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Hei H, Hoegg C, Smathers S, Coffin S, Sammons JS. A Multidimensional Quality Improvement Initiative to Reduce Pediatric Healthcare-Associated Respiratory Viral Infections. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sammons JS, Ross R, Ditaranto S, Gilman M, Reilly A, Kersun L, Shanahan A, Coffin S. Mucosal Barrier Injury Central Line-Associated Bloodstream Infections: What Is the Impact of Standard Prevention Bundles? Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Odeniyi F, Szymczak JE, Metlay J, Coffin S, Feemster K. Exploring Clinic Characteristics and Opportunities for Hand Hygiene Among Parents and Patients in Pediatric Ambulatory Settings. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Odeniyi F, Szymczak JE, Coffin S, Metlay J, Feemster K. Healthcare Worker (HCW) Perceptions of Healthcare-Associated Respiratory Infection in Pediatric Clinics: A Qualitative Study. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Feemster K, Coffin S, Sastri N. Who Gets Treated for Influenza: Predictors of Antiviral Prescription Receipt Among Children With Outpatient Influenza-Like Illness. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Kelly B, Lautenbach E, Nachamkin I, Coffin S, Gerber JS, Fuchs B, Garrigan C, Han X, Bilker W, Wise J, Tolomeo P, Han, J. Combined Biomarkers Discriminate Mortality Risk Among Critically Ill Patients With Suspected Sepsis. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dimopoulou A, Kourlaba G, Psarris A, Coffin S, Spoulou V, Zaoutis T. Perioperative antimicrobial prophylaxis in pediatric patients in Greece: Compliance with guidelines and impact of an educational intervention. J Pediatr Surg 2016; 51:1307-11. [PMID: 26711690 DOI: 10.1016/j.jpedsurg.2015.11.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 11/03/2015] [Accepted: 11/22/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Appropriate antimicrobial prophylaxis (PAP) prevents surgical site infections (SSI). The aim of this study was to evaluate the effectiveness of an educational intervention to improve adherence to PAP guidelines in pediatric patients. METHODS A three-phase prospective study with a pre-post design was conducted from April 2013 to December 2014. All patients who underwent one or more surgical procedures were enrolled. A modified Centers for Disease Control's (CDC) Denominator for Procedure form was used to collect clinical and PAP data. The educational intervention was targeted at all pediatric surgeons in the department. Outcomes assessed were the appropriateness of the agent selected for PAP (according to international guidelines) and appropriate termination of PAP within 24h of surgery completion. SSI rates were calculated before and after the intervention. RESULTS During the study period 889 children were enrolled (219 in the preintervention and 670 in the postintervention period). The percentage of patients receiving appropriate PAP improved from 6.2% to 77.1% after the educational intervention (p<0.001). The median duration of PAP was reduced from 5 to 1days in preintervention and postintervention period, respectively. There was no increase in the rate of SSIs (0.93% and 0.92%, p=0.992, in preinterventionand postintervention, respectively). CONCLUSIONS An educational intervention targeted at pediatric surgeons improved the selection of agent and timely discontinuation of PAP.
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Dimopoulou A, Papanikolaou Z, Kourlaba G, Kopsidas I, Coffin S, Zaoutis T. Surgical Site Infections and Compliance with Perioperative Antimicrobial Prophylaxis in Greek Children. Infect Control Hosp Epidemiol 2016; 35:1425-7. [DOI: 10.1086/678411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Cocoros NM, Kleinman K, Priebe GP, Gray JE, Logan LK, Larsen G, Sammons J, Toltzis P, Miroshnik I, Horan K, Burton M, Sims S, Harper M, Coffin S, Sandora TJ, Hocevar SN, Checchia PA, Klompas M, Lee GM. Ventilator-Associated Events in Neonates and Children--A New Paradigm. Crit Care Med 2016; 44:14-22. [PMID: 26524075 PMCID: PMC10884951 DOI: 10.1097/ccm.0000000000001372] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify a pediatric ventilator-associated condition definition for use in neonates and children by exploring whether potential ventilator-associated condition definitions identify patients with worse outcomes. DESIGN Retrospective cohort study and a matched cohort analysis. SETTING Pediatric, cardiac, and neonatal ICUs in five U.S. hospitals. PATIENTS Children 18 years old or younger ventilated for at least 1 day. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We evaluated the evidence of worsening oxygenation via a range of thresholds for increases in daily minimum fraction of inspired oxygen (by 0.20, 0.25, and 0.30) and daily minimum mean airway pressure (by 4, 5, 6, and 7 cm H2O). We required worsening oxygenation be sustained for at least 2 days after at least 2 days of stability. We matched patients with a ventilator-associated condition to those without and used Cox proportional hazard models with frailties to examine associations with hospital mortality, hospital and ICU length of stay, and duration of ventilation. The cohort included 8,862 children with 10,209 hospitalizations and 77,751 ventilator days. For the fraction of inspired oxygen 0.25/mean airway pressure 4 definition (i.e., increase in minimum daily fraction of inspired oxygen by 0.25 or mean airway pressure by 4), rates ranged from 2.9 to 3.2 per 1,000 ventilator days depending on ICU type; the fraction of inspired oxygen 0.30/mean airway pressure 7 definition yielded ventilator-associated condition rates of 1.1-1.3 per 1,000 ventilator days. All definitions were significantly associated with greater risk of hospital death, with hazard ratios ranging from 1.6 (95% CI, 0.7-3.4) to 6.8 (2.9-16.0), depending on thresholds and ICU type. Each definition was associated with prolonged hospitalization, time in ICU, and duration of ventilation, among survivors. The advisory board of the study proposed using the fraction of inspired oxygen 0.25/mean airway pressure 4 thresholds to identify pediatric ventilator-associated conditions in ICUs. CONCLUSIONS Pediatric patients with ventilator-associated conditions are at substantially higher risk for mortality and morbidity across ICUs, regardless of thresholds used. Next steps include identification of risk factors, etiologies, and preventative measures for pediatric ventilator-associated conditions.
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Han J, Nachamkin I, Coffin S, Gerber JS, Garrigan C, Han X, Bilker W, Wise J, Tolomeo P, Lautenbach E. Use of a Combination Biomarker Algorithm to Identify Critically Ill Surgical Patients With Suspected Sepsis at Very Low Likelihood of Bacterial Infection. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ross R, Canning D, Coffin S, Gerber JS. Patterns of Perioperative Antibiotic Use After Ambulatory Surgery in Ambulatory Surgical Centers Versus a Hospital-Based Facility. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Downes K, Weiss S, Klieger SB, Fitzgerald J, Balamuth F, Kubis S, Tolomeo P, Bilker W, Han X, Nachamkin I, Garrigan C, Han J, Lautenbach E, Gerber JS, Coffin S. Developing a Biomarker-Driven Algorithm to Improve Antibiotic Use in the Pediatric Intensive Care Unit: The Optimizing Antibiotic Strategies in Sepsis (OASIS) Study. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chang C, Feemster K, Coffin S, Handy L. Treatment-Related Complications in Children With Disseminated Lyme Disease. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Han J, Nachamkin I, Coffin S, Gerber JS, Fuchs B, Garrigan C, Han X, Bilker W, Wise J, Tolomeo P, Lautenbach E. Use of a Combination Biomarker Algorithm to Identify Intensive Care Unit Patients With Suspected Sepsis at Very Low Likelihood of Bacterial Infection. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Feemster K, Vendetti N, Coffin S. Who Gets Tested for Influenza: Exploring Socioeconomic Disparities in Influenza Testing Practices for Children in Pediatric Clinics. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cocoros N, Sandora TJ, Logan LK, Coffin S, Priebe GP, Sammons JS, Larsen G, Toltzis P, Horan K, Miroshnik I, Burton M, Checchia PA, Klompas M, Lee G. Infection-Related Ventilator-Associated Complications (iVAC) in Neonates and Children: Can We Identify It? Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Odeniyi F, Szymczak JE, Coffin S, Feemster K. Parent Perceptions of Healthcare-Associated Respiratory Infection in Pediatric Clinics: A Qualitative Study. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Marlowe L, Mistry RD, Coffin S, Leckerman KH, McGowan KL, Dai D, Bell LM, Zaoutis T. Blood Culture Contamination Rates after Skin Antisepsis with Chlorhexidine Gluconate versus Povidone-Iodine in a Pediatric Emergency Department. Infect Control Hosp Epidemiol 2015; 31:171-6. [DOI: 10.1086/650201] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective.To determine blood culture contamination rates after skin antisepsis with Chlorhexidine, compared with povidone-iodine.Design.Retrospective, quasi-experimental study.Setting.Emergency department of a tertiary care children's hospital.Patients.Children aged 2-36 months with peripheral blood culture results from February 2004 to June 2008. Control patients were children younger than 2 months with peripheral blood culture results.Methods.Blood culture contamination rates were compared using segmented regression analysis of time-series data among 3 patient groups: (1) patients aged 2-36 months during the 26-month preintervention period, in which 10% povidone-iodine was used for skin antisepsis before blood culture; (2) patients aged 2-36 months during the 26-month postintervention period, in which 3% Chlorhexidine gluconate was used; and (3) patients younger than 2 months not exposed to the Chlorhexidine intervention (ie, the control group).Results.Results from 11,595 eligible blood cultures were reviewed (4,942 from the preintervention group, 4,274 from the postintervention group, and 2,379 from the control group). For children aged 2-36 months, the blood culture contamination rate decreased from 24.81 to 17.19 contaminated cultures per 1,000 cultures (P< .05) after implementation of Chlorhexidine. This decrease of 7.62 contaminated cultures per 1,000 cultures (95% confidence interval, —0.781 to —15.16) represented a 30% relative decrease from the preintervention period and was sustained over the entire postintervention period. No change in contamination rate was observed in the control group (P= .337).Conclusion.Skin antisepsis with Chlorhexidine significantly reduces the blood culture contamination rate among young children, as compared with povidone-iodine.
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Wilson K, Smathers S, Teszner E, Farrell L, Cohen D, Schleelein L, Coffin S, Sammons JS. Improving Hand Hygiene in a Pediatric Operative Environment. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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See I, Chang J, Gualandi N, Buser GL, Rohrbach P, Smeltz D, Bellush MJ, Coffin S, Gould JM, Hennessey P, Hess D, Hubbard S, Kiernan A, O'donnell J, Pegues D, Miller JR, Magill SS. 894Evaluating Clinical Credibility of Surveillance Definitions for Healthcare-Associated Pneumonia and Lower Respiratory Infections. Open Forum Infect Dis 2014. [PMCID: PMC5781482 DOI: 10.1093/ofid/ofu052.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Tribble A, Coffin S, Campos D, Feemster K. 1413Factors Associated with Pertussis Testing: Potential Disparities in Case Ascertainment. Open Forum Infect Dis 2014. [DOI: 10.1093/ofid/ofu052.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mougkou K, Kouni S, Kurlaba G, Kitra M, Gkentzi D, Maroudi-Manta S, Lourida A, Coffin S, Zaoutis T. P218: Active surveillance for central line associated bloodstream infections in hospitalized children in Greece. Antimicrob Resist Infect Control 2013. [PMCID: PMC3688088 DOI: 10.1186/2047-2994-2-s1-p218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kouni S, Mougkou K, Kurlaba G, Nteli C, Lourida A, Maroudi-Manta S, Zaoutis T, Coffin S. P130: Assessment of hand hygiene practices at the two children's hospitals in Greece. Antimicrob Resist Infect Control 2013. [PMCID: PMC3687970 DOI: 10.1186/2047-2994-2-s1-p130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Thu TA, Rahman M, Coffin S, Harun-Or-Rashid M, Sakamoto J, Hung NV. Antibiotic use in Vietnamese hospitals: a multicenter point-prevalence study. Am J Infect Control 2012; 40:840-4. [PMID: 22341530 DOI: 10.1016/j.ajic.2011.10.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 10/28/2011] [Accepted: 10/28/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Inappropriate antibiotic prescribing appears to be common worldwide and is contributing to the selection of resistant organisms. This study examined the prevalence of antibiotic prescription and the appropriateness of indications for these prescriptions in 36 representative general hospitals across Vietnam. METHODS A point-prevalence study was performed between February and December 2008. All inpatients on the day of the survey were included in the analysis. Standard published guidelines were used to evaluate the appropriateness of indications for antibiotic prescription. RESULTS On the day of the study, 5,104 of 7,571 patients (67.4%) were receiving antibiotic therapy. The antibiotic prescription rate was highest in surgery wards (93.2%) and lowest in medical wards (48.2%). Of the 5,104 patients receiving antibiotics, the most commonly prescribed agents were cephalosporins (70.2%), penicillins (21.6%), and aminoglycosides (18.9%). Approximately one-third of the patients (1,573 of 5,104) had an inappropriate indication for prescription. Risk factors independently associated with inappropriate indication for antibiotic prescription were seen in hospitals at the national level, obstetrics and gynecology departments, and surgical wards. CONCLUSIONS Our data indicate a high rate of antibiotic use in Vietnamese hospitals, and also a high prevalence of inappropriate indications for antibiotic prescriptions. These findings suggest important areas for intervention and implementation of antibiotic stewardship policies in Vietnamese hospitals.
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Smathers S, Smathers SA, Hoegg CL, Sherman E, Brittingham L, Evans JR, Coffin S. Control of MRSA Colonization in a Teritiary NICU. Am J Infect Control 2012. [DOI: 10.1016/j.ajic.2012.04.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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