Infection preventionists seen as key provider in responding to superbugs.
When the US Centers for Disease Control and Prevention (CDC) released its report updating the state of infection prevalence and antibiotic-resistance threats Wednesday, most of the attention focused on the revelation that more people have died from antibiotic-resistant infections than was previously believed. In 2013, the CDC estimated that 23,000 people a year die as a result of antibiotic-resistant germs. The new estimate nearly doubles that figure to 44,000.
Attention was also paid to the fact that, despite this initial undercounting of mortality, prevention methods seem to be working. Although the overall number of deaths each year is higher, the overall number of people dying from antibiotic-resistant infections has dropped since 2013.
Acute care hospitals reduced Clostridium difficile infections by 12%, central line-associated bloodstream infections by 9%, and catheter-associated urinary tract infections by 8% between 2017 and 2018.
Michael Craig, a senior adviser with the CDC's Antibiotic Resistance Coordination and Strategy Unit, said at the press conference held when the report was released that “infection prevention and control in healthcare facilities works. Improving the use of antibiotics we already have works. Proper food handling works. Safe sex works. Vaccines and keeping hands clean works.”
Hilary Babcock, MD, president of the Society for Healthcare Epidemiology of America, said in a press release that “this data is exciting because it shows that we are not powerless against antibiotic resistance.”
Still, much more needs to be done. About 35,000 Americans die of antibiotic-resistant infections each year, or 1 every 15 minutes.
And some infections are gaining deadly momentum.
CDC categorizes pathogenic infection threats as concerning, serious, or urgent. Hospital administrators, infection preventionists, nurses, doctors, and every other provider in healthcare have 2 superbugs to worry about that have been newly placed in the urgent category: the fungus Candida auris and the bacteria carbapenem-resistant Acinetobacter (they join C. difficile, carbapenem-resistant Enterobacteriacese, and drug-resistant Neisseria gonorrhoeae).
C. auris first popped up in Asia in 2009 and has quickly spread, becoming a cause of severe infections worldwide. Some strains are resistant to all 3 classes of antifungals. In addition, it can trigger outbreaks at healthcare facilities, and patients can carry it on their skin without being infected (making them silent carriers). Common healthcare disinfectants can’t always eliminate it.
CDC Director Robert Redfield, MD, noted that 1 in 3 patients infected with C. auris dies. “To underscore the threat we’re facing, Candida aurise merged on five continents at the same time,” Redfield said at the press conference.
The report noted that “a key finding was that C. auris spreads mostly in longterm healthcare facilities among patients with severe medical problems.”
Carbapenem-resistant Acinetobacter causes pneumonia in addition to wound, bloodstream, and urinary tract infections. Intensive care patients are particularly vulnerable.
“Acinetobacter is a challenging threat to hospitalized patients because it frequently contaminates healthcare facility surfaces and shared medical equipment,” the report noted. “If not addressed through infection control measures, including rigorous cleaning and disinfection, outbreaks in hospitals and nursing homes can occur.”
Some Acinetobacter resists nearly all antibiotics and few drugs are in development to treat it.
C. auris made headlines this week when New York state health regulators listed the healthcare facilities that cared for someone infected, colonized, or possibly colonized with the fungus between Jan. 1, 2016, and June 28, 2019. They had kept the names of the particular facilities under wraps until now.
The information is meant to help patients when making a decision on where to get care, but the New York report also notes that “the detailed information [in the report] is primarily intended for use by hospital infection preventionists….”
The report measured the number of infection preventionists (IPs) on the staffs of 175 hospitals. IP staffing levels are measured as the number of patients for which 1 full-time equivalent IP is responsible. In 2018, the average IP in New York State was responsible for 89 inpatients and 228 total patients per day.
IPs in New York spent most of their time on surveillance (36%), department rounds (12%), daily isolation issues (8%), quality and performance improvement (8%), administrative policy and procedure development (7%), environment/construction rounds (6%), prevention in outpatient areas (5%), employee and occupational health (4%), emergency preparedness (4%), staff education, risk management and other issues (9%).
“Facilities with low IP resources are encouraged to review the responsibilities of their IPs to ensure that staffing levels are appropriate,” the New York state report said. “The review should take into consideration the range of the clinical programs, the risks of the patient population, the scope of the duties covered by the IPs, and the availability of support staff and information technology to assist with surveillance functions and reporting requirements.”
Marie Wilson, a spokesperson for the Association for Professionals in Infection Control and Epidemiology, told Infection Control Today that “if C. auris is confirmed, healthcare providers will need to follow contact precautions, including use of gowns and gloves in the patient’s room, cleaning with sporicidal disinfectants (such as bleach) and routine hand hygiene.” IPs will also need to work closely with “environmental services personnel to monitor cleaning processes,” Wilson said.