Quality improvement in hospitals: barriers and facilitators.

Purpose The purpose of this paper is to examine quality improvement (QI) initiatives in acute care hospitals, the factors associated with success, and the impacts on patient care and safety. Design/methodology/approach An extensive online survey was completed by senior managers responsible for QI. The survey assessed QI project types, QI methods, staff engagement, and barriers and factors in the success of QI initiatives. Findings The response rate was 37 percent, 46 surveys were completed from 125 acute care hospitals. QI initiatives had positive impacts on patient safety and care. Staff in all hospitals reported conducting past or present hand-hygiene QI projects and C. difficile and surgical site infection were the next most frequent foci. Hospital staff not having time and problems with staff prioritizing QI with other duties were identified as important QI barriers. All respondents reported hospital leadership support, data utilization and internal champions as important QI facilitators. Multiple regression models identified nurses' active involvement and medical staff engagement in QI with improved patient care and physicians' active involvement and medical staff engagement with greater patient safety. Practical implications There is the need to study how best to support and encourage physicians and nurses to become more engaged in QI. Originality/value QI initiatives were shown to have positive impacts on patient safety and patient care and barriers and facilitating factors were identified. The results indicated patient care and safety would benefit from increased physician and nurse engagement in QI initiatives.

Evaluation of hospital and patient factors that influence the effective administration of surgical antimicrobial prophylaxis.

OBJECTIVE: To analyze and model the patient and healthcare system factors that may interfere with the appropriate administration of surgical antimicrobial prophylaxis. DESIGN: Between 1994 and 1998, surgical-site surveillance data were collected prospectively for a cohort of eligible surgical patients. For all cases, and each individual procedure (cardiothoracic, colonic, gynecologic, orthopedic, or vascular), forward stepwise multiple logistic regression was applied to relate key hospital and patient factors to an effective first prophylactic dose (ie, appropriate administration time, dose, route, and drug). SETTING: A 450-bed, tertiary-care teaching hospital in Canada. PATIENTS: A total of 4,835 patients admitted for surgical procedures who required antimicrobial prophylaxis. RESULTS: Factors positive for an effective first prophylactic dose for all cases were when an order was written (OR, 19.7; CI95, 9.1-42.7; P < .001) and given in the operating room (OR, 13.9; CI95, 7.5-25.6; P < .001). Factors negative for an effective first prophylactic dose were beta-lactam allergy (OR, 0.49; CI95, 0.4-0.61; P < .001) and same-day surgery (OR, 0.57; CI95, 0.4-0.82; P < .001). CONCLUSIONS: With few exceptions, the four factors included in the procedure models showed that when a preoperative order was written or the antibiotic was given in the operating room, a patient was more likely to receive an effective first prophylactic dose. Conversely, when a patient had a beta-lactam allergy or the surgery was performed on the day the patient was admitted, the administration of an effective first prophylactic dose was less likely.

The relationship between hospital infection surveillance and control activities and antibiotic-resistant pathogen rates.

BACKGROUND: Antibiotic-resistant pathogen rates are rising in Canada and the United States with significant health and economic costs. The examination of the relationship of surveillance and control activities in hospitals with rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile -associated diarrhea (CDAD), and vancomycin-resistant Enterococcus (VRE) may identify strategies for controlling this growing problem. METHODS: Surveys were sent to infection control programs in hospitals that participated in an earlier survey of infection control practices in Canadian acute care hospitals. RESULTS: One hundred twenty of 145 (82.8%) hospitals responded to the survey. The mean MRSA rate was 2.0 (SD 2.9) per 1000 admissions, the mean CDAD rate was 3.8 (SD 4.3), and the mean VRE rate was 0.4 (SD 1.5). Multiple stepwise regression analysis found that hospitals that reported infection rates by specific risk groups ( r = -0.27, P < .01) and that kept attendance records of infection control teaching activities ( r = -0.23, P < .01) were associated with lower MRSA rates. Multiple stepwise regression analysis found that larger hospitals ( r = 0.25, P < .01) and hospitals at which infection control committees or staff had the direct authority to close a ward or unit to further admissions because of outbreaks ( r = 0.22, P < .05) were associated with higher CDAD rates. Multiple logistic regression analysis found that larger hospitals (OR, 1.6; 95% CI, 1.2-2.0; P = .003) and teaching hospitals (OR, 3.7 95% CI, 1.2-11.8; P = .02) were associated with the presence of VRE. Hospitals were less likely to have VRE when infection control staff frequently contacted physicians and nurses for reports of new infections (OR, 0.5; 95% CI, 0.3-0.7; P = .02) and there were in-service programs for updating nursing and ancillary staff on current infection control practices (OR, 0.2; 95% CI, 0.1-0.7; P = .01). CONCLUSION: Surveillance and control activities were associated with MRSA and CDAD rates and the presence of VRE. Surveillance and control activities might be especially beneficial in large and teaching hospitals.

The state of infection surveillance and control in Canadian acute care hospitals.

BACKGROUND: Nosocomial infections and antibiotic-resistant pathogens cause significant morbidity, mortality, and economic costs. The infection surveillance and control resources and activities in Canadian acute care hospitals had not been assessed in 20 years. METHODS: In 2000, surveys were mailed to infection control programs in all Canadian hospitals with more than 80 acute care beds. The survey was modeled after the US Study on the Efficacy of Nosocomial Infection Control instrument, with new items dealing with resistant pathogens and computerization. Surveillance and control indices were calculated. RESULTS: One hundred seventy-two of 238 (72.3%) hospitals responded. In 42.1% of hospitals, there was fewer than 1 infection control practitioner per 250 beds. Just 60% of infection control programs had physicians or doctoral professionals with infection control training who provided services. The median surveillance index was 65.6/100, and the median control index was 60.5/100. Surgical site infection rates were reported to individual surgeons in only 36.8% of hospitals. CONCLUSIONS: There were deficits in the identified components of effective infection control programs. Greater investment in resources is needed to meet recommended standards and thereby reduce morbidity, mortality, and expense associated with nosocomial infections and antibiotic-resistant pathogens.

Compliance with NCCLS approved standard M22-A2 for bacteriologic media quality assurance: a survey of 124 Ontario microbiology laboratories.

OBJECTIVE: The purpose of this QMP-LS patterns-of-practice survey was to determine quality assurance (QA) processes used in Ontario for purchased and in-house culture media, and compliance with recommended practices. METHODS: QMP-LS required laboratories to submit copies of media QC records for August to October 1998. Target media were blood agar, chocolate agar, MacConkey agar, sorbitol MacConkey agar (SMAC), Campylobacter agar, and selective media for pathogenic Neisseria spp. Procedures for acquisition and maintenance of QC stock cultures, media-type specific QC strains, time and temperature of incubation, and the test inoculum were required. Data were captured and analysed using Microsoft Excel. RESULTS: Marked variability and inadequacy of media QC records of 124 participating laboratories was noted. 12/124 prepared media in-house, most did not comply with NCCLS QA recommendations. Those purchasing prepared media frequently did not comply with NCCLS recommendations. In-house QC was not performed by 9% for chocolate agar, 87% for MacConkey agar without crystal violet, and 53% for SMAC agar. Recommended ATCC strains were used by less than half of participants. Time and temperature of incubation of the QC plates were not always appropriate. Only 65/117 laboratories used a correct inoculum to test the sensitivity and selectivity of media for pathogenic Neisseriae. Physical characteristics of prepared media were rarely recorded. Most laboratories were not aware of their supplier's QC protocols. DISCUSSION: Few Ontario laboratories comply with the NCCLS recommendations for QA of culture media. Major compliance failures were not performing QC at all, inappropriate choice of QC bacterial strains, and inoculum used. Incomplete record keeping was common and methods for maintaining stock cultures were sub-optimal. External quality assessment of this important parameter of microbiology practice needs to be undertaken on an ongoing basis.

Optimizing antibiotics in residents of nursing homes: protocol of a randomized trial.

BACKGROUND: Antibiotics are frequently prescribed for older adults who reside in long-term care facilities. A substantial proportion of antibiotic use in this setting is inappropriate. Antibiotics are often prescribed for asymptomatic bacteriuria, a condition for which randomized trials of antibiotic therapy indicate no benefit and in fact harm. This proposal describes a randomized trial of diagnostic and therapeutic algorithms to reduce the use of antibiotics in residents of long-term care facilities. METHODS: In this on-going study, 22 nursing homes have been randomized to either use of algorithms (11 nursing homes) or to usual practise (11 nursing homes). The algorithms describe signs and symptoms for which it would be appropriate to send urine cultures or to prescribe antibiotics. The algorithms are introduced by inservicing nursing staff and by conducting one-on-one sessions for physicians using case-scenarios. The primary outcome of the study is courses of antibiotics per 1000 resident days. Secondary outcomes include urine cultures sent and antibiotic courses for urinary indications. Focus groups and semi-structured interviews with key informants will be used to assess the process of implementation and to identify key factors for sustainability.

Effect of lidocaine and epinephrine on Staphylococcus aureus in a guinea pig model of surgical wound infection.

Postoperative wound infection, most often with, is of ubiquitous concern in surgical practice, occurring in an average of 1.5 to 5 percent of all procedures. The antimicrobial properties of local anesthetics have been documented over the past 25 years by in vitro studies. This study evaluates the effects of lidocaine preparations on in an in vivo setting. In a wound infection model using live albino guinea pigs, inoculum was introduced for the reproducible bacterial colonization of clean surgical wounds. One of two sites on the dorsum of each animal was infiltrated with a commercial lidocaine preparation (with and without epinephrine) prior to inoculation with (10 cfu/ml). The other site, inoculated with without preinfiltration with lidocaine, served as the control. Cultures from the sites treated with lidocaine were then compared with cultures from the control sites. All control sites had a consistent presence >or=10 cfu/ml, the threshold for bacterial inhibition of wound healing. Infiltration of the wound with 2 ml of 2% lidocaine prior to inoculation was associated with an average decrease in bacterial count of >70 percent ( n= 19). On the other hand, the addition of epinephrine (1:100,000) to lidocaine was associated with a 20-fold in bacterial counts compared with control values ( n= 10). This is the first study to demonstrate inhibition of by a local anesthetic agent in an in vivo model of a surgical wound. This information suggests a possible role for local anesthetics in prophylaxis against surgical wound infection.

Health effects of anthrax vaccination in the Canadian forces.

OBJECTIVE: The objective of this study was to determine whether anthrax vaccine resulted in adverse health effects in Canadian Forces members 8 months after vaccination. METHODS: A quasi-experimental, retrospective chart review was undertaken for two groups within the Canadian Forces, one group that received anthrax vaccination and another that did not. Information on symptoms, diagnoses, and injuries for 848 persons for which there were approximately 35,000 chart entries was abstracted from charts over a 4.5-year period and was coded using the International Statistical Classification of Diseases and Related Health Problems, 10th edition. RESULTS: The chart retrieval rate was 84%. The mean number of chart entries per person was higher in the comparison group (43.4) than in the vaccine group (38.2). No statistically significant differences were seen in the percent change before and after vaccination in the number of chart entries for specific diagnoses and symptoms for the vaccine group compared with the comparison group. Visual inspection of the time trend in rates showed no unexplained increases in the rate of diagnosis and symptoms in the vaccine group after vaccination. CONCLUSION: This study found no evidence that the anthrax vaccination resulted in an increase in adverse health effects in the 8-month period after vaccination.

Environmental cleaning resources and activities in Canadian acute care hospitals.

BACKGROUND: Environmental cleaning interventions have increased cleaning effectiveness and reduced antibiotic-resistant organisms in hospitals. This study examined cleaning in Canadian acute care hospitals with the goal of developing strategies to improve cleaning and reduce antibiotic-resistant organism rates. METHODS: Managers most responsible for environmental services (EVS) completed an extensive online survey that assessed EVS resources and cleaning practices. RESULTS: The response rate was 50.5%; 96 surveys were completed, representing 103 of 204 hospitals. Whereas 86.3% (82/95) of managers responsible for EVS reported their staff was adequately trained and 76.0% (73/96) that supplies and equipment budgets were sufficient, only 46.9% (45/96) reported that EVS had enough personnel to satisfactorily clean their hospital. A substantial minority (36.8%, 35/95) of EVS departments did not audit the cleaning of medical surgical patient rooms on at least a monthly basis. Cleaning audits of medical surgical patient rooms frequently included environmental marking methods in only one third (33.3%, 31/93) of hospitals and frequently included the measurement of residual bioburden in only 13.8% (13/94). CONCLUSION: There was a general need for increased and improved auditing of environmental cleaning in Canadian hospitals, and there were perceived EVS staffing deficits in the majority of hospitals.

Working relationships of infection prevention and control programs and environmental services and associations with antibiotic-resistant organisms in Canadian acute care hospitals.

BACKGROUND: Environmental contamination in hospitals with antibiotic-resistant organisms (AROs) is associated with patient contraction of AROs. This study examined the working relationship of Infection Prevention and Control (IPAC) and Environmental Services and the impact of that relationship on ARO rates. METHODS: Lead infection control professionals completed an online survey that assessed the IPAC and Environmental Services working relationship in their acute care hospital in 2011. The survey assessed cleaning collaborations, staff training, hospital cleanliness, and nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection, vancomycin-resistant Enterococcus (VRE) infection, and Clostridium difficile infection (CDI). RESULTS: The survey was completed by 58.3% of hospitals (119 of 204). Two-thirds (65.8%; 77 of 117) of the respondents reported that their cleaners were adequately trained, and 62.4% (73 of 117) reported that their hospital was sufficiently clean. Greater cooperation between IPAC and Environmental Services was associated with lower rates of MRSA infection (r = -0.22; P = .02), and frequent collaboration regarding cleaning protocols was associated with lower rates of VRE infection (r = -0.20; P = .03) and CDI (r = -0.31; P < .001). CONCLUSIONS: Canadian IPAC programs generally had collaborative working relationships with Environmental Services, and this was associated with lower rates of ARO. Deficits in the adequacy of cleaning staff training and hospital cleanliness were identified. The promotion of collaborative working relationships and additional training for Environmental Services workers would be expected to lower ARO rates.

Herpes simplex virus lymphadenitis: the elusive doppelganger in immunocompromised patients.

Herpes simplex virus has protean manifestations and is an important cause of morbidity in the immunocompromised host. We report a case of recurrent lymphadenopathy and rash in a patient with chronic lymphocytic leukemia. The elusive clinical diagnosis eventually required core biopsy of a lymph node with immunohistochemistry and confirmation by polymerase chain reaction. This case illustrates the challenging clinical and laboratory diagnosis of herpes simplex virus lymphadenitis and the need to maintain a high index of suspicion for infection when treating an immunocompromised patient with unusual and/or persistent symptoms.

Chikungunya-related arthritis: case report and review of the literature.

INTRODUCTION: Chikungunya fever often presents with severe arthritis/arthralgias, high fever, myalgias, headache, and maculopapular rash (Chow et al., 2011 [1]; Das et al., 2010 [2]; Mizuno et al., 2011 [3]; Powers, 2010 [4]; Sissoko et al., 2010 [5]; Staples et al., 2009 [6]). Persistent arthritis/arthralgias commonly develop after symptomatic infection and are the most common long-term complication (Chow et al., 2011 [1]; Powers, 2010 [4]; Sissoko et al., 2010 [5]; Staples et al., 2009 [6]). The small joints are most often affected in a symmetric pattern that can mimic adult rheumatoid arthritis (RA) (Mizuno et al., 2011 [3]; Bouquillard and Combe, 2009 [7]; Chabbra et al., 2008 [8]; Jaffar-Bandjee et al., 2009 [9]; Simon et al., 2007 [10]). OBJECTIVE: We present a case of Chikungunya virus (CHIKV)-induced arthritis and review the literature surrounding Chikungunya-induced arthritis/arthralgias and associated musculoskeletal (MSK) manifestations. METHODS: A Medline search was completed from 1946--November 2011. Key words included Chikungunya virus and arthritis. A PubMed search was completed from 1996--November 2011. Search terms included Chikungunya virus, etiology, and fever. Searches were limited to humans and English language publications. Additional relevant articles were obtained from the reference lists.

Effectiveness of a novel ozone-based system for the rapid high-level disinfection of health care spaces and surfaces.

BACKGROUND: Vapor-based fumigant systems for disinfection of health care surfaces and spaces is an evolving technology. A new system (AsepticSure) uses an ozone-based process to create a highly reactive oxidative vapor with broad and high-level antimicrobial properties. METHODS: Ozone gas at 50-500 ppm was combined with 3% hydrogen peroxide vapor in a test chamber and upscaled in rooms measuring 82 m3 and 90 m3 in area. Test organisms included methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, Escherichia coli, Pseudomonas aeruginosa, Clostridium difficile, and Bacillus subtilis spores dried onto steel discs or cotton gauze pads. RESULTS: The combination of 80-ppm ozone with 1% hydrogen peroxide vapor achieved a very high level of disinfection, with a ≥6 log10 reduction in the bacteria and spores tested on steel discs and MRSA tested on cotton gauze during a 30- to 90-minute exposure. The entire system was scalable such that it achieved the same high level of disinfection in both the 81-m3 and 90-m3 rooms in 60-90 minutes. CONCLUSION: The ozone hydrogen peroxide vapor system provides a very high level of disinfection of steel and gauze surfaces against health care-associated bacterial pathogens. The system is an advanced oxidative process providing a rapid and effective means of disinfecting health care surfaces and spaces.

Exposure to hospital roommates as a risk factor for health care-associated infection.

BACKGROUND: Numerous patient- and hospital-level characteristics have been established as risk factors for the transmission of health care-associated infections (HAIs). Few studies have quantitatively assessed the impact of exposure to hospital roommates on the acquisition of infections. This study evaluated the association between roommate exposures and the risk of HAIs. METHODS: A retrospective cohort of adult patients admitted to a Canadian teaching hospital between June 30, 2001, and December 31, 2005, was studied. Exposures were characterized as total daily roommate exposures and daily unique roommate exposures. Outcomes examined were methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridium difficile. RESULTS: The number of roommate exposures per day was significantly associated with MRSA and VRE infection or colonization (MRSA: hazard ratio [HR] = 1.10, 95% confidence interval [CI] = 1.05 to 1.15; VRE: HR = 1.11, 95% CI = 1.02 to 1.21), and with C difficile infection (HR = 1.11, 95% CI = 1.03 to 1.19). A significant association also was found for number of unique roommate exposures per day and VRE (HR = 1.15, 95% CI = 1.02 to 1.28). CONCLUSIONS: The significant associations found between daily roommate exposures and the infection outcomes suggest a possible role for limiting patient-to-patient contact in an infection prevention and control program in this facility. These findings have implications for the deployment and design of acute care hospitals.

The pandemic influenza planning process in Ontario acute care hospitals.

BACKGROUND: There will be little time to prepare when an influenza pandemic strikes; hospitals need to develop and test pandemic influenza plans beforehand. METHODS: Acute care hospitals in Ontario were surveyed regarding their pandemic influenza preparedness plans. RESULTS: The response rate was 78.5%, and 95 of 121 hospitals participated. Three quarters (76.8%, 73 of 95) of hospitals had pandemic influenza plans. Only 16.4% (12 of 73) of hospitals with plans had tested them. Larger (chi(2) = 6.7, P = .01) and urban hospitals (chi(2) = 5.0, P = .03) were more likely to have tested their plans. 70.4% (50 of 71) Of respondents thought the pandemic influenza planning process was not adequately funded. No respondents were "very satisfied" with the completeness of their hospital's pandemic plan, and only 18.3% were "satisfied." CONCLUSION: Important challenges were identified in pandemic planning: one quarter of hospitals did not have a plan, few plans were tested, key players were not involved, plans were frequently incomplete, funding was inadequate, and small and rural hospitals were especially disadvantaged. If these problems are not addressed, the result may be increased morbidity and mortality when a virulent influenza pandemic hits.

Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada.

BACKGROUND: In the 2003 Toronto SARS outbreak, SARS-CoV was transmitted in hospitals despite adherence to infection control procedures. Considerable controversy resulted regarding which procedures and behaviours were associated with the greatest risk of SARS-CoV transmission. METHODS: A retrospective cohort study was conducted to identify risk factors for transmission of SARS-CoV during intubation from laboratory confirmed SARS patients to HCWs involved in their care. All SARS patients requiring intubation during the Toronto outbreak were identified. All HCWs who provided care to intubated SARS patients during treatment or transportation and who entered a patient room or had direct patient contact from 24 hours before to 4 hours after intubation were eligible for this study. Data was collected on patients by chart review and on HCWs by interviewer-administered questionnaire. Generalized estimating equation (GEE) logistic regression models and classification and regression trees (CART) were used to identify risk factors for SARS transmission. RESULTS: 45 laboratory-confirmed intubated SARS patients were identified. Of the 697 HCWs involved in their care, 624 (90%) participated in the study. SARS-CoV was transmitted to 26 HCWs from 7 patients; 21 HCWs were infected by 3 patients. In multivariate GEE logistic regression models, presence in the room during fiberoptic intubation (OR = 2.79, p = .004) or ECG (OR = 3.52, p = .002), unprotected eye contact with secretions (OR = 7.34, p = .001), patient APACHE II score > or = 20 (OR = 17.05, p = .009) and patient Pa0(2)/Fi0(2) ratio < or = 59 (OR = 8.65, p = .001) were associated with increased risk of transmission of SARS-CoV. In CART analyses, the four covariates which explained the greatest amount of variation in SARS-CoV transmission were covariates representing individual patients. CONCLUSION: Close contact with the airway of severely ill patients and failure of infection control practices to prevent exposure to respiratory secretions were associated with transmission of SARS-CoV. Rates of transmission of SARS-CoV varied widely among patients.

A comparison of infection control program resources, activities, and antibiotic resistant organism rates in Canadian acute care hospitals in 1999 and 2005: pre- and post-severe acute respiratory syndrome.

INTRODUCTION: The Resources for Infection Control in Hospitals (RICH) project assessed infection control programs and rates of antibiotic-resistant organisms (AROs) in Canadian acute care hospitals in 1999. In the meantime, the Severe Acute Respiratory Syndrome (SARS) outbreak and the concern over pandemic influenza have stimulated considerable government and healthcare institutional efforts to improve infection control systems in Canada. METHODS: In 2006, a version of the RICH survey similar to the original RICH instrument was mailed to infection control programs in all Canadian acute care hospitals with 80 or more beds. Chi-square, ANOVA, and analysis of covariance analyses tested for differences between the 1999 and 2005 samples for infection control program components and ARO rates. RESULTS: 72.3% of Canadian acute care hospitals completed the RICH survey for 1999 and 60.1% for 2005. Hospital size was controlled for in analyses involving AROs and surveillance and control intensity levels. Methicillin-resistant Staphylococcus aureus (MRSA) rates increased from 1999 to 2005 (F = 9.4, P = 0.003). In 2005, the MRSA rate was 5.2 (SD 6.1) per 1,000 admissions and in 1999 was 2.0 (SD 2.9). Clostridium difficile-associated diarrhea (CDAD) rates, trended up from 1999 to 2005 (F = 2.9, P = 0.09). In 2005, the mean CDAD rate was 4.7 (SD 4.3) and in 1999 it was 3.8 (SD 4.3). The proportion of hospitals that reported having new nosocomial Vancomycin-resistant Enterococcus (VRE) cases was greater in 2005 than in 1999 (X = 10.5, P = 0.001). In 1999, 34.5% (40 of 116) hospitals reported having new nosocomial VRE cases and in 2005, 61.0% (64 of 105) reported new cases. Surveillance intensity index scores increased from 61.7 (SD 18.5) in 1999 to 68.1 (SD 15.4) in 2005 (F = 4.1, P = 0.04). Control intensity index scores, trended upwards slightly from 60.8 (SD 14.6) in 1999 to 64.1 (12.2) in 2005 (F = 3.2, P = 0.07). ICP full time equivalents (FTEs) per 100 beds increased from 0.5 (SD 0.2) in 1999 to 0.8 (SD 0.3) in 2005 (F = 90.8, P < 0.0001). However, the proportion of ICPs in hospitals certified by the Certification Board of Infection Control (CBIC) decreased from 53% (SD 46) in 1999 to 38% (SD 36) in 2005 (F = 8.7, P = 0.004). CONCLUSIONS: Canadian infection control programs in 2005 continued to fall short of expert recommendations for human resources and surveillance and control activities. Meanwhile, Nosocomial MRSA rates more than doubled between 1999 and 2005 and hospitals reporting new nosocomial VRE cases increased 77% over the same period. While investments have been made towards infection control programs in Canadian acute hospitals, the rapid rise in ICP positions has not yet translated into marked improvements in surveillance and control activities. In the face of substantial increases in ARO rates in Canada, continued efforts to train ICPs and support hospital infection control programs are necessary.

A cross-Canada survey of infection prevention and control in long-term care facilities.

BACKGROUND: Residents in long-term care facilities (LTCFs) are at considerable risk for developing infections. This is the first comprehensive examination of infection control programs in Canadian LTCFs in almost 20 years. METHODS: A survey designed to assess resident and LTCF characteristics; personnel, laboratory, computer, and reference resources; and surveillance and control activities of infection prevention and control programs was sent in 2005 to all eligible LTCFs across Canada. RESULTS: One third of LTCFs (34%, 488/1458) responded. Eighty-seven percent of LTCFs had infection control committees. Most LTCFs (91%) had 24-hour care by registered nurses, and 84% had on-site infection control staff. The mean number of full-time equivalent infection control professionals (ICPs) per 250 beds was 0.6 (standard deviation [SD], 1.0). Only 8% of ICPs were certified by the Certification Board of Infection Control and Epidemiology. Only one fifth of LTCFs had physicians or doctoral level professionals providing service to the infection control program. The median surveillance index score was 63 out of a possible 100, and the median control index score was 79 of 100. Influenza vaccinations were received by 93.0% (SD, 11.3) of residents in 2004. CONCLUSION: To bring infection control programs in Canadian LTCFs up to expert suggested resource and intensity levels will necessitate considerable investment. More and better trained ICPs are essential to providing effective infection prevention and control programs in LTCFs and protecting vulnerable residents from preventable infections.

Molecular epidemiology of Acinetobacter baumannii in central intensive care unit in Kosova Teaching Hospital.

Infections caused by bacteria of genus Acinetobacter pose a significant health care challenge worldwide. Information on molecular epidemiological investigation of outbreaks caused by Acinetobacter species in Kosova is lacking. The present investigation was carried out to enlight molecular epidemiology of Acinetobacter baumannii in the Central Intensive Care Unit (CICU) of a University hospital in Kosova using pulse field gel electrophoresis (PFGE). During March - July 2006, A. baumannii was isolated from 30 patients, of whom 22 were infected and 8 were colonised. Twenty patients had ventilator-associated pneumonia, one patient had meningitis, and two had coinfection with bloodstream infection and surgical site infection. The most common diagnoses upon admission to the ICU were politrauma and cerebral hemorrhage. Bacterial isolates were most frequently recovered from endotracheal aspirate (86.7%). First isolation occurred, on average, on day 8 following admission (range 1-26 days). Genotype analysis of A. baumannii isolates identified nine distinct PFGE patterns, with predominance of PFGE clone E represented by isolates from 9 patients. Eight strains were resistant to carbapenems. The genetic relatedness of Acinetobacter baumannii was high, indicating cross-transmission within the ICU setting. These results emphasize the need for measures to prevent nosocomial transmission of A. baumannii in ICU.