{"title":"Clean Your Hands May 5, 2017: Fight Antibiotic Resistance—It’s in Your Hands","authors":"E. Tartari, D. Pires, D. Pittet","doi":"10.1017/ICE.2017.43","DOIUrl":"https://doi.org/10.1017/ICE.2017.43","url":null,"abstract":"","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"131 1","pages":"499 - 499"},"PeriodicalIF":0.0,"publicationDate":"2017-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75824013","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}
Pub Date : 2017-03-01Epub Date: 2016-12-05DOI: 10.1017/ice.2016.289
Kevin Hsueh, Maria Reyes, Tamara Krekel, Ed Casabar, David J Ritchie, S Reza Jafarzadeh, Amanda J Hays, Michael A Lane, Michael J Durkin
We present the first description of an antimicrobial stewardship program (ASP) used to successfully manage a multi-antimicrobial drug shortage. Without resorting to formulary restriction, meropenem utilization decreased by 69% and piperacillin-tazobactam by 73%. During the shortage period, hospital mortality decreased (P=.03), while hospital length of stay remained unchanged. Infect Control Hosp Epidemiol 2017;38:356-359.
{"title":"Effective Antibiotic Conservation by Emergency Antimicrobial Stewardship During a Drug Shortage.","authors":"Kevin Hsueh, Maria Reyes, Tamara Krekel, Ed Casabar, David J Ritchie, S Reza Jafarzadeh, Amanda J Hays, Michael A Lane, Michael J Durkin","doi":"10.1017/ice.2016.289","DOIUrl":"10.1017/ice.2016.289","url":null,"abstract":"<p><p>We present the first description of an antimicrobial stewardship program (ASP) used to successfully manage a multi-antimicrobial drug shortage. Without resorting to formulary restriction, meropenem utilization decreased by 69% and piperacillin-tazobactam by 73%. During the shortage period, hospital mortality decreased (P=.03), while hospital length of stay remained unchanged. Infect Control Hosp Epidemiol 2017;38:356-359.</p>","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"36 7 1","pages":"356-359"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80170408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Bellissimo-Rodrigues, D. Pires, H. Soule, A. Gayet-Ageron, D. Pittet
BACKGROUND Although the hands of healthcare workers (HCWs) are implicated in most episodes of healthcare-associated infections, the correlation between hand contamination and the likelihood of cross-transmission remains unknown. METHODS We conducted a laboratory-based study involving pairs of HCWs. The hands of a HCW (transmitter) were contaminated with Escherichia coli ATCC 10536 before holding hands with another HCW (host) for 1 minute. Meanwhile, the unheld hand of the transmitter was sampled. Afterward, the host’s held hand was also sampled. Each experiment consisted of 4 trials with increasing concentrations of E. coli (103–106 colony-forming units [cfu]/mL). The primary outcome was the likelihood of transmission of at least 1 cfu from transmitter to host. We used a mixed logistic regression model with a random effect on the subject to assess the association between transmission and bacterial count on the transmitter’s hands. RESULTS In total, 6 HCWs performed 30 experiments and 120 trials. The bacterial counts recovered from host hands were directly associated with the bacterial counts on transmitter hands (P<.001). The probability of cross-transmission was 8.22 higher (95% confidence interval [CI], 0.98–68.8) when transmitter hand bacterial count was >1 and ≤3 log10 cfu compared to ≤1 log10. When transmitter contamination was <1 log10 cfu, no cross-transmission was detected. CONCLUSION There is a direct relationship between the bacterial burden on HCWs hands and the likelihood of cross-transmission. Under the described conditions, at least 1 log10 cfu must be present on HCW hands to be potentially transmitted. Further studies are needed at the low contamination range. Infect Control Hosp Epidemiol 2017;38:553–558
{"title":"Assessing the Likelihood of Hand-to-Hand Cross-Transmission of Bacteria: An Experimental Study","authors":"F. Bellissimo-Rodrigues, D. Pires, H. Soule, A. Gayet-Ageron, D. Pittet","doi":"10.1017/ice.2017.9","DOIUrl":"https://doi.org/10.1017/ice.2017.9","url":null,"abstract":"BACKGROUND Although the hands of healthcare workers (HCWs) are implicated in most episodes of healthcare-associated infections, the correlation between hand contamination and the likelihood of cross-transmission remains unknown. METHODS We conducted a laboratory-based study involving pairs of HCWs. The hands of a HCW (transmitter) were contaminated with Escherichia coli ATCC 10536 before holding hands with another HCW (host) for 1 minute. Meanwhile, the unheld hand of the transmitter was sampled. Afterward, the host’s held hand was also sampled. Each experiment consisted of 4 trials with increasing concentrations of E. coli (103–106 colony-forming units [cfu]/mL). The primary outcome was the likelihood of transmission of at least 1 cfu from transmitter to host. We used a mixed logistic regression model with a random effect on the subject to assess the association between transmission and bacterial count on the transmitter’s hands. RESULTS In total, 6 HCWs performed 30 experiments and 120 trials. The bacterial counts recovered from host hands were directly associated with the bacterial counts on transmitter hands (P<.001). The probability of cross-transmission was 8.22 higher (95% confidence interval [CI], 0.98–68.8) when transmitter hand bacterial count was >1 and ≤3 log10 cfu compared to ≤1 log10. When transmitter contamination was <1 log10 cfu, no cross-transmission was detected. CONCLUSION There is a direct relationship between the bacterial burden on HCWs hands and the likelihood of cross-transmission. Under the described conditions, at least 1 log10 cfu must be present on HCW hands to be potentially transmitted. Further studies are needed at the low contamination range. Infect Control Hosp Epidemiol 2017;38:553–558","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"23 1","pages":"553 - 558"},"PeriodicalIF":0.0,"publicationDate":"2017-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83424697","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}
Maria M Reyes, S. Munigala, Emily L Church, Tobias Kulik, S. Keyrouz, G. Zipfel, D. Warren
OBJECTIVE To evaluate the agreement between the current National Healthcare Safety Network (NHSN) definition for ventriculitis and others found in the literature among patients with an external ventricular drain (EVD) DESIGN Retrospective cohort study from January 2009 to December 2014 SETTING Neurology and neurosurgery intensive care unit of a large tertiary-care center PATIENTS Patients with an EVD were included. Patients with an infection prior to EVD placement or a permanent ventricular shunt were excluded. METHODS We reviewed the charts of patients with positive cerebrospinal fluid (CSF) cultures and/or abnormal CSF results while they had an EVD in place and applied various ventriculitis definitions. RESULTS We identified 48 patients with a total of 52 cases of ventriculitis (41 CSF culture-positive cases and 11 cases based on abnormal CSF test results) using the NHSN definition. The most common organisms causing ventriculitis were gram-positive commensals (79.2%); however, 45% showed growth of only 1 colony on 1 piece of media. Approximately 60% of the ventriculitis cases by the NHSN definition met the Honda criteria, approximately 56% met the Gozal criteria, and 23% met Citerio’s definition. Cases defined using Honda versus Gozal definitions had a moderate agreement (κ=0.528; P<.05) whereas comparisons of Honda versus Citerio definitions (κ=0.338; P<.05) and Citerio versus Gozal definitions (κ=0.384; P<.05) had only fair agreements. CONCLUSIONS The agreement between published ventriculostomy-associated infection (VAI) definitions in this cohort was moderate to fair. A VAI surveillance definition that better defines contaminants is needed for more homogenous application of surveillance definitions between institutions and better comparison of rates. Infect Control Hosp Epidemiol 2017;38:574–579
目的评估当前国家医疗安全网络(NHSN)对脑室炎的定义与文献中其他脑室外引流(EVD)患者定义的一致性。设计2009年1月至2014年12月的回顾性队列研究背景:某大型三级医疗中心神经病学和神经外科重症监护室纳入EVD患者。排除EVD植入前感染或永久性心室分流的患者。方法我们回顾了脑脊液(CSF)培养阳性和/或CSF结果异常的患者的图表，而他们有EVD，并应用各种脑室炎的定义。结果根据NHSN的定义，我们鉴定了48例共52例脑室炎患者(41例脑脊液培养阳性，11例脑脊液检测结果异常)。引起脑室炎最常见的微生物是革兰氏阳性共生菌(79.2%);然而，45%的人在1块培养基上只生长了1个菌落。NHSN定义的脑室炎病例中，约60%符合Honda标准，约56%符合goal标准，23%符合Citerio标准。使用Honda和goal定义的病例具有中等一致性(κ=0.528;P< 0.05)，而本田与Citerio定义的比较(κ=0.338;P< 0.05)和Citerio vs . goal定义(κ=0.384;P< 0.05)只有公平协议。结论:在该队列中公布的脑室造口相关感染(VAI)定义之间的一致性是中等到公平的。需要一个更好地定义污染物的VAI监测定义，以便在各机构之间更加统一地应用监测定义并更好地比较比率。中华流行病学杂志，2017;38:574-579
{"title":"Comparing External Ventricular Drains-Related Ventriculitis Surveillance Definitions","authors":"Maria M Reyes, S. Munigala, Emily L Church, Tobias Kulik, S. Keyrouz, G. Zipfel, D. Warren","doi":"10.1017/ice.2017.21","DOIUrl":"https://doi.org/10.1017/ice.2017.21","url":null,"abstract":"OBJECTIVE To evaluate the agreement between the current National Healthcare Safety Network (NHSN) definition for ventriculitis and others found in the literature among patients with an external ventricular drain (EVD) DESIGN Retrospective cohort study from January 2009 to December 2014 SETTING Neurology and neurosurgery intensive care unit of a large tertiary-care center PATIENTS Patients with an EVD were included. Patients with an infection prior to EVD placement or a permanent ventricular shunt were excluded. METHODS We reviewed the charts of patients with positive cerebrospinal fluid (CSF) cultures and/or abnormal CSF results while they had an EVD in place and applied various ventriculitis definitions. RESULTS We identified 48 patients with a total of 52 cases of ventriculitis (41 CSF culture-positive cases and 11 cases based on abnormal CSF test results) using the NHSN definition. The most common organisms causing ventriculitis were gram-positive commensals (79.2%); however, 45% showed growth of only 1 colony on 1 piece of media. Approximately 60% of the ventriculitis cases by the NHSN definition met the Honda criteria, approximately 56% met the Gozal criteria, and 23% met Citerio’s definition. Cases defined using Honda versus Gozal definitions had a moderate agreement (κ=0.528; P<.05) whereas comparisons of Honda versus Citerio definitions (κ=0.338; P<.05) and Citerio versus Gozal definitions (κ=0.384; P<.05) had only fair agreements. CONCLUSIONS The agreement between published ventriculostomy-associated infection (VAI) definitions in this cohort was moderate to fair. A VAI surveillance definition that better defines contaminants is needed for more homogenous application of surveillance definitions between institutions and better comparison of rates. Infect Control Hosp Epidemiol 2017;38:574–579","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"16 1","pages":"574 - 579"},"PeriodicalIF":0.0,"publicationDate":"2017-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85997993","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}
M. Nicholson, Peter N. Freswick, C. Di Pentima, Li Wang, Kathryn M. Edwards, Gregory Wilson, T. Talbot
BACKGROUND Infants and young children are frequently colonized with C. difficile but rarely have symptomatic disease. However, C. difficile testing remains prevalent in this age group. OBJECTIVE To design a computerized provider order entry (CPOE) alert to decrease testing for C. difficile in young children and infants. DESIGN An interventional age-targeted before-after trial with comparison group SETTING Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, Tennessee. PATIENTS All children seen in the inpatient or emergency room settings from July 2012 through July 2013 (pre-CPOE alert) and September 2013 through September 2014 (post-CPOE alert) INTERVENTION In August of 2013, we implemented a CPOE alert advising against testing in infants and young children based on the American Academy of Pediatrics recommendations with an optional override. We further offered healthcare providers educational seminars regarding recommended C. difficile testing. RESULTS The average monthly testing rate significantly decreased after the CPOE alert for children 0–11 months old (11.5 pre-alert vs 0 post-alert per 10,000 patient days; P<.001) and 12–35 months old (61.6 pre-alert vs 30.1 post-alert per 10,000 patients days; P<.001), but not for those children ≥36 months old (50.9 pre-alert vs 46.4 post-alert per 10,000 patient days; P=.3) who were not targeted with a CPOE alert. There were no complications in those children who testing positive for C. difficile. CONCLUSIONS The average monthly testing rate for C. difficile for children <35 months old decreased without complication after the use of a CPOE alert in those who tested positive for C. difficile. Infect Control Hosp Epidemiol 2017;38:542–546
{"title":"The Use of a Computerized Provider Order Entry Alert to Decrease Rates of Clostridium difficile Testing in Young Pediatric Patients","authors":"M. Nicholson, Peter N. Freswick, C. Di Pentima, Li Wang, Kathryn M. Edwards, Gregory Wilson, T. Talbot","doi":"10.1017/ice.2017.16","DOIUrl":"https://doi.org/10.1017/ice.2017.16","url":null,"abstract":"BACKGROUND Infants and young children are frequently colonized with C. difficile but rarely have symptomatic disease. However, C. difficile testing remains prevalent in this age group. OBJECTIVE To design a computerized provider order entry (CPOE) alert to decrease testing for C. difficile in young children and infants. DESIGN An interventional age-targeted before-after trial with comparison group SETTING Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, Tennessee. PATIENTS All children seen in the inpatient or emergency room settings from July 2012 through July 2013 (pre-CPOE alert) and September 2013 through September 2014 (post-CPOE alert) INTERVENTION In August of 2013, we implemented a CPOE alert advising against testing in infants and young children based on the American Academy of Pediatrics recommendations with an optional override. We further offered healthcare providers educational seminars regarding recommended C. difficile testing. RESULTS The average monthly testing rate significantly decreased after the CPOE alert for children 0–11 months old (11.5 pre-alert vs 0 post-alert per 10,000 patient days; P<.001) and 12–35 months old (61.6 pre-alert vs 30.1 post-alert per 10,000 patients days; P<.001), but not for those children ≥36 months old (50.9 pre-alert vs 46.4 post-alert per 10,000 patient days; P=.3) who were not targeted with a CPOE alert. There were no complications in those children who testing positive for C. difficile. CONCLUSIONS The average monthly testing rate for C. difficile for children <35 months old decreased without complication after the use of a CPOE alert in those who tested positive for C. difficile. Infect Control Hosp Epidemiol 2017;38:542–546","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"46 1","pages":"542 - 546"},"PeriodicalIF":0.0,"publicationDate":"2017-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80915231","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}
1. Haun N, Hooper-Lane C, Safdar N. Healthcare personnel attire and devices as fomites: a systematic review. Infect Control Hosp Epidemiol 2016;37:1367–1373. 2. Arnaud I, Maugat S, Jarlier V, Astagneau P, National Early Warning, Investigation and Surveillance of HealthcareAssociated Infections Network (RAISIN)/Multidrug Resistance Study Group. Ongoing increasing temporal and geographical trends of the incidence of extended-spectrum beta-lactamaseproducing Enterobacteriaceae infections in France, 2009 to 2013. Euro Surveill 2015;19: pii= 20804. 3. Cardoso T, Almeida M, Carratalà J, et al. Microbiology of healthcare-associated infections and the definition accuracy to predict infection by potentially drug resistant pathogens: a systematic review. BMC Infect Dis 2015;11:15–565. 4. Huskins WC, Huckabee CM, O’Grady NP, et al; STAR*ICU Trial Investigators. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364: 1407–1418. 5. Tschudin-Sutter S, Sepulcri D, Dangel M, Schuhmacher H, Widmer AF. Compliance with the World Health Organization hand hygiene technique: a prospective observational study. Infect Control Hosp Epidemiol 2015;36:482–483.
1. Haun N, Hooper-Lane C, Safdar N.卫生保健人员着装和设备作为污染的系统评价。中华流行病学杂志(英文版);2016;37(3):1367 - 1373。2. Arnaud I, Maugat S, Jarlier V, Astagneau P，国家卫生保健相关感染早期预警、调查和监测网络(RAISIN)/多药耐药研究组。2009年至2013年，法国产β -内酰胺酶的肠杆菌科广谱感染发病率的时间和地理趋势持续增加。欧洲监测2015;19:pii= 20804。3.Cardoso T, Almeida M, carrataljo J，等。卫生保健相关感染的微生物学和预测潜在耐药病原体感染的定义准确性:系统综述。中华医学杂志2015;11:15-565。4. Huskins WC, Huckabee CM, O’grady NP等;STAR*ICU试验调查员。采取干预措施减少重症监护中耐药细菌的传播。中华医学杂志，2011;31(4):397 - 398。5. Tschudin-Sutter S, Sepulcri D, Dangel M, Schuhmacher H, Widmer AF.世界卫生组织手部卫生技术依从性的前瞻性观察研究。中华流行病学杂志，2015;36:482-483。
{"title":"Multidrug-Resistant Organisms in the Rooms of Patients in Healthcare Facilities","authors":"F. Manian","doi":"10.1017/ice.2017.23","DOIUrl":"https://doi.org/10.1017/ice.2017.23","url":null,"abstract":"1. Haun N, Hooper-Lane C, Safdar N. Healthcare personnel attire and devices as fomites: a systematic review. Infect Control Hosp Epidemiol 2016;37:1367–1373. 2. Arnaud I, Maugat S, Jarlier V, Astagneau P, National Early Warning, Investigation and Surveillance of HealthcareAssociated Infections Network (RAISIN)/Multidrug Resistance Study Group. Ongoing increasing temporal and geographical trends of the incidence of extended-spectrum beta-lactamaseproducing Enterobacteriaceae infections in France, 2009 to 2013. Euro Surveill 2015;19: pii= 20804. 3. Cardoso T, Almeida M, Carratalà J, et al. Microbiology of healthcare-associated infections and the definition accuracy to predict infection by potentially drug resistant pathogens: a systematic review. BMC Infect Dis 2015;11:15–565. 4. Huskins WC, Huckabee CM, O’Grady NP, et al; STAR*ICU Trial Investigators. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364: 1407–1418. 5. Tschudin-Sutter S, Sepulcri D, Dangel M, Schuhmacher H, Widmer AF. Compliance with the World Health Organization hand hygiene technique: a prospective observational study. Infect Control Hosp Epidemiol 2015;36:482–483.","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"10 1","pages":"630 - 631"},"PeriodicalIF":0.0,"publicationDate":"2017-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83523649","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}
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