Gloria C. Morrell

Device-Associated Infections among Neonatal Intensive Care Unit Patients: Incidence and Associated Pathogens Reported to the National Healthcare Safety Network, 2006–2008

OBJECTIVE To describe rates and pathogen distribution of device-associated infections (DAIs) in neonatal intensive care unit (NICU) patients and compare differences in infection rates by hospital type (childrens vs general hospitals). PATIENTS AND SETTING Neonates in NICUs participating in the National Healthcare Safety Network from 2006 through 2008. METHODS We analyzed central line-associated bloodstream infections (CLABSIs), umbilical catheter-associated bloodstream infections (UCABs), and ventilator-associated pneumonia (VAP) among 304 NICUs. Differences in pooled mean incidence rates were examined using Poisson regression; nonparametric tests for comparing medians and rate distributions were used. RESULTS Pooled mean incidence rates by birth weight category (750 g or less, 751-1,000 g, 1,001-1,500 g, 1,501-2,500 g, and more than 2,500 g, respectively) were 3.94, 3.09, 2.25, 1.90, and 1.60 for CLABSI; 4.52, 2.77, 1.70, 0.91, and 0.92 for UCAB; and 2.36, 2.08, 1.28, 0.86, and 0.72 for VAP. When rates of infection between hospital types were compared, only pooled mean VAP rates were significantly lower in childrens hospitals than in general hospitals among neonates weighing 1,000 g or less; no significant differences in medians or rate distributions were noted. Pathogen frequencies were coagulase-negative staphylococci (28%), Staphylococcus aureus (19%), and Candida species (13%) for bloodstream infections and Pseudomonas species (16%), S. aureus (15%), and Klebsiella species (14%) for VAP. Of 673 S. aureus isolates with susceptibility results, 33% were methicillin resistant. CONCLUSIONS Neonates weighing 750 g or less had the highest DAI incidence. With the exception of VAP, pooled mean NICU incidence rates did not differ between childrens and general hospitals. Pathogens associated with these infections can pose treatment challenges; continued efforts at prevention need to be applied to all NICU settings.

Healthcare-associated Infections Studies Project: An American Journal of Infection Control and National Healthcare Safety Network Data Quality Collaboration

This is the first case study published in a series in the American Journal of Infection Control since the National Healthcare Safety Network (NHSN) of the Centers for Disease Control and Prevention surveillance definition update of 2016. These cases represent some of the complex patient scenarios infection preventionists have encountered in their daily surveillance of health care-associated infections using NHSN procedural approaches and definitions. Case study objectives have been previously published.1 With each case, a link to an online survey is provided, where you may enter answers to questions and receive immediate feedback in the form of correct answers and explanations. All individual participant answers will remain confidential, although it is the authors’ intention to share a summary of the survey responses at a later date. Cases, answers, and explanations have been reviewed and approved by NHSN. We hope that you will take advantage of this offering, and we look forward to your active participation. The online survey may be found at https://www.surveymonkey.com/r/ 2016Case1. We strongly recommend that you review/reference the NHSN Patient Safety Component Manual, Multidrug-Resistant Organism and Clostridium difficile Infection (MDRO/CDI) Module2 for information you may need to answer the case study questions and use the MDRO and CDI LabID event calculator3 as needed. The findings and conclusions in this case study are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. For each question, please select the most correct answer.

An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration: a supplement of new case studies.

The rationale for the case study series is presented, along with results of the first 5 American Journal of Infection Control-National Healthcare Safety Network case studies. Although the respondents were correct in their assessments more often than not, opportunities for improvement remain. Ten new case studies with questions are provided. Participants are provided with instructions on how to submit responses for continuing education credit through the Centers for Disease Control and Prevention. Answers with referenced explanations will be provided immediately to those who seek continuing education credit and at a later date via the online journal for those who do not.

Healthcare-associated infections studies project: an American Journal of Infection Control and National Healthcare Safety Network data quality collaboration-Ventilator-associated event 1, 2013.

This is the second case study published in a series in AJIC since the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) surveillance definition update of 2013. These cases reflect some of the complex patient scenarios Infection Preventionists (IP) have encountered in their daily surveillance of health care-associated infections (HAI) using NHSN definitions. This is the first case utilizing the new NHSN Ventilator-associated Events (VAE) module and criteria.