Measuring Antibiotic Appropriateness for Urinary Tract Infections in Nursing Home Residents.

We assessed the appropriateness of initiating antibiotics in 49 nursing home (NH) residents receiving antibiotics for urinary tract infection (UTI) using 3 published algorithms. Overall, 16 residents (32%) received prophylaxis, and among the 33 receiving treatment, the percentage of appropriate use ranged from 15% to 45%. Opportunities exist for improving UTI antibiotic prescribing in NH. Infect Control Hosp Epidemiol 2017;38:998-1001.

Validation of surgical site infection surveillance data in colon procedures reported to the Connecticut Department of Public Health.

A validation study of 692 patients undergoing colon surgery during the fourth quarter of 2012 identified 102 surgical site infections, of which 34% were not reported to the National Healthcare Safety Network. Possible reasons for underreporting included the misinterpretation of the National Healthcare Safety Network surgical site infection definition and variations in case-finding methods. Colon procedure denominator data were also reviewed to determine inaccuracies. Error rates were highest for implant presence (34%), endoscope use (32%), and procedure duration (33%).

Prevalence of Antimicrobial Use and Opportunities to Improve Prescribing Practices in U.S. Nursing Homes.

OBJECTIVES: To describe the prevalence and epidemiology of antimicrobial use (AU) in nursing home residents. DESIGN: One-day point prevalence survey. SETTING AND PARTICIPANTS: Nine nursing homes in four states; 1,272 eligible residents. MEASUREMENT: Frequency of antimicrobials prescribed, drug name, start date, duration, route, rationale, and treatment site. AU prevalence per 100 residents overall and by resident characteristic. RESULTS: AU prevalence was 11.1% (95% confidence interval, 9.4%-12.9%) and varied by resident characteristics. Most (32%) antimicrobials were given for urinary tract infection. For 38% of AU, key prescribing information was not documented. CONCLUSION: Opportunities to improve AU documentation and prescribing exist in nursing homes.

Comparison of Data Collection for Healthcare-Associated Infection Surveillance in Nursing Homes.

OBJECTIVE To facilitate surveillance and describe the burden of healthcare-associated infection (HAI) in nursing homes (NHs), we compared the quality of resident-level data collected by NH personnel and external staff. DESIGN A 1-day point-prevalence survey SETTING AND PARTICIPANTS Overall, 9 nursing homes among 4 Centers for Disease Control and Prevention (CDC) Emerging Infection Program (EIP) sites were included in this study. METHODS NH personnel collected data on resident characteristics, clinical risk factors for HAIs, and the presence of 3 HAI screening criteria on the day of the survey. Trained EIP surveillance officers collected the same data elements via retrospective medical chart review for comparison; surveillance officers also collected available data to identify HAIs (using revised McGeer definitions). Overall agreement was calculated among residents identified by both teams with selected risk factors and HAI screening criteria. The impact of using NH personnel to collect screening criteria on HAI prevalence was assessed. RESULTS The overall prevalence of clinical risk factors among the 1,272 residents was similar between NH personnel and surveillance officers, but the level of positive agreement (residents with factors identified by both teams) varied between 39% and 87%. Surveillance officers identified 253 residents (20%) with ≥1 HAI screening criterion, resulting in 67 residents with an HAI (5.3 per 100 residents). The NH personnel identified 152 (12%) residents with ≥1 HAI screening criterion; 42 residents had an HAI (3.5 per 100 residents). CONCLUSION We identified discrepancies in resident-level data collection between surveillance officers and NH personnel, resulting in varied estimates of the HAI prevalence. These findings have important implications for the design and implementation of future HAI prevalence surveys. Infect Control Hosp Epidemiol 2016;1440-1445.

Notes from the field: Fatal gastrointestinal mucormycosis in a premature infant associated with a contaminated dietary supplement--Connecticut, 2014.

In October 2014, a hospital in Connecticut notified CDC and the Connecticut Department of Public Health of a fatal case of gastrointestinal mucormycosis in a preterm infant. The infant, born at 29 weeks' gestation and weighing 1,400 grams (about 3 pounds), had developed signs and symptoms initially consistent with necrotizing enterocolitis approximately 1 week after birth. Exploratory laparotomy revealed complete ischemia of the gastrointestinal tract from the esophagus to the rectum; a portion of necrotic cecum was sent for microscopic examination. Following surgery, the infant developed multiple areas of vascular occlusion, including a large clot in the aorta, findings not usually associated with necrotizing enterocolitis. The infant died soon after. Histopathology results from the resected cecum revealed an angioinvasive fungal infection consistent with mucormycosis. Gastrointestinal mucormycosis is an extremely rare fungal infection caused by mold in the order Mucorales. It occurs predominantly in low birth weight infants, patients with diarrhea and malnutrition, and those receiving peritoneal dialysis; mortality is 85%. Local investigation revealed that the infant had received a dietary supplement, ABC Dophilus Powder, for 7 days, beginning on day 1 of life.

Validation of the surveillance and reporting of central line-associated bloodstream infection denominator data.

BACKGROUND: While the main focus of validating central line-associated infections (CLABIs) has been applying strict definitions to identify cases, assessing the denominator counts has received less attention. This study evaluates the accuracy of the reporting of CLABSI denominator patient-day (PD) and central line-day (CLD) counts to the National Healthcare Safety Network (NHSN) system in one state. METHODS: The Connecticut Department of Public Health (CT DPH) performed a blinded retrospective chart review on the collection of CLABSI PD and CLD on 9 selected days during the fourth quarter of 2009 from 23 acute care hospitals. RESULTS: Overall, 1,988 intensive care unit patient charts were reviewed. Comparison of hospital and CT DPH counts identified over-reporting by 300 PD (17.2%) and 200 CLD (21.7%) with 17 hospitals (74%) collecting data manually. PD manual collection methods were more accurate than electronic methods (P < .01). For CLD, there was no significant difference in collection method (P > .05). Wednesday PD counts were more accurate than Monday (P < .05) or Saturday (P < .05). For CLD counts, there was no significant difference among the 3 days (P > .05). CONCLUSION: Our results provide some evidence for the prerequisite internal validation of denominator data by hospitals before reporting to the national surveillance system.

Connecticut competency-based point of dispensing worker training needs assessment.

OBJECTIVES: In April 2006, Connecticut conducted an exercise that tested its ability to receive and dispense antibiotics from the Strategic National Stockpile. In conjunction with the exercise, a competency-based assessment was performed to determine the training needs of point of dispensing (POD) workers. METHODS: POD core competencies were developed by adapting existing preparedness materials. They were used to assess the training needs of more than 250 people who staffed a POD during the exercise. The assessment measured their confidence in their ability to perform 17 competency-based tasks. RESULTS: The vast majority needed training on 5 or fewer tasks, suggesting that they were fairly well trained. Pharmacists were particularly likely to need training on at least 5 tasks. Given their role in a POD operation, they should be a focus of further training. Almost one third of participants needed additional training on at least 1 of the 3 basic POD Incident Command System tasks. Additional training is also needed on competencies concerning POD safety and security, liability protections, and family preparedness. POD workers who are concerned about these matters may be less willing or able to staff a POD. People who participated in training both before and on the day of the exercise were best prepared to staff the POD, indicating that both types of training have value. CONCLUSIONS: When compared with the competencies, POD workers possessed many of the necessary skills to staff a POD; however, training with emphasis on areas of weakness revealed by the assessment could improve willingness to report for duty and performance.

Validation of the surveillance and reporting of central line-associated bloodstream infection data to a state health department.

BACKGROUND: The primary goal of health care-associated infection reporting is to identify and measure progress towards achieving the irreducible minimum number of infections. Assessing the accuracy of reporting data using independent validation is critical to this goal. In January 2008, all 30 acute care hospitals in Connecticut began mandatory reporting of central line-associated bloodstream infections (CLABSI) to the National Healthcare Safety Network (NHSN) system. METHODS: A state nurse epidemiologist performed a blinded retrospective chart review for NHSN-reported CLABSI based on positive blood cultures from October to December 2008. RESULTS: Of 476 septic events, 48 met the NHSN CLABSI definition, of which 23 (48%) had been reported to NHSN. Concordance of non-CLABSI events was 99% sensitive. Components of the case definition that were a source of misinterpretation included the following: NHSN surveillance definition of primary and secondary bacteremia (45%), CLABSI rules (19%), CLABSI terms (10%), and differentiation between laboratory-confirmed bloodstream criterion 1 (recognized pathogen) and criterion 2 (skin contaminant) (13%). CONCLUSION: The validation study identified >50% underreporting of CLABSI, most related to misinterpretation of components of the NHSN definition. Continued validation and training will be needed in Connecticut to improve completeness of reported health care-associated infection data and to assure that publicly reported data are valid.