Archive for December 3, 2018

Patient- and hospital-level predictors of vancomycin-resistant Enterococcus (VRE) bacteremia in Ontario, Canada

American Journal of Infection Control November 2018 V.46 N.11 P.1266–1271

Jennie Johnstone, Cynthia Chen, Laura Rosella, Kwaku Adomako, Michelle E. Policarpio, Freda Lam, Chatura Prematunge, Gary Garber on behalf of the Ontario VRE Investigators

Highlights

  • Forty percent of patients with VRE bacteremia died within 30 days.
  • Patients with a bone marrow transplant, solid organ transplant, cancer, or who are admitted to the intensive care unit are at highest risk of VRE bacteremia.
  • Larger hospital size and teaching hospitals were independent predictors of VRE bacteremia.

Background

Data are limited on risk factors for vancomycin-resistant Enterococcus (VRE) bacteremia.

Methods

All patients with a confirmed VRE bacteremia in Ontario, Canada, between January 2009 and December 2013 were linked to provincial healthcare administrative data sources and frequency matched to 3 controls based on age, sex, and aggregated diagnosis group. Associations between predictors and VRE bacteremia were estimated by generalized estimating equations and summarized using odds ratios (ORs) and corresponding 95% confidence intervals (CIs).

Results

In total, 217 cases and 651 controls were examined. In adjusted analyses, patient-level predictors included bone marrow transplant (OR 106.99 [95% CI 12.19–939.26]); solid organ transplant (OR 17.17 [95% CI 4.95–59.54]); any cancer (OR 8.64 [95% CI 3.88–19.21]); intensive care unit (ICU) admission (OR 6.81 [95% CI 3.53–13.13]); heart disease (OR 5.27 [95% CI 2.00–13.90]); and longer length of stay (OR 1.07 per day [95% CI 1.06–1.09]). Hospital-level predictors included hospital size (per increase in 100 beds (OR 1.26 [95% CI 1.07–1.48]) and teaching hospitals (OR 3.87 [95% CI 1.85–8.08]).

Conclusions

Patients with a bone marrow transplant, solid organ transplant, cancer, or who are admitted to the ICU are at highest risk of VRE bacteremia, particularly at large hospitals and teaching hospitals.

FULL TEXT

https://www.ajicjournal.org/article/S0196-6553(18)30576-5/fulltext

PDF

https://www.ajicjournal.org/article/S0196-6553(18)30576-5/pdf

December 3, 2018 at 7:44 am

High-risk Staphylococcus aureus transmission in the operating room: A call for widespread improvements in perioperative hand hygiene and patient decolonization practices

American Journal of Infection Control October 2018 V.46 N.10 P.1134–1141

Randy W. Loftus, Franklin Dexter, Alysha D.M. Robinson

Highlights

  • Intraoperative Staphylococcus aureus multilocus sequence type 5 is hypertransmissible and pathogenic.
  • Intraoperative provider hands and patient skin surfaces are confirmed sources of sequence type 5 transmission.

Background

Increased awareness of the epidemiology of transmission of pathogenic bacterial strain characteristics may help to improve compliance with intraoperative infection control measures. Our aim was to characterize the epidemiology of intraoperative transmission of high-risk Staphylococcus aureus sequence types (STs).

Methods

S aureus isolates collected from 3 academic medical centers underwent whole cell genome analysis, analytical profile indexing, and biofilm absorbance. Transmission dynamics for hypertransmissible, strong biofilm-forming, antibiotic-resistant, and virulent STs were assessed.

Results

S aureus ST 5 was associated with increased risk of transmission (adjusted incidence risk ratio, 6.67; 95% confidence interval [CI], 1.82-24.41; P?=?.0008), greater biofilm absorbance (ST 5 median absorbance ± SD, 3.08 ± 0.642 vs other ST median absorbance ± SD, 2.38 ± 1.01; corrected P?=?.021), multidrug resistance (odds ratio, 7.82; 95% CI, 2.19-27.95; P?=?.002), and infection (6/38 ST 5 vs 6/140 STs; relative risk, 3.68; 95% CI, 1.26-10.78; P?=?.022). Provider hands (n?=?3) and patients (n?=?4) were confirmed sources of ST 5 transmission. Transmission locations included provider hands (n?=?3), patient skin sites (n?=?4), and environmental surfaces (n?=?2). All observed transmission stories involved the within-case mode of transmission. Two of the ST 5 transmission events were directly linked to infection.

Conclusions

Intraoperative S aureus ST 5 isolates are hypertransmissible and pathogenic. Improved compliance with hand hygiene and patient decolonization may help to control the spread of these dangerous pathogens.

FULL TEXT

https://www.ajicjournal.org/article/S0196-6553(18)30464-4/fulltext

PDF

https://www.ajicjournal.org/article/S0196-6553(18)30464-4/pdf

December 3, 2018 at 7:40 am

Rapid diagnostics for bloodstream infections: A primer for infection preventionists

American Journal of Infection Control September 2018 V.46 N.9 P.1060–1068

Charles E. Edmiston, Robert Garcia, Marsha Barnden, Barbara DeBaun, Helen Boehm Johnson

Accurate and rapid antimicrobial susceptibility testing with pathogen identification in bloodstream infections is critical to life results for early sepsis intervention. Advancements in rapid diagnostics have shortened the time to results from days to hours and have had positive effects on clinical outcomes and on efforts to combat antimicrobial resistance when paired with robust antimicrobial stewardship programs. This article provides infection preventionists with a working knowledge of available rapid diagnostics for bloodstream infections.

FULL TEXT

https://www.ajicjournal.org/article/S0196-6553(18)30145-7/fulltext

PDF

https://www.ajicjournal.org/article/S0196-6553(18)30145-7/pdf

December 3, 2018 at 7:37 am

Speaking up about hand hygiene failures: A vignette survey study among healthcare professionals

American Journal of Infection Control August 2018 V.46 N.8 P.870–875

David L.B. Schwappach

Highlights

  • Healthcare professionals who are confronted with breaches in infection control practices often do not speak up.
  • Likelihood to speak up is affected by profession and by hierarchy within profession.
  • Risk to patients and past voicing behaviors are key drivers for speaking up.
  • Resignation to speaking up was high and contributes to withholding voice.
  • Hospital climate explains only a minor fraction of variance in speaking-up intentions.

Background

Speaking up by healthcare professionals (HCPs) is an important resource to reduce risks to patient safety. Due to complex tradeoffs, HCPs are often reluctant to voice their concerns. A survey investigated HCPs’ likelihood to speak up.

Methods

A cross-sectional survey study among HCPs in 5 Swiss hospitals addressed speaking-up behaviors, safety climate, and likelihood to speak up about poor hand hygiene practice described in a vignette. Likelihood to speak up was analyzed using a multilevel regression model.

Results

Of surveyed HCPs (n?=?1217), 56% reported that they would speak up to a colleague with poor hand hygiene practice. Nurses as compared to doctors rated the situation as more realistic (5.25 vs 4.32, P?<?.001), felt more discomfort with speaking up (4.00 vs 3.34, P?<?.001), and reported a slightly lower likelihood of speaking up (4.41 vs 4.77, P?<?.001). Clinical function (hierarchy) was strongly associated with speaking-up behavior (P?<?.001). Higher risk of harm to the patient (P?<?.001) and higher frequencies of past speaking-up behaviors (P?=?.006) were positively associated with the likelihood to speak up. Higher frequencies of past withholding voice (P?=?.013) and higher levels of resignation (P?=?.008) were both associated with a lower likelihood to speak up.

Conclusions

Infection control interventions should empower HCPs to speak up about non-adherence with prevention practices by addressing authority gradients and risk perceptions and by focusing on resignation.

FULL TEXT

https://www.ajicjournal.org/article/S0196-6553(18)30150-0/fulltext

PDF

https://www.ajicjournal.org/article/S0196-6553(18)30150-0/pdf

December 3, 2018 at 7:35 am


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