scholarly journals Impact of the coronavirus disease 2019 (COVID-19) pandemic on nosocomial Clostridioides difficile infection

2020 ◽  
pp. 1-5 ◽  
Author(s):  
Manuel Ponce-Alonso ◽  
Javier Sáez de la Fuente ◽  
Angela Rincón-Carlavilla ◽  
Paloma Moreno-Nunez ◽  
Laura Martínez-García ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Control Period ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
Incidence Density ◽  
Care Hospital ◽  
Patient Mobility ◽  
Clostridioides Difficile ◽  
Defined Daily Doses ◽  
The Impact

Abstract Objectives: The coronavirus disease 2019 (COVID-19) pandemic has induced a reinforcement of infection control measures in the hospital setting. Here, we assess the impact of the COVID-19 pandemic on the incidence of nosocomial Clostridioides difficile infection (CDI). Methods: We retrospectively compared the incidence density (cases per 10,000 patient days) of healthcare-facility–associated (HCFA) CDI in a tertiary-care hospital in Madrid, Spain, during the maximum incidence of COVID-19 (March 11 to May 11, 2020) with the same period of the previous year (control period). We also assessed the aggregate in-hospital antibiotic use (ie, defined daily doses [DDD] per 100 occupied bed days [BD]) and incidence density (ie, movements per 1,000 patient days) of patient mobility during both periods. Results: In total, 2,337 patients with reverse transcription-polymerase chain reaction–confirmed COVID-19 were admitted to the hospital during the COVID-19 period. Also, 12 HCFA CDI cases were reported at this time (incidence density, 2.68 per 10,000 patient days), whereas 34 HCFA CDI cases were identified during the control period (incidence density, 8.54 per 10,000 patient days) (P = .000257). Antibiotic consumption was slightly higher during the COVID-19 period (89.73 DDD per 100 BD) than during the control period (79.16 DDD per 100 BD). The incidence density of patient movements was 587.61 per 1,000 patient days during the control period and was significantly lower during the COVID-19 period (300.86 per 1,000 patient days) (P < .0001). Conclusions: The observed reduction of ~70% in the incidence density of HCFA CDI in a context of no reduction in antibiotic use supports the importance of reducing nosocomial transmission by healthcare workers and asymptomatic colonized patients, reinforcing cleaning procedures and reducing patient mobility in the epidemiological control of CDI.

Ecological Study of the Effectiveness of Isolation Precautions in the Management of Hospitalized Patients Colonized or Infected WithAcinetobacter baumannii

2008 ◽  
Vol 29 (12) ◽  
pp. 1118-1123 ◽  
Author(s):  
Houssein Gbaguidi-Haore ◽  
Sophie Legast ◽  
Michelle Thouverez ◽  
Xavier Bertrand ◽  
Daniel Talon
Keyword(s):  
Ecological Study ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Antibiotic Use ◽  
Annual Incidence ◽  
University Hospital ◽  
Outcome Variable ◽  
Care Hospital ◽  
Aggregated Data ◽  
The Impact

Objective.To assess the impact of isolation precautions on the incidence of patients colonized or infected withAcinetobacter baumannii(case patients) in a university hospital during the period from 1999 to 2006.Design.Ecological study.Setting.The Besançon University Hospital in France, a 1,200-bed acute care hospital with approximately 50,000 admissions per year.Methods.Using Poisson regression analysis, we evaluated a total of 350,000 patient-days to determine the annual incidence of case patients. This annual incidence was used as the outcome variable, and infection control practices, antibiotic use, and other aggregated data regarding patients' age, sex, McCabe score, and immune status were used as covariates.Results.The implementation of isolation precautions was independently and negatively associated with the incidence of patients colonized or infected withA. baumannii(relative risk, 0.50 [95% confidence interval, 0.40–0.64];P< .001).Conclusions.Our study suggests that the implementation of isolation precautions, in addition to standard precautions, effectively prevents the spread ofA. baumanniiin a hospital setting.

scholarly journals Smoking Cessation Intervention in a Cardiovascular Hospital Based Clinical Setting

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Zainab Samaan ◽  
Barb Nowacki ◽  
Karleen Schulze ◽  
Patrick Magloire ◽  
Sonia S. Anand
Keyword(s):  
Smoking Cessation ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Smoking Reduction ◽  
Quit Smoking ◽  
The Impact ◽  
Cessation Clinic ◽  
Smoking Cessation Clinic

Introduction. Smoking is a leading cause of morbidity and mortality globally and it is a significant modifiable risk factor for cardiovascular disease (CVD) and other chronic diseases. Efforts to encourage and support smokers to quit are critical to prevent premature smoking-associated morbidity and mortality. Hospital settings are seldom equipped to help patients to quit smoking thus missing out a valuable opportunity to support patients at risk of smoking complications. We report the impact of a smoking cessation clinic we have established in a tertiary care hospital setting to serve patients with CVD. Methods. Patients received behavioural and pharmacological treatments and were followed up for a minimum of 6 months (mean 541 days, SD 197 days). The main study outcome is ≥50% reduction in number of cigarettes smoked at followup. Results. One hundred and eighty-six patients completed ≥6 months followup. More than half of the patients (52.7%) achieved ≥50% smoking reduction at follow up. Establishment of a plan to quit smoking and use of nicotine replacement therapy (NRT) were significantly associated with smoking reduction at followup. Conclusions. A hospital-based smoking cessation clinic is a beneficial intervention to bring about smoking reduction in approximately half of the patients.

Impact of Education and an Antifungal Stewardship Program for Candidiasis at a Thai Tertiary Care Center

2010 ◽  
Vol 31 (7) ◽  
pp. 722-727 ◽  
Author(s):  
Anucha Apisarnthanarak ◽  
Apiwat Yatrasert ◽  
Linda M. Mundy ◽  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Cost Savings ◽  
Care Hospital ◽  
Prescribing Practices ◽  
Antifungal Stewardship ◽  
Defined Daily Doses ◽  
Stewardship Program ◽  
Antifungal Use ◽  
The Impact

Background.We evaluated the impact of education and an antifungal stewardship program for candidiasis on prescribing practices, antifungal consumption, Candida species infections, and estimated costs at a Thai tertiary care hospital.Methods.A hospital-wide, quasi-experimental study was conducted for 1.5 years before the intervention and 1.5 years after the implementation of an antifungal stewardship program. Inpatient antifungal prescriptions were prospectively observed, and patients' demographic, clinical, and administrative-cost data were collected. Interventions included education, introduction of an antifungal hepatic and/or renal dose adjustment tool, antifungal prescription forms, and prescription-control strategies.Results.After the intervention, there was a 59% reduction in antifungal prescriptions (from 194 to 80 prescriptions per 1,000 hospitalizations; P < .001). Inappropriate antifungal use decreased (from 71% to 24%; P < .001), a sustained reduction in antifungal use was observed (r = 0.83; P < .001), and fluconazole use decreased (from 242 to 117 defined daily doses per 1,000 patient-days; P < .001). Reductions in the incidence of infection with Candida glabrata (r = 0.69; P < .001) and Candida krusei (r = 0.71; P < .001) were observed, whereas the incidence of infection with Candida albicans (r = —0.81; P < .001) increased. Total cost savings were US$31,615 during the 18-month postintervention period.Conclusions.Implementation of an antifungal stewardship program was associated with appropriate antifungal drug use, improved resource utilization, and cost savings.

scholarly journals Discontinuation of Contact Precautions in Patients with Nosocomial MRSA and VRE Infections During the COVID-19 Pandemic

2021 ◽  
Vol 1 (S1) ◽  
pp. s24-s24
Author(s):  
Marisa Hudson ◽  
Mayar Al Mohajer
Keyword(s):  
Hand Hygiene ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Incidence Density ◽  
Contact Precautions ◽  
Before And After ◽  
Hospital Acquired ◽  
The Impact

Background: Gaps exist in the evidence supporting the benefits of contact precautions for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The Centers for Disease Control and Prevention allow suspending contact precautions for MRSA and VRE in cases of gown shortages, as we have seen during the COVID-19 pandemic. We evaluated the impact of discontinuing isolation precautions in hospitalized patients with MRSA and VRE infection, due to gown shortage, on the rate of hospital-acquired (HA) MRSA and VRE infections. Methods: A retrospective chart review was performed on adult patients (n = 2,200) with established MRSA or VRE infection at 5 hospitals in CommonSpirit Health, Texas Division, from March 2019 to October 2020. Data including demographics, infection site, documented symptoms, and antibiotic use were stratified based on patient location (floor vs ICU). Rates of hospital-acquired MRSA and VRE infection before and after the discontinuation of isolation (implemented in March 2020) were compared. Incidence density rate was used to assess differences in the rate of MRSA and VRE infections between pre- and postintervention groups. Results: The rate of hospital-acquired (HA) MRSA infection per 10,000 patient days before the intervention (March 19–February 20) was 12.19, compared to 10.64 after the intervention (March 20–July 20) (P = .038). The rates of HA MRSA bacteremia were 1.13 and 0.93 for the pre- and postintervention groups, respectively (P = .074). The rates of HA VRE per 10,000 patient days were 3.53 and 4.44 for the pre- and postintervention groups, respectively (P = .274). The hand hygiene rates were 0.93 before the intervention and 0.97 after the intervention (P = .028). Conclusions: Discontinuing isolation from MRSA and VRE in the hospital setting did not lead to a statistically significant increase in hospital-acquired MRSA or VRE infections. In fact, rates of hospital-acquired MRSA decreased, likely secondary to improvements in hand hygiene during this period. These results support the implementation of policies for discontinuing contact isolation for hospitalized patients with documented MRSA or VRE infection, particularly during shortages of gowns.Funding: NoDisclosures: None

scholarly journals Prevalence of Plasmid-Mediated Quinolone Resistance Genes among Ciprofloxacin-NonsusceptibleEscherichia coliandKlebsiella pneumoniaeIsolated from Blood Cultures in Korea

2014 ◽  
Vol 25 (3) ◽  
pp. 163-169 ◽  
Author(s):  
Hee Young Yang ◽  
You Sun Nam ◽  
Hee Joo Lee
Keyword(s):  
Tertiary Care Hospital ◽  
Direct Sequencing ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
Blood Cultures ◽  
Quinolone Resistance ◽  
Care Hospital ◽  
E Coli ◽  
Polymerase Chain

OBJECTIVES:To analyze the prevalence of plasmid-mediated quinolone resistance (PMQR) determinants in ciprofloxacin-nonsusceptibleEscherichia coliandKlebsiella pneumoniaeisolated from patients at a tertiary care hospital in Korea.METHODS: A total of 102 nonduplicate isolates of ciprofloxacin-intermediate or ciprofloxacin-resistantE coli(n=80) andK pneumoniae(n=22) from blood cultures were obtained. Theqnr(qnrA, qnrB,qnrS),aac(6′)-Ib-cr,qepAandoqxABgenes were detected using polymerase chain reaction (PCR) and confirmed using direct sequencing. To determine whether the PMQR-positive plasmid was horizontally transferable, conjugation experiments were performed.RESULTS: Of the 102 isolates, 81 (79.4%) had one or more PMQR genes; these consisted of 59 (73.8%)E coliand 22 (100%)K pneumoniaeisolates. Theqnrgenes were present in 15 isolates (14.7%):qnrB4was detected in 10.8% andqnrS1was detected in 3.9%. Theaac(6′)-Ib-cr,qepAandoqxABgenes were detected in 77.5%, 3.9% and 10.8%, respectively. In conjugation experiments, PMQR genes were successfully transferred from seven (8.6%) isolates. The range of minimum inhibitory concentrations of ciprofloxacin for these seven transconjugants increased to 0.5 mg/L to 1 mg/L, which was 16- to 33-fold that of the recipientE coliJ53 bacteria.CONCLUSIONS: PMQR genes were highly prevalent among ciprofloxacin-nonsusceptibleE coliandK pneumoniaefrom blood cultures in the authors’ hospital. Therefore, it is necessary to monitor for the spread of PMQR genes of clinical isolates and to ensure careful antibiotic use in a hospital setting.

scholarly journals Decreasing Clostridium difficile Infections by an Antimicrobial Stewardship Program That Reduces Moxifloxacin Use

2014 ◽  
Vol 58 (9) ◽  
pp. 5079-5083 ◽  
Author(s):  
Judith Maria Wenisch ◽  
Susanne Equiluz-Bruck ◽  
Marta Fudel ◽  
Ingun Reiter ◽  
Andrea Schmid ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Content Type ◽  
Period 2 ◽  
Defined Daily Doses ◽  
Stewardship Program ◽  
The Mean

ABSTRACTClostridium difficileinfections (CDI) in hospitalized patients are known to be closely related to antibiotic exposure. Although several substances can cause CDI, the risk differs between individual agents. In Vienna and other eastern parts of Austria, CDI ribotype 027 is currently highly prevalent. This ribotype has the characteristic of intrinsic moxifloxacin resistance. Therefore, we hypothesized that moxifloxacin restriction can decrease the number of CDI cases in hospitalized patients. Our antibiotic stewardship (ABS) group applied an information campaign on CDI and formal restriction of moxifloxacin in Wilhelminenspital (Vienna, Austria), a 1,000- bed tertiary care hospital. The preintervention period (period 1) was January through May 2013, and the intervention period (period 2) was June through December 2013. We recorded the defined daily doses (DDD) of moxifloxacin and the number of CDI patients/month. Moxifloxacin use was reduced from a mean (± standard error of the mean [SEM]) of 1,038 ± 109 DDD per month (period 1) to 42 ± 10 DDD per month (period 2) (P= 0.0045). Total antibiotic use was not affected. The mean (±SEM) numbers of CDI cases in period 1 were 59 ± 3 per month and in period 2 were 32 ± 3 per month (46% reduction;P= 0.0044). Reducing moxifloxacin use in combination with providing structured information on CDI was associated with an immediate decrease in CDI rates in this large community teaching hospital.

scholarly journals 1195. Hand Hygiene Compliance of Patients’ Family Members in India: Importance of Educating the Unofficial “Fourth Category” of Healthcare Personnel

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S429-S429
Author(s):  
Manisha Biswal ◽  
Archana Angrup ◽  
Surria Rajpoot ◽  
Rupinder Kaur ◽  
Kulbeer Kaur ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Tertiary Care ◽  
Family Members ◽  
Hospital Setting ◽  
Healthcare Personnel ◽  
Care Hospital ◽  
Awareness Campaigns ◽  
Hygiene Compliance ◽  
The Impact

Abstract Background In India,due to manpower constraints, patients’ family members are often actively involved in healthcare activities of their near and dear ones. They have significant contact with the patient at all the 5 moments for hand hygiene (HH) as listed by WHO. At our tertiary care hospital in north India, we have been monitoring HH compliance (HHC) for nearly a decade. In this study, we analyzed the impact of decade long awareness campaigns to improve HH compliance in our patients’ attendants. Methods Trained infection control nurses directly observed the compliance to hand hygiene at each of the five moments for patients’ attendants over different areas of the hospital over a period of 5 years (January 2014–December 2018). Compliance was calculated as percentage of events over total opportunities and compared. Results 7290 opportunities were observed with an overall compliance of 46.3%. The overall HHC in patient attendants has increased from 35.5% in 2014 to 48.2% in 2018 (P < 0.0001). Compliance at WHO moment 1, 2, 3, 4 and 5 was 51.2%, 47.8%, 67.8%, 48.9% and 24.4% respectively. Among family members, mothers of newborn babies had a much higher HHC (77%) than others (44.7%) (P < 0.0001). Also, the compliance was higher in medical vs. surgical wards and pediatric wards vs. adult wards (P < 0.0001 in both). Conclusion This is the first study about family members’ HHC in a hospital setting in a low and middle-income country. Once trained, family members exhibit fairly good hand hygiene compliance while involved in healthcare activities of their patients. Mothers of newborn babies exhibit exemplary hand hygiene compliance while caring for their babies in our hospital. It is worthwhile empowering and educating patient attendants about the importance and process of hand hygiene as it is likely to result in immense benefit for patients. Disclosures All authors: No reported disclosures.

Hand Hygiene, and Not Ertapenem Use, Contributed to Reduction of Carbapenem-Resistant Pseudomonas aeruginosa Rates

2011 ◽  
Vol 32 (6) ◽  
pp. 584-590 ◽  
Author(s):  
Rodrigo Pires dos Santos ◽  
Thalita Jacoby ◽  
Denise Pires Machado ◽  
Thiago Lisboa ◽  
Sandra Ludwig Gastal ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Regression Analysis ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
University Hospital ◽  
Incidence Density ◽  
Level Change ◽  
Carbapenem Resistant ◽  
Defined Daily Doses ◽  
The Impact

Objective.To evaluate the impact of ertapenem use in Pseudomonas aeruginosa carbapenem resistance, taking into account the volume of antimicrobial consumption, the consumption by the entire hospital of alcohol-based antiseptic hand rub, and the density rate of invasive practices.Design.Before-and-after trial.Setting.A tertiary care university hospital in southern Brazil.Methods.Ertapenem was first added to the hospital formulary in June 2006, and it was excluded in February 2009. We evaluated Pseudomonas aeruginosa resistance rates through 3 study periods: period 1, before ertapenem use (17 months); period 2, during ertapenem use (33 months); and period 3, after exclusion of ertapenem (15 months).Results.After introduction of ertapenem, there was a significant decrease in median consumption of imipenem or meropenem, from 2.6 to 2.2 defined daily doses (DDDs) per 100 patient-days (level change from 0.04 to -1.08; P < .01), and an increase in the use of these medications after ertapenem exclusion, from 2.2 to 3.3 DDDs per 100 patient-days (level change from -0.14 to 0.91; P < .01), by segmented regression analysis. There was no difference in the incidence density of carbapenem-resistant P. aeruginosa infection related to ertapenem use throughout the study periods. However, by multiple regression analysis, the reduction in the rate of carbapenem-resistant P. aeruginosa infection correlated significantly with the increase in the volume of alcohol used as hand sanitizer, which was from 660.7 mL per 100 patient-days in period 1 to 2,955.1 mL per 100 patient-days in period 3 (P = .04). Ertapenem use did not impact the rate of carbapenem-resistant P. aeruginosa infection.Conclusions.Use of alcohol-based hand gel, rather than ertapenem, was associated with a reduction in the rates of carbapenem-resistant P. aeruginosa infection. Measures to reduce resistance must include factors other than just antimicrobial stewardship programs alone.

scholarly journals Impact of restricting procalcitonin measurements in a Swiss tertiary-care hospital on antibiotic use, clinical outcomes, and costs: An interrupted time-series analysis

2020 ◽  
pp. 1-3
Author(s):  
Mohamed Abbas ◽  
Nathalie Vernaz ◽  
Elodie von Dach ◽  
Nicolas Vuilleumier ◽  
Stephan J. Harbarth ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
The Impact

Abstract We evaluated the impact of a restriction of procalcitonin measurements on antibiotic use, length of stay, mortality, and cost in a Swiss tertiary-care hospital using interrupted time-series analysis. There was no significant change in level or slope for rates of antibiotic consumption, and costs decreased considerably, by ~54,488 CHF (US$55,714) per month.

scholarly journals 753. Impact of COVID-19 on Healthcare Facility-Onset Clostridiodes difficile Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S474-S474
Author(s):  
Geehan Suleyman ◽  
Rafa Khansa ◽  
Ramesh Mayur ◽  
Indira Brar ◽  
Rachel Kenney
Keyword(s):  
Hand Hygiene ◽  
Tertiary Care ◽  
Healthcare Facility ◽  
P Value ◽  
Care Hospital ◽  
Order Rate ◽  
Clostridioides Difficile ◽  
Antibiotic Utilization ◽  
The Impact ◽  
Antimicrobial Administration

Abstract Background It is estimated that the majority of hospitalized COVID-19 patients around the world received antibiotics despite the fact that bacterial co-infections are rare. This can lead to increased antimicrobial resistance and Clostridioides difficile infections (CDI). Gastrointestinal symptoms of COVID-19 may also contribute to increased testing. The objective of this study was to assess the impact of the COVID-19 pandemic on our healthcare facility-onset (HO) CDI rates. Methods This was a retrospective cross-sectional study comparing CDI rate per 1,000 patient days, C. diff order rate per 1,000 patient days, Standardized Antimicrobial Administration Ratio (SAAR), and Standardized Infection Ratio (SIR) in the pre-COVID-19 period from January 1, 2019 to December 31, 2019 to the COVID-19 period from April 1, 2020 to March 31, 2021 at a 877-bed tertiary care hospital in Detroit, Michigan. CDI and order rates were extracted from the electronic medical record (Epic™ Bugsy). SAAR and SIR data were extracted from National Healthcare Safety Network (NHSN). Results The average CDI rate per 1,000 patient days was 4.29 pre-COVID-19 compared to 1.98 during COVID-19 with a 54% reduction, and the C. diff order rate per 1,000 patient days also decreased from 130.89 to 93.03, resulting in a 29% reduction (Figure 1). The SIR was 0.383 compared to 0.308 during COVID-19 (P-value 0.404). SAAR decreased from 1.095 to 0.945 (P-value &lt; 0.001). However, our institution experienced three COVID-19 waves, with peaks in April 2020, November 2020 and March 2021, that correlated with high risk CDI antibiotic utilization in intensive care unit (ICU) (Figure 2). The average hand hygiene rate increased from 82% to 92%. Figure 1. Clostridioides difficile order and infection rates pre-and during COVID-19 pandemic. Figure 2. Standardized Antimicrobial Administration Ratio (SAAR) pre-and during COVID-19 pandemic. Conclusion Despite the COVID-19 pandemic, the HO-CDI and C. diff order rates and overall SAAR decreased; however, antibiotic utilization increased in the ICU during the COVID-19 waves. The overall decrease may be multifactorial and related to increased hand hygiene compliance, isolation and personal protective equipment use and overall decreased antibiotic use and C. diff orders. Disclosures Rachel Kenney, PharmD, Medtronic, Inc. (Other Financial or Material Support, spouse is an employee and shareholder)

Sign in / Sign up

Export Citation Format

Share Document