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1.
Infect Control Hosp Epidemiol ; 44(4): 638-642, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-35993573

RESUMEN

OBJECTIVE: To determine how engagement of the hospital and/or vendor with performance improvement strategies combined with an automated hand hygiene monitoring system (AHHMS) influence hand hygiene (HH) performance rates. DESIGN: Prospective, before-and-after, controlled observational study. SETTING: The study was conducted in 58 adult and pediatric inpatient units located in 10 hospitals. METHODS: HH performance rates were estimated using an AHHMS. Rates were expressed as the number of soap and alcohol-based hand rub portions dispensed divided by the number of room entries and exits. Each hospital self-assigned to one of the following intervention groups: AHHMS alone (control group), AHHMS plus clinician-based vendor support (vendor-only group), AHHMS plus hospital-led unit-based initiatives (hospital-only group), or AHHMS plus clinician-based vendor support and hospital-led unit-based initiatives (vendor-plus-hospital group). Each hospital unit produced 1­2 months of baseline HH performance data immediately after AHHMS installation before implementing initiatives. RESULTS: Hospital units in the vendor-plus-hospital group had a statistically significant increase of at least 46% in HH performance compared with units in the other 3 groups (P ≤ .006). Units in the hospital only group achieved a 1.3% increase in HH performance compared with units that had AHHMS alone (P = .950). Units with AHHMS plus other initiatives each had a larger change in HH performance rates over their baseline than those in the AHHMS-alone group (P < 0.001). CONCLUSIONS: AHHMS combined with clinician-based vendor support and hospital-led unit-based initiatives resulted in the greatest improvements in HH performance. These results illustrate the value of a collaborative partnership between the hospital and the AHHMS vendor.


Asunto(s)
Infección Hospitalaria , Higiene de las Manos , Adulto , Niño , Humanos , Higiene de las Manos/métodos , Estudios Prospectivos , Unidades Hospitalarias , Etanol
3.
Am J Infect Control ; 42(6): 638-42, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24837114

RESUMEN

BACKGROUND: Interrater reliability of central line-associated bloodstream infection (CLABSI) determination has not been well studied. The present study evaluated interrater reliability between infection preventionists (IPs) for CLABSI- and other bloodstream infection (BSI)-related factors and examined whether any nurse characteristics are associated with interrater reliability. METHODS: A total of 165 blood cultures were reviewed by 2 IPs assigned at random. Reliability outcomes were CLABSI, infection type (hospital- or community-acquired), presence of a central line, primary versus secondary BSI, secondary source of BSI, and IP-determined source of BSI (primary, secondary, or indeterminate). Kappa coefficients were calculated. Logistic regression was used to evaluate associations between IP characteristics and agreement on diagnosis of CLABSI. RESULTS: CLABSI agreement was moderate in IP pairs (κ = 0.562 ± 0.080) and not associated with IP characteristics. After controlling for IP characteristics associated with secondary outcomes, agreement regarding secondary source was more likely in pairs with a larger absolute difference in years employed (P = .013), and agreement regarding infection source was more likely in pairs with larger differences in years employed and duration of certification (P = .025). CONCLUSIONS: The rate of IP agreement regarding CLABSI was moderate and not associated with IP characteristics, reflecting adequate training. Education and reassessment of definitions may promote higher rates of agreement between IPs.


Asunto(s)
Infecciones Relacionadas con Catéteres/diagnóstico , Cateterismo Venoso Central/efectos adversos , Infección Hospitalaria/diagnóstico , Profesionales para Control de Infecciones , Variaciones Dependientes del Observador , Sepsis/diagnóstico , Infecciones Relacionadas con Catéteres/microbiología , Competencia Clínica , Infección Hospitalaria/microbiología , Estudios Transversales , Humanos , Estudios Prospectivos , Sepsis/microbiología
4.
Biol Blood Marrow Transplant ; 19(5): 720-4, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23380342

RESUMEN

Central line-associated blood stream infections (CLABSI) commonly complicate the care of patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) after allogeneic stem cell transplantation (HCT). We developed a modified CLABSI (MCLABSI) definition that attempts to exclude pathogens usually acquired because of disruption of mucosal barriers during the vulnerable neutropenic period following HCT that are generally included under the original definition (OCLABSI). We conducted a retrospective study of all AML and MDS patients undergoing HCT between August 2009 and December 2011 at the Cleveland Clinic (N = 73), identifying both OCLABSI and MCLABSI incidence. The median age at transplantation was 52 years (range, 16 to 70); 34 had a high (≥3) HCT comorbidity index (HCT-CI); 34 received bone marrow (BM), 24 received peripheral stem cells (PSC), and 15 received umbilical cord blood cells (UCB). Among these 73 patients, 23 (31.5%) developed OCLABSI, of whom 16 (69.6%) died, and 8 (11%) developed MCLABSI, of whom 7 (87.5%) died. OCLABSI was diagnosed a median of 9 days from HCT: 5 days (range, 2 to 12) for UCB and 78 days (range, 7 to 211) for BM/PSC (P < .001). MCLABSI occurred a median of 12 days from HCT, with similar earlier UCB and later BM/PSC diagnosis (P = .030). Risk factors for OCLABSI in univariate analysis included CBC (P < .001), human leukocyte antigen (HLA)-mismatch (P = .005), low CD34(+) count (P = .007), low total nucleated cell dose (P = .016), and non-Caucasian race (P = .017). Risk factors for OCLABSI in multivariable analysis were UCB (P < .001) and high HCT-CI (P = .002). There was a significant increase in mortality for both OCLABSI (hazard ratio, 7.14; CI, 3.31 to 15.37; P < .001) and MCLABSI (hazard ratio, 6.44; CI, 2.28 to 18.18; P < .001). CLABSI is common and associated with high mortality in AML and MDS patients undergoing HCT, especially in UCB recipients and those with high HCT-CI. We propose the MCLABSI definition to replace the OCLABSI definition, given its greater precision for identifying preventable infection in HCT patients.


Asunto(s)
Infecciones Relacionadas con Catéteres/etiología , Cateterismo Venoso Central/efectos adversos , Trasplante de Células Madre Hematopoyéticas/métodos , Leucemia Mieloide Aguda/cirugía , Síndromes Mielodisplásicos/cirugía , Sepsis/etiología , Adolescente , Adulto , Anciano , Infecciones Relacionadas con Catéteres/sangre , Infecciones Relacionadas con Catéteres/prevención & control , Femenino , Humanos , Incidencia , Leucemia Mieloide Aguda/sangre , Leucemia Mieloide Aguda/microbiología , Masculino , Persona de Mediana Edad , Síndromes Mielodisplásicos/sangre , Síndromes Mielodisplásicos/microbiología , Estudios Retrospectivos , Factores de Riesgo , Sepsis/prevención & control , Análisis de Supervivencia , Resultado del Tratamiento , Adulto Joven
5.
Infect Control Hosp Epidemiol ; 33(9): 865-8, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22869258

RESUMEN

OBJECTIVE: To develop a modified surveillance definition of central line-associated bloodstream infection (mCLABSI) specific for our population of patients with hematologic malignancies to better support ongoing improvement efforts at our hospital. DESIGN: Retrospective cohort study. PATIENTS: Hematologic malignancies population in a 1,200-bed tertiary care hospital on a 22-bed bone marrow transplant (BMT) unit and a 22-bed leukemia unit. METHODS: An mCLABSI definition was developed, and pathogens and rates were compared against those determined using the National Healthcare Safety Network (NHSN) definition. RESULTS: By the NHSN definition the CLABSI rate on the BMT unit was 6.0 per 1,000 central line-days, and by the mCLABSI definition the rate was 2.0 per 1,000 line-days ([Formula: see text]). On the leukemia unit, the NHSN CLABSI rate was 14.4 per 1,000 line-days, and the mCLABSI rate was 8.2 per 1,000 line-days ([Formula: see text]). The top 3 CLABSI pathogens by the NHSN definition were Enterococcus species, Klebsiella species, and Escherichia coli. The top 3 CLABSI pathogens by the mCLABSI definition were coagulase-negative Staphylococcus (CONS), Pseudomonas aeruginosa, and Staphylococcus aureus. The difference in the incidence of CONS as a cause of CLABSI under the 2 definitions was statistically significant ([Formula: see text]). CONCLUSIONS: A modified surveillance definition of CLABSI was associated with an increase in the identification of staphylococci as the cause of CLABSIs, as opposed to enteric pathogens, and a decrease in CLABSI rates.


Asunto(s)
Infecciones Relacionadas con Catéteres/diagnóstico , Cateterismo Venoso Central/efectos adversos , Infección Hospitalaria/diagnóstico , Neoplasias Hematológicas/complicaciones , Control de Infecciones/métodos , Sepsis/diagnóstico , Infecciones Relacionadas con Catéteres/complicaciones , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/microbiología , Estudios de Cohortes , Infección Hospitalaria/complicaciones , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Diagnóstico Diferencial , Neoplasias Hematológicas/terapia , Humanos , Incidencia , Estudios Retrospectivos , Sepsis/complicaciones , Sepsis/epidemiología , Sepsis/microbiología
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