To the Editor—Ventilator-associated pneumonia (VAP) is one of the most serious healthcare-associated infections; it has a high mortality rate, especially in intensive care units (ICUs). Diagnosing VAP is a complex issue, and the precise role of microbiologic parameters such as cultures (if qualitative or quantitative), as well as Gram stain, remain unclear. Microscopic evaluation by Gram stain of easily obtained respiratory secretions, such as endotracheal aspirate (EA), could provide a potentially useful guide to appropriate antimicrobial therapy in patients with suspected VAP. To evaluate the performance of microscopic examinations by Gram staining of endotracheal aspirates (EAs) recovered from intensive care patients, a prospective study was performed. Endotracheal aspirates were consecutively recovered from mechanically ventilated patients in an adult ICU in a tertiary hospital of Porto Alegre, southern Brazil, between January 1 and October 3, 2016. Smears were stained with Gram stain and were then cultured quantitatively. As selection criteria, only specimens with <10 squamous epithelial cells by microscopic examination in a low-power field were included in the study. Also, microorganisms presenting growth ≥10 colony forming units (CFU) per milliliter of sample plated were considered a positive culture. Results from microscopy and culture were obtained independently and carried out by double-blind analysis. A total of 717 EAs were obtained. Among them, 52 EAs were excluded due to the presence of >10 epithelial cells, and 13 (1.8%) were excluded due to inconsistent results in the culture (growth of non-pathogenic organisms such as yeasts). In the remaining 652 samples, a negative culture (ie, no bacterial growth ≥10CFU/mL) was observed in 415 (63.6%). Among the 237 positive cultures, gram-negative rods were recovered from 218 (92%) and gram-positive cocci were recovered from 19 (8%). For gram-positive cocci, only S. aureus were recovered in sufficient numbers to meet study criteria; only 2 of these (10.5%) were methicillin-resistant (MRSA). Overall, 560 of 652 (85.9%) samples showed agreement between Gram stain and culture results. The sensitivity, specificity, positive and negative predictive values, and their confidence intervals (95% CI) for clustered gram-positive cocci and gram-negative rods are shown in Table 1. Fast and accurate microbiological diagnosis of VAP is a major challenge, and no generally accepted gold standard exists for its diagnosis. In recent guidelines by the Infectious Diseases Society of America and the American Thoracic Society on the management of adults with hospital-acquired pneumonia and VAP, noninvasive sampling with semiquantitative cultures has been suggested instead of invasive sampling with quantitative cultures. Although universally accepted as a useful tool for evaluating clinical specimens, the real value of the Gram stain to guide an empirical approach is also controversial. Detection of gram-positive co
{"title":"Improving Compliance With Antibiotic Stewardship: What Is the Role of Initial Microscopy on the Management of Mechanically Ventilated Patients?","authors":"L. Perez, G. Narvaez, C. Dias","doi":"10.1017/ice.2016.305","DOIUrl":"https://doi.org/10.1017/ice.2016.305","url":null,"abstract":"To the Editor—Ventilator-associated pneumonia (VAP) is one of the most serious healthcare-associated infections; it has a high mortality rate, especially in intensive care units (ICUs). Diagnosing VAP is a complex issue, and the precise role of microbiologic parameters such as cultures (if qualitative or quantitative), as well as Gram stain, remain unclear. Microscopic evaluation by Gram stain of easily obtained respiratory secretions, such as endotracheal aspirate (EA), could provide a potentially useful guide to appropriate antimicrobial therapy in patients with suspected VAP. To evaluate the performance of microscopic examinations by Gram staining of endotracheal aspirates (EAs) recovered from intensive care patients, a prospective study was performed. Endotracheal aspirates were consecutively recovered from mechanically ventilated patients in an adult ICU in a tertiary hospital of Porto Alegre, southern Brazil, between January 1 and October 3, 2016. Smears were stained with Gram stain and were then cultured quantitatively. As selection criteria, only specimens with <10 squamous epithelial cells by microscopic examination in a low-power field were included in the study. Also, microorganisms presenting growth ≥10 colony forming units (CFU) per milliliter of sample plated were considered a positive culture. Results from microscopy and culture were obtained independently and carried out by double-blind analysis. A total of 717 EAs were obtained. Among them, 52 EAs were excluded due to the presence of >10 epithelial cells, and 13 (1.8%) were excluded due to inconsistent results in the culture (growth of non-pathogenic organisms such as yeasts). In the remaining 652 samples, a negative culture (ie, no bacterial growth ≥10CFU/mL) was observed in 415 (63.6%). Among the 237 positive cultures, gram-negative rods were recovered from 218 (92%) and gram-positive cocci were recovered from 19 (8%). For gram-positive cocci, only S. aureus were recovered in sufficient numbers to meet study criteria; only 2 of these (10.5%) were methicillin-resistant (MRSA). Overall, 560 of 652 (85.9%) samples showed agreement between Gram stain and culture results. The sensitivity, specificity, positive and negative predictive values, and their confidence intervals (95% CI) for clustered gram-positive cocci and gram-negative rods are shown in Table 1. Fast and accurate microbiological diagnosis of VAP is a major challenge, and no generally accepted gold standard exists for its diagnosis. In recent guidelines by the Infectious Diseases Society of America and the American Thoracic Society on the management of adults with hospital-acquired pneumonia and VAP, noninvasive sampling with semiquantitative cultures has been suggested instead of invasive sampling with quantitative cultures. Although universally accepted as a useful tool for evaluating clinical specimens, the real value of the Gram stain to guide an empirical approach is also controversial. Detection of gram-positive co","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"6 1","pages":"376 - 377"},"PeriodicalIF":0.0,"publicationDate":"2016-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85158032","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. Augustine, T. Testerman, J. Justo, P. Bookstaver, J. Kohn, H. Albrecht, M. Al-Hasan
OBJECTIVE To develop a risk score to predict probability of bloodstream infections (BSIs) due to extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBLE). DESIGN Retrospective case-control study. SETTING Two large community hospitals. PATIENTS Hospitalized adults with Enterobacteriaceae BSI between January 1, 2010, and June 30, 2015. METHODS Multivariate logistic regression was used to identify independent risk factors for ESBLE BSI. Point allocation in extended-spectrum β-lactamase prediction score (ESBL-PS) was based on regression coefficients. RESULTS Among 910 patients with Enterobacteriaceae BSI, 42 (4.6%) had ESBLE bloodstream isolates. Most ESBLE BSIs were community onset (33 of 42; 79%), and 25 (60%) were due to Escherichia coli. Independent risk factors for ESBLE BSI and point allocation in ESBL-PS included outpatient procedures within 1 month (adjusted odds ratio [aOR], 8.7; 95% confidence interval [CI], 3.1–22.9; 1 point), prior infections or colonization with ESBLE within 12 months (aOR, 26.8; 95% CI, 7.0–108.2; 4 points), and number of prior courses of β-lactams and/or fluoroquinolones used within 3 months of BSI: 1 course (aOR, 6.3; 95% CI, 2.7–14.7; 1 point), ≥2 courses (aOR, 22.0; 95% CI, 8.6–57.1; 3 points). The area under the receiver operating characteristic curve for the ESBL-PS model was 0.86. Patients with ESBL-PSs of 0, 1, 3, and 4 had estimated probabilities of ESBLE BSI of 0.7%, 5%, 24%, and 44%, respectively. Using ESBL-PS ≥3 to indicate high risk provided a negative predictive value of 97%. CONCLUSIONS ESBL-PS estimated patient-specific risk of ESBLE BSI with high discrimination. Incorporation of ESBL-PS with acute severity of illness may improve adequacy of empirical antimicrobial therapy and reduce carbapenem utilization. Infect Control Hosp Epidemiol 2017;38:266–272
{"title":"Clinical Risk Score for Prediction of Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae in Bloodstream Isolates","authors":"M. Augustine, T. Testerman, J. Justo, P. Bookstaver, J. Kohn, H. Albrecht, M. Al-Hasan","doi":"10.1017/ice.2016.292","DOIUrl":"https://doi.org/10.1017/ice.2016.292","url":null,"abstract":"OBJECTIVE To develop a risk score to predict probability of bloodstream infections (BSIs) due to extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBLE). DESIGN Retrospective case-control study. SETTING Two large community hospitals. PATIENTS Hospitalized adults with Enterobacteriaceae BSI between January 1, 2010, and June 30, 2015. METHODS Multivariate logistic regression was used to identify independent risk factors for ESBLE BSI. Point allocation in extended-spectrum β-lactamase prediction score (ESBL-PS) was based on regression coefficients. RESULTS Among 910 patients with Enterobacteriaceae BSI, 42 (4.6%) had ESBLE bloodstream isolates. Most ESBLE BSIs were community onset (33 of 42; 79%), and 25 (60%) were due to Escherichia coli. Independent risk factors for ESBLE BSI and point allocation in ESBL-PS included outpatient procedures within 1 month (adjusted odds ratio [aOR], 8.7; 95% confidence interval [CI], 3.1–22.9; 1 point), prior infections or colonization with ESBLE within 12 months (aOR, 26.8; 95% CI, 7.0–108.2; 4 points), and number of prior courses of β-lactams and/or fluoroquinolones used within 3 months of BSI: 1 course (aOR, 6.3; 95% CI, 2.7–14.7; 1 point), ≥2 courses (aOR, 22.0; 95% CI, 8.6–57.1; 3 points). The area under the receiver operating characteristic curve for the ESBL-PS model was 0.86. Patients with ESBL-PSs of 0, 1, 3, and 4 had estimated probabilities of ESBLE BSI of 0.7%, 5%, 24%, and 44%, respectively. Using ESBL-PS ≥3 to indicate high risk provided a negative predictive value of 97%. CONCLUSIONS ESBL-PS estimated patient-specific risk of ESBLE BSI with high discrimination. Incorporation of ESBL-PS with acute severity of illness may improve adequacy of empirical antimicrobial therapy and reduce carbapenem utilization. Infect Control Hosp Epidemiol 2017;38:266–272","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"38 1","pages":"266 - 272"},"PeriodicalIF":0.0,"publicationDate":"2016-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75804517","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}
This report describes the unique challenges of managing potential exposure to bats in a neonatal intensive care unit. The outcome demonstrates that rabies post-exposure prophylaxis can be safely administered to preterm infants with evidence that preterm infants are able to develop adequate titers post vaccination. Infect Control Hosp Epidemiol 2017;38:483–485
{"title":"Management of Rabies Prophylaxis for Potential Bat Exposures in a Level III Neonatal Intensive Care Unit","authors":"Ann Bailey, R. Quick, Joanne Dixon, S. Hauger","doi":"10.1017/ice.2016.297","DOIUrl":"https://doi.org/10.1017/ice.2016.297","url":null,"abstract":"This report describes the unique challenges of managing potential exposure to bats in a neonatal intensive care unit. The outcome demonstrates that rabies post-exposure prophylaxis can be safely administered to preterm infants with evidence that preterm infants are able to develop adequate titers post vaccination. Infect Control Hosp Epidemiol 2017;38:483–485","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"38 1","pages":"483 - 485"},"PeriodicalIF":0.0,"publicationDate":"2016-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76816738","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. Ridgway, D. Lauderdale, R. Thisted, A. Robicsek
OBJECTIVE Syndromic surveillance for influenza-like illness (ILI) is predominantly performed in the outpatient setting. The objective of this study was to compare patterns of ILI activity in outpatient, emergency department (ED), and inpatient settings using an electronic syndromic surveillance algorithm. DESIGN Retrospective cohort study over 7.5 years. SETTING A large community health system comprised of 5 hospitals and >50 clinics. METHODS We applied an electronic syndromic surveillance algorithm for ILI to all primary-care outpatient visits, inpatient encounters, and ED encounters at our health system. Comparisons of ILI activity over time were performed using Spearman’s rank correlation coefficient. Cross correlation was used to compare the timing of ILI activity among treatment settings. RESULTS Overall, 4,447,769 patient encounters occurred during the study period; 152,607 of these (3.4%) were consistent with ILI. The correlation coefficient for ILI activity in the outpatient versus ED setting was 0.877, and for the outpatient versus inpatient setting, the correlation coefficient was 0.699. ILI activity among outpatients preceded ILI activity among inpatients by 1 week. ILI activity among children in the outpatient setting preceded ILI activity among adults in all 3 settings by 1 week. CONCLUSIONS Syndromic surveillance for ILI in the outpatient setting yields similar results to surveillance in the ED setting, but it produces less similar results than ILI surveillance in the inpatient setting. ILI activity in the pediatric outpatient population is a potential predictor of future ILI activity in the general population. Infect Control Hosp Epidemiol 2017;38:393–398
{"title":"Electronic Syndromic Surveillance for Influenza-Like Illness Across Treatment Settings","authors":"J. Ridgway, D. Lauderdale, R. Thisted, A. Robicsek","doi":"10.1017/ice.2016.299","DOIUrl":"https://doi.org/10.1017/ice.2016.299","url":null,"abstract":"OBJECTIVE Syndromic surveillance for influenza-like illness (ILI) is predominantly performed in the outpatient setting. The objective of this study was to compare patterns of ILI activity in outpatient, emergency department (ED), and inpatient settings using an electronic syndromic surveillance algorithm. DESIGN Retrospective cohort study over 7.5 years. SETTING A large community health system comprised of 5 hospitals and >50 clinics. METHODS We applied an electronic syndromic surveillance algorithm for ILI to all primary-care outpatient visits, inpatient encounters, and ED encounters at our health system. Comparisons of ILI activity over time were performed using Spearman’s rank correlation coefficient. Cross correlation was used to compare the timing of ILI activity among treatment settings. RESULTS Overall, 4,447,769 patient encounters occurred during the study period; 152,607 of these (3.4%) were consistent with ILI. The correlation coefficient for ILI activity in the outpatient versus ED setting was 0.877, and for the outpatient versus inpatient setting, the correlation coefficient was 0.699. ILI activity among outpatients preceded ILI activity among inpatients by 1 week. ILI activity among children in the outpatient setting preceded ILI activity among adults in all 3 settings by 1 week. CONCLUSIONS Syndromic surveillance for ILI in the outpatient setting yields similar results to surveillance in the ED setting, but it produces less similar results than ILI surveillance in the inpatient setting. ILI activity in the pediatric outpatient population is a potential predictor of future ILI activity in the general population. Infect Control Hosp Epidemiol 2017;38:393–398","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"17 6","pages":"393 - 398"},"PeriodicalIF":0.0,"publicationDate":"2016-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91482915","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}
H. Pailhoriès, Muhammad Tanveer Munir, F. Aviat, M. Federighi, C. Belloncle, M. Eveillard
concurrent increase in cases of SSIs caused by MSSA, however, was unexpected. This finding suggests that despite the increase in MRSA, MSSA still plays a large role in causing SSIs. Therefore, preoperative screening for Staphylococcus spp., not just MRSA, may help guide preoperative antibiotic selection, skin preparation, and postoperative wound care to minimize the risk of infection with either of these organisms. The predominance of gram-negative organisms in polymicrobial SSIs suggests that external contamination of the wound, (eg, with fecal matter) plays a major role in polymicrobial SSI pathogenesis. This finding highlights the ongoing importance of postoperative wound management and the need for protective barriers to prevent contamination of the wound. Our conclusions are limited by our inability to account for potential correlations between patient-level characteristics, such as comorbidities, with particular organisms causing SSIs. 10 Another limitation was our inability to assess the direct influence of specific interventions that occurred in our medical center over the study period. Further study is planned to examine such interactions. Our study findings indicate that among pediatric patients, skin and bowel flora play a significant role in SSIs. Future interventions to target aspects such as preoperative screening and management of MSSA and MRSA colonization and postoperative wound management to prevent fecal contamination may reduce pediatric SSIs. Further study is planned to assess the effect of patient and procedure factors as well as interventions on both the incidence of and the type of pathogens associated with SSIs.
{"title":"Oak in Hospitals, the Worst Enemy of Staphylococcus aureus?","authors":"H. Pailhoriès, Muhammad Tanveer Munir, F. Aviat, M. Federighi, C. Belloncle, M. Eveillard","doi":"10.1017/ice.2016.304","DOIUrl":"https://doi.org/10.1017/ice.2016.304","url":null,"abstract":"concurrent increase in cases of SSIs caused by MSSA, however, was unexpected. This finding suggests that despite the increase in MRSA, MSSA still plays a large role in causing SSIs. Therefore, preoperative screening for Staphylococcus spp., not just MRSA, may help guide preoperative antibiotic selection, skin preparation, and postoperative wound care to minimize the risk of infection with either of these organisms. The predominance of gram-negative organisms in polymicrobial SSIs suggests that external contamination of the wound, (eg, with fecal matter) plays a major role in polymicrobial SSI pathogenesis. This finding highlights the ongoing importance of postoperative wound management and the need for protective barriers to prevent contamination of the wound. Our conclusions are limited by our inability to account for potential correlations between patient-level characteristics, such as comorbidities, with particular organisms causing SSIs. 10 Another limitation was our inability to assess the direct influence of specific interventions that occurred in our medical center over the study period. Further study is planned to examine such interactions. Our study findings indicate that among pediatric patients, skin and bowel flora play a significant role in SSIs. Future interventions to target aspects such as preoperative screening and management of MSSA and MRSA colonization and postoperative wound management to prevent fecal contamination may reduce pediatric SSIs. Further study is planned to assess the effect of patient and procedure factors as well as interventions on both the incidence of and the type of pathogens associated with SSIs.","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"147 Pt 10 1","pages":"382 - 384"},"PeriodicalIF":0.0,"publicationDate":"2016-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84052696","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. Roselló, C. Horner, S. Hopkins, A. Hayward, S. Deeny
OBJECTIVES (1) To systematically search for all dynamic mathematical models of infectious disease transmission in long-term care facilities (LTCFs); (2) to critically evaluate models of interventions against antimicrobial resistance (AMR) in this setting; and (3) to develop a checklist for hospital epidemiologists and policy makers by which to distinguish good quality models of AMR in LTCFs. METHODS The CINAHL, EMBASE, Global Health, MEDLINE, and Scopus databases were systematically searched for studies of dynamic mathematical models set in LTCFs. Models of interventions targeting methicillin-resistant Staphylococcus aureus in LTCFs were critically assessed. Using this analysis, we developed a checklist for good quality mathematical models of AMR in LTCFs. RESULTS AND DISCUSSION Overall, 18 papers described mathematical models that characterized the spread of infectious diseases in LTCFs, but no models of AMR in gram-negative bacteria in this setting were described. Future models of AMR in LTCFs require a more robust methodology (ie, formal model fitting to data and validation), greater transparency regarding model assumptions, setting-specific data, realistic and current setting-specific parameters, and inclusion of movement dynamics between LTCFs and hospitals. CONCLUSIONS Mathematical models of AMR in gram-negative bacteria in the LTCF setting, where these bacteria are increasingly becoming prevalent, are needed to help guide infection prevention and control. Improvements are required to develop outputs of sufficient quality to help guide interventions and policy in the future. We suggest a checklist of criteria to be used as a practical guide to determine whether a model is robust enough to test policy. Infect Control Hosp Epidemiol 2017;38:216–225
{"title":"Understanding the Impact of Interventions to Prevent Antimicrobial Resistant Infections in the Long-Term Care Facility: A Review and Practical Guide to Mathematical Modeling","authors":"A. Roselló, C. Horner, S. Hopkins, A. Hayward, S. Deeny","doi":"10.1017/ice.2016.286","DOIUrl":"https://doi.org/10.1017/ice.2016.286","url":null,"abstract":"OBJECTIVES (1) To systematically search for all dynamic mathematical models of infectious disease transmission in long-term care facilities (LTCFs); (2) to critically evaluate models of interventions against antimicrobial resistance (AMR) in this setting; and (3) to develop a checklist for hospital epidemiologists and policy makers by which to distinguish good quality models of AMR in LTCFs. METHODS The CINAHL, EMBASE, Global Health, MEDLINE, and Scopus databases were systematically searched for studies of dynamic mathematical models set in LTCFs. Models of interventions targeting methicillin-resistant Staphylococcus aureus in LTCFs were critically assessed. Using this analysis, we developed a checklist for good quality mathematical models of AMR in LTCFs. RESULTS AND DISCUSSION Overall, 18 papers described mathematical models that characterized the spread of infectious diseases in LTCFs, but no models of AMR in gram-negative bacteria in this setting were described. Future models of AMR in LTCFs require a more robust methodology (ie, formal model fitting to data and validation), greater transparency regarding model assumptions, setting-specific data, realistic and current setting-specific parameters, and inclusion of movement dynamics between LTCFs and hospitals. CONCLUSIONS Mathematical models of AMR in gram-negative bacteria in the LTCF setting, where these bacteria are increasingly becoming prevalent, are needed to help guide infection prevention and control. Improvements are required to develop outputs of sufficient quality to help guide interventions and policy in the future. We suggest a checklist of criteria to be used as a practical guide to determine whether a model is robust enough to test policy. Infect Control Hosp Epidemiol 2017;38:216–225","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"1 1","pages":"216 - 225"},"PeriodicalIF":0.0,"publicationDate":"2016-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77291986","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}
H. Limper, L. Slawsky, Sylvia Garcia-Houchins, S. Mehta, R. Hershow, E. Landon
BACKGROUND Despite significant advances in technological methods for hand hygiene surveillance, a lack of evidence prohibits comparison of systems to one another or against the current gold standard of direct observation. OBJECTIVE To validate a hand hygiene monitoring technology (HHMT) designed to capture hand hygiene behaviors aggregated at the hospital-unit level (GOJO Industries, Akron, OH). METHODS Our team followed a rigorous validation approach to assess the sensitivity and positive predictive value (PPV) of an HHMT. A planned path was first used to measure the accuracy of the system when purposefully activated by investigators. Next, behavioral validation was used to quantify accuracy of the system in capturing real-world behaviors. RESULTS During the planned path phase, investigators performed 4,872 unique events across 3 distinct hospital buildings varying in size and age since construction. Overall sensitivity across the medical center was 88.7% with a PPV of 99.2%. During the behavioral validation phase, trained direct observers recorded 5,539 unique events across 3 distinct hospital buildings. Overall sensitivity across the medical center was 92.7% and PPV was 84.4%. CONCLUSION Objective measures of sensitivity and PPV indicate the promise of the benefit of this and other HHMTs to capture basic behaviors associated with hand hygiene. Infect Control Hosp Epidemiol 2017;38:348–352
{"title":"Assessment of an Aggregate-Level Hand Hygiene Monitoring Technology for Measuring Hand Hygiene Performance Among Healthcare Personnel","authors":"H. Limper, L. Slawsky, Sylvia Garcia-Houchins, S. Mehta, R. Hershow, E. Landon","doi":"10.1017/ice.2016.298","DOIUrl":"https://doi.org/10.1017/ice.2016.298","url":null,"abstract":"BACKGROUND Despite significant advances in technological methods for hand hygiene surveillance, a lack of evidence prohibits comparison of systems to one another or against the current gold standard of direct observation. OBJECTIVE To validate a hand hygiene monitoring technology (HHMT) designed to capture hand hygiene behaviors aggregated at the hospital-unit level (GOJO Industries, Akron, OH). METHODS Our team followed a rigorous validation approach to assess the sensitivity and positive predictive value (PPV) of an HHMT. A planned path was first used to measure the accuracy of the system when purposefully activated by investigators. Next, behavioral validation was used to quantify accuracy of the system in capturing real-world behaviors. RESULTS During the planned path phase, investigators performed 4,872 unique events across 3 distinct hospital buildings varying in size and age since construction. Overall sensitivity across the medical center was 88.7% with a PPV of 99.2%. During the behavioral validation phase, trained direct observers recorded 5,539 unique events across 3 distinct hospital buildings. Overall sensitivity across the medical center was 92.7% and PPV was 84.4%. CONCLUSION Objective measures of sensitivity and PPV indicate the promise of the benefit of this and other HHMTs to capture basic behaviors associated with hand hygiene. Infect Control Hosp Epidemiol 2017;38:348–352","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"23 1","pages":"348 - 352"},"PeriodicalIF":0.0,"publicationDate":"2016-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81793936","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}
To the Editor—Switzerland is one of the few countries where routine postdischarge surveillance (PDS) for the surveillance of surgical site infections (SSIs) is practiced by telephone interview 1 month (and for implanted devices a second interview at 12 months) after the procedure, which is comparable with the system in the Netherlands. This survey was designed to analyze the perceptions on work load and value of PDS by Swiss infection control practitioners in order to assess the efficiency of resource utilization. The online questionnaire was distributed in December 2015 and January 2016. A major limitation of the study is the subjective assessment method of the survey, but the high response rate of 76 (62.3%) of the 122 Swiss hospitals that were asked to participate provides a representative sample. Although the practical value of PDS related to clinical infection control is rated moderate on an 8-item Likert scale, the work load is rated high compared with other duties (Figure 1). A total of 23 (37.1%) of the 62 respondents for this item say that they definitely have curtailed other duties owing to the requirements of PDS and 13 (20.9%) feel that sometimes they neglect other duties because time is needed for PDS. A total of 30 respondents (48.4%) would define the costs and effort for PDS for the hospital as high but 34 (55.8%) agree that without PDS many SSIs would not be detected. The time effort for one telephone interview and data logging was
{"title":"Postdischarge Surveillance: Value and Problems Perceived by Infection Control Practitioners in Switzerland","authors":"G. Santoro, E. Tabori, A. Rytz, S. Schulz-Stübner","doi":"10.1017/ice.2016.270","DOIUrl":"https://doi.org/10.1017/ice.2016.270","url":null,"abstract":"To the Editor—Switzerland is one of the few countries where routine postdischarge surveillance (PDS) for the surveillance of surgical site infections (SSIs) is practiced by telephone interview 1 month (and for implanted devices a second interview at 12 months) after the procedure, which is comparable with the system in the Netherlands. This survey was designed to analyze the perceptions on work load and value of PDS by Swiss infection control practitioners in order to assess the efficiency of resource utilization. The online questionnaire was distributed in December 2015 and January 2016. A major limitation of the study is the subjective assessment method of the survey, but the high response rate of 76 (62.3%) of the 122 Swiss hospitals that were asked to participate provides a representative sample. Although the practical value of PDS related to clinical infection control is rated moderate on an 8-item Likert scale, the work load is rated high compared with other duties (Figure 1). A total of 23 (37.1%) of the 62 respondents for this item say that they definitely have curtailed other duties owing to the requirements of PDS and 13 (20.9%) feel that sometimes they neglect other duties because time is needed for PDS. A total of 30 respondents (48.4%) would define the costs and effort for PDS for the hospital as high but 34 (55.8%) agree that without PDS many SSIs would not be detected. The time effort for one telephone interview and data logging was","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"34 1","pages":"250 - 251"},"PeriodicalIF":0.0,"publicationDate":"2016-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82815023","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}
T. Walsh, Ashley M. Querry, S. Mccool, Alison L. Galdys, K. Shutt, M. Saul, Carlene A. Muto
OBJECTIVE To determine risk factors for the development of surgical site infections (SSIs) in neurosurgery patients undergoing spinal fusion. DESIGN Retrospective case-control study. SETTING Large, academic, quaternary care center. PATIENTS The study population included all neurosurgery patients who underwent spinal fusion between August 1, 2009, and August 31, 2013. Cases were defined as patients in the study cohort who developed an SSI. Controls were patients in the study cohort who did not develop an SSI. METHODS To achieve 80% power with an ability to detect an odds ratio (OR) of 2, we performed an unmatched case-control study with equal numbers of cases and controls. RESULTS During the study period, 5,473 spinal fusion procedures were performed by neurosurgeons in our hospital. With 161 SSIs recorded during the study period, the incidence of SSIs associated with these procedures was 2.94%. While anterior surgical approach was found to be a protective factor (OR, 0.20; 95% confidence interval [CI], 0.08–0.52), duration of procedure (OR, 1.58; 95% CI, 1.29–1.93), American Society of Anesthesiologists score of 3 or 4 (OR, 1.79; 95% CI, 1.00–3.18), and hospitalization within the prior 30 days (OR, 5.8; 95% CI, 1.37–24.57) were found in multivariate analysis to be independent predictors of SSI following spinal fusion. Prior methicillin-resistant Staphylococcus aureus (MRSA) nares colonization was highly associated with odds 20 times higher of SSI following spinal fusion (OR, 20.30; 95% CI, 4.64–8.78). CONCLUSIONS In additional to nonmodifiable risk factors, prior colonization with MRSA is a modifiable risk factor very strongly associated with development of SSI following spinal fusion. Infect Control Hosp Epidemiol 2017;38:348–352
{"title":"Risk Factors for Surgical Site Infections Following Neurosurgical Spinal Fusion Operations: A Case Control Study","authors":"T. Walsh, Ashley M. Querry, S. Mccool, Alison L. Galdys, K. Shutt, M. Saul, Carlene A. Muto","doi":"10.1017/ice.2016.307","DOIUrl":"https://doi.org/10.1017/ice.2016.307","url":null,"abstract":"OBJECTIVE To determine risk factors for the development of surgical site infections (SSIs) in neurosurgery patients undergoing spinal fusion. DESIGN Retrospective case-control study. SETTING Large, academic, quaternary care center. PATIENTS The study population included all neurosurgery patients who underwent spinal fusion between August 1, 2009, and August 31, 2013. Cases were defined as patients in the study cohort who developed an SSI. Controls were patients in the study cohort who did not develop an SSI. METHODS To achieve 80% power with an ability to detect an odds ratio (OR) of 2, we performed an unmatched case-control study with equal numbers of cases and controls. RESULTS During the study period, 5,473 spinal fusion procedures were performed by neurosurgeons in our hospital. With 161 SSIs recorded during the study period, the incidence of SSIs associated with these procedures was 2.94%. While anterior surgical approach was found to be a protective factor (OR, 0.20; 95% confidence interval [CI], 0.08–0.52), duration of procedure (OR, 1.58; 95% CI, 1.29–1.93), American Society of Anesthesiologists score of 3 or 4 (OR, 1.79; 95% CI, 1.00–3.18), and hospitalization within the prior 30 days (OR, 5.8; 95% CI, 1.37–24.57) were found in multivariate analysis to be independent predictors of SSI following spinal fusion. Prior methicillin-resistant Staphylococcus aureus (MRSA) nares colonization was highly associated with odds 20 times higher of SSI following spinal fusion (OR, 20.30; 95% CI, 4.64–8.78). CONCLUSIONS In additional to nonmodifiable risk factors, prior colonization with MRSA is a modifiable risk factor very strongly associated with development of SSI following spinal fusion. Infect Control Hosp Epidemiol 2017;38:348–352","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"1992 1","pages":"340 - 347"},"PeriodicalIF":0.0,"publicationDate":"2016-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89874252","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. Olsen, Kelly E. Ball, K. Nickel, A. Wallace, V. Fraser
BACKGROUND Few studies have validated ICD-9-CM diagnosis codes for surgical site infection (SSI), and none have validated coding for noninfectious wound complications after mastectomy. OBJECTIVES To determine the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in health insurer claims data to identify SSI and noninfectious wound complications, including hematoma, seroma, fat and tissue necrosis, and dehiscence, after mastectomy. METHODS We reviewed medical records for 275 randomly selected women who were coded in the claims data for mastectomy with or without immediate breast reconstruction and had an ICD-9-CM diagnosis code for a wound complication within 180 days after surgery. We calculated the positive predictive value (PPV) to evaluate the accuracy of diagnosis codes in identifying specific wound complications and the PPV to determine the accuracy of coding for the breast surgical procedure. RESULTS The PPV for SSI was 57.5%, or 68.9% if cellulitis-alone was considered an SSI, while the PPV for cellulitis was 82.2%. The PPVs of individual noninfectious wound complications ranged from 47.8% for fat necrosis to 94.9% for seroma and 96.6% for hematoma. The PPVs for mastectomy, implant, and autologous flap reconstruction were uniformly high (97.5%–99.2%). CONCLUSIONS Our results suggest that claims data can be used to compare rates of infectious and noninfectious wound complications after mastectomy across facilities, even though PPVs vary by specific type of postoperative complication. The accuracy of coding was highest for cellulitis, hematoma, and seroma, and a composite group of noninfectious complications (fat necrosis, tissue necrosis, or dehiscence). Infect Control Hosp Epidemiol 2017;38:334–339
{"title":"Validation of ICD-9-CM Diagnosis Codes for Surgical Site Infection and Noninfectious Wound Complications After Mastectomy","authors":"M. Olsen, Kelly E. Ball, K. Nickel, A. Wallace, V. Fraser","doi":"10.1017/ice.2016.271","DOIUrl":"https://doi.org/10.1017/ice.2016.271","url":null,"abstract":"BACKGROUND Few studies have validated ICD-9-CM diagnosis codes for surgical site infection (SSI), and none have validated coding for noninfectious wound complications after mastectomy. OBJECTIVES To determine the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in health insurer claims data to identify SSI and noninfectious wound complications, including hematoma, seroma, fat and tissue necrosis, and dehiscence, after mastectomy. METHODS We reviewed medical records for 275 randomly selected women who were coded in the claims data for mastectomy with or without immediate breast reconstruction and had an ICD-9-CM diagnosis code for a wound complication within 180 days after surgery. We calculated the positive predictive value (PPV) to evaluate the accuracy of diagnosis codes in identifying specific wound complications and the PPV to determine the accuracy of coding for the breast surgical procedure. RESULTS The PPV for SSI was 57.5%, or 68.9% if cellulitis-alone was considered an SSI, while the PPV for cellulitis was 82.2%. The PPVs of individual noninfectious wound complications ranged from 47.8% for fat necrosis to 94.9% for seroma and 96.6% for hematoma. The PPVs for mastectomy, implant, and autologous flap reconstruction were uniformly high (97.5%–99.2%). CONCLUSIONS Our results suggest that claims data can be used to compare rates of infectious and noninfectious wound complications after mastectomy across facilities, even though PPVs vary by specific type of postoperative complication. The accuracy of coding was highest for cellulitis, hematoma, and seroma, and a composite group of noninfectious complications (fat necrosis, tissue necrosis, or dehiscence). Infect Control Hosp Epidemiol 2017;38:334–339","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"120 16","pages":"334 - 339"},"PeriodicalIF":0.0,"publicationDate":"2016-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91408109","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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