What bugs are keeping YOU up at night?

Transcription

1 What bugs are keeping YOU up at night? Barbara DeBaun, RN, MSN, CIC 26 th Annual Medical Surgical Nursing Conference South San Francisco, CA April 15, 2016

2 Objectives Describe the top three infectious disease public health priorities Discuss the primary modes of disease transmission and how they influence public reaction Describe modes of prevention to reduce the risk of public health threats

3 Why do we worry about some things and not others?

4 What scares you more?

5 Confirmed Unprovoked Shark Attacks TOTAL = 2,899 FATAL = 548

6 Impact of Mosquitos One million deaths per year Hundreds of millions endure pain and suffering

7 Mosquitos Malaria West Nile Chikungunya Zika Dengue Yellow Fever

8 Perceived Risk

9 Reaction to Risk

10 Perceptions of Risk We do not tend to be afraid of things that are most likely to harm us Planes, trains, automobiles Sedentary lifestyle We are afraid of things that pose little danger We fear sharks while mosquitos are a much bigger danger

11 Perception of Germs

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13 Three Categories of Threats Urgent Serious Concerning

14 Concerning Threats Vancomycin-resistant Staphylococcus aureus (VRSA) Erythromycin-resistant Group A Streptococcus Clindamycin-resistant Group B Streptococcus

15 Serious Threats Multidrug-resistant Acinetobacter Drug-resistant Campylobacter Fluconazole-resistant Candida Extended spectrum β-lactamase producing Enterobacteriaceae (ESBL) Vancomycin-resistant Enterococcus (VRE) Multi-drug resistant Non-typhoidal Salmonella Drug-resistant Salmonella Typhi Drug-resistant Shigella Methicillin-resistant Staphylococcus aureus (MRSA) Drug-resistant Streptococcus pneumoniae Drug-resistant tuberculosis Multi-drug resistant Pseudomonas aeruginosa

16 Urgent Threats Clostridium difficile Carbapenem-resistant Enterobacteriaceae (CRE) Drug-resistant Neiserria gonorrhoeae

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18 Neisseria gonorrhoeae Causes gonorrhea (STD) Results in discharge and inflammation at the urethra, cervix, pharynx or rectum Is 2 nd most common reported notifiable infection in the US 820,000 estimated infections/year

19 Drug-resistant Neisseria Gonorrhoeae 246,000 drug resistant cases/year Resistant to cefixime, ceftriaxone, azithromycin and tetracycline CDC recommendation for treatment is ceftriaxone PLUS either azithromycin OR doxycycline as first-line treatment

20 Carbapenem-resistant Enterobacteriaceae (CRE) Two most common types of CRE are Klebsiella sp. and E. coli Resistant to all or nearly all antibiotics 50% mortality in patients with CRE bloodstream infections More than 9,000 healthcareassociated infections/year

21 CRE Outbreak: 2015

22 CRE Vital Signs: Key Points CRE are increasing 1% to 4% overall Over 10% of Klebsiella are CRE Most Hospitals don t see CRE regularly 4% of hospitals 18% of LTACHs Most CRE are still healthcare - associated

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24 Evolution of Antimicrobial Resistance in S. aureus S. aureus Penicillin [1940s] Penicillin-resistant S. aureus Methicillin [1960s] Methicillin-resistant S. Aureus (MRSA) [1961] Vancomycin Resistant S. Aureus [2002] Vancomycin intermediate-resistant S. Aureus [1997] CA-MRSA [1980s] Vancomycin Ciprofloxacin

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26 Antibiotic Resistance Threats in the US More than 2 million people in the US become sick every year with an antibiotic resistant infection At least 23,000 people die as a result

27 Use of Antibiotics Single most important factor leading to antibiotic resistance Antibiotics are the most commonly prescribed drugs used in human medicine 50% of antibiotics prescribed for people are not needed or are not optimally effective as prescribed Commonly used in food animals

28 Urgent Threats Clostridium difficile Carbapenem-resistant Enterobacteriaceae (CRE) Drug-resistant Neiserria gonorrhoeae

29 Clostridium difficile Causes life threatening diarrhea 250,000 infections/year 14,000 deaths/year At least $1 billion in excess medical costs/year Occurs mostly in persons who have been exposed to recent antibiotics and healthcare

30 C. Difficile Infection Significant increase between % higher than national baseline

31 Antibiotic misuse adversely impacts patients Clostridium difficile Antibiotic exposure is the single most important risk factor for the development of Clostridium difficile infection (CDI) Up to 85% of patients with CDI have antibiotic exposure in the 28 days before infection Chang HT et al. Infect Control Hosp Epidemiol 2007; 28:

32 Clostridium difficile 70% of <1 year olds are colonized By age 2, normal colonic flora is established 2-5% of healthy adults have C. difficile colonization of the colon 20-40% of hospitalized adults are colonized with C. difficile

33 CDI Risk Factors Antimicrobial exposure Acquisition of C. difficile Advanced age Underlying illness Immunosuppression Tube feeds? Gastric acid suppression

34 More bugs to keep us up at night

35 Influenza

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41 Measles at Disneyland: 2015

42 If we stopped vaccinating, what would happen? 2.7 million measles deaths worldwide 600 children in the US would die from Haemophilus influenzae meningitis Polio would reappear resulting in 13,000 to 20,000 cases of paralytic polio in the US every year

43 Herd Immunity

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46 Famous faces of HIV

47 HIV

48 Global threats

49 Ebola: 2014

50 Ebola:2014

51 Ebola: 2014

52 Zika

53 Potential risk areas for Zika

54 Lessons Learned

55 What we do matters

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57 How we practice matters

58 Where we travel matters

59 How we protect ourselves and others matters

60 What we teach matters

61 Make sure the forest is not missed while staring at the trees... Cigarette Her Unborn Child

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