Publications (71) View all
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Article: Role of the environment in the transmission of Clostridium difficile in health care facilities.
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ABSTRACT: Recent data demonstrate that the contaminated hospital surface environment plays a key role in the transmission of Clostridium difficile. Enhanced environmental cleaning of rooms housing Clostridium difficile-infected patients is warranted, and, if additional studies demonstrate a benefit of "no-touch" methods (eg, ultraviolet irradiation, hydrogen peroxide systems), their routine use should be considered.American journal of infection control 05/2013; 41(5 Suppl):S105-10. · 3.01 Impact Factor -
Article: Decontamination of targeted pathogens from patient rooms using an automated ultraviolet-C-emitting device.
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ABSTRACT: Objective. To determine the effectiveness of an automated ultraviolet-C (UV-C) emitter against vancomycin-resistant enterococci (VRE), Clostridium difficile, and Acinetobacter spp. in patient rooms. Design. Prospective cohort study. Setting. Two tertiary care hospitals. Participants. Convenience sample of 39 patient rooms from which a patient infected or colonized with 1 of the 3 targeted pathogens had been discharged. Intervention. Environmental sites were cultured before and after use of an automated UV-C-emitting device in targeted rooms but before standard terminal room disinfection by environmental services. Results. In total, 142 samples were obtained from 27 rooms of patients who were colonized or infected with VRE, 77 samples were obtained from 10 rooms of patients with C. difficile infection, and 10 samples were obtained from 2 rooms of patients with infections due to Acinetobacter. Use of an automated UV-C-emitting device led to a significant decrease in the total number of colony-forming units (CFUs) of any type of organism (1.07 log10 reduction; [Formula: see text]), CFUs of target pathogens (1.35 log10 reduction; [Formula: see text]), VRE CFUs (1.68 log10 reduction; [Formula: see text]), and C. difficile CFUs (1.16 log10 reduction; [Formula: see text]). CFUs of Acinetobacter also decreased (1.71 log10 reduction), but the trend was not statistically significant ([Formula: see text]). CFUs were reduced at all 9 of the environmental sites tested. Reductions similarly occurred in direct and indirect line of sight. Conclusions. Our data confirm that automated UV-C-emitting devices can decrease the bioburden of important pathogens in real-world settings such as hospital rooms.Infection Control and Hospital Epidemiology 05/2013; 34(5):466-71. · 3.67 Impact Factor -
Article: Utility of a Clinical Risk Factor Scoring Model in Predicting Infection with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae on Hospital Admission.
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ABSTRACT: Objective. To validate the utility of a previously published scoring model (Italian) to identify patients infected with community-onset extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-EKP) and develop a new model (Duke) based on local epidemiology. Methods. This case-control study included patients 18 years of age or more admitted to Duke University Hospital between January 1, 2008, and December 31, 2010, with culture-confirmed infection due to an ESBL-EKP (cases). Uninfected controls were matched to cases (3∶1). The Italian model was applied to our patient population for validation. The Duke model was developed through logistic-regression-based prediction scores calculated on variables independently associated with ESBL-EKP isolation. Sensitivities and specificities at various point cutoffs were determined, and determination of the area under the receiver operating characteristic curve (ROC AUC) was performed. Results. A total of 123 cases and 375 controls were identified. Adjusted odds ratios and 95% confidence intervals for variables previously identified in the Italian model were as follows: hospitalization (3.20 [1.62-6.55]), transfer (4.31 [2.15-8.78]), urinary catheterization (5.92 [3.09-11.60]), β-lactam and/or fluoroquinolone therapy (3.76 [2.06-6.95]), age 70 years or more (1.55 [0.79-3.01]), and Charlson Comorbidity Score of 4 or above (1.06 [0.55-2.01]). Sensitivity and specificity were, respectively, more than or equal to 95% and less than or equal to 47% for scores 3 or below and were less than or equal to 50% and more than or equal to 96% for scores 8 or above. The ROC AUC was 0.88. Variables identified in the Duke model were as follows: hospitalization (2.63 [1.32-5.41]), transfer (5.30 [2.67-10.71]), urinary catheterization (6.89 [3.62-13.38]), β-lactam and/or fluoroquinolone therapy (3.47 [1.91-6.41]), and immunosuppression (2.34 [1.14-4.80]). Sensitivity and specificity were, respectively, more than or equal to 94% and less than or equal to 65% for scores 3 or below and were less than or equal to 58% and more than or equal to 95% for scores 8 or above. The ROC AUC was 0.89. Conclusion. While the previously reported model was an excellent predictor of community-onset ESBL-EKP infection, models utilizing factors based on local epidemiology may be associated with improved performance.Infection Control and Hospital Epidemiology 04/2013; 34(4):385-92. · 3.67 Impact Factor -
Article: Observing and improving hand hygiene compliance: implementation and refinement of an electronic-assisted direct-observer hand hygiene audit program.
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ABSTRACT: We implemented a direct-observer hand hygiene audit program that used trained observers, wireless data entry devices, and an intranet portal. We improved the reliability and utility of the data by standardizing audit processes, regularly retraining auditors, developing an audit guidance tool, and reporting weighted composite hand hygiene compliance scores.Infection Control and Hospital Epidemiology 02/2013; 34(2):207-10. · 3.67 Impact Factor -
Article: Increasing Rates of Methicillin-Resistant Staphylococcus aureus in Academic Hospitals: A Result of Active Surveillance?
Infection Control and Hospital Epidemiology 01/2013; 34(1):105-106. · 3.67 Impact Factor
