scholarly journals Discontinuation of Contact Precautions in Patients with Nosocomial MRSA and VRE Infections During the COVID-19 Pandemic

2021 ◽  
Vol 1 (S1) ◽  
pp. s24-s24
Author(s):  
Marisa Hudson ◽  
Mayar Al Mohajer
Keyword(s):  
Hand Hygiene ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Incidence Density ◽  
Contact Precautions ◽  
Before And After ◽  
Hospital Acquired ◽  
The Impact

Background: Gaps exist in the evidence supporting the benefits of contact precautions for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The Centers for Disease Control and Prevention allow suspending contact precautions for MRSA and VRE in cases of gown shortages, as we have seen during the COVID-19 pandemic. We evaluated the impact of discontinuing isolation precautions in hospitalized patients with MRSA and VRE infection, due to gown shortage, on the rate of hospital-acquired (HA) MRSA and VRE infections. Methods: A retrospective chart review was performed on adult patients (n = 2,200) with established MRSA or VRE infection at 5 hospitals in CommonSpirit Health, Texas Division, from March 2019 to October 2020. Data including demographics, infection site, documented symptoms, and antibiotic use were stratified based on patient location (floor vs ICU). Rates of hospital-acquired MRSA and VRE infection before and after the discontinuation of isolation (implemented in March 2020) were compared. Incidence density rate was used to assess differences in the rate of MRSA and VRE infections between pre- and postintervention groups. Results: The rate of hospital-acquired (HA) MRSA infection per 10,000 patient days before the intervention (March 19–February 20) was 12.19, compared to 10.64 after the intervention (March 20–July 20) (P = .038). The rates of HA MRSA bacteremia were 1.13 and 0.93 for the pre- and postintervention groups, respectively (P = .074). The rates of HA VRE per 10,000 patient days were 3.53 and 4.44 for the pre- and postintervention groups, respectively (P = .274). The hand hygiene rates were 0.93 before the intervention and 0.97 after the intervention (P = .028). Conclusions: Discontinuing isolation from MRSA and VRE in the hospital setting did not lead to a statistically significant increase in hospital-acquired MRSA or VRE infections. In fact, rates of hospital-acquired MRSA decreased, likely secondary to improvements in hand hygiene during this period. These results support the implementation of policies for discontinuing contact isolation for hospitalized patients with documented MRSA or VRE infection, particularly during shortages of gowns.Funding: NoDisclosures: None

The impact of a multimodel approach to designing a new orthopedic department

2020 ◽  
pp. 1-6
Author(s):  
Elad Keren ◽  
Abraham Borer ◽  
Lior Nesher ◽  
Tali Shafat ◽  
Rivka Yosipovich ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Prevention Measures ◽  
Orthopedic Department ◽  
Before And After ◽  
The Impact

Abstract Objective: To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department. Design: Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention. Setting: A 1,000-bed, tertiary-care, university hospital. Patients: Adult patients admitted to the orthopedics department between January 2015 and December 2018. Methods: During the preintervention period (2015–2016), 1 general orthopedic department was in operation. In the postintervention period (2017–2018), 2 separate departments were created: one designated for elective “clean” surgeries and another that included a “complicated wound” unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed. Results: The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6–9) to the postintervention period (median, 4 days; IQR, 2–7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001). Conclusions: Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.

scholarly journals The Use of Probiotics in the Prevention of Clostridium Difficile Infection

2016 ◽  
Author(s):  
Lindsay Mook
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Healthcare Providers ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
The United States ◽  
Hospitalized Patients ◽  
Study Results ◽  
Prescribing Trends ◽  
Hospital Acquired

<p>Despite advances in the diagnosis and treatment of Clostridium difficile infection (CDI), the prevention of CDI, particularly in the inpatient hospital setting, remains a challenge. Clostridium difficile now rivals methicillin-resistant staphylococcus aureus (MRSA) as the most common pathogen to cause hospital acquired infections (HAI) in the United States. Hospitalized patients are considered to be especially high risk for CDI, and among inpatient cases, antibiotic treatment, especially with Fluoroquinolones has been an almost universal factor in the development of CDIs. One preventative measure that is incontinently used in the prevention of CDI is oral probiotics. Probiotic consumption is reported to exert a myriad of beneficial effects including enhanced immune response, balancing of colonic microbiota, treatment of diarrhea associated with travel and antibiotic therapy, control of rotavirus and clostridium difficile induced colitis. The American College of Gastroenterology recognizes the role of probiotics and included probiotics as a level B recommendation for the treatment of CDI. It has been hypothesized that the use of probiotics, as an adjunctive therapy in patients receiving antibiotics, may provide a key intervention in reducing primary CDI. The purpose of this study was to conduct a retrospective chart review to explore healthcare providers prescribing trends regarding Fluoroquinolone antibiotics and adjunctive probiotics in patients with hospital acquired CDI. The Synergy model was used to guide the study. Results indicated that probiotics are not frequently prescribed for hospitalized patients on Fluoroquinolones and when they are it is with inconsistency. Additional research is recommended to further assess the use of probiotics in conjunction with other classes of commonly used antibiotics; this study solely looked at Fluoroquinolones.</p>

The Impact of Discontinuing Contact Precautions for VRE and MRSA on Device-Associated Infections

2015 ◽  
Vol 36 (8) ◽  
pp. 978-980 ◽  
Author(s):  
Michael B. Edmond ◽  
Nadia Masroor ◽  
Michael P. Stevens ◽  
Janis Ober ◽  
Gonzalo Bearman
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Infection Rates ◽  
Hospital Acquired Infection ◽  
Contact Precautions ◽  
Academic Medical ◽  
Before And After ◽  
Hospital Acquired ◽  
The Impact ◽  
Before And After Study

The impact of discontinuing contact precautions for patients with MRSA and VRE colonization/infection on device-associated hospital-acquired infection rates at an academic medical center was investigated in this before-and-after study. In the setting of a strong horizontal infection prevention platform, discontinuation of contact precautions had no impact on device-associated hospital-acquired infection rates.Infect. Control Hosp. Epidemiol. 2015;36(8):978–980

scholarly journals Impact of the coronavirus disease 2019 (COVID-19) pandemic on nosocomial Clostridioides difficile infection

2020 ◽  
pp. 1-5 ◽  
Author(s):  
Manuel Ponce-Alonso ◽  
Javier Sáez de la Fuente ◽  
Angela Rincón-Carlavilla ◽  
Paloma Moreno-Nunez ◽  
Laura Martínez-García ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Control Period ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
Incidence Density ◽  
Care Hospital ◽  
Patient Mobility ◽  
Clostridioides Difficile ◽  
Defined Daily Doses ◽  
The Impact

Abstract Objectives: The coronavirus disease 2019 (COVID-19) pandemic has induced a reinforcement of infection control measures in the hospital setting. Here, we assess the impact of the COVID-19 pandemic on the incidence of nosocomial Clostridioides difficile infection (CDI). Methods: We retrospectively compared the incidence density (cases per 10,000 patient days) of healthcare-facility–associated (HCFA) CDI in a tertiary-care hospital in Madrid, Spain, during the maximum incidence of COVID-19 (March 11 to May 11, 2020) with the same period of the previous year (control period). We also assessed the aggregate in-hospital antibiotic use (ie, defined daily doses [DDD] per 100 occupied bed days [BD]) and incidence density (ie, movements per 1,000 patient days) of patient mobility during both periods. Results: In total, 2,337 patients with reverse transcription-polymerase chain reaction–confirmed COVID-19 were admitted to the hospital during the COVID-19 period. Also, 12 HCFA CDI cases were reported at this time (incidence density, 2.68 per 10,000 patient days), whereas 34 HCFA CDI cases were identified during the control period (incidence density, 8.54 per 10,000 patient days) (P = .000257). Antibiotic consumption was slightly higher during the COVID-19 period (89.73 DDD per 100 BD) than during the control period (79.16 DDD per 100 BD). The incidence density of patient movements was 587.61 per 1,000 patient days during the control period and was significantly lower during the COVID-19 period (300.86 per 1,000 patient days) (P < .0001). Conclusions: The observed reduction of ~70% in the incidence density of HCFA CDI in a context of no reduction in antibiotic use supports the importance of reducing nosocomial transmission by healthcare workers and asymptomatic colonized patients, reinforcing cleaning procedures and reducing patient mobility in the epidemiological control of CDI.

scholarly journals 1985. Impact of Suppressing Ciprofloxacin Susceptibility Results on Antibiotic Utilization and Hospital-acquired Clostridioides difficile Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S664-S665
Author(s):  
Bryan P White ◽  
Daniel B Chastain ◽  
Karen Kinney ◽  
Katie Thompson ◽  
Jerry Kelley ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Interrupted Time Series Analysis ◽  
E Coli ◽  
Clostridioides Difficile ◽  
Antibiotic Utilization ◽  
Increased Risk ◽  
Days Of Therapy ◽  
Before And After ◽  
Hospital Acquired ◽  
The Impact

Abstract Background Fluoroquinolones (FQs) are broad-spectrum antibiotics associated with multiple adverse effects and an increased risk of Clostridioides difficile infections (CDI). Previous data suggest that suppression of FQ susceptibility results decreased FQ use. The purpose of this study was to examine the impact of suppressing ciprofloxacin susceptibility on antibiotic use, susceptibility, and CDI. Methods This was a single-center quasi-experimental study of the effect of the suppression of ciprofloxacin susceptibility on pan susceptible urine isolates for Klebsiella sp. and E. coli starting in March 2018 in the 11 months before and after the intervention. Monthly antibiotic utilization in days of therapy (DOT)/1,000 patient-days for levofloxacin, ciprofloxacin, ceftriaxone, trimethoprim/sulfamethoxazole (TMP/SMZ), fosfomycin, and nitrofurantoin, hospital-acquired CDI (HA-CDI) rates as defined by CDC, and Pseudomonas aeruginosa susceptibility was compared with interrupted time series analysis using Stata MP 12.1 before and after the intervention to compare the level, intercept, and rate, slope, of a trend line. Results There was no change in the level or rate of ciprofloxacin DOT (0.27, 95% CI: −0.94 to 1.48–3.49; 95% CI: −10.89 to 3.90) and levofloxacin DOT (−5.87, 95% CI: −17.79 to 6.06; −0.98, 95% CI −2.86 to 0.90) with the intervention, respectively. Level of P. aeruginosa susceptibility to ciprofloxacin level (8.13, 95% CI: 0.00 to 16.26) had a trend toward increasing and rate (1.65, 95% CI: 0.44 to 2.87) increased after the intervention. Ceftriaxone DOT level decreased after the intervention (P = 0.01), but the rate did not change. Cephalexin (P = 0.01) and nitrofurantoin (P = 0.01) DOT levels increased after the intervention without changes in rates. There was no change in the level or rate of HA-CDI, fosfomycin, or TMP/SMZ DOTs. Conclusion Suppressing ciprofloxacin susceptibility results on pan susceptible Klebsiella sp. and E. coli urine isolates was associated with increased P. aeruginosa susceptibility to ciprofloxacin and increased cephalexin and nitrofurantoin DOTs. No changes were seen in FQ use or HA-CDI rates. Disclosures All authors: No reported disclosures.

scholarly journals Impact of Antibiotic Use during Hospitalization on the Development of Gastrointestinal Colonization with Escherichia coli with Reduced Fluoroquinolone Susceptibility

2013 ◽  
Vol 34 (10) ◽  
pp. 1070-1076 ◽  
Author(s):  
Jennifer H. Han ◽  
Warren B. Bilker ◽  
Irving Nachamkin ◽  
Pam Tolomeo ◽  
Xiangqun Mao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
Cox Proportional Hazards ◽  
Hospitalized Patients ◽  
Fluoroquinolone Resistance ◽  
Gastrointestinal Colonization ◽  
The Impact ◽  
Time Varying Covariates

Objective.Infections due to fluoroquinolone-resistant Escherichia coli (FQREC) are associated with significant morbidity and mortality. Fluoroquinolone resistance likely arises at the level of gastrointestinal colonization. The objective of this study was to identify risk factors for the development of FQREC gastrointestinal tract colonization in hospitalized patients, including the impact of antibiotics prescribed during hospitalization.Design.A prospective cohort study was conducted from 2002 to 2004 within a university health system.Methods.Hospitalized patients initially colonized with fluoroquinolone-susceptible E. coli were followed up with serial fecal sampling for new FQREC colonization or until hospital discharge or death. A Cox proportional hazards regression model was developed to identify risk factors for new FQREC colonization, with antibiotic exposure modeled as time-varying covariates.Results.Of 395 subjects, 73 (18.5%) became newly colonized with FQREC. Length of stay before sampling (hazard ratio [HR], 1.02 [95% confidence interval (CI), 1.1–1.03]; P = .003) and malignancy (HR, 0.37 [95% CI, 0.21–0.67]; P = .001) were significantly associated with the development of FQREC colonization. In addition, receipt of a first-generation cephalosporin (HR, 1.19 [95% CI, 1.10–1.29]; P<.001) or cefepime (HR, 1.05 [95% CI, 1.00–1.10]; P = .048) during hospitalization increased the risk of new FQREC colonization.Conclusions.The acquisition of FQREC in the hospital setting is complex, and antimicrobial stewardship programs should take into account patterns of antibiotic use in implementing strategies to reduce the development of new FQREC colonization. Future studies are needed to identify risk factors for infection in hospitalized patients newly colonized with FQREC.

scholarly journals Effect of Removing Contact Precautions for Multidrug-Resistant Organisms on Hospital Infections in a Pediatric Health System

2020 ◽  
Vol 41 (S1) ◽  
pp. s199-s200
Author(s):  
Matthew Linam ◽  
Dorian Hoskins ◽  
Preeti Jaggi ◽  
Mark Gonzalez ◽  
Renee Watson ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Contact Precautions ◽  
Stewardship Program ◽  
Tract Infections ◽  
The Impact

Background: Discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) have failed to show an increase in associated transmission or infections in adult healthcare settings. Pediatric experience is limited. Objective: We evaluated the impact of discontinuing contact precautions for MRSA, VRE, and extended-spectrum β-lactamase–producing gram-negative bacilli (ESBLs) on device-associated healthcare-associated infections (HAIs). Methods: In October 2018, contact precautions were discontinued for children with MRSA, VRE, and ESBLs in a large, tertiary-care pediatric healthcare system comprising 2 hospitals and 620 beds. Coincident interventions that potentially reduced HAIs included blood culture diagnostic stewardship (June 2018), a hand hygiene education initiative (July 2018), a handshake antibiotic stewardship program (December 2018) and multidisciplinary infection prevention rounding in the intensive care units (November 2018). Compliance with hand hygiene and HAI prevention bundles were monitored. Device-associated HAIs were identified using standard definitions. Annotated run charts were used to track the impact of interventions on changes in device-associated HAIs over time. Results: Average hand hygiene compliance was 91%. Compliance with HAI prevention bundles was 81% for ventilator-associated pneumonias, 90% for catheter-associated urinary tract infections, and 97% for central-line–associated bloodstream infections. Overall, device-associated HAIs decreased from 6.04 per 10,000 patient days to 3.25 per 10,000 patient days after October 2018 (Fig. 1). Prior to October 2018, MRSA, VRE and ESBLs accounted for 10% of device-associated HAIs. This rate decreased to 5% after October 2018. The decrease in HAIs was likely related to interventions such as infection prevention rounds and handshake stewardship. Conclusions: Discontinuation of contact precautions for children with MRSA, VRE, and ESBLs were not associated with increased device-associated HAIs, and such discontinuation is likely safe in the setting of robust infection prevention and antibiotic stewardship programs.Funding: NoneDisclosures: None

scholarly journals The impact of a ‘milking the COW’ campaign in a regional hospital in Singapore

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Surinder Kaur M. S. Pada ◽  
Poh Lishi ◽  
Kim Sim Ng ◽  
Sarathamani Rethenam ◽  
Lilibeth Silagan Alenton ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Pathogenic Bacteria ◽  
Mixed Model ◽  
Mixed Model Analysis ◽  
Colony Forming Units ◽  
Skin Flora ◽  
Before And After ◽  
The Difference ◽  
And Control ◽  
The Impact

Abstract Background Computerisation of various processes in hospitals and reliance on electronic devices raises the concern of contamination of these devices from the patient environment. We undertook this study to determine if an attached hand hygiene device that unlocks the screen of a computer on wheels (COW) on usage can be effective in decreasing the microbiological burden on computer keyboards. Methods An electronic hand sanitizer was integrated onto the COW. A prospective cohort study with a crossover design involving 2 control and 2 intervention wards was used. The study end point was the number of colony forming units found on the keyboards. Bacteria were classified into 4 main groups; pathogenic, skin flora, from the environment or those thought to be commensals in healthy individuals. We then used a mixed effects model for the statistical analysis to determine if there were any differences before and after the intervention. Results Thirty-nine keyboards were swabbed at baseline, day 7 and 14, with 234 keyboards cultured, colony forming units (CFUs) counted and organisms isolated. By mixed model analysis, the difference of mean bacteria count between intervention and control for week 1 was 32.74 (− 32.74, CI − 94.29 to 28.75, p = 0.29), for week 2 by 155.86 (− 155.86, CI − 227.45 to − 83.53, p < 0.0001), and after the 2-week period by 157.04 (− 157.04, CI − 231.53 to − 82.67, p < 0.0001). In the sub-analysis, there were significant differences of pathogenic bacteria counts for the Intervention as compared to the Control in contrast with commensal counts. Conclusion A hand hygiene device attached to a COW may be effective in decreasing the microbiological burden on computer keyboards.

scholarly journals The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

2019 ◽  
Vol 3 (4) ◽  
pp. 545-552
Author(s):  
Nathalia De Oro ◽  
Maria E Gauthreaux ◽  
Julie Lamoureux ◽  
Joseph Scott
Keyword(s):  
Lactic Acid ◽  
Length Of Stay ◽  
Community Hospital ◽  
Unit Length ◽  
Hospital Setting ◽  
Control Group ◽  
Before And After ◽  
Quasi Experimental ◽  
Current Cutoff ◽  
The Impact

Abstract Background Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients. Methods This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation. Results Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods. Conclusions There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.

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