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1.
JAMA ; 313(21): 2162-71, 2015 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-26034956

RESUMO

IMPORTANCE: Previous studies suggested that a bundled intervention was associated with lower rates of Staphylococcus aureus surgical site infections (SSIs) among patients having cardiac or orthopedic operations. OBJECTIVE: To evaluate whether the implementation of an evidence-based bundle is associated with a lower risk of S. aureus SSIs in patients undergoing cardiac operations or hip or knee arthroplasties. DESIGN, SETTING, AND PARTICIPANTS: Twenty hospitals in 9 US states participated in this pragmatic study; rates of SSIs were collected for a median of 39 months (range, 39-43) during the preintervention period (March 1, 2009, to intervention) and a median of 21 months (range, 14-22) during the intervention period (from intervention start through March 31, 2014). INTERVENTIONS: Patients whose preoperative nares screens were positive for methicillin-resistant S. aureus (MRSA) or methicillin-susceptible S. aureus (MSSA) were asked to apply mupirocin intranasally twice daily for up to 5 days and to bathe daily with chlorhexidine-gluconate (CHG) for up to 5 days before their operations. MRSA carriers received vancomycin and cefazolin or cefuroxime for perioperative prophylaxis; all others received cefazolin or cefuroxime. Patients who were MRSA-negative and MSSA-negative bathed with CHG the night before and morning of their operations. Patients were treated as MRSA-positive if screening results were unknown. MAIN OUTCOMES AND MEASURES: The primary outcome was complex (deep incisional or organ space) S. aureus SSIs. Monthly SSI counts were analyzed using Poisson regression analysis. RESULTS: After a 3-month phase-in period, bundle adherence was 83% (39% full adherence; 44% partial adherence). Overall, 101 complex S. aureus SSIs occurred after 28,218 operations during the preintervention period and 29 occurred after 14,316 operations during the intervention period (mean rate per 10,000 operations, 36 for preintervention period vs 21 for intervention period, difference, -15 [95% CI, -35 to -2]; rate ratio [RR], 0.58 [95% CI, 0.37 to 0.92]). The rates of complex S. aureus SSIs decreased for hip or knee arthroplasties (difference per 10,000 operations, -17 [95% CI, -39 to 0]; RR, 0.48 [95% CI, 0.29 to 0.80]) and for cardiac operations (difference per 10,000 operations, -6 [95% CI, -48 to 8]; RR, 0.86 [95% CI, 0.47 to 1.57]). CONCLUSIONS AND RELEVANCE: In this multicenter study, a bundle comprising S. aureus screening, decolonization, and targeted prophylaxis was associated with a modest, statistically significant decrease in complex S. aureus SSIs.


Assuntos
Antibioticoprofilaxia , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus/isolamento & purificação , Infecção da Ferida Cirúrgica/prevenção & controle , Administração Intranasal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril , Artroplastia do Joelho , Procedimentos Cirúrgicos Cardíacos , Cefazolina/uso terapêutico , Cefuroxima/uso terapêutico , Clorexidina/administração & dosagem , Clorexidina/análogos & derivados , Quimioterapia Combinada , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Mupirocina/administração & dosagem , Nariz/microbiologia , Vancomicina/uso terapêutico , Adulto Jovem
2.
Clin Infect Dis ; 58(2): 248-59, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24107409

RESUMO

Many studies have evaluated bundled interventions to improve hand hygiene compliance. However, there are few evidence-based recommendations on optimal interventions for implementation. We aimed to systematically review all studies on interventions to improve hand hygiene compliance to evaluate existing bundles and identify areas of promise to target high-quality studies. Adjusted risk ratios were pooled to assess common bundles. Of the 8148 studies evaluated, 6 randomized controlled trials and 39 quasi-experimental studies met inclusion criteria. Three studies evaluated the interventions education, reminders, feedback, administrative support, and access to alcohol-based hand rub as a bundle, which was associated with improved hand hygiene compliance (pooled odds ratio [OR], 1.82; 95% confidence interval [CI], 1.69-1.97). Another bundle of education, reminders, and feedback evaluated in 3 studies was associated with improved compliance (pooled OR, 1.47; 95% CI, 1.12-1.94). These bundles should be further studied using high-quality study designs and compared with other interventions.


Assuntos
Higiene das Mãos/métodos , Instalações de Saúde , Pessoal de Saúde , Controle de Infecções/métodos , Pacotes de Assistência ao Paciente/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos
3.
Infect Control Hosp Epidemiol ; 45(1): 13-20, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37493031

RESUMO

BACKGROUND: Surgical-site infections (SSIs) can be catastrophic. Bundles of evidence-based practices can reduce SSIs but can be difficult to implement and sustain. OBJECTIVE: We sought to understand the implementation of SSI prevention bundles in 6 US hospitals. DESIGN: Qualitative study. METHODS: We conducted in-depth semistructured interviews with personnel involved in bundle implementation and conducted a thematic analysis of the transcripts. SETTING: The study was conducted in 6 US hospitals: 2 academic tertiary-care hospitals, 3 academic-affiliated community hospitals, 1 unaffiliated community hospital. PARTICIPANTS: In total, 30 hospital personnel participated. Participants included surgeons, laboratory directors, clinical personnel, and infection preventionists. RESULTS: Bundle complexity impeded implementation. Other barriers varied across services, even within the same hospital. Multiple strategies were needed, and successful strategies in one service did not always apply in other areas. However, early and sustained interprofessional collaboration facilitated implementation. CONCLUSIONS: The evidence-based SSI bundle is complicated and can be difficult to implement. One implementation process probably will not work for all settings. Multiple strategies were needed to overcome contextual and implementation barriers that varied by setting and implementation climate. Appropriate adaptations for specific settings and populations may improve bundle adoption, fidelity, acceptability, and sustainability.


Assuntos
Recursos Humanos em Hospital , Infecção da Ferida Cirúrgica , Humanos , Pesquisa Qualitativa , Infecção da Ferida Cirúrgica/prevenção & controle , Hospitais Comunitários
4.
Artigo em Inglês | MEDLINE | ID: mdl-39465214

RESUMO

Objectives: We evaluated SARS-CoV-2 anti-nucleocapsid (anti-N) seroconversion and seroreversion rates, risk factors associated with SARS-CoV-2 seroconversion, and COVID-19 risk perceptions among academic healthcare center employees in a rural state. Methods: Among employees aged ≥18 years who completed a screening survey (n = 1,377), we invited all respondents reporting previous COVID-19 (n = 85; 82 accepted) and a random selection of respondents not reporting previous COVID-19 (n = 370; 220 accepted) to participate. Participants completed surveys and provided blood samples at 3-month intervals (T0, T3, T6, T9). We used logistic regression to identify risk factors for seropositivity at T0. Results: The cohort was primarily direct patient caregivers (205/302; 67.9%), white (278/302; 92.1%), and female (212/302; 70.2%). At T0, 86/302 (28.4%) participants were seropositive. Of the seronegative participants, 6/198 (3.0%), 6/183 (3.3%), and 14/180 (7.8%) had seroconverted at T3, T6, and T9, respectively. The overall seroreversion rate was 6.98% at T9. At T0, nursing staff (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.08, 5.19) and being within six feet of a non-household member outside of work (OR, 2.91; 95% CI, 1.02, 8.33) had significantly higher odds of seropositivity. Vaccination (OR, 0.05; 95% CI, 0.02, 0.12) and face mask use (OR, 0.36; 95% CI, 0.17, 0.78) were protective. Conclusions: The seroconversion and seroreversion rates were low among participants. Public health and infection prevention measures implemented early in the COVID-19 pandemic - vaccination, face mask use, and social distancing - were associated with significantly lower odds of SARS-CoV-2 seropositivity among participants.

5.
Infect Control Hosp Epidemiol ; : 1-6, 2024 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-38779819

RESUMO

BACKGROUND: A substantial proportion of patients undergoing hemodialysis carry Staphylococcus aureus in their noses, and carriers are at increased risk of S. aureus bloodstream infections. Our pragmatic clinical trial implemented nasal povidone-iodine (PVI) decolonization for the prevention of bloodstream infections in the novel setting of hemodialysis units. OBJECTIVE: We aimed to identify pragmatic strategies for implementing PVI decolonization among patients in outpatient hemodialysis units. DESIGN: Qualitative descriptive study. SETTING: Outpatient hemodialysis units affiliated with five US academic medical centers. Units varied in size, patient demographics, and geographic location. INTERVIEWEES: Sixty-six interviewees including nurses, hemodialysis technicians, research coordinators, and other personnel. METHODS: We conducted interviews with personnel affiliated with all five academic medical centers and conducted thematic analysis of transcripts. RESULTS: Hemodialysis units had varied success with patient recruitment, but interviewees reported that patients and healthcare personnel (HCP) found PVI decolonization acceptable and feasible. Leadership support, HCP engagement, and tailored patient-focused tools or strategies facilitated patient engagement and PVI implementation. Interviewees reported both patients and HCP sometimes underestimated patients' infection risks and experienced infection-prevention fatigue. Other HCP barriers included limited staffing and poor staff engagement. Patient barriers included high health burdens, language barriers, memory issues, and lack of social support. CONCLUSION: Our qualitative study suggests that PVI decolonization would be acceptable to patients and clinical personnel, and implementation is feasible for outpatient hemodialysis units. Hemodialysis units could facilitate implementation by engaging unit leaders, patients and personnel, and developing education for patients about their infection risk.

6.
BMJ Open ; 11(12): e048830, 2021 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-34862278

RESUMO

INTRODUCTION: Approximately 38% of haemodialysis patients carry Staphylococcus aureus in their noses, and carriers have a nearly four-fold increased risk of S. aureus access-related bloodstream infections (BSIs) compared with non-carriers. Our objective is to determine the clinical efficacy and effectiveness of a novel intervention using nasal povidone-iodine (PVI) to prevent BSIs among patients in haemodialysis units. We will survey patients and conduct qualitative interviews with healthcare workers to identify barriers and facilitators to implementing the intervention. METHODS AND ANALYSIS: We will perform an open-label, stepped-wedge cluster randomised trial to assess the effectiveness of nasal PVI compared with standard care. Sixteen outpatient haemodialysis units will participate in the study. The 3-year trial period will be divided into a 4-month baseline period and eight additional 4-month time blocks. The primary outcome of the study will be S. aureus BSI, defined as a S. aureus positive blood culture collected in the outpatient setting or within one calendar day after a hospital admission. The study team will evaluate characteristics of individual patients and the clusters by exposure status (control or intervention) to assess the balance between groups, and calculate descriptive statistics such as average responses separately for control and intervention survey questions. ETHICS AND DISSEMINATION: This study has received IRB approval from all study sites. A Data Safety and Monitoring Board will monitor this multicentre clinical trial. We will present our results at international meetings. The study team will publish findings in peer-reviewed journals and make each accepted peer-reviewed manuscript publicly available. TRIAL REGISTRATION NUMBER: NCT04210505.


Assuntos
Sepse , Infecções Estafilocócicas , Humanos , Estudos Multicêntricos como Assunto , Povidona-Iodo/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Diálise Renal , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus
7.
JAMA Netw Open ; 3(1): e1917597, 2020 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-31913488

RESUMO

Importance: An understanding of the incidence and outcomes of Clostridium difficile infection (CDI) in the United States can inform investments in prevention and treatment interventions. Objective: To quantify the incidence of CDI and its associated hospital length of stay (LOS) in the United States using a systematic literature review and meta-analysis. Data Sources: MEDLINE via Ovid, Cochrane Library Databases via Wiley, Cumulative Index of Nursing and Allied Health Complete via EBSCO Information Services, Scopus, and Web of Science were searched for studies published in the United States between 2000 and 2019 that evaluated CDI and its associated LOS. Study Selection: Incidence data were collected only from multicenter studies that had at least 5 sites. The LOS studies were included only if they assessed postinfection LOS or used methods accounting for time to infection using a multistate model or compared propensity score-matched patients with CDI with control patients without CDI. Long-term-care facility studies were excluded. Of the 119 full-text articles, 86 studies (72.3%) met the selection criteria. Data Extraction and Synthesis: Two independent reviewers performed the data abstraction and quality assessment. Incidence data were pooled only when the denominators used the same units (eg, patient-days). These data were pooled by summing the number of hospital-onset CDI incident cases and the denominators across studies. Random-effects models were used to obtain pooled mean differences. Heterogeneity was assessed using the I2 value. Data analysis was performed in February 2019. Main Outcomes and Measures: Incidence of CDI and CDI-associated hospital LOS in the United States. Results: When the 13 studies that evaluated incidence data in patient-days due to hospital-onset CDI were pooled, the CDI incidence rate was 8.3 cases per 10 000 patient-days. Among propensity score-matched studies (16 of 20 studies), the CDI-associated mean difference in LOS (in days) between patients with and without CDI varied from 3.0 days (95% CI, 1.44-4.63 days) to 21.6 days (95% CI, 19.29-23.90 days). Conclusions and Relevance: Pooled estimates from currently available literature suggest that CDI is associated with a large burden on the health care system. However, these estimates should be interpreted with caution because higher-quality studies should be completed to guide future evaluations of CDI prevention and treatment interventions.


Assuntos
Infecções por Clostridium/epidemiologia , Infecção Hospitalar/epidemiologia , Tempo de Internação/estatística & dados numéricos , Humanos , Incidência , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Pontuação de Propensão , Estados Unidos/epidemiologia
8.
Infect Control Hosp Epidemiol ; 40(7): 755-760, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31099327

RESUMO

OBJECTIVE: Healthcare-associated infections (HAIs) are a significant burden on healthcare facilities. Universal gloving is a horizontal intervention to prevent transmission of pathogens that cause HAI. In this meta-analysis, we aimed to identify whether implementation of universal gloving is associated with decreased incidence of HAI in clinical settings. METHODS: A systematic literature search was conducted to find all relevant publications using search terms for universal gloving and HAIs. Pooled incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated using random effects models. Heterogeneity was evaluated using the Woolf test and the I2 test. RESULTS: In total, 8 studies were included. These studies were moderately to substantially heterogeneous (I2 = 59%) and had varied results. Stratified analyses showed a nonsignificant association between universal gloving and incidence of methicillin-resistant Staphylococcus aureus (MRSA; pooled IRR, 0.94; 95% CI, 0.79-1.11) and vancomycin-resistant enterococci (VRE; pooled IRR, 0.94; 95% CI, 0.69-1.28). Studies that implemented universal gloving alone showed a significant association with decreased incidence of HAI (IRR, 0.77; 95% CI, 0.67-0.89), but studies implementing universal gloving as part of intervention bundles showed no significant association with incidence of HAI (IRR, 0.95; 95% CI, 0.86-1.05). CONCLUSIONS: Universal gloving may be associated with a small protective effect against HAI. Despite limited data, universal gloving may be considered in high-risk settings, such as pediatric intensive care units. Further research should be performed to determine the effects of universal gloving on a broader range of pathogens, including gram-negative pathogens.


Assuntos
Infecção Hospitalar/prevenção & controle , Luvas Protetoras/estatística & dados numéricos , Infecções por Bactérias Gram-Positivas/prevenção & controle , Controle de Infecções/métodos , Infecções Estafilocócicas/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Unidades de Terapia Intensiva Pediátrica , Staphylococcus aureus Resistente à Meticilina , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecções Estafilocócicas/epidemiologia , Enterococos Resistentes à Vancomicina
9.
Clin Infect Dis ; 46(8): 1241-7, 2008 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-18444862

RESUMO

Invasive disease following methicillin-resistant Staphylococcus aureus (MRSA) detection is common, regardless of whether initial detection involves colonization or infection. We assessed the genetic relatedness of isolates obtained > or =2 weeks apart representing either repeated infections or colonization-infection sets to determine if infections are likely to be caused by previously harbored strains. We found that MRSA infection following initial colonization or infection is caused by the same strain in most cases, suggesting that a single successful attempt at decolonization may prevent the majority of later infection.


Assuntos
Resistência a Meticilina/genética , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Eletroforese em Gel de Campo Pulsado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , Staphylococcus aureus/classificação , Staphylococcus aureus/isolamento & purificação
10.
Infect Control Hosp Epidemiol ; 28(11): 1236-9, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17926273

RESUMO

OBJECTIVE: To determine the risk factors for Clostridium difficile-associated disease (CDAD) in a 25-bed rural hospital and to compare antimicrobial use ratios at the study hospital with those at a large academic medical center. DESIGN: Case-control study. SETTING: A 25-bed rural hospital in Iowa during the period from August 2002 through January 2005. PATIENTS: A total of 17 case patients with CDAD and 34 control patients matched for age (ie, within 10 years of the case patient's age), sex, and admission date (ie, within 2 weeks of the case patient's admission date). METHODS: Retrospective medical record review was performed to obtain data on antimicrobial exposures during the 6 weeks before hospital admission for both case and control patients. Exact conditional logistic regression was used for univariable and multivariable analyses. Antimicrobial use ratios were calculated to compare the rates of antimicrobial use for case and control patients at the study hospital with the rates for patients evaluated in a study of CDAD at a nearly 700-bed teaching hospital. RESULTS: Case patients had a larger cumulative number of days of antimicrobial use (P=.004), and they received a larger total number of antimicrobial agents during hospitalization (P=.001). Antimicrobial use ratios were higher for both case and control patients at the smaller hospital, compared with the larger hospital. CONCLUSIONS: CDAD at a small rural hospital was not associated with exposure to the antimicrobial classes that are typically associated with CDAD, but was instead related to the total number of antimicrobials used to treat patients. The rate of antimicrobial use for case and control patients was about 40% higher at the small rural hospital, compared with the corresponding rates at a large academic medical center.


Assuntos
Clostridioides difficile , Infecção Hospitalar/epidemiologia , Enterocolite Pseudomembranosa/epidemiologia , Hospitais Rurais , Idoso , Anti-Infecciosos/uso terapêutico , Estudos de Casos e Controles , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/prevenção & controle , Enterocolite Pseudomembranosa/tratamento farmacológico , Enterocolite Pseudomembranosa/prevenção & controle , Feminino , Humanos , Controle de Infecções/métodos , Iowa/epidemiologia , Tempo de Internação , Modelos Logísticos , Masculino , Estudos Retrospectivos , Fatores de Risco
11.
Infect Control Hosp Epidemiol ; 38(2): 203-215, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27825401

RESUMO

BACKGROUND Information about the health and economic impact of infections caused by vancomycin-resistant enterococci (VRE) can inform investments in infection prevention and development of novel therapeutics. OBJECTIVE To systematically review the incidence of VRE infection in the United States and the clinical and economic outcomes. METHODS We searched various databases for US studies published from January 1, 2000, through June 8, 2015, that evaluated incidence, mortality, length of stay, discharge to a long-term care facility, readmission, recurrence, or costs attributable to VRE infections. We included multicenter studies that evaluated incidence and single-center and multicenter studies that evaluated outcomes. We kept studies that did not have a denominator or uninfected controls only if they assessed postinfection length of stay, costs, or recurrence. We performed meta-analysis to pool the mortality data. RESULTS Five studies provided incidence data and 13 studies evaluated outcomes or costs. The incidence of VRE infections increased in Atlanta and Detroit but did not increase in national samples. Compared with uninfected controls, VRE infection was associated with increased mortality (pooled odds ratio, 2.55), longer length of stay (3-4.6 days longer or 1.4 times longer), increased risk of discharge to a long-term care facility (2.8- to 6.5-fold) or readmission (2.9-fold), and higher costs ($9,949 higher or 1.6-fold more). CONCLUSIONS VRE infection is associated with large attributable burdens, including excess mortality, prolonged in-hospital stay, and increased treatment costs. Multicenter studies that use suitable controls and adjust for time at risk or confounders are needed to estimate the burden of VRE infections. Infect Control Hosp Epidemiol. 2017;38:203-215.


Assuntos
Infecção Hospitalar/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Tempo de Internação/estatística & dados numéricos , Enterococos Resistentes à Vancomicina/isolamento & purificação , Custos de Cuidados de Saúde , Humanos , Incidência , Estados Unidos , Resistência a Vancomicina
12.
Infect Control Hosp Epidemiol ; 37(10): 1212-8, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27406609

RESUMO

BACKGROUND Our objective was to estimate the per-infection and cumulative mortality and cost burden of multidrug-resistant (MDR) Acinetobacter healthcare-associated infections (HAIs) in the United States using data from published studies. METHODS We identified studies that estimated the excess cost, length of stay (LOS), or mortality attributable to MDR Acinetobacter HAIs. We generated estimates of the cost per HAI using 3 methods: (1) overall cost estimates, (2) multiplying LOS estimates by a cost per inpatient-day ($4,350) from the payer perspective, and (3) multiplying LOS estimates by a cost per inpatient-day from the hospital ($2,030) perspective. We deflated our estimates for time-dependent bias using an adjustment factor derived from studies that estimated attributable LOS using both time-fixed methods and either multistate models (70.4% decrease) or matching patients with and without HAIs using the timing of infection (47.4% decrease). Finally, we used the incidence rate of MDR Acinetobacter HAIs to generate cumulative incidence, cost, and mortality associated with these infections. RESULTS Our estimates of the cost per infection were $129,917 (method 1), $72,025 (method 2), and $33,510 (method 3). The pooled relative risk of mortality was 4.51 (95% CI, 1.10-32.65), which yielded a mortality rate of 10.6% (95% CI, 2.5%-29.4%). With an incidence rate of 0.141 (95% CI, 0.136-0.161) per 1,000 patient-days at risk, we estimated an annual cumulative incidence of 12,524 (95% CI, 11,509-13,625) in the United States. CONCLUSION The estimates presented here are relevant to understanding the expenditures and lives that could be saved by preventing MDR Acinetobacter HAIs. Infect Control Hosp Epidemiol 2016;1-7.


Assuntos
Infecções por Acinetobacter/economia , Infecções por Acinetobacter/mortalidade , Infecção Hospitalar/economia , Infecção Hospitalar/mortalidade , Custos de Cuidados de Saúde/estatística & dados numéricos , Acinetobacter/efeitos dos fármacos , Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter baumannii , Custos e Análise de Custo , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Custos Hospitalares , Hospitais , Humanos , Tempo de Internação , Método de Monte Carlo , Estados Unidos/epidemiologia , United States Department of Veterans Affairs
13.
Am J Infect Control ; 42(5): 472-8, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24773785

RESUMO

BACKGROUND: Hand hygiene is one of the most effective ways to prevent transmission of health care-associated infections. Electronic systems and tools are being developed to enhance hand hygiene compliance monitoring. Our systematic review assesses the existing evidence surrounding the adoption and accuracy of automated systems or electronically enhanced direct observations and also reviews the effectiveness of such systems in health care settings. METHODS: We systematically reviewed PubMed for articles published between January 1, 2000, and March 31, 2013, containing the terms hand AND hygiene or hand AND disinfection or handwashing. Resulting articles were reviewed to determine if an electronic system was used. RESULTS: We identified 42 articles for inclusion. Four types of systems were identified: electronically assisted/enhanced direct observation, video-monitored direct observation systems, electronic dispenser counters, and automated hand hygiene monitoring networks. Fewer than 20% of articles identified included calculations for efficiency or accuracy. CONCLUSIONS: Limited data are currently available to recommend adoption of specific automatic or electronically assisted hand hygiene surveillance systems. Future studies should be undertaken that assess the accuracy, effectiveness, and cost-effectiveness of such systems. Given the restricted clinical and infection prevention budgets of most facilities, cost-effectiveness analysis of specific systems will be required before these systems are widely adopted.


Assuntos
Automação/métodos , Infecção Hospitalar/prevenção & controle , Eletrônica Médica/métodos , Higiene das Mãos/métodos , Controle de Infecções/métodos , Automação/economia , Eletrônica Médica/economia , Monitoramento Epidemiológico , Higiene das Mãos/economia , Humanos , Controle de Infecções/economia
14.
Am J Infect Control ; 42(8): 868-73, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25087139

RESUMO

BACKGROUND: The Institute for Healthcare Improvement (IHI) created an evidence-based bundle to help reduce methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections. The study aim was to identify which components of the IHI's MRSA bundle that rural hospitals have implemented and to identify barriers that hindered implementation of bundle components. METHODS: Four surveys about the IHI's MRSA bundle were administered at the Iowa Statewide Infection Prevention Seminar between 2007 and 2011. Surveys were mailed to infection preventionists (IPs) who did not attend the meetings. RESULTS: The percentage of IPs reporting that their hospital implemented a hand hygiene program (range by year, 87%-94%) and used contact precautions for patients infected (range by year, 97%-100%) or colonized (range by year, 77%-92%) with MRSA did not change significantly. The number of hospitals that monitored the effectiveness of environmental cleaning significantly increased from 23%-71% (P < .01). Few hospitals assessed daily if central lines were necessary (range by year, 22%-26%). IPs perceived lack of support to be a major barrier to implementing bundle components. CONCLUSION: Most IPs reported that their hospitals had implemented most components of the MRSA bundle. Support within the health care system is essential for implementing each component of an evidence-based bundle.


Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/prevenção & controle , Infecção Hospitalar/microbiologia , Estudos Transversais , Higiene das Mãos/métodos , Hospitais Rurais , Zeladoria Hospitalar/normas , Humanos , Controle de Infecções/normas , Iowa/epidemiologia , Estudos Longitudinais , Infecções Estafilocócicas/microbiologia , Inquéritos e Questionários
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