scholarly journals Impact of Discontinuing Contact Precautions for Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcus: An Interrupted Time Series Analysis

2018 ◽  
Vol 39 (6) ◽  
pp. 676-682 ◽  
Author(s):  
Gonzalo Bearman ◽  
Salma Abbas ◽  
Nadia Masroor ◽  
Kakotan Sanogo ◽  
Ginger Vanhoozer ◽  
...  
Keyword(s):  
Time Series ◽  
Infection Prevention ◽  
Urinary Catheter ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interrupted Time Series ◽  
Infection Rates ◽  
Interrupted Time Series Analysis ◽  
Contact Precautions ◽  
The Impact

OBJECTIVETo investigate the impact of discontinuing contact precautions among patients infected or colonized with methicillin-resistantStaphylococcus aureus(MRSA) or vancomycin-resistantEnterococcus(VRE) on rates of healthcare-associated infection (HAI). DESIGN. Single-center, quasi-experimental study conducted between 2011 and 2016.METHODSWe employed an interrupted time series design to evaluate the impact of 7 horizontal infection prevention interventions across intensive care units (ICUs) and hospital wards at an 865-bed urban, academic medical center. These interventions included (1) implementation of a urinary catheter bundle in January 2011, (2) chlorhexidine gluconate (CHG) perineal care outside ICUs in June 2011, (3) hospital-wide CHG bathing outside of ICUs in March 2012, (4) discontinuation of contact precautions in April 2013 for MRSA and VRE, (5) assessments and feedback with bare below the elbows (BBE) and contact precautions in August 2014, (6) implementation of an ultraviolet-C disinfection robot in March 2015, and (7) 72-hour automatic urinary catheter discontinuation orders in March 2016. Segmented regression modeling was performed to assess the changes in the infection rates attributable to the interventions.RESULTSThe rate of HAI declined throughout the study period. Infection rates for MRSA and VRE decreased by 1.31 (P=.76) and 6.25 (P=.21) per 100,000 patient days, respectively, and the infection rate decreased by 2.44 per 10,000 patient days (P=.23) for device-associated HAI following discontinuation of contact precautions.CONCLUSIONThe discontinuation of contact precautions for patients infected or colonized with MRSA or VRE, when combined with horizontal infection prevention measures was not associated with an increased incidence of MRSA and VRE device-associated infections. This approach may represent a safe and cost-effective strategy for managing these patients.Infect Control Hosp Epidemiol2018;39:676–682

Chasing the rate: An interrupted time series analysis of interventions targeting reported hospital onset Clostridioides difficile, 2013–2018

2020 ◽  
Vol 41 (10) ◽  
pp. 1142-1147
Author(s):  
Michelle E. Doll ◽  
Jinlei Zhao ◽  
Le Kang ◽  
Barry Rittmann ◽  
Michael Alvarez ◽  
...  
Keyword(s):  
Time Series ◽  
Decision Support ◽  
Infection Control ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Test Volume ◽  
Clostridioides Difficile ◽  
The Impact

AbstractObjective:To assess the impact of major interventions targeting infection control and diagnostic stewardship in efforts to decrease Clostridioides difficile hospital onset rates over a 6-year period.Design:Interrupted time series.Setting:The study was conducted in an 865-bed academic medical center.Methods:Monthly hospital-onset C. difficile infection (HO-CDI) rates from January 2013 through January 2019 were analyzed around 5 major interventions: (1) a 2-step cleaning process in which an initial quaternary ammonium product was followed with 10% bleach for daily and terminal cleaning of rooms of patients who have tested positive for C. difficile (February 2014), (2) UV-C device for all terminal cleaning of rooms of C. difficile patients (August 2015), (3) “contact plus” isolation precautions (June 2016), (4) sporicidal peroxyacetic acid and hydrogen peroxide cleaning in all patient areas (June 2017), (5) electronic medical record (EMR) decision support tool to facilitate appropriate C. difficile test ordering (March 2018).Results:Environmental cleaning interventions and enhanced “contact plus” isolation did not impact HO-CDI rates. Diagnostic stewardship via EMR decision support decreased the HO-CDI rate by 6.7 per 10,000 patient days (P = .0079). When adjusting rates for test volume, the EMR decision support significance was reduced to a difference of 5.1 case reductions per 10,000 patient days (P = .0470).Conclusion:Multiple aggressively implemented infection control interventions targeting CDI demonstrated a disappointing impact on endemic CDI rates over 6 years. This study adds to existing data that outside of an outbreak situation, traditional infection control guidance for CDI prevention has little impact on endemic rates.

The impact of formulary restriction on the relative consumption of carbapenems in intensive care units at an academic medical center

2019 ◽  
Vol 40 (9) ◽  
pp. 1056-1058
Author(s):  
Jacob W. Pierce ◽  
Andrew Kirk ◽  
Kimberly B. Lee ◽  
John D. Markley ◽  
Amy Pakyz ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Surgical Intensive Care ◽  
Academic Medical ◽  
The Impact ◽  
Formulary Restriction

AbstractAntipseudomonal carbapenems are an important target for antimicrobial stewardship programs. We evaluated the impact of formulary restriction and preauthorization on relative carbapenem use for medical and surgical intensive care units at a large, urban academic medical center using interrupted time-series analysis.

The Impact of Discontinuing Contact Precautions for VRE and MRSA on Device-Associated Infections

2015 ◽  
Vol 36 (8) ◽  
pp. 978-980 ◽  
Author(s):  
Michael B. Edmond ◽  
Nadia Masroor ◽  
Michael P. Stevens ◽  
Janis Ober ◽  
Gonzalo Bearman
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Infection Rates ◽  
Hospital Acquired Infection ◽  
Contact Precautions ◽  
Academic Medical ◽  
Before And After ◽  
Hospital Acquired ◽  
The Impact ◽  
Before And After Study

The impact of discontinuing contact precautions for patients with MRSA and VRE colonization/infection on device-associated hospital-acquired infection rates at an academic medical center was investigated in this before-and-after study. In the setting of a strong horizontal infection prevention platform, discontinuation of contact precautions had no impact on device-associated hospital-acquired infection rates.Infect. Control Hosp. Epidemiol. 2015;36(8):978–980

scholarly journals Reduction in Abdominal Hysterectomy Surgical Site Infection Rates After the Addition of Anaerobic Antimicrobial Prophylaxis

2020 ◽  
Vol 41 (S1) ◽  
pp. s47-s47
Author(s):  
Kyle Jenn ◽  
Noelle Bowdler ◽  
Stephanie Holley ◽  
Mary Kukla ◽  
Oluchi Abosi ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Antimicrobial Prophylaxis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Abdominal Hysterectomy ◽  
Site Infection ◽  
Prevention Measures ◽  
Infection Rates ◽  
Interrupted Time Series Analysis ◽  
The Impact

Background: Antimicrobial prophylaxis is one of the strongest surgical site infection (SSI) prevention measures. Current guidelines recommend the use of cefazolin as antimicrobial prophylaxis for abdominal hysterectomy procedures. However, there is growing evidence that anaerobes play a role in abdominal hysterectomy SSIs. We assessed the impact of adding anaerobic coverage on abdominal hysterectomy SSI rates in our institution. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center that serves as a referral center for Iowa and neighboring states. Each year, ~33,000 major surgical operations are performed here, and on average, 600 are abdominal hysterectomies. Historically, patients have received cefazolin only, but beginning November 2017, patients undergoing abdominal hysterectomy received cefazolin + metronidazole for antimicrobial prophylaxis. Order sets within the electronic medical record were modified, and education was provided to surgeons, anesthesiologists, and other ordering providers. Procedures and subsequent SSIs were monitored and reported using National Healthcare Safety Network (NHSN) definitions. Infection rates are calculated using all depths (superficial, deep and organ space) and by deep and organ space only, as this is how they are publicly reported. We used numerator (SSIs) and denominator (number of abdominal hysterectomy procedures) data from the NHSN from January 2015 through September 2019. We performed an interrupted time-series analysis to determine how the addition of metronidazole was associated with abdominal hysterectomy SSIs (all depths, and deep and organ space). Results: From January 2015 through October 2017, the hysterectomy SSI rates were 3.2% (all depths) and 1.5% (deep and organ space). After the adjustment was made to antimicrobial prophylaxis in November 2017, the rates decreased to 1.6% (all depths) and 0.6% (deep and organ space). Of the SSIs with pathogens identified, the proportion of anaerobes decreased from 59% to 25% among all depths and from 82% to 50% among deep and organ-space SSIs. The rate of SSI decline after the intervention was statistically significant (P = .01) for deep and organ-space infections but not for all depths (P = .73). Conclusions: The addition of anaerobic coverage with metronidazole was associated with a decrease in deep and organ-space abdominal hysterectomy SSI rates at our institution. Hospitals should assess the microbiology of abdominal hysterectomy SSIs and should consider adding metronidazole to their antimicrobial prophylaxis.Funding: NoneDisclosures: None

scholarly journals Does admission prevalence change after reconfiguration of inpatient services? An interrupted time series analysis of the impact of reconfiguration in five centres

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joanne Martin ◽  
Edwin Amalraj Raja ◽  
Steve Turner
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Emergency Admission ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Emergency Admissions ◽  
Series Analysis ◽  
Inpatient Services ◽  
The Impact ◽  
Admission Prevalence

Abstract Background Service reconfiguration of inpatient services in a hospital includes complete and partial closure of all emergency inpatient facilities. The “natural experiment” of service reconfiguration may give insight into drivers for emergency admissions to hospital. This study addressed the question does the prevalence of emergency admission to hospital for children change after reconfiguration of inpatient services? Methods There were five service reconfigurations in Scottish hospitals between 2004 and 2018 where emergency admissions to one “reconfigured” hospital were halted (permanently or temporarily) and directed to a second “adjacent” hospital. The number of emergency admissions (standardised to /1000 children in the regional population) per month to the “reconfigured” and “adjacent” hospitals was obtained for five years prior to reconfiguration and up to five years afterwards. An interrupted time series analysis considered the association between reconfiguration and admissions across pairs comprised of “reconfigured” and “adjacent” hospitals, with adjustment for seasonality and an overall rising trend in admissions. Results Of the five episodes of reconfiguration, two were immediate closure, two involved closure only to overnight admissions and one with overnight closure for a period and then closure. In “reconfigured” hospitals there was an average fall of 117 admissions/month [95% CI 78, 156] in the year after reconfiguration compared to the year before, and in “adjacent” hospitals admissions rose by 82/month [32, 131]. Across paired reconfigured and adjacent hospitals, in the months post reconfiguration, the overall number of admissions to one hospital pair slowed, in another pair admissions accelerated, and admission prevalence was unchanged in three pairs. After reconfiguration in one hospital, there was a rise in admissions to a third hospital which was closer than the named “adjacent” hospital. Conclusions There are diverse outcomes for the number of emergency admissions post reconfiguration of inpatient facilities. Factors including resources placed in the community after local reconfiguration, distance to the “adjacent” hospital and local deprivation may be important drivers for admission pathways after reconfiguration. Policy makers considering reconfiguration might consider a number of factors which may be important determinants of admissions post reconfiguration.

Recession and risk of suicide in Denmark during the 2009 global financial crisis: an ecological register-based study

2021 ◽  
pp. 140349482110132
Author(s):  
Agnieszka Konieczna ◽  
Sarah Grube Jakobsen ◽  
Christina Petrea Larsen ◽  
Erik Christiansen
Keyword(s):  
Time Series ◽  
Financial Crisis ◽  
Time Series Analysis ◽  
Suicide Rate ◽  
Global Financial Crisis ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Prevention Programmes ◽  
The Impact

Aim: The aim of this study is to analyse the potential impact from the financial crisis (onset in 2009) on suicide rates in Denmark. The hypothesis is that the global financial crisis raised unemployment which leads to raising the suicide rate in Denmark and that the impact is most prominent in men. Method: This study used an ecological study design, including register data from 2001 until 2016 on unemployment, suicide, gender and calendar time which was analysed using Poisson regression models and interrupted time series analysis. Results: The correlation between unemployment and suicide rates was positive in the period and statistically significant for all, but at a moderate level. A dichotomised version of time (calendar year) showed a significant reduction in the suicide rate for women (incidence rate ratio 0.87, P=0.002). Interrupted time series analysis showed a significant decreasing trend for the overall suicide rate and for men in the pre-recession period, which in both cases stagnated after the onset of recession in 2009. The difference between the genders’ suicide rate changed significantly at the onset of recession, as the rate for men increased and the rate for women decreased. Discussion: The Danish social welfare model might have prevented social disintegration and suicide among unemployed, and suicide prevention programmes might have prevented deaths among unemployed and mentally ill individuals. Conclusions: We found some indications for gender-specific differences from the impact of the financial crises on the suicide rate. We recommend that men should be specifically targeted for appropriate prevention programmes during periods of economic downturn.

Reducing Broad Spectrum Antimicrobial Use in Extracorporeal Membrane Oxygenation (ECMO): Reduce AMMO Study

2021 ◽  
Author(s):  
Aditya Shah ◽  
Priya Sampathkumar ◽  
Ryan W Stevens ◽  
John K Bohman ◽  
Brian D Lahr ◽  
...  
Keyword(s):  
Time Series ◽  
Extracorporeal Membrane Oxygenation ◽  
Broad Spectrum ◽  
Antimicrobial Prophylaxis ◽  
Current Evidence ◽  
Antimicrobial Use ◽  
Infection Rates ◽  
Interrupted Time Series Analysis ◽  
Membrane Oxygenation ◽  
The Impact

Abstract Background The use of extracorporeal membrane oxygenation (ECMO) in critically ill adults is increasing. There are currently no guidelines for antimicrobial prophylaxis. We analyzed 7 years of prophylactic antimicrobial use across three time series for patients on ECMO at our institution in the development, improvement, and streamlining of our ECMO antimicrobial prophylaxis protocol. Study design and Methods In this quasi-experimental interrupted time series analysis, we evaluated the impact of an initial ECMO antimicrobial prophylaxis protocol, implemented in 2014, on antimicrobial use and NHSN reportable infection rates. Then, following a revision and streamlining of the protocol in November 2018, we re-evaluated the same metrics. Results Our study population included 338 ICU patients who received ECMO between July 2011 and November 2019. After implementation of the first version of the protocol we did not observe significant changes in antimicrobial use or infection rates in these patients; however, following revision and streamlining of the protocol, we demonstrated a significant reduction in broad spectrum antimicrobial use for prophylaxis in patients on ECMO without any evidence of a compensatory increase in infection rates. Conclusion Our final protocol significantly reduces broad spectrum antimicrobial use for prophylaxis in patients on ECMO. We propose a standard antimicrobial prophylaxis regimen for patients on ECMO based on current evidence and our experience.

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