Cathryn Murphy

Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: Position statement from the joint SHEA and APIC task force

Legislation aimed at controlling antimicrobial-resistant pathogens through the use of active surveillance cultures to screen hospitalized patients has been introduced in at least 2 US states. In response to the proposed legislation, the Society for Healthcare Epidemiology of America (SHEA) and the Association of Professionals in Infection Control and Epidemiology (APIC) have developed this joint position statement. Both organizations are dedicated to combating healthcare-associated infections with a wide array of methods, including the use of active surveillance cultures in appropriate circumstances. This position statement reviews the proposed legislation and the rationale for use of active surveillance cultures, examines the scientific evidence supporting the use of this strategy, and discusses a number of unresolved issues surrounding legislation mandating use of active surveillance cultures. The following 5 consensus points are offered. (1) Although reducing the burden of antimicrobial-resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), is of preeminent importance, APIC and SHEA do not support legislation to mandate use of active surveillance cultures to screen for MRSA, VRE, or other antimicrobial-resistant pathogens. (2) SHEA and APIC support the continued development, validation, and application of efficacious and cost-effective strategies for the prevention of infections caused by MRSA, VRE, and other antimicrobial-resistant and antimicrobial-susceptible pathogens. (3) APIC and SHEA welcome efforts by healthcare consumers, together with private, local, state, and federal policy makers, to focus attention on and formulate solutions for the growing problem of antimicrobial resistance and healthcare-associated infections. (4) SHEA and APIC support ongoing additional research to determine and optimize the appropriateness, utility, feasibility, and cost-effectiveness of using active surveillance cultures to screen both lower-risk and high-risk populations. (5) APIC and SHEA support stronger collaboration between state and local public health authorities and institutional infection prevention and control experts.

Moving toward elimination of healthcare-associated infections: A call to action

Jointly, the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the Association of State and Territorial Health Officials (ASTHO), the Council of State and Territorial Epidemiologists (CSTE), Pediatric Infectious Diseases Society (PIDS), and the Centers for Disease Control and Prevention (CDC) propose a call to action to move toward the elimination of healthcare-associated infections (HAIs) by adapting the concept and plans used for the elimination of other diseases, including infections. Elimination, as defined for other infectious diseases, is the maximal reduction of “the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts; continued measures to prevent reestablishment of transmission are required.” (p24) This definition has been useful for elimination efforts directed toward polio, tuberculosis, and syphilis and can be readily adapted to HAIs. Sustained elimination of HAIs can be based on this public health model of constant action and vigilance. Elimination will require the implementation of evidence-based practices, the alignment of financial incentives, the closing of knowledge gaps, and the acquisition of information to assess progress and to enable response to emerging threats. These efforts must be under-pinned by substantial research investments, the development of novel prevention tools, improved organizational and personal accountabilities, strong collaboration among a broad coalition of public and private stakeholders, and a clear national will to succeed in this arena.

Standardising surveillance of nosocomial infections: The HISS Program

Standardised surveillance of nosocomial infections in Australia had not been addressed until June 1998 when the New South Wales Health Department funded the development and implementation of the first standardised surveillance system for hospital infection: the Hospital Infection Standardised Surveillance program (HISS). The introduction of a standardised surveillance system needs to balance the requirements of a Health Department and the needs of hospitals. The Health Department requires data to develop aggregated rates for the setting of thresholds for all nosocomial infections while hospitals require rates to reflect the quality of clinical care and provide data for evidence-based infection control practices. The Hospital Infection Epidemiology and Surveillance (HIES) Unit has attempted to balance these requirements using a ‘sentinel surveillance’ approach with standardised definitions and methodology. The HISS program utilizes eICAT® software modified for its standardised requirements of data collection. To date, 10 hospitals surveyed sentinel multiple resistant organisms (MRO), eight also elected sentinel surgical procedures (SSP) and intravascular device-related bacteraemia (IVDRB) modules, and two the seasonal respiratory syncytial (RSV) and rota-virus modules in paediatric patients. The surgical site infection rates in three commonly monitored SSP were 1.8% (95% confidence interval (CI) 0.7–3.9%) for coronary artery bypass (CABG), 3.3% (95% CI 1.4–6.8%) lower segment Caesarean section (LSCS) and 7.7% (95% CI 3.4–14.6%) colorectal surgery. The rate of IVDRB was 4.7 per 1000 central venous catheter days (95% CI 2.2–8.6) and 1.1 per 1000 peripheral line-days (95% CI 0.1–3.9). Methicillin resistant Staphylococcus aureus (MRSA) accounted for 99% of all new infections diagnosed with an endemic MRO.

Rate of seasonal spread of respiratory syncytial virus in a pediatric hospital.

The rate of nosocomial respiratory syncytial virus (RSV) infection was measured in a large pediatric hospital using an incidence density method. The at-risk days for nosocomial RSV were summed during a defined winter period in which there were 54 admissions with community-acquired RSV infection giving a rate of 2.9 cases per 1,000 at-risk days (95% confidence interval, 0.3-5.4 per 1,000).

Should we routinely use mupirocin to prevent staphylococcal infections

Routine use of mupirocin to prevent staphylococcal infections is controversial. We assessed attitudes and practices of healthcare professionals attending the Fourth Decennial International Conference on Nosocomial and Healthcare-Associated Infections regarding mupirocin prophylaxis. Eighty percent of participants did not use mupirocin routinely. At the end of the session, 58% indicated they would consider increased use of mupirocin.

Preventing catheter-related bloodstream infections: An executive summary of the APIC elimination guide

This article is an executive summary of the APIC Elimination Guide for catheter-related bloodstream infections. Infection preventionists are encouraged to obtain the original, full-length APIC Elimination Guide for more thorough coverage of catheter-related bloodstream infections prevention.

The Way Forward: A strategic Plan and Position Papers Developed by a Sub-committee of the AICA National Executive May 1997

This document is the final report of the AICA Strategic Planning Committee. The adoptions of its recommendations are dependent on the outcome of the Annual General Meeting - 8 May 1997.

When fiction mirrors reality: 2010 Odyssey Two

In 2010 Odyssey Two, Arthur C. Clarke describes the adventures of a multinational crew of US and Russian space explorers working towards a better understanding of problems during a previously unsuccessful 2001 space mission. Clarke’s space explorers have several other goals to achieve including the need to urgently reach Jupiter. The US/Soviet team believes their technological capability will guarantee success. In a surprise twist, they learn that another nation previously unknown for space expedition capacity has achieved remarkable growth and development and is also rapidly pursuing a landing on Jupiter. It could be argued that subtle similarities exist between the tasks and circumstances facing APIC’s leadership in the real 2010 and those experienced by Clarke’s US/Soviet crew in the fictional 2010. Both teams comprise a blend of backgrounds and viewpoints. To successfully achieve their respective goals, each team must have a healthy respect for divergent opinions and an ability to understand the perspectives and roles of others. The most notable perspectives and roles being those for whom each team serves. APIC’s 2010 leadership is a robust crew indeed, and it is with respect and gratitude that I look forward to embarking on this mission with co-pilots President-Elect Russell Olmsted; CEO Kathy Warye; and APIC’s talented volunteers, staff, and elected crew members. The direction and priorities of the work plans of Clarke’s team and the APIC team are both informed

Editorial: Detection and management of outbreaks in Australia: well founded or a house of cards?

Healthcare associated infection (HAI) monitoring remains a cornerstone of good infection prevention practice. Another cornerstone is detection of outbreaks. A third cornerstone is management of outbreaks to arrest their potential for harm. The final and sometimes most difficult piece is intervention which often requires modification of clinical practice or in devices or equipment used.