Screening for MRSA: A Flawed Hospital Infection Control Intervention

2008 ◽  
Vol 29 (11) ◽  
pp. 1012-1018 ◽  
Author(s):  
Richard P. Wenzel ◽  
Gonzalo Bearman ◽  
Michael B. Edmond
Keyword(s):  
Infection Control ◽  
Bloodstream Infections ◽  
Population Based ◽  
Attributable Mortality ◽  
Antibiotic Resistant ◽  
Control Programs ◽  
Basic Model ◽  
Control Intervention ◽  
Hospital Infection Control ◽  
Hospital Resources

Focusing hospital resources on a single antibiotic-resistant pathogen as a sole approach to infection control is inherently flawed. We applied attributable mortality principles to a basic model of bloodstream infections to outline the argument. Screening for methicillin-resistantStaphylococcus aureusalone made sense in the 1980s, but the ongoing emergence of vancomycin-resistant enterococci and antibiotic-resistant strains of gram-negative rods andCandidaspecies, as well as the recognition of the value of team-based infection control programs, support a population-based approach.

scholarly journals A67 Bloodstream infections by carbapenem-resistant Klebsiella pneumoniae subsp. pneumoniae: Bayesian phylogenetic analysis of whole genomes

2019 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Eleonora Cella ◽  
Davide Leoni ◽  
Walter Mirandola ◽  
Carla Fontana ◽  
Loredana Sarmati ◽  
...  
Keyword(s):  
Phylogenetic Analysis ◽  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Minimum Spanning Tree ◽  
Hospital Setting ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Epidemiological Surveillance ◽  
Health Concern ◽  
Hospital Infection Control

Abstract Bloodstream infection (BSI) caused by carbapenemase-producing Enterobacteriaceae (CPE) is a major public health concern, particularly in the hospital setting. The rapid detection of resistance patterns is of paramount importance for establishing the proper antibiotic regime. In addition, in countries where CPE are endemic, it is also important to evaluate genetic relationship among the isolates in order to trace pathogen circulation and to improve the infection control programs. This study is an application of a rapid blood culture (BC) workflow consisting of fast reporting of Gram stain results, rapid pathogen identification (using MALDI TOF technology), and a molecular assay for the detection of the major genes conferring resistance, all of them performed directly from positive BCs. The application of phylogenetic and phylodynamic analyses to bacterial whole-genome sequencing (WGS) data have become essential in the epidemiological surveillance of multidrug-resistant nosocomial pathogens. We analyzed 40 strains of Klebsiella pneumoniae subsp. pneumoniae (KP) carrying blaKPC (KP-KPC), randomly selected among 147 CPE identified from BCs collected from consecutive patients from 2013 to 2016. The number of BSIs-related CPE were 23, 31, 43, and 50 in 2013, 2014, 2015, and 2016, respectively. Among 147 CPE isolates, 143 were KP and four were Escherichia coli (EC). The gene blaKPC was detected in 117 strains of KP and in four strains of EC. Other carbapenemase genes, such as blaVIM and blaOXA-48, were detected in four and nine different isolates of KP, respectively. Moreover, 13 KP strains carried two resistance genes: twelve vehicled blaKPC plus blaVIM and one blaKPC plus blaOXA-48. Phylogenetic analysis of bacterial WGS data was used to investigate the evolution and spatial dispersion of KP in support of hospital infection control. The maximum likelihood tree showed two main clades statistically supported, with statistical support for several subclusters within as well. The minimum spanning tree showed mixing between sequences from different years and wards with only few specific groups. Bayesian analyses are ongoing, as the aid of Bayesian genomic epidemiology in combination with active microbial surveillance is highly informative regarding the development of effective infection prevention in healthcare settings or constant strain reintroduction.

“The Coccus-Conscious” or “The Conscious Careful”

1987 ◽  
Vol 8 (1) ◽  
pp. 34-35 ◽  
Author(s):  
Albert F. Brown ◽  
Joan L. Otterman
Keyword(s):  
Staphylococcus Aureus ◽  
Infection Control ◽  
Hospital Infection ◽  
Methicillin Resistant ◽  
Persistent Problem ◽  
Control Programs ◽  
Hospital Infection Control ◽  
To Come

Staphylococcus aureus continues to be a resilient and persistent problem for hospital infection control programs. Now methicillin-resistant S. aureus (MRSA) is emerging as an even more formidable foe, bringing with it controversies in laboratory reporting, treatment, and isolation strategies.History suggests that the best solution to the hospital bacteria problem may well lie in the realm of spirit more than material methods. So, in the manner of Dickens' Christmas Carol fantasy, let us travel with three spirits— the Spirit of Conscience Past, the Spirit of Conscience Present, and the Spirit of Conscience to Come.

scholarly journals A Study of Hospital Infection Control Program against Normative Weighted Criteria at a Large Public Hospital

2014 ◽  
Vol 2 (2) ◽  
pp. 130-132
Author(s):  
Sunil Kant ◽  
Jitender Mehta ◽  
Sanjay Arya ◽  
Shakti Kumar Gupta
Keyword(s):  
Infection Control ◽  
Program Implementation ◽  
Public Hospital ◽  
Control Program ◽  
Healthcare Facility ◽  
Hospital Infection ◽  
Infection Control Program ◽  
Control Programs ◽  
Hospital Infection Control ◽  
Hospital Acquired

ABSTRACT Hospital infection control programs are important for prevention and control of hospital acquired infection in a healthcare facility. An evaluatory study was done to measure the quality dimensions of hospital infection control program in a public hospital to compare the program implementation in different speciality centers against the normative weighted criteria developed by Gupta and Kant (2002). Result showed variations in infection control program activities in various speciality centers. A centralized administration of infection control program and emphasis on more training and education is recommended. How to cite this article Mehta J, Arya S, Kant S, Gupta SK. A Study of Hospital Infection Control Program against Normative Weighted Criteria at a Large Public Hospital. Int J Res Foundation Hosp Healthc Adm 2014;2(2):130-132.

An Outbreak of Bloodstream Infections in an Outpatient Hemodialysis Center

2002 ◽  
Vol 23 (12) ◽  
pp. 725-729 ◽  
Author(s):  
Connie S. Price ◽  
Donna Hacek ◽  
Gary A. Noskin ◽  
Lance R. Peterson
Keyword(s):  
Infection Control ◽  
Povidone Iodine ◽  
Bloodstream Infections ◽  
Baseline Period ◽  
Access Site ◽  
Control Programs ◽  
Before And After ◽  
And Control ◽  
Control Study ◽  
Microbiological Data

Objectives:Investigate and control an increase in bloodstream infections (BSIs) in an outpatient hemodialysis center.Patients and Design:A retrospective cohort study was conducted for patients receiving dialysis at the center from February 2000 to April 2001. A case–control study compared microbiological data for all BSIs that occurred during the study period with those for BSIs that occurred during a baseline period Qanuary 1999 to January 2000). BSI rates before and after a 1-month intervention (May 2001) were assessed. A case was defined as a new BSI during the study period.Results:The outbreak was polymicrobial, with approximately 30 species. The baseline BSI rate was 0.7 per 100 patient-months. From February 2000 to April 2001, the BSI rate increased to 4.2 per 100 patient-months. Overall, 75% of the BSIs were associated with central venous catheters (CVCs), but CVC use did not fully explain the increase in BSIs. In January 2000, when the center changed ownership, prepackaged CVC dressing kits and biweekly infection control monitoring were discontinued. Beginning in May 2001, staff were educated on CVC care, chlorhexidine replaced povidone-iodine for cutaneous antisepsis, gauze replaced transparent dressings, antimicrobial ointments containing polyethylene glycol at CVC exit sites were discontinued, and patients with CVCs were educated on cutaneous hygiene. After the intervention period, by October 2001, rates decreased to less than 1 BSI per 100 patient-months.Conclusions:Proper cutaneous antisepsis and access site care is crucial in preventing BSIs in patients receiving hemodialysis. Infection control programs, staff and patient education, and use of optimal antisepsis agents or prepackaged kits are useful toward this end.

Raising Standards While Watching the Bottom Line Making a Business Case for Infection Control

2007 ◽  
Vol 28 (10) ◽  
pp. 1121-1133 ◽  
Author(s):  
Eli N. Perencevich ◽  
Patricia W. Stone ◽  
Sharon B. Wright ◽  
Yehuda Carmeli ◽  
David N. Fisman ◽  
...  
Keyword(s):  
Infection Control ◽  
Task Force ◽  
Case Analysis ◽  
Business Case ◽  
Bottom Line ◽  
Control Programs ◽  
Control Intervention ◽  
Evidence Based Guideline ◽  
Healthcare Associated ◽  
And Control

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.

scholarly journals Quality of the hospital infection control programs: an integrative review

2020 ◽  
Vol 41 ◽  
Author(s):  
André Luiz Silva Alvim ◽  
Bráulio Roberto Gonçalves Marinho Couto ◽  
Andrea Gazzinelli
Keyword(s):  
Infection Control ◽  
Web Of Science ◽  
Hospital Infection ◽  
Structural Elements ◽  
Control Programs ◽  
Final Sample ◽  
Hospital Infection Control ◽  
Process And Outcome ◽  
And Control

ABSTRACT Objective: To analyze the quality of health in relation to the components of structure, process, and outcome in actions for the prevention and control of infections. Method: An integrative literature review in the LILACS, Web of Science, Scopus, and SciELO databases. The time delimitation covered articles published between January 2009 and May 2019. Results: The final sample consisted of 10 articles published, mainly in Scopus (60%), and in Web of Science (30%). The structural elements varied among the study countries, suggesting opportunities for improvement of organizational characteristics and human resources. Regarding the process of the implemented routines, inconsistencies were found to comply with the guidelines. The result component was not emphasized among the studies included in the review. Conclusion: The quality of hospital infection control programs has yet to be improved among the health services, highlighting the need for investment in the structure, process, and outcome components.

scholarly journals Status of Tuberculosis Infection Control Programs in Canadian Acute Care Hospitals, 1989 to 1993 – Part 1

1997 ◽  
Vol 8 (4) ◽  
pp. 188-194 ◽  
Author(s):  
Donna Holton ◽  
Shirley Paton ◽  
Helen Gibson ◽  
Geoffrey Taylor ◽  
Carol Whyman ◽  
...  
Keyword(s):  
Infection Control ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Respiratory Protection ◽  
Care Hospital ◽  
Screening Programs ◽  
Control Programs ◽  
Environmental Controls ◽  
Hospital Infection Control

OBJECTIVE: To document tuberculosis (TB) prevention and control activities in Canadian acute care hospitals from 1989 to 1993.DESIGN: Retrospective questionnaire.PARTICIPANTS: All members of the Community and Hospital Infection Control Association-Canada and l’Association des professionnels pour la prévention des infections who lived in Canada and worked in an acute care hospital received a questionnaire. One questionnaire per hospital was completed.OUTCOME: The study documented the number of respiratory TB cases admitted to the hospital, the type of engineering and environmental controls available, and the type of occupational tuberculin skin test (TST) screening programs offered by the hospital.RESULTS: Questionnaires were received from 319 hospitals. Ninety-nine (32%) hospitals did not admit a respiratory TB case during the study. Thirty-one (10%) hospitals averaged six or more TB cases per year. TST results were reported for 47,181 health care workers, and 819 (1.7%) were reported as TST converters; physicians had a significantly higher TST conversion rate than other occupational groups. Most hospitals did not have isolation rooms with air exhausted outside the building, negative air pressure and six or more air changes per hour. Surgical masks were used as respiratory protection by 74% of staff.CONCLUSIONS: Canadian hospitals can expect to admit TB patients. Participating hospitals did not meet TB engineering or environmental recommendations published in 1990 and 1991. In addition, occupational TB screening programs in 1989 to 1993 did not meet Canadian recommendations published in 1988.

A Statewide Characterization of Hospital Infection Control Practices and Practitioners

1980 ◽  
Vol 1 (4) ◽  
pp. 227-232 ◽  
Author(s):  
Anita L. Booth ◽  
R. Mark Weeks ◽  
Robert H. Hutcheson ◽  
William Schaffner
Keyword(s):  
Infection Control ◽  
Rural Areas ◽  
Medical Specialty ◽  
Hospital Infection ◽  
Modest Improvement ◽  
Hospital Size ◽  
Control Programs ◽  
Infection Control Practitioner ◽  
Hospital Infection Control ◽  
Control Resource

AbstractSelected features of infection control programs among the 163 general hospitals in Tennessee were surveyed in 1976 and 1979. Each hospital but one had a designated infection control practitioner. Three-fourths of the hospitals had fewer than 200 beds and most were in rural areas. The practitioners in these small hospitals worked in an isolated professional milieu: few (4%) had attended a basic training course or were members of a national (11%) or local (16%) infection control association. They also had significantly less access to standard infection control resource publications than did practitioners in large hospitals. Use of aqueous quaternary ammonium compounds for disinfection was reported by 37% of all hospitals in 1979; 68% of hospitals routinely performed bacteriologic cultures of personnel or the environment. In contrast, only 3% of hospitals did not have a policy specifying the use of sterile closed-system drainage of indwelling bladder catheters. Although these practices varied somewhat by hospital size, the differences were not statistically significant. Modest improvement in each parameter was noted since 1976. Pathology was the most common medical specialty (34%) among chairman of infection control committees; internal medicine and pediatrics accounted for only 13%. The practice of routine microbiologic monitoring was significantly more common among hospitals with chairmen who were pathologists. The implications of these findings for national priorities in hospital infection control are discussed.

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