Resources needed by critical access hospitals to address identified infection prevention and control program gaps.

Objective: The study examined resources needed by Infection Preventionists (IP) to address infection prevention and control (IPC) program gaps. Design: A 49-question survey. Setting: Licensed Critical Access Hospitals (CAHs) in Federal Emergency Management Area (FEMA) Region VII. Participants: IP at licensed CAHs. Methods: The survey conducted between December 2020 and January 2021 consisted of questions focusing on four categories including IPC program infrastructure, competency-based training, audit and feedback, and identification of high-risk pathogens/serious communicable diseases (HRP/SCD). An IPC score was calculated for each facility by totaling "Yes" responses (which indicate best practices) to 49 main survey questions. Follow-up questions explored the resources needed by the CAHs to implement or further strengthen best practices and mitigate IPC practice gaps. Welch t-test was used to study differences in IPC practice scores between states. Results: 50 of 259 (19.3%) CAHs participated in the survey with 37 (14.3%) answering all 49 questions. CAHs responding to all questions had a median IPC score of 35. There was no significant difference between IPC practice scores of CAHs in NE and IA. The top three IPC gaps were absence of drug diversion program (77%), lack of audits and feedback for insertion and maintenance of central venous catheters (76%), and missing laboratory risk assessments to identify tests that can be offered safely for patients under investigation for HRP/SCD (76%). Standardized audit tools, educational resources, and staff training materials were cited as much-needed resources. Conclusion: IPC practice gaps exist in CAHs. Various resources are needed for gap mitigation.

Improving antibiotic prescribing for acute bronchitis in the ambulatory setting using a multifaceted approach.

Antibiotics are frequently prescribed inappropriately for acute respiratory infections in the outpatient setting. We report the implementation of a multifaceted outpatient antimicrobial stewardship initiative resulting in a 12.3% absolute reduction of antibiotic prescribing for acute bronchitis in primary care clinics receiving active interventions.

Hospital-wide assessment of compliance with central venous catheter dressing recommendations.

This hospital-wide assessment of central venous catheter (CVC) site maintenance evaluated a total of 420 CVC sites and found deficiencies in 31%. Internal jugular CVC dressings were the most frequently deficient type (P = 0.001). No correlation between CVC site maintenance and central line-associated bloodstream infections was detected (Spearman's correlation coefficient = 0.007; P = 0.98).

Effect of hospital-wide chlorhexidine patient bathing on healthcare-associated infections.

BACKGROUND: Chlorhexidine gluconate (CHG) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. The objective was to determine the effect of hospital-wide CHG patient bathing on healthcare-associated infections (HAIs). DESIGN: Quasi-experimental, staged, dose-escalation study for 19 months followed by a 4-month washout period, in 3 cohorts. SETTING: Academic medical center. PATIENTS: All patients except neonates and infants. INTERVENTION AND MEASUREMENTS: CHG bathing in the form of bed basin baths or showers administered 3 days per week or daily. CHG bathing compliance was monitored, and the rate of HAIs was measured. RESULTS: Over 188,859 patient-days, 68,302 CHG baths were administered. Adherence to CHG bathing in the adult critical care units (90%) was better than that observed in other units (57.7%, [Formula: see text]). A significant decrease in infections due to Clostridium difficile was observed in all cohorts of patients during the intervention period, followed by a significant rise during the washout period. For all cohorts, the relative risk of C. difficile infection compared to baseline was 0.71 (95% confidence interval [CI], 0.57-0.89; [Formula: see text]) for 3-days-per-week CHG bathing and 0.41 (95% CI, 0.29-0.59; [Formula: see text]) for daily CHG bathing. During the washout period, the relative risk of infection was 1.85 (95% CI, 1.38-2.53; [Formula: see text]), compared to that with daily CHG bathing. A consistent effect of CHG bathing on other HAIs was not observed. No adverse events related to CHG bathing were reported. CONCLUSIONS: CHG bathing was well tolerated and was associated with a significant decrease in C. difficile infections in hospitalized patients.