rodneyrohde112108The following is a guest post provided by Dr. Rodney E. Rohde, Chair & Professor, Clinical Laboratory Science (CLS), Associate Dean for Research, College of Health Professions at Texas State University.

I tend to get asked daily about the concern I have regarding the recent Ebola case that showed up in Dallas, TX which is about three hours from my home. I usually count to ten silently, and then try to educate my friends, family, colleagues, and others who know my professional credentials (Specialist in Microbiology and Specialist in Virology via ASCP certification) and my career as a public and clinical microbiologist for over two decades.

Yes, Ebola is a killer. Yes, it’s a very scary type of death with hemorrhaging and multi-organ failure. Yes, it’s true. More travelers could arrive in the US from those regions in the world where Ebola has been endemic for decades. Yes, we should be concerned about travel from those regions. Yes, we should review how we take travel and patient histories from individuals coming to emergency departments, to our primary care clinics, and other healthcare facilities with typical Ebola symptoms. YES, we should as a nation be vigilant in our handling of exposure contacts and ensure that our public health standard operating procedures are current and decisive in how we enact those plans.

NOW….everyone, relax and let me try to give you some perspective. Take a step out of the media news blitz and breathe. Ebola is primarily a “caregiver’s disease” that typically only is transmitted by those who handle patients and those who have died from Ebola, specifically their body fluids (blood, etc.). It is NOT transmitted via airborne routes. Those of us in epidemiology and public health talk about a pathogen’s Ro (basic reproduction number/rate/ratio) which can be thought of as the number of cases one case generates on average over the course of its infectious period, in an otherwise uninfected population. Generally, the larger the value of Ro, the harder it is to control the epidemic. For some typical, well know diseases and their Ro values, see the list below.

Measles, Airborne, Ro = 12-18
Pertussis, Airborne droplet, Ro = 12-17
Diphtheria, Saliva, Ro = 6-7
Smallpox, Airborne droplet, Ro = 5-7
Polio, Fecal-oral route, Ro = 5-7
HIV, STD, Ro = 2-5
Ebola, Bodily fluids, Ro = 1-4

The basic reproductive rate is affected by several factors including the duration of infectivity of affected patients, the infectiousness of the organism, and the number of susceptible people in the population that the affected patients are in contact with. When we truly examine Ebola with an unbiased eye, experts agree that Ebola is not a threat to start a rampaging epidemic in the US. Indeed, its Ro is one of the lowest when it comes to scary diseases.

Certainly, we see that outbreaks can happen in areas where standard healthcare precautions (personal protective equipment, quarantine measures, barrier nursing, aseptic technique, burial techniques, etc.) are not being followed with Ebola patients and those who die from Ebola. If we follow proper procedures and are vigilant in our efforts, everything can and should be fine. Will we have other cases in the US? Of course we will. World travel makes this possibility inevitable. We do not have an exclusive right to not have Ebola cross our borders and oceans. Microbes, not just Ebola, do not CARE about politics or how well we think our healthcare system works REGARDLESS of ones economic status or political affiliation. I always tell my clinical laboratory science students that “microbes do not read the books” and do not always follow the rules. Viruses are particularly brutal when it comes to their mutation rate and ability to adapt to the human immune system or environmental barriers.

I also would like to offer this important information for those who are becoming critical of our physicians, nurses, and public health system in general. It is almost impossible to recognize Ebola in a person who has just started undergoing symptoms. Fever of about 102F, headaches, muscle pain, and maybe some nausea. Hmmm….does this sound like influenza? How about food-borne illness? Allergies can even mimic these types of symptoms. Please keep this in mind. Those in healthcare are sometimes like policemen. They make an educated judgement based on what they see and other information (patient history) that they can gather, usually under very difficult and busy circumstances. Our healthcare system can not panic and begin to quarantine every person who shows up at an emergency room with these symptoms. So, please, unless you truly understand the difficult circumstances that these healthcare professionals face on a daily basis don’t be so quick to crucify them. They are often doing the best they can in not so great conditions. But…that’s another subject, and perhaps, another post at a later date.

And, what is also sad about the Dallas Ebola patient being “sent home with antibiotics” the first time he visited is just that – all too often any illness is treated this way. Throw a prescription at it instead of doing a proper work up with a culture and other laboratory tests to confirm an illness. This is often related to a number of difficult factors – too many patients, financial concerns, jam packed waiting rooms – that we can’t get too in depth about here.

Finally, I would like to remind everyone in the US (and in many other countries like the UK, etc.) that what you should be most concerned about is not Ebola when it comes to infectious diseases. Influenza and tuberculosis are constant killers every year in this country. New viruses like Enterovirus 68, which IS TRANSMITTED by airborne routes, is causing new concerns that it may be linked to paralysis in children. Please don’t get me started on vaccine-preventable diseases that are ignored more and more. Just look to the current resurgence of pertussis and measles in this country. Our grandparents and those before them should be ashamed of us. They know how deadly these agents are and can be again!

Lastly, please, consider this exploding and growing US and global epidemic that is occurring right now. Did you know that Healthcare Associated Infections (HAIs), such asMRSA, Clostridium difficile, VRE, CRE, etc.) are responsible for about 279 deaths in the United States EVERY DAY?

Folks, if you want to talk about perspective regarding Ebola, try this on for size.

HAIs kill over 100,000 people every year in this country.

Most of these infections occur in the healthcare setting or in the community (like jails, athletic centers, college dorms, and other common environments). Yes, I said every year in the United States. Consider a jet airliner crashing every day in this country with your loved ones aboard. Now, THAT IS SOMETHING to get upset over. HAIs are just one of many public health threats we should all be upset over.

Let’s all try to keep our perspective and find ways to work cooperatively and constructively across this country and with others around the globe to strengthen our public health system and support our healthcare professionals. These are usually hidden professionals who are all too often taken for granted until it’s easy to criticize an “event” like the recent Ebola cases in the US. Perhaps, we should all keep that in perspective.

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CDC infographicToday, the Centers for Disease Control and Prevention (CDC) has released two new reports showing progress in prevention efforts aimed at healthcare-associated infections (HAIs). However, despite success shown by the reports, more work is needed to meet new challenges.

The reports detail the estimates of HAIs occurring throughout the nation, and also report on national and state-specific progress in the prevention of HAIs.

“Although there has been some progress, today and every day, more than 200 Americans with healthcare-associated infections will die during their hospital stay,” said CDC Director Tom Frieden, M.D., M.P.H. “The most advanced medical care won’t work if clinicians don’t prevent infections through basic things such as regular hand hygiene. Health care workers want the best for their patients; following standard infection control practices every time will help ensure their patients’ safety.”

Major findings of the reports include:

  • 1 in 25 hospitalized patients will experience at least one HAI
  • Approximately 75,000 hospital patients with HAIs died during their hospitalizations
  • Progress has been made in preventing certain infections.  This includes central line-associated bloodstream infections, infections related to 10 types of surgery, hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections, and hospital-onset Clostridium difficile infections.
  • The most common germs causing HAIs were C. difficileStaphylococcus aureus, including MRSA; KlebsiellaE. coli; Enterococcus; and Pseudomonas.

The reports and additional data can be found by clicking on the following links:

Photo: CDC Infographic.  What Patients Can Do: Six Ways To Be A Safe Patient.

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Evelyn McKnight HONOReformThe following is a guest post by Dr. Evelyn McKnight, founder and president of HONOReform (Hepatitis Outbreaks’ National Organization for Reform).

I remain troubled by the news that 4,277 patients on Long Island, because of improper use of an insulin pen, have been placed in harm’s way (“Nassau hospital’s call to test injected patients seen as opportunity,” March 15, Newsday). These men and women are in my thoughts and prayers.

I joined the CDC and its partners in 2008 to launch the One and Only Campaign. Because of troubling patient notifications and devastating outbreaks that have occurred in the last six years, our work on the campaign has expanded. We developed extraordinary resources on proper use of the insulin pen, for instance. I encourage healthcare workers throughout New York and the area—and throughout the country—to please take time to reeducate themselves on all injection safety fundamentals.

In addition to my encouragement to healthcare workers to always give a safe injection, I encourage them to be unafraid in addressing each other directly, anytime injection safety standards are violated—or seem to be.

I was one of 99 people in Fremont, Nebraska, who was infected with hepatitis C while receiving treatment for cancer at an outpatient clinic in 2002. Syringes were reused, and the saline flush was used improperly. Not only does an outbreak of hepatitis C affect patients, it affects an entire community. Notifications like the current one on Long Island chip away at a community’s confidence in its medical care.

Did anyone speak up, when my fellow patients and I, people who were fighting one fatal disease only to have to take on another, were being violated through unsafe injection practices? Sadly, the answer is no.

In the recent reports, it appears an unnamed healthcare worker did make a stand. According to recent reports, he or she heard a colleague say it’s okay to reuse an insulin pen on more than one patient. As we know, blood can become trapped in the reservoir and, if the device is reused, cause an infection. As it states in the One and Only Campaign materials, “Insulin pens that contain more than one dose of insulin are only meant for one person. “

To the healthcare worker who said to his or her colleague, “No, that is not how it is done,” we issue our thanks. I expect this person will not perceive himself or herself as strong or brave or innovative. I expect he or she would say, if I had a chance to provide a commendation, “I was just doing my job.”

However, speaking up to a coworker or colleague, and especially to a person of higher rank, clearly does not occur as often as it should in healthcare. I am one of many people throughout the United States who has been deeply affected by ongoing, unchecked unsafe injection practices.

On behalf of my fellow patients, and with the patients from Long Island in our minds and hearts, I urge healthcare workers to be unafraid to say, “Stop.” To say, “No…Let’s talk.” Lives depend on you.

Evelyn McKnight is the founder and president of HONOReform (Hepatitis Outbreaks’ National Organization for Reform) and the co-author of A Never Event: Exposing the Largest Outbreak of Hepatitis C in American Healthcare History.

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The Centers for Disease Control and Prevention (CDC) has released its 2013 Prevention Status Reports (PSRs) highlighting policies and practices aimed at preventing or reducing problems affecting public health.  Individual reports are available for all 50 states and the District of Columbia on various health topics, including healthcare-associated infections (HAIs).

The individual state HAI PSRs provide information about the status of state health department HAI prevention efforts.

The individual state reports can be found by visiting the CDC’s Healthcare-Associated Infections PSR 2013 webpage.

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The U.S. Senate Committee on Health, Education, Labor & Pensions will be holding a full committee hearing on U.S. efforts to reduce healthcare-associated infections (HAIs).

The committee hearing will take place on Tuesday, September 24, 2013.

Witness speakers include:

  • Patrick Conway, MD, MSc , Chief Medical Officer and Director, Center for Clinical Standards and Quality, and Acting Director, Center for Medicare and Medicaid Innovation, Baltimore, MD
  • Beth Bell, MD, MPH , Director, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
  • Ciaran Staunton , The Rory Staunton Foundation, New York, NY
  • Jonathan B. Perlin, MD, PhD, MSHA, FACP, FACMI , President, Clinical and Physician Services & Chief Medical Officer, HCA/Hospital Corporation of America, Nashville, TN
  • Joe Kiani , Founder, the Patient Safety Movement, Irvine, CA

Click here to view the committee notice.

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Lauren Lollini and Evelyn McKnight of HONOReform are calling attention to unsafe injection practices with their new “Survivor Stories Blog.”

According to the CDC, since 1999, “more than 125,000 patients in the United States have been notified of potential exposure to hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV due to unsafe injection practices. Many of these incidents involved healthcare providers reusing syringes, resulting in contamination of medication vials or containers which were used then on subsequent patients.”

As patients who contracted Hepatitis C from unsafe medical injections, Lauren and Evelyn know from firsthand experience how these exposures impact patient’s lives:

As survivors ourselves, we know firsthand how pervasively an outbreak affects lives. Everything changes for victims – their health, family life, ability to work, emotional well being. The community in which they live reels from the resulting litigation and damage to the medical community’s reputation.

Through the Survivor Stories Blog, Evelyn and Lauren hope to bring focused attention to the issue of unsafe injections in our healthcare system:

Along with telling survivors’ stories, we will share the educational, engineering and policy efforts in place and those proposed to prevent unsafe injections. Guest bloggers will frequently join us to comment on injection safety – and tell their stories. We want to use these stories and information to foster a healthcare system in which no American will have a story to tell about going to the doctor seeking good health, but coming away with a deadly disease.

For more information, visit the HONOReform Survivor Stories Blog.  If you have a personal experience involving unsafe injections and you would like to share that information, email evelyn@HONOReform.org.

For more information about injection safety, visit http://www.oneandonlycampaign.org or http://www.cdc.gov/injectionsafety/unsafepractices.html.

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HIV occupational exposure, federal guidelinesNew federal guidelines for managing occupational exposures to HIV have been published online today in the journal Infection Control and Hospital Epidemiology.  The guidelines recommend the immediate use of an HIV postexposure prophylaxis (PEP) regimen consisting of three or more antiretroviral drugs following any occupational exposure to HIV.

Previous recommendations involved an assessment of the level of risk associated with individual exposures for deciding on the number of recommended drugs for PEP.  The new recommendations eliminate this previous recommendation.

Click here to view the new recommendations.  An infographic from the CDC is also available.  The infographic provides a “plain language” version of the main points provided by the guidelines.

Photo credit:  Centers for Disease Control and Prevention.  Infographic, Exposed to HIV? The Clock is Ticking.

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Jersey Shore University Medical Center, clostridium difficile infection, vaccine clinical trialThe Jersey Shore University Medical Center in Neptune, New Jersey has announced it will be participating in a Phase III Trial of an investigational vaccine to prevent Clostridium difficile infections.

The clinical study will evaluate the “safety, immunogenicity and efficacy of an investigational vaccine for the prevention of primary symptomatic” Clostridium difficile infection (CDI).

Click here to read the Jersey Shore University News Release.

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C. difficile bacteria.  Photo credit: CDC

Rebiotix Inc. has announced it has received FDA approval on its Investigational New Drug (IND) application to begin a Phase 2 clinical study of a treatment of recurrent Clostridium difficile infection (CDI).

The treatment, RBX2660, is a “preparation containing live microbes designed to rebuild a healthy intestinal micro biome.”  If successful, the treatment will become the first FDA-approved drug based on the human microbiome, according to the press release.

“IND approval represents a significant milestone for Rebiotix, and continues our progress toward developing and commercializing a new therapy to treat patients with this debilitating and potentially life-threatening disease,” said Rebiotix CEO Lee Jones. “We are working quickly to get the clinical trial running and to recruit patients.” Jones also noted that Rebiotix is committed to conducting a full program of clinical trials to expand treatment options for recurrent CDI and to explore additional indications for its microbiota restoration therapy.

Click here to read the Rebiotix press release.

Photo: C. difficile bacteria. Photo credit: CDC

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Webbertraining.com is offering a great lineup of courses for the month of August.  Click on the links below for more information.

August 7
(FREE WHO Teleclass … North America).
Decontamination of High-Touch Environmental Surfaces in Healthcare: A Critical Look at Current Practices and Newer Approaches.
With Prof. Syed Sattar, University of Ottawa, Canada
Teleclass sponsored by WHO Clean Care is Safer Care

August 22
The Infectious Disease Fallout Following Natural Disasters — The Hurricane Sandy Story
With Dr. Michael Tapper, Lenox Hill Hospital, New York

August 22
(FREE South Pacific Teleclass … Broadcast live from the IPCNC conference in New Zealand)
From Little Things Big Things Grow: The Importance of Leadership Skills in Infection Prevention
Prof. Cathryn Murphy, Infection Control Plus, Australia
Teleclass broadcast sponsored by Johnson & Johnson Medical (www.jnj.com)

August 29
(FREE Teleclass)
Decontamination of High-Touch Environmental Surfaces in Healthcare: A Critical Look at Current Practices and Newer Approaches
With Dr. Shams B. Syed, WHO African Partnerships for Patient Safety, Geneva

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iowa dental board Jay BuckleyAn Iowa dentist has been fined $5,000 for poor infection control practices, including the failure to change gloves between patients according to the Iowa Des Moines Register.

An investigation was launched after a dental assistant working for Dr. Jay Buckley informed state regulators that Buckley was violating proper infection protocols. For example, instead of changing gloves between patients, the dentist would wash them with soap and water. Other investigation findings included poor cleaning of exam rooms and issues with equipment sterilization.

According to the Des Moines Register article, the Iowa Dental Board ruled as follows:

Buckley “repeatedly and willfully failed to maintain safety and sanitary conditions in his dental practice.” The board noted that Buckley disputed the allegations, but it said his “statements and testimony denying the violations were filled with inconsistencies and self-serving statements.” Besides levying the fine, the board ordered the Buckley to serve five years probation; to have infection-control training for himself and his staff; and have another dentist monitor his practice.

Buckley’s lawyer intends to appeal the board’s decision saying the decision was built around a disgruntled employee who was fired.

Click here to view the original Notice of Hearing and Statement of Charges against Dr. Buckley.

Photo: Iowa Dental Board.

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North Carolina healthcare-associated infections reportThe North Carolina Department of Health Prevention Program has issued it’s latest healthcare-associated infection (HAI) quarterly report.

The prevention program issues year-to-date statistical updates on a quarterly basis.  This newest report contains hospital-specific data from North Carolina short-term acute care hospitals, long-term acute care hospitals and inpatient rehabilitation facilities.  The data contained in the report is from the time period of January to March 2013.

Two versions are available: Healthcare Consumer Version and Healthcare Provider Version.

Photo: North Carolina Department of Health and Human Services.  Healthcare-Associated Infections (HAIs), Facts and Figures.  Available at http://epi.publichealth.nc.gov/cd/hai/figures.html.  Accessed July 24, 2013.

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Cyclospora InfectionThe U.S. Food and Drug Administration (FDA) has stated it is investigating a multi-state outbreak of Cyclospora infections. The investigation is being conducted along with the Centers for Disease Control and Prevention (CDC) and state and local officials.

According to the statement, the CDC and several state health departments have reported infections. As of July 18, 2013, more than 200 cases of Cyclospora infection have been reported in Iowa, Nebraska, Texas, and Wisconsin. Illinois has also reported one case that may have been acquired out of state.

Officials are still investigating the possible sources of the outbreak.

Click here to view the FDA Statement.

Photo: Moser, Melanie.  Centers for Disease Control and Prevention.  Public Health Image Library.  Cyclospora cayetanensis oocysts.  

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Pseudomonas aeruginosa bacteriaAccording to a press release issued by the Society for Healthcare Epidemiology of America (SHEA), a 2011 healthcare-associated outbreak of P. aerugenosa has been linked to contaminated ultrasound gel.

Investigators at Beaumont Health System near Detroit, Michigan determined the source of the bacteria causing the healthcare-associated infection was indeed contaminated ultrasound gel.  The findings were published in the August issue of SHEA’s journal Infection Control and Hospital Epidemiology (ICHE). The study underscores the need for increased scrutiny of contaminated medical products.

“Ultrasound is a critical healthcare tool used every day in both diagnostic and interventional procedures,” said Paul Chittick, MD, lead author of the study. “Although contaminated gel has been the cause of several documented outbreaks of infection, its potential role as a vehicle for spreading infections to patients is frequently overlooked.”

In December 2011, researchers uncovered an unusual cluster of P. aeruginosa in the cardiovascular surgery intensive care unit during routine infection control surveillance. The bug is known to increase the risk of bloodstream and respiratory infections in immune-compromised individuals. Sixteen patients became colonized or infected with the bacteria, with all cases occurring in the respiratory tract. The outbreak was found to have stemmed from bottles of ultrasound transmission gel used during cardiovascular surgery. Following replacement of this gel with a sterile product, no further cases occurred.

Cultures of gel from a bottle in use in the operating room grew P. aeruginosa that was identical to the outbreak strain. It was originally thought that the gel had likely become contaminated during use. However, sealed bottles of gel grew the same P. aeruginosa strain, proving that the product was contaminated during the manufacturing process at the plant of Pharmaceutical Innovations.

The FDA has subsequently issued a warning about the gel, alerting practitioners to the risk of infection.  The Beaumont Health System investigators have also recently published proposed guidelines in ICHE for the use of sterile versus non-sterile ultrasound gel.  The guidelines stress the importance of sterile, single-dose ultrasound gel to be used for all invasive procedures.  The guidelines also provide the appropriate storage and warning methods for the gel.

Photo: Centers for Disease Control and Prevention, Janice Haney Carr.

According to the CDC, Pseudomonas aeruginosa infection “is caused by strains of bacteria found widely in the environment; the most common type causing infections in humans is called Pseudomonas aeruginosa.” “Serious Pseudomonas infections usually occur in people in the hospital and/or with weakened immune systems. Infections of the blood, pneumonia, and infections following surgery can lead to severe illness and death in these people.”

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Beth Carey, LPN, Tyrone Hospital, Infection Prevention Today

Congratulations to Beth Carey, LPN, Infection Prevention Coordinator at Tyrone Hospital for being nominated and elected for Infection Prevention Today’s National list of Who’s Who in Infection Prevention for 2013.

Mrs. Carey was recognized for her hard work to maintain the standards for isolation and surveillance, being very proactive and innovative in the promotion of hand washing – most recently initiating and championing Tyrone Hospital’s “Don’t Bug Me Hand Hygiene Campaign”, spearheading a committee of peer champions to promote hand washing, initiating numerous infection prevention policies and developing an employee seasonal influenza vaccine campaign that helped Tyrone Hospital exceed the requirements of the Pennsylvania Department of Health, raising Tyrone Hospital’s compliance rate to 93 percent for the 2012-2013 influenza season.

“I was very surprised and overwhelmed when I learned about this recognition,” said Mrs. Carey. “Providing and maintaining a safe environment, and the best care possible for our patients can be challenging. Without the cooperation from administration and hospital staff, my job would be impossible. It is truly a team effort.”

Photo: Tyrone Hospital.  National Recognition Extended to Tyrone Hospital’s Infection Prevention Coordinator.

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Julie ReaganA new webinar created by Julie Reagan of HAI Focus and offered through ComplianceOnline is currently available.

The majority of U.S. states have responded to the occurrence of HAIs by implementing state-level HAI prevention and public reporting programs. Most states have also enacted legislation and promulgated administrative regulations placing mandates on hospitals and other healthcare facilities to report data on HAIs. In addition, the Centers for Medicare and Medicaid Services (CMS) has implemented its HAI reporting program requiring reporting of HAI data by Medicare certified facilities.

This 90-minute online webinar will provide an overview of the regulatory landscape applicable to HAI data reporting and infection prevention. For those individuals not familiar with HAIs, the webinar will begin with an overview of the various infections that may be acquired in the healthcare setting and will provide a basic introductory overview of the regulatory landscape applicable to HAI public reporting and prevention. The course will provide a current and comprehensive review of U.S. state laws applicable to HAIs as well as a detailed discussion of federal CMS reporting requirements.

The training is scheduled for July 12, Friday, 10:00 AM PDT / 1:00 PM EDT. Cost: $149.00 per attendee. Group rates are available.

Click here to register for the course.

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The New York One & Only Campaign has released the latest issue of its Injection Safety Newsletter.

In this issue, you will find information about:

This is a highly informative newsletter providing a wealth of information.  To access the newsletter, click here.

The One and Only Campaign is a public health campaign aimed at raising awareness among the general public and healthcare providers about safe injection practices.  Visit http://www.oneandonlycampaign.org for more information.

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According to a press release issued by the European Centre for Disease Prevention and Control, a new report containing the results of a point prevalence survey of healthcare-associated infections (HAIs) and antimicrobial use in European acute care hospitals reveals that HAIs are a major public health problem in Europe.

The survey, the first Europe-wide point prevalence survey of HAIs, reveals that approximately 80,000 patients — or one in 18 patients — will contract at least one HAI.

Over 1000 hospitals in 30 European countries were surveyed, providing the most comprehensive information about HAIs in European acute care hospitals to date.

The data are published in a report and are also available online as an interactive database.

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The Hospitals Contribution Fund of Australia (HCF) has developed a new web-based search engine allowing patients to compare certain quality indicators of Australian hospitals.

The new web-based search engine allows consumers to compare the information of up to 10 hospitals at a time.  The site provides information about hand hygiene and Staphylococcus Aureus Bacteremia (SAB) or Golden Staph).

The information is collated from information contained in another web-based site maintained by the National Health Performance Authority (NHPA).  That site, www.myhospitals.gov.au, provides more extensive hospital information.

The National Health Performance Authority (NHPA) has recently released a report about healthcare-associated Staphylococcus aureus bloodstream infections occurring in Australian hospitals in 2011-2012.  That report, issued in May 2013, details how “Australia’s biggest public hospitals account for a disproportionate share of reported healthcare-associated S. aureus bloodstream infections.”

 

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MMWR, Morbidity and Mortality Weekly Report.  Notifiable diseases

 

 

The July 5, 2013 issue of the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR) presents a Summary of Notifiable Diseases — United States, 2011.

The report contains the official statistics for the occurrence of notifiable infectious diseases reported in the United States in 2011.  The statistical data presented in the report originate from reports sent by individual state health departments and territories to the National Notifiable Diseases Surveillance System (NNDSS).  That system is operated by the CDC in conjunction with the Council of State and Territorial Epidemiologists (CSTE).

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