Healthcare-associated Infection Rates Research Articles

Chlorhexidine daily bathing: Impact on health care–associated infections caused by gram-negative bacteria

Health care-associated infections (HAIs) are a major cause of morbidity and mortality in intensive care unit (ICU) patients. Our objective was to evaluate the impact of daily bathing with chlorhexidine gluconate (CHG) on the incidence rates of HAIs, with a focus on their causative bacteria, in a French ICU. From March 2012-May 2013, we enrolled 325 patients with at least 1 episode of suspected sepsis in the ICU, during two 6-month periods. The intervention group was subjected daily to skin cleansing with 2% CHG-impregnated cloths, whereas the control group was bathed daily with soap and water. HAI included bloodstream infections, ventilator-associated pneumonia, and urinary tract infections. Incidence rates corresponded to the number of infections per 1,000 patient days. Incidence of HAI was significantly decreased in the intervention group (29 vs 56; P = .01). After adjustment for baseline patient characteristics, the increased risk of HAI in the water and soap group was significant (odds ratio = 1.993; 95% confidence interval [CI], 1.132-3.508; P = .017). The incidence rate of clinical cultures positive for gram-negative bacteria, including Enterobacteriaceae and nonfermenting bacilli, decreased in the intervention group (risk ratio = 0.588; 95% CI, 0.346-0.978; P = .04). CHG daily cleansing reduced the incidence rate of HAI caused by gram-negative bacteria, highlighting the role of the transient gram-negative bacteria skin colonization in the pathogenesis of HAI.

Denominator doesn't matter: standardizing healthcare-associated infection rates by bed days or device days.

To examine the impact on infection rates and hospital rank for catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP) using device days and bed days as the denominator Retrospective survey from October 2010 to July 2013 SETTING: Veterans Health Administration medical centers providing acute medical and surgical care Patients admitted to 120 Veterans Health Administration medical centers reporting healthcare-associated infections We examined the importance of using device days and bed days as the denominator between infection rates and hospital rank for CAUTI, CLABSI, and VAP for each medical center. The relationship between device days and bed days as the denominator was assessed using a Pearson correlation, and changes in infection rates and device utilization were evaluated by an analysis of variance. A total of 7.9 million bed days were included. From 2011 to 2013, CAUTI decreased whether measured by device days (2.32 to 1.64, P=.001) or bed days (4.21 to 3.02, P=.006). CLABSI decreased when measured by bed days (1.67 to 1.19, P=.04). VAP rates and device utilization ratios for CAUTI, CLABSI, and VAP were not statistically different across time. Infection rates calculated with device days were strongly correlated with infection rates calculated with bed days (r=0.79-0.94, P<.001). Hospital relative performance measured by ordered rank was also strongly correlated for both denominators (r=0.82-0.96, P<.001). These findings suggest that device days and bed days are equally effective adjustment metrics for comparing healthcare-associated infection rates between hospitals in the setting of stable device utilization.

What's trending in the infection prevention and control literature? From HIS 2012 to HIS 2014, and beyond

SummaryThis is an informal review of some of the trends in the infection prevention and control literature since the last Healthcare Infection Society (HIS) conference in late 2012. Google Trends was used to investigate how the volume of interest in various infection control topics had changed over time. Ebola trumped all the others in Google searches, reflecting a surge of publications in the literature. Aside from Ebola, other trends in the infection prevention and control literature covered in this article include Middle East Respiratory Syndrome (MERS) coronavirus, universal versus targeted interventions, faecal microbiota transplantation, whole genome sequencing, carbapenem-resistant Enterobacteriaceae, and some aspects of environmental science. The review ends with an attempt to predict some of the trends in the infection prevention and control literature between now and the next HIS conference in 2016.

Case vignettes to evaluate the accuracy of identifying healthcare-associated infections by surveillance persons

National surveillance systems depend on accurate and reproducible diagnosis of infections. To investigate the effect of accuracy of diagnosing healthcare-associated infections (HCAIs) on HCAI rates in a national healthcare-associated surveillance system. Data from the validation process from the intensive care unit (ICU) surveillance component of the German Krankenhaus Infektions Surveillance System (KISS; Hospital Infection Surveillance System) were used to calculate the accuracy of diagnosing HCAI for each individual surveillance person (SP) responsible for surveillance of HCAI in the ICU of his or her hospital. Multivariate analyses were performed to identify factors that were attributed to surveillance accuracy. A total of 189 SPs responsible for surveillance in 218 ICUs assessed 30 case vignettes. The chance of belonging to the group of SPs with high accuracy was increased by being a physician (odds ratio: 3.14; P = 0.02) and by being an external SP (odds ratio: 4.69; P ≤ 0.01). ICU HCAI rates depend on the sensitivity of the ICU's SP [incidence rate ratio (IRR): 1.28 (1.07, 1.53); P ≤ 0.01]. High sensitivity increases healthcare-associated urinary tract infection rates [IRR: 1.33 (1.02, 1.75); P = 0.03] and bloodstream infection rates [IRR: 1.33 (1.06, 1.68); P = 0.01]. High specificity was not a significant factor. In light of the link between sensitivity of diagnosing HCAI by case vignettes and the ICU HCAI rates, this validation method can be recommended for validation of other surveillance systems.

Clinical and molecular epidemiology of Staphylococcus argenteus infections in Thailand.

Molecular typing of 246 Staphylococcus aureus isolates from unselected patients in Thailand showed that 10 (4.1%) were actually Staphylococcus argenteus. Contrary to the suggestion that S. argenteus is less virulent than S. aureus, we demonstrated comparable rates of morbidity, death, and health care-associated infection in patients infected with either of these two species.

Mandatory public reporting of healthcare-associated infections in developed countries: how can developing countries follow?

The threat posed by increased transmission of drug-resistant pathogens within healthcare settings and from healthcare settings to the community is very real and alarming. Although the developed world has taken strong steps to curb this menace, there has been little pressure on developing countries to take any corrective action. If the reporting of alarming rates of healthcare-associated infections (HCAIs) from hospitals in India and many other developing countries was made mandatory, it would help to force stakeholders (e.g. healthcare workers, legislators, administrators and policy makers in hospitals) to acknowledge and tackle the problem. This would introduce quality control in a long neglected area of health care, and enable patient empowerment which is practically non-existent in India. Healthcare institutions should commit towards enforcing 'zero tolerance' towards lapses in prevention of HCAIs. Public pressure would force the Indian Government to acknowledge the problem, and to allocate more funds to improve resources and infrastructure; this could substantially elevate the standard of health care given to the average Indian. Despite the numerous challenges, overall public benchmarking of HCAIs is a commendable goal that would go a long way towards tackling this menace in developing countries such as India.

A decade of investment in infection prevention: A cost-effectiveness analysis

Health care-associated infection (HAI) rates have fallen with the development of multifaceted infection prevention programs. These programs require ongoing investments, however. Our objective was to examine the cost-effectiveness of hospitals' ongoing investments in HAI prevention in intensive care units (ICUs). Five years of Medicare data were combined with HAI rates and cost and quality of life estimates drawn from the literature. Life-years (LYs), quality-adjusted LYs (QALYs), and health care expenditures with and without central line-associated bloodstream infection (CLABSI) and/or ventilator-associated pneumonia (VAP), as well as incremental cost-effectiveness ratios (ICERs) of multifaceted HAI prevention programs, were modeled. Total LYs and QALYs gained per ICU due to infection prevention programs were 15.55 LY and 9.61 QALY for CLABSI and 10.84 LY and 6.55 QALY for VAP. Reductions in index admission ICU costs were $174,713.09 for CLABSI and $163,090.54 for VAP. The ICERs were $14,250.74 per LY gained and $23,277.86 per QALY gained. Multifaceted HAI prevention programs are cost-effective. Our results underscore the importance of maintaining ongoing investments in HAI prevention. The welfare benefits implied by the advantageous ICERs would be lost if the investments were suspended.

Incidence Rates of Healthcare-associated Infections in Hospitals: A Multicenter, Pooled Patient Data Analysis in India

ABSTRACT Aim The aim of this study was to collect the multicenter data of healthcare-associated infections (HAIs) to assess the infection control scenario in India in context with CDC/NHSN and INICC database. Materials and methods Four National Accreditation Board for Hospitals and Health Care Providers (NABH) accredited hospitals were selected on random basis and raw data on healthcare-associated infections—number of days and number of infections in all intensive care patients was obtained as per the CDC-NHSN definitions and formula. Three major device related infections were considered for analysis based on the prevalence of HAIs and discussions with subject matter experts. All nodal champions from each hospital were trained and common data collection sheet for surveillance in accordance to CDC-NHSN was formed. The pooled means for HAI rates and average of the pooled means for all were calculated using data from four hospitals and were compared with CDC/NHSN and international nosocomial infection control consortium (INICC) percentiles of HAIs rates. Results The Indian pooled mean HAI rates for all infections were above CDC/NHSN percentile threshold but below INICC percentile. Ventilator-associated pneumonia (VAP) was considered as matter of prime concern, crossing P90 line of CDC/NHSN threshold. However, no HAI rate was in limit of P25. Conclusion Indian HAI rates were higher when mapped with CDC threshold. This promotes the need for more standardized and evidence-based protocols been adhered to so as to bring HAI within CDC/NHSN thresholds. However, the four hospitals have better HAI rates as compared to pooled INICC database. How to cite this article Singh S, Chakravarthy M, Sengupta S, Munshi N, Jose T, Chhaya V. Incidence Rates of Healthcareassociated Infections in Hospitals: A Multicenter, Pooled Patient Data Analysis in India. Int J Res Foundation Hosp Healthc Adm 2015;3(2):86-90.

Hand hygiene practices among nursing students: importance of improving current training programs

Background: Although numerous studies have demonstrated that hand hygiene reduces health care–associated infection rates, adherence to hand hygiene guidelines remains uniformly low among health care workers. The present study was undertaken to assess the hand hygiene practices among the nursing students of Bareilly and to suggest the suitable corrective and preventive measures to be taken in future . Methods: These six months cross sectional study was carried out among the nursing students of Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India. A total of 50 students participated in the study. A structured, self-administered pretested questionnaire was used to collect detailed information about the subjects’ self-reported hand washing practices. Knowledge was assessed using 25 questions which included multiple choice and “yes” or “no” questions. A scoring system was used where 1 point was given for each correct response to knowledge, positive attitudes and practices and 0 was given for incorrect knowledge, negative attitudes, and poor practices. Data entry and statistical analysis were performed using the Microsoft Excel and SPSS windows version 14.0 software. Results: Majority of the healthcare workers were females (72.0%), were aged between 31-40 years (60.0%) and had received formal training in hand hygiene in the last 3 years (90.0%). A higher proportion of them routinely used alcohol based hand rub (52.0%). Nearly 28% had poor knowledge and 72% had moderate knowledge regarding hand hygiene . Conclusions: The knowledge about good hand washing practices and compliance of the same according to WHO guidelines amongst health care workers is essential for lowering the health care associated infections. Our study shows the importance of improving the current training programs targeting hand hygiene practices among nursing students.

Staff-developed infection prevention program decreases health care-associated infection rates in pediatric critical care.

The health care team identified the causes of health care-associated infections (HAI) and developed interventions in a pediatric intensive care unit in Gaza. A quasi-experimental pretest-posttest design was used. All 26 full-time staff members in the pediatric intensive care unit participated. The HAI rate decreased significantly from the first to the second year following the implementation of the intervention (208 vs 120.55, odds ratio: 3.21, 95% confidence interval: 1.87-5.11; P < .001).

Changes in healthcare-associated infections after the introduction of a national hand hygiene initiative

Abstract Introduction Interventions that prevent healthcare-associated infections should lead to fewer deaths and shorter hospital stays. Cleaning hands with soap and water or alcohol rub is an effectiveway to prevent the transmission of organisms, but compliance is sometimes low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infections. Methods We examined if the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for six types of healthcare-associated infections were examined in 38 Australian hospitals across six states. Infection categories were: bloodstream infections, centralline associated bloodstream infections, methicillin-resistant and methicillin-sensitive Staphylococcus aureus , Staphylococcus aureus bacteraemia and surgical site infections. Results The National Hand Hygiene Initiative was associated with a statistically significant reduction in infection rates in 11 out of 23 state and infection combinations studied. There was no change in infection rates for nine combinations, and there was an increase in three infection rates in South Australia. Conclusions The intervention was associated with reduced infection rates in many cases. The lack of improvement in nine cases may have been because they already had effective initiatives before the national initiative's introduction.

Health care-associated infections among critically ill children in the US, 2007-2012.

Health care-associated infections (HAIs) are harmful and costly and can result in substantial morbidity for hospitalized children; however, little is known about national trends in HAIs in neonatal and pediatric populations. Our objective was to determine the incidence of HAIs among a large sample of hospitals in the United States caring for critically ill children from 2007 to 2012. In this cohort study, we included NICUs and PICUs located in hospitals reporting data to the Centers for Disease Control and Prevention's National Healthcare Safety Network for central line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonias, and catheter-associated urinary tract infections. We used a time-series design to evaluate changes in HAI rates. A total of 173 US hospitals provided data from NICUs, and 64 provided data from PICUs. From 2007 to 2012, rates of CLABSIs decreased in NICUs from 4.9 to 1.5 per 1000 central-line days (incidence rate ratio (IRR) per quarter = 0.96, 95% confidence interval 0.94-0.97) and in PICUs from 4.7 to 1.0 per 1000 central-line days (IRR per quarter = 0.96 [0.94-0.98]). Rates of ventilator-associated pneumonias decreased in NICUs from 1.6 to 0.6 per 1000 ventilator days (IRR per quarter = 0.97 [0.93-0.99]) and PICUs from 1.9 to 0.7 per 1000 ventilator-days (IRR per quarter = 0.95 [0.92-0.98]). Rates of catheter-associated urinary tract infections did not change significantly in PICUs. Between 2007 and 2012 there were substantial reductions in HAIs among hospitalized neonates and children.

Introduction to "preventing healthcare-associated infections: results and lessons learned from AHRQ's HAI program".

Affiliations: 1. Agency for Healthcare Research and Quality, Rockville, Maryland; 2. RAND Corporation, Santa Monica, California; 3. IMPAQ International, LLC, Columbia, Maryland. Received June 9, 2014; accepted June 16, 2014; electronically published September 15, 2014. 2014 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2014/35S3-0001$15.00. DOI: 10.1086/677817 For over a decade, the Agency for Healthcare Research and Quality (AHRQ) has invested in research and implementation projects to prevent healthcare-associated infections (HAIs) in diverse healthcare settings. AHRQ’s commitment to HAI prevention has been expressed in activities within the agency and through its funding of contracts and grants. In 2011, AHRQ funded IMPAQ International and the RAND Corporation to conduct a synthesis of results of AHRQ-funded HAI projects to identify the major results and lessons learned stemming from AHRQ-funded research, disseminate this information, and identify remaining gaps in the HAI knowledge base. To accomplish these goals, the synthesis draws information from AHRQ-funded project documents (final reports, peerreviewed literature, and HAI-prevention tool kits), in-depth interviews with project leaders, and the AHRQ-published Advances in the Prevention and Control of HAIs, which focuses on methods. In addition, the present volume, “Preventing Healthcare-Associated Infections: Results and Lessons Learned from AHRQ’s HAI Program,” is one of two supplements published in peer-reviewed infection control journals. The American Journal of Infection Control is publishing the other special supplement. Both publications are key information sources for the synthesis project and the field and serve as valuable mechanisms for disseminating the scientific results of the HAI projects. This volume presents 18 manuscripts developed by AHRQfunded HAI project leaders who have agreed to share important scientific findings. The articles examine epidemiological topics such as regional variation in catheter-associated urinary tract infection and urinary catheter use; the spread of multidrug-resistant organisms (MDROs) between nursing homes and acute care hospitals; risk factors and detection of surgical site infections; mortality among patients with healthcare-associated pneumonia; age, gender, racial, and ethnic disparities in HAI rates; and resistance of Staphylococcus aureus to zinc and cadmium. In addition, the studies included herein report results related to HAI-prevention and quality-improvement efforts, such as effectiveness of and cost savings from universal methicillin-resistant Staphylococcus aureus decolonization versus screening and isolation and targeted decolonization; development of a tool to assess the Comprehensive Unit-Based Safety Program to Eliminate Ventilator-Associated Pneumonia implementation progress; effectiveness of antibiotic stewardship programs in acute care hospitals, skilled nursing facilities, pediatric primary care practices, and assisted living; and the use of microbiology data to notify infection preventionists about admission of patients with MDROs. Collectively, the articles presented in this volume contribute substantially to HAIprevention science, and we trust they will be of interest to readers of this journal.

Racial and ethnic disparities in healthcare-associated infections in the United States, 2009-2011.

Little is known about racial and ethnic disparities in the occurrence of healthcare-associated infections (HAIs) in hospitalized patients. To determine whether racial/ethnic disparities exist in the rate of occurrence of HAIs captured in the Medicare Patient Safety Monitoring System (MPSMS). Chart-abstracted MPSMS data from randomly selected all-payer hospital discharges of adult patients (18 years old or above) between January 1, 2009, and December 31, 2011, for 3 common medical conditions: acute cardiovascular disease (composed of acute myocardial infarction and heart failure), pneumonia, and major surgery for 6 HAI measures (hospital-acquired antibiotic-associated Clostridium difficile, central line-associated bloodstream infections, postoperative pneumonia, catheter-associated urinary tract infections, hospital-acquired methicillin-resistant Staphylococcus aureus, and ventilator-associated pneumonia). The study sample included 79,019 patients who had valid racial/ethnic information divided into 6 racial/ethnic groups-white non-Hispanic (n = 62,533), black non-Hispanic (n = 9,693), Hispanic (n = 4,681), Asian (n = 1,225), Native Hawaiian/Pacific Islander (n = 94), and other (n = 793)-who were at risk for at least 1 HAI. The occurrence rate for HAIs was 1.1% for non-Hispanic white patients, 1.3% for non-Hispanic black patients, 1.5% for Hispanic patients, 1.8% for Asian patients, 1.7% for Native Hawaiian/Pacific Islander patients, and 0.70% for other patients. Compared with white patients, the age/gender/comorbidity-adjusted odds ratios of occurrence of HAIs were 1.1 (95% confidence interval [CI], 0.99-1.23), 1.3 (95% CI, 1.15-1.53), 1.4 (95% CI, 1.07-1.75), and 0.7 (95% CI, 0.40-1.12) for black, Hispanic, Asian, and a combined group of Native Hawaiian/Pacific Islander and other patients, respectively. Among patients hospitalized with acute cardiovascular disease, pneumonia, and major surgery, Asian and Hispanic patients had significantly higher rates of HAIs than white non-Hispanic patients.

PO-0516 Healthcare-associated Infections In A Turkey Neonatal Intensive Care Unit

<h3>Aim</h3> The aim of this study was to determine the incidence of (Healthcare-associated infection) HAI, causative organisms, associated risk factors in a neonatal intensive care unit in Turkey. <h3>Methods</h3> A prospective cohort study was conducted on patients admitted to the neonatal intensive care unit (NICU) from July 2011 to June 2012. The criteria that were used to diagnose infection were in accordance with the Centres for Disease Control and Prevention. The incidence, causative organisms, risk factors and mortality of healthcare-associated infections were assessed. <h3>Results</h3> The study included 352 patients, 37 of these developed HAIs, totaling 60 HAI episodes. Overall HAI patient rate was 17.04%, and 11.51 HAIs per 1000 NICU days. The most frequent HAIs were bloodstream infections (70%) and nosocomial pneumonia (18.3%). The central venous catheter/umblical catheter-related bloodstream infections (CVC/UC BSIs) rate was 18.3/1,000 catheter days; the ventilator-associated pneumonia (VAP) rate was 13.6/1,000 ventilator days; and the catheter-associated urinary tract infections rate found was 14.9/1,000 catheter days. Prematurity, gestational age less than 32 weeks, birth weight &lt; 1500 g, mechanical ventilation, use of CVC/UC, use of urinary catheter, and total parenteral nutrition appeared to be associated with a significantly higher risk of HAI (p ≤ 0.05). The most frequent pathogens were <i>Enterobacter spp</i>. (18.5%) and <i>Acinetobacter baumannii</i> (13.8%). Overall mortality rate in neonates was 3.9%, and the mortality rate in neonates with HAI was 10.8%. <h3>Conclusions</h3> Healthcare-associated infection rates of our NICU were higher than international standards. The decrement of risk factors in newborns would help to improve the outcome.

Evaluation of the effectiveness of an infection control program in adult intensive care units: A report from a middle-income country

The rates of hand hygiene improvement and health care-associated infections (HAIs) were evaluated after the introduction in 2004 of an infection surveillance and prevention program at a university teaching hospital in a low- to middle-income country. Data on hand hygiene compliance, HAI rate, multiresistant organisms, and antibiotic consumption in 4 adult intensive care units (ICUs; medical, general surgery, anesthesiology and reanimation, and neurosurgery) were collected retrospectively for each year from 2004 to 2012. Negative binomial regression modeling with a log link was used to adjust for overdispersion in observations, and the first year of observations served as the baseline for comparing changes in incidence rate ratio (IRR) over the subsequent years. Total hand hygiene compliance improved from 30.5% in 2004 to 43.5% by 2010 (IRR, 1.3; P <.0001) and reached 63.8% by 2012 (IRR, 1.9; P < .0001). The HAI rate was 42.6/1,000 patient-days at baseline and increased significantly thereafter until 2012, when it decreased by 20% to 33.6/1,000 patient-days (IRR, 0.8; P = .001). The rate of central line-associated bloodstream infection was 7.85 (95% confidence interval [CI], 5.89-10.26)/1,000 catheter-days in 2004 and increased to 12.4 (95% CI, 9.98-14.39)/1,000 catheter-days in 2012 (IRR, 1.5; P = .024). The rate of ventilator-associated pneumonia remained stable from the 2004 baseline rate of 31.66/1,000 ventilator-days to the 2012 rate of 24.04/ 1,000 ventilator-days (IRR, 0.88; P = .574). The rate of catheter-associated urinary tract infection remained relatively stable between 2004 and 2012 (from 7.92/1,000 catheter-days to 4.97/1,000 catheter-days; P = .101). The rate of methicillin-resistant Staphylococcus aureus infection was 6.24/1,000 patient-days at baseline and decreased significantly to 0.73/1,000 patient-days by 2007 (IRR, 0.13; P <.001) and continued to remain below 2/1,000 patient-days for the next 5 years. The rate of Pseudomonas aeruginosa infection decreased significantly from 8.66/1,000 patient-days in 2004 to 6.09/1,000 patient-days in 2010 (IRR, 0.72; P = .026) and to 5.44/1,000 patient-days by 2012 (IRR, 0.63; P = .002). The rate of Acinetobacter baumannii infection was 14.3/1,000 patient-days at baseline, decreased significantly by 2005 (IRR, 0.73; P = .012), fluctuated between 2006 and 2010, and then decreased significantly to 10.44/1,000 patient-days in 2011 (IRR, 0.74; P = .007) and then to 7.6/1,000 patient-days in 2012 (IRR, 0.53; P < .001). Antibiotic consumption did not decrease noticeably over the 9-year study period. Hand hygiene improved in all of the ICUs evaluated. Measuring changes in HAI rates in a single health care setting can be statistically challenging, and a bias in the detection rates is not uncommon in the early years of a new infection prevention program. Here, for the first time, implementation of an infection surveillance and prevention program was associated with a reduction in HAI rate.

Blood culture-guided de-escalation of empirical antimicrobial regimen for critical patients in an online antimicrobial stewardship programme

A blood culture-guided review strategy was applied to a hospital-wide computerised antimicrobial approval system (HCAAS) at a medical centre in Taiwan. The study aimed to evaluate the impact of this deployment on prescribers’ behaviours, antimicrobial consumption, antimicrobial expenditure and healthcare quality in adult intensive care units (ICUs). The HCAAS automatically identifies patients with positive blood cultures and notifies the pre-assigned infectious diseases (ID) physicians for an online second review of the current antimicrobial regimen. Patients from 16 adult ICUs were selected as a focus group. Descriptive analysis, McNemar's test, interrupted time-series analysis and univariate regression analysis were applied. The number of prescriptions assigned for second review increased from 304 in 2010 to 682 in 2012. The approval rate for the antimicrobial regimen in the second review exceeded 70%. In disapproved cases, prescribers accepted the recommendation from ID physicians in 66.1% of cases in the first year; the acceptance rate increased to 80.6% in 2012. Among the restricted antimicrobial agents, consumption gradients decreased for all eight drug classes. The overall antimicrobial expenditure gradient declined significantly following deployment of the second review strategy. The healthcare-associated infection rate continued to decrease over time, and the mortality and ICU re-admission rates remained stable after deployment. A blood culture-guided review of antimicrobial use based on clinical and microbiological evidence improves accuracy in choosing appropriate antimicrobial agents and encourages de-escalation. Consumption and expenditure gradients of antimicrobial agents decreased after the intervention, and healthcare quality was not compromised.

Surveillance of health care–associated infections in a tertiary hospital neonatal intensive care unit in Egypt: 1-year follow-up

Reported rates of neonatal health care-associated infections (HAIs) in neonatal intensive care units (NICUs) have risen rapidly in recent years. Little data are available in Egypt, however. The aim of the present study was to determine the incidence of and risk factors for HAIs in the NICU of Ain Shams University Hospital of Obstetrics and Gynecology. A prospective study was carried out on all neonates admitted in the NICU of Ain Shams University Hospital of Obstetrics and Gynecology in 2012. Centers for Disease Control and Prevention criteria were followed for identifying HAIs. A total of 434 neonates were enrolled in the study. The cumulative incidence of HAIs in the NICU was 28%. Bloodstream infections accounted for 85% of HAI episodes; pneumonia, for 10%. The most common organism isolated was Klebsiella spp. The main risk factors identified on multivariable analysis were gestational age <38 weeks (relative risk [RR], 1.63), birth weight <1,500 g (RR, 1.39), mechanical ventilation (RR, 1.74), and surgical procedures (RR, 1.65). The mortality rate attributed to HAIs was 11.75%, and the extra hospital length of stay attributed to HAIs was 8 days. The high incidence of HAI identified in the study NICU mandates more vigorous infection control interventions.

Weekly chlorhexidine douche: does it reduce healthcare-associated bloodstream infections?

Daily chlorhexidine (CHG) bathing has been used as a precaution to reduce the rate of healthcare-associated bloodstream infections (HA-BSI). The application frequency of CHG bathing remains unclear, this procedure has been implemented daily by this time. The aim of this study was to determine the efficacy of weekly whole-body douche with CHG shower gel on rates of HA-BSI. We conducted a prospective intervention trial in medical, surgical, and anesthesiology intensive care units (ICUs) in a tertiary teaching hospital from June 2011 to November 2012. This study included three periods. During the first period, patients received a daily bed bath by wiping with water and soap. In the second period patients were given a weekly douche with water and soap; in the third period patients were given a weekly douche with CHG shower gel. The rates of HA-BSI were compared between the three periods using Poisson regression analysis. The central line-associated bloodstream infection rates did not decline significantly between periods (p = 0.76). The laboratory-confirmed bloodstream infection (LCBSI) rates in the first, second, and third periods were 7.1, 4, and 1.7, respectively. The LCBSI rates were reduced 43.7% from the first period to the second period (p = 0.03). In addition, there was a 57.5% reduction in LCBSI rates between the second and third periods (p < 0.001). Interestingly, the major decline (76.1%) was determined from the first to the third period (p < 0.002). Weekly douche with CHG shower gel significantly reduced LCBSI rates. Further studies are needed to validate the clinical impact of different intervals of CHG bathing.

Changes in healthcare-associated Staphylococcus aureus bloodstream infections after the introduction of a national hand hygiene initiative.

Interventions that prevent healthcare-associated infection should lead to fewer deaths and shorter hospital stays. Cleaning hands (with soap or alcohol) is an effective way to prevent the transmission of organisms, but rates of compliance with hand hygiene are sometimes disappointingly low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infection. We examined whether the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for healthcare-associated Staphylococcus aureus bloodstream infections were examined in 38 Australian hospitals across 6 states. We used Poisson regression and examined 12 possible patterns of change, with the best fitting pattern chosen using the Akaike information criterion. Monthly bed-days were included to control for increased hospital use over time. The National Hand Hygiene Initiative was associated with a reduction in infection rates in 4 of the 6 states studied. Two states showed an immediate reduction in rates of 17% and 28%, 2 states showed a linear decrease in rates of 8% and 11% per year, and 2 showed no change in infection rates. The intervention was associated with reduced infection rates in most states. The failure in 2 states may have been because those states already had effective initiatives before the national initiative's introduction or because infection rates were already low and could not be further reduced.