Outbreak of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in hospitalized hemodialysis patients: An epidemiologic and genomic investigation.

We performed an epidemiological investigation and genome sequencing of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) to define the source and scope of an outbreak in a cluster of hospitalized patients. Lack of appropriate respiratory hygiene led to SARS-CoV-2 transmission to patients and healthcare workers during a single hemodialysis session, highlighting the importance of infection prevention precautions.

Implementation of standardized color-coded isolation signs at a teaching hospital and their effect on compliance with isolation precautions.

ISSUE: In an effort to increase knowledge regarding infection prevention and compliance with isolation precautions among our staff in a 722 bed tertiary referral teaching hospital, we created a standardized color-coded isolation signs. PROJECT: Different versions of isolation precaution signs existed at our institution. Concerns in regards to these signs included being in a neutral color and easily overlooked, providing insufficient information regarding isolated pathogen, ignoring appropriate isolation garb, and technique required for performing hand hygiene. This led to the creation of a standardized signage throughout the institution. Signs were color-coded, with each color representing a common pathogen requiring isolation. Such a system allowed us to maintain patient confidentiality. Pocket references explaining the coding system, as well as cards that would adhere to personal identification badges were provided to care providers. the reason for isolation. Staff was no longer required to reference the patient’s chart to discern the reason for isolation, which saved time. Housekeeping could immediately discern appropriate needs in cleaning and disinfection. Our rate of compliance with isolation precautions was maintained in the ninetieth percentile. A Lesson Learned: Communication and cooperation amongst healthcare workers were essential keys in problem solving and served to increase both staff and patient safety and increase the knowledge and comfort level with the infection control practices and guidelines. The process was driven by frontline care providers and, as such, led to immediate uptake and likely improved adherence.

Cost-benefit and effectiveness analysis of rapid testing for MRSA carriage in a hospital setting.

A cost-effectiveness analysis was conducted comparing the polymerase chain reaction assay and traditional microbiological culture as screening tools for the identification of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to the pediatric and surgical intensive care units (PICU and SICU) at a 722 bed academic medical center. In addition, the cost benefits of identification of colonized MRSA patients were determined. The cost-effectiveness analysis employed actual hospital and laboratory costs, not patient costs. The actual cost of the PCR assay was higher than the microbiological culture identification of MRSA ($602.95 versus $364.30 per positive carrier identified). However, this did not include the decreased turn-around time of PCR assays compared to traditional culture techniques. Patient costs were determined indirectly in the cost-benefit analysis of clinical outcome. There was a reduction in MRSA hospital-acquired infection (3.5 MRSA HAI/month without screening versus 0.6/month with screening by PCR). A cost-benefit analysis based on differences in length of stay suggests an associated savings in hospitalization costs: MRSA HAI with 29.5 day median LOS at $63,810 versus MRSA identified on admission with 6 day median LOS at $14,561, a difference of $49,249 per hospitalization. Although this pilot study was small and it is not possible to directly relate the cost-effectiveness and cost-benefit analysis due to confounding factors such as patient underlying morbidity and mortality, a reduction of 2.9 MRSA HAI/month associated with PCR screening suggests potential savings in hospitalization costs of $142,822 per month.

Increasing hand hygiene compliance by use of a novel hand held device at a university hospital - biomed 2013.

ISSUE: Hand hygiene (HH) is the single most effective modality to prevent the spread of infection in healthcare. HH is also one of the most difficult quality measures to monitor. In a 722 bed tertiary referral teaching hospital, collection of accurate and timely HH compliance data on 25 inpatient units was problematic. We needed a process that avoided confrontation and keep secret the identity of HH surveyors to avoid compromise of professional work relationships. Our solution was to employ a unique handheld device. PROJECT: iScrub®, a hand-held application developed by The University of Iowa, was used to record compliance with HH. Dates of intervention were January 1st – December 31st, 2011. HH observations were collected by trained nursing volunteers and displayed on a central intranet –based database using SharePoint software®. Data was then included in quality scorecards, and in the Infection Prevention (IP) monthly report. Episodes of non-compliance generated e-mail notifications with escalating consequences that might end with termination of employment. Multi-drug resistant organisms (MDROs) surveillance was performed by the infection prevention department (IPD). HH and MDROs monthly data analysis was published on SharePoint® for stakeholders’ review. RESULTS: During the intervention we collected 26,657 observations. Average HH compliance was 95%,( average physician’s compliance was 88%, and average nurse’s compliance was 98%). Non-compliance occurred at a similar frequency both before and after patient contact. Alcohol hand rub was the most frequently used method to perform HH. Physicians demonstrated the lowest compliance rates among healthcare workers. Time and date of observations had no effect on compliance. LESSONS LEARNED: Shielding the identity of HH observers eliminated confrontation, and probably increased the accuracy of collected data. Applying strict consequences for non-compliance with HH aided in increasing compliance among staff and physicians. Publishing HH data analysis aided in increasing the compliance with HH. Data analysis identified issues related to the use of the current application and led to the creation of a new HH application.