bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Infection Control Resource Use and the Number of Penalties Under Medicare’s Hospital-Acquired Condition Reduction Program
Authors: Scott Robert , Baggs James , Culler Steven , Jernigan John 
Published: November 2020

Background: The Hospital-Acquired Condition Reduction Program (HACRP) is a pay-for-performance Medicare program that promotes reducing patient harm, particularly healthcare-associated infections (HAIs). We examined the association between infection-control–related activities and the number of penalties a hospital received between fiscal years 2015 and 2018. Methods: We used logistic regression with ordered categories to assess infection control resource use and the number of penalties, an ordered categorical dependent variable with 5 categories ranging from 0 to 4, as of 2018. Data sources included National Healthcare Safety Network, American Hospital Association Annual Survey, Medicare Impact and Cost Report files, and Data.Medicare.gov. We excluded hospitals lacking data to calculate any HACRP score or component score for HAI and hospitals missing observations for model variables (301 hospitals). We assessed the following model variables: teaching hospital status, infection preventionists (IP) per 1,000 beds, surveillance hours per week per bed, other infection control activities per week per bed, nurse-to-bed ratio, housekeeping expenditure per 10,000 beds, nursing position vacancies per bed, bed size, electronic health record (EHR) implementation, number of skilled nursing beds, rural or urban location, and Medicare patient case-mix (cmi_quartiles). Results: In our model, negative logit model point estimates indicated that increased values of the variable are associated with a lower odds of having a higher number of penalties. The final data set consisted of 3,004 US hospitals. Lower penalties were significantly associated with higher IP-to-bed ratio. Although the point estimates were <1, an association between lower penalties and higher nurse-to-bed ratios or electronic health records was not demonstrated (Table 1). Conclusions: Our results suggest that after controlling for selected hospital structural factors, incremental resources related to infection control have a protective association with HCARP penalties.Funding: NoneDisclosures: None
Automated Risk Analysis of Surgical Site Infection in Hip Arthroplasty Surgeries
Authors: Souza Flávio , Couto Braulio , Conceição Felipe Leandro Andrade da , Silva Gabriel Henrique Silvestre da , Dias Igor Gonçalves , Rigueira Rafael Vieira Magno , Pimenta Gustavo Maciel , Martins Maurilio , Mendes Julio Cesar , Quintão Ana Flavia Viana , Brandão Camila Vieira , Borges Débora Martins , Lage Eduarda Muzzi Torres , Sabadini Luiza da Conceição , Lopes Sabrina de Almeida 
Published: November 2020

Background: In 7 hospitals in Belo Horizonte, a city with >3,000,000 inhabitants, a survey was conducted between July 2016 and June 2018, focused on surgical site infection (SSI) in patients undergoing arthroplasty surgery procedures. The main objective is to statistically evaluate such incidences and enable a study of the prediction power of SSI through pattern recognition algorithms, the MLPs (multilayer perceptron). Methods: Data were collected on SSI by the hospital infection control committees (CCIHs) of the hospitals involved in the research. All data used in the analysis during their routine SSI surveillance procedures were collected. The information was forwarded to the NOIS (Nosocomial Infection Study) Project, which used 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 database collected for the 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 (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). The results were compared by measuring AUC (area under the curve; range, 0–1) presented for each of the configurations. Results: Of 1,246 records, 535 were intact for analysis. We obtained the following statistics: the average surgery time was 190 minutes (range, 145–217 minutes); the average age of the patients was 67 years (range, 9–103); the prosthetic implant index was 98.13%; the SSI rate was 1.49%, and the death rate was 1.21%. Regarding the prediction power, the maximum prediction power was 0.744. Conclusions: Despite the considerable loss rate of almost 60% of the database samples due to the presence of noise, it was possible to perform relevant sampling for the profile evaluation of hospitals in Belo Horizonte. For the predictive process, some configurations have results that reached 0.744, which indicates the usefulness of the structure for automated SSI monitoring for patients undergoing hip arthroplasty surgery. To optimize data collection and to enable other hospitals to use the SSI prediction tool (available in www.sacihweb.com ), a mobile application was developed.Funding: NoneDisclosures: None
Candida auris Infection Among Patients With Cancer in an Oncology Center in Eastern India
Authors: Bhattacharya Sanjay , Das Parijat , Goel Gaurav , Mukherjee Sudipta , Ghosh Pralay Shankar , Singh Rohit , Sinha Subir , Chandy Mammen , Walia Kamini , Chakrabarti Arunaloke 
Published: November 2020

Background: The multidrug-resistant fungus Candida auris is emerging as a major cause of healthcare-associated infection globally. Understanding the epidemiology of these infections in vulnerable groups such as cancer patients is important for hospital infection control and their effective management. In this report we present diagnostic, clinical, antifungal resistance and outcome data of 11 cases of C. auris infection from an oncology center in India. Methods:C. auris strains were identified by Sanger-based DNA sequencing of the internal transcriber spacer (ITS) gene. Antifungal susceptibility testing (AFST) was performed using the broth dilution method. Identification and AFST were checked by the WHO Collaborating Center for Reference & Research on Fungi of Medical Importance. Patients had both empirical as well as directed therapy with antifungal agents based on AFST results and clinical assessment. Results: Between November 2018 and March 2019, 11 cases of C. auris (8 from patients with solid-organ tumors and 3 from hematological malignancy) were detected. Two distinct genetic clusters were identified by ITS gene sequencing; one of these clusters showed 100% homology with a previously unknown C. auris isolate (GenBank accession no. MK881076) and the other cluster had a 100% identity score with isolates from Japan and South Korea (GenBank accession nos. MH071441, KY657027, and EU884189). All 11 strains were resistant to fluconazole. With voriconazole, 1 isolate was susceptible, 3 were resistant, and 7 showed dose-dependent susceptibility. Two isolates were resistant to amphotericin B. Resistance to caspofungin or anidulafungin was noted in 1 of 11 isolates (9%); most showed intermediate susceptibility (63% to caspofungin). Among all of the patients, 72% were from the intensive care unit (ICU) or the high-dependency unit. The 30-day all-cause mortality was 5 of 11 (45%) in the C. auris group and 4 of 11 (36%) the control group (ie, infections with other Candida spp during same period). Duration of ICU stay in the C. auris group was 12 days and in the control group it was 6 days. The median cost (in terms of hospital bill at the time of discharge or death) for management of Candida auris infection and the primary medical condition was US$10,121 for the C. auris groups and US$8,608 for the control group. Most cases (10 of 11) were detected in wards without isolation rooms, and 8 of the 11 C. auris cases (73%) were detected in patients in the intensive care unit. Conclusions: Morbidity, mortality, ICU stay, and healthcare costs are significant in C. auris infection.Funding: NoneDisclosures: None
Carbapenemase-Producing, Carbapenem-Resistant Acinetobacter baumannii: Summary of CDC Consultations, 2017–2019
Authors: Epstein Lauren , Shugart Alicia , Ham David , Vallabhaneni Snigdha , Brooks Richard , McAllister Gillian , Halpin Alison , Gilbert Sarah , Walters Maroya 
Published: November 2020

Background: Carbapenemase-producing carbapenem-resistant Acinetobacter baumannii (CP-CRAB) are a public health threat due to potential for widespread dissemination and limited treatment options. We describe CDC consultations for CP-CRAB to better understand transmission and identify prevention opportunities. Methods: We defined CP-CRAB as CRAB isolates with a molecular test detecting KPC, NDM, VIM, or IMP carbapenemases or a plasmid-mediated oxacillinase (OXA-23, OXA-24/40, OXA-48, OXA-58, OXA-235/237). We reviewed the CDC database of CP-CRAB consultations with health departments from January 1, 2017, through June 1, 2019. Consultations were grouped into 3 categories: multifacility clusters, single-facility clusters, and single cases. We reviewed the size, setting, environmental culturing results, and identified infection control gaps for each consultation. Results: We identified 29 consultations involving 294 patients across 19 states. Among 9 multifacility clusters, the median number of patients was 12 (range, 2–87) and the median number of facilities was 2 (range, 2–6). Among 9 single-facility clusters, the median number of patients was 5 (range, 2–50). The most common carbapenemase was OXA-23 (Table 1). Moreover, 16 consultations involved short-stay acute-care hospitals, and 6 clusters involved ICUs and/or burn units. Also, 8 consultations involved skilled nursing facilities. Environmental sampling was performed in 3 consultations; CP-CRAB was recovered from surfaces of portable, shared equipment (3 consultations), inside patient rooms (3 consultations) and nursing stations (2 consultations). Lapses in environmental cleaning and interfacility communication were common across consultations. Among 11 consultations for single CP-CRAB cases, contact screening was performed in 7 consultations and no additional CP-CRAB was identified. All 4 patients with NDM-producing CRAB reported recent international travel. Conclusions: Consultations for clusters of oxacillinase-producing CP-CRAB were most often requested in hospitals and skilled nursing facilities. Healthcare facilities and public health authorities should be vigilant for possible spread of CP-CRAB via shared equipment and the potential for CP-CRAB spread to connected healthcare facilities.Funding: NoneDisclosures: None
Chlorhexidine Dressings to Prevent Catheter-Related Bloodstream Infections: A Systematic Literature Review and Meta-analysis
Authors: Puig-Asensio Mireia , Marra Alexandre R. , Childs Christopher A , Perencevich Eli N. , Schweizer Marin L. 
Published: November 2020

Background: Catheter-related bloodstream infections (CRBSIs) are associated with significant morbidity and mortality. We aimed to determine the effectiveness of chlorhexidine (CHG) dressings in preventing incident CRBSI in different settings and types of catheters. Methods: We searched PubMed, Cochrane Library, CINAHL, Embase, and ClinicalTrials.gov through March 2019 for studies with the following inclusion criteria: (1) population consisted of patients requiring short or long-term catheters; (2) CHG dressing was used in the intervention group and a nonantimicrobial impregnated dressing was used in the control group; (3) CRBSI was reported as an outcome. Randomized controlled trials (RCTs) and quasi-experimental studies were included. We used a random-effect models to obtain pooled OR estimates. Heterogeneity was evaluated with I 2 test and the Cochran Q statistic. Results: The review included 21 studies (17 RCTs). The use of CHG dressings was associated with a lower incidence of CRBSI (pooled RR, 0.63; 95% CI, 0.53–0.76). There was no evidence of publication bias. In stratified analyses, CHG dressing reduced CRBSI in ICU adult patients (9 studies, pRR, 0.52; 95% CI, 0.38–0.72) and adults with oncohematological disease (3 studies, pRR, 0.53; 95% CI, 0.35–0.81) but not in neonates and pediatric populations (6 studies, pRR, 0.90; 95% CI, 0.57–1.40). When stratified by type of catheter, CHG dressing remained protective against CRBSI in short-term venous catheters (11 studies, pRR, 0.65; 95% CI, 0.48–0.88) but not in long-term catheters (3 studies, pRR, 0.76:; 95% CI, 0.19–3.06). Other subgroup analyses are shown in Table 1. Conclusions: CHG dressings reduce the incidence of CRBSI, particularly in adult ICU patients and adults with an onco-hematological disease. Future studies need to evaluate the benefit of CHG in non-ICU settings, in neonates and pediatric populations, and in long-term catheters.Funding: NoneDisclosures: None
Cobweb Chart for Infection Rates, Infectometer, and Outbreak Alert System: Real-Time Systems for Summarizing Nosocomial Data
Authors: Couto Braulio , Starling Carlos 
Published: November 2020

Background: Reporting nosocomial surveillance data can be difficult because the quantity of statistics, graphics, tables, and numeric data may confuse people. Another issue related to feedback regarding healthcare infections rate is that gaps exist between collecting data, the analysis, and implementation of actions based on the information produced. Even when a statistical process control chart (SPC) is used, it is interpreted retrospectively. Here, we present 3 epidemiological tools: (1) a cobweb chart for infection rates, (2) the infectometer, and (3) an outbreak alert system. Methods: For the cobweb chart, the first step is to choose how many and which infection rates will be summarized. Thereafter, all infection rates, respective benchmarks, endemic level, and actual values are placed in a spreadsheet. Although each infection rate has different units (eg, %, rates per 100 discharges, and/or rates per 1,000 denominator days), when we compare the respective endemic level and actual rate with the benchmark, dimensionless quantities are generated for each indicator, making it possible to build the cobweb graph. Using the infectometer for calculations, we (1) built an SPC chart for each infection or microorganism; (2) estimated the average month and standard deviation of the infection cases, excluding outlier data, and (3) calculated the monthly expected incidence, assuming that nosocomial infection occurrence follows a normal distribution. If the supposition of normal distribution fails, a percentile method is used. The outbreak alert system predicts outbreaks using the infectometer parameters, the last month’s observed infection cases, and a Poisson model for predicting the chance of new cases of each infection above monthly expected incidence. Results: With the adapted radar chart, we can report many infection rates in only 1 chart (Fig. 1). The SPC charts for infection rates, stratified by all the types of healthcare infections or by microorganism, can be built, and the infectometer can then be produced, showing weekly and monthly expected cases of an endemic condition. The outbreak alert system is presented as a speedometer that is analyzed at the beginning of each month (Fig. 2). Conclusions: The idea behind the cobweb chart for infection rate method is to report all infection rates in only 1 graph. With the infectometer, it is not necessary to wait until the end of the month to analyze the surveillance data; the analysis becomes prospective and timely. The outbreak alert system brings the future to the present, showing the risk of an outbreak.Funding: NoneDisclosures: None
Colonization of Resistant Microorganisms in Renal Transplants
Authors: Taminato Monica , Fram Dayana , Rezende Thaís Freitas Teles , Grothe Cibele , Pignatari Antonio Carlos , Barbosa Dulce Aparecida 
Published: November 2020

Background: Kidney transplant recipients are a group of patients at risk for healthcare-related infections. The results of this study make an important clinical contribution and contribute to findings options to decrease the infection-related morbidity and mortality that affects this patient population. Objectives: We evaluated the prevalence of colonization by multidrug-resistant bacteria, Klebsiella pneumoniae carbapenemase (KPC)–producing bacteria, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) in renal transplant patients; we identified the infection rate, morbidity, and mortality in this population. Methods: Prospective cohort study was conducted at the Kidney and Hypertension Hospital from 2012 to 2015. This project was approved by the Unifesp Research Ethics Committee (no. 1630/11) and an informed consent form was obtained from patients included in the study. Study protocol: Data collection was performed in 2 phases: within the first 24 hours after transplantation and 7 days after transplantation. For all included patients, the following data were collected: identification data, clinical data, and laboratory tests of the first day in the study. All included patients (colonized or not) were followed prospectively for 6 months or until treatment change or death. Results: The study included 200 renal transplant patients in accordance with the inclusion and exclusion criteria. We observed that 76 (38%) patients included in our sample were colonized; 8% S. aureus, 11% Enterococcus, and 19% K. pneumoniae. We verified the presence of concomitant colonization of 1 or more of these pathogens. The most prevalent concomitance identified in our population was E. coli and K. pneumoniae. We identified the presence of diabetes and diabetes associated with hypertension as risk factor for colonization. Thus, patients with more systemic complications may be at risk for colonization by multidrug-resistant bacteria. Another risk factor for colonization was antibiotic use in the 6 months prior to transplantation. Transplant-related outcomes were length of stay after transplantation, delayed graft function (ie, dialysis after the transplantation) and postoperative care in an intensive care unit. At the 6-month follow-up, we identified urinary infection and surgical site infection as risk factors. One death occurred due to stroke in the group of colonized patients, unrelated to infectious causes. Conclusions: These results show fundamental aspects for health professionals for bacterial characterization, transmission, and resistance mechanisms and, mainly, tools for prevention and control of multidrug-resistant bacteria from patients colonized under conservative treatment before the complexity of high-risk procedures begins, such as dialysis and transplantation to reduce morbidity and mortality.Funding: FAPESP São Paulo Research Support FoundationDisclosures: None
Compliance with Standard Precautions Among University Nursing Students From Croatia: A Cross-Sectional Study
Authors: Mestrovic Tomislav , Neuberg Marijana , Kozina Goran 
Published: November 2020

Background: Stringent compliance with standard precautions is of utmost importance for reducing the spread of healthcare-associated infections (HAIs); however, the role of medical and nursing students is often underappreciated. Because undergraduate and graduate nursing programs combine classroom education and clinical training, nursing students are already important stakeholders in HAI risk reduction and patient safety endeavors. Objectives: In this study, we appraised self-reported adherence to standard precautions among university nursing students, and we examined factors that may influence their level of compliance. Methods: In total, 362 undergraduate and graduate university nursing students form the University North in Croatia (Europe), enrolled in courses or modules with clinical placement, were surveyed in this self-reported cross-sectional study. A 2-part self-administered questionnaire was used, consisting of a demographic survey and a globally applicable 20-item Compliance with Standard Precautions Scale (CSPS). Differences were examined by an independent t test and analysis of variance (ANOVA), and factors influencing compliance were further appraised by a standard multiple linear regression analysis. Significance was set at P <.05 (2-sided). Results: The overall compliance rate in this study was 58.4%. The highest compliance rate was observed for wearing gloves when exposed to body fluids, blood products, and any excretion of patients (82.8%); conversely, the lowest compliance rate was reported for disposing a sharps box before it was full (27.2%). Higher rates of compliance were seen in female nursing students compared with their male counterparts (P = 0.039). Even though age was not a significant predictor, there was an increase in compliance rates according to the academic year level (P < .001). Conclusions: Our results indicate that the overall compliance rate of the Croatian nursing students was moderate, although there was a trend toward more rigorous standard precaution adherence with more education and clinical experience. These findings highlight the need to improve the nursing curriculum to integrate more material on infection control practices early in the program, consequently bridging the gap between theory and practice. Finally, a supportive culture of infection control adherence in quotidian clinical practice must be continuously fostered.Funding: NoneDisclosures: None