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
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
Why do we worry about some things and not others?
What scares you more?
Confirmed Unprovoked Shark Attacks 1958-2014 TOTAL = 2,899 FATAL = 548
Impact of Mosquitos One million deaths per year Hundreds of millions endure pain and suffering
Mosquitos Malaria West Nile Chikungunya Zika Dengue Yellow Fever
Perceived Risk
Reaction to Risk
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
Perception of Germs
Three Categories of Threats Urgent Serious Concerning
Concerning Threats Vancomycin-resistant Staphylococcus aureus (VRSA) Erythromycin-resistant Group A Streptococcus Clindamycin-resistant Group B Streptococcus
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
Urgent Threats Clostridium difficile Carbapenem-resistant Enterobacteriaceae (CRE) Drug-resistant Neiserria gonorrhoeae
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
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
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
CRE Outbreak: 2015
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
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
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
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
Urgent Threats Clostridium difficile Carbapenem-resistant Enterobacteriaceae (CRE) Drug-resistant Neiserria gonorrhoeae
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
C. Difficile Infection Significant increase between 2013-2014 9% higher than national baseline
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; 28:926 931.
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
CDI Risk Factors Antimicrobial exposure Acquisition of C. difficile Advanced age Underlying illness Immunosuppression Tube feeds? Gastric acid suppression
More bugs to keep us up at night
Influenza
Measles at Disneyland: 2015
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
Herd Immunity
Famous faces of HIV
HIV
Global threats
Ebola: 2014
Ebola:2014
Ebola: 2014
Zika
Potential risk areas for Zika
Lessons Learned
What we do matters
How we practice matters
Where we travel matters
How we protect ourselves and others matters
What we teach matters
Make sure the forest is not missed while staring at the trees... Cigarette Her Unborn Child
barbdebaun@me.com