RESUMO
We employed an interrupted time series analysis to assess the impact of ultraviolet-C light disinfection at terminal discharge in an oncology unit and a bone marrow transplant unit on the incidence of hospital-acquired infections. The deployment of ultraviolet-C light disinfection was associated with a significant decrease in the rate of Clostridioides difficile infections and a significant decrease in the rate of central line-associated blood stream infections in the bone marrow transplant unit.
Assuntos
Infecção Hospitalar , Desinfecção , Transplante de Medula Óssea , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Hospitais , Humanos , Alta do Paciente , Raios UltravioletaRESUMO
OBJECTIVE: To assess the impact of major interventions targeting infection control and diagnostic stewardship in efforts to decrease Clostridioides difficile hospital onset rates over a 6-year period. DESIGN: Interrupted time series. SETTING: The study was conducted in an 865-bed academic medical center. METHODS: Monthly hospital-onset C. difficile infection (HO-CDI) rates from January 2013 through January 2019 were analyzed around 5 major interventions: (1) a 2-step cleaning process in which an initial quaternary ammonium product was followed with 10% bleach for daily and terminal cleaning of rooms of patients who have tested positive for C. difficile (February 2014), (2) UV-C device for all terminal cleaning of rooms of C. difficile patients (August 2015), (3) "contact plus" isolation precautions (June 2016), (4) sporicidal peroxyacetic acid and hydrogen peroxide cleaning in all patient areas (June 2017), (5) electronic medical record (EMR) decision support tool to facilitate appropriate C. difficile test ordering (March 2018). RESULTS: Environmental cleaning interventions and enhanced "contact plus" isolation did not impact HO-CDI rates. Diagnostic stewardship via EMR decision support decreased the HO-CDI rate by 6.7 per 10,000 patient days (P = .0079). When adjusting rates for test volume, the EMR decision support significance was reduced to a difference of 5.1 case reductions per 10,000 patient days (P = .0470). CONCLUSION: Multiple aggressively implemented infection control interventions targeting CDI demonstrated a disappointing impact on endemic CDI rates over 6 years. This study adds to existing data that outside of an outbreak situation, traditional infection control guidance for CDI prevention has little impact on endemic rates.
Assuntos
Clostridioides difficile , Infecções por Clostridium , Infecção Hospitalar , Clostridioides , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Hospitais , Humanos , Análise de Séries Temporais InterrompidaRESUMO
In a 12-month study, a nurse driven protocol was implemented at a tertiary academic medical center. The purpose of the nurse driven protocol was to identify community-onset Clostridioides difficile infections, expeditiously isolate patients with presumed C difficile diarrheal illness, and prevent transmission while simultaneously decreasing the incidence of hospital-onset C difficile. The overall adherence to fidelity of the protocol was poor and failed to have a significant impact on infection rates.
Assuntos
Infecções por Clostridium/enfermagem , Infecção Hospitalar/prevenção & controle , Diarreia/enfermagem , Enterocolite Pseudomembranosa/enfermagem , Controle de Infecções/organização & administração , Centros Médicos Acadêmicos , Clostridioides difficile , Infecções por Clostridium/microbiologia , Diarreia/microbiologia , Enterocolite Pseudomembranosa/microbiologia , Humanos , Incidência , Serviço Hospitalar de Enfermagem , Isolamento de PacientesRESUMO
PURPOSE OF REVIEW: New controversies in the diagnosis and prevention of Clostridiodes difficile are challenging and at times changing infection control practice at many medical centers. RECENT FINDINGS: Molecular epidemiologic studies are changing our understanding of C. difficile and its spectrum of disease. C. difficile as a hospital-acquired infection is likely largely overdiagnosed given overly sensitive molecular testing and widespread colonization of ill or debilitated patients. Clostridiodes difficile infection continues to challenge infection prevention programs. Shifts in our understanding of the epidemiology of this organism and its spectrum of clinical presentations are changing the approach to prevention efforts. Nevertheless, cleanliness of the healthcare environment and antimicrobial stewardship remain core risk reduction strategies. Other strategies such as screening and isolation are inciting controversy. The optimal infection prevention strategies for C. difficile remain the subject of intense study and debate.
RESUMO
We assessed barriers and knowledge of disinfection of noncritical items (NCIs) between intensive care unit (ICU) and non-ICU staff members. General understanding of cleaning NCIs was low across all staff. Non-ICU staff had a better understanding of who is responsible for disinfecting and where to access information on storing cleaned NCIs. Opportunities exist for heightened disinfection of NCIs through improved point-of-care instructional information, improved cleaning supply access, and increased instrument storage space.
Assuntos
Infecções por Clostridium/prevenção & controle , Infecção Hospitalar/prevenção & controle , Desinfecção/métodos , Higiene das Mãos/métodos , Conhecimentos, Atitudes e Prática em Saúde , Competência Profissional , Infecções por Clostridium/epidemiologia , Infecção Hospitalar/epidemiologia , Equipamentos e Provisões/microbiologia , Pessoal de Saúde , Humanos , Inquéritos e QuestionáriosRESUMO
We investigated the impact of discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus infected or colonized patients on central-line associated bloodstream infection rates at an academic children's hospital. Discontinuation of contact precautions with a bundled horizontal infection prevention platform resulted in no adverse impact on CLABSI rates.
Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Infecção Hospitalar/prevenção & controle , Infecções por Bactérias Gram-Positivas/epidemiologia , Controle de Infecções/métodos , Centros Médicos Acadêmicos , Adolescente , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/epidemiologia , Resistência a Vancomicina , Virginia/epidemiologiaRESUMO
We assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.
Assuntos
Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/diagnóstico , Sistemas de Apoio a Decisões Clínicas , Testes Diagnósticos de Rotina , Software , Centros Médicos Acadêmicos , Algoritmos , Antibacterianos/uso terapêutico , Registros Eletrônicos de Saúde , Humanos , Missouri , Estudos RetrospectivosRESUMO
Touchless ultraviolet disinfection (UVD) devices effectively reduce the bioburden of epidemiologically relevant pathogens, including Clostridium difficile. During a 25-month implementation period, UVD devices were deployed facilitywide for the terminal disinfection of rooms that housed a patient who tested positive for C difficile. The deployment was performed with structured education, audit and feedback, and resulted in a multidisciplinary practice change that maximized the UVD capture rate from 20% to 100%.
Assuntos
Bactérias/efeitos da radiação , Desinfecção/métodos , Quartos de Pacientes , Robótica , Raios Ultravioleta , Humanos , Fatores de TempoRESUMO
Limited treatment options and a growing global threat from carbapenem-resistant Enterobacteriaceae (CRE) infections illustrate the importance of understanding the epidemiology of CRE. Using a retrospective chart review and point prevalence testing demonstrated specific patient risk factors for CRE-positive clinical cultures in a tertiary medical center with a low CRE prevalence.
Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos , Infecção Hospitalar/epidemiologia , Infecções por Enterobacteriaceae/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Infecções por Enterobacteriaceae/etiologia , Infecções por Enterobacteriaceae/prevenção & controle , Humanos , Prevalência , Fatores de RiscoRESUMO
The present study investigated predictors of problematic Internet use. Undergraduate students (N = 272) completed a self-report questionnaire measuring extraversion, impulsivity, online group membership, frequency of use, and gender as predictors of problematic Internet use. Males and females differed significantly in their use of the Internet, with males significantly more likely to be Gamers than were females, and females significantly more likely to be Workers. Professional users reported significantly less problematic Internet use than nonprofessional users. Hierarchical regression analysis indicated that higher frequency of use, lack of perseverance (an aspect of impulsivity), and online group membership significantly predicted problematic Internet use. Given recent concerns about the growth of Internet addiction, this study extends our knowledge of the role played by personality, usage profile, and gender in this developing field of study.