Philip Carling

Philip Carling
Steward Health Care System

About

39
Publications
9,001
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
2,628
Citations

Publications

Publications (39)
Article
Full-text available
Background The patient care environment plays an important role in the transmission of potential pathogens. Efforts to improve the thoroughness of environmental cleaning and disinfection have largely concentrated on ICUs and other inpatient units. The purpose of this study was to ascertain baseline data on the thoroughness of cleaning in ambulatory...
Article
Anesthesiologists may contribute to postoperative infections by means of the transmission of blood and pathogens to the patient and the environment in the operating room (OR). Our primary aims were to determine whether contamination of the IV hub, the anesthesia work area, and the patient could be reduced after induction of anesthesia by removing t...
Article
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their Clostridium difficile...
Article
Sustaining performance is a difficult and often overlooked aspect of quality improvement and implementation science. Over a 4-year period, we observed that monthly feedback of performance data in face-to-face meetings with frontline personnel was crucial in maintaining environmental-cleaning effectiveness in adult critical care units. Infect Contro...
Article
The effectiveness and efficiency of 17 housekeepers in terminal cleaning 292 hospital rooms was evaluated through adenosine triphosphate detection. A subgroup of housekeepers was identified who were significantly more effective and efficient than their coworkers. These optimum outliers may be used in performance improvement to optimize environmenta...
Article
Full-text available
Background: Oral flora, blood-borne pathogens, and bacterial contamination pose a direct risk of infection to patients and health care workers. We conducted a study in a simulated operating room using a newly validated technology to determine whether the use of 2 sets of gloves, with the outer set removed immediately after endotracheal intubation,...
Article
Pathogenic organisms have been found in the intraoperative environment, potentially posing a risk of infection that could cause morbidity and mortality. In an effort to understand how a patient's bacteria can be spread throughout the operating room with the anesthesia provider as a vector, we conducted a study using recently developed experimental...
Article
Full-text available
This white paper identifies knowledge gaps and new challenges in healthcare epidemiology research, assesses the progress made toward addressing research priorities, provides the Society for Healthcare Epidemiology of America (SHEA) Research Committee's recommendations for high-priority research topics, and proposes a road map for making progress to...
Article
Our institution continued to experience a hyperendemic situation with carbapenem-resistant Acinetobacter baumannii despite a bundle of interventions. We aim to describe the effect of the subsequent implementation of electronic dissemination of the weekly findings of a bundle of interventions. This was a quasiexperimental study performed at a 1,500-...
Article
We describe 1,132 contacts between anesthesiologists and the operating room. Objects most commonly touched included anesthesia machines and keyboards. Only 13 hand hygiene events were witnessed during 8 hours of observations. Line insertions, bronchoscopies, or blood exposures were not followed by hand hygiene. Stopcocks were accessed 66 times and...
Article
Full-text available
Education and passive observation resulted in a significant improvement in housekeeper disinfection of nontoxigenic Clostridium difficile spores artificially inoculated onto surfaces in C. difficile infection rooms. A further significant reduction occurred with direct supervision and real-time feedback, suggesting that optimal disinfection is achie...
Article
Traditional monitoring of environmental cleaning using visual assessment can identify gross lapses in practice, but the limitations underlying such an approach to ensure ongoing compliance with cleaning policies in the patient zone have become widely recognized in recent years. ¹¹ • Carling P.C. • Bartley J.M. Evaluating hygienic cleaning in healt...
Article
Environmental surfaces in hospital rooms often become contaminated with microbes, and evidence has linked the patient care environment to transmission of potential pathogens. Despite attempts at standardization of training and cleaning techniques, there is great variation between housekeepers with regard to room cleaning practices. Environmental cl...
Article
Full-text available
Potential transmission of organisms from the environment to patients is a concern, especially in enclosed settings, such as operating rooms, in which there are multiple and frequent contacts between patients, provider's hands, and environmental surfaces. Therefore, adequate disinfection of operating rooms is essential. We aimed to determine the cha...
Article
Objective: We needed to better understand the usefulness of different methods of monitoring and achieving sustained improvement in cleaning. Common elements of successful international approaches include a covert nature, the use of a method to visually identify and highlight deficiencies in the cleaning of high touch objects (HTOs) and the provisio...
Article
Environmental cleaning and disinfection is essential for optimizing safe patient care in the OR; however, perioperative staff members have not had an easy-to-use, objective method for determining whether high-touch, potentially contaminated surfaces have been cleaned during terminal room cleaning. To address this issue, members of the Healthcare En...
Article
Recent studies using direct covert observation or a fluorescent targeting method have consistently confirmed that most near patient surfaces are not being cleaned in accordance with existing hospital policies while other studies have confirmed that patients admitted to rooms previously occupied by patients with hospital pathogens have a substantial...
Article
To determine the thoroughness of terminal disinfection and cleaning of patient rooms in hospital intensive care units and to assess the value of a structured intervention program to improve the quality of cleaning as a means of reducing environmental transmission of multidrug-resistant organisms within the intensive care unit. Prospective, multicen...
Conference Paper
Background: Boston MedFlight (BMF) is a critical care transport service with 3000 calls per year divided between 3 rotor wing , 1 fixed wing, and 2 ground vehicles. Patients may be transported from the scene of an acute traumatic injury (16%) or between hospitals (84%). Environmental contamination of shared medical equipment and high touch surfaces...
Conference Paper
Background: Environmental surfaces may become contaminated by a variety of potential pathogens and, unless adequately cleaned and disinfected, may serve as a source for transmission to healthcare providers and/or patients. Objective: Assess environmental cleanliness of high-touch surfaces throughout inpatient units of an academic medical center....
Conference Paper
Background: Microbial contamination of the near patient environment has become increasingly recognized as having a role in the transmission of healthcare associated pathogens. Indeed, since 2007, the Center for Medicare Services has required that The infection and prevention control program (for healthcare facilities) must include appropriate monit...
Article
Full-text available
Norovirus infection outbreaks (NoVOs) occur frequently in closed populations, such as cruise ship passengers. Environmental contamination is believed to play an important role in NoVO propagation. Trained health care professionals covertly evaluated the thoroughness of disinfection cleaning (TDC) of 6 standardized objects (toilet seat, flush handle...
Article
Keyboards in intensive care units have been shown to serve as reservoirs for multidrug-resistant microorganisms. The thoroughness of disinfection cleaning of keyboards on computers on wheels (COWs) in an intensive care units of an academic medical center were evaluated using an invisible florescent marker, and the movements of the COWs were tracked...
Article
Full-text available
The prevalence of serious infections caused by multidrug-resistant pathogens transmitted in the hospital setting has reached alarming levels, despite intensified interventions. In the context of mandates that hospitals ensure compliance with disinfection procedures of surfaces in the environment surrounding the patient, we implemented a multihospit...
Article
The quality of environmental hygiene in hospitals is under increasing scrutiny from both healthcare providers and consumers because the prevalence of serious infections due to multidrug-resistant pathogens has reached alarming levels. On the basis of the results from a small number of hospitals, we undertook a study to evaluate the thoroughness of...
Article
Despite isolation precautions and enhanced hand hygiene product use, the transmission of healthcare-associated pathogens remains a major problem. Recent studies have confirmed that microbial contamination of the environment in intensive care units (ICUs) can lead to colonisation and infection of patients. Although environmental disinfectants have b...
Article
Although environmental cleaning and disinfecting practices have become a cornerstone of patient care, assessment of actual compliance with such procedures has not been reported. Using a novel methodology, we developed a means to monitor directly such activities. A nontoxic target solution, which intensely fluoresces with a black light, was formulat...
Article
We developed a new method using an invisible fluorescent marker to target standardized high-touch surfaces in hospital rooms. Evaluation of 1404 surface objects in 157 rooms in 3 hospitals revealed that 47% of targets had been cleaned. Educational interventions were implemented, leading to sustained improvement in cleaning of all objects and a >2-f...
Article
To evaluate the impact of an interventional multidisciplinary antibiotic management program on expenditures for antibiotics and on the incidence of nosocomial infections caused by Clostridium difficile and antibiotic-resistant pathogens during 7 years. Prospective study with comparison with preintervention trends. University-affiliated teaching hos...
Article
Full-text available
This article reports 13 cases of pneumococcal septic arthritis and reviews another 177 cases reported since 1965. Of 2407 cases of septic arthritis from large series, 156 (6%) were caused by Streptococcus pneumoniae. Mortality was 19% among adults and 0% among children. Pneumococcal bacteremia was the strongest predictor of mortality. At least 1 kn...

Network

Cited By