scholarly journals Has UTI and Clostridioides difficile Testing and Treatment Stewardship Diffused Into Oregon Hospitals? A Survey of the Current State

2020 ◽  
Vol 41 (S1) ◽  
pp. s243-s244
Author(s):  
Angela Villamagna ◽  
Rebecca Pierce ◽  
Dat Tran ◽  
Roza Tammer ◽  
Lisa Iguchi ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Acute Care ◽  
Infection Prevention ◽  
Acute Care Hospitals ◽  
Urine Collection ◽  
Treatment Algorithms ◽  
Clostridioides Difficile ◽  
Formed Stool

Background: Urinary tract infection (UTI) and Clostridioides difficile infection (CDI) both pose significant diagnostic challenges. Excess testing has implications for hospital-associated infection surveillance and may also lead to overtreatment and associated patient risk. Accurate diagnosis requires stewardship efforts to ensure that the correct patients are tested appropriately. In coordination with clinicians and microbiology labs, hospital infection prevention departments can aid diagnostic stewardship efforts by creating policies for order indications and proper test collection methods and by developing electronic medical record (EMR) support for diagnostic and treatment algorithms. The prevalence of these practices in Oregon, however, is unknown. Methods: We deployed a web-based survey to infection preventionists at all 61 acute-care hospitals in Oregon in January 2019. Responses were collected through April 2019, and a subset of applicable questions were analyzed. Results: Of 61 acute-care hospitals, 58 (95%) responded. A response from a single long-term acute-care hospital was excluded. For urinary tract infections (UTIs), a minority of hospitals reported having policies requiring annual sterile urine collection training for registered nurses (n = 7, 12%), annual observation of the RN sterile urine collection procedure (n = 1, 2%), or use of boric acid containers for urine collection (n = 10, 17%). UTI testing and treatment algorithms embedded in the electronic medical record (EMR) were more common (Fig. 1). Regarding urine culture reflex policies, 39 facilities (68%) reported reflexing abnormal urinalyses to culture only if ordered, whereas 14 respondents (25%) reported automatically reflexed all abnormal urinalyses to culture. For Clostridioides difficile infection (CDI), respondents reported using a variety of methods to discourage inappropriate testing (Fig. 2). Although almost all facilities (n = 53, 93%) reported having a policy to reject formed stool, less than half (n = 27, 47%) reported having a policy to reject stool in patients receiving laxatives. Furthermore, 74% of respondents (n = 42) had a published testing algorithm, more than twice the 18 (32%) hospitals that reported having a comparable UTI algorithm. Conclusions: Infection prevention departments in Oregon acute-care hospitals utilize a variety of tools to contribute to diagnostic and treatment stewardship for UTI and CDI. Our survey revealed many opportunities for improvement in UTI and C. difficile testing and treatment stewardship in Oregon hospitals. For example, although most hospitals reject formed stool for CDI testing, policies for other diagnosis and treatment stewardship techniques were much less commonly employed. Future work will compare the results of this survey to a set of similar questions on a statewide microbiology laboratory survey, assess best practices, and form consensus recommendations on stewardship practices for the state.Funding: NoneDisclosures: None

Types of Interventions

2021 ◽  
pp. 24-39
Author(s):  
Jennifer Meddings ◽  
Vineet Chopra ◽  
Sanjay Saint
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Infection Prevention ◽  
Indwelling Catheters ◽  
Inappropriate Use ◽  
Day Hospitals ◽  
Healthcare Associated

Infection prevention programs were slow to develop—they were a rarity as recently as the 1950s—but they have become a staple of modern-day hospitals. Great strides have been made in identifying clinician activities that can control or prevent various healthcare-associated infections. This chapter describes the contents of an infection prevention bundle for catheter-associated urinary tract infection (CAUTI). In the case of CAUTI, the so-called bladder bundle sets forth appropriate and inappropriate use of indwelling catheters. A nursing checklist, on paper or as a template in the electronic medical record, is used to track patients’ daily urinary catheter status. Doctors and nurses are asked to rethink when a Foley is called for, what alternatives should be considered, what catheter equipment should be used, and how long the Foley should remain in place.

scholarly journals Validation of an Automated Mortality Index using the Electronic Medical Record System in a Network of Acute Care Hospitals

2019 ◽  
Vol 8 (3) ◽  
pp. 8
Author(s):  
Deborah Morris ◽  
Brynn Sheehan ◽  
Rajan Lamichahane ◽  
Kathie Zimbro ◽  
Merri K Morgan ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Acute Care ◽  
Mortality Risk ◽  
Characteristic Curve ◽  
Risk Index ◽  
Acute Care Hospitals ◽  
Risk Of Death ◽  
Risk Of Mortality

Objective: Physicians struggle with prognostication for patients facing the final year of life. Practical tools which identify patients at the time of hospital admission who are at high risk of mortality would be helpful to provide timely access to supportive services, including palliative care and hospice. The PREDICT is a validated tool that predicts mortality risk but has not been implemented into electronic medical record (EMR) systems. The current study evaluated the validity of PREDICT within an EMR system and tracked patient mortality over 12 months.Methods: The study sample consisted of 3,488 adult patients admitted to a network of acute care hospitals. The PREDICT tool was evaluated for its ability to predict mortality within 6 and 12 months of hospitalization and was compared to the APR-DRG Mortality Risk Index (MRI).Results: A total of 299 patients (9%) were deceased within 12 months of hospital admission. Logistic regressions revealed that higher PREDICT scores were associated with greater risk of mortality within 6 and 12 months post-discharge. Receiver Operating Characteristic curve (ROC) analysis revealed that the overall PREDICT score significantly predicted mortality at 12 months (ROC = .767) and was a better predictor than the MRI.Conclusions: The PREDICT tool is a valid assessment of mortality risk and unlike the MRI, it can be readily automated in the EMR to help identify patients at greater risk of death. More research is needed to apply this tool in clinical practice and calibrate its performance across clinical settings. 

scholarly journals Effectiveness of Ultraviolet-C Room Disinfection on Preventing Healthcare-Associated Clostridioides difficile Infection

2020 ◽  
Vol 41 (S1) ◽  
pp. s33-s33
Author(s):  
Michihiko Goto ◽  
Erin Balkenende ◽  
Gosia Clore ◽  
Rajeshwari Nair ◽  
Loretta Simbartl ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Incidence Rates ◽  
Positive Test ◽  
Negative Binomial Regression Model ◽  
Test Results ◽  
Clostridioides Difficile ◽  
Ultraviolet C ◽  
Healthcare Associated ◽  
Uv C

Background: Enhanced terminal room cleaning with ultraviolet C (UVC) disinfection has become more commonly used as a strategy to reduce the transmission of important nosocomial pathogens, including Clostridioides difficile, but the real-world effectiveness remains unclear. Objectives: We aimed to assess the association of UVC disinfection during terminal cleaning with the incidence of healthcare-associated C. difficile infection and positive test results for C. difficile within the nationwide Veterans Health Administration (VHA) System. Methods: Using a nationwide survey of VHA system acute-care hospitals, information on UV-C system utilization and date of implementation was obtained. Hospital-level incidence rates of clinically confirmed hospital-onset C. difficile infection (HO-CDI) and positive test results with recent healthcare exposures (both hospital-onset [HO-LabID] and community-onset healthcare-associated [CO-HA-LabID]) at acute-care units between January 2010 and December 2018 were obtained through routine surveillance with bed days of care (BDOC) as the denominator. We analyzed the association of UVC disinfection with incidence rates of HO-CDI, HO-Lab-ID, and CO-HA-LabID using a nonrandomized, stepped-wedge design, using negative binomial regression model with hospital-specific random intercept, the presence or absence of UVC disinfection use for each month, with baseline trend and seasonality as explanatory variables. Results: Among 143 VHA acute-care hospitals, 129 hospitals (90.2%) responded to the survey and were included in the analysis. UVC use was reported from 42 hospitals with various implementation start dates (range, June 2010 through June 2017). We identified 23,021 positive C. difficile test results (HO-Lab ID: 5,014) with 16,213 HO-CDI and 24,083,252 BDOC from the 129 hospitals during the study period. There were declining baseline trends nationwide (mean, −0.6% per month) for HO-CDI. The use of UV-C had no statistically significant association with incidence rates of HO-CDI (incidence rate ratio [IRR], 1.032; 95% CI, 0.963–1.106; P = .65) or incidence rates of healthcare-associated positive C. difficile test results (HO-Lab). Conclusions: In this large quasi-experimental analysis within the VHA System, the enhanced terminal room cleaning with UVC disinfection was not associated with the change in incidence rates of clinically confirmed hospital-onset CDI or positive test results with recent healthcare exposure. Further research is needed to understand reasons for lack of effectiveness, such as understanding barriers to utilization.Funding: NoneDisclosures: None

scholarly journals Survey of Infection Prevention Informatics Use and Practitioner Satisfaction in US Hospitals

2014 ◽  
Vol 35 (7) ◽  
pp. 891-893 ◽  
Author(s):  
Max Masnick ◽  
Daniel J. Morgan ◽  
Marc-Oliver Wright ◽  
Michael Y. Lin ◽  
Lisa Pineles ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Antimicrobial Stewardship ◽  
Infection Prevention ◽  
Infect Control Hosp ◽  
Infection Preventionists

We surveyed hospital epidemiologists and infection preventionists on their usage of and satisfaction with infection prevention–specific software supplementing their institution’s electronic medical record. Respondents with supplemental software were more satisfied with their software’s infection prevention and antimicrobial stewardship capabilities than those without. Infection preventionists were more satisfied than hospital epidemiologists.Infect Control Hosp Epidemiol 2014;35(7):891–893

scholarly journals 785. Association between Prevalence of Laboratory-Identified Clostridioides difficile Infections (CDIs) and CDI Antibiotic Treatment in U.S. Acute Care Hospitals, 2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S437-S437
Author(s):  
Kerui Xu ◽  
Andrea L Benin ◽  
Hsiu Wu ◽  
Jonathan R Edwards ◽  
Qunna Li ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Prevalence Rates ◽  
Hospital Level ◽  
First Line ◽  
Oral Vancomycin ◽  
Patient Admissions ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Abstract Background Clostridioides difficile infections (CDIs) are an urgent public health threat, accounting for 223,900 infections and 12,800 deaths in hospitalized patients annually. In early 2018, the Infectious Disease Society of America (IDSA) recommended oral vancomycin or fidaxomicin as the first-line antibiotics for CDIs. To track the uptake of IDSA’s recommendations, we evaluated the association between CDI prevalence and use of first-line antibiotics in hospitals reporting to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN). Methods We matched 2018 hospital-level, NHSN data on laboratory-identified CDIs with NHSN antimicrobial use (AU) data for the same time period. Hospitals that submitted < 6 months of either data type in 2018 were excluded. The association between quarterly hospital-level CDI prevalence rates per 100 patient-admissions and use of CDI antibiotics (oral vancomycin plus fidaxomicin) per 1,000 days-present was evaluated using Pearson’s linear correlation coefficient and using Goodman and Kruskal’s gamma (G) on ordinal quartiles to assess rates of discordant pairs. Results Among the 2735 hospital-level quarters based on 714 hospitals included in the study, CDI prevalence (median: 0.46 per 100 patient-admissions) and CDI antibiotic use (median: 8.85 antibiotic-days per 1,000 days-present) demonstrated only a moderately positive correlation (r = 0.48). Among hospitals in the highest quartile for CDI prevalence, 5.1% were in the lowest quartile for antibiotic use. Among hospitals in the highest quartile for antibiotic use, 5.3% were in the lowest quartile for CDI prevalence, and 54.2% were in the highest quartile for CDI prevalence (G = 0.60; 95% CI: 0.57–0.63). Correlation of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in U.S. acute care hospitals, 2018 Distribution of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in ordinal quartiles (Q1–Q4) to access rates of discordant pairs Conclusion The moderate correlation and discordant rates suggest that vancomycin and fidaxomicin are less frequently used as primary antibiotics in some hospitals; whereas in others, CDI antibiotic use is occurring in the absence of positive laboratory tests for CDI. To further investigate this discordance, there is a need to assess hospitals’ prescribing and testing practices in an ongoing manner. These findings may be useful to serve as baseline for measuring progress of appropriateness of treatment and testing for CDIs. Disclosures All Authors: No reported disclosures

Taking on Clostridioides difficile

2021 ◽  
pp. 141-157
Author(s):  
Jennifer Meddings ◽  
Vineet Chopra ◽  
Sanjay Saint
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Clostridium Difficile ◽  
Tract Infection ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Infection Prevention ◽  
Hospital Staff ◽  
Clostridioides Difficile

The adaptive approach used in the previous chapters to prevent catheter-associated urinary tract infection (CAUTI) is applied to an initiative to prevent Clostridioides difficile (formerly Clostridium difficile) infection. These two initiatives differ regarding their scope, the members of their teams, and the elements of their bundles. For preventing C. difficile, for example, the most important bundle item is antimicrobial stewardship since the use of broad-spectrum antibiotics vastly increases a person’s risk of becoming infected. Infectious diseases physicians or clinical pharmacists are to examine the circumstances of antimicrobial prescriptions they have filled to see whether they meet infection prevention standards; if not, the prescribing physician will receive prompt feedback. Differences aside, the basic elements of the CAUTI framework apply, from the C-suite’s decision to go ahead with the initiative to the tactics used to sell the C. difficile bundle to the hospital staff.

Enterococcal Infections: An Increasing Problem in Hospitalized Patients

1988 ◽  
Vol 9 (10) ◽  
pp. 457-461 ◽  
Author(s):  
Margaret S. Terpenning ◽  
Marcus J. Zervos ◽  
Dennis R. Schaberg ◽  
Carol A. Kauffman
Keyword(s):  
Nursing Home ◽  
Urinary Tract ◽  
Soft Tissue ◽  
Home Care ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Older Men ◽  
Hospitalized Patients ◽  
Nursing Home Care ◽  
Overall Mortality

AbstractWe studied 157 episodes of infection or colonization with enterococci in 122 patients over a six-month period. One hundred twelve episodes (71.3%) occurred in patients over age 60 years. The most common sites for isolation of enterococci were the urinary tract, and bone and soft tissue. Nosocomial acquisition of enterococci occurred in 74.7% of all infections, and an additional 21% of episodes occurred in patients who had been transferred from another hospital or were regularly seen in the clinic. The overall mortality was 19.6%; 71.4% of those with bacteremia died. Enterococci appear to be significant pathogens, especially in older men in veterans' acute care hospitals and nursing home care units.

scholarly journals 1228Preventing Catheter-Associated Urinary Tract Infection in Acute Care Hospitals: Results from a National Collaborative

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S44-S44
Author(s):  
Mohamad G. Fakih ◽  
M. Todd Greene ◽  
Sarah L. Krein ◽  
Mary AM. Rogers ◽  
David Ratz ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Acute Care ◽  
Acute Care Hospitals
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