scholarly journals 121. Temporal Trends in Urine Culture Rates in the U.S. Acute Care Hospitals During 2012–2017

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S74-S74
Author(s):  
Sophia Kazakova ◽  
Natalie McCarthy ◽  
James Baggs ◽  
Kelly M Hatfield ◽  
Hannah Wolford ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Acute Care ◽  
Urine Culture ◽  
Temporal Trends ◽  
Acute Care Hospitals ◽  
Level Variation ◽  
Hospital Level ◽  
Hospital Variation ◽  
Teaching Status ◽  
The Impact

Abstract Background Decreasing inappropriate urine cultures in hospitalized patients has been a target of diagnostic stewardship to improve infection surveillance and antimicrobial use. The impact of such efforts has been largely unstudied. This study assessed temporal trends in urine culture rates in a cohort of acute care hospitals (ACHs) between 2012 and 2017. Hospital Level Variation in Admission Urine Culture Rates Hospital Level Variation in Post-admission Urine Culture Rates Methods We used microbiology data from ACHs participating in the Premier Healthcare Database and Cerner Health Facts to measure monthly urine culture rates. All cultures from the urinary tract collected on or before day 3 were defined as admission cultures (AC) and those collected on day 4 or later as post-admission cultures (PAC). Temporal trends in AC and PAC rates were estimated using general estimating equation models adjusting for hospital-level clustering, hospital size, teaching status, urban/rural designation, discharge month, and region. Results During the study period, ACHs had 20.8 million discharges and performed 4,946,717 urine cultures, of which 21% were PAC. In 2012 and 2017, the unadjusted AC rates were 18.7 and 18.4 per 100 discharges; the unadjusted PAC rates were 11.5 and 8.5 per 1,000 patient days (PD) respectively. The median annual hospital-level AC rate was 17.2 with inter-hospital variation ranging from 12.7 (quartile 1) to 24.1 (quartile 3) per 100 discharges, Figure 1. Similarly, the PAC rates varied among the ACHs with a median of 7.1 and inter-hospital variation ranging from 4.6 (quartile 1) to 10.5 (quartile 3) per 1,000 PDs, Figure 2. In multivariable analysis, no temporal trends in AC rates were detected (rate ratio (RR) 1.01; 95% confidence interval (CI): 0.99–1.02). However, PAC rates decreased 6.3% annually (RR 0.937; 95% CI: 0.93–0.95). Factors significantly associated (p< 0.02) with PAC rates were discharge month, teaching status, bed size, and region. For AC, significant associations (p< 0.0001) were discharge month and region. Conclusion Between 2012 and 2017, the rate of AC remained unchanged, but PAC rates decreased significantly. Factors driving this trend are unknown, but potential explanations include changes in culturing practices and/or decreases in hospital-onset urinary tract infections. Understanding factors related to the decrease and the impact on patient outcomes warrants further study. Disclosures All Authors: No reported disclosures

Abstract 214: Improvement Among All Hospital Types and Reduced Hospital Level Variation in Use of Intravenous tPA for Acute Ischemic Stroke 2003-2011: Findings from Get With The Guideline-Stroke

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Lee H Schwamm ◽  
Syed F Ali ◽  
Mathew J Reeves ◽  
Eric E Smith ◽  
Jeffrey L Saver ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Temporal Trends ◽  
Level Variation ◽  
Hospital Level ◽  
The Past ◽  
Teaching Status ◽  
Get With The Guidelines ◽  
Very High ◽  
Iv Tpa ◽  
Hospital Characteristics

Introduction: IV tPA delivery is challenging and use varies widely. We analyzed differences in patient and hospital characteristics at the hospital level in the Get with the Guidelines (GWTG) - Stroke database. Methods: We analyzed data on 73574 patients from 2003-2011 at 1231 hospitals with ≥10 tPA-eligible ischemic stroke (AIS) patients arriving < 2 hr of onset, divided into quartiles of rates of tPA delivered within 3 hrs of onset. Median percentages are reported, and temporal trends were calculated using absolute changes from 2010-2011 vs. 2003-2005. Results: Patients at hospitals with lower rates of tPA treatment within 3 hrs were older, more frequently white, used EMS less often, had lower NIHSS values with very high rates of missing NIHSSS, and greater door to imaging times as compared to better performing hospitals. Hospitals with lower rates of tPA treatment were smaller and more rural, had fewer ICU beds, and were less often teaching or primary stroke centers (Table 1). IV tPA use increased across all types of hospitals from 2003-2011, but increased to a greater degree in non-primary stroke centers and those in the South and West (Table 2). Teaching status, bed size and other measured variables were not different. Conclusion: Significant increases in IV tPA treatment among patients arriving < 2hr have occurred over the past decade, and rates of increase vary by hospital characteristics. The profile of tPA treated eligible patients also changes across the range of hospital tPA use rates, with highest performing sites reporting NIHSS in >90% of tPA patients, and treating greater numbers of patients who are non-white or with more severe strokes. Low performing sites may benefit from greater focus on NIHSS assessment and timeliness of care. .

scholarly journals The Impact of a Massachusetts State-Sponsored Educational Program on Antimicrobial Stewardship in Acute Care Hospitals

2013 ◽  
Vol 34 (4) ◽  
pp. 437-439 ◽  
Author(s):  
Adam Weston ◽  
Lauren Epstein ◽  
Lisa E. Davidson ◽  
Alfred DeMaria ◽  
Shira Doron
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Educational Program ◽  
Business Models ◽  
National Level ◽  
State Level ◽  
Acute Care Hospitals ◽  
The State ◽  
Team Approach ◽  
The Impact

Antimicrobial stewardship programs (ASPs) are critically important for combating the emergence of antimicrobial resistance. Despite this, there are no regulatory requirements at a national level, which makes initiatives at the state level critical. The objectives of this study were to identify existing antimicrobial stewardship practices, characterize barriers to antimicrobial stewardship implementation in acute care hospitals throughout Massachusetts, and evaluate the impact on these hospitals of a state-sponsored educational conference on antimicrobial stewardship.In September 2011, a state-sponsored educational program entitled “Building Stewardship: A Team Approach Enhancing Antibiotic Stewardship in Acute Care Hospitals” was offered to interested practitioners from throughout the state. The program consisted of 2 audio conferences, reading materials, and a 1-day conference consisting of lectures focusing on the importance of ASPs, strategies for implementation, improvement strategies for existing programs, and panel discussions highlighting successful practices. Smaller breakout sessions focused on operational issues, including understanding of pharmacodynamics, business models, and electronic surveillance.

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 &lt; 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

Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study

2018 ◽  
Vol 39 (8) ◽  
pp. 941-946 ◽  
Author(s):  
Bradley J. Langford ◽  
Julie Hui-Chih Wu ◽  
Kevin A. Brown ◽  
Xuesong Wang ◽  
Valerie Leung ◽  
...  
Keyword(s):  
Observational Study ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Defined Daily Doses ◽  
Prospective Audit And Feedback ◽  
The Impact

AbstractObjectivesAntibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.DesignObservational study of acute-care hospitals in Ontario, CanadaMethodsA survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.ResultsOf 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.ConclusionsWide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.

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

scholarly journals 1162. An Evaluation of Metrics for Catheter-Associated Urinary Tract Infections (CAUTIs): A Statewide Comparison

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S415-S416
Author(s):  
Dana Pepe ◽  
Meghan Maloney ◽  
Vivian Leung ◽  
Adora Harizaj ◽  
David Banach ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Healthcare Research ◽  
Hospital Data ◽  
Care Practices ◽  
Data Elements ◽  
Tract Infections ◽  
Facility Size ◽  
Catheter Care

Abstract Background The Standardized Infection Ratio (SIR) is a metric used to gauge catheter-associated urinary tract infection (CAUTI) prevention, both locally and nationally. The device utilization ratio (DUR) is a process metric that captures catheter harm. More recently, the cumulative attributable difference (CAD) was introduced, which identifies the number of excess infections that need to be prevented to reach the desired goal. Our objective was to evaluate these metrics across all acute care hospitals in Connecticut (CT) by facility size. Methods A CAUTI Targeted Assessment for Prevention (TAP) Report for acute care hospitals across CT was generated from 1/1/2018 to December 31/2018, using the National Healthcare Safety Network (NHSN) database. CAUTI events, SIR, DUR, and CAD were compared across all hospitals. The SIR goal of 0.75 was used to calculate the CAD. Hospitals were stratified into large ( >425 beds), medium (250 to 424 beds), and small ( <249 beds) based on the Healthcare Cost and Utilization Project NIS Description of Data Elements, Agency for Healthcare Research and Quality for urban hospitals in the northeast region. Results A comparison of CAUTI metrics for 29 acute care hospitals across CT is shown in Table 1. Median SIR and DUR were 0.97, 1.02, 0.77, and 22%, 14%, 14.5% for large, medium and small hospitals, respectively. Of the 20 small hospitals, SIR could not be calculated for 5 hospitals, while 2 hospitals had an SIR = 0, as they had no reported infections. Median CAD for large, medium and small hospitals was 6.17, 1.3 and 0.25, respectively. Of note, 40% of small hospitals (J – CC, as in Table 1) had a negative CAD. Interestingly, 5 of these 8 hospitals with a negative CAD had a DUR higher than 16%. Conclusion Based on CT hospital data, metrics like CAD and SIR may be more suitable for larger hospitals or hospitals with higher CAUTI events, whereas DUR may be a more useful metric for smaller hospitals or hospitals with rare events. Hospitals with high SIR and low DUR may represent a population with high-risk catheter use, poor catheter care or higher rates of urine culturing. On the other hand, hospitals with high DUR and low SIR may represent low-risk populations, better catheter care practices or lower rates of urine culturing. Ultimately, we need a combination of metrics to measure preventable catheter harm. Disclosures Louise Dembry, MD, MS, MBA, ReadyDock: Consultant, Stock options.

scholarly journals Clostridium DifficileInfection in Acute Care Hospitals: Systematic Review and Best Practices for Prevention

2017 ◽  
Vol 38 (4) ◽  
pp. 476-482 ◽  
Author(s):  
Irene K. Louh ◽  
William G. Greendyke ◽  
Emilia A. Hermann ◽  
Karina W. Davidson ◽  
Louise Falzon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hand Hygiene ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Grey Literature ◽  
Quality Criteria ◽  
Acute Care Hospitals ◽  
Cochrane Library ◽  
Chlorhexidine Bathing ◽  
The Impact

OBJECTIVEPrevention ofClostridium difficileinfection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009.DESIGNWe searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015.SETTINGWe included studies performed in acute-care hospitals.PATIENTS OR PARTICIPANTSWe included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates.INTERVENTIONSWe used the QI-Minimum Quality Criteria Set (QI-MQCS) to assess the quality of included studies. Interventions were grouped thematically: environmental disinfection, antimicrobial stewardship, hand hygiene, chlorhexidine bathing, probiotics, bundled approaches, and others. A meta-analysis was performed when possible.RESULTSOf 3,236 articles screened, 261 met the criteria for full-text review and 46 studies were ultimately included. The average quality rating was 82% according to the QI-MQCS. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products. Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates. Chlorhexidine bathing and intensified hand-hygiene practices were not effective for reducing CDI rates.CONCLUSIONSDaily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals. Further studies are needed to identify the components of bundled interventions that reduce CDI rates.Infect Control Hosp Epidemiol2017;38:476–482

Sharps Injuries among Employees of Acute Care Hospitals in Massachusetts, 2002–2007

2011 ◽  
Vol 32 (6) ◽  
pp. 538-544 ◽  
Author(s):  
Angela K. Laramie ◽  
Vivian C. Pun ◽  
Shona C. Fang ◽  
David Kriebel ◽  
Letitia Davis
Keyword(s):  
Acute Care ◽  
Surveillance System ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Acute Care Hospitals ◽  
Injury Surveillance System ◽  
Hospital Size ◽  
Sharps Injury ◽  
The Impact ◽  
Sharps Injuries

Objective.Sharps with engineered sharps injury protections (SESIPs) have been found to reduce risk of sharps injuries (Sis). We examined trends in SI rates among employees of acute care hospitals in Massachusetts, including the impact of SESIPs on SI trends during 2002-2007.Design.Prospective surveillance.Setting.Seventy-six acute care hospitals licensed by the Massachusetts Department of Public Health.Participants.Employees of acute care hospitals who reported Sis to their employers.Methods.Data on Sis in acute care hospitals collected by the Massachusetts Sharps Injury Surveillance System were used to examine trends in SI rates over time by occupation, hospital size, and device. Negative binomial regression was used to assess trends.Results.During 2002-2007, 16,158 Sis among employees of 76 acute care hospitals were reported to the surveillance system. The annual SI rate decreased by 22%, with an annual decline of 4.7% (P< .001). Rates declined significantly among nurses (—7.2% per year;P< .001) but not among physicians (—0.9% per year;P= .553). SI rates associated with winged steel needles and hypodermic needles and syringes also declined significantly as the proportion of injuries involving devices with sharps injury prevention features increased during the same time period.Conclusion.SI rates involving devices for which SESIPs are widely available and appear to be increasingly used have declined. The continued use of devices lacking SI protections for which SESIPs are available needs to be addressed. The extent to which injuries involving SESIPs are due to flaws in design or lack of experience and training must be examined.

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