Melissa A. Ward
Roy J. and Lucille A. Carver College of Medicine
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Publication
Featured researches published by Melissa A. Ward.
JAMA | 2015
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.
Infection Control and Hospital Epidemiology | 2007
Philip M. Polgreen; Yiyi Chen; Joseph E. Cavanaugh; Melissa A. Ward; Stacy L. Coffman; Douglas B. Hornick; Daniel J. Diekema; Loreen A. Herwaldt
We report a severe outbreak of Clostridium difficile infection. According to a chart review, half of the patients who received treatment for bacterial pneumonia before they developed C. difficile infection may not have had pneumonia. Excessive use of the hospitals new pneumonia care plan during the influenza season may have contributed to the intensity of this outbreak.
American Journal of Infection Control | 2014
Melissa A. Ward; Marin L. Schweizer; Philip M. Polgreen; Kalpana Gupta; Heather Schacht Reisinger; Eli N. Perencevich
BACKGROUND Hand hygiene is one of the most effective ways to prevent transmission of health care-associated infections. Electronic systems and tools are being developed to enhance hand hygiene compliance monitoring. Our systematic review assesses the existing evidence surrounding the adoption and accuracy of automated systems or electronically enhanced direct observations and also reviews the effectiveness of such systems in health care settings. METHODS We systematically reviewed PubMed for articles published between January 1, 2000, and March 31, 2013, containing the terms hand AND hygiene or hand AND disinfection or handwashing. Resulting articles were reviewed to determine if an electronic system was used. RESULTS We identified 42 articles for inclusion. Four types of systems were identified: electronically assisted/enhanced direct observation, video-monitored direct observation systems, electronic dispenser counters, and automated hand hygiene monitoring networks. Fewer than 20% of articles identified included calculations for efficiency or accuracy. CONCLUSIONS Limited data are currently available to recommend adoption of specific automatic or electronically assisted hand hygiene surveillance systems. Future studies should be undertaken that assess the accuracy, effectiveness, and cost-effectiveness of such systems. Given the restricted clinical and infection prevention budgets of most facilities, cost-effectiveness analysis of specific systems will be required before these systems are widely adopted.
Clinical Infectious Diseases | 2014
Marin L. Schweizer; Heather Schacht Reisinger; Michael E. Ohl; Michelle Formanek; Amy E. Blevins; Melissa A. Ward; Eli N. Perencevich
Many studies have evaluated bundled interventions to improve hand hygiene compliance. However, there are few evidence-based recommendations on optimal interventions for implementation. We aimed to systematically review all studies on interventions to improve hand hygiene compliance to evaluate existing bundles and identify areas of promise to target high-quality studies. Adjusted risk ratios were pooled to assess common bundles. Of the 8148 studies evaluated, 6 randomized controlled trials and 39 quasi-experimental studies met inclusion criteria. Three studies evaluated the interventions education, reminders, feedback, administrative support, and access to alcohol-based hand rub as a bundle, which was associated with improved hand hygiene compliance (pooled odds ratio [OR], 1.82; 95% confidence interval [CI], 1.69-1.97). Another bundle of education, reminders, and feedback evaluated in 3 studies was associated with improved compliance (pooled OR, 1.47; 95% CI, 1.12-1.94). These bundles should be further studied using high-quality study designs and compared with other interventions.
Clinical Infectious Diseases | 2008
Susan S. Huang; Daniel J. Diekema; David K. Warren; Gianna Zuccotti; Patricia L. Winokur; S. Tendolkar; L. Boyken; Rupak Datta; Rebecca M. Jones; Melissa A. Ward; Tanya Aubrey; Andrew B. Onderdonk; Christian Garcia; Richard Platt
Invasive disease following methicillin-resistant Staphylococcus aureus (MRSA) detection is common, regardless of whether initial detection involves colonization or infection. We assessed the genetic relatedness of isolates obtained > or =2 weeks apart representing either repeated infections or colonization-infection sets to determine if infections are likely to be caused by previously harbored strains. We found that MRSA infection following initial colonization or infection is caused by the same strain in most cases, suggesting that a single successful attempt at decolonization may prevent the majority of later infection.
Journal of Burn Care & Research | 2010
Lucy Wibbenmeyer; Ingrid Williams; Melissa A. Ward; Xiangjun Xiao; Timothy D. Light; Barbara A. Latenser; Robert W. Lewis; Gerald P. Kealey; Loreen A. Herwaldt
The incidence of hospital-associated infections secondary to methicillin-resistant Staphylococcus aureus (MRSA) and those caused by vancomycin-resistant enterococci (VRE) continue to increase, despite the publication of evidence-based guidelines on infection control. We sought to determine modifiable risks factors for acquisition of MRSA or VRE or both on a burn trauma unit (BTU). We performed a retrospective single-center–matched control study. Our study group comprised 94 patients who acquired MRSA or VRE or both while on the BTU from January 1, 2001 to December 31, 2005. The case-patients were matched 1:1 to control-patients based on the time the cases were exposed to the BTU before they became colonized or infected. Logistic regression was used to analyze the relationship of demographic, procedure, and antimicrobial exposure variables to acquisition of MRSA or VRE. Acquisition of MRSA or VRE was related to patient factors, antimicrobial exposure, and device use. Younger age and prior vancomycin treatment while on the BTU were independently associated with MRSA acquisition. The presence of a Foley catheter was related to VRE acquisition. Sixteen study patients (17.0%) who became colonized on the BTU subsequently acquired 17 infections: six patients had MRSA bloodstream infections, nine had MRSA burn wound infections, and two had VRE urinary tract infections. Younger age, exposure to vancomycin, or Foley catheters were associated with increased risk of acquiring MRSA or VRE. Protocols or algorithms that help physicians remember to assess the necessity of antimicrobial agents and devices may help limit the duration of exposure to these risk factors, which may enhance infection prevention efforts. Future studies need to explore the effect of these variables on cross-transmission and their impact predominately in a burn unit.
The Patient: Patient-Centered Outcomes Research | 2014
Mary Vaughan Sarrazin; Peter Cram; Alexandur Mazur; Melissa A. Ward; Heather Schacht Reisinger
BackgroundIn 2010 the US FDA approved dabigatran, the first new anticoagulant for stroke prevention in non-valvular atrial fibrillation (AF) since 1954. To date there is little data that reflects the experiences and perceptions of real-world patients with dabigatran. The abundance of Internet-based discussion forums and support groups related to AF or anticoagulation may provide a low-cost resource for assessing patient experiences.ObjectiveThe aim of this study was to determine patient experiences and perceptions regarding dabigatran through qualitative thematic content analysis of comments posted on publicly accessible virtual discussion forums and Internet support groups.MeasurementsComments posted between January 2011 and September 2012 were downloaded from websites focusing on support of patients with AF or on anticoagulation therapy. Comments were analyzed for thematic content.ResultsFive broad thematic categories emerged from the posted comments: general concerns about safety and efficacy, questions about indications and contraindications, questions about proper use and storage, questions about diet and drug restrictions, and experiences with perceived side effects. Our data revealed that a primary concern for patients taking dabigatran is the lack of antidote to reverse the effects of dabigatran if bleeding occurs. Several questions pertaining to the use of dabigatran with other medications or medical conditions were noted, and multiple patients expressed confusion about instructions for using dabigatran before and after medical procedures. An unexpected finding included several criticisms of the medication packaging, which many patients found inconvenient or difficult to open. Finally, several perceived side effects were noted, including some not reported in clinical trials.ConclusionsOnline communities may provide information about topics that are a concern to patients and that may not be discernible in clinical trials, such as medication side effects, proper use, and safety. Our data also highlighted potential topics that may not be a priority to researchers but are nevertheless important to patients (e.g. medication convenience or packaging). Despite the growing use of online health-related communities, very little research makes use of this low-cost resource for identifying patient interests regarding therapeutic treatments to guide patient-oriented research.
Infection Control and Hospital Epidemiology | 2009
Amber Reighard; Daniel J. Diekema; Lucy Wibbenmeyer; Melissa A. Ward; Loreen A. Herwaldt
OBJECTIVE To determine whether Staphylococcus aureus isolates from the nares of patients on a burn trauma unit were related to isolates colonizing or infecting other body sites. DESIGN Active surveillance for S. aureus, a case-control study, and pulsed-field gel electrophoresis of S. aureus isolates. SETTING A burn trauma unit of a Midwestern university teaching hospital. PATIENTS Patients admitted from February 1, 2002, through March 30, 2007, who had S. aureus isolated either from a nasal culture and from another body site (case patients) or from a nasal culture alone (control subjects). RESULTS Nineteen patients met the case patient definition and had paired isolates from the nares and an additional site available for typing. Of the 19 case patients, 8 had infections, 7 of which were caused by methicillin-resistant S. aureus (5 USA100 strain and 2 USA300 strain). A total length of stay of more than 3 weeks (odds ratio [OR], 8.75 [95% confidence interval {CI}, 2.2-34.6]; P = .002), residence in a long-term care facility (OR, 9.4 [95% CI, 2.1-42.5]; P = .004), and diabetes (OR, 3.2 [95% CI, 1.0-10.0]; P = .05) were associated with the isolation of S. aureus from the nares and other sites. Seventeen case patients (89.5%) had closely related isolates obtained from culture of samples from the nares and from other sites. CONCLUSIONS Prolonged length of stay, diabetes, or residing in a long-term care facility increased the risk of having S. aureus at sites other than the nares. S. aureus isolates from other body sites usually were closely related to nasal isolates. Most case patients had colonized or infected wounds that could be a source of S. aureus for other patients.
Infection Control and Hospital Epidemiology | 2017
Hsiu-Yin Chiang; Eli N. Perencevich; Rajeshwari Nair; Richard E. Nelson; Matthew H. Samore; Karim Khader; Margaret L. Chorazy; Loreen A. Herwaldt; Amy Blevins; Melissa A. Ward; Marin L. Schweizer
BACKGROUND Information about the health and economic impact of infections caused by vancomycin-resistant enterococci (VRE) can inform investments in infection prevention and development of novel therapeutics. OBJECTIVE To systematically review the incidence of VRE infection in the United States and the clinical and economic outcomes. METHODS We searched various databases for US studies published from January 1, 2000, through June 8, 2015, that evaluated incidence, mortality, length of stay, discharge to a long-term care facility, readmission, recurrence, or costs attributable to VRE infections. We included multicenter studies that evaluated incidence and single-center and multicenter studies that evaluated outcomes. We kept studies that did not have a denominator or uninfected controls only if they assessed postinfection length of stay, costs, or recurrence. We performed meta-analysis to pool the mortality data. RESULTS Five studies provided incidence data and 13 studies evaluated outcomes or costs. The incidence of VRE infections increased in Atlanta and Detroit but did not increase in national samples. Compared with uninfected controls, VRE infection was associated with increased mortality (pooled odds ratio, 2.55), longer length of stay (3-4.6 days longer or 1.4 times longer), increased risk of discharge to a long-term care facility (2.8- to 6.5-fold) or readmission (2.9-fold), and higher costs (
Infection Control and Hospital Epidemiology | 2007
Jennifer Kuntz; Joseph E. Cavanaugh; Laura K. Becker; Melissa A. Ward; Dianna M. Appelgate; Loreen A. Herwaldt; Philip M. Polgreen
9,949 higher or 1.6-fold more). CONCLUSIONS VRE infection is associated with large attributable burdens, including excess mortality, prolonged in-hospital stay, and increased treatment costs. Multicenter studies that use suitable controls and adjust for time at risk or confounders are needed to estimate the burden of VRE infections. Infect Control Hosp Epidemiol. 2017;38:203-215.