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Teter J, Guajardo I, Al-Rammah T, Rosson G, Perl TM, Manahan M. Assessment of operating room airflow using air particle counts and direct observation of door openings. Am J Infect Control 2017; 45:477-482. [PMID: 28209451 DOI: 10.1016/j.ajic.2016.12.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/23/2016] [Accepted: 12/23/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The role of the operating room (OR) environment has been thought to contribute to surgical site infection rates. The quality of OR air, disruption of airflow, and other factors may increase contamination risks. We measured air particulate counts (APCs) to determine if they increased in relation to traffic, door opening, and other common activities. METHODS During 1 week, we recorded APCs in 5-minute intervals and movement of health care workers. Trained observers recorded information about traffic, door openings, job title of the opener, and the reason for opening. RESULTS At least 1 OR door was open during 47% of all readings. There were 13.4 door openings per hour during cases. Door opening rates ranged from 0.19-0.28 per minute. During this time, a total of 660 air measurements were obtained. The mean APCs were 9,238 particles (95% confidence interval [CI], 5,494- 12,982) at baseline and 14,292 particles (95% CI, 12,382-16,201) during surgery. Overall APCs increased 13% when either door was opened (P < .15). Larger particles that correlated to bacterial size were elevated significantly (P < .001) on door opening. CONCLUSIONS We observed numerous instances of verbal communication and equipment movement. Improving efficiency of communication and equipment can aid in reduction of traffic. Further study is needed to examine links between microbiologic sampling, outcome data, and particulate matter to enable study of risk factors and effects of personnel movement.
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Mantyh CR, Xi H, Pearson L, Perl TM. Minimizing hair dispersal: Is this an opportunity for improvement in health care-acquired infection prevention? Am J Infect Control 2017; 45:308-310. [PMID: 27814925 DOI: 10.1016/j.ajic.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 01/16/2023]
Abstract
We performed a study to understand common practices in surgical site hair removal and barriers to guideline compliance in surgical site hair removal. We found most health care providers in the United States do not remove hair outside of the operating room. Our findings reveal minimizing hair dispersal in the operating room, including improved and innovative ways for collecting clipped loose hair, is a significant area for improvement in surgical quality and health care-acquired infection prevention.
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Keller SC, Williams D, Gavgani M, Hirsch D, Adamovich J, Hohl D, Krosche A, Cosgrove S, Perl TM. Environmental Exposures and the Risk of Central Venous Catheter Complications and Readmissions in Home Infusion Therapy Patients. Infect Control Hosp Epidemiol 2017; 38:68-75. [PMID: 27697084 PMCID: PMC5502130 DOI: 10.1017/ice.2016.223] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients are frequently discharged with central venous catheters (CVCs) for home infusion therapy. OBJECTIVE To study a prospective cohort of patients receiving home infusion therapy to identify environmental and other risk factors for complications. DESIGN Prospective cohort study between March and December 2015. SETTING Home infusion therapy after discharge from academic medical centers. PARTICIPANTS Of 368 eligible patients discharged from 2 academic hospitals to home with peripherally inserted central catheters and tunneled CVCs, 222 consented. Patients remained in the study until 30 days after CVC removal. METHODS Patients underwent chart abstraction and monthly telephone surveys while the CVC was in place, focusing on complications and environmental exposures. Multivariable analyses estimated adjusted odds ratios and adjusted incident rate ratios between clinical, demographic, and environmental risk factors and 30-day readmissions or CVC complications. RESULTS Of 222 patients, total parenteral nutrition was associated with increased 30-day readmissions (adjusted odds ratio, 4.80 [95% CI, 1.51-15.21) and CVC complications (adjusted odds ratio, 2.41 [95% CI, 1.09-5.33]). Exposure to soil through gardening or yard work was associated with a decreased likelihood of readmissions (adjusted odds ratio, 0.09 [95% CI, 0.01-0.74]). Other environmental exposures were not associated with CVC complications. CONCLUSIONS complications and readmissions were common and associated with the use of total parenteral nutrition. Common environmental exposures (well water, cooking with raw meat, or pets) did not increase the rate of CVC complications, whereas soil exposures were associated with decreased readmissions. Interventions to decrease home CVC complications should focus on total parenteral nutrition patients. Infect Control Hosp Epidemiol 2016;1-8.
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Krosche A, Bessesen M, Cummings D, Gaydos C, Gibert C, Gorse G, Los J, Nyquist AC, Price C, Radonovich L, Reich N, Rodriguez-Barradas MC, Simberkoff MS, Perl TM. Correlation of Corrective Eyewear to Acute Respiratory Infection (ARI) Among Outpatient Healthcare Personnel (HCP). Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.992] [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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Cummings D, Pierce R, Kaye KS, Price C, Herwaldt LA, Sreeramoju P, Murthy R, Milstone AM, Klein E, Maragakis LL, Eickhoff M, Sifakis F, Los J, Perl TM. Ventilator-Associated Staphylococcus aureus and Pseudomonas aeruginosa Infections Among Intensive Care Unit (ICU) Patients in Six Healthcare Systems: Temporal Trends and Risk Factors. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.284] [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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Nadimpalli M, Stewart JR, Pierce E, Pisanic N, Love DC, Hall D, Larsen J, Carroll KC, Tekle T, Perl TM, Heaney CD. Livestock-Associated, Antibiotic-Resistant Staphylococcus aureus Nasal Carriage and Recent Skin and Soft Tissue Infection among Industrial Hog Operation Workers. PLoS One 2016; 11:e0165713. [PMID: 27851746 PMCID: PMC5112983 DOI: 10.1371/journal.pone.0165713] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/17/2016] [Indexed: 12/21/2022] Open
Abstract
Swine production work is a risk factor for nasal carriage of livestock-associated (LA-) Staphylococcus aureus and also for skin and soft tissue infection (SSTI). However, whether LA-S. aureus nasal carriage is associated with increased risk of SSTI remains unclear. We aimed to examine S. aureus nasal carriage and recent (≤3 months prior to enrollment) SSTI symptoms among industrial hog operation (IHO) workers and their household contacts. IHO workers and their household contacts provided a nasal swab and responded to a questionnaire assessing self-reported personal and occupational exposures and recent SSTI symptoms. Nasal swabs were analyzed for S. aureus, including methicillin-resistant S. aureus (MRSA), multidrug-resistant-S. aureus (MDRSA), absence of scn (livestock association), and spa type. S. aureus with at least one indicator of LA was observed among 19% of 103 IHO workers and 6% of 80 household members. Prevalence of recent SSTI was 6% among IHO workers and 11% among 54 minor household members (0/26 adult household members reported SSTI). Among IHO workers, nasal carriers of MDRSA and scn-negative S. aureus were 8.8 (95% CI: 1.8, 43.9) and 5.1 (95% CI: 1.2, 22.2) times as likely to report recent SSTI as non-carriers, respectively. In one household, both an IHO worker and child reported recent SSTI and carried the same S. aureus spa type (t4976) intranasally. Prevalence of scn-negative S. aureus (PR: 5.0, 95% CI: 1.2, 21.4) was elevated among IHO workers who reported never versus always wearing a face mask at work. Although few SSTI were reported, this study of IHO workers and their household contacts is the first to characterize a relation between nasal carriage of antibiotic-resistant LA-S. aureus and SSTI. The direction and temporality of this relation and IHO workers' use of face masks to prevent nasal carriage of these bacteria warrant further investigation.
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Krosche A, Bessesen M, Cummings D, Gaydos C, Gibert C, Gorse G, Los J, Nyquist AC, Price C, Radonovich L, Reich N, Rodriguez-Barradas MC, Simberkoff MS, Perl TM, Team TRS. Acute Respiratory Infections (ARIs) Among Outpatient Healthcare Personnel (HCP). Open Forum Infect Dis 2016. [PMCID: PMC7117593 DOI: 10.1093/ofid/ofw194.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Pelz RK, Lipsett PA, Swoboda SM, Diener-West M, Powe NR, Brower RG, Perl TM, Hammond JM, Hendrix CW. Candida Infections: Outcome and Attributable ICU Costs in Critically Ill Patients. J Intensive Care Med 2016. [DOI: 10.1177/088506660001500504] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Candida species are an increasingly common cause of nosocomial infections. Candida infections have been associated with significant attributable morbidity and mortality, especially among critically ill patients. However, little is known about the cost implications of these increasingly common infections. In order to evaluate the costs associated with Candida infections in the critically ill, we report the findings of a 3–month prospective cohort study of Candida infections in the medical intensive care unit (MICU) and the surgical intensive care unit (SICU) at Johns Hopkins Hospital. Infections were diagnosed according to prospectively established definitions. Cost data were extracted from the computerized billing database and used to estimate the ICU costs associated with nosocomial Candida infection. Using multiple linear regression, the effect of Candida infections on cost was adjusted for clinical variables in order to estimate the cost of ICU care attributable to Candida infection. Of 117 ICU patients enrolled in the study, 14 developed Candida infections. In a stepwise linear regression model adjusting for multiple clinical variables including APACHE II score, infection with Candida species was associated with an attributable ICU cost of $21,590. Over the cohort, the increased cost associated with Candida infections translates into a cost of $230/ICU patient-day. In addition, Candida infections were associated with an increased length of hospital stay of 17 days and an increased length of ICU stay of 8 days. In this small, prospective, cohort study, nosocomial Candida infections are independently associated with an increase in the cost of ICU care and an increased length of stay. No increase in mortality was noted, though it is possible a difference in mortality was missed due to the study's small sample size.
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Siberry GK, Paquette NR, Ross TL, Perl TM, Valsamakis A. Low Prevalence of Pertussis Among Children Admitted With Respiratory Symptoms During Respiratory Syncytial Virus Season. Infect Control Hosp Epidemiol 2016; 27:95-7. [PMID: 16418999 DOI: 10.1086/499999] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2004] [Accepted: 10/11/2004] [Indexed: 11/03/2022]
Abstract
Pertussis may go unrecognized during respiratory syncytial virus (RSV) epidemics. Nosocomially transmitted pertussis can be severe in infants. Polymerase chain reaction (PCR) screening may identify infants with pertussis on admission, allowing for preemptive isolation. In a random sample, 1 (0.6%) of 166 children admitted to the hospital during RSV season were Bordetella pertussis PCR positive during a nonepidemic period. These data show that screening may not be useful when pertussis prevalence is low.
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Wong ES, Rupp ME, Mermel L, Perl TM, Bradley S, Ramsey KM, Ostrowsky B, Valenti AJ, Jernigan JA, Voss A, Tapper ML. Public Disclosure of Healthcare-Associated Infections: The Role of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 2016; 26:210-2. [PMID: 15756894 DOI: 10.1086/502528] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Prior to 2004, only two states, Pennsylvania and Illinois, had enacted legislation requiring healthcare facilities to collect nosocomial or healthcare-associated infection (HAI) data intended for public disclosure. In 2004, two additional states, Missouri and Florida, passed disclosure laws. Currently, several other states are considering similar legislation. In California, Senate Bill 1487 requiring hospitals to collect HAI data and report them to the Office of Statewide Health Planning was passed by the legislature, but was not signed into law by Governor Schwarzenegger, effectively vetoing it. The impetus for these laws is complex. Support comes from consumer advocates, who argue that the public has the right to be informed, and from others who view HAI as preventable and hope that public disclosure would provide an incentive to healthcare providers and institutions to improve their care.
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Srinivasan A, Karchmer T, Richards A, Song X, Perl TM. A Prospective Trial of a Novel, Silicone-Based, Silver-Coated Foley Catheter for the Prevention of Nosocomial Urinary Tract Infections. Infect Control Hosp Epidemiol 2016; 27:38-43. [PMID: 16418985 DOI: 10.1086/499998] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Accepted: 10/22/2004] [Indexed: 11/03/2022]
Abstract
Objective.To evaluate the efficacy of silicone-based, silver ion–impregnated urinary catheters in the prevention of nosocomial urinary tract infections (NUTIs).Design.Prospective, crossover study to compare the efficacy of a silicone-based, hydrogel-coated, silver-impregnated Foley catheter with that of a silicone-based, hydrogel-coated catheter in the prevention of NUTIs.Setting.Adult medical and surgical wards of a university teaching hospital.Results.A total of 3,036 patients with catheters were evaluated; 1,165 (38%) of the catheters were silver impregnated, and 1,871 (62%) were not silver impregnated. Study groups were not identical; there were more men, a shorter duration of catheterization, and fewer urine cultures per 1,000 catheter-days in the silver catheter group. The rate of NUTIs per 1,000 Foley-days was 14.29 in the silver catheter group, compared with 16.15 in the nonsilver catheter group (incidence rate ratio, 0.88; 95% confidence interval, 0.70-1.11;P= .29). The median length of catheterization prior to the onset of a urinary tract infection (ie, exposure time) was 4 days for each group. There were no differences in the recovery of gram-positive, gram-negative, or fungal organisms in NUTIs. In a multivariate survival analysis, no factors, including silver catheters, were protective against NUTI.Conclusions.Unlike previous trials of latex-based, silver ion–impregnated Foley catheters, we found that silicone-based, silver-impregnated Foley catheters were not effective in preventing NUTIs; however, this study was affected by differences in the study groups. Prospective trials remain important in assessing the efficacy and cost-effectiveness of new silver-coated products.
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Herwaldt LA, Cullen JJ, Scholz D, French P, Zimmerman MB, Pfaller MA, Wenzel RP, Perl TM. A Prospective Study of Outcomes, Healthcare Resource Utilization, and Costs Associated With Postoperative Nosocomial Infections. Infect Control Hosp Epidemiol 2016; 27:1291-8. [PMID: 17152025 DOI: 10.1086/509827] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Accepted: 06/14/2006] [Indexed: 01/08/2023]
Abstract
Objective.We evaluated 4 important outcomes associated with postoperative nosocomial infection: costs, mortality, excess length of stay, and utilization of healthcare resources.Design.The outcomes for patients who underwent general, cardiothoracic, and neurosurgical operations were recorded during a previous clinical trial. Multivariable analyses including significant covariates were conducted to determine whether nosocomial infection significantly affected the outcomes.Setting.A large tertiary care medical center and an affiliated Veterans Affairs Medical Center.Patients.A total of 3,864 surgical patients.Results.The overall nosocomial infection rate was 11.3%. Important covariates included age, Karnofsky score, McCabe and Jackson classification of the severity of underlying disease, National Nosocomial Infection Surveillance system risk index, and number of comorbidities. After accounting for covariates, nosocomial infection was associated with increased postoperative length of stay, increased costs, increased hospital readmission rate, and increased use of antimicrobial agents in the outpatient setting. Nosocomial infection was not associated independently with a significantly increased risk of death in this surgical population.Conclusion.Postoperative nosocomial infection was associated with increased costs of care and with increased utilization of medical resources. To accurately assess the effects of nosocomial infections, one must take into account important covariates. Surgeons seeking to decrease the cost of care and resource utilization must identify ways to decrease the rate of postoperative nosocomial infection.
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Warren DK, Yokoe DS, Climo MW, Herwaldt LA, Noskin GA, Zuccotti G, Tokars JI, Perl TM, Fraser VJ. Preventing Catheter-Associated Bloodstream Infections: A Survey of Policies for Insertion and Care of Central Venous Catheters From Hospitals in the Prevention Epicenter Program. Infect Control Hosp Epidemiol 2016; 27:8-13. [PMID: 16418980 DOI: 10.1086/499151] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 08/23/2005] [Indexed: 12/13/2022]
Abstract
Objective.To determine the extent to which evidence-based practices for the prevention of central venous catheter (CVC)-associated bloodstream infections are incorporated into the policies and practices of academic intensive care units (ICUs) in the United States and to determine variations in the policies on CVC insertion, use, and care.Design.A 9-page written survey of practices and policies for nontunneled CVC insertion and care.Setting.ICUs in 10 academic tertiary-care hospitals.Participants.ICU medical directors and nurse managers.Results.Twenty-five ICUs were surveyed (1-6 ICUs per hospital). In 80% of the units, 5 separate groups of clinicians inserted 24%-50% of all nontunneled CVCs. In 56% of the units, placement of more than two-thirds of nontunneled CVCs was performed in a single location in the hospital. Twenty units (80%) had written policies for CVC insertion. Twenty-eight percent of units had a policy requiring maximal sterile-barrier precautions when CVCs were placed, and 52% of the units had formal educational programs with regard to CVC insertion. Eighty percent of the units had a policy requiring staff to perform hand hygiene before inserting CVCs, but only 36% and 60% of the units required hand hygiene before accessing a CVC and treating the exit site, respectively.Conclusion.ICU policy regarding the insertion and care of CVCs varies considerably from hospital to hospital. ICUs may be able to improve patient outcome if evidence-based guidelines for CVC insertion and care are implemented.
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Radonovich LJ, Bessesen MT, Cummings DA, Eagan A, Gaydos C, Gibert C, Gorse GJ, Nyquist AC, Reich NG, Rodrigues-Barradas M, Savor-Price C, Shaffer RE, Simberkoff MS, Perl TM. The Respiratory Protection Effectiveness Clinical Trial (ResPECT): a cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel. BMC Infect Dis 2016; 16:243. [PMID: 27255755 PMCID: PMC4890247 DOI: 10.1186/s12879-016-1494-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/18/2016] [Indexed: 12/04/2022] Open
Abstract
Background Although N95 filtering facepiece respirators and medical masks are commonly used for protection against respiratory infections in healthcare settings, more clinical evidence is needed to understand the optimal settings and exposure circumstances for healthcare personnel to use these devices. A lack of clinically germane research has led to equivocal, and occasionally conflicting, healthcare respiratory protection recommendations from public health organizations, professional societies, and experts. Methods The Respiratory Protection Effectiveness Clinical Trial (ResPECT) is a prospective comparison of respiratory protective equipment to be conducted at multiple U.S. study sites. Healthcare personnel who work in outpatient settings will be cluster-randomized to wear N95 respirators or medical masks for protection against infections during respiratory virus season. Outcome measures will include laboratory-confirmed viral respiratory infections, acute respiratory illness, and influenza-like illness. Participant exposures to patients, coworkers, and others with symptoms and signs of respiratory infection, both within and beyond the workplace, will be recorded in daily diaries. Adherence to study protocols will be monitored by the study team. Discussion ResPECT is designed to better understand the extent to which N95s and MMs reduce clinical illness among healthcare personnel. A fully successful study would produce clinically relevant results that help clinician-leaders make reasoned decisions about protection of healthcare personnel against occupationally acquired respiratory infections and prevention of spread within healthcare systems. Trial registration The trial is registered at clinicaltrials.gov, number NCT01249625 (11/29/2010).
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Septimus E, Yokoe DS, Weinstein RA, Perl TM, Maragakis LL, Berenholtz SM. Maintaining the Momentum of Change: The Role of the 2014 Updates to the Compendium in Preventing Healthcare-Associated Infections. Infect Control Hosp Epidemiol 2016; 35:460-3. [DOI: 10.1086/675820] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Preventing healthcare-associated infections (HAIs) is a national priority. Although substantial progress has been achieved, considerable deficiencies remain in our ability to efficiently and effectively translate existing knowledge about HAI prevention into reliable, sustainable, widespread practice. “A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates” is the product of a highly collaborative endeavor designed to support hospitals' efforts to implement and sustain HAI prevention strategies.
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Block L, Pitts S, Perl TM. Barriers and Facilitators of Implementation of a Mandate for Influenza Vaccination among Healthcare Personnel. Infect Control Hosp Epidemiol 2016; 35:724-7. [DOI: 10.1086/676434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Mandatory influenza vaccination is associated with improved healthcare personnel vaccination rates, but institutional barriers to implementation and enforcement are reported. We explored barriers and facilitators to mandatory vaccination among a national sample of hospital administrators. Support from employees and administration were cited as key to the success of a mandate.Infect Control Hosp Epidemiol 2014;35(6):724-727
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Tschudin-Sutter S, Tamma PD, Milstone AM, Perl TM. The Prediction of Complicated Clostridium difficile Infections in Children. Infect Control Hosp Epidemiol 2016; 35:901-3. [DOI: 10.1086/676874] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We validated proposed definitions for severe Clostridium difficile infection (CDI) in adults for prediction of complicated CDI in children. Complicated CDI occurred in 9 of 202 cases. Definitions for severe CDI in adults showed poor measures for discrimination of complicated CDI in children, which calls into question the usefulness of such definitions in pediatric cohorts.Infect Control Hosp Epidemiol 2014;35(7):901–903
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Kline S, Highness M, Herwaldt LA, Perl TM. Variable Screening and Decolonization Protocols for Staphylococcus aureus Carriage Prior to Surgical Procedures. Infect Control Hosp Epidemiol 2016; 35:880-2. [DOI: 10.1086/676866] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We surveyed the Society for Healthcare Epidemiology of America Research Network, the Minnesota Association for Professionals in Infection Control and Epidemiology, and the Minnesota Hospital Association to assess presurgical Staphylococcus aureus screening and decolonization practices. The practices varied widely among responding facilities. The majority of respondents (63%) did not screen for S. aureus preoperatively.Infect Control Hosp Epidemiol 2014;35(7):880–882
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Dhar S, Marchaim D, Tansek R, Chopra T, Yousuf A, Bhargava A, Martin ET, Talbot TR, Johnson LE, Hingwe A, Zuckerman JM, Bono BR, Shuman EK, Poblete J, Tran M, Kulhanek G, Thyagarajan R, Nagappan V, Herzke C, Perl TM, Kaye KS. Contact Precautions More Is Not Necessarily Better. Infect Control Hosp Epidemiol 2016; 35:213-21. [DOI: 10.1086/675294] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To determine whether increases in contact isolation precautions are associated with decreased adherence to isolation practices among healthcare workers (HCWs).Design.Prospective cohort study from February 2009 to October 2009.Setting.Eleven teaching hospitals.Participants.HCWs.Methods.One thousand thirteen observations conducted on HCWs. Additional data included the number of persons in isolation, types of HCWs, and hospital-specific contact precaution practices. Main outcome measures included compliance with individual components of contact isolation precautions (hand hygiene before and after patient encounter, donning of gown and glove upon entering a patient room, and doffing upon exiting) and overall compliance (all 5 measures together) during varying burdens of isolation.Results.Compliance with hand hygiene was as follows: prior to donning gowns/gloves, 37.2%; gowning, 74.3%; gloving, 80.1%; doffing of gowns/gloves, 80.1%; after gown/glove removal, 61%. Compliance with all components was 28.9%. As the burden of isolation increased (20% or less to greater than 60%), a decrease in compliance with hand hygiene (43.6%—4.9%) and with all 5 components (31.5%—6.5%) was observed. In multivariable analysis, there was an increase in noncompliance with all 5 components of the contact isolation precautions bundle (odds ratio [OR], 6.6 [95% confidence interval (CI), 1.15-37.44];P= .03) and in noncompliance with hand hygiene prior to donning gowns and gloves (OR, 10.1 [95% CI, 1.84—55.54];P= .008) associated with increasing burden of isolation.Conclusions.As the proportion of patients in contact isolation increases, compliance with contact isolation precautions decreases. Placing 40% of patients under contact precautions represents a tipping point for noncompliance with contact isolation precautions measures.
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Balkhy HH, Perl TM, Arabi YM. Preventing healthcare-associated transmission of the Middle East Respiratory Syndrome (MERS): Our Achilles heel. J Infect Public Health 2016; 9:208-12. [PMID: 27158023 PMCID: PMC7128197 DOI: 10.1016/j.jiph.2016.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Middle East Respiratory Syndrome (MERS) coronavirus is the most recent among the Coronaviridae family to jump species and infect humans. Major healthcare associated MERS outbreaks have occurred in the Middle East and Korea that affected both patients and healthcare workers. These outbreaks were characterized by intra and inter-hospital spread and were exacerbated specifically by overcrowding, delayed diagnosis and appropriate use of personal protective equipment. Recent experience with this virus emphasizes the importance of compliance with infection control practices and with other interventions addressing patient triage, placement and flow within and between healthcare facilities. Our Achilles heel remains compliance with the best infection prevention practices and their harmonization with patient flow. Both infection prevention compliance and maintenance of patient flow are critical in preventing healthcare-associated transmission of many of these emerging infectious diseases, including MERS.
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Al Ghamdi M, Alghamdi KM, Ghandoora Y, Alzahrani A, Salah F, Alsulami A, Bawayan MF, Vaidya D, Perl TM, Sood G. Treatment outcomes for patients with Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV) infection at a coronavirus referral center in the Kingdom of Saudi Arabia. BMC Infect Dis 2016; 16:174. [PMID: 27097824 PMCID: PMC4839124 DOI: 10.1186/s12879-016-1492-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/31/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) is a poorly understood disease with no known treatments. We describe the clinical features and treatment outcomes of patients with laboratory confirmed MERS-CoV at a regional referral center in the Kingdom of Saudi Arabia. METHODS In 2014, a retrospective chart review was performed on patients with a laboratory confirmed diagnosis of MERS-CoV to determine clinical and treatment characteristics associated with death. Confounding was evaluated and a multivariate logistic regression was performed to assess the independent effect of treatments administered. RESULTS Fifty-one patients had an overall mortality of 37 %. Most patients were male (78 %) with a mean age of 54 years. Almost a quarter of the patients were healthcare workers (23.5 %) and 41 % had a known exposure to another person with MERS-CoV. Survival was associated with male gender, working as a healthcare worker, history of hypertension, vomiting on admission, elevated respiratory rate, abnormal lung exam, elevated alanine transaminase (ALT), clearance of MERS-CoV on repeat PCR polymerase chain reaction (PCR) testing, and mycophenolate mofetil treatment. Survival was reduced in the presence of coronary artery disease, hypotension, hypoxemia, CXR (chest X-ray) abnormalities, leukocytosis, creatinine >1 · 5 mg/dL, thrombocytopenia, anemia, and renal failure. In a multivariate analysis of treatments administered, severity of illness was the greatest predictor of reduced survival. CONCLUSIONS Care for patients with MERS-CoV remains a challenge. In this retrospective cohort, interferon beta and mycophenolate mofetil treatment were predictors of increased survival in the univariate analysis. Severity of illness was the greatest predictor of reduced survival in the multivariate analysis. Larger randomized trials are needed to better evaluate the efficacy of these treatment regimens for MERS-CoV.
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Halwani MA, Turnbull AE, Harris M, Witter F, Perl TM. Postdischarge surveillance for infection following cesarean section: A prospective cohort study comparing methodologies. Am J Infect Control 2016; 44:455-7. [PMID: 26706153 DOI: 10.1016/j.ajic.2015.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/16/2015] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess how enhanced postdischarge telephone follow-up calls would improve case finding for surgical site infection (SSI) surveillance after cesarean section. METHODS We conducted a prospective cohort study of all patients who delivered by cesarean section between April 22 and August 22, 2010. In addition to our routine surveillance, using clinical databases and electronic patient records, we also made follow-up calls to the patients at 7, 14, and 30 days postoperation. A standard questionnaire with questions about symptoms of SSI, health-seeking behaviors, and treatment received was administered. Descriptive statistics and univariate analysis were performed to assess the effect of the enhanced surveillance. RESULTS One hundred ninety-three patients underwent cesarean section during this study period. Standard surveillance identified 14 infections with telephone follow-ups identifying an additional 5 infections. Using the call as a gold standard, the sensitivity of the standard methodology to capture SSI was 73.3%. The duration of the calls ranged from 1 to 5 minutes and were well received by the patients. CONCLUSIONS Results suggest that follow-up telephone calls to patients following cesarean section identifies 26.3% of the total SSIs. Enhanced surveillance can provide more informed data to enhance performance and avoid underestimation of rates.
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Frederick J, Dansky M, Brown AC, Bessesen M, Cummings D, Gibert C, Gorse G, Nyquist AC, Perl TM, Price C, Radonovich L, Reich NG, Rodriguez-Barradas M, Simberkoff MS, Study R. The Impact of Mandatory Versus Non-Mandatory Vaccination Programs on Employee Sick Days During Three Consecutive Acute Respiratory Illness Seasons: Observations From the ResPECT Study. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1419] [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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Keller S, Cosgrove S, Perl TM, Pulice K, Gavgani M, Hirsch D, Williams D. Complications of Home Central Venous Catheters and Home-Based Outpatient Parenteral Antimicrobial Therapy: A Prospective Study. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1007] [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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75
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Branch-Elliman W, Savor Price C, Bessesen MT, Perl TM. Using the Pillars of Infection Prevention to Build an Effective Program for Reducing the Transmission of Emerging and Reemerging Infections. Curr Environ Health Rep 2015; 2:226-35. [PMID: 26231500 PMCID: PMC7099308 DOI: 10.1007/s40572-015-0059-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Preventing transmission of emerging infectious diseases remains a challenge for infection prevention and occupational safety programs. The recent Ebola and measles outbreaks highlight the need for pre-epidemic planning, early identification, and appropriate isolation of infected individuals and health care personnel protection. To optimally allocate limited infection control resources, careful consideration of major modes of transmission, the relative infectiousness of the agent, and severity of the pathogen-specific disease are considered. A framework to strategically approach pathogens proposed for health care settings includes generic principles (1) elimination of potential exposure, (2) implementation of administrative controls, (3) facilitation of engineering and environmental controls, and (4) protection of the health care worker and patient using hand hygiene and personal protective equipment. Additional considerations are pre-epidemic vaccination and incremental costs and benefits of infection prevention interventions. Here, major strategies for preventing health-care-associated transmissions are reviewed, including reducing exposure; vaccination; administrative, engineering, and environmental controls; and personal protective equipment. Examples from recent outbreaks are used to highlight key infection prevention aspects and controversies.
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