Successful diagnostic stewardship for Clostridioides difficile testing in pediatrics.

OBJECTIVE: To reduce both inappropriate testing for and diagnosis of healthcare-onset (HO) Clostridioides difficile infections (CDIs). DESIGN: We performed a retrospective analysis of C. difficile testing from hospitalized children before (October 2017-October 2018) and after (November 2018-October 2020) implementing restrictive computerized provider order entry (CPOE). SETTING: Study sites included hospital A (a ∼250-bed freestanding children's hospital) and hospital B (a ∼100-bed children's hospital within a larger hospital) that are part of the same multicampus institution. METHODS: In October 2018, we implemented CPOE. No testing was allowed for infants aged ≤12 months, approval of the infectious disease team was required to test children aged 13-23 months, and pathology residents' approval was required to test all patients aged ≥24 months with recent laxative, stool softener, or enema use. Interrupted time series analysis and Mann-Whitney U test were used for analysis. RESULTS: An interrupted time series analysis revealed that from October 2017 to October 2020, the numbers of tests ordered and samples sent significantly decreased in all age groups (P < .05). The monthly median number of HO-CDI cases significantly decreased after implementation of the restrictive CPOE in children aged 13-23 months (P < .001) and all ages combined (P = .003). CONCLUSION: Restrictive CPOE for CDI in pediatrics was successfully implemented and sustained. Diagnostic stewardship for CDI is likely cost-saving and could decrease misdiagnosis, unnecessary antibiotic therapy, and overestimation of HO-CDI rates.

A comparison of the incidence of midline catheter-associated bloodstream infections to that of central line-associated bloodstream infections in 5 acute care hospitals.

In a retrospective study conducted over 12 months in a multi-hospital system, the incidence of bloodstream infections associated with midline catheters was not significantly lower than that associated with central venous catheters (0.88 vs 1.10 infections per 1,000 catheter-days). Additional research is needed to further characterize the infectious risks of midline catheters and to determine optimal strategies to minimize these risks.

Reducing indwelling urinary catheter use through staged introduction of electronic clinical decision support in a multicenter hospital system.

OBJECTIVE: To integrate electronic clinical decision support tools into clinical practice and to evaluate the impact on indwelling urinary catheter (IUC) use and catheter-associated urinary tract infections (CAUTIs).Design, Setting, and ParticipantsThis 4-phase observational study included all inpatients at a multicampus, academic medical center between 2011 and 2015.InterventionsPhase 1 comprised best practices training and standardization of electronic documentation. Phase 2 comprised real-time electronic tracking of IUC duration. In phase 3, a triggered alert reminded clinicians of IUC duration. In phase 4, a new IUC order (1) introduced automated order expiration and (2) required consideration of alternatives and selection of an appropriate indication. RESULTS: Overall, 2,121 CAUTIs, 179,070 new catheters, 643,055 catheter days, and 2,186 reinsertions occurred in 3·85 million hospitalized patient days during the study period. The CAUTI rate per 10,000 patient days decreased incrementally in each phase from 9·06 in phase 1 to 1·65 in phase 4 (relative risk [RR], 0·182; 95% confidence interval [CI], 0·153-0·216; P<·001). New catheters per 1,000 patient days declined from 53·4 in phase 1 to 39·5 in phase 4 (RR, 0·740; 95% CI, 0·730; P<·001), and catheter days per 1,000 patient days decreased from 194·5 in phase 1 to 140·7 in phase 4 (RR, 0·723; 95% CI, 0·719-0·728; P<·001). The reinsertion rate declined from 3·66% in phase 1 to 3·25% in phase 4 (RR, 0·894; 95% CI, 0·834-0·959; P=·0017). CONCLUSIONS: The phased introduction of decision support tools was associated with progressive declines in new catheters, total catheter days, and CAUTIs. Clinical decision support tools offer a viable and scalable intervention to target hospital-wide IUC use and hold promise for other quality improvement initiatives.

Overreporting healthcare-associated C. difficile: A comparison of NHSN LabID with clinical surveillance definitions in the era of molecular testing.

BACKGROUND: Clostridium difficile infection (CDI) is the most common healthcare-associated gastrointestinal infection. Hospitals are required to report cases of healthcare facility-onset CDI (HO-CDI) using the National Healthcare Safety Network's CDI laboratory-identified (LabID) event definition. The aim of this study was to determine the extent of potential over-reporting due to the exclusion of important clinical data within LabID reporting definitions. METHODS: In 2015, retrospective chart review was performed on 212 HO-CDI cases reported from a large urban medical center. Cases had positive polymerase chain reaction test for the C. difficile toxin B gene from an unformed stool specimen collected >3 days after admission and >8 weeks after most recent LabID event. Cases were categorized into "clinical surveillance" groups: community-acquired infection, recurrence/relapse, asymptomatic colonization, colonization with self-limited symptoms, possible HO-CDI, and probable HO-CDI. RESULTS: Of the infections, 13.6% were community acquired, 2.8% were recurrent/relapse, 1.9% were asymptomatic colonization, 18.4% were symptomatic colonization, 38.7% were possible HO-CDI, and 24.5% were probable HO-CDI. Within 24 hours of testing, 34.1% of patients had received a stool softener and/or laxative. CONCLUSIONS: Laxative use and failure to identify community-onset infection may contribute to misclassification of HO-CDI. Only 62% of reported cases met clinical surveillance criteria.

Estimativa de geração de energia e emissão evitada de gás de efeito estufa na recuperação de biogás produzido em estação de tratamento de esgotos / Estimate of energy generation and of greenhouse gas emission on biogas recovery from wastewater treatment plant

RESUMO: O aproveitamento do biogás proveniente do tratamento de esgoto doméstico, de dejetos animais e da disposição de resíduos sólidos é uma alternativa de geração de energia elétrica com grande potencial de expansão no Brasil. O objetivo deste trabalho foi quantificar a energia fornecida pelo biogás gerado em uma estação de tratamento de esgotos (ETE) e estimar a emissão evitada de gases de efeito estufa (GEEs) com a recuperação do biogás. A ETE analisada possui vazão 33.220,8 m3.d-1 e DQO afluente 14.617,1 kg.d-1 e atende a cerca de 190.000 habitantes. Foram utilizados dados de monitoramento de agosto de 2012 a março de 2013 para quantificar os seguintes parâmetros: demanda química de oxigênio (DQO) convertida em biomassa; sulfato convertido em sulfeto; DQO convertida em metano; perdas de metano (fase líquida e gasosa); potencial energético disponível; potência elétrica disponível; emissão evitada de metano. Os seguintes resultados foram obtidos: eficiência média de tratamento de 65,6%; produção de metano de 1.427,2 m3.d-1; energia elétrica média disponível de 65.280,3 kWh.mês-1 (59% da demanda média mensal de energia da estação); emissão real evitada de metano de 946,2 kgCH4.d-1 e 17.192,6 kgCO2 eq.d-1 (potencial de aquecimento global - PAG - do CH4=21). Pode-se concluir que a recuperação do biogás na ETE Santa Quitéria resultaria em benefícios econômicos e ambientais.

ABSTRACT: The use of biogas from treatment of domestic sewage, animal waste and solid waste disposal is an alternative to generate electricity with great potential for expansion in Brazil. The aim of this paper is quantifying the energy from the biogas produced in a wastewater treatment plant (WWTP) and estimating the greenhouse gas emission avoided with the biogas recovery. The WWTP evaluated has flow 33,220.8 m3.d-1 and COD 14,617.1 kg.d-1 and serves about 190,000 inhabitants. It was used monitoring data from August/2012 to March/2013 to quantify the following parameters: COD converted into biomass; sulfate converted to sulfide; COD converted to methane; methane loss (liquid and gas); potential energy available; electrical power available; avoided emissions of methane. The following results were obtained: average treatment efficiency of 65.6%; methane production of 1,427.2 m3.d-1; average electricity available of 65,280.3 kWh.month-1 (59% of the average monthly energy demand of the WWTP); avoided emissions of 941.9 kgCH4.d-1 and 17,189.7 kgCO2 eq.d-1. Therefore, it can be concluded that the biogas recovery of in Santa Quitéria WWTP can result in economic and environmental benefits.

Electronic surveillance for catheter-associated urinary tract infections at a university-affiliated children's hospital.

We sought to describe the characteristics of catheter-associated urinary tract infections (CAUTIs) in a children's hospital while demonstrating efficacy of electronic identification of CAUTIs. There were 25 CAUTIs identified over 24 months, with most (88%) occurring in the intensive care units (ICUs). The incidence of ICU CAUTIs decreased during the study period (P = .04). Concordance between electronic identification and validation by infection control staff was 83% and increased to 100% with correction of nursing documentation.

Dysfunctional cognitions of depressive inpatients and their relationship with treatment outcome.

BACKGROUND: Dysfunctional cognitions can contribute to depression and its maintenance. They may be related to a higher relapse rate and a longer duration of the depressive episode. The relevance of dysfunctional cognitions for acute inpatient treatment of unipolar depression is examined in this study and its variability by cognitive behavioural therapy (CBT). METHODS: 222 patients suffering from Major Depressive Disorder (MDD) were evaluated during their inpatient treatment by assessing admission and discharge depression scores and their relationship to dysfunctional cognitions, using the Dysfunctional Attitude Scale (DAS). The relationship between dysfunctional cognitions and treatment outcome was examined. Primary outcome measures were the Hamilton-Rating-Scale (HRSD) and the Beck Depression Inventory (BDI). RESULTS: Higher age, depression severity at admission, comorbid personality disorders and recurrent depressive disorders are related with higher DAS-scores at admission. DAS-Scores declined during treatment but to a lower extend than depressive symptom scales (effect size dDAS-G t1-t2 = .31; dHRSD t1-t2 = 2.88; dBDI t1-t2 = 1.38). Higher DAS-scores at admission correlated negatively with the improvement of depressive symptoms during treatment (HRSD: r = -.62; p < .01; BDI: r = -.54; p < .01) and remission rates (HRSD: r = -.65; p < .01; BDI: r = -.48; p < .01). CBT did not additionally reduce DAS-scores compared to pharmacotherapy only. CONCLUSION: Dysfunctional cognitions are relatively stable compared to other depressive symptoms and are associated with poorer treatment outcome even in combined treatment of antidepressant medication and CBT during inpatient treatment. Changes of dysfunctional cognitions seem to be a long-term treatment goal, especially because of their association with comorbid personality disorders and recurrent depressive disorders.

The relationship of health-related quality of life and treatment outcome during inpatient treatment of depression.

PURPOSE: Health-related quality of life (HRQoL) is important for long-term social functioning. It is considerably reduced in patients with depression. We studied the impact of HRQoL on treatment outcome in patients with unipolar depression. Furthermore, we analysed factors associated with HRQoL in inpatients with unipolar depression. METHODS: One hundred and eighty patients suffering from major depressive disorder were evaluated during their inpatient treatment by assessing admission and discharge depression severity and their HRQoL, using the Medical Outcomes Study 12-item Short Form (SF-12). Baseline and treatment variables associated with HRQoL were examined by regression analysis. Primary outcome measures were the Hamilton Rating Scale and the Beck Depression Inventory. RESULTS: HRQoL improved significantly during inpatient treatment. Lower HRQoL outcomes were strongly associated with higher age, somatic comorbidities, a recurrent depressive disorder and stronger depressive symptoms at admission. Additionally, patients with a complex treatment situation (high number of medications, antidepressant switch) showed stronger impairment of HRQoL. Personality disorders and additional psychotherapy did not predict HRQoL. CONCLUSION: The inpatient treatment resulted in an increase of the SF-12 scores, although to a lower extent than depressive symptoms. Several factors negatively influence HRQoL, such as the presence of somatic and axis I psychiatric comorbiditites and a recurrent or severe depressive episode. Targeting somatic comorbidities in patients with unipolar depression seem to play an important role for HRQoL.

Utility of surveillance cultures for antimicrobial resistant organisms in infants transferred to the neonatal intensive care unit.

BACKGROUND: Infections with antibiotic resistant organisms (AROs) are an important source of morbidity and mortality among infants hospitalized in the neonatal intensive care unit (NICU). To identify potential reservoirs of AROs in the NICU, active surveillance strategies have been adopted by many NICUs to detect infants colonized with AROs. However, the yield, risks, benefits and costs of different strategies have not been fully evaluated. METHODS: We conducted a retrospective study in 2 level III NICUs from 2004 to 2010 to investigate the yield of surveillance cultures obtained from infants transferred to the NICU from other hospitals. Cultures were processed for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and antibiotic-resistant gram-negative rods. Risk factors, selected outcomes and laboratory costs associated with ARO colonization were assessed. RESULTS: Among 1751 infants studied, the rate of colonization for methicillin-resistant S. aureus, vancomycin-resistant enterococci and antibiotic-resistant gram-negative rods was 3%, 1.7% and 1%, respectively. Age at transfer was the strongest predictor of ARO colonization; infants transferred at ≥ 7 days of life had 5.8 increased odds of ARO colonization compared with infants <7 days of age. Transferred infants who were colonized had similar rates of mortality, ARO infection and duration of hospitalization compared with those who were not colonized. The laboratory cost of surveillance cultures during the study period was $58,425. CONCLUSIONS: The rate of colonization with AROs at transfer was low particularly in infants <7 days old. Future studies should examine the safety of targeted surveillance strategies focused on older infants.

Impact of electronic surveillance on isolation practices.

OBJECTIVE: To assess the impact of an electronic surveillance system on isolation practices and rates of methicillin-resistant Staphylococcus aureus (MRSA). DESIGN: A pre-post test intervention. SETTING: Inpatient units (except psychiatry and labor and delivery) in 4 New York City hospitals. PATIENTS: All patients for whom isolation precautions were indicated, May 2009-December 2011. METHODS: Trained observers assessed isolation sign postings, availability of isolation carts, and staff use of personal protective equipment (PPE). Infection rates were obtained from the infection control department. Regression analyses were used to examine the association between the surveillance system, infection prevention practices, and MRSA infection rates. RESULTS: A total of 54,159 isolation days and 7,628 staff opportunities for donning PPE were observed over a 31-month period. Odds of having an appropriate sign posted were significantly higher after intervention than before intervention (odds ratio [OR], 1.10 [95% confidence interval {CI}, 1.01-1.20]). Relative to baseline, postintervention sign posting improved significantly for airborne and droplet precautions but not for contact precautions. Sign posting improved for vancomycin-resistant enterococci (OR, 1.51 [95% CI, 1.23-1.86]; [Formula: see text]), Clostridium difficile (OR, 1.59 [95% CI, 1.27-2.02]; [Formula: see text]), and Acinetobacter baumannii (OR, 1.41 [95% CI, 1.21-1.64]; [Formula: see text]) precautions but not for MRSA precautions (OR, 1.11 [95% CI, 0.89-1.39]; [Formula: see text]). Staff and visitor adherence to PPE remained low throughout the study but improved from 29.1% to 37.0% after the intervention (OR, 1.14 [95% CI, 1.01-1.29]). MRSA infection rates were not significantly different after the intervention. CONCLUSIONS: An electronic surveillance system resulted in small but statistically significant improvements in isolation practices but no reductions in infection rates over the short term. Such innovations likely require considerable uptake time.

Impact of different educational methods on nursing knowledge and satisfaction.

Despite the reality of high patient acuity, staffing challenges, and financial constraints, nurse educators must convey information to staff in an expeditious and effective manner. Determining which educational methods meet the staff's needs and learning preferences is a daily challenge for educators. This experimental study compared two different educational methods, lecture and poster presentation, examining nursing knowledge acquisition and retention as well as satisfaction with the educational method.

Time lag for posting transmission-based isolation precaution signs.

BACKGROUND: Rapid identification and isolation of patients colonized or infected with virulent pathogens is essential to minimize risk of exposure to other patients, visitors, and health care workers. OBJECTIVE: Our objective was to determine the time lag between when a patient is identified as requiring isolation precautions and when an isolation sign is posted outside of their room. METHODS: Patients requiring assessment of isolation precautions because of a new positive culture, readmission, or transfers within the institution were identified through an electronic surveillance system. Observers recorded the presence of isolation signs at the patient's door at time (T) 0hr, T2hr, T4hr, T24hr, and T48hr or until an isolation sign was posted. RESULTS: The majority of patients was adults in nonintensive care units. Isolation signs were present for 79.0% of the patients at T0hr and increased to 83.8% by T48hr. No difference was seen between the unit type or indications for isolation. The most common organisms for which isolation was indicated were influenza and resistant enterococci, Staphylococcus aureus; isolation sign postings at T0hr were 87.9%, 85.7%, and 80.7%, respectively. There was a significant difference seen in compliance among the adult (82.8%) and pediatrics (66.7%) sites (P = .0268). CONCLUSION: Isolation precautions are indicated to prevent transmission of virulent pathogens; however, their implementation in a timely manner can be challenging. In this study, approximately 20% of patients for whom isolation was needed had no sign posted within the first 24 hours, and there were only minimal increases thereafter. Simple processes are needed for early identification of patients, communication of the protective equipment needed, and continuous monitoring of adherence to guidelines.

Measuring compliance with transmission-based isolation precautions: comparison of paper-based and electronic data collection.

BACKGROUND: Decreasing the transmission of resistant organisms in hospitals is a key goal of infection prevention plans. Studies have consistently shown inadequate health care worker (HCW) compliance with isolation precautions. Evaluating adherence through direct observation of HCW behavior is considered the "gold standard" but is labor-intensive, requiring the collection and analysis of a large volume of observations. METHODS: Two methods of data collection to assess HCW compliance were evaluated: a manual method using a paper form (PF), with subsequent data entry into a database, and an electronic method using a Web-based form (WBF) with real-time data recording. Observations were conducted at 4 hospitals (a total of 2,065 beds) to assess the availability of gloves, gowns, and masks; isolation sign postings; and HCW isolation practices. RESULTS: A total of 13,878 isolation rooms were observed in 2009. The median number of rooms observed per day was 61 for PF and 60 for WBF, and the respective mean observation times per room were 149 seconds and 60 seconds. Thus, use of the WBF provided a time savings of 89 seconds per room. CONCLUSION: Simple electronic forms can significantly decrease the required resources for monitoring HCW adherence to hospital policies. Use of the WBF decreased the observation time by 60%, allowing for increases in the frequency and intensity of surveillance activities.

Documentation of contact precautions in an electronic health record.

Contact precautions are implemented to reduce transmission of multidrug-resistant organisms but may also increase hospital costs and patient complications. The goal of this study was to determine the prevalence of documentation of contact precautions (provider orders and nursing flowsheet documentation) in an electronic health record. Orders and nursing documentation were simultaneously present for only 42.3% of patient rooms with contact precaution signs, and 17.8% of rooms with signs had neither orders nor nursing documentation.

Challenges of applying the SHEA/HICPAC metrics for multidrug-resistant organisms to a real-world setting.

OBJECTIVE: To test in a real-world setting the recommendations for measuring infection with multidrug-resistant organisms (MDRO) from the Society for Healthcare Epidemiology of America (SHEA) and the Centers for Disease Control and Prevention's Healthcare Infection Control Practices Advisory Committee (HICPAC). METHODS: Using data from 3 hospital settings within a healthcare network, we applied the SHEA/HICPAC recommendations to measure methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization. Data were obtained from the hospitals' electronic surveillance system and were supplemented by manual medical record review as necessary. Additionally, we tested (1) different definitions for nosocomial incidence, (2) the effect of excluding patients not at risk from the denominator for hospital-onset incidence, and (3) the appropriate time period to use when including or excluding patients with a prior history of MRSA infection or colonization from nosocomial rates. Negative binomial regression models were used to test for differences between rate definitions. A rating scale was created for each metric, assessing the extent to which manual or electronic data elements were required. RESULTS: There was no statistically significant difference between using 72 hours or 3 calendar days as the cutoff to define hospital-onset incidence. Excluding patients not at risk from the denominator when calculating hospital-onset incidence led to statistically significant increases in rates. When excluding patients with a prior history of MRSA infection or colonization from nosocomial incidence rates, rates were similar regardless of whether we looked at 1, 2, or 3 years' worth of prior data. CONCLUSIONS: The SHEA/HICPAC MDRO metrics are useful but can be challenging to implement. We include in our description of the data sources and processes required to calculate these metrics information that may simplify the process for institutions.

Neuropsychological Profile of Parkin Mutation Carriers with and without Parkinson Disease: The CORE-PD Study.

The cognitive profile of early onset Parkinson's disease (EOPD) has not been clearly defined. Mutations in the parkin gene are the most common genetic risk factor for EOPD and may offer information about the neuropsychological pattern of performance in both symptomatic and asymptomatic mutation carriers. EOPD probands and their first-degree relatives who did not have Parkinson's disease (PD) were genotyped for mutations in the parkin gene and administered a comprehensive neuropsychological battery. Performance was compared between EOPD probands with (N = 43) and without (N = 52) parkin mutations. The same neuropsychological battery was administered to 217 first-degree relatives to assess neuropsychological function in individuals who carry parkin mutations but do not have PD. No significant differences in neuropsychological test performance were found between parkin carrier and noncarrier probands. Performance also did not differ between EOPD noncarriers and carrier subgroups (i.e., heterozygotes, compound heterozygotes/homozygotes). Similarly, no differences were found among unaffected family members across genotypes. Mean neuropsychological test performance was within normal range in all probands and relatives. Carriers of parkin mutations, whether or not they have PD, do not perform differently on neuropsychological measures as compared to noncarriers. The cognitive functioning of parkin carriers over time warrants further study.

Frequency of known mutations in early-onset Parkinson disease: implication for genetic counseling: the consortium on risk for early onset Parkinson disease study.

OBJECTIVE: To assess the frequency and clinical characteristics of carriers of previously identified mutations in 6 genes associated with early-onset Parkinson disease (PD) and provide empirical data that can be used to inform genetic counseling. DESIGN: Cross-sectional observational study. SETTING: Thirteen movement disorders centers. PATIENTS: Nine hundred fifty-three individuals with early-onset PD defined as age at onset (AAO) younger than 51 years. Participants included 77 and 139 individuals of Hispanic and Jewish ancestry, respectively. Intervention Mutations in SNCA, PRKN, PINK1, DJ1, LRRK2, and GBA were assessed. A validated family history interview and the Unified Parkinson Disease Rating Scale were administered. Demographic and phenotypic characteristics were compared among groups defined by mutation status. Main Outcome Measure Mutation carrier frequency stratified by AAO and ethnic background. RESULTS: One hundred fifty-eight (16.6%) participants had mutations, including 64 (6.7%) PRKN, 35 (3.6%) LRRK2 G2019S, 64 (6.7%) GBA, and 1 (0.2%) DJ1. Mutation carriers were more frequent in those with an AAO of 30 years or younger compared with those with AAO between 31 and 50 years (40.6% vs 14.6%, P < .001), in individuals who reported Jewish ancestry (32.4% vs 13.7%, P < .001), and in those reporting a first-degree family history of PD (23.9% vs 15.1%, P = .01). Hispanic individuals were more likely to be PRKN carriers than non-Hispanic individuals (15.6% vs 5.9%, P = .003). The GBA L444P mutation was associated with a higher mean Unified Parkinson Disease Rating Scale III score after adjustment for covariates. CONCLUSION: Individuals of Jewish or Hispanic ancestry with early-onset PD, those with AAO of 30 years or younger, and those with a history of PD in a first-degree relative may benefit from genetic counseling.

Polyamine pathway contributes to the pathogenesis of Parkinson disease.

The full complement of molecular pathways contributing to the pathogenesis of Parkinson disease (PD) remains unknown. Here we address this issue by taking a broad approach, beginning by using functional MRI to identify brainstem regions differentially affected and resistant to the disease. Relying on these imaging findings, we then profiled gene expression levels from postmortem brainstem regions, identifying a disease-related decrease in the expression of the catabolic polyamine enzyme spermidine/spermine N1-acetyltransferase 1 (SAT1). Next, a range of studies were completed to support the pathogenicity of this finding. First, to test for a causal link between polyamines and α-synuclein toxicity, we investigated a yeast model expressing α-synuclein. Polyamines were found to enhance the toxicity of α-synuclein, and an unbiased genome-wide screen for modifiers of α-synuclein toxicity identified Tpo4, a member of a family of proteins responsible for polyamine transport. Second, to test for a causal link between SAT1 activity and PD histopathology, we investigated a mouse model expressing α-synuclein. DENSPM (N1, N11-diethylnorspermine), a polyamine analog that increases SAT1 activity, was found to reduce PD histopathology, whereas Berenil (diminazene aceturate), a pharmacological agent that reduces SAT1 activity, worsened the histopathology. Third, to test for a genetic link, we sequenced the SAT1 gene and a rare but unique disease-associated variant was identified. Taken together, the findings from human patients, yeast, and a mouse model implicate the polyamine pathway in PD pathogenesis.

Terms used for isolation practices by nurses at an academic medical center.

AIM: This paper is a report of a study to determine if the terms used by nurses to describe isolation precautions are associated with correct identification of required personal protective equipment. BACKGROUND: Isolation measures are important in the prevention of healthcare-associated infections. The terms used to describe categories of isolation have changed in response to new pathogens and with advances in infection prevention. METHODS: For 3 months in 2009, nurses from an academic medical center on the East Coast of the United States of America completed a survey consisting of ten clinical scenarios which asked about recommended personal protective equipment and for the name of the recommended isolation type. Correct identification of required personal protective equipment was compared to use of an approved isolation category term, controlling for infection knowledge and demographic variables. RESULTS: Three hundred and seventeen nurses gave responses to 2215 clinical scenarios. Use of non-approved category terms was associated with statistically significantly lower rates of correct personal protective equipment identification compared to use of an approved term (62.2% vs. 77.8%; P < 0.001). Specific PPE was also selected for use when not indicated - including gowns (42%), N-95 respirators (13%), fluid shield masks (13%) and sterile gloves (6%). CONCLUSION: Inconsistent terminology for isolation precautions may contribute to variations in practice. Adoption of internationally accepted and standardized category terms may improve adherence to these precautions.