Building and Validating a Computerized Algorithm for Surveillance of Ventilator-Associated Events

2015 ◽  
Vol 36 (9) ◽  
pp. 999-1003 ◽  
Author(s):  
Tal Mann ◽  
Joseph Ellsworth ◽  
Najia Huda ◽  
Anupama Neelakanta ◽  
Thomas Chevalier ◽  
...  
Keyword(s):  
Infection Control ◽  
Predictive Value ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Mechanically Ventilated ◽  
Automated Method ◽  
Sensitivity Specificity ◽  
Infection Preventionists

OBJECTIVETo develop an automated method for ventilator-associated condition (VAC) surveillance and to compare its accuracy and efficiency with manual VAC surveillanceSETTINGThe intensive care units (ICUs) of 4 hospitalsMETHODSThis study was conducted at Detroit Medical Center, a tertiary care center in metropolitan Detroit. A total of 128 ICU beds in 4 acute care hospitals were included during the study period from August to October 2013. The automated VAC algorithm was implemented and utilized for 1 month by all study hospitals. Simultaneous manual VAC surveillance was conducted by 2 infection preventionists and 1 infection control fellow who were blinded to each another’s findings and to the automated VAC algorithm results. The VACs identified by the 2 surveillance processes were compared.RESULTSDuring the study period, 110 patients from all the included hospitals were mechanically ventilated and were evaluated for VAC for a total of 992 mechanical ventilation days. The automated VAC algorithm identified 39 VACs with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%. In comparison, the combined efforts of the IPs and the infection control fellow detected 58.9% of VACs, with 59% sensitivity, 99% specificity, 91% PPV, and 92% NPV. Moreover, the automated VAC algorithm was extremely efficient, requiring only 1 minute to detect VACs over a 1-month period, compared to 60.7 minutes using manual surveillance.CONCLUSIONSThe automated VAC algorithm is efficient and accurate and is ready to be used routinely for VAC surveillance. Furthermore, its implementation can optimize the sensitivity and specificity of VAC identification.Infect. Control Hosp. Epidemiol. 2015;36(9):999–1003

scholarly journals First Candida auris Outbreak during a COVID-19 Pandemic in a Tertiary-Care Center in Lebanon

Pathogens ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 157
Author(s):  
Fatima Allaw ◽  
Nada Kara Zahreddine ◽  
Ahmad Ibrahim ◽  
Joseph Tannous ◽  
Hussein Taleb ◽  
...  
Keyword(s):  
Infection Control ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Arab Countries ◽  
Infection Prevention And Control ◽  
Tertiary Care Center ◽  
Candida Auris ◽  
American University ◽  
American University Of Beirut

Candida auris is an emerging fungal pathogen considered as a global health threat. Recently there has been growing concern regarding drug resistance, difficulty in identification, as well as problems with eradication. Although outbreaks have been reported throughout the globe including from several Arab countries, there were no previous reports from Lebanon. We herein report the first cases of C. auris infection from the American University of Beirut Medical Center, a tertiary care center in Lebanon describing the clinical features of the affected patients in addition to the infection control investigation and applied interventions to control the outbreak. Fourteen patients with C. auris infection/colonization identified using MALDI-TOF and VITEK 2- Compact system were reported over a period of 13 weeks. Patients were admitted to four separate critical care units. All of them came through the emergency room and had comorbid conditions. Half of the patients were infected with COVID-19 prior to isolation of the C. auris. C. auris was isolated from blood (two isolates), urine (three isolates), respiratory tract (10 isolates) and skin (one isolate). All the patients had received broad spectrum antibiotics prior to isolation of C. auris. Six patients received antifungal treatment, while the remaining eight patients were considered colonized. Environmental cultures were taken from all four units and failed to isolate the organism from any cultured surfaces. A series of interventions were initiated by the Infection Prevention and Control team to contain the outbreak. Rapid detection and reporting of cases are essential to prevent further hospital transmission. A national standardized infection control registry needs to be established to identify widespread colonization.

scholarly journals Promoting COVID-19 vaccination among healthcare personnel: a multifaceted intervention at a tertiary care center in Japan

2021 ◽  
pp. 1-26
Author(s):  
Akane Takamatsu ◽  
Hitoshi Honda ◽  
Tomoya Kojima ◽  
Kengo Murata ◽  
Hilary Babcock
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Vaccination Rate ◽  
Multifaceted Intervention ◽  
Vaccine Hesitancy ◽  
Healthcare Personnel ◽  
Tertiary Care Center ◽  
Post Intervention ◽  
Post Vaccination

Abstract Objective The COVID-19 vaccine may hold the key to ending the pandemic, but vaccine hesitancy is hindering the vaccination of healthcare personnel (HCP). Design Before-after trial Participants and setting Healthcare personnel at a 790-bed tertiary care center in Tokyo, Japan. Interventions A pre-vaccination questionnaire was administered to HCP to examine their perceptions of the COVID-19 vaccine. Then, a multifaceted intervention involving (1) distribution of informational leaflets to all HCP, (2) hospital-wide announcements encouraging vaccination, (3) a mandatory lecture, (4) an educational session about the vaccine for pregnant or breastfeeding HCP, and (5) allergy testing for HCP at risk of allergic reactions to the vaccine was implemented. A post-vaccination survey was also performed. Results Of 1,575 HCP eligible for enrollment, 1,224 (77.7%) responded to the questionnaire, 43.5% (n =533) expressed willingness to be vaccinated, 48.4% (n = 593) were uncertain, and 8.0% (n=98) expressed unwillingness to be vaccinated. The latter two groups were concerned about the vaccine’s safety rather than its efficacy. Post-intervention, the overall vaccination rate reached 89.7% (1,413/1,575), with 88.9% (614/691) of the pre-vaccination survey respondents who answered “unwilling” or “unsure” eventually receiving a vaccination. In the post-vaccination questionnaire, factors contributing to increased COVID-19 vaccination included information and endorsement of vaccination at the medical center (26.4%; 274/1,037). Conclusions The present, multifaceted intervention increased COVID-19 vaccinations among HCP at a Japanese hospital. Frequent support and provision of information were crucial for increasing the vaccination rate and may be applicable to the general population as well.

Validation of semiautomated surgical site infection surveillance using electronic screening algorithms in 38 surgery categories

2018 ◽  
Vol 39 (8) ◽  
pp. 931-935 ◽  
Author(s):  
Sun Young Cho ◽  
Doo Ryeon Chung ◽  
Jong Rim Choi ◽  
Doo Mi Kim ◽  
Si-Ho Kim ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Surveillance System ◽  
Chart Review ◽  
Medical Center ◽  
Tertiary Care ◽  
Microbial Culture ◽  
Site Infection ◽  
Electronic Screening ◽  
Sensitivity Specificity ◽  
Infection Preventionists

ObjectiveTo verify the validity of a semiautomated surgical site infection (SSI) surveillance system using electronic screening algorithms in 38 categories of surgery.DesignA cohort study for validation of semiautomated SSI surveillance system using screening algorithms.SettingA 1,989-bed tertiary-care referral center in Seoul, Republic of Korea.MethodsA dataset of 40,516 surgical procedures in 38 categories stored in the conventional SSI surveillance registry at the Samsung Medical Center between January 2013 and December 2014 was used as the reference standard. In the semiautomated surveillance system, electronic screening algorithms flagged cases meeting at least 1 of 3 criteria: antibiotic prescription, microbial culture, and infectious disease consultation. Flagged cases were audited by infection preventionists. Analyses of sensitivity, specificity, and positive predictive value (PPV) were conducted for the semiautomated surveillance system, and its effect on reducing the workload for chart review was evaluated.ResultsA total of 575 SSI events (1·42%) were identified by conventional SSI surveillance. The sensitivity of the semiautomated SSI surveillance was 96·7%, and the PPV of the screening algorithms alone was 4·1%. Semiautomated SSI surveillance reduced the chart review workload of the infection preventionists from 1,283 to 482 person hours per year (a 62·4% decrease).ConclusionsCompared to conventional surveillance, semiautomated surveillance using electronic screening algorithms followed by chart review of selected cases can provide high-validity surveillance results and can significantly reduce the workload of infection preventionists.

scholarly journals 1196. Is the Weekend Staff Really to Blame? Challenges in Isolation Compliance at an Academic Tertiary Care Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S429-S429
Author(s):  
Sonia Bassett ◽  
Kelley M Boston ◽  
Luis Ostrosky-Zeichner
Keyword(s):  
Hand Hygiene ◽  
Infection Control ◽  
Significant Variation ◽  
Normal Approximation ◽  
Care Center ◽  
Tertiary Care ◽  
Visual Observation ◽  
Protective Equipment ◽  
Drug Resistant ◽  
Tertiary Care Center

Abstract Background Transmission-based isolation precautions are implemented in an effort to decrease the risk of transmission of pathogens. Weekend staff are perceived to have lower compliance. Methods Visual observation of healthcare worker (HCW) compliance with an institutional isolation precautions practices was done at an academic tertiary care center. In the first quarter of 2019, observations were completed for 894 patients who required contact, droplet or airborne isolation precautions. Observations included patients with infection or colonization with multi-drug-resistant organisms (MDRO) or highly transmissible infections. Observations focused on availability of appropriate supplies, compliance with infection control practices, and documentation. Audits were performed on workdays and weekends, and results were communicated to unit leadership via email. Comparison of proportions was calculated using the normal approximation in Minitab18. Results Compliance with the different elements of the audit can be seen in Table 1. HCW compliance with the use of personal protective equipment and hand hygiene on exit from the room had the lowest compliance and was statistically lower on weekends than on weekdays, and compliance was significantly lower than all other categories for both weekday and weekend measurements. Fifty-seven percent of all patients had missed compliance on one or more elements. There was not a statistically significant variation in practice between weekends and weekdays in overall compliance. Conclusion There is opportunity for improvement in all compliance on isolation practices facility-wide, and elements that require changes in behavior had the lowest compliance, and were lower on weekend shifts. We did not find other differences in performance for weekend staff vs. weekday staff. Educational measures should focus on all individual staff across all shifts. Disclosures All authors: No reported disclosures.

scholarly journals Salivary Gland FNA Diagnostics in a Real-Life Setting: One-Year-Experiences of the Implementation of the Milan System in a Tertiary Care Center

Cancers ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 1589 ◽  
Author(s):  
Erkka Tommola ◽  
Satu Tommola ◽  
Sinikka Porre ◽  
Ivana Kholová
Keyword(s):  
Salivary Gland ◽  
Classification System ◽  
Predictive Value ◽  
Care Center ◽  
Tertiary Care ◽  
Diagnostic Category ◽  
Real Life ◽  
Benign Neoplasm ◽  
Tertiary Care Center ◽  
One Year

The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was introduced in 2018 following other organ specific cytopathological reporting systems and it aimed at bringing a practical, evidence-based, user-friendly classification system with characterization and management algorithms. At the Department of Pathology, Fimlab Laboratories, Tampere, Finland all salivary fine needle aspirations (FNAs) have been given cytopathological diagnoses according to the MSRSGC since January 2018. Analyses of a one-year-period (January 2018–December 2018) consisted of 183 salivary FNA samples from 138 patients with correlation to histopathology in 90 cases with surgical follow-up. The MSRSGC performance in patient based analysis was as follows: accuracy was 90.9%, sensitivity was 61.5%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 89.4%, respectively. Risks of malignancy (ROMs) in MSRSGC categories were: 0.0% (0/15) in non-diagnostic category, 100.0% (1/1) in non-neoplastic category biased by only one falsely-negative lymphoma case, 14.3% (1/7) in atypia of undetermined significance category, 0.0% (0/28) in benign neoplasm category, 27.3% (3/11) in neoplasm of uncertain malignant potential category, and 100% for both suspicious for malignancy (4/4) and malignancy (4/4) categories, respectively. The MSRSGC has been proven as a reliable classification system in salivary gland FNA routine diagnostics in a tertiary care center.

Observations of Cleaning Techniques at a Tertiary Care Center during Observational Infection Control Rounds

2011 ◽  
Vol 39 (5) ◽  
pp. E72
Author(s):  
Lori Coddington ◽  
Dianne DeAngelis ◽  
Jackie Sanner ◽  
Rashida A. Khakoo
Keyword(s):  
Infection Control ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

scholarly journals Outbreak of Postoperative Endophthalmitis in a Thai Tertiary Care Center

2008 ◽  
Vol 29 (6) ◽  
pp. 564-566
Author(s):  
Anucha Apisarnthanarak ◽  
Supanee Jirajariyavej ◽  
Kanokporn Thongphubeth ◽  
Chananart Yuekyen ◽  
David K. Warren ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Multivariate Analysis ◽  
Infection Control ◽  
Care Center ◽  
Tertiary Care ◽  
Postoperative Endophthalmitis ◽  
Tertiary Care Center ◽  
Associated Risk Factors

We performed a study with a 1:3 ratio of case patients (n = 11) to control patients (n = 33) to evaluate risk factors for postoperative endophthalmitis in a Thai tertiary care center. Multivariate analysis revealed that diabetes mellitus and surgeon A were associated risk factors. Preoperative diabetes mellitus control and the improvement of infection control practices led to the termination of the outbreak.

The Importance of Ground Critical Care Transport

2016 ◽  
Vol 32 (2) ◽  
pp. 163-169 ◽  
Author(s):  
Susan R. Wilcox ◽  
Michael Ries ◽  
Ted A. Bouthiller ◽  
E. Dean Berry ◽  
Travis L. Dowdy ◽  
...  
Keyword(s):  
Critical Care ◽  
Life Support ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Respiratory Acidosis ◽  
Advanced Life Support ◽  
Integrated Approach ◽  
Tertiary Care Center ◽  
Transport Services

Critical care transport (CCT) teams are specialized transport services, comprised of highly trained paramedics, nurses, and occasionally respiratory therapists, offering an expanded scope of practice beyond advanced life support (ALS) emergency medical service teams. We report 4 cases of patients with severe acute respiratory distress syndrome from influenza in need of extracorporeal membrane oxygenation evaluation at a tertiary care center, transported by ground. Our medical center did not previously have a ground CCT service, and therefore, in these cases, a physician and/or a respiratory therapist was sent with the paramedic team. In all 4 cases, the ground transport team enhanced the intensive care provided to these patients prior to arrival at the tertiary care center. In 2 of the cases, although limited by the profound hypoxemia, the team decreased the pressures and tidal volumes in an effort to approach evidence-based ventilator goals. In 3 cases, they stopped bicarbonate drips being used to treat mixed metabolic and respiratory acidosis, and in 1 case, they administered furosemide. In 1 case, they started cisatracurium, and in 3 others, they initiated inhaled epoprostenol. Existing literature supports the use of CCT teams over ALS teams for transport of the most critically ill patients, and helicopter CCT is not always available or practical. Therefore, offering comparable air and ground options, with similar staffing and resources, is a hallmark of a mature medical system with an integrated approach to CCT.

scholarly journals A Longitudinal Seroprevalence Study Evaluating Infection Control and Prevention Strategies at a Large Tertiary Care Center with Low COVID-19 Incidence

2021 ◽  
Vol 18 (8) ◽  
pp. 4201
Author(s):  
Lorenz Schubert ◽  
Robert Strassl ◽  
Heinz Burgmann ◽  
Gabriella Dvorak ◽  
Matthias Karer ◽  
...  
Keyword(s):  
Infection Control ◽  
Personal Protective Equipment ◽  
Care Center ◽  
Tertiary Care ◽  
Protective Equipment ◽  
Tertiary Care Center ◽  
Prevention Strategies ◽  
Travel History ◽  
Specific Antibodies ◽  
Prospective Longitudinal

Personal protective equipment and adherence to disinfection protocols are essential to prevent nosocomial severe acute respiratory syndrome coronavirus (SARS-CoV-2) transmission. Here, we evaluated infection control measures in a prospective longitudinal single-center study at the Vienna General Hospital, the biggest tertiary care center in Austria, with a structurally planned low SARS-CoV-2 exposure. SARS-CoV-2-specific antibodies were assessed by Abbott ARCHITECT chemiluminescent assay (CLIA) in 599 health care workers (HCWs) at the start of the SARS-CoV-2 epidemic in early April and two months later. Neutralization assay confirmed CLIA-positive samples. A structured questionnaire was completed at both visits assessing demographic parameters, family situation, travel history, occupational coronavirus disease 2019 (COVID-19) exposure, and personal protective equipment handling. At the first visit, 6 of 599 participants (1%) tested positive for SARS-CoV-2-specific antibodies. The seroprevalence increased to 1.5% (8/553) at the second visit and did not differ depending on the working environment. Unprotected SARS-CoV-2 exposure (p = 0.003), positively tested family members (p = 0.04), and travel history (p = 0.09) were more frequently reported by positively tested HCWs. Odds for COVID-19 related symptoms were highest for congestion or runny nose (p = 0.002) and altered taste or smell (p < 0.001). In conclusion, prevention strategies proved feasible in reducing the risk of transmission of SARS-CoV-2 from patients and among HCWs in a low incidence hospital, not exceeding the one described in the general population.

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