Antimicrobial Stewardship & Healthcare Epidemiology最新文献

{"title":"Risk factors for the transmission of <i>Clostridioides difficile</i> or methicillin-resistant <i>Staphylococcus aureus</i> in acute care","authors":"Xuetao Wang, Matthew Garrod, Tamara Duncombe, Eunsun Lee, Katy Short Joyce Ng","doi":"10.1017/ash.2023.376","DOIUrl":"https://doi.org/10.1017/ash.2023.376","url":null,"abstract":"Background: Some hospitals continue to struggle with nosocomial transmission of Clostridioides difficile infection (CDI) and methicillin-resistant Staphylococcus aureus (MRSA) despite years of infection control efforts. We investigated the relationship between unit infrastructural–organizational risk factors and nosocomial transmission of CDI and MRSA. Methods: This retrospective observational study included 100 eligible acute-care inpatient units from 12 hospitals in British Columbia, Canada, from April 1, 2020, to September 16, 2021. The outcome variables included whether a unit was on the CDI or MRSA vulnerable unit list (ie, defined as having ≥5 CDI cases or ≥6 MRSA cases being attributed to the unit in the last 6 fiscal periods), the average CDI/MRSA rate, as well as the average CDI/MRSA standardized infection ratio (SIR). Independent variables included, but were not limited to, infection control factors (eg hand hygiene rate), infrastructural factors (eg, unit age, total beds on unit), and organizational factors (eg, hallway bed utilization, nursing overtime). Multivariable regression was performed to identify statistically significant risk factors using SAS, R Studio, and Stata software. Results: For CDI, older units were associated with higher odds of being on the CDI vulnerable unit list (aOR, 1.086; 95% CI, 1.024–1.175), higher CDI rate (adjusted relative risk [aRR], 0.012; 95% CI, 0.004–0.020), and higher CDI SIR (aRR, 0.011; 95% CI, 0.003–0.020). Larger unit size was associated with higher odds of being on the CDI vulnerable unit list (aOR, 1.210; 95% CI, 1.095–1.400) and higher CDI SIR (aRR, 0.013; 95% CI, 0.001–0.026). For MRSA, an increase in hand hygiene rate was associated with lower odds of being on the MRSA vulnerable unit list (aOR, 0.71; 95% CI, 0.53–0.897), lower MRSA rate (aRR, −0.035; 95% CI, −0.063 to −0.008), and lower MRSA SIR (aRR, −0.039; 95% CI, −0.069 to −0.008). Higher MRSA bioburden was associated with higher odds of being on the MRSA vulnerable unit list (aOR, &gt;999; 95% CI, &gt;999 to &gt;999), higher MRSA rate (aRR, 9.008; 95% CI, 5.586–12.429), and higher MRSA SIR (aRR, 4.964; 95% CI, 1.971–7.958). Additionally, higher MRSA rates were associated increased utilization of hallway beds (aRR, 0.680; 95% CI, 0.094–1.267), increased nursing overtime rate (aRR, 5.018; 95% CI, 1.210–8.826), and not having a clean supply room with the door consistently closed (aRR, −0.283; 95% CI, −0.536 to −0.03). Conclusions: Several infrastructural and organizational factors were associated with nosocomial transmissions of CDI and MRSA. Further research is needed to investigate the mechanisms by which these factors are associated. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of four environmental sampling methods for the recovery of multidrug-resistant organisms","authors":"Ahmed Babiker, Alex Page, Julia Van Riel, Eli Wilber, Amanda Strudwick, Chris Bower, Michael Woodworth, Sarah Satola","doi":"10.1017/ash.2023.232","DOIUrl":"https://doi.org/10.1017/ash.2023.232","url":null,"abstract":"Background: Environmental contamination is a major risk factor for multidrug-resistant organism (MDRO) exposure and transmission in the healthcare setting. Sponge-stick sampling methods have been developed and validated for MDRO epidemiological investigations, leading to their recommendation by public health agencies. However, similar bacteriological yields with more readily available methods that require less processing time or specialized equipment have also been reported. We compared the ability of 4 sampling methods to recover a variety of MDRO taxa from a simulated contaminated surface. Methods: We assessed the ability of (1) cotton swabs moistened with phosphate buffer solution (PBS), (2) e-swabs moistened with e-swab solution, (3) cellulose-containing sponge sticks (CSS), and (4) non–cellulose-containing sponge sticks (NCS) to recover extended-spectrum β-lactamase (ESBL)–producing Escherichia coli , carbapenem-resistant Pseudomonas aeruginosa (CRPA), carbapenem-resistant Acinetobacter baumannii (CRAB), methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium (VRE), and a mixture that contained VRE, MRSA, and ESBL organisms. A solution of known bacterial inoculum (~10 5 CFU/mL) was made for each MDRO. Then, 1 mL solution was pipetted on a stainless-steel surface (8 × 12 inch) in 5 µL dots and allowed to dry for 1 hour. All samples were collected by 1 individual to minimize variation in technique. Sponge sticks were expressed in PBS containing 0.02% Tween 80 using a stomacher, were centrifuged, and were then resuspended in PBS. Cotton and e-swabs were spun in a vortexer. Then, 1 mL of fluid from each method was plated to selective and nonselective media in duplicate and incubated at 35°C for 24 hours (MRSA plates, 48 hours) (Fig. 1). CFU per square inch and percentage recovery were calculated. Results: Table 1 shows the CFU per square inch and percentage recovery for each sampling method–MDRO taxa combination. The percentage recovery varied across MDRO taxa. Across all methods, the lowest rate of recovery was for CRPA and the highest was for VRE. Regardless of MDRO taxa, the percentage recovery was highest for the sponge stick (CSS and NCS) compared to swab (cotton and E-swab) methods across all taxa (Table 1 and Fig. 2). Conclusions: These findings support the preferential use of sponge sticks for the recovery of MDROs from the healthcare environment, despite the additional processing and equipment time needed for sponge sticks. Further studies are needed to assess the robustness of these findings in noncontrived specimens as well as the comparative effectiveness of different sampling methods for non–culture-based MDRO detection. Disclosure: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outbreak of <i>Burkholderia multivorans</i> among patients at two acute-care hospitals in California, August 2021–July 2022","authors":"Kiara McNamara, W. Wyatt Wilson, Dipesh Solanky, Sophie Jones, Elizabeth Ohlsen, J.B. Bertumen, Mark Beatty, Heather Moulton-Meissner, Paige Gable, John LiPuma, Grace Kang, Margaret Turner, Erin Epson, Kiran Perkin, Raymond Chinn, Jane Siegel","doi":"10.1017/ash.2023.353","DOIUrl":"https://doi.org/10.1017/ash.2023.353","url":null,"abstract":"Background: Burkholderia multivorans are gram-negative bacteria typically found in water and soil. B. multivorans outbreaks among patients without cystic fibrosis have been associated with exposure to contaminated medical devices or nonsterile aqueous products. Acquisition can also occur from exposure to environmental reservoirs like sinks or other hospital water sources. We describe an outbreak of B. multivorans among hospitalized patients without cystic fibrosis at 2 hospitals within the same healthcare system in California (hospitals A and B) between August 2021 and July 2022. Methods: We defined confirmed case patients as patients without cystic fibrosis hospitalized at hospital A or hospital B between January 2020 to July 2022 with B. multivorans isolated from any body site matching the outbreak strain. We reviewed medical records to describe case patients and to identify common exposures. We evaluated infection control practices and interviewed staff to detect exposures to nonsterile water. Select samples from water, ice, drains, and sink splash zone surfaces were collected and cultured for B. multivorans in March 2022 and July 2022 from both hospitals. Common aqueous products used among case patients were tested for B. multivorans . Genetic relatedness between clinical and environmental samples was determined using random amplified polymorphic DNA (RAPD) and repetitive extragenic palindromic polymerase chain reaction (Rep-PCR). Results: We identified 23 confirmed case patients; 20 (87%) of these were identified at an intensive care unit (ICU) in hospital A. B. multivorans was isolated from respiratory sources in 18 cases (78%). We observed medication preparation items, gloves, and patient care items stored within sink splash zones in ICU medication preparation rooms and patient rooms. Nonsterile water and ice were used for bed baths, swallow evaluations, and ice packs. B. multivorans was cultured from ice and water dispensed from an 11-year-old ice machine in the ICU at hospital A in March 2022 but no other water sources. Additional testing in July 2022 yielded B. multivorans from ice and a drain pan from a new ice machine in the same ICU location at hospital A. All products were negative. Clinical and environmental isolates were the same strain by RAPD and Rep-PCR. Conclusions: The use of nonsterile water and ice from a contaminated ice machine contributed to this outbreak. Water-related fixtures can serve as reservoirs for Burkholderia , posing infection risk to hospitalized and immunocompromised patients. During outbreaks of water-related organisms, such as B. multivorans , nonsterile water and ice use should be investigated as potential sources of transmission and other options should be considered, especially for critically ill patients. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A national survey of PICU clinician practices and perceptions about respiratory cultures for invasively ventilated patients","authors":"Anna Sick-Samuels, Danielle Koontz, Anping Xie, Daniel Kell, Charlotte Woods-Hill, Anushree Aneja, Shaoming Xiao, Elizabeth Colantuoni, Jill Marsteller, Aaron Milstone","doi":"10.1017/ash.2023.236","DOIUrl":"https://doi.org/10.1017/ash.2023.236","url":null,"abstract":"Background: Respiratory cultures are commonly obtained from patients with suspicion for ventilator-associated infections (VAIs). In the absence of specimen ordering and collection guidelines, management practices may differ. We characterized current respiratory culture collection practices and perceptions and identified potential barriers to changing practices among a national collaborative of pediatric intensive care units (PICUs). Methods: We conducted an electronic survey of PICU physicians, advanced practice providers (APPs), respiratory therapists (RTs), and nurses at 16 US academic pediatric hospitals across the United States. Positive Likert-scale responses (eg, “agree” and “strongly agree”) were grouped. To account for varying hospital representation, we analyzed the results as the median proportion of participants with that response across the hospitals. Results: After excluding incomplete responses, 568 (44%) of 1,301 invited participants responded (range, 16–107 per site); the median hospital response rate was 60% (range, 17%–83%). Roles included physicians (35%), APPs (10%), RTs (24%), and nurses (31%). Moreover, 44% of the participating units cared for cardiac surgery patients. Across hospitals, specimens are often collected by RTs, followed by nurses, typically via inline endotracheal aspirate for either endotracheal tubes or tracheostomies. Saline lavage is a common practice, but only 4% reported a standardized approach. Examining the likeliness to obtain cultures for different clinical symptoms, the widest variation in responses were for fever and inflammatory markers without respiratory symptoms (median proportion, 68%; IQR, 54%–79%), isolated change in secretion characteristics (67%; IQR, 54%–78%), isolated increased secretions (55%; IQR, 40%–65%), isolated inflammatory markers (49%; IQR, 38%–57%) or isolated fever (49%; IQR, 38%–61%). Overall, 75% (IQR, 70%–86%) of reported respiratory cultures were likely to be obtained as a “pan culture.” Most respondents (median proportion, 69%) felt confident about the indications to obtain cultures, but 60% felt that clinicians had a low threshold, and 84% reported clinical practice variation. Barriers to change included reluctance to change (70%), opinion of consultants (64%), and fear of missing a diagnosis of VAI (62%). Respondents agreed that they would find clinical decision support (CDS) tools helpful (79%). In addition, 83% expected that they would follow CDS, and 82% thought that CDS would help align ICU and/or consulting teams. Conclusions: Among 16 participating hospitals, we detected a lack of standardized respiratory-culture specimen collection and ordering practices. Most respondents agreed that CDS tools would be helpful. Diagnostic stewardship of respiratory cultures using CDS must account for potential reluctance to change and needs to address stakeholder perspectives, including fear of missing infections. Disclosure: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated safety analysis of phase 3 studies for investigational microbiome therapeutic, SER-109, in recurrent CDI","authors":"Matthew Sims, Charles Berenson, Stuart Cohen, Elaine Wang, Elizabeth Hohmann, Richard Nathan, Alberto Odio, Paul Cook, Kelly Brady, David Lombardi, Asli Memisoglu, Ananya De, Brooke Hasson, Bret Lashner, Louis Korman, Doria Grimard, Juan Carlos Moises Gutierrez, Barbara McGovern, Lisa Von Moltke","doi":"10.1017/ash.2023.281","DOIUrl":"https://doi.org/10.1017/ash.2023.281","url":null,"abstract":"Background: Clostridioides difficile infection (CDI) often recurs in patients aged ≥65 years and those with comorbidities. Clinical trials often exclude patients with history of immunosuppression, malignancy, renal insufficiency, or other comorbidities. In a phase 3 trial (ECOSPOR III), SER-109 was superior to placebo in reducing recurrent CDI (rCDI) risk at week 8 and was well tolerated. We report integrated safety data for SER-109 in a broad patient population through week 24 from phase 3 studies: ECOSPOR III and ECOSPOR IV. Methods: ECOSPOR III was a double-blind, placebo-controlled trial conducted in participants with ≥2 CDI recurrences randomized 1:1 to placebo or SER-109. ECOSPOR IV was an open-label, single-arm study conducted in 263 patients with rCDI enrolled in 2 cohorts: (1) rollover participants from ECOSPOR III with on-study recurrence and (2) participants with ≥1 CDI recurrence, inclusive of the current episode. In both studies, the investigational product was administered as 4 oral capsules over 3 days. Treatment-emergent adverse events (TEAEs) were collected through week 8; serious TEAEs and TEAEs of special interest (ie, bacteremia, abscess, meningitis) were collected through week 24. Results: In total, 349 participants received SER-109 in ECOSPOR III and/or ECOSPOR IV (mean age 64.2; 68.8% female). Chronic diseases included cardiac disease (31.2%), immunocompromised or immunosuppressed (21.2%), diabetes (18.9% ), and renal impairment or failure (13.2%). Overall, 221 (63.3%) of 349 participants who received SER-109 experienced TEAEs through week 24. Most were mild to moderate and gastrointestinal. The most common (&gt;5% of participants) treatment related TEAEs were flatulence, abdominal pain and distension, decreased appetite, constipation, nausea, fatigue, and diarrhea. No participants experienced a treatment-related TEAE leading to study withdrawal. Invasive infections were observed in 28 participants (8%); those with identified pathogens were unrelated to SER-109 species, and all were deemed unrelated to treatment by the investigators. There were 11 deaths (3.2%) and 48 participants (13.8%) with serious TEAEs, none of which were deemed treatment related. There were no clinically important differences in the safety profile across subgroups of sex, race, prior antibiotic regimen, or number of CDI recurrences. No safety signals were observed in participants with renal impairment or failure, diabetes, cardiac disease, or immunocompromised or immunosuppressed individuals. Conclusions: In this integrated analysis of phase 3 trials, SER-109, an investigational microbiome therapeutic, was well tolerated in this vulnerable patient population with prevalent comorbidities. No infections, nor those with identified pathogens, were attributed to SER-109 or product species. This safety profile might be expected because this purified product is composed of spore-forming Firmicutes normally abundant in the healthy microbiome. Financial suppor","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"66 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Team-based infection preventionist review improves interrater reliability in identification of hospital-acquired infections","authors":"Alyssa Castillo, Sarah Totten, Larissa Pisney","doi":"10.1017/ash.2023.366","DOIUrl":"https://doi.org/10.1017/ash.2023.366","url":null,"abstract":"Background: The University of Colorado Health (UCHealth) metropolitan region is composed of 4 hospitals. Therein, 10 infection preventionists (IPs) retrospectively review all cases of potential central-line–associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and surgical site infection (SSI) to adjudicate whether each case meets the NHSN definitions for hospital-acquired infection (HAI). In August 2021, the UCHealth IP team structure transitioned from a subject-matter expert model (in which each IP reviewed a specific HAI) to a unit-based model (in which each IP reviewed all HAIs and SSIs on their assigned units) to create redundancy in knowledge and skill. The IP team subsequently instituted a weekly meeting to review all potential cases of HAI. We hypothesized that this review structure would result in increased consistency in the application of NHSN definitions across the UCHealth hospitals and units. Methods: From August 17, 2022, through March 3, 2023, the UCHealth IPs, managers, and medical directors met weekly for 1 hour via teleconferencing. Each IP presented key details for all near-miss and confirmed cases of SSI or HAI on their respective units and received questions and feedback from their peers and medical directors. Case determination was based on team discussion and consensus. If there was discordance in the interpretation of an NHSN case definition, a formal inquiry was sent to resolve the uncertainty. The number of cases reviewed, case determinations changed, and formal inquiries to NHSN were tracked. Results: During the study period, the IP team convened weekly meetings and reviewed 248 patient cases—of which 208 (83.9%) were confirmed HAIs. Based on collaborative team discussion, 14 cases (5.6%) were changed from reportable to nonreportable. Three cases (1.2%) originally thought to be nonreportable were changed to reportable. The HAI determination of a reportable case (eg, revision of a “superficial” SSI to “deep” SSI) was changed for 9 (6.0%). Following team discussion, 13 formal inquiries were sent to the NHSN to clarify case definitions, and these responses were collated for future reference. Conclusions: Team-based IP review of HAI cases improves consistency in application of NHSN case definitions and highlights areas of uncertainty in their interpretation. This team-based model of case review is a useful educational and practical tool to increase interrater reliability in case adjudication across large teams of IPs, to create a systematic way to query NHSN, and to ensure that knowledge gained is disseminated for future benefit. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRSA PCR improves sensitivity of detection of colonization in neonates","authors":"Nahid Hiermandi, Catherine Foster, Krystal Purnell, James Dunn, Judith Campbell, Lucila Marquez","doi":"10.1017/ash.2023.302","DOIUrl":"https://doi.org/10.1017/ash.2023.302","url":null,"abstract":"Background: Neonates colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at high risk of developing life-threatening MRSA infection. Due to lack of evidence, national guidelines do not currently recommend a specific methodology for detecting MRSA colonization. We hypothesize that surveillance for MRSA colonization via polymerase chain reaction (PCR) is superior to culture for the detection of colonization. Methods: In this retrospective study, we compared results of MRSA surveillance by 2 methodologies, culture and PCR, after implementation of an MRSA surveillance and decolonization protocol in the Texas Children’s Hospital Pavilion for Women, a 42-bed neonatal intensive care unit. MRSA colonization of 3 body sites via the 2 methodologies was assessed from June 2017 through December 2020. All neonates were screened for MRSA upon admission to the NICU and weekly thereafter until MRSA-positive or discharged. Swab specimens were initially tested by PCR (Xpert MRSA NxG, Cepheid) and when MRSA-positive reflexed to culture to recover the organism for further characterization. This study was approved through the Baylor College of Medicine Institutional Review Board. Results: During the study period, 2,351 neonates were assessed for MRSA colonization by PCR; 81 (3.4%) infants were PCR positive (Fig. 1). Of those 81, 57 (70.4%) had concordant MRSA PCR and culture results, and 24 (29.6%) were MRSA PCR positive but no isolate was recovered in culture. Also, 8 specimens were indeterminate by PCR. However, 1 infant who was negative by culture but was PCR positive developed an MRSA orbital infection. Compared to PCR, the overall sensitivity of MRSA culture was 70.4% (range, 57.7%–80.8%, depending on the year) (Table 1). Conclusions: PCR is more sensitive than culture for detecting MRSA colonization in neonates. Utilizing a PCR method enhances the ability to identify MRSA colonized infants more readily and allows for prompt initiation of infection control interventions including isolation precautions and decolonization strategies. Reflex to culture remains important for strain characterization during outbreak investigations and for additional susceptibility testing. Resource utilization and cost–benefit analyses should be done in future studies to influence changes in national guidelines for the control of Staphylococcus aureus colonization and infection in neonatal intensive care units. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of ventilation in low-resource healthcare settings: Montserrado County, Liberia—2022−2023","authors":"Krithika Srinivasan, Ronan Arthur, Ashley Styczynski, Ethan Bell, Thomas Baer, Jorge Salinas","doi":"10.1017/ash.2023.225","DOIUrl":"https://doi.org/10.1017/ash.2023.225","url":null,"abstract":"Background: Mitigating the risk of nosocomial respiratory disease transmission in the healthcare facilities of low- and middle−income countries (LMICs) poses unique challenges because mechanical ventilation and mixed−mode strategies are often unavailable. Carbon dioxide (CO 2 ) can serve as a proxy for ventilation and, hence, airborne infectious disease transmission risk in naturally ventilated spaces. We assessed the adequacy of ventilation in Liberian hospitals. Methods: We sampled 3 hospitals, both urban and rural, in Montserrado County, Liberia. Moreover, 3 CO 2 meters were concurrently utilized to measure CO 2 levels at a 1-meter height in every patient-care room in each facility. We recorded temperature, humidity, room dimensions, and number of people in the rooms. From these variables, we calculated absolute ventilation using the ASHRAE equation to determine areas with the highest risk of nosocomial respiratory disease transmission. We also recorded qualitative observations about the sampled spaces. Results: From August 2022 to February 2023, 39 rooms in 3 healthcare facilities were sampled. Initial quantitative findings show that only 8 rooms (21%) met the WHO-recommended ventilation rate of 60 L per second per person. The average ventilation rate per person in the adequately ventilated settings was 86 L per second per patient, compared to 19 liters per second per patient in inadequately ventilated rooms. Additionally, 467 ppm mean CO 2 was noted in well-ventilated rooms compared to 895 ppm mean CO 2 in inadequately ventilated rooms. Initial qualitative observations showed that facilities with lower CO 2 readings tended to be older constructions that likely had been constructed with airborne disease such as tuberculosis in mind. Willingness to open windows was limited by lack of window screens for malaria prevention, and there was a pervasive fallacy that air conditioning was a source of ventilation. Correspondingly, of the 31 inadequately ventilated rooms, 22 (71%) had operating air conditioning units compared with 4 (50%) of the 8 adequately ventilated rooms. Overall, of the 13 rooms without air conditioning, 7 (54%) were more frequently characterized by open windows compared to only 5 of 26 (28%) of rooms that did have air conditioners. Conclusions: Being prepared for the next respiratory disease outbreak and creating more resilient healthcare systems in LMICs requires a frameshift of prevention strategies. Measuring CO 2 provides a simple strategy for identifying areas at highest risk for nosocomial respiratory disease transmission, which can be prioritized for low-cost environmental interventions, such as provision of window screens, as part of routine infection prevention and control efforts. Disclosure: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"214 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a statewide infection prevention program assessment service for dialysis settings using a six-sigma framework","authors":"Chelsea Ludington, Renee Brum","doi":"10.1017/ash.2023.309","DOIUrl":"https://doi.org/10.1017/ash.2023.309","url":null,"abstract":"Background: Due to the need for recurrent and direct access to the bloodstream, patients who require hemodialysis are at higher risk of developing healthcare-associated infections. Failure to assess gaps in systems and processes impedes the implementation of quality and performance improvement initiatives. In Michigan, there is no consultative service offered to dialysis units to assist with infection prevention practices, and no statewide dialysis data are being utilized. The Michigan Department of Health and Human Services developed a consultative, nonregulatory service dedicated to providing a comprehensive assessment of dialysis-based infection prevention programs. Methods: A multidisciplinary team created an infection prevention dialysis evaluation program using the six-sigma define–measure–analyze–design–verify model. These elements included content within the dialysis-specific Infection Control Assessment and Response (ICAR) Tool from the CDC with supporting program assessment items. From August 2021 through August 2022, the team completed 17 inpatient dialysis assessments within our cohort’s 17 hospitals. Data were analyzed using descriptive statistical analysis, and the final analysis included 1,086 observations from the developed assessment tool. Observations were grouped into 7 infection prevention categories: appropriate use of single and multiuse devices and supplies, aseptic technique, bloodborne pathogen prevention, cleaning and disinfection, hand hygiene, personal protection equipment (PPE) use, and storage of devices and supplies. Detailed summary reports were provided to the participating facilities after each site visit that included identified gaps, recommendations for improvement, and evidence-based resources. Results: Deficiencies were grouped into 7 major infection prevention categories among the 17 assessments, including cleaning and disinfection (n = 17, 100%), hand hygiene (n = 9, 53%), PPE use (n = 9, 53%), appropriate use of single and multiuse devices and supplies (n = 6, 35%), bloodborne pathogen prevention measures (n = 6, 35%), aseptic technique (n = 5, 29%), and storage of devices and supplies (n = 4, 24%). Conclusions: Our program’s prototype has been successful at detecting gaps in dialysis-based IP programs. By conducting data analyses of assessment findings, we have been able to assist the organization in establishing priorities for quality and performance improvement. Based on the results, comprehensive and robust systems to assess infection prevention programs, including those in dialysis settings, are necessary to enhance infection prevention operations across the continuum of care. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative cefazolin prescribing rates following suppression of alerts for non-IgE-mediated penicillin allergies","authors":"Ashley Bogus, Kelley McGinnis, Sara May, Erica Stohs, Trevor Van Schooneveld, Scott Bergman","doi":"10.1017/ash.2023.369","DOIUrl":"https://doi.org/10.1017/ash.2023.369","url":null,"abstract":"Background: Cefazolin is the preferred antimicrobial for prevention of surgical-site infections in most procedures at our institution. Our first alternative is vancomycin which is associated with higher adverse events and infection rates. The presence of penicillin allergies can influence prescribing of vancomycin despite a low risk of cross-reactivity between penicillin and cephalosporins. Nebraska Medicine implemented a systemwide change in April 2022 that suppressed alerts for non–IgE-mediated penicillin allergies in the electronic medical record (EMR, Epic Systems) upon cephalosporin prescribing. We evaluated changes in perioperative antimicrobial surgical infection prophylaxis after this change. Methods: We conducted a quasi-experimental study of all patients undergoing procedures for which cefazolin is considered preferred per institutional guidance. Preintervention data were from April 1, 2021, to March 31, 2022, and postintervention data included patients from April 11, 2022, to October 31, 2022, after guidance was distributed to surgeons, operating room staff, and pharmacists. Patients were excluded if they were aged <19 years, had a hospital length of stay <24 hours, underwent procedures after their first throughout the time frame, or received both vancomycin and cefazolin. Statistical significance was set at P < .05, determined using the Fisher exact test. Results: The study included 6,676 patients: 4,147 in the preintervention group and 2,529 in the postintervention group. We identified 15 procedure categories, with no significant differences between periods (Table 1). The average age was 61 years. Penicillin allergy was reported in 508 patients (12.3%) in the preintervention group and in 319 patients (12.6%) in the postintervention group. In individuals with penicillin allergy, cefazolin prescribing increased from 49.6% to 74.3% ( P < .01) and vancomycin prescribing decreased from 50.4% to 25.7% ( P < .01). The largest changes occurred in patients undergoing cardiac, spinal, neurological, and vascular procedures. For patients without penicillin allergy, prescribing remained unchanged. Overall, cefazolin prescribing increased from 92.0% to 95.0% ( P < .01), and the rate of vancomycin prescribing decreased from 8.0% to 5.0% ( P < .01) in procedures for which cefazolin was preferred. Conclusions: Following the suppression of EMR alerts for non–IgE-mediated allergies when ordering cephalosporins, penicillin prescribing rates of cefazolin for surgical infection prophylaxis improved significantly in procedures for which it was the preferred agent. Further research on infection rates and adverse events with these and other alternative agents are needed. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"101 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}