bluuebunny/crossref_metadata_2025_split huggingface dataset:
Observational Bias Within Hospital-Wide Hand Hygiene Program
Authors: Marques Amy , Tucker Robert , Klompas Michael 
Published: November 2020

Background:
Hand hygiene (HH) is critical to prevent hospital-acquired infections. Running a successful HH program requires valid and accurate HH data to monitor the status and progress of HH improvement efforts. HH data are frequently subject to variable forms of bias, for which considerations must be made to enhance the validity of HH data. Objective: We assessed the extent to which observers may be prone to report more favorable HH rates when observing healthcare workers from the same professional group versus members of other job categories. Methods: We analyzed HH data from 48,543 electronically collected observations conducted by frontline healthcare workers in a 793-bed acute-care hospital from January 1, 2019, through July 31, 2019. All auditors received training on HH observations and proper use of the data collection application. Compliance data were sorted into peer versus nonpeer observations by profession. We compared HH compliance rates for members of each professional group when monitoring peers versus nonpeers. We further stratified results by ancillary professions (central transport, unit associates, food services, pharmacy, phlebotomy, rehabilitation services, and respiratory therapy) versus nonancillary professions (doctors, nurses, physician assistants, patient care assistants). Results: Of 12,488 ancillary observations, 7,184 (57.5%) were peer observations and 36,055 were nonancillary observations, of which 15,942 (44.2%) were peer observations. The percentage of peer-to-peer observations versus nonpeer observations varied by profession, ranging from 96% of central transport workers and 91% of environmental services observations to 21% of patient care assistants and 34% of physician’s assistants. Average compliance rates for peer versus nonpeer observations in ancillary groups were 98% (95% CI, 98.7%–99.2%) versus 83% (95% CI, 82.5%–84.5%). Average compliance rates nonancillary groups were 92% (95% CI, 92.0%–92.8%) for peers versus 88% (95% CI, 87.8%–88.7%) for nonpeers (Table 1). Conclusions: We documented a propensity for some categories of healthcare workers to record discrepant rates of HH compliance when observing members of the same peer group versus others. This effect was more pronounced amongst ancillary versus nonancillary services. This study adds to the literature of potential sources of bias in HH monitoring programs. Operational changes in HH program data collection may be warranted to try to mitigate these biases such as increasing the frequency of validation exercises conducted by nonaffiliated observers, weighting peer versus nonpeer observations differently, or switching to automated electronic monitoring systems.Funding: NoneDisclosures: None
Occupational Health Hazards Among Medical Waste Handlers in Ahmadu Bello University Teaching Hospital Zaria Northwest Nigeria
Authors: Onoja-Alexander Mary , Zakari Usman , Alexander Onoja , Umar Ahmad , Ajumoka Emmanuel , Igboanusi Chinedu John-Cemillus , Aliyu Alhaji 
Published: November 2020

Background: Occupational injuries are important public health issues, especially among healthcare workers. The medical waste handler is at risk of hazards posed by medical waste as well as from the environment. The aim of the study was to determine occupational hazards that hospital waste handlers in Ahmadu Bello University Teaching Hospital, Zaria, were exposed to and to assess their knowledge and practice of safety measures. Methods: A cross-sectional descriptive study was conducted among 79 medical waste handlers in Ahmadu Bello University Zaria using a multistage sampling technique. Data were collected using structured self-administered and interviewer administered questionnaire and analyzed using SPSS version 20 software with significance set at P < .05. Results: More than half of the respondents (56.4%) were men, and most (70.3%) had <5 years work experience. Most of the respondents (60.8%) had had an injury in the previous 6 months. The most common injuries were falling on a slippery floor (48.1%), contact/irritant dermatitis (40.5%), and 34.2% from stress. Only 45.6% received treatment following injury at the work place. Most respondents (75.9%) were aware of safety devices, and more than half (51.9%) received their information from special safety training. More than half of the respondents (51.1%) had poor knowledge of use of safety devices, and 60% had special training in occupational safety. Most respondents (89.9%) used heavy-duty rubber hand gloves, but only 5.1% used aprons. Also, 82.3% of respondents used these devices regularly at work, and more than half of respondents (62%) had been immunized against hepatitis. Also, 65.8% practiced universal precautions. Occupational injury was higher among those aged 15–19 years (occupational injury rate, 75%) compared to those aged 34–39 years (occupational injury rate, 16%). A positive association was detected between gender and injury in the last 6 months; injury was more common among men (43%) than among women (15%). Conclusions: Among respondents, there was a high level of injury and poor knowledge of the use of protective devices. Regular use of protective measures was not commensurate with the reported level of awareness. Concerted efforts are needed to ensure the safety of the medical waste handlers in his work place.Funding: NoneDisclosures: None
Octenidine Body Wash and Nasal Gel Reduces MRSA Bacteremia
Authors: Ang Brenda , Chow Angela 
Published: November 2020

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in Singapore hospitals. The Ministry of Health (MOH) has set a reduction of MRSA bacteremia as a key performance indicator for publicly funded hospitals, resulting in the adoption of various strategies to achieve this goal. Decolonization regimens have been implemented in different institutions with variable outcomes. In Tan Tock Seng hospital (TTSH), octenidine was chosen instead of chlorhexidine for its gentler action on the skin, and nasal octenidine was chosen instead of mupirocin (which has a high resistance rate) for nasal decolonization. Methods: All patients admitted to TTSH are screened for MRSA on admission. Patients who are either colonized or infected with MRSA are either placed in isolation rooms (when available) or are placed in cohorts in MRSA wards. The Department of Infection Prevention and Control (IPC) keeps a database of all patients with positive cultures for MRSA, including bacteremia. We used this database to implement and evaluate targeted strategies in such MRSA wards. In January 2018 we began a pilot project in 1 ward, whereby all patients had intranasal octenidine gel applied twice a day for 5 days, as well as daily octenisan baths throughout their stay in the ward. The outcome of interest was MRSA bacteremia occurring ≥3 days after admission. This quasi-experimental before-and-after study was conducted from January 2016 to September 2019 with January 2018 excluded as a washout month. Results: In total, 44 observational months (24 months before the intervention 20 months after the intervention) and 4,309 patients were included. In the preintervention period, 12 bacteremia cases occurred among 2,333 patients (0.5%); in the postintervention period, 4 MRSA bacteremia cases occurred in 1,976 patients (0.2%): RR, 0.49 (95% CI, 0.13–1.22), 1-sided P = .07. The rate of MRSA bacteremia was halved, but it did not reach statistical significance due to the small number of cases overall. The products were well tolerated by patients and staff who applied them to nonambulant patients. Conclusions: Octenidine baths and nasal gel reduced risk of MRSA bacteremia in a cohort of MRSA-positive patients, and this strategy may be preferable to the universal use of antiseptic baths.Funding: NoneDisclosures: None
Operating Room Nurses’ Knowledge of Surgical Site Infection Prevention Measures
Authors: Oliveira Adriana 
Published: November 2020

Background:
Surgical site infection (SSI) stands out among healthcare-related infections as one of the most important globally due to its associated morbidity and mortality. However, it is well known that the transoperative period is recognized as one of the most critical moments for the prevention of SSI. Objective: We evaluated the knowledge of the operating room (OR) nurse coordinators regarding SSI prevention measures. Methods: We conducted a cross-sectional study in 30 large hospitals in the state of Minas Gerais, Brazil, from February 2018 to April 2019. Data were collected through interviews with OR nurse coordinators. Results: Administration time of prophylactic antibiotic administered between 30 and 60 minutes prior to surgery was reported by 84% of the professionals and the suspension of this agent in the first 24 hours was reported by 47.8%. Preoperative hair removal within the operating room was mentioned by 60% of respondents and 36.7% mentioned using a razor. The Safe Surgery program of the WHO was unknown to 6.7% of nurses. Among those who knew about it, 20.8% stated that there was no surgical site demarcation. Presentation of the surgical team occurred before the beginning of the procedure in only 53.3% of the institutions. Patient surveillance for SSI was reported by 93.3% of respondents, but the criteria adopted for the diagnosis of SSI were unknown, even though SSI rates were given for 90% of services, predominantly via meetings (53.5%). Conclusions: The knowledge of nurses related to the prevention of SSI was not satisfactory, pointing to the need for immediate efforts in education and awareness programs. Such programs may facilitate changes in practice through the recognition of surgical patient risk by these professionals, thus leading to better planning and practice during the trans-operative period.Funding: NoneDisclosures: None
Optimizing Sentinel Surveillance to Target Containment of Emerging Multidrug-Resistant Organisms in Regional Networks
Authors: Paul Prabasaj , Slayton Rachel , Kallen Alexander , Walters Maroya , Jernigan John 
Published: November 2020

Background: Successful containment of regional outbreaks of emerging multidrug-resistant organisms (MDROs) relies on early outbreak detection. However, deploying regional containment is resource intensive; understanding the distribution of different types of outbreaks might aid in further classifying types of responses. Objective: We used a stochastic model of disease transmission in a region where healthcare facilities are linked by patient sharing to explore optimal strategies for early outbreak detection. Methods: We simulated the introduction and spread of Candida auris in a region using a lumped-parameter stochastic adaptation of a previously described deterministic model (Clin Infect Dis 2019 Mar 28. doi:10.1093/cid/ciz248). Stochasticity was incorporated to capture early-stage behavior of outbreaks with greater accuracy than was possible with a deterministic model. The model includes the real patient sharing network among healthcare facilities in an exemplary US state, using hospital claims data and the minimum data set from the CMS for 2015. Disease progression rates for C. auris were estimated from surveillance data and the literature. Each simulated outbreak was initiated with an importation to a Dartmouth Atlas of Health Care hospital referral region. To estimate the potential burden, we quantified the “facility-time” period during which infectious patients presented a risk of subsequent transmission within each healthcare facility. Results: Of the 28,000 simulated outbreaks initiated with an importation to the community, 2,534 resulted in patients entering the healthcare facility network. Among those, 2,480 (98%) initiated a short outbreak that died out or quickly attenuated within 2 years without additional intervention. In the simulations, if containment responses were initiated for each of those short outbreaks, facility time at risk decreased by only 3%. If containment responses were initiated for the 54 (2%) outbreaks lasting 2 years or longer, facility time at risk decreased by 79%. Sentinel surveillance through point-prevalence surveys (PPSs) at the 23 skilled-nursing facilities caring for ventilated patients (vSNF) in the network detected 50 (93%) of the 54 longer outbreaks (median, 235 days to detection). Quarterly PPSs at the 23 largest acute-care hospitals (ie, most discharges) detected 48 longer outbreaks (89%), but the time to detection was longer (median, 716 days to detection). Quarterly PPSs also identified 76 short-term outbreaks (in comparison to only 14 via vSNF PPS) that self-terminated without intervention. Conclusions: A vSNF-based sentinel surveillance system likely provides better information for guiding regional intervention for the containment of emerging MDROs than a similarly sized acute-care hospital–based system.Funding: NoneDisclosures: None
Outbreaks of Healthcare-Associated Infections in Sao Paulo State, Brazil: Results From a Statewide Monitoring System
Authors: de Jesus Marçal Heloisa , Madalosso Geraldine , Assis Denise , Padoveze Maria Clara 
Published: November 2020

Background:
Outbreaks of healthcare-associated infections (HAI) are relevant causes of morbidity and mortality. Healthcare-authorities should monitor them to allow prompt interventions, identify tendencies along the time, and develop large scale strategies to avoid new cases and clusters. According to the Brazilian legislation, any outbreak should be reported to health authorities. Sao Paulo State Health Department (Brazil) has a system in place since 2011 to monitor HAI outbreaks. This study aims at describing the 3.5 last year’s results of surveillance system for monitoring HAI outbreaks. Methods:Study design: Quantitative descriptive study. Source of information: Database from HAI outbreak reports, Division of Hospital Infection at Sao Paulo State Health Department. Reports were filled out online by professionals from healthcare settings or regional health authorities according to predefined criteria. Interventions were put in place by the health authorities based on the analysis of each situation in a timely manner. Variables analyzed: Number of reports, local, infection site, type of care unit, causative microorganisms, number of cases, and number of deaths. Results: The number of reports have been stable for 3 years: 2016 (n = 34, 34.7%), 2017 (n = 28, 28.6%), 2018 (n = 25, 25.5%) and the first semester of 2019 (n = 11, 11.2%). These reports encompassed 712 confirmed cases and 123 deaths. The reports were mainly about infection outbreaks; 6 reports were about colonization of multidrug-resistant microorganisms. The bloodstream was the most frequent infection site in the HAI outbreak reports (n = 37, 37.7%), followed by respiratory tract (n = 25, 25.5%), urinary tract (n = 10, 10.2%), and surgical wound (n = 9, 9.2%). HAI outbreaks happened more frequently in intensive care units, including neonatal, pediatric, and adult ICUs (n = 38, 38.8%), followed by clinical and general wards (n = 20, 20.4%), hemodialysis (n = 6, 6.1%), and surgical wards (n = 5, 5.1%). Among reported outbreaks, 62.2% occurred in the capital and the metropolitan region of São Paulo. Microorganisms causing the HAI outbreaks reports were mainly carbapenem resistant, both Klebsiella pneumoniae (n = 28, 28.5%) and Acinetobacter baumannii (n = 12, 12.2%), but carbapenem-susceptible Pseudomonas aeruginosa (n = 7, 7.1%) was also reported. Conclusions: HAI outbreaks reported to health authorities in Sao Paulo may represent only a minute percentage of the total outbreaks, most of which are still not being reported, despite the normative. However, the available data emphasize the importance of developing strategies for intensive care units and hemodialysis units that focus on reducing bloodstream infections caused by multidrug-resistant gram-negative organisms.Funding: NoneDisclosures: None
Outpatient Fluoroquinolone Medication Use Evaluation at an Academic Veterans Affairs Medical Center
Authors: Markley John Daniel , Vaughan Leroy , Stevens Michael , Hitchcock Matthew 
Published: November 2020

Background: Fluoroquinolones (FQs) are one of the most commonly prescribed antibiotic classes in the United States. In recent years, their widespread use has come under heightened scrutiny due potential adverse drug reactions including risks of mental health side effects, serious blood sugar disturbances, and Food and Drug Administration (FDA) black-box warnings for tendinopathy, aortic aneurysm, and dissection. These warnings prompted the Department of Veterans Affairs Pharmacy Benefits Management Service to perform a nationwide FQ utilization review, which identified our facility for potential overuse of FQs in the outpatient setting: 82.2 prescriptions per 1,000 unique patients compared to an average of 48 prescriptions per 1,000 unique patients across all VHA facilities. We then embarked on a FQ medication use evaluation (MUE). Objective: To determine appropriateness of FQ prescribing practices in the outpatient setting. Methods: The study setting was a 399-bed tertiary-care Veterans Hospital with >250 affiliated outpatient clinics in Richmond, Virginia. A retrospective chart review was conducted on a convenience sample of consecutive patients prescribed an FQ from each quarter between April 1, 2018, and March 31, 2019. Chart review included patient demographics, location, FQ used, dose, indication, appropriateness, prescriber, and documentation of patient counseling on FDA black box warnings. Appropriate treatment was defined by national and local antimicrobial therapy guidelines. Results: In total, 265 patients were included the study. Among them, 233 patients (88%) were men and the mean age was 68 years. Overall, 127 patients (48%) were prescribed FQs inappropriately. Primary care clinics and the emergency department (ED) had the highest frequency of inappropriate FQ prescriptions (Fig. 1). Moreover, 92 patients (35%) were prescribed FQs for surgical prophylaxis prior to urological procedures. FQs were most commonly inappropriately prescribed for urinary tract infection (UTI, n =74, 84%) and upper respiratory tract infection (URI, n=27, 84%) (Fig. 2). Documented counseling on FDA black box warnings occurred in 82 cases (31%). Conclusions: In our MUE, outpatient prescribing of FQs was inappropriate nearly 50% of the time. The most commonly documented indications for FQs determined to be inappropriate included UTI and URI. Inappropriate prescriptions most commonly originated from primary care and the emergency department. Urology had the highest volume of FQ prescriptions, which were mostly appropriate surgical prophylaxis based on indication (though an alternative agent would be preferred based on local resistance rates). Documentation of patient counseling for FDA black-box warnings on FQs was uncommon.Funding: NoneDisclosures: None
Healthcare Professionals Perception of Mobile Phone Usage and Hand Hygiene Adhesion in Intensive Care Units
Authors: Sanchez Evelyn , Perdigão-Neto Lauro , dos Santos Sânia Alves , Rizek Camila , Gomez Maria Renata , Martins Roberta , de Oliveira Gaspar , Guimaraes Thais , Boszczowski Icaro , Rossi Flavia , Freire Maristela , Levin Anna , Costa Silvia Figueiredo , Farrel Marina 
Published: November 2020

Background: The introduction of new technologies into the medical field has the duality of improvement and concerns about correct usage and cleaning. Mobile phones are used by healthcare professionals (HCPs) in the work place, and there is not an official policy about their use in health environment. Methods: We asked 60 intensive care unit (ICU) HCPs from 2 units (the burn unit and the internal medicine unit) to participate in an electronic survey about mobile phone usage and hand hygiene compliance; we also cultured the hands and mobile phones of the participants. Unfortunately, 13 HCPs did not participate. Susceptibility testing of the strains was conducted, as well as molecular testing. Results: Overall, 47 HCPs responded to the inquiry: 19% were nurses (9 of 47), 19% were resident physicians (9 of 47), 17% were nursery technicians (8 of 47), 17% were physiotherapists (8 of 47), 13% were cleaning staff (6 of 47), 11% were consultants (5 of 47), and 4% were technicians (2 of 47). Moreover, 26 of 47 participants (55%) were woman and 21 (45%) were men. From all HCP categories, 39 of 47 respondents (83%) reported that they had optimal hand hygiene compliance. However, 92% of respondents had a colonized hand and 90% had a colonized mobile phone. Also, 44 of 47 HCPs (94%) reported that the took their personal mobile phone into the workplace; 40 (85%) reported that they used it during the work day and 35 (74%) reported that they cleaned it. However, 8 HCPs (26%) reported that they had never cleaned the device. All of the HCPs understood that mobile phones can harbor bacteria, and 27 of 47 HCPs (57.45%) indicated that they use 70% alcohol to clean their mobile phones. In contrast, the first choice for hand hygiene was water and soap in 51% of HCPs (24 of 47). Also, 3 HCPs did not have any colonization in the hand culture but had healthcare-associated infection (HAI) pathogens in the mobile phone culture. Conclusions: A policy regarding mobile phone usage in the healthcare setting should be in place, and cleaning of electronic devices in hospitals should be standardized.Funding: NoneDisclosures: NoneFunding: NoneDisclosures: None
Peripherally Inserted Central Catheters Present on Admission and the Risk of Central-Line–Associated Bloodstream Infection
Authors: Burke Patrick , Nickoli Elise , Sitaras Joanne , Mullins Wanda , Dandache Patricia 
Published: November 2020

Background: Patients presenting to hospitals often arrive with peripherally inserted central catheters (PICC) in place upon admission. The admitting facility may not be familiar with that device’s history and the unknown risk for bloodstream infection associated with it often prompts requests for device replacement. A blanket approach to “change all lines” must be balanced with the potential for patient discomfort and insertion-related complications. To better inform our approach to prevention, we determined the incidence of central-line–associated bloodstream infection (CLABSI) in adult patients presenting to hospitals in our health system with a PICC present on admission (POA), relative to those who have a PICC placed after admission (PAA). Methods: This retrospective cohort study included all adult hospital encounters at 11 Cleveland Clinic acute-care hospitals lasting > 2 days in 2018 with electronic medical record nursing care flowsheet documentation of a PICC during the stay. Patients whose admission diagnosis was related to intravascular catheter infection, children aged <18 years, and observation unit encounters were excluded. Patients were categorized as having a PICC POA if a nurse selected that option on a PICC flowsheet, otherwise the patient was categorized has having a PICC PAA. Surveillance for CLABSI was performed in all inpatient locations at all hospitals according to the NHSN protocol. Patients with ≥1 CLABSI were matched to encounters by name and date of admission. Repeat infections occurring to the same patient were excluded. Results: Of the 8,827 eligible hospital encounters, 1,799 (20%) involved a PICC POA and 7,028 (80%) had PICCs PAA. Across 11 hospitals, the median proportion of PICC-associated encounters with a device POA was 15% (range, 8%–25%). Moreover, 23 of the 112 CLABSIs (21%) in our cohort occurred in patients with a PICC POA and 89 (79%) occurred in patients with a PICC PAA (Table 1). The overall relative risk of CLABSI, whether the PICC was placed before or after admission, was 1.00 (95% CI, 0.64–1.60). Conclusions: Patients with a PICC present on admission to our hospitals were no more likely to experience a CLABSI than patients who had a PICC placed after admission. Replacing vascular catheters that are POA may not reduce the risk of CLABSI. With up to 25% of PICC-associated encounters having the device POA, universal device replacement at admission would involve hundreds of patients per year at our multihospital health system.Funding: NoneDisclosures: None