Cynthia Fatica

Impact of PCR testing for Clostridium difficile on incident rates and potential on public reporting: is the playing field level?

ten MJ. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis 2009;48:922-930. 2. van Rijen MM, Bonten M, Wenzel RP, Kluytmans IA. Intranasal mupirocin for reduction of Staphylococcus aureus infections in surgical patients with nasal carriage: a systematic review. / Antimicrob Chemother 2008;61:254-261. 3. Kallen AJ, Wilson CT, Larson RJ. Perioperative intranasal mupirocin for the prevention of surgical-site infections: systematic review of the literature and meta-analysis. Infect Control Hosp Epidemiol 2005;26:916-922. 4. Robicsek A, Beaumont JL, Thomson RB Jr, Govindarajan G, Peterson LR. Topical therapy for methicillin-resistant Staphylococcus aureus colonization: impact on infection risk. Infect Control Hosp Epidemiol 2009;30:623-632. 5. Infectious Diseases Society of America, Emerging Infections Network. Perioperative Staphylococcus aureus Screening and Decolonization. Arlington, VA: Infectious Diseases Society of America, 2010. 6. Strom B, Kimmel S, eds. Textbook of Pharmacoepidemiology. Chichester: Wiley, 2006. 7. Hansen D, Patzke PI, Werfel U, Benner D, Brauksiepe A, Popp W Success of MRSA eradication in hospital routine: depends on compliance. Infection 2007;35:260-264. 8. Caffrey AR, Quilliam BJ, LaPlante KL. Risk factors associated with mupirocin resistance in methicillin-resistant Staphylococcus aureus. J Hosp Infect 2010;76:206-210.

Secular Trends in Nosocomial Bloodstream Infections in a 55-Bed Cardiothoracic Intensive Care Unit

BACKGROUND Although bloodstream infections (BSIs) occur more frequently in intensive care unit patients than in ward patients, most studies of nosocomial BSIs in critically ill patients have not distinguished between intensive care unit populations beyond surgical, medical, and pediatric patients. METHODS The primary objective of this study was to characterize the secular trends in rates of nosocomial BSIs for all pathogens among patients admitted to a busy cardiothoracic intensive care unit in a single tertiary care institution between January 1986 and December 1995. Patients with nosocomial BSIs were identified through continual prospective surveillance. RESULTS A total of 40,207 patients were admitted to the cardiothoracic intensive care unit during the 10-year study period, and 804 episodes of nosocomial BSIs among 681 patients were identified. The mean crude BSI infection rate was 6.0 per 1,000 patient-care days and increased linearly during the study period (range, 4.4 to 8.1 per 1000 patient-care days), and approached statistical significance (p value = 0.07). The most common organisms causing BSIs were Staphylococcus aureus (12%), coagulase-negative staphylococci (11%), Candida albicans (11%), Pseudomonas aeruginosa (10%), and Enterococci (9%). The leading sources of nosocomial BSIs were primary BSIs (33%), intravascular devices (27%), lower respiratory tract infections (17%), and surgical wound infections (12%). The etiologic fraction or the proportion of deaths in cardiothoracic intensive care unit patients with BSIs was 15-fold higher than those patients without BSIs (37% versus 2.5%, p < 0.001). CONCLUSIONS Rates of nosocomial BSIs among patients in our cardiothoracic intensive care unit have increased linearly during the past decade and patients with nosocomial BSIs have an increased risk of in hospital mortality.

Decrease in Staphylococcus aureus colonization and hospital-acquired infection in a medical intensive care unit after institution of an active surveillance and decolonization program.

OBJECTIVE To evaluate the effects of an active surveillance program for Staphylococcus aureus linked to a decolonization protocol on the incidence of healthcare-associated infection and new nasal colonization due to S. aureus. DESIGN Retrospective quasi-experimental study. SETTING An 18-bed medical intensive care unit at a tertiary care center in Cleveland, Ohio. METHODS From January 1, 2006, through December 31, 2007, all patients in the medical intensive care unit were screened for S. aureus nasal carriage at admission and weekly thereafter. During the preintervention period, January 1 through September 30, 2006, only surveillance occurred. During the intervention period, January 1 through December 31, 2007, S. aureus carriers received mupirocin intranasally. Beginning in February 2007, carriers also received chlorhexidine gluconate baths. RESULTS During the preintervention period, 604 (73.7%) of 819 patients were screened for S. aureus nasal carriage, yielding 248 prevalent carriers (30.3%). During the intervention period, 752 (78.3%) of 960 patients were screened, yielding 276 carriers (28.8%). The incidence of S. aureus carriage decreased from 25 cases in 3,982 patient-days (6.28 cases per 1,000 patient-days) before intervention to 18 cases in 5,415 patient-days (3.32 cases per 1,000 patient-days) (P=.04; relative risk [RR], 0.53 [95% confidence interval {CI}, 0.28-0.97]) and from 9.57 to 4.77 cases per 1,000 at-risk patient-days (P=.02; RR, 0.50 [95% CI, 0.27-0.91]). The incidence of S. aureus hospital-acquired bloodstream infection during the 2 periods was 2.01 and 1.11 cases per 1,000 patient-days, respectively (P=.28). The incidence of S. aureus ventilator-associated pneumonia decreased from 1.51 to 0.18 cases per 1,000 patient-days (P=.03; RR, 0.12 [95% CI, 0.01-0.83]). The total incidence of S. aureus hospital-acquired infection decreased from 3.52 to 1.29 cases per 1,000 patient-days (P=.03; RR, 0.37 [95% CI, 0.14-0.90]). CONCLUSIONS Active surveillance for S. aureus nasal carriage combined with decolonization was associated with a decreased incidence of S. aureus colonization and hospital-acquired infection.

A Multifaceted Approach to Reduction of Catheter-Associated Urinary Tract Infections in the Intensive Care Unit With an Emphasis on “Stewardship of Culturing”

BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications. OBJECTIVE To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture. METHODS A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared. RESULTS The CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014. CONCLUSIONS Effectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts. Infect Control Hosp Epidemiol 2017;38:186-188.

The impact of multidrug resistance on outcomes in ventilator-associated pneumonia

Multidrug-resistant (MDR) organisms in ventilator-associated pneumonia were found in 49 of 107 patients and were associated with home antibiotics, pre-ventilator-associated pneumonia hospital stay, and health care exposure. Overall, MDR organisms were associated with increased mortality (P = .006). On multivariate analysis, MDR status was modulated by organism class. In nonfermenting gram-negative rods, no association between MDR and mortality was found, but, in all other organisms, MDR was associated with increased mortality risk (hazard ratio, 6.15; 95% confidence interval: 1.80-21.05, P = .004).

Durable improvement in hand hygiene compliance following implementation of an automated observation system with visual feedback.

&NA; Automated observations systems for monitoring hand hygiene facilitate more measurements than feasible with direct observation and may enhance performance. We report that an automated observation system with immediate feedback was associated with a rapid and durable improvement in hand hygiene compliance.

Hospital-acquired Staphylococcus aureus primary bloodstream infection: A comparison of events that do and do not meet the central line–associated bloodstream infection definition

BACKGROUND This study was done to describe the incidence and outcomes of primary hospital-acquired bloodstream infection (HABSI) secondary to Staphylococcus aureus (SA) that did and did not meet the National Healthcare Safety Networks (NHSNs) definition for central line-associated bloodstream infection (CLABSI). METHODS Consecutive hospitalized patients during a 48-month study period with an SA HABSI were categorized according to those who did and did not meet the NHSNs definitions for CLABSI and non-CLABSI. Primary outcomes were mortality at 30 days and 1 year. Secondary outcomes were the incidence of complicated bacteremia and the need for operative intervention secondary to the HABSI event. RESULTS A total of 122 episodes of primary SA HABSIs were identified: 78 (64%) were CLABSIs, and 44 (36%) were non-CLABSIs. Overall 30-day and 1-year mortality in the cohort was 21.3% and 38.5%, respectively, and did not differ significantly between the 2 groups. Complicated SA HABSI was significantly more common in the non-CLABSI group (15.9% [n = 7] vs 0% [n = 0], P ≤ .001). CONCLUSIONS Primary SA HABSI was associated with significant 30-day and 1-year mortality. Complications from SA non-CLABSI requiring surgical intervention were significantly more common than in those with a CLABSI event. Our findings affirm the significance of non-device-related hospital-acquired infections.

Implementation of a pharmacy-driven program to improve nasal mupirocin use

Staphylococcus aureus is a leading cause of serious hospital-acquired infections and is associated with significant morbidity and mortality. Colonization with S. aureus within the anterior nares is a risk factor for invasive disease.[1][1] Previous work at our institution revealed that active

856Hospital Acquired Staphylococcus aureus Primary Blood Stream Infection: A Comparison of Events That Do and Do Not Meet Central Line Associated Bloodstream Infection (CLABSI) Definition

Background. Hospital acquired bloodstream infection (HABSI) due to Staphylococcus aureus (SA) causes infectious complications in hospitalized patients. We assessed the outcomes of primary SA HABSIs that meet and do not meet the NHSN CLABSI definition. Methods. Cases of primary SA HABSI were identified using an infection prevention surveillance database from January 1, 2010 to December 31, 2013 and categorized as being CLABSI or non-CLABSI (nCLABSI) according to NHSN definitions. The electronic medical record was reviewed to obtain clinical variables. Complicated bacteremia was defined as the presence of: septic thrombophlebitis, cardiac device infections, vertebral osteomyelitis, or infective endocarditis. Primary outcomes were mortality at 30 days and 1 year, septic thrombophlebitis, cardiac device infection, vertebral osteomyelitis, infective endocarditis, and complicated bacteremia. Results. CLABSI and nCLABSI infections numbered 78 and 44, respectively, and are described in the table. 26 nCLABSI infections were associated with a peripheral IV (16) or a midline catheter (10). Mean time from admission to first positive culture was shorter for nCLABSI infections (6 vs 16.3 days; p = <0.001). The Charlson Comorbidity Indices, rate of ID consultation, 30 day and 1 year mortality were not different between the groups.

Implementing a Sterilization and High Level Disinfection (SHLD) Training Program across a Healthcare System Using an Online Learning Module

ISSUE: Our facility had less than 40% compliance with wearing proper personal protective equipment when entering an isolation room.We had tried many tactics to correct this, but all results were short lived and we would soon return to our baseline. After seeing the Red Box at a previous APIC, we decided to see if it couldwork for us. The Red Box ia a three foot square of red duct tape placed on the floor at the entrance to patient rooms. You can step inside this red box without have to wear a gown and gloves. PROJECT: It was decided to initially roll out the Red Box in our ICUs. I beganwith a survey of staff on these floors. We asked their perception of proper isolation practice for themselves and other staff. The survey showed staff were only fully compliant 40% of the time and believed co-workers to be fully compliant 5.7% of the time. We then gave some pre rollout education including teasers such as “The Red BoxComing Soon to a Room Near You”. We also did some education on why we felt the Red Box was important and how we believed it would make their job easier. We worked with our Environmental Service team on selecting a tape that would not leave marks and would easily lift up. We also decided that the unit would be responsible for placing the tape and housekeeping would remove it upon discharge. The initial trial lasted 6 months. We then invited other floors to participate. RESULTS: The overall conceptwas a success. It is now being actively used on six of our units with three others ready to begin use. Once staff got used to the Red Box, they started to notice that other floors weren’t using it and would ask where it was. The follow up survey showed that staff were fully compliant 60% of the time, but believed their co-workers were only fully compliant 3.2% of the time. Staff admitted the Red Box was only being put down 62.9% of the time. However, 83.3% believed it made a difference and 96.8% believed we should continue the practice. Decreased infection rates were noted on several floors. LESSON LEARNED: We needed to do a better job engaging our support staff, as they were expected to put the tape down. We also discovered that even though the Red Box wasn’t put down the three foot barrier became an ingrained habit in some staff. 75% of staff believe that having the Red Box significantly raised there awareness level. We’ll continue to monitor and improve PPE compliance and surveillance.Wealsoneed to continue to educatenewstaff on theRed Box.