Greetings from the PPP. Much has happened since the last newsletter.
- NBC ran a segment on controlling VRE and MRSA nosocomial
infections on its Nightly News, the Today Show, and on its
continuous news program MSNBC at the end of December. It showed
patients being cultured and cared for using barrier precautions
and talked about why this worked. At the end of the segment,
Michael Osterholm, M.D. from ICANPrevent spoke in support of this
approach and said that many hospitals and nursing homes "have
their heads in the sand" when it comes to infection control. One
of the PPP hospitals is reviewing the tape of that news segment
for possible use for creating a videotape to show patients about
the problem and what is being done to address it.
- The Siouxland public health initiative to control nosocomial
VRE with assistance from the CDC and the Iowa Department of Health
was published last week in the New England Journal of Medicine by
Drs. Ostrowsky, Jarvis, and others (304:1427-1433). Those who
attended the organizational meeting last June will remember that
this was the effort that PPP is seeking to replicate, only in a
larger fashion.
- Two PPP abstracts were presented at the SHEA annual meeting in
Toronto: a) The first reported the low proportion of hospitals in
VA an NC that have had an active surveillance culture program for
identifying patients that require isolation (i.e., according to
CDC guideline that specifies "patients colonized or infected"). It
concluded that meaningful compliance with the guideline requires
such a program because a large majority of colonized patients
otherwise go unrecognized and unisolated. b) The second abstract
examined the question of when it might be cheaper to isolate
patients pending MRSA culture results. The conclusion was, "when
the patients come from a high prevalence population." A related
abstract from UVa described the most recent results of culturing
all patients coming from other facilities to UVa and reported that
25% of nursing home patients not previously known to be colonized
were culture positive for MRSA and/or VRE.
- GOJO has announced that it will continue to offer to provide
alcohol hand hygiene product dispensers (Purell) and keep them
filled for two years free of charge for every room of every
facility joining PPP throughout the two states. A cutoff date for
facilities to join and receive this benefit hasn't been formally
set, but November 30, 2001 is being considered as a cutoff date.
Hospitals in the Premier buying group should be aware that Premier
has signaled its approval for GOJO to provide this product to
Premier hospitals that join PPP (even though GOJO doesn't sell
products through Premier). The benefit of the alcohol gel (other
than being free) is that it removes microbes from the hands faster
and also is quicker for healthcare workers to use than soap and
water, thereby enhancing both prevention of spread and
cost-effectiveness (i.e., by minimizing the amount of time
healthcare workers have to spend standing in lines at sinks).
- Some facilities are organizing group PPP visits so that an
epidemiologist can present to administrators from multiple
hospitals at the same time. If you would like to organize such a
presentation for your area, please contact Dr. Farr or Dr.
Karchmer (using the contact information listed in the attached
document regarding "How to Join the PPP").
- As an alternative, some hospitals may wish to lower the
expense required for the visit by arranging to have this
presentation via Telemedicine. The UVa Office of Telemedicine can
accommodate transmission to several hospitals simultaneously. For
those unfamiliar with telemedicine, it allows the audience to see
and hear a speaker and his/her slides from a remote location,
while also allowing the speaker to hear and see members of the
audience. This makes question and answer sessions possible at a
dramatically lower cost than transporting the speaker to and from
most locations throughout the two states. Depending on the number
of facilities participating in the broadcast, the charges would
range from $30 - $200 per facility for a one hour teleconference.
In order to participate in a UVa teleconference, recipient sites must have one of the following setups:
- Access to "Network VA" (onsite or at a neighboring facility - see the map on the UVa telemedicine website: www.telemed.virginia.edu); OR
- Three (3) ISDN lines capable of 384 kbps with either H.320 or H.323 communication protocols (UVa uses the POLYCOM H.320 and H.323 protocol standards).
Please check with your facility's education director and/or Information Technology group to see if you have either of the requirements listed above, as well as for questions you might have about what it would take to receive a teleconference from UVa. At that point, any additional questions you might have regarding the details of setting up or scheduling a teleconference should be directed to David Corzilius (see the contact info shown below).
The important challenge at this time is getting both acute and long-term care facilities (LTCF) working together on controlling the problem (as in the Siouxland public health initiative). If your hospital has begun identifying colonized patients and controlling spread, it would be helpful to begin discussions with nursing homes in your area about joining the partnership. Contact already has been made with a large number of LTCF in central Virginia and also with some in certain parts of North Carolina. The LTCF infection control approach in the past of trying to avoid admitting an individual known to have MRSA or VRE (so that they wouldn't have to worry about controlling spread) clearly hasn't kept the problem out of the LTCF. Administrative and medical directors of the LTCF that have been contacted are considering whether to join, but many have acknowledged that the present system really has not worked to protect their patients from this problem. Some already have said that they will support joining the PPP. Some nursing homes already have had initial prevalence surveys and others have expressed interest. For nursing homes with formal partnership with a particular hospital, it is likely that that hospital will be able to perform the cultures for the nursing home. For nursing homes without such a formal relationship, it will probably work best for each hospital joining to try to convince the closest 2 or 3 nursing homes to join and perhaps do the cultures for them.
Thank you for your continued interest in the Problem Pathogen Partnership. If you have any questions or comments regarding the information in this newsletter, please direct your comments to:
| Barry M. Farr, MD, MSc Hospital Epidemiologist UVA Health System, Box 800473 Charlottesville, VA 22908-0473 |
Phone: (434) 924-2777 Fax: (434) 243-6483 Email: bmf@virginia.edu |
| David Corzilius Administrative Office Manager UVA Health System, Box 800473 Charlottesville, VA 22908-0473 |
Phone: (434) 924-2777 Fax: (434) 243-6483 Email: dbc8c@virginia.edu |