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Featured researches published by Julia Moody.


The New England Journal of Medicine | 2013

Targeted versus Universal Decolonization to Prevent ICU Infection

Susan S. Huang; Edward Septimus; Ken Kleinman; Julia Moody; Jason Hickok; Taliser R. Avery; Julie Lankiewicz; Adrijana Gombosev; Leah Terpstra; Fallon Hartford; Mary K. Hayden; John A. Jernigan; Robert A. Weinstein; Victoria J. Fraser; Katherine Haffenreffer; Eric Cui; Rebecca E. Kaganov; Karen Lolans; Jonathan B. Perlin; Richard Platt

BACKGROUND Both targeted decolonization and universal decolonization of patients in intensive care units (ICUs) are candidate strategies to prevent health care-associated infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS We conducted a pragmatic, cluster-randomized trial. Hospitals were randomly assigned to one of three strategies, with all adult ICUs in a given hospital assigned to the same strategy. Group 1 implemented MRSA screening and isolation; group 2, targeted decolonization (i.e., screening, isolation, and decolonization of MRSA carriers); and group 3, universal decolonization (i.e., no screening, and decolonization of all patients). Proportional-hazards models were used to assess differences in infection reductions across the study groups, with clustering according to hospital. RESULTS A total of 43 hospitals (including 74 ICUs and 74,256 patients during the intervention period) underwent randomization. In the intervention period versus the baseline period, modeled hazard ratios for MRSA clinical isolates were 0.92 for screening and isolation (crude rate, 3.2 vs. 3.4 isolates per 1000 days), 0.75 for targeted decolonization (3.2 vs. 4.3 isolates per 1000 days), and 0.63 for universal decolonization (2.1 vs. 3.4 isolates per 1000 days) (P=0.01 for test of all groups being equal). In the intervention versus baseline periods, hazard ratios for bloodstream infection with any pathogen in the three groups were 0.99 (crude rate, 4.1 vs. 4.2 infections per 1000 days), 0.78 (3.7 vs. 4.8 infections per 1000 days), and 0.56 (3.6 vs. 6.1 infections per 1000 days), respectively (P<0.001 for test of all groups being equal). Universal decolonization resulted in a significantly greater reduction in the rate of all bloodstream infections than either targeted decolonization or screening and isolation. One bloodstream infection was prevented per 54 patients who underwent decolonization. The reductions in rates of MRSA bloodstream infection were similar to those of all bloodstream infections, but the difference was not significant. Adverse events, which occurred in 7 patients, were mild and related to chlorhexidine. CONCLUSIONS In routine ICU practice, universal decolonization was more effective than targeted decolonization or screening and isolation in reducing rates of MRSA clinical isolates and bloodstream infection from any pathogen. (Funded by the Agency for Healthcare Research and the Centers for Disease Control and Prevention; REDUCE MRSA ClinicalTrials.gov number, NCT00980980).


Infection Control and Hospital Epidemiology | 2014

Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals: 2014 Update

David P. Calfee; Cassandra D. Salgado; Aaron M. Milstone; Anthony D. Harris; David T. Kuhar; Julia Moody; Kathy Aureden; Susan S. Huang; Lisa L. Maragakis; Deborah S. Yokoe

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their methicillin-resistant Staphylococcus aureus (MRSA) prevention efforts. This document updates “Strategies to Prevent Transmission of Methicillin-Resistant Staphylococcus aureus in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.


JAMA | 2015

Association of a Bundled Intervention With Surgical Site Infections Among Patients Undergoing Cardiac, Hip, or Knee Surgery

Marin L. Schweizer; Hsiu-Yin Chiang; Edward Septimus; Julia Moody; Barbara I. Braun; Joanne Hafner; Melissa A. Ward; Jason Hickok; Eli N. Perencevich; Daniel J. Diekema; Cheryl Richards; Joseph E. Cavanaugh; Jonathan B. Perlin; Loreen A. Herwaldt

IMPORTANCE Previous studies suggested that a bundled intervention was associated with lower rates of Staphylococcus aureus surgical site infections (SSIs) among patients having cardiac or orthopedic operations. OBJECTIVE To evaluate whether the implementation of an evidence-based bundle is associated with a lower risk of S. aureus SSIs in patients undergoing cardiac operations or hip or knee arthroplasties. DESIGN, SETTING, AND PARTICIPANTS Twenty hospitals in 9 US states participated in this pragmatic study; rates of SSIs were collected for a median of 39 months (range, 39-43) during the preintervention period (March 1, 2009, to intervention) and a median of 21 months (range, 14-22) during the intervention period (from intervention start through March 31, 2014). INTERVENTIONS Patients whose preoperative nares screens were positive for methicillin-resistant S. aureus (MRSA) or methicillin-susceptible S. aureus (MSSA) were asked to apply mupirocin intranasally twice daily for up to 5 days and to bathe daily with chlorhexidine-gluconate (CHG) for up to 5 days before their operations. MRSA carriers received vancomycin and cefazolin or cefuroxime for perioperative prophylaxis; all others received cefazolin or cefuroxime. Patients who were MRSA-negative and MSSA-negative bathed with CHG the night before and morning of their operations. Patients were treated as MRSA-positive if screening results were unknown. MAIN OUTCOMES AND MEASURES The primary outcome was complex (deep incisional or organ space) S. aureus SSIs. Monthly SSI counts were analyzed using Poisson regression analysis. RESULTS After a 3-month phase-in period, bundle adherence was 83% (39% full adherence; 44% partial adherence). Overall, 101 complex S. aureus SSIs occurred after 28,218 operations during the preintervention period and 29 occurred after 14,316 operations during the intervention period (mean rate per 10,000 operations, 36 for preintervention period vs 21 for intervention period, difference, -15 [95% CI, -35 to -2]; rate ratio [RR], 0.58 [95% CI, 0.37 to 0.92]). The rates of complex S. aureus SSIs decreased for hip or knee arthroplasties (difference per 10,000 operations, -17 [95% CI, -39 to 0]; RR, 0.48 [95% CI, 0.29 to 0.80]) and for cardiac operations (difference per 10,000 operations, -6 [95% CI, -48 to 8]; RR, 0.86 [95% CI, 0.47 to 1.57]). CONCLUSIONS AND RELEVANCE In this multicenter study, a bundle comprising S. aureus screening, decolonization, and targeted prophylaxis was associated with a modest, statistically significant decrease in complex S. aureus SSIs.


Medical Care | 2010

Cluster randomized trials in comparative effectiveness research: randomizing hospitals to test methods for prevention of healthcare-associated infections.

Richard Platt; Samuel U. Takvorian; Edward Septimus; Jason Hickok; Julia Moody; Jonathan B. Perlin; John A. Jernigan; Ken Kleinman; Susan S. Huang

Background:The need for evidence about the effectiveness of therapeutics and other medical practices has triggered new interest in methods for comparative effectiveness research. Objective:Describe an approach to comparative effectiveness research involving cluster randomized trials in networks of hospitals, health plans, or medical practices with centralized administrative and informatics capabilities. Research Design:We discuss the example of an ongoing cluster randomized trial to prevent methicillin-resistant Staphylococcus aureus (MRSA) infection in intensive care units (ICUs). The trial randomizes 45 hospitals to: (a) screening cultures of ICU admissions, followed by Contact Precautions if MRSA-positive, (b) screening cultures of ICU admissions followed by decolonization if MRSA-positive, or (c) universal decolonization of ICU admissions without screening. Subjects:All admissions to adult ICUs. Measures:The primary outcome is MRSA-positive clinical cultures occurring ≥2 days following ICU admission. Secondary outcomes include blood and urine infection caused by MRSA (and, separately, all pathogens), as well as the development of resistance to decolonizing agents. Results:Recruitment of hospitals is complete. Data collection will end in Summer 2011. Conclusions:This trial takes advantage of existing personnel, procedures, infrastructure, and information systems in a large integrated hospital network to conduct a low-cost evaluation of prevention strategies under usual practice conditions. This approach is applicable to many comparative effectiveness topics in both inpatient and ambulatory settings.


Infection Control and Hospital Epidemiology | 2012

Antimicrobial Stewardship: A Collaborative Partnership between Infection Preventionists and Healthcare Epidemiologists

Julia Moody; Sara E. Cosgrove; Russell N. Olmsted; Edward Septimus; Kathy Aureden; Shannon Oriola; Gita Wasan Patel; Kavita K. Trivedi

Misuse and overuse of antimicrobials, primarily involving therapeutic agents used to treat infection in humans, is considered one of the worlds most pressing public health problems. Not only does such inappropriate use diminish the therapeutic benefit of essential medications, it also facilitates the development and spread of multidrug-resistant organisms (MDROs). Antimicrobial resistance and the rise in MDROs globally are associated with increased morbidity and mortality, cross-transmission within and between healthcare settings, and increased consumption of limited patient-care resources. Despite elevated awareness, publication of guidelines on antimicrobial stewardship, and several initiatives, the proportion of resistant strains causing both health care- and community-associated infections continues to increase and the number of new antimicrobials continues to decline.


American Journal of Infection Control | 2012

Antimicrobial stewardship: A collaborative partnership between infection preventionists and health care epidemiologists

Julia Moody; Sara E. Cosgrove; Russell N. Olmsted; Edward Septimus; Kathy Aureden; Shannon Oriola; Gita Wasan Patel; Kavita K. Trivedi

It is clear that the widespread and injudicious use of antimicrobials has greatly increased the presence of MDROs that threaten the health of all. There is worldwide acknowledgement that this threat is growing, and that prudent use of antimicrobials combined with infection prevention can prevent harm and improve patient safety. Antimicrobial stewardship programs must harness the talents of all members of the health care team to effectively identify the organism, determine its susceptibility, institute any precautions required, and prescribe the narrowest-acting antibiotic that will destroy it. IPs/HEs play a pivotal role in this approach, by assisting with early organism and infected patient identification, by promoting compliance with standard and transmission-based precautions and other infection prevention strategies such as care bundle practices, hand hygiene, and by educating staff, patients, and visitors.


Infection Control and Hospital Epidemiology | 2014

Cost Savings of Universal Decolonization to Prevent Intensive Care Unit Infection: Implications of the REDUCE MRSA Trial

Susan S. Huang; Edward Septimus; Taliser R. Avery; Grace M. Lee; Jason Hickok; Robert A. Weinstein; Julia Moody; Mary K. Hayden; Jonathan B. Perlin; Richard Platt; G. Thomas Ray

OBJECTIVE To estimate and compare the impact on healthcare costs of 3 alternative strategies for reducing bloodstream infections in the intensive care unit (ICU): methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, targeted decolonization (ie, screening, isolation, and decolonization of MRSA carriers or infections), and universal decolonization (ie, no screening and decolonization of all ICU patients). DESIGN Cost analysis using decision modeling. METHODS We developed a decision-analysis model to estimate the health care costs of targeted decolonization and universal decolonization strategies compared with a strategy of MRSA nares screening and isolation. Effectiveness estimates were derived from a recent randomized trial of the 3 strategies, and cost estimates were derived from the literature. RESULTS In the base case, universal decolonization was the dominant strategy and was estimated to have both lower intervention costs and lower total ICU costs than either screening and isolation or targeted decolonization. Compared with screening and isolation, universal decolonization was estimated to save


Journal of Clinical Microbiology | 2016

Chlorhexidine and Mupirocin Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolates in the REDUCE-MRSA Trial

Mary K. Hayden; Karen Lolans; Katherine Haffenreffer; Taliser R. Avery; Ken Kleinman; Haiying Li; Rebecca E. Kaganov; Julie Lankiewicz; Julia Moody; Edward Septimus; Robert A. Weinstein; Jason Hickok; John A. Jernigan; Jonathan B. Perlin; Richard Platt; Susan S. Huang

171,000 and prevent 9 additional bloodstream infections for every 1,000 ICU admissions. The dominance of universal decolonization persisted under a wide range of cost and effectiveness assumptions. CONCLUSIONS A strategy of universal decolonization for patients admitted to the ICU would both reduce bloodstream infections and likely reduce healthcare costs compared with strategies of MRSA nares screening and isolation or screening and isolation coupled with targeted decolonization.


Journal for Healthcare Quality | 2013

A bundled approach to reduce methicillin-resistant Staphylococcus aureus infections in a system of community hospitals.

Jonathan B. Perlin; Jason Hickok; Edward Septimus; Julia Moody; Jane Englebright; Richard M. Bracken

ABSTRACT Whether targeted or universal decolonization strategies for the control of methicillin-resistant Staphylococcus aureus (MRSA) select for resistance to decolonizing agents is unresolved. The REDUCE-MRSA trial (ClinicalTrials registration no. NCT00980980) provided an opportunity to investigate this question. REDUCE-MRSA was a 3-arm, cluster-randomized trial of either screening and isolation without decolonization, targeted decolonization with chlorhexidine and mupirocin, or universal decolonization without screening to prevent MRSA infection in intensive-care unit (ICU) patients. Isolates from the baseline and intervention periods were collected and tested for susceptibility to chlorhexidine gluconate (CHG) by microtiter dilution; mupirocin susceptibility was tested by Etest. The presence of the qacA or qacB gene was determined by PCR and DNA sequence analysis. A total of 3,173 isolates were analyzed; 2 were nonsusceptible to CHG (MICs, 8 μg/ml), and 5/814 (0.6%) carried qacA or qacB. At baseline, 7.1% of MRSA isolates expressed low-level mupirocin resistance, and 7.5% expressed high-level mupirocin resistance. In a mixed-effects generalized logistic regression model, the odds of mupirocin resistance among clinical MRSA isolates or MRSA isolates acquired in an ICU in intervention versus baseline periods did not differ across arms, although estimates were imprecise due to small numbers. Reduced susceptibility to chlorhexidine and carriage of qacA or qacB were rare among MRSA isolates in the REDUCE-MRSA trial. The odds of mupirocin resistance were no different in the intervention versus baseline periods across arms, but the confidence limits were broad, and the results should be interpreted with caution.


Lancet Infectious Diseases | 2016

Effect of body surface decolonisation on bacteriuria and candiduria in intensive care units: an analysis of a cluster-randomised trial

Susan S. Huang; Edward Septimus; Mary K. Hayden; Ken Kleinman; Jessica L. Sturtevant; Taliser R. Avery; Julia Moody; Jason Hickok; Julie Lankiewicz; Adrijana Gombosev; Rebecca E. Kaganov; Katherine Haffenreffer; John A. Jernigan; Jonathan B. Perlin; Richard Platt; Robert A. Weinstein

&NA; Methicillin‐resistant Staphylococcus aureus (MRSA) infections pose a significant challenge to U.S. healthcare facilities, but there has been limited study of initiatives to reduce infection and increase patient safety in community hospitals. To address this need, a multifaceted program for MRSA infection prevention was developed for implementation in 159 acute care facilities. This program featured five distinct tools—active MRSA surveillance of high‐risk patients, enhanced barrier precautions, compulsive hand hygiene, disinfection and cleaning, and executive champions and patient empowerment—and was implemented during 1Q–2Q 2007. Postintervention (3Q 2007–2Q 2008), 10.2% of patients with high‐risk for infection or complications due to MRSA had nasal colonization. Volume of disposable gown and alcohol‐based hand sanitizer use increased substantially following program implementation. Self‐reported rates, based on NHSN definitions, of healthcare‐associated central line‐associated bloodstream infections and ventilator‐associated pneumonia due to MRSA decreased 39% (p < .001) and 54% (p < .001), respectively. Infection rates continued to decrease during the follow‐up period (1Q–4Q 2009). This sustained improvement demonstrates that reducing healthcare‐associated MRSA infections in a large number of diverse facilities is possible and that a “bundled” approach that translates science into clinical and executive performance expectations may aid in overcoming traditional barriers to implementation.

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Edward Septimus

Hospital Corporation of America

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Jason Hickok

Hospital Corporation of America

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Jonathan B. Perlin

Hospital Corporation of America

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Susan S. Huang

University of California

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Ken Kleinman

University of Massachusetts Amherst

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Mary K. Hayden

Rush University Medical Center

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Robert A. Weinstein

Rush University Medical Center

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John A. Jernigan

Centers for Disease Control and Prevention

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