Anthony J. Russo

Peripherally Inserted Central Venous Catheter–Associated Bloodstream Infections in Hospitalized Adult Patients

BACKGROUND Limited data on the risk of peripherally inserted central venous catheter-associated bloodstream infections (PICC BSIs) in hospitalized patients are available. In 2007, dedicated intravenous therapy nurses were no longer available to place difficult peripheral intravenous catheters or provide PICC care Barnes-Jewish Hospital. OBJECTIVES To determine the hospital-wide incidence of PICC BSIs and to assess the effect of discontinuing intravenous therapy service on PICC use and PICC BSI rates. SETTING A 1,252-bed tertiary care teaching hospital. METHODS A 31-month retrospective cohort study was performed. PICC BSIs were defined using National Healthcare Safety Network criteria. RESULTS In total, 163 PICC BSIs were identified (3.13 BSIs per 1,000 catheter-days). PICC use was higher in intensive care units (ICUs) than non-ICU areas (PICC utilization ratio, 0.109 vs 0.059 catheter-days per patient-day for ICU vs non-ICU; rate ratio [RR], 1.84 [95% confidence interval {CI}, 1.78-1.91]). PICC BSI rates were higher in ICUs (4.79 vs 2.79 episodes per 1,000 catheter-days; RR, 1.7 [95% CI, 1.10-2.61]). PICC use increased hospital-wide after the intravenous therapy service was discontinued (0.049 vs 0.097 catheter-days per patient-day; P =.01), but PICC BSI rates did not change (2.68 vs 3.63 episodes per 1,000 catheter-days; P =.06). Of PICC BSIs, 73% occurred in non-ICU patients. CONCLUSIONS PICC use and PICC BSI rates were higher in ICUs; however, most of the PICC BSIs occurred in non-ICU areas. Reduction in intravenous therapy services was associated with increased PICC use across the hospital, but PICC BSI rates did not increase.

Long-term effect of infection prevention practices and case mix on cesarean surgical site infections.

OBJECTIVE: To estimate trends in patient characteristics and obstetric complications in an 8-year cohort of patients undergoing cesarean delivery and to use time series analysis to estimate the effect of infection prevention interventions and secular trends in patient characteristics on postcesarean delivery surgical site infections. METHODS: A multivariable autoregressive integrated moving average model was used to perform time series analysis on a 96-month retrospective cohort of patients who underwent cesarean delivery (January 2003–December 2010) in a U.S. tertiary care hospital. RESULTS: We identified 8,668 women who underwent cesarean delivery. Median age was 26 years (range 12–53 years), 3,093 (35.7%) of patients had body mass indexes (BMIs) of 35 or greater, 2,561 (29.5%) were of white race, and 303 (3.5%) had a surgical site infection. Over the study period, there was a significant increase in the proportion of patients who underwent cesarean delivery who had BMIs of 35 or higher, hypertension or mild preeclampsia, and severe preeclampsia or eclampsia. A nonseasonal autoregressive integrated moving average model with a linear trend and no autocorrelation was identified. In the multivariable autoregressive integrated moving average model of postcesarean surgical site infections, implementation of a policy to administer prophylactic antibiotics within 1 hour before incision, instead of at the time of cord clamp, led to a 48% reduction in cesarean delivery surgical site infections (&Dgr;=−5.4 surgical site infections per 100 cesarean deliveries; P<.001). CONCLUSION: A change in policy to administer prophylactic antibiotics before incision resulted in a significant reduction in postcesarean surgical site infections. LEVEL OF EVIDENCE: III

Reinstatement of reflex testing of stool samples for Vancomycin-Resistant Enterococci (VRE) resulted in decreased incidence of hospital-associated VRE

patients in a neonatal intensive care unit. J Hosp Infect 2001;48:108–116. 4. Loveday H, Wilson J, Pratt R, et al. Epic3: national evidencebased guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2014;86: S1–S70. 5. Hong H, Morrow DF, Sandora TJ, Priebe GP. Disinfection of needleless connectors with chlorhexidine-alcohol provides longlasting residual disinfectant activity. Am J Infect Control 2013;41: e77–e79. 6. Menyhay SZ, Maki DG. Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap. Infect Control Hosp Epidemiol 2006;27:23–27. 7. Stango C, Runyan D, Stern J, Macri I, Vacca M. A successful approach to reducing bloodstream infections based on a disinfection device for intravenous needleless connector hubs. J Infus Nurs 2014;37:462–465. 8. Wright MO, Tropp J, Schora DM, et al. Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. Am J Infect Control 2013;41:33–38.

Implementation of a Housewide Chlorhexidine Gluconate Bathing Program

BACKGROUND: The 2015 “superbug” outbreaks associated with duodenoscopes alerted the nation and made the public aware of the importance of proper cleaning and disinfection of these complex devices. In response, The Centers for Disease Control and Prevention (CDC) published an Interim Duodenoscope Surveillance Protocol for healthcare facilities. METHODS: In April 2015, a multi-disciplinary team examined all procedures and processes related to duodenoscopes at the three campuses of the health system. Utilizing the CDC protocol, all endoscopes were sampled to determine baseline results. Duodenoscope testing continued monthly, thereafter. Additionally, duodenoscopes used on patients with a multi-drug resistant gram negative bacilli (MDRGNB) were processed and then sampled, cultured, and quarantined until results were final. Infection Control, in collaboration with Endoscopy management, performed the sampling; the microbiology department performed the testing. RESULTS: Following an initial concern related to contamination of broth in the microbiology lab, baseline results of the 32 endoscopes sampledwere negative for high-concern bacteria. Subsequent monthly sampling of all duodenoscopes, and scopes used on MDRGNB patients was negative for high-concern bacteria. CONCLUSIONS: Procedural inconsistencies were discovered; consequently system-wide changes were implemented. A recommendation was made that all scopes go to Endoscopy for processing in the automated endoscope reprocessor (AER). Gloves are usedwhen handling clean scopes from the cabinet and the AER. Staff competencies are now conducted every six months. Manual flushes are performed prior to the scope being placed in the AER. Adenosine Triphosphate (ATP) testing is performed on duodenoscopes used on MDR-GNB patients (prior to placing in AER). A patient education sheet was created with the most frequently asked questions regarding duodenoscopes, and explains the cleaning process. Endoscopy has assumed the role of monthly sampling of the duodenoscopes. The recently reported outbreaks of duodenoscope related infections led to several pro-active process improvements as well as implementation of a comprehensive scope culturing program.

Geographical Variability in the Likelihood of Bloodstream Infections Due to Gram-Negative Bacteria: Correlation with Proximity to the Equator and Health Care Expenditure (vol 9, e114548, 2014)

Hosp Univ Austral, Div Infect Dis Prevent & Infect Control Serv, Buenos Aires, DF, Argentina

Variation in the use of diagnostic bronchoscopy among intensive care unit patients: implications for surveillance.

Implications for Surveillance Author(s): Kathleen M. McMullen, MPH, CIC; Anthony J. Russo, MPH; Trent J. Dondero; David K. Warren, MD, MPH Source: Infection Control and Hospital Epidemiology, Vol. 33, No. 10 (October 2012), pp. 10551057 Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America Stable URL: http://www.jstor.org/stable/10.1086/667734 . Accessed: 28/06/2014 17:58