bluuebunny/crossref_metadata_2025_split huggingface dataset:
Direct Data Mining from the Electronic Medical Record to Assess and Improve Compliance With Infection Prevention Bundles
Authors: Conner Janet , Ivaska Joan 
Published: November 2020

Background: Bundles have been proven to reduce the risk of healthcare-associated infections and to provide for rapid recognition and response for the best outcome in patients with sepsis. Each element alone does not provide the statistical significance that all elements together allow. Providing near real-time compliance with bundle measures to clinical staff can drive performance improvement with the bundle during the patient’s hospital stay, resulting in improved clinical care and prevention of infection. Methods: In 2019, 3 clinical initiatives were chartered that applied evidence-based bundles for early identification and treatment of sepsis, prevention of healthcare-associated pneumonia (HAP), and prevention of surgical site infection. The bundle included the following elements: assessment of sepsis, measurement of lactic acid, collection of blood culture, timely administration of antibiotics. The HAP bundle included the following elements: assessment of aspiration risk, elevation of the head of the bed, oral care twice daily and preoperatively, and incentive spirometry postoperatively. And the SSI bundle included the following elements: preoperative CHG bath, appropriate preoperative antibiotic, perioperative glucose control, and perioperative temperature control. A multidisciplinary team developed and implemented dashboards that extracted bundle elements from the electronic medical record (EMR) nightly. Bundle compliance was calculated at the individual element level as well as the aggregate. Bundle failure data were available at the patient level as well as in aggregate by care location and provider, allowing for real-time feedback to staff and creation of improvement plans. An unanticipated benefit was the identification and correction of charting inconsistencies. Results: Collection, aggregation, and analysis of bundle compliance data were displayed in a system dashboard, and data were refreshed nightly. This approach allowed us to display overall bundle compliance at the facility and system level, including a heat map showing each facility’s compliance with the bundle and each associated element. Utilization of an EMR dashboard allowed for performance review on 100% of eligible patients rather than a sample, as occurs with manual review and abstraction processes. Routine review of performance via the dashboards with frontline staff, clinical leaders, medical staff, and executives has resulted in month-by- month improvement in bundle compliance. Conclusions: Direct data mining, data aggregation and analysis, followed by direct feedback to frontline staff, has resulted in steady improvement in overall bundle compliance, compliance with individual bundle components, and standardization of charting in the EMR. This approach has ultimately resulted in better outcomes for sepsis patients, reduction in healthcare-associated pneumonia, and reduction in surgical site infections.Funding: NoneDisclosures: None
High-Risk Interactions for Transmission of CRE to Health Worker Gloves or Gown: A Multicenter Cohort Study
Authors: Calfee David , Miller Loren , Nguyen Minh-Hong , Pineles Lisa , Magder Laurence , Johnson J. Kristie , Morgan Daniel , Harris Anthony 
Published: November 2020

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are a serious threat to public health due to high associated morbidity and mortality. Healthcare personnel (HCP) gloves and gowns are frequently contaminated with antibiotic-resistant bacteria, including CRE. We aimed to identify patients more likely to transmit CRE to HCP gloves or gowns and HCP types and interactions more likely to lead to glove or gown contamination. Methods:Between January 2016 and August 2018, patients with a clinical or surveillance culture positive for CRE in the preceding 7 days were enrolled at 5 hospitals in California, Maryland, New York, and Pennsylvania. Ten HCP–patient interactions were observed for each patient and were recorded by research staff. Following patient care, but prior to doffing, the gloves and gown of each HCP were sampled for the presence of CRE. Results: We enrolled 313 CRE-colonized patients, and we observed 3,070 HCP interactions. CRE was transmitted to HCP gloves in 242 of 3,070 observations (7.9%) and to gowns in 132 of 3,070 observations (4.3%). Transmission to either gloves or gown occurred in 308 of 3,070 interactions observed (10%). The most frequently identified organism was Klebsiella pneumoniae (n = 171, 53.2%), followed by Enterobacter cloacae (n = 36, 11.2%), and Escherichia coli (n = 33, 10.3%). Patients in the intensive care unit (n = 177, 56.5%) were more likely to transmit CRE to HCP gloves or gown (OR, 1.65; 95% CI, 1.03–2.64) compared to those not in an ICU and adjusted for HCP type. The odds of CRE transmission increased with the number of different items touched near the patient (OR, 1.32; 95% CI, 1.21–1.44) and with the number of different items touched in the environment (OR, 1.13; 95% CI, 1.06–1.21). Respiratory therapists had the highest rates of transmission to gloves and gown (OR, 3.79; 95% CI, 1.61–8.94), followed by physical therapists and occupational therapists (OR, 2.82; 95% CI, 1.01–8.32) when compared to HCP in the “other” category. Manipulating the rectal tube (OR, 3.03; 95% CI, 1.53–6.04), providing wound care (OR, 2.81; 95% CI, 1.73–4.59), and touching the endotracheal tube (OR, 2.79; 95% CI, 1.86–4.19) were the interactions most strongly associated with CRE transmission compared to not touching these items and adjusted for HCP type. Conclusions: Transmission of CRE to HCP gloves and gowns occurs frequently. We identified interactions and HCP types that were particularly high risk for transmission. Infection control programs may wish to target infection prevention resources and education toward these high-risk professions and interactions.Funding: This work was supported by the CDC Prevention Epicenter Program (U43CK000450-01) and the NIH National Institute of Allergy and Infectious Diseases (R01 AI121146-01).Disclosures: None
Incidence and Characteristics of Nosocomial Influenza at an Academic Medical Center
Authors: Azim Ahmed Abdul , Schrank Gregory , Feeser Baevin , Wright Sharon 
Published: November 2020

Background: Despite introduction of mandatory vaccination of healthcare workers (HCWs) in 2011, we continued to see occasional cases of nosocomial influenza. We sought to understand the characteristics of patients who acquired nosocomial influenza to better target prevention efforts. Methods: The study population was a retrospective cohort of all patients aged ≥18 years admitted to an academic medical center between September 2012 and August 2018. Patient data obtained included age, admission/discharge date, service line, influenza vaccination status on admission, and virus serotype. Nosocomial influenza was defined as positive polymerase chain reaction (PCR) or antigen testing for influenza A/B >3 days after admission. Each influenza season, patients with nosocomial influenza or community-acquired influenza (CA-I) were censored after the positive test. Means with standard deviations are reported (SAS version 9.4). Results: Overall, 223,005 patient admissions occurred during the study period: 222,154 (99.6%) were without confirmed influenza infection, 788 (0.35%) had CA-I, and 63 (0.03%) had nosocomial influenza (Fig. 1). The mean age of patients without influenza infection was 57.6 ± 19.3 years compared to 66.5 ± 18.8 years for those with CA-I and 67.1 ± 13.5 with nosocomial influenza. Influenza A accounted for 630 cases (80%) of CA-I, and 58 cases (92%) of nosocomial influenza. Also, 31 (48%) with nosocomial influenza had been vaccinated against influenza prior to admission (Table 1). Most nosocomial influenza cases (78%) occurred on medicine and oncology units. Conclusions: Influenza A represented a larger percentage of nosocomial influenza compared to CA-I. The proportion of nosocomial influenza cases remained stable during the study period, even after introduction of PCR tests in the 2014–2015 season. The mean age of the nosocomial influenza group was greater compared to the CA-I and no influenza groups. More than half of nosocomial influenza cases were unvaccinated at the time of admission, demonstrating the importance of improving vaccine uptake among vulnerable populations.Funding: NoneDisclosures: None
The Burden of Infection in Transfers from Nursing Homes to Hospitals
Authors: Dick Andrew , Sorbero Mark , Furuya E. Yoko , Agarwal Mansi , Stone Patricia 
Published: November 2020

Background: The focus on infection prevention in nursing homes is growing, but little is known about the role infections play in transfers from nursing home to hospital. Our goals were (1) to identify rates of infection-related transfers to the hospital and (2) to identify trends in these rates from 2011 to 2014. Methods: Using a nationally representative sample of 2,501 nursing homes (2011–2014), elderly resident data from the Minimum Data Set 3.0 were combined with CMS inpatient data (MedPAR). We classified transfers from nursing home to hospital as caused by infection (1) if infection was the primary diagnosis and present on admission (POA) or (2) if infection was indicated as the MedPAR admitting diagnosis code and POA. We classified all transfers, including those caused by infection, for which infection was POA in any of the 25 diagnosis codes as transfers with infection. Types of infection included respiratory, sepsis, urinary tract infection (UTI), and all (including ‘other’). Results: Table 1 shows the number of all-cause transfers and the percentage caused by infections. From 2011 to 2014, the rate of all-cause transfers declined from 0.479 to 0.396 per patient; infections were primarily responsible for ~1 in 3 transfers each year. The rate of transfers caused by sepsis increased by 37% from 2011 to 2014, and the rate for respiratory infections fell by 18%. More than half of all transfers from nursing home to hospital in each year had an infection POA. Although the percentage of transfers caused by any kind of infection increased by >7% during the period, the number of transfers per patient dropped by 17%. Conclusions: A large number of elderly nursing home residents are transferred to hospitals with infection each year. Many of these transitions may be avoidable with improved infection prevention and surveillance in nursing homes. Reduced infection rates would improve health and quality of life of nursing home residents and reduce infection-related inpatient costs.Funding: NoneDisclosures: None
Use of Simulations to Evaluate the Effectiveness of Barrier Precautions for Prevention of pathogen Transmission
Authors: Alhmidi Heba , Li Daniel , Cadnum Jennifer , Herrera Natalia Pinto , Haq Muhammed Fawwaz , Wilson Brigid , Donskey Curtis 
Published: November 2020

Background: Barrier precautions (eg, gloves and gowns) are often used in clinical settings to reduce the risk for transmission of healthcare-associated pathogens. However, uncertainty persists regarding the efficacy of different types of barrier precautions in preventing transmission. Methods: We used simulated patient care interactions to compare the effectiveness of different levels of barrier precautions in reducing transfer of pathogen surrogate markers. Overall, 30 personnel performed standardized examinations of contaminated mannequins while wearing either no barriers, gloves, or gloves plus cover gowns followed by examination of a noncontaminated mannequin; the order of the barrier precautions was randomly assigned. Participants used their usual technique for hand hygiene, stethoscope cleaning, and protective equipment removal. The surrogate markers included cauliflower mosaic virus DNA, bacteriophage MS2, nontoxigenic Clostridium difficile spores, and a fluorescent tracer. We compared the frequency and route of transfer of each of the surrogate markers to the second mannequin or to the surrounding environment. Results: As shown in Fig. 1, wearing gloves alone or gloves plus gowns significantly reduced transfer of each of the surrogate markers by the hands of participants (P < .05 for each marker). However, wearing gloves or gloves plus gowns only modestly reduced transfer by stethoscopes despite cleaning of stethoscopes between exams by approximately half of the participants. Contamination of the clothing of participants was significantly reduced in the glove plus gown group versus the gloves only or no-barriers groups (P < .05). Conclusion: Barrier precautions are effective in reducing hand transfer of pathogens from patient to patient, but transfer may still occur via devices such as stethoscopes. Cover gowns reduce the risk for contamination of the clothing of personnel.Funding: Proprietary Organization: The Center for Disease Control.Disclosures: None
Validation of a Semiautomated Surveillance Algorithm for Deep Surgical Site Infections After Primary Hip or Knee Arthroplasty
Authors: Verberk Janneke , van Rooden Stephanie , Koek Mayke , Hopmans Titia , Bonten Marc , de Greeff Sabine , van Mourik Maaikevan 
Published: November 2020

Background: Surgical site infections (SSIs) complicate ~2% of primary total hip (THAs) or total knee arthroplasties (TKAs). Accurate and timely identification through surveillance is essential for targeted implementation and monitoring of preventive interventions. Electronic health records (EHR) facilitate (semi)-automated surveillance and enable upscaling. A validated algorithm is a prerequisite for broader implementation of semiautomated surveillance. Objectives: To validate a previously published algorithm for semiautomated surveillance of deep SSI after THA or TKA in 4 independent regional Dutch hospitals. The algorithm was developed and implemented in the University Medical Centre Utrecht and relies on retrospective routine care data. Methods: For this multicenter retrospective cohort study, the following data required for the algorithm were extracted from the EHR from all patients under THA and TKA surveillance: microbiology results, antibiotics, (re)admissions, and surgical procedures within the 120 days following the primary surgery. Patients were retrospectively classified with a low or high probability of having developed a deep SSI after THA or TKA, according to the algorithm. Sensitivity, positive predictive value (PPV), and workload reduction (defined as the proportion of manuals requiring review) were calculated compared to the traditional (manual) surveillance results, as reported to the national surveillance PREZIES. Discrepancy analyses were performed to understand algorithm results. Results: Data from 8,378 total THA and TKA surgeries (deep SSI n = 95, 1.1%) performed between 2012 and 2018 were extracted by 4 hospitals (Table 1). Sensitivity ranged across centers from 93.6% to 100%, with a PPV from 55.8% to 72.2%. In all hospitals, the algorithm resulted in >98% workload reduction. Cases missed by the algorithm could be explained by incomplete data extraction. Conclusions: This study shows that the surveillance algorithm performance is good in general Dutch hospitals. Broader implementation of this semiautomated surveillance for SSIs after THA or TKA may be possible in the near future and will result in a substantial workload reduction.Funding: This work was supported by the Regional Healthcare Network Antibiotic Resistance Utrecht with a subsidy of the Dutch Ministry of Health, Welfare and Sport (grant number 326835).Disclosures: None
Communications and Screening for 2019 Novel Coronavirus at a Tertiary-Care Medical Center
Authors: Sheeler Lorinda , Kukla Mary , Abosi Oluchi , Meacham Holly , Holley Stephanie , Salinas Jorge 
Published: November 2020

Background: In December of 2019, the World Health Organization reported a novel coronavirus (severe acute respiratory coronavirus virus 2 [SARS-CoV-2)]) causing severe respiratory illness originating in Wuhan, China. Since then, an increasing number of cases and the confirmation of human-to-human transmission has led to the need to develop a communication campaign at our institution. We describe the impact of the communication campaign on the number of calls received and describe patterns of calls during the early stages of our response to this emerging infection. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center with >200 outpatient clinics. In response to the coronavirus disease 2019 (COVID-19) outbreak, we launched a communications campaign on January 17, 2020. Initial communications included email updates to staff and a dedicated COVID-19 webpage with up-to-date information. Subsequently, we developed an electronic screening tool to guide a risk assessment during patient check in. The screening tool identifies travel to China in the past 14 days and the presence of symptoms defined as fever >37.7°C plus cough or difficulty breathing. The screening tool was activated on January 24, 2020. In addition, university staff contacted each student whose primary residence record included Hubei Province, China. Students were provided with medical contact information, signs and symptoms to monitor for, and a thermometer. Results: During the first 5 days of the campaign, 3 calls were related to COVID-19. The number of calls increased to 18 in the 5 days following the implementation of the electronic screening tool. Of the 21 calls received to date, 8 calls (38%) were generated due to the electronic travel screen, 4 calls (19%) were due to a positive coronavirus result in a multiplex respiratory panel, 4 calls (19%) were related to provider assessment only (without an electronic screening trigger), and 2 calls (10%) sought additional information following the viewing of the web-based communication campaign. Moreover, 3 calls (14%) were for people without travel history but with respiratory symptoms and contact with a person with recent travel to China. Among those reporting symptoms after travel to China, mean time since arrival to the United States was 2.7 days (range, 0–11 days). Conclusion: The COVID-19 outbreak is evolving, and providing up to date information is challenging. Implementing an electronic screening tool helped providers assess patients and direct questions to infection prevention professionals. Analyzing the types of calls received helped tailor messaging to frontline staff.Funding: NoneDisclosures: None
Siblings’ Precautions and Parents’ Decolonization to Control Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit (NICU)
Authors: Dias Livio , Silva Camila de A , Richtmann Rosana , Miglioli Lisia , Dea Bruna Dalla , Lima Aurivan , Tobara Mariana , Silva Pollyana , Fernades Vanessa 
Published: November 2020

Background: Following the first reports of the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in the 1970s, several measures to prevent its transmission were introduced in hospitals. However, controversy continues regarding the best approach to prevent and control MRSA, especially in neonatal intensive care units (NICUs). Objective: To report the reduction of colonization and primary central venous catheter–related bloodstream infection (CRBSI) caused by MRSA through surveillance, decolonization, and adoption of best practices in intravenous catheter care. Methods: Quasi-experimental, nonrandomized, before-and-after intervention study conducted in a 70-bed NICU in a private maternity hospital in Brazil. Period studied comprehended between August 2018 and May 2019 (period 1 - preintervention) and June to December 2019 (period II - postintervention). At the end of period 1, several measures were implanted to control and prevent colonization and CRBSI in the unit. The following measures were implemented: incentive to hand hygiene; best practices training on medication preparation and central catheter manipulation; systematic screening of colonized patients with nasal and umbilical swabs; contact precautions for colonized newborn (NB); contact precautions for twins of a colonized NB even when they had a negative swab; decolonization of patients with nasal mupirocin and chlorohexidine (oral preparation) for oral hygiene; concurrent linen change at the end of the patient’s decolonization; decolonization of parents of colonized siblings with chlorohexidine bath and nasal mupirocin; environmental organization; intensification of cleaning and disinfection of equipment and articles; cohort of patients and workers; isolation and precautions compliance audit; professional investigation and decolonization and universal chlorhexidine bath for newborns. Results: In periods I and II, the positivity rates of the collected swabs were 4.14% and 0.75% (P < .0001), respectively, with a peak of positivity of 11.8% in January. Also, 12 episodes of CRBSI were documented in period I (incidence, 2.9%) versus no episode in period 2, with a significant difference in incidence rate between the 2 periods (P = .002). Conclusion: The innovative measures were effective for eradicating the outbreak when instituted together with recognized good practices. In an outbreak scenario is difficult to define the isolated impact of each measure, although, parents’ decolonization to prevent the colonization of other siblings and contact precautions for twins of colonized NB seemed to improve the results.Funding: NoneDisclosures: None