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Subjective Qualitative Hand Hygiene Compliance Observation: A Feasibility Trial 主观定性手卫生依从性观察:可行性试验
Pub Date : 2016-12-14 DOI: 10.1017/ice.2016.300
J. Bierwirth, S. Schulz-Stübner
average costs per interview calculated with 19.69 CHF (Swiss francs). This corresponds to approximately 1,510,892 CHF for 76,734 telephone interviews in the surveillance period 2013-2014. Although PDS is able to produce more reliable SSI data compared with surveillance systems that limit the data acquisition period to the time in the hospital and readmissions, most additional captured SSIs are superficial ones, so the cost-effectiveness of routine PDS has been questioned. In Germany efforts are underway to conduct SSI surveillance for all inpatient and outpatient surgical procedures with an algorithm based on health insurance data and using International Classification of Diseases (ICD) codes, German procedure codes, and diagnosis-related group administrative datasets as part of the mandatory quality assurance program starting in January 2017. This approach will include the postdischarge period but will not need any input by infection control practitioners, thus freeing up their time. However, physicians who treat a case of presumed SSI detected by the automatic algorithm will be required to fill out a short questionnaire to verify the classification. International benchmarking will become more difficult, given the variety of surveillance systems from active PDS in Switzerland and the Netherlands to future “big data” mining in Germany to classical active surveillance reporting using standardized definitions. Therefore, we believe that an internationally synchronized effort to streamline a cost-effective surveillance approach to detect SSIs is warranted, keeping in mind the RUMBA rule of meaningful quality indicators: Reliable, Understandable, Measureable, Behaviorable, and Achievable.
每次面试的平均费用为19.69瑞士法郎。这相当于2013-2014年监测期间76,734次电话访谈的约1,510,892瑞士法郎。尽管与将数据采集周期限制在住院和再入院时间的监测系统相比,PDS能够产生更可靠的SSI数据,但大多数额外捕获的SSI是表面的,因此常规PDS的成本效益受到质疑。作为2017年1月开始的强制性质量保证计划的一部分,德国正在努力对所有住院和门诊外科手术进行SSI监测,采用基于健康保险数据的算法,并使用国际疾病分类(ICD)代码、德国程序代码和诊断相关的组管理数据集。这种方法将包括出院后的时间,但不需要感染控制从业人员的任何投入,从而腾出他们的时间。然而,治疗由自动算法检测到的假定SSI病例的医生将被要求填写一份简短的问卷来验证分类。鉴于监控系统的多样性,从瑞士和荷兰的主动PDS到德国未来的“大数据”挖掘,再到使用标准化定义的经典主动监控报告,国际基准测试将变得更加困难。因此,我们认为,国际同步努力简化一种具有成本效益的监测方法来检测ssi是有必要的,牢记RUMBA规则的有意义的质量指标:可靠、可理解、可测量、可行为和可实现。
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引用次数: 0
Phantom Prescribing: Examining the Frequency of Antimicrobial Prescriptions Without a Patient Visit 幻影处方:检查抗菌药物处方的频率没有病人访问
Pub Date : 2016-12-13 DOI: 10.1017/ice.2016.269
B. Riedle, Linnea A. Polgreen, J. Cavanaugh, M. Schroeder, P. Polgreen
OBJECTIVE To investigate the scale of antimicrobial prescribing without a corresponding visit, and to compare the attributes of patients who received antimicrobials with a corresponding visit with those who did not have a visit. DESIGN Retrospective cohort. METHODS We followed up 185,010 Medicare patients for 1 year after an acute myocardial infarction. For each antimicrobial prescribed, we determined whether the patient had an inpatient, outpatient, or provider claim in the 7 days prior to the antimicrobial prescription being filled. We compared the proportions of patient characteristics for those prescriptions associated with a visit and without a visit (ie, phantom prescriptions). We also compared the rates at which different antimicrobials were prescribed without a visit. RESULTS We found that of 356,545 antimicrobial prescriptions, 14.75% had no evidence of a visit in the week prior to the prescription being filled. A higher percentage of patients without a visit were identified as white (P<.001) and female (P<.001). Patients without a visit had a higher likelihood of survival and fewer additional cardiac events (acute myocardial infarction, cardiac arrest, stroke, all P<.001). Among the antimicrobials considered, amoxicillin, penicillin, and agents containing trimethoprim and methenamine were much more likely to be prescribed without a visit. In contrast, levofloxacin, metronidazole, moxifloxacin, vancomycin, and cefdinir were much less likely to be prescribed without a visit. CONCLUSIONS Among this cohort of patients with chronic conditions, phantom prescriptions of antimicrobials are relatively common and occurred more frequently among those patients who were relatively healthy. Infect Control Hosp Epidemiol 2017;38:273–280
目的了解未进行相应就诊的抗菌药物处方规模,比较有相应就诊的患者与未进行相应就诊的患者的属性。设计回顾性队列。方法:我们对185,010例急性心肌梗死后的医保患者进行了为期1年的随访。对于每种抗菌素处方,我们确定患者在填写抗菌素处方前7天内是否有住院、门诊或提供者索赔。我们比较了那些与就诊和未就诊相关的处方(即虚幻处方)的患者特征比例。我们还比较了在没有就诊的情况下处方不同抗菌剂的比率。结果:在356545张抗菌药物处方中,14.75%的患者在配药前一周没有就诊证据。未就诊的患者比例较高的是白人(P< 0.001)和女性(P< 0.001)。没有就诊的患者有更高的生存可能性和更少的额外心脏事件(急性心肌梗死、心脏骤停、中风,均P< 0.001)。在所考虑的抗菌剂中,阿莫西林、青霉素和含有甲氧苄啶和甲基苯丙胺的药物更有可能在没有就诊的情况下开处方。相比之下,左氧氟沙星、甲硝唑、莫西沙星、万古霉素和头孢地尼在没有就诊的情况下开处方的可能性要小得多。结论:在这组慢性疾病患者中,抗菌药物的虚幻处方相对常见,在相对健康的患者中发生的频率更高。中华流行病学杂志,2017;38 (4):391 - 391
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引用次数: 14
Outbreak of Klebsiella pneumoniae Carbapenemase–Producing Citrobacter freundii at a Tertiary Acute Care Facility in Miami, Florida 在佛罗里达州迈阿密一家三级急症护理机构爆发的产碳青霉烯酶肺炎克雷伯菌弗伦地柠檬酸杆菌
Pub Date : 2016-12-07 DOI: 10.1017/ice.2016.273
A. Jimenez, José G. Castro, L. Munoz-Price, Dennise de Pascale, L. Shimose, M. Mustapha, Caressa N. Spychala, R. Mettus, V. Cooper, Y. Doi
OBJECTIVE To describe the investigation and control of a rare cluster of Klebsiella pneumoniae carbapenemase–producing Citrobacter freundii in a hospital in southern Florida. METHODS An epidemiologic investigation, review of infection prevention procedures, and molecular studies including whole genome sequencing were conducted. RESULTS An outbreak of K. pneumoniae carbapenemase–3-producing C. freundii was identified at a tertiary hospital in Florida in 2014. Of the 6 cases identified, 3 occurred in the same intensive care unit and were caused by the same clone. For 2 of the 3 remaining cases, the isolates had low carbapenem minimum inhibitory concentrations and were unrelated by whole genome sequencing. As a response to the outbreak, supplementary environmental cleaning was implemented, including closure and terminal cleaning of the unit where the 3 cases clustered, in addition to the infection control bundle already in place at the time. No further cases were identified after these additional interventions. CONCLUSIONS Although C. freundii is not a species that commonly demonstrates carbapenem resistance, our findings suggest that carbapenemase-producing C. freundii may be underdetected even when active surveillance is in place and has a potential to cause hospital outbreak. Infect Control Hosp Epidemiol 2017;38:320–326
目的了解佛罗里达州南部某医院罕见的产碳青霉烯酶肺炎克雷伯菌弗伦迪柠檬酸杆菌聚集性感染的调查和控制情况。方法进行流行病学调查、感染预防程序回顾和分子研究,包括全基因组测序。结果2014年在佛罗里达州某三级医院发现了产碳青霉烯酶3的肺炎克雷伯菌弗伦地菌暴发。在确定的6例病例中,3例发生在同一重症监护病房,由同一克隆引起。其余3例中有2例碳青霉烯最低抑菌浓度低,且经全基因组测序无相关性。作为对疫情的应对措施,除了当时已经实施的感染控制措施外,还实施了补充环境清洁,包括对3例病例聚集的单位进行关闭和终末清洁。在这些额外的干预措施之后,没有发现进一步的病例。结论:虽然弗氏弓形虫不是一种常见的碳青霉烯类耐药物种,但我们的研究结果表明,即使在积极监测的情况下,产碳青霉烯类酶的弗氏弓形虫也可能未被发现,并有可能导致医院暴发。中华流行病学杂志,2017;38 (8):326 - 326
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引用次数: 22
Emergence of OXA-72-producing Acinetobacter baumannii Belonging to High-Risk Clones (CC15 and CC79) in Different Brazilian States 产oxa -72的鲍曼不动杆菌属于高危克隆(CC15和CC79)在巴西不同州的出现
Pub Date : 2016-12-06 DOI: 10.1017/ice.2016.287
M. Pagano, L. Rocha, J. Sampaio, A. F. Martins, A. Barth
hand hygiene compliance observations and consecutive training efforts is important, given that <10% of all hand disinfections were performed correctly in an observational study by Tschudin-Sutter et al, who observed the 6-step technique. Appropriate hand-surface coverage was reached in only 7.9% of hand hygiene procedures observed by Park et al, despite a high rate of compliance with the correct indications. Shah et al performed a video observation of hand washing. Of 1,081 recordings, 403 (37.3%) were excellent, 521 (48.2%) were acceptable, and 157 (14.5%) were unacceptable. A limitation of our study is the lack of bacterial counts, but the results of Riley et al, who showed no correlation between hand coverage and bacterial counts with a 6-step technique compared to a 3-step approach, had not been published at the time of our experiment. Another limitation is the small number of participants and the experimental setting of this proof-of-principle study. However, we believe that based on our results, the addition of dichotomous subjective quality assessment using the parameters time and skin coverage during live observation by experienced infection control staff is feasible and could be a valuable addition to conventional hand hygiene observation.
鉴于Tschudin-Sutter等人在观察六步法的观察性研究中,手部卫生依从性观察和连续的培训努力是重要的,因为只有不到10%的人正确执行了手部消毒。Park等人观察到的手卫生程序中,只有7.9%达到了适当的手表面覆盖,尽管正确指征的符合率很高。Shah等人对洗手进行了视频观察。1081份录音中,优秀403份(37.3%),合格521份(48.2%),不合格157份(14.5%)。我们研究的一个局限性是缺乏细菌计数,但Riley等人的研究结果显示,与三步法相比,6步法的手覆盖率与细菌计数之间没有相关性,但在我们进行实验时尚未发表。另一个限制是参与者数量少和实验设置的原理证明研究。然而,基于我们的研究结果,我们认为,由经验丰富的感染控制人员在现场观察期间使用时间和皮肤覆盖范围参数进行二元主观质量评估是可行的,并且可能是传统手卫生观察的有价值的补充。
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引用次数: 16
A Silent Epidemic of Colistin- and Carbapenem-Resistant Enterobacteriaceae at a Turkish University Hospital 在土耳其大学医院的粘菌素和碳青霉烯耐药肠杆菌科的无声流行
Pub Date : 2016-12-05 DOI: 10.1017/ice.2016.255
G. Metan, A. İlbay, O. Eser, S. Unal, P. Zarakolu
Financial support: This study was supported by the CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil, and by FIPE/HCPA (Research and Events Support Fund at Hospital de Clínicas de Porto Alegre). A.L.B is a research fellow and receives support from the CNPq, Ministry of Science and Technology, Brazil (grant no. 458489/2014-0). Potential conflict of interest:All authors report no conflicts of interest relevant to this article.
财政支持:本研究由巴西教育部CAPES基金会(Brasília,巴西)和FIPE/HCPA (Clínicas de Porto Alegre医院研究和活动支持基金)支持。A.L.B是巴西科技部CNPq资助的一名研究人员(批准号:458489/2014-0)。潜在利益冲突:所有作者均未报告与本文相关的利益冲突。
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引用次数: 6
A Pediatric Approach to Ventilator-Associated Events Surveillance 呼吸机相关事件监测的儿科方法
Pub Date : 2016-12-05 DOI: 10.1017/ice.2016.277
N. Cocoros, G. Priebe, L. Logan, S. Coffin, G. Larsen, P. Toltzis, Thomas J. Sandora, M. Harper, J. Sammons, J. Gray, D. Goldmann, Kelly Horan, Michael Burton, P. Checchia, Matthew D. Lakoma, S. Sims, M. Klompas, Grace M. Lee
OBJECTIVE Adult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children. DESIGN Retrospective cohort SETTING Pediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitals PATIENTS Patients ≤18 years old ventilated for ≥1 day METHODS We identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models. RESULTS In total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on “pediatric VAC with antimicrobial use” (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test (“pediatric PVAP”) occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls. CONCLUSIONS We propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes. Infect Control Hosp Epidemiol 2017;38:327–333
成人呼吸机相关事件(VAE)的定义包括呼吸机相关疾病(VAC)和感染相关呼吸机相关并发症(IVAC)和可能的呼吸机相关肺炎(PVAP)的子类别。我们为儿童探索了这些定义。设计回顾性队列设置美国6家医院的儿科、心脏或新生儿重症监护病房(icu)患者≤18岁患者通气≥1天方法我们根据先前提出的标准确定儿童VAC患者。我们对这些患者应用成人体温、白细胞计数、抗生素和IVAC和PVAP培养标准。我们将儿科VAC患者与对照组进行匹配,并使用Cox比例风险模型评估其与不良结局的关联。结果共发现233例儿科vac(12,167次通气发作)。在心脏ICU (CICU), 62.5%的VACs符合成人IVAC标准;在儿科ICU (PICU), 54.2%的VACs符合成人IVAC标准;在新生儿重症监护病房(NICU), 20.2%的VACs符合成人IVAC标准。大多数患者白细胞计数和体温异常;因此,我们建议简化监测工作,将重点放在“使用抗菌药物的儿科VAC”(儿科AVAC)上。呼吸诊断试验阳性的儿科AVAC(“儿科PVAP”)发生在CICU的VACs中为8.9%,PICU为13.3%,NICU为4.3%。与对照组相比,所有儿童VAE亚组的住院死亡率增加,住院和ICU住院时间以及通气时间延长。结论:我们建议将儿科AVAC用于与抗菌药物使用相关的监测,将儿科PVAP作为AVAC的一个子集。需要对这些指标的普遍性和对质量改进计划的响应性进行研究,以及确定较低的儿科VAE率是否与其他结果的改善相关的研究。中华流行病学杂志,2017;38 (8):327 - 333
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引用次数: 34
Evaluation of an Ethanol-Based Spray Disinfectant for Decontamination of Cover Gowns Prior to Removal 以乙醇为基础的喷雾消毒剂在脱下防护服前进行除污的评估
Pub Date : 2016-12-05 DOI: 10.1017/ice.2016.295
Sreelatha Koganti, Heba Alhmidi, Myreen E. Tomas, J. Cadnum, Christopher Sass, A. Jencson, C. Donskey
An ethanol-based spray disinfectant significantly reduced bacteriophage MS2 contamination on material from gowns meeting ASTM standard 1671 for resistance to blood and viral penetration and on a cover gown worn by personnel. Effectiveness of disinfection was affected by the type of gown material and the correctness of fit. Infect Control Hosp Epidemiol 2017;38:364–366
基于乙醇的喷雾消毒剂显著减少了符合ASTM标准1671的抗血液和病毒渗透的长袍材料和人员穿着的罩衣上的噬菌体MS2污染。消毒效果受衣料种类和合身与否的影响。中华流行病学杂志,2017;38 (5):364 - 366
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引用次数: 7
Quantifying Antimicrobial Exposure: Hazards in Populations With End-Stage Renal Disease 量化抗菌素暴露:终末期肾脏疾病人群的危害
Pub Date : 2016-12-05 DOI: 10.1017/ice.2016.290
G. Snyder, Christopher M. McCoy, E. D’Agata
Using a rigorously collected data set of antimicrobial use among patients receiving chronic hemodialysis, antimicrobial use was calculated using 3 different methodologies: daily defined dose, days of therapy, and start–stop days. Estimates of antimicrobial use varied by as much as 10-fold, depending on the type of antimicrobial. Infect Control Hosp Epidemiol 2017;38:360–363
使用严格收集的慢性血液透析患者抗菌药物使用数据集,使用3种不同的方法计算抗菌药物使用:每日定义剂量、治疗天数和开始停止天数。根据抗菌素的种类,抗菌素使用的估计差异可达10倍之多。中华流行病学杂志,2017;38 (8):363 - 363
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引用次数: 0
Uptake and Beliefs Regarding Seasonal Influenza Vaccination Among Childcare Center Staff, Administrators, and Parents 托儿中心工作人员、管理人员和家长对季节性流感疫苗的吸收和信念
Pub Date : 2016-12-05 DOI: 10.1017/ice.2016.263
T. Rebmann, T. Loux, B. Daly
Surveys were distributed to parents and childcare agency staff to determine seasonal influenza vaccine uptake. Multivariate logistic regressions identified vaccination determinants. Overall, 351 parents and staff participated (response rate, 32%). One-half (168 [48%]) received vaccine. Vaccination predictors included healthcare provider or employer recommendation, perceived seriousness, and no vaccine fear. Infect Control Hosp Epidemiol 2017;38:367–370
向家长和托儿机构工作人员分发了调查问卷,以确定季节性流感疫苗的接种情况。多变量logistic回归确定了疫苗接种决定因素。总共有351名家长和工作人员参与(回复率为32%)。一半(168例[48%])接种了疫苗。疫苗接种预测因子包括医疗保健提供者或雇主推荐、感知严重性和无疫苗恐惧。中华流行病学杂志,2017;38 (5):367 - 367
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引用次数: 2
Top 1% of Inpatients Administered Antimicrobial Agents Comprising 50% of Expenditures: A Descriptive Study and Opportunities for Stewardship Intervention 前1%的住院患者使用抗菌药物,占支出的50%:一项描述性研究和管理干预的机会
Pub Date : 2016-12-05 DOI: 10.1017/ice.2016.261
Jennifer Dela-Pena, L. Kerstenetzky, Lucas T. Schulz, R. Kendall, A. Lepak, B. Fox
OBJECTIVE To characterize the top 1% of inpatients who contributed to the 6-month antimicrobial budget in a tertiary, academic medical center and identify cost-effective intervention opportunities targeting high-cost antimicrobial utilization. DESIGN Retrospective cohort study. PATIENTS Top 1% of the antimicrobial budget from July 1 through December 31, 2014. METHODS Patients were identified through a pharmacy billing database. Baseline characteristics were collected through a retrospective medical chart review. Patients were presented to the antimicrobial stewardship team to determine appropriate utilization of high-cost antimicrobials and potential intervention opportunities. Appropriate use was defined as antimicrobial therapy that was effective, safe, and most cost-effective compared with alternative agents. RESULTS A total of 10,460 patients received antimicrobials in 6 months; 106 patients accounted for $889,543 (47.2%) of the antimicrobial budget with an antimicrobial cost per day of $219±$192 and antimicrobial cost per admission of $4,733±$7,614. Most patients were immunocompromised (75%) and were followed by the infectious disease consult service (80%). The most commonly prescribed antimicrobials for treatment were daptomycin, micafungin, liposomal amphotericin B, and meropenem. Posaconazole and valganciclovir accounted for most of the prophylactic therapy. Cost-effective opportunities (n=71) were present in 57 (54%) of 106 patients, which included dose optimization, de-escalation, dosage form conversion, and improvement in transitions of care. CONCLUSION Antimicrobial stewardship oversight is important in implementing cost-effective strategies, especially in complex and immunocompromised patients who require the use of high-cost antimicrobials. Infect Control Hosp Epidemiol 2017;38:259–265
目的:分析三级学术医疗中心住院患者中贡献6个月抗菌药物预算的前1%患者的特征,并确定针对高成本抗菌药物使用的成本效益干预机会。设计回顾性队列研究。2014年7月1日至12月31日抗菌药物预算的前1%。方法通过药房计费数据库对患者进行识别。通过回顾性病历回顾收集基线特征。患者被提交给抗菌药物管理小组,以确定高成本抗菌药物的适当利用和潜在的干预机会。适当使用被定义为与替代药物相比有效、安全且最具成本效益的抗菌药物治疗。结果6个月内共有10460例患者接受了抗菌药物治疗;106例患者占抗菌预算889,543美元(47.2%),每日抗菌费用为219±192美元,每次住院抗菌费用为4,733±7,614美元。大多数患者免疫功能低下(75%),其次是传染病咨询服务(80%)。最常用的抗菌药是达托霉素、米卡芬金、两性霉素B脂质体和美罗培南。泊沙康唑和缬更昔洛韦占预防性治疗的大部分。106例患者中有57例(54%)存在成本效益机会(n=71),包括剂量优化、剂量递减、剂型转换和护理过渡的改善。结论:抗菌药物管理监督对于实施具有成本效益的策略非常重要,特别是在需要使用高成本抗菌药物的复杂和免疫功能低下患者中。中华流行病学杂志,2017;38 (5):559 - 559
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引用次数: 8
期刊
Infection Control &#x0026; Hospital Epidemiology
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