Elaine Larson

Publications (93)237.26 Total impact

• Article: Gender Differences in Risk of Bloodstream and Surgical Site Infections.

  Bevin Cohen, Yoon Jeong Choi, Sandra Hyman, E Yoko Furuya, Matthew Neidell, Elaine Larson
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  ABSTRACT: BACKGROUND: Identifying patients most at risk for hospital- and community-associated infections is one essential strategy for preventing infections. OBJECTIVE: To investigate whether rates of community- and healthcare-associated bloodstream and surgical site infections varied by patient gender in a large cohort after controlling for a wide variety of possible confounders. DESIGN: Retrospective cohort study. PARTICIPANTS: All patients discharged from January 1, 2006 through December 31, 2008 (133,756 adult discharges and 66,592 pediatric discharges) from a 650-bed tertiary care hospital, a 220-bed community hospital, and a 280-bed pediatric acute care hospital within a large, academic medical center in New York, NY. MAIN MEASURES: Data were collected retrospectively from various electronic sources shared by the hospitals and linked using patients' unique medical record numbers. Infections were identified using previously validated computerized algorithms. KEY RESULTS: Odds of community-associated bloodstream infections, healthcare-associated bloodstream infections, and surgical site infections were significantly lower for women than for men after controlling for present-on-admission patient characteristics and events during the hospital stay [odds ratios (95 % confidence intervals) were 0.85 (0.77-0.93), 0.82 (0.74-0.91), and 0.78 (0.68-0.91), respectively]. Gender differences were greatest for older adolescents (12-17 years) and adults 18-49 years and least for young children (<12 years) and older adults (≥70 years). CONCLUSIONS: In this cohort, men were at higher risk for bloodstream and surgical site infections, possibly due to differences in propensity for skin colonization or other anatomical differences.
  Journal of General Internal Medicine 04/2013; · 2.83 Impact Factor
• Article: Infection prevention in long-term care: a systematic review of randomized and nonrandomized trials.

  Mayuko Uchida, Monika Pogorzelska-Maziarz, Philip W Smith, Elaine Larson
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  ABSTRACT: The purpose of this systematic review was to critically review and synthesize current evidence and the methodological quality of nonpharmacological infection-prevention interventions in long-term care (LTC) facilities for older adults. Two reviewers searched three electronic databases for studies published over the last decade assessing randomized and nonrandomized trials designed to reduce infections in older adults in which primary outcomes were infection rates and reductions of risk factors related to infections. To establish clarity and standardized reporting of findings, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used. Data extracted included study design, sample size, type and duration of interventions, outcome measures reported, and findings. Two reviewers independently assessed study quality using a validated quality assessment tool. Twenty-four articles met inclusion criteria; the majority were randomized control trials (67%) in which the primary purpose was to reduce pneumonia (66%). Thirteen (54%) studies reported statistically significant results in favor of interventions on at least one of their outcome measures. The methodological clarity of available evidence was limited, placing them at potential risk of bias. Gaps and inconsistencies surrounding interventions in LTC are evident. Future interventional studies need to enhance methodological rigor using clearly defined outcome measures and standardized reporting of findings.
  Journal of the American Geriatrics Society 04/2013; 61(4):602-14. · 3.74 Impact Factor
• Article: Advanced Practice Nursing Students' Identification of Patient Safety Issues in Ambulatory Care.

  Rebecca Schnall, Elaine Larson, Patricia W Stone, Rita Marie John, Suzanne Bakken
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  ABSTRACT: Despite more than a decade of patient safety initiatives in our health care system, nurses (N = 172) identified a large number of safety issues in the ambulatory care setting, including issues in their own practice (50.7% of the encounters), feeling rushed or hurried (34.8% of encounters), and being interrupted (27.0% of encounters). Greater patient complexity was a significant predictor of identifying a diagnostic or management and treatment issue. The presence of an electronic health record was not related to reporting of a patient safety issue.
  Journal of nursing care quality 12/2012; · 1.19 Impact Factor
• Article: On the role of length of stay in healthcare-associated bloodstream infection.

  Christie Y Jeon, Matthew Neidell, Haomiao Jia, Matt Sinisi, Elaine Larson
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  ABSTRACT: Design. We conducted a retrospective cohort study to examine the role played by length of hospital stay in the risk of healthcare-associated bloodstream infection (BSI), independent of demographic and clinical risk factors for BSI. Patients. We employed data from 113,893 admissions from inpatients discharged between 2006 and 2008. Setting. Large tertiary healthcare center in New York City. Methods. We estimated the crude and adjusted hazard of BSI by conducting logistic regression using a person-day data structure. The covariates included in the fully adjusted model included age, sex, Charlson score of comorbidity, renal failure, and malignancy as static variables and central venous catheterization, mechanical ventilation, and intensive care unit stay as time-varying variables. Results. In the crude model, we observed a nonlinear increasing hazard of BSI with increasing hospital stay. This trend was reduced to a constant hazard when fully adjusted for demographic and clinical risk factors for BSI. Conclusion. The association between longer length of hospital stay and increased risk of infection can largely be explained by the increased duration of stay among those who have underlying morbidity and require invasive procedures. We should take caution in attributing the association between length of stay and BSI to a direct negative impact of the healthcare environment.
  Infection Control and Hospital Epidemiology 12/2012; 33(12):1213-8. · 3.67 Impact Factor
• Article: Frequency of patient contact with health care personnel and visitors: implications for infection prevention.

  Bevin Cohen, Sandra Hyman, Lauren Rosenberg, Elaine Larson
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  ABSTRACT: Contact with health care workers may be an important means of infection transmission between patients, yet little is known about patterns of patient contact with staff and visitors in hospitals. In a cross-sectional study, the frequency, type, and duration of contacts made by health care workers, other hospital staff, and visitors to patients in acute care settings were documented. Patients were observed in seven units of three academic hospitals, with recording of each occurrence of someone's entry into the patient's room. The health care worker's role, the duration of the visit, and the highest level of patient contact made were noted. Staff were also surveyed to determine their perception of how many patients per hour they come into contact with, how long they spend with patients, and the level of patient contact that occurs. Hourly room entries ranged from 0 to 28 per patient (median, 5.5), and patients received visits from 0 to 18 different persons per hour (median, 3.5). Nurses made the most visits (45%), followed by personal visitors (23%), medical staff (17%), nonclinical staff (7%), and other clinical staff (4%). Visits lasted 1 to 124 minutes (median, 3 minutes for all groups). Persons entering patients' rooms touched nothing inside the room, only the environment, the patient's intact skin, or the patient's blood/body fluids 22%, 33%, 27%, and 18% of the time, respectively. Medical staff estimated visiting an average of 2.8 different patients per hour (range, 0.5-7.0), and nursing staff estimated visiting an average of 4.5 different patients per hour (range, 0.5-18.0). Examining patterns of patient contact may improve understanding of transmission dynamics in hospitals. New transmission models should consider the roles of health care workers beyond patients' assigned nurses and physicians.
  Joint Commission journal on quality and patient safety / Joint Commission Resources 12/2012; 38(12):560-5.
• Article: Long-term survival and healthcare utilization outcomes attributable to sepsis and pneumonia.

  Andrew Dick, Hangsheng Liu, Jack Zwanziger, Eli Perencevich, E Yoko Furuya, Elaine Larson, Monika Pogorzelska-Maziarz, Patricia W Stone
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  ABSTRACT: BACKGROUND: Hospital associated infections are major problems, which are increasing in incidence and very costly. However, most research has focused only on measuring consequences associated with the initial hospitalization. We explored the long-term consequences of infections in elderly Medicare patients admitted to an intensive care unit (ICU) and discharged alive, focusing on: sepsis, pneumonia, central-line-associated bloodstream infections (CLABSI), and ventilator-associated pneumonia (VAP); the relationships between the infections and long-term survival and resource utilization; and how resource utilization was related to impending death during the follow up period. METHODS: Clinical data and one year pre- and five years post-index hospitalization Medicare records were examined. Hazard ratios (HR) and healthcare utilization incidence ratios (IR) were estimated from state of the art econometric models. Patient demographics (i.e., age, gender, race and health status) and Medicaid status (i.e., dual eligibility) were controlled for in these models. RESULTS: In 17,537 patients, there were 1,062 sepsis, 1,802 pneumonia, 42 CLABSI and 52 VAP cases. These subjects accounted for 62,554 person-years post discharge. The sepsis and CLABSI cohorts were similar as were the pneumonia and VAP cohorts. Infection was associated with increased mortality (sepsis HR = 1.39, P < 0.01; and pneumonia HR = 1.58, P < 0.01) and the risk persisted throughout the follow-up period. Persons with sepsis and pneumonia experienced higher utilization than controls (e.g., IR for long-term care utilization for those with sepsis ranged from 2.67 to 1.93 in years 1 through 5); and, utilization was partially related to impending death. CONCLUSIONS: The infections had significant and lasting adverse consequences among the elderly. Yet, many of these infections may be preventable. Investments in infection prevention interventions are needed in both community and hospitals settings.
  BMC Health Services Research 11/2012; 12(1):432. · 1.66 Impact Factor
• Article: Time lag for posting transmission-based isolation precaution signs.

  Maryam Behta, Rebecca Landzberg, Haomiao Jia, Melissa Marine, Barbara Ross, Rohit Chaudhry, Bevin Cohen, Elaine Larson
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  ABSTRACT: BACKGROUND: Rapid identification and isolation of patients colonized or infected with virulent pathogens is essential to minimize risk of exposure to other patients, visitors, and health care workers. OBJECTIVE: Our objective was to determine the time lag between when a patient is identified as requiring isolation precautions and when an isolation sign is posted outside of their room. METHODS: Patients requiring assessment of isolation precautions because of a new positive culture, readmission, or transfers within the institution were identified through an electronic surveillance system. Observers recorded the presence of isolation signs at the patient's door at time (T) 0hr, T2hr, T4hr, T24hr, and T48hr or until an isolation sign was posted. RESULTS: The majority of patients was adults in nonintensive care units. Isolation signs were present for 79.0% of the patients at T0hr and increased to 83.8% by T48hr. No difference was seen between the unit type or indications for isolation. The most common organisms for which isolation was indicated were influenza and resistant enterococci, Staphylococcus aureus; isolation sign postings at T0hr were 87.9%, 85.7%, and 80.7%, respectively. There was a significant difference seen in compliance among the adult (82.8%) and pediatrics (66.7%) sites (P = .0268). CONCLUSION: Isolation precautions are indicated to prevent transmission of virulent pathogens; however, their implementation in a timely manner can be challenging. In this study, approximately 20% of patients for whom isolation was needed had no sign posted within the first 24 hours, and there were only minimal increases thereafter. Simple processes are needed for early identification of patients, communication of the protective equipment needed, and continuous monitoring of adherence to guidelines.
  American journal of infection control 09/2012; · 3.01 Impact Factor
• Article: Parental Health Literacy, Knowledge and Beliefs Regarding Upper Respiratory Infections (URI) in an Urban Latino Immigrant Population.

  Ann-Margaret Dunn-Navarra, Melissa S Stockwell, Dodi Meyer, Elaine Larson
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  ABSTRACT: Parents who are recent immigrants and/or non-native English speakers are at increased risk for poor health literacy. For example, misconceptions regarding treatment for upper respiratory infections (URIs), including nonjudicious use of antibiotics, have been described among Latinos. We sought to assess the influence of health literacy on knowledge and beliefs surrounding URI care and to explore the correlation between two health literacy measures among Latino parents in northern Manhattan. A descriptive survey design was used, and a total of 154 Latino parents were enrolled from four early head start programs between September 2009 and December 2009. Health literacy was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and Newest Vital Sign (NVS); parental knowledge and beliefs regarding antibiotic treatment for URIs were also assessed. Analyses were conducted in 2010 with multivariable logistic regression performed to examine predictors of health literacy. Inadequate health literacy was observed in 83.8 % of respondents using NVS and 35.7 % with the S-TOFHLA. College education was significantly associated with adequate health literacy using either the NVS or S-TOFHLA; however, other results varied between measures. Using NVS, there was a greater likelihood of adequate health literacy with US birth status (AOR 13.8; 95 % CI, 1.99-95.1), >5 years US residency (AOR 7.6; 95 % CI, 1.3-43.1) and higher antibiotic knowledge scores (AOR 1.7; 95 % CI, 1.2-2.4). Using S-TOFHLA, the odds of adequate health literacy increased with access to a regular care provider (AOR 2.6; 95 % CI, 1.2-5.6). Scores consistent with adequate health literacy on the NVS, but not the S-TOFHLA, were associated with correct beliefs regarding antibiotic use for URIs in comparison to scores of participants with inadequate health literacy. Since health literacy levels were low in this population and the risk of viral URI was high during the first few years of life, targeted education to improve health literacy, knowledge, and beliefs about URI and related antibiotic treatment is needed.
  Journal of Urban Health 06/2012; 89(5):848-60. · 2.13 Impact Factor
• Article: A new metric of antibiotic class resistance in gram-negative bacilli isolated from hospitalized children.

  Sameer J Patel, Dana O'Toole, Elaine Larson
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  ABSTRACT: The purpose of this study was to describe patterns of infection or colonization with antibiotic-resistant gram-negative bacilli (GNB) in hospitalized children utilizing an electronic health record. Tertiary care facility. Pediatric patients 18 years of age or younger hospitalized from January 1, 2006, to December 31, 2008. Children were identified who had (1) at least 1 positive culture for a multidrug-resistant (MDR) GNB, defined as a GNB with resistance to 3 or more antibiotic classes; or (2) additive drug resistance, defined as isolation of more than 1 GNB that collectively as a group demonstrated resistance to 3 or more antibiotic classes over the study period. Differences in clinical characteristics between the 2 groups were ascertained, including history of admissions and transfers, comorbid conditions, receipt of procedures, and antibiotic exposure. Of 56,235 pediatric patients, 46 children were infected or colonized with an MDR GNB, of which 16 were resistant to 3 classes and 30 were resistant to 4 classes. Another 39 patients had positive cultures for GNB that exhibited additive drug resistance. Patients with additive drug resistance were more likely than patients with MDR GNB to have had previous admissions to a long-term facility (8 vs 2; P = .04) and had more mean admissions (7 vs 3; P < .01) and more mean antibiotic-days (P < .01 to P = .02). Six patients with additive drug resistance later had a positive culture with an MDR GNB. An electronic health record can be used to track antibiotic class resistance in GNB isolated from hospitalized children over multiple cultures and hospitalizations.
  Infection Control and Hospital Epidemiology 06/2012; 33(6):602-7. · 3.67 Impact Factor
• Article: Hand Hygiene Opportunities in Pediatric Extended Care Facilities.

  Amanda Buet, Bevin Cohen, Melissa Marine, Fiona Scully, Paul Alper, Edwin Simpser, Lisa Saiman, Elaine Larson
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  ABSTRACT: INTRODUCTION: Introduction: Children in extended care facilities (ECFs) are at risk of healthcare-associated infections, but little hand hygiene (HH) research has been conducted in this unique setting. METHODS: Eight children across four pediatric ECFs were observed for a cumulative 128 hours, and all care giver HH opportunities were characterized by the World Health Organization's '5 Moments for HH'. Data were analyzed using Pearson's χ2 test. RESULTS: Observers documented 865 HH opportunities. Overall HH adherence was 43% and was significantly higher among clinical care givers than among non-clinical care givers (61% and 14%, respectively, (p < .01). CONCLUSIONS: Hand hygiene adherence was low, suggesting multiple opportunities for transmission of infectious agents.
  Journal of pediatric nursing 06/2012;
• Article: Adoption of policies to prevent catheter-associated urinary tract infections in United States intensive care units.

  Laurie J Conway, Monika Pogorzelska, Elaine Larson, Patricia W Stone
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  ABSTRACT: Little is known about whether recommended strategies to prevent catheter-associated urinary tract infection (CAUTI) are being implemented in intensive care units (ICU) in the United States. Our objectives were to describe the presence of and adherence to CAUTI prevention policies in ICUs, to identify variations in policies based on organizational characteristics, and to determine whether a relationship exists between prevention policies and CAUTI incidence rates. Four hundred forty-one hospitals that participate in the National Healthcare Safety Network were surveyed in spring 2008. Two hundred fifty hospitals provided information for 415 ICUs (response rate, 57%). A small proportion of ICUs surveyed had policies supporting bladder ultrasound (26%, n = 106), condom catheters (20%, n = 82), catheter removal reminders (12%, n = 51), or nurse-initiated catheter discontinuation (10%, n = 39). ICUs in hospitals with ≥ 500 beds were half as likely as those in smaller hospitals to have adopted at least 1 CAUTI prevention policy (odds ratio, 0.52; 95% confidence interval: 0.33-0.86), and ICUs in hospitals where the infection control director reported always having access to key decision makers for planning were more than twice as likely as those with less access to have adopted a policy (odds ratio, 2.41; 95% confidence interval: 1.56-3.72). Little attention is currently placed on CAUTI prevention in ICUs in the United States. Further research is needed to elucidate relationships between adherence to CAUTI prevention recommendations and CAUTI incidence rates.
  American journal of infection control 02/2012; 40(8):705-10. · 3.01 Impact Factor
• Source

  Available from: PubMed Central

  Article: Development of an antimicrobial stewardship intervention using a model of actionable feedback.

  Sameer J Patel, Lisa Saiman, Jennifer M Duchon, David Evans, Yu-Hui Ferng, Elaine Larson
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  ABSTRACT: We describe the development of an audit and feedback intervention to improve antibiotic prescribing in the neonatal intensive care unit (NICU) using a theoretical framework. Participants included attending physicians, neonatal fellows, pediatric residents, and nurse practitioners. The intervention was based on the "model of actionable feedback" which emphasizes that feedback should be timely, individualized, nonpunitive, and customized to be effective. We found that real-time feedback could not be provided for the parameters established in this study, as we had to collect and analyze numerous data elements to assess appropriate initiation and continuation of antibiotics and required longer intervals to examine trends in antibiotic use. We learned during focus groups that NICU clinicians strongly resisted assigning individual responsibility for antibiotic prescribing as they viewed this as a shared responsibility informed by each patient's laboratory data and clinical course. We were able to create a non-punitive atmosphere thanks to written informed consent from NICU attendings and assurance from leadership that prescribing practices would not be used to assess job performance. We provided customized, meaningful feedback integrating input from the participants. Adapting the principles of the "model of actionable feedback" to provide feedback for antimicrobial prescribing practices proved challenging in the NICU setting.
  Interdisciplinary Perspectives on Infectious Diseases 01/2012; 2012:150367.
• Article: Comparison of two computer algorithms to identify surgical site infections.

  Mandar Apte, Timothy Landers, Yoko Furuya, Sandra Hyman, Elaine Larson
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  ABSTRACT: Surgical site infections (SSIs), the second most common healthcare-associated infections, increase hospital stay and healthcare costs significantly. Traditional surveillance of SSIs is labor-intensive. Mandatory reporting and new non-payment policies for some SSIs increase the need for efficient and standardized surveillance methods. Computer algorithms using administrative, clinical, and laboratory data collected routinely have shown promise for complementing traditional surveillance. Two computer algorithms were created to identify SSIs in inpatient admissions to an urban, academic tertiary-care hospital in 2007 using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes (Rule A) and laboratory culture data (Rule B). We calculated the number of SSIs identified by each rule and both rules combined and the percent agreement between the rules. In a subset analysis, the results of the rules were compared with those of traditional surveillance in patients who had undergone coronary artery bypass graft surgery (CABG). Of the 28,956 index hospital admissions, 5,918 patients (20.4%) had at least one major surgical procedure. Among those and readmissions within 30 days, the ICD-9-CM-only rule identified 235 SSIs, the culture-only rule identified 287 SSIs; combined, the rules identified 426 SSIs, of which 96 were identified by both rules. Positive and negative agreement between the rules was 36.8% and 97.1%, respectively, with a kappa of 0.34 (95% confidence interval [CI] 0.27-0.41). In the subset analysis of patients who underwent CABG, of the 22 SSIs identified by traditional surveillance, Rule A identified 19 (86.4%) and Rule B identified 13 (59.1%) cases. Positive and negative agreement between Rules A and B within these "positive controls" was 81.3% and 50.0% with a kappa of 0.37 (95% CI 0.04-0.70). Differences in the rates of SSI identified by computer algorithms depend on sources and inherent biases in electronic data. Different algorithms may be appropriate, depending on the purpose of case identification. Further research on the reliability and validity of these algorithms and the impact of changes in reimbursement on clinician practices and electronic reporting is suggested.
  Surgical Infections 12/2011; 12(6):459-64. · 1.80 Impact Factor
• Article: Using electronically available inpatient hospital data for research.

  Mandar Apte, Matthew Neidell, E Yoko Furuya, David Caplan, Sherry Glied, Elaine Larson
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  ABSTRACT: Despite a push to create electronic health records and a plethora of healthcare data from disparate sources, there are no data from a single electronic source that provide a full picture of a patient's hospital course. This paper describes a process to utilize electronically available inpatient hospital data for research. We linked several different sources of extracted data, including clinical, procedural, administrative, and accounting data, using patients' medical record numbers to compile a cohesive, comprehensive account of patient encounters. Challenges encountered included (1) interacting with distinct administrative units to locate data elements; (2) finding a secure, central location to house the data; (3) appropriately defining health measures of interest; (4) obtaining and linking these data to create a usable format for conducting research; and (5) dealing with missing data. Although the resulting data set is incredibly rich and likely to prove useful for a wide range of clinical and comparative effectiveness research questions, there are multiple challenges associated with linking hospital data to improve the quality of patient care.
  Clinical and Translational Science 10/2011; 4(5):338-45. · 1.13 Impact Factor
• Article: Patient safety issues in advanced practice nursing students' care settings.

  Rebecca Schnall, Sarah Cook, Rita Marie John, Elaine Larson, Patricia W Stone, Caroline Sullivan, Suzanne Bakken
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  ABSTRACT: The purpose of this project was to identify and characterize patient safety issues across advanced practice nursing (APN) care settings including ambulatory care visits. A total of 162 registered nurses enrolled in an APN education program completed an online survey. Respondents reported patient safety issues related to diagnosis or management and treatment in almost half of 489 encounters. The most common issues were clinician communication problems with patients, which occurred during 42.4% of encounters. Adoption of information technology may be a pathway for improving patient safety issues in APN practice settings.
  Journal of nursing care quality 09/2011; 27(2):132-8. · 1.19 Impact Factor
• Article: Measuring compliance with transmission-based isolation precautions: comparison of paper-based and electronic data collection.

  Barbara Ross, Melissa Marine, Mei Chou, Bevin Cohen, Rohit Chaudhry, Elaine Larson, Timothy Landers, Maryam Behta
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  ABSTRACT: Decreasing the transmission of resistant organisms in hospitals is a key goal of infection prevention plans. Studies have consistently shown inadequate health care worker (HCW) compliance with isolation precautions. Evaluating adherence through direct observation of HCW behavior is considered the "gold standard" but is labor-intensive, requiring the collection and analysis of a large volume of observations. Two methods of data collection to assess HCW compliance were evaluated: a manual method using a paper form (PF), with subsequent data entry into a database, and an electronic method using a Web-based form (WBF) with real-time data recording. Observations were conducted at 4 hospitals (a total of 2,065 beds) to assess the availability of gloves, gowns, and masks; isolation sign postings; and HCW isolation practices. A total of 13,878 isolation rooms were observed in 2009. The median number of rooms observed per day was 61 for PF and 60 for WBF, and the respective mean observation times per room were 149 seconds and 60 seconds. Thus, use of the WBF provided a time savings of 89 seconds per room. Simple electronic forms can significantly decrease the required resources for monitoring HCW adherence to hospital policies. Use of the WBF decreased the observation time by 60%, allowing for increases in the frequency and intensity of surveillance activities.
  American journal of infection control 07/2011; 39(10):839-43. · 3.01 Impact Factor
• Article: Clinical vignettes provide an understanding of antibiotic prescribing practices in neonatal intensive care units.

  Sameer Patel, Timothy Landers, Elaine Larson, Theoklis Zaoutis, Patricia Delamora, David A Paul, Jennifer Wong-McLoughlin, Yu-Hui Ferng, Lisa Saiman
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  ABSTRACT: To use clinical vignettes to understand antimicrobial prescribing practices in neonatal intensive care units (NICUs). Vignette-based survey. Four tertiary care NICUs. Antibiotic prescribers in NICUs. Clinicians from 4 tertiary care NICUs completed an anonymous survey containing 12 vignettes that described empiric, targeted, or prophylactic antibiotic use. Responses were compared with Centers for Disease Control and Prevention guidelines for appropriate use. Overall, 161 (59% of 271 eligible respondents) completed the survey, 37% of whom had worked in NICUs for 7 or more years. Respondents were more likely to appropriately identify use of targeted therapy for methicillin-susceptible Staphylococcus aureus, that is, use of oxacillin rather than vancomycin, than for Escherichia coli, that is, use of first-generation rather than third-generation cephalosporin, (P < .01). Increased experience significantly predicted appropriate prescribing (P = .02). The proportion of respondents choosing appropriate duration of postsurgical prophylaxis (P < .01) and treatment for necrotizing enterocolitis differed by study site (P = .03). The survey provides insight into antibiotic prescribing practices and informs the development of future antibiotic stewardship interventions for NICUs.
  Infection Control and Hospital Epidemiology 06/2011; 32(6):597-602. · 3.67 Impact Factor
• Article: Challenges of applying the SHEA/HICPAC metrics for multidrug-resistant organisms to a real-world setting.

  E Yoko Furuya, Elaine Larson, Timothy Landers, Haomiao Jia, Barbara Ross, Maryam Behta
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  ABSTRACT: To test in a real-world setting the recommendations for measuring infection with multidrug-resistant organisms (MDRO) from the Society for Healthcare Epidemiology of America (SHEA) and the Centers for Disease Control and Prevention's Healthcare Infection Control Practices Advisory Committee (HICPAC). Using data from 3 hospital settings within a healthcare network, we applied the SHEA/HICPAC recommendations to measure methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization. Data were obtained from the hospitals' electronic surveillance system and were supplemented by manual medical record review as necessary. Additionally, we tested (1) different definitions for nosocomial incidence, (2) the effect of excluding patients not at risk from the denominator for hospital-onset incidence, and (3) the appropriate time period to use when including or excluding patients with a prior history of MRSA infection or colonization from nosocomial rates. Negative binomial regression models were used to test for differences between rate definitions. A rating scale was created for each metric, assessing the extent to which manual or electronic data elements were required. There was no statistically significant difference between using 72 hours or 3 calendar days as the cutoff to define hospital-onset incidence. Excluding patients not at risk from the denominator when calculating hospital-onset incidence led to statistically significant increases in rates. When excluding patients with a prior history of MRSA infection or colonization from nosocomial incidence rates, rates were similar regardless of whether we looked at 1, 2, or 3 years' worth of prior data. The SHEA/HICPAC MDRO metrics are useful but can be challenging to implement. We include in our description of the data sources and processes required to calculate these metrics information that may simplify the process for institutions.
  Infection Control and Hospital Epidemiology 04/2011; 32(4):323-32. · 3.67 Impact Factor
• Source

  Available from: Helen Halpin

  Article: Patient safety climate: variation in perceptions by infection preventionists and quality directors.

  Shanelle Nelson, Patricia W Stone, Sarah Jordan, Monika Pogorzelska, Helen Halpin, Megan Vanneman, Elaine Larson
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  ABSTRACT: Background. Healthcare-associated infections (HAIs) are an important patient safety issue, and safety climate is an important organizational factor. This study explores perceptions of infection preventionists (IPs) and quality directors (QDs) regarding two safety microclimates, Senior Management Engagement (SME) and Leadership on Patient Safety (LOPS), across California hospitals. Methods. This was an analysis of two cross-sectional surveys. We conducted Wilcoxon signed-rank test, univariate analyses, and a multivariate ordinary least square regression. Results. There were 322 eligible hospitals; 149 hospitals (46.3%) responded to both surveys. The IP response rate was 59%, and the QD response rate was 79.5%. We found IPs perceived SME more positively than did QDs (21.4 vs. 20.4, P < 0.01). No setting characteristics predicted variation in perceptions. Presence of an independent budget predicted more positive perceptions of microclimates across personnel types (P < 0.01). Conclusions. Differences in perceptions continue to exist between essential leaders in acute health care settings which could have critical effects on outcomes such as HAIs. Having an independent budget for the infection prevention and control department may enhance the overall safety climate and in turn patient care.
  Interdisciplinary Perspectives on Infectious Diseases 01/2011; 2011:357121.
• Source

  Available from: Marc-Oliver Wright

  Article: Moving evidence from the literature to the bedside: report from the APIC Research Task Force.

  Patricia W Stone, Elaine Larson, Sanjay Saint, Marc-Oliver Wright, Sue Slavish, Cathryn Murphy, Jerome E Granato, Ann Marie Pettis, Claire Kilpatrick, Denise Graham, Kathy Warye, Russell Olmsted
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  ABSTRACT: Research is an integral component of the mission of the Association for Professionals in Infection Control and Epidemiology (APIC). In January 2010, APIC 's Board of Directors decided to update and clarify the Association's approach to research. The purpose of this paper is to briefly review the history of APIC's role in research and to report on the recent vision and direction developed by a research task force regarding appropriate roles and contributions for APIC and its members in regards to research. APIC and its membership play critical roles in the research process, especially in terms of setting the research agenda so that research resources can be directed to important areas. Additionally, dissemination and implementation are areas in which APIC members can utilize their unique talents to ensure that patients receive the most up-to-date and evidence-based infection prevention practices possible.
  American journal of infection control 12/2010; 38(10):770-7. · 3.01 Impact Factor