P. Saliou, J. Ianotto, M. Couturier, G. Guillerm, H. Le Bars, D. Quinio, S. Le Gal, R. Baron
Scientific best practices and controlled experimentation are not evident in the execution of the Saito et al study and published cleaning efficacy data refute the results. Additionally, the safety of robotic-assisted surgery has been extensively reported in the clinical literature; numerous multisite studies have reported statistically significant lower infection rates for robotic-assisted surgery compared to other surgical methods. Thus, the assertions and assumptions of the article are without merit.
{"title":"Emergency Evacuation of Immunocompromised Patients From a Hematology Unit Following Flooding of High-Efficiency Particulate Air (HEPA) Filtration","authors":"P. Saliou, J. Ianotto, M. Couturier, G. Guillerm, H. Le Bars, D. Quinio, S. Le Gal, R. Baron","doi":"10.1017/ice.2017.18","DOIUrl":"https://doi.org/10.1017/ice.2017.18","url":null,"abstract":"Scientific best practices and controlled experimentation are not evident in the execution of the Saito et al study and published cleaning efficacy data refute the results. Additionally, the safety of robotic-assisted surgery has been extensively reported in the clinical literature; numerous multisite studies have reported statistically significant lower infection rates for robotic-assisted surgery compared to other surgical methods. Thus, the assertions and assumptions of the article are without merit.","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"89 1","pages":"626 - 629"},"PeriodicalIF":0.0,"publicationDate":"2017-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86857499","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}
A. Stewardson, R. Stuart, C. Marshall, M. Cruickshank, M. Grayson
To the Editor—Previous reports have demonstrated low hand-hygiene (HH) compliance in emergency departments (EDs).1,2 Barriers to compliance in this setting include crowding, higher patient acuity, nonstandardized workflow, higher staff turnover, lower penetration of HH promotion activities, and high representation of doctors in ED audits, a group with known suboptimal HH compliance.1,3,4 We sought to use a nationwide dataset to describe HH performance in Australian EDs and to test the hypothesis that lower HH compliance in EDs is explained by a higher proportion of observed HH activity by doctors in this setting.
{"title":"More Doctor–Patient Contact Is Not the Only Explanation For Lower Hand-Hygiene Compliance in Australian Emergency Departments","authors":"A. Stewardson, R. Stuart, C. Marshall, M. Cruickshank, M. Grayson","doi":"10.1017/ice.2016.336","DOIUrl":"https://doi.org/10.1017/ice.2016.336","url":null,"abstract":"To the Editor—Previous reports have demonstrated low hand-hygiene (HH) compliance in emergency departments (EDs).1,2 Barriers to compliance in this setting include crowding, higher patient acuity, nonstandardized workflow, higher staff turnover, lower penetration of HH promotion activities, and high representation of doctors in ED audits, a group with known suboptimal HH compliance.1,3,4 We sought to use a nationwide dataset to describe HH performance in Australian EDs and to test the hypothesis that lower HH compliance in EDs is explained by a higher proportion of observed HH activity by doctors in this setting.","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"12 1","pages":"502 - 504"},"PeriodicalIF":0.0,"publicationDate":"2017-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76336380","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}
R. Mistry, J. Newland, J. Gerber, A. Hersh, L. May, S. Perman, N. Kuppermann, P. Dayan
BACKGROUND Antimicrobial stewardship programs (ASPs) effectively optimize antibiotic use for inpatients; however, the extent of emergency department (ED) involvement in ASPs has not been described. OBJECTIVE To determine current ED involvement in children’s hospital ASPs and to assess beliefs and preferred methods of implementation for ED-based ASPs. METHODS A cross-sectional survey of 37 children’s hospitals participating in the Sharing Antimicrobial Resistance Practices collaboration was conducted. Surveys were distributed to ASP leaders and ED medical directors at each institution. Items assessed included beliefs regarding ED antibiotic prescribing, ED prescribing resources, ASP methods used in the ED such as clinical decision support and clinical care guidelines, ED participation in ASP activities, and preferred methods for ED-based ASP implementation. RESULTS A total of 36 ASP leaders (97.3%) and 32 ED directors (86.5%) responded; the overall response rate was 91.9%. Most ASP leaders (97.8%) and ED directors (93.7%) agreed that creation of ED-based ASPs was necessary. ED resources for antibiotic prescribing were obtained via the Internet or electronic health records (EHRs) for 29 hospitals (81.3%). The main ASP activities for the ED included production of antibiograms (77.8%) and creation of clinical care guidelines for pneumonia (83.3%). The ED was represented on 3 hospital ASP committees (8.3%). No hospital ASPs actively monitored outpatient ED prescribing. Most ASP leaders (77.8%) and ED directors (81.3%) preferred implementation of ED-based ASPs using clinical decision support integrated into the EHR. CONCLUSIONS Although ED involvement in ASPs is limited, both ASP and ED leaders believe that ED-based ASPs are necessary. Many children’s hospitals have the capability to implement ED-based ASPs via the preferred method: EHR clinical decision support. Infect Control Hosp Epidemiol 2017;38:469–475
{"title":"Current State of Antimicrobial Stewardship in Children’s Hospital Emergency Departments","authors":"R. Mistry, J. Newland, J. Gerber, A. Hersh, L. May, S. Perman, N. Kuppermann, P. Dayan","doi":"10.1017/ice.2017.3","DOIUrl":"https://doi.org/10.1017/ice.2017.3","url":null,"abstract":"BACKGROUND Antimicrobial stewardship programs (ASPs) effectively optimize antibiotic use for inpatients; however, the extent of emergency department (ED) involvement in ASPs has not been described. OBJECTIVE To determine current ED involvement in children’s hospital ASPs and to assess beliefs and preferred methods of implementation for ED-based ASPs. METHODS A cross-sectional survey of 37 children’s hospitals participating in the Sharing Antimicrobial Resistance Practices collaboration was conducted. Surveys were distributed to ASP leaders and ED medical directors at each institution. Items assessed included beliefs regarding ED antibiotic prescribing, ED prescribing resources, ASP methods used in the ED such as clinical decision support and clinical care guidelines, ED participation in ASP activities, and preferred methods for ED-based ASP implementation. RESULTS A total of 36 ASP leaders (97.3%) and 32 ED directors (86.5%) responded; the overall response rate was 91.9%. Most ASP leaders (97.8%) and ED directors (93.7%) agreed that creation of ED-based ASPs was necessary. ED resources for antibiotic prescribing were obtained via the Internet or electronic health records (EHRs) for 29 hospitals (81.3%). The main ASP activities for the ED included production of antibiograms (77.8%) and creation of clinical care guidelines for pneumonia (83.3%). The ED was represented on 3 hospital ASP committees (8.3%). No hospital ASPs actively monitored outpatient ED prescribing. Most ASP leaders (77.8%) and ED directors (81.3%) preferred implementation of ED-based ASPs using clinical decision support integrated into the EHR. CONCLUSIONS Although ED involvement in ASPs is limited, both ASP and ED leaders believe that ED-based ASPs are necessary. Many children’s hospitals have the capability to implement ED-based ASPs via the preferred method: EHR clinical decision support. Infect Control Hosp Epidemiol 2017;38:469–475","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"17 1","pages":"469 - 475"},"PeriodicalIF":0.0,"publicationDate":"2017-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86971927","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}
taminated surfaces in hospital settings. Am J Infect Control 2013; 41:S6–S11. 7. Manian FA, Griesnauer S, Senkel D, et a. Isolation of Acinetobacter baumannii complex and methicillin-resistant Staphylococcus aureus from hospital rooms following terminal cleaning and disinfection: Can we do better? Infect Control Hosp Epidemiol 2011; 32:667–672. 8. Manian FA, Griesnauer S, Senkel D. Impact of terminal cleaning and disinfection on isolation of Acinetobacter baumannii complex from inanimate surfaces of hospital rooms by quantitative and qualitative methods. Am J Infect Control 2013: 384–385. 9. Eckstein BC, Adams DA, Eckstein EC, et al. Reduction of Clostridium difficile and vancomycin-resistant contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis 2007;7:61.
{"title":"An Observational Study to Compare Oral Hygiene Care With Chlorhexidine Gluconate Gel Versus Mouthwash to Prevent Ventilator-Associated Pneumonia","authors":"H. Tang, C. Chao, P. Leung, Chih-Cheng Lai","doi":"10.1017/ice.2017.24","DOIUrl":"https://doi.org/10.1017/ice.2017.24","url":null,"abstract":"taminated surfaces in hospital settings. Am J Infect Control 2013; 41:S6–S11. 7. Manian FA, Griesnauer S, Senkel D, et a. Isolation of Acinetobacter baumannii complex and methicillin-resistant Staphylococcus aureus from hospital rooms following terminal cleaning and disinfection: Can we do better? Infect Control Hosp Epidemiol 2011; 32:667–672. 8. Manian FA, Griesnauer S, Senkel D. Impact of terminal cleaning and disinfection on isolation of Acinetobacter baumannii complex from inanimate surfaces of hospital rooms by quantitative and qualitative methods. Am J Infect Control 2013: 384–385. 9. Eckstein BC, Adams DA, Eckstein EC, et al. Reduction of Clostridium difficile and vancomycin-resistant contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis 2007;7:61.","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"14 1","pages":"631 - 632"},"PeriodicalIF":0.0,"publicationDate":"2017-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87001186","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}
L. Marquez, K. Jones, Elaine M Whaley, Tjin H Koy, P. Revell, R. Taylor, M. Bernhardt, Jeffrey Wagner, J. Dunn, J. Lipuma, Judith R. Campbell
OBJECTIVE To investigate an outbreak of Burkholderia cepacia complex and describe the measures that revealed the source. SETTING A 629-bed, tertiary-care, pediatric hospital in Houston, Texas. PATIENTS Pediatric patients without cystic fibrosis (CF) hospitalized in the pediatric and cardiovascular intensive care units. METHODS We investigated an outbreak of B. cepacia complex from February through July 2016. Isolates were evaluated for molecular relatedness with repetitive extragenic palindromic polymerase chain reaction (rep-PCR); specific species identification and genotyping were performed at an independent laboratory. The investigation included a detailed review of all cases, direct observation of clinical practices, and respiratory surveillance cultures. Environmental and product cultures were performed at an accredited reference environmental microbiology laboratory. RESULTS Overall, 18 respiratory tract cultures, 5 blood cultures, 4 urine cultures, and 3 stool cultures were positive in 24 patients. Among the 24 patients, 17 had symptomatic infections and 7 were colonized. The median age of the patients was 22.5 months (range, 2–148 months). Rep-PCR typing showed that 21 of 24 cases represented the same strain, which was identified as a novel species within the B. cepacia complex. Product cultures of liquid docusate were positive with an identical strain of B. cepacia complex. Local and state health departments, as well as the CDC and FDA, were notified, prompting a multistate investigation. CONCLUSIONS Our investigation revealed an outbreak of a unique strain of B. cepacia complex isolated in clinical specimens from non-CF pediatric patients and from liquid docusate. This resulted in a national alert and voluntary recall by the manufacturer. Infect Control Hosp Epidemiol 2017;38:567–573
{"title":"An Outbreak of Burkholderia cepacia Complex Infections Associated with Contaminated Liquid Docusate","authors":"L. Marquez, K. Jones, Elaine M Whaley, Tjin H Koy, P. Revell, R. Taylor, M. Bernhardt, Jeffrey Wagner, J. Dunn, J. Lipuma, Judith R. Campbell","doi":"10.1017/ice.2017.11","DOIUrl":"https://doi.org/10.1017/ice.2017.11","url":null,"abstract":"OBJECTIVE To investigate an outbreak of Burkholderia cepacia complex and describe the measures that revealed the source. SETTING A 629-bed, tertiary-care, pediatric hospital in Houston, Texas. PATIENTS Pediatric patients without cystic fibrosis (CF) hospitalized in the pediatric and cardiovascular intensive care units. METHODS We investigated an outbreak of B. cepacia complex from February through July 2016. Isolates were evaluated for molecular relatedness with repetitive extragenic palindromic polymerase chain reaction (rep-PCR); specific species identification and genotyping were performed at an independent laboratory. The investigation included a detailed review of all cases, direct observation of clinical practices, and respiratory surveillance cultures. Environmental and product cultures were performed at an accredited reference environmental microbiology laboratory. RESULTS Overall, 18 respiratory tract cultures, 5 blood cultures, 4 urine cultures, and 3 stool cultures were positive in 24 patients. Among the 24 patients, 17 had symptomatic infections and 7 were colonized. The median age of the patients was 22.5 months (range, 2–148 months). Rep-PCR typing showed that 21 of 24 cases represented the same strain, which was identified as a novel species within the B. cepacia complex. Product cultures of liquid docusate were positive with an identical strain of B. cepacia complex. Local and state health departments, as well as the CDC and FDA, were notified, prompting a multistate investigation. CONCLUSIONS Our investigation revealed an outbreak of a unique strain of B. cepacia complex isolated in clinical specimens from non-CF pediatric patients and from liquid docusate. This resulted in a national alert and voluntary recall by the manufacturer. Infect Control Hosp Epidemiol 2017;38:567–573","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"2 1","pages":"567 - 573"},"PeriodicalIF":0.0,"publicationDate":"2017-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83491905","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}
comes associated with infections caused by vancomycin-resistant enterococci in the United States: systematic literature review and meta-analysis. Infect Control Hosp Epidemiol 2016:1–13. 4. Fisher D, Pang L, Salmon S, et al. A successful vancomycinresistant enterococci reduction bundle at a Singapore hospital. Infect Control Hosp Epidemiol 2016;37:107–109. 5. Humphreys H. Controlling the spread of vancomycin-resistant enterococci. Is active screening worthwhile? J Hosp Infect 2014; 88:191–198. 6. Mendes ET, Ranzani OT, Marchi AP, et al. Chlorhexidine bathing for the prevention of colonisation and infection with multidrug-resistant microorganisms in a hematopoietic stem cell transplantation over a 9-year period. Impact of chlorhexidine susceptibility. Medicine 2016;95:46 (e5271). 7. DeAngelis G, Cataldo MA, DeWaure C, et al. Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients: a systematic review and metaanalysis. J Antimicrob Chemother 2014;69:1185–1192. 8. Derde LPG, Cooper BS, Goossens H, et al. Interventions to reduce colonization and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomized trial. Lancet Infect Dis 2014;14:31–39. 9. Passaretti CL, Otter JA, Reich NG, et al. An evaluation of an environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms. Clin Infect Dis 2013;56:27–35. 10. Cheng VCC, Chen JHK, Tai JWM, et al. Decolonisation of gastrointestinal carriage of vancomycin-resistant Enterococcus faecium: cases series and review of literature. BMC Infect Dis 2014;14:514.
在美国与万古霉素耐药肠球菌引起的感染相关:系统文献综述和荟萃分析。感染控制医院流行病学杂志2016:1-13。4. 李建军，李建军，李建军，等。新加坡一家医院成功的万古霉素耐药肠球菌减少束。中华流行病学杂志(英文版);2016;37(7):1079 - 1079。5. 控制万古霉素耐药肠球菌的传播。主动筛查是否值得?中华医院感染杂志2014;88:191 - 198。6. Mendes ET, Ranzani OT, Marchi AP等。氯己定沐浴预防9年多耐药微生物在造血干细胞移植中的定植和感染氯己定药敏的影响。医学杂志2016;95:46 (e5271)。7. DeAngelis G, Cataldo MA, DeWaure C，等。感染控制和预防措施减少万古霉素耐药肠球菌在住院患者中的传播:一项系统综述和荟萃分析中国生物医学工程学报(英文版);2014;39(1):444 - 444。8. Derde LPG, Cooper BS, Goossens H，等。减少重症监护病房中耐药细菌定植和传播的干预措施:一项中断时间序列研究和聚类随机试验柳叶刀传染病2014;14:31-39。9. 张建军，李建军，李建军，等。用过氧化氢蒸汽进行环境净化以降低患者获得多重耐药生物的风险的评价。临床感染杂志2013;56:27-35。10. 程维成，陈建宏，邰建文，等。万古霉素耐药屎肠球菌胃肠道运输的去菌落:病例系列和文献回顾。中华医学会传染病杂志2014;14:514。
{"title":"Food Indwelling Clostridium difficile in Naturally Contaminated Household Meals: Data for Expanded Risk Mathematical Predictions","authors":"A. Rodriguez-Palacios, Sanja Ilic, J. Lejeune","doi":"10.1017/ice.2016.332","DOIUrl":"https://doi.org/10.1017/ice.2016.332","url":null,"abstract":"comes associated with infections caused by vancomycin-resistant enterococci in the United States: systematic literature review and meta-analysis. Infect Control Hosp Epidemiol 2016:1–13. 4. Fisher D, Pang L, Salmon S, et al. A successful vancomycinresistant enterococci reduction bundle at a Singapore hospital. Infect Control Hosp Epidemiol 2016;37:107–109. 5. Humphreys H. Controlling the spread of vancomycin-resistant enterococci. Is active screening worthwhile? J Hosp Infect 2014; 88:191–198. 6. Mendes ET, Ranzani OT, Marchi AP, et al. Chlorhexidine bathing for the prevention of colonisation and infection with multidrug-resistant microorganisms in a hematopoietic stem cell transplantation over a 9-year period. Impact of chlorhexidine susceptibility. Medicine 2016;95:46 (e5271). 7. DeAngelis G, Cataldo MA, DeWaure C, et al. Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients: a systematic review and metaanalysis. J Antimicrob Chemother 2014;69:1185–1192. 8. Derde LPG, Cooper BS, Goossens H, et al. Interventions to reduce colonization and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomized trial. Lancet Infect Dis 2014;14:31–39. 9. Passaretti CL, Otter JA, Reich NG, et al. An evaluation of an environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms. Clin Infect Dis 2013;56:27–35. 10. Cheng VCC, Chen JHK, Tai JWM, et al. Decolonisation of gastrointestinal carriage of vancomycin-resistant Enterococcus faecium: cases series and review of literature. BMC Infect Dis 2014;14:514.","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"29 1","pages":"509 - 510"},"PeriodicalIF":0.0,"publicationDate":"2017-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91105696","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}
J. Njoku, T. V. Van Schooneveld, M. Rupp, K. Olsen, F. Qiu, J. Meza, E. Hermsen
Limited data exist regarding combination therapy for Clostridium difficile infection (CDI). After adjusting for confounders in a cohort of patients with CDI and≥1 year old, combination therapy was not associated with significant differences in clinical outcomes, but it was associated with prolonged duration of therapy (1.22 days; 95% confidence interval, 1.03–1.44 days; P=.02). Infect Control Hosp Epidemiol 2017;38:602–605
{"title":"Lack of Benefit With Combination Therapy for Clostridium difficile Infection","authors":"J. Njoku, T. V. Van Schooneveld, M. Rupp, K. Olsen, F. Qiu, J. Meza, E. Hermsen","doi":"10.1017/ice.2016.320","DOIUrl":"https://doi.org/10.1017/ice.2016.320","url":null,"abstract":"Limited data exist regarding combination therapy for Clostridium difficile infection (CDI). After adjusting for confounders in a cohort of patients with CDI and≥1 year old, combination therapy was not associated with significant differences in clinical outcomes, but it was associated with prolonged duration of therapy (1.22 days; 95% confidence interval, 1.03–1.44 days; P=.02). Infect Control Hosp Epidemiol 2017;38:602–605","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"28 1","pages":"602 - 605"},"PeriodicalIF":0.0,"publicationDate":"2017-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78759276","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}
OBJECTIVE To describe the effect of universal methicillin-resistant Staphylococcus aureus (MRSA) decolonization therapy in a large intensive care unit (ICU) on the rates of MRSA cases and acquisitions in a UK hospital. DESIGN Descriptive study. SETTING University Hospitals Birmingham (UHB) NHS Foundation Trust is a tertiary referral teaching hospital in Birmingham, United Kingdom, that provides clinical services to nearly 1 million patients every year. METHODS A break-point time series analysis and kernel regression models were used to detect significant changes in the cumulative monthly numbers of MRSA bacteremia cases and acquisitions from April 2013 to August 2016 across the UHB system. RESULTS Prior to 2014, all ICU patients at UHB received universal MRSA decolonization therapy. In August 2014, UHB discontinued the use of universal decolonization due to published reports in the United Kingdom detailing the limited usefulness and cost-effectiveness of such an intervention. Break-point time series analysis of MRSA acquisition and bacteremia data indicated that break points were associated with the discontinuation and subsequent reintroduction of universal decolonization. Kernel regression models indicated a significant increase (P<.001) in MRSA acquisitions and bacteremia cases across UHB during the period without universal decolonization. CONCLUSION We suggest that routine decolonization for MRSA in a large ICU setting is an effective strategy to reduce the spread and incidence of MRSA across the whole hospital. Infect Control Hosp Epidemiol 2017;38:430–435
{"title":"The Effect of Universal Decolonization With Screening in Critical Care to Reduce MRSA Across an Entire Hospital","authors":"C. Bradley, M. Wilkinson, M. Garvey","doi":"10.1017/ice.2017.4","DOIUrl":"https://doi.org/10.1017/ice.2017.4","url":null,"abstract":"OBJECTIVE To describe the effect of universal methicillin-resistant Staphylococcus aureus (MRSA) decolonization therapy in a large intensive care unit (ICU) on the rates of MRSA cases and acquisitions in a UK hospital. DESIGN Descriptive study. SETTING University Hospitals Birmingham (UHB) NHS Foundation Trust is a tertiary referral teaching hospital in Birmingham, United Kingdom, that provides clinical services to nearly 1 million patients every year. METHODS A break-point time series analysis and kernel regression models were used to detect significant changes in the cumulative monthly numbers of MRSA bacteremia cases and acquisitions from April 2013 to August 2016 across the UHB system. RESULTS Prior to 2014, all ICU patients at UHB received universal MRSA decolonization therapy. In August 2014, UHB discontinued the use of universal decolonization due to published reports in the United Kingdom detailing the limited usefulness and cost-effectiveness of such an intervention. Break-point time series analysis of MRSA acquisition and bacteremia data indicated that break points were associated with the discontinuation and subsequent reintroduction of universal decolonization. Kernel regression models indicated a significant increase (P<.001) in MRSA acquisitions and bacteremia cases across UHB during the period without universal decolonization. CONCLUSION We suggest that routine decolonization for MRSA in a large ICU setting is an effective strategy to reduce the spread and incidence of MRSA across the whole hospital. Infect Control Hosp Epidemiol 2017;38:430–435","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"25 1","pages":"430 - 435"},"PeriodicalIF":0.0,"publicationDate":"2017-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81194733","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":"Experience with Rapid Microarray-Based Diagnostic Technology and Antimicrobial Stewardship for Patients with Gram-Positive Bacteremia – CORRIGENDUM","authors":"","doi":"10.1017/ice.2017.8","DOIUrl":"https://doi.org/10.1017/ice.2017.8","url":null,"abstract":"","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"150 1","pages":"385 - 385"},"PeriodicalIF":0.0,"publicationDate":"2017-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85014048","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}
Andrew T. Dysangco, A. Kressel, Stephanie Dearth, Reema Patel, Shawn M. Richards
To the Editor—Respiratory viral pathogens (RVPs) have been increasingly identified as a serious concern in immunocompromised patients. In this population, RVPs cause more lower-respiratory tract infections (LRIs), leading to increased mortality and morbidity. Prolonged viral shedding of RVP can become an infection control problem and has been implicated in at least 1 hospital outbreak. With respect to the hematopoietic stem cell transplant (HSCT) population, most publications have studied more virulent RVPs, whereas data on the nontransplant immunocompromised population with less virulent RVP are lacking altogether. Compared with other RVPs, rhinoviruses (RVs) cause proportionately fewer LRIs in the healthy population, but RVs are more prevalent than other RVPs and infect 22.3% of HSCT recipients within 100 days of transplantation. In a small retrospective study of immunocompromised patients and without inferring causation, RVs were associated with the same mortality as the 2009 H1N1 influenza. We report a patient with relapsed Hodgkin’s Disease (HD) without a transplant who was found to have prolonged RV shedding of 96 days with LRI. Our patient was a 37-year-old man with prior lung injury from acute respiratory distress syndrome, CD4 lymphopenia with recurrent pneumonia, and relapsed HD after treatment with bleomycin, adriamycin, vinblastine, and dacarbazine, treated with brentuximab. He experienced intermittent fever beginning in September 2014 and presented in late October 2014 with progressive dyspnea, continuing intermittent fever, and a nonproductive cough. He was hypoxemic on admission. Chest CT showed bilateral ground-glass opacities. Bronchoalveolar lavage (BAL) performed on October 29, 2014, was RT-PCR positive for RV/ enterovirus (EV). Other infectious disease testing was negative. Intravenous immunoglobulin was given with tapering prednisone for bronchospasm. He improved and was discharged a few days later. He remained afebrile with continued dry cough and dyspnea during November and December. In January, he began having afternoon fevers (38.9–39.5°C [102–103°F]), dyspnea, productive cough of whitish to yellow sputum, weight loss, drenching night sweats, and lymphadenopathy. He was readmitted in late January 2015 with severe sepsis and hypoxemia. Another chest CT showed progression of interstitial and airspace opacities. A nasopharyngeal swab was collected on January 31, 2015, and BAL was performed on February 2, 2015; both were RT-PCR positive for RV/EV; adenovirus PCR was also positive on the BAL. The patient was transitioned to comfort care after a repeat biopsy showed progression of HD, and he died February 5, 2015. Sanger-sequencing and bioinformatic analyses of clinical specimens from October 29, 2014, January 31, 2015, and February 2, 2015, identified RV-A51. Prolonged viral shedding, seen in immunocompromised patients, is dependent on the host’s immune status, virus species and strain, lung injury, and other risk factors, all
{"title":"Prolonged Rhinovirus Shedding in a Patient with Hodgkin Disease","authors":"Andrew T. Dysangco, A. Kressel, Stephanie Dearth, Reema Patel, Shawn M. Richards","doi":"10.1017/ice.2016.338","DOIUrl":"https://doi.org/10.1017/ice.2016.338","url":null,"abstract":"To the Editor—Respiratory viral pathogens (RVPs) have been increasingly identified as a serious concern in immunocompromised patients. In this population, RVPs cause more lower-respiratory tract infections (LRIs), leading to increased mortality and morbidity. Prolonged viral shedding of RVP can become an infection control problem and has been implicated in at least 1 hospital outbreak. With respect to the hematopoietic stem cell transplant (HSCT) population, most publications have studied more virulent RVPs, whereas data on the nontransplant immunocompromised population with less virulent RVP are lacking altogether. Compared with other RVPs, rhinoviruses (RVs) cause proportionately fewer LRIs in the healthy population, but RVs are more prevalent than other RVPs and infect 22.3% of HSCT recipients within 100 days of transplantation. In a small retrospective study of immunocompromised patients and without inferring causation, RVs were associated with the same mortality as the 2009 H1N1 influenza. We report a patient with relapsed Hodgkin’s Disease (HD) without a transplant who was found to have prolonged RV shedding of 96 days with LRI. Our patient was a 37-year-old man with prior lung injury from acute respiratory distress syndrome, CD4 lymphopenia with recurrent pneumonia, and relapsed HD after treatment with bleomycin, adriamycin, vinblastine, and dacarbazine, treated with brentuximab. He experienced intermittent fever beginning in September 2014 and presented in late October 2014 with progressive dyspnea, continuing intermittent fever, and a nonproductive cough. He was hypoxemic on admission. Chest CT showed bilateral ground-glass opacities. Bronchoalveolar lavage (BAL) performed on October 29, 2014, was RT-PCR positive for RV/ enterovirus (EV). Other infectious disease testing was negative. Intravenous immunoglobulin was given with tapering prednisone for bronchospasm. He improved and was discharged a few days later. He remained afebrile with continued dry cough and dyspnea during November and December. In January, he began having afternoon fevers (38.9–39.5°C [102–103°F]), dyspnea, productive cough of whitish to yellow sputum, weight loss, drenching night sweats, and lymphadenopathy. He was readmitted in late January 2015 with severe sepsis and hypoxemia. Another chest CT showed progression of interstitial and airspace opacities. A nasopharyngeal swab was collected on January 31, 2015, and BAL was performed on February 2, 2015; both were RT-PCR positive for RV/EV; adenovirus PCR was also positive on the BAL. The patient was transitioned to comfort care after a repeat biopsy showed progression of HD, and he died February 5, 2015. Sanger-sequencing and bioinformatic analyses of clinical specimens from October 29, 2014, January 31, 2015, and February 2, 2015, identified RV-A51. Prolonged viral shedding, seen in immunocompromised patients, is dependent on the host’s immune status, virus species and strain, lung injury, and other risk factors, all","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"369 1","pages":"500 - 501"},"PeriodicalIF":0.0,"publicationDate":"2017-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85459635","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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