Colonization with Vancomycin-Resistant Enterococcus faecium: Comparison of a Long-Term-Care Unit with an Acute-Care Hospital

1997 ◽  
Vol 18 (5) ◽  
pp. 333-339 ◽  
Author(s):  
Hector F. Bonilla ◽  
Marcus A. Zervos ◽  
Michael J. Lyons ◽  
Suzanne F. Bradley ◽  
Sara A. Hedderwick ◽  
...  
Keyword(s):  
Acute Care ◽  
Enterococcus Faecium ◽  
Long Term Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Vancomycin Resistant Enterococcus ◽  
Term Care ◽  
Vancomycin Resistant

Colonization with Vancomycin-Resistant Enterococcus faecium: Comparison of a Long-Term-Care Unit with an Acute-Care Hospital

1997 ◽  
Vol 18 (5) ◽  
pp. 333-339 ◽  
Author(s):  
Hector F. Bonilla ◽  
Marcus A. Zervos ◽  
Michael J. Lyons ◽  
Suzanne F. Bradley ◽  
Sara A. Hedderwick ◽  
...  
Keyword(s):  
Acute Care ◽  
Enterococcus Faecium ◽  
Long Term Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Vancomycin Resistant Enterococcus ◽  
Term Care ◽  
Vancomycin Resistant

scholarly journals 1442. Effect of Reflex Urine Culturing on Rates of Cultures and Infections in an Acute Care Hospital, Emergency Department, and Two Long-Term Care Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S526-S526
Author(s):  
Chelsea Lynch ◽  
Andrea Appleby-Sigler ◽  
Jacqueline Bork ◽  
Rohini Dave ◽  
Kimberly C Claeys ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Long Term Care ◽  
White Blood Cells ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Post Intervention ◽  
Term Care ◽  
Absolute Increase

Abstract Background Urine cultures are often positive in the absence of urinary tract infection (UTI) leading to unnecessary antibiotics. Reflex culturing decreases unnecessary urine culturing in acute care settings but the benefit in other settings is unknown. Methods This was a quasi-experimental study performed at a health system consisting of an acute care hospital, an emergency department (ED), and two long-term care (LTC) facilities. Reflex urine criterion was a urine analysis with > 10 white blood cells/high-power field. Urine cultures performed per 100 bed days of care (BDOC) were compared pre- (August 2016 to July 2017) vs. post-intervention (August 2017 to August 2018) using interrupted time series regression. Catheter-associated UTI (CAUTI) rates were reviewed to determine potential CAUTIs that would have been prevented. Results In acute care, pre-intervention, 894 cultures were performed (3.6 cultures/100 BDOC). Post-intervention, 965 urine cultures were ordered and 507 cultures were performed (1.8 cultures/100 BDOC). Reflex culturing resulted in an immediate 49% decrease in cultures performed (P < 0.001). The CAUTI rate 2 years pre-intervention was 1.8/1000 catheter days and 1.6/1000 catheter days post-intervention. Reflex culturing would have prevented 4/14 CAUTIs. In ED, pre-intervention, 1393 cultures were performed (5.4 cultures/100 visits). Post-intervention, 1959 urine cultures were ordered and 917 were performed (3.3 cultures/100 visits). Reflex culturing resulted in an immediate 47% decrease in cultures performed (P = 0.0015). In LTC, pre-intervention, 257 cultures were performed (0.4 cultures/100 BDOC). Post-intervention, 432 urine cultures were ordered and 354 were performed (0.5 cultures/100 BDOC). Reflex culturing resulted in an immediate 75% increase in cultures performed (P < 0.001). The CAUTI rate 2 years pre-intervention was 1.0/1000 catheter days vs. 1.6/1,000 catheter days post-intervention. Reflex culturing would have prevented 1/13 CAUTIs. Conclusion Reflex culturing canceled 16%-51% of cultures ordered with greatest impact in acute care and the ED and a small absolute increase in LTC. CAUTI rates did not change although reflex culturing would have prevented 29% of CAUTIs in acute care and 8% in LTC. Disclosures All authors: No reported disclosures.

Agitation in Demented Patients in an Acute Care Hospital: Prevalence, Disruptiveness, and Staff Burden

2001 ◽  
Vol 13 (2) ◽  
pp. 183-197 ◽  
Author(s):  
Rosa Sourial ◽  
Jane McCusker ◽  
Martin Cole ◽  
Michal Abrahamowicz
Keyword(s):  
Acute Care ◽  
Nursing Staff ◽  
Barthel Index ◽  
Long Term Care ◽  
Acute Care Hospital ◽  
Patient Characteristics ◽  
Care Hospital ◽  
Term Care ◽  
Research Attention

Background/literature review: The prevalence of agitated behaviors in different populations with dementia is between 24% and 98%. Although agitated behaviors are potentially disruptive, little research attention has been focused on the effects of these behaviors upon nursing staff. The objectives of this study of demented patients in long-term-care beds at an acute care community hospital were to determine the frequency and disruptiveness of agitated behaviors; to investigate the associations of patient characteristics and interventions with the level of agitation; and to explore the burden of these agitated behaviors on nursing staff. Method: The study sample comprised 56 demented patients in the long-term-care unit during the study period. Twenty-seven staff who cared for these patients during three shifts over a 2-week period were interviewed to rate the frequency and disruptiveness of agitated behaviors using the Cohen-Mansfield Agitation Inventory, and the burden of care using a modified version of the Zarit Burden Interview. Data on patient characteristics and interventions extracted from the hospital chart included scores on the Barthel Index and Mini-Mental State Examination, the use of psychotropic medication, and the use of physical restraints. Results: Ninety-five percent of the patients with dementia were reported to have at least one agitated behavior; 75% had at least one moderately disruptive behavior. A small group of six patients (11%) had 17 or more disruptive behaviors. The frequency of most behaviors did not vary significantly by shift. Length of stay on long-term care, Barthel Index score, and the use of psychotropic medications were significantly associated with the number of agitated behaviors. The number of behaviors, their mean frequency, and their mean disruptiveness were all significantly correlated with staff burden. Discussion: The prevalence of agitated behaviors in patients with dementia in long-term-care beds at an acute care hospital is similar to that reported in long-term-care facilities. These behaviors are associated with staff burden.

Clostridium difficileInfection in a Long-Term Care Facility: Hospital-Associated Illness Compared with Long-Term Care-Associated Illness

2011 ◽  
Vol 32 (7) ◽  
pp. 656-660 ◽  
Author(s):  
Jong Hun Kim ◽  
Diana Toy ◽  
Robert R. Muder
Keyword(s):  
Acute Care ◽  
Long Term Care ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Optimal Strategies ◽  
Care Hospital ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility

Background.Controversy exists over whetherClostridium difficileinfection (CDI) commonly occurs in long-term care facility residents who have not been recently transferred from an acute care hospital.Objective.To assess the incidence and outcome of CDI in a long-term care facility.Methods.Retrospective cohort study in a 262-bed long-term care Veterans Affairs facility in Pittsburgh, Pennsylvania, for the period January 2004 through June 2010. CDI was identified by positive stoolC. difficiletoxin assay and acute diarrhea. Patients were categorized as hospital-associated CDI (HACDI) or long-term care facility–associated CDI (LACDI) and followed for 6 months.Results.The annual rate of CDI varied between 0.11 and 0.23 per 1,000 resident-days for HACDI patients and between 0.04 and 0.28 per 1,000 resident-days for LACDI patients. We identified 162 patients, 96 patients (59.3%) with HACDI and 66 patients (40.7%) with LACDI. Median age was 74 and 77 years, respectively, for HACDI and LACDI (P= .055) patients. There were more patients with at least 1 relapse of CDI during 6 months of follow up in LACDI patients (32/66, 48.5%) than in HACDI patients (28/96, 29.2%;P= .009). Logistic regression showed that ages of at least 75 years (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.07–5.07;P= .033), more than 2 transfers to an acute care hospital (OR, 7.88; 95% CI, 1.88–32.95;P= .005), and LACDI (OR, 3.15; 95% CI, 1.41–7.05;P= .005) were associated with relapse of CDI.Conclusions.Forty percent of CDI cases were acquired within the long-term care facility, indicating a substantial degree of transmission. Optimal strategies to prevent CDI in the long-term care facility are needed.

Colonization and Transmission of High-Level Gentamicin-Resistant Enterococci in a Long-Term Care Facility

1994 ◽  
Vol 15 (11) ◽  
pp. 703-709 ◽  
Author(s):  
Carol E. Chenoweth ◽  
Suzanne F. Bradley ◽  
Margaret S. Terpenning ◽  
Lidija T. Zarins ◽  
Mary A. Ramsey ◽  
...  
Keyword(s):  
Acute Care ◽  
Long Term Care ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Care Hospital ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
High Level

AbstractObjectives:To assess the prevalence of high-level gentamicin-resistant enterococcus (HGRE) colonization, transmission patterns, and spectrum of illness among residents of a long-term care facility.Design:Monthly surveillance for HGRE colonization of wounds, rectum, and perineum over a 1-year period.Setting:A Veterans Affairs long-term care facility attached to an acute-care facility.Patients:All 341 patients in the facility during the observation period.Results:Over the 1-year period, 120 patients (35.2%) were colonized with HGRE at least once, with an overall monthly colonization rate of 20± 1.5%. HGRE were isolated from rectum (12.8%), wounds (11.7%), and perineum (9.3%). Patients with the poorest functional status had the highest rate of colonization (P<0.0005). HGRE-colonized patients were more likely to be colonized with methicillin-resistantStaphylococcus aureus(51% versus 25%; P<0.0005). Seventy-four patients (21.7%) were colonized at admission or at the start of the study. Another 46 patients (13.5%) acquired HGRE during the study, including 36 who acquired HGRE while in the long-term care facility and 10 who were positive when transferred back from the acute-care hospital. Based on plasmid profiles, only two patients appeared to have isolates similar to those of current or previous roommates. Carriage of HGRE was transient in most cases. Only 20 patients were colonized for 4 or more months, and those patients usually carried different strains intermittently. Infections were infrequent, occurring in only 4.1% of total patients.Conclusions:In our long-term care facility, HGRE were endemic, and new acquisition of HGRE occurred frequently. However, only two patients had evidence of acquisition from a roommate, suggesting that cross-infection from a roommate was not a major route of spread of HGRE.

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