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1.
Am J Transplant ; 20(12): 3673-3679, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32530145

RESUMO

Candida auris is a yeast that is difficult to eradicate and has caused outbreaks in health care facilities. We report a cluster of 5 patients in 1 intensive care unit who were colonized or infected in 2017. The initial 2 patients were recipients of liver transplants who had cultures that grew C auris within 3 days of each other in June 2017 (days 43 and 30 posttransplant). Subsequent screening cultures identified 2 additional patients with C auris colonization. Respiratory and urine cultures from a fifth patient yielded C auris. All isolates were fluconazole resistant but susceptible to echinocandins. Whole genome sequencing showed the strains were clonal, suggesting in-hospital transmission, and related but distinct from New York/New Jersey strains, consistent with a separate introduction. However, no source or contact was found. Two of the 5 patients died. C auris infection likely contributed to 1 patient death by infecting a vascular aneurysm at the graft anastomosis. Strict infection control precautions were initiated to control the outbreak. Our experience reveals that although severe disease from C auris can occur in transplant recipients, outbreaks can be controlled using recommended infection control practices. We have had no further patients infected with C auris to date.


Assuntos
Transplante de Fígado , Antifúngicos/uso terapêutico , Candida , Candidíase Invasiva , Cuidados Críticos , Surtos de Doenças , Humanos , Unidades de Terapia Intensiva , Transplante de Fígado/efeitos adversos , Testes de Sensibilidade Microbiana
2.
J Clin Microbiol ; 58(5)2020 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-32075902

RESUMO

The number of onsite clinical microbiology laboratories in hospitals is decreasing, likely related to the business model for laboratory consolidation and labor shortages, and this impacts a variety of clinical practices, including that of banking isolates for clinical or epidemiologic purposes. To determine the impact of these trends, infectious disease (ID) physicians were surveyed regarding their perceptions of offsite services. Clinical microbiology practices for retention of clinical isolates for future use were also determined. Surveys were sent to members of the Infectious Diseases Society of America's (IDSA) Emerging Infections Network (EIN). The EIN is a sentinel network of ID physicians who care for adult and/or pediatric patients in North America and who are members of IDSA. The response rate was 763 (45%) of 1,680 potential respondents. Five hundred forty (81%) respondents reported interacting with the clinical microbiology laboratory. Eighty-six percent of respondents thought an onsite laboratory very important for timely diagnostic reporting and ongoing communication with the clinical microbiologist. Thirty-five percent practiced in institutions where the core microbiology laboratory has been moved offsite, and an additional 7% (n = 38) reported that movement of core laboratory functions offsite was being considered. The respondents reported that only 24% of laboratories banked all isolates, with the majority saving isolates for less than 30 days. Based on these results, the trend toward centralized core laboratories negatively impacts the practice of ID physicians, potentially delays effective implementation of prompt and targeted care for patients with serious infections, and similarly adversely impacts infection control epidemiologic investigations.


Assuntos
Doenças Transmissíveis , Laboratórios , Adulto , Criança , Doenças Transmissíveis/diagnóstico , Humanos , Controle de Infecções , Microbiologia , América do Norte , Propriedade
3.
Emerg Infect Dis ; 24(4)2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29553923

RESUMO

The epidemic of illicit intravenous drug use (IVDU) in the United States has been accompanied by a surge in drug overdose deaths and infectious sequelae. Candida albicans infections were associated with injection of contaminated impure brown heroin in the 1970s-1990s; however, candidiasis accompanying IVDU became considerably rarer as the purity of the heroin supply increased. We reviewed cases of candidemia occurring over a recent 7-year period in persons >14 years of age at a tertiary care hospital in central Massachusetts. Of the 198 patients with candidemia, 24 cases occurred in patients with a history of IVDU. Compared with non-IVDU patients, those with a history of IVDU were more likely to have non-albicans Candida, be co-infected with hepatitis C, and have end-organ involvement, including endocarditis and osteomyelitis. Thus, IVDU appears to be reemerging as a risk factor for invasive candidiasis.


Assuntos
Candidemia/epidemiologia , Candidemia/etiologia , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/etiologia , Usuários de Drogas , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Comorbidade , Feminino , Humanos , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Medição de Risco , Fatores de Risco , Adulto Jovem
4.
J Infect Dis ; 213(6): 1041-8, 2016 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-26503983

RESUMO

Approximately 3% of Staphylococcus aureus strains that, according to results of conventional phenotypic methods, are highly susceptible to methicillin-like antibiotics also have polymerase chain reaction (PCR) results positive for mecA. The genetic nature of these mecA-positive methicillin-susceptible S. aureus (MSSA) strains has not been investigated. We report the first clearly defined case of reversion from methicillin susceptibility to methicillin resistance among mecA-positive MSSA within a patient during antibiotic therapy. We describe the mechanism of reversion for this strain and for a second clinical isolate that reverts at a similar frequency. The rates of reversion are of the same order of magnitude as spontaneous resistance to drugs like rifampicin. When mecA is detected by PCR in the clinical laboratory, current guidelines recommend that these strains be reported as resistant. Because combination therapy using both a ß-lactam and a second antibiotic suppressing the small revertant population may be superior to alternatives such as vancomycin, the benefits of distinguishing between mecA-positive MSSA and MRSA in clinical reports should be evaluated.


Assuntos
Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Infecções Estafilocócicas/microbiologia , Idoso , Sequência de Aminoácidos , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Sequência de Bases , DNA Bacteriano/genética , Mutação da Fase de Leitura , Regulação Bacteriana da Expressão Gênica , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/fisiologia , Nafcilina/administração & dosagem , Nafcilina/uso terapêutico , Proteínas de Ligação às Penicilinas/genética , Proteínas de Ligação às Penicilinas/metabolismo , Infecções Relacionadas à Prótese , Infecções Estafilocócicas/tratamento farmacológico , Vancomicina/administração & dosagem , Vancomicina/uso terapêutico
5.
Clin Infect Dis ; 62(12): 1552-1555, 2016 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-27045122

RESUMO

We investigated the duration of Ebola virus (EBOV) RNA and infectious EBOV in semen specimens of 5 Ebola virus disease (EVD) survivors. EBOV RNA and infectious EBOV was detected by real-time RT-PCR and virus culture out to 290 days and 70 days, respectively, after EVD onset.


Assuntos
Ebolavirus/isolamento & purificação , Doença pelo Vírus Ebola/virologia , Sêmen/virologia , Adulto , Estudos de Coortes , Ebolavirus/patogenicidade , Humanos , Masculino , Sobreviventes
6.
Emerg Infect Dis ; 22(2): 295-7, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26812218

RESUMO

We report a case of probable Zaire Ebola virus-related ophthalmologic complications in a physician from the United States who contracted Ebola virus disease in Liberia. Uveitis, immune activation, and nonspecific increase in antibody titers developed during convalescence. This case highlights immune phenomena that could complicate management of Ebola virus disease-related uveitis during convalescence.


Assuntos
Ebolavirus , Doença pelo Vírus Ebola/complicações , Doença pelo Vírus Ebola/virologia , Uveíte/diagnóstico , Uveíte/etiologia , Ebolavirus/genética , Doença pelo Vírus Ebola/diagnóstico , Humanos , Libéria , Masculino , Tomografia de Coerência Óptica , Uveíte/tratamento farmacológico
7.
Anesth Analg ; 120(4): 868-76, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24149581

RESUMO

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) have decreased significantly over the last decade. Further reductions in CLABSI rates should be possible. We describe a multidisciplinary approach to the reduction of CLABSIs. METHODS: This was an observational study of critically ill patients requiring central venous catheters in 8 intensive care units in a tertiary medical center. We implemented a catheter bundle that included hand hygiene, education of providers, chlorhexidine skin preparation, use of maximum barrier precautions, a dedicated line cart, checklist, avoidance of the femoral vein for catheter insertion, chlorhexidine-impregnated dressings, use of anti-infective catheters, and daily consideration of the need for the catheter. Additional measures included root cause analyses of all CLABSIs, creation of a best practice atlas for internal jugular catheters, and enhanced education on blood culture collection. Data were analyzed using the Poisson test and regression. RESULTS: CLABSI, catheter use, and microbiology were tracked from 2004 to 2012. There was a 92% reduction in CLABSIs (95% lower confidence limit: 67.4% reduction, P < 0.0001). Central venous catheter use decreased significantly from 2008 to 2012 (P = 0.032, -151 catheters per year, 95% confidence limits: -277 to -25), whereas peripherally inserted central catheter use increased (P = 0.005, 89 catheters per year, 95% confidence limits: 50 to 127). There was no apparent association between unit-specific Acute Physiology And Chronic Health Evaluation III/IV scores and CLABSI. Three units have not had a CLABSI in more than a year. The most common organism isolated was coagulase-negative staphylococcus. Since the implementation of minocycline/rifampin catheters, no cases of methicillin-resistant Staphylococcus aureus CLABSI have occurred. CONCLUSIONS: The implementation of a standard catheter bundle combined with chlorhexidine dressings, minocycline/rifampin catheters, and other behavioral changes was associated with a sustained reduction in CLABSIs.


Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Equipe de Assistência ao Paciente , Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Clorexidina/química , Cuidados Críticos , Estado Terminal , Higiene das Mãos , Humanos , Unidades de Terapia Intensiva , Comunicação Interdisciplinar , Análise de Regressão , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/prevenção & controle , Staphylococcus
8.
Crit Care Med ; 42(9): 2019-28, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24810522

RESUMO

OBJECTIVES: The primary aim of the study was to measure the test characteristics of the National Health Safety Network ventilator-associated event/ventilator-associated condition constructs for detecting ventilator-associated pneumonia. Its secondary aims were to report the clinical features of patients with National Health Safety Network ventilator-associated event/ventilator-associated condition, measure costs of surveillance, and its susceptibility to manipulation. DESIGN: Prospective cohort study. SETTING: Two inpatient campuses of an academic medical center. PATIENTS: Eight thousand four hundred eight mechanically ventilated adults discharged from an ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The National Health Safety Network ventilator-associated event/ventilator-associated condition constructs detected less than a third of ventilator-associated pneumonia cases with a sensitivity of 0.325 and a positive predictive value of 0.07. Most National Health Safety Network ventilator-associated event/ventilator-associated condition cases (93%) did not have ventilator-associated pneumonia or other hospital-acquired complications; 71% met the definition for acute respiratory distress syndrome. Similarly, most patients with National Health Safety Network probable ventilator-associated pneumonia did not have ventilator-associated pneumonia because radiographic criteria were not met. National Health Safety Network ventilator-associated event/ventilator-associated condition rates were reduced 93% by an unsophisticated manipulation of ventilator management protocols. CONCLUSIONS: The National Health Safety Network ventilator-associated event/ventilator-associated condition constructs failed to detect many patients who had ventilator-associated pneumonia, detected many cases that did not have a hospital complication, and were susceptible to manipulation. National Health Safety Network ventilator-associated event/ventilator-associated condition surveillance did not perform as well as ventilator-associated pneumonia surveillance and had several undesirable characteristics.


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Vigilância em Saúde Pública/métodos , APACHE , Centros Médicos Acadêmicos/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Pneumonia Associada à Ventilação Mecânica/mortalidade , Prevalência , Estudos Prospectivos , Indicadores de Qualidade em Assistência à Saúde , Fatores de Risco
9.
J Intensive Care Med ; 29(6): 311-26, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23753240

RESUMO

Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection.


Assuntos
Infecção Hospitalar/prevenção & controle , Desinfecção , Fidelidade a Diretrizes , Higiene das Mãos , Zeladoria Hospitalar , Controle de Infecções , Unidades de Terapia Intensiva , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres Venosos Centrais/efeitos adversos , Infecção Hospitalar/microbiologia , Desinfecção/normas , Desinfecção/tendências , Enterocolite Pseudomembranosa/prevenção & controle , Higiene das Mãos/normas , Higiene das Mãos/tendências , Zeladoria Hospitalar/normas , Zeladoria Hospitalar/tendências , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Controle de Infecções/tendências , Unidades de Terapia Intensiva/normas , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Guias de Prática Clínica como Assunto , Melhoria de Qualidade , Fatores de Risco , Infecções Urinárias/prevenção & controle
10.
J Infect Dis ; 213(10): 1671-2, 2016 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-26962234
11.
PLoS One ; 17(3): e0265476, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35303019

RESUMO

BACKGROUND: Panton-Valentine Leukocidin (PVL) toxin in Staphylococcus aureus has been associated with both severe pneumonia and skin and soft tissue infections. However, there are only limited data on how this virulence factor may influence the clinical course or complications of bacteremic S. aureus infections. METHODS: Between September 2016 and March 2018, S. aureus isolates from clinical cultures from hospitals in an academic medical center underwent comprehensive genomic sequencing. Four hundred sixty-nine (29%) of 1681 S. aureus sequenced isolates were identified as containing the genes that encode for PVL. Case patients with one or more positive blood cultures for PVL were randomly matched with control patients having positive blood cultures with lukF/lukS-PV negative (PVL strains from a retrospective chart review). RESULTS: 51 case and 56 control patients were analyzed. Case patients were more likely to have a history of injection drug use, while controls more likely to undergo hemodialysis. Isolates from 78.4% of case patients were methicillin resistant as compared to 28.6% from control patients. Case patients had a higher incidence of pneumonia and skin and soft tissue infection and longer duration of fever without differences in length of bacteremia. Clinical cure or expiration was comparable. CONCLUSIONS: These results are consistent with prior observations associating the PVL toxin with both community-acquired MRSA strains as well as severe staphylococcal pneumonia. The presence of the PVL toxin does not appear to otherwise influence the natural history of bacteremic S. aureus disease other than in prolonging the duration of fever.


Assuntos
Bacteriemia , Infecções Comunitárias Adquiridas , Staphylococcus aureus Resistente à Meticilina , Pneumonia Estafilocócica , Infecções dos Tecidos Moles , Infecções Estafilocócicas , Bacteriemia/epidemiologia , Toxinas Bacterianas , Estudos de Casos e Controles , Infecções Comunitárias Adquiridas/epidemiologia , Exotoxinas/genética , Febre , Humanos , Leucocidinas/genética , Estudos Retrospectivos , Infecções dos Tecidos Moles/epidemiologia , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus
12.
J Intensive Care Med ; 26(6): 347-67, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21220275

RESUMO

In a 5-week span during the 1918 influenza A pandemic, more than 2000 patients were admitted to Cook County Hospital in Chicago, with a diagnosis of either influenza or pneumonia; 642 patients, approximately 31% of those admitted, died, with deaths occurring predominantly in patients of age 25 to 30 years. This review summarizes basic information on the biology, epidemiology, control, treatment and prevention of influenza overall, and then addresses the potential impact of pandemic influenza in an intensive care unit setting. Issues that require consideration include workforce staffing and safety, resource management, alternate sites of care surge of patients, altered standards of care, and crisis communication.


Assuntos
Cuidados Críticos/organização & administração , Atenção à Saúde/métodos , Controle de Infecções/organização & administração , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Pandemias/prevenção & controle , Humanos , Influenza Humana/terapia , Unidades de Terapia Intensiva/organização & administração
13.
Open Forum Infect Dis ; 8(11): ofab431, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35559122

RESUMO

Rezafungin is a semisynthetic, long-acting echinocandin with broad-spectrum activity against many Candida species and Aspergillus species, including a subset of drug-resistant strains. It is currently in phase III trials and was found to be safe and effective for the treatment of candidemia and/or invasive Candida infections in a phase II trial. However, there are no long-term safety or efficacy data. We report on the successful ongoing compassionate use of rezafungin obtained through expanded access for over 1 year in a patient with a multidrug-resistant Candida glabrata mediastinal infection from a vascular graft infection and retained foreign material.

15.
Infect Control Hosp Epidemiol ; 41(12): 1446-1448, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32669135

RESUMO

Decontamination of N95 respirators is being used by clinicians in the face of a global shortage of these devices. Some treatments for decontamination, such as some vaporized hydrogen peroxide methods or ultraviolet methods, had no impact on respiratory performance, while other treatments resulted in substantial damage to masks.


Assuntos
COVID-19 , Dispositivos de Proteção Respiratória , Descontaminação , Reutilização de Equipamento , Humanos , Máscaras , SARS-CoV-2 , Ventiladores Mecânicos
16.
Infect Control Hosp Epidemiol ; 40(6): 649-655, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31012399

RESUMO

BACKGROUND: Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates. OBJECTIVE: To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review. METHODS: Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification. RESULTS: Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance. CONCLUSIONS: Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.


Assuntos
Infecção Hospitalar/epidemiologia , Genoma Bacteriano , Controle de Infecções/métodos , Tipagem Molecular , Sequenciamento Completo do Genoma , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Análise por Conglomerados , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Massachusetts , Pessoa de Meia-Idade , Epidemiologia Molecular/métodos , Adulto Jovem
17.
Infect Control Hosp Epidemiol ; 28(6): 708-12, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17520545

RESUMO

OBJECTIVE: To assess the impact of outbreaks of Bordetella pertussis infection on a tertiary care medical system. DESIGN: Retrospective study. SETTING: Academic tertiary care medical center and affiliated ambulatory care settings. SUBJECTS: All patients and healthcare workers (HCWs) who were in close contact with patients with laboratory-confirmed cases of B. pertussis infection from October 1, 2003, through September 30, 2004. INTERVENTION: Direct and indirect medical center costs were determined, including low and high estimates of time expended in the evaluation and management of exposed patients and HCWs during outbreak investigations of laboratory-confirmed cases of B. pertussis infection. RESULTS: During this period, 20 primary and 3 secondary laboratory-confirmed cases of B. pertussis infection occurred, with 2 primary pertussis cases and 1 secondary case occurring in HCWs. Outbreak investigations prompted screening of 353 medical center employees. Probable or definitive exposure was identified for 296 HCWs, and 287 subsequently received treatment or prophylaxis for B. pertussis infection. Direct medical center costs for treatment and prophylaxis were $13,416 and costs for personnel time were $19,500-$31,190. Indirect medical center costs for time lost from work were $51,300-$52,300. The total cost of these investigations was estimated to be $85,066-$98,456. CONCLUSIONS: Frequent B. pertussis exposures had a major impact on our facility. Given the impact of exposures on healthcare institutions, routine vaccination for HCWs may be beneficial.


Assuntos
Centros Médicos Acadêmicos/economia , Busca de Comunicante/economia , Infecção Hospitalar/epidemiologia , Surtos de Doenças/prevenção & controle , Controle de Infecções/economia , Transmissão de Doença Infecciosa do Profissional para o Paciente/estatística & dados numéricos , Coqueluche/epidemiologia , Antibacterianos/economia , Antibacterianos/uso terapêutico , Bordetella pertussis/isolamento & purificação , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/economia , Fidelidade a Diretrizes , Custos Hospitalares , Humanos , Controle de Infecções/organização & administração , Transmissão de Doença Infecciosa do Profissional para o Paciente/economia , Massachusetts/epidemiologia , Isolamento de Pacientes , Recursos Humanos em Hospital , Vacina contra Coqueluche , Estudos Retrospectivos , Coqueluche/economia , Coqueluche/prevenção & controle
18.
Chest ; 151(5): 1011-1017, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28215789

RESUMO

BACKGROUND: The rates of central line-associated bloodstream infections (CLABSIs) in U.S. ICUs have decreased significantly, and a parallel reduction in the rates of total hospital-onset bacteremias in these units should also be expected. We report 10-year trends for total hospital-onset ICU-associated bacteremias at a tertiary-care academic medical center. METHODS: This was a retrospective analysis of all positive-result blood cultures among patients admitted to seven adult ICUs for fiscal year 2005 (FY2005) through FY2014 according to Centers for Disease Control and Prevention National Healthcare Safety Network definitions. The rate of change for primary and secondary hospital-onset BSIs was determined, as was the distribution of organisms responsible for these BSIs. Data from three medical, two general surgical, one combined neurosurgical/trauma, and one cardiac/cardiac surgery adult ICU were analyzed. RESULTS: Across all ICUs, the rates of primary BSIs progressively fell from 2.11/1,000 patient days in FY2005 to 0.32/1,000 patient days in FY2014; an 85.0% decrease (P < .0001). Secondary BSIs also progressively decreased from 3.56/1,000 to 0.66/1,000 patient days; an 81.4% decrease (P < .0001). The decrease in BSI rates remained significant after controlling for the number of blood cultures obtained and patient acuity. CONCLUSIONS: An increased focus on reducing hospital-onset infections at the academic medical center since 2005, including multimodal multidisciplinary efforts to prevent central line-associated BSIs, pneumonia, Clostridium difficile disease, surgical site infections, and urinary tract infections, was associated with progressive and sustained decreases for both primary and secondary hospital-onset BSIs.


Assuntos
Bacteriemia/epidemiologia , Candidemia/epidemiologia , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Pseudomonas/epidemiologia , Infecções Estafilocócicas/epidemiologia , APACHE , Centros Médicos Acadêmicos , Bacteriemia/etiologia , Hemocultura , Candidemia/etiologia , Gastroenteropatias/complicações , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Positivas/complicações , Humanos , Unidades de Terapia Intensiva , Modelos Lineares , Modelos Logísticos , Mortalidade , Infecções por Pseudomonas/complicações , Infecções Respiratórias/complicações , Estudos Retrospectivos , Infecções dos Tecidos Moles/complicações , Infecções Estafilocócicas/complicações , Infecção da Ferida Cirúrgica/complicações , Estados Unidos/epidemiologia , Infecções Urinárias/complicações
19.
Open Forum Infect Dis ; 2(4): ofv121, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26430698

RESUMO

Background. The use of electronic hand hygiene reminder systems has been proposed as an approach to improve hand hygiene compliance among healthcare workers, although information on efficacy is limited. We prospectively assessed whether hand hygiene activities among healthcare workers could be increased using an electronic hand hygiene monitoring and reminder system. Methods. A prospective controlled clinical trial was conducted in 2 medical intensive care units (ICUs) at an academic medical center with comparable patient populations, healthcare staff, and physical layout. Hand hygiene activity was monitored concurrently in both ICUs, and the reminder system was installed in the test ICU. The reminder system was tested during 3 administered phases including: room entry/exit chimes, display of real-time hand hygiene activity, and a combination of the 2. Results. In the test ICU, the mean number of hand hygiene events increased from 1538 per day at baseline to 1911 per day (24% increase) with the use of a combination of room entry/exit chimes, real-time displays of hand hygiene activity, and manager reports (P < .001); in addition, the ratio of hand hygiene to room entry/exit events also increased from 26.1% to 36.6% (40% increase, P < .001). The performance returned to baseline (1473 hand hygiene events per day) during the follow-up phase. There was no significant change in hand hygiene activity in the control ICU during the course of the trial. Conclusions. In an ICU setting, an electronic hand hygiene reminder system that provided real-time feedback on overall unit-wide hand hygiene performance significantly increased hand hygiene activity.

20.
Am J Infect Control ; 42(4): 421-2, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24559597

RESUMO

A near-miss patient incident involving body fluid seeping from a mattress led to a visual inspection of 656 hospital bed mattresses of which 177 were contaminated because of occult damage to mattress covers.


Assuntos
Leitos , Patógenos Transmitidos pelo Sangue/isolamento & purificação , Líquidos Corporais , Exposição Ambiental , Humanos , Masculino
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