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Electronic hand hygiene monitoring systems allow the collection of large volumes of data. However, significant resources are required to validate and maintain these systems. Additionally, data are lacking on the correlation with clinically important outcomes. Direct observation of hand hygiene remains the gold standard for monitoring hand hygiene compliance.
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Challenges for infection prevention and antimicrobial stewardship programs have arisen with the fourth wave of the coronavirus disease 2019 (COVID-19) pandemic, fueled by the delta variant. These challenges include breakthrough infections in vaccinated individuals, decisions to re-escalate infection prevention measures, critical medication shortages, and provider burnout. Various strategies are needed to meet these challenges.
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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.
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Clostridioides difficile , Infecciones por Clostridium , Infección Hospitalaria , Clostridioides , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/epidemiología , Infecciones por Clostridium/prevención & control , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Hospitales , Humanos , Análisis de Series de Tiempo InterrumpidoAsunto(s)
Infecciones por Coronavirus/diagnóstico , Pacientes Internos/estadística & datos numéricos , Selección de Paciente , Neumonía Viral/diagnóstico , Betacoronavirus , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico , Reacciones Falso Negativas , Humanos , Nasofaringe/virología , Pandemias , SARS-CoV-2 , Factores de TiempoRESUMEN
Interest in electronic hand hygiene monitoring systems (EHHMSs) is now widespread throughout the infection control community. We tested 2 types of EHHMS for accuracy. The type B EHHMS captured more HH events with superior accuracy. Hospitals considering an EHHMS should assess the technology's ability to accurately capture HH performance in the clinical workflow.
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Procesamiento Automatizado de Datos/métodos , Monitoreo Epidemiológico , Adhesión a Directriz/estadística & datos numéricos , Higiene de las Manos/instrumentación , Humanos , Control de InfeccionesRESUMEN
Antipseudomonal carbapenems are an important target for antimicrobial stewardship programs. We evaluated the impact of formulary restriction and preauthorization on relative carbapenem use for medical and surgical intensive care units at a large, urban academic medical center using interrupted time-series analysis.