Moving toward elimination of healthcare-associated infections: a call to action.

Centers for Disease Control and Prevention (CDC), Division of Healthcare Quality Promotion (DHQP), Atlanta, GA 30039, USA.
Infection Control and Hospital Epidemiology (Impact Factor: 4.02). 11/2010; 31(11):1101-5. DOI: 10.1086/656912
Source: PubMed
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    ABSTRACT: Objective. To review and describe device utilization and central line-associated bloodstream (CLABSI) events among patients in a non-intensive care unit (ICU) setting and to examine the morbidity and mortality associated with these events. Design. One-year descriptive review. Setting. A single tertiary center with a 1,200-bed hospital and 209 adult ICU beds. Patients. Hospitalized patients identified as having a CLABSI event attributed to a non-ICU setting. Methods. The cohort was identified from a prospective infection prevention database. Charts and administrative data sets were reviewed to further characterize the patients. Device utilization ratios (DURs) and CLABSI rates were calculated using National Health and Safety Network (NHSN) CLABSI definitions. Need for ICU stay and crude mortality rates were recorded. Results. A total of 136 patients with 156 CLABSIs were identified, of whom 78 (57%) were being treated for a hematological malignancy (HM). The overall DUR was 0.27. A tunneled line was in place for 118 (76%) of the CLABSI events, and a peripherally inserted central catheter was in place for 32 (21%) of the CLABSI events. The non-ICU CLABSI rate was significantly higher than the concurrent ICU rate (2.1 CLABSIs per 1,000 catheter-days vs 1.5 CLABSIs per 1,000 catheter-days; [Formula: see text]). Hospital mortality was 23% in the affected group and was significantly higher in patients with HM. Conclusions. CLABSI rates over a 1-year period were higher in patients outside the ICU at our hospital and were associated with significant mortality.
    Infection Control and Hospital Epidemiology 02/2014; 35(2):164-8. · 4.02 Impact Factor
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    ABSTRACT: Objectives. We evaluated capacity built and outcomes achieved from September 1, 2009, to December 31, 2011, by 51 health departments (HDs) funded through the American Recovery and Reinvestment Act (ARRA) for health care-associated infection (HAI) program development. Methods. We defined capacity for HAI prevention at HDs by 25 indicators of activity in 6 categories: staffing, partnerships, training, technical assistance, surveillance, and prevention. We assessed state-level infection outcomes by modeling quarterly standardized infection ratios (SIRs) for device- and procedure-associated infections with longitudinal regression models. Results. With ARRA funds, HDs created 188 HAI-related positions and supported 1042 training programs, 53 surveillance data validation projects, and 60 prevention collaboratives. All states demonstrated significant declines in central line-associated bloodstream and surgical site infections. States that implemented ARRA-funded catheter-associated urinary tract infection prevention collaboratives showed significantly greater SIR reductions over time than states that did not (P = .02). Conclusions. ARRA-HAI funding substantially improved HD capacity to reduce HAIs not targeted by other national efforts, suggesting that HDs can play a critical role in addressing emerging or neglected HAIs. (Am J Public Health. Published online ahead of print February 13, 2014: e1-e7. doi:10.2105/AJPH.2013.301809).
    American Journal of Public Health 02/2014; · 3.93 Impact Factor
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    ABSTRACT: Compliance with hand hygiene practices is directly affected by the accessibility and availability of cleaning agents. Nevertheless, the decision of where to locate these dispensers is often not explicitly or fully addressed in the literature. In this paper, we study the problem of selecting the locations to install alcohol-based hand sanitizer dispensers throughout a hospital unit as an indirect approach to maximize compliance with hand hygiene practices. We investigate the relevant criteria in selecting dispenser locations that promote hand hygiene compliance, propose metrics for the evaluation of various location configurations, and formulate a dispenser location optimization model that systematically incorporates such criteria. A complete methodology to collect data and obtain the model parameters is described. We illustrate the proposed approach using data from a general care unit at a collaborating hospital. A cost analysis was performed to study the trade-offs between usability and cost. The proposed methodology can help in evaluating the current location configuration, determining the need for change, and establishing the best possible configuration. It can be adapted to incorporate alternative metrics, tailored to different institutions and updated as needed with new internal policies or safety regulation.
    Health Care Management Science 11/2013; · 1.05 Impact Factor

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