bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survey for “iCarePATH”: Improving Caregivers’ Perceptions and Attitudes Towards Hand Washing
Authors: Zahradnik Stephanie , Okeny-Owere James , Tsampalieros Anne , Webster Richard , Bedard Pat , Seidman Gillian , Thampi Nisha 
Published: November 2020

Background: Hand hygiene (HH) is the most effective means of preventing healthcare-associated infections (HAI). HH improvement strategies primarily focus on healthcare staff, often overlooking the significant contribution of caregivers to HAI risk. We sought to understand caregivers’ HH knowledge and practices to identify improvement opportunities. Methods: A self-administered survey was developed and distributed to families from June to August 2019; open-ended questions and Likert scales assessed caregivers’ perceptions and practices regarding HH at home and in hospital. HH compliance audits of caregivers entering and exiting inpatient rooms were performed in the same time period. Results: Among 81 caregivers surveyed, median patient age was 4.0 (IQR, 0.9–13.0) years. This was the first admission for 42 patients (53.8%). During this admission, 22 (27.2%) patients had been admitted for ≤1 day and 45 (55.6%) for >3 days. Caregivers reported good knowledge of HH practice, with strongly positive responses to knowledge of HH moments (94%) and proper technique (96%). Caregivers recognized that HH is required of hospital visitors (96%) to protect others (99%) and prevent illness in hospital (93%). Responses were less consistent for performing HH before entering a hospital room (83%), after exiting the room (70%), or after coughing or sneezing (65%). The attitudes of caregivers of children above 2 years were equivocal regarding expectations of their child to wash hands upon entering (40%), or exiting (41%) the hospital room. Multivariable modeling identified higher self-reported HH compliance in caregivers during first admission to hospital, compared to subsequent admissions (OR, 3.15; 95% CI, 1.11–9.65). Reported barriers to HH included hand irritation (27.2%) and perceived HH frequency (18.5%). At the time of survey completion, 62 caregivers (77%) reported not having received HH information during their child’s admission from a healthcare provider or volunteer. Information was most commonly gained from posters (75%) and information in the room (31%). Most caregivers (58.0%) reported that they would prefer to receive HH information in the first 24 hours of admission. Among 200 audits, overall caregiver compliance with HH was 9%; HH before entering the room was 7.2% compared to 11.2% after exiting (P = .33). Conclusions: Reported caregiver knowledge of HH was not reflected in audited practice. Fewer than 1 in 4 had received HH information from healthcare staff. HH education in the hospital environment within the first day of admission provides an opportunity for caregivers to improve compliance as partners in HAI prevention and safer pediatric care.Funding: NoneDisclosures: None
Temporal Change of Risk Factors in Hospital-Acquired Clostridioides difficile Infection Using Time-Trend Analysis
Authors: Song Jiyoun , Cohen Bevin , Zachariah Philip , Liu Jianfang , Larson Elaine 
Published: November 2020

Background: In the past few decades, the epidemiology of Clostridioides difficile infection (CDI) has evolved. Given recent changes in the incidence of CDI and prevention efforts, we investigated temporal changes over a period of 8 years (2009–2016) in the incidence of and risk factors for CDI. Methods: Both pediatric and adult inpatients discharged from hospitals in metropolitan New York City were included. Individual and environmental (eg, pharmacological) risk factors were identified through a matched case-control by the length of stay at a ratio of 1:4. A Cochran–Armitage test or Mann-Kendall test was used to investigate trends of incidence and risk factors. Results: During the study period, 6,038 of 694,849 (0.87%) patients had a positive test for C. difficile during their hospitalization. Of these, 2,659 of 6,038 (44.04%) were identified as hospital-acquired CDI (HA-CDI) and just over half (3,379 of 6,038, 55.96%) were identified as community-acquired CDI (CA-CDI). There were no trends in total CDI incidence rates; rather, we detected downward trends in HA-CDI and upward trends in CA-CDI (Ptrend < .05). Younger patients and patients with lower risk of illness had HA-CDI over time (Ptrend < .05). Antibiotics were administered to more patients over time and in longer cumulative days (+3% and +3.1% per year). We detected a reduction in the receipt of high-risk antibiotics in all cohorts (−0.12% per year) and a decrease in cumulative days of high-risk antibiotics in the cohort with HA-CDI (−1.1% per year). When stratified by the type of high-risk antibiotics, the use of carbapenem, cephalosporins, clindamycin, and monobactam increased (+0.53%, +1.8%, +0.5%, and +0.39% per year, respectively), whereas the use of broad-spectrum penicillins and glycylcycline significantly decreased over time in all cohorts (−1.8% and −0.22% per year). Among the cohorts with HA-CDI, only cephalosporins showed a significant upward trend (+ 5.7% per year) and only fluoroquinolones showed a significant downward trend (−2.2% per year). Lastly, a reduction of proton pump inhibitors and an increased use of histamine-2 blockers were detected in all cohorts (−3.8% and +7.3% per year) (all Ptrend < .05). Conclusions: Although the incidence of HA-CDI decreased, more effort to decrease all antibiotics use and cumulative days should be emphasized as part of antibiotic stewardship. The downward trends of high-risk antibiotics might have been associated with the decrease in the trend of HA-CDI; however, the impact of the trends of risk factors on the trend of HA-CDI should be further investigated.Funding: NoneDisclosures: None
The Great Masquerade: Identification of Clinically Relevant Clostridioides difficile Infections
Authors: Sickbert-Bennett Emily , Stancill Lisa , DiBiase Lauren , Alby Kevin , Weber David Jay 
Published: November 2020

Background: Despite clear guidance for appropriate testing of symptomatic patients for Clostridioides difficile testing (McDonald et al), the ideal testing methodology remains unresolved. Laboratories currently use different algorithms that incorporate enzyme immunoassay (EIA) testing for toxin, glutamate dehydrogenase (GDH) antigen, and polymerase chain reaction (PCR) testing in combination or as a single test. At UNC Hospitals, a large academic hospital with nearly 1,000 beds in the ninth most populous state in the United States, patients are currently tested by an EIA test for toxin and GDH antigen first, and discordant toxin/GDH results are referred for PCR testing. Previous studies have demonstrated that detection of toxin by EIA is a better predictor of C. difficile infection (CDI) complications (Polage et al). Methods: We investigated all patients who were tested for C. difficile from July 2018 to June 2019. Within each testing methodology and result, we assessed the percentage of patients with at least 3 loose stools documented within a 24-hour period, percentage with a severe episode based on white blood cell (WBC) counts >15,000 cells/mL, or percentage with a serum creatinine level >1.5 mg/dL. Fisher-type confidence intervals were calculated for each proportion. Results: Patients positive for C. difficile by the EIA method had 66.9% appropriate loose stool documentation (95% CI, 57.4%–75.5%), whereas patients with EIA-indeterminate (toxin negative, GDH positive) and positive by only PCR had 49.7% appropriate loose stool documentation (95% CI, 42.7%–56.8%). C. difficile patients that tested negative had 48.1% appropriate loose stool documentation (95% CI, 46.0–50.2%). In addition, patients positive by the EIA method had nearly double the proportion of severe disease by WBC or creatinine criteria compared to patients who were either positive by PCR or who tested negative (Table 1). Conclusions: Patients positive for C. difficile by the EIA method were statistically more likely to meet criteria for loose stool documentation. There was no statistically significant difference between patients that tested positive only by PCR or who tested negative. The percentage of patients with severe episode criteria based on WBC or creatinine was nearly doubled between those who tested positive by EIA and PCR (20% vs 10%), although this finding was not statistically significant. The percentage with severe disease (WBC or creatinine) was nearly identical among patients who were positive by PCR and who tested negative. These findings demonstrate that documentation of loose stool is a more sensitive indicator of toxin detection than either clinical parameter, reinforcing the importance of stool documentation in evaluating patients for C. difficile testing.Funding: NoneDisclosures: None
The ICEL Healthcare-Associated Infection Probability Equation
Authors: Moore Mark 
Published: November 2020

Backround: In American hospitals alone, the CDC estimates that hospital acquired infections (HAIs) account for an estimated 1.7 million infections and 99,000 associated deaths each year.1 Although the United states and most industrialized nations have made strides in lowering the overall HAI rate by taking critical steps to reduce HAIs, an overall formula that combines a global risk assessment per patient for HAI acquisition has yet to be established. To address this issue, we developed the ICEL equation. This equation uses a probabilistic argument to estimate the likelihood of HAI acquisition and to promote infection control dialogue among healthcare practitioners from diverse healthcare disciplines. Methods: We defined HAI risk using the ICEL acronym as follows: HAI risk = (I + C + E + L), where I is invasive devices present; C is patient-specific characteristics; E is the average number of pathogenic organisms in the patient environment; and L is the length of stay. A simple scale of 1–10 points is subjectively assigned for each of the following categories:I = (number of invasive devices / surgeries / % body surface areas open)C = Patient specific characteristics (immune system integrity / immunomodulators / radiation exposure / chemotherapy, etc)E = Environmental conditions / cleaning (average number of pathogenic bacteria in room, 100% hand hygiene compliance, patient / staff colonization, etc)L = Length of stay days risk, where 0–3 days is low risk, 4–7 is moderate risk, and 8–10+ is high riskSumming the points for each of the 4 categories, the greatest possible total is 40. A total score of 0–10 indicates low risk of HAI; 11–20 indicates low-to-medium risk of HAI; 20–30 indicates a high risk of HAI; and 30–40 indicates a very high risk of HAI. Results:This equation was designed to stimulate thought and encourage multidisciplinary cooperation among providers, nursing, environmental services, and facilities departments rather than provide an exact number for HAI risk. All of these categories are key players in the determining patient risk of acquiring an HAI. If any of the 4 hospital departments mentioned fails in their duties, the patient is at higher risk of HAI. Conclusions: This categorical HAI risk assessment relies on the subjective medical and environmental knowledge of the assessor to assign risk across the continuum of the healthcare environment. Although it is nearly impossible to provide exact numbers regarding total risk in these risk categories, the goal of the scoring system is to encourage clinical dialogue among hospital staff so that they communicate and collaborate within their specialties and with their peers to assure that each category poses as low a risk as possible, thus driving the total risk for HAI lower.1. https://www.cdc.gov/hai/data/portal/progress-report.htmlFunding: NoneDisclosures: None
The Role of Routine Practice in Healthcare Worker Strategies when Doffing Unfamiliar Personal Protective Equipment
Authors: Chasco Emily , Silva Jaqueline Pereira da , Dukes Kimberly , Baloh Jure , Ward Melissa , Salehi Hugh , Reisinger Heather , Pennathur Priyadarshini , Abbott Loreen Herwaldt 
Published: November 2020

Background: Appropriate doffing of personal protective equipment (PPE) prevents healthcare worker (HCW) self-contamination and spread of pathogens. HCWs may encounter an array of PPE types (eg, gloves, gowns, masks) and designs (eg, masks with elastic ear loops vs ties) during their duties, some of which may be unfamiliar. We know little about how HCWs strategize when doffing unfamiliar PPE. As part of a larger study examining the doffing process and the risk of self-contamination, we used qualitative methods to explore factors influencing HCW PPE doffing strategies. Methods: In total, 70 HCW participants from 2 Midwestern academic hospitals were assigned to 1 of 4 doffing simulation scenarios. In the first 3 scenarios, participants were asked to doff 3 mask designs (n = 10), 2 gown designs (n = 10), or 2 glove designs (n = 10). In the fourth scenario, HCWs with different levels of training (n = 40) participated in 2 doffing simulations randomized per participant: a distraction simulation and a nondistraction simulation (using identical PPE types and designs). In all scenarios, participants were instructed to doff in their usual manner. Doffing performances were video-recorded. Participants then reviewed the recordings and took part in short semistructured interviews about their performance. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Results: When faced with unfamiliar PPE during the simulations, participants were required to problem solve. In so doing, participants reported drawing on their day-to-day routine practices with familiar PPE to inform their doffing strategies. Aspects of routine practice identified as influential included PPE types typically worn, PPE donning and doffing order, doffing frequency, familiar PPE design cues, and experience tailoring strategies to specific patient care contexts. Participants frequently reported the desire to avoid self-contamination as driving doffing strategies and problem solving, but they also noted unique patient care demands related to their specific roles when they explained their doffing decisions. At the same time, HCWs identified lack of familiarity, lack of training, and nonintuitive design as barriers to doffing appropriately when encountering unfamiliar PPE. Conclusions: Different PPE designs may not be interchangeable, and proper doffing techniques may not be intuitive. The previous experiences of HCWs informed their strategies when doffing unfamiliar PPE. However, this practice sometimes caused them to use inappropriate doffing techniques and resulted in self-contamination. This finding has important implications for hospital policies and procedures regarding the introduction of new PPE and indicates that HCWs need training when new items are introduced.Funding: NoneDisclosures: None
The Use of Light Sensors in Alcohol Gel Dispensers to Improve Hand Hygiene Compliance of Health Care Workers
Authors: Gonçalves Priscila , Menezes Fernando Gatti de , Santiago Ana Carolina , Kataoka Laura , Martineli Paula Fernanda , Lucinio Neide Marcela , Ferraz Leonardo Jose Rolim , Victor Elivane da Silva , Prado Marcelo , Gagliardi Guilherme Machado , Marra Alexandre 
Published: November 2020

Background:
Improving adherence to hand hygiene (HH) of healthcare workers (HCWs) is a challenge for health institutions, and the use of technologies has been considered an important strategy within this process. Methods: To evaluate the impact of the use of alcohol-based hand rub gel (ABHR) dispensers with light sensors on the adherence to HH by HCWs. This is a prospective quasi-experimental study with comparative analysis between two 4-bed adult intensive care units at a private, tertiary-care hospital conducted over 22 weeks. An approach detection module with an LED lamp was attached to the ABHR dispenser. As a healthcare personnel approached it, the sensor was activated, and a red light turned on as a visual stimulus for HH. The color of the light changed to blue when HH was performed. All ABHR dispensers had electronic counters, but light sensors were installed only in the 4-bed dispensers of the intervention unit. Throughout the period, direct observation of adherence to HH was performed by 4 nurses who had previously been rated with an excellent coefficient of agreement (κ test = 0.951 and 0.902). At the end of the study, a perception survey was performed with the HCWs. Results: The median activation of ABHR dispensers per week was higher in the intervention unit with 1,004 (IQR, 706–1,455) versus 432 (IQR, 350–587) in the control group (P < .001). The same occurred when compared to the median activation per 1,000 patient days, with 53,069 (IQR, 47,575–67,275) versus 19,602 (IQR, 15,909–24,500) in the control group (P < .001). However, there was no evidence of difference in adherence to HH during direct observation between the 2 groups: 51.0% HH compliance (359 of 704) in the control group and 53.8% HH compliance (292 of 543) in the intervention group (P = .330). The same result emerged when we evaluated the “My Five Moments for HH” and by professional category. HCWs (N=66) answered the perception survey: 66.6% stated that lighting devices caught their attention regularly or most of the time and 59% agreed that the devices motivated HH. Conclusions: Using light sensors in ABHR dispensers can be an effective technology for improving HH. This finding was evident in the evaluation of the number of uses of the ABHR dispensers and in the HCW perceptions. Although direct observation did not show statistical evidence of difference between the groups, adherence was higher in the intervention group.Funding: NoneDisclosures: None
Treatment Outcomes and Subsequent Healthcare Utilization Among Patients With Injection Drug Use–Associated Endocarditis
Authors: Dhanani Muhammad , Acuna-Villaorduna Carlos , Barlam Tamar 
Published: November 2020

Background: Addiction medicine consultation and medication-assisted treatment (MAT) have been promoted as a way to improve outcomes for patients hospitalized with injection drug use–associated endocarditis (IDU-IE). However, IDU-IE outcomes have not been evaluated in settings where these services are commonplace. Objective: In this study, we evaluated IDU-IE outcomes in a setting where involvement of addiction medicine consultants and use of MAT is well integrated into patient care. Methods: Medical records of patients hospitalized with a diagnosis of bacteremia or infective endocarditis (IE) between October 1, 2015, and December 31, 2017, at a safety-net hospital in Boston were screened for evidence of active injection drug use (IDU) within 6 months of hospitalization (as documented by providers or as supported by urine toxicology assays) for suspected or definite IE using modified Duke criteria. Patients without active IDU or IE were excluded, as were those with a diagnosis of IDU-IE over the 6 months prior to the index hospitalization. Demographic parameters, receipt of antibiotics and MAT, other clinical information, and details of rehospitalizations were recorded. Analyses of descriptive statistics were performed. Results: Of 567 subjects screened for inclusion, 47 patients met inclusion criteria. All had opiate use disorder (OUD); 41 patients (87.2%) had polysubstance abuse. Addiction medicine consultation was completed for 41 patients (87.2%). Of the 47 subjects, 23 patients (54.8%) received MAT (methadone or buprenorphine/naloxone) over their entire hospitalization, and 31 patients (73.8%) received MAT for >75% of the index admission. Moreover, 43 patients (91.5%) survived to discharge, of whom 28 (59.6%) completed antibiotic therapy. Relapsed IDU was observed in 33 patients (76.7%). Relapsed IDU trended toward significance among undomiciled patients (OR, 4.07,; 95% CI, 0.93–17.85; P = .06). Also, 24 patients (55.8%) were rehospitalized within 1 year due to infectious complications of IDU; undomiciled patients were readmitted more frequently (OR, 20.45; 95% CI, 1.09–383.99; P = .04). Completion of IDU-IE antibiotic therapy, relapse of IDU, and rehospitalization were not associated with prior AMA discharges, duration or variety of IDU, receipt of MAT during the index admission, or addiction medicine consultation. The rate of readmission due to an infectious complication of IDU within 1 year was unrelated to the proportion of hospital days where MAT was prescribed. Conclusions: In settings with high rates of addiction medicine consultation and in-hospital MAT administration, inpatient interventions targeting OUD may not necessarily be protective against morbidity and rehospitalization. Focusing on housing instability and outpatient continuation of MAT may be beneficial.Funding: NoneDisclosures: None
Two-Year Surveillance of Central-Line–Associated Bloodstream Infections in Non-ICU Wards in a Dutch Teaching Hospital
Authors: Weterings Veronica , Boersma Rinske , Rijen Breda Miranda van , Rijpstra Tom , Kluytmans Jan 
Published: November 2020

Background: Central-line–associated bloodstream infections (CLABSIs) are serious complications of modern health care, leading to increased morbidity, mortality, and costs. Since 2012, a multimodal insertion and care bundle for central venous catheters (CVCs) has been implemented in the intensive care unit (ICU) of the Amphia Hospital Breda, The Netherlands. The implementation of this bundle was associated with sustainable low CLABSI rates (1 per 1,000 CVC days). There was no surveillance of CLABSI in the other departments of the hospital. Objectives: We implemented semiautomated surveillance for CLABSI in non-ICU inpatients. Methods: A single-center, retrospective study was conducted in a 1,370-bed teaching hospital in The Netherlands between January 2017 and December 2018. All hospitalized patients (aged ≥18 years) in non-ICU wards, with a CVC inserted, were screened for CLABSI. CLABSIs were diagnosed using the definitions of the national nosocomial surveillance network PREZIES, excluding infections already present on admission and secondary bloodstream infection. CLABSI rates were calculated as cases per 1,000 CVC days with 95% CIs. Results: In 2017, 14 CLABSI were reported during 4,656 CVC days (3.0 per 1,000 CVC days; 95% CI, 1.8–5.1). In 2018, 13 CLABSIs were reported during 4,995 catheter days (2.6 per 1,000 CVC days; 95% CI, 1.5–4.5). The mean duration of CVC days prior to CLABSI in 2017 and 2018 were 20 days (range, 4–28) and 14 days (range, 4–25), respectively. Most CLABSI events occurred in patients admitted to the hematology ward (13 of 27, 48.1%). Of those, 11 of 13 (84,6%) were patients with an acute myeloid leukemia (AML) and severe mucositis due to the intensive chemotherapy at the time of CLABSI. The remaining cases occurred in patients of 4 different surgical departments. Coagulase-negative staphylococci were the most common organisms recovered (25 of 27, 92.6%). Conclusions: To our knowledge, this is the first report of CLABSI-rates in non-ICU wards in the Netherlands. The CLABSI rates were higher in non-ICU wards compared to the ICU of our hospital. This difference was mainly because of the high CLABSI rate in the patients with AML.Funding: NoneDisclosures: None