scholarly journals Incidence and Risk Factors for Inpatient Falls in an Academic Acute-care Hospital

2006 ◽  
Vol 73 (5) ◽  
pp. 265-270 ◽  
Author(s):  
Akihito Nakai ◽  
Masami Akeda ◽  
Ikuno Kawabata
Keyword(s):  
Risk Factors ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Inpatient Falls

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.

Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Acquisition in Roommate Contacts of Patients Colonized or Infected With MRSA in an Acute-Care Hospital

2008 ◽  
Vol 29 (7) ◽  
pp. 600-606 ◽  
Author(s):  
Christine Moore ◽  
Jastej Dhaliwal ◽  
Agnes Tong ◽  
Sarah Eden ◽  
Cindi Wigston ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Acute Care ◽  
Significant Risk ◽  
Acute Care Hospital ◽  
Skin Lesions ◽  
Care Hospital ◽  
Methicillin Resistant ◽  
The Impact

Objective.To identify risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in patients exposed to an MRSA-colonized roommate.Design.Retrospective cohort study.Setting.A 472-bed acute-care teaching hospital in Toronto, Canada.Patients.Inpatients who shared a room between 1996 and 2004 with a patient who had unrecognized MRSA colonization.Methods.Exposed roommates were identified from infection-control logs and from results of screening for MRSA in the microbiology database. Completed follow-up was defined as completion of at least 2 sets of screening cultures (swab samples from the nares, the rectum, and skin lesions), with at least 1 set of samples obtained 7–10 days after the last exposure. Chart reviews were performed to compare those who did and did not become colonized with MRSA.Results.Of 326 roommates, 198 (61.7%) had completed follow-up, and 25 (12.6%) acquired MRSA by day 7–10 after exposure was recognized, all with strains indistinguishable by pulsed-field gel electrophoresis from those of their roommate. Two (2%) of 101 patients were not colonized at day 7–10 but, with subsequent testing, were identified as being colonized with the same strain as their roommate (one at day 16 and one at day 18 after exposure). A history of alcohol abuse (odds ratio [OR], 9.8 [95% confidence limits {CLs}, 1.8, 53]), exposure to a patient with nosocomially acquired MRSA (OR, 20 [95% CLs, 2.4,171]), increasing care dependency (OR per activity of daily living, 1.7 [95% CLs, 1.1, 2.7]), and having received levofloxacin (OR, 3.6 [95% CLs, 1.1,12]) were associated with MRSA acquisition.Conclusions.Roommates of patients with MRSA are at significant risk for becoming colonized. Further study is needed of the impact of hospital antimicrobial formulary decisions on the risk of acquisition of MRSA.

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 Medication use as a risk factor for inpatient falls in an acute care hospital: a case-crossover study

2010 ◽  
Vol 69 (5) ◽  
pp. 535-542 ◽  
Author(s):  
Hideki Shuto ◽  
Osamu Imakyure ◽  
Junichi Matsumoto ◽  
Takashi Egawa ◽  
Ying Jiang ◽  
...  
Keyword(s):  
Risk Factor ◽  
Crossover Study ◽  
Acute Care ◽  
Medication Use ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Case Crossover ◽  
Inpatient Falls

scholarly journals The Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Colonization and Infection among Long-Term Acute Care Hospital Residents

2015 ◽  
Vol 37 (1) ◽  
pp. 55-60 ◽  
Author(s):  
John P Mills ◽  
Naasha J Talati ◽  
Kevin Alby ◽  
Jennifer H Han
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Significant Risk ◽  
Acute Care Hospital ◽  
Carbapenem Resistance ◽  
Solid Organ ◽  
Care Hospital ◽  
Carbapenem Resistant

OBJECTIVEAn improved understanding of carbapenem-resistant Klebsiella pneumoniae (CRKP) in long-term acute care hospitals (LTACHs) is needed. The objective of this study was to assess risk factors for colonization or infection with CRKP in LTACH residents.METHODSA case-control study was performed at a university-affiliated LTACH from 2008 to 2013. Cases were defined as all patients with clinical cultures positive for CRKP and controls were those with clinical cultures positive for carbapenem-susceptible K. pneumoniae (CSKP). A multivariate model was developed to identify risk factors for CRKP infection or colonization.RESULTSA total of 222 patients were identified with K. pneumoniae clinical cultures during the study period; 99 (45%) were case patients and 123 (55%) were control patients. Our multivariate analysis identified factors associated with a significant risk for CRKP colonization or infection: solid organ or stem cell transplantation (OR, 5.05; 95% CI, 1.23–20.8; P=.03), mechanical ventilation (OR, 2.56; 95% CI, 1.24–5.28; P=.01), fecal incontinence (OR, 5.78; 95% CI, 1.52–22.0; P=.01), and exposure in the prior 30 days to meropenem (OR, 3.55; 95% CI, 1.04–12.1; P=.04), vancomycin (OR, 2.94; 95% CI, 1.18–7.32; P=.02), and metronidazole (OR, 4.22; 95% CI, 1.28–14.0; P=.02).CONCLUSIONSRates of colonization and infection with CRKP were high in the LTACH setting, with nearly half of K. pneumoniae cultures demonstrating carbapenem resistance. Further studies are needed on interventions to limit the emergence of CRKP in LTACHs, including targeted surveillance screening of high-risk patients and effective antibiotic stewardship measures.Infect. Control Hosp. Epidemiol. 2015;37(1):55–60

scholarly journals Risk Factors for Acquisition of Rectal Colonization With KPC-Producing Enterobacteriaceae (KPC) Among Long-Term Acute Care Hospital (LTACH) Patients

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Koh Okamoto ◽  
Michael Y. Lin ◽  
Manon Haverkate ◽  
Karen Lolans ◽  
Nicholas M. Moore ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Rectal Colonization

scholarly journals Risk factor assessment of hospice patients who are readmitted within 7 days of acute care hospital discharge.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 121-121
Author(s):  
Anthony E Wilson ◽  
Diana Martins-Welch ◽  
Bridget Earle ◽  
Andrzej Kozikowski ◽  
Lori Attivissimo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Discharge ◽  
Acute Care ◽  
Private Insurance ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Retrospective Case ◽  
Chi Square ◽  
Exact Test ◽  
Dual Eligibility

121 Background: Although 20% of adults 65 and older are re-hospitalized within 30 days of discharge, there is a dearth of research investigating readmission of patients discharged to hospice and the predictors of the readmissions. The study aim was to identify risk factors for hospital readmission within 7 days of discharge to home hospice. Methods: This was a retrospective case control study with cases being patients discharged to home hospice that were readmitted to the hospital within 7 days. Controls were patients discharged to home hospice and not readmitted to the hospital within 7 days. Descriptive statistics were used to describe demographic and clinical characteristics. The chi-square or Fisher’s Exact test were used to compare categorical predictors between cases and controls. The two-sample t-test or the Mann-Whitney test were used to compare continuous predictors between cases and controls. Results: There were 163 subjects; 46 cases (28.22%) and 117 controls (71.78%). The most frequent hospital diagnosis was cancer (56.4%). There was a significant association between 7-day readmission (i.e., case) and age (P < 0.0041), race (P < 0.0008), language (P < 0.0007) and insurance (P < 0.0001). Specifically, cases were significantly younger than controls (69.5 vs. 77.0). Cases were more likely to be Hispanic (15.2 vs. 5.1), Asian (15.2 vs. 5.1) and other (13.0 vs. 2.6) when compared to controls. Cases were more likely to speak Spanish (13.3 vs. 3.5) or other (20.0 vs. 5.3) and less likely to speak English (66.7 vs. 91.2). Cases were less likely to have Medicare (8.7 vs. 82.9) and more likely to have Medicaid (32.6 vs. 4.3), private insurance (13.0 vs. 10.3) or other form of insurance including dual eligibility (45.7 vs. 2.6). Gender, marital status, religion, hospital diagnosis, discharge day, family support at home, symptoms and emergency contact relationship were not significantly association with 7-day readmission. Conclusions: Our data highlights four risk factors, namely age, race, language and insurance status as factors predicting readmission within seven days of acute care hospital discharge. Further study of these predictors may identify opportunities for interventions to obviate these readmissions.

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