Infection Control and Hospital Epidemiology

BACKGROUND: Peripherally inserted central catheters (PICCs) are increasingly used for vascular access in inpatient settings. Compared to multilumen PICCs, single-lumen PICCs carry a lower rate of complications, including central-line-associated bloodstream infection and thrombosis. Despite this, multilumen PICCs are still overused. METHODS: This quality improvement initiative was implemented across 11 hospitals at New York City Health + Hospitals safety net system...

We studied 83 cardiac-surgery patients with nasal S. aureus carriage who received 4 intranasal administrations of XF-73 nasal gel or placebo <24 hours before surgery. One hour before surgery, patients exhibited a S. aureus nasal carriage reduction of 2.5 log10 with XF-73 compared to 0.4 log10 CFU/mL for those who received placebo (95% CI, -2.7 to -1.5; P < .0001).

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OBJECTIVE: The incidence of surgical site infection (SSI) is highest after colorectal surgery. We assessed the impact of risk factors for SSI using the population attributable fraction (PAF). DESIGN: Retrospective cohort study. SETTING: Portuguese hospitals performing regular surveillance. PATIENTS: We identified patients who underwent colorectal procedures in hospitals that reported colorectal surgeries every year between 2015 and 2019...

OBJECTIVE: Contaminated blood cultures result in extended hospital stays and extended durations of antibiotic therapy. Rapid molecular-based blood culture testing can speed positive culture detection and improve clinical outcomes, particularly when combined with an antimicrobial stewardship program. We investigated the impact of a multiplex polymerase chain reaction (PCR) FilmArray Blood Culture Identification (BCID) system on clinical outcomes associated with contaminated blood cultures...

BACKGROUND: Ordering Clostridioides difficile diagnostics without appropriate clinical indications can result in inappropriate antibiotic prescribing and misdiagnosis of hospital onset C. difficile infection. Manual processes such as provider review of order appropriateness may detract from other infection control or antibiotic stewardship activities. METHODS: We developed an evidence-based clinical algorithm that defined appropriateness criteria for testing for C...

OBJECTIVE: Dental healthcare personnel (DHCP) are at high risk of exposure to coronavirus disease 2019 (COVID-19). We sought to identify how DHCP changed their use of personal protective equipment (PPE) as a result of the COVID-19 pandemic, and to pilot an educational video designed to improve knowledge of proper PPE use. DESIGN: The study comprised 2 sets of semistructured qualitative interviews. SETTING: The study was conducted in 8 dental clinics in a Midwestern metropolitan area...

OBJECTIVE: To describe the effect of a microbiology comment nudge on antibiotic use for asymptomatic bacteriuria (ASB). DESIGN: Single-center, before-and-after, quasi-experimental study. SETTING: Community-based, public, not-for-profit teaching hospital in the southeastern United States. PARTICIPANTS: Adult inpatients with a positive urine culture and the absence of urinary tract infection signs and symptoms. INTERVENTION: Implementation of a microbiology comment nudge on urine cultures...

OBJECTIVE: Many studies have described nosocomial outbreaks of influenza in specialized wards. We evaluated nosocomial transmission of influenza in a pediatric general ward. DESIGN: Retrospective observational study. SETTING: Single secondary hospital. PATIENTS: The study included 814 hospitalized children with influenza between September 2015 and August 2020. METHODS: The medical records of the included children were retrospectively reviewed, and clinical characteristics of children with community-acquired (CA) influenza and hospital-acquired (HA) influenza were determined...

OBJECTIVE: To describe variation in blood culture practices in the neonatal intensive care unit (NICU). DESIGN: Survey of neonatal practitioners involved with blood culturing and NICU-level policy development. PARTICIPANTS: We included 28 NICUs in a large antimicrobial stewardship quality improvement program through the California Perinatal Quality Care Collaborative. METHODS: Web-based survey of bedside blood culture practices and NICU- and laboratory-level practices...

OBJECTIVE: Surveillance of non-ventilator-associated hospital-acquired pneumonia (NV-HAP) is complicated by subjectivity and variability in diagnosing pneumonia. We compared a fully automatable surveillance definition using routine electronic health record data to manual determinations of NV-HAP according to surveillance criteria and clinical diagnoses. METHODS: We retrospectively applied an electronic surveillance definition for NV-HAP to all adults admitted to Veterans' Affairs (VA) hospitals from January 1, 2015, to November 30, 2020...

OBJECTIVE: To estimate the incidence, duration and risk factors for diagnostic delays associated with pertussis. DESIGN: We used longitudinal retrospective insurance claims from the Marketscan Commercial Claims and Encounters, Medicare Supplemental (2001-2020), and Multi-State Medicaid (2014-2018) databases. SETTING: Inpatient, emergency department, and outpatient visits. PATIENTS: The study included patients diagnosed with pertussis ( International Classification of Diseases [ICD] codes) and receipt of macrolide antibiotic treatment...

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In total, 50 healthcare facilities completed a survey in 2021 to characterize changes in infection prevention and control and antibiotic stewardship practices. Notable findings include sustained surveillance for multidrug-resistant organisms but decreased use of human resource-intensive interventions compared to previous surveys in 2013 and 2018 conducted prior to the COVID-19 pandemic.

BACKGROUND: Resistant gram-negative bacteria (R-GNB) colonization in nursing home patients can cause clinical infection and intrafacility transmission. Limited data exist on the roles of age and function on R-GNB colonization. METHODS: A secondary data analysis was performed from a cohort study of 896 patients admitted to 6 Michigan nursing homes between November 2013 and May 2018. Swabs obtained upon enrollment, weekly for 1 month, then monthly until nursing home discharge from 5 anatomical sites were cultured for GNB...

OBJECTIVES: We quantified the percentage of multidrug-resistant organism (MDRO) carriers among repatriated patients. We identified factors associated with MDRO carriage, and we evaluated the yield of MDRO detection per screened body site. DESIGN: Retrospective cohort study. SETTING: A tertiary-care center in Switzerland. PATIENTS: Adult patients after a stay in a healthcare institution abroad. METHODS: Patients were screened for MDRO carriage...

OBJECTIVE: To model the effects of active detection and isolation (ADI) regarding Clostridioides difficile infection (CDI) in the bone marrow transplant (BMT) unit of our hospital. SETTING: ADI was implemented in a 21-patient bone marrow unit. PATIENTS: Patients were bone marrow recipients on this unit. INTERVENTIONS: We compared active ADI, in which patients who tested positive for colonization of C. difficile before their hospital stay were placed under extra contact precautions, with cases not under ADI...

OBJECTIVE: Healthcare workers (HCWs) in long-term care facilities (LTCFs) are disproportionately affected by severe acute respiratory coronavirus virus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). To characterize factors associated with SARS-CoV-2 positivity among LTCF HCWs, we performed a retrospective cohort study among HCWs in 32 LTCFs in the Minneapolis-St Paul region. METHODS: We analyzed the outcome of SARS-CoV-2 polymerase chain reaction (PCR) positivity among LTCF HCWs during weeks 34-52 of 2020...

OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) hospital outbreaks have been common and devastating during the coronavirus disease 2019 (COVID-19) pandemic. Understanding SARS-CoV-2 transmission in these environments is critical for preventing and managing outbreaks. DESIGN: Outbreak investigation through epidemiological mapping and whole-genome sequencing phylogeny. SETTING: Hospital in-patient medical unit outbreak in Toronto, Canada, from November 2020 to January 2021...

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