Healthcare-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration-LabID Clostridium Difficile event 2013
ABSTRACT This is the first in a series of case studies that will be published in American Journal of Infection Control following the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) surveillance definition update of 2013. These cases reflect some of the complex patient scenarios infection professionals encounter during daily surveillance of health care-associated infections using NHSN definitions. Answers to the questions posed and immediate feedback in the form of answers and explanations are available at: http://www.surveymonkey.com/s/AJIC-NHSN-LbId2013. All individual participant answers will remain confidential, although it is the authors' hope to share a summary of the findings at a later date. Cases, answers, and explanations have been reviewed and approved by NHSN staff. Active participation is encouraged and recommended. Review/reference Chapter 12-Multidrug-resistant organism &C difficile infection module protocol, of the NHSN Patient Safety Component Manual (http://www.cdc.gov/nhsn/PDFs/pscManual/12pscMDRO_CDADcurrent.pdf), for information you may need to answer the case study questions.
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ABSTRACT: BACKGROUND: Catheter hub decontamination requires a thorough scrub and compliance varies. This study evaluates the effectiveness of a disinfection cap with 70% alcohol in preventing contamination/infection. METHODS: A 3-phased, multifacility, quasi-experimental study of adult patients with central lines divided into P1 (baseline), when the standard scrub was used; P2, when the cap was used on all central lines; and P3, when standard disinfection was reinstituted. House-wide central-line associated bloodstream infection (CLABSI) rates are reported with catheter-associated urinary tract infections (CAUTI) as a control measure. Adults with peripherally inserted central catheters inserted during hospitalization having 5+ consecutive line-days gave consent and were enrolled, and 1.5 mL of blood was withdrawn from each lumen not in use and quantitatively cultured. RESULTS: Contamination was 12.7% (32/252) during P1; 5.5% (20/364) in P2 (P = .002), and 12.0% (22/183; P = 0.88 vs P1 and P = .01 vs P2) in P3 (P = .001 vs P2). The median colony-forming units per milliliter was 4 for P1, 1 for P2 (P = .009), and 2 for P3 (P = .05 vs P2). CLABSI rates declined from 1.43 per 1,000 line-days (16/11,154) to 0.69 (13/18,972) in P2 (P = .04) and increased to 1.31 (7/5,354) in P3. CAUTI rates remained stable between P1 and P2 (1.42 and 1.41, respectively, P = .90) but declined in P3 (1.04, P = .03 vs P1 and P2). CONCLUSION: Disinfecting caps reduce line contamination, organism density, and CLABSIs.American journal of infection control 10/2012; 41(1). DOI:10.1016/j.ajic.2012.05.030 · 2.33 Impact Factor
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ABSTRACT: IMPORTANCE Antibiotic-resistant bacteria are associated with increased patient morbidity and mortality. It is unknown whether wearing gloves and gowns for all patient contact in the intensive care unit (ICU) decreases acquisition of antibiotic-resistant bacteria. OBJECTIVE To assess whether wearing gloves and gowns for all patient contact in the ICU decreases acquisition of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) compared with usual care. DESIGN, SETTING, AND PARTICIPANTS Cluster-randomized trial in 20 medical and surgical ICUs in 20 US hospitals from January 4, 2012, to October 4, 2012. INTERVENTIONS In the intervention ICUs, all health care workers were required to wear gloves and gowns for all patient contact and when entering any patient room. MAIN OUTCOMES AND MEASURES The primary outcome was acquisition of MRSA or VRE based on surveillance cultures collected on admission and discharge from the ICU. Secondary outcomes included individual VRE acquisition, MRSA acquisition, frequency of health care worker visits, hand hygiene compliance, health care-associated infections, and adverse events. RESULTS From the 26 180 patients included, 92 241 swabs were collected for the primary outcome. Intervention ICUs had a decrease in the primary outcome of MRSA or VRE from 21.35 acquisitions per 1000 patient-days (95% CI, 17.57 to 25.94) in the baseline period to 16.91 acquisitions per 1000 patient-days (95% CI, 14.09 to 20.28) in the study period, whereas control ICUs had a decrease in MRSA or VRE from 19.02 acquisitions per 1000 patient-days (95% CI, 14.20 to 25.49) in the baseline period to 16.29 acquisitions per 1000 patient-days (95% CI, 13.48 to 19.68) in the study period, a difference in changes that was not statistically significant (difference, -1.71 acquisitions per 1000 person-days, 95% CI, -6.15 to 2.73; P = .57). For key secondary outcomes, there was no difference in VRE acquisition with the intervention (difference, 0.89 acquisitions per 1000 person-days; 95% CI, -4.27 to 6.04, P = .70), whereas for MRSA, there were fewer acquisitions with the intervention (difference, -2.98 acquisitions per 1000 person-days; 95% CI, -5.58 to -0.38; P = .046). Universal glove and gown use also decreased health care worker room entry (4.28 vs 5.24 entries per hour, difference, -0.96; 95% CI, -1.71 to -0.21, P = .02), increased room-exit hand hygiene compliance (78.3% vs 62.9%, difference, 15.4%; 95% CI, 8.99% to 21.8%; P = .02) and had no statistically significant effect on rates of adverse events (58.7 events per 1000 patient days vs 74.4 events per 1000 patient days; difference, -15.7; 95% CI, -40.7 to 9.2, P = .24). CONCLUSIONS AND RELEVANCE The use of gloves and gowns for all patient contact compared with usual care among patients in medical and surgical ICUs did not result in a difference in the primary outcome of acquisition of MRSA or VRE. Although there was a lower risk of MRSA acquisition alone and no difference in adverse events, these secondary outcomes require replication before reaching definitive conclusions. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT0131821.JAMA The Journal of the American Medical Association 10/2013; 310(15). DOI:10.1001/jama.2013.277815 · 30.39 Impact Factor
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ABSTRACT: As legislative mandates for disclosure of data on health care-associated infections (HAIs) to the public escalate, with both economic and reputational implications for hospitals, the development of a valid national surveillance system has become imperative. Recent studies have identified interinstitutional variability of surveillance techniques. These inconsistencies affect the validity of publicly reported HAI data, which has as a primary goal the advancement of patient safety through the reduction of HAIs. The continued funding of state validation studies, the expansion of qualitative research to further assess interrater bias, the endorsement of educational materials to assist infection preventionists with application of National Healthcare Safety Network criteria, and the development of automated surveillance methods are all necessary to ensure a national HAI surveillance system that can be used for public reporting.American journal of infection control 06/2012; 40(5 Suppl):S29-31. DOI:10.1016/j.ajic.2012.03.009 · 2.33 Impact Factor