Infection Control and Hospital Epidemiology (Infect Contr Hosp Epidemiol)

Publisher: Society of Hospital Epidemiologists of America, Cambridge University Press (CUP)

Journal description

Infection Control and Hospital Epidemiology, the official journal of the Society for Healthcare Epidemiology of America, is a leading monthly journal providing original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program with a hospital or health care facility. Written by infection control practitioners and epidemiologists and guided by an Editorial Board composed of the nation's leaders in the field, Infection Control and Hospital Epidemiology provides a critical forum for this vital information.

Current impact factor: 4.02

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2011 Impact Factor 3.669

Additional details

5-year impact 3.71
Cited half-life 6.00
Immediacy index 0.79
Eigenfactor 0.02
Article influence 1.32
Website Infection Control & Hospital Epidemiology website
Other titles Infection control and hospital epidemiology (Online), Infection control and hospital epidemiology
ISSN 1559-6834
OCLC 60616144
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Cambridge University Press (CUP)

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Author's Pre-print on author's personal website, departmental website, social media websites, institutional repository, non-commercial subject-based repositories, such as PubMed Central, Europe PMC or arXiv
    • Author's post-print on author's personal website on acceptance of publication
    • Author's post-print on departmental website, institutional repository, non-commercial subject-based repositories, such as PubMed Central, Europe PMC or arXiv, after a 6 months embargo
    • Publisher's version/PDF cannot be used
    • Published abstract may be deposited
    • Pre-print to record acceptance for publication
    • Publisher copyright and source must be acknowledged with set statement, for deposit of Authors Post-print or Publisher's version/PDF
    • Must link to publisher version
    • Publisher last reviewed on 07/10/2014
    • This policy is an exception to the default policies of 'Cambridge University Press (CUP)'
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE To identify factors associated with the development of surgical site infection (SSI) among adult patients undergoing renal transplantation DESIGN A retrospective cohort study SETTING An urban tertiary care center in Baltimore, Maryland, with a well-established renal transplantation program that performs ~200-250renal transplant procedures annually RESULTS At total of 441 adult patients underwent renal transplantation between January 1, 2010, and December 31, 2011. Of these 441patients, 66 (15%) developed an SSI; of these 66, 31 (47%) were superficial incisional infections and 35 (53%) were deep-incisional or organ-space infections. The average body mass index (BMI) among this patient cohort was 29.7; 84 (42%) were obese (BMI >30). Patients who developed an SSI had a greater mean BMI (31.7 vs 29.4; P=.004) and were more likely to have a history of peripheral vascular disease, rheumatologic disease, and narcotic abuse. History of cerebral vascular disease was protective. Multivariate analysis showed BMI (odds ratio [OR] 1.06; 95% confidence interval [CI], 1.02-1.11) and past history of narcotic use/abuse (OR, 4.86; 95% CI, 1.24-19.12) to be significantly associated with development of SSI after controlling for National Healthcare Surveillance Network (NHSN) score and presence of cerebrovascular, peripheral vascular, and rheumatologic disease. CONCLUSIONS We identified higher BMI as a risk factor for the development of SSI following renal transplantation. Notably, neither aggregate comorbidity scores nor NHSN risk index were associated with SSI in this population. Additional risk adjustment measures and research in this area are needed to compare SSIs across transplant centers. Infect Control Hosp Epidemiol 2015;00(0): 1-7.
    Infection Control and Hospital Epidemiology 04/2015; 36(4):417-23. DOI:10.1017/ice.2014.77
  • Infection Control and Hospital Epidemiology 04/2015; 36(4):484-6. DOI:10.1017/ice.2014.40
  • [Show abstract] [Hide abstract]
    ABSTRACT: Centers for Disease Control and Prevention (CDC) risk adjustment methods for central-line-associated bloodstream infections (CLABSI) only adjust for type of intensive care unit (ICU). This cohort study explored risk factors for CLABSI using 2 comorbidity classification schemes, the Charlson Comorbidity Index (CCI) and the Chronic Disease Score (CDS). Our study supports the need for additional research into risk factors for CLABSI, including electronically available comorbid conditions. Infect Control Hosp Epidemiol 2014;00(0): 1-3.
    Infection Control and Hospital Epidemiology 04/2015; 36(4):479-81. DOI:10.1017/ice.2014.81
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE To examine the prevalence of healthcare-associated pathogens and the infection control policies and practices in a national sample of nursing homes (NHs). METHODS In 2012, we conducted a national survey about the extent to which NHs follow suggested infection control practices with regard to 3 common healthcare-associated pathogens: methicillin-resistant Staphylococcus aureus, Clostridium difficile, and extended-spectrum β-lactamase producers, and their prevalence in NHs. We adapted a previously used and validated NH infection control survey, including questions on prevalence, admission and screening policies, contact precautions, decolonization, and cleaning practices. RESULTS A total of 1,002 surveys were returned. Of the responding NHs, 14.2% were less likely to accept residents with methicillin-resistant Staphylococcus aureus, with the principal reason being lack of single or cohort rooms. NHs do not routinely perform admission screening (96.4%) because it is not required by regulation (56.2%) and would not change care provision (30.7%). Isolation strategies vary substantially, with gloves being most commonly used. Most NHs (75.1%) do not decolonize carriers of methicillin-resistant Staphylococcus aureus, but some (10.6%) decolonize more than 90% of residents. Despite no guidance on how resident rooms on contact precautions should be cleaned, 59.3% of NHs report enhanced cleaning for such rooms. CONCLUSION Overall, NHs tend to follow voluntary infection control guidelines only if doing so does not require substantial financial investment in new or dedicated staff or infrastructure. Infect Control Hosp Epidemiol 2015;00(0): 1-8.
    Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.59
  • [Show abstract] [Hide abstract]
    ABSTRACT: The performance of a hospital- and community-onset Clostridium difficile infection definition using administrative data with a present-on-admission indicator was compared with definitions using clinical surveillance. For hospital-onset C. difficile infection, there was moderate sensitivity (68%) and high specificity (93%); for community-onset, sensitivity and specificity were high (both 85%). Infect Control Hosp Epidemiol 2015;00(0): 1-3.
    Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.63
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND Staphylococcus aureus carriage among healthcare workers (HCWs) is a concern in hospital settings, where it may provide a reservoir for later infections in both patients and staff. Earlier studies have shown that the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriage in HCWs is highly variable, depending notably on location, hospital department type, MRSA prevalence among patients, and type of contacts with patients. However, MRSA incidence in HCWs and its occupational determinants have seldom been studied. METHODS A prospective, observational cohort study was conducted between May and October 2009 in a French rehabilitation center hospital. HCWs and patients were screened weekly for S. aureus nasal carriage. Methicillin-susceptible S. aureus and MRSA prevalence and incidence were estimated and factors associated with MRSA acquisition were identified using generalized estimating equation regression methods. RESULTS Among 343 HCWs included in the analysis, the average prevalence was 27% (95% CI, 24%-29%) for methicillin-susceptible S. aureus and 10% (8%-11%) for MRSA. We observed 129 MRSA colonization events. According to the multivariable analysis, high MRSA prevalence level among patients and HCW occupation were significantly associated with MRSA acquisition in HCWs, with assistant nurses being more at risk than nurses (odds ratio, 2.2; 95% CI, 1.4-3.6). CONCLUSIONS Our findings may help further our understanding of the transmission dynamics of MRSA carriage acquisition in HCWs, suggesting that it is notably driven by carriage among patients and by the type of contact with patients. Infect Control Hosp Epidemiol 2015;00(0): 1-10.
    Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.51
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clostridium difficile spores survive for months on environmental surfaces and are highly resistant to decontamination. We evaluated the effect of cold-air plasma against C. difficile spores. The single-jet had no effect while the multi-jet achieved 2-3 log10 reductions in spore counts and may augment traditional decontamination. Infect Control Hosp Epidemiol 2015;00(0):1-3.
    Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.39
  • Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.58
  • [Show abstract] [Hide abstract]
    ABSTRACT: An accepted practice for patients colonized with multidrug-resistant organisms is to discontinue contact precautions following 3 consecutive negative surveillance cultures. Our experience with surveillance cultures to detect persistent carbapenemase-producing Enterobacteriaceae (CPE) colonization suggests that extrapolation of this practice to CPE-colonized patients may not be appropriate. Infect Control Hosp Epidemiol 2015;00(0): 1-3.
    Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.57
  • Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.52
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND The number of pediatric antimicrobial stewardship programs (ASPs) is increasing and program evaluation is a key component to improve efficiency and enhance stewardship strategies. OBJECTIVE To determine the antimicrobials and diagnoses most strongly associated with a recommendation provided by a well-established pediatric ASP. DESIGN AND SETTING Retrospective cohort study from March 3, 2008, to March 2, 2013, of all ASP reviews performed at a free-standing pediatric hospital. METHODS ASP recommendations were classified as follows: stop therapy, modify therapy, optimize therapy, or consult infectious diseases. A multinomial distribution model to determine the probability of each ASP recommendation category was performed on the basis of the specific antimicrobial agent or disease category. A logistic model was used to determine the odds of recommendation disagreement by the prescribing clinician. RESULTS The ASP made 2,317 recommendations: stop therapy (45%), modify therapy (26%), optimize therapy (19%), or consult infectious diseases (10%). Third-generation cephalosporins (0.20) were the antimicrobials with the highest predictive probability of an ASP recommendation whereas linezolid (0.05) had the lowest probability. Community-acquired pneumonia (0.26) was the diagnosis with the highest predictive probability of an ASP recommendation whereas fever/neutropenia (0.04) had the lowest probability. Disagreement with ASP recommendations by the prescribing clinician occurred 22% of the time, most commonly involving community-acquired pneumonia and ear/nose/throat infections. CONCLUSIONS Evaluation of our pediatric ASP identified specific clinical diagnoses and antimicrobials associated with an increased likelihood of an ASP recommendation. Focused interventions targeting these high-yield areas may result in increased program efficiency and efficacy. Infect Control Hosp Epidemiol 2015;00(0): 1-8.
    Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.45
  • [Show abstract] [Hide abstract]
    ABSTRACT: Factors favoring blood stream infections associated with gastrointestinal mucosa versus skin organisms were explored. An observed difference was attributable to bacteremia from oral flora in patients with acute myelogenous leukemia or mucositis. Our data do not support the conclusion that isolation of enteric Gram-negatives is unrelated to the central catheter. Infect Control Hosp Epidemiol 2015;00(0): 1-4.
    Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.48
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE To observe patient care across hemodialysis facilities enrolled in the National Opportunity to Improve Infection Control in ESRD (end-stage renal disease) (NOTICE) project in order to evaluate adherence to evidence-based practices aimed at prevention of infection. SETTING AND PARTICIPANTS Thirty-four hemodialysis facilities were randomly selected from among 772 facilities in 4 end-stage renal disease participating networks. Facility selection was stratified on dialysis organization affiliation, size, socioeconomic status, and urban/rural status. MEASUREMENTS Trained infection control evaluators used an infection control worksheet to observe 73 distinct infection control practices at the hemodialysis facilities, from October 1, 2011, through January 31, 2012. RESULTS There was considerable variation in infection control practices across enrolled facilities. Overall adherence to recommended practices was 68% (range, 45%-92%) across all facilities. Overall adherence to expected hand hygiene practice was 72% (range, 10%-100%). Compliance to hand hygiene before and after procedures was high; however, during procedures hand hygiene compliance averaged 58%. Use of chlorhexidine as the specific agent for exit site care was 19% overall but varied from 0% to 35% by facility type. The 8 checklists varied in the frequency of perfect performance from 0% for meeting every item on the checklist for disinfection practices to 22% on the arteriovenous access practices at initiation. CONCLUSIONS Our findings suggest that there are many areas for improvement in hand hygiene and other infection prevention practices in end-stage renal disease. These NOTICE project findings will help inform the development of a larger quality improvement initiative at dialysis facilities. Infect Control Hosp Epidemiol 2015;00(0): 1-5.
    Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.55
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE Adherence engineering applies human factors principles to examine non-adherence within a specific task and to guide the development of materials or equipment to increase protocol adherence and reduce human error. Central line maintenance (CLM) for intensive care unit (ICU) patients is a task through which error or non-adherence to protocols can cause central line-associated bloodstream infections (CLABSIs). We conducted an economic analysis of an adherence engineering CLM kit designed to improve the CLM task and reduce the risk of CLABSI. METHODS We constructed a Markov model to compare the cost-effectiveness of the CLM kit, which contains each of the 27 items necessary for performing the CLM procedure, compared with the standard care procedure for CLM, in which each item for dressing maintenance is gathered separately. We estimated the model using the cost of CLABSI overall ($45,685) as well as the excess LOS (6.9 excess ICU days, 3.5 excess general ward days). RESULTS Assuming the CLM kit reduces the risk of CLABSI by 100% and 50%, this strategy was less costly (cost savings between $306 and $860) and more effective (between 0.05 and 0.13 more quality-adjusted life-years) compared with not using the pre-packaged kit. We identified threshold values for the effectiveness of the kit in reducing CLABSI for which the kit strategy was no longer less costly. CONCLUSION An adherence engineering-based intervention to streamline the CLM process can improve patient outcomes and lower costs. Patient safety can be improved by adopting new approaches that are based on human factors principles. Infect Control Hosp Epidemiol 2015;00(0): 1-7.
    Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.26
  • [Show abstract] [Hide abstract]
    ABSTRACT: We assessed frequency and predictors of seasonal influenza vaccination acceptance among inpatients at a large tertiary referral hospital, as well as reasons for vaccination refusal. Over 5 seasons, >60% of patients unvaccinated on admission refused influenza vaccination while hospitalized; "believes not at risk" was the reason most commonly given. Infect Control Hosp Epidemiol 2015;00(0): 1-3.
    Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.56
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE To estimate the summary effectiveness of different needle-stick injury (NSI)-prevention interventions. DESIGN We conducted a meta-analysis of English-language articles evaluating methods for reducing needle stick, sharp, or percutaneous injuries published from 2002 to 2012 identified using PubMed and Medline EBSCO databases. Data were extracted using a standardized instrument. Random effects models were used to estimate the summary effectiveness of 3 interventions: training alone, safety-engineered devices (SEDs) alone, and the combination of training and SEDs. SETTING Healthcare facilities, mainly hospitals PARTICIPANTS Healthcare workers including physicians, midwives, and nurses RESULTS From an initial pool of 250 potentially relevant studies, 17 studies met our inclusion criteria. Six eligible studies evaluated the effectiveness of training interventions, and the summary effect of the training intervention was 0.66 (95% CI, 0.50-0.89). The summary effect across the 5 studies that assessed the efficacy of SEDs was 0.51 (95% CI, 0.40-0.64). A total of 8 studies evaluated the effectiveness of training plus SEDs, with a summary effect of 0.38 (95% CI, 0.28-0.50). CONCLUSION Training combined with SEDs can substantially reduce the risk of NSIs. Infect Control Hosp Epidemiol 2015;00(0): 1-7.
    Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.50
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE To predict the likelihood of hospital-onset Clostridium difficile infection (HO-CDI) based on patient clinical presentations at admission DESIGN Retrospective data analysis SETTING Six US acute care hospitals PATIENTS Adult inpatients METHODS We used clinical data collected at the time of admission in electronic health record (EHR) systems to develop and validate a HO-CDI predictive model. The outcome measure was HO-CDI cases identified by a nonduplicate positive C. difficile toxin assay result with stool specimens collected >48 hours after inpatient admission. We fit a logistic regression model to predict the risk of HO-CDI. We validated the model using 1,000 bootstrap simulations. RESULTS Among 78,080 adult admissions, 323 HO-CDI cases were identified (ie, a rate of 4.1 per 1,000 admissions). The logistic regression model yielded 14 independent predictors, including hospital community onset CDI pressure, patient age ≥65, previous healthcare exposures, CDI in previous admission, admission to the intensive care unit, albumin ≤3 g/dL, creatinine >2.0 mg/dL, bands >32%, platelets ≤150 or >420 109/L, and white blood cell count >11,000 mm3. The model had a c-statistic of 0.78 (95% confidence interval [CI], 0.76-0.81) with good calibration. Among 79% of patients with risk scores of 0-7, 19 HO-CDIs occurred per 10,000 admissions; for patients with risk scores >20, 623 HO-CDIs occurred per 10,000 admissions (P<.0001). CONCLUSION Using clinical parameters available at the time of admission, this HO-CDI model demonstrated good predictive ability, and it may have utility as an early risk identification tool for HO-CDI preventive interventions and outcome comparisons. Infect Control Hosp Epidemiol 2015;00(0):1-7.
    Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.37
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE To evaluate the long-term outcomes of an antimicrobial stewardship program (ASP) implemented in a hospital with low baseline antibiotic use. DESIGN Quasi-experimental, interrupted time-series study. SETTING Public safety net hospital with 525 beds. INTERVENTION Implementation of a formal ASP in July 2008. METHODS We conducted a time-series analysis to evaluate the impact of the ASP over a 6.25-year period (July 1, 2008-September 30, 2014) while controlling for trends during a 3-year preintervention period (July 1, 2005-June 30, 2008). The primary outcome measures were total antibacterial and antipseudomonal use in days of therapy (DOT) per 1,000 patient-days (PD). Secondary outcomes included antimicrobial costs and resistance, hospital-onset Clostridium difficile infection, and other patient-centered measures. RESULTS During the preintervention period, total antibacterial and antipseudomonal use were declining (-9.2 and -5.5 DOT/1,000 PD per quarter, respectively). During the stewardship period, both continued to decline, although at lower rates (-3.7 and -2.2 DOT/1,000 PD, respectively), resulting in a slope change of 5.5 DOT/1,000 PD per quarter for total antibacterial use (P=.10) and 3.3 DOT/1,000 PD per quarter for antipseudomonal use (P=.01). Antibiotic expenditures declined markedly during the stewardship period (-$295.42/1,000 PD per quarter, P=.002). There were variable changes in antimicrobial resistance and few apparent changes in C. difficile infection and other patient-centered outcomes. CONCLUSION In a hospital with low baseline antibiotic use, implementation of an ASP was associated with sustained reductions in total antibacterial and antipseudomonal use and declining antibiotic expenditures. Common ASP outcome measures have limitations. Infect Control Hosp Epidemiol 2015;00(0): 1-9.
    Infection Control and Hospital Epidemiology 03/2015; DOI:10.1017/ice.2015.41