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1.
Nursing ; 54(5): 11-12, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38640025
2.
Am J Infect Control ; 52(2): 249-251, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37683731

RESUMO

The complexity and risks of long-term care (LTC) resident care has continued to increase, including infection risk, as regulatory agencies and the LTC industry seek credible and knowledgeable infection preventionists for their facilities. Developing an LTC infection prevention and control certification exam indicates infection preventionists can proficiently manage infection prevention and control programs.


Assuntos
Certificação , Assistência de Longa Duração , Humanos
3.
Nurse Pract ; 48(10): 35-39, 2023 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-37751614

RESUMO

ABSTRACT: Travelers from parts of the world where diphtheria is endemic and vaccines are underutilized or unavailable may carry diphtheria, become ill, and spread the disease. This article provides an overview of diphtheria as well as management updates that are particularly critical amid new travel records and a climate of vaccine hesitancy.


Assuntos
Difteria , Humanos , Difteria/prevenção & controle , Viagem
4.
Nursing ; 53(7): 41-44, 2023 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-37343263

RESUMO

ABSTRACT: Increasing cases of invasive group A Streptococcal (GAS) disease have been reported in Europe and the US, particularly after the relaxation of lockdowns and mitigation strategies related to the COVID-19 pandemic. This article provides an overview of GAS infection, with updates on testing, treatment, and patient education.


Assuntos
COVID-19 , Infecções Estreptocócicas , Humanos , Pandemias , Streptococcus pyogenes , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/prevenção & controle
5.
Nursing ; 53(6): 46-49, 2023 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-37212819

RESUMO

ABSTRACT: Travelers from parts of the world where diphtheria is endemic and vaccines are underutilized may carry diphtheria and become ill. This article provides an overview of diphtheria as well as management updates that are particularly critical amid a pandemic with healthcare disruptions and vaccine hesitancy.


Assuntos
Difteria , Vacinas , Humanos , Difteria/epidemiologia , Difteria/prevenção & controle , Vacinação
7.
JAMA Intern Med ; 180(7): 944-951, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32391862

RESUMO

Importance: Urinary tract infections are the most common infections in nursing home residents. However, most antibiotic use is for unlikely cystitis (ie, nonspecific symptoms and positive culture results secondary to asymptomatic bacteriuria or a urine sample improperly collected for culture) that is unnecessary and inappropriate. This antibiotic use is associated with an increased risk of antimicrobial resistance, adverse drug events, and Clostridioides difficile (formerly Clostridium difficile) infections. Objective: To determine the association of a multifaceted antimicrobial stewardship and quality improvement intervention with the reduction in unnecessary antimicrobial use for unlikely cystitis among noncatheterized nursing home residents. Design, Setting, and Participants: A quality improvement intervention evaluation was conducted to target antimicrobial use among residents with unlikely cystitis in 25 nursing homes across the United States. Baseline data were collected between February 1, 2017, and April 30, 2017. The intervention was conducted from May 1, 2017, to April 30, 2018. Interventions: Intervention nursing homes (n = 12) were randomized to receive a 1-hour introductory webinar, pocket-sized educational cards, tools for system change, and educational clinical vignettes addressing the diagnosis and treatment of suspected uncomplicated cystitis. Monthly web-based coaching calls were held for staff of intervention nursing homes. All facilities received quarterly feedback reports regarding the management of uncomplicated cystitis. Control group nursing homes (n = 13) received usual care. Main Outcomes and Measures: The primary outcome was the incidence of antibiotic treatment for unlikely cystitis cases, defined using published criteria. Secondary outcomes included overall antibiotic use for any urinary tract infection and the safety outcomes of C difficile infections, as well as all-cause hospitalizations and death. Results: Among the 25 nursing homes participating in this quality improvement study, including 512 408 intervention facility resident-days and 443 912 control facility resident-days, fewer unlikely cystitis cases were treated with antibiotics in intervention facilities compared with control facilities (adjusted incident rate ratio [AIRR], 0.73 [95% CI, 0.59-0.91]); C difficile infection rates were also lower in intervention nursing homes vs control nursing homes (AIRR, 0.35 [95% CI, 0.19-0.64]). Overall antibiotic use for any type of urinary tract infection was 17% lower in the intervention facilities than the control facilities (AIRR, 0.83 [95% CI, 0.70-0.99]; P = .04). There was no increase in all-cause hospitalizations or deaths due to the intervention (all-cause hospitalizations: AIRR, 0.95 [95% CI, 0.75-1.19]; all-cause death: AIRR, 0.92 [95% CI, 0.73-1.16]). Conclusions and Relevance: This study suggests that a low-intensity, multifaceted intervention was associated with improved antibiotic prescribing for uncomplicated cystitis in a cohort of nursing homes without an adverse association with other safety outcomes. Although promising, further study is needed to determine whether the intervention could be widely implemented to assist facilities in meeting new federal nursing home requirements for antimicrobial stewardship and quality assurance performance improvement programs.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/métodos , Cistite/tratamento farmacológico , Casas de Saúde , Melhoria de Qualidade , Idoso , Cistite/epidemiologia , Feminino , Hospitalização/tendências , Humanos , Masculino , Resultado do Tratamento
8.
J Am Med Dir Assoc ; 21(1): 12-24.e2, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31888862

RESUMO

The diagnosis and management of urinary tract infections (UTIs) among residents of post-acute and long-term care (PALTC) settings remains challenging. Nonspecific symptoms, complex medical conditions, insufficient awareness of diagnostic criteria, and unnecessary urine studies all contribute to the inappropriate diagnosis and treatment of UTIs in PALTC residents. In 2017, the Infection Advisory Subcommittee at AMDA-The Society for Post-Acute and Long-Term Care Medicine convened a workgroup comprised of experts in geriatrics and infectious diseases to review recent literature regarding UTIs in the PALTC population. The workgroup used evidence as well as their collective clinical expertise to develop this consensus statement with the goal of providing comprehensive guidance on the diagnosis, treatment, and prevention of UTIs in PALTC residents. The recommendations acknowledge limitations inherent to providing medical care for frail older adults, practicing within a resource limited setting, and prevention strategies tailored to PALTC populations. In addition, the consensus statement encourages integrating antibiotic stewardship principles into the policies and procedures used by PALTC nursing staff and by prescribing clinicians as they care for residents with a suspected UTI.


Assuntos
Instituições Residenciais , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/prevenção & controle , Comitês Consultivos , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Consenso , Humanos
9.
J Am Med Dir Assoc ; 21(1): 25-28.e2, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31888863

RESUMO

Preventing influenza infections is a national health priority, particularly among geriatric and adults with frailty who reside in post-acute and long-term care (PALTC) settings. Older adults account for more than 70% of deaths from influenza, a reflection of decreased vaccine effectiveness in that age group. Annually vaccinating health care personnel (HCP) working with these patients against influenza is critical to reducing influenza morbidity and mortality among patients. PALTC HCP have the lowest influenza vaccination rate when compared to HCP in other settings. The Advisory Committee on Immunization Practices recommends that all HCP receive an annual influenza vaccination, including those who do not have direct patient care responsibilities. Here, we discuss the importance of influenza vaccination for HCP, detail recommendations for influenza vaccination practice and procedures for PALTC settings, and offer support to PALTC settings and their staff on influenza vaccinations.


Assuntos
Pessoal de Saúde/legislação & jurisprudência , Vacinas contra Influenza/administração & dosagem , Vacinação/legislação & jurisprudência , Comitês Consultivos , Humanos , Influenza Humana/prevenção & controle
12.
J Am Geriatr Soc ; 67(3): 539-545, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30584657

RESUMO

OBJECTIVE: To establish consensus recommendations for empirical treatment of uncomplicated cystitis with anti-infectives in noncatheterized older nursing home residents to be implemented in the Improving Outcomes of UTI Management in Long-Term Care Project (IOU) funded by the Agency for Healthcare Research and Quality. DESIGN: Two-round modified Delphi survey. PARTICIPANTS: Expert panel of 19 clinical pharmacists. MEASUREMENTS: Comprehensive literature search and development/review/edit of draft survey by the investigative group (one geriatric clinical pharmacist, two geriatric medicine physicians, and one infectious disease physician). The expert panel members rated their agreement with each of 31 recommendations for drugs of choice, dosing medications at various levels of renal function, drug-drug interactions to avoid, and duration of therapy by sex on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Consensus agreement was defined as a lower 95% confidence limit of 4.0 or higher for the recommendation-specific mean score. RESULTS: The response rate was 95% for the first round, and three recommendations achieved consensus (dosing for nitrofurantoin and trimethoprim/sulfamethoxazole in those without chronic kidney disease, and drug-drug interaction between trimethoprim/sulfamethoxazole and warfarin). In the second round, 90% responded and reached consensus on an additional eight recommendations (two for nitrofurantoin or trimethoprim/sulfamethoxazole as initial drugs of choice, three for dosing ciprofloxacin, nitrofurantoin, and trimethoprim/sulfamethoxazole at various levels of chronic kidney disease, and three drug-drug interactions to avoid: trimethoprim/sulfamethoxazole with phenytoin and ciprofloxacin with theophylline or with tizanidine). CONCLUSION: An expert panel of clinical pharmacists was able to reach consensus on a set of recommendations for the empirical treatment of cystitis with oral anti-infective medications in older nursing home residents. The recommendations were incorporated into a treatment algorithm for uncomplicated cystitis in noncatheterized nursing home residents and used in educational materials for health professionals in an ongoing controlled intervention study. J Am Geriatr Soc 67:539-545, 2019.


Assuntos
Anti-Infecciosos , Cistite , Assistência de Longa Duração , Conduta do Tratamento Medicamentoso/normas , Melhoria de Qualidade/organização & administração , Idoso , Anti-Infecciosos/classificação , Anti-Infecciosos/farmacologia , Consenso , Cistite/diagnóstico , Cistite/tratamento farmacológico , Técnica Delphi , Relação Dose-Resposta a Droga , Interações Medicamentosas , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Feminino , Geriatria/métodos , Geriatria/normas , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/normas , Masculino , Casas de Saúde/normas , Estados Unidos
13.
Am J Infect Control ; 46(9): 973-979, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30172338

RESUMO

BACKGROUND: In the postacute and long-term care setting, the practice of changing the indwelling urinary catheter large sterile drainage bag to a small-size leg drainage bag is intended to maintain a person's mobility, dignity, and comfort. There is scant evidence that assesses the impact of intermittent use of a leg bag on frequency of urinary tract infection since this breaks the closed urinary drainage system. METHODS: We reviewed research published between 1993 and 2014 for the answers to 20 practice questions developed by experts and long-term care clinicians on the risks and benefits, cleaning, connection, and storage of reusable leg bags. RESULTS: Seventeen of the 26 publications and studies provided varying advice on the risk of breaking the closed system and on practices for changing, disinfecting, and storing leg bags between uses. Thirteen of 20 practice questions were answered by ≥1 publications, few of which were evidence based. CONCLUSIONS: We identified the existence of low-level evidence that leg bags pose no evident, disproportionate risk of infection compared with maintaining a closed system. The lack of uniformity in evidence in the literature suggests aseptic technique should guide practice. Available evidence suggests that aseptic technique should guide practice.


Assuntos
Cuidados Críticos/métodos , Assistência de Longa Duração/métodos , Cateterismo Urinário/métodos , Infecções Urinárias/epidemiologia , Drenagem/efeitos adversos , Drenagem/métodos , Humanos , Medição de Risco , Cateterismo Urinário/efeitos adversos
14.
J Am Med Dir Assoc ; 19(9): 765-769.e3, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30037743

RESUMO

OBJECTIVES: To identify a set of signs and symptoms most likely to indicate uncomplicated cystitis in noncatheterized nursing home residents ≥65 years of age using consensus-based methods informed by a literature review. DESIGN: Literature review and modified Delphi survey with strict inclusion criteria. SETTING AND PARTICIPANTS: Expert panel of 20 physicians certified in geriatric medicine and/or medical direction, actively practicing in post-acute and long-term care settings. METHODS: The authors performed a literature review to produce a comprehensive list of potential signs and symptoms of presumptive uncomplicated cystitis, including nonspecific "quality control" items deemed unlikely to indicate uncomplicated cystitis. The expert panel rated their agreement for each sign/symptom using a 5-point Likert-type scale (1 = strongly disagree to 5 = strongly agree). Agreed upon signs and symptoms were summarized using a diagnostic algorithm for easy clinical use. RESULTS: The literature review identified 16 signs and symptoms that were evaluated in 3 Delphi survey rounds. The response rate was 100% for round 1 and 95% for the second 2 rounds. Consensus agreement for inclusion was achieved for dysuria on round 1 with exclusion of the 3 quality controls, and "offensive smelling urine." Consensus in the second round was reached for including 4 additional items (gross hematuria, suprapubic pain, urinary frequency, and urinary urgency). Round 3 evaluated dysuria alone and combinations of symptoms. Consensus that dysuria alone is sufficient for diagnosis of cystitis was not reached. CONCLUSIONS/IMPLICATIONS: The panel identified 5 signs and symptoms likely indicative of uncomplicated cystitis in nursing home residents and developed a diagnostic algorithm that can be used to promote antibiotic stewardship in nursing homes. Given similarities in populations, the algorithm may also be applicable to the older adult and the broader post-acute/long-term care populations.


Assuntos
Cistite/diagnóstico , Instituição de Longa Permanência para Idosos , Infecções Urinárias , Idoso , Técnica Delphi , Feminino , Guias como Assunto , Humanos , Masculino , Resultado do Tratamento , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico
16.
J Am Med Dir Assoc ; 18(11): 913-920, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28935515

RESUMO

In response to a rising concern for multidrug resistance and Clostridium difficile infections, the Centers for Medicare and Medicaid services (CMS) will require all long-term care (LTC) facilities to establish an antibiotic stewardship program by November 2017. Thus far, limited evidence describes implementation of antibiotic stewardship in LTC facilities, mostly in academic- or hospital-affiliated settings. To support compliance with CMS requirements and aid facilities in establishing a stewardship program, the Infection Advisory Committee at AMDA-The Society for Post-Acute and Long-Term Care Medicine, has developed an antibiotic stewardship policy template tailored to the LTC setting. The intent of this policy, which can be adapted by individual facilities, is to help LTC facilities implement an antibiotic stewardship policy that will meet or exceed CMS requirements. We also briefly discuss implementation of an antibiotic stewardship program in LTC settings, including a list of free resources to support those efforts.


Assuntos
Gestão de Antimicrobianos/organização & administração , Infecções por Clostridium/tratamento farmacológico , Resistência a Múltiplos Medicamentos , Política de Saúde , Assistência de Longa Duração/organização & administração , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Centers for Medicare and Medicaid Services, U.S. , Infecções por Clostridium/prevenção & controle , Feminino , Avaliação Geriátrica/métodos , Humanos , Controle de Infecções , Masculino , Formulação de Políticas , Avaliação de Programas e Projetos de Saúde , Instituições de Cuidados Especializados de Enfermagem , Estados Unidos
17.
JAMA Intern Med ; 177(8): 1154-1162, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28525923

RESUMO

Importance: Catheter-associated urinary tract infection (UTI) in nursing home residents is a common cause of sepsis, hospital admission, and antimicrobial use leading to colonization with multidrug-resistant organisms. Objective: To develop, implement, and evaluate an intervention to reduce catheter-associated UTI. Design, Setting, and Participants: A large-scale prospective implementation project was conducted in community-based nursing homes participating in the Agency for Healthcare Research and Quality Safety Program for Long-Term Care. Nursing homes across 48 states, Washington DC, and Puerto Rico participated. Implementation of the project was conducted between March 1, 2014, and August 31, 2016. Interventions: The project was implemented over 12-month cohorts and included a technical bundle: catheter removal, aseptic insertion, using regular assessments, training for catheter care, and incontinence care planning, as well as a socioadaptive bundle emphasizing leadership, resident and family engagement, and effective communication. Main Outcomes and Measures: Urinary catheter use and catheter-associated UTI rates using National Healthcare Safety Network definitions were collected. Facility-level urine culture order rates were also obtained. Random-effects negative binomial regression models were used to examine changes in catheter-associated UTI, catheter utilization, and urine cultures and adjusted for covariates including ownership, bed size, provision of subacute care, 5-star rating, presence of an infection control committee, and an infection preventionist. Results: In 4 cohorts over 30 months, 568 community-based nursing homes were recruited; 404 met inclusion criteria for analysis. The unadjusted catheter-associated UTI rates decreased from 6.78 to 2.63 infections per 1000 catheter-days. With use of the regression model and adjustment for facility characteristics, the rates decreased from 6.42 to 3.33 (incidence rate ratio [IRR], 0.46; 95% CI, 0.36-0.58; P < .001). Catheter utilization was 4.5% at baseline and 4.9% at the end of the project. Catheter utilization remained unchanged (4.50 at baseline, 4.45 at conclusion of project; IRR, 0.95; 95% CI, 0.88-1.03; P = .26) in adjusted analyses. The number of urine cultures ordered for all residents decreased from 3.49 per 1000 resident-days to 3.08 per 1000 resident-days. Similarly, after adjustment, the rates were shown to decrease from 3.52 to 3.09 (IRR, 0.85; 95% CI, 0.77-0.94; P = .001). Conclusions and Relevance: In a large-scale, national implementation project involving community-based nursing homes, combined technical and socioadaptive catheter-associated UTI prevention interventions successfully reduced the incidence of catheter-associated UTIs.


Assuntos
Antibacterianos/uso terapêutico , Infecções Relacionadas a Cateter , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Cateterismo Urinário , Cateteres Urinários , Infecções Urinárias , Idoso , Técnicas Bacteriológicas/estatística & dados numéricos , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/prevenção & controle , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Assistência de Longa Duração/métodos , Assistência de Longa Duração/normas , Masculino , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/organização & administração , Estados Unidos/epidemiologia , Urinálise/métodos , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/métodos , Cateterismo Urinário/normas , Cateteres Urinários/efeitos adversos , Cateteres Urinários/estatística & dados numéricos , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
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