Christina Silkaitis

Effects of Mumps Outbreak in Hospital, Chicago, Illinois, USA, 2006

Controlling the outbreak cost 4 times more than a routine prevention program.

Respiratory syncytial virus outbreak on an adult stem cell transplant unit

BACKGROUND An increase in respiratory syncytial virus type B (RSV-B) infections was detected on an adult hematology/oncology and stem cell transplant unit during March 2015. This prompted an outbreak investigation. METHODS Nosocomial cases were defined as RSV-B-positive patients who developed respiratory virus symptoms ≥ 7 days after admission to the unit or were readmitted with symptoms ≤ 7 days since last discharge from the unit. Strict outbreak control measures were implemented to stop the outbreak. RESULTS During the outbreak, 19 cases of RSV-B were detected, 14 among patients and 5 among health care workers (HCWs). Additionally, 2 HCWs tested positive for respiratory syncytial virus type A and 1 tested positive for influenza B among the 27 symptomatic HCWs evaluated. No specific antiviral therapy was given and all cases recovered without progression to lower respiratory tract infection. After no new cases were identified for 2 weeks, the outbreak was declared over. CONCLUSIONS High vigilance for respiratory viruses on high-risk inpatient units is required for detection and prevention of potential outbreaks. Multiple respiratory viruses with outbreak potential were identified among HCWs. HCWs with respiratory virus symptoms should not provide direct patient care. Absence of lower respiratory tract infection suggests lower virulence of RSV-B, compared with respiratory syncytial virus type A, among immunocompromised adults.

Reducing catheter-associated urinary tract infections in a neuro–spine intensive care unit

A collaborative effort reduced catheter-associated urinary tract infections in the neuro-spine intensive care unit where the majority of infections occurred at our institution. Our stepwise approach included retrospective data review, daily rounding with clinicians, developing and implementing an action plan, conducting practice audits, and sharing of real-time data outcomes. The catheter-associated urinary tract infection rate was reduced from 8.18 to 0.93 per 1,000 catheter-days and standardized infection ratio decreased from 2.16 to 0.37.

Correlation between hospital-level antibiotic consumption and incident health care facility-onset Clostridium difficile infection

Background: The purpose of this single‐center, ecologic study is to characterize the relationship between facility‐wide (FacWide) antibiotic consumption and incident health care facility‐onset Clostridium difficile infection (HO‐CDI). Methods: FacWide antibiotic consumption and incident HO‐CDI were tallied on a monthly basis and standardized, from January 2013 through April 2015. Spearman rank‐order correlation coefficients were calculated using matched‐months analysis and a 1‐month delay. Regression analyses were performed, with P < .05 considered statistically significant. Results: FacWide analysis identified a matched‐months correlation between ceftriaxone and HO‐CDI (&rgr; = 0.44, P = .018). A unit of stem cell transplant recipients did not have significant correlation between carbapenems and HO‐CDI in matched months (&rgr; = 0.37, P = .098), but a significant correlation was observed when a 1‐month lag was applied (&rgr; = 0.54, P = .014). Discussion: Three statistically significant lag associations were observed between FacWide/unit‐level antibiotic consumption and HO‐CDI, and 1 statistically significant nonlagged association was observed FacWide. Antibiotic consumption may convey extended ward‐level risk for incident CDI. Conclusions: Consumption of antibiotic agents may have immediate and prolonged influence on incident CDI. Additional studies are needed to investigate the immediate and delayed associations between antibiotic consumption and C difficile colonization, infection, and transmission at the hospital level.

Measuring the impact of varying denominator definitions on standardized antibiotic consumption rates: implications for antimicrobial stewardship programmes

Objectives To quantify the impact of varying the at-risk days definition on the overall report of at-risk days and on the calculated standardized consumption rates (SCRs) for piperacillin/tazobactam, amikacin, daptomycin and vancomycin. Methods Data were evaluated for two system hospitals, an 894 bed academic centre and a 114 bed community hospital. Aggregate inpatient antibiotic administration and occupancy data were extracted from electronic databases at the facility-wide level. Occupancy data were reported from admission-discharge-transfer systems. At-risk days were defined as hospital days present (DP), patient days (PD), persons present (PP) and billing days (BD). Inpatient antimicrobial days of therapy (DOT) across four major antimicrobial agents were used to calculate facility-wide SCRs using each denominator and were evaluated by least-squares regression and R2 values. Results Within the 894 bed academic hospital, the average monthly facility-wide days were 28 424, 22 198, 15 957 and 14 789 by the DP, PP, PD and BD definitions, respectively. Within the 114 bed community hospital, the average monthly facility-wide days were 5175, 3523 and 2816 by the DP, PP and PD definitions, respectively. Strong concordance was observed between facility-wide SCRs using the DP and PP definitions in both the academic (R2 = 0.99, y = 0.78x - 0.001) and community (R2 = 0.99, y = 0.68x - 0.03) centres across all four inpatient antibiotics evaluated. In an analysis of piperacillin/tazobactam SCRs, rates were over-predicted by 28%-93% at the facility-wide level across centres using alternative denominators. Conclusions We found that data source and definitions of at-risk denominator days meaningfully impact antibiotic SCRs. Centres should carefully consider these potential sources of variation when setting consumption benchmarks and internally evaluating use.

Triage documentation–based decision support to improve infectious disease risk screening and mitigate exposure

Multidisciplinary focus group review of current triage practice identified gaps in identification of potentially infectious diseases. Modifications were made to triage and nursing assessment forms that were easy to maneuver, rapidly modifiable, and provided documentation-based decision support to expedite infection prevention measures. Development of a decision support infectious disease risk screening tool enhances outbreak preparedness, occupational safety, and response.

Use of acid-fast bacilli staining to determine the need for airborne infection isolation precautions: a comparison of respiratory specimens.

Institution of appropriate airborne infection isolation (AII) precautions for patients with suspected Mycobacterium tuberculosis is critical to prevent disease transmission. We compared the yield of acid-fast bacilli smears from different types of respiratory specimens and found that smear sensitivity was highest for specimens obtained by endotracheal aspirates (92%), followed by sputum (79%), and then by bronchoalveolar lavage (37%). As a result of this study, our institutional policy regarding discontinuation of AII precautions was amended.