care Clinic, was a guest speaker for the Healthy Lifestyles curriculum at her alma mater, Ridge View Middle School (formerly Schaller-Crestland), in Early, IA.

Regan led a discussion about HIV and stigma for a group of approximately sixty (very curious) 8th graders. They talked about HIV basics, like how it is transmitted and, more importantly, how to prevent transmission, as well as the stigma associated with the disease. The sub-title of the presentation was Caring for Yourself and Caring for Others. “My goal was for these adolescents to know the facts. With the facts, they can protect themselves, and also treat those already impacted by HIV with respect and compassion, because they are no longer fearful”, states Regan.

The students had plenty of great questions. On a pre-survey of the class, 60% of them had reported they thought they would become HIV positive at some point in their life. “They were afraid they would acquire HIV from casual contact. They didn’t quite understand that HIV doesn’t just ‘happen’, so we talked a lot about how it has to be transmitted from a HIV-positive person, and ways that can occur”, Regan said.

Regan added, “I am very passionate about taking care of our patients at the HIV clinic, but I am just as passionate about educating the next generation about HIV, so they don’t become one of my patients. HIV is 100% preventable, and hopefully after today, these kids are prepared to protect themselves by avoiding high-risk behaviors.”

 

-Content from Nikki Regan, APRN


 

Dr. Zimmer on “Why I Love ID”

Dr. Zimmer on “Why I Love ID”: I love the diversity and complexity of the field and especially enjoy working with immunocompromised populations. Seeing a variety of challenging cases and working with multiple different teams makes every day interesting.

Learn more about Dr. Zimmer and the UNMC ID Division here.

Share Your Story

I was given the rare opportunity to share my story via the AAMC of how I came to be both a physician and Infectious Diseases/Critical Care subspecialist. Everyone has an amazing story to tell full of both successes and failures, lessons learned and lessons yet to come. Here at UNMC I am honored to be surrounded my amazing, inspiring faculty members within my Division, Department and University as a whole.

There are new generations of students –  aspiring physicians, nurses, respiratory therapists, scientists, nurse practitioners, physician assistants, scientists and so many others – preparing to step forward into careers in healthcare. By sharing our stories we remind students of our vulnerability, humanity and persistence in improving the lives of those around us.

At the encouragement of a friend and co-faculty member, I am sharing my story with you in hopes to encourage others to do the same.

Who will you share your story with?

– Post and content are the personal opinion of Dr. Kelly Cawcutt and may not reflect the opinions of the Division of Infectious Diseases or UNMC as a whole. 

 

 

 

Infectious Diseases’ Medical Students Win Recognition for Research Projects

Two medical students working with UNMC ID Division faculty were recognized by the Department of Internal Medicine for excellence and will receive the 2017 Medical Student Research Award at Grand Rounds on June 2.

Jordan Broekhuis, a fourth year student working with Dr. Sara Bares in the HIV Enhanced Medical Education Track (EMET), conducted a survey of pharmacists in Nebraska and Iowa and found that although many respondents had limited knowledge and experience with HIV pre-exposure prophylaxis (PrEP), most indicated a willingness to provide PrEP after additional training.  The results of the study were presented in Seattle at the Conference on Retroviruses and Opportunistic Infections (CROI).

Logan Jones, a fourth year medical student working with Dr. Mark Rupp, conducted a study examining blood culture practices at Nebraska Medicine.  In a retrospective review using a conditional hierarchical linear model, Logan noted that blood cultures obtained through a central venous catheter contained a significantly greater volume of blood than cultures obtained via peripheral venipuncture.  This observation has clinically significant implications regarding the diagnostic yield of blood cultures and the accuracy of the differential time to positivity assessment.  Logan presented his findings at the annual ID Week meeting in New Orleans in October 2016.

Jordan Broekhuis will start Surgery Residency training in July at Beth Israel Deaconess Medical Center, Boston, MA, and Logan Jones will enter Internal Medicine residency training at the University Health Science Center in Portland, OR.

Congratulations to Jordan Broekhuis and Logan Jones!

 

-Content courtesy of Dr. Mark Rupp

Happy Medical Laboratory Professionals Week – Celebrating our AWESOME Microbiology team!

Work hard, play hard.

Medicine is a hard job AND a team sport. We must take time out to celebrate our colleagues work and accomplishments!

This week is Medical Laboratory Professionals Week, which is held the last full week of April each year.  Events are held to celebrate the critical work that clinical laboratory scientists perform on a daily basis.  This week our Microbiology teams celebrated with a night of bowling and had two teams, the Honey Bowlers and the Gippidy doo doos.

Thank you for all of your efforts to provide amazing patient care!

 

 – Post content courtesy of Dr. Paul Fey.

UNMC Study Documents Value of Blood Diversion Device to Prevent Contamination of Blood Cultures

A prospective controlled trial conducted by Rupp and colleagues in the UNMC ID Division demonstrates a significant 87.6% decrease in blood culture contamination.  Results were recently published in Clinical Infectious Diseases and are available on open access at:  https://academic.oup.com/cid/article/3099374/Reduction-in-Blood-Culture-Contamination-Through

The study was conducted in the Nebraska Medicine Emergency Department and involved 971 patients and 1,942 blood cultures.  Patients needing blood cultures who granted informed consent had one culture obtained in the standard fashion and the other obtained using an innovative device that diverts and sequesters the first 1.5-2.0 mL of blood.  It is thought that the first portion of blood carries contaminating skin cells and microbes. Blood culture contamination was significantly reduced through use of the initial specimen diversion device (ISDD) compared to standard procedures: (2/904 (0.22%) ISDD vs 16/904 (1.78%) standard practice, P=0.001).  Sensitivity was not compromised: true bacteremia was noted in 65/904 (7.2%) ISDD vs 69/904 (7.6%) standard procedure, P=0.41. No needle stick injuries or potential blood borne pathogen exposures were reported. Seventy-three percent of phlebotomists completed a post-study anonymous survey and widespread user satisfaction was noted.

Blood culture contamination is a common and clinically significant problem. False positive blood cultures increase laboratory costs by approximately 20%, are associated with nearly 40% increase in antibiotic charges, are treated with antimicrobials up to one-half of the time, extend the length of hospital stay up to five days and subject patients to the real harms associated with antibiotic exposures such as toxicity, side effects, interactions and emergence of resistance.  It is estimated that a contaminated blood culture costs somewhere between $1,000 (1998) and $8,700 (2009) per case.  Approximately 30,000,000 blood cultures are performed in the United States each year. If our findings were extended to all blood cultures in the United States, and a midpoint cost of $4,850 was applied, it would result in approximately 467,000 fewer contaminated blood cultures and a cost saving of $2,270,000,000-that’s real money!

Citation:

Rupp ME, Cavalieri RJ, Marolf C, Lyden E. Reduction in Blood Culture Contamination Through Use of Initial Specimen Diversion Device. Clinical Infectious Diseases. Electronic ahead of print April3, 2017.  https://academic.oup.com/cid/article/3099374/Reduction-in-Blood-Culture-Contamination-Through

 

– Content courtesy of Dr. Mark Rupp

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