Pandemic Influenza A(H1N1)2009 in Hospital Healthcare Workers in New Zealand.

Infect Control Hosp Epidemiol. 2012 Feb;33(2):196-9

Authors: Raymond NJ, Berry N, Blackmore TK, Jefferies S, Norton K, Perrin K, Beasley R

Abstract
We evaluated A/H1N1 influenza in healthcare workers (HCWs) and in a flu room during the 2009 pandemic. The flu room aided HCW care and management by facilitating rapid diagnosis and treatment. Absence of fever was common, and symptoms were nonspecific. A higher rate of H1N1 occurred in HCWs deployed in acute services.

PMID: 22227991 [PubMed - in process]

Infection Prevention Promotion Program Based on the PRECEDE Model: Improving Hand Hygiene Behaviors among Healthcare Personnel.

Infect Control Hosp Epidemiol. 2012 Feb;33(2):144-51

Authors: Aboumatar H, Ristaino P, Davis RO, Thompson CB, Maragakis L, Cosgrove S, Rosenstein B, Perl TM

Abstract
Background.?Healthcare-associated infections (HAIs) result in significant morbidity and mortality. Hand hygiene remains a cornerstone intervention for preventing HAIs. Unfortunately, adherence to hand hygiene guidelines among healthcare personnel is poor. Objective.?To assess short- and long-term effects of an infection prevention promotion program on healthcare personnel hand hygiene behaviors. Design.?Time series design. Setting?Our study was conducted at a tertiary care academic center. Participants.?Hospital healthcare personnel. Methods.?We developed a multimodal program that included a multimedia communications campaign, education, leadership engagement, environment modification, team performance measurement, and feedback. Healthcare personnel hand hygiene practices were measured via direct observations over a 3-year period by "undercover" observers. Results.?Overall hand hygiene compliance increased by 2-fold after full program implementation ([Formula: see text]), and this increase was sustained over a 20-month follow-up period ([Formula: see text]). The odds for compliance with hand hygiene increased by 3.8-fold in the 6 months after full program implementation (95% confidence interval, 3.53-4.23; [Formula: see text]), and this increase was sustained. There was even a modest increase at 20 months of follow up. Hand hygiene compliance increased among all disciplines and hospital units. Hand hygiene compliance increased from 35% in the first 6 months after program initiation to 77% in the last 6 months of the study period among nursing providers ([Formula: see text]), from 38% to 62% among medical providers ([Formula: see text]), and from 27% to 75% among environmental services staff ([Formula: see text]). Conclusions.?Implementation of the infection prevention promotion program was associated with a significant and sustained increase in hand hygiene practices among healthcare personnel of various disciplines.

PMID: 22227983 [PubMed - in process]

Prior Vancomycin Use Is a Risk Factor for Reduced Vancomycin Susceptibility in Methicillin-Susceptible but Not Methicillin-Resistant Staphylococcus aureus Bacteremia.

Infect Control Hosp Epidemiol. 2012 Feb;33(2):160-6

Authors: Mascitti KB, Edelstein PH, Fishman NO, Morales KH, Baltus AJ, Lautenbach E

Abstract
Objective.?Staphylococcus aureus is a cause of community- and healthcare-acquired infections and is associated with substantial morbidity, mortality, and costs. Vancomycin minimum inhibitory concentrations (MICs) among S. aureus have increased, and reduced vancomycin susceptibility (RVS) may be associated with treatment failure. We aimed to identify clinical risk factors for RVS in S. aureus bacteremia. Design.?Case-control. Setting.?Academic tertiary care medical center and affiliated urban community hospital. Patients.?Cases were patients with RVS S. aureus isolates (defined as vancomycin E-test MIC >1.0 ?g/mL). Controls were patients with non-RVS S. aureus isolates. Results.?Of 392 subjects, 134 (34.2%) had RVS. Fifty-eight of 202 patients (28.7%) with methicillin-susceptible S. aureus (MSSA) isolates had RVS, and 76 of 190 patients (40.0%) with methicillin-resistant S. aureus (MRSA) isolates had RVS ([Formula: see text]). In unadjusted analyses, prior vancomycin use was associated with RVS (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.00-4.32; [Formula: see text]). In stratified analyses, there was significant effect modification by methicillin susceptibility on the association between vancomycin use and RVS ([Formula: see text]). In multivariable analyses, after hospital of admission and prior levofloxacin use were controlled for, the association between vancomycin use and RVS was significant for patients with MSSA infection (adjusted OR, 4.02; 95% CI, 1.11-14.50) but not MRSA infection (adjusted OR, 0.87; 95% CI, 0.36-2.13). Conclusions.?A substantial proportion of patients with S. aureus bacteremia had RVS. The association between prior vancomycin use and RVS was significant for patients with MSSA infection but not MRSA infection, suggesting a complex relationship between the clinical and molecular epidemiology of RVS in S. aureus.

PMID: 22227985 [PubMed - in process]

Temporary central venous catheter utilization patterns in a large tertiary care center: tracking the "idle central venous catheter".

Infect Control Hosp Epidemiol. 2012 Jan;33(1):50-7

Authors: Chernetsky Tejedor S, Tong D, Stein J, Payne C, Dressler D, Xue W, Steinberg JP

Abstract
Objectives.?Although central venous catheter (CVC) dwell time is a major risk factor for catheter-related bloodstream infections (CR-BSIs), few studies reveal how often CVCs are retained when not needed ("idle"). We describe use patterns for temporary CVCs, including peripherally inserted central catheters (PICCs), on non-ICU wards. Design.?A retrospective observational study. Setting.?A 579-bed acute care, academic tertiary care facility. Methods.?A retrospective observational study of a random sample of patients on hospital wards who have a temporary, nonimplanted CVC, with a focus on on daily ward CVC justification. A uniform definition of idle CVC-days was used. Results.?We analyzed 89 patients with 146 CVCs (56% of which were PICCs); of 1,433 ward CVC-days, 361 (25.2%) were idle. At least 1 idle day was observed for 63% of patients. Patients had a mean of 4.1 idle days and a mean of 3.4 days with both a CVC and a peripheral intravenous catheter (PIV). After adjusting for ward length of stay, mean CVC dwell time was 14.4 days for patients with PICCs versus 9.0 days for patients with non-PICC temporary CVCs (other CVCs; [Formula: see text]). Patients with a PICC had 5.4 days in which they also had a PIV, compared with 10 days in other CVC patients ([Formula: see text]). Patients with PICCs had more days in which the only justification for the CVC was intravenous administration of antimicrobial agents (8.5 vs 1.6 days; [Formula: see text]). Conclusions.?Significant proportions of ward CVC-days were unjustified. Reducing "idle CVC-days" and facilitating the appropriate use of PIVs may reduce CVC-days and CR-BSI risk.

PMID: 22173522 [PubMed - in process]

Association between Contact Precautions and Delirium at a Tertiary Care Center.

Infect Control Hosp Epidemiol. 2012 Jan;33(1):34-9

Authors: Day HR, Perencevich EN, Harris AD, Gruber-Baldini AL, Himelhoch SS, Brown CH, Dotter E, Morgan DJ

Abstract
Objective.?To investigate the relationship between contact precautions and delirium among inpatients, adjusting for other factors. Design.?Retrospective cohort study. Setting.?A 662-bed tertiary care center. Patients.?All nonpyschiatric adult patients admitted to a tertiary care center from 2007 through 2009. Methods.?Generalized estimating equations were used to estimate the association between contact precautions and delirium in a retrospective cohort of 2 years of admissions to a tertiary care center. Results.?During the 2-year period, 60,151 admissions occurred in 45,266 unique nonpsychiatric patients. After adjusting for comorbid conditions, age, sex, intensive care unit status, and length of hospitalization, contact precautions were significantly associated with delirium (as defined by International Classification of Diseases, Ninth Revision), medication, or restraint exposure (adjusted odds ratio [OR], 1.40 [95% confidence interval {CI}, 1.24-1.51]). The association between contact precautions and delirium was seen only in patients who were newly placed under contact precautions during the course of their stay (adjusted OR, 1.75 [95% CI, 1.60-1.92]; [Formula: see text]) and was not seen in patients who were already under contact precautions at admission (adjusted OR, 0.97 [95% CI, 0.86-1.09]; [Formula: see text]). Conclusions.?Although delirium was more common in patients who were newly placed under contact precautions during the course of their hospital admission, delirium was not associated with contact precautions started at hospital admission. Patients newly placed under contact precautions after admission but during hospitalization appear to be at a higher risk and may benefit from proven delirium-prevention strategies.

PMID: 22173520 [PubMed - in process]

Frequent Hospital Readmissions for Clostridium difficile Infection and the Impact on Estimates of Hospital-Associated C. difficile Burden.

Infect Control Hosp Epidemiol. 2012 Jan;33(1):20-8

Authors: Murphy CR, Avery TR, Dubberke ER, Huang SS

Abstract
Objective.?Clostridium difficile infection (CDI) is associated with hospitalization and may cause readmission following admission for any reason. We aimed to measure the incidence of readmissions due to CDI. Design.?Retrospective cohort study. Patients.?Adult inpatients in Orange County, California, who presented with new-onset CDI within 12 weeks of discharge. Methods.?We assessed mandatory 2000-2007 hospital discharge data for trends in hospital-associated CDI (HA-CDI) incidence, with and without inclusion of postdischarge CDI (PD-CDI) events resulting in rehospitalization within 12 weeks of discharge. We measured the effect of including PD-CDI events on hospital-specific CDI incidence, a mandatory reporting measure in California, and on relative hospital ranks by CDI incidence. Results.?From 2000 to 2007, countywide hospital-onset CDI (HO-CDI) incidence increased from 15 per 10,000 to 22 per 10,000 admissions. When including PD-CDI events, HA-CDI incidence doubled (29 per 10,000 in 2000 and 52 per 10,000 in 2007). Overall, including PD-CDI events resulted in significantly higher hospital-specific CDI incidence, although hospitals had disproportionate amounts of HA-CDI occurring postdischarge. This resulted in substantial shifts in some hospitals' rankings by CDI incidence. In multivariate models, both HO and PD-CDI were associated with increasing age, higher length of stay, and select comorbidities. Race and Hispanic ethnicity were predictive of PD-CDI but not HO-CDI. Conclusions.?PD-CDI events associated with rehospitalization are increasingly common. The majority of HA-CDI cases may be occurring postdischarge, raising important questions about both accurate reporting and effective prevention strategies. Some risk factors for PD-CDI may be different than those for HO-CDI, allowing additional identification of high-risk groups before discharge.

PMID: 22173518 [PubMed - in process]

A real-life snapshot of the use and abuse of urinary catheters on general medical wards.

Infect Control Hosp Epidemiol. 2011 Dec;32(12):1216-8

Authors: Harley G, Yeo AL, Stuart RL, Dendle C

Abstract
An observational study was performed on 2 wards in a tertiary hospital to determine staff awareness, knowledge, and documentation of catheter use and the effects these have on duration of catheterization. Overall, there was poor knowledge of the indications and date of catheterization. Doctor awareness decreases duration of catheterization.

PMID: 22080662 [PubMed - in process]

"The dirty hand in the latex glove": a study of hand hygiene compliance when gloves are worn.

Infect Control Hosp Epidemiol. 2011 Dec;32(12):1194-9

Authors: Fuller C, Savage J, Besser S, Hayward A, Cookson B, Cooper B, Stone S

Abstract
Background and objective.?Wearing of gloves reduces transmission of organisms by healthcare workers' hands but is not a substitute for hand hygiene. Results of previous studies have varied as to whether hand hygiene is worse when gloves are worn. Most studies have been small and used nonstandardized assessments of glove use and hand hygiene. We sought to observe whether gloves were worn when appropriate and whether hand hygiene compliance differed when gloves were worn. Design.?Observational study. Participants and setting.?Healthcare workers in 56 medical or care of the elderly wards and intensive care units in 15 hospitals across England and Wales. Methods.?We observed hand hygiene and glove usage (7,578 moments for hand hygiene) during 249 one-hour sessions. Observers also recorded whether gloves were or were not worn for individual contacts. Results.?Gloves were used in 1,983 (26.2%) of the 7,578 moments for hand hygiene and in 551 (16.7%) of 3,292 low-risk contacts; gloves were not used in 141 (21.1%) of 669 high-risk contacts. The rate of hand hygiene compliance with glove use was 41.4% (415 of 1,002 moments), and the rate without glove use was 50.0% (1,344 of 2,686 moments). After adjusting for ward, healthcare worker type, contact risk level, and whether the hand hygiene opportunity occurred before or after a patient contact, glove use was strongly associated with lower levels of hand hygiene (adjusted odds ratio, 0.65 [95% confidence interval, 0.54-0.79]; [Formula: see text]). Conclusion.?The rate of glove usage is lower than previously reported. Gloves are often worn when not indicated and vice versa. The rate of compliance with hand hygiene was significantly lower when gloves were worn. Hand hygiene campaigns should consider placing greater emphasis on the World Health Organization indications for gloving and associated hand hygiene. Trial registration.?National Research Register N0256159318.

PMID: 22080658 [PubMed - in process]

Epidemiology of hospital-acquired urinary tract-related bloodstream infection at a university hospital.

Infect Control Hosp Epidemiol. 2011 Nov;32(11):1127-9

Authors: Chang R, Todd Greene M, Chenoweth CE, Kuhn L, Shuman E, Rogers MA, Saint S

Abstract
Little is known about the epidemiology of nosocomial urinary tract-related bloodstream infection. In a case series from an academic medical center, Enterococcus (28.7%) and Candida (19.6%) species were the predominant microorganisms, which suggests a potential shift from gram-negative microorganisms. A case-fatality rate of 32.8% highlights the severity of this condition.

PMID: 22011543 [PubMed - in process]

Antimicrobial Prescribing Practices in Response to Different Clostridium difficile Diagnostic Methodologies.

Infect Control Hosp Epidemiol. 2011 Nov;32(11):1133-6

Authors: Sydnor ER, Lenhart A, Trollinger B, Avdic E, Maragakis LL, Carroll KC, Cosgrove SE

Abstract
We evaluated treatment decisions and antimicrobial use related to 2 testing algorithms for Clostridium difficile infection (CDI). Our findings suggest that a 2-step testing algorithm using rapid polymerase chain reaction confirmatory testing leads to decreased unnecessary anti-CDI antimicrobial use. In addition, a significant proportion of patients with confirmed CDI were not treated according to recommended guidelines.

PMID: 22011545 [PubMed - in process]

A clinical prediction rule for fluoroquinolone resistance in healthcare-acquired gram-negative urinary tract infection.

Infect Control Hosp Epidemiol. 2011 Nov;32(11):1124-6

Authors: Rattanaumpawan P, Tolomeo P, Bilker WB, Lautenbach E

Abstract
Data from a case-control study were used to derive and internally validate a prediction rule for identifying fluoroquinolone resistance in healthcare-acquired gram-negative urinary tract infection. This prediction rule has an excellent sensitivity and specificity (C-statistic, 0.816). External validation is necessary before implementing this rule to optimize empirical antibiotic use in clinical practice.

PMID: 22011542 [PubMed - in process]

Effectiveness of low-temperature domestic laundry on the decontamination of healthcare workers' uniforms.

Infect Control Hosp Epidemiol. 2011 Nov;32(11):1103-8

Authors: Lakdawala N, Pham J, Shah M, Holton J

Abstract
Objective.?Most professionals in the healthcare environment wear uniforms. For the purpose of this study, we concentrated on nurses' uniforms. In the United Kingdom, many nurses are expected to launder their uniforms at home by using a domestic washing machine that frequently has low-temperature wash cycles. We have investigated whether the use of low-temperature wash cycles results in a microbiologically acceptable product to wear on the wards. Methods.?We have assessed the bioburden on uniforms before and after laundry and the effectiveness of low-temperature wash cycles and ironing on removal of methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii. We did not assess the role of tumble drying. Results.?We demonstrate contamination of uniforms by gram-negative bacteria after wash, the removal of MRSA at low-temperature wash cycles in the presence of detergent, and the eradication of gram-negative bacteria after ironing. Conclusions.?Our conclusions are that laundry in a domestic situation at 60°C (140°F) for 10 minutes is sufficient to decontaminate hospital uniforms and reduces the bacterial load by more than 7-log reduction, that items left in the pockets are decontaminated to the same extent, that the addition of either a biological detergent or a nonbiological detergent is beneficial in removing MRSA from experimentally contaminated swatches, and that uniforms become recontaminated with low numbers of principally gram-negative bacteria after laundry but that these are effectively removed by ironing.

PMID: 22011538 [PubMed - in process]

Carbapenem-Resistant Klebsiella pneumoniae in Post-Acute-Care Facilities in Israel.

Infect Control Hosp Epidemiol. 2011 Sep;32(9):845-53

Authors: Ben-David D, Masarwa S, Navon-Venezia S, Mishali H, Fridental I, Rubinovitch B, Smollan G, Carmeli Y, Schwaber MJ

Objective.?To assess the prevalence of and risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) carriage among patients in post-acute-care facilities (PACFs) in Israel. Design, Setting, and Patients.?A cross-sectional prevalence survey was conducted in 12 PACFs. Rectal swab samples were obtained from 1,144 patients in 33 wards. Risk factors for CRKP carriage were assessed among the cohort. Next, a nested, matched case-control study was conducted to define individual risk factors for colonization. Finally, the cohort of patients with a history of CRKP carriage was characterized to determine risk factors for continuous carriage. Results.?The prevalence of rectal carriage of CRKP among 1,004 patients without a history of CRKP carriage was 12.0%. Independent risk factors for CRKP carriage were prolonged length of stay (odds ratio [OR], 1.001; [Formula: see text]), sharing a room with a known carrier (OR, 3.09; [Formula: see text]), and increased prevalence of known carriers on the ward (OR, 1.02; [Formula: see text]). A policy of screening for carriage on admission was protective (OR, 0.41; [Formula: see text]). Risk factors identified in the nested case-control study were antibiotic exposure during the prior 3 months (OR, 1.66; [Formula: see text]) and colonization with other resistant pathogens (OR, 1.64; [Formula: see text]). Among 140 patients with a history of CRKP carriage, 47% were colonized. Independent risk factors for continued CRKP carriage were antibiotic exposure during the prior 3 months (OR, 3.05; [Formula: see text]), receipt of amoxicillin-clavulanate (OR, 4.18; [Formula: see text]), and screening within 90 days of the first culture growing CRKP (OR, 2.9; [Formula: see text]). Conclusions.?We found a large reservoir of CRKP in PACFs. Infection-control polices and antibiotic exposure were associated with patient colonization.

PMID: 21828964 [PubMed - in process]

High Incidence of Multidrug-Resistant Gram-Negative Bacteria Recovered from Afghan Patients at a Deployed US Military Hospital.

Infect Control Hosp Epidemiol. 2011 Sep;32(9):854-60

Authors: Sutter DE, Bradshaw LU, Simkins LH, Summers AM, Atha M, Elwood RL, Robertson JL, Murray CK, Wortmann GW, Hospenthal DR

Objective.?To investigate potential sources and risks associated with multidrug-resistant (MDR) bacteria in a deployed US military hospital. Design.?Retrospective analysis of factors associated with recovery of MDR bacteria, supplemented by environmental sampling. Setting.?The largest US military hospital in Afghanistan. Patients.?US and Afghan patients with positive bacterial culture results, from September 2007 through August 2008. Methods.?Microbiologic, demographic, and clinical data were analyzed. Potential risk factors included admission diagnosis or mechanism of injury, length of stay, gender, age, and nationality (US or Afghan). Environmental sampling of selected hospital high-touch surfaces and equipment was performed to help elucidate whether environmental MDR bacteria were contributing to nosocomial spread. Results.?A total of 266 patients had 411 bacterial isolates that were identified during the study period, including 211 MDR bacteria (51%). Gram-negative bacteria were common among Afghan patients (241 [76%] of 319), and 70% of these were classified as MDR. This included 58% of bacteria recovered from Afghan patients within 48 hours of hospital admission. The most common gram-negative bacteria were Escherichia coli (53% were MDR), Acinetobacter (90% were MDR), and Klebsiella (63% were MDR). Almost one-half of potential extended-spectrum ?-lactamase (ESBL) producers were community acquired. Of 100 environmental swab samples, 18 yielded MDR bacteria, including 10 that were Acinetobacter, but no potential ESBL-producing bacteria. Conclusions.?Gram-negative bacteria from Afghan patients had high rates of antimicrobial resistance. Patients experiencing complex trauma and prolonged hospital stays likely contribute to the presence of MDR bacteria in this facility. However, many of these patients had community-acquired cases, which implies high rates of colonization prior to hospital admission.

PMID: 21828965 [PubMed - in process]

Clostridium difficile Outbreak Strain BI Is Highly Endemic in Chicago Area Hospitals.

Infect Control Hosp Epidemiol. 2011 Sep;32(9):897-902

Authors: Black SR, Weaver KN, Jones RC, Ritger KA, Petrella LA, Sambol SP, Vernon M, Burton S, Garcia-Houchins S, Weber SG, Lavin MA, Gerding D, Johnson S, Gerber SI

Objective.?Describe the clinical and molecular epidemiology of incident Clostridium difficile infection (CDI) cases in Chicago area acute healthcare facilities (HCFs). Design and Setting.?Laboratory, clinical, and epidemiologic information was collected for patients with incident CDI who were admitted to acute HCFs in February 2009. Stool cultures and restriction endonuclease analysis typing of the recovered C. difficile isolates was performed. Patients.?Two hundred sixty-three patients from 25 acute HCFs. Results.?Acute HCF rates ranged from 2 to 7 patients with CDI per 10,000 patient-days. The crude mortality rate was 8%, with 20 deaths occurring in patients with CDI. Forty-two (16%) patients had complications from CDI, including 4 patients who required partial, subtotal, or total colectomy, 3 of whom died. C. difficile was isolated and typed from 129 of 178 available stool specimens. The BI strain was identified in 79 (61%) isolates. Of patients discharged to long-term care who had their isolate typed, 36 (67%) had BI-associated CDI. Conclusions.?Severe disease was common and crude mortality was substantial among patients with CDI in Chicago area acute HCFs in February 2009. The outbreak-associated BI strain was the predominant endemic strain identified, accounting for nearly two-thirds of cases. Focal HCF outbreaks were not reported, despite the presence of the BI strain. Transfer of patients between acute and long-term HCFs may have contributed to the high incidence of BI cases in this investigation.

PMID: 21828970 [PubMed - in process]