ANTIBIOTIC RESISTANCE. What you should KNOW What you should DO. Seth Johnson, RN,MSN,CNN May 7, 2014. Test Your Knowledge. 1. How do you put a giraffe into a refrigerator? The correct answer is: Open the refrigerator, put in the giraffe and close the door
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ANTIBIOTIC RESISTANCE What you should KNOW What you should DO Seth Johnson, RN,MSN,CNN May 7, 2014
Test Your Knowledge • 1. How do you put a giraffe into a refrigerator? • The correct answer is: Open the refrigerator, put in the giraffe and close the door • This question tests whether you tend to do simple things in an overly complicated way http://www.tik.ee.ethz.ch/~lubich/extdoc/jokes/quiz/answer4.html
Test Your Knowledge • 2. How do you put an elephant into a refrigerator? • Wrong Answer: Open the refrigerator, put in the elephant and close the refrigerator. • Correct Answer: Open the refrigerator, take out the giraffe, put in the elephant and close the door. • This tests your ability to think through the repercussions of your actions http://www.tik.ee.ethz.ch/~lubich/extdoc/jokes/quiz/answer4.html
Test Your Knowledge • 3. The Lion King is hosting an animal conference. All the animals attend except one. Which animal does not attend? • Correct Answer: The Elephant. The Elephant is in the refrigerator • This tests your memory http://www.tik.ee.ethz.ch/~lubich/extdoc/jokes/quiz/answer4.html
Test Your Knowledge • OK, even if you did not answer the first three questions, correctly, you still have one more chance to show your abilities. • According to Andersen Consulting Worldwide, around 90% of the professionals they tested got all questions wrong. But many preschoolers got several correct answers. • Anderson Consulting says this conclusively disproves the theory that most professionals have the brains of a four year old. http://www.tik.ee.ethz.ch/~lubich/extdoc/jokes/quiz/answer4.html
Test Your Knowledge • 4. There is a river you must cross. But it is inhabited by crocodiles. How do you manage it? • Correct Answer: You swim across. All the Crocodiles are attending the Animal Meeting. • This tests whether you learn quickly from your mistakes http://www.tik.ee.ethz.ch/~lubich/extdoc/jokes/quiz/answer4.html
Objectives • At the completion of this presentation participants will be able to: • Identify the treat of antibiotic resistance • Identify patients at high risk for antibiotic resistance • Identify the safe use of antibiotics • Identify measures to prevent or reduce antibiotic resistance
Introduction • Antibiotic resistance is a worldwide problem • New forms of antibiotic resistance can cross international boundaries and spread between continents with ease • World health leaders have described antibiotic resistant microorganisms as “nightmare bacteria” that “pose a catastrophic threat” to people in every country in the world.
What is antibiotic resistance? • The ability of bacteria or other microbes to resist the effects of an antibiotic. • Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. • The bacteria survive and continue to multiply causing more harm.
How Bacteria Become Resistant • When bacteria are exposed to antibiotics, they start learning how to outsmart the drugs. • This process occurs in bacteria found in humans, animals, and the environment. • Resistant bacteria can multiply and spread easily and quickly, causing severe infections. • They can also share genetic information with other bacteria, making the other bacteria resistant as well. • Each time bacteria learn to outsmart an antibiotic, treatment options are more limited, and these infections pose a greater risk to human health.
The United States • Each year in the United States, at least 2 million people acquire serious infections with bacteria that are resistant to one or more of the antibiotics designed to treat those infections. • At least 23,000 people die each year as a direct result of these antibiotic-resistant infections. • Many more die from other conditions that were complicated by an antibiotic-resistant infection.
Clostridium Difficile • In addition, almost 250,000 people each year require hospital care for Clostridium difficile (C. difficile) infections. • In most of these infections, the use of antibiotics was a major contributing factor leading to the illness. • At least 14,000 people die each year in the United States from C. difficile infections. • Many of these infections could have been prevented.
Antibiotic Prescriptions per 1000 Persons of All Ages According to State, 2010
Cost • Antibiotic-resistant infections add considerable and avoidable costs to the already overburdened U.S. healthcare system. • Total economic cost of antibiotic resistance to the U.S. economy - difficult to calculate. • Estimates vary -ranged as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars)
The Threat of Antibiotic Resistance • http://www.youtube.com/watch?v=RpKZvnJwicA&feature=youtu.be
Urgent Threats • Clostridium difficile • Carbapenem-resistant Enterobacteriaceae (CRE) • Drug-resistant Neisseria gonorrhoeae
Serious Threats • Multidrug-resistant Acinetobacter • Drug-resistant Campylobacter • Fluconazole-resistant Candida (a fungus) • Extended spectrum β-lactamase producing Enterobacteriaceae (ESBLs) • Vancomycin-resistant Enterococcus (VRE) • Multidrug-resistant Pseudomonas aeruginosa
Serious Threats-cont’d • Drug-resistant Non-typhoidal Salmonella • Drug-resistant Salmonella Typhi • Drug-resistant Shigella • Methicillin-resistant Staphylococcus aureus (MRSA) • occurs most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems. • Drug-resistant Streptococcus pneumoniae • Drug-resistant tuberculosis
Concerning Threats • Vancomycin-resistant Staphylococcus aureus (VRSA) • Erythromycin-resistant Group A Streptococcus • Clindamycin-resistant Group B Streptococcus
Action • There are four core actions that will help fight these deadly infections: • preventing infections and preventing the spread of resistance • tracking resistant bacteria • improving the use of today’s antibiotics • promoting the development of new antibiotics and developing new diagnostic tests for resistant bacteria
Infection Prevention & spread of resistant bacteria • Infections prevention reduces the amount of antibiotics that have to be used and reduces the likelihood that resistance will develop during therapy • Ways that drug-resistant infections can be prevented: • Immunization • safe food preparation • handwashing, and • using antibiotics as directed and only when necessary. • Preventing infections also prevents the spread of resistant bacteria
Tracking • CDC gathers data on antibiotic-resistant infections, causes of infections and whether there are particular reasons (risk factors) that caused some people to get a resistant infection. • With that information, experts can develop specific strategies to prevent those infections and prevent the resistant bacteria from spreading.
Improving antibiotic prescribing/stewardship • Single most important action needed - to greatly slow down the development and spread of antibiotic-resistant infections is to change the way antibiotics are used • Up to half of antibiotic use in humans is unnecessary and inappropriate and makes everyone less safe • Antibiotic stewardship - always use antibiotics appropriately and safely, only when they are needed to treat disease, and to choose the right antibiotics and to administer them in the right way in every case
Developing new drugs & diagnostic tests • Because antibiotic resistance occurs as part of a natural process in which bacteria evolve, it can be slowed but not stopped. • Need for new antibiotics to keep up with resistant bacteria as well as new diagnostic tests to track the development of resistance
NBC News • http://www.youtube.com/watch?v=3klxO3Dt3jU
Dialysis Patients & Antibiotic Resistance • Increased risk for getting a bloodstream infection • Bloodstream infections are the second leading cause of death in dialysis patients • Infections also complicate heart disease, the leading cause of death in dialysis patients • Infection risk is higher • weakened immune systems • catheters
Infection Prevention in Dialysis Settings A Continuing Education (CE) Training Course for Outpatient Hemodialysis Healthcare Workers
What dialysis care providers can do to protect patients from drug-resistant infections • Infection prevention and control • Hand hygiene – observations • Proper catheter /vascular care and reduction in catheters • Proper cleaning measures • Safe medication management • Preparation • Handling • Storage • administration • Vaccination – patients and staff • Staff education and competency • Patient education and engagement
What dialysis care providers can do to protect patients from drug-resistant infections • Follow all necessary infection control recommendations, including hand hygiene, standard precautions, and contact precautions. • Diagnose and treat resistant infections quickly and efficiently • Treatment options change often because resistance is complex • Make sure to follow the latest recommendations to ensure you are prescribing appropriately. • Only prescribe antibiotics when likely to benefit the patient, and be sure to prescribe the right dose and duration.
What dialysis care providers can do to protect patients from drug-resistant infections • When transferring patients, ensure the other facilities are notified of any infection or known colonization. • Keep tabs on resistance patterns in your facility and in the area around your facility. • Encourage prevention methods with your patients. • Be sure they understand how to protect themselves with vaccines, treatment, and infection control practices such as hand washing and safe food handling
Basic Steps in Fistula/Graft Care Decannulation Procedure: • Perform hand hygiene • Put on a new, clean pair of gloves • Wear proper face protection • Remove needles using aseptic technique • Apply clean gauze/bandage to site • Compress the site with clean gloves • Remove gloves and perform hand hygiene
Basic Steps in Catheter Care Catheter Connection Procedure: • Perform hand hygiene • Put on a new, clean pair of gloves • Wear proper face protection • Apply antiseptic to catheter hub and allow it to dry • Connect the catheter to blood lines using aseptic technique • Unclamp the catheter • Remove gloves and perform hand hygiene
Basic Steps in Catheter Care Catheter Disconnection Procedure: • Perform hand hygiene • Put on a new, clean pair of gloves • Wear proper face protection • Disconnect the catheter from blood lines using aseptic technique • Apply antiseptic to catheter hub and allow it to dry • Replace caps using aseptic technique • Make sure the catheter remains clamped • Remove gloves and perform hand hygiene
Catheter Exit Site Care • Perform hand hygiene • Put on a new, clean pair of gloves • Wear a face mask if required • Apply antiseptic to catheter exit site and allow it to dry • Apply antimicrobial ointment • Apply clean dressing to exit site • Remove gloves and perform hand hygiene Photo provided by Stephanie Booth, used with permission
Separate Clean Areas from Contaminated Areas • Clean areas should be used for the preparation, handling and storage of medications and unused supplies and equipment • Your center should have clean medication and clean supply areas • Contaminated areas are where used supplies and equipment are handled • Do not handle or store medications or clean supplies in the same area as where used equipment or blood samples are handled Remember: Treatment stations are contaminated areas! Clean area Photo provided by Stephanie Booth, used with permission
Dedicate Supplies to a Single Patient • Any item taken to a patient’s dialysis station could become contaminated • Items taken into the dialysis station should either be: • Disposed of, or • Cleaned and disinfected before being taken to a common clean area or used on another patient • Unused medications or supplies taken to the patient’s station should not be returned to a common clean area (e.g., medication vials, syringes, alcohol swabs) Photo provided by Marshia Coe and Teresa Hoosier, used with permission
Safe Use of Medication Vials • Prepare all individual patient doses in a clean area away from dialysis stations • Prepare doses as close as possible to the time of use • Do not carry medications from station to station • Do not prepare or store medications at patient stations • CDC recommends that dialysis facilities: • Use single-dose vials whenever possible and dispose of them immediately after use
Guidelines for Carrying Medications • Do not use the same medication cart to deliver medications to multiple patients • Do not carry medication vials, syringes, alcohol swabs, or supplies in pockets • Be sure to prepare the medication in a clean area away from the patient station and bring it to the patient station for that patient only at the time of use
Cleaning and Disinfecting theDialysis Station • Cleaning and disinfection reduce the risk of spreading an infection • Cleaning is done using cleaning detergent,water and friction, and is intended toremove blood, body fluids, and othercontaminants from objects and surfaces • Disinfection is a process that kills manyor all remaining infection-causinggerms on clean objects and surfaces • Use an EPA-registered hospital disinfectant • Follow label instructions for proper dilution • Wear gloves during the cleaning/disinfection process
Disinfecting the Dialysis Station • All equipment and surfaces are considered to be contaminated after a dialysis session and therefore must be disinfected • After the patient leaves the station,disinfect the dialysis station(including chairs, trays, countertops,and machines) after each patienttreatment • Wipe all surfaces • Surfaces should be wet with disinfectant and allowed to air dry • Give special attention to cleaning control panels on the dialysis machines and other commonly touched surfaces • Empty and disinfect all surfaces of prime waste containers Photo provided by Stephanie Booth, used with permission
Safe Handling of Dialyzers andBlood Tubing • Before removing or transporting used dialyzers and blood tubing, cap dialyzer ports and clamp tubing • Place all used dialyzers and tubing in leak-proof containers for transport from station to reprocessing or disposal area • If dialyzers are reused, follow published methods (e.g., AAMI standards) for reprocessing AAMI is the Association for the Advancement of Medical Instrumentation Photo provided by Stephanie Booth, used with permission