bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Site Infection Trend Analysis Following Colon Surgeries, National Healthcare Safety Network, 2009–2018
Authors: Li Qunna , Soe Minn , Nkwata Allan , Russo Victoria , Dudeck Margaret , Edwards Jonathan 
Published: November 2020

Background: Hospitals have submitted surveillance data for surgical site infections (SSIs) following colon surgeries (COLO) to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) since 2005. COLO SSI data submissions to NHSN have increased substantially beginning in 2012 as result of a Centers for Medicare and Medicaid Services (CMS) mandatory reporting requirement that began that year. A trend analysis of COLO SSIs, using data submitted to NHSN, has not been previously reported. To estimate the national trend of COLO SSI rates, we analyzed data reported from acute-care hospitals during 2009–2018. Methods: We analyzed inpatient adult COLO procedures with primary closure and resulting deep incisional primary and organ-space SSIs detected during the same hospitalization or rehospitalization in the same hospital. SSIs reported as infection present at time of surgery (PATOS) were included in the analysis. A protocol change that reprioritized COLO above small bowel surgery (SB) in the multiprocedural abdominal operations selection list for SSI attribution beginning in 2013 was a potential interruption to COLO SSI outcome. An interrupted time series with mixed-effects logistic regression was used to estimate the annual change in the log odds of COLO SSI. The estimates were adjusted for the following variables: hospital bed size, gender, emergency, trauma, general anesthesia, scope, ASA score, wound classification, medical school affiliation type, procedure duration and age. We also assessed the slope and level change of log odds before and after 2013. Results: The number of hospitals and procedures increased and then stabilized after 2012 (Table 1). The annual crude SSI rates ranged from 2.40% to 3.10%. There was no statistically significant slope change in 2013 and after. Compared to 2009–2012, the log odds of COLO SSI increased in 2013–2018 (OR, 1.1975; P < .0001). Based on this model, we estimate a 0.58% annual decrease in the odds of having a COLO SSI during 2009–2012 and 2013–2018 after controlling for the aforementioned variables (Table 2). Conclusions: We observed a substantial increase in the volume of hospitals and procedures reported to the NHSN since 2012 and an increase in odds of having a COLO SSI in 2013–2018 associated with surveillance protocol changes. After adjusting for these changes, we found a slight annual decrease in the overall odds of COLO SSI. Greater prevention efforts are needed for COLO SSI.Funding: NoneDisclosures: None
Targeted Assessment for Prevention: A Statewide Collaborative
Authors: Hou Cindy , Davila Shannon , Miller Mary , Hiester Ashlee , Hosmer Katherine , Kelley LaKisha 
Published: November 2020

Background: Infection preventionists (IPs) are the backbone of the quality and safety matrix of their organizations. Tools to help locate potential gaps can provide unique viewpoints from frontline staff. The CDC provides a Targeted Assessment for Prevention (TAP) strategy that identifies vulnerabilities in the prevention of healthcare-associated infection (HAIs). Methods: A statewide quality improvement organization, partnering with the CDC TAP team, administered TAP facility assessments for catheter-associated urinary tract infection (CAUTI), central-line–associated bloodstream infection (CLABSI), and Clostridioides difficile infection (CDI) to a collaborative of 15 acute-care and 2 long-term acute hospitals. More than 800 respondents filled out surveys based on their individualized perceptions of infection prevention practices. Results: The survey results yielded the following lagging indicators: lack of awareness of nursing and physician champions, need for competency-based training of clinical equipment, and feedback on device utilization. At the hospital system level, one improvement team focused on CDI, uncovered leading and lagging areas in general infrastructure, antibiotic stewardship, early detection and appropriate testing, contact precautions, and environmental cleaning. To culminate the TAP collaborative, the cohort of organizations, supported by interdisciplinary teams, participated in a full-day TAP workshop in which they reviewed detailed analyses of their HAI data and assessment results, shared best practices for infection prevention and planned for specific improvement projects using the plan-do-study-act model. Conclusions: Results of a statewide analysis of HAI prevention data and opportunities at a local level were reviewed. The TAP strategy can be used to target opportunities for improvement, to assess gaps in practice, and to develop and implement interventions for improving outcomes. Healthcare facilities and quality improvement organizations can drive infection prevention actions.Funding: NoneDisclosures: None
The Burden of Gastroenteritis Outbreaks in Long-Term Care Settings in Philadelphia, 2009–2018
Authors: Kang Hansol , Coffin Susan , Peritz Tiina 
Published: November 2020

Background: Gastroenteritis causes significant morbidity and mortality in long-term care facility (LTCF) residents, a growing population within the United States. Methods: We conducted a retrospective cross-sectional study in LTCFs in Philadelphia County from 2009 to 2018. Outbreak characteristics and interventions were extracted from Philadelphia Department of Public Health’s (PDPH) database, and quality data on all LTCFs was extracted from the CMS Nursing Home Compare database. Results: We identified 121 gastroenteritis outbreaks in 49 facilities. Numbers of affected patients ranged from 2 to 211 patients (median patient attack rate, 17%). Staff were reported ill in 94 outbreaks (median staff attack rate, 5%). Outbreak facilities were associated with higher occupancy rates (91% vs 88%; P = .033) and total bed numbers (176 vs 122; P = .071) when compared to nonoutbreak facilities. Higher rates of staff illness were associated with prolonged outbreaks (13% vs 4%; P < .001) and higher patient illness rates (9% vs 4%; P = .012). Prolonged outbreaks were associated with lower frequency of cohorting for outbreak management (13% vs 41%; P = .046). Conclusions: This study is the largest published analysis of gastroenteritis outbreaks in LTCFs. Facility characteristics and staff disease 20 activity were associated with more severe outbreaks. Heightened surveillance for gastrointestinal symptoms among staff and increased 21 use of cohorting might reduce the risk of prolonged gastroenteritis outbreaks in LTCF.Funding: NoneDisclosures: None
The Daily Direct Costs of Isolating Patients Identified With Highly Resistant Microorganisms
Authors: Dijk Manon van , holt t , Severin tte , Polinder Suzanne , Vos M. 
Published: November 2020

Background: Isolation precautions are recommended when caring for patients identified with highly resistant microorganisms (HRMOs). However, the direct costs of isolating patients are largely unknown. Therefore, we aimed to obtain detailed information on the daily direct costs associated with isolating patients identified with HRMO. Methods: This study was performed from November until December 2017 on a 12-bed surgical ward. This ward contained solely isolation rooms with an anteroom. The daily direct costs of isolation were based on three cost items: (1) additional personal protective equipment (PPE); measured by counting the consumption of empty packaging materials, (2) cleaning and disinfection of the isolation room; based on the costs of an outsourced cleaning company, and (3) additional workload for healthcare workers; based on literature and multiplied by the average gross hourly salary of nurses. A distinction was made between the costs for strict isolation, contact-plus isolation, and contact isolation. Results: During the study period, 26 patients were nursed in isolation because of HRMO carriage, resulting in a total of 304 isolation days (median 7 isolation days; range 1-44). Gloves were consumed the most and hair caps the least. The average daily direct costs of isolation were the least expensive for contact isolation, €28/$31, and the most expensive for strict isolation, €41/$47. Conclusions: By using a novel, easy method to estimate consumption of PPE, we conclude that the daily direct costs of isolating a patient, differs per type of isolation. Insight into the direct costs of isolation is of utmost importance when developing or revising policies.Funding: NoneDisclosures: None
The Impact of a Best-Practice Advisory on Inpatient Use of Piperacillin-Tazobactam
Authors: Peterson Katherine , Smith Lindsay , Ahern John , Tompkins Bradley 
Published: November 2020

Background: Antibiotic “time outs” have been identified as a way to decrease inappropriate use of antibiotics in hospitals.1 The University of Vermont Medical Center created a best-practice advisory (BPA) to alert clinicians to review piperacillin-tazobactam prescriptions after 72 hours (Fig. 1). Data examining the use of a BPA as a method to prompt clinicians to perform an antibiotic “time out” are limited. Objective: The purpose of our retrospective study was to evaluate the effectiveness of the BPA on the rate of piperacillin-tazobactam prescribing as measured by defined daily dose per 1,000 patient days (DDD). Methods: The BPA was integrated into the electronic health record and designed to activate once piperacillin-tazobactam has been prescribed for ≥72 hours. Under approval of the University of Vermont’s Institutional Review Board, administered data for piperacillin-tazobactam and 3 control antibiotics (cefazolin, ceftriaxone, and meropenem) were collected for 1 year prior to and 1 year following the launch of the BPA. Administered data were converted to DDD, and an interrupted time-series analysis was performed to evaluate for changes in antibiotic use. Results: The data included 7,094 patients in the preintervention group and 6,661 patients in the postintervention group. The BPA fired 1,478 times. The prescribing rate of piperacillin-tazobactam 1 year prior to the BPA was 32.34 DDD and decreased every month both before (−1.22 DDD) and after (−0.27 DDD) the BPA initiation, with no significant difference in prescribing trends (P = .10). Meropenem prescribing in the BPA era increased each month compared to the pre-BPA period (1.16 DDD; P = 0.02), whereas cefazolin use (P = .93) and ceftriaxone (P = .09) use did not significantly change. Conclusions: The data show that piperacillin-tazobactam utilization at our institution is decreasing. Considering that this trend started prior to the launch of the BPA and that rate of decline remained unchanged post-BPA, we conclude that the BPA did not further impact our piperacillin-tazobactam consumption. It is possible that other factors influencing prescribing account for the observed decline, including an institution-wide educational campaign regarding the appropriate use of broad-spectrum antibiotics that was initiated in the months prior to the BPA. The reason for the significant rise in meropenem post-BPA is unclear. This may be unrelated to the BPA; however, it requires further investigation.1. Core elements of hospital antibiotic stewardship programs. Centers for Disease Control and Prevention website. https://www.cdc.gov/antibioticuse/healthcare/implementation/core-elements.html. Updated July 19, 2019. Accessed October 6, 2019.Funding: NoneDisclosures: None
The Impact of Changing to an Algorithm-Based Clostridioides difficile Test on the Decision to Treat Clostridioides difficile
Authors: Dbeibo Lana , Williams Joy , Sadowski Josh , Fadel William , Winn Vera , Beeler Cole , Kelley Kristen , Webb Douglas Houston , Kara Areeba 
Published: November 2020

Background: Polymerase chain reaction (PCR) testing for the diagnosis of Clostridioides difficile infection (CDI) detects the presence of the organism; a positive result therefore cannot differentiate between colonization and the pathogenic presence of the bacterium. This may result in overdiagnosis, overtreatment, and risking disruption of microbial flora, which may perpetuate the CDI cycle. Algorithm-based testing offers an advantage over PCR testing as it detects toxin, which allows differentiation between colonization and infection. Although previous studies have demonstrated the clinical utility of this testing algorithm in differentiating infection from colonization, it is unknown whether the test changes CDI treatment decisions. Our facility switched from PCR to an algorithm-based testing method for CDI in June 2018. Objective: In this study, we evaluated whether clinicians’ decisions to treat patients are impacted by a test result that implies colonization (GDH+/Tox−/PCR+ test), and we examined the impact of this decision on patient outcomes. Methods: This is a retrospective cohort study of inpatients with a positive C. diff test between June 2017 and June 2019. The primary outcome was the proportion of patients treated for CDI. We compared this outcome in 3 groups of patients: those with a positive PCR test (June 2017–June 2018), those who had a GDH+/Tox−/PCR+ or a GDH+/Tox+ test result (June 2018–June 2019). Secondary outcomes included toxic megacolon, critical care admission, and mortality in patients with GDH+/Tox−/PCR+ who were treated versus those who were untreated. Results: Of patients with a positive PCR test, 86% were treated with CDI-specific antibiotics, whereas 70.4% with GDH+/Tox+ and 29.25% with GDH+/Tox−/PCR+ result were treated (P < .0001). Mortality was not different between patients with GDH+/Tox−/PCR+ who were treated versus those who were untreated (2.7% vs 3.4%; P = .12), neither was critical care admission within 2 or 7 days of test result (2% vs 1.4%; P = .15) and (4.1% vs 5.4%, P = .39), respectively. There were no cases of toxic megacolon during the study period. Conclusions: The change to an algorithm-based C. difficile testing method had a significant impact on the clinicians’ decisions to treat patients with a positive test, as most patients with a GDH+/Tox−/PCR+ result did not receive treatment. These patients did not suffer more adverse outcomes compared to those who were treated, which has implications for testing practices. It remains to be explored whether clinicians are using clinical criteria to decide whether or not to treat patients with a positive algorithm-based test, as opposed to the more reflexive treatment of patients with a positive PCR test.Funding: NoneDisclosures: None
The Impact of Intervention-Related Risk Factors on the Risk of Ventilator-Associated Pneumonia Is High in a Neurosurgical Intensive Care Unit
Authors: Ershova Ksenia , Khomenko Oleg , Ershova Olga , Savin Ivan , Kurdumova Natalia , Danilov Gleb , Shifrin Michael 
Published: November 2020

Background:
Ventilator-associated pneumonia (VAP) represents the highest burden among all healthcare-associated infections (HAIs), with a particularly high rate in patients in neurosurgical ICUs. Numerous VAP risk factors have been identified to provide a basis for preventive measures. However, the impact of individual factors on the risk of VAP is unclear. The goal of this study was to evaluate the dynamics of various VAP risk factors given the continuously declining prevalence of VAP in our neurosurgical ICU. Methods: This prospective cohort unit-based study included neurosurgical patients who stayed in the ICU >48 consecutive hours in 2011 through 2018. The infection prevention and control (IPC) program was implemented in 2010 and underwent changes to adopt best practices over time. We used a 2008 CDC definition for VAP. The dynamics of VAP risk factors was considered a time series and was checked for stationarity using theAugmented Dickey-Fuller test (ADF) test. The data were censored when a risk factor was present during and after VAP episodes. Results: In total, 2,957 ICU patients were included in the study, 476 of whom had VAP. Average annual prevalence of VAP decreased from 15.8 per 100 ICU patients in 2011 to 9.5 per 100 ICU patients in 2018 (Welch t test P value = 7.7e-16). The fitted linear model showed negative slope (Fig. 1). During a study period we observed substantial changes in some risk factors and no changes in others. Namely, we detected a decrease in the use of anxiolytics and antibiotics, decreased days on mechanical ventilation, and a lower rate of intestinal dysfunction, all of which were nonstationary processes with a declining trend (ADF testP > .05) (Fig. 2). However, there were no changes over time in such factors as average age, comorbidity index, level of consciousness, gender, and proportion of patients with brain trauma (Fig. 2). Conclusions: Our evidence-based IPC program was effective in lowering the prevalence of VAP and demonstrated which individual measures contributed to this improvement. By following the dynamics of known VAP risk factors over time, we found that their association with declining VAP prevalence varies significantly. Intervention-related factors (ie, use of antibiotics, anxiolytics and mechanical ventilation, and a rate of intestinal dysfunction) demonstrated significant reduction, and patient-related factors (ie, age, sex, comorbidity, etc) remained unchanged. Thus, according to the discriminative model, the intervention-related factors contributed more to the overall risk of VAP than did patient-related factors, and their reduction was associated with a decrease in VAP prevalence in our neurosurgical ICU.Funding: NoneDisclosures: None
To Err is Human, To Forget is Device-related: A Cautionary Note for Endoscopists
Authors: Lesho Emil , Fede Jennifer , Vore Kelly , Bronstein Melissa 
Published: November 2020

Background: In the United States, ∼5 million endoscopies are performed annually. Contaminated endoscopes account for more nosocomial infections than any other medical device, but the vast majority of such events go unreported. We found no reports in the literature or the FDA Manufacturer and User Facility Device Experience (MAUDE) database of the incident described below. Methods: During a colonoscopy, the operator noticed resistance while advancing a clipping wire through the channel. A balloon-tipped catheter sheath was then extruded into the colonic lumen. The sheath and endoscope were withdrawn without incident, and the procedure was completed with a different endoscope. According to equipment logs, the last time that type of balloon-tipped catheter was used occurred 20 days prior, resulting in 20 patients having potentially been exposed to an incompletely disinfected device. Interrogation of the endoscope with various inserts revealed that the presence of a retained sheath would allow passage of all types of guide wires, (snips, snares, etc), including the cleaning brush. The only device whose passage would have been prevented by a retained sheath was a vascular clipping device. A review of procedure notes and interviews of involved physicians revealed that such clippings were performed as recently as 2 days prior to the incident, thus reducing the number of potentially exposed to 2, plus the index. The county and state health departments were notified, a MAUDE report was filed, and patients were notified and offered free testing for bloodborne and enteric pathogens. Discussion: The root causes of the exposure included the absence of a closed-loop feedback for removable components (similar to an operating room sponge count), an inexperienced endoscopy technologist, and, in our opinion, a design flaw of the sheath that allows the sheath to enter the channel. Specifically, unlike other sheath brands, this brand lacks a large, irremovable warning flag that precludes channel entry (Fig. 1). Had we not been able to trace the use of each individual endoscope (n = 45) in the clinic and link each to specific patients, procedures, and reprocessing logs, we would have had no way to determine the extent of exposures. This incident, which we present as a cautionary tail to others, highlights (1) a possible equipment design flaw, (2) the importance of closed-loop feedbacks for removable components, (3) the criticality of detailed procedure notes along with granular cleaning and reprocessing logs traceable to every endoscope, and (4) the challenge of communicating risk of disease transmission to patients.Funding: NoneDisclosures: None
Understanding the Short-Term Dynamics of MRSA Between Patients and Their Immediate Environment
Authors: Gibson Kristen , Mody Lona , Sax Hugo , Gontjes Kyle , Cassone Marco , Mang Nora , Wolfensberger Aline 
Published: November 2020

Background:
Methicillin-resistant Staphylococcus aureus (MRSA) colonization of patients and contamination of their immediate environmental surfaces is common in the acute care setting, but there is much to be learned about the dynamics of MRSA transmission over a short period of time. Methods: A prospective, observational time-motion qualitative study was conducted at 2 hospitals: 1 in Michigan (hospital 1) and 1 in Zurich, Switzerland (hospital 2)—between November 2018 and July 2019. Hospitalized patients with a MRSA infection or colonization were enrolled. Microbiologic cultures for MRSA were collected from patient nares, axilla, groin and hands and several high-touch surfaces in their room (bed controls, call button, tray table, etc) at the first visit, and patient hands and high-touch surfaces continued to be swabbed every 90 minutes over the course of 5 hours. Patient hands and environment were disinfected after each swabbing. Clinical data were collected from patient’s medical chart. Results: We recruited 10 MRSA colonized or infected patients for the study with 50 hours of observation and obtained 360 patient and environmental swabs. Most were women (7 of 10); the average age was 52.8 years (Table 1). At the first visit, 8 (80%) patients were MRSA-colonized (at 1 or more body sites) and 5 (50%) rooms were MRSA-contaminated (at 1 or more surfaces). Also, 6 patients (60%) had an active MRSA infection and were actively receiving an anti-MRSA agent (eg, Vancomycin). Among those 6 patients receiving an anti-MRSA agent, 4 patients (67%) and 2 rooms (33%) were contaminated at the first visit. Among those 4 patients not receiving an anti-MRSA agent, all 4 patients (100%) and 3 rooms (75%) were contaminated at the baseline visit. Acquisitions (ie, MRSA recovered from a site it was not previously recovered from) occurred on 3 of 7 patient hands (43%) and on 6 occasions in the room (among 5 patients), most commonly at the toilet seat (2 of 6 times). MRSA prevalence on patient and room surfaces for the 5 patients enrolled at hospital 2 are illustrated in Figure 1, which shows colonization of patient and contamination of environment as well as activities performed by the patient in between culturing. Conclusions: We evaluated transmission of MRSA over brief periods of time; our results show that transmission of MRSA depended on patient activity in the room. Furthermore, degree of patient colonization is reflected by environmental contamination and supports the notion of constant transmission of MRSA from patients to environment.Funding: NoneDisclosures: None