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1.
Am J Infect Control ; 2024 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-39233014

RESUMO

External urinary device (EUD) use and modification of the electronic medical record system with defaulting EUD for selected indications significantly decreased the utilization of indwelling urinary catheters while there was no observed significant reduction in catheter-associated urinary tract infections. The introduction of EUD alone may not decrease catheter-associated urinary tract infections and a comprehensive approach involving various strategies from different perspectives will be necessary, particularly diagnostic stewardship.

2.
Infect Control Hosp Epidemiol ; 45(1): 110-113, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37528757

RESUMO

Of the 2,668 patients admitted with coronavirus disease 2019 (COVID-19), 4% underwent prolonged isolation for >20 days. Reasons for extended isolation were inconsistent with Centers for Disease Control and Prevention (CDC) guidelines in 25% of these patients and were questionable in 54% due to an ongoing critically ill condition at day 20 without CDC-defined immunocompromised status.


Assuntos
COVID-19 , Humanos , Pacientes Internados , Iowa , SARS-CoV-2 , Centros de Atenção Terciária , Estudos Retrospectivos
3.
Am J Infect Control ; 52(4): 436-442, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37827243

RESUMO

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) increased nationally during the COVID-19 pandemic. We described CLABSIs at our institution during 2019 to 2022. METHODS: This retrospective observational study examined CLABSIs among adult inpatients at an 866-bed teaching hospital in the Midwest. CLABSI incidence was trended over time and compared to monthly COVID-19 admissions. Manual chart review was performed to obtain patient demographics, catheter-associated variables, pathogens, and clinical outcomes. RESULTS: We identified 178 CLABSIs. The CLABSI incidence (cases per 1,000 line days) tripled in October 2020 as COVID-19 admissions increased. CLABSIs in 2020 were more frequently caused by coagulase-negative staphylococci and more frequently occurred in the intensive care units 7+ days after central line insertion. The CLABSI incidence normalized in early 2021 and did not increase during subsequent COVID-19 surges. Throughout 2019 to 2022, about half of the nontunneled central venous catheters involved in CLABSI were placed emergently. One-quarter of CLABSIs involved multiple central lines. Chlorhexidine skin treatment adherence was limited by patient refusal. CONCLUSIONS: The increase in CLABSIs in late 2020 during a surge in COVID-19 admissions was likely related to central line maintenance but has resolved. Characterizing CLABSI cases can provide insight into adherence to guideline-recommended prevention practices and identify areas for improvement at individual institutions.


Assuntos
Bacteriemia , COVID-19 , Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateteres Venosos Centrais , Sepse , Adulto , Humanos , Cateterismo Venoso Central/efeitos adversos , Infecções Relacionadas a Cateter/prevenção & controle , Iowa/epidemiologia , Pandemias , Cateteres Venosos Centrais/efeitos adversos , Estudos Retrospectivos , Hospitais de Ensino , Sepse/epidemiologia , COVID-19/epidemiologia , COVID-19/complicações , Bacteriemia/prevenção & controle
4.
Infect Control Hosp Epidemiol ; 44(8): 1351-1354, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-35652600

RESUMO

We describe COVID-19 cases among nonphysician healthcare personnel (HCP) by work location. The proportion of HCP with coronavirus disease 2019 (COVID-19) was highest in the emergency department and lowest among those working remotely. COVID-19 and non-COVID-19 units had similar proportions of HCP with COVID-19 (13%). Cases decreased across all work locations following COVID-19 vaccination.


Assuntos
COVID-19 , Humanos , Iowa/epidemiologia , Vacinas contra COVID-19 , Pessoal de Saúde , Local de Trabalho , Atenção à Saúde
5.
Artigo em Inglês | MEDLINE | ID: mdl-36483395

RESUMO

We analyzed blood-culture practices to characterize the utilization of the Infectious Diseases Society of America (IDSA) recommendations related to catheter-related bloodstream infection (CRBSI) blood cultures. Most patients with a central line had only peripheral blood cultures. Increasing the utilization of CRBSI guidelines may improve clinical care, but may also affect other quality metrics.

6.
Artigo em Inglês | MEDLINE | ID: mdl-36505945

RESUMO

We describe the association between job roles and coronavirus disease 2019 (COVID-19) among healthcare personnel. A wide range of hazard ratios were observed across job roles. Medical assistants had higher hazard ratios than nurses, while attending physicians, food service workers, laboratory technicians, pharmacists, residents and fellows, and temporary workers had lower hazard ratios.

7.
Clin Infect Dis ; 75(7): 1187-1193, 2022 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-35100620

RESUMO

BACKGROUND: Inappropriate Clostridioides difficile testing has adverse consequences for patients, hospitals, and public health. Computerized clinical decision support (CCDS) systems in the electronic health record (EHR) may reduce C. difficile test ordering; however, effectiveness of different approaches, ease of use, and best fit into healthcare providers' (HCP) workflow are not well understood. METHODS: Nine academic and 6 community hospitals in the United States participated in this 2-year cohort study. CCDS (hard stop or soft stop) triggered when a duplicate C. difficile test order was attempted or if laxatives were recently received. The primary outcome was the difference in testing rates pre- and post-CCDS interventions, using incidence rate ratios (IRRs) and mixed-effect Poisson regression models. We performed qualitative evaluation (contextual inquiry, interviews, focus groups) based on a human factors model. We identified themes using a codebook with primary nodes and subnodes. RESULTS: In 9 hospitals implementing hard-stop CCDS and 4 hospitals implementing soft-stop CCDS, C. difficile testing incidence rate (IR) reduction was 33% (95% confidence interval [CI]: 30%-36%) and 23% (95% CI: 21%-25%), respectively. Two hospitals implemented a non-EHR-based human intervention with IR reduction of 21% (95% CI: 15%-28%). HCPs reported generally favorable experiences and highlighted time efficiencies such as inclusion of the patient's most recent laxative administration on the CCDS. Organizational factors, including hierarchical cultures and communication between HCPs caring for the same patient, impact CCDS acceptance and integration. CONCLUSIONS: CCDS systems reduced unnecessary C. difficile testing and were perceived positively by HCPs when integrated into their workflow and when displaying relevant patient-specific information needed for decision making.


Assuntos
Clostridioides difficile , Infecções por Clostridium , Sistemas de Apoio a Decisões Clínicas , Clostridioides , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/epidemiologia , Estudos de Coortes , Hospitais , Humanos , Laxantes
8.
Am J Infect Control ; 50(3): 277-282, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35000801

RESUMO

BACKGROUND: The COVID-19 pandemic has affected infection prevention and control (IPC) programs worldwide. We evaluated the impact of COVID-19 on the University of Iowa Hospitals & Clinics IPC program by measuring the volume of calls to the program, changes in healthcare-associated infection rates, and team member perceptions. METHODS: We retrieved the IPC call log and healthcare-associated infection trends for 2018-2020. We defined 2 periods: pre-COVID-19 (2018-2019) and COVID-19 (January-December 2020). We also conducted one-on-one interviews and focus group interviews with members of the IPC program and describe changes in their working conditions during the COVID-19 period. RESULTS: A total of 6,564 calls were recorded during 2018-2020. The pre-COVID-19 period had a median of 71 calls and/or month (range: 50-119). During the COVID-19 period, the median call volume increased to 368/month (range: 149-829), and most calls were related to isolation precautions (50%). During the COVID-19 period, the central line-associated bloodstream infection incidence increased significantly. Infection preventionists reported that the ambiguity and conflicting guidance during the pandemic were major challenges. CONCLUSIONS: Our IPC program experienced a 500% increase in consultation requests. Planning for future bio-emergencies should include creative strategies to increase response capacity within IPC programs.


Assuntos
COVID-19 , COVID-19/prevenção & controle , Humanos , Controle de Infecções , Iowa/epidemiologia , Pandemias/prevenção & controle , SARS-CoV-2
9.
Infect Control Hosp Epidemiol ; 43(8): 974-978, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-34169812

RESUMO

OBJECTIVE: Patients admitted to the hospital may unknowingly carry severe acute respiratory coronavirus virus 2 (SARS-CoV-2), and hospitals have implemented SARS-CoV-2 admission screening. However, because SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) assays may remain positive for months after infection, positive results may represent active or past infection. We determined the prevalence and infectiousness of patients who were admitted for reasons unrelated to COVID-19 but tested positive for SARS-CoV-2 on admission screening. METHODS: We conducted an observational study at the University of Iowa Hospitals & Clinics from July 7 to October 25, 2020. All patients admitted without suspicion of COVID-19 were included, and medical records of those with a positive admission screening test were reviewed. Infectiousness was determined using patient history, PCR cycle threshold (Ct) value, and serology. RESULTS: In total, 5,913 patients were screened and admitted for reasons unrelated to COVID-19. Of these, 101 had positive admission RT-PCR results; 36 of these patients were excluded because they had respiratory signs/symptoms on admission on chart review. Also, 65 patients (1.1%) did not have respiratory symptoms. Finally, 55 patients had Ct values available and were included in this analysis. The median age of the final cohort was 56 years and 51% were male. Our assessment revealed that 23 patients (42%) were likely infectious. The median duration of in-hospital isolation was 5 days for those likely infectious and 2 days for those deemed noninfectious. CONCLUSIONS: SARS-CoV-2 was infrequent among patients admitted for reasons unrelated to COVID-19. An assessment of the likelihood of infectiousness using clinical history, RT-PCR Ct values, and serology may help in making the determination to discontinue isolation and conserve resources.


Assuntos
COVID-19 , Centros Médicos Acadêmicos , COVID-19/diagnóstico , COVID-19/epidemiologia , Feminino , Hospitalização , Humanos , Iowa/epidemiologia , Masculino , Pessoa de Meia-Idade , SARS-CoV-2
10.
Infect Control Hosp Epidemiol ; 43(12): 1910-1913, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-34250882

RESUMO

The incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure in shared patient rooms was low at our institution: 1.8 per 1,000 shared-room patient days. However, the secondary attack rate (21.6%) was comparable to that reported in household exposures. Lengthier exposures were associated with SARS-CoV-2 conversion. Hospitals should implement measures to decrease shared-room exposures.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , SARS-CoV-2 , Incidência , Quartos de Pacientes , Iowa/epidemiologia , Centros de Atenção Terciária
11.
Infect Control Hosp Epidemiol ; 43(12): 1948-1950, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-34396947

RESUMO

We described the epidemiology of bat intrusions into a hospital and subsequent management of exposures during 2018-2020. Most intrusions occurred in older buildings during the summer and fall months. Hospitals need bat intrusion surveillance systems and protocols for bat handling, exposure management, and intrusion mitigation.


Assuntos
Quirópteros , Animais , Humanos , Idoso , Centros de Atenção Terciária , Iowa
12.
Gen Hosp Psychiatry ; 73: 64-70, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34619441

RESUMO

OBJECTIVE: Acceptance and Commitment Therapy (ACT) is a behavioral intervention demonstrating sustained improvements in anxiety in individuals with chronic anxiety and psychological distress. Because anxiety disorders are associated with the development of cardiovascular disease (CVD), we hypothesized that a novel 1-day ACT workshop would both lower anxiety and improve vascular function in persons with moderate/high anxiety. METHODS: In a randomized controlled study, 72 adults (age 33.9 ± 8.6 (SD) years) with baseline moderate/high anxiety completed a one-day ACT intervention (n = 44, age 33.9 ± 8.7 years) or control (n = 28, age 37.1 ± 10.1 years). Pre-specified secondary outcomes were measured over 12 weeks: aortic stiffness (carotid-femoral pulse wave velocity [cfPWV]), forearm vascular endothelial function (post-ischemic peak forearm blood flow [FBF] via plethysmography), and brachial artery flow-mediated dilation (FMD). Carotid artery stiffness (ß-stiffness index), and inflammatory markers (C-reactive protein and tumor necrosis factor-alpha) were also explored. RESULTS: Although the intervention had a significant and sustained effect on the primary outcome of anxiety as measured by the Beck Anxiety Inventory, the 1-day ACT workshop was not associated with improvement in vascular or inflammatory endpoints. The intervention was unexpectedly associated with increases in ß-stiffness index that were also associated with changing trait anxiety. CONCLUSION: Anxiety improvements did not translate into improvements in any of the vascular function outcomes. This may reflect a less-than-robust effect of the intervention on anxiety, failure in design to select those with vascular dysfunction, or not intervening on a relevant causal pathway. (Trial registration NCT02915874 at www.clinicaltrials.gov).


Assuntos
Terapia de Aceitação e Compromisso , Adulto , Ansiedade/terapia , Transtornos de Ansiedade , Humanos , Inflamação/terapia , Pessoa de Meia-Idade , Análise de Onda de Pulso
13.
Am J Infect Control ; 49(12): 1567-1568, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34400244

RESUMO

We compared the incidence of Clostridioides difficile infection before and after the discontinuation of Ultraviolet light used in addition to bleach in terminal disinfection of hospital rooms. We found no difference in C. difficile infection rates but found a decreased turn over time. The benefit of Ultraviolet light may be diminished in hospitals with a high thoroughness of manual cleaning.


Assuntos
Clostridioides difficile , Infecção Hospitalar , Clostridioides , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Desinfecção , Humanos , Iowa , Centros de Atenção Terciária , Raios Ultravioleta
16.
Clin Infect Dis ; 73(9): e3116-e3119, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33103196

RESUMO

We implemented serial coronavirus disease 2019 testing for inpatients with a negative test on admission. The conversion rate (negative to positive) on repeat testing was 1%. We identified patients during their incubation period and hospital-onset cases, rapidly isolated them, and potentially reduced exposures. Serial testing and infectiousness determination were resource intensive.


Assuntos
COVID-19 , Teste para COVID-19 , Hospitais , Humanos , SARS-CoV-2
20.
Infect Control Hosp Epidemiol ; 41(12): 1461-1463, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32772952

RESUMO

We performed a retrospective analysis of the impact of using the International Classification of Diseases, Tenth Revision procedure coding system (ICD-10) or current procedural terminology (CPT) codes to calculate surgical site infection (SSI) rates. Denominators and SSI rates vary depending on the coding method used. The coding method used may influence interhospital performance comparisons.


Assuntos
Current Procedural Terminology , Infecção da Ferida Cirúrgica , Humanos , Classificação Internacional de Doenças , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia
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