D. Shirley, Harry Scholtz, Kurt Osterby, Jackson S. Musuuza, B. Fox, N. Safdar
A prospective quasi-experimental before-and-after study of an electronic medical record–anchored intervention of embedded education on appropriate urine culture indications and indication selection reduced the number of urine cultures ordered for catheterized patients at an academic medical center. This intervention could be a component of CAUTI-reduction bundles. Infect Control Hosp Epidemiol 2017;38:486–488
{"title":"Optimizing Inpatient Urine Culture Ordering Practices Using the Electronic Medical Record: A Pilot Study","authors":"D. Shirley, Harry Scholtz, Kurt Osterby, Jackson S. Musuuza, B. Fox, N. Safdar","doi":"10.1017/ice.2016.301","DOIUrl":"https://doi.org/10.1017/ice.2016.301","url":null,"abstract":"A prospective quasi-experimental before-and-after study of an electronic medical record–anchored intervention of embedded education on appropriate urine culture indications and indication selection reduced the number of urine cultures ordered for catheterized patients at an academic medical center. This intervention could be a component of CAUTI-reduction bundles. Infect Control Hosp Epidemiol 2017;38:486–488","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"46 1","pages":"486 - 488"},"PeriodicalIF":0.0,"publicationDate":"2016-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82359514","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. Tsai, Yen-Kuang Lin, Yen-Jung Huang, E. Loh, Hsiao-Yun Wen, Chia-Hui Wang, Y. Tsai, Wen-Shyang Hsieh, K. Tam
OBJECTIVE Effective perioperative hand antisepsis is crucial for the safety of patients and medical staff in surgical rooms. The antimicrobial effectiveness of different antiseptic methods, including conventional hand scrubs and waterless hand rubs, has not been well evaluated. DESIGN, SETTING, AND PARTICIPANTS A randomized controlled trial was conducted to investigate the effectiveness of the 3 antiseptic methods among surgical staff of Taipei Medical University—Shuang Ho Hospital. For each method used, a group of 80 participants was enrolled. INTERVENTION Surgical hand cleansing with conventional 10% povidone–iodine scrub, conventional 4% chlorhexidine scrub, or waterless hand rub (1% chlorhexidine gluconate and 61% ethyl alcohol). RESULTS Colony-forming unit (CFU) counts were collected using the hand imprinting method before and after disinfection and after surgery. After surgical hand disinfection, the mean CFU counts of the conventional chlorhexidine (0.5±0.2, P<0.01) and waterless hand rub groups (1.4±0.7, P<0.05) were significantly lower than that of the conventional povidone group (4.3±1.3). No significant difference was observed in the mean CFU count among the groups after surgery. Similar results were obtained when preexisting differences before disinfection were considered in the analysis of covariance. Furthermore, multivariate regression indicated that the antiseptic method (P=.0036), but not other variables, predicted the mean CFU count. CONCLUSIONS Conventional chlorhexidine scrub and waterless hand rub were superior to a conventional povidone–iodine product in bacterial inhibition. We recommend using conventional chlorhexidine scrub as a standard method for perioperative hand antisepsis. Waterless hand rub may be used if the higher cost is affordable. Infect Control Hosp Epidemiol 2017;38:417–422
{"title":"Antiseptic Effect of Conventional Povidone–Iodine Scrub, Chlorhexidine Scrub, and Waterless Hand Rub in a Surgical Room: A Randomized Controlled Trial","authors":"J. Tsai, Yen-Kuang Lin, Yen-Jung Huang, E. Loh, Hsiao-Yun Wen, Chia-Hui Wang, Y. Tsai, Wen-Shyang Hsieh, K. Tam","doi":"10.1017/ice.2016.296","DOIUrl":"https://doi.org/10.1017/ice.2016.296","url":null,"abstract":"OBJECTIVE Effective perioperative hand antisepsis is crucial for the safety of patients and medical staff in surgical rooms. The antimicrobial effectiveness of different antiseptic methods, including conventional hand scrubs and waterless hand rubs, has not been well evaluated. DESIGN, SETTING, AND PARTICIPANTS A randomized controlled trial was conducted to investigate the effectiveness of the 3 antiseptic methods among surgical staff of Taipei Medical University—Shuang Ho Hospital. For each method used, a group of 80 participants was enrolled. INTERVENTION Surgical hand cleansing with conventional 10% povidone–iodine scrub, conventional 4% chlorhexidine scrub, or waterless hand rub (1% chlorhexidine gluconate and 61% ethyl alcohol). RESULTS Colony-forming unit (CFU) counts were collected using the hand imprinting method before and after disinfection and after surgery. After surgical hand disinfection, the mean CFU counts of the conventional chlorhexidine (0.5±0.2, P<0.01) and waterless hand rub groups (1.4±0.7, P<0.05) were significantly lower than that of the conventional povidone group (4.3±1.3). No significant difference was observed in the mean CFU count among the groups after surgery. Similar results were obtained when preexisting differences before disinfection were considered in the analysis of covariance. Furthermore, multivariate regression indicated that the antiseptic method (P=.0036), but not other variables, predicted the mean CFU count. CONCLUSIONS Conventional chlorhexidine scrub and waterless hand rub were superior to a conventional povidone–iodine product in bacterial inhibition. We recommend using conventional chlorhexidine scrub as a standard method for perioperative hand antisepsis. Waterless hand rub may be used if the higher cost is affordable. Infect Control Hosp Epidemiol 2017;38:417–422","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"23 1","pages":"417 - 422"},"PeriodicalIF":0.0,"publicationDate":"2016-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87088479","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}
Jessica Y Ramirez Mendoza, N. Daneman, M. Elias, J. Amuah, K. Bush, C. Couris, K. Leeb
BACKGROUND In Canadian hospitals, clinical information is coded according to national coding standards and is routinely collected as administrative data. Administrative data may complement active surveillance programs by providing in-hospital MRSA infection data in a standardized and efficient manner, but only if infections are accurately captured. OBJECTIVE To assess the accuracy of administrative data regarding in-hospital bloodstream infections (BSIs) and all-body-site infections due to MRSA. METHODS A retrospective study of all (adult and pediatric) in-hospital MRSA infections was conducted by comparing administrative data against surveillance data from 217 acute Canadian hospitals (124 in Ontario, 93 in Alberta) over a 12-month period. Hospital-associated MRSA BSI cases in Ontario, and for all-body-site MRSA infections in Alberta were identified. Pearson correlation coefficients were used to compare the number of hospital-level MRSA cases within administrative versus surveillance datasets. The correlation of all-body-site MRSA infections versus MRSA BSIs was also assessed using the Ontario administrative data. RESULTS Strong correlations between hospital-level MRSA cases in administrative and surveillance datasets were identified for Ontario (r=0.79; 95% CI, 0.72–0.85) and Alberta (r=0.92; 95% CI, 0.88–0.94). A strong correlation between all-body-site and bloodstream-only MRSA infection rates was identified across Ontario hospitals (r=0.95; P<.0001; 95% CI, 0.93–0.96). CONCLUSIONS This study provides good evidence of the comparability of administrative and surveillance datasets in identifying in-hospital MRSA infections. With standard definitions, administrative data can provide estimates of in-hospital infections for monitoring and/or comparisons across hospitals. Infect Control Hosp Epidemiol 2017;38:436–443
{"title":"A Comparison of Administrative Data Versus Surveillance Data for Hospital-Associated Methicillin-Resistant Staphylococcus aureus Infections in Canadian Hospitals","authors":"Jessica Y Ramirez Mendoza, N. Daneman, M. Elias, J. Amuah, K. Bush, C. Couris, K. Leeb","doi":"10.1017/ice.2016.302","DOIUrl":"https://doi.org/10.1017/ice.2016.302","url":null,"abstract":"BACKGROUND In Canadian hospitals, clinical information is coded according to national coding standards and is routinely collected as administrative data. Administrative data may complement active surveillance programs by providing in-hospital MRSA infection data in a standardized and efficient manner, but only if infections are accurately captured. OBJECTIVE To assess the accuracy of administrative data regarding in-hospital bloodstream infections (BSIs) and all-body-site infections due to MRSA. METHODS A retrospective study of all (adult and pediatric) in-hospital MRSA infections was conducted by comparing administrative data against surveillance data from 217 acute Canadian hospitals (124 in Ontario, 93 in Alberta) over a 12-month period. Hospital-associated MRSA BSI cases in Ontario, and for all-body-site MRSA infections in Alberta were identified. Pearson correlation coefficients were used to compare the number of hospital-level MRSA cases within administrative versus surveillance datasets. The correlation of all-body-site MRSA infections versus MRSA BSIs was also assessed using the Ontario administrative data. RESULTS Strong correlations between hospital-level MRSA cases in administrative and surveillance datasets were identified for Ontario (r=0.79; 95% CI, 0.72–0.85) and Alberta (r=0.92; 95% CI, 0.88–0.94). A strong correlation between all-body-site and bloodstream-only MRSA infection rates was identified across Ontario hospitals (r=0.95; P<.0001; 95% CI, 0.93–0.96). CONCLUSIONS This study provides good evidence of the comparability of administrative and surveillance datasets in identifying in-hospital MRSA infections. With standard definitions, administrative data can provide estimates of in-hospital infections for monitoring and/or comparisons across hospitals. Infect Control Hosp Epidemiol 2017;38:436–443","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"54 1","pages":"436 - 443"},"PeriodicalIF":0.0,"publicationDate":"2016-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79338249","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—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}
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}
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