Infection Control and Hospital Epidemiology最新文献

{"title":"A telehealth approach to central line-associated bloodstream infection prevention activities in nursing homes: the SAFER lines program.","authors":"Raveena D Singh, Bardia Bahadori, Tom Tjoa, Mohamad N Alsharif, Shereen Nourollahi, Justin Chang, Amarah Mauricio, Jessica Bethlahmy, Syma Rashid, Raheeb Saavedra, Isabel Y Ashbaugh, Steven Tam, Shruti K Gohil","doi":"10.1017/ice.2024.203","DOIUrl":"10.1017/ice.2024.203","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the impact of a mobile-app-based central line-associated bloodstream infection (CLABSI) prevention program in nursing home residents with peripherally inserted central catheters (PICCs).</p><p><strong>Design: </strong>Pre-post prospective cohort study with baseline (September 2015-December 2016), phase-in (January 2017-April 2017), and intervention (May 2017-December 2018). Generalized linear mixed models compared intervention with baseline frequency of localized inflammation/infection, dressing peeling, and infection-related hospitalizations. Cox proportional hazards models compared days-to-removal of lines with localized inflammation/infection.</p><p><strong>Setting: </strong>Six nursing homes in Orange County, California.</p><p><strong>Patients: </strong>Adult nursing home residents with PICCs.</p><p><strong>Intervention: </strong>CLABSI prevention program consisting of an actionable scoring system for identifying insertion site infection/inflammation coupled with a mobile-app enabling photo-assessments and automated physician alerting for remote response.</p><p><strong>Results: </strong>We completed 8,131 assessments of 817 PICCs in 719 residents (baseline: 4,865 assessments, 422 PICCs, 385 residents; intervention: 4,264 assessments, 395 PICCs, 334 residents). The intervention was associated with 57% lower odds of peeling dressings (OR 0.43, 95% CI 0.28-0.64, <i>P</i> < .001), 73% lower local inflammation/infection (OR = 0.27, 95% CI: 0.13-0.56, <i>P</i> < .001), and 41% lower risk of infection-related hospitalizations (OR = 0.59, 95% CI: 0.42-0.83, <i>P</i> = .002). Physician mobile-app alerting and response enabled 62% lower risk of lines remaining in place after inflammation/infection was identified (HR 0.38, CI: 0.24-0.62, <i>P</i> < .001) and 95% faster removal of infected lines from mean (SD) 19 (20) to 1 (2) days.</p><p><strong>Conclusions: </strong>A mobile-app-based CLABSI prevention program decreased the frequency of inflamed/infected central line insertion sites, improved dressing integrity, increased speed of removal when inflammation/infection were found, and reduced infection-related hospitalization risk.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079674","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":"Identifying healthcare transmission routes of nontuberculous mycobacteria with whole genome sequencing: a systematic review.","authors":"Spencer D Schrank, Dale Z Gozum, Elise M Martin, Graham M Snyder","doi":"10.1017/ice.2025.6","DOIUrl":"10.1017/ice.2025.6","url":null,"abstract":"<p><strong>Objective: </strong>To enumerate and describe the effect of whole genome sequencing (WGS) on epidemiological investigations of healthcare-associated transmission of nontuberculous mycobacteria (NTM).</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Methods: </strong>We performed a literature search using targeted search terms to identify articles meeting inclusion criteria. Data extraction of study characteristics and outcomes was performed by two independent researchers. The primary outcome was the author interpretation of WGS utility in the investigation of suspected healthcare-associated transmission of NTM. The secondary outcome was whether a transmission route was identified through WGS.</p><p><strong>Results: </strong>Thirty-one studies were included in the final analysis with 28 (90%) concluding that WGS was helpful in transmission investigations and in 19 of these 28 (68%) WGS aided in identifying a transmission route. The most common identified transmission routes were water-borne point sources (10), heater-cooler units (6), patient-to-patient (4), and a healthcare worker (1).</p><p><strong>Conclusion: </strong>WGS is an informative tool in investigating healthcare transmission of NTM.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12015626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079676","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":"Central line utilization reduction via weekly prospective audit and feedback using a standardized audit tool.","authors":"Ken Dekitani, Meghan S Madhusudhan, Jonathan D Grein, Angelena R Lopez, Isabel F Pedraza, Michael A Ben-Aderet","doi":"10.1017/ice.2025.10","DOIUrl":"https://doi.org/10.1017/ice.2025.10","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065435","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":"Social mixing patterns of United States healthcare personnel at a quaternary health center: a prospective observational study.","authors":"Lauren Pischel, Obianuju G Aguolu, Noureen Ahmed, Melissa M Campbell, Ryan Borg, Chelsea Duckwall, Kathryn Willebrand, Agnieska Zaleski, Elliott E Paintsil, M Catherine Muenker, Amyn A Malik, Moses C Kiti, Joshua L Warren, Samuel M Jenness, Ben A Lopman, Justin Belsky, Richard A Martinello, Inci Yildirim, Albert I Ko, Saad B Omer","doi":"10.1017/ice.2024.234","DOIUrl":"10.1017/ice.2024.234","url":null,"abstract":"<p><strong>Background: </strong>Understanding healthcare personnel's (HCP) contact patterns are important to mitigate healthcare-associated infectious disease transmission. Little is known about how HCP contact patterns change over time or during outbreaks such as the COVID-19 pandemic.</p><p><strong>Methods: </strong>This study in a large United States healthcare system examined the social contact patterns of HCP via standardized social contact diaries. HCP were enrolled from October 2020 to June 2022. Participants completed monthly surveys of social contacts during a representative working day. In June 2022, participants completed a 2-day individual-level contact diary. Regression models estimated the association between contact rates and job type. We generated age-stratified contact matrices.</p><p><strong>Results: </strong>Three-hundred and sixty HCP enrolled, 157 completed one or more monthly contact diaries and 88 completed the intensive 2-day diary. In the monthly contact diaries, the median daily contacts were 15 (interquartile range (IQR) 8-20), this increased slightly during the study (slope-estimate 0.004, p-value 0.016). For individual-level contact diaries, 88 HCP reported 2,550 contacts over 2 days. HCP were 2.8 times more likely to contact other HCP (n = 1,592 contacts) than patients (n = 570 contacts). Rehabilitation/transport staff, diagnostic imaging technologists, doctors, nurses, mid-level, and laboratory personnel had higher contacts compared with the lowest contact group (Nursing aids). Contact matrices concentrated in working-age populations.</p><p><strong>Conclusions: </strong>HCP contacts concentrate in their work environment, primarily with other HCP. Their contacts remained stable over time even during large changes to societal contact patterns during the COVID-19 pandemic. This stability is critical for designing outbreak and pandemic responses.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065442","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":"Prospective, crossover, comparative study of two methods of chlorhexidine bathing.","authors":"Richard Jordan Hankins, Luke Handke, Paul D Fey, Ruth Jennifer Cavalieri, Kelly A Cawcutt, Trevor Van Schooneveld, Elizabeth Lyden, Robin High, Mark E Rupp","doi":"10.1017/ice.2024.243","DOIUrl":"10.1017/ice.2024.243","url":null,"abstract":"<p><strong>Background: </strong>Bathing intensive care unit (ICU) patients with chlorhexidine gluconate (CHG) decreases healthcare-associated infections (HAIs). The optimal method of CHG bathing remains undefined.</p><p><strong>Methods: </strong>Prospective crossover study comparing CHG daily bathing with 2% CHG-impregnated cloths versus 4% CHG solution. In phase 1, from January 2020 through March 2020, 1 ICU utilized 2% cloths, while the other ICU utilized 4% solution. After an interruption caused by the coronavirus disease 2019 pandemic, in phase 2, from July 2020 through September 2020, the unit CHG bathing assignments were reversed. Swabs were performed 3 times weekly from patients' arms and legs to measure skin microbial colonization and CHG concentration. Other outcomes included HAIs, adverse reactions, and skin tolerability.</p><p><strong>Results: </strong>411 assessments occurred after baths with 2% cloth, and 425 assessments occurred after baths with 4% solution. Average microbial colonization was 691 (interquartile range 0, 30) colony-forming units per square centimeter (CFU/cm²) for patients bathed with 2% cloths, 1,627 (0, 265) CFUs/cm² for 4% solution, and 8,519 (10, 1130) CFUs/cm² for patients who did not have a CHG bath (<i>P</i> < .001). Average CHG skin concentration (parts per million) was 1300.4 (100, 2000) for 2% cloths, 307.2 (30, 200) for 4% solution, and 32.8 (0, 20) for patients without a recorded CHG bath. Both CHG bathing methods were well tolerated. Although underpowered, no difference in HAI was noted between groups.</p><p><strong>Conclusions: </strong>Either CHG bathing method resulted in a significant decrease in microbial skin colonization with a greater CHG concentration and fewer organisms associated with 2% CHG cloths.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065439","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":"Real-world clinical impact of plasma cell-free DNA metagenomic next-generation sequencing assay.","authors":"Ishminder Kaur, Bennett Shaw, Ashrit Multani, Christine Pham, Sanchi Malhotra, Ethan Smith, Kristina Adachi, Paul Allyn, Zackary Bango, Omer Eugene Beaird, J R Caldera, Sukantha Chandrasekaran, Lynn Chan, Rabia Cheema, Sarah Daouk, Jaime Deville, Huan Vinh Dong, Austin Fan, Omai Garner, Pryce Gaynor, Hannah Gray, Aleksandr Gorin, Sowmya Kalava, Meganne Kanatani, Andrew Karnaze, Tawny Saleh, Yamini Sharma, Stacey Stauber, Moises Vargas, Monette Veral, Drew Winston, Lauren Yanagimoto-Ogawa, Grace Aldrovandi, Karin Nielsen-Saines, Trevon Fuller, Nicholas Jackson, Daniel Uslan, Joanna Schaenman, Tara Vijayan, Ashlyn Sakona, Shangxin Yang","doi":"10.1017/ice.2024.242","DOIUrl":"10.1017/ice.2024.242","url":null,"abstract":"<p><strong>Objective: </strong>To describe the real-world clinical impact of a commercially available plasma cell-free DNA metagenomic next-generation sequencing assay, the Karius test (KT).</p><p><strong>Methods: </strong>We retrospectively evaluated the clinical impact of KT by clinical panel adjudication. Descriptive statistics were used to study associations of diagnostic indications, host characteristics, and KT-generated microbiologic patterns with the clinical impact of KT. Multivariable logistic regression modeling was used to further characterize predictors of higher positive clinical impact.</p><p><strong>Results: </strong>We evaluated 1000 unique clinical cases of KT from 941 patients between January 1, 2017-August 31, 2023. The cohort included adult (70%) and pediatric (30%) patients. The overall clinical impact of KT was positive in 16%, negative in 2%, and no clinical impact in 82% of the cases. Among adult patients, multivariable logistic regression modeling showed that culture-negative endocarditis (OR 2.3; 95% CI, 1.11-4.53; <i>P</i> .022) and concern for fastidious/zoonotic/vector-borne pathogens (OR 2.1; 95% CI, 1.11-3.76; <i>P</i> .019) were associated with positive clinical impact of KT. Host immunocompromised status was not reliably associated with a positive clinical impact of KT (OR 1.03; 95% CI, 0.83-1.29; <i>P</i> .7806). No significant predictors of KT clinical impact were found in pediatric patients. Microbiologic result pattern was also a significant predictor of impact.</p><p><strong>Conclusions: </strong>Our study highlights that despite the positive clinical impact of KT in select situations, most testing results had no clinical impact. We also confirm diagnostic indications where KT may have the highest yield, thereby generating tools for diagnostic stewardship.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-8"},"PeriodicalIF":3.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065441","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":"Examining the impact of clinical features and built environment on risk of hospital onset <i>Clostridioides difficile</i> infection.","authors":"Priti Singh, Endia Reid, Justin Smyer, Jennifer Martin, James Odei, Courtney Hebert, David Kline","doi":"10.1017/ice.2024.239","DOIUrl":"10.1017/ice.2024.239","url":null,"abstract":"<p><strong>Objective: </strong>Environmental features of a patient's room depend on the patient's level of acuity and their clinical manifestations upon admission and during their hospital stay. In this study, we wish to apply statistical methodology to explore the association between room features and hospital onset infections caused by <i>Clostridioides difficile</i> (HO-CDI) while accounting for room assignment.</p><p><strong>Method: </strong>We conducted a nested case-control study using retrospective electronic health record (EHR) data of patients hospitalized at the Ohio State University Wexner Medical Center (OSUWMC) between January 2019 and April 2021. We collected clinical information and combined that with room-based information, collected as surveys. Data were analyzed to assess the association between room factors and HO-CDI.</p><p><strong>Results: </strong>2427 patients and 968 unique rooms were included in the study. Results indicated protective effects for rooms with cubical curtains near the patient (OR = 0.705, 95% CI = 0.549-0.906), rooms with separate shower units (OR = 0.674, 95% CI = 0.528-0.860), rooms with wall-mounted toilets (OR = 0.749, 95% CI = 0.592-0.950), rooms with sliding bathroom doors (OR = 0.593, 95% CI = 0.432-0.816), and sliding door knobs (OR = 0.593, 95% CI = 0.431-0.815). Rooms with manual paper towel dispensers had increased odds of HO-CDI (OR = 1.334, 95% CI = 1.053-1.691) compared to those with automatic towel dispensers.</p><p><strong>Conclusion: </strong>Results suggest possible association between specific room features and HO-CDI, which could be further investigated with techniques like environmental sampling. Moreover, findings from the study offer valuable insights for targeted intervention measures.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065437","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":"Benchmarking antimicrobial use to antimicrobial resistance: a comparative study of two hospitals using current National Healthcare Safety Network (NHSN) metrics.","authors":"Carlos A Q Santos, Sarah Y Won, Ryan Dwyer, Caren Perez, William E Trick","doi":"10.1017/ice.2024.210","DOIUrl":"https://doi.org/10.1017/ice.2024.210","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to determine whether benchmarking antimicrobial use (AU) to antimicrobial resistance (AR) using select AU/AR ratios is more informative than AU metrics in isolation.</p><p><strong>Design: </strong>We retrospectively measured AU (antimicrobial therapy days per 1,000 days present) and AU/AR ratios (specific antimicrobial therapy days per corresponding AR event) in two hospitals during 2020 through 2022. We then had antimicrobial stewardship committee members evaluate each AU and corresponding AU/AR value and indicate whether they believed it represented potential overuse, appropriate use, or potential underuse of the antimicrobials, or whether they could not provide an assessment.</p><p><strong>Setting: </strong>Two acute-care hospitals.</p><p><strong>Patients: </strong>Hospitalized patients.</p><p><strong>Results: </strong>In semi-annual facility-wide analyses, echinocandins had a median AU/AR ratio of 658.5 therapy days per fluconazole-resistant <i>Candida</i> event in Hospital A, IV vancomycin had a median AU/AR ratio of 114.9 and 108.2 therapy days per methicillin-resistant <i>Staphylococcus aureus</i> event in Hospital A and B, respectively, and linezolid had a median AU/AR ratio of 33.8 and 88.0 therapy days per vancomycin-resistant <i>Enterococcus</i> event in Hospital A and B, respectively. When AU and AU/AR values were evaluated by stewardship committees, more respondents were able to assess antimicrobial use based on AU/AR values compared to AU values. Based on AU/AR ratios, most respondents identified potential overuse of echinocandins and IV vancomycin in Hospital A, and potential overuse of linezolid and IV vancomycin in Hospital B.</p><p><strong>Conclusion: </strong>Select AU/AR ratios provided informative metrics to antimicrobial stewardship personnel, which can be used to motivate audits of antimicrobial administration to determine appropriateness.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-8"},"PeriodicalIF":3.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046509","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":"Beyond the hospital doors: challenges and insights from a multi-state healthcare system outpatient infection prevention program.","authors":"Kelli Heisner, Jessica Layell, Robert Citronberg, Mindy Sampson, Catherine Passaretti, Lynn Skelton","doi":"10.1017/ice.2024.232","DOIUrl":"https://doi.org/10.1017/ice.2024.232","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046513","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":"Heterogeneity in preoperative <i>Staphylococcus aureus</i> screening and decolonization strategies among healthcare institutions.","authors":"Sarah L Bennis, Shalini Kulasingam, Patricia Ferrieri, Susan E Kline","doi":"10.1017/ice.2024.231","DOIUrl":"10.1017/ice.2024.231","url":null,"abstract":"<p><p>We surveyed 111 institutions' practices for screening and decolonization of <i>Staphylococcus aureus</i> in presurgical patients. Institutions commonly utilize universal, targeted, or no decolonization strategies. Frequently reported products were nasal mupirocin, chlorhexidine gluconate bathing, and nasal povidone-iodine. Practice variability indicates opportunities to define optimal strategies.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-4"},"PeriodicalIF":3.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046576","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}