Eve T. Giannetta

Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians.

OBJECTIVES To assess the effects of interventions to prevent transmission of influenza and to increase employee compliance with influenza vaccination. DESIGN The change in the proportion of hospitalized patients with laboratory-confirmed nosocomial influenza was observed over time and assessed using chi-square for trend analysis. The association between nosocomial influenza in patients and healthcare worker (HCW) compliance with vaccine was assessed by logistic regression. SETTING A 600-bed, tertiary-care academic hospital. METHODS After an outbreak of influenza A at this hospital in 1988, a mobile cart program was instituted with increased efforts to motivate employees to be vaccinated and furloughed when ill as well as new measures to prevent nosocomial spread. RESULTS HCW vaccination rates increased from 4% in 1987-1988 to 67% in 1999-2000 (P < .0001). Proportions of nosocomially acquired influenza cases among employees or patients both declined significantly (P < .0001). Logistic regression analysis revealed a significant inverse association between HCW compliance with vaccination and the rate of nosocomial influenza among patients (P < .001). CONCLUSION A mobile cart vaccination program and an increased emphasis on HCWs to receive the vaccine were associated with a significant increase in vaccine acceptance and a significant decrease in the rate of nosocomial influenza among patients.

COST-EFFECTIVENESS OF PERIRECTAL SURVEILLANCE CULTURES FOR CONTROLLING VANCOMYCIN-RESISTANT ENTEROCOCCUS

BACKGROUND Several hospitals opting not to use active surveillance cultures to identify carriers of vancomycin-resistant Enterococcus (VRE) have reported that adoption of other parts of the Centers for Disease Control and Prevention guideline for controlling VRE has had little to no impact. Because use of surveillance cultures and contact isolation controlled a large outbreak at this hospital, their costs were estimated for comparison with the excess costs of VRE bacteremias occurring at a higher rate at a hospital not employing these measures. SETTING Two university hospitals. METHODS Inpatients deemed high risk for VRE acquisition at this hospital underwent weekly perirectal surveillance cultures. Estimated costs of cultures and resulting isolation during a 2-year period were compared with the estimated excess costs of more frequent VRE bacteremias at another hospital of similar size and complexity not using surveillance cultures to control spread throughout the hospital. RESULTS Of 54,052 patients admitted, 10,400 had perirectal swabs taken. Cultures and isolation cost an estimated

Ultraviolet light disinfection of hospital water for preventing nosocomial Legionella infection: a 13-year follow-up.

253,099. VRE culture positivity was limited to 193 (0.38%) and VRE bacteremia to 1 (0.002%) as compared with 29 bacteremias at the comparison hospital. The estimated attributable cost of VRE bacteremia at the comparison hospital of

FAILURE TO DEVELOP VANCOMYCIN-RESISTANT ENTEROCOCCUS WITH ORAL VANCOMYCIN TREATMENT OF CLOSTRIDIUM DIFFICILE

761,320 exceeded the cost of the control program at this hospital by threefold. CONCLUSIONS The excess costs of VRE bacteremia may justify the costs of preventive measures. The costs of VRE infections at other body sites, of deaths from untreatable infections, and of dissemination of genes for vancomycin resistance also help to justify the costs of implementing an effective control program.

The Limits of Serial Surveillance Cultures in Predicting Clearance of Colonization with Carbapenemase-Producing Enterobacteriaceae

BACKGROUND AND OBJECTIVE CDC has estimated that 23% of Legionella infections are nosocomial. When a new hospital was being constructed and a substantial increase in transplantation was anticipated, an ultraviolet light apparatus was installed in the water main of the new building because 27% of water samples from taps in the old hospital contained Legionella. This study reports the rate of nosocomial Legionella infection and water contamination since opening the new hospital. METHODS Charts of all patients with positive Legionella cultures, direct immunofluorescent antibody (DFA), or urine antigen between April 1989 and November 2001 were reviewed. Frequencies of DFAs and urine antigens were obtained from the laboratory. RESULTS None of the 930 cultures of hospital water have been positive since moving into the new building. Fifty-three (0.02%) of 219,521 patients had a positive Legionella test; 41 had pneumonia (40 community acquired). One definite L. pneumophila pneumonia confirmed by culture and DFA in August 1994 was nosocomial (0.0005%) by dates. This patient was transferred after prolonged hospitalization in another country, was transplanted 11 days after admission, and developed symptoms 5 days after liver transplant. However, tap water from the patients room did not grow Legionella. Seventeen (2.5%) of 670 urine antigens were positive for Legionella (none nosocomial). Thirty-three (1.2%) of 2,671 DFAs were positive, including 7 patients (21%) without evidence of pneumonia and 6 (18%) who had an alternative diagnosis. CONCLUSION Ultraviolet light usage was associated with negative water cultures and lack of clearly documented nosocomial Legionella infection for 13 years at this hospital.

Septic arthritis due to oral streptococci following intra-articular injection: A case series

OBJECTIVE Oral vancomycin therapy has been a risk factor for turning culture positive for vancomycin-resistant Enterococcus (VRE). VRE colonization status was reviewed for all patients who received oral vancomycin and underwent prospective cultures. METHODS Data were extracted from the medical records of all patients receiving oral vancomycin between August 1995 and February 2001 regarding history, hospital course, and perirectal VRE cultures. Hospital policy required contact isolation for patients receiving oral vancomycin until colonization with VRE was excluded. RESULTS Twenty-six courses of oral vancomycin were given to 22 patients. VRE colonization status after completion of therapy was evaluated for 23 courses in 20 (91%) of these patients. None of these patients became VRE culture positive during a median follow-up of 18 days (range, 9 to 39 days), with a median duration of treatment of 10 days (range, 3 to 58 days), and with a median total dose of 6,500 mg (range, 1,250 to 29,000 mg). All patients received other antibiotics within 30 days prior to therapy with oral vancomycin, during therapy with oral vancomycin, or both; 95% had received anti-anaerobic therapy and 35% had received parenteral vancomycin. CONCLUSIONS Even when other risk factors were present, no patient receiving oral vancomycin at our facility subsequently became culture positive for VRE. This suggests that oral vancomycin therapy or other antibiotic use, including anti-anaerobic therapy, may not be a significant independent risk factor for turning culture positive for VRE among patients not previously exposed to the microbe.

Hidden Reservoir: An Outbreak of Tuberculosis in Hospital Employees with No Patient Contact.

An accepted practice for patients colonized with multidrug-resistant organisms is to discontinue contact precautions following 3 consecutive negative surveillance cultures. Our experience with surveillance cultures to detect persistent carbapenemase-producing Enterobacteriaceae (CPE) colonization suggests that extrapolation of this practice to CPE-colonized patients may not be appropriate.

852Housewide use of Chlorehexidine Bathing to reduce Healthcare Associated Infections

Highlights69,540 joint injections/aspirations were performed over 9 years.4 cases of septic arthritis from common oral flora following injection were found.All case‐patients presented within 2‐5 days after joint injection.In 1 case the provider who performed the injection confirmed he did not wear a mask.All received treatment with irrigation and debridement and parenteral antibiotics. &NA; Oral streptococcal species are a rare cause of septic arthritis. We describe 4 cases of septic arthritis due to oral streptococcal species following joint injection. The routine use of face masks during joint injection may prevent this rare but serious complication.

Oral Abstract Session 1—Device Squad: Preventing the PreventableBlue Ribbon Abstract Award: Increased central venous catheter–associated bloodstream infection rates temporally associated with changing from a split-septum to a Leur-access mechanical valve needleless device: A nationwide outbreak?

We describe an outbreak of tuberculosis (TB) in the food preparation area of a hospital, which demonstrates that employees in healthcare settings may serve as potential risks for spread of TB even if they have no direct patient contact. Infect Control Hosp Epidemiol 2016;37:1111-1113.

Blue Ribbon Abstract Award: Increased central venous catheter–associated bloodstream infection rates temporally associated with changing from a split-septum to a Leur-access mechanical valve needleless device: A nationwide outbreak?

Associated Infections Kyle Enfield, MD, MS; Costi D. Sifri, MD; Elizabeth Enfield, RN, MSN; Jessica Lewis, MD; Beth Quatrara, DNP, RN, CMSRN, ACNS-BC; Eve Giannetta, RN, BSN, CIC; Kristi Kimpel, RN, MSN; Kathleen Rea, RN, MSN; Department of Medicine, Division of Pulmonology, Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, VA; Department of Medicine, Division of Infectious Diseases and International Health, Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, VA; Coronary Care Unit, University of Virginia, Charlottesville, VA; Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, VA; University of Virginia, Charlottesville, VA; Infection Prevention and Control, University of Virginia Health System, Charlottesville, VA; Surgical Trauma Burn ICU, University of Virginia, Charlottesville, VA; Surgical Services/5 Central, University of Virginia, Charlottesville, VA