Late in a High Anxiety Season, Some Flu and Vaccine Basics

After what has seemed like constant media scrutiny for months, influenza hasn’t been in the news as often in recent days. Still, CDC data indicate that flu activity remains “widespread” across the country, so it’s still too early to eliminate flu from your list of “differential diagnoses,” at work or at home.

Maybe it’s the general state of our national psyche, but this year the “flu” seems to have caused more than its usual share of anxiety. This is not a pandemic; there are no brand-new strains of flu in circulation to which no one is immune. But the H3N2 strain that has been predominant this year does tend to lead to a harsher-than-usual season. (The 2014-2015 season was also severe, but the public heard relatively little about it because media were focused on the Ebola outbreak.)

Influenza surveillance basics.

How do we know how bad a flu season really is? Since the 1997–1998 flu season, lab data and clinical reporting have facilitated real-time flu surveillance in the U.S. Public health laboratories in every state, in collaboration with National Respiratory and Enteric Virus Surveillance System laboratories, track the types (A or B) and subtypes (H3N2, H1N1, etc.) of flu in circulation.

To complement these data, the U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet) tracks the percentage […]

2018-02-28T12:20:28-05:00February 28th, 2018|infectious diseases, Nursing, Public health|0 Comments
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A Closer Look at Preventing C. Diff Transmission

Clostridium difficile/ CDC

It’s estimated that Clostridium difficile (C. diff) causes about 450,000 infections and 15,000 deaths each year. Recently, on Facebook, AJN’s question of the week asked about isolation precautions for patients with C. diff. Most readers could not provide the correct answer to the multiple choice question.

In this month’s issue, “Six Things You Can Do Today to Prevent Hospital-Onset C. difficile Tomorrow” offers a quick update of the best ways to prevent C. diff infection and transmission in hospitalized patients.

Author and infection prevention nurse Nancy O’Connor explores the finer points of key basics, including the importance of maintaining a high index of suspicion for cases, performing excellent hand hygiene, and cleaning all surfaces in a case patient’s room with a bleach solution. (And did you know that if the patient remains in the same room posttreatment, after symptoms have resolved, the room should be terminally cleaned to avoid reinfection?)

Isolation precautions and C. diff.

So, what about isolation precautions, which need to be started as soon as C. diff is suspected? Most respondents to our Facebook question thought that standard precautions were sufficient until a C. diff diagnosis was confirmed. But if this “rule-out” patient with diarrhea is positive, does s/he begin to shed C. diff only after the infection […]

2017-09-22T11:21:11-04:00September 22nd, 2017|infectious diseases, Nursing|0 Comments
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Tuberculosis: Nurses Play Critical Role in Prevention, Diagnosis, Treatment

Mantoux skin test/CDC PHIL

In the U.S., the chances are that tuberculosis isn’t on your mind a lot. Most of us focus on TB only when we have a patient on airborne precautions—or when we’ve been exposed to TB at work.

Globally, TB was one of the top 10 causes of death in 2015. In the U.S., after a spike in cases early in the HIV epidemic, the incidence of TB has fallen to about three cases per 100,000 people. In TB-endemic countries, incidence rates run into hundreds per 100,000. But with TB elimination defined as a rate of less than one case per million people, we are far from eradicating this disease in the U.S. In fact, the number of TB cases in the U.S. rose slightly from 2014 to 2015.

Also, of course, nurses often work with people who are at high risk of acquiring TB—transplant recipients, others who are immunocompromised, people with HIV or certain cancers, those who are refugees or homeless—increasing our own risk for the disease as well. Therefore, the low overall U.S. incidence rate doesn’t reflect the experience (or risk) of most nurses. (And if you are “PPD positive,” click here for some reminders about what that should mean to you as a nurse: “Nurses and Latent TB Infection.”) […]

2017-08-18T08:58:20-04:00August 18th, 2017|infectious diseases, Nursing, Public health|2 Comments
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A Status Update for World AIDS Day

Photo of AJN editor-in-chief Shawn KennedyIn light of the recent focus on Zika virus and the last few years’ attention to Ebola, there’s been little attention to HIV/AIDS. Today, December 1, World AIDS Day, is a good time to remember that millions still suffer from this disease and thousands contract it annually.

According to the MMWR report released last week by the Centers for Disease Control and Prevention (CDC), the statistics are still sobering:

  • Globally, over 36 million people have AIDS and 2.1 million were newly infected in 2015; 1.1 million died.
  • In the United States in 2013, approximately 1.2 million people had an AIDS diagnosis; approximately 44,000 were newly diagnosed in 2014.

There is good news, in that global access to treatment has increased greatly—in 2010, 7.5 million had access to antiretroviral treatment; by June 2016, over 18 million had access to antiretrovirals.

It’s been over 35 years since AIDS was first reported by the CDC—you can read an overview of the CDC’s response here. I recall the AIDS epidemic only too well. As I wrote in an editorial in 2010:

In 1975, while attending graduate school, I worked part time as a chemotherapy nurse for a hematologist in New York City. Because of his expertise, he was increasingly being asked to consult on cases involving seemingly healthy young men, most of them gay, […]

2016-12-01T10:24:35-05:00November 30th, 2016|infectious diseases, Nursing, Public health|1 Comment
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The Real and Evolving Threat of Superbugs: A Primer

pillsinspaceJust how super is the latest superbug? The good news is that the infected U.S. patient has recovered. The bad news:  mcr-1, the resistance gene identified in this strain of E. coli, has brought us another frightening step closer to a “post-antibiotic” era.

In recent years, antimicrobial resistance among Gram-negative bacteria (E. coli, Klebsiella, Pseudomonas, Acinetobacter, Salmonella, and others) has been a growing public health concern. Most of the increase in resistance has been the result of mobile genetic elements that can easily transfer resistance from one bacterium to another, allowing bacteria to “catch” antibiotic resistance from one another.

To make matters worse, resistance enzymes are often packaged together. One genetic “cassette” can carry multiple resistance determinants, thereby spreading resistance to more than one class of antibiotics at the same time.

Early on, we relied on the carbapenem class of antibiotics to treat infections caused by multidrug-resistant (MDR) organisms such as the “ESBLs” (extended-spectrum beta-lactamase-producing organisms). But carbapenemase-producing organisms soon developed, and resistance to carbapenems spread quickly.

In 2009, the emergence of a “super” kind of carbapenem resistance gene, ndm-1 (New Delhi metallo-beta-lactamase) was found to be highly resistant to many antibiotic classes, including:

  • the carbapenems and other beta-lactams (penicillin derivatives and cephalosporins)
  • the fluoroquinolones (ciprofloxacin, levofloxacin, et al)
  • the aminoglycosides (gentamicin, amikacin, et al).

These antibiotic classes include the main drugs used to […]

2016-11-21T13:01:11-05:00June 6th, 2016|infectious diseases, Nursing, Public health|1 Comment
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