4 CEOs share their best advice . The Corner Office series asks healthcare executives to answer seven questions about their life in and outside the C-suite. In each interview, CEOs share the piece of advice they remember most clearly.

Here are a few answers collected by Becker’s Hospital Review in the last four months, in alphabetical order.

Roxanna Gapstur, PhD, RN, president and CEO of WellSpan Health (York, Pa.)

Since this is the year of the nurse and midwife, one of the things which has stuck with me over the years is attributed to the pioneer of hand hygiene, Florence Nightingale, whose 200th birthday was just celebrated: “Wash your hands.” As we’ve seen with the pandemic, it’s never been more important. By washing our hands, we can save lives and improve the health of our families and our communities.

Philip Ozuah, MD, PhD, president and CEO of Montefiore Medicine (New York City)

In Lewis Carroll’s Alice’s Adventures in Wonderland, Alice asks the Cheshire Cat for directions. The cat responds, “That depends a good deal on where you want to go.” When Alice says she doesn’t care much, the cat tells her, “Then it doesn’t matter which way you go.” The lesson is you need to have absolute clarity about your goal, your mission, your destination. This is true in every realm of life, whether you’re a leader or just starting out. If you don’t know where you’re going, any road will take you there.

Cliff Robertson, MD, CEO of CHI Health and senior vice president of operations for Chicago-based CommonSpirit Health’s Midwest division (Omaha, Neb.)

I tape weekly video blogs for CHI Health’s front-line staff. A sticky note taped to my computer reads, “Where are we going?” and “What does it mean to me?”

Someone along the way in my career shared this advice with me, and it’s what I remember most clearly: When you’re communicating with any other human being, whether it’s your spouse, your co-worker or caregivers that make up your organizations, those are the two things they care about. So, when I tape the videos, I try to frame the information I’m sharing so it might answer those two questions.

Daryl Tol, president and CEO of Altamonte Springs, Fla.-based AdventHealth’s Central Florida division

Put your heart and soul into the job you have. Don’t continually scan the horizon for your next opportunity. Let the future develop naturally.

By Becker’s Hospital Review / Kelly Gooch
© Copyright ASC COMMUNICATIONS 2020.
Published Aug 11 2020
https://www.beckershospitalreview.com


Improving Hand Hygiene Requires a Multi-Modal Approach

As hospitals reopen services, patients are seeking assurances the facility has made their well-being a priority from the moment they walk in the door.

Studies show patients feel safer knowing that their healthcare providers’ hand hygiene is being monitored.1 Hand Hygiene (HH) is a simple task performed in a complex environment. It is one of the most foundational aspects of patient safety that spans across all hierarchies and disciplines and there is much room for improvement in virtually every healthcare organization. The gold standard metric for measuring compliance has been direct observation (DO). However, less than 1% of all HH opportunities are captured.

Monitoring hand hygiene performance and providing personnel with feedback on their performance are essential elements of successful improvement programs. Recognizing that unit leadership and frontline healthcare workers (HCW) are closest to the patient – who better to speak up and provide the immediate reminders when hand hygiene opportunities are missed? To this end, many hospitals also have their infection preventionists or other hand hygiene team members serve as coaches, or just-in-time (JIT) coaches, who stop HCW when they observe a missed opportunity and have a conversation about contributing factors for noncompliance and provide education on hand hygiene protocols. While extremely valuable, this coaching occurs sporadically and often exclusively during dayshift, not on off-shifts and weekends. Considering the many opportunities for hand hygiene, the current system simply isn’t providing HCW with what they need to make hand hygiene a ritual, automatic behavior-– consistent immediate feedback.

Unit-led-just-in-time-coaching may very well be the key to providing consistent (24/7), nonpunitive, on-the-spot feedback when hand hygiene noncompliance is observed. Real-time identification of hand hygiene misses along with direct individual accountability have been shown to improve compliance.2,3 As hospitals seek to maximize resources, it is critical to find efficiencies that save time and reduce waste without detracting from patient care. Electronic compliance monitoring (ECM) systems provide the resources to track, monitor, and develop data-driven solutions. ECMs track soap and sanitizer dispenser activations (events) and room entries and exits (opportunities) to provide real-time performance metrics on staff, patients and visitors and captures data 24/7. The purpose of any ECM is to collect data about hand hygiene events and provide feedback to staff so that they can use it to change and improve their practices. Understanding how the ECM system works and having trust in the validity of the data generated is critical for staff buy-in and behavior change.

By Megan J. DiGiorgio and Lori Moore
Published August 12, 2020
www.healthleadersmedia.com


How better home hygiene could curb antibiotic resistance

Pharmacologists and infectious disease specialists say there is an urgent need to promote good hygiene in the home and in community settings. They believe that this will be essential in reducing antibiotic use and preventing the spread of drug-resistant bacteria in the coming years.

Rates of resistance to commonly used antibiotics have already reached 40–60% in some countries outside the Organisation for Economic Co-operation and Development (OECD) and are set to continue rising fast.

In OECD countries, rates of resistance could reach nearly 1 in 5 (or 18%) by 2030 for eight different bacterium-antibiotic combinations.

By 2050, about 10 million people could die each year as a result of resistance to antimicrobial agents.

While policymakers usually focus on hygiene in healthcare settings, such as hospitals, a group of pharmacology and infectious disease experts believes that improved hygiene in homes and community settings is just as important.

The scientists have published a position paper in the American Journal of Infection Control on behalf of the Global Hygiene Council.

“Although global and national [antimicrobial resistance] action plans are in place,” they write, “infection prevention and control is primarily discussed in the context of healthcare facilities with home and everyday life settings barely addressed.”

They have also launched a manifesto that calls on health policymakers to recognize the importance of this topic.

‘More urgent than ever’

Simple hygiene measures, such as hand washing, can help reduce infections and antibiotic use, the authors argue. In turn, this will minimize the development of resistance.

“In light of the current COVID-19 pandemic and evidence presented in this paper, it is more urgent than ever for policymakers to recognize the role of community hygiene to minimize the spread of infections, which, in turn, will help in reducing the consumption of antibiotics and help the fight against [antimicrobial resistance],” says lead author Prof. Jean-Yves Maillard from the School of Pharmacy and Pharmaceutical Sciences at Cardiff University in the United Kingdom.

The World Health Organization (WHO) estimate that 35% of common infections are already resistant to currently available medicines, with this figure rising to 80–90% in some low and middle income countries.

Overuse of the drugs accelerates the development of resistance. In the United States, for example, the Centers for Disease Control and Prevention (CDC) estimate that of the 80–90% of antibiotic use that occurs outside hospitals, about half is inappropriate or unnecessary.

The authors point out that while the majority of bacteria that are multidrug-resistant (resistant to at least one agent in three or more antimicrobial classes) get picked up in hospitals, some have become prevalent in the community.

Patients leaving the hospital can carry methicillin-resistant Staphylococcus aureus (MRSA) on their skin, for example, or resistant strains of enterobacteria in their gut. Resistant bacteria can then pass to other family members.

The authors write:

“Although the precise impact of hygiene on transmission of infection between community and healthcare settings needs further investigation, it is important to recognize that reducing the need for antibiotic prescribing and the circulation of [antimicrobial-resistant] strains in healthcare settings cannot be achieved without also reducing circulation of infections and [resistant] strains in the community. We cannot allow hygiene in home and everyday life settings to become the weak link in the chain.”

 

Hand washing is a crucial measure

They argue that better hand hygiene would prevent many infections in the home and in community settings, such as schools, nurseries, and workplaces.

Only about 19% of people wash their hands after using the toilet, according to a review of research that the paper cites. The same review found that hand washing reduces the risk of diarrhea by nearly one-quarter (23%) in studies with good methodological design.

Educating people to wash their hands with ordinary soap is one of the best ways to reduce infections, according to experts. Overall, research has shown that improvements in hand hygiene lead to a 21% reduction in respiratory illnesses and a 31% reduction in gastrointestinal illnesses.

In addition, the position paper highlights the problem of foodborne pathogens, including Salmonella, Campylobacter, and Escherichia coli. These affect millions of people globally every year, causing diarrhea and other debilitating symptoms.

A 2014 study in Mexico found Salmonella in almost all cleaning cloths. Soaking these dish clothes in a 2% solution of bleach twice a day reduced the bacteria by 98%.

Key risks and strategies

The authors identify key risk moments for transmitting infections in the home. These are:

• food handling, including contaminated chopping boards and kitchen sponges
• using the toilet
• changing a baby’s diaper
• coughing, sneezing, and nose blowing
• touching surfaces that others frequently touch
• handling and laundering clothing and household linen
caring for domestic animals
• disposing of refuse
• caring for an infected family member

As key strategies to combat infection in the home, they recommend:

• soap or detergent-based cleaning together with adequate rinsing
• alcohol-based hand sanitizer
• inactivation or eradication using a disinfectant on hard surfaces
• mechanical removal using dry wiping
• heating to at least 60°C (140°F)
• UV treatment
• a combination of the above

However, they note that further research is necessary to evaluate the extent to which these practices might contribute to preventing the transmission of antimicrobial-resistant bacteria.

____________________________________

Written by James Kingsland on May 25, 2020 – Fact checked by Hilary Guite, FFPH, MRCGP

Published: https://www.medicalnewstoday.com


In a pandemic, hospital staffers need to get better at hand-washing

After visiting Ellis Island in 1906, President Theodore Roosevelt noted the lack of hand-washing by doctors and wrote the Public Health Service that he was “struck by the way doctors made the examinations with dirty hands,” turning the examinations themselves into “a fruitful source of carrying infection.”

Fast forward 114 years: Today’s hospitals aren’t doing much better at hand-washing. That’s a serious problem in ordinary times; during the Covid-19 national emergency it could become extraordinarily dangerous. One way the government can protect public safety is by immediately setting specific hand hygiene standards for doctors, nurses, and hospital staff.

There’s not even monitoring of a national compliance rate, although hand-washing remains “the most important intervention” to reduce the “staggering mortality” associated with hospital infections, according to an article in an infection control journal.

The most recent hand hygiene data — an 18-year-old study from the Centers for Disease Control and Prevention — is discouraging. It concluded that adherence “has remained low.”

How low is “low”? According to the CDC, health care providers in U.S. hospitals clean their hands less than half the time they should. In comparison, people using bathrooms in New York train stations washed their hands afterward 80% of the time.

The medical literature doesn’t show much systemic improvement in hand-washing since the CDC last looked at the issue or, for that matter, since the Public Health Service issued an educational video showing hospital staff how to wash their hands back in 1961!

Hospitals with hand hygiene compliance in the 50% to 60% range include the kind of large, urban medical centers designated by the CDC as “first tier” treatment centers during the 2014-16 Ebola outbreak. After reviewing hundreds of inspection reports, ProPublica recently reported that “infection control has been a recurring problem at some of the very hospitals that would likely be called upon to treat Covid-19 patients.”

Better hand-washing won’t solve all infection control issues, of course, but it would significantly improve safety. The first step to achieving it is valid measurement.

A new standard from the Leapfrog Group, a nonprofit focused on improving patient safety where one of us (L.B.) works, encourages hospitals to measure hand hygiene using electronic monitoring of clinician compliance. This kind of technology is commonplace in retail and other industries.
Related:
‘We didn’t follow through’: He wrote the Ebola ‘lessons learned’ report for Obama. Now he weighs in on coronavirus response

Hospitals traditionally measure hand hygiene by having someone spot violations and report them, a technique with questionable reliability. Monitoring hand hygiene in a way that yields accurate data is vital. The Leapfrog standard is evidence-based; the government should adopt it.

The next step, getting to universal compliance with hand hygiene best practices, is even more crucial.

Based on what hospitals have already shown they can achieve, the secretary of Health and Human Services should call on all hospitals to meet an 85% hand hygiene goal within 90 days. While President Trump’s well-known use of hand sanitizer even before the Covid-19 crisis should make this an easy step for the administration to take, its obvious importance should also draw support from both parties in Congress.

Meanwhile, the Centers for Medicare and Medicaid Services should start the process of issuing formal regulations that would include an aggressive time frame for 100% hand hygiene compliance by any health care facility receiving Medicare payments — which is virtually all of them.

It took 98 years from the time President Roosevelt pointed out the hand-washing problem at Ellis Island until U.S. hospitals were required to institute a hand hygiene program that followed the CDC’s recommendations. If a deadly pandemic doesn’t justify urgently demanding accountability for making patients safer by the simple act of clinicians washing their hands, it’s hard to imagine what will.

Leah Binder is CEO of the Leapfrog Group. Michael L. Millenson is a patient safety activist, researcher, consultant, and author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age” (University of Chicago Press).

 

 

By Leah Binder and Michael L. Millenson

Published March 25, 2020
https://www.statnews.com


Hand hygiene a key defence in Europe’s fight against antibiotic resistance

Antimicrobial resistance (AMR), and resistance to antibiotics in particular, continues to grow in the WHO European Region and hundreds of thousands of patients die or are considerably affected each year by health care-associated infections (HAI) and diseases caused by germs that are resistant to antimicrobial medicines.

This year’s SAVE LIVES: Clean Your Hands campaign on 5 May uses the slogan “Fight antibiotic resistance – it’s in your hands” to highlight the fact that health-care workers and the public have a responsibility to prevent and control AMR and HAI, in turn helping to prevent related complications and deaths.

It is estimated that 7–10% of patients will acquire at least one HAI at any given time under treatment. A large percentage of these are preventable by improving hand hygiene practices and other infection prevention and control measures.

Taking action from many sides

HAI, including those resistant to antibiotics, are among the most common adverse events in health care delivery. Such infections can impact quality of life and lead to serious disease or even death. Action across all sectors of society is required to effectively prevent AMR. The following key recommendations will help prevent the spread of AMR and protect people in the Region from HAI:

• Health workers must clean their hands at the right times (see below).
• Chief executive officers and managers of health facilities need to support hand hygiene campaigning and infection prevention and control (IPC) programmes.
• IPC leaders should champion hand hygiene campaigns and comply with WHO’s “core components” for IPC.
• Policy-makers should stop the spread of AMR by demonstrating national support for and commitment to infection prevention programmes.

Cleaning hands at the right times

Protecting patients against HAI can be achieved by improving hand hygiene at five key moments, preferably by using an alcohol-based rub or by hand washing with soap and water if hands are visibly dirty. The “five moments” for hand hygiene comprise:

• before patient contact
• before preparing and administering injections
• after contact with body fluids
• after patient contact
• after touching patient surroundings.

Reinforcing the importance of hand hygiene through policy-making

Making infection prevention and hand hygiene a national policy priority by aligning and strengthening existing programmes will go far in combating AMR and protecting patients from resistant infections.

National authorities should implement or reinvigorate any or all of the following options according to the new WHO recommendations on core components for IPC programmes:

• establish a national IPC programme linked with other relevant national programmes and professional organizations;
• ensure that any national IPC programme supports the education and training of the health workforce as one of its core functions;
• establish an HAI surveillance programme and networks that include mechanisms for timely data feedback;
• consider hand hygiene as a key national performance indicator providing vital feedback data on health-care practices;
• have a system in place to ensure patient care activities are undertaken in a clean and/or hygienic, well-equipped environment to prevent and control HAI.

 

Building momentum in the fight against antibiotic resistance

This year’s campaign builds important momentum ahead of World Antibiotic Awareness Week (WAAW), which takes place on 13–19 November 2017. WAAW encourages all countries, health partners and the public to help raise awareness of AMR and to emphasize that we all have a part to play in preserving the effectiveness of antimicrobial medicines.

 

By WHO Europe
Publihed May 4th 2017
http://www.euro.who.int


Clean care for all - it's in your hands

Professor Didier Pittet’s work saves 5 to 8 million lives every year by focusing on hand hygiene in hospitals. In this fascinating talk that draws parallels from behavior change strategies that take resources, belief and culture into account he explains the global success of this ongoing campaign that depends on letting people adapt their own creativity and ideas to their own needs.

Professor Pittet is a Hospital Epidemiologist, Director of the Infection Control Programme and WHO’s Collaborating Centre on Patient Safety, at the University of Geneva Hospitals. He is the Lead Adviser of the WHO Clean Care is Safe Care & African Partnerships for Patient Safety programmes. Today, the Clean Care is Safer Care campaign runs in over 180 countries.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx


Patient safety: too little, but not too late

The first-ever World Patient Safety Day is taking place on Sept 17, 2019. Every day, countless patients worldwide are put at risk by unsafe care and end up requiring treatment for ailments caused by the very system that was supposed to help them get better. Protecting patients from errors, injuries, accidents, and infections is an essential goal for every health system, but no health system has so far successfully addressed patient safety.

Some of the statistics proffered by WHO to high-light patient safety are striking. In low-income and middle-income countries (LMICs), 134 million adverse events per year are directly attributable to unsafe care. These adverse events—including misdiagnosis, hospital-acquired infections, and medical errors—lead to 2·6 million unnecessary deaths. Worldwide, the risk of patient death because of a preventable medical accident is one in 300. One in ten patients suffer injury while receiving health care, and 15% of all hospital expenses are incurred as a result of treating failures in patient safety.

Patient safety hinges on quality of care. The Lancet Global Health’s 2018 Commission highlighted the need for “high-quality health systems that optimise health care in each context by consistently delivering care that improves or maintains health”. It feels obvious to state that a health-care system should aim to improve the health of those accessing it. Similarly, all health professionals expect that patients will have their condition improved by health care. However, the data compiled by WHO should be a wake-up call as they would be in any other industry. So what can be done?

First, do no harm. The safety of patients must be the paramount concern of professionals and the systems they work in. Rather than a platitude, this ask is an exhortation to strengthen systems, build better infrastructure, and value strong leadership. Reporting in US hospitals shows some health-care-associated infections can be reduced by as much as 70% with proper patient safety interventions that include stan-dardised clinician education, proper notification processes, and strict hand hygiene procedures. However, the WHO hand hygiene guidelines sug-gest compliance with proper hygiene can be as low s 40%. Hence, a greater effort needs to be made in monitoring and ensuring that basic practices of patient safety are strong and robust across all institutions, no matter how obvious the need for such procedures.

Second, health professionals must recognise that patient safety is a two-way partnership. Patients must be involved—indeed be central—in their own care. The myriad ways inadvertent harm can be done to patients indicate that everyone, from policy maker and health advocate to caregiver and health worker, holds a vital stake in patient safety. Indeed, evidence suggests that involving patients, service users, and carers in important decisions relating to care and treatment strengthens patient safety and is the best way for patients to achieve a positive outcome. As WHO comments, “safe health care starts with good communication”.

Finally, awareness of the burden that patient safety requirements place on LMICs is needed: addressing all improvements necessary for increased patient safety require resources. Two-thirds of all adverse events resulting from unsafe care occur in LMICs. Health professionals in high-income countries must ask themselves what they can do, not just to promote patient safety in their own system but also to offer outreach, support, resources, and expertise to LMICs bearing the burden of raised patient safety standards, rapidly changing disease patterns, and expectations of achieving the same development goals.

Recognising the importance of patient safety world wide is something that strikes right at the philosophical heart of health care. A Comment in this issue highlights how patient safety is now a core part of the move towards universal health coverage and states, importantly, that “addressing systemic, organisational, cultural and behavioural drivers of patient harm remains extremely challenging and a lot of known problems remain unsolved”. World Patient Safety Day is a prompt to everyone involved in care to examine their role in contributing to these drivers. In the treatment of immediate illness, health-care systems must offer best practice and consistent treatment for all patients, and at all levels, to ensure further damage is prevented.

The Lancet
www.thelancet.com Vol 394 September 14, 2019


Epidemiology and impact of norovirus outbreaks in Norwegian healthcare institutions, 2005–2018

Outbreaks in healthcare settings affect vulnerable populations, disrupt normal routines and may spread to other healthcare institutions (HCIs). Outbreaks can be limited in extent by good routines for detection, management of cases and other infection-control measures [1]. Norovirus infection is most often seen in the winter months and is a common cause of outbreaks in HCIs [2] as it has a low infectious dose, short incubation period, and symptoms such as diarrhoea and vomiting which facilitate spread. Symptoms normally lasts around one to three days, but can be longer in hospital patients [3]; and in this type of setting, infection can lead to slower recovery from other illness and even death [4]. Norovirus can be divided into several genogroups and genotypes [5]. Genogroup II genotype 4 is the most prevalent genotype globally [6] as well as in the Nordic countries [6]. There is no vaccine and immunity is not well understood; at best it is strain-specific but probably only partial and shortlived as the virus readily undergoes mutation [7, 8]. Humans are the only reservoir of the virus and spread of the infection in outbreaks is particularly difficult to control because of the low infectious dose, its stability in the environment and efficient transmission by person-to-person contact and exposure through contaminated surfaces [9]. Norway has national recommendations on norovirus infection in long-term-care facilities (LTCFs) in which the most important measure is isolation or cohort nursing of sick residents. Exclusion of sick staff until 48 h after they are symptom free is also recommended [10]. In a hospital setting, the infection-prevention-control unit will have local procedures. There are around 60 hospitals and 950 LTCFs in Norway [11]. The responsibility for management of local outbreaks lies within the hospital or with the community medical officer (one in each of the 422 municipalities) for outbreaks in LTCFs. All suspected outbreaks in Norwegian HCIs, regardless of the causative pathogen, should be alerted by law to relevant actors, including the Norwegian Insititute of Public Health (NIPH), to facilitate communication and response [12, 13]. The aim of this study was to describe, for the first time, the epidemiology and impact of these outbreaks in order to identify areas which may improve outbreak response.

This study shows that norovirus outbreaks pose an important burden for HCIs all over Norway, especially in the winter months. In addition to affecting an already vulnerable population, this study shows that these outbreaks indeed also impact on the internal workflow and resources, with a conservative estimate of around 1800 days of absenteeism per year due to these outbreaks, during which staff would have to be covered for by other internal or external healthcare staff.

Surveillance of norovirus outbreaks exists in Germany and Scotland. In Germany, reporting of norovirus outbreaks in HCIs has been mandatory since 2001. In contrast to what is seen in Norway, outbreaks were smaller (median nine cases vs 15 in this study) and around 80% of norovirus outbreaks were reported from hospitals (vs 23% in this study) during the first 12 months after introduction of the system [15]. Varying ways of counting interdepartmental outbreaks, better collaboration with the local level or under-reporting from hospitals may explain this. In Scotland, surveillance of ward closures due to norovirus infection has been in place since October 2017. From then until week 26, 2018, 219 wards or bays have been closed due to confirmed or suspected norovirus [16]. This is markedly more than the 16 reported outbreaks in hospitals in Norway 2017/18, in a population of similar size. The occurrence of norovirus outbreaks has also been studied prospectively; Curran et al. [17] aimed to identify the index cases of norovirus outbreaks in the UK and Ireland in 54 acute and non-acute healthcare centres; only five out of the 54 included centres did not experience any outbreak during one winter. Also, Lopman et al. found that 171 inpatients units, had on average 1.3 gastroenteritis outbreaks in the 1-year follow-up period. Of these, 63%were caused by norovirus [2].

It was seen that a small proportion of residents at LTCFs were admitted to hospital during norovirus outbreaks. This may be necessary in severe cases despite the risk of spread from one institution to the next. Our results suggest that hospitals are affected by norovirus outbreaks earlier in the epidemiological year than LTCFs. Potentially because there is a greater influx of patients from the community, where norovirus circulates, to and from hospital than between the community and LTCFs as also suggested by Sadique et al. [18]. This finding, however, could only be evaluated on the national level, as the number of reported outbreaks is low. That the start of the outbreak season seemed to start earlier in hospitals than in LTCFs, at least at the national level, suggests an opportunity that with improved communication, hospitals could alert LTCFs within the same area in order to prepare for the outbreak season and limit the extent of further outbreaks.

Slightly more cases were seen amongst healthcare staff in hospitals compared to LTCFs, though no information about the number of healthcare staff at risk during the outbreaks is available. The patient or resident:healthcare-staff ratio varies with the level of care needed and type of department and will most often be higher in hospitals. Whether this explains the slightly higher proportion of staff affected in hospital outbreaks is unknown. Nevertheless, healthcare staff do represent a big proportion of cases in the reported outbreaks, indicating a need for improved compliance with infection prevention and control measures. Outbreaks are an economic burden for HCIs, both as infected staff need to be covered for during illness and ‘quarantine’ and cohort nursing may require extra staff.

The relatively high number of people infected during an outbreak underscores the infectiousness of norovirus and norovirus can serve as a worst-case scenario for introduction of other, more virulent, person-to-person transmitted pathogens into HCIs. With the current information captured in the alert system, it was not possible to assess the extent to which national recommendations were followed and/or which infection prevention control procedures are in place locally. But the high number of people infected do suggest a potential for limiting spread, for example by having systems and routines in place before outbreaks happen, as advised in the national recommendations.

Even though NIPH routinely promotes the web-based outbreak alert system and teaches outbreak management, both at the regional and national level, in order to strengthen local capacity and encourage the use of the alert system, under-reporting is still apparent. If the under-reporting of outbreaks reflects a lack of awareness concerning outbreak management, or a lack of communication between the LTCF and the municipal doctors about ongoing outbreaks, it is worrying. The alert system serves to alert relevant stakeholders so that outbreak support and advice can be given in an early phase. The alert system can also be used for statistical purposes to get a national overview of outbreaks which will facilitate targeted capacity building, guideline development and communication messages in order to increase awareness and investigate whether there are any changes in trends.

Limitations
This study has three main limitations: the sensitivity of the norovirus outbreak definition and under-reporting of number of outbreaks and number of cases in each outbreak. Classification as a norovirus outbreak is dependent on local definitions. The infection prevention measures for diarrhoea and vomiting are the same for all the common pathogens in this setting. Samples were submitted for testing in two thirds of the outbreaks and most were confirmed as norovirus at the time of reporting or updating. Information about the genotypes of the isolated strains from each outbreak or of dominant strain of the season was not available. For this reason, it was not possible to evaluate the effect of the genotype.

Concerning under-reporting, the number of outbreaks notified through the outbreak alert system and reported here, most likely represent only a proportion of all norovirus outbreaks occurring in Norwegian HCIs. Although outbreaks were reported from all parts of Norway, some areas had not reported any outbreaks of any kind during the 13-year study-period.

The alert system is used for the mandatory alerting of suspected outbreaks. Reporting should happen as soon as the outbreak is suspected and before the full extent of the outbreak is known. Even though the system sends a reminder to update the details about the outbreak, including the case numbers, three weeks after the initial alert, some under-reporting of the extent of each outbreak is expected.

This is the first comprehensive description of norovirus outbreaks in HCIs in Norway. Even though the analyses revealed under-reporting that is unlikely to reflect the real epidemiology, this study clearly shows that these outbreaks affect both hospital and LTCFs all over Norway. Norovirus infection may delay medically important procedures and recovery, but also presents a major challenge to the functional ability of an HCI and its resources as up to one-half of cases were healthcare personnel.

It is recommended that NIPH promotes the outbreak alert system to increase reporting and improve the quality of the data and strengthen local capacity for outbreak management and general infection control. It is also recommended to investigate possibilities for improving communication between hospitals and LTCFs regarding when the norovirus season starts and progresses, for hospitals and LTCFs to be prepared and to take early action to prevent and limit further spread.

Read full article: https://www.journalofhospitalinfection.com/article/S0195-6701(19)30268-3/fulltext?dgcid=raven_jbs_etoc_email

© 2019 The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society.


A Breeding Ground for a Fatal Scourge: Nursing Homes

From The New York Times:

Drug-resistant germs, including Candida auris, prey on severely ill patients in skilled nursing facilities, a problem sometimes amplified by poor care and low staffing.

https://www.nytimes.com/2019/09/11/health/nursing-homes-fungus.html

“They are caldrons that are constantly seeding and reseeding hospitals with increasingly dangerous bacteria,” said Betsy McCaughey, a former lieutenant governor of New York who leads the nonprofit Committee to Reduce Infection Deaths. “You’ll never protect hospital patients until the nursing homes are forced to clean up.”

Resistant germs can then move from bed to bed, or from patient to family or staff, and then to hospitals and the public because of lax hygiene and poor staffing.

A recent inquiry by the New York State Department of Health found that some long-term hospitals grappling with C. auris were failing to take basic measures, such as using disposable gowns and latex gloves, or to post warning signs outside the rooms of infected patients. At one unnamed facility, it said, “hand sanitizers were completely absent.”

https://www.ncbi.nlm.nih.gov/pubmed/30753383