Infection Control & Hospital Epidemiology最新文献

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Healthcare worker attitudes on routine non-urological preoperative urine cultures: a qualitative assessment 医护人员对常规非泌尿科术前尿培养的态度：定性评估

Infection Control & Hospital Epidemiology

Pub Date : 2024-09-19 DOI: 10.1017/ice.2024.85

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

Objective: Many preoperative urine cultures are of low value and may even lead to patient harms. This study sought to understand practices around ordering preoperative urine cultures and prescribing antibiotic treatment. Design: Open-ended, semi-structured qualitative interviews Setting: 5 Veterans Affairs hospitals. Participants: Interviews with 14 surgeons (9 surgeons, 5 surgical leaders), 7 infectious disease physicians, 8 surgical advanced practice providers (APPs), 1 surgical nurse manager, 3 infectious disease pharmacists, 1 hospitalist, and 1 lab manager. Methods: We interviewed participants using a qualitative semi-structured interview guide. Collected data was coded inductively and with the Dual Process Model (DPM) using MAXQDA software. Data in the “Testing Decision-Making” code was further reviewed using the concept of perceived risk as a sensitizing concept. Results: We identified themes relating to surgeons’ concerns about de-implementing preoperative urine cultures to detect asymptomatic bacteriuria (ASB) in patients undergoing non-urological procedures: (1) anxiety and uncertainty surrounding missing infection signs spanned surgical specialties, (2) there were perceived risks of negative consequences associated with omitting urine cultures and treatment prior to specific procedure sites and types, and additionally, (3) participants suggested potential routes for adjusting these perceived risks to facilitate de-implementation acceptance. Notably, participants suggested that leadership support and peer engagement could help improve surgeon buy-in. Conclusions: Concerns about perceived risks sometimes outweigh the evidence against routine preoperative urine cultures to detect ASB. Evidence from trusted peers may improve openness to de-implementing preoperative urine cultures.

目的：许多术前尿液培养的价值很低，甚至可能对患者造成伤害。本研究旨在了解术前尿液培养和抗生素治疗处方的使用方法。设计：开放式、半结构化定性访谈设定：5 家退伍军人事务医院：5 家退伍军人事务医院。参与人员：14 名外科医生（其中包括一名副主任医师访谈对象： 14 名外科医生（9 名外科医生、5 名外科主任）、7 名传染病医生、8 名外科高级医师 (APP)、1 名外科护士长、3 名传染病药剂师、1 名住院医师和 1 名实验室经理。调查方法我们使用半结构化定性访谈指南对参与者进行了访谈。收集到的数据使用 MAXQDA 软件以归纳法和双重过程模型 (DPM) 进行编码。使用感知风险这一敏感概念对 "检验决策 "代码中的数据进行了进一步审查。结果：我们发现了外科医生对取消术前尿培养检测非泌尿外科手术患者无症状菌尿（ASB）的担忧的相关主题：(1)外科医生对错过感染征兆感到焦虑和不确定；(2)他们认为在特定手术部位和类型之前忽略尿液培养和治疗可能会带来不良后果；此外，(3)与会者提出了调整这些风险的潜在途径，以促进对取消实施的接受。值得注意的是，与会者建议领导支持和同行参与有助于提高外科医生的接受度。结论：对感知风险的担忧有时会超过反对常规术前尿培养检测 ASB 的证据。来自值得信赖的同行的证据可能会提高不再实施术前尿液培养的开放性。

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引用次数: 0

A need for a global alert system for rapid recall of contaminated products to prevent ongoing hospital outbreaks. 有必要建立全球警报系统，迅速召回受污染产品，防止医院疫情持续爆发。

Infection Control & Hospital Epidemiology

Pub Date : 2024-09-18 DOI: 10.1017/ice.2024.87

Jyoti Somani,Nazira Fauzi,Revathi Sridhar,Hwang Ching Chan,Isaac Taoyang Low,Yvonne Luh Ping Lum,Rohit Agrawal,Ka Lip Chew,Gabriel Yan,Vernon Lee,Michelle Ang,Dale Fisher

引用次数: 0

Impact and learner perspectives of a spaced-education platform to assess hand hygiene auditor competency 评估手部卫生审核员能力的间隔教育平台的影响和学习者视角

Infection Control & Hospital Epidemiology

Pub Date : 2024-09-18 DOI: 10.1017/ice.2024.115

Ana M. Vaughan-Malloy, Renée Lehane, Mary M. Wells, Thomas J. Sandora

Objective: To ensure whether spaced education, which increases long-term knowledge retention, could be integrated into auditor competency assessment. Design: Quality improvement project. Setting: Academic, freestanding children’s hospital. Participants: Hand hygiene (HH) auditors. Intervention: We enrolled trained HH auditors in an online spaced-education platform to assess mastery of knowledge, delivering 46 unique questions at spaced intervals followed by rationale; we retired questions after 3 correct answers. An e-mailed 10-item survey gauged participant satisfaction with the program. The Wilcoxon signed-rank test was used to compare change in median knowledge score from first to final attempt. Results: A total of 12,120 questions were attempted by 126 auditors, and 49 (39%) completed the entire course. Median knowledge score increased significantly by 10.5 percentage points (IQR 4–15) between first and final attempts (P < 0.001). Thirty auditors (27%) responded to the survey. The majority agreed the number and complexity of questions were appropriate (57% and 67%, respectively). Eighty-seven percent reported the platform easy to navigate, and 77% agreed adequate time was provided for completion. Free-text suggestions included delivering fewer questions at a narrower spacing interval over a shorter time frame because of competing work demands. Conclusions: Auditor knowledge of HH indications and technique is critical to ensuring data validity. A spaced-education competency program improved HH auditor knowledge in the short term. Completion rate was low, and some participants expressed a desire for fewer questions over a shorter time frame. This study offers insight into ways to optimize spaced education as a potential tool for HH competency assessment.

目的：确保能否将可提高长期知识保留率的间隔教育纳入审计员能力评估。设计：质量改进项目。地点：学术性独立儿童医院学术性独立儿童医院。参与者：手部卫生（HH）审核员。干预：我们将经过培训的手部卫生审核员纳入在线间隔教育平台，以评估其对知识的掌握情况，该平台每隔一段时间会提出 46 个独特的问题，并在问题后给出理由；在回答 3 个正确答案后，我们会将问题撤下。我们还通过电子邮件发送了一份包含 10 个项目的调查问卷，以评估参与者对项目的满意度。我们使用 Wilcoxon 符号秩检验来比较从第一次尝试到最后一次尝试的知识得分中位数变化。结果：126 名旁听者共回答了 12120 个问题，其中 49 人（39%）完成了整个课程。在首次尝试和最后一次尝试之间，知识得分中位数明显增加了 10.5 个百分点（IQR 4-15）（P < 0.001）。30 名审计员（27%）对调查做出了回应。大多数人认为问题的数量和复杂程度是适当的（分别为 57% 和 67%）。87%的人认为平台易于浏览，77%的人认为有足够的时间完成问卷。自由撰写的建议包括：由于工作需要，在较短的时间内以较小的间隔提供较少的问题。结论：审核员对 HH 适应症和技术的了解对于确保数据有效性至关重要。间隔教育能力项目在短期内提高了 HH 审核员的知识水平。完成率较低，一些参与者表示希望在更短的时间内减少问题。这项研究为如何优化作为 HH 能力评估潜在工具的间隔教育提供了启示。

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引用次数: 0

Use of human-centric and participatory design for modifying a daily environmental cleaning checklist: a quality improvement study 利用以人为本和参与式设计修改日常环境清洁清单：一项质量改进研究

Infection Control & Hospital Epidemiology

Pub Date : 2024-09-18 DOI: 10.1017/ice.2024.112

Linda McKinley, Julie Keating, Sydney Hoel, Vishala Parmasad, Nasia Safdar

A major tenet of healthcare environmental cleaning focuses on high-touch surfaces (HTSs). HTSs have high rates of contamination, yet cleaning compliance remains low, particularly in patient-occupied rooms. This quality improvement study aimed to use human-centric and participatory design to modify an HTS cleaning checklist and conduct initial trial and evaluation.

医疗环境清洁的一个主要原则是关注高接触表面 (HTS)。高接触表面的污染率很高，但清洁依从性仍然很低，尤其是在病人使用的房间。这项质量改进研究旨在利用以人为本和参与式设计来修改高接触表面清洁清单，并进行初步试验和评估。

引用次数: 0

Development and implementation of the Antimicrobial Stewardship Intervention Scoring Tool at a single pediatric institution 在一家儿科机构开发并实施抗菌药物管理干预评分工具

Infection Control & Hospital Epidemiology

Pub Date : 2024-09-16 DOI: 10.1017/ice.2024.114

Ann L. Wirtz, Alaina N. Burns, Elizabeth Monsees, Brian R. Lee, Joshua C. Herigon

Objective:

The primary objective was to grade the potential impact of antimicrobial stewardship program (ASP) interventions on patient safety at a single center using a newly developed scoring tool, the Antimicrobial Stewardship Impact Scoring Tool (ASIST).

Design:

Retrospective descriptive study.

Setting:

A 367-bed free-standing, pediatric academic medical center.

Methods:

The ASP team developed the ASIST which scored each intervention on an impact level (low, moderate, high) based on patient harm avoidance and degree of antibiotic optimization. Intervention frequency and characteristics were collected between May 1, 2022 and October 31, 2023. Intervention rates per impact level were calculated monthly.

Results:

The ASP team made 1024 interventions further classified as low (45.1%), moderate (47%), and high impact (7.9%). The interventions for general pediatrics (53.9%) and those to modify formulation (62.2%), dose/frequency (58.1%), and duration (57.5%) were frequently low impact. Hematology/oncology (12.5%), sub-specialty (11.7%), and surgical services (11.3%) had the greatest rate of high-impact interventions. Interventions to broaden antibiotics (40.8%) and those associated with antibiotics used to treat bacteremia (20.6%) were frequently classified as high-impact.

Conclusion:

The ASIST is an effective tool to link ASP interventions to prevention of antimicrobial-associated patient harm. For our ASP team, it provided meaningful data to present to hospital leadership and identified opportunities to prevent future harm and reduce ASP team workload.

目的：主要目的是使用新开发的评分工具--抗菌药物管理影响评分工具（ASIST），对一个中心的抗菌药物管理计划（ASP）干预措施对患者安全的潜在影响进行评分。方法：抗菌药物管理计划团队开发了抗菌药物管理影响评分工具，该工具根据避免对患者造成伤害的程度和抗生素优化程度，对每项干预措施的影响等级（低、中、高）进行评分。在 2022 年 5 月 1 日至 2023 年 10 月 31 日期间收集了干预频率和特征。结果：ASP 团队进行了 1024 次干预，进一步分为低影响（45.1%）、中影响（47%）和高影响（7.9%）。普通儿科（53.9%）的干预措施以及修改配方（62.2%）、剂量/频率（58.1%）和持续时间（57.5%）的干预措施通常影响较小。血液学/肿瘤学（12.5%）、亚专科（11.7%）和外科服务（11.3%）的高影响干预率最高。结论：ASIST 是将 ASP 干预措施与预防抗菌药物相关性患者伤害联系起来的有效工具。对于我们的 ASP 团队来说，它提供了有意义的数据，可以提交给医院领导层，并确定了预防未来伤害和减少 ASP 团队工作量的机会。

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引用次数: 0

The association between the timing of initial hepatitis B vaccination and seropositivity in healthcare personnel 首次接种乙型肝炎疫苗的时间与医护人员血清反应阳性率之间的关系

Infection Control & Hospital Epidemiology

Pub Date : 2024-09-16 DOI: 10.1017/ice.2024.107

Elizabeth H. Lees, M. Hassan Murad, Laura E. Breeher, Melanie D. Swift

This study reports on the relationship between timing of initial hepatitis B virus (HBV) vaccine series and HBV antibody immunity in healthcare personnel (HCP) screened prior to employment. HCPs vaccinated as neonates were significantly more likely to have negative or indeterminate antibodies. An alternative screening approach is considered.

本研究报告了首次接种乙型肝炎病毒（HBV）疫苗系列的时间与医护人员（HCP）在就业前接受筛查时的 HBV 抗体免疫力之间的关系。新生儿时接种疫苗的医护人员抗体呈阴性或不确定的可能性明显更高。考虑采用另一种筛查方法。

引用次数: 0

Impact of an enterprise-wide ambulatory antibiotic stewardship bundle on patient satisfaction surveys 全机构门诊抗生素管理捆绑计划对患者满意度调查的影响

Infection Control & Hospital Epidemiology

Pub Date : 2024-09-16 DOI: 10.1017/ice.2024.116

Kelsey L. Jensen, Ryan W. Stevens, Paschalis Vergidis, Abinash Virk, Dan Ilges

An association between antibiotic prescribing in upper respiratory infection and improved patient satisfaction has been documented, though data are mixed. Following implementation of a multifaceted antimicrobial stewardship bundle, no difference in patient satisfaction was observed between groups, despite a reduction in antibiotic prescribing from 28.3% to 14.1%.

上呼吸道感染的抗生素处方与患者满意度的提高之间存在关联，但相关数据不一。在实施多方面的抗菌药物管理捆绑措施后，尽管抗生素处方从 28.3% 减少到 14.1%，但观察到不同组别之间的患者满意度并无差异。

引用次数: 0

Healthcare personnel opinions regarding the feasibility of a risk-tailored approach to contact precautions for methicillin-resistant Staphylococcus aureus in the acute care setting 医护人员对急症护理环境中针对耐甲氧西林金黄色葡萄球菌的接触预防措施的风险定制方法的可行性的看法

Infection Control & Hospital Epidemiology

Pub Date : 2024-04-22 DOI: 10.1017/ice.2024.54

Lyndsay M. O’Hara, Anthony D. Harris, David P. Calfee, Graham M. Snyder, James Cottam, Nathan N. O’Hara, Elise M. Martin

“All or none” approaches to the use of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) both fail to recognize that transmission risk varies. This qualitative study assessed healthcare personnel perspectives regarding the feasibility of a risk-tailored approach to use contact precautions for MRSA more strategically in the acute care setting.

针对耐甲氧西林金黄色葡萄球菌（MRSA）使用接触预防措施的 "全有或全无 "方法都没有认识到传播风险的不同。这项定性研究评估了医护人员对于在急诊护理环境中更有策略地针对 MRSA 使用接触预防措施的风险定制方法的可行性的看法。

引用次数: 0

A multi-center validation of the electronic health record admission source and discharge location fields against the clinical notes for identifying inpatients with long-term care facility exposure 电子健康记录入院来源和出院地点字段与临床笔记的多中心验证，用于识别接触过长期护理设施的住院患者

Infection Control & Hospital Epidemiology

Pub Date : 2024-04-18 DOI: 10.1017/ice.2024.37

Katherine E. Goodman, Monica Taneja, Laurence S. Magder, Eili Y. Klein, Mark Sutherland, Scott Sorongon, Pranita D. Tamma, Philip Resnik, Anthony D. Harris

Identifying long-term care facility (LTCF)-exposed inpatients is important for infection control research and practice, but ascertaining LTCF exposure is challenging. Across a large validation study, electronic health record data fields identified 76% of LTCF-exposed patients compared to manual chart review.

确定长期护理机构（LTCF）暴露的住院患者对于感染控制研究和实践非常重要，但确定长期护理机构暴露却具有挑战性。在一项大型验证研究中，与人工病历审查相比，电子健康记录数据字段确定了 76% 的长期护理设施暴露患者。

引用次数: 0

Surveillance of carbapenem-resistant Klebsiella pneumoniae and Escherichia coli in perianal swab samples 对肛周拭子样本中耐碳青霉烯类肺炎克雷伯菌和大肠埃希菌的监测

Infection Control & Hospital Epidemiology

Pub Date : 2024-04-12 DOI: 10.1017/ice.2024.60

Gül Çalışkan, Hale Eren, Funda Aslan, Nergis Tezgeç, Habibe İmer, Esma Souleiman, Ülkü Tüzemen, Uğur Önal, Esra Kazak, Yasemin Heper, Emel Yılmaz, Cüneyt Özakın, Halis Akalın

Our study aimed to detect carbapenem-resistant Klebsiella pneumoniae (CRKP) and/or carbapenem-resistant Escherichia coli in perianal swab samples, exploring their link to bloodstream infections (BSIs) in a tertiary-care university hospital. CRKP-related BSIs ranged from 3.7% to 9.58%, emphasizing the need to understand local risk factors for effective infection control.

我们的研究旨在检测肛周拭子样本中的耐碳青霉烯类肺炎克雷伯菌（CRKP）和/或耐碳青霉烯类大肠埃希菌，探讨它们与一家三级甲等大学医院的血流感染（BSI）之间的联系。与CRKP相关的BSI从3.7%到9.58%不等，强调了了解当地风险因素以有效控制感染的必要性。

引用次数: 0

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