The Perfect Storm: Emerging Trends and Pathogens in Healthcare

Abstract

1. Pat Tille, PhD, MT(ASCP) 1. Medical Laboratory Science, College of Pharmacy, South Dakota State University, SD 2. Rodney E. Rohde, PhD, MS, SV, SM (ASCP)CM, MBCM[⇑][1] 1. Clinical Laboratory Science Program, College of Health Professions, Texas State University, San Marcos, TX 3. Julie Reagan, PhD, JD, MPH 1. Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA 4. Marilyn Felkner, DrPH, MT(ASCP) 1. Emerging and Acute Infectious Disease Branch (EAIDB), Infectious Disease Control Unit, Texas Department of State Health Services (DSHS), Austin, TX 5. Amber Hogan Mitchell, DrPH, MPH, CPH 1. The International Safety Center, Apopka, FL 1. Address for Correspondence: Rodney E. Rohde, PhD, MS, SV, SM (ASCP)CM, MBCM, Professor & Chair, CLS Program; Associate Dean for Research, Clinical Laboratory Science Program, College of Health Professions, Texas State University, 601 University Drive, San Marcos, TX 78666, 512-245-2562, 512-245-7860, rrohde{at}txstate.edu 1. Explain how vulnerable populations, current healthcare delivery, and emerging pathogens have contributed to an increase in healthcare-associated infections. 2. Compare and contrast pathogens that occur in persons with HIV/AIDS, persons with cancer, and persons undergoing transplants. 3. Identify ways that community-based healthcare delivery may increase risk of HAIs. 4. Discuss the role of antibiotic overuse and international travel in the development of emerging pathogens. 5. Plan activities that are effective in preventing HAIs. INTRODUCTION In 1999, the article To Err is Human brought healthcare-associated infections (HAI) to the nation's attention. However, the risk posed by healthcare facilities to those who went there for healing had not developed overnight. Decades of changing demography, microbial evolution, and –ironically-- healthcare advancements had resulted in this perfect storm. Since the change in paradigm in healthcare that nosocomial or healthcare-associated infections are a natural consequence of treatment to a practice of surveillance and prevention, hospital acquired infections are no longer considered consequences of inpatient treatment. Prevention of healthcare-associated infections includes protecting patients, healthcare workers, visitors, volunteers and health science students. This paper aims to describe the contributory roles of affected populations with their attendant, diverse healthcare sites and healthcare workers, and emerging pathogens. Affected Populations Prior to the identification of the Acquired Immune Deficiency (AIDS) virus, persons with chronic immune deficiencies were anomalies—“bubble children” who were occasionally brought to the public's attention through the media. With the advent of HIV/AIDS, healthcare facilities faced the daunting task of caring for many individuals with immune deficiency on a long-term basis. Just as many infectious diseases seemed to have been conquered through vaccine or antibiotics, healthcare was called upon to manage a new infectious disease with no treatment and also to protect those individuals from other potential infections including pathogens that did not cause disease in persons with healthy immune systems. HIV/AIDS required healthcare facilities not only to protect their patients but their workers from a high fatality disease that was… ABBREVIATIONS: AIDS – Acquired Immune Deficiency Syndrome, CA-MRSA – Community-Associated Methicillin Resistant Staphylococcus aureus , CDC – Centers for Disease Control and Prevention, CRE - carbapenem-resistant Enterobacteriaceae, CMV – Cytomegalovirus, FDA - Food and Drug Administration, HA-MRSA – Healthcare-Associated Methicillin Resistant Staphylococcus aureus , HAI – Healthcare-Associated Infections, HCW – Healthcare Worker, HIV – Human Immunodeficiency Virus, KPC-Kp – Klebsiella pneumoniae Carbapenemase Producing, MERS – Middle Eastern Respiratory Syndrome, MDRO – Multiple Drug Resistant Organisms, MRSA – Methicillin Resistant Staphylococcus aureus , NICU – Neonatal Intensive Care Unit, NHSN – National Health Safety Network, PPE – Personal Protective Equipment, RSV – Respiratory Syncitial Virus, VRE - Vancomycin-resistant Enterococci 1. Explain how vulnerable populations, current healthcare delivery, and emerging pathogens have contributed to an increase in healthcare-associated infections. 2. Compare and contrast pathogens that occur in persons with HIV/AIDS, persons with cancer, and persons undergoing transplants. 3. Identify ways that community-based healthcare delivery may increase risk of HAIs. 4. Discuss the role of antibiotic overuse and international travel in the development of emerging pathogens. 5. Plan activities that are effective in preventing HAIs. [1]: #corresp-1