83. During A Million Patient-Days of Surveillance, Low Levels of Infection Prevention Staff Correlated with Higher Rates of Some Healthcare-Associated Infections

Abstract Background Reports regarding the correlations between infection preventionist (IP) staffing levels and healthcare-associated infections (HAI) are scarce, conflicting, and crucial for resource allocation and effort prioritization. We evaluated such correlations from January 1, 2012 to March 1, 2019 at a 528-bed teaching hospital in Rochester, NY; a period when IP staffing levels fluctuated between the recommended ratio of 1 IP: 80 patients and a critically low of 1 IP: >375. Methods Standardized National Health Safety Network (NHSN) definitions, along with laboratory events, re-admissions, interactions with surgical teams, and an independent data management company were used for case finding of catheter-associated urinary tract infection (CAUTI), Clostridiodes difficile (CDI), central line-associated bloodstream infection (CLABSI), carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus (MRSA). Colon, prosthetic knee and hip joint, hysterectomies, and coronary artery bypass graft surgical site infections (SSI) were also studied. Standardized infection ratios (SIR) were extracted from NHSN. Staffing levels were grouped into low (/ = 7 FTE). Correlations between HAI rates, SIR, and staffing levels were examined using Poisson and T-tests with the R statistical package. Results The average daily census of 451 resulted in 1.18 million total patient-days of surveillance. Periods of low and recommended IP levels occurred at similar seasons and for similar durations. There were fewer CDI, CAUTI, CLABSI, and MRSA infections when IP staff were at recommended levels than when IP staff were at the lowest level, but only CDI and CLABSI rates were significantly lower (P = 0.003 and 0.005, respectively). CLABSI SIR was 1.07 and 0.64 during periods of low and recommended staffing levels, respectively (P = 0.004). No significant differences occurred in SSI, either by type or by combined. Conclusion Hospitals often cannot achieve or maintain recommended IP staffing levels. Our findings suggest that, during critical personnel shortages, IP may have more impact by focusing on the types of HAI that correlated with preventionist staffing levels. This is among the largest such study to date, and uniquely includes the most types of HAI. Disclosures All Authors: No reported Disclosures.

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Infection preventionist staffing levels and rates of 10 types of healthcare-associated infections: A 9-year ambidirectional observation

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.507 ◽

2022 ◽

pp. 1-6

Author(s):

Robert J. Clifford ◽

Donna Newhart ◽

Maryrose R. Laguio-Vila ◽

Jennifer L. Gutowski ◽

Melissa Z. Bronstein ◽

...

Keyword(s):

Control Charts ◽

Bloodstream Infections ◽

Central Line ◽

Healthcare Associated Infections ◽

Full Time ◽

Staffing Levels ◽

Clostridioides Difficile ◽

Carbapenem Resistant ◽

Healthcare Associated ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Objective: To quantitatively evaluate relationships between infection preventionists (IPs) staffing levels, nursing hours, and rates of 10 types of healthcare-associated infections (HAIs). Design and setting: An ambidirectional observation in a 528-bed teaching hospital. Patients: All inpatients from July 1, 2012, to February 1, 2021. Methods: Standardized US National Health Safety Network (NHSN) definitions were used for HAIs. Staffing levels were measured in full-time equivalents (FTE) for IPs and total monthly hours worked for nurses. A time-trend analysis using control charts, t tests, Poisson tests, and regression analysis was performed using Minitab and R computing programs on rates and standardized infection ratios (SIRs) of 10 types of HAIs. An additional analysis was performed on 3 stratifications: critically low (2–3 FTE), below recommended IP levels (4–6 FTE), and at recommended IP levels (7–8 FTE). Results: The observation covered 1.6 million patient days of surveillance. IP staffing levels fluctuated from ≤2 IP FTE (critically low) to 7–8 IP FTE (recommended levels). Periods of highest catheter-associated urinary tract infection SIRs, hospital-onset Clostridioides difficile and carbapenem-resistant Enterobacteriaceae infection rates, along with 4 of 5 types of surgical site SIRs coincided with the periods of lowest IP staffing levels and the absence of certified IPs and a healthcare epidemiologist. Central-line–associated bloodstream infections increased amid lower nursing levels despite the increased presence of an IP and a hospital epidemiologist. Conclusions: Of 10 HAIs, 8 had highest incidences during periods of lowest IP staffing and experience. Some HAI rates varied inversely with levels of IP staffing and experience and others appeared to be more influenced by nursing levels or other confounders.

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Impact of Healthcare-Associated Infections Connected to Medical Devices—An Update

Microorganisms ◽

10.3390/microorganisms9112332 ◽

2021 ◽

Vol 9 (11) ◽

pp. 2332

Author(s):

Nitin Chandra Teja Dadi ◽

Barbora Radochová ◽

Jarmila Vargová ◽

Helena Bujdáková

Keyword(s):

Medical Devices ◽

Surgical Site Infections ◽

Central Line ◽

Ventilator Associated Pneumonia ◽

Healthcare Associated Infections ◽

Care Bundles ◽

Planktonic Form ◽

Novel Approaches ◽

Healthcare Associated ◽

The Impact

Healthcare-associated infections (HAIs) are caused by nosocomial pathogens. HAIs have an immense impact not only on developing countries but also on highly developed parts of world. They are predominantly device-associated infections that are caused by the planktonic form of microorganisms as well as those organized in biofilms. This review elucidates the impact of HAIs, focusing on device-associated infections such as central line-associated bloodstream infection including catheter infection, catheter-associated urinary tract infection, ventilator-associated pneumonia, and surgical site infections. The most relevant microorganisms are mentioned in terms of their frequency of infection on medical devices. Standard care bundles, conventional therapy, and novel approaches against device-associated infections are briefly mentioned as well. This review concisely summarizes relevant and up-to-date information on HAIs and HAI-associated microorganisms and also provides a description of several useful approaches for tackling HAIs.

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Costs of ambulatory pediatric healthcare-associated infections: Central-line–associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs)

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.305 ◽

2020 ◽

Vol 41 (11) ◽

pp. 1292-1297

Author(s):

Michael L. Rinke ◽

Suzette O. Oyeku ◽

William J. H. Ford ◽

Moonseong Heo ◽

Lisa Saiman ◽

...

Keyword(s):

Urinary Tract ◽

Ambulatory Surgery ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Central Line ◽

Healthcare Associated Infections ◽

Retrospective Case ◽

Additional Costs ◽

Tract Infections ◽

Healthcare Associated

AbstractObjective:Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This study estimated additional costs associated with pediatric ambulatory central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery.Design:Retrospective case-control study.Setting:Four academic medical centers.Patients:Children aged 0–22 years seen between 2010 and 2015 and at risk for HAI as identified by electronic queries.Methods:Chart review adjudicated HAIs. Charges were obtained for patients with HAIs and matched controls 30 days before HAI, on the day of, and 30 days after HAI. Charges were converted to costs and 2015 USD. Mixed-effects linear regression was used to estimate the difference-in-differences of HAI case versus control costs in 2 models: unrecorded charge values considered missing and a sensitivity analysis with unrecorded charge considered $0.Results:Our search identified 177 patients with ambulatory CLABSIs, 53 with ambulatory CAUTIs, and 26 with SSIs following ambulatory surgery who were matched with 382, 110, and 75 controls, respectively. Additional cost associated with an ambulatory CLABSI was $5,684 (95% confidence interval [CI], $1,005–$10,362) and $6,502 (95% CI, $2,261–$10,744) in the 2 models; cost associated with a CAUTI was $6,660 (95% CI, $1,055, $12,145) and $2,661 (95% CI, −$431 to $5,753); cost associated with an SSI following ambulatory surgery at 1 institution only was $6,370 (95% CI, $4,022–$8,719).Conclusions:Ambulatory HAI in pediatric patients are associated with significant additional costs. Further work is needed to reduce ambulatory HAIs.

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Healthcare-associated infections in the postoperative period after cardiac surgery

International Journal of Infection Control ◽

10.3396/ijic.v14i1.002.18 ◽

2018 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Edivete Regina Andrioli ◽

Rubens Andrioli Cavalheiro ◽

Guilherme Campos Furtado ◽

Walter José Gomes ◽

Eduardo Alexandrino Medeiros

Keyword(s):

Cardiac Surgery ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Central Line ◽

Healthcare Associated Infections ◽

Independent Variables ◽

Tract Infections ◽

Healthcare Associated

Background: This study aimed to determine the incidence of healthcare-associated infections (HAIs) in patients undergoing cardiac surgery, analyzing data and clinical outcomes in patients with and without HAIs. Methods: This was a prospective cohort study involving 293 consecutive adult patients undergoing cardiac surgery between April 2011 and October 2012. Results: Of the 293 patients, 60 (24.9%) developed 73 HAIs: 24 surgical site infections, 24 pneumonias, 14 urinary tract infections (UTIs), and 11 bloodstream infections (BSIs). The incidence of ventilator-associated pneumonia was 14.6 cases/1,000 ventilator-days, whereas that of catheter-associated UTI was 7.15 cases/1,000 catheter-days and that of central line-associated BSI was 4.52 cases/1,000 central line-days. Of the 60 patients with HAIs, 20 (33%) died before postoperative day 90, compared with 18 (7.7%) of the 233 patients without HAIs (P < .001). Independent variables associated with infection were length of hospital stay (OR, 1.04; 95% CI, 1.01-1.06; P = .002), duration of urinary catheter use (OR, 1.19; 95% CI, 1.07-1.13; P = .001), and duration of central line use (OR, 1.07; 95% CI, 1.01-1.13; P = .032). Independent variables associated with mortality were Acute Physiology and Chronic Health Evaluation II score (OR, 1.27; 95% CI 1.14-1.42; P < .001), pneumonia (OR, 11.94; 95% CI, 3.83-37.17; P < .001), UTI (OR, 8.59; 95% CI, 1.91-38.7; P = .005), and BSI (OR, 6.16; 95% CI, 1.08-34.98; P = .040). Conclusion: Among the most important complications after cardiac surgery are HAIs. Patients who experience postoperative infections have increased length of hospital stay and mortality.

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Prevention of healthcare associated infections

Manual of Infection Prevention and Control ◽

10.1093/med/9780198815938.003.0007 ◽

2019 ◽

pp. 233-304 ◽

Cited By ~ 1

Author(s):

Nizam Damani

Keyword(s):

Prevention And Control ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Central Line ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Tract Infections ◽

Healthcare Associated ◽

Hospital Acquired ◽

And Control

This chapter provides the most up-to-date advice on infection prevention and control (IPC) of the four most common healthcare-associated infections (HAIs). These are: surgical site infections; infection associated with peripheral IV line/cannula and central line-associated bloodstream infections (CLABSIs); catheter-associated urinary tract infections (CAUTI); and hospital-acquired and ventilator-acquired pneumonias (VAP). The chapter examines and summarizes various key elements and discusses implementation of HAI care bundles and high impact interventions which are necessary to reduce these infections.

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PP34 Costs Of Healthcare-Associated Infections In Latin America

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462319001971 ◽

2019 ◽

Vol 35 (S1) ◽

pp. 43-43

Author(s):

Ângela Bagattini ◽

Martha Martinez-Silveira ◽

Ana Zara ◽

Valeska Stempliuk ◽

Cristiana Toscano

Keyword(s):

Latin American ◽

Data Extraction ◽

Surgical Site Infections ◽

Central Line ◽

Healthcare Associated Infections ◽

Cross Sectional ◽

Middle Income ◽

Quasi Experimental ◽

Tract Infections ◽

Healthcare Associated

IntroductionHealthcare-associated infections (HAI) are among the most common preventable health adverse event, associated with significant burden globally. Limited data on HAI costs in lower and middle-income countries is available. The aim of this study is to assess the cost, additional length-of-stay (LOS) and extra-mortality of HAI in the Latin American and Caribbean (LAC) Region.MethodsWe searched Medline/PubMed, Embase, Web of Science, Lilacs, Cochrane, National Health Service Economic Evaluation Database, Centre for Reviews and Dissemination, EconLit, and gray literature published in any language without restriction of date till July 2017. We included observational studies addressing the outcomes of interest, in which hospitalized patients with HAI are compared to those without HAI. The following study designs were included: quasi-experimental, controlled before-after, prospective and retrospective comparative cohort, case-control, and cross-sectional studies. We considered the following HAI-sites: surgical site infections (SSI), catheter-associated urinary-tract infections (CA-UTI), ventilator-associated pneumonia (VAP), and central line-associated bloodstream infection (CLA-BSI), as well as cross-infection (CI). Screening of citations, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers, according to the study protocol registered on PROSPERO. Reported costs were converted to USD considering official exchange rates.ResultsWe identified 4,339 citations. After removing duplicates, a total of 3,029 citations were screened for eligibility. A total of 87 studies from 17 countries were included. The majority (27.4 percent) reported on VAP, followed by CLA-BSI (21.2 percent), SSI (16.4 percent), and CA-UTI (14.4 percent). Most studies (46.7 percent) reported on incremental LOS, with an average of 14.8 days (range 0.9-49 days). Costs were reported by 25 percent of studies, with average incremental costs of USD 3,460 (range 49-12,155). Average extra-mortality of 15.6 percent (range -2.8-45.2 percent) was reported by 12.6 percent of studies.ConclusionsAvailable evidence from the LAC Region reports significant economic burden of HAI. This information will be useful for cost-effectiveness analysis of interventions aimed at reducing HAI economic and health burden.

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Pathogens Associated With Repeat Versus Single Central-Line–Associated Bloodstream Infections, Acute-Care Hospitals, NHSN

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.956 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s343-s344

Author(s):

Margaret A. Dudeck ◽

Katherine Allen-Bridson ◽

Jonathan R. Edwards

Keyword(s):

Acute Care ◽

National Level ◽

Bloodstream Infections ◽

Acute Care Hospitals ◽

Central Line ◽

Patient Specific ◽

Healthcare Associated Infections ◽

Healthcare Associated ◽

Repeat Infection ◽

Single Versus

Background: The NHSN is the nation’s largest surveillance system for healthcare-associated infections. Since 2011, acute-care hospitals (ACHs) have been required to report intensive care unit (ICU) central-line–associated bloodstream infections (CLABSIs) to the NHSN pursuant to CMS requirements. In 2015, this requirement included general medical, surgical, and medical-surgical wards. Also in 2015, the NHSN implemented a repeat infection timeframe (RIT) that required repeat CLABSIs, in the same patient and admission, to be excluded if onset was within 14 days. This analysis is the first at the national level to describe repeat CLABSIs. Methods: Index CLABSIs reported in ACH ICUs and select wards during 2015–2108 were included, in addition to repeat CLABSIs occurring at any location during the same period. CLABSIs were stratified into 2 groups: single and repeat CLABSIs. The repeat CLABSI group included the index CLABSI and subsequent CLABSI(s) reported for the same patient. Up to 5 CLABSIs were included for a single patient. Pathogen analyses were limited to the first pathogen reported for each CLABSI, which is considered to be the most important cause of the event. Likelihood ratio χ2 tests were used to determine differences in proportions. Results: Of the 70,214 CLABSIs reported, 5,983 (8.5%) were repeat CLABSIs. Of 3,264 nonindex CLABSIs, 425 (13%) were identified in non-ICU or non-select ward locations. Staphylococcus aureus was the most common pathogen in both the single and repeat CLABSI groups (14.2% and 12%, respectively) (Fig. 1). Compared to all other pathogens, CLABSIs reported with Candida spp were less likely in a repeat CLABSI event than in a single CLABSI event (P < .0001). Insertion-related organisms were more likely to be associated with single CLABSIs than repeat CLABSIs (P < .0001) (Fig. 2). Alternatively, Enterococcus spp or Klebsiella pneumoniae and K. oxytoca were more likely to be associated with repeat CLABSIs than single CLABSIs (P < .0001). Conclusions: This analysis highlights differences in the aggregate pathogen distributions comparing single versus repeat CLABSIs. Assessing the pathogens associated with repeat CLABSIs may offer another way to assess the success of CLABSI prevention efforts (eg, clean insertion practices). Pathogens such as Enterococcus spp and Klebsiella spp demonstrate a greater association with repeat CLABSIs. Thus, instituting prevention efforts focused on these organisms may warrant greater attention and could impact the likelihood of repeat CLABSIs. Additional analysis of patient-specific pathogens identified in the repeat CLABSI group may yield further clarification.Funding: NoneDisclosures: None

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Longitudinal Trends in All Healthcare-Associated Infections through Comprehensive Hospital-wide Surveillance and Infection Control Measures over the Past 12 Years: Substantial Burden of Healthcare-Associated Infections Outside of Intensive Care Units and “Other” Types of Infection

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.142 ◽

2015 ◽

Vol 36 (10) ◽

pp. 1139-1147 ◽

Cited By ~ 14

Author(s):

Hajime Kanamori ◽

David J. Weber ◽

Lauren M. DiBiase ◽

Emily E. Sickbert-Bennett ◽

Rebecca Brooks ◽

...

Keyword(s):

Intensive Care ◽

Tract Infection ◽

Intensive Care Units ◽

Linear Models ◽

Infection Type ◽

Tertiary Care ◽

Surgical Site Infections ◽

Control Measures ◽

Healthcare Associated Infections ◽

Healthcare Associated

OBJECTIVETargeted surveillance has focused on device-associated infections and surgical site infections (SSIs) and is often limited to healthcare-associated infections (HAIs) in high-risk areas. Longitudinal trends in all HAIs, including other types of HAIs, and HAIs outside of intensive care units (ICUs) remain unclear. We examined the incidences of all HAIs using comprehensive hospital-wide surveillance over a 12-year period (2001–2012).METHODSThis retrospective observational study was conducted at the University of North Carolina (UNC) Hospitals, a tertiary care academic facility. All HAIs, including 5 major infections with 14 specific infection sites as defined using CDC criteria, were ascertained through comprehensive hospital-wide surveillance. Generalized linear models were used to examine the incidence rate difference by infection type over time.RESULTSA total of 16,579 HAIs included 6,397 cases in ICUs and 10,182 cases outside ICUs. The incidence of overall HAIs decreased significantly hospital-wide (−3.4 infections per 1,000 patient days), in ICUs (−8.4 infections per 1,000 patient days), and in non-ICU settings (−1.9 infections per 1,000 patient days). The incidences of bloodstream infection, urinary tract infection, and pneumonia in hospital-wide settings decreased significantly, but the incidences of SSI and lower respiratory tract infection remained unchanged. The incidence of Clostridium difficile infection (CDI) increased remarkably. The outcomes were estimated to include 700 overall HAIs prevented, 40 lives saved, and cost savings in excess of $10 million.CONCLUSIONSWe demonstrated success in reducing overall HAIs over a 12-year period. Our data underscore the necessity for surveillance and infection prevention interventions outside of the ICUs, for non–device-associated HAIs, and for CDI.Infect Control Hosp Epidemiol 2015;36(10):1139–1147

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Burden of healthcare-associated infections among hospitalized children within community hospitals participating in an infection control network

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.67 ◽

2021 ◽

pp. 1-3

Author(s):

Ibukunoluwa C. Akinboyo ◽

Rebecca R. Young ◽

Michael J. Smith ◽

Sarah S. Lewis ◽

Becky A. Smith ◽

...

Keyword(s):

Infection Control ◽

Bloodstream Infections ◽

Central Line ◽

Control Network ◽

Hospitalized Children ◽

Healthcare Associated Infections ◽

Community Hospitals ◽

Prospective Surveillance ◽

Healthcare Associated ◽

Pediatric Healthcare

Abstract We describe the frequency of pediatric healthcare-associated infections (HAIs) identified through prospective surveillance in community hospitals participating in an infection control network. Over a 6-year period, 84 HAIs were identified. Of these 51 (61%) were pediatric central-line–associated bloodstream infections, and they often occurred in children <1 year of age.

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Current Pattern and Clinico-Bacteriological Profile of Healthcare Associated Infections (HAI) in an ICU Setting: An Observational Study

10.21203/rs.3.rs-874099/v1 ◽

2021 ◽

Author(s):

Mradul Kumar Daga ◽

Govind Mawari ◽

Saman Wasi ◽

Naresh Kumar ◽

Udbhav Sharma ◽

...

Keyword(s):

Age Groups ◽

Healthcare Facility ◽

Central Line ◽

Multidrug Resistant ◽

Gram Negative Bacteria ◽

Healthcare Associated Infections ◽

Acinetobacter Species ◽

Gram Negative ◽

Causative Agents ◽

Healthcare Associated

Abstract Objective To understand the pattern and types of healthcare associated infections (HAI) at our healthcare facility, and to determine the common causative agents and their antibiotic susceptibility profile. Methods One hundred consecutive patients diagnosed with HAI were enrolled and monitored; the causative organisms isolated on culture were recorded and their sensitivity profile was generated. Results Of the 100 patients diagnosed with HAI (mean age ± SD being 42 ± 17 years), there were a total of 110 hospital acquired infections with 10 patients having two infections each. Out of 100 patients with HAI, 69 patients had ventilator associated pneumonia (VAP), 21 patients had catheter associated urinary tract infection (CAUTI) patients, and 20 patients had central line associated bloodstream infection (CLABSI). There were 10 patients with both VAP and CAUTI. All of the HAIs were device associated. A total of 76 pathogens were isolated on culture. No organism was isolated in 40 HAI. Majority (94.7%) of the organisms isolated from HAIs were gram-negative bacteria and all were multidrug resistant. Seventy-seven of the enrolled patients expired while 23 were discharged from the hospital Conclusions Our study demonstrated that HAIs occur in patients of all age groups; younger patients are not spared. Majority of the HAIs were caused by multidrug resistant gram-negative bacteria and were associated with high patient mortality. Acinetobacter species was the most common organism associated with HAI.

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