Vickie Brown

Microbiology of ventilator-associated pneumonia compared with that of hospital-acquired pneumonia.

OBJECTIVE Nosocomial pneumonia is the leading cause of mortality attributed to nosocomial infection. Appropriate empirical therapy has been associated with improved survival, but data are limited regarding the etiologic agents of hospital-acquired pneumonia in nonventilated patients (HAP). This evaluation assessed whether the currently recommended empirical therapy is appropriate for both ventilator-associated pneumonia (VAP) and HAP by evaluating the infecting flora. DESIGN Prospectively collected hospitalwide surveillance data was obtained by infection control professionals using standard Centers for Disease Control and Prevention definitions. SETTING A tertiary care academic hospital. PATIENTS All patients admitted from 2000 through 2003. RESULTS A total of 588 episodes of pneumonia were reported in 556 patients: 327 episodes of VAP in 309 patients, and 261 episodes of HAP in 247 patients. The infecting flora in ventilated patients included gram-positive cocci (32.0% [oxacillin-susceptible Staphylococcus aureus {OSSA}, 9.25%; oxacillin-resistant Staphylococcus aureus {ORSA}, 17.75%]), gram-negative bacilli (59.0% (Pseudomonas aeruginosa, 17.50%; Stenotrophomonas maltophilia, 6.75%; Acinetobacter species, 7.75%), and miscellaneous pathogens (9.0%). The infecting flora in nonventilated patients included gram-positive cocci (42.59% [OSSA, 13.33%; ORSA, 20.37%]), gram-negative bacilli (39.63% [P. aeruginosa, 9.26%; S. maltophilia, 1.11%; Acinetobacter species, 3.33%), and miscellaneous pathogens (17.78%). CONCLUSIONS Our data demonstrated that patients with HAP, compared with those with VAP, had a similar frequency of infection with ORSA but less commonly had infections due to P. aeruginosa, Acinetobacter species, and S. maltophilia. However, the overall frequency of infection with these pathogens was sufficiently high to warrant the use of empirical therapy likely to be active against them. Our data supports using the currently recommended empirical therapy for both HAP and VAP.

Comparison of hospitalwide surveillance and targeted intensive care unit surveillance of healthcare-associated infections.

OBJECTIVES To assess the surveillance coverage obtained with Centers for Disease Control and Prevention (CDC)-recommended surveillance of healthcare-associated infections (HAIs), which is focused on intensive care units (ICUs) and emphasizes device-related infections (ie, those associated with central venous catheters, ventilators, and/or urinary catheters), compared with the surveillance coverage achieved by comprehensive hospitalwide surveillance. In addition, we assessed whether the infection rates in step-down units more resemble those in wards or ICUs. METHODS Review of prospectively obtained, comprehensive hospitalwide surveillance data from 2004 through 2005 for an acute care tertiary care hospital with approximately 700 beds. Surveillance data was obtained by trained infection control professionals using standard CDC criteria for HAIs. RESULTS CDC-recommended ICU surveillance for catheter-related bloodstream infection (BSI) and ventilator-associated pneumonia would have detected only 87 (21.4%) of 407 catheter-related BSIs and only 66 (37.9%) of 174 respiratory tract infections that occurred in the medical and surgical services. Only 31 (34.8%) of 89 infections caused by methicillin-resistant Staphylococcus aureus and 7 (31.8%) of 22 infections caused by vancomycin-resistant Enterococcus occurred in our adult ICUs. CONCLUSIONS Rates of HAIs were highest in the ICUs, intermediate in step-down units, and lowest in the wards. The rates of infections in the step-down units were more similar to those in the wards than to those in the ICUs. To prevent HAIs, more comprehensive surveillance may be indicated.

Compliance with isolation precautions at a university hospital.

Compliance with isolation precautions recommended by the Centers for Disease Control and Prevention (CDC) was evaluated in 3 hospital-wide observational surveys. The compliance rate, by type of isolation, was as follows: droplet transmission, 100% (4 observations); airborne transmission, 61.5% (13 observations); contact isolation, 73.3% (165 observations); and protective isolation, 73.6% (72 observations). As with hand hygiene, there is suboptimal compliance with recommended isolation precautions.

Relative frequency of health care-associated pathogens by infection site at a university hospital from 1980 to 2008

BACKGROUND We describe the relative frequency of health care-associated pathogens by infection site over 29 years using hospital-wide surveillance data from a large academic hospital. METHODS Comprehensive hospital-wide surveillance was provided by trained infection preventionists using Centers for Disease Control and Prevention definitions. Five 5-year blocks and one 4-year block were created for each site: bloodstream infections (BSI), urinary tract infections (UTI), respiratory tract infections (RTI), and surgical site infections (SSI). The blocks of relative frequency of health care-associated pathogens were compared by χ(2) analysis, and trends for each pathogen were estimated by regression analysis. RESULTS At least 1 pathogen was isolated from 28,208 (83.5%) of 33,797 health care-associated infections (HAI). Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Enterococcus species, and Clostridium difficile and other anaerobes significantly increased, whereas Escherichia coli, Pseudomonas aeruginosa, Klebsiella species, Enterobacter species, and other streptococci significantly decreased in the relative proportion of pathogens during the study period. By infection site, results showed significant increasing trends of S aureus in UTI, RTI, and SSI; CoNS in BSI and SSI; Candida in SSI; and Enterococcus in BSI and UTI. CONCLUSION Significant changes in relative frequency of health care-associated pathogens by infection site occurred over the 29-year period. These findings have implications for implementation of infection prevention strategies.

Lessons learned from a norovirus outbreak in a locked pediatric inpatient psychiatric unit

We report an outbreak of norovirus in a locked pediatric inpatient psychiatric unit with attack rates of 75% among 4 patients and 26% among 38 staff. Factors contributing to the outbreak included environmental contamination, close staff-patient contact including sharing meals, and inability to confine the index patient with the use of contact precautions.

Sustained and prolonged reduction in central line-associated bloodstream infections as a result of multiple interventions.

Result of Multiple Interventions • Author(s): David J. Weber, MD, MPH; Vickie M. Brown, RN, MPH; Emily E. Sickbert‐Bennett, MS, PhD; William A. Rutala, MPH, PhD Source: Infection Control and Hospital Epidemiology, Vol. 31, No. 8 (August 2010), pp. 875-877 Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America Stable URL: http://www.jstor.org/stable/10.1086/655438 . Accessed: 18/05/2014 10:03

Preventing Catheter-Associated Urinary Tract Infections: Hospital Location of Catheter Insertion

Infection Control & Hospital Epidemiology / Volume 33 / Issue 10 / October 2012, pp 1057 1058 DOI: 10.1086/667771, Published online: 02 January 2015 Link to this article: http://journals.cambridge.org/abstract_S0195941700031842 How to cite this article: David J. Weber, JaHyun Kang, Vickie M. Brown, Emily E. Sickbert-Bennett and William A. Rutala (2012). Preventing Catheter-Associated Urinary Tract Infections: Hospital Location of Catheter Insertion. Infection Control & Hospital Epidemiology, 33, pp 1057-1058 doi:10.1086/667771 Request Permissions : Click here

SARS Management: Lessons Learned at the University of North Carolina Health Care System

Abstract BACKGROUND: University of North Carolina Health Care System (UNCHCS) provided care for the eighth laboratory-confirmed case of SARS and a CDC special interest case (clinical symptoms without epidemiological link). The confirmed case was managed on an outpatient basis. The special interest case was critically ill and died with all laboratory tests negative for SARS, including autopsy studies. PROJECT: Hospital Epidemiology Department (ED) was responsible for the implementation of the CDC SARS recommendations. This required the coordinated effort of multiple hospital and university departments and daily contact with the local and state health departments. Due to heightened concern by coworkers of the confirmed case, a special SARS screening clinic was provided for 42 “exposed” people. RESULTS: No SARS transmission occurred. Three employees were exposed to the confirmed SARS case. One was a physician who did not wear protective eyewear during an exam, and two were environmental service workers who failed to wear appropriate protective equipment. Four employees removed their protective eyewear during a code of the special interest case and were considered exposed. LESSONS LEARNED: Use sitters to ensure correct PPE use, provide anti-fog goggles, organize SARS laboratory test kits, provide SARS reference notebook for ED, identify alternative site for outpatient screening with an outside entrance that leads directly to exam rooms, identify ventilation system of emergency transport vehicles, plan for emergency fit-testing, use telephone triage for medical referral/information combined with signs and monitors at entrances regarding SARS alert, consider use of a special SARS precautions sign, use isolation rooms with anterooms, and designate a SARS coordinator for the facility.