A. Kelly, Makoto M. Jones, K. Echevarria, S. Kralovic, M. Samore, M. Goetz, K. Madaras-Kelly, L. Simbartl, A. Morreale, M. Neuhauser, G. Roselle
OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513–520
{"title":"A Report of the Efforts of the Veterans Health Administration National Antimicrobial Stewardship Initiative","authors":"A. Kelly, Makoto M. Jones, K. Echevarria, S. Kralovic, M. Samore, M. Goetz, K. Madaras-Kelly, L. Simbartl, A. Morreale, M. Neuhauser, G. Roselle","doi":"10.1017/ice.2016.328","DOIUrl":"https://doi.org/10.1017/ice.2016.328","url":null,"abstract":"OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513–520","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"55 1","pages":"513 - 520"},"PeriodicalIF":0.0,"publicationDate":"2017-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84495550","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}
Yin-Yin Chen, Wan-Tsuei Huang, Chia-Ping Chen, Shu-mei Sun, Fu-Mei Kuo, Y. Chan, S. Kuo, Fu-Der Wang
OBJECTIVE Ralstonia pickettii has caused contamination of pharmaceutical solutions in many countries, resulting in healthcare infections or outbreak events. We determined the source of the outbreak of R. pickettii bloodstream infection (BSI). METHODS This study was conducted in a 3,000-bed tertiary referral medical center in Taiwan with >8,500 admissions during May 2015. Patients had been treated in the injection room or chemotherapy room at outpatient departments, emergency department, or hospital wards. All patients who were culture positive for R. pickettii from May 3 to June 11, 2015, were eligible for the study. The aim of the survey was to conduct clinical epidemiological and microbiological investigations to identify possible sources of infection. RESULTS We collected 57 R. pickettii–positive specimens from 30 case patients. We performed 24 blood cultures; 14 of these revealed >2 specimens and 6 used fluid withdrawn from Port-a-Cath implantable venous access devices. All patients received an injection of 20 mL 0.9% normal saline via catheter flushing. In addition, 2 unopened ampules of normal saline solution (20 mL) were confirmed positive for R. pickettii. The Taiwan Centers for Disease Control and Prevention performed sampling and testing of the same manufactured batch and identified the same strain of R. pickettii. Pulsed-field gel electrophoresis tests revealed that all clinical isolates had similarity of >90%, validating the outbreak of the same clone of R. pickettii. CONCLUSIONS R. pickettii can grow in saline solutions and cause bloodstream infections. Hospital monitoring mechanisms are extremely important measures in identifying and ending such outbreaks. Infect Control Hosp Epidemiol 2017;38:444–448
{"title":"An Outbreak of Ralstonia pickettii Bloodstream Infection Associated with an Intrinsically Contaminated Normal Saline Solution","authors":"Yin-Yin Chen, Wan-Tsuei Huang, Chia-Ping Chen, Shu-mei Sun, Fu-Mei Kuo, Y. Chan, S. Kuo, Fu-Der Wang","doi":"10.1017/ice.2016.327","DOIUrl":"https://doi.org/10.1017/ice.2016.327","url":null,"abstract":"OBJECTIVE Ralstonia pickettii has caused contamination of pharmaceutical solutions in many countries, resulting in healthcare infections or outbreak events. We determined the source of the outbreak of R. pickettii bloodstream infection (BSI). METHODS This study was conducted in a 3,000-bed tertiary referral medical center in Taiwan with >8,500 admissions during May 2015. Patients had been treated in the injection room or chemotherapy room at outpatient departments, emergency department, or hospital wards. All patients who were culture positive for R. pickettii from May 3 to June 11, 2015, were eligible for the study. The aim of the survey was to conduct clinical epidemiological and microbiological investigations to identify possible sources of infection. RESULTS We collected 57 R. pickettii–positive specimens from 30 case patients. We performed 24 blood cultures; 14 of these revealed >2 specimens and 6 used fluid withdrawn from Port-a-Cath implantable venous access devices. All patients received an injection of 20 mL 0.9% normal saline via catheter flushing. In addition, 2 unopened ampules of normal saline solution (20 mL) were confirmed positive for R. pickettii. The Taiwan Centers for Disease Control and Prevention performed sampling and testing of the same manufactured batch and identified the same strain of R. pickettii. Pulsed-field gel electrophoresis tests revealed that all clinical isolates had similarity of >90%, validating the outbreak of the same clone of R. pickettii. CONCLUSIONS R. pickettii can grow in saline solutions and cause bloodstream infections. Hospital monitoring mechanisms are extremely important measures in identifying and ending such outbreaks. Infect Control Hosp Epidemiol 2017;38:444–448","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"86 1","pages":"444 - 448"},"PeriodicalIF":0.0,"publicationDate":"2017-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83770578","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":"An Evaluation of Food as a Potential Source for Clostridium difficile Acquisition in Hospitalized Patients – CORRIGENDUM","authors":"","doi":"10.1017/ice.2017.2","DOIUrl":"https://doi.org/10.1017/ice.2017.2","url":null,"abstract":"","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"21 1","pages":"258 - 258"},"PeriodicalIF":0.0,"publicationDate":"2017-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74166039","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}
S. Benenson, A. Moses, Matan J. Cohen, M. Brezis, N. Minster, C. Schwartz, L. Kandel, M. Liebergall, Y. Mattan
Continuous surveillance of surgical-site infection (SSI) is labor intensive. We developed a semiautomatic surveillance system partly assisted by surgeons. Most patients who developed postdischarge SSI were readmitted, which allowed us to limit postdischarge surveillance to this group. This procedure significantly reduced workload while maintaining high sensitivity and specificity for SSI diagnosis. Infect Control Hosp Epidemiol 2017;38:610–613
{"title":"A Practical Tool for Surveillance of Surgical-Site Infections: A 5-Year Experience in Orthopedic Surgeries","authors":"S. Benenson, A. Moses, Matan J. Cohen, M. Brezis, N. Minster, C. Schwartz, L. Kandel, M. Liebergall, Y. Mattan","doi":"10.1017/ice.2016.322","DOIUrl":"https://doi.org/10.1017/ice.2016.322","url":null,"abstract":"Continuous surveillance of surgical-site infection (SSI) is labor intensive. We developed a semiautomatic surveillance system partly assisted by surgeons. Most patients who developed postdischarge SSI were readmitted, which allowed us to limit postdischarge surveillance to this group. This procedure significantly reduced workload while maintaining high sensitivity and specificity for SSI diagnosis. Infect Control Hosp Epidemiol 2017;38:610–613","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"12 1","pages":"610 - 613"},"PeriodicalIF":0.0,"publicationDate":"2017-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79181352","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. Monogue, Linda K Tanner, S. Brecher, J. Aslanzadeh, D. Nicolau
infection in patients with indwelling urinary catheters: a prospective study of 761 patients. Arch Intern Med 2000;160: 673–677. 9. Humphries RM, Dien Bard J. Point-counterpoint: reflex cultures reduce laboratory workload and improve antimicrobial stewardship in patients suspected of having urinary tract infections. J Clin Microbiol 2016;54:254–258. 10. Fakih MG, Krein SL, Edson B, Watson SR, Battles JB, Saint S. Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm. Am J Infect Control 2014;42:S223–S229.
{"title":"Detection of Piperacillin-Tazobactam-Resistant/Pan-β-Lactam-Susceptible Escherichia coli with Current Automated Susceptibility Test Systems","authors":"M. Monogue, Linda K Tanner, S. Brecher, J. Aslanzadeh, D. Nicolau","doi":"10.1017/ice.2016.325","DOIUrl":"https://doi.org/10.1017/ice.2016.325","url":null,"abstract":"infection in patients with indwelling urinary catheters: a prospective study of 761 patients. Arch Intern Med 2000;160: 673–677. 9. Humphries RM, Dien Bard J. Point-counterpoint: reflex cultures reduce laboratory workload and improve antimicrobial stewardship in patients suspected of having urinary tract infections. J Clin Microbiol 2016;54:254–258. 10. Fakih MG, Krein SL, Edson B, Watson SR, Battles JB, Saint S. Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm. Am J Infect Control 2014;42:S223–S229.","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"124 1","pages":"379 - 380"},"PeriodicalIF":0.0,"publicationDate":"2017-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83640609","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}
B. Coleman, Wil Ng, Vinaya Mahesh, Maja McGuire, K. Hassan, K. Green, S. Mcneil, A. McGeer, K. Katz
OBJECTIVE To describe the frequency, characteristics, and exposure associated with influenza in hospitalized patients in a Toronto hospital DESIGN/METHOD Prospective data collected for consenting patients with laboratory-confirmed influenza and a retrospective review of infection control charts for roommates of cases over 3 influenza seasons RESULTS Of the 661 patients with influenza (age range: 1 week–103 years), 557 were placed on additional precautions upon admission. Of 104 with symptoms detected after admission, 57 cases were community onset and 47 were nosocomial (10 nosocomial were part of outbreaks). A total of 78 cases were detected after admission exposing 143 roommates. Among roommates tested for influenza after exposure, no roommates of community-onset cases and 2 of 16 roommates of nosocomial cases were diagnosed with influenza. Of 637 influenza-infected patients, 25% and 57% met influenza-like illness definitions from the Public Health Agency of Canada (PHAC) and Centers for Disease Control and Prevention (CDC), respectively, and 70.3% met the Provincial Infectious Diseases Advisory Committee (PIDAC) febrile respiratory illness definition. Among the 56 patients with community-onset influenza detected after admission, only 13%, 23%, and 34%, met PHAC, CDC, and PIDAC classifications, respectively. CONCLUSIONS In a setting with extensive screening and testing for influenza, 1 in 6 patients with influenza was not diagnosed until patients and healthcare workers had been exposed for >24 hours. Only 30% of patients with community-onset influenza detected after admission met the Ontario definition intended to identify cases, hampering efforts to prevent patient and healthcare worker exposures and reinforcing the need for prevention through vaccination. Infect Control Hosp Epidemiol 2017;38:387–392
{"title":"Active Surveillance for Influenza Reduces but Does Not Eliminate Hospital Exposure to Patients With Influenza","authors":"B. Coleman, Wil Ng, Vinaya Mahesh, Maja McGuire, K. Hassan, K. Green, S. Mcneil, A. McGeer, K. Katz","doi":"10.1017/ice.2016.321","DOIUrl":"https://doi.org/10.1017/ice.2016.321","url":null,"abstract":"OBJECTIVE To describe the frequency, characteristics, and exposure associated with influenza in hospitalized patients in a Toronto hospital DESIGN/METHOD Prospective data collected for consenting patients with laboratory-confirmed influenza and a retrospective review of infection control charts for roommates of cases over 3 influenza seasons RESULTS Of the 661 patients with influenza (age range: 1 week–103 years), 557 were placed on additional precautions upon admission. Of 104 with symptoms detected after admission, 57 cases were community onset and 47 were nosocomial (10 nosocomial were part of outbreaks). A total of 78 cases were detected after admission exposing 143 roommates. Among roommates tested for influenza after exposure, no roommates of community-onset cases and 2 of 16 roommates of nosocomial cases were diagnosed with influenza. Of 637 influenza-infected patients, 25% and 57% met influenza-like illness definitions from the Public Health Agency of Canada (PHAC) and Centers for Disease Control and Prevention (CDC), respectively, and 70.3% met the Provincial Infectious Diseases Advisory Committee (PIDAC) febrile respiratory illness definition. Among the 56 patients with community-onset influenza detected after admission, only 13%, 23%, and 34%, met PHAC, CDC, and PIDAC classifications, respectively. CONCLUSIONS In a setting with extensive screening and testing for influenza, 1 in 6 patients with influenza was not diagnosed until patients and healthcare workers had been exposed for >24 hours. Only 30% of patients with community-onset influenza detected after admission met the Ontario definition intended to identify cases, hampering efforts to prevent patient and healthcare worker exposures and reinforcing the need for prevention through vaccination. Infect Control Hosp Epidemiol 2017;38:387–392","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"14 1","pages":"387 - 392"},"PeriodicalIF":0.0,"publicationDate":"2017-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78551083","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}
S. S. Spires, H. Talbot, Carolyn A. Pope, T. Talbot
OBJECTIVE We report an outbreak of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) infections in a dementia care ward containing 2 separately locked units (A and B) to heighten awareness of these pathogens in the older adult population and highlight some of the infection prevention challenges faced during a noninfluenza respiratory viral outbreak in a congregate setting. METHODS Cases were defined by the presence of new signs or symptoms that included (1) a single oral temperature ≥ 37.8°C (100.0°F) and (2) the presence of at least 2 of the following symptoms: cough, dyspnea, rhinorrhea, hoarseness, congestion, fatigue, and malaise. Attempted infection-control measures included cohorting patients and staff, empiric isolation precautions, and cessation of group activities. Available nasopharyngeal swab specimens were sent to the Tennessee Department of Health for identification by rT-PCR testing. RESULTS We identified 30 of the 41 (73%) residents as cases over this 16-day outbreak. Due to high numbers of sick personnel, we were unable to cohort staff to 1 unit. Unit B developed its first case 8 days after infection control measures were implemented. Of the 14 cases with available specimens, 6 patients tested positive for RSV-B, 7 for HMPV and 1 patient test positive for influenza A. Overall, 15 cases (50%) required transfer to acute care facilities; 10 of these patients (34%) had chest x-ray confirmed pulmonary infiltrates; and 5 residents (17%) died. CONCLUSIONS This case report highlights the importance of RSV and HMPV in causing substantial disease in the older adult population and highlights the challenges in preventing transmission of these viruses. Infect Control Hosp Epidemiol 2017;38:399–404
{"title":"Paramyxovirus Outbreak in a Long-Term Care Facility: The Challenges of Implementing Infection Control Practices in a Congregate Setting","authors":"S. S. Spires, H. Talbot, Carolyn A. Pope, T. Talbot","doi":"10.1017/ice.2016.316","DOIUrl":"https://doi.org/10.1017/ice.2016.316","url":null,"abstract":"OBJECTIVE We report an outbreak of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) infections in a dementia care ward containing 2 separately locked units (A and B) to heighten awareness of these pathogens in the older adult population and highlight some of the infection prevention challenges faced during a noninfluenza respiratory viral outbreak in a congregate setting. METHODS Cases were defined by the presence of new signs or symptoms that included (1) a single oral temperature ≥ 37.8°C (100.0°F) and (2) the presence of at least 2 of the following symptoms: cough, dyspnea, rhinorrhea, hoarseness, congestion, fatigue, and malaise. Attempted infection-control measures included cohorting patients and staff, empiric isolation precautions, and cessation of group activities. Available nasopharyngeal swab specimens were sent to the Tennessee Department of Health for identification by rT-PCR testing. RESULTS We identified 30 of the 41 (73%) residents as cases over this 16-day outbreak. Due to high numbers of sick personnel, we were unable to cohort staff to 1 unit. Unit B developed its first case 8 days after infection control measures were implemented. Of the 14 cases with available specimens, 6 patients tested positive for RSV-B, 7 for HMPV and 1 patient test positive for influenza A. Overall, 15 cases (50%) required transfer to acute care facilities; 10 of these patients (34%) had chest x-ray confirmed pulmonary infiltrates; and 5 residents (17%) died. CONCLUSIONS This case report highlights the importance of RSV and HMPV in causing substantial disease in the older adult population and highlights the challenges in preventing transmission of these viruses. Infect Control Hosp Epidemiol 2017;38:399–404","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"116 1","pages":"399 - 404"},"PeriodicalIF":0.0,"publicationDate":"2017-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80376014","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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