Contributed by David Saunders, MD
Updated Guidelines for the Prevention of IV Catheter-Related Infections
New recommendations from the Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) for the prevention of intravascular catheter-related infections were published in the May 1, 2011 issue of Clinical Infectious Diseases. Catheter-related bloodstream infections (CRBSI) increase hospital costs and length of stay. Due to its adverse impact on patient outcomes and healthcare costs, preventative strategies have been studied with the goal of eliminating CRBSI. The updated guidelines emphasized 1) educating and training healthcare personnel who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a >0.5% chlorhexidine skin preparation with alcohol for antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters and chlorhexidine impregnated sponge dressings if the rate of infection is not decreasing despite adherence to other strategies. Bundled strategies that incorporate the updated guidelines and reporting rates of compliance by healthcare personnel optimize performance improvement and quality assurance.
Cluster of ARDS in Montana and an Outbreak of Candida parapsilosis in Connecticut
Members of the Emerging Infections Network (EIN) discussed a recent cluster of acute respiratory distress syndrome (ARDS) in Montana. Five cases in four weeks presented with an upper respiratory tract syndrome over five days that progressed to multilobar pneumonia and ARDS. Negative testing included rapid influenza testing, serum influenza antibodies for immunoglobulin M (IgM), cultures (viral, bacterial, and fungal), serologies (Hantavirus, Epstein-Barr virus, and cytomegalovirus), antigens (cryptococcal [serum and cerebrospinal fluid], legionella, and pneumococcal), and pertussis polymerase chain reaction (PCR). Several cases of influenza A (H3) and pertussis occurred in the area concomitantly. Patients did not improve despite broad-spectrum antimicrobial therapy. Other EIN members mentioned recent reports of severe pneumonia due to novel adenovirus serotype 14 in Tennessee and pandemic H1N1 influenza that required bronchoalveolar lavage (BAL) PCR for diagnosis in Indiana. Another EIN discussion addressed four cases of positive joint fluid (broth culture) for Candida parapsilosis at three outpatient rheumatology practices in Connecticut. It was suggested that typing the organisms would be useful to determine a possible common source.
Budget Cuts to Several Federal Health Agencies
The fiscal year 2011 budget agreement reached in April included major cuts to several federal health agencies: the CDC ($730 million cut), the National Institutes of Health (NIH; $260 million cut), the Agency for Health Care Research and Quality (AHRQ; $20 million cut), the President’s Emergency Plan for AIDS Relief (PEPFAR; $23.2 million cut), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria ($2.1 million cut). Funding for the Prevention and Public Health Fund and the Affordable Care Act was not reduced. Spending increased for the Food and Drug Administration (FDA; $107 million increase) and the AIDS Drug Assistance Program (ADAP; $25 million increase). In sum, labor, health, and education programs were cut by $5.5 billion. In response to disproportionate cuts to global health funding, op-eds by HIVMA and IDSA members in several newspapers encouraged policymakers to preserve global health funding.
Addressing the Global Impact of HIV/AIDS and TB
HIV/AIDS and Tuberculosis (TB) are major contributors to global mortality. HIV and TB are the world’s first and second most common causes of death due to an infectious disease, respectively. HIV/AIDS and TB accounted for 2 million and nearly 1.8 million deaths in 2007, respectively. Nearly a quarter of deaths in patients with TB were due to HIV/TB co-infection in 2009. Despite the high mortality associated with HIV/TB co-infection, only a minority (28 percent) of TB-infected patients were tested for HIV and accessed HIV preventative and treatment services in 2009. The Center for Global Health Policy was established by the Infectious Diseases Society of America (IDSA) and the HIV Medicine Association (HIVMA) in 2008 to help promote U.S. efforts to combat HIV/AIDS and TB worldwide. In response to evidence from sub-Saharan Africa that medical male circumcision reduces male acquisition of HIV infection (through vaginal intercourse) by up to 60 percent, the Center released a report in December 2010 that emphasized expanding circumcision services in countries with high HIV prevalence. In response to increased awareness of the HIV/TB epidemic, PEPFAR made possible the distribution of antiretroviral therapy to 3.2 million people worldwide in 2010, an increase from less than 2.5 million people in 2009.