Infection Control and Hospital Epidemiology最新文献

{"title":"WHO global research agenda for hand hygiene improvement in health care: a Delphi consensus study.","authors":"Benedetta Allegranzi, Ermira Tartari, Claire Kilpatrick, Julie Storr, Nita Bellare, João Bana, Ana Flávia Santos, Sarah Charnaud, Anna Laura Ross, Mitchell J Schwaber, Didier Pittet","doi":"10.1017/ice.2025.32","DOIUrl":"10.1017/ice.2025.32","url":null,"abstract":"<p><strong>Objective: </strong>To identify global research priorities for improving hand hygiene in healthcare settings and develop a 2023-2030 research agenda to guide funding, coordinate research, promote investment, and inform policy for enhanced healthcare quality and safety.</p><p><strong>Design: </strong>Expert consensus study using a modified Delphi process.</p><p><strong>Participants: </strong>A 105-member panel of international hand hygiene experts including the World Health Organization (WHO) Technical Advisory Group of Experts on Hand Hygiene in Healthcare representing all WHO regions and World Bank income levels.</p><p><strong>Methods: </strong>The research priorities were identified through a multiphase approach including a meta-review to establish knowledge gaps and inform initial priorities, followed by expert consultations using a modified Delphi process. 192 preliminary priorities were included in a two-round Delphi survey. Experts rated each priority in the first round, and then reviewed and adjusted responses based on the panel's aggregated, anonymous responses in the second round. Ratings were collected on a five-point Likert scale. Consensus was defined as a combined \"strongly agree\" and \"agree\" frequency of at least 70%.</p><p><strong>Results: </strong>Consensus was achieved for 178 of 192 priorities (92.7%), categorized into six domains: system change; training and education; evaluation and feedback; reminders and communications; institutional safety climate; and hand hygiene improvement impact on healthcare-associated infections and antimicrobial resistance. Of these, 121 priorities reached >80% consensus. The Delphi process, maintained a 92% response rate over two rounds.</p><p><strong>Conclusions: </strong>A structured consensus process yielded a research agenda to address gaps in hand hygiene improvement, supporting enhanced healthcare quality and safety globally.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-16"},"PeriodicalIF":3.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7617569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Mr. Babar's Letter to the Editor regarding \"Healthcare worker attitudes on routine non-urological preoperative urine cultures: a qualitative assessment\".","authors":"Julia E Friberg Walhof, Marin L Schweizer, Kalpana Gupta, Madisen Brown, Daniel Suh, Judith Strymish, William J O'Brien, Jeffrey Chan, Kelly Miell, Vanessa Au, Barbara W Trautner, Kimberly C Dukes","doi":"10.1017/ice.2024.216","DOIUrl":"https://doi.org/10.1017/ice.2024.216","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1"},"PeriodicalIF":3.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657193","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":"Reducing catheter-associated urinary tract infection rates in surgical critical care units via an informal catheter exchange protocol.","authors":"Aricia Shen, Ryan Raypon, Meghan Madhusudhan, Michael Nurok, Tejal Brahmbhatt, Jonathan D Grein, Galinos Barmparas, Michael A Ben-Aderet","doi":"10.1017/ice.2025.47","DOIUrl":"10.1017/ice.2025.47","url":null,"abstract":"<p><p>Urinary catheter replacement prior to urinary tract infection assessment, introduced as a quality improvement recommendation in two surgical intensive care units, was associated with (88% and 84%) reduction in catheter-associated urinary tract infections and significant reductions in urine cultures performed.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the safety of increased outpatient cephalosporin use following the modification of penicillin allergy cross-reactivity alerts.","authors":"Bryan Schneider, Kelly M Percival, Anna M Rhinehart, Jared Frye, Deanna L McDanel, Kevin L Bebout, Lukasz D Weiner, Sarah A Auerbach, Amy M Dowden, Dilek Ince, Patrick Kinn","doi":"10.1017/ice.2025.9","DOIUrl":"https://doi.org/10.1017/ice.2025.9","url":null,"abstract":"<p><strong>Background: </strong>Concerns about penicillin-cephalosporin cross-reactivity have historically led to conservative prescribing and avoidance of cephalosporins in patients with penicillin allergy labels, potentially causing suboptimal outcomes. Recent evidence suggests a lower risk of cross-reactivity, prompting a reassessment of alert systems.</p><p><strong>Objective: </strong>To assess the impact of limited penicillin cross-reactivity alerts on outpatient cephalosporin use and the incidence of adverse reactions in a healthcare setting.</p><p><strong>Methods: </strong>This retrospective cohort study compared cephalosporin prescribing and adverse reactions in patients labeled as penicillin-allergic before and after limiting penicillin cross-reactivity alerts in the electronic medical record at a large academic medical center.</p><p><strong>Results: </strong>Among 17,174 patients (8,131 pre- and 9,043 post-implementation), there was a statistically significant increase in outpatient cephalosporin prescribing by 8% (<i>P</i> < .001). The use of alternative antibiotic classes decreased. There was no statistically significant increase in adverse events pre- and post-implementation (0.036%-0.058%, <i>P</i> = .547), and no severe events were attributable to cross-reactivity. The alert modification reduced alerts by 92% (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>The reduction of penicillin-cephalosporin cross-reactivity alerts was associated with increased cephalosporin use, without a significant increase in adverse reactions. This demonstrates that the practice is safe and decreases alert burden.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614869","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":"Evaluation of Department of Defense hospital antimicrobial stewardship programs (ASPs) using a novel Core Elements scoring approach and modeling Core Elements scores with metrics related to ASP outcomes.","authors":"LeeAnne C Lynch, Katrin Mende, Rana F Hamdy, Cara H Olsen, Paige E Waterman, John M Young, David R Tribble","doi":"10.1017/ice.2025.33","DOIUrl":"https://doi.org/10.1017/ice.2025.33","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate Department of Defense (DoD) antimicrobial stewardship programs (ASPs) by assessing the relationship between key clinical outcome metrics (antibiotic use, incidence of resistant pathogens, and incidence of <i>Clostridioides difficile</i> infections) and CDC Core Element (CE) adherence.</p><p><strong>Design: </strong>Retrospective, cross-sectional study of DoD hospitals in 2018 and 2021.</p><p><strong>Methods: </strong>National Healthcare Safety Network Standardized Antimicrobial Administration Ratios (SAARs) were used to measure antibiotic use and microbiology results to evaluate four types of pathogen incidence. A novel CE scoring approach used scores to quantitatively assess relationships with CE adherence and outcome metrics using correlation and regression models. Assessments were repeated with 2021 data for Priority CE adherence and to conduct adjusted regressions for CEs and Priority CEs controlling for categorical bed size.</p><p><strong>Results: </strong>Compared to 2022 national data, DoD hospitals in 2021 had a similar proportion of facilities with a SAAR statistically significantly > 1.0. Leadership, Action, and Tracking CEs followed a more normal score distribution, while Reporting and Education were somewhat left-skewed. Unadjusted models often showed a positive relationship with higher CE scores associated with worse outcomes for the SAAR and pathogen incidence. Adjusted models indicated that procedural CEs, particularly Priority Reporting, were associated with better ASP-related outcomes.</p><p><strong>Conclusions: </strong>CEs should be more quantitatively assessed. Results provide initial evidence to prioritize procedural CE implementation within the DoD; however, additional investigation for structural CEs is needed. Patient outcome data should be collected as an important indicator of ASP performance.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-11"},"PeriodicalIF":3.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614870","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":"A mixed-methods study assessing the performance of a clinical decision support tool for <i>Clostridioides difficile</i> testing for patients receiving laxatives.","authors":"David R Peaper, Shardul N Rathod, L Scott Sussman, Marwan M Azar, Christina Murdzek, Scott C Roberts, Eric M Tichy, Jeffrey E Topal, Nitu Kashyap, Dayna McManus, Richard A Martinello","doi":"10.1017/ice.2025.30","DOIUrl":"10.1017/ice.2025.30","url":null,"abstract":"<p><strong>Objective: </strong>To better understand clinicians' rationale for ordering testing for <i>C. difficile</i> infection (CDI) for patients receiving laxatives and the impact of the implementation of a clinical decision support (CDS) intervention.</p><p><strong>Design: </strong>A mixed-methods, case series was performed from March 2, 2017 to December 31, 2018.</p><p><strong>Setting: </strong>Yale New Haven Hospital, a 1,541 bed tertiary academic medical center.</p><p><strong>Participants: </strong>Hospitalized patients ≥ 18 years old, and clinicians who were alerted by the CDS.</p><p><strong>Intervention: </strong>CDS was triggered in real-time when a clinician sought to order testing for CDI for a patient who received one or more doses of laxatives within the preceding 24 hours.</p><p><strong>Results: </strong>A total of 3,376 CDS alerts were triggered during the 21-month study period from 2,567 unique clinician interactions. Clinicians bypassed the CDS alert 74.5% of the time, more frequent among residents (48.3% bypass vs. 39.9% accept) and advanced practice providers (APPs) (34.9% bypass vs. 30.6% accept) than attendings (11.3% bypass vs. 22.5% accept). Ordering clinicians noted increased stool frequency/output (48%), current antibiotic exposure (34%), and instructions by an attending physician to test (28%) were among the most common reasons for overriding the alert and proceeding with testing for CDI.</p><p><strong>Conclusions: </strong>Testing for CDI despite patient laxative use was associated with an increased clinician concern for CDI, patient risk for CDI, and attending physician instruction for testing. Attendings frequently accepted CDS guidance while residents and APPs often reinstated CDI test orders, suggesting a need for greater empowerment and discretion when ordering tests.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of central line-associated bloodstream infection: focus on time of insertion.","authors":"Ari Moskowitz, Melissa Fazzari, Luke Andrea, Jianwen Wu, Arup Gope, Thomas Butler, Amira Mohamed, Christine Shen, Fran Ganz-Lord, Inessa Gendlina, Michelle Ng Gong","doi":"10.1017/ice.2025.1","DOIUrl":"https://doi.org/10.1017/ice.2025.1","url":null,"abstract":"<p><strong>Objective: </strong>Central line-associated bloodstream infections (CLABSIs) result in morbidity and mortality among hospitalized patients. Hospital interventions to reduce the incidence of CLABSI are often broadly applied to all patients with central venous access. Identifying central lines at high risk for CLABSI at time of insertion will allow for a more focused delivery of preventative interventions.</p><p><strong>Design: </strong>This was an observational cohort study conducted at three hospitals including all patients who received central venous access. CLABSIs were identified using an institutional CLABSI database maintained by the hospital epidemiology team. Logistic regression (LASSO) and machine learning (random forest, XGboost) techniques were applied for the prediction of CLABSI occurrence, adjusting for selected patent and insertion-level characteristics.</p><p><strong>Results: </strong>A total of 40,008 central venous catheters were included, of which 409 (1.02%) were associated with CLABSI. The random forest and the XGBoost models had the highest discrimination (Area Under the Received Operating Curve [AUC] 0.79) followed by LASSO (0.73). High illness severity, receipt of total parenteral nutrition, receipt of hemodialysis, pre-insertion hospital length-of-stay, and low albumin levels were all predictive of CLABSI occurrence. Precision for all models was poor owing to a high false-positive rate.</p><p><strong>Discussion: </strong>CLABSI can be predicted based upon patient and insertion level factors in the electronic health record. In this study, random forest and gradient-boosted models had the highest AUC. Prediction cut-offs for the identification of CLABSI can be adjusted based upon the acceptable rate of false-positives for a given CLABSI preventative intervention.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-8"},"PeriodicalIF":3.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584857","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":"Association of facility vaccination policy with influenza vaccination among healthcare personnel in acute care hospitals: national Healthcare Safety Network, 2021-22 influenza season.","authors":"Cam-Van T Huynh, Emily Haanschoten, Minn M Soe, Kira Barbre, Lu Meng, Jonathan R Edwards, Elizabeth J Kalayil, Megan C Lindley, Hannah E Reses, David T Kuhar, Matthew J Stuckey, Andrea Benin, Jeneita M Bell","doi":"10.1017/ice.2025.24","DOIUrl":"https://doi.org/10.1017/ice.2025.24","url":null,"abstract":"<p><p>We examined the association between influenza vaccination policies at acute care hospitals and influenza vaccination coverage among healthcare personnel for the 2021-22 influenza season. Mandatory vaccination and masking for unvaccinated personnel were associated with increased odds of vaccination. Hospital employees had higher vaccination coverage than licensed independent practitioners.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-5"},"PeriodicalIF":3.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536710","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":"Real-word utility of procalcitonin in patients hospitalized with community-acquired pneumonia: A matched cohort study.","authors":"Dan Ilges, Dylan Kosaski, Maria Teresa Seville, Alyssa K McGary, John C O'Horo, Christine L Snozek, Ryan W Stevens, Aditya Shah","doi":"10.1017/ice.2025.35","DOIUrl":"https://doi.org/10.1017/ice.2025.35","url":null,"abstract":"<p><strong>Objective: </strong>To retrospectively observe procalcitonin (PCT) and antibiotic ordering practices in patients hospitalized with community-acquired pneumonia (CAP).</p><p><strong>Design: </strong>Retrospective, exact matched, multicenter cohort study from October 1, 2018 - March 31, 2023.</p><p><strong>Setting: </strong>All hospitals across the Mayo Clinic Enterprise.</p><p><strong>Participants: </strong>Adult patients with CAP, identified using pneumonia diagnosis codes and receipt of systemic antibiotics with an indication of \"respiratory tract infection\" within 48 hours of hospitalization.</p><p><strong>Methods: </strong>PCT testing within the first 7 days of hospitalization was compared to non-PCT care (nPCT). The primary outcomes were treatment duration, antibiotic days of therapy (DOT), and length of stay (LOS).</p><p><strong>Results: </strong>15364 patients met inclusion criteria. PCT testing occurred in 42.4% (6515/15364) of encounters, totaling 8214 PCT results. 12880 unique patient encounters were matched 1:1, 6440 in each group. Treatment duration was longer in the PCT group compared to the nPCT group (5.1 vs 4.6 days, respectively, <i>P</i> < 0.001). Patients in the PCT group also received more DOT (8.6 vs 7.6 DOT, <i>P</i> < 0.001) and had a longer LOS (6.8 vs 5.9 days, <i>P</i> < 0.001), respectively. There was no difference in 30-day all-cause mortality or <i>C. difficile</i> infection between groups. In a sensitivity analysis of nPCT patients compared to those with a peak value <0.25 ng/mL (i.e. normal result) there was no difference in treatment duration (4.6 days nPCT vs 4.7 days normal PCT, <i>P</i> = 0.104) or LOS (5.9 days nPCT vs 6.0 days normal PCT, <i>P</i> = 0.134).</p><p><strong>Conclusion: </strong>PCT testing in patients hospitalized with CAP was not associated with reduced antimicrobial utilization, LOS, or 30-day all-cause mortality.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523270","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":"Hand hygiene opportunities in neonatal intensive care: a multicenter observational study to calibrate group electronic monitoring systems.","authors":"Eugene Lee, Stacey Clark, Paige Reason, Sarah Khan, Sabrina Fan, Michelle Li, Alex Cen, Asaph Rolnitsky, Alexander Kiss, Dominik Mertz, Jerome A Leis","doi":"10.1017/ice.2025.36","DOIUrl":"10.1017/ice.2025.36","url":null,"abstract":"<p><p>Observers were randomized to time and location across two different Neonatal Intensive Care Units (NICUs) to count hand hygiene opportunities (HHOs). Mean hourly HHO was lower at night and during use of precautions, and higher in shared rooms. HHO benchmarks can support implementation of group electronic monitoring systems in NICUs.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}