bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antibiotic Stewardship for Nursing: Can E-learning Be a First Step?
Authors: Catanzaro Mary T. 
Published: November 2020

Background: The CDC and The Joint Commission have called for an interdisciplinary approach to antibiotic stewardship implementation. The healthcare team should consist of infectious disease physicians, pharmacists, infectious disease pharmacists, infection preventionists, microbiologists, and nurses. The scant literature to date has looked at nurses’ attitudes and beliefs toward participating in antibiotic stewardship and have identified several factors that contribute to the lack of uptake by nurses: lack of education around stewardship, poor communication among healthcare providers, and hospital or unit culture, among others. Additionally, nurses’ lack of interest in what would be more work or not within their scope of work was put forth as an additional factor by infection preventionists and pharmacists as a barrier to implementation. Method: An investigator-developed online survey was used to assess the usefulness of 3 investigator-developed educational e-learning modules that encompassed the role of nurses in antibiotic stewardship, pharmacy and laboratory topics related to antimicrobial stewardship, as well as the nurses’ attitudes toward their participation in such activities. Results: Participants took the survey after review of the 3 e-learning modules. The results indicate that, contrary to what pharmacists and infection preventionists thought, 82% of nurses felt they should contribute to and be part of the antimicrobial stewardship team. Additionally, after completing the modules, 73% felt more empowered to participate in stewardship discussions with an additional 23% wanting more education. 100% felt that they learned information that they could utilize in their everyday work. Barriers to implementation of stewardship activities on their unit included lack of education (41%), hospital or unit culture (27%), with only 4% citing they did not feel it was their job or that they had anything to contribute to a discussion. Also, 24% felt that there were no obstacles to participation. Conclusions: Surprisingly, most nurses who took this educational series and survey felt that they should be part of the antibiotic stewardship team. As cited previously from the literature, education and culture need to be addressed to overcome the nurses’ barriers to stewardship involvement. E-learning can provide an easy first step to educating nurses when time permits and can provide a good springboard for discussion on the units and with physicians and pharmacists. For a copy of the modules, please contact the author.Funding: NoneDisclosures: None
Assessing the Potential Impact of a Long-Acting Skin Disinfectant in the Prevention of MRSA
Authors: Lofgren Eric 
Published: November 2020

Background: Healthcare-associated transmission of methicillin-resistant Staphylococcus aureus (MRSA) remains a persistent problem despite advances in prevention. The use of chlorhexidine gluconate (CHG) as a means of decolonizing patients, either through targeted decolonization or daily bathing, is a frequently used measure to supplement other MRSA reduction interventions. However, there is room for new and innovative decolonizing agents. We explored the potential utility of a long-acting CHG-like disinfectant with a persistent protective effect as well as an immediate decolonizing action in the prevention of MRSA acquisition as well as the subsequent development of clinical illness and MRSA-related mortality. Methods: We modeled MRSA transmission throughout an 18-bed intensive care unit, based on previously published models. A baseline model with no daily decolonizing protocol was used as a baseline and was compared to a scenario assuming that patients were bathed with CHG, which decolonizes them but provides no ongoing protection, as well as a scenario involving a hypothetical treatment that both decolonizes and provides ongoing protection from subsequent colonization. We varied the duration and efficacy of this protection to fully explore the potential utility of such a treatment. Results: The results of the simulations are shown in Fig. 1, where duration and efficacy of protection varied. The number of MRSA acquisitions from each combination is depicted as a single point, with blue points indicating correspondingly fewer MRSA acquisitions. Overall, improved efficacy of the hypothetical disinfectant resulted in immediate improvements in MRSA acquisition rates when compared to the baseline. To see major improvements in the MRSA acquisition rate due to the duration of infection, that duration must be well above 10 hours in many scenarios. There is also little evidence of synergy between the two. Conclusions: Based on recent results suggesting CHG has a relatively modest per-use efficacy (<.20), there is room for improvement in the formulation and administration of decolonizing agents. Although there has been considerable excitement about the possibility of long-acting agents that not only decolonize but provide long-acting protection against colonization, these results suggest that such protection would only result in markedly decreased acquisition rates only if that duration of protection was extremely long, or if the agent itself was also considerably more efficacious than CHG. These results may be used to help consider the necessary study size for clinical studies of these agents in the future, or to set research priorities and properly calibrate expectations.Funding: NoneDisclosures: None
Automated Prediction of Surgical Site Infection Coronary Artery Bypass (CABG) Grafting Surgery
Authors: Souza Flávio , Couto Braulio , Conceição Felipe Leandro Andrade da , da Silva Gabriel Henrique Silvestre , Dias Igor Gonçalves , Rigueira Rafael Vieira Magno , Pimenta Gustavo Maciel , Martins Maurilio , Almeida Aline Castro de , Amaral Filipe Batista do , Januário Guilherme Brangioni , Caldeira Maria Luiza Neves , Guerra Miriam Alice , Moraes Rayane Thamires Oliveira 
Published: November 2020

Background: In 5 hospitals located in Belo Horizonte city (>3,000,000 inhabitants) a focused survey on surgical site infection (SSI) was performed in patients undergoing CABG surgery. We statistically evaluated such incidences to enable study of the prediction power of SSI through pattern recognition algorithms, in this case the multilayer perceptron (MLP) artificial neural networks. Methods: Data were collected between July 2016 and June 2018 on SSI by the hospital infection control committees (CCIHs) of the hospitals involved in the research. We collected all data used in the analysis during their routine SSI surveillance procedures. The information was forwarded to the NOIS (Nosocomial Infection Study) Project, which uses the SACIH (Automated Hospital Infection Control System) software to collect data from a sample of hospitals participating voluntarily in the project. After data collection, 3 procedures were performed: (1) a treatment of the collected database for use of intact samples; (2) a statistical analysis on the profile of the hospitals collected; and (3) an assessment of the predictive power of 5 types of MLP (ie, backpropagation standard, momentum, resilient propagation, weight decay, and quick propagation) for SSI prediction. MLPs were tested with 3, 5, 7, and 10 hidden layer neurons and a database split for the resampling process (65% or 75% for testing and 35% or 25% for validation). They were compared by measuring the AUC (area under the curve; range, 0–1) presented for each of the configurations. Results: From 666 initial data, only 278 were able for analysis. We obtained the following statistics: 9.35% manifested SSIs; length of stay varied from 1 to 119 days, with ~40% staying between 10 and 19 days; 15.1% of the patients died. Regarding the prediction power of SSI, the experiments have a maximum value of 0.713. Conclusions: Despite the considerable loss rate of >50% of the database samples due to the presence of noise, it was possible to have a relevant sampling to evaluate the profile of hospitals in Belo Horizonte. In addition, for the predictive process, although some configurations had results equal to 0.5, others reached 0.713, which indicates that the automated SSI monitoring framework for patients undergoing coronary artery bypass grafting surgery is promising. To optimize data collection and to enable other hospitals to use the SSI prediction tool (available at www.sacihweb.com), a mobile application was developed.Funding: NoneDisclosures: None
Beyond Bundles in Prevention of CAUTI and UTI’s
Authors: Ford Delvina , Haupt Bonnie , Rochon Renada , Bartoshevich Debra , Rodriguez Monalisa , Zuluaga Jose Cadena 
Published: November 2020

Background: Urinary tract infections (UTIs) are common healthcare-associated infections. Evidenced-based practice (EBP) successes of catheter associated urinary tract infection (CAUTI) bundles has resulted in rates decreasing >50% in community-based nursing homes. The South Texas Community Living Center (CLC SA), our 42-bed long-term care and rehabilitation center, conducts routine infection prevention surveillance. During routine surveillance, the infection prevention team noticed an increase in UTI percentages and CAUTI rates. Thus, we sought to increase compliance with standard CAUTI bundles, and we implemented an intervention called the “bladder bundle.” Methods: A multidisciplinary team (ie, infection preventionist, clinical nurse leader, simulation director, educator, leadership and frontline staff champions) identified and evaluated practices through documentation of audits and safety rounds during April and May of 2017 (FY19 QTR 3). The comprehensive bladder bundle was initiated in June 2017, based on EBP interventions and included education for staff with audit and feedback. The team reviewed the literature and expanded the bladder bundle to include a comprehensive urinary note and oral hydration program for the veterans in addition to the standard CAUTI bundles (ie, minimize catheter use, use with appropriate indications, consider alternatives to catheters, proper insertion and securement). In May 2018, a facility-wide, hospital-wide initiative focused on a new urinary catheter insertion kit, insertion competencies and perineal care to improve outcomes. This initiative was added to our bladder bundle for CLC SA. Results: Before the intervention (FY16 Q3 to FY17 Q2), percentages of veterans with a UTI had increased to 4.65%, in FY17 Q3, this rate had increased to 11.76%. After the intervention (FY17 Q4 to FY19 Q3) the percentage dropped significantly to 0%, and this rate has now been sustained for 8 quarters. Our CLC SA has remained at zero harm and has no NHSN CAUTI has occurred since October 2017 (FY18Q1). The catheterization in bladder days has decreased from 162 days in FY14 to 49 in FY18, and for the first 2 quarters of FY19, there were only 25 days. For the last 8 quarters, documentation compliance has increased, as has use of BB interventions. Conclusions: The continuous improvement project targeted within the CLC SA, with education to staff, audit and feedback tools, and a comprehensive urinary note with the oral hydration program in combination with the standard CAUTI bundles, have improved veteran health outcomes and have expanded provider and nursing practices. The interprofessional team approach enhanced the success of this project.Funding: NoneDisclosures: None
Blackwater Event: Water Management and Remediation at a Major Medical Center
Authors: Sampathkumar Priya , Apenhorst Debra , Kubly Al , Keller Mark , Wright Alan 
Published: November 2020

Background: The CMS and the CDC recommend that all healthcare facilities have an effective water management program (WMP). Our WMP has been in place since 2010; it includes members from facilities operations, infection prevention and control, environmental services, and industrial hygiene. The team meets regularly to discuss current water issues, reviews validation data and water testing reports. Description of event: In April 2018, we suddenly experienced discolored water and sediment at multiple water fixtures throughout the 3.3 million square-foot hospital campus. The hospital incident command structure (HICS) was activated to assist in investigating and managing the situation. Immediate response: Water was deemed unsafe while the cause was being investigated. Bottled water was distributed to 950 hospital patients, and >8,000 staff and visitors. The impact included alternative methods for hand hygiene, the use of bottled water for food preparation and drinking, and the elimination of showers for patients and staff. The dialysis unit used an independent water supply that was not affected. Investigation and remediation: The hospital had 2 sources of domestic cold water: municipal water and a private well that had been in use since 1912. An investigation revealed that the well pump had malfunctioned, drawing gravel into the potable water supply. This overwhelmed the plumbing, blocked toilets and likely dislodged biofilm from the pipes. Early testing showed high levels of corrosion byproducts (ie, iron, copper, and lead) and bacterial contamination in the water, including presence of Legionella. Remediation involved isolating the well, switching to municipal water as the sole source of potable water, flushing the system, and retesting. Overall, 105 technicians flushed the water system including 6,000 water fixtures, 125 drinking fountains, and 95 emergency showers and eyewashes; they sanitized and cleaned 130 ice machines and tested 240 backflow preventers. We retested 437 water samples after remediation; all parameters had returned to the normal range. The existing water process flow diagrams were used to guide sampling for water testing. Conclusions: The hospital’s water system was brought back on line in 78 hours after the first report of “black water.” An active, mature WMP with multiple facilities technicians trained in water sampling enabled a quick response. Coordination through the HICS structure streamlined the response and enabled clear communication throughout the process.Funding: NoneDisclosures: None
Candida auris in the US Department of Veterans’ Affairs (VA)
Authors: Lucero-Obusan Cynthia , Schirmer Patricia , Oda Gina , Holodniy Mark 
Published: November 2020

Background:Candida auris is an emerging pathogen with high mortality and challenges in detection. C. auris healthcare-associated infections are now being reported worldwide. Most isolates are resistant to fluconazole, and some show resistance to all 3 classes of antifungals. Herein, we describe C. auris surveillance in the VA. Methods: Cultures were identified using VA data sources for C. auris isolates and surveillance cultures (axilla and groin) performed January 1, 2010, through October 15, 2019. Chart reviews were performed for patients with C. auris, including isolate susceptibilities and antifungal treatment. Results: Overall, 6 C. auris isolates from 3 patients at 2 VA hospitals (located in the Midwest and Northeast) were identified. From a single patient, 3 urine isolates were identified June–July 2018, and they were susceptible to all antifungals tested (voriconazole, posaconazole, micafungin, itraconazole, flucytosine, caspofungin, anidulafungin, amphotericin B, and fluconazole). No antifungal treatment was received (presumed colonization). C. auris surveillance cultures for 32 additional patients at this facility between July 10, 2018, and July 19, 2018, were negative. From a second patient (admitted November 9, 2018), 2 C. auris blood isolates were identified at the same facility, first on February 3, 2019, and they were susceptible to all antifungals tested (same as above). The infection was deemed healthcare associated, and the patient received 2 weeks of micafungin. On October 11, 2019, C. auris was identified again (susceptibilities as above) and another course of micafungin was started. A third patient from a different VA hospital had a C. auris sputum isolate (September 5, 2018, susceptibilities not reported), which was not treated with antifungals. This patient with tracheostomy had a documented history of C. auris colonization from a non-VA long-term care facility. This VA facility screened 3 additional patients for “rule out C. auris” between July 2018 and March 2019,finalized as C. parapsilosis (1 blood and 1 wound isolate) and C. tropicalis (1 blood isolate). At 2 other VA facilities, 3 patients had C. auris surveillance cultures performed in 2019, which were negative. Additionally, at least 65 isolates of C. haemulonii, which can be difficult to distinguish from C. auris, have been identified from 51 unique individuals at 24 other VA facilities since 2010. Conclusions: Two VA facilities have identified cases of C. auris infection and colonization. Additional awareness is needed because C. auris can be difficult to identify using traditional biochemical methods and may be resistant to standard treatment. According to the CDC, screening of close healthcare contacts should be considered for patients with newly identified C. auris infection or colonization. Early and accurate diagnosis are important for improving outcomes and reducing transmission of this rapidly emerging pathogen.Funding: NoneDisclosures: None
Candida auris Outbreak Control in Critical Care Units in a Tertiary-Care Hospital in Nairobi, Kenya
Authors: Kanyua Alice , Ngugi Rose , Ombajo Loice , Mwangi Joyce , Olasya Bolivya , Musyoki Felister , Njoroge Rachel , Ngirita Margaret , Sang Evaline , Makau Paul , Toda Mitsuru , Berkow Elizabeth , Bancroft Elizabeth , Luvsansharav Ulzii-Oshikh 
Published: November 2020

Background:Candida auris is an emerging pathogen associated with nosocomial outbreaks. During January to May 2019, 11 invasive cases of C. auris were identified in the intensive care unit (ICU) and high-dependency unit (HDU) at a hospital in Nairobi, Kenya. We report on the interventions implemented to control the outbreak. Methods: Intensified infection prevention and control (IPC) interventions were implemented. All patients infected or colonized with C. auris were placed in single-patient rooms with strict contact precautions. Cleaning of the patient care environment was enhanced by instituting a 3-step procedure of cleaning with soap and water, disinfecting with 0.5% chlorine, and rinsing with water. Glo-Germ gel was used to evaluate the cleaning processes, and percentage of missed surfaces was calculated. Hand hygiene training and compliance observations were conducted to enforce adherence to hand hygiene. The IPC team provided training and observational feedback of IPC to staff, patients, and their families. The IPC interventions were guided by screening activities. To monitor ongoing transmission, a biweekly point-prevalence survey (PPS) was performed to screen all previously negative ICU and HDU patients for C. auris. Furthermore, admission and contact screening were added to guide patient placement. Screening was conducted by collecting a composite swab from the bilateral axilla and groin. Samples were incubated in salt dulcitol broth for 5 days at 40°C then subcultured onto Sabouraud dextrose agar. Colony identification was performed using a Vitek 2 system (bioMérieux). Results: In total, 177 patients were placed in single-patient rooms under contact precautions during May–August 2019. We conducted 123 environmental cleaning observations, and the percentage of missed surfaces decreased from 71% (10 of 14) in June to 7% (1 of 16) in August. Hand hygiene compliance among ICU and HDU staff was 79% (204 of 257) in May, 71% (159 of 223) in June, 73% (170 of 233) in July, and 81% (534 of 657) in August. In total, 283 screening swabs from 234 patients were processed during May–August 2019. Overall, 18 of 88 PPS swabs (20%), 13 of 180 admission screening swabs (7%), and 0 of 15 contact screening swabs (0%) were positive for C. auris. The PPS results showed a rapid decrease in colonization: 6 of 14 (43%) in May, 12 of 54 (22%) in June, 9 of 98 (9%) in July, and 1 of 70 (2%) in August. No new C. auris infections were identified from June to October 2019. Conclusions: The control of C. auris in a hospital outbreak requires multimodal interventions, including enhanced IPC interventions, PPS, admission and contact screening for colonization, rigorous monitoring, and team effort.Funding: NoneDisclosures: None
Challenges and Facilitators to Effective Infection Prevention in Home Health Care: Results From Qualitative Interviews of Home Health Care Services
Authors: Pogorzelska-Maziarz Monika , Shang Jingjing , Chastain Ashley , Mangal Sabrina L. , Stone Patricia 
Published: November 2020

Background: As the population of older Americans with chronic conditions continues to grow, the role of home health care (HHC) services in improving care transitions between acute care and independent living has become a national priority. Infection prevention and control (IPC) is often a focus of quality improvement initiatives at HHC agencies. In this study, we investigated barriers and facilitators of effective IPC in HHC. Methods: In 2018, we conducted in-depth, telephone interviews with 41 staff from 13 agencies across the United States including administrators, IPC and quality improvement personnel, registered nurses and HHC aides. Interview transcripts were coded in NVivo v 12 software (QSR International), and themes were identified using content analysis. Results: We identified 4 themes: (1) IPC as a priority, (2) uniqueness of home health care, (3) importance of education, and (4) keys to success and innovation. When discussing the top priorities in the agency, participants described IPC as a big part of patient safety and as playing a major role in reducing rates of rehospitalization. Protection of patients and staff was described as a major motivator for compliance with IPC policies and procedures, and agencies placed specific focus on improving hand hygiene, bag technique, and disinfection of equipment. Almost all participants described the uniqueness of providing health care in a patient’s home, which was often talked about as an unpredictable environment due to lack of cleanliness, presence of pets and/or pests, and family dynamics. Furthermore, the intermittent nature of HHC was described as affecting effective implementation of IPC procedures. Education was seen as a tool to improve and overcome patient, caregiver, and families’ lack of compliance with IPC procedures. However, to be effective educators and role models, participants stated that they themselves needed to be properly educated on IPC policies and procedures. Several keys to success and innovation were discussed including (1) agency reputation as a key driver of quality; (2) agency focus on quality and patient satisfaction; (3) using agency infection data to improve the quality of patient care; (4) utilizing all available resources within and outside of the agency, and (5) a coordinated approach to patient care with direct, multimodal communication among all clinical disciplines. Conclusions: This qualitative work identified barriers to effective infection prevention and control in HHC and important facilitators that HHC agencies can use to improve implementation of policies and procedures to improve patient care.Funding: NoneDisclosures: None