Investigation of the first reported outbreak of New Delhi metallo-ß-lactamase-1-producing Pseudomonas aeruginosa in Texas.

We describe an epidemiologic investigation and successful control measures for the first reported outbreak of blaNDM-1-carrying Pseudomonas aeruginosa in Texas occurring in a veteran with transmission of the same organism and a blaNDM-5-carrying Escherichia coli, respectively, to two roommates and blaNDM-carrying organism/s to a patient cared for by common staff.

Effect of serious infectious threat response initiative (SITRI) during the coronavirus disease 2019 (COVID-19) pandemic at the Veterans Affairs North Texas Health Care System.

BACKGROUND: Health care-associated infections (HAIs) increased worldwide as health care facilities struggled through the pandemic. We describe our methods in the implementation of a programmatic initiative called serious infectious threat response initiative (SITRI) that was conceptualized to support our staff, to facilitate day-to-day clinical operations related to COVID-19 and to shield our infection prevention and control program (IPC) from excessive COVID-19 work burden to the extent possible to retain routine prevention focused efforts. Post implementation, we sought to understand and quantify the workload and utility of SITRI, IPC burnout and HAI incidence during the implementation period. METHODS: We correlated the number of weekly phone calls with inpatient COVID-19 census, assessed types of calls, staff feedback, IPC burnout, pre- and postpandemic HAI incidence, and the cost. RESULTS: There was significant correlation between SITRI calls and the weekly average COVID-19 census (P = .00026). IPC burnout evaluation indicated improvement in scores for exhaustion and reduced achievement and worsening in score for depersonalization. HAI incidence did not increase. SITRI's cost was $360,000. CONCLUSIONS: Staff solicited SITRI's support in tandem with the COVID-19 burden. Our HAI during the pandemic did not increase while SITRI was operational in contrast to what is published in literature.

Build upon basics: An intervention utilizing safety huddles to achieve near-zero incidence of catheter associated urinary tract infection at a department of Veterans Affairs long-term care facility.

BACKGROUND: When traditional interventions are used in long term care for catheter associated urinary tract infection (CAUTI) prevention, residual rates are still high despite a decrease. We conducted a quality improvement study focusing our interventions on patient and staff behavioral patterns identified through a structured huddle process to improve upon the basics for CAUTI prevention. METHODS: Baseline was from January 2016 to March 2017; the intervention period was from April 2017 to June 2020. We implemented a systematic huddle to determine root cause of each CAUTI and applied lessons throughout the facility. We measured the monthly CAUTI incidence per 1000 urinary catheter days and analyzed the reduction in CAUTI during the intervention period. RESULTS: CAUTI decreased by 73% during the intervention period compared to the baseline period, with an IRR of 0.27 (95% confidence interval [CI]: 0.11-0.66; P = .004). The number of catheter days per month increased by 4% in the intervention period (17,407 in 39 months) compared to the baseline period (6,440 in 15 months) with IRR of 1.04 (95% confidence interval [CI]: 1.01-1.07; P = .008). No patterns were noted in organisms responsible for CAUTI. CONCLUSIONS: Our findings stress the importance of looking beyond the traditional interventions for CAUTI prevention in long term care population. By doing this, interventions can be customized for this special population to achieve optimal outcomes.