Public Health England launches toolkit to manage hospital infections caused by antibiotic-resistant bacteria

Experts at Public Health England (PHE) have launched a toolkit for hospitals to detect, manage and control antibiotic-resistant bacterial infections caused by carbapenemase-producing Enterobacteriaceae (CPE).

The use of many different types of antibiotics in hospitals creates evolutionary pressures that encourage the development and spread of antibiotic resistant bacteria. This process is a natural consequence of the use of antibiotics and cannot be stopped, only managed.

Enterobacteriaceae are a group of bacteria carried in the gut of all humans and animals, which is perfectly normal. While they are usually harmless they may sometimes spread to other parts of the body such as the urinary tract or into the bloodstream (bacteraemia) where they can cause serious infections.

This can occur after an injury or via the use of medical devices such as urinary catheters or intravenous drips where the skin is punctured allowing the bacteria to get into the body.

CPE is the name given to some strains of gut bacteria that have developed the ability to destroy an important group of antibiotics called carbapenems, making them resistant to these drugs. Carbapenems are considered to be antibiotics of 'last resort' and doctors rely on them to treat certain difficult infections when other antibiotics would or have failed.

Infections caused by CPE can usually still be treated with antibiotics. However, treatment is more difficult and may require a combination of drugs or the use of older antibiotics to be effective.

Since 2003, there has been a sustained increase in the numbers of CPE being identified from carriers and as causes of infections within the hospital setting. Identification of CPE in England by the PHE national reference laboratory has risen from fewer than five patients reported in 2006 to over 600 in 2013. These figures include patients with infections and also those where they have tested positive for the presence of the bacteria in the gut.

In England, approximately two thirds of trusts have had between one and 20 patients identified with CPE carriage or infection over the past five years, including two Trusts in Manchester that have had more than 100 patients identified with CPE during the same period.

In November 2013, PHE established a national incident management team to work to prevent and control spread of this resistant bacteria. The aim of the expert group is to provide ongoing guidance and support to local experts, not only in areas where trusts are affected but across the healthcare system.

To encourage implementation of the toolkit, PHE has, together with NHS England, written to every Acute Trust Chief Executive Officer in England asking for their essential support and action to address the risk posed to trusts and other healthcare organisations by CPE and other carbapenem-resistant organisms. PHE and NHS England have also issued a Patient Safety Alert which recommends trusts urgently identify if there are, or have been, cases of CPE in their organisation and to instigate the development of a CPE management plan at Board level.

Managing cases or outbreaks of antibiotic resistant infections in hospitals requires four key elements:

• Samples taken early for microbiological testing if there is a suspicion that a patient is colonised or infected with a resistant strain of bacteria


• Managing the patient to prevent any resistant bacteria spreading to others


• Strict infection prevention and control procedures including hand washing and thorough cleaning and decontamination


• Reviewing the use of medical devices and prescribed antibiotics

Professor Dame Sally Davies, Chief Medical Officer, said: "Antibiotic resistance poses a real threat to our ability to treat diseases. Although there has been an increase in this strain of bacteria, the new toolkit will ensure that hospitals are well placed to detect, manage and control any cases. Systems of monitoring for resistant bacteria are essential in safeguarding the effect of our antibiotics."

Dr Paul Cosford, Director for Health Protection and Medical Director at PHE, said: "In order to minimise the wide spread of these multi-drug resistant infections across England it is essential that all trusts are aware of this toolkit and that they develop plans for detecting and managing patients with infections caused by CPE and other antibiotic resistant bacteria.

"These infections are already causing national concern due to the observed increasing trends in the number of infections, outbreaks and clusters across England. We now have a window of opportunity, if we act quickly and decisively, to address this very real public health treat and prevent widespread problems by minimising the negative impact of these organisms.

"As these bacteria can spread through faecal contamination it's very important that everyone in the hospital setting including healthcare staff, patients and visitors practise good hand hygiene to stop CPE and other infections spreading to other vulnerable people."

Powered By WizardRSS.com | Info CPNS Terlengkap | Bisnis Dari Rumah | Kerja Sambil Bisnis

View the original article here

Read More

Guidance on hospital community benefit programs

A new analysis led by the University of Pittsburgh Graduate School of Public Health offers insights for nonprofit hospitals in implementing community health improvement programs. In a special issue of the Journal of Health Care for the Poor and Underserved that focuses on the Affordable Care Act (ACA), a multidisciplinary team of Pitt researchers explore published research on existing community benefit programs at U.S. hospitals and explain how rigorous implementation of such programs could help hospitals both meet federal requirements and improve the health of the populations they serve.

"Hospitals have long provided uncompensated care to people who could not otherwise afford it, and this in part has justified their nonprofit status. One goal of the ACA is to provide health insurance to more individuals, thereby potentially reducing uncompensated care," said lead author Jessica Burke, Ph.D., M.H.S., associate professor of community and behavioral health sciences at Pitt Public Health. "By working with public health professionals, hospitals can design and implement effective community benefit programs, such as preventative care outreach, that will improve the health of people in their service area and ultimately support continued nonprofit status."

Dr. Burke and her colleagues note that "community health needs assessments," which are required by the ACA and rely on large surveys and input from community stakeholders, including minorities and underserved populations, can provide information to help guide the development of community benefit programs, as well as provide data needed to assess their impact.

By evaluating 106 scientific articles detailing hospital-based community benefit programs, Dr. Burke and her colleagues were able to categorize the programs into those based in the hospital and those administered at a community facility, finding that the programs were split almost evenly.

Hospital-based programs typically included preventative screenings or health education. Outside the hospitals, the programs included hospital after-care and benefits and coverage counseling, but were largely community-based programs, either with or without a community partner organization, such as a local school or community center.

"More than 80 percent of the community-based programs included a community partner, which can facilitate greater reach into a community," said Dr. Burke. "The more you can engage the community in the benefit programs you are trying to provide, the greater the likelihood of a positive outcome."

The analysis reinforces the value hospitals and health systems can derive from partnering with public health professionals to design their community health needs assessments and determine the best community benefit programs to address those needs, said senior author Everette James, J.D., M.B.A., professor of health policy and management in Pitt Public Health and director of Pitt's Health Policy Institute.

"Public health researchers add methodological rigor and experience with a range of evidence-based interventions to hospital community health implementation strategies," said Mr. James, who recently served as the 25th Pennsylvania Secretary of Health. "Our study is intended to strengthen this link between hospital programs and population health, and to provide useful information for hospitals and their public health partners as they comply with new ACA requirements."

UPMC worked with Dr. Burke and her colleagues at Pitt Public Health and Pitt's Health Policy Institute to conduct community health needs assessments for 13 of its hospitals, which the health system then used to guide its community benefit programs and set community health improvement goals.

Powered By WizardRSS.com | Info CPNS Terlengkap | Bisnis Dari Rumah | Kerja Sambil Bisnis

View the original article here

Read More

Patients' stories used to improve care on hospital wards

Videos of patients talking about care they received at various hospitals are used to trigger a discussion between NHS staff, managers, patients and family members about the ward where they are. Ideas for change are prioritized and staff and patients work together as partners to introduce them.

The new approach has been used in pilot projects at two hospital trusts -- Royal Brompton & Harefield NHS Foundation Trust in London and the Royal Berkshire in Reading.

Many of the changes that come out of the process may be small. But after a year of headlines that have focused on scandals of poor care in hospitals and social care, the approach brings compassion and dignity to the fore.

Simple examples included putting clocks on the wall where patients in intensive care can see them, where previously they may have had no sense of what time of day it is. Having teeth brushed more often and changing the time for patients' main wash were also important, while more comfortable V-shaped pillows for post-operative patients were also introduced. A lot of the changes involved providing better information to patients.

Improving patients' experience has become a priority for the NHS, and the NHS in England has led the way in measuring patient experience by introducing the first nationally mandated patient survey. Yet despite this and the efforts of staff committed to providing high-quality services, examples of poor care and the lack of a genuinely patient-centred approach have dominated healthcare debate in the last year.

'We already know the aspects of care that patients and families think are important,' says lead researcher Dr Louise Locock of the Health Experiences Research Group at the University of Oxford. 'The challenge is to find ways of enabling organisations to learn from this evidence, to move beyond gathering data and really use patient experiences to improve care.'

'This approach is a new way of boosting compassionate care by using patient stories to stimulate change,' says Dr Sue Ziebland, also of the Health Experiences Research Group.

The research carried out by the research group informs the health websites Healthtalkonline.org and Youthhealthtalk.org. These websites provide free, reliable information about health issues by sharing people's real-life experiences. Videos of people sharing their stories about cancer, autism, motor neuron disease, pregnancy, drugs, depression and much more mean if anyone is looking for good advice and reassurance on any of these conditions, they can find out what happened to around 40 other people in the same situation.

As well as providing a tremendous health resource for patients and families, the researchers have been exploring how the bank of patient experience they have built up can be used to improve healthcare services.

This new work builds on an approach developed by Professor Glenn Robert and others at King's College London, and Professor Robert is also part of this research project. However, where previously new videos specific to the ward or hospital where the exercise is carried out would have to be developed, the large set of video clips of patient stories already collected by the Oxford researchers is made use of.

The Health Experiences Research Group now has an archive of around 3,000 interviews on over 80 different conditions or health topics. Using this existing video material to stimulate discussions between staff and patients cuts the time and costs of the process greatly, and makes the approach more scalable.

Dr Caroline Shuldham, director of nursing and clinical governance, led the pilot at Royal Brompton & Harefield NHS Foundation Trust, which focused on an intensive care unit (ICU) and services for lung cancer patients.

Dr Shuldham explains some of the changes that have been implemented as a result: 'In the ICU, we are now providing additional information to patients and families. It's all about greater explanation to ensure they fully understand their treatment. We go through a plan of care for the day and make sure it is understood. We explain what the alarms mean on various bits of equipment and what happens when they go off. We have made sure that patient privacy and dignity is respected at all times, with new guidelines for when people shouldn't go through curtains, for example.

'With lung cancer, patients can be in different places: they might be on a high dependency unit (HDU) or they may be on a ward. They move through the hospital as they get better and we now have better systems for making sure they can access their belongings at all times, wherever they are. A leaflet for patients before they have lung surgery now includes a page of advice from previous patients.

She adds: 'These changes are small wellbeing things which can be done quite easily. But most importantly, it gives staff at all levels a framework in which to work with patients.

'These were wards that were already providing excellent care. But what the process does is allow people -- staff and patients -- to see through each others' eyes a bit. The big thing for me was that patients felt they were being listened to. They were impressed that when they raised things they were taken seriously.

'One member of staff commented that they'd worked in an ICU for 20 years and had never interacted with patients in this way. A manager explained how the process had really highlighted the effect that hospital administration and routine has on patients.'

Powered By WizardRSS.com | Info CPNS Terlengkap | Bisnis Dari Rumah | Kerja Sambil BisnisView the original article here

Read More