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Kopuit P, Bier L, Abu-Gush S, Smadga H, David R, Shraga T, Dery I, Ezagui BS, Yinnon AM, Benenson S. How effective are monthly departmental tracer surveys? A 5-year retrospective study of 138 surveys in 96 departments. Am J Infect Control 2024:S0196-6553(24)00161-5. [PMID: 38583776 DOI: 10.1016/j.ajic.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Repeat department-wide surveys are commonly employed for infection control. There remains debate concerning their cost-effectivess. The aim of the study was to measure the impact of repeat department-wide surveys in major in-patient departments (IPDs) and ambulatory facilities (AFs) in a tertiary care hospital. This was a retrospective study of 138 surveys condcuted in 96 departments over a 5-year period. METHODS Two itemized questionnaires were designed to assess the most frequently inadequately adhered to infection control measures: one for IPD (with 21 items) and the other for AF (with 17 items). RESULTS A total of 72 surveys were conducted in 49 IPDs, of which 39 (54%) were repeat surveys, and 66 surveys in 47 AFs, of which 33 (50%) were repeat surveys. The baseline rate of adherence/department was 71% ± 14 for the IPD, with an increase from the first to the last survey to 82% ± 13 (P = .037). In 15/21 measured infection control items, adherence improved. Adherence to infection control items was lower at baseline in the AFs than in the IPDs (63 ± 27), with an increase to 76 ± 20 (non significant). Although adherence improved for 9 items, it deteriorated in another 8, producing an overall statistically unchanged outcome. CONCLUSION Repeat whole-department surveys contribute moderately to increased adherence to infection control guidelines. AFs demonstrate lower rates of adherence to infection control guidelines and are less receptive to educational measures.
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Affiliation(s)
- Puah Kopuit
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Liora Bier
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Samar Abu-Gush
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Hanna Smadga
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ruth David
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Tova Shraga
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ilana Dery
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Bath Sheva Ezagui
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Amos M Yinnon
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew-University Hadassah Medical School, Jerusalem, Israel.
| | - Shmuel Benenson
- Infection Control and Prevention Unit, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew-University Hadassah Medical School, Jerusalem, Israel
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Hassoun-Kheir N, Hussien K, Karram M, Saffuri M, Badaan S, Peleg S, Aboelhega W, Warman S, Alon T, Pollak D, Szwarcwort Cohen M, Paul M. Clinical significance and burden of carbapenem-resistant Enterobacterales (CRE) colonization acquisition in hospitalized patients. Antimicrob Resist Infect Control 2023; 12:129. [PMID: 37986092 PMCID: PMC10658805 DOI: 10.1186/s13756-023-01323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/20/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Enterobacterales (CRE) infections have a significant morbidity and mortality toll. The clinical significance and associated burden of CRE colonization rather than infection state are not frequently investigated. We aimed to assess the outcomes of CRE colonized patients compared to matched controls. METHODS A secondary analysis of a 1:2 matched case-control study at a tertiary hospital in northern Israel (January-2014 to June-2017). Cases were adults who newly acquired CRE colonization during hospitalization. Controls were inpatients negatively screened for CRE, matched by age, hospitalization division and total days of hospitalization 90 days prior to screening. Our primary outcome was 1-year all-cause mortality. Secondary outcomes included 30-day mortality, diagnosis of any clinical infection, overall days of hospital stay and bloodstream infections all in 1-year follow-up. We estimated crude and propensity score weighted estimates for study outcomes. RESULTS We included a total of 1019 patients: 340 CRE colonized and 679 non-colonized controls. After adjustment, CRE colonization was not associated with increased 1-year mortality (weighted OR 0.98, 95% CI 0.64-1.50, p = 0.936). CRE colonized patients had 1.7 times the odds of clinical infection of any cause (weighted odds ratio (OR) 1.65, 95% CI 1.06-2.56, p = 0.025). CRE colonized patients had increased length of hospital stay compared to controls (weighted OR 1.52, 95%CI 1.10-2.10, p < 0.001) among 1-year survivors. CONCLUSIONS CRE colonization may not be independently associated with mortality but with higher risk of clinical infections and longer hospital stays. Infection prevention and antimicrobial stewardship are of utmost importance to prevent acquisition and infections in colonized patients.
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Affiliation(s)
- Nasreen Hassoun-Kheir
- Faculty of Medicine Geneva, Geneva University Hospitals, 1205, Geneva, Switzerland.
- Infectious Diseases and Infection Control Unit, Rambam Health Care Campus, Haifa, Israel.
| | - Khetam Hussien
- Infectious Diseases and Infection Control Unit, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Marianne Karram
- Sackler Faculty of Medicine, School of Public Health, University of Tel-Aviv, Tel-Aviv, Israel
| | - Maram Saffuri
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Sally Badaan
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shani Peleg
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Worood Aboelhega
- Infectious Diseases and Infection Control Unit, Rambam Health Care Campus, Haifa, Israel
| | - Sigal Warman
- Infectious Diseases and Infection Control Unit, Rambam Health Care Campus, Haifa, Israel
| | - Tamar Alon
- Infectious Diseases and Infection Control Unit, Rambam Health Care Campus, Haifa, Israel
| | - Dina Pollak
- Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel
| | | | - Mical Paul
- Infectious Diseases and Infection Control Unit, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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3
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Henoun Loukili N, Loquet A, Perrin A, Gaillot O, Bruandet A, Sendid B, Zahar JR, Nseir S. Time to intestinal clearance of carbapenemase-producing Enterobacterales in hospital patients: a longitudinal retrospective observational cohort study. J Hosp Infect 2023; 135:4-10. [PMID: 36871872 DOI: 10.1016/j.jhin.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Intestinal clearance of carbapenemase-producing Enterobacterales (CPE-IC) is a cornerstone to discontinue isolation precautions for CPE patients in hospitals. This study aimed to evaluate the time to spontaneous CPE-IC and identify its potential associated risk factors. METHODS This retrospective cohort study was carried out between January 2018 and September 2020 on all patients in a 3200-bed teaching referral hospital with confirmed CPE intestinal carriage. CPE-IC was defined as at least three consecutive CPE-negative rectal swab cultures without a subsequent positive result. A survival analysis was performed to determine the median time to CPE-IC. A multivariate Cox model was implemented to explore the factors associated with CPE-IC. RESULTS A total of 110 patients were positives for CPE, of whom 27 (24.5%) achieved CPE-IC. Median time to CPE-IC was 698 days. Univariate analysis showed that female sex (P=0.046), multiple CPE-species in index cultures (P=0.005), Escherichia coli or Klebsiella spp. (P=0.001 and P=0.028, respectively) were significantly associated with the time to CPE-IC. Multivariate analysis highlighted that identification of E. coli carbapenemase-producing or CPEs harbouring ESBL genes in index culture extended the median time to CPE-IC, respectively (adjusted hazard ratio (aHR) = 0.13 (95% confidence interval: 0.04-0.45]; P=0.001 and aHR = 0.34 (95% confidence interval: 0.12-0.90); P=0.031). CONCLUSION Intestinal decolonization of CPE can take several months to years to occur. Carbapenemase-producing E. coli are likely to play a key role in delaying intestinal decolonization, probably through horizontal gene transfer between species. Therefore, discontinuation of isolation precautions in CPE-patients should be considered with caution.
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Affiliation(s)
- N Henoun Loukili
- Infection Control and Prevention Unit, Centre Hospitalier Universitaire de Lille, Lille, France.
| | - A Loquet
- Infection Control and Prevention Unit, Centre Hospitalier Universitaire de Lille, Lille, France
| | - A Perrin
- Infection Control and Prevention Unit, Centre Hospitalier Universitaire de Lille, Lille, France
| | - O Gaillot
- Department of Bacteriology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - A Bruandet
- Department of Medical Information, Centre Hospitalier Universitaire de Lille, Lille, France
| | - B Sendid
- Microbiology Institut, Centre Hospitalier Universitaire de Lille, Lille, France; Inserm U1285, University of Lille, CNRS, UMR, 8576, Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - J R Zahar
- Infection Control and Prevention Unit, Centre Hospitalier Universitaire Avicenne-APHP, Bobigny, France; IAME, UMR, 1137, Université Paris 13, Paris, France
| | - S Nseir
- Inserm U1285, University of Lille, CNRS, UMR, 8576, Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France; Pôle de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire de Lille, Lille, France
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Garcia R, Barnes S, Boukidjian R, Goss LK, Spencer M, Septimus EJ, Wright MO, Munro S, Reese SM, Fakih MG, Edmiston CE, Levesque M. Recommendations for change in infection prevention programs and practice. Am J Infect Control 2022; 50:1281-1295. [PMID: 35525498 PMCID: PMC9065600 DOI: 10.1016/j.ajic.2022.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 01/25/2023]
Abstract
Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future.
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Affiliation(s)
- Robert Garcia
- Department of Healthcare Epidemiology, State University of New York at Stony Brook, Stony Brook, NY,Address correspondence to Robert Garcia, BS, MT(ASCP), CIC, FAPIC, Department of Healthcare Epidemiology, State University of New York at Stony Brook, 100 Nicolls Rd, Stony Brook, NY, 11580
| | - Sue Barnes
- Infection Preventionist (Retired), San Mateo, CA
| | | | - Linda Kaye Goss
- Department of Infection Prevention, The Queen's Health System, Honolulu, HI
| | | | | | | | - Shannon Munro
- Department of Veterans Affairs Medical Center, Research and Development, Salem, VA
| | - Sara M. Reese
- Quality and Patient Safety Department, SCL Health System Broomfield, CO
| | - Mohamad G. Fakih
- Clinical & Network Services, Ascension Healthcare and Wayne State University School of Medicine, Grosse Pointe Woods, MI
| | | | - Martin Levesque
- System Infection Prevention and Control, Henry Ford Health, Detroit, MI
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