scholarly journals Association Between Healthcare-Associated Infection and Exposure to Hospital Roommates and Previous Bed Occupants with the Same Organism

2018 ◽  
Vol 39 (5) ◽  
pp. 541-546 ◽  
Author(s):  
Bevin Cohen ◽  
Jianfang Liu ◽  
Adam Ross Cohen ◽  
Elaine Larson
Keyword(s):  
New York ◽  
Multivariable Analysis ◽  
Acute Care Hospital ◽  
Patient Characteristics ◽  
Care Hospital ◽  
Healthcare Associated Infection ◽  
Wound Culture ◽  
Matched Case ◽  
Healthcare Associated ◽  
Control Study

OBJECTIVETo quantify the association between having a prior bed occupant or roommate with a positive blood, respiratory, urine, or wound culture and subsequent infection with the same organism.DESIGNCase-control study.SETTINGThe study included 4 hospitals within an academically affiliated network in New York City, including a community hospital (221 beds), a pediatric acute-care hospital (283 beds), an adult tertiary-/quaternary-care hospital (647 beds), and a pediatric and adult tertiary-/quaternary-care hospital (914 beds).PATIENTSAll 761,426 inpatients discharged from 2006 to 2012 were eligible. Cases included all patients who developed a healthcare-associated infection (HAI) with Staphylococcus aureus, Acinetobacter baumannii, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus faecalis, or Enterococcus faecium. Controls were uninfected patients matched by fiscal quarter, hospital, and length of stay. For each bed occupied during the 3–5-day period prior to infection, microbiology results for assigned roommates and the patient who occupied the bed immediately prior to the case were collected. For controls, the day of infection of the matched case served as the reference point.RESULTSIn total, 10,289 HAIs were identified. In a multivariable analysis controlling for both exposures and patient characteristics, the odds of cases having been exposed to a prior bed occupant with the same organism were 5.83 times that of controls (95% confidence interval [CI], 3.62–9.39), and the odds of cases having been exposed to a roommate with the same organism were 4.82 times that of controls (95% CI, 3.67–6.34).CONCLUSIONInfected or colonized roommates and prior occupants do pose a risk, which may warrant enhanced terminal and intermittent cleaning measures.Infect Control Hosp Epidemiol 2018;39:541–546

Risk Factors for and Outcomes of Healthcare-Associated Infection Due to Extended-Spectrum β-Lactamase-Producing Escherichia coli or Klebsiella pneumoniae in Thailand

2007 ◽  
Vol 28 (7) ◽  
pp. 873-876 ◽  
Author(s):  
Anucha Apisarnthanarak ◽  
Pattarachai Kiratisin ◽  
Payawan Saifon ◽  
Rungrueng Kitphati ◽  
Surang Dejsirilert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Klebsiella Pneumoniae ◽  
Multivariable Analysis ◽  
Healthcare Associated Infection ◽  
Extended Spectrum ◽  
Matched Case ◽  
Healthcare Associated ◽  
Third Generation Cephalosporins ◽  
Control Study

A matched case-control study was performed to evaluate the risk factors for and outcomes of healthcare-associated infection due to extended-spectrum β-lactamase-producing Escherichia coli or extended-spectrum β-lactamase-producing Klebsiella pneumoniae in Thailand. By multivariable analysis, prior exposure to third-generation cephalosporins and transfer from another hospital were risk factors associated with infection. Receipt of inadequate antimicrobial therapy was a predictor of mortality.

scholarly journals Assessing The Impact of The National Healthcare Safety Network’s (NHSN’s) New Baseline on Acute Care Hospital Standardized Infection Ratios (SIRs)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S49-S50
Author(s):  
Minn Soe ◽  
Allan Nkwata ◽  
Jonathan R Edwards ◽  
Margaret Dudeck ◽  
Daniel Pollock
Keyword(s):  
Acute Care ◽  
Risk Adjustment ◽  
Acute Care Hospital ◽  
Healthcare Facility ◽  
Care Hospital ◽  
Healthcare Associated Infection ◽  
Quality Reporting ◽  
National Healthcare ◽  
Healthcare Associated ◽  
The Impact

Abstract Background To more accurately measure the progress of healthcare-associated infection (HAI) prevention efforts, the CDC’s National Healthcare Safety Network (NHSN) surveillance system updated risk-adjustment models for computation of updated Standardized Infection Ratios (SIRs), the primary HAI summary measure by NHSN. This study sought to examine how the updated SIRs varied from the previous SIRs calculated using older baselines for acute care hospital HAIs. Methods We analyzed NHSN data for healthcare facility-onset laboratory-identified Clostridium difficile [CDI] and methicillin-resistant Staphylococcus aureus [MRSA] bacteremia reported in accordance with the CMS’ inpatient quality reporting program requirement. The unit of analysis was CMS certification number (CCN) facility reporting in 2015. We compared overall distributions of CCN-level SIRs (CCN-SIRs) between new risk-adjustment models using a 2015 baseline (SIR_NEW) and old models using a 2011 baseline (SIR_OLD) and tested location shift (median away from null) of pairwise differences. We also examined the magnitude of shift in SIR from old to new baseline. Results For each HAI, the national pooled mean SIR of the new baseline was ~1.0. For CDI, the overall distributions of CCN SIR_NEW and CCN-SIR_OLD were different, and the median of pairwise difference was away from null with CCN-SIR_NEW slightly higher. For MRSA, the SIR differences were not significant. Most CCN-SIRs (83% for CDI, 93% for MRSA) remained in the same significance category across the old and new baselines (“worse,” “better, ‘not different from national benchmark’), and few CCN-SIRs were reclassified to a less favorable category. For 75% of CCN-SIRs, their relative position in the quartile distributions of SIR_NEW and SIR_OLD remained the same. The discrepancies between SIR_NEW and SIR_OLD tended to be larger among CCNs with high SIRs. Conclusion The updated national pooled mean SIRs were close to 1.0, validating the potential use of new risk adjustment models and baseline as updated benchmarks for tracking CDI and MRSA prevention progress. The shifts in CCN-level SIRs between old and new baselines were not large, indicating a modest impact of new baselines at the CCN level, except among hospitals with high SIRs. Disclosures All authors: No reported disclosures.

scholarly journals 2481. Comparing inter-hospital patient movement patterns to better understand mechanisms for regional dissemination of carbapenem-resistant Enterobacteriaceae

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S859-S859
Author(s):  
Hannah Wolford ◽  
Justin O’Hagan ◽  
Prabasaj Paul ◽  
Sujan Reddy ◽  
Brandon Attell ◽  
...  
Keyword(s):  
New York ◽  
Skilled Nursing Facility ◽  
Acute Care Hospital ◽  
Movement Patterns ◽  
Patient Characteristics ◽  
Multidrug Resistant ◽  
Care Hospital ◽  
Specific Patient ◽  
Patient Movement ◽  
Hospital Population

Abstract Background Understanding inter-hospital movement of patients provides insight into regional transmission of multidrug-resistant organisms (MDROs) that can guide containment efforts. Movement of general patient populations are often used for this purpose, but movement of the specific patient population of MDRO carriers may be more useful. We sought to compare movement of CRE patients with that of other patient populations to explore whether CRE carriers move differently, and if so, to determine whether administrative data can be used to identify patient populations with transfer patterns that mimic CRE patients. Methods We used New York’s Statewide Planning and Research Cooperative System (SPARCS), to create a patient network of all acute care hospital encounters (“overall hospital population”) during 2013–2015. We identified the subset of CRE cases in the network by linking the SPARCS data to CRE cases reported to the National Healthcare Safety Network in 2014, matching on admission date, date of birth, gender, and facility. We described patient characteristics and movement patterns across 3 cohorts: (1) CRE cases, (2) overall hospital population, (3) CRE surrogate (patients clinically similar to CRE cases based on length of stay [LOS] ≥14 days and Clinical Classification Software [CCS] category of sepsis plus at least one of the following additional CCS categories: adult respiratory failure, acute renal failure, procedure complication or device complication). Correlations between cohorts were calculated using patient transfer matrices to determine similarities between the networks. Results The average LOS for CRE cases was 25× higher than the overall hospital population (31.4 vs. 1.3 days, Figure 1a), and CRE cases were more likely to die or be discharged to a skilled nursing facility (Figure 1b). CRE movement networks were only moderately correlated with the overall hospital population (R2 = 0.51); there was higher correlation between CRE case and CRE surrogate networks (R2 = 0.73). Conclusion CRE patients have different healthcare experiences in the hospital and between hospitals in New York compared with the overall hospital population. The CRE surrogate cohort transfer patterns were more similar, and could be used to understand CRE patient movement in the absence of CRE culture data. Disclosures All authors: No reported disclosures.

scholarly journals Timing and Route of Contamination of Patient Rooms With Healthcare-Associated Pathogens

2020 ◽  
Vol 41 (S1) ◽  
pp. s412-s412
Author(s):  
Sarah Redmond ◽  
Jennifer Cadnum ◽  
Basya Pearlmutter ◽  
Natalia Pinto Herrera ◽  
Curtis Donskey
Keyword(s):  
Acute Care Hospital ◽  
Current Control ◽  
Pathogen Transmission ◽  
Control Measures ◽  
Effective Control ◽  
Portable Devices ◽  
Care Hospital ◽  
Spa Typing ◽  
Persistent Problem ◽  
Healthcare Associated

Background: Transmission of healthcare-associated pathogens such as Clostridioides difficile and methicillin-resistant Staphylococcus aureus (MRSA) is a persistent problem in healthcare facilities despite current control measures. A better understanding of the routes of pathogen transmission is needed to develop effective control measures. Methods: We conducted an observational cohort study in an acute-care hospital to identify the timing and route of transfer of pathogens to rooms of newly admitted patients with negative MRSA nares results and no known carriage of other healthcare-associated pathogens. Rooms were thoroughly cleaned and disinfected prior to patient admission. Interactions of patients with personnel and portable equipment were observed, and serial cultures for pathogens were collected from the skin of patients and from surfaces, including those observed to come in contact with personnel and equipment. For MRSA, spa typing was used to determine relatedness of patient and environmental isolates. Results: For the 17 patients enrolled, 1 or more environmental cultures became positive for MRSA in rooms of 10 patients (59%), for C. difficile in rooms of 2 patients (12%) and for vancomycin-resistant enterococci (VRE) in rooms of 2 patients (12%). The patients interacted with an average of 2.4 personnel and 0.6 portable devices per hour of observation. As shown in Figure 1, MRSA contamination of the floor occurred rapidly as personnel entered the room. In a subset of patients, MRSA was subsequently recovered from patients’ socks and bedding and ultimately from the high-touch surfaces in the room (tray table, call button, bedrail). For several patients, MRSA isolates recovered from the floor had the same spa type as isolates subsequently recovered from other sites (eg, socks, bedding, and/or high touch surfaces). The direct transfer of healthcare-associated pathogens from personnel or equipment to high-touch surfaces was not detected. Conclusions: Healthcare-associated pathogens rapidly accumulate on the floor of patient rooms and can be transferred to the socks and bedding of patients and to high-touch surfaces. Healthcare facility floors may be an underappreciated source of pathogen dissemination not addressed by current infection control measures.Funding: NoneDisclosures: None

scholarly journals Is Cefazolin Inferior to Nafcillin for Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteremia?

2011 ◽  
Vol 55 (11) ◽  
pp. 5122-5126 ◽  
Author(s):  
Shinwon Lee ◽  
Pyoeng Gyun Choe ◽  
Kyoung-Ho Song ◽  
Sang-Won Park ◽  
Hong Bin Kim ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Treatment Failure ◽  
Propensity Scores ◽  
Tertiary Care ◽  
Care Hospital ◽  
Clinical Failure ◽  
Content Type ◽  
Staphylococcus Aureus Bacteremia ◽  
Matched Case ◽  
Control Study

ABSTRACTAbout 20% of methicillin-susceptibleStaphylococcus aureus(MSSA) isolates have a substantial inoculum effect with cefazolin, suggesting that cefazolin treatment may be associated with clinical failure for serious MSSA infections. There are no well-matched controlled studies comparing cefazolin with nafcillin for the treatment of MSSA bacteremia. A retrospective propensity-score-matched case-control study was performed from 2004 to 2009 in a tertiary care hospital where nafcillin was unavailable from August 2004 to August 2006. The cefazolin group (n= 49) included MSSA-bacteremic patients treated with cefazolin during the period of nafcillin unavailability, while the nafcillin group (n= 84) comprised those treated with nafcillin. Treatment failure was defined as a composite outcome of a change of antibiotics due to clinical failure, relapse, and mortality. Of 133 patients, 41 patients from each group were matched by propensity scores. There were no significant differences in baseline characteristics between the matched groups. The treatment failure rates were not significantly different at 4 or 12 weeks (10% [4/41] versus 10% [4/41] at 4 weeks [P> 0.99] and 15% [6/41] versus 15% [6/41] at 12 weeks [P> 0.99]). Cefazolin treatment was interrupted less frequently than nafcillin treatment due to drug adverse events (0% versus 17%;P= 0.02). Cefazolin had clinical efficacy similar to that of nafcillin and was more tolerable than nafcillin for the treatment of MSSA bacteremia.

scholarly journals Incidence of healthcare associated infection in the surgical ICU of a tertiary care hospital

2013 ◽  
Vol 69 (2) ◽  
pp. 124-129 ◽  
Author(s):  
Shivinder Singh ◽  
R. Chaturvedi ◽  
S.M. Garg ◽  
Rashmi Datta ◽  
Ambikesh Kumar
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Healthcare Associated Infection ◽  
Surgical Icu ◽  
Healthcare Associated

scholarly journals A six-years point prevalence survey of healthcare-associated infections in an Italian hospital

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Gentili ◽  
D I La Milia ◽  
D Vallone ◽  
M Di Pumpo ◽  
G Vangi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Acute Care Hospital ◽  
Point Prevalence ◽  
Healthcare Associated Infections ◽  
Care Hospital ◽  
Prevalence Survey ◽  
Point Prevalence Survey ◽  
The Moment ◽  
Healthcare Associated

Abstract Healthcare-Associated Infections (HAIs) are among the most serious public health problems in Europe representing the most frequent adverse event during care delivery. Despite their limitations, point prevalence surveys of HAIs are often preferred to prospective surveillance, since they provide a feasible estimate when resources are limited. The aim of this study was to analyze the results of a six-years point prevalence survey of HAIs in a teaching acute care hospital in Italy and to investigate the main risk factors of HAIs in the acute-care hospital. A point prevalence survey to detect HAIs was carried out in Gemelli Hospital during the last 6 years, from 2013 to 2018. Inpatients of any age in Gemelli Hospital were eligible for inclusion. Patients in outpatient areas were excluded. HAIs were identified according to diagnosis guideline from ECDC in 2011. Statistically significant differences were tested through t-test and Chi-square test. Multi-variate analysis was performed to evaluate the impact of regressor factors for predict HAI’s prevalence. The statistical significance level was set at p < 0.05. The point prevalence ranged from 3,16% in 2017 to 6,64% in 2013. Pneumonia and surgical site infections (SSI) were the most frequent HAIs during the 6 years, with a rate of 27,31% and 26,20% respectively of all HAIs. The multiple logistic regression showed that length of stay at the moment of detection, urinary catheter, CVC and antibiotic therapy are useful to meaningfully predict HAI prevalence, with a regression coefficient (adjusted R2) of 0.2780. Thanks to proper hospital policies, the point prevalence of HAIs does not seem to increase through the years, even though it is still too early to draw any conclusions. Pneumonia and SSI represented each one more than a quarter of all the HAIs, as reported also in literature. There is a strong association between length of stay at the moment of detection and HAIs but it is hard to understand which one is the cause of the other. Key messages Point prevalence from 2013 to 2018 seems to be stable. An accurate incidence survey is needed in order to identify the main risk factors of HAI and to realize more specific hospital programmes. Length of stay at the moment of detection is useful to meaningfully predict HAIs prevalence although the cause-and-effect relationship is still not clear.

scholarly journals Antimicrobial Consumption and Resistance in a Tertiary Care Hospital in Jordan: Results of an Internet-Based Global Point Prevalence Survey

Antibiotics ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 598
Author(s):  
Khawla Abu Hammour ◽  
Esraa AL-Heyari ◽  
Aya Allan ◽  
Ann Versporten ◽  
Herman Goossens ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Point Prevalence ◽  
Antibiotic Prescribing ◽  
Prescription Data ◽  
Care Hospital ◽  
Antimicrobial Consumption ◽  
Healthcare Associated Infection ◽  
Prevalence Survey ◽  
Point Prevalence Survey ◽  
Healthcare Associated

Background: The Global Point Prevalence Survey (Global-PPS) provides a standardised method to conduct surveillance of antimicrobial prescribing and resistance at hospital level. The aim of the present study was to assess antimicrobial consumption and resistance in a Jordan teaching hospital as part of the Global-PPS network. Methods: Detailed antimicrobial prescription data were collected according to the Global Point Prevalence Survey protocol. The internet-based survey included all inpatients present at 8:00 am on a specific day in June–July 2018. Resistance data were based on microbiological results available on the day of the PPS. Results: Data were collected for 380 patients admitted to adult wards, 72 admitted children, and 36 admitted neonates. The overall prevalence of antimicrobial use in adult, paediatric, and neonatal wards was 45.3%, 30.6%, and 22.2% respectively. Overall, 36 patients (7.4%) were treated for at least one healthcare-associated infection (HAI). The most frequent reason for antimicrobial treatment was pneumonia. Cephalosporins and carbapenems were most frequent prescribed among adult (50.6%) and paediatric/neonatal wards (39.6%). Overall resistance rates among patients treated for a community or healthcare-associated infection was high (26.0%). Analysis of antibiotic quality indicators by activity revealed good adherence to treatment guidelines but poor documentation of the reason for prescription and a stop/review date in the notes. Conclusion: The present study has established baseline data in a teaching hospital regarding the quantity and quality of prescribed antibiotics in the hospital. The study should encourage the establishment of tailor-made antimicrobial stewardship interventions and support educational programs to enhance appropriate antibiotic prescribing.

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