Infection Control and Hospital Epidemiology最新文献

{"title":"Impact of diagnostic stewardship on catheter-associated urinary tract infections and patient outcomes.","authors":"Sarah E Sansom, Audrey Goldstein, Brian D Stein, Michael E Schoeny, Alexandra Seguin, Ruth Kniuksta, Alexander Tomich, Mary K Hayden, Michael Y Lin, John Segreti","doi":"10.1017/ice.2024.209","DOIUrl":"10.1017/ice.2024.209","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic stewardship of urine cultures from patients with indwelling urinary catheters may improve diagnostic specificity and clinical relevance of the test, but risk of patient harm is uncertain.</p><p><strong>Methods: </strong>We retrospectively evaluated the impact of a computerized clinical decision support tool to promote institutional appropriateness criteria (neutropenia, kidney transplant, recent urologic surgery, or radiologic evidence of urinary tract obstruction) for urine cultures from patients with an indwelling urinary catheter. The primary outcome was a change in catheter-associated urinary tract infection (CAUTI) rate from baseline (34 mo) to intervention period (30 mo, including a 2-mo wash-in period). We analyzed patient-level outcomes and adverse events.</p><p><strong>Results: </strong>Adjusted CAUTI rate decreased from 1.203 to 0.75 per 1,000 catheter-days (<i>P</i> = 0.52). Of 598 patients triggering decision support, 284 (47.5%) urine cultures were collected in agreement with institutional criteria and 314 (52.5%) were averted. Of 314 patients whose urine cultures were averted, 2 had a subsequent urine culture within 7 days that resulted in a change in antimicrobial therapy and 2 had diagnosis of bacteremia with suspected urinary source, but there were no delays in effective treatment.</p><p><strong>Conclusion: </strong>A diagnostic stewardship intervention was associated with an approximately 50% decrease in urine culture testing for inpatients with a urinary catheter. However, the overall CAUTI rate did not decrease significantly. Adverse outcomes were rare and minor among patients who had a urine culture averted. Diagnostic stewardship may be safe and effective as part of a multimodal program to reduce unnecessary urine cultures among patients with indwelling urinary catheters.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing and upgrading the cleanliness of the emergency department brief title: upgrading the emergency room's cleanliness.","authors":"Elisheva Levine, Samar Abo-Gush, Bath Sheva Ezagui, Ruth David, Puah Kopuit, Naama Bagrish, Todd Zalut, Marc V Assous, Yossi Freier-Dror, Amos M Yinnon, Shmuel Benenson","doi":"10.1017/ice.2024.177","DOIUrl":"https://doi.org/10.1017/ice.2024.177","url":null,"abstract":"<p><strong>Objective: </strong>To upgrade cleaning and disinfection of patient rooms in a crowded emergency department (ED).</p><p><strong>Setting: </strong>Tertiary referral hospital.</p><p><strong>Design: </strong>Prospective, 3-component, before-and-after intervention study.</p><p><strong>Methods: </strong>Phase 1 consisted of a 4-week baseline determination of ED patient-room cleanliness, using two means: (1) the fluorescence spray, applied before cleaning and assessed subsequently with an ultraviolet lamp. Results are expressed as % of removed spots/all spots (≥7/10 cleaned spots/room was considered clean; (2) ATP swabs obtained after cleaning, which test for presence of residual organic material; readings <45 were considered clean. Phase 2 consisted of revision and reorganization of established cleaning practices. Phase 3 consisted of adding one cleaning person in afternoon/evening shifts, for 4-weeks, during which room cleanliness was assessed as previously described.</p><p><strong>Results: </strong>Cleanliness of the 79 patient rooms, for which fluorescence tests were available from before and after cleaning for all three phases of the study, increased from a baseline of 50% ± 35 removed spots/all spots, to 61% ± 36 after the first intervention (CI95 -0.6 - 21, <i>P</i> = 0.54) and to 68% ± 35 after the second intervention (CI95 5 - 31, <i>P</i> = 0.004, as compared to the baseline). Subanalysis showed that evening shifts improved most remarkably, from 47% ± 32 (n = 45), to 60% ± 33 (n = 49) to 76%±29 (n = 29), respectively, from baseline through the second and third phase (<i>P</i> = 0.001). ATP testing appeared less sensitive for assessment of cleanliness but confirmed the assessment by fluorescence for overall cleanliness (CI95 1 - 14, <i>P</i> = 0.018).</p><p><strong>Conclusions: </strong>Our data demonstrate that a two-step intervention significantly improves cleaning in a busy ED.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bad habits that stick: adhesive tape use practices and beliefs.","authors":"Julia Fischer, Reva Kleppel, Manju Mathew, Morgan Gilmore, Laura Hegarty-Moore, Michele Maryanski, Stacey Peters, Kristin Smith, Steven Roncaioli, Jacob Smith, Megan C Gallagher, Esteban DelPilar-Morales, Sarah Haessler","doi":"10.1017/ice.2024.175","DOIUrl":"https://doi.org/10.1017/ice.2024.175","url":null,"abstract":"<p><p>Tape rolls are often used for multiple patients despite recommendations by manufacturers for single-patient use. We developed a survey to query Health Care Personnel about their tape use practices and beliefs and uncovered behaviors that put patients at risk for hospital-acquired infections due to tape use.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of copper-impregnated antimicrobial surfaces against <i>Clostridioides difficile</i> spores.","authors":"Thanuri Navarathna, Piyali Chatterjee, Hosoon Choi, John D Coppin, Brandon Corona, Emma Brackens, Lynn Mayo, Munok Hwang, Marjory Williams, Morgan Bennett, Chetan Jinadatha","doi":"10.1017/ice.2024.219","DOIUrl":"https://doi.org/10.1017/ice.2024.219","url":null,"abstract":"<p><strong>Objective: </strong><i>Clostridioides difficile</i> (<i>C. difficile</i>) is one of the most common causes of healthcare-associated infections (HAIs). Elimination of <i>C. difficile</i> spores is difficult as they are resistant to common hospital-grade disinfectants. Copper-impregnated surfaces provide continuous reduction of multiple pathogens, potentially lowering the risk of infections. This manuscript aims to evaluate the efficacy of copper-impregnated surfaces on <i>C. difficile</i> spores.</p><p><strong>Methods: </strong>Control (no copper) coupons and copper coupons containing 20% copper-oxide were inoculated with <i>C. difficile</i> spore loads ranging from 10⁵ to 10⁷ spores, with or without 5% fetal bovine serum soil load. After 4 hours of contact time, the <i>C. difficile</i> spores were recovered, plated on <i>C. difficile</i> growth media, and colony forming units were counted. The efficacy of copper (log₁₀ kill) was estimated using a Bayesian latent variables model.</p><p><strong>Results: </strong>After 4 hours, unsoiled copper bedrail and copper table coupons at mean spore inoculation resulted in a 97.3% and 96.8% reduction in spore count (1.57 and 1.50 log₁₀ kill, respectively). That of soiled bedrail and table coupons showed a 91.8% and 91.7% reduction (1.10 and 1.10 log₁₀ kill, respectively).</p><p><strong>Conclusions: </strong>Copper coupons can substantially reduce <i>C. difficile</i> spores after 4 hours, but results vary depending on the initial spore concentration and presence or absence of organic material. Higher initial spore loads or excess organic material may prevent spores from contact with copper surfaces, thus decreasing kill efficacy. Continuous sporicidal effect of copper-impregnated surfaces may decrease spore burden and help prevent transmission of spores.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mixed-methods multicenter assessment of healthcare workers' knowledge, perceptions, and practices related to blood culture utilization in hospitalized adults.","authors":"Valeria Fabre, Sara E Cosgrove, Aaron M Milstone, Alejandra B Salinas, Kathleen O Degnan, Erin B Gettler, Laurel J Glaser, J Kristie Johnson, Rebekah W Moehring, George E Nelson, Barry Rittmann, Guillermo Rodriguez-Nava, Jonathan H Ryder, Jorge L Salinas, Gregory M Schrank, Thomas T Talbot, Trevor C Van Schooneveld, Anastasia Wasylyshyn, Anping Xie","doi":"10.1017/ice.2024.208","DOIUrl":"https://doi.org/10.1017/ice.2024.208","url":null,"abstract":"<p><strong>Objective: </strong>To understand healthcare workers' (HCWs) beliefs and practices toward blood culture (BCx) use.</p><p><strong>Design: </strong>Cross-sectional electronic survey and semi-structured interviews.</p><p><strong>Setting: </strong>Academic hospitals in the United States.</p><p><strong>Participants: </strong>HCWs involved in BCx ordering and collection in adult intensive care units (ICU) and wards.</p><p><strong>Methods: </strong>We administered an anonymous electronic survey to HCWs and conducted semi-structured interviews with unit staff and quality improvement (QI) leaders in these institutions to understand their perspectives regarding BCx stewardship between February and November 2023.</p><p><strong>Results: </strong>Of 314 HCWs who responded to the survey, most (67.4%) were physicians and were involved in BCx ordering (82.3%). Most survey respondents reported that clinicians had a low threshold to culture patients for fever (84.4%) and agreed they could safely reduce the number of BCx obtained in their units (65%). However, only half of them believed BCx was overused. Although most made BCx decisions as a team (74.1%), a minority reported these team discussions occurred daily (42.4%). A third of respondents reported not usually collecting the correct volume per BCx bottle, half were unaware of the improved sensitivity of 2 BCx sets, and most were unsure of the nationally recommended BCx contamination threshold (87.5%). Knowledge regarding the utility of BCx for common infections was limited.</p><p><strong>Conclusions: </strong>HCWs' understanding of best collection practices and yield of BCx was limited.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The adoption and compliance to central line-associated bloodstream infection insertion and maintenance bundle programs in intensive care unit settings across Canada.","authors":"Zhi Lin Zhou, Anada Silva, Kristine Cannon, Blanda Chow, Jeannette L Comeau, Chelsey Ellis, Charles Frenette, Amir Hadzic, Jennifer Happe, Lynn Johnston, Kevin C Katz, Jamal Khan, Joanne M Langley, Bonita E Lee, Santina Lee, Marie-Astrid Lefebvre, Cassandra Lybeck, Allison McGeer, Andrew Neitzel, Jennifer Parsonage, Connie Patterson, Caroline Quach, Michelle Science, Stephanie W Smith, Nisha Thampi, Reena Titoria, Jen Tomlinson, Joseph Vayalumkal, Kathryn N Suh, Jocelyn A Srigley","doi":"10.1017/ice.2024.189","DOIUrl":"https://doi.org/10.1017/ice.2024.189","url":null,"abstract":"<p><p>Evidence-based insertion and maintenance bundles are effective in reducing the incidence of central line-associated bloodstream infections (CLABSI) in intensive care unit (ICU) settings. We studied the adoption and compliance of CLABSI prevention bundle programs and CLABSI rates in ICUs in a large network of acute care hospitals across Canada.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-4"},"PeriodicalIF":3.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In vitro assessment of effect of initial specimen diversion device on detection of central venous catheter contamination or colonization.","authors":"Mark E Rupp, Paul D Fey, Elizabeth Lyden, Luke Handke","doi":"10.1017/ice.2024.220","DOIUrl":"https://doi.org/10.1017/ice.2024.220","url":null,"abstract":"<p><p>The role of initial specimen diversion devices (ISDDs) in preventing contamination of central venous catheter (CVC) blood cultures is undefined. A model to simulate CVC colonization and contamination compared standard cultures with ISDD technique. ISDD detected 100% of colonized CVCs while decreasing false-positive cultures from 36% to 16%.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-4"},"PeriodicalIF":3.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of daily prompt to vaccinate inpatients awaiting rehabilitation against SARS-CoV-2 and influenza.","authors":"Amber Linkenheld, Victoria R Williams, Karen Chan, Helene Carating, Romina Marchesano, Jennifer Do, Sherri Sullivan, Danette Beechinor, William K Silverstein, Jerome A Leis","doi":"10.1017/ice.2024.221","DOIUrl":"https://doi.org/10.1017/ice.2024.221","url":null,"abstract":"<p><p>A daily prompt to offer vaccination to inpatients awaiting transfer to rehabilitation resulted in increased SARS-CoV-2 (OR 5.64, 95% CI 3.3-10.15; <i>P</i> < 0.001) and influenza (OR 3.80, 95% CI 2.45-6.06; <i>P</i> < 0.001) vaccination. Compared to baseline, this intervention was associated with reduced incidence of viral respiratory infection during subsequent admission to rehabilitation.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation and generalizability of an asymptomatic bacteriuria metric in critical access hospitals.","authors":"Hannah Imlay, Claire E Ciarkowski, Chloe Bryson-Cahn, Jeannie D Chan, Whitney P Hartlage, Adam L Hersh, John B Lynch, Natalia Martinez-Paz, Emily S Spivak, Hannah Hardin, Andrea T White, Chaorong Wu, Zahra Kassamali Escobar, Valerie M Vaughn","doi":"10.1017/ice.2024.206","DOIUrl":"https://doi.org/10.1017/ice.2024.206","url":null,"abstract":"<p><strong>Objective: </strong>Inappropriate diagnosis and treatment of urinary tract infections (UTIs) contribute to antibiotic overuse. The Inappropriate Diagnosis of UTI (ID-UTI) measure uses a standard definition of asymptomatic bacteriuria (ASB) and was validated in large hospitals. Critical access hospitals (CAHs) have different resources which may make ASB stewardship challenging. To address this inequity, we adapted the ID-UTI metric for use in CAHs and assessed the adapted measure's feasibility, validity, and reliability.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Participants: </strong>10 CAHs.</p><p><strong>Methods: </strong>From October 2022 to July 2023, CAHs submitted clinical information for adults admitted or discharged from the emergency department who received antibiotics for a positive urine culture. Feasibility of case submission was assessed as the number of CAHs achieving the goal of 59 cases. Validity (sensitivity/specificity) and reliability of the ID-UTI definition were assessed by dual-physician review of a random sample of submitted cases.</p><p><strong>Results: </strong>Among 10 CAHs able to participate throughout the study period, only 40% (4/10) submitted >59 cases (goal); an additional 3 submitted >35 cases (secondary goal). Per the ID-UTI metric, 28% (16/58) of cases were ASB. Compared to physician review, the ID-UTI metric had 100% specificity (ie all cases called ASB were ASB on clinical review) but poor sensitivity (48.5%; ie did not identify all ASB cases). Measure reliability was high (93% [54/58] agreement).</p><p><strong>Conclusions: </strong>Similar to measure performance in non-CAHs, the ID-UTI measure had high reliability and specificity-all cases identified as ASB were considered ASB-but poor sensitivity. Though feasible for a subset of CAHs, barriers remain.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electronic evaluation of infection risk from room environment and prior room occupants: the transmission from room environment events (TREE) measure.","authors":"Clare Rock, Yea-Jen Hsu, Aaron M Milstone, Alejandra B Salinas, Lisa Maragakis, Nathan Kwon, Sara E Cosgrove, Patricia J Simner, Zunaira Virk, Abigail H Vorsteg, Eili Klein","doi":"10.1017/ice.2024.194","DOIUrl":"https://doi.org/10.1017/ice.2024.194","url":null,"abstract":"<p><p>Over a 2-year period, we identified Transmission from Room Environment Events (TREE) across the Johns Hopkins Health System, where the subsequent room occupant developed the same organism with the same antimicrobial susceptibilities as the patient who had previously occupied that room. Overall, the TREE rate was 50/100,000 inpatient days.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-4"},"PeriodicalIF":3.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}