Infection Control and Hospital Epidemiology最新文献

Objective: We evaluated whether patient perceptions of cleanliness are associated with objective measures of Clostridioides difficile infection (CDI), as an early indicator of facility-level CDI rates and prevention.

Design: Cross-sectional analysis of Medicare-certified hospitals across the United States.

Methods: Data from the CMS Hospital Compare website and U.S. Census Bureau from 2023 were analyzed using multivariate logistic regression models. The primary outcome was C. difficile standardized infection ratios (SIRs) compared to the national average. The primary exposure was patient-rated cleanliness star ratings from the Hospital Consumer Assessment of Healthcare Providers and Systems survey.

Results: The population studied was 3,616 medicare-certified hospitals with an estimated 17,994,034 unique patient admissions. There was no association between better patient-rated cleanliness and improved CDI performance. Facilities with a 5-star cleanliness rating were not more likely to have an SIR less than or equal to the national average compared to those with a lower star rating. For every 1% increase in patients who reported their room and bathroom as always clean, the odds of CDI observed cases being higher than predicted increases by 4.2% (ie, increasing patient-related cleanliness was weakly associated with worse CDI performance).

Conclusions: Patient-rated cleanliness was not associated with improved CDI performance in U.S. national hospital data. Findings were consistent across multiple operationalizations of cleanliness and CDI suggesting patient perceptions of cleanliness are not a strong indicator of CDI control measure performance.

Objective: Community-acquired pneumonia (CAP) is a leading cause of hospitalization and mortality in the US. Studies report racial disparities in various infectious syndromes. Our objective was to assess the relationship between patient race and antibiotic prescribing in inpatient CAP management.

Design: Retrospective cohort study.

Setting: 11 Cleveland Clinic community hospitals.

Patients: Patients aged ≥18 years hospitalized with CAP between November 1, 2022, and January 31, 2025.

Methods: Parametric and non-parametric methods were used to describe demographic and clinical differences by race. The association between race and extended spectrum antibiotic (ESA) guideline concordance was assessed using multivariable logistic regression models adjusting for age, gender, admission source, area deprivation index (ADI), hospital, diabetes, cardiovascular disease, chronic respiratory disease, renal failure, liver disease, immunocompromising condition, alcohol and substance use disorder, dialysis, and clinical instability and severity on day 1.

Results: In bivariate analyses, Non-Hispanic Black (NHB) patients were less likely than NHW patients to receive ESA guideline-concordant CAP therapy (63.2% vs 64.4%; OR = 0.91, P = .2). After adjusting for patient characteristics, there were no differences between NHB and NHW patients in receipt of ESA therapy (adjusted OR = 0.93; 95% CI = 0.83, 1.00). After adjusting for hospital, NHB patients were more likely to receive ESA guideline-concordant CAP therapy (adjusted OR = 1.17; 95% CI = 1.06, 1.30).

Conclusion: NHB patients were more likely to receive ESA-guideline concordant therapy, but this was influenced by where they sought care. Further studies are needed to understand why prescribing varies across hospitals.

Background: An improved understanding of the epidemiology of hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infection (HO-MRSA BSI) could inform future prevention strategies for HO-MRSA BSI.

Methods: We performed a retrospective cohort study of HO-MRSA BSI reported to NHSN from 2020-2023 at a system of 9 acute care hospitals located in New York City. The primary outcome was to describe the demographic and clinical characteristics of patients with HO-MRSA BSI. Secondary outcomes included comparisons of tertiary (TH) and community (CH) hospitals, standardized infection ratio (SIR) and rates per 10,000 patient-discharges, presumptive potential infectious sources, and mortality.

Results: Between 2020 and 2023, 222 patients had HO-MRSA BSI. Their median age was 65 years, 139 (63%) were male, 92 (41%) had central lines, 89 (40%) were in ICUs, and 63 (28%) were on a ventilator. These characteristics were similar across the 176 (79%) patients in TH and the 46 (21%) patients in CH. SIRs were similar across each year of the study (with cumulative SIRs of 0.815 overall, 1.412 [CH] and 0.732 [TH]). Overall HO-MRSA BSI rates ranged from 2.58-3.53 per 10,000 patient-discharges. The most common sources of HO-MRSA BSI were pneumonia (41%), SSTIs (17%), CLABSIs (13%), and PIV catheter-related issues (9%). The all-cause mortality rate was 35%.

Discussion: The unchanged HO-MRSA BSI SIRs in this study support the need for additional interventions that focus on prevention of the primary sources of MRSA infections. Ongoing systematic surveillance of the primary sources of HO-MRSA BSI should be implemented to inform and monitor best practices for prevention.

In a propensity-matched cohort of adult cardiac or neurosurgical procedures (n = 1,342), infection was less frequent with continuous infusion (1.8%) versus intermittent cefazolin (2.4%), though the difference was statistically non-significant (-0.6%, 95% CI-2.3 to 1.1; p = 0.57). The 0% infection rate among cardiac cases receiving continuous cefazolin infusion warrants further investigation.

Objective: To deconstruct the multiple levels of risk factors for Clostridioides difficile infection, using multilevel models (MLMs) accounting for patient movement.

Study design and setting: Case-control study of patients hospitalized in three acute care Delaware hospitals, December 2019-December 2023.

Patients: Cases were patients aged ≥18 years who tested positive for hospital-onset C. difficile infection. Controls were patients aged ≥18 years hospitalized more than 72 hours, who did not test positive for C. difficile infection.

Methods: Hierarchical and cross-classified MLMs were used to calculate odds of C. difficile infection based on patient-level risk factors and to evaluate the variation in odds of infection attributable to environmental risk factors using the hospital unit(s) a patient was assigned to during hospitalization.

Results: Our study included 1,223 patients (249 cases, 974 controls). In both models, greater odds of infection were associated with antibiotic exposure [adjusted odds ratio (aOR) = 11.20, 95% confidence interval (CI) = 7.19, 17.40; aOR = 12.80, 95% CI = 8.46, 19.40 for hierarchical and cross-classified models respectively] and health insurance (aOR = 1.74, 95% CI = 1.12, 2.68; aOR = 1.62, 95% CI = 1.03, 2.53; public vs. private). Median odds ratios (MOR) for both models indicated greater relevance of between-unit heterogeneity in the outcome than health insurance but less than antibiotic exposure (MOR = 1.83, 95% CI = 1.56, 2.30 and 2.71 95% CI = 2.10, 4.06).

Conclusion: Using multilevel methods accounting for patient movement, we found that while antibiotic use is the most important risk factor in patients that developed C. difficile infection, environmental risk factors are additionally important and should be considered in research involving hospitalized patients and healthcare-associated infections.

Objective: To explore the impact of an immersive virtual reality (VR) training module on infection prevention and control (IPC) knowledge and attitudes of healthcare personnel (HCP) and to demonstrate the use of VR for performance assessment in cleaning and disinfection of portable medical equipment (PME).

Design: Quasi-experimental study.

Setting: Two academic medical centers and three long-term care facilities.

Participants: HCP in clinical roles were recruited.

Methods: Pilot sites trained participants on an immersive VR training module on PME cleaning and disinfection. Participants completed the VR module and pre- and post-knowledge and attitude assessment surveys, including a post-survey on the user experience of the VR module. Performance data were collected from the head-mounted displays (HMD) on the duration of the VR session, and participant performance including in-module task completion, hand hygiene compliance, PME disinfection percentage, and in-module quiz performance. Statistical significance and effect size were calculated using paired sample t-tests and Cohen's D for pre- and post-survey results. HMD data were analyzed using descriptive statistics.

Results: A total of 60 participants were recruited; 54 were included for analysis, with improvements in knowledge and attitudes post-training. Participant user experience was rated 50.19/55. HMD data demonstrated: 22-minute mean module duration, mean of 2.15/28 tasks not completed, mean of 2.56 missed hand hygiene opportunities, and 54% PME mean disinfection percentage, and varied performance on in-module quizzes.

Conclusions: Immersive VR training may be effective in improving HCP knowledge and attitudes in IPC concepts. Performance data collected through VR training can evaluate learner performance and be used to target training for improvement.

An outbreak of emm92/ST82 Streptococcus pyogenes was detected through prospective genomic surveillance at a military treatment facility. Twenty-one of twenty-six patients had confirmed epidemiological links to grappling sports. One case resulted from household transmission. The benefits of routine surveillance extend beyond the hospital environment enabling the detection of community-driven transmission.

This anonymous survey of hospitalists and acute care nurses evaluated awareness of peripheral intravenous catheters (PIVC) presence and decision-making regarding PIVC insertion, maintenance, and removal. Nurses were most aware of PIVC presence and regarded as best to make decisions about PIVC, yet <50% of respondents felt nurses should remove PIVC without an order.

Objective: Cardiovascular surgeries can be lifesaving, but mediastinitis following these procedures results in increased morbidity and mortality. We sought to increase the number of days between cases of mediastinitis at our institution from an average of 58 to greater than 223 days, the upper control limit of our baseline data.

Design: Quality improvement initiative.

Setting: Freestanding pediatric hospital.

Methods: We convened a multidisciplinary team to identify potential interventions. As many infections were not captured by the Solutions for Patient Safety definition, we monitored mediastinitis cases using the Society of Thoracic Surgeons definition. Our outcome measure was cases of mediastinitis. Plan-Do-Study-Act cycles were completed within our operating rooms (ORs) and cardiac care unit (CCU). We tracked measures on statistical process control charts and with descriptive statistics.

Results: From a baseline of 58 days, our hospital has gone over 450 days without a case of mediastinitis. No special causes were noted in our balancing measures. All process measures showed improvement.

Conclusions: A series of OR- and CCU-based interventions significantly increased the amount of time between our cases of mediastinitis. This work highlights the importance of engaging both OR and postoperative stakeholders in proactive mediastinitis prevention work.