Teresa Fitzgerald

The time spent cleaning a hospital room does not correlate with the thoroughness of cleaning.

Cleaning Author(s): Mark E. Rupp, MD; Ann Adler, RN; Margaret Schellen, BA; Kyle Cassling, BA; Teresa Fitzgerald, RN; Lee Sholtz, RN; Elizabeth Lyden, MS; Philip Carling, MD Source: Infection Control and Hospital Epidemiology, Vol. 34, No. 1 (January 2013), pp. 100102 Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America Stable URL: http://www.jstor.org/stable/10.1086/668779 . Accessed: 25/06/2014 10:07

Effect of Cessation of Contact Isolation for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci

To limit the transmission of multidrug-resistant organisms (MDROs) such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), contact isolation precautions (CP) have been employed that includes use of gowns and gloves for provider interactions with the patient. Most studies on CP have been conducted during outbreaks and often include multiple interventions utilized simultaneously. CP adversely influences provider behavior and results in decreased provider interactions with patients. In addition, some studies have associated CP with delays in admission and transfer, excess adverse events, psychologic harm, and patient dissatisfaction. Other studies do not indicate an increase in adverse consequences. There is a growing diversity of practice with regard to CP. We evaluated the effect of discontinuing CP for patients colonized or infected with MRSA or VRE on the rate of bloodstream infection and pathogen acquisition.

Frequently Identified Gaps in Antimicrobial Stewardship Programs in Critical Access Hospitals

Abstract Background Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a CDC funded project. ICAP team works in collaboration with NE Department of Health and Human Services (NEDHHS) to assess and improve infection prevention and control programs (IPCP) in various health care settings including resource limited settings like critical access hospitals (CAH). Little is known about the existing gaps in antimicrobial stewardship programs (ASP) of CAH. Hence, we decided to study the current level of ASP activities and factors associated with these activities in CAH. Methods NE ICAP conducted on-site surveys in 36 CAH from October 2015 to February 2017. ASP activities related to the 7 CDC recommended core elements (CE) including leadership support (LS), accountability, drug expertise (DE), action, tracking, reporting, and education were assessed using a CDC Infection Control Assessment Tool for acute care hospitals. Descriptive analyses evaluated CAH characteristics and frequency of CE implementation. Fisher’s exact, Mann–Whitney, and Kruskal–Wallis tests were used for statistical analyses examining the association of various factors with level of ASP activities. Results The 36 surveyed CAH had a median of 20 (range 10–25) beds and employed a median of 0.4 (range 0.1–1.6) infection preventionist (IP) full-time equivalent (FTE)/25-bed. Frequency of CE implementation varied among CAH with action and LS as the most (69%) and least (28%) frequently implemented elements, respectively. Close to half (47%) of surveyed CAH had implemented ≥4 CE but only 14% of facilities had all 7 CE. Median bed size and IP FTE/25-bed were similar among CAH with 0–2, 3-5, or ≥6 CE in place. CAH with LS or accountability for ASP implemented higher median numbers of the remaining CE compared with CAH without LS or accountability (5 vs. 2, P < 0.01 and 4 vs. 2, P < 0.01, respectively). Facilities with The presence of LS, accountability and drug expertise were more likely to have all 4 remaining CE implemented than others (56% vs. 8%, P < 0.01). Conclusion LS, accountability, and DE are important factors for the implementation of the remaining 4 CE in CAH. Although LS was the least frequently implemented CE, when present was associated with implementation of most of the other CE. Acquiring LS will facilitate implementation of additional ASP efforts in CAH. Disclosures All authors: No reported disclosures.

Frequently Identified Gaps in Antimicrobial Stewardship Programs in Long-Term Care Facilities

Abstract Background Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a CDC funded project. ICAP team works in collaboration with NE Department of Health and Human Services (NEDHHS) to assess and improve infection prevention and control programs (IPCP) in acute care, outpatient and long-term care facilities (LTCF). New Centers for Medicare and Medicaid Services (CMS) regulation requires LTCF to develop antimicrobial stewardship programs (ASP) by November 2017. Hence, we decided to study the current level of ASP activities and associated factors in LTCF. Methods NE ICAP conducted on-site surveys in 30 LTCF from 11/2015 to 3/2017. ASP activities related to 7 CDC recommended core elements (CE) including leadership support (LS), accountability, drug expertise, action, tracking, reporting, and education were assessed using the CDC Infection Control Assessment Tool for LTCF. Gap frequencies were calculated for CE. Fisher’s exact, Mann–Whitney and Kruskal–Wallis tests were used for statistical analyses examining the associations of LS, accountability, bed size (BS), hospital affiliation (HA), presence of trained infection preventionist (IP), and IP weekly hours (WH)/100-bed for IPCP with level of ASP activites. Results Of the 30 LTCF surveyed, 23% had HA and 60% had trained IP. Median BS, IP WH/100-bed for IPCP, and number of CE implemented were 60.5, 6.5, and 3, respectively. Only 1 (3%) LTCF had all 7 CE in place. LTCF with LS had a higher median number of the 6 remaining CE implemented compared with LTCF without LS (3 vs. 2; P = 0.03). Similarly, LTCF with accountability for ASP had a median of 3 remaining CE in place as opposed to 2 in LTCF without accountability (P < 0.05). LTCF with LS, accountability, and ≥20 IP WH/100-bed for IPCP were more likely to implement ≥2 of the last 4 CE, i.e., action, tracking, reporting and education (100% vs. 30%, P < 0.05). LTCF with ≥20 IP WH/100-bed dedicated towards IPCP were more likely to have ≥5 CE in place than the LTCF with lower dedicated IP time (60% vs. 8%, P < 0.05). Conclusion Implementation of all 7 ASP CE in LTCF is uncommon. The presence of LS, accountability for ASP, and ≥20 IP WH/100-bed for IPCP are significant factors driving implementation of more ASP CE. Further guidance is needed for LTCF to assist them in dedicating appropriate IP time towards IPCP for promoting ASP as IP time varies greatly among LTCF. Disclosures All authors: No reported disclosures.