scholarly journals 1268. Transmissibility of Candida auris by Type of Inpatient Healthcare Facility

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S386-S387
Author(s):  
Prabasaj Paul ◽  
Kaitlin Forsberg ◽  
Snigdha Vallabhaneni ◽  
Shawn R Lockhart ◽  
Anastasia P Litvintseva ◽  
...  
Keyword(s):  
Acute Care ◽  
Reproduction Number ◽  
Acute Care Hospital ◽  
Healthcare Facility ◽  
Control Measures ◽  
Care Hospital ◽  
Candida Auris ◽  
Healthcare Facilities ◽  
Colonization Pressure ◽  
Facility Type

Abstract Background Candida auris is a multidrug-resistant yeast causing outbreaks in healthcare settings. Stopping the spread of C. auris requires rapid identification of healthcare facilities at risk of higher transmission to help targeted implementation of infection control measures. We used data collected during public health investigations to quantify transmissibility of C. auris by type of healthcare facility. Methods In two states, 3,159 patient swabs were collected during 96 C. auris point prevalence surveys conducted at 36 inpatient healthcare facilities in November 2016 and April 2018. We estimated facility transmissibility and facility reproduction number (number infected by one index colonized patient per day, and per stay, respectively, at the facility) of C. auris based on estimated colonization pressure, a count of newly colonized patients between successive surveys at the same facility, and mean lengths of stay at facilities (estimated from CMS administrative data). The results were summarized by facility type: acute care hospital (ACH), long-term acute care hospital (LTACH) or ventilator unit at skilled nursing facility (VSNF), and were compared with previous estimates for transmissibility of carbapenem-resistant Enterobacteriaceae (CRE). Results Swabs were collected from 13 ACHs, 12 LTACHs, and 11 VSNFs. The C. auris facility reproduction number may exceed the critical value of 1 in both ACHs and VSNFs, and may exceed that for CRE in ACHs (table). Conclusion Transmissibility of C. auris is comparable to that of CRE. The transmissibility within VSNFs emphasizes their potential role as amplifiers in the outbreak. Understanding transmissibility by facility type helps evaluate the potential impact of interventions in various settings. Disclosures All authors: No reported disclosures.

scholarly journals 161. Prevalence and Risk Factors for Candida auris Colonization Among Patients in a Long-term Acute Care Hospital—New Jersey, 2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S14-S14
Author(s):  
Faye Rozwadowski ◽  
Jarred McAteer ◽  
Nancy A Chow ◽  
Kimberly Skrobarcek ◽  
Kaitlin Forsberg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Clinical Information ◽  
Control Measures ◽  
Resistant Organism ◽  
Invasive Infection ◽  
Care Hospital ◽  
Candida Auris

Abstract Background Candida auris can be transmitted in healthcare settings, and patients can become asymptomatically colonized, increasing risk for invasive infection and transmission. We investigated an ongoing C. auris outbreak at a 30-bed long-term acute care hospital to identify colonization for C. auris prevalence and risk factors. Methods During February–June 2017, we conducted point prevalence surveys every 2 weeks among admitted patients. We abstracted clinical information from medical records and collected axillary and groin swabs. Swabs were tested for C. auris. Data were analyzed to identify risk factors for colonization with C. auris by evaluating differences between colonized and noncolonized patients. Results All 101 hospitalized patients were surveyed, and 33 (33%) were colonized with C. auris. Prevalence of colonization ranged from 8% to 38%; incidence ranged from 5% to 20% (figure). Among colonized patients with available data, 19/27 (70%) had a tracheostomy, 20/31 (65%) had gastrostomy tubes, 24/33 (73%) ventilator use, and 12/27 (44%) had hemodialysis. Also, 31/33 (94%) had antibiotics and 13/33 (34%) antifungals during hospitalization. BMI for colonized patients (mean = 30.3, standard deviation (SD) = 10) was higher than for noncolonized patients (mean = 26.5, SD = 7.9); t = −2.1; P = 0.04). Odds of colonization were higher among Black patients (33%) vs. White patients (16%) (odds ratio [OR] 3.5; 95% confidence interval [CI] 1.3–9.8), and those colonized with other multidrug-resistant organism (MDRO) (72%) vs. noncolonized (44%) (OR 3.2; CI 1.3–8.0). Odds of death were higher among colonized patients (OR 4.6; CI 1.6—13.6). Conclusion Patients in long-term acute care facilities and having high prevalences of MDROs might be at risk for C. auris. Such patients with these risk factors could be targeted for enhanced surveillance to facilitate early detection of C. auris. Infection control measures to reduce MDROs’ spread, including hand hygiene, contact precautions, and judicious use of antimicrobials, could prevent further C. auris transmission. Acknowledgements The authors thank Janet Glowicz and Kathleen Ross. Disclosures All authors: No reported disclosures.

scholarly journals Aggressive Colonization Screening and Infection Control Measures in Containment of NDM-5 Carbapenemase-Producing CRE

2020 ◽  
Vol 41 (S1) ◽  
pp. s458-s459
Author(s):  
Ishrat Kamal-Ahmed ◽  
Kate Tyner ◽  
Teresa Fitzgerald ◽  
Heather Adele Moulton-Meissner ◽  
Gillian McAllister ◽  
...  
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Acute Care Hospital ◽  
Healthcare Facility ◽  
The United States ◽  
Control Measures ◽  
Care Hospital ◽  
Clinical Culture ◽  
Medical Histories ◽  
Asymptomatic Case

Background: In April 2019, Nebraska Public Health Laboratory identified an NDM-producing Enterobacter cloacae from a urine sample from a rehabilitation inpatient who had recently received care in a specialized unit (unit A) of an acute-care hospital (ACH-A). After additional infections occurred at ACH-A, we conducted a public health investigation to contain spread. Methods: A case was defined as isolation of NDM-producing carbapenem-resistant Enterobacteriaceae (CRE) from a patient with history of admission to ACH-A in 2019. We conducted clinical culture surveillance, and we offered colonization screening for carbapenemase-producing organisms to all patients admitted to unit A since February 2019. We assessed healthcare facility infection control practices in ACH-A and epidemiologically linked facilities by visits from the ICAP (Infection Control Assessment and Promotion) Program. The recent medical histories of case patients were reviewed. Isolates were evaluated by whole-genome sequencing (WGS). Results: Through June 2019, 7 cases were identified from 6 case patients: 4 from clinical cultures and 3 from 258 colonization screens including 1 prior unit A patient detected as an outpatient (Fig. 1). Organisms isolated were Klebsiella pneumoniae (n = 5), E. cloacae (n = 1), and Citrobacter freundii (n = 1); 1 patient had both NDM-producing K. pneumoniae and C. freundii. Also, 5 case patients had overlapping stays in unit A during February–May 2019 (Fig. 2); common exposures in unit A included rooms in close proximity, inhabiting the same room at different times and shared caregivers. One case-patient was not admitted to unit A but shared caregivers, equipment, and devices (including a colonoscope) with other case patients while admitted to other ACH-A units. No case patients reported travel outside the United States. Screening at epidemiologically linked facilities and clinical culture surveillance showed no evidence of transmission beyond ACH-A. Infection control assessments at ACH-A revealed deficiencies in hand hygiene, contact precautions adherence, and incomplete cleaning of shared equipment within and used to transport to/from a treatment room in unit A. Following implementation of recommended infection control interventions, no further cases were identified. Finally, 5 K. pneumoniae of ST-273 were related by WGS including carriage of NDM-5 and IncX3 plasmid supporting transmission of this strain. Further analysis is required to relate IncX3 plasmid carriage and potential transmission to other organisms and sequence types identified in this study. Conclusions: We identified a multiorganism outbreak of NDM-5–producing CRE in an ACH specialty care unit. Transmission was controlled through improved infection control practices and extensive colonization screening to identify asymptomatic case-patients. Multiple species with NDM-5 were identified, highlighting the potential role of genotype-based surveillance.Funding: NoneDisclosures: Muhammad Salman Ashraf reports that he is the principal investigator for a study funded by an investigator-initiated research grant.

scholarly journals 1263. Managing an Influenza Outbreak Which Spilled Over to an Acute Care Hospital from a Behavioral Health Unit

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S385-S385
Author(s):  
Colleen M Clay ◽  
Leonardo Girio-Herrera ◽  
Faheem Younus
Keyword(s):  
Behavioral Health ◽  
Acute Care ◽  
Influenza A ◽  
Average Length ◽  
Acute Care Hospital ◽  
Control Measures ◽  
Care Hospital ◽  
Prevention Measures ◽  
Influenza Outbreak ◽  
Hospital Acquired

Abstract Background Behavioral health units (BHU) have been implicated in influenza outbreaks due to group activities, low availability of alcohol-based hand gels and unique host factors. We describe the management of an unusual influenza outbreak, which started in the BHU and then spilled over to the acute care hospital (ACH). Methods University of Maryland Harford Memorial Hospital is a 95-bed ACH with a 14-bed closed-door adult BHU located on the fifth floor. Two cases each of hospital-acquired influenza were identified in our BHU during 2016 and 2017. In January 2018, however, hospital-acquired influenza cases in the BHU spilled over to the adjacent ACH to cause an outbreak. A case was defined as a patient with fever of >100.4°F, presence of influenza-like illness, and a positive influenza test >72 hours after admission. Outbreak control measures included twice daily fever screening, enhanced droplet precautions, visitor restrictions, discontinuing community activities, enforcing hand hygiene at all hospital entrances, and hospital-wide chemoprophylaxis with oseltamivir. Results On January 15, 2018, the index patient developed influenza in the BHU followed by a second case in BHU 4-days later. Over the next 10 days, five more patients on the third and fourth floors of ACH tested positive. Attack rate was 3% and average length of stay was 8.9 days. Chemoprophylaxis with oseltamivir 75 mg orally once a day was given to 71% of all eligible hospitalized patients for a week (at a cost of $17,000). All seven patients yielded influenza A, subtype H3N2 and were successfully treated with oseltamivir 75 mg orally twice a day for 7 days. The outbreak lasted 11 days. Figure 1 shows the epidemiologic curve. Conclusion Special attention should be paid to influenza prevention in the BHUs due to the risk of spillover effect to sicker patients in the adjacent ACH. A short, 7-day course of hospital-wide oseltamivir chemoprophylaxis, in addition to promptly implementing the infection prevention measures was effective in controlling the outbreak. Disclosures All authors: No reported disclosures.

scholarly journals 2440. Using a geospatially explicit agent-based model of a regional healthcare network to assess varied antibiotic risk on Clostridioides difficile infection incidence

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S843-S844
Author(s):  
Sarah Rhea ◽  
Kasey Jones ◽  
Georgiy Bobashev ◽  
Breda Munoz ◽  
James Rineer ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Healthcare Facilities ◽  
Agent Based ◽  
Healthcare Network ◽  
Clostridioides Difficile ◽  
Unit Increase ◽  
Clostridioides Difficile Infection ◽  
The Impact

Abstract Background Different antibiotic classes are associated with different Clostridioides difficile infection (CDI) risk. The impact of varied antibiotic risk on CDI incidence can be explored using agent-based models (ABMs). ABMs can simulate complete systems (e.g., regional healthcare networks) comprised of discrete, unique agents (e.g., patients) which can be represented using a synthetic population, or model-generated representation of the population. We used an ABM of a North Carolina (NC) regional healthcare network to assess the impact of increasing antibiotic risk ratios (RRs) across network locations on healthcare-associated (HA) and community-associated (CA) CDI incidence. Methods The ABM describes CDI acquisition and patient movement across 14 network locations (i.e., nodes) (11 short-term acute care hospitals, 1 long-term acute care hospital, 1 nursing home, and the community). We used a sample of 2 million synthetic NC residents as ABM microdata. We updated agent states (i.e., location, antibiotic exposure, C. difficile colonization, CDI status) daily. We applied antibiotic RRs of 1, 5, 8.9 (original model RR), 15, and 20 to agents across the network to simulate varied risk corresponding to different antibiotic classes. We determined network HA-CDI and CA-CDI incidence and percent mean change for each RR. Results In this simulation study, HA-CDI incidence increased with increasing antibiotic risk, ranging from 11.3 to 81.4 HA-CDI cases/100,000 person-years for antibiotic RRs of 1 to 20, respectively. On average, the per unit increase in antibiotic RR was 33% for HA-CDI and 6% for CA-CDI (figure). Conclusion We used a geospatially explicit ABM to simulate increasing antibiotic risk, corresponding to different antibiotic classes, and to explore the impact on CDI incidence. The per unit increase in antibiotic risk was greater for HA-CDI than CA-CDI due to the higher probability of receiving antibiotics and higher concentration of agents with other CDI risk factors in the healthcare facilities of the ABM. These types of analyses, which demonstrate the interconnectedness of network healthcare facilities and the associated community served by the network, might help inform targeted antibiotic stewardship efforts in certain network locations. Disclosures All authors: No reported disclosures.

scholarly journals Modifiable Risk Factors for the Spread of Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae Among Long-Term Acute-Care Hospital Patients

2017 ◽  
Vol 38 (06) ◽  
pp. 670-677 ◽  
Author(s):  
Koh Okamoto ◽  
Michael Y. Lin ◽  
Manon Haverkate ◽  
Karen Lolans ◽  
Nicholas M. Moore ◽  
...  
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Modifiable Risk Factors ◽  
Surveillance Culture ◽  
Care Hospital ◽  
Colonization Pressure ◽  
Comorbidity Index

OBJECTIVETo identify modifiable risk factors for acquisition ofKlebsiella pneumoniaecarbapenemase-producing Enterobacteriaceae (KPC) colonization among long-term acute-care hospital (LTACH) patients.DESIGNMulticenter, matched case-control study.SETTINGFour LTACHs in Chicago, Illinois.PARTICIPANTSEach case patient included in this study had a KPC-negative rectal surveillance culture on admission followed by a KPC-positive surveillance culture later in the hospital stay. Each matched control patient had a KPC-negative rectal surveillance culture on admission and no KPC isolated during the hospital stay.RESULTSFrom June 2012 to June 2013, 2,575 patients were admitted to 4 LTACHs; 217 of 2,144 KPC-negative patients (10.1%) acquired KPC. In total, 100 of these patients were selected at random and matched to 100 controls by LTACH facility, admission date, and censored length of stay. Acquisitions occurred a median of 16.5 days after admission. On multivariate analysis, we found that exposure to higher colonization pressure (OR, 1.02; 95% CI, 1.01–1.04;P=.002), exposure to a carbapenem (OR, 2.25; 95% CI, 1.06–4.77;P=.04), and higher Charlson comorbidity index (OR, 1.14; 95% CI, 1.01–1.29;P=.04) were independent risk factors for KPC acquisition; the odds of KPC acquisition increased by 2% for each 1% increase in colonization pressure.CONCLUSIONSHigher colonization pressure, exposure to carbapenems, and a higher Charlson comorbidity index independently increased the odds of KPC acquisition among LTACH patients. Reducing colonization pressure (through separation of KPC-positive patients from KPC-negative patients using strict cohorts or private rooms) and reducing carbapenem exposure may prevent KPC cross transmission in this high-risk patient population.Infect Control Hosp Epidemiol2017;38:670–677

scholarly journals COVID-19 Outbreak in an Acute-Care Hospital: Lessons Learned

2021 ◽  
Vol 1 (S1) ◽  
pp. s56-s57
Author(s):  
Supriya Narasimhan ◽  
Vidya Mony ◽  
Tracey Stoll ◽  
Sherilyn Oribello ◽  
Karanas Yvonne ◽  
...  
Keyword(s):  
Acute Care ◽  
Infection Prevention ◽  
Environmental Control ◽  
Acute Care Hospital ◽  
Lessons Learned ◽  
Control Measures ◽  
Additional Patient ◽  
Care Hospital ◽  
Eye Protection ◽  
Containment Measures

Background: We describe the infection prevention investigation of a cluster of 15 healthcare workers (HCWs) and 7 patients in a single non–COVID-19 unit of an acute-care hospital in September 2020. Methods: The infection prevention team was notified of 13 SARS-CoV-2–positive, symptomatic HCWs in an acute-care non–COVID-19 unit in 1 week (August 30, 2020, to September 3, 2020). In the same week, 2 patients who had been on the unit were diagnosed with nosocomial COVID-19. An epidemiologic investigation identified the exposure period to be between August 19, 2020, and September 3, 2020. The following immediate containment measures were implemented: closing the unit to new admissions, restricting float staff, moving existing patients to private rooms, mandatory masking of patients, and mandatory respirator and eye protection on unit entry for all HCWs. Exposed unit staff were tested immediately and then every 4 days until September 18, 2020. Likewise, exposed patients, including those discharged, were notified and offered testing. Hospital-wide HCW surveillance testing was conducted. Enhanced environmental control measures were conducted, including terminal cleaning and ultraviolet C (UV-C) disinfection of common areas and patient rooms and a thorough investigation of airflow. Detailed staff interviews were performed to identify causes of transmission. Multiple town hall meetings were held for staff education and updates. Results: In total, 108 total patients were deemed exposed: 33 were inpatients and 75 had been discharged. Testing identified 5 additional patient cases among 57 patients who received testing; 51 chose to self-monitor for symptoms. Staff testing identified 2 additional cases. Thus, 15 HCWs and 7 patients were linked in this cluster. The containment measures successfully ended staff transmission as of September 5, 2020. The last patient case was detected on September 10, 2020. Secondary cases were noted in 6 HCW families. We identified staff presenteeism, complacency, and socialization in break rooms and outside work as major causes of transmission. Suboptimal compliance with universal eye protection and hand hygiene (67%) were contributing factors. We determined by contact tracing and temporality that the outbreak could have stemmed from nursing home patient(s) through floating HCWs to staff on the affected unit. Directionality of transmission was from staff to patients in this cluster. Conclusions: Many facets of pandemic fatigue were apparent in this outbreak, namely, inability of HCWs to adhere to changing PPE guidance, presenteeism pressures due to workforce needs, and socialization with peers due to a false sense of security conferred by biweekly surveillance testing. Ongoing PPE education, repeated reinforcement, as well as engagement in staff wellness are crucial to combatting pandemic fatigue, conserving our workforce, and preventing future outbreaks.Funding: NoDisclosures: None

scholarly journals Repeated Prevalence Surveys and Admission Screening for Candida auris at One Long-Term Acute-Care Hospital, Chicago, 2016–2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s14-s15
Author(s):  
Massimo Pacilli ◽  
Kelly Walblay ◽  
Hira Adil ◽  
Shannon Xydis ◽  
Janna Kerins ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospital ◽  
Venous Catheter ◽  
Patient Characteristics ◽  
Care Hospital ◽  
Candida Auris ◽  
Term Care ◽  
Medical Issues ◽  
Admission Screening

Background: Since the initial identification of Candida auris in 2016 in Chicago, ongoing spread has been documented in the Chicago area, primarily among older adults with complex medical issues admitted to high-acuity long-term care facilities, including long-term acute-care hospitals (LTACHs). As of October 2019, 790 cases have been reported in Illinois. Knowing C. auris colonization status on admission is important for prompt implementation of infection control precautions. We describe periodic facility point-prevalence surveys (PPSs) and admission screening at LTACH A. Methods: Beginning September 2016, we conducted repeated PPSs for C. auris colonization at LTACH A. After a baseline PPS, we initiated admission screening in May 2019 for patients without prior evidence of C. auris colonization or infection. C. auris screening specimens consisted of composite bilateral axillary/inguinal swabs tested at public health laboratories. We compared a limited set of patient characteristics based on admission screening results. Results: From September 2016 through October 2019, 277 unique patients were screened at LTACH A during 10 PPSs. Overall, 36 patients (13%) were identified to be colonized. The median facility C. auris prevalence increased from 2.8% in 2016 to 37% in 2019 (Fig. 1). During May–September 2019, among 174 unique patients admitted, 151 (87%) were screened for C. auris colonization on admission, of whom 18 (12%) were found to be colonized. Overall, 14 patients were known to have C. auris colonization on admission and were not rescreened, and 9 patients were discharged before screening specimens could be collected. A significantly higher proportion of patients testing positive for C. auris on admission had a central venous catheter or a peripherally inserted central catheter or were already on contact precautions (Table 1). The PPS conducted on October 1, 2019, revealed 5 new C. auris colonized patients who had screened negative on admission. Conclusions: Repeated PPSs at LTACH A indicated control of C. auris transmission in 2016–2017, followed by increasing prevalence beginning in May 2018, likely from patients admitted with unrecognized C. auris colonization and subsequent facility spread. Admission screening allowed for early detection of C. auris colonization. However, identification during subsequent PPS of additional colonized patients indicates that facility transmission is ongoing. Both admission screening and periodic PPSs are needed for timely detection of colonized patients. Given the high C. auris prevalence in LTACHs and challenges in identifying readily apparent differences between C. auris positive and negative patients on admission, we recommend that all patients being admitted to an LTACH in endemic areas should be screened for C. auris.Funding: NoneDisclosures: None

scholarly journals Impact of an antimicrobial stewardship programme on antimicrobial utilization and the prevalence of MDR Pseudomonas aeruginosa in an acute care hospital in Qatar

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Mazen A Sid Ahmed ◽  
Hamad Abdel Hadi ◽  
Sulieman Abu Jarir ◽  
Abdul Latif Al Khal ◽  
Muna A Al-Maslamani ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Acute Care Hospital ◽  
Antibiotic Use ◽  
Significant Rise ◽  
Successful Implementation ◽  
Care Hospital ◽  
Antimicrobial Consumption ◽  
Healthcare Facilities

Abstract Background The excessive and inappropriate use of antibiotics is universal across all healthcare facilities. In Qatar there has been a substantial increase in antimicrobial consumption coupled with a significant rise in antimicrobial resistance (AMR). Antimicrobial stewardship programmes (ASPs) have become a standard intervention for effective optimization of antimicrobial prescribing. Methods A before–after study was conducted in Hamad General Hospital (603 bed acute care hospital): 1 year before implementation of a comprehensive ASP compared with the following 2 years. The ASP included a hospital-wide pre-authorization requirement by infectious diseases physicians for all broad-spectrum antibiotics. Prevalence of MDR Pseudomonas aeruginosa was compared with antimicrobial consumption, calculated as DDD per 1000 patient-days (DDD/1000 PD). Susceptibility was determined using broth microdilution, as per CLSI guidelines. Antibiotic use was restricted through the ASP, as defined in the hospital’s antibiotic policy. Results A total of 6501 clinical isolates of P. aeruginosa were collected prospectively over 3 years (2014–17). Susceptibility to certain antimicrobials improved after the ASP was implemented in August 2015. The prevalence of MDR P. aeruginosa showed a sustained decrease from 2014 (9%) to 2017 (5.46%) (P = 0.019). There was a significant 23.9% reduction in studied antimicrobial consumption following ASP implementation (P = 0.008). The yearly consumption of meropenem significantly decreased from 47.32 to 31.90 DDD/1000 PD (P = 0.012), piperacillin/tazobactam from 45.35 to 32.67 DDD/1000 PD (P < 0.001) and ciprofloxacin from 9.71 to 5.63 DDD/1000 PD (P = 0.015) (from 2014 to 2017). Conclusions The successful implementation of the ASP led to a significant reduction in rates of MDR P. aeruginosa, pointing towards the efficacy of the ASP in reducing AMR.

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 Outbreak of Carbapenem-Resistant Enterobacteriaceae at a Long-Term Acute Care Hospital: Sustained Reductions in Transmission through Active Surveillance and Targeted Interventions

2012 ◽  
Vol 33 (10) ◽  
pp. 984-992 ◽  
Author(s):  
Amit S. Chitnis ◽  
Pam S. Caruthers ◽  
Agam K. Rao ◽  
JoAnne Lamb ◽  
Robert Lurvey ◽  
...  
Keyword(s):  
Acute Care ◽  
Genetic Relatedness ◽  
Acute Care Hospital ◽  
Public Health Approach ◽  
Care Hospital ◽  
Healthcare Facilities ◽  
Targeted Interventions ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Objective.To describe a Klebsiella pneumoniae carbapenemase (KPC)–producing carbapenem-resistant Enterobacteriaceae (CRE) outbreak and interventions to prevent transmission.Design, Setting, and Patients.Epidemiologic investigation of a CRE outbreak among patients at a long-term acute care hospital (LTACH).Methods.Microbiology records at LTACH A from March 2009 through February 2011 were reviewed to identify CRE transmission cases and cases admitted with CRE. CRE bacteremia episodes were identified during March 2009–July 2011. Biweekly CRE prevalence surveys were conducted during July 2010–July 2011, and interventions to prevent transmission were implemented, including education and auditin? of staff and isolation and cohorting of CRE patients with dedicated nursing staff and shared medical equipment. Trends were evaluated using weighted linear or Poisson regression. CRE transmission cases were included in a case-control study to evaluate risk factors for acquisition. A real-time polymerase chain reaction assay was used to detect the blaKPC gene, and pulsed-field gel electrophoresis was performed to assess the genetic relatedness of isolates.Results.Ninety-nine CRE transmission cases, 16 admission cases (from 7 acute care hospitals), and 29 CRE bacteremia episodes were identified. Significant reductions were observed in CRE prevalence (49% vs 8%), percentage of patients screened with newly detected CRE (44% vs 0%), and CRE bacteremia episodes (2.5 vs 0.0 per 1,000 patient-days). Cases were more likely to have received β-lactams, have diabetes, and require mechanical ventilation. All tested isolates were KPC-producing K. pneumoniae, and nearly all isolates were genetically related.Conclusion.CRE transmission can be reduced in LTACHs through surveillance testing and targeted interventions. Sustainable reductions within and across healthcare facilities may require a regional public health approach.Infect Control Hosp Epidemiol 2012;33(10):984-992

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