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Dhar S, Sandhu AL, Valyko A, Kaye KS, Washer L. Strategies for Effective Infection Prevention Programs: Structures, Processes, and Funding. Infect Dis Clin North Am 2021; 35:531-551. [PMID: 34362533 DOI: 10.1016/j.idc.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Successful Infection Prevention Programs (IPPs) consist of a multidisciplinary team led by a hospital epidemiologist and managed by infection preventionists. Knowledge of the economics of health care-associated infections (HAIs) and the ability to make a business plan is now essential to the success of programs. Prevention of HAIs is the core function of IPPs with impact on patient outcomes, quality of care, and cost savings for hospitals. This article discusses the structure and responsibilities of an IPP, the regulatory pressures and opportunities that these programs face, and how to build and manage a successful program.
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Affiliation(s)
- Sorabh Dhar
- Division of Infectious Diseases, Wayne State University, Harper University Hospital, 5 Hudson, 3990 John R, Detroit, MI 48201, USA; Department of Hospital Epidemiology and Infection Prevention, John D. Dingell VA Medical Center, Detroit, MI, USA.
| | - Avnish L Sandhu
- Division of Infectious Diseases, Wayne State University, Harper University Hospital, 5 Hudson, 3990 John R, Detroit, MI 48201, USA
| | - Amanda Valyko
- Department of Infection Prevention and Epidemiology, Michigan Medicine, 300 North Ingalls - NIB8B02, Ann Arbor, MI 48109-5479, USA
| | - Keith S Kaye
- Division of Infectious Diseases, University of Michigan, University of Michigan Medical School, 5510A MSRB 1, SPC 5680, 1150 West Medical Center Drive, Ann Arbor, MI 48109-5680, USA
| | - Laraine Washer
- Department of Infection Prevention and Epidemiology, Michigan Medicine, F4151 University Hospital South, 1500 East Medical Center Drive, SPC 5226, Ann Arbor, MI 48109-5226, USA; Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
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Incidence and risk factors of non-device-associated pneumonia in an acute-care hospital. Infect Control Hosp Epidemiol 2019; 41:73-79. [PMID: 31658914 DOI: 10.1017/ice.2019.300] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To update current estimates of non-device-associated pneumonia (ND pneumonia) rates and their frequency relative to ventilator associated pneumonia (VAP), and identify risk factors for ND pneumonia. DESIGN Cohort study. SETTING Academic teaching hospital. PATIENTS All adult hospitalizations between 2013 and 2017 were included. Pneumonia (device associated and non-device associated) were captured through comprehensive, hospital-wide active surveillance using CDC definitions and methodology. RESULTS From 2013 to 2017, there were 163,386 hospitalizations (97,485 unique patients) and 771 pneumonia cases (520 ND pneumonia and 191 VAP). The rate of ND pneumonia remained stable, with 4.15 and 4.54 ND pneumonia cases per 10,000 hospitalization days in 2013 and 2017 respectively (P = .65). In 2017, 74% of pneumonia cases were ND pneumonia. Male sex and increasing age we both associated with increased risk of ND pneumonia. Additionally, patients with chronic bronchitis or emphysema (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.40-3.06), congestive heart failure (HR, 1.48; 95% CI, 1.07-2.05), or paralysis (HR, 1.72; 95% CI, 1.09-2.73) were also at increased risk, as were those who were immunosuppressed (HR, 1.54; 95% CI, 1.18-2.00) or in the ICU (HR, 1.49; 95% CI, 1.06-2.09). We did not detect a change in ND pneumonia risk with use of chlorhexidine mouthwash, total parenteral nutrition, all medications of interest, and prior ventilation. CONCLUSION The incidence rate of ND pneumonia did not change from 2013 to 2017, and 3 of 4 nosocomial pneumonia cases were non-device associated. Hospital infection prevention programs should consider expanding the scope of surveillance to include non-ventilated patients. Future research should continue to look for modifiable risk factors and should assess potential prevention strategies.
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Incidence and risk factors of non-device-associated urinary tract infections in an acute-care hospital. Infect Control Hosp Epidemiol 2019; 40:1242-1247. [PMID: 31475662 DOI: 10.1017/ice.2019.241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To update current estimates of non-device-associated urinary tract infection (ND-UTI) rates and their frequency relative to catheter-associated UTIs (CA-UTIs) and to identify risk factors for ND-UTIs. DESIGN Cohort study. SETTING Academic teaching hospital. PATIENTS All adult hospitalizations between 2013 and 2017 were included. UTIs (device and non-device associated) were captured through comprehensive, hospital-wide active surveillance using Centers for Disease Control and Prevention case definitions and methodology. RESULTS From 2013 to 2017 there were 163,386 hospitalizations (97,485 unique patients) and 1,273 UTIs (715 ND-UTIs and 558 CA-UTIs). The rate of ND-UTIs remained stable, decreasing slightly from 6.14 to 5.57 ND-UTIs per 10,000 hospitalization days during the study period (P = .15). However, the proportion of UTIs that were non-device related increased from 52% to 72% (P < .0001). Female sex (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.50-2.50) and increasing age were associated with increased ND-UTI risk. Additionally, the following conditions were associated with increased risk: peptic ulcer disease (HR, 2.25; 95% CI, 1.04-4.86), immunosuppression (HR, 1.48; 95% CI, 1.15-1.91), trauma admissions (HR, 1.36; 95% CI, 1.02-1.81), total parenteral nutrition (HR, 1.99; 95% CI, 1.35-2.94) and opioid use (HR, 1.62; 95% CI, 1.10-2.32). Urinary retention (HR, 1.41; 95% CI, 0.96-2.07), suprapubic catheterization (HR, 2.28; 95% CI, 0.88-5.91), and nephrostomy tubes (HR, 2.02; 95% CI, 0.83-4.93) may also increase risk, but estimates were imprecise. CONCLUSION Greater than 70% of UTIs are now non-device associated. Current targeted surveillance practices should be reconsidered in light of this changing landscape. We identified several modifiable risk factors for ND-UTIs, and future research should explore the impact of prevention strategies that target these factors.
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Abstract
Surveillance of antibiotic resistance involves the collection of antibiotic susceptibility patterns undertaken by clinical microbiology laboratories on bacteria isolated from clinical specimens. Global surveillance programs have shown that antibiotic resistance is a major threat to the public at large and play a crucial role in the development of enhanced diagnostics as well as potential vaccines and novel antibiotics with activity against antimicrobial-resistant organisms. This review focuses primarily on examples of global surveillance systems. Local, national, and global integrated surveillance programs with sufficient data linkage between these schemes, accompanied by enhanced genomics and user-friendly bioinformatics systems, promise to overcome some of the stumbling blocks encountered in the understanding, emergence, and transmission of antimicrobial-resistant organisms.
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Sanger PC, Granich M, Olsen-Scribner R, Jain R, Lober WB, Stapleton A, Pottinger PS. Electronic Surveillance For Catheter-Associated Urinary Tract Infection Using Natural Language Processing. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2017:1507-1516. [PMID: 29854220 PMCID: PMC5977673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Catheter-associated urinary tract infection (CAUTI) is a common and costly healthcare-associated infection, yet measuring it accurately is challenging and resource-intensive. Electronic surveillance promises to make this task more objective and efficient in an era of new financial and regulatory imperatives, but previous surveillance approaches have used a simplified version of the definition. We applied a complete definition, including subjective elements identified through natural language processing of clinical notes. Through examination of documentation practices, we defined a set of rules that identified positively and negatively asserted symptoms of CAUTI. Our algorithm was developed on a training set of 1421 catheterizedpatients and prospectively validated on 1567 catheterizedpatients. Compared to gold standard chart review, our tool had a sensitivity of 97.1%, specificity of 94.5% PPV of 66.7% and NPV of 99.6% for identifying CAUTI. We discuss sources of error and suggestions for more computable future definitions.
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Dhar S, Cook E, Oden M, Kaye KS. Building a Successful Infection Prevention Program: Key Components, Processes, and Economics. Infect Dis Clin North Am 2017; 30:567-89. [PMID: 27515138 DOI: 10.1016/j.idc.2016.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Infection control is the discipline responsible for preventing health care-associated infections (HAIs) and has grown from an anonymous field, to a highly visible, multidisciplinary field of incredible importance. There has been increasing focus on prevention rather than control of HAIs. Infection prevention programs (IPPs) have enormous scope that spans multiple disciplines. Infection control and the prevention and elimination of HAIs can no longer be compartmentalized. This article discusses the structure and responsibilities of an IPP, the regulatory pressures and opportunities that these programs face, and how to build and manage a successful program.
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Affiliation(s)
- Sorabh Dhar
- Department of Hospital Epidemiology and Infection Prevention, Detroit Medical Center, Detroit, MI, USA; Department of Medicine, Wayne State University, Detroit, MI, USA; Department of Hospital Epidemiology and Infection Prevention, John D Dingell VA Medical Center, Detroit, MI, USA; Harper University Hospital, 5 Hudson, 3990 John R, Detroit, MI 48201, USA.
| | - Evelyn Cook
- Duke Infection Control Outreach Network, Duke University Medical Center, 1610 Sycamore Street, Durham, NC 27707, USA
| | - Mary Oden
- Infection Prevention, Clinical Operations, Tenet Health, 1443 Ross Avenue Suite 1400, Dallas, TX 75202, USA
| | - Keith S Kaye
- Department of Hospital Epidemiology and Infection Prevention, Detroit Medical Center, Detroit, MI, USA; Department of Medicine, Wayne State University, Detroit, MI, USA; University Health Center, 4201 Saint Antoine, Suite 2B, Box 331, Detroit, MI 48201, USA
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Farr BM. What To Think If the Results of the National Institutes of Health Randomized Trial of Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcusControl Measures Are Negative (and Other Advice to Young Epidemiologists): A Review and an Au Revoir. Infect Control Hosp Epidemiol 2016; 27:1096-106. [PMID: 17006818 DOI: 10.1086/508759] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 08/31/2006] [Indexed: 12/27/2022]
Abstract
The incidence of methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistantEnterococcus(VRE) infections continues to rise in National Nosocomial Infections Surveillance system hospitals, and these pathogens are reportedly causing more than 100,000 infections and many deaths each year in US healthcare facilities. This has led some to insist that control measures are now urgently needed, but several recent articles have suggested that isolation of patients does not work, is not needed, or is unsafe, or that a single cluster-randomized trial could be used to decide such matters. At least 101 studies have reported controlling MRSA infection and 38 have reported controlling VRE infection by means of active detection by surveillance culture and use of isolation for all colonized patients in healthcare settings where the pathogens are epidemic or endemic, in academic and nonacademic hospitals, and in acute care, intensive care, and long-term care settings. MRSA colonization and infection have been controlled to exceedingly low levels in multiple nations and in the state of Western Australia for decades by use of active detection and isolation. Studies suggesting problems with using such data to control MRSA colonization and infection have their own problems, which are discussed. Randomized trials are epidemiologic tools that can sometimes provide erroneous results, and they have not been considered necessary for studying isolation before it is used to control other important infections, such as tuberculosis, smallpox, and severe acute respiratory syndrome. No single epidemiologic study should be considered definitive. One should always weigh all available evidence. Infection with antibiotic-resistant pathogens such as MRSA and VRE is controllable to a low level by active detection and isolation of colonized and infected patients. Effective measures should be used to minimize the morbidity and mortality attributable to these largely preventable infections.
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Affiliation(s)
- Barry M Farr
- Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA.
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Farr BM. Doing The Right Thing (and Figuring Out What That Is). Infect Control Hosp Epidemiol 2016; 27:999-1003. [PMID: 17006804 DOI: 10.1086/508672] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 08/28/2006] [Indexed: 11/03/2022]
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Longitudinal trends in all healthcare-associated infections through comprehensive hospital-wide surveillance and infection control measures over the past 12 years: substantial burden of healthcare-associated infections outside of intensive care units and "other" types of infection. Infect Control Hosp Epidemiol 2015; 36:1139-47. [PMID: 26108686 DOI: 10.1017/ice.2015.142] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Targeted surveillance has focused on device-associated infections and surgical site infections (SSIs) and is often limited to healthcare-associated infections (HAIs) in high-risk areas. Longitudinal trends in all HAIs, including other types of HAIs, and HAIs outside of intensive care units (ICUs) remain unclear. We examined the incidences of all HAIs using comprehensive hospital-wide surveillance over a 12-year period (2001-2012). METHODS This retrospective observational study was conducted at the University of North Carolina (UNC) Hospitals, a tertiary care academic facility. All HAIs, including 5 major infections with 14 specific infection sites as defined using CDC criteria, were ascertained through comprehensive hospital-wide surveillance. Generalized linear models were used to examine the incidence rate difference by infection type over time. RESULTS A total of 16,579 HAIs included 6,397 cases in ICUs and 10,182 cases outside ICUs. The incidence of overall HAIs decreased significantly hospital-wide (-3.4 infections per 1,000 patient days), in ICUs (-8.4 infections per 1,000 patient days), and in non-ICU settings (-1.9 infections per 1,000 patient days). The incidences of bloodstream infection, urinary tract infection, and pneumonia in hospital-wide settings decreased significantly, but the incidences of SSI and lower respiratory tract infection remained unchanged. The incidence of Clostridium difficile infection (CDI) increased remarkably. The outcomes were estimated to include 700 overall HAIs prevented, 40 lives saved, and cost savings in excess of $10 million. CONCLUSIONS We demonstrated success in reducing overall HAIs over a 12-year period. Our data underscore the necessity for surveillance and infection prevention interventions outside of the ICUs, for non-device-associated HAIs, and for CDI.
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Cook E, Marchaim D, Kaye KS. Building a successful infection prevention program: key components, processes, and economics. Infect Dis Clin North Am 2011; 25:1-19. [PMID: 21315992 DOI: 10.1016/j.idc.2010.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Infection control is the discipline responsible for preventing nosocomial infections. There has been an increasing focus on prevention rather than control of hospital-acquired infections. Individuals working in infection control have seen their titles change from infection control practitioner to infection control professional and most recently to infection preventionist (IP), emphasizing their critical role in protecting patients. The responsibilities of IPs span multiple disciplines including medicine, surgery, nursing, occupational health, microbiology, pharmacy, sterilization and disinfection, emergency medicine, and information technology. This article discusses the structure and responsibilities of an infection control program and the regulatory pressures and opportunities the program faces.
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Affiliation(s)
- Evelyn Cook
- Department of Medicine, Duke Infection Control Outreach Network, Durham, NC, USA.
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Beyersmann J, Wolkewitz M, Allignol A, Grambauer N, Schumacher M. Application of multistate models in hospital epidemiology: advances and challenges. Biom J 2011; 53:332-50. [PMID: 21374697 DOI: 10.1002/bimj.201000146] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 10/11/2010] [Accepted: 10/29/2010] [Indexed: 11/07/2022]
Abstract
Survival analysis has established itself as a major statistical technique in medical research. Applications in hospital epidemiology, however, are only beginning to emerge. One reason for this delay is that usually complete follow-up of patients in hospital is feasible. This overview discusses where survival techniques provide additional insight into hospital epidemiology, and where they are, in fact, needed even in the absence of right-censoring.
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Affiliation(s)
- Jan Beyersmann
- Freiburg Centre for Data Analysis and Modelling, University of Freiburg, Eckerstraße 1, Freiburg, Germany.
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Rodríguez-Baño J, Bischofberger C, Álvarez-Lerma F, Asensio Á, Delgado T, García-Arcal D, García-Ortega L, Jesús Hernández M, Molina-Cabrillana J, Pérez-Canosa C, Pujol M. Vigilancia y control de Staphylococcus aureus resistente a meticilina en hospitales españoles. Documento de consenso GEIH-SEIMC y SEMPSPH. Enferm Infecc Microbiol Clin 2008; 26:285-98. [DOI: 10.1157/13120418] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Birnbaum D. Self‐directed (distance) learning infectious disease control MPH program. Leadersh Health Serv (Bradf Engl) 2008. [DOI: 10.1108/17511870810845897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to confirm what program features potential students would view as incentives or disincentives toward enrolling in a unique self‐directed (distance) learning infectious disease control MPH (Master of Public Health) program currently being developed.Design/methodology/approachAn internet discussion list announcement invited infection control professionals to participate in structured telephone interviews. This pilot study survey was conducted to confirm underlying assumptions about program features that might be viewed as incentives or disincentives by prospective students.FindingsResponses were received from all regions of the USA except Alaska. Findings from 78 interviews confirm our underlying assumptions about delivery preferences, critical features, perceived value and reasonable cost for a self‐directed (distance) learning Infectious Disease Control MPH degree. Respondents clearly expressed a preference for distance education, but exhibited lack of familiarity with the various types and relative merits of different distance delivery modalities.Originality/value“Build it and they will come” has long been a widespread assumption in curriculum development. However, continuing education and advanced credentialing needs of health professionals can be better served by executive‐MBA‐style programs. One lesson from examining the experience of our academic MBA colleagues is to know your clients. This study uniquely confirms assumptions about the educational preferences of infection control professionals.
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Siegel JD, Rhinehart E, Jackson M, Chiarello L. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007; 35:S165-93. [PMID: 18068814 DOI: 10.1016/j.ajic.2007.10.006] [Citation(s) in RCA: 672] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jane D Siegel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Perencevich EN, Stone PW, Wright SB, Carmeli Y, Fisman DN, Cosgrove SE. Raising standards while watching the bottom line: making a business case for infection control. Infect Control Hosp Epidemiol 2007; 28:1121-33. [PMID: 17933084 DOI: 10.1086/521852] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
While society would benefit from a reduced incidence of nosocomial infections, there is currently no direct reimbursement to hospitals for the purpose of infection control, which forces healthcare institutions to make economic decisions about funding infection control activities. Demonstrating value to administrators is an increasingly important function of the hospital epidemiologist because healthcare executives are faced with many demands and shrinking budgets. Aware of the difficulties that face local infection control programs, the Society for Healthcare Epidemiology of America (SHEA) Board of Directors appointed a task force to draft this evidence-based guideline to assist hospital epidemiologists in justifying and expanding their programs. In Part 1, we describe the basic steps needed to complete a business-case analysis for an individual institution. A case study based on a representative infection control intervention is provided. In Part 2, we review important basic economic concepts and describe approaches that can be used to assess the financial impact of infection prevention, surveillance, and control interventions, as well as the attributable costs of specific healthcare-associated infections. Both parts of the guideline aim to provide the hospital epidemiologist, infection control professional, administrator, and researcher with the tools necessary to complete a thorough business-case analysis and to undertake an outcome study of a nosocomial infection or an infection control intervention.
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Affiliation(s)
- Eli N Perencevich
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Salgado CD, Ison MG. Should clinicians worry about vancomycin-resistant Enterococcus bloodstream infections? Bone Marrow Transplant 2007; 38:771-4. [PMID: 17133239 DOI: 10.1038/sj.bmt.1705532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Muto CA, Vos MC, Jarvis WR, Farr BM. Control of nosocomial methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 2006; 43:387-8. [PMID: 16804860 PMCID: PMC7107895 DOI: 10.1086/505605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Carlene A. Muto
- University of Pittsburgh, Pittsburgh, Pennsylvania
- Reprints or correspondence: Dr. Carlene A. Muto, Infection Control and Hospital Epidemiology, University of Pittsburgh Medical Center, Presbyterian Campus, 3471 Fifth Ave., 1215 Kaufmann Bldg., Pittsburgh, PA 15213 ()
| | - Margreet C. Vos
- Erasmus University Medical Center, Rotterdam, The Netherlands
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Coia JE, Duckworth GJ, Edwards DI, Farrington M, Fry C, Humphreys H, Mallaghan C, Tucker DR. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2006; 63 Suppl 1:S1-44. [PMID: 16581155 DOI: 10.1016/j.jhin.2006.01.001] [Citation(s) in RCA: 388] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Indexed: 01/01/2023]
Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) remains endemic in many UK hospitals. Specific guidelines for control and prevention are justified because MRSA causes serious illness and results in significant additional healthcare costs. Guidelines were drafted by a multi-disciplinary group and these have been finalised following extensive consultation. The recommendations have been graded according to the strength of evidence. Surveillance of MRSA should be undertaken in a systematic way and should be fed back routinely to healthcare staff. The inappropriate or unnecessary use of antibiotics should be avoided, and this will also reduce the likelihood of the emergence and spread of strains with reduced susceptibility to glycopeptides, i.e. vancomycin-intermediate S. aureus/glycopeptide-intermediate S. aureus (VISA/GISA) and vancomycin-resistant S. aureus (VRSA). Screening for MRSA carriage in selected patients and clinical areas should be performed according to locally agreed criteria based upon assessment of the risks and consequences of transmission and infection. Nasal and skin decolonization should be considered in certain categories of patients. The general principles of infection control should be adopted for patients with MRSA, including patient isolation and the appropriate cleaning and decontamination of clinical areas. Inadequate staffing, especially amongst nurses, contributes to the increased prevalence of MRSA. Laboratories should notify the relevant national authorities if VISA/GISA or VRSA isolates are identified.
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Affiliation(s)
- J E Coia
- Department of Bacteriology, Glasgow Royal Infirmary, Glasgow, UK
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Zapantis A, Lacy MK, Horvat RT, Grauer D, Barnes BJ, O'Neal B, Couldry R. Nationwide antibiogram analysis using NCCLS M39-A guidelines. J Clin Microbiol 2005; 43:2629-34. [PMID: 15956376 PMCID: PMC1151919 DOI: 10.1128/jcm.43.6.2629-2634.2005] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Lack of standardization in antibiogram (ABGM) preparation (the overall profile of antimicrobial susceptibility results of a microbial species to a battery of antimicrobial agents) has not been addressed until recently. The objective of this study was to analyze current antibiograms using the recently published NCCLS M39-A guidelines for preparation of antibiograms to identify areas for improvement in the reporting of antibiogram susceptibility data. Antibiograms from across the United States were obtained by various methods, including direct mailings, Internet searches, and professional contacts. Each ABGM collected was analyzed using prospectively defined elements from the M39-A guidelines. Additionally, seven quality indicators were also evaluated to look for the reporting of any atypical or inappropriate susceptibility data. The 209 antibiograms collected from 149 institutions showed at least 85% compliance to 5 of the 10 M39-A elements analyzed. Clinically relevant elements not met included annual analysis, duplicate isolate notation, and the exclusion of organisms with fewer than 10 isolates. As for the quality indicators evaluated, unexpected results included the 7% of antibiograms that reported <100% vancomycin susceptibility for Staphylococcus aureus, 24% that had inconsistent beta-lactam susceptibility for Staphylococcus aureus, 20% that reported <100% imipenem susceptibility for Escherichia coli, and 37% that reported >0% ampicillin susceptibility for Klebsiella pneumoniae. These findings suggest that antibiograms should be reviewed thoroughly by infectious disease specialists (physicians and pharmacists), clinical microbiologists, and infection control personnel for identification of abnormal findings prior to distribution.
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Affiliation(s)
- Antonia Zapantis
- Nova Southeastern University College of Pharmacy, 3200 South University Drive, Fort Lauderdale, FL 33308, USA.
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Wilson SJ, Knipe CJ, Zieger MJ, Gabehart KM, Goodman JE, Volk HM, Sood R. Direct costs of multidrug-resistant Acinetobacter baumannii in the burn unit of a public teaching hospital. Am J Infect Control 2004; 32:342-4. [PMID: 15454892 DOI: 10.1016/j.ajic.2004.02.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We conducted a case-control study to determine the attributable direct costs of multidrug-resistant Acinetobacter baumannii (MDRAB) in the burn unit of a public teaching hospital. The mean total hospital cost of patients who acquired MDRAB was 98,575 dollars higher than that of control patients who had identical burn severity of illness indices ( P <.01). These data should help infection control practitioners and others determine the cost-effectiveness of specific interventions designed to control this emerging nosocomial pathogen.
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Affiliation(s)
- Stephen J Wilson
- Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, USA.
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Marshall C, Wesselingh S, McDonald M, Spelman D. Control of endemic MRSA-what is the evidence? A personal view. J Hosp Infect 2004; 56:253-68. [PMID: 15066735 DOI: 10.1016/j.jhin.2004.02.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2004] [Accepted: 01/23/2004] [Indexed: 11/28/2022]
Abstract
Although there is extensive literature on the control of MRSA, when that concerning epidemics is excluded, only a limited amount remains regarding the control of endemic MRSA. Several guidelines have been recently published recommending stringent control measures, which are often suggested based on their success in controlling MRSA outbreaks in hospitals with few MRSA or in containing MRSA cases introduced into a hospital with no MRSA. In these settings, multiple measures are usually introduced with apparently successful results. However, results may not be generalizable to other settings and we do not know the minimum effective measures required for MRSA containment. This paper aims critically to review the literature to determine whether evidence exists for the value of the infection control measures that are widely recommended in the endemic setting. Much of this literature is based on observational studies, with few randomized, controlled trials having been conducted. More well-designed studies are required before many of the principles on which we build infection control programmes can be regarded as evidence based.
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Affiliation(s)
- C Marshall
- Department of Epidemiology and Preventive Medicine, Monash University and Infection Control and Hospital Epidemiology Unit, Alfred Hospital, Melbourne, Australia.
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Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, Farr BM. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003; 24:362-86. [PMID: 12785411 DOI: 10.1086/502213] [Citation(s) in RCA: 1110] [Impact Index Per Article: 52.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Infection control programs were created three decades ago to control antibiotic-resistant healthcare-associated infections, but there has been little evidence of control in most facilities. After long, steady increases of MRSA and VRE infections in NNIS System hospitals, the Society for Healthcare Epidemiology of America (SHEA) Board of Directors made reducing antibiotic-resistant infections a strategic SHEA goal in January 2000. After 2 more years without improvement, a SHEA task force was appointed to draft this evidence-based guideline on preventing nosocomial transmission of such pathogens, focusing on the two considered most out of control: MRSA and VRE. METHODS Medline searches were conducted spanning 1966 to 2002. Pertinent abstracts of unpublished studies providing sufficient data were included. RESULTS Frequent antibiotic therapy in healthcare settings provides a selective advantage for resistant flora, but patients with MRSA or VRE usually acquire it via spread. The CDC has long-recommended contact precautions for patients colonized or infected with such pathogens. Most facilities have required this as policy, but have not actively identified colonized patients with surveillance cultures, leaving most colonized patients undetected and unisolated. Many studies have shown control of endemic and/or epidemic MRSA and VRE infections using surveillance cultures and contact precautions, demonstrating consistency of evidence, high strength of association, reversibility, a dose gradient, and specificity for control with this approach. Adjunctive control measures are also discussed. CONCLUSION Active surveillance cultures are essential to identify the reservoir for spread of MRSA and VRE infections and make control possible using the CDC's long-recommended contact precautions.
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Affiliation(s)
- Carlene A Muto
- Division of Hospital Epidemiology and Infection Control, UPMC-P, Pittsburgh, Pennsylvania 15213, USA
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Affiliation(s)
- John P Burke
- Department of Clinical Epidemiology and Infectious Diseases, LDS Hospital, Salt Lake City, Utah, USA
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Burke JP. Surveillance, reporting, automation, and interventional epidemiology. Infect Control Hosp Epidemiol 2003; 24:10-2. [PMID: 12558229 DOI: 10.1086/502108] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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