Timothy Landers

A Review of Antibiotic Use in Food Animals: Perspective, Policy, and Potential

Antibiotic use plays a major role in the emerging public health crisis of antibiotic resistance. Although the majority of antibiotic use occurs in agricultural settings, relatively little attention has been paid to how antibiotic use in farm animals contributes to the overall problem of antibiotic resistance. The aim of this review is to summarize literature on the role of antibiotics in the development of resistance and its risk to human health. We searched multiple databases to identify major lines of argument supporting the role of agricultural antibiotic use in the development of resistance and to summarize existing regulatory and policy documents. Several lines of reasoning support the conclusion that agricultural antibiotics are associated with resistance, yet most public policy is based on expert opinion and consensus. Finally, we propose strategies to address current gaps in knowledge.

CMS Changes in Reimbursement for HAIs: Setting A Research Agenda

Background:The Centers for Medicare and Medicaid Services (CMS) promulgated regulations commencing October 1, 2008, which deny payment for selected conditions occurring during the hospital stay and are not present on admission. Three of the 10 hospital-acquired conditions covered by the new CMS policy involve healthcare-associated infections, which are a common, expensive, and often preventable cause of inpatient morbidity and mortality. Objective:To outline a research agenda on the impact of CMSs payment policy on the healthcare system and the prevention of healthcare-associated infections. Methods:An invitational daylong conference was convened in April 2009. Including the planning committee and speakers there were 41 conference participants who were national experts and senior researchers. Results:Building upon a behavioral model and organizational theory and management research a conceptual framework was applied to organize the wide range of issues that arose. A broad array of research topics was identified. Thirty-two research agenda items were organized in the areas of incentives, environmental factors, organizational factors, clinical outcomes, staff outcomes, and financial outcomes. Methodological challenges are also discussed. Conclusions:This policy is a first significant step to move output-based inpatient funding to outcome-based funding, and this agenda is applicable to all hospital-acquired conditions. Studies beginning soon will have the best hope of capturing data for the years preceding the policy change, a key element in nonexperimental research. The CMS payment policy offers an excellent opportunity to understand and influence the use of financial incentives for improving patient safety.

Building Interdisciplinary Research Models: A Didactic Course to Prepare Interdisciplinary Scholars and Faculty

Many academicians assume that anyone can engage in interdisciplinary research, but it is clear that successful interdisciplinary efforts require mastery of specific competencies that can be learned and improved. This paper describes the development and implementation of a course designed for Master’s, pre‐ and postdoctoral students and research faculty on models of interdisciplinary research skills, based on a set of core competencies. Major challenges included working through institutional structures that made it difficult to offer cross‐school courses, and interpersonal challenges among a diverse group of students from a number of disciplines. Although universities may be poised for interdisciplinary research, strategies for faculty preparation and support are lacking. Institutions embracing the concept of team and interdisciplinary science must focus not only on the structural barriers and facilitators, but also on direct support to faculty. The didactic course described in this paper is one approach to enhance interdisciplinary research skills of scholars‐in‐training and faculty, and we recommend that similar efforts be widely implemented. Clin Trans Sci 2011; Volume 4: 38–41

A Comparison of Methods to Detect Urinary Tract Infections Using Electronic Data

BACKGROUND The use of electronic medical records to identify common health care-associated infections (HAIs), including pneumonia, surgical site infections, bloodstream infections, and urinary tract infections (UTIs), has been proposed to help perform HAI surveillance and guide infection prevention efforts. Increased attention on HAIs has led to public health reporting requirements and a focus on quality improvement activities around HAIs. Traditional surveillance to detect HAIs and focus prevention efforts is labor intensive, and computer algorithms could be useful to screen electronic data and provide actionable information. METHODS Seven computer-based decision rules to identify UTIs were compared in a sample of 33,834 admissions to an urban academic health center. These decision rules included combinations of laboratory data, patient clinical data, and administrative data (for example, International Statistical Classification of Diseases and Related Health Problems, Ninth Revision [ICD-9] codes). RESULTS Of 33,834 hospital admissions, 3,870 UTIs were identified by at least one of the decision rules. The use of ICD-9 codes alone identified 2,614 UTIs. Laboratory-based definitions identified 2,773 infections, but when the presence of fever was included, only 1,125 UTIs were identified. The estimated sensitivity of ICD-9 codes was 55.6% (95% confidence interval [CI], 52.5%-58.5%) when compared with a culture- and symptom-based definition. Of the UTIs identified by ICD-9 codes, 167/1,125 (14.8%) also met two urine-culture decision rules. DISCUSSION Use of the example of UTI identification shows how different algorithms may be appropriate, depending on the goal of case identification. Electronic surveillance methods may be beneficial for mandatory reporting, process improvement, and economic analysis.

Hand hygiene compliance and associated factors among health care providers in Gondar University Hospital, Gondar, North West Ethiopia

BackgroundHealth care associated infections are more predominant in developing countries where Hand hygiene compliance is associated with so many factors. However, these factors have not been studied so far in the study area. This study sought to determine Hand hygiene compliance and associated factors among health care providers.MethodsInstitution based cross-sectional study was conducted from April to May, 2013 in Gondar University Hospital. Stratified sampling technique was used to select 405 health care providers. Standardized questionnaire and world health organization observational checklist was used to collect the data. Data was entered and analyzed by using SPSS version 20. Descriptive statistics and binary logistic regression model was used to summarize the result.ResultsA total of 405 study participants were interviewed and observed with a response rate of 96.4%. Good Hand hygiene compliance of healthcare providers was found to be 16.5%. Having knowledge about hand hygiene compliance, (AOR = 3.80, 95% CI 1.60, 8.97), getting training (AOR = 2.60, 95% Cl 1.21, 5.62), the presence of individual towel/tissue paper (AOR = 1.91, 95% CI 1.03, 3.56) presence of alcohol based hand rub for Hand hygiene compliance (AOR = 6.58, 95% CI 2.67, 16.22) and knew the presence of infection prevention committees (AOR = 2.6, 95% CI 1.23, 5.37) were significantly associated with hand hygiene compliance.ConclusionsHand hygiene compliance among health care providers in Gondar University Hospital was found to be low. It is better to give training on Hand hygiene compliance and provide Alcohol based hand rub and individual towel or tissue paper for hand hygiene compliance.

Point-of-care hand hygiene: preventing infection behind the curtain.

Best practices for hand hygiene provide indications for performance of hand hygiene at specific points in time during patient care. For hand hygiene to prevent infections, hand hygiene resources must be readily available to health care workers whenever required. This article reviews practices and recommendations intended to facilitate hand hygiene behavior at the point of care (POC) within the health care setting. Key aspects of POC hand hygiene include the provision of alcohol-based hand rub products, integration of dispensing solutions within the patient zone, consideration of patient care workflow, and dispenser designs that optimize acceptance and usage.

Swab Type, Moistening, and Preenrichment for Staphylococcus aureus on Environmental Surfaces

ABSTRACT We compared five swabs, dry or premoistened and with or without preenrichment, to detect surface contamination with Staphylococcus aureus. Sensitivities varied based on swab type, as follows: 71.9% and 75% for rayon, 71.2% for cotton, 81.3% for polyester, and 53.2% for calcium alginate. Preenrichment improved sensitivity (80%, versus 61.3% for direct-plated specimens), as did premoistening (83.4%, versus 57.5% for dry swabs). All of the premoistened, preenriched swabs were positive.

Educating Future Nursing Scientists: Recommendations for Integrating Omics Content in PhD Programs

Preparing the next generation of nursing scientists to conduct high-impact, competitive, sustainable, innovative, and interdisciplinary programs of research requires that the curricula for PhD programs keep pace with emerging areas of knowledge and health care/biomedical science. A field of inquiry that holds great potential to influence our understanding of the underlying biology and mechanisms of health and disease is omics. For the purpose of this article, omics refers to genomics, transcriptomics, proteomics, epigenomics, exposomics, microbiomics, and metabolomics. Traditionally, most PhD programs in schools of nursing do not incorporate this content into their core curricula. As part of the Council for the Advancement of Nursing Sciences Idea Festival for Nursing Science Education, a work group charged with addressing omics preparation for the next generation of nursing scientists was convened. The purpose of this article is to describe key findings and recommendations from the work group that unanimously and enthusiastically support the incorporation of omics content into the curricula of PhD programs in nursing. The work group also calls to action faculty in schools of nursing to develop strategies to enable students needing immersion in omics science and methods to execute their research goals.

ArticleSpecial Issue: Council for the Advancement of Nursing Science: PhD EducationEducating future nursing scientists: Recommendations for integrating omics content in PhD programs

Preparing the next generation of nursing scientists to conduct high-impact, competitive, sustainable, innovative, and interdisciplinary programs of research requires that the curricula for PhD programs keep pace with emerging areas of knowledge and health care/biomedical science. A field of inquiry that holds great potential to influence our understanding of the underlying biology and mechanisms of health and disease is omics. For the purpose of this article, omics refers to genomics, transcriptomics, proteomics, epigenomics, exposomics, microbiomics, and metabolomics. Traditionally, most PhD programs in schools of nursing do not incorporate this content into their core curricula. As part of the Council for the Advancement of Nursing Sciences Idea Festival for Nursing Science Education, a work group charged with addressing omics preparation for the next generation of nursing scientists was convened. The purpose of this article is to describe key findings and recommendations from the work group that unanimously and enthusiastically support the incorporation of omics content into the curricula of PhD programs in nursing. The work group also calls to action faculty in schools of nursing to develop strategies to enable students needing immersion in omics science and methods to execute their research goals.

Clinical Vignettes Provide an Understanding of Antibiotic Prescribing Practices in Neonatal Intensive Care Units

OBJECTIVE To use clinical vignettes to understand antimicrobial prescribing practices in neonatal intensive care units (NICUs). DESIGN Vignette-based survey. SETTING Four tertiary care NICUs. PARTICIPANTS Antibiotic prescribers in NICUs. METHODS Clinicians from 4 tertiary care NICUs completed an anonymous survey containing 12 vignettes that described empiric, targeted, or prophylactic antibiotic use. Responses were compared with Centers for Disease Control and Prevention guidelines for appropriate use. RESULTS Overall, 161 (59% of 271 eligible respondents) completed the survey, 37% of whom had worked in NICUs for 7 or more years. Respondents were more likely to appropriately identify use of targeted therapy for methicillin-susceptible Staphylococcus aureus, that is, use of oxacillin rather than vancomycin, than for Escherichia coli, that is, use of first-generation rather than third-generation cephalosporin, (P < .01). Increased experience significantly predicted appropriate prescribing (P = .02). The proportion of respondents choosing appropriate duration of postsurgical prophylaxis (P < .01) and treatment for necrotizing enterocolitis differed by study site (P = .03). CONCLUSIONS The survey provides insight into antibiotic prescribing practices and informs the development of future antibiotic stewardship interventions for NICUs.