scholarly journals 181. Potential Benefit of Masking and other COVID-19 Infection Prevention Measures on Late-Onset Infections in the NICU

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S110-S111
Author(s):  
Charlene Bultmann ◽  
Jaclyn Wiggins ◽  
Sagori Mukhopadhyay ◽  
Dustin Flannery ◽  
Mark Conaway ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Infection Prevention ◽  
Late Onset ◽  
Prevention Measures ◽  
Infection Rates ◽  
Interrupted Time Series Analysis ◽  
Number Of Patients ◽  
Pennsylvania Hospital ◽  
Lagged Dependent Variable ◽  
Post Period

Abstract Background Incidence of blood stream infections (BSI) among NICU admissions remains high, with associated mortality and morbidity. Due to COVID-19, there are increased infection prevention (IP) measures in NICUs including universal masking for all healthcare workers and families, social distancing, visitation restrictions, and increased attention to hand hygiene. These measures may also affect late-onset infection rates and offer understanding of novel interventions for prevention. Methods We examined infection rates during the 24 months prior to implementation of COVID-19 IP measures (PRE-period) compared to the months after implementation from April 2020 (POST-period). Late-onset infections were defined as culture-confirmed infection of the blood, urine, or identification of respiratory viral pathogens. An interrupted time series analysis of infection per 1000 patient days was performed based on a change-point Poisson regression with a lagged dependent variable and the number of patient days used as offsets. Each month was treated as independent with additional analysis using an observation-driven model to account for serial dependence. Results Multicenter analysis to date included all infants cared for at three centers (Level 3 and 4) from 2018-2020. Monthly BSI rates decreased in the POST-period at the three centers (Figure 1). At all centers actual BSI rate was lower than the expected rate in the POST-period (Figure 2). The combined BSI rate per 1000 patient days was 41% lower compared to the rate prior to implementation (95% CI, 0.42 to 0.84, P=0.004) (Table 1). In subgroup analysis by birthweight, infants< 1000g had a 39% reduction in BSI (P=0.023), for1000-1500g patients there was a 44% reduction (P=0.292) and in those > 1500g there was a 53% reduction (0.083). Figure 1. PRE and POST MASKING and other COVID Infection Prevention Measures and Monthly BSI Rates. Figure 2. PRE and POST MASKING and other COVID infection prevention measures and BSI Trends. At all centers actual BSI rate was lower than the expected rate for that center in the POST period. UVA and Duke showed a baseline decrease and Pennsylvania Hospital showed a downward trend in infection rates. There was an approximate decrease in expected bloodstream infection events at Pennsylvania Hospital by 7 events, at UVA by 22 events and at Duke by 23 events. Overall, all three centers saw a decrease in their expected infections after COVID-19 infection prevention measures were implemented. Table 1. Percent reduction in Bloodstream Infection at each center. Conclusion In this preliminary analysis, we found a reduction of BSI after the implementation of COVID-19 infection prevention measures. Additionally, there were fewer viral infections, though there were a limited number of episodes. Further analyses of multicenter data and a larger number of patients will elucidate the significance of these findings and the role some of these IP measures such as universal masking may have in infection prevention in the NICU. Disclosures All Authors: No reported disclosures

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

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

Local hospital experience of emergency management in the response to SARS (Preprint)

2020 ◽  
Author(s):  
Ying Yan
Keyword(s):  
Emergency Management ◽  
Infection Prevention ◽  
Public Health Emergency ◽  
The Novel ◽  
Prevention Measures ◽  
Hospital Emergency ◽  
Local Hospital ◽  
Referral Network ◽  
Novel Coronavirus ◽  
Hospital Transmission

UNSTRUCTURED The ongoing outbreak of SARS-CoV-2 infection was first identified in Wuhan, China at the late of 2019. Following the acceleration of the novel coronavirus spreading, person-person transmissions in family residences, hospitals and other public environments have led to a major public hazard in China. Currently, the SARS-CoV-2 outbreak has been further developed into a public health emergency of international concern. In response to an occurring pandemic, hospitals need an emergency strategy and plan to manage their space, staff, and other essential resources, therefore, to provide optimum care to patients involved. In addition, infection prevention measures urgently need to be implemented to reduce in-hospital transmission and avoid the occurrence of virus super-spreading. For hospitals without capacity to manage severe patients, a referral network is often needed. We present our successful field experience regarding hospital emergency management and local hospitals network model in response to SARS-CoV-2 emerging epidemic.

scholarly journals Universal Masking to Control Healthcare-Associated Transmission of SARS-CoV-2

2021 ◽  
pp. 1-24
Author(s):  
Eliza R. Thompson ◽  
Faith S. Williams ◽  
Pat A. Giacin ◽  
Shay Drummond ◽  
Eric Brown ◽  
...  
Keyword(s):  
Large Scale ◽  
Infection Prevention ◽  
Index Patient ◽  
Field Investigation ◽  
Point Prevalence ◽  
Control Measures ◽  
Prevention Measures ◽  
Infection Control Measures ◽  
Va Health Care System ◽  
Healthcare Associated

Abstract Objective: To assess extent of a healthcare-associated outbreak of SARS-CoV-2 and evaluate effectiveness of infection control measures, including universal masking Design: Outbreak investigation including 4 large-scale point-prevalence surveys Setting: Integrated VA Health Care System with 2 facilities and 330 beds Participants: Index patient and 250 exposed patients and staff Methods: We identified exposed patients and staff and classified them as probable and confirmed cases based on symptoms and testing. We performed a field investigation and assessment of patient and staff interactions to develop probable transmission routes. Infection prevention interventions implemented included droplet and contact precautions, employee quarantine, and universal masking with medical and cloth facemasks. Four point-prevalence surveys of patient and staff subsets were conducted using real-time reverse-transcriptase polymerase chain reaction for SARS-CoV-2. Results: Among 250 potentially exposed patients and staff, 14 confirmed cases of Covid-19 were identified. Patient roommates and staff with prolonged patient contact were most likely to be infected. The last potential date of transmission from staff to patient was day 22, the day universal masking was implemented. Subsequent point-prevalence surveys in 126 patients and 234 staff identified 0 patient cases and 5 staff cases of Covid-19, without evidence of healthcare-associated transmission. Conclusions: Universal masking with medical facemasks was effective in preventing further spread of SARS-CoV-2 in our facility in conjunction with other traditional infection prevention measures.

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.

The impact of a multimodel approach to designing a new orthopedic department

2020 ◽  
pp. 1-6
Author(s):  
Elad Keren ◽  
Abraham Borer ◽  
Lior Nesher ◽  
Tali Shafat ◽  
Rivka Yosipovich ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Prevention Measures ◽  
Orthopedic Department ◽  
Before And After ◽  
The Impact

Abstract Objective: To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department. Design: Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention. Setting: A 1,000-bed, tertiary-care, university hospital. Patients: Adult patients admitted to the orthopedics department between January 2015 and December 2018. Methods: During the preintervention period (2015–2016), 1 general orthopedic department was in operation. In the postintervention period (2017–2018), 2 separate departments were created: one designated for elective “clean” surgeries and another that included a “complicated wound” unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed. Results: The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6–9) to the postintervention period (median, 4 days; IQR, 2–7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001). Conclusions: Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.

scholarly journals Impact of joint management of a COVID-19 mother and her newborn on the virus transmission: a case report

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Maria Chiara De Nardo ◽  
Anna Rita Bellomo ◽  
Francesca Perfetti ◽  
Francesco Antonino Battaglia ◽  
Miriam Lichtner ◽  
...  
Keyword(s):  
Infection Prevention ◽  
Virus Transmission ◽  
The Novel ◽  
Transplacental Transmission ◽  
Prevention Measures ◽  
Infected Mother ◽  
Case Presentation ◽  
Joint Management ◽  
Healthy Neonate

Abstract Background Since last year, COVID-19, the disease caused by the novel Sars-Cov-2 virus, has been globally spread to all the world. COVID-19 infection among pregnant women has been described. However, transplacental transmission of Sars-Cov-2 virus from infected mother to the newborn is not yet established. The appropriate management of infants born to mothers with confirmed or suspected COVID-19 and the start of early breastfeeding are being debated. Case presentation We report a case of the joint management of a healthy neonate with his mother tested positive for Covid-19 before the delivery and throughout neonatal follow-up. The infection transmission from the mother to her baby is not described, even after a long period of contact between them and breastfeeding. Conclusion It may consider an appropriate practice to keep mother and her newborn infant together in order to facilitate their contact and to encourage breastfeeding, although integration with infection prevention measures is needed.

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