present. Contaminated urine cultures (≥3 organisms present) were misclassified as infections in 6 of 58 cases (10.3%), and in 5 of 58 cases (8.6%), no urine culture was obtained. Lastly, in 15 of 58 cases (25.9%), bacteriuria was present (1 or 2 organisms), but the colony count did not reach the NHSN metric threshold of ≥ 100,000 CFU/mL. The study period comprised 233,921 patient days. The CAUTI rate was 0.24 CAUTIs per 1,000 patient days using the ICD-10-CM metric; this rate was 0.18 when POA cases were eliminated. The CAUTI rate was 0.20 per 1,000 patient days using the NHSN metric. The NHSN CAUTI metric and the ICD-10-CM CAUTI-like code produce widely discrepant results. Even when ICD-10 cases that were POA were removed to better align with the NHSN criteria, the sensitivity of the ICD-10 metric was only 2.4%. Importantly, no patient safety indicator from AHRQ is available for CAUTI as there is for central venous catheterrelated bloodstream infection. This was the primary reason that we used the administrative code (ICD-10-CM) to compare to NHSN surveillance data for detecting CAUTI. Our results demonstrate that updating ICD-9-CMwith more codes to produce ICD-10-CM did not improve the ability of administrative data to identify CAUTIs. The date of the event is an important element used to meet an NHSN site-specific infection criterion, including CAUTI, and that is one reason that administrative data fail to accurately identify cases of HAI. This study has several limitations. First, it was performed in a single medical center. In addition, we did not review the negative cases via either method, and we assumed that traditional surveillance (NHSN) is the gold standard surveillance method. Therefore, it was not possible to calculate the specificity because our aim was to compare only NHSN and ICD-10-CM CAUTI identified cases. Given that CAUTI is a relatively rare event, we can assume that the specificity of the ICD-10-CM metric is high. In summary, we found that ICD-10-CM has an extremely low sensitivity for detecting CAUTI cases; it failed to detect 98.3% of the infections at our institution. Almost all cases identified via ICD-10-CM did not fulfill the NHSN criteria. Thus, administrative coding for this HAI is not a useful tool for use as a surveillance method.
{"title":"Measures to Prevent and Control Vancomycin-Resistant Enterococci: Do They Really Matter?","authors":"H. Humphreys","doi":"10.1017/ice.2016.329","DOIUrl":"https://doi.org/10.1017/ice.2016.329","url":null,"abstract":"present. Contaminated urine cultures (≥3 organisms present) were misclassified as infections in 6 of 58 cases (10.3%), and in 5 of 58 cases (8.6%), no urine culture was obtained. Lastly, in 15 of 58 cases (25.9%), bacteriuria was present (1 or 2 organisms), but the colony count did not reach the NHSN metric threshold of ≥ 100,000 CFU/mL. The study period comprised 233,921 patient days. The CAUTI rate was 0.24 CAUTIs per 1,000 patient days using the ICD-10-CM metric; this rate was 0.18 when POA cases were eliminated. The CAUTI rate was 0.20 per 1,000 patient days using the NHSN metric. The NHSN CAUTI metric and the ICD-10-CM CAUTI-like code produce widely discrepant results. Even when ICD-10 cases that were POA were removed to better align with the NHSN criteria, the sensitivity of the ICD-10 metric was only 2.4%. Importantly, no patient safety indicator from AHRQ is available for CAUTI as there is for central venous catheterrelated bloodstream infection. This was the primary reason that we used the administrative code (ICD-10-CM) to compare to NHSN surveillance data for detecting CAUTI. Our results demonstrate that updating ICD-9-CMwith more codes to produce ICD-10-CM did not improve the ability of administrative data to identify CAUTIs. The date of the event is an important element used to meet an NHSN site-specific infection criterion, including CAUTI, and that is one reason that administrative data fail to accurately identify cases of HAI. This study has several limitations. First, it was performed in a single medical center. In addition, we did not review the negative cases via either method, and we assumed that traditional surveillance (NHSN) is the gold standard surveillance method. Therefore, it was not possible to calculate the specificity because our aim was to compare only NHSN and ICD-10-CM CAUTI identified cases. Given that CAUTI is a relatively rare event, we can assume that the specificity of the ICD-10-CM metric is high. In summary, we found that ICD-10-CM has an extremely low sensitivity for detecting CAUTI cases; it failed to detect 98.3% of the infections at our institution. Almost all cases identified via ICD-10-CM did not fulfill the NHSN criteria. Thus, administrative coding for this HAI is not a useful tool for use as a surveillance method.","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"12 1","pages":"507 - 509"},"PeriodicalIF":0.0,"publicationDate":"2017-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80753664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Kelly, Makoto M. Jones, K. Echevarria, S. Kralovic, M. Samore, M. Goetz, K. Madaras-Kelly, L. Simbartl, A. Morreale, M. Neuhauser, G. Roselle
OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513–520
{"title":"A Report of the Efforts of the Veterans Health Administration National Antimicrobial Stewardship Initiative","authors":"A. Kelly, Makoto M. Jones, K. Echevarria, S. Kralovic, M. Samore, M. Goetz, K. Madaras-Kelly, L. Simbartl, A. Morreale, M. Neuhauser, G. Roselle","doi":"10.1017/ice.2016.328","DOIUrl":"https://doi.org/10.1017/ice.2016.328","url":null,"abstract":"OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513–520","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"55 1","pages":"513 - 520"},"PeriodicalIF":0.0,"publicationDate":"2017-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84495550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yin-Yin Chen, Wan-Tsuei Huang, Chia-Ping Chen, Shu-mei Sun, Fu-Mei Kuo, Y. Chan, S. Kuo, Fu-Der Wang
OBJECTIVE Ralstonia pickettii has caused contamination of pharmaceutical solutions in many countries, resulting in healthcare infections or outbreak events. We determined the source of the outbreak of R. pickettii bloodstream infection (BSI). METHODS This study was conducted in a 3,000-bed tertiary referral medical center in Taiwan with >8,500 admissions during May 2015. Patients had been treated in the injection room or chemotherapy room at outpatient departments, emergency department, or hospital wards. All patients who were culture positive for R. pickettii from May 3 to June 11, 2015, were eligible for the study. The aim of the survey was to conduct clinical epidemiological and microbiological investigations to identify possible sources of infection. RESULTS We collected 57 R. pickettii–positive specimens from 30 case patients. We performed 24 blood cultures; 14 of these revealed >2 specimens and 6 used fluid withdrawn from Port-a-Cath implantable venous access devices. All patients received an injection of 20 mL 0.9% normal saline via catheter flushing. In addition, 2 unopened ampules of normal saline solution (20 mL) were confirmed positive for R. pickettii. The Taiwan Centers for Disease Control and Prevention performed sampling and testing of the same manufactured batch and identified the same strain of R. pickettii. Pulsed-field gel electrophoresis tests revealed that all clinical isolates had similarity of >90%, validating the outbreak of the same clone of R. pickettii. CONCLUSIONS R. pickettii can grow in saline solutions and cause bloodstream infections. Hospital monitoring mechanisms are extremely important measures in identifying and ending such outbreaks. Infect Control Hosp Epidemiol 2017;38:444–448
{"title":"An Outbreak of Ralstonia pickettii Bloodstream Infection Associated with an Intrinsically Contaminated Normal Saline Solution","authors":"Yin-Yin Chen, Wan-Tsuei Huang, Chia-Ping Chen, Shu-mei Sun, Fu-Mei Kuo, Y. Chan, S. Kuo, Fu-Der Wang","doi":"10.1017/ice.2016.327","DOIUrl":"https://doi.org/10.1017/ice.2016.327","url":null,"abstract":"OBJECTIVE Ralstonia pickettii has caused contamination of pharmaceutical solutions in many countries, resulting in healthcare infections or outbreak events. We determined the source of the outbreak of R. pickettii bloodstream infection (BSI). METHODS This study was conducted in a 3,000-bed tertiary referral medical center in Taiwan with >8,500 admissions during May 2015. Patients had been treated in the injection room or chemotherapy room at outpatient departments, emergency department, or hospital wards. All patients who were culture positive for R. pickettii from May 3 to June 11, 2015, were eligible for the study. The aim of the survey was to conduct clinical epidemiological and microbiological investigations to identify possible sources of infection. RESULTS We collected 57 R. pickettii–positive specimens from 30 case patients. We performed 24 blood cultures; 14 of these revealed >2 specimens and 6 used fluid withdrawn from Port-a-Cath implantable venous access devices. All patients received an injection of 20 mL 0.9% normal saline via catheter flushing. In addition, 2 unopened ampules of normal saline solution (20 mL) were confirmed positive for R. pickettii. The Taiwan Centers for Disease Control and Prevention performed sampling and testing of the same manufactured batch and identified the same strain of R. pickettii. Pulsed-field gel electrophoresis tests revealed that all clinical isolates had similarity of >90%, validating the outbreak of the same clone of R. pickettii. CONCLUSIONS R. pickettii can grow in saline solutions and cause bloodstream infections. Hospital monitoring mechanisms are extremely important measures in identifying and ending such outbreaks. Infect Control Hosp Epidemiol 2017;38:444–448","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"86 1","pages":"444 - 448"},"PeriodicalIF":0.0,"publicationDate":"2017-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83770578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An Evaluation of Food as a Potential Source for Clostridium difficile Acquisition in Hospitalized Patients – CORRIGENDUM","authors":"","doi":"10.1017/ice.2017.2","DOIUrl":"https://doi.org/10.1017/ice.2017.2","url":null,"abstract":"","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"21 1","pages":"258 - 258"},"PeriodicalIF":0.0,"publicationDate":"2017-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74166039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Benenson, A. Moses, Matan J. Cohen, M. Brezis, N. Minster, C. Schwartz, L. Kandel, M. Liebergall, Y. Mattan
Continuous surveillance of surgical-site infection (SSI) is labor intensive. We developed a semiautomatic surveillance system partly assisted by surgeons. Most patients who developed postdischarge SSI were readmitted, which allowed us to limit postdischarge surveillance to this group. This procedure significantly reduced workload while maintaining high sensitivity and specificity for SSI diagnosis. Infect Control Hosp Epidemiol 2017;38:610–613
{"title":"A Practical Tool for Surveillance of Surgical-Site Infections: A 5-Year Experience in Orthopedic Surgeries","authors":"S. Benenson, A. Moses, Matan J. Cohen, M. Brezis, N. Minster, C. Schwartz, L. Kandel, M. Liebergall, Y. Mattan","doi":"10.1017/ice.2016.322","DOIUrl":"https://doi.org/10.1017/ice.2016.322","url":null,"abstract":"Continuous surveillance of surgical-site infection (SSI) is labor intensive. We developed a semiautomatic surveillance system partly assisted by surgeons. Most patients who developed postdischarge SSI were readmitted, which allowed us to limit postdischarge surveillance to this group. This procedure significantly reduced workload while maintaining high sensitivity and specificity for SSI diagnosis. Infect Control Hosp Epidemiol 2017;38:610–613","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"12 1","pages":"610 - 613"},"PeriodicalIF":0.0,"publicationDate":"2017-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79181352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Monogue, Linda K Tanner, S. Brecher, J. Aslanzadeh, D. Nicolau
infection in patients with indwelling urinary catheters: a prospective study of 761 patients. Arch Intern Med 2000;160: 673–677. 9. Humphries RM, Dien Bard J. Point-counterpoint: reflex cultures reduce laboratory workload and improve antimicrobial stewardship in patients suspected of having urinary tract infections. J Clin Microbiol 2016;54:254–258. 10. Fakih MG, Krein SL, Edson B, Watson SR, Battles JB, Saint S. Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm. Am J Infect Control 2014;42:S223–S229.
{"title":"Detection of Piperacillin-Tazobactam-Resistant/Pan-β-Lactam-Susceptible Escherichia coli with Current Automated Susceptibility Test Systems","authors":"M. Monogue, Linda K Tanner, S. Brecher, J. Aslanzadeh, D. Nicolau","doi":"10.1017/ice.2016.325","DOIUrl":"https://doi.org/10.1017/ice.2016.325","url":null,"abstract":"infection in patients with indwelling urinary catheters: a prospective study of 761 patients. Arch Intern Med 2000;160: 673–677. 9. Humphries RM, Dien Bard J. Point-counterpoint: reflex cultures reduce laboratory workload and improve antimicrobial stewardship in patients suspected of having urinary tract infections. J Clin Microbiol 2016;54:254–258. 10. Fakih MG, Krein SL, Edson B, Watson SR, Battles JB, Saint S. Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm. Am J Infect Control 2014;42:S223–S229.","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"124 1","pages":"379 - 380"},"PeriodicalIF":0.0,"publicationDate":"2017-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83640609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Coleman, Wil Ng, Vinaya Mahesh, Maja McGuire, K. Hassan, K. Green, S. Mcneil, A. McGeer, K. Katz
OBJECTIVE To describe the frequency, characteristics, and exposure associated with influenza in hospitalized patients in a Toronto hospital DESIGN/METHOD Prospective data collected for consenting patients with laboratory-confirmed influenza and a retrospective review of infection control charts for roommates of cases over 3 influenza seasons RESULTS Of the 661 patients with influenza (age range: 1 week–103 years), 557 were placed on additional precautions upon admission. Of 104 with symptoms detected after admission, 57 cases were community onset and 47 were nosocomial (10 nosocomial were part of outbreaks). A total of 78 cases were detected after admission exposing 143 roommates. Among roommates tested for influenza after exposure, no roommates of community-onset cases and 2 of 16 roommates of nosocomial cases were diagnosed with influenza. Of 637 influenza-infected patients, 25% and 57% met influenza-like illness definitions from the Public Health Agency of Canada (PHAC) and Centers for Disease Control and Prevention (CDC), respectively, and 70.3% met the Provincial Infectious Diseases Advisory Committee (PIDAC) febrile respiratory illness definition. Among the 56 patients with community-onset influenza detected after admission, only 13%, 23%, and 34%, met PHAC, CDC, and PIDAC classifications, respectively. CONCLUSIONS In a setting with extensive screening and testing for influenza, 1 in 6 patients with influenza was not diagnosed until patients and healthcare workers had been exposed for >24 hours. Only 30% of patients with community-onset influenza detected after admission met the Ontario definition intended to identify cases, hampering efforts to prevent patient and healthcare worker exposures and reinforcing the need for prevention through vaccination. Infect Control Hosp Epidemiol 2017;38:387–392
{"title":"Active Surveillance for Influenza Reduces but Does Not Eliminate Hospital Exposure to Patients With Influenza","authors":"B. Coleman, Wil Ng, Vinaya Mahesh, Maja McGuire, K. Hassan, K. Green, S. Mcneil, A. McGeer, K. Katz","doi":"10.1017/ice.2016.321","DOIUrl":"https://doi.org/10.1017/ice.2016.321","url":null,"abstract":"OBJECTIVE To describe the frequency, characteristics, and exposure associated with influenza in hospitalized patients in a Toronto hospital DESIGN/METHOD Prospective data collected for consenting patients with laboratory-confirmed influenza and a retrospective review of infection control charts for roommates of cases over 3 influenza seasons RESULTS Of the 661 patients with influenza (age range: 1 week–103 years), 557 were placed on additional precautions upon admission. Of 104 with symptoms detected after admission, 57 cases were community onset and 47 were nosocomial (10 nosocomial were part of outbreaks). A total of 78 cases were detected after admission exposing 143 roommates. Among roommates tested for influenza after exposure, no roommates of community-onset cases and 2 of 16 roommates of nosocomial cases were diagnosed with influenza. Of 637 influenza-infected patients, 25% and 57% met influenza-like illness definitions from the Public Health Agency of Canada (PHAC) and Centers for Disease Control and Prevention (CDC), respectively, and 70.3% met the Provincial Infectious Diseases Advisory Committee (PIDAC) febrile respiratory illness definition. Among the 56 patients with community-onset influenza detected after admission, only 13%, 23%, and 34%, met PHAC, CDC, and PIDAC classifications, respectively. CONCLUSIONS In a setting with extensive screening and testing for influenza, 1 in 6 patients with influenza was not diagnosed until patients and healthcare workers had been exposed for >24 hours. Only 30% of patients with community-onset influenza detected after admission met the Ontario definition intended to identify cases, hampering efforts to prevent patient and healthcare worker exposures and reinforcing the need for prevention through vaccination. Infect Control Hosp Epidemiol 2017;38:387–392","PeriodicalId":13655,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":"14 1","pages":"387 - 392"},"PeriodicalIF":0.0,"publicationDate":"2017-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78551083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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