Infection surveillance in nursing homes in Stockholm County, Sweden, 2005 - 2014

2016 ◽  
Vol 12 (3) ◽  
Author(s):  
Ann Tammelin
Keyword(s):  
Nursing Homes ◽  
Infection Control ◽  
Urinary Catheter ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
County Council ◽  
Antibiotic Prescribing ◽  
Viral Gastroenteritis ◽  
Stockholm County ◽  
Infection Surveillance

Swedish nursing homes are obliged to have a management system for systematic quality work including self-monitoring of which surveillance of infections is one part. The Department of Infection Control in Stockholm County Council has provided a simple system for infection surveillance to the nursing homes in Stockholm County since 2002. A form is filled in by registered nurses in the nursing homes at each episode of infection among the residents. A bacterial infection is defined by antibiotic prescribing and a viral infection by clinical signs and symptoms. Yearly reports of numbers of infections in each nursing home and calculated normalized figures for incidence, i.e. infections per 100 residents per year, as well as proportion of residents with urinary catheter are delivered to the medically responsible nurses in each municipality by the Department of Infection Control. Number of included residents has varied from 4,531 in 2005 to 8,157 in 2014 with a peak of 10,051 in 2009. The yearly incidences during 2005 - 2014 (cases per 100 residents) were: Urinary tract infection (UTI) 7.9-16.0, Pneumonia 3.7-5.3, Infection of chronic ulcer 3.4–6.8, Other infection in skin or soft tissue 1.4–2.9, Clostridium difficile-infection 0.2–0.7, Influenza 0–0.4 and Viral gastroenteritis 1.2–3.7. About 1 % of the residents have a suprapubic urinary catheter, 6–7 % have an indwelling urinary catheter. Knowledge about the incidence of UTI has contributed to the decrease of this infection both in residents with and without urinary catheter.

scholarly journals 2193. Factors Impacting the Duration of Antimicrobial Therapy for Community-Acquired Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S746-S747
Author(s):  
Avnish Sandhu ◽  
Erin Goldman ◽  
Jordan Polistico ◽  
Sarah Polistico ◽  
Ahmed Oudeif ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Clinical Signs ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Community Acquired Pneumonia ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Factors Associated ◽  
Specific Risk

Abstract Background Pneumonia is a common cause of infection associated with hospitalization. Treatment durations for community-acquired pneumonia (CAP) often exceed guideline recommended durations of 5–7 days without a clear explanation. The objective of this study was to determine factors that may lead to durations exceeding this recommendation. Methods A retrospective chart review of 89 patients admitted to the Detroit Medical Center (DMC) for the treatment of pneumonia was conducted. Demographics, clinical signs and symptoms, antibiotic data, pneumonia severity score (CURB 65), risk factors for resistance, microbiology results, and outcomes were recorded and analyzed for factors associated with increased durations of antibiotics. Average durations of antibiotics and durations of antibiotics greater that 7 days were assessed for each risk factor. Results Average durations of antibiotics was 9 days (SD 3.8) for the cohort, and 55 (61%) received durations of > 7 days. Average durations of antibiotics for risk factors are shown in Table 1. Factors associated with durations of antibiotics longer than 7 days are shown in Table 2. There was a trend toward longer average durations of antibiotics for persons with risk factors for resistance [Drug Resistance in Pneumonia (DRIP) score ≥ 4 (increased duration of antibiotics by 1.7 days, P = 0.07] and those with a positive legionella antigen [increased durations of antibiotics by 6.6 days, P = 0.07]. Conclusion Specific risk factors could not be associated with increased durations of antibiotics, although there was a trend toward longer durations for persons with markers for resistance and positive legionella testing. Efforts to reduce durations of antibiotics must target global clinician antibiotic prescribing patterns and not specific risk factors. Disclosures All authors: No reported disclosures.

scholarly journals Coronavirus Disease-19 and Dentistry: A Review

2020 ◽  
Vol 8 (T1) ◽  
pp. 618-621
Author(s):  
Fareedi Mukram Ali ◽  
Kishor Patil ◽  
Elnur Ibrahim Albashir ◽  
Abdulhamid Aidarous Alamir
Keyword(s):  
Infection Control ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Control Measures ◽  
Clinical Settings ◽  
Related Information ◽  
Infection Control Measures ◽  
Dental Practitioners ◽  
Clinical Signs And Symptoms ◽  
Novel Coronavirus

Novel coronavirus (nCoV) is a novel form of virus with a new strain identified recently in humans. Common clinical signs and symptoms primarily consist of fever, cough, and breathing difficulties. In severe cases, it can results in pneumonia, severe acute respiratory syndrome, kidney failure, and even death. It is important to follow all infection control measures in prevention of the nCoV from spreading and controlling the epidemic situation. The risk of cross infection can be high between dental practitioners and patients due to the features of dental clinical settings. Here, we are summarizing the nCoV related information and infection control measures to be followed in dental practice.

scholarly journals 808. Evaluating the Incidence of Bacteriuria in Female Patients Before and After Implementation of External Catheter Devices

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S447-S447
Author(s):  
Mandee Noval ◽  
Surbhi Leekha ◽  
Meghna Bhatt ◽  
Michael Armhazizer ◽  
Abigale Celotto ◽  
...  
Keyword(s):  
Urinary Catheter ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Antibiotic Use ◽  
Urinary Catheters ◽  
Post Intervention ◽  
Icu Patients ◽  
Female Population ◽  
Days Of Therapy ◽  
Positive Urine

Abstract Background Bacteriuria associated with indwelling urinary catheters is commonly linked to inappropriate antibiotic use in hospitals. The use of external catheter devices (ECD) has increased in recent years to reduce bacteriuria risk in women, based on data in male patients. Currently no studies have shown a similar benefit in the female population. Methods This was a quasi-experimental study among adult female ICU patients with urinary catheters (indwelling or external) between 12/2015 – 5/2017 (pre-ECD) and 12/2017 – 6/2019 (post-ECD). The primary outcome was the incidence of positive urine cultures pre- vs post-intervention. An a priori subgroup patient-level analysis evaluated positive urine cultures and antibiotic use pre- vs post-intervention in medical and surgical ICU patients who had a urinalysis ordered in the presence of an indwelling or external urinary catheter. Antibiotic use was considered appropriate when prescribed in the presence of a positive urine culture, clinical signs and symptoms of UTI, and a UTI order indication. Results There were 4,640 patient ICU encounters during the study period; 2,201 pre- vs 2,439 post-intervention. Mean age was 59.2 (SD 15.4) years, median Elixhauser Score was 6 (IQR 4, 7), and there were no significant differences between groups. In the overall cohort, there was a decrease in the monthly rate of indwelling urinary catheter use pre- versus post- intervention (Figure 1) of 182/1,000 vs 166/1,000 patient days, P = 0.03. There was also a decrease in rate of positive urine cultures from pre- to post- intervention (38/1,000 vs 28/1,000 patient days, P = 0.004). Antibiotic days of therapy (DOTs) for UTI indication was similar in the pre- versus post-intervention groups with 1.9/1000 vs. 1.8 DOT/1,000 patient days (P = 0.7). In the subgroup of 210 patients (73 pre- vs 137 post-intervention) who underwent urinalysis, there was also a decrease in the proportion of positive urine cultures from pre- to post-intervention (42.5% vs. 24.3%; P = 0.007). Of patient receiving antibiotics for UTI indication, appropriateness was numerically higher post-intervention (9.1% vs. 31.6%; P = 0.21). Conclusion The use of external urinary catheters may be beneficial in reducing bacteriuria and related antibiotic use among female ICU patients. Disclosures All Authors: No reported disclosures

scholarly journals Reliability of nonlocalizing signs and symptoms as indicators of the presence of infection in nursing-home residents

2020 ◽  
pp. 1-10
Author(s):  
Theresa A. Rowe ◽  
Robin L.P. Jump ◽  
Bjørg Marit Andersen ◽  
David B. Banach ◽  
Kristina A. Bryant ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Drug Effects ◽  
Signs And Symptoms ◽  
Antibiotic Use ◽  
Drug Dose ◽  
Antibiotic Prescribing ◽  
Negative Consequences ◽  
Clostridioides Difficile

Antibiotics are among the most common medications prescribed in nursing homes. The annual prevalence of antibiotic use in residents of nursing homes ranges from 47% to 79%, and more than half of antibiotic courses initiated in nursing-home settings are unnecessary or prescribed inappropriately (wrong drug, dose, or duration). Inappropriate antibiotic use is associated with a variety of negative consequences including Clostridioides difficile infection (CDI), adverse drug effects, drug–drug interactions, and antimicrobial resistance. In response to this problem, public health authorities have called for efforts to improve the quality of antibiotic prescribing in nursing homes.

scholarly journals Clinical characteristics of rotaviruses disease

2004 ◽  
Vol 4 (2) ◽  
pp. 22-24 ◽  
Author(s):  
Šukrija Zvizdić ◽  
Sađida Telalbašić ◽  
Edina Bešlagić ◽  
Semra Čavaljuga ◽  
Jasminka Maglajlić ◽  
...  
Keyword(s):  
Young Children ◽  
Wide Spectrum ◽  
Age Groups ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Latex Agglutination ◽  
Hospitalized Patients ◽  
Viral Gastroenteritis ◽  
Age Group ◽  
Stool Samples

Rotaviruses are the major causes of viral gastroenteritis in infant and the young children. There are a wide spectrum of clinical signs and symptoms of rotavirosis. Rotavirus infection is fecal-oral infection. Rotaviruses prove with Latex agglutination test and electron microscopy. In a four year period 943 stool samples out of 527 hospitalized patients had been analyzed. A presence of rotavirus is proved with a LA and EM tests at 170 (32,2%) patients age 0-7 years, in their stool samples. Analyzing age groups of these patients, it was found that the rotavirusesinfection the most frequently occurred at age group from 7-24 months. From 170 positive patients, 122 or 71,8% were in this age group. At all patients was found diarrhea, vomiting in a 90,5% cases. Mild fever had 65,5% patients, signs of a respiratory infection appeared at 60,7% patients, abdominal pain at 13,3% patients. Severe dehydration had 49,9% patients and metabolic acidosis had 79,2% cases. Macroscopically blood in stool had 6,4% patients, slime in a stool 46,0% patients was found, and aholic stool had 8,4% patients. In all hospitalized patients disease lasted in average 12,6 days, and the hospitalization in average 10,2 days. None of the patient had any kind of complication, all of them very successfully cured. These results confirm that rotaviruses are important health problem among infant and the young children in Bosnia and Herzegovina.

Comparison of criteria for determining appropriateness of antibiotic prescribing in nursing homes

2021 ◽  
pp. 1-4
Author(s):  
Daniela Uribe-Cano ◽  
Mozhdeh Bahranian ◽  
Sally A. Jolles ◽  
Lindsay N. Taylor ◽  
Jill J. Miller ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Infection Type ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Infection Surveillance ◽  
Treatment Indications ◽  
Tract Infections ◽  
Antibiotic Courses ◽  
Level Of Agreement ◽  
Ongoing Monitoring

Abstract Background: Measuring the appropriateness of antibiotic prescribing in nursing homes remains a challenge. The revised McGeer criteria, which are widely used to conduct infection surveillance in nursing homes, were not designed to assess antibiotic appropriateness. The Loeb criteria were explicitly designed for this purpose but are infrequently used outside investigational studies. The extent to which the revised McGeer and Loeb criteria overlap and can be used interchangeably for tracking antibiotic appropriateness in nursing homes remains insufficiently studied. Methods: We conducted a cross-sectional chart review study in 5 Wisconsin nursing homes and applied the revised McGeer and Loeb criteria to all nursing home–initiated antibiotic treatment courses. Kappa (κ) statistics were employed to assess level of agreement overall and by treatment indications. Results: Overall, 734 eligible antibiotic courses were initiated in participating nursing homes during the study period. Of 734 antibiotic courses, 372 (51%) satisfied the Loeb criteria, while only 211 (29%) of 734 satisfied the revised McGeer criteria. Only 169 (23%) of 734 antibiotic courses satisfied both criteria, and the overall level of agreement between them was fair (κ = 0.35). When stratified by infection type, levels of agreement between the revised McGeer and Loeb criteria were moderate for urinary tract infections (κ = 0.45), fair for skin and soft-tissue infections (0.36), and slight for respiratory tract infections (0.17). Conclusions: Agreement between the revised McGeer and Loeb criteria is limited, and nursing homes should employ the revised McGeer and Loeb criteria for their intended purposes. Studies to establish the best method for ongoing monitoring of antibiotic appropriateness in nursing homes are needed.

scholarly journals Associations with antibiotic prescribing for acute exacerbation of COPD in primary care

2021 ◽  
pp. BJGP.2020.0823
Author(s):  
David Gillespie ◽  
Christopher Butler ◽  
Janine Bates ◽  
Kerry Hood ◽  
Hasse Melbye ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Exacerbation ◽  
Point Of Care ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Bacterial Aetiology ◽  
Clinical Signs And Symptoms ◽  
Demographic Features

Background: C-reactive protein point-of-care testing (CRP-POCT) has been shown to reduce antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in primary care by 26%, without compromising patient care. Fewer than half of AECOPD patients present with bacterial aetiology and further safe reductions may be possible. Aim: To investigate the associations between presenting features and antibiotic prescribing in patients with AECOPD in UK primary care. Design and Setting: This was a secondary analysis of a randomised controlled trial of participants presenting with AECOPD in primary care. Method: Clinicians collected participant’s demographic features, comorbid illnesses, clinical signs, and symptoms. Antibiotic prescribing decisions were made following participants being randomised to receive a point-of-care CRP measurement. Multivariable regression models were fitted to explore the association between patient and clinical features and antibiotic prescribing and extended to further explore any interactions with CRP measurement category (CRP not measured, CRP <20mg/L, CRP ≥20mg/L). Results: We included 649 participants from 86 general practices across England and Wales. The odds of antibiotic prescribing were higher in the presence of clinician-recorded crackles (adjusted odds ratio (AOR)=5.22,95%CI:3.24-8.41), wheeze (AOR=1.64,95% CI:1.07-2.52), diminished vesicular breathing (AOR=2.95,95%CI:1.70-5.10), or evidence of consolidation (AOR=34.40,95% CI:2.84-417.27). Increased age was associated with lower odds of antibiotic prescribing (AOR per-year increase =0.98,95% CI:0.95-1.00), as was the presence of heart failure (AOR=0.32,95% CI:0.12-0.85). Conclusion: Several demographic features and clinical signs and symptoms are associated with antibiotic prescribing in AECOPD. The diagnostic and prognostic value of these features may help identify further safe reductions.

USE OF AN ELECTRONIC DATA WAREHOUSE TO ENHANCE CARDIAC SURGICAL SITE SURVEILLANCE AT A LARGE CANADIAN CENTRE

2008 ◽  
Vol 31 (4) ◽  
pp. 21 ◽  
Author(s):  
G W Rose ◽  
V R Roth ◽  
K N Suh ◽  
M Taljaard ◽  
C Van Walraven ◽  
...  
Keyword(s):  
Infection Control ◽  
Surgical Site Infection ◽  
Data Warehouse ◽  
Stepwise Logistic Regression ◽  
Site Infection ◽  
Electronic Data ◽  
Trigger Mechanism ◽  
Trigger Tool ◽  
Infection Surveillance ◽  
Trigger Mechanisms

Background/Purpose: Surgical site infection surveillance to determineincidence is a key infection control activity. Case detection is labour-intensive, therefore most infection control programs use manual or simple electronic mechanisms to “trigger” chart review. However, such “trigger” mechanisms are also labour-intensive, and often of poor specificity. Our objective is to develop a complex trigger mechanism using data from an electronic data warehouse, to improve specificity of surveillance of surgical site infection compared to current trigger mechanisms. Methods: We will derive an electronic trigger tool for cardiac surgical site infection surveillance using a nested case-control design, among a cohort of all patients undergoing coronary artery bypass grafting, cardiac valve repairor replacement, or heart transplant at the University of Ottawa Heart Institute, from July 1 2004 to June 30 2007. We will perform a systematic literature review to identify potential trigger factors to include in the model, then construct the trigger tool by backwards stepwise logistic regression. The best-fit model will be used to calculate the probability of surgical site infection. We will select the threshold probability to use in surveillance by visual inspection of receiver-operator-characteristic curves. The accuracy of this electronic trigger mechanism will be compared to pre-existing manual and simple electronic mechanisms using relative true positive ratios and relative false positive ratios. Results/Conclusions: We have selected 200 cases of surgical site infection and 541 controls from among 3744 procedures performed during the study period. As of the date ofthis abstract we are still undertaking the systematic review.

scholarly journals Prevalence and Course of IgA and IgG Antibodies against SARS-CoV-2 in Healthcare Workers during the First Wave of the COVID-19 Outbreak in Germany: Interim Results from an Ongoing Observational Cohort Study

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 498
Author(s):  
Mark Reinwald ◽  
Peter Markus Deckert ◽  
Oliver Ritter ◽  
Henrike Andresen ◽  
Andreas G. Schreyer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Healthcare Workers ◽  
Significant Proportion ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Observational Cohort Study ◽  
Igg Antibodies ◽  
University Hospitals ◽  
Observational Cohort

(1) Background: Healthcare workers (HCWs) are prone to intensified exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the ongoing pandemic. We prospectively analyzed the prevalence of antibodies against SARS-CoV-2 in HCWs at baseline and follow up with regard to clinical signs and symptoms in two university hospitals in Brandenburg, Germany. (2) Methods: Screening for anti-SARS-CoV-2 IgA and IgG antibodies was offered to HCWs at baseline and follow up two months thereafter in two hospitals of Brandenburg Medical School during the first wave of the COVID-19 pandemic in Germany in an ongoing observational cohort study. Medical history and signs and symptoms were recorded by questionnaires and analyzed. (3) Results: Baseline seroprevalence of anti-SARS-CoV-2 IgA was 11.7% and increased to 15% at follow up, whereas IgG seropositivity was 2.1% at baseline and 2.2% at follow up. The rate of asymptomatic seropositive cases was 39.5%. Symptoms were not associated with general seropositivity for anti-SARS-CoV-2; however, class switch from IgA to IgG was associated with increased symptom burden. (4) Conclusions: The seroprevalence of antibodies against SARS-CoV-2 was low in HCWs but higher compared to population data and increased over time. Screening for antibodies detected a significant proportion of seropositive participants cases without symptoms.

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