Weekly EBM Update 11.9.018

Changes in Prevalence of Health Care–Associated Infections in U.S. Hospitals (NEJM 11/2018)

Healthcare associated infections are a common cause of morbidity and mortality. Additionally, a concern exists regarding increasing antimicrobial resistance in the form of multidrug resistant (MDR) organisms. As such, a large push to minimize hospital acquired infections such as catheter associated UTI’s (CAUTI’s), central line associated bloodstream infections (CLABSI), and ventilator associated pneumonia (VAP) has been seen across the country and are often reported as hospital performance measures or quality measures. The authors of the above study conducted an observational point prevalence study to investigate changes in healthcare associated infections from 2011 to 2015. The most common pathogens found (at frequencies of 10% or greater) included Clostridioides difficile, Staphylococcus Aureus (of which 45% of isolates were MRSA), and Escherichia Coli. There was no significant change in the rate of ventilator associated or healthcare associated pneumonia (the most common healthcare associated infection), C. Difficile associated diarrhea, or CLABSI between time periods. There was a significant decrease in CAUTI’s and surgical site infections. Patients admitted in 2015 had significantly less healthcare associated infections (3.2% vs. 4.0%), and after adjustment for age, time from admission to survey, presence of devices, and status of being in a large hospital, patients in 2015 were approximately 16% less likely to have a healthcare associated infection (RR 0.84, 95% CU 0.74-0.95).

Take home: Healthcare associated infections decreased in prevalence from 2011 to 2015. There was a reduction in UTI’s and surgical site infections, likely due to improved recognition and quality improvement measures aimed at prevention of these infections. Healthcare associated pneumonia and C. difficile infections did not decrease significantly over this time period. C. difficile, E. coli, and Staph Aureus (both MSSA and MRSA) remain the most common hospital acquired pathogens.

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Acute Clinical Care for Transgender Patients A Review (JAMA IM 11/2018)

Transgender patients often have negative experiences with healthcare providers. The review included here cites the 2015 US transgender survey, which noted that 33% of transgender responders reported at least 1 negative experience with the healthcare system, and 23% reported avoiding medical care out of fear of mistreatment. From the standpoint of the provider, clinical care directed towards the needs of transgender patients is growing, but remains a small field. This integral review touches on topics from how to address transgender patients using appropriate terminology to the benefits and risks associated with hormone gender-affirming hormone therapy. It is an easy, and essential read for all healthcare providers in order to continue providing high quality care for all of our patients.

Take home: Read this review! Or at the very least, save it somewhere it can be accessed for future reference.

Read the article here