Interfacility transfer communication of multidrug-resistant organism colonization or infection status: Practices and barriers in the acute-care setting

Abstract Objective: To describe interfacility transfer communication (IFTC) methods for notification of multidrug-resistant organism (MDRO) status in a diverse sample of acute-care hospitals. Design: Cross-sectional survey. Participants: Hospitals within the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). Methods: SRN members completed an electronic survey on protocols and methods for IFTC. We assessed differences in IFTC frequency, barriers, and perceived benefit by presence of an IFTC protocol. Results: Among 136 hospital representatives who were sent the survey, 54 (40%) responded, of whom 72% reported having an IFTC protocol in place. The presence of a protocol did not differ significantly by hospital size, academic affiliation, or international status. Of those with IFTC protocols, 44% reported consistent notification of MDRO status (>75% of the time) to receiving facilities, as opposed to 13% from those with no IFTC protocol (P = .04). Respondents from hospitals with IFTC protocols reported significantly fewer barriers to communication compared to those without (2.8 vs 4.3; P = .03). Overall, however, most respondents (56%) reported a lack of standardization in communication. Presence of an IFTC protocol did not affect whether respondents perceived IFTC protocols as having a significant impact on infection prevention or antimicrobial stewardship. Conclusions: Most respondents reported having an IFTC protocol, which was associated with reduced communication barriers at transfer. Standardization of protocols and clarity about expectations for sending and receipt of information related to MDRO status may facilitate IFTC and promote appropriate and timely infection prevention practices.

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Variation in Definitions and Isolation Procedures for Multidrug-Resistant Gram-Negative Bacteria: A Survey of the Society for Healthcare Epidemiology of America Research Network

Infection Control and Hospital Epidemiology ◽

10.1086/675600 ◽

2014 ◽

Vol 35 (4) ◽

pp. 362-366 ◽

Cited By ~ 23

Author(s):

Marci Drees ◽

Lisa Pineles ◽

Anthony D. Harris ◽

Daniel J. Morgan

Keyword(s):

Infection Control ◽

Online Survey ◽

Multidrug Resistant ◽

Research Network ◽

Gram Negative Bacteria ◽

Emerging Pathogens ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Gram Negative ◽

Healthcare Epidemiology

Objective.To assess definitions, experience, and infection control practices for multidrug-resistant gram-negative bacteria (MDR-GNB), including Enterobacteriaceae, Acinetobacter, and Pseudomonas species, in acute care hospitals.Design.Cross-sectional survey.Participants.US and international members of the Society for Healthcare Epidemiology of America (SHEA) Research Network.Methods.Online survey that included definitions, infection control procedures, and microbiology capability related to MDR-GNB and other MDR bacteria.Results.From November 2012 through February 2013, 66 of 170 SHEA Research Network members responded (39% response rate), representing 26 states and 15 countries. More than 80% of facilities reported experience with each MDR-GNB isolate, and 78% had encountered GNB resistant to all antibiotics except colistin (62% Acinetobacter, 59% Pseudomonas, and 52% Enterobacteriaceae species). Participants varied regarding their definitions of “multidrug resistant,” with 14 unique definitions for Acinetobacter, 18 for Pseudomonas, and 22 for Enterobacteriaceae species. Substantial variation also existed in isolation practices. Although isolation was commonly used for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and carbapenem-resistant Enterobacteriaceae (CRE), approximately 20% of facilities did not isolate for MDR Pseudomonas or Acinetobacter. The majority of those that isolated MDR organisms also removed isolation using a wide variety of criteria.Conclusion.Facilities vary significantly in their approach to preventing MDR-GNB transmission. Although practices for MRSA and VRE are relatively standardized, emerging pathogens CRE and other MDR-GNB have highly varied definitions and management. This confusion makes communication difficult, and varied use of isolation may contribute to emergence of these organisms. Public health agencies need to promote standard definitions and management to enable broader initiatives to limit emergence of MDR-GNB.

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542. Los Angeles County Acute Care Regional Antibiogram Suggests Changing Landscape of MDRO Threats Between 2015 and 2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.611 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S258-S259

Author(s):

James McKinnell ◽

Chelsea Foo ◽

Kelsey OYong ◽

Janet Hindler ◽

Sandra Ceja ◽

...

Keyword(s):

Public Health ◽

Los Angeles ◽

Acute Care ◽

Los Angeles County ◽

Multivariable Analysis ◽

Multidrug Resistant ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Level Data ◽

Facility Level

Abstract Background National surveillance for multidrug-resistant organisms (MDRO) are limited by narrow geographic sampling, few hospitals, and failure to account for local epidemiology. A Los Angeles County (LAC) regional antibiogram was created to inform public health interventions and provide a baseline for susceptibility patterns countywide. We present data to compare the 2015 and 2017 LAC regional antibiogram. Methods We conducted a cross-sectional survey of cumulative facility-level antibiograms from all hospitals in LAC; 83 hospitals (AH) and 9 Long-term Acute Care (LTAC). For 2015, submission was voluntary, 2017 data were collected by public health order. Non-respondents were contacted by phone and in person. Isolates from sterile sources were pooled. Countywide susceptibility was calculated by weighting each facility’s isolate count by its reported susceptibility rate with minimum–maximim observed (2015) and Interquartile range (IQR) for 2017. Change from 2015 mean susceptibility is reported. Results Seventy-five (75) facilities submitted antibiograms for 2015 and 86 facilities for 2017. Among non-respondents in 2017, two facilities could not provide an adequate antibiogram and 4 were specialty hospitals with too few cultures to create an antibiogram. Regional summmary tables are presented in Tables 1–4. Klebsiella pneumoniae (n = 50 hospitals/19,382 isolates) % S to meropenem was 97% (IQR 94–100%), no change from 2015. Pseudomonas aeruginosa (PA) (n = 52 hospitals/17,770 isolates)% S to meropenem was 84% (IQR 74–93%), no change from 2015. Susceptibility to Acinetobacter baumannii (AB) was reported by 48 hospitals, including 1,4361 isolates,% S to meropenem was 39% (IQR 25–75%), 14% lower than 2015. Streptococcus agalactiae (n = 13 hospitals/647 isolates)% S to clindamycin was 43% (IQR 13–59%), a 22% increase from 2015. Conclusion LAC regional antibiograms identified stable patterns of antimicrobial resistance for most pathogens, but concerning results with AB and PA. Analysis of highly drug-resistant pathogens such as AB and PA would be improved with patient-level data to generate a combination antibiogram. We favor presenting IQR %S as done for 2017. Ongoing analysis will include multivariable analysis of observed changed S controlling for hospital characteristics. Disclosures All authors: No reported disclosures.

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Infection prevention practices in the United States, the Netherlands, Switzerland, and Japan: Results from national surveys

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1395 ◽

2021 ◽

pp. 1-9

Author(s):

M. Todd Greene ◽

Sarah L. Krein ◽

Anita Huis ◽

Marlies Hulscher ◽

Hugo Sax ◽

...

Keyword(s):

United States ◽

The Netherlands ◽

Acute Care ◽

Infection Prevention ◽

Acute Care Hospitals ◽

The United States ◽

Survey Study ◽

Surveillance Systems ◽

Cross Sectional Survey ◽

Cross Sectional

Abstract Objective: To assess the extent to which evidence-based practices are regularly used in acute care hospitals in different countries. Design: Cross-sectional survey study. Participants and setting: Infection preventionists in acute care hospitals in the United States (US), the Netherlands, Switzerland, and Japan. Methods: Data collected from hospital surveys distributed between 2015 and 2017 were evaluated to determine the use of practices to prevent catheter-associated urinary tract infection (CAUTI), central-line–associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and Clostridioides difficile infection (CDI). Descriptive statistics were used to examine hospital characteristics and the percentage of hospitals reporting regular use of each infection prevention practice. Results: Survey response rates were 59% in the United States, 65% in the Netherlands, 77% in Switzerland, and 65% in Japan. Several recommended practices were used in the majority of hospitals: aseptic catheter insertion and maintenance (CAUTI), maximum sterile barrier precautions (CLABSI), semirecumbent patient positioning (VAP), and contact precautions and routine daily cleaning (CDI). Other prevention practices for CAUTI and VAP were used less frequently, particularly in Swiss and Japanese hospitals. Established surveillance systems were also lacking in Dutch, Swiss and Japanese hospitals. Conclusions: Most hospitals in the United States, the Netherlands, Switzerland, and Japan have adopted certain infection prevention practices. Clear opportunities for reducing HAI risk in hospitals exist across all 4 countries surveyed.

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Infection prevention and control practices related to carbapenemase-producing Enterobacteriaceae (CPE) in acute-care hospitals in Ontario, Canada

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.173 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1006-1012 ◽

Cited By ~ 2

Author(s):

Alainna J. Jamal ◽

Felipe Garcia-Jeldes ◽

Mahin Baqi ◽

Sergio Borgia ◽

Jennie Johnstone ◽

...

Keyword(s):

Acute Care ◽

Prevention And Control ◽

Infection Prevention ◽

Indian Subcontinent ◽

Acute Care Hospitals ◽

Infection Prevention And Control ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Admission Screening ◽

And Control

AbstractObjective:To determine infection prevention and control (IPAC) practices for carbapenemase-producing Enterobacteriaceae (CPE), an emerging threat, at acute-care hospitals in Ontario, Canada.Design:A descriptive cross-sectional survey.Methods:We surveyed IPAC directors and managers at all acute-care hospitals in Ontario, Canada, to gather information on IPAC practices related to CPE, including admission screening, other patient screening, environmental testing, use of precautions to prevent transmission, and outbreak management.Results:Of 116 acute-care hospitals, 105 (91%) responded. Admission screening included patients previously colonized or infected with CPE (n = 64, 61%), patients recently hospitalized outside of Canada (Indian subcontinent, n = 62, 59%; other countries, n = 56, 53%), and patients recently hospitalized in Canada (n = 22, 21%). Fifty-one hospitals (49%) screened patients for colonization during an outbreak. Almost all hospitals (n = 101, 96%) used precautions to prevent transmission from patients with CPE colonization or infection; most hospitals (n = 54, 53%) continued precautions indefinitely. Few hospitals (n = 19, 18%) performed environmental cultures. Eight hospitals (8%) reported at least 1 outbreak, and 6 hospitals (6%) reported transmission from sink or shower drains to patients.Conclusions:Variability in practices may result from lack of evidence and challenges in updating guidelines as evidence emerges. A coordinated approach to slow the emergence of CPE should be considered in our population.

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Implementation of Infection Prevention and Antimicrobial Stewardship in Cardiac Electrophysiology Laboratories: Results from the SHEA Research Network

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.309 ◽

2017 ◽

Vol 38 (4) ◽

pp. 496-498 ◽

Cited By ~ 7

Author(s):

Preeti Mehrotra ◽

Kalpana Gupta ◽

Judith Strymish ◽

Daniel B. Kramer ◽

Anne Lambert-Kerzner ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Cardiac Electrophysiology ◽

Infection Prevention ◽

Research Network ◽

Antimicrobial Use ◽

Cross Sectional Survey ◽

Cross Sectional

Infection prevention in electrophysiology (EP) laboratories is poorly characterized; thus, we conducted a cross-sectional survey using the SHEA Research Network. We found limited uptake of basic interventions, such as surveillance and appropriate peri-procedural antimicrobial use. Further study is needed to identify ways to improve infection prevention in this setting.

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Do Experts Understand Performance Measures? A Mixed-Methods Study of Infection Preventionists

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.243 ◽

2017 ◽

Vol 39 (1) ◽

pp. 71-76 ◽

Cited By ~ 1

Author(s):

Sushant Govindan ◽

Beth Wallace ◽

Theodore J. Iwashyna ◽

Vineet Chopra

Keyword(s):

Central Line ◽

Research Network ◽

Quality Data ◽

Expert Performance ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Percent Correct ◽

Average Proportion ◽

Healthcare Epidemiology ◽

Data Design

OBJECTIVECentral line-associated bloodstream infection (CLABSI) is associated with significant morbidity and mortality. Despite a nationwide decline in CLABSI rates, individual hospital success in preventing CLABSI is variable. Difficulty in interpreting and applying complex CLABSI metrics may explain this problem. Therefore, we assessed expert interpretation of CLABSI quality data. DESIGN. Cross-sectional survey PARTICIPANTS. Members of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) METHODS. We administered a 10-item test of CLABSI data comprehension. The primary outcome was percent correct of attempted questions pertaining to the CLABSI data. We also assessed expert perceptions of CLABSI reporting.RESULTSThe response rate was 51% (n=67).Among experts, the average proportion of correct responses was 73% (95% confidence interval [CI], 69%–77%). Expert performance on unadjusted data was significantly better than risk-adjusted data (86% [95% CI, 81%–90%] vs 65% [95% CI, 60%–70%];P<.001). Using a scale of 1 to 100 (0, never reliable; 100, always reliable), experts rated the reliability of CLABSI data as 61. Perceived reliability showed a significant inverse relationship with performance (r=–0.28;P=.03), and as interpretation of data improved, perceptions regarding reliability of those data decreased. Experts identified concerns regarding understanding and applying CLABSI definitions as barriers to care.CONCLUSIONSSignificant variability in the interpretation of CLABSI data exists among experts. This finding is likely related to data complexity, particularly with respect to risk-adjusted data. Improvements appear necessary in data sharing and public policy efforts to account for this complexity.Infect Control Hosp Epidemiol2018;39:71–76

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The Comparison of Role Conflict Among Registered Nurses and Registered Practical Nurses Working in Acute Care Hospitals in Ontario Canada

Canadian Journal of Nursing Research ◽

10.1177/08445621211014421 ◽

2021 ◽

pp. 084456212110144

Author(s):

Behdin Nowrouzi-Kia ◽

Mary T. Fox ◽

Souraya Sidani ◽

Sherry Dahlke ◽

Deborah Tregunno

Keyword(s):

Emergency Department ◽

Role Conflict ◽

Acute Care ◽

Acute Care Hospitals ◽

Cross Sectional Survey ◽

Eligibility Criteria ◽

Cross Sectional ◽

Medical Unit ◽

Scale Scores ◽

Surgical Unit

Objectives The study aimed to describe and compare nurses’ perceptions of role conflict by professional designation [registered nurse (RN) vs registered practical nurse (RPN)] in three primary areas of practice (emergency department, medical unit, and surgical unit). Methods This analysis used data (n = 1,981) from a large cross-sectional survey of a random sample of RNs and RPNs working as staff nurses in acute care hospitals in Ontario, Canada. Role conflict was measured by the Role Conflict Scale. Results A total of 1,981 participants (RN = 1,427, RPN = 554) met this study’s eligibility criteria and provided complete data. In general, RN and RPN mean total scale scores on role conflict hovered around the scale’s mid-point (2.72 to 3.22); however, RNs reported a higher mean score than RPNs in the emergency department (3.22 vs. 2.81), medical unit (2.95 vs 2.81) and surgical unit (2.90 vs 2.72). Where statistically significant differences were found, the effect sizes were negligible to medium in magnitude with the largest differences noted between RNs and RPNs working in the emergency department. Conclusions The results suggest the need to implement strategies that diminish role conflict for both RNs and RPNs.

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Comparison of two methods to estimate adverse events in the IBEAS Study (Ibero-American study of adverse events): cross-sectional versus retrospective cohort design

BMJ Open ◽

10.1136/bmjopen-2017-016546 ◽

2017 ◽

Vol 7 (10) ◽

pp. e016546 ◽

Cited By ~ 3

Author(s):

Jesus Maria Aranaz Andrés ◽

Ramon Limón Ramírez ◽

Carlos Aibar Remón ◽

Maria Teresa Gea-Velázquez de Castro ◽

Francisco Bolúmar ◽

...

Keyword(s):

Cohort Study ◽

Adverse Events ◽

Retrospective Cohort Study ◽

Medical Records ◽

Retrospective Cohort ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Hospital Size ◽

Cohort Design ◽

Cohort Study Design

BackgroundAdverse events (AEs) epidemiology is the first step to improve practice in the healthcare system. Usually, the preferred method used to estimate the magnitude of the problem is the retrospective cohort study design, with retrospective reviews of the medical records. However this data collection involves a sophisticated sampling plan, and a process of intensive review of sometimes very heavy and complex medical records. Cross-sectional survey is also a valid and feasible methodology to study AEs.ObjectivesThe aim of this study is to compare AEs detection using two different methodologies: cross-sectional versus retrospective cohort design.SettingSecondary and tertiary hospitals in five countries: Argentina, Colombia, Costa Rica, Mexico and Peru.ParticipantsThe IBEAS Study is a cross-sectional survey with a sample size of 11 379 patients. The retrospective cohort study was obtained from a 10% random sample proportional to hospital size from the entire IBEAS Study population.MethodsThis study compares the 1-day prevalence of the AEs obtained in the IBEAS Study with the incidence obtained through the retrospective cohort study.ResultsThe prevalence of patients with AEs was 10.47% (95% CI 9.90 to 11.03) (1191/11 379), while the cumulative incidence of the retrospective cohort study was 19.76% (95% CI 17.35% to 22.17%) (215/1088). In both studies the highest risk of suffering AEs was seen in Intensive Care Unit (ICU) patients. Comorbid patients and patients with medical devices showed higher risk.ConclusionThe retrospective cohort design, although requires more resources, allows to detect more AEs than the cross-sectional design.

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2480. Communication During Patient Transfers: Describing Gaps in the Infectious Status Information Pipeline

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2158 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S859-S859

Author(s):

Jeanmarie Mayer ◽

Roberta Horth ◽

Madison Todd ◽

Randon Gruninger ◽

Allyn K Nakashima

Keyword(s):

Acute Care ◽

Skilled Nursing Facility ◽

Multidrug Resistant ◽

The State ◽

Cross Sectional ◽

Skilled Nursing ◽

Patient Transfers ◽

Healthcare Facilities ◽

Additional Information ◽

Infection Preventionists

Abstract Background Fragmented communication of patients’ infectious status across healthcare networks impact regional spread of multidrug-resistant organisms (MDRO). This study aimed to quantify gaps in communication of patient MDRO status across Utah healthcare facilities and to identify opportunities to improve. Methods This is a cross-sectional retrospective mixed-methods study of patient transfers from three purposively selected healthcare facilities: an acute care (ACF), long-term acute care (LTAC), and skilled-nursing facility (SNF). Patients with known MDRO transferred out of these facilities over the previous week were identified in bimonthly samples spanning 2 months. Infection preventionists and admission nurses from facilities receiving these patients were interviewed. Results Of 293 patients transferred to another facility, 13% (n = 38) had an active infection or colonization with an MDRO. These 38 patients were transferred to 26 healthcare facilities within the state (4 ACF, 3 LTAC, 19 SNF). Gram-negative organisms with resistance to a carbapenem accounted for 15.8% of those transferred with an MDRO. There was no documentation of the state infection control transfer form (ICTF) at the sending facility for 68.5% of MDRO patient transfers. Of 22 admitting nurses interviewed, 19 (86.4%) did not receive an ICTF, 6 (27.3%) received no communication regarding patients’ infectious status, and 11 (50%) had to contact the sending facility for additional information. Moreover, 18.2% of patients had not been put on appropriate precautions. Several nurses expressed confusion with MDRO definitions and lack of guidance regarding care of MDRO colonized patients. Among infection preventionists asked about general MDRO transfers (n = 26), 26.9% reported that communication on infectious status of MDRO patients was received in under 40% of incoming transfers. When asked about a planned statewide MDRO registry, 80.8% felt that such a system would be actively searched at their facility, and 96.2% felt that a system that pushes out alerts would be useful. Conclusion Given the widespread gaps in communication of infectious status of patients with MDROs transferred across the healthcare facilities sampled, efforts to standardize and improve MDRO communication in the region is warranted. Disclosures All authors: No reported disclosures.

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Australian osteopaths as non-medical prescribers: comparison of healthcare practitioner characteristics from a nationally representative survey

Australian Journal of Primary Health ◽

10.1071/py19248 ◽

2020 ◽

Vol 26 (5) ◽

pp. 417

Author(s):

Brett Vaughan ◽

Michael Fleischmann ◽

Kylie Fitzgerald ◽

Sandra Grace ◽

Paul Orrock ◽

...

Keyword(s):

Diagnostic Imaging ◽

Patient Management ◽

Secondary Analysis ◽

Research Network ◽

Scope Of Practice ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Future ◽

Practice Based Research ◽

Nationally Representative

The study aimed to compare the characteristics of Australian osteopaths who definitely agree that prescribing scheduled medicines is part of their future scope of practice with those who do not. A secondary analysis of a cross-sectional survey of osteopaths from an Australian practice-based research network was undertaken. Demographic, practice and treatment characteristics were identified using inferential statistics and backward linear regression modelling. Over one-quarter (n=257, 25.9%) of the total participants (n=992) indicated that they ‘definitely’ agree that osteopaths should seek prescription rights. Adjusted odds ratios (OR) suggested these osteopaths were more likely to engage in medication discussions with patients (OR 1.88), frequently manage migraines (OR 1.68) and seek increased practice rights for referrals to medical specialists (OR 2.61) and diagnostic imaging (OR 2.79). Prescribing as part of the future scope of practice for Australian osteopaths is associated with patient management (medication discussions) and practice characteristics (increased referral rights for specialists and diagnostic imaging) that warrant additional investigation. Understanding of the practice, clinical and patient management characteristics of Australian osteopaths who see prescribing as part of the future scope of practice informs the case for regulatory and health policy changes for prescribing scheduled medicines.

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