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Schmaltz SP, Longo BA, Williams SC. Infection Control Measure Performance in Long-Term Care Hospitals and Their Relationship to Joint Commission Accreditation. Jt Comm J Qual Patient Saf 2024; 50:425-434. [PMID: 38492986 DOI: 10.1016/j.jcjq.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND This study evaluated the relationship between Joint Commission accreditation and health care-associated infections (HAIs) in long-term care hospitals (LTCHs). METHODS This observational study used Centers for Medicare & Medicaid Services (CMS) LTCH data for the period 2017 to June 2021. The standardized infection ratio (SIR) of three measures used by the Centers for Disease Control and Prevention's National Healthcare Safety Network were used as dependent variables in a random coefficient Poisson regression model (adjusting for CMS region, owner type, and bed size quartile): catheter-associated urinary tract infections (CAUTIs), Clostridioides difficile infections (CDIs), and central line-associated bloodstream infections (CLABSIs) for the periods 2017 to 2019 and July 1, 2020, to June 30, 2021. Data from January 1 to June 30, 2020, were excluded due to the COVID-19 pandemic. RESULTS The data set included 244 (73.3%) Joint Commission-accredited and 89 (26.7%) non-Joint Commission-accredited LTCHs. Compared to non-Joint Commission-accredited LTCHs, accredited LTCHs had significantly better (lower) SIRs for CLABSI and CAUTI measures, although no differences were observed for CDI SIRs. There were no significant differences in year trends for any of the HAI measures. For each year of the study period, a greater proportion of Joint Commission-accredited LTCHs performed significantly better than the national benchmark for all three measures (p = 0.04 for CAUTI, p = 0.02 for CDI, p = 0.01 for CLABSI). CONCLUSION Although this study was not designed to establish causality, positive associations were observed between Joint Commission accreditation and CLABSI and CAUTI measures, and Joint Commission-accredited LTCHs attained more consistent high performance over the four-year study period for all three measures. Influencing factors may include the focus of Joint Commission standards on infection control and prevention (ICP), including the hierarchical approach to selecting ICP-related standards as inputs into LTCH policy.
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Goodman KE, Taneja M, Magder LS, Klein EY, Sutherland M, Sorongon S, Tamma PD, Resnik P, Harris AD. A multi-center validation of the electronic health record admission source and discharge location fields against the clinical notes for identifying inpatients with long-term care facility exposure. Infect Control Hosp Epidemiol 2024:1-6. [PMID: 38634555 DOI: 10.1017/ice.2024.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Identifying long-term care facility (LTCF)-exposed inpatients is important for infection control research and practice, but ascertaining LTCF exposure is challenging. Across a large validation study, electronic health record data fields identified 76% of LTCF-exposed patients compared to manual chart review. OBJECTIVE Residence or recent stay in a long-term care facility (LTCF) is an important risk factor for antibiotic-resistant bacterial colonization. However, absent dedicated intake questionnaires or resource-intensive chart review, ascertaining LTCF exposure in inpatients is challenging. We aimed to validate the electronic health record (EHR) admission and discharge location fields against the clinical notes for identifying LTCF-exposed inpatients. METHODS We conducted a retrospective study of 1020 randomly sampled adult admissions between 2016 and 2021 across 12 University of Maryland Medical System hospitals. Using study-developed guidelines, we categorized the following data for LTCF exposure: each admission’s history & physical (H&P) note, each admission’s EHR-extracted “Admission Source,” and (3) the EHR-extracted admission and discharge locations for previous admissions (≤90 days). We estimated sensitivities, with 95% CIs, of H&P notes and of EHR admission/discharge location fields for detecting “current” and “any recent” (≤90 days, including current) LTCF exposure. RESULTS For detecting current LTCF exposure, the sensitivity of the index admission’s EHR-extracted “Admission Source” was 46% (95% CI: 35%–58%) and of the H&P note was 92% (83%–97%). For detecting any recent LTCF exposure, the sensitivity of “Admission Source” across the index and previous admissions was 32% (24%–41%), “Discharge Location” across previous admission(s) was 57% (47%–66%), and of the H&P note was 68% (59%–76%). The combined sensitivity of admission source and discharge location for detecting any recent LTCF exposure was 76% (67%–83%). CONCLUSIONS The EHR-obtained admission source and discharge location fields identified 76% of LTCF-exposed patients compared to chart review but disproportionately missed currently exposed patients.
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Affiliation(s)
- Katherine E Goodman
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, MD, USA
- The University of Maryland Institute for Health Computing, Bethesda, MD, USA
| | - Monica Taneja
- The University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laurence S Magder
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eili Y Klein
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Sutherland
- Departments of Emergency Medicine and Internal Medicine, The University of Maryland School of Medicine, Baltimore, MD, USA
| | - Scott Sorongon
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pranita D Tamma
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philip Resnik
- Department of Linguistics and Institute for Advanced Computer Studies, The University of Maryland, College Park, College Park, MD, USA
| | - Anthony D Harris
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, MD, USA
- The University of Maryland Institute for Health Computing, Bethesda, MD, USA
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Rankin DA, Walters MS, Caicedo L, Gable P, Moulton-Meissner HA, Chan A, Burks A, Edwards K, McAllister G, Kent A, Laufer Halpin A, Moore C, McLemore T, Thomas L, Dotson NQ, Chu AK. Concurrent transmission of multiple carbapenemases in a long-term acute-care hospital. Infect Control Hosp Epidemiol 2024; 45:292-301. [PMID: 38196201 PMCID: PMC10933503 DOI: 10.1017/ice.2023.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE We investigated concurrent outbreaks of Pseudomonas aeruginosa carrying blaVIM (VIM-CRPA) and Enterobacterales carrying blaKPC (KPC-CRE) at a long-term acute-care hospital (LTACH A). METHODS We defined an incident case as the first detection of blaKPC or blaVIM from a patient's clinical cultures or colonization screening test. We reviewed medical records and performed infection control assessments, colonization screening, environmental sampling, and molecular characterization of carbapenemase-producing organisms from clinical and environmental sources by pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing. RESULTS From July 2017 to December 2018, 76 incident cases were identified from 69 case patients: 51 had blaKPC, 11 had blaVIM, and 7 had blaVIM and blaKPC. Also, blaKPC were identified from 7 Enterobacterales, and all blaVIM were P. aeruginosa. We observed gaps in hand hygiene, and we recovered KPC-CRE and VIM-CRPA from drains and toilets. We identified 4 KPC alleles and 2 VIM alleles; 2 KPC alleles were located on plasmids that were identified across multiple Enterobacterales and in both clinical and environmental isolates. CONCLUSIONS Our response to a single patient colonized with VIM-CRPA and KPC-CRE identified concurrent CPO outbreaks at LTACH A. Epidemiologic and genomic investigations indicated that the observed diversity was due to a combination of multiple introductions of VIM-CRPA and KPC-CRE and to the transfer of carbapenemase genes across different bacteria species and strains. Improved infection control, including interventions that minimized potential spread from wastewater premise plumbing, stopped transmission.
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Affiliation(s)
- Danielle A. Rankin
- Florida Department of Health in Orange County, Orlando, Florida
- Bureau of Epidemiology, Florida Department of Health, Tallahassee, Florida
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maroya Spalding Walters
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Luz Caicedo
- Florida Department of Health in Orange County, Orlando, Florida
| | - Paige Gable
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Allison Chan
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee
| | - Albert Burks
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee
| | - Kendra Edwards
- Bureau of Epidemiology, Florida Department of Health, Tallahassee, Florida
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gillian McAllister
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alyssa Kent
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christina Moore
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee
| | - Tracy McLemore
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee
| | - Linda Thomas
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee
| | - Nychie Q. Dotson
- Bureau of Epidemiology, Florida Department of Health, Tallahassee, Florida
- HCA Healthcare, Nashville, Tennessee
| | - Alvina K. Chu
- Florida Department of Health in Orange County, Orlando, Florida
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Lyman M, Forsberg K, Sexton DJ, Chow NA, Lockhart SR, Jackson BR, Chiller T. Worsening Spread of Candida auris in the United States, 2019 to 2021. Ann Intern Med 2023; 176:489-495. [PMID: 36940442 DOI: 10.7326/m22-3469] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND Candida auris is an emerging fungal threat that has been spreading in the United States since it was first reported in 2016. OBJECTIVE To describe recent changes in the U.S. epidemiology of C auris occurring from 2019 to 2021. DESIGN Description of national surveillance data. SETTING United States. PATIENTS Persons with any specimen that was positive for C auris. MEASUREMENTS Case counts reported to the Centers for Disease Control and Prevention by health departments, volume of colonization screening, and antifungal susceptibility results were aggregated and compared over time and by geographic region. RESULTS A total of 3270 clinical cases and 7413 screening cases of C auris were reported in the United States through 31 December 2021. The percentage increase in clinical cases grew each year, from a 44% increase in 2019 to a 95% increase in 2021. Colonization screening volume and screening cases increased in 2021 by more than 80% and more than 200%, respectively. From 2019 to 2021, 17 states identified their first C auris case. The number of C auris cases that were resistant to echinocandins in 2021 was about 3 times that in each of the previous 2 years. LIMITATION Identification of screening cases depends on screening that is done on the basis of need and available resources. Screening is not conducted uniformly across the United States, so the true burden of C auris cases may be underestimated. CONCLUSION C auris cases and transmission have risen in recent years, with a dramatic increase in 2021. The rise in echinocandin-resistant cases and evidence of transmission is particularly concerning because echinocandins are first-line therapy for invasive Candida infections, including C auris. These findings highlight the need for improved detection and infection control practices to prevent spread of C auris. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Meghan Lyman
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Kaitlin Forsberg
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - D Joseph Sexton
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Nancy A Chow
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Shawn R Lockhart
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Brendan R Jackson
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Tom Chiller
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
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Yang M, Huang Y, Li Q, Zhao H, Liu X, Gao S, Zhou X, Chen Y. A matrix management of prevention and control for carbapenem-resistant Enterobacteriaceae in an urban compact medical union. Indian J Med Microbiol 2022; 43:30-35. [PMID: 36357265 DOI: 10.1016/j.ijmmb.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/04/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To understand the epidemiological characteristics of nosocomial infection of carbapenem-resistant Enterobacteriaceae (CRE) in an urban medical union includes 10 medical hospitals with different number of beds in China. METHODS Epidemiological data on age, department, and infection of CRE cases detected from January 2014 to December 2021 were collected via a real-time hospital-infection monitoring system or manually for subsequent characterization. A multi-departmental and multi-disciplinary matrix (MMM) management of CRE was established and implemented within a medical union. RESULTS A total of 1327 cases of CRE infection were detected during the 8 years, of which 352 were due to nosocomial infection, with an infection morbidity of 0.046% and a resistance rate of 10.79%. The morbidity of CRE infection showed a trend of year-to-year fluctuation. The morbidity of CRE infection was significantly higher in winter and spring than that in summer and autumn, significantly higher in men than in women (χ2 = 55.891, p < 0.001), and 3 times higher in elderly patients ≥65 years old than in patients <65 years old (χ2 = 117.517, p < 0.001). The morbidity of CRE infection after intervention with MMM management decreased significantly from 0.071% to 0.042% (χ2 = 15.628, p < 0.001). CONCLUSIONS CRE prevention and control practice should be adapted to seasonal variations, gender and age differences. The effective prevention and control of CRE nosocomial infections can be achieved by implementing MMM management within a medical association.
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