Kirk Huslage

Role of hospital surfaces in the transmission of emerging health care-associated pathogens: Norovirus, Clostridium difficile, and Acinetobacter species

Health care-associated infections (HAI) remain a major cause of patient morbidity and mortality. Although the main source of nosocomial pathogens is likely the patients endogenous flora, an estimated 20% to 40% of HAI have been attributed to cross infection via the hands of health care personnel, who have become contaminated from direct contact with the patient or indirectly by touching contaminated environmental surfaces. Multiple studies strongly suggest that environmental contamination plays an important role in the transmission of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus spp. More recently, evidence suggests that environmental contamination also plays a role in the nosocomial transmission of norovirus, Clostridium difficile, and Acinetobacter spp. All 3 pathogens survive for prolonged periods of time in the environment, and infections have been associated with frequent surface contamination in hospital rooms and health care worker hands. In some cases, the extent of patient-to-patient transmission has been found to be directly proportional to the level of environmental contamination. Improved cleaning/disinfection of environmental surfaces and hand hygiene have been shown to reduce the spread of all of these pathogens. Importantly, norovirus and C difficile are relatively resistant to the most common surface disinfectants and waterless alcohol-based antiseptics. Current hand hygiene guidelines and recommendations for surface cleaning/disinfection should be followed in managing outbreaks because of these emerging pathogens.

A Quantitative Approach to Defining “High-Touch” Surfaces in Hospitals

Fifty interactions between healthcare workers and patients were observed to obtain a quantifiable definition of high-touch (ie, frequently touched) surfaces based on frequency of contact. Five surfaces were defined as high-touch surfaces: the bed rails, the bed surface, the supply cart, the over-bed table, and the intravenous pump.

Rising Rates of Carbapenem-Resistant Enterobacteriaceae in Community Hospitals: A Mixed-Methods Review of Epidemiology and Microbiology Practices in a Network of Community Hospitals in the Southeastern United States

OBJECTIVEnDescribe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) and examine the effect of lower carbapenem breakpoints on CRE detection.nnnDESIGNnRetrospective cohort.nnnSETTINGnInpatient care at community hospitals.nnnPATIENTSnAll patients with CRE-positive cultures were included.nnnMETHODSnCRE isolated from 25 community hospitals were prospectively entered into a centralized database from January 2008 through December 2012. Microbiology laboratory practices were assessed using questionnaires.nnnRESULTSnA total of 305 CRE isolates were detected at 16 hospitals (64%). Patients with CRE had symptomatic infection in 180 cases (59%) and asymptomatic colonization in the remainder (125 cases; 41%). Klebsiella pneumoniae (277 isolates; 91%) was the most prevalent species. The majority of cases were healthcare associated (288 cases; 94%). The rate of CRE detection increased more than fivefold from 2008 (0.26 cases per 100,000 patient-days) to 2012 (1.4 cases per 100,000 patient-days; incidence rate ratio (IRR), 5.3 [95% confidence interval (CI), 1.22-22.7]; P = .01). Only 5 hospitals (20%) had adopted the 2010 Clinical and Laboratory Standards Institute (CLSI) carbapenem breakpoints. The 5 hospitals that adopted the lower carbapenem breakpoints were more likely to detect CRE after implementation of breakpoints than before (4.1 vs 0.5 cases per 100,000 patient-days; P < .001; IRR, 8.1 [95% CI, 2.7-24.6]). Hospitals that implemented the lower carbapenem breakpoints were more likely to detect CRE than were hospitals that did not (3.3 vs 1.1 cases per 100,000 patient-days; P = .01).nnnCONCLUSIONSnThe rate of CRE detection increased fivefold in community hospitals in the southeastern United States from 2008 to 2012. Despite this, our estimates are likely underestimates of the true rate of CRE detection, given the low adoption of the carbapenem breakpoints recommended in the 2010 CLSI guidelines.

Microbial assessment of high-, medium-, and low-touch hospital room surfaces.

Author(s): Kirk Huslage, RN, BSN, MSPH; William A. Rutala, PhD, MPH; Maria F. Gergen, MT(ASCP); Emily E. Sickbert-Bennett, MS, PhD; David J. Weber, MD, MPH Source: Infection Control and Hospital Epidemiology, Vol. 34, No. 2 (February 2013), pp. 211212 Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America Stable URL: http://www.jstor.org/stable/10.1086/669092 . Accessed: 25/06/2014 06:11

Optimizing Antibiotic Use in Nursing Homes Through Antibiotic Stewardship

Antibiotic stewardship is becoming a requirement for nursing homes. Programs should be interdisciplinary and multifaceted; should have support from nursing home administrators; and should aim to promote antibiotics only when needed, not just in case. Recommended components include use of evidence-based guidelines; ongoing monitoring of antibiotic prescriptions, cultures, and study results; monitoring of health outcomes; use of nursing home–specific antibiograms; regular reporting and feedback to medical providers and nurses; and education of residents and families.

To Be a CLABSI or Not to Be a CLABSI—That is the Question: The Epidemiology of BSI in a Large ECMO Population

identified venues to receive this education. Nurses with master’s degrees were less likely to believe that nurses might play a role in ASPs, perhaps due to greater familiarity with the current state of ASP, and perhaps, therefore, they were less likely to think “outside the box” regarding a nursing role. Nonetheless, most nurses felt that they played a role in antimicrobial stewardship. The strengths of this study include the large number of nursing respondents across different hospitals and patient care units. The study also has several limitations. The survey had a relatively low response rate, and because responses to the survey were voluntary, respondents may not be representative of all nurses at our hospital system. Similarly, responses obtained from nurses in our institution may not be generalizable among all nurses. This study illustrates a need to educate nurses on general principles of antimicrobial stewardship, and our findings point to multiple areas for nursing-targeted interventions that merit additional research. Nurses could ensure or facilitate acquisition of proper allergy histories, blood culture techniques, prioritization of antimicrobial administration, and antimicrobial de-escalation. Given the number of bedside nurses in practice, such interventions have the potential to substantially lower inappropriate antimicrobial utilization.