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Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices

Abstract

OBJECTIVE: The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees.

METHODS: A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups).… Read more

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Meta-analysis on central line-associated bloodstream infections associated with a needleless intravenous connector with a new engineering design

Abstract

BACKGROUND: Intravenous needleless connectors (NCs) with a desired patient safety design may facilitate effective intravenous line care and reduce the risk for central line-associated bloodstream infection (CLA-BSI). We conducted a meta-analysis to determine the risk for CLA-BSI associated with the use of a new NC with an improved engineering design.… Read more

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Multicenter cohort study to assess the impact of a silver-alloy and hydrogel-coated urinary catheter on symptomatic catheter-associated urinary tract infections

Abstract

PURPOSE: The purpose of this study was to determine the effect of a silver-alloy hydrogel catheter on symptomatic catheter-associated urinary tract infections (CAUTIs).

DESIGN: Multicenter before-after non-randomized cohort study.

SUBJECTS AND SETTING: Seven acute care hospitals ranging in size from 124 to 607 beds participated in this study.… Read more

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Comparison of central line-associated bloodstream infection rates when changing to a zero fluid displacement intravenous needleless connector in acute care settings

Abstract

This was a multicenter, quasiexperimental, 140-month, acute care study comparing central line-associated bloodstream infection rates associated with positive or negative intravenous connectors to a zero fluid displacement connector. A decrease in central line-associated bloodstream infections was found after changing from either negative or positive intravenous connectors to the zero fluid displacement connector (P = .004) with total cost savings of over $3 million.… Read more

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Reply to letter to the editor on “comparative efficacy of commercially available alcohol-based hand rubs and World Health Organization-recommended hand rubs”

Abstract

Edmonds SL, Macinga DR, Jarvis WR

Am J Infect Control 2013 May;41(5):474-5

PMID: 23622706… Read more

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In vitro study assessing the antibacterial activity of three silver-impregnated/coated mechanical valve needleless connectors after blood exposure

Abstract

This in vitro study’s purpose was to assess antibacterial activity of 3 different connectors: V-Link (Baxter, Deerfield, IL), Ultrasite Ag (B. Braun, Bethlehem, PA), and MaxGuard (CareFusion, Ontario, CA), impregnated with silver nanoparticles after blood exposure. All 3 silver-coated/impregnated connectors grew Staphylococcus aureus and Staphylococcus epidermidis.… Read more

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Colonization pressure as a risk factor for colonization by multiresistant Acinetobacter spp and carbapenem-resistant Pseudomonas aeruginosa in an intensive care unit

Abstract

OBJECTIVE: To determine factors associated with colonization by carbapenem-resistant Pseudomonas aeruginosa and multiresistant Acinetobacter spp.

METHODS: Surveillance cultures were collected from patients admitted to the intensive care unit at admission, on the third day after admission and weekly until discharge.… Read more

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Comparative efficacy of commercially available alcohol-based hand rubs and World Health Organization-recommended hand rubs: formulation matters

Abstract

BACKGROUND: Use of alcohol-based hand rubs (ABHRs) effectively reduces transmission of pathogenic microorganisms. However, the impact of alcohol concentration and format on product efficacy is currently being debated.

METHODS: Two novel ABHR formulations containing 70% ethanol were evaluated according to American Society for Testing and Materials E1174 (Health Care Personnel Handwash [HCPHW]) and European Norm (EN) 1500 global standards.… Read more

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Socioeconomic impact on device-associated infections in pediatric intensive care units of 16 limited-resource countries: international Nosocomial Infection Control Consortium findings

Abstract

OBJECTIVES: We report the results of the International Nosocomial Infection Control Consortium prospective surveillance study from January 2004 to December 2009 in 33 pediatric intensive care units of 16 countries and the impact of being in a private vs. public hospital and the income country level on device-associated health care-associated infection rates.… Read more

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National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010

Abstract

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most prevalent multidrug-resistant organisms causing health care-associated infections. Limited data are available about how the prevalence of MRSA has changed over the past several years and what MRSA prevention practices have been implemented since the 2006 Association for Professionals in Infection Control and Epidemiology, Inc, MRSA survey.… Read more

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Health care-associated infection outbreak investigations by the Centers for Disease Control and Prevention, 1946-2005

Abstract

Since 1946, Centers for Disease Control and Prevention (CDC) personnel have investigated outbreaks of infections and adverse events associated with delivery of health care. CDC Epidemic Intelligence Service officers have led onsite investigations of these outbreaks by systematically applying epidemiology, statistics, and laboratory science.… Read more

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Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC

Abstract

PURPOSE: To evaluate the impact of country socioeconomic status and hospital type on device-associated healthcare-associated infections (DA-HAIs) in neonatal intensive care units (NICUs).

METHODS: Data were collected on DA-HAIs from September 2003 to February 2010 on 13,251 patients in 30 NICUs in 15 countries.… Read more

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Economic impact of use of chlorhexidine-impregnated sponge dressing for prevention of central line-associated infections in the United States

Abstract

BACKGROUND: The economic impact of adding chlorhexidine gluconate (CHG)-impregnated sponge dressing to standard care (ie, chg-impregnated sponge dressing + skin preparation and transparent film dressing vs skin preparation and transparent film dressing) for the prevention of central-line infections was evaluated.… Read more

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Risk factors and risk adjustment for surgical site infections in pediatric cardiothoracic surgery patients

Abstract

BACKGROUND: The complexity of congenital cardiac defects and the aggressive medical management required to support patients through their recovery place children at high risk for surgical site infection (SSI).

METHODS: We conducted a retrospective review of children undergoing cardiothoracic surgery at a tertiary care referral center between January 1, 2000, and June 30, 2001.… Read more

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Guidelines on blood cultures

Abstract

Just over one-third of sepsis patients have positive blood cultures, mainly due to inadequate sampling volumes (50% of adults have < 1.0 CFU/mL blood) and the prior use of antibiotics. However, 20-30% of sepsis patients are given inappropriate empirical antibiotics. The Clinical and Laboratory Standards Institute guidelines recommend paired culture sets to help discriminate between contaminant organisms and true pathogens; four 10-mL bottles (2 sets) should be used for the initial evaluation to detect about 90-95% of bacteremias and six 10-mL bottles (3 sets) should be used to detect about 95-99% of bacteremias. It has also been shown that the positivity rate increased by 15-35% with resin-based media in patients on antibiotics. For diagnosing catheter-related bloodstream infections, differential time-to-positivity is one method recommended to help determine whether the catheter is truly the source of infection. The proper training of personnel with regard to drawing an appropriate blood volume and the importance of clear labeling of culture bottles is also of critical importance. Furthermore, if the contamination rate is relatively high, hiring dedicated staff who are well-trained in order to get a lower blood culture contamination rate may be cost-effective. It is because high false-positive blood culture rates due to contamination are associated with significantly increased hospital and laboratory charges.

Towns ML, Jarvis WR, Hsueh PR

J Microbiol Immunol Infect 2010 Aug;43(4):347-9

PMID: 20688297… Read more

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Health care-associated bloodstream infections associated with negative- or positive-pressure or displacement mechanical valve needleless connectors

Abstract

BACKGROUND: Health care-associated, central venous catheter-related bloodstream infections (HA-BSIs) are a major cause of morbidity and mortality. Needleless connectors (NCs) are an important component of the intravenous system. NCs initially were introduced to reduce health care worker needlestick injuries, yet some of these NCs may increase HA-BSI risk.… Read more

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Prevention of central venous catheter-associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative

Abstract

OBJECTIVE: The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based intervention.

METHODS: An observational study was conducted in 26 freestanding children’s hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative.… Read more

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Healthcare-associated infection in Italy: annual point-prevalence surveys, 2002-2004

Abstract

OBJECTIVE: Healthcare-associated infections (HAIs) are an important cause of morbidity and mortality worldwide. During the period from 2002 through 2004, a group of Italian hospitals was recruited to conduct HAI point-prevalence surveys.

DESIGN: Three point-prevalence surveys.

METHODS: A total of 9,609 patients were surveyed.… Read more

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Gram-negative bloodstream infections in hematopoietic stem cell transplant patients: the roles of needleless device use, bathing practices, and catheter care

Abstract

BACKGROUND: Between August 1 and October 30, 1998 (outbreak period), an increased incidence of central venous catheter (CVC)-associated gram-negative bacterial bloodstream infection (GN-BSI) was detected in hematopoietic stem cell transplantation (HSCT) candidates and recipients in an outpatient HSCT unit. The objectives of the present study were to determine strategies for controlling the outbreak and identify risk factors for GN-BSI.… Read more

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National point prevalence of Clostridium difficile in US health care facility inpatients, 2008

Abstract

BACKGROUND: Recent published estimates of Clostridium difficile infection (CDI) incidence have been based on small numbers of hospitals or national hospital discharge data. These data suggest that CDI incidence is increasing.

METHODS: We conducted a point prevalence survey of C difficile in inpatients at US health care facilities.… Read more

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Decision instrument for the isolation of pneumonia patients with suspected pulmonary tuberculosis admitted through US emergency departments

Abstract

STUDY OBJECTIVE: Many patients with pneumonia are admitted to respiratory isolation for possible tuberculosis (TB), but most do not have active TB. We created a decision instrument to predict which pneumonia patients do not need admission to a TB isolation bed.… Read more

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Reprocessing and reuse of single-use medical devices used during hemodynamic procedures in Brazil: a widespread and largely overlooked problem

Abstract

BACKGROUND: Several medical devices used during hemodynamic procedures, particularly angiographic diagnostic and therapeutic cardiac catheters, are manufactured for single use only. However, reprocessing and reuse of these devices has been reported, to determine the frequency of reuse and reprocessing of single-use medical devices used during hemodynamic procedures in Brazil and to evaluate how reprocessing is performed.… Read more

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National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities, 2006

Abstract

BACKGROUND: Despite methicillin-resistant Staphylococcus aureus (MRSA) being endemic in virtually all US health care facilities, there are no data on the prevalence of MRSA in US health care facilities.

METHODS: We conducted a national prevalence survey of MRSA in inpatients at US health care facilities.… Read more

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The Lowbury Lecture. The United States approach to strategies in the battle against healthcare-associated infections, 2006: transitioning from benchmarking to zero tolerance and clinician accountability

Abstract

Approximately 2,000,000 healthcare-associated infections (HAIs) annually occur in US healthcare facilities and lead to approximately 60,000 90,000 deaths and cost $17 29 billion dollars. Such HAIs are an equal, if not more common problem, worldwide. Many evidence-based HAI prevention guidelines exist.… Read more

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Reduction in surgical site infections in neurosurgical patients associated with a bedside hand hygiene program in Vietnam

Abstract

OBJECTIVE: We conducted an intervention study to assess the impact of the use of an alcohol-chlorhexidine-based hand sanitizer on surgical site infection (SSI) rates among neurosurgical patients in Ho Chi Minh City, Vietnam.

DESIGN: A quasi-experimental study with an untreated control group and assessment of neurosurgical patients admitted to 2 neurosurgical wards at Cho Ray Hospital between July 11 and August 15, 2000 (before the intervention), and July 14 and August 18, 2001 (after the intervention).… Read more

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Nationwide outbreak of red eye syndrome associated with transfusion of leukocyte-reduced red blood cell units

Abstract

OBJECTIVE: To characterize red eye reactions occurring within 24 hours after receipt of units of leukocyte-reduced red blood cells, determine their etiology, and investigate their potential link to transfusion.

METHODS: We conducted a survey of transfusion facilities nationwide to determine the scope and magnitude of the reactions; performed case-control and cohort studies among transfused patients at the facility where most reactions occurred; and performed animal experiments, using cellulose acetate derivatives extracted from leukocyte-reduction filters and filter precursors, to reproduce reactions.… Read more

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Infectious diseases physicians’ preferences for continuing medical education on antimicrobial resistance and other general topics

Abstract

A 19-item survey instrument was designed and mailed by the Infectious Diseases Society of America to its membership to determine the media preferred by infectious diseases physicians for continuing medical education on general topics and on antimicrobial resistance. The objective of the survey was to offer the developers of educational programs knowledge on which to base more-effective ways to deliver educational materials to physicians in this specialty.… Read more

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Incidence of pediatric and neonatal intensive care unit-acquired infections

Abstract

OBJECTIVE: To compare the cumulative incidence of infections acquired in the pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU).

DESIGN: Estimation of the cumulative incidence of infections with data obtained from the Pediatric Prevention Network (PPN) point-prevalence survey and observed rates from the National Nosocomial Infections Surveillance (NNIS) system.… Read more

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Pyrogenic reactions in hemodialysis patients, Hanoi, Vietnam

Abstract

Of 33,111 patients admitted to a large hospital in Vietnam from November 2000 through July 2001, a total of 303 were undergoing hemodialysis and had pyrogenic reactions (ie, fever and/or rigors). Ten case patients (3.3%) had documented bacteremia; pathogens were largely waterborne microorganisms.… Read more

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A multicenter evaluation of tuberculin skin test positivity and conversion among health care workers in Brazilian hospitals

Abstract

SETTING: Four general Brazilian hospitals.

OBJECTIVE: To assess the occupational risk of Mycobacterium tuberculosis (TB) in participating hospitals.

DESIGN: In phase one of this longitudinal study, a cross-sectional survey documented baseline tuberculin skin test (TST) positivity rates. In phase two, TST conversion rates were evaluated in participants with an initial negative two-step TST.… Read more

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Use of antimicrobial agents in United States neonatal and pediatric intensive care patients

Abstract

OBJECTIVE: Antimicrobial use contributes to the development of emergence and dissemination of antimicrobial-resistant bacteria among intensive care unit (ICU) patients. There are few published data on antimicrobial use in neonatal (NICU) and pediatric ICU (PICU) patients.

METHODS: Personnel at 31 Pediatric Prevention Network hospitals participated in point prevalence surveys on August 4, 1999 (summer) and February 8, 2000 (winter).… Read more

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Saline-filled breast implant contamination with Curvularia species among women who underwent cosmetic breast augmentation

Abstract

BACKGROUND: During December 2000-July 2001, black sediment was noted in saline-filled silicone breast implants of women who had undergone revision surgery at facility A. Curvularia fungus was isolated from implant saline.

METHODS: To identify risk factors for contamination with Curvularia species, we performed case-control, retrospective cohort, and laboratory studies and conducted procedural reviews.… Read more

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Neonatal sepsis in Egypt associated with bacterial contamination of glucose-containing intravenous fluids

Abstract

BACKGROUND: Rates of sepsis exceeding 50% in a neonatal intensive care unit (NICU) in Cairo, Egypt, were not controlled by routine antimicrobial therapy. We investigated these conditions in September 2001.

METHODS: Case series and retrospective cohort studies were conducted on 2 groups of NICU infants admitted to an academic medical center between February 12 and July 31, 2001.… Read more

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TST reversion in a BCG-revaccinated population of nursing and medical students, São Paulo, Brazil, 1997-2000

Abstract

SETTING: A major university in São Paulo, Brazil, where vaccination against tuberculosis (TB) with bacille Calmette-Guerin (BCG) was routinely offered to first-year medical and nursing students.

OBJECTIVES: To estimate the probability of negative tuberculin skin test (TST) results over a 4-year period following BCG revaccination, and to evaluate the effect of factors associated with reversion.… Read more

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Comparison of routine glove use and contact-isolation precautions to prevent transmission of multidrug-resistant bacteria in a long-term care facility

Abstract

OBJECTIVES: To compare routine glove use by healthcare workers for all residents, without use of contact-isolation precautions, with contact-isolation precautions for the care of residents who had vancomycin-resistant enterococci or methicillin-resistant Staphylococcus aureus isolated from a clinical culture.

DESIGN: Random allocation of two similar sections of the skilled-care unit to one of the infection-control strategies during an 18-month study period.… Read more

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The state of the science of health care epidemiology, infection control, and patient safety, 2004

Abstract

Being aware and implementing the latest and best scientific evidence in infection control and health care epidemiology is critical to enhancing patient outcomes. In this review, the latest published scientific data in health care epidemiology and patient safety were reviewed for the period May 2003-May 2004.… Read more