Health care...associated infections studies project: An American Journal of Infection Control and National Health Care Safety Network data quality collaboration case study..÷Laboratory-identified event reporting validation.

This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) health care...associated infection surveillance definitions. This specific case study focuses on the application of the common surveillance concepts included in Laboratory-Identified Event Reporting (Chapter 12 of the NHSN Patient Safety Manual..÷Multidrug-Resistant Organism & Clostridioides difficile Infection Module) used with validation efforts. The intent of the case study series is to foster standardized application of the NHSN surveillance definitions and encourage accurate event determination among infection preventionists.

Recommendations for change in infection prevention programs and practice.

Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future.

Health care-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network Data Quality Collaboration Case Study - Chapter 9 Surgical site infection event (SSI) case study.

This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) surveillance definitions. This specific case study focuses on the application of common surveillance concepts included in the Patient Safety Component, Chapter 9 - Surgical Site Infection Event (SSI). The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions and encourage accurate HAI event determination among Infection Preventionists (IPs).

Health care-associated infections studies project: An American journal of infection control and national healthcare safety network data quality collaboration case study - Chapter 2 Identifying Healthcare-associated Infections (HAI) for NHSN Surveillance case study vignettes.

This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) surveillance definitions. This specific case study focuses on the application of three of the surveillance concepts included in the Patient Safety Component, Chapter 2 - Identifying Healthcare-associated Infections (HAI) for NHSN Surveillance. The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions and encourage accurate HAI event determination among Infection Preventionists (IPs).

How infection present at time of surgery (PATOS) data impacts your surgical site infection (SSI) standardized infection ratios (SIR), with focus on the complex 30-day SSI SIR model.

This case study is part of a series centered on the Centers for Disease Control and Prevention's National Healthcare Safety Network's (NHSN) health care-associated infection (HAI) surveillance definitions. This is the first analytic case study published in AJIC since the CDC/ NHSN updated its HAI risk adjustment models and rebaselined the standardized infection ratios (SIRs) in 2015. This case describes a scenario that Infection Preventionists (IPs) have encountered during their analysis of surgical site infection (SSI) surveillance data. The case study is intended to illustrate how specific models can impact the SIR results by highlighting differences in the criteria for NHSN's older and newer risk models: the original versions and the updated models introduced in 2015. Understanding these differences provides insight into how SSI SIR calculations differ between the older and newer NHSN baseline models. NHSN plans to produce another set of HAI risk adjustment models in the future, using newer HAI incidence and risk factor data. While the timetable for these changes remains to be determined, the statistical methods used to produce future models and SIR calculations will continue the precedents that NHSN has established. An online survey link is provided where participants may confidentially answer questions related to the case study and receive immediate feedback in the form of correct answers, explanations, rationales, and summary of teaching points. Details of the case study, answers, and explanations have been reviewed and approved by NHSN staff. We hope that participants take advantage of this educational offering and thereby gain a greater understanding of the NHSN's HAI data analysis. There are 2 baselines available for SSI standardized infection ration (SIRs) in the National Healthcare Safety Network (NHSN); one based on the 2006-2008 national aggregate data and another based on the 2015 data. Each of the 2 baselines has a different set of inclusion criteria for the SSI data, which impact the calculation of the SIR. In this case study, we focused on the impact of the inclusion of PATOS in the calculation of the 2006-2008 baseline SSI SIR and the exclusion of PATOS from the calculation of the 2015 baseline SSI SIR. In the 2006-2008 baseline SSI SIRs, PATOS events and the procedures to which they are linked are included in the calculation of the SSI SIR whereas in the 2015 baseline SSI SIRs, PATOS events and the procedures to which they are linked are excluded from the calculation of the SSI SIR. Meaning, if we control for all other inclusion criteria other than PATOS data for both baselines, we will notice differences in the number of observed events as well as the number of predicted infections for the 2 baselines. For details of the 2015 baseline and risk adjustment calculation, please review the NHSN Guide to the SIR referenced below. For details of the 2006-2008 baseline4 and risk adjustment, please see the SHEA paper "Improving Risk-Adjusted Measures of Surgical Site Infection for the National Healthcare Safety Network" by author Yi Mu.

Healthcare-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration.

This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) surveillance definitions. This specific case study focuses on the application of the Pneumonia (PNEU), Ventilator-associated event (VAE), and Bloodstream infections (BSI) surveillance definitions to a patient with COVID-19. The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions among Infection Preventionists (IPs) and encourage accurate determination of HAI events.

Health Care-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration case study.

This National Healthcare Safety Network (NHSN) surveillance case study is part of a case-study series in the American Journal of Infection Control (AJIC). These cases reflect some of the complex patient scenarios Infection preventionists have encountered in their daily surveillance of health care-associated infections using NHSN definitions. Objectives have been previously published.

Evaluation of a successful fluoroquinolone restriction intervention among high-risk patients: A mixed-methods study.

OBJECTIVE: We conducted a quality improvement initiative to restrict fluoroquinolone prescribing on two inpatient units housing high-risk patients and applied a human factors approach to understanding the barriers and facilitators to success of this intervention by front-line providers. METHODS: This was a mixed-methods, quasi-experimental study. This study was conducted on two inpatient units at a tertiary care academic medical center: the medical-surgical intensive care and abdominal solid organ transplant units. Unit-level data were collected retrospectively for 24 months pre- and post- fluoroquinolone restriction intervention, implemented in July 2016, for all admissions to the study units. Our restriction intervention required antimicrobial stewardship pre-approval for fluoroquinolone prescribing. We explored barriers and facilitators to optimal fluoroquinolone prescribing using semi-structured interviews attending, fellow and resident physicians, advanced practice providers and pharmacists on these units. RESULTS: Hospital-onset C. difficile infection did not decrease significantly, but fluoroquinolone use declined significantly from 111.6 to 19.8 days of therapy per 1000 patient-days without negatively impacting length of stay, readmissions or mortality. Third generation cephalosporin and aminoglycoside use increased post-restriction. Providers identified our institution's strong antimicrobial stewardship program and pharmacy involvement in antimicrobial decision making as key facilitators of fluoroquinolone optimization and patient complexity, lack of provider education and organizational culture as barriers to optimal prescribing. CONCLUSIONS: Fluoroquinolones can be safely restricted even among high-risk patients without negatively impacting length of stay, readmissions or mortality. Our study provides a framework for successful antimicrobial stewardship interventions informed by perceptions of front line providers.

Association of hospital-area deprivation with hospital performance on health care associated infection rates in 2018.

BACKGROUND AND OBJECTIVE: Healthcare-associated infections (HAIs) are common and often preventable complications of care, with reduction emphasized in national policy. The Centers for Medicare and Medicaid Services introduced an HAI-focused Hospital Acquired Condition Reduction Program in 2015 to penalize poor-performing hospitals. Standardized infection ratios (SIRs) are used for comparisons between healthcare organizations, though they are not adjusted for socioeconomic risks known to impact infection. The objectives of this study were to assess the relationship between hospital-area deprivation with reported SIRs and reimbursement penalties. METHODS: This was a cohort study using 2018 Hospital Compare, as well as area deprivation data and other hospital characteristics. Multivariable regression models were used to evaluate associations between hospital-area deprivation and SIR reporting as well as payment reduction, adjusting for case mix index and hospital ownership. RESULTS: Of the 2102 unique hospitals in our study, 12.8% reported at least one worse than national benchmark SIR and 23.7% had a payment reduction. After adjustment, there was a 17% increased risk of reporting worse than benchmarked SIRs with quartile increases in deprivation (95% confidence interval: 5%-30%, P = .004). Despite this, there were no significant relationships between reimbursement penalties and ADI (risk ratio: 1.00, 95% confidence interval: 0.997-1.005, P = .567). CONCLUSIONS: This study documented a significant relationship between hospital-area deprivation and the risk of reporting worse than national benchmark SIRs. Though this did not appear to translate to Hospital Acquired Condition Reduction Program penalties in this dataset, it reinforces problems with the current use of SIRs for interhospital comparisons.

Health care-associated infections studies project: an American Journal of Infection Control and National Healthcare Safety Network data quality collaboration.

This case study is part of a series centered on the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) health care-associated infection (HAI) surveillance definitions. The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions among infection preventionists and to promote accurate determination of HAI events. These cases reflect some of the complex patient scenarios that infection preventionists have encountered in their daily surveillance of HAIs using NHSN definitions. Objectives have been previously published.1.

An in-room observation study of hand hygiene and contact precaution compliance for Clostridioides difficile patients.

Using an innovative, covert, in-room observer method to evaluate infection control practices for patients with Clostridioides difficile infection, we found no difference between physician and nursing hand hygiene compliance and contact precaution usage. There was also no diurnal variation in hand hygiene practices, but decreased contact precaution usage at night. Conversely, hospital-wide data from overt observations collected over the same time period showed significantly higher hand hygiene compliance among nurses than physicians.

Health care-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration case study: Bloodstream infection-patient injection into vascular access 2018.

This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) health care-associated infection surveillance definitions. These cases reflect some of the complex patient scenarios infection preventionists have encountered in their daily surveillance of health care-associated infections using NHSN definitions and protocols. Teaching points for this case study are.

Healthcare-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration: Location mapping.

This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) health care-associated infection (HAI) surveillance definitions. This specific case study focuses on appropriately mapping locations within an NHSN-enrolled facility. The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions among IPs and encourage accurate determination of HAI events. An online survey link is provided where participants may confidentially answer questions related to the case study and receive immediate feedback in the form of correct answers and explanations and rationales. Details of the case study, answers, and explanations have been reviewed and approved by NHSN staff. We hope that participants take advantage of this educational offering and thereby gain a greater understanding of NHSN HAI surveillance definitions.

Methods for computational disease surveillance in infection prevention and control: Statistical process control versus Twitter's anomaly and breakout detection algorithms.

BACKGROUND: Although not all health care-associated infections (HAIs) are preventable, reducing HAIs through targeted intervention is key to a successful infection prevention program. To identify areas in need of targeted intervention, robust statistical methods must be used when analyzing surveillance data. The objective of this study was to compare and contrast statistical process control (SPC) charts with Twitter's anomaly and breakout detection algorithms. METHODS: SPC and anomaly/breakout detection (ABD) charts were created for vancomycin-resistant Enterococcus, Acinetobacter baumannii, catheter-associated urinary tract infection, and central line-associated bloodstream infection data. RESULTS: Both SPC and ABD charts detected similar data points as anomalous/out of control on most charts. The vancomycin-resistant Enterococcus ABD chart detected an extra anomalous point that appeared to be higher than the same time period in prior years. Using a small subset of the central line-associated bloodstream infection data, the ABD chart was able to detect anomalies where the SPC chart was not. DISCUSSION: SPC charts and ABD charts both performed well, although ABD charts appeared to work better in the context of seasonal variation and autocorrelation. CONCLUSIONS: Because they account for common statistical issues in HAI data, ABD charts may be useful for practitioners for analysis of HAI surveillance data.

What do visitors know and how do they feel about contact precautions?

Patients with Clostridium difficile infection (CDI) are placed in contact precautions. We surveyed 31 visitors of CDI patients to understand their compliance, knowledge, and perceptions of contact precautions. Although most visitors knew where to find the required personal protective equipment, only 42% were fully compliant with gown and gloves. Family members accounted for 90% of visitors, and roughly half of the reasons given for not gowning were related to a lack of perceived risk for family members. Nursing staff are fundamental sources of personal protective equipment (PPE) information for visitors; however, we found variation in staff communication regarding need for visitor PPE use.

Health care-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration.

This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) health care-associated infection (HAI) surveillance definitions. This specific case study focuses on the definitions and protocols used to make HAI infection determinations, such as the infection window period and secondary bloodstream infection attribution period. The case reflects the real-life and complex patient scenarios that infection preventionists (IPs) face when identifying and reporting HAIs to NHSN. The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions among IPs and encourage accurate determination of HAI events. An online survey link is provided where participants may confidentially answer questions related to the case study and receive immediate feedback in the form of correct answers and explanations and rationales. Details of the case study, answers, and explanations have been reviewed and approved by NHSN staff. We hope that participants take advantage of this educational offering and thereby gain a greater understanding of NHSN HAI surveillance definitions.

On the hands of patients with Clostridium difficile: A study of spore prevalence and the effect of hand hygiene on C difficile removal.

The prevalence of Clostridium difficile spores was assessed in 48 observations of infected inpatients. Participants were randomized to hand hygiene with either alcohol-based handrub or soap and water. C difficile was recovered in 14.6% of pre-hand hygiene observations. It was still present on 5 of these 7 participants after hand hygiene (3/3 using alcohol-based handrub; 2/4 using soap and water).