Major Healthcare-associated Infection Research Articles

Assessing equity in preventing central line-associated bloodstream infections and surgical site infections in pediatric patients.

Central line-associated bloodstream infections (CLABSIs) and surgical site infections (SSIs) are major healthcare-associated infections that can be prevented by consistently applying evidence-based infection prevention practices. To assess equity in preventing CLABSIs and SSIs in pediatric patients at a free-standing pediatric hospital, where evidence-based infection prevention practices are consistently implemented. This observational study evaluated 2 cohorts of pediatric patients under 18 years. The CLABSI cohort included inpatients with a central line between 1/1/2016 and 12/31/2022, and the SSI cohort included patients undergoing colon, ventricular shunt, or spinal fusion surgeries between 1/1/2016 and 10/31/2022. The CLABSI rate per 1000 central line days and SSI rate per 100 surgeries were compared across different racial, ethnic, and gender groups. In the CLABSI cohort of 8575 patients, encompassing 243,803 central line days, there were 156 CLABSIs. There was no statistical difference in CLABSI rate across race, ethnicity, and/or gender groups. The SSI cohort included 68 SSIs among 1710 patients who underwent 2230 procedures, including 714 colon, 749 ventricular shunt, and 767 spinal fusion procedures. The SSI rate was statistically higher in multiracial (9.9) and Asian (8.6) groups, compared to Caucasian (2.4) and Black (2.2) groups. A nested case-control study of the SSI cohort showed a higher SSI rate in Asians, compared to Caucasians (Odds Ratio: 3.3; 95% CI: 1.3-8.3). Equity in preventing CLABSIs is achievable through standardized central-line care. Further study is warranted to assess if improvement opportunities exist for achieving equity in preventing SSIs.

Protective Effects of Huo Xiang Zheng Qi Liquid on Clostridioides difficile Infection on C57BL/6 Mice.

Clostridioides difficile-associated disease (CDAD) is a major healthcare-associated infection. New treatment options for CDAD are needed. A traditional Chinese medicinal formula, Huo Xiang Zheng Qi (HXZQ), was chosen to test against CDAD in a mouse model. C57BL/6 mice were challenged with C difficile (ATCC 43255) orally; then received saline; vancomycin 25 mg/kg; or HXZQ in two different concentrations twice daily for 5 days. The animals' body weight; clinical signs; and survival rates were registered daily. Fecal pellets from each animal were taken for PCR analysis as a control of infection. 50% of the mice receiving saline died; 85.7% of the mice receiving vancomycin survived; 75% of the mice receiving HXZQ survived; and 87.5% of the mice receiving a 1:1 saline dilution of HXZQ survived. The HXZQ-treated groups were C. difficile PCR positive with loads less than that of the untreated mice. The weight loss in the vancomycin plus HXZQ 1:1 treated group; the vancomycin-treated group; and the untreated group were 3.08%, 4.06%, and 9.62%, respectively. our results showed that HXZQ can protect mice from CDAD-related death as effectively as vancomycin and the combination of vancomycin and HXZQ may give even better protection.

Phenotypic and genomic characterization of Pseudomonas aeruginosa isolates recovered from catheter-associated urinary tract infections in an Egyptian hospital.

Catheter-associated urinary tract infections (CAUTIs) represent one of the major healthcare-associated infections, and Pseudomonas aeruginosa is a common Gram-negative bacterium associated with catheter infections in Egyptian clinical settings. The present study describes the phenotypic and genotypic characteristics of 31 P. aeruginosa isolates recovered from CAUTIs in an Egyptian hospital over a 3 month period. Genomes of isolates were of good quality and were confirmed to be P. aeruginosa by comparison to the type strain (average nucleotide identity, phylogenetic analysis). Clonal diversity among the isolates was determined; eight different sequence types were found (STs 244, 357, 381, 621, 773, 1430, 1667 and 3765), of which ST357 and ST773 are considered to be high-risk clones. Antimicrobial resistance (AMR) testing according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines showed that the isolates were highly resistant to quinolones [ciprofloxacin (12/31, 38.7 %) and levofloxacin (9/31, 29 %) followed by tobramycin (10/31, 32.5 %)] and cephalosporins (7/31, 22.5 %). Genotypic analysis of resistance determinants predicted all isolates to encode a range of AMR genes, including those conferring resistance to aminoglycosides, β-lactamases, fluoroquinolones, fosfomycin, sulfonamides, tetracyclines and chloramphenicol. One isolate was found to carry a 422 938 bp pBT2436-like megaplasmid encoding OXA-520, the first report from Egypt of this emerging family of clinically important mobile genetic elements. All isolates were able to form biofilms and were predicted to encode virulence genes associated with adherence, antimicrobial activity, anti-phagocytosis, phospholipase enzymes, iron uptake, proteases, secretion systems and toxins. The present study shows how phenotypic analysis alongside genomic analysis may help us understand the AMR and virulence profiles of P. aeruginosa contributing to CAUTIs in Egypt.

Time to Place Clostridium difficile Infections in Major Healthcare-associated Infections List.

How to cite this article: Sinha S, Behera S. Time to Place Clostridium difficile Infections in Major Healthcare-associated Infections List. Indian J Crit Care Med 2023;27(2):152-153.

1705. Filamentous Hemagglutinin Polyclonal Antibodies Protect against Multidrug resistant Gram-negative bacteria

Abstract Background Multidrug-resistant (MDR) Gram-negative bacteria (GNB) are among the major healthcare-associated infections and have high mortality especially in immunocompromised patients. Acinetobacter baumannii (AB) and Pseudomonas aeruginosa (PA) are classified as “critical organism” by CDC. Therefore, new anti-infective therapies are critically needed. Our studies showed that passive immunization using antibodies against Candida Hyr1 peptide#5 are protective in AB pneumonia mouse model and this was attributed to the structure homology between Candida Hyr1 and AB Filamentous hemagglutinin protein B (FhaB). In this study, we identified FhaB epitopes that shared sequence homology with Candida Hyr1 peptide#5. We aim to evaluate antibody-based therapy targeting these epitopes against AB and PA infection. Designing and evaluating FhaB peptides that share sequence similarity to Hyr1#5 In vivo protection of FhaB antibodies in mouse model on different MDR GNB A) AB B)PA Methods Sequence homology was done using BLAST online tool. FhaB peptides and their polyclonal antibodies (pAbs) were commercially produced. Indirect ELISA was done to test recognition FhaB peptides to Hyr1#5 Abs. Binding ability of FhaB pAbs was tested against AB and PA using flow cytometry. The efficacy of pAbs in protecting against AB- or PA-induced pneumonia was studied in immunosuppressed CD1 mice by administering 30 µg of pAbs (i.p.) on Day +1 relative to infection. Survival of mice served as an endpoint. Results We identified seven FhaB peptides that shared ∼50% sequence homology with Hyr1#5. These peptides are conserved among many GNB including AB and PA. Two peptides (FhaB#4 & FhaB#5) showed strong binding to Hyr1 Abs in ELISA. The pAbs generated against these two peptides showed ∼90% and 50% binding to AB and PA, respectively. Finally, pAbs targeting FhaB#4 protected mice from lethal dose of both AB and PA with 70% and 40% survival efficacies, respectively (p< 0.05). Conclusion We used FhaB to generate protective pAb against MDR AB and PA. Our results warrant the further development of these Ab as novel immunotherapeutics against MDR GNB. Disclosures All Authors: No reported disclosures.

Covid-period-associated changes in organism profile of neonatal sepsis in a tertiary center from East India.

Neonatal sepsis is a major cause of morbidity and mortality with a higher burden from the low- and middle-income countries. The coronavirus disease 2019 (Covid 19) pandemic has impacted healthcare in various ways including healthcare-associated infections (HAI). The objective of the present study was to determine changes in organism profile and incidence rates of HAI in neonates admitted to the index hospital during the pandemic and compared it with the data from the pre-pandemic period. The study design was a retrospective, observational analysis of data from neonates with culture-positive sepsis, in a tertiary care children's hospital, between January 2018 and December 2021. Pre-Covid (January 2018 to December 2019) and Covid period data (January 2020 to December 2021) were analyzed for the significance of change. The prevalence of culture-positive sepsis, in pre-Covid and Covid periods, was 19.55% [95% confidence interval (95% CI) 17.13-21.52)] and 18.36% (CI 16.05-20.74), respectively. HAI rates/1000 patient days increased slightly during the Covid pandemic [7.2% (95% CI 6.98-10.08) to 9.8% (95% CI 9.78-13.67)] mainly due to an increase in fungal HAI (26% pre- vs. 41.5% Covid period). However, the proportion of Gram-negative (GN) infections fell significantly (70.5% vs. 48.6%) during the same period. In the pre-Covid period, Klebsiella followed by Burkholderia cepacia, Acinetobacter spp and Pseudomonas, were the major HAI isolates. During the Covid period, there was a decline in these isolates and Burkholderia spp was not detected. All fungal isolates were Candida species. The case fatality ratio (CFR) from HAI decreased significantly from 38% to 15.45%, mainly due to a decrease in GN HAI. During Covid pandemic, there was a significant decline in GN HAI and CFR from HAI, due to improved compliance with infection control measures in the neonatal intensive care unit (NICU). At the same time, there was a rise in the fungal HAI, possibly because of a higher proportion of premature, and sick neonates with longer hospital stay and more invasive procedures. Consolidations of gains in infection control and restriction of invasive procedures could help to minimize HAI in NICUs.

A STUDY OF BACTERIOLOGICAL AETIOLOGICAL AGENTS IN POST OPERATIVE ABDOMINAL WOUND INFECTIONS IN A TERTIARY CARE HOSPITAL

Background and Objectives: Surgical Site Infection (SSI) continues to be a major healthcareassociated infection. Primary objective: To isolate, identify and study the aerobic bacteriological spectrum of Abdominal Surgical Site Infection. Secondary objective: 1) To study the antibiotic sensitivity pattern. 2) To detect multidrug resistant strains in abdominal Surgical Site Infection. Materials and Methods: A total of 139 patients with post operative wound infections were included in this study during the course of one year from 1/10/16 to 30/09/2017. The study group included patients who underwent surgical procedure in a tertiary care hospital and developed Surgical Site Infection while in Hospital or after discharge within 30 days post surgery. These patients were followed up closely from the period of developing SSI to the time of discharge and during follow up in the hospital. Specimens such as double swabs for open surgical wounds and aspirates for localized infections were collected. Double swabs were inoculated into the following media: 5% Sheep Blood agar (SBA), MacConkey agar (MA), Salt agar (SA) and Glucose broth. Needle aspirates were also inoculated into Chocolate Agar (CA) in addition to the above media. The organisms were identied by conventional biochemical reactions and antibiotic sensitivity was done according to the CLSI guidelines 2017. Results: Out of the 139 cases in the study, the incidence of SSI's following abdominal surgeries were 41.7 %. The commonest age group for developing SSI was spread equally in the age groups between 51 – 60 and 61 – 70 years (20.14% each). Of the risk factors, Diabetes mellitus (40.28%) were associated with SSI's in 56 patients. Maximum number of cases were after Staging Laparotomies / Tumor excision for GIT Carcinoma- 48 (35.25%). 13.66 % cases were after Appendicectomy; LSCS - 12.23 %, Laparotomy- Peritonitis 10.79 %, Laparotomy- Intestinal obstruction 3.59 %, Hernioraphy 9.35 %, Tubectomy 3.59 %, TAH 7.19 %, Laparotomy -Abdominal injury 0.71 % and others 4.31 %. There were 58 (41.7%) of cases with microbial isolates and 81 (58.3%) cases were sterile. S.aureus was the predominant organism in Abdominal Surgical Site Infection 20 (34.48%), followed by E.coli and Klebsiella pneumoniae 15 (25.85%) each. Out of 15 Klebsiella pneumoniae 53.33 % were ESBL producers and 33.33 % were MBL producers. Where as in 15 E.coli isolates, 80 % were ESBL producers and 6.67 % MBL producers. Discussion: Surgical Site Infection (SSI) are the most common Health care associated infection in low and middle income countries. Surgical Site Infection was found to be higher in patients above 50 years of age which can be due to multiple factors like a low healing rate, malnutrition, mal-absorption, increased catabolic processes and low immunity. Diabetes mellitus is a major risk factor associated with Surgical Site Infections. Patients requiring prolonged hospitalization were more prone to Surgical Site Infections. Enterococcus which is a member of the normal ora of the Gastrointestinal and Genitourinary tract in humans is an emerging pathogen in abdominal Surgical Site Infections. Interpretation and Conclusion: The prevalence of multidrug resistant organisms is to be considered as a warning sign for the emerging spread of antibiotic resistance and the need for urgent implementation of strict antibiotic policy and infection control measures. Identication of SSI's involves interpretation of clinical and laboratory ndings, and it is crucial that a surveillance programme uses denitions that are consistent and standardized; otherwise inaccurate or uninterpretable SSI rates will be computed and reported.

Structural insights into the inhibition of bacterial RecA by naphthalene polysulfonated compounds.

SummaryAs a promising target for alternative antimicrobials, bacterial recombinase A (RecA) protein has attracted much attention for its roles in antibiotic-driven SOS response and mutagenesis. Naphthalene polysulfonated compounds (NPS) such as suramin have previously been explored as antibiotic adjuvants targeting RecA, although the underlying structural bases for RecA-ligand interactions remain obscure. Based on our in silico predictions and documented activity of NPS in vitro, we conclude that the analyzed NPS likely interact with Tyr103 (Y103) and other key residues in the ATPase activity center (pocket A). For validation, we generated recombinant RecA proteins (wild-type versus Y103 mutant) to determine the binding affinities for RecA protein interactions with suramin and underexamined NPS in isothermal titration calorimetry. The corresponding dissociation constants (Kd) ranged from 11.5 to 18.8 μM, and Y103 was experimentally shown to be critical to RecA-NPS interactions.

Charlson Comorbidity Index (CCI): An Independent Predictor of Outcomes in Clostridium difficile Infection (CDI)

Introduction: Clostridium difficile infection (CDI) has emerged as a major healthcare-associated infection. The incidence of this infection, related hospitalizations and mortality rates seem to be increasing every year. Certain established risk factors and comorbid conditions are thought to have a prognostic impact on the outcomes of patients with CDI. We studied the significance of Charlson Comorbidity Index (CCI) as an independent tool to predict the outcomes in these patients. Methods: We conducted a retrospective observational study at our institution between July 1st, 2014 and June 30th, 2017. We included all individual admitted to our institution whose stool tested positive for Glutamate Dehydrogenase (GDH) and was confirmed by Nucleic Acid Amplification Test (NAAT). Demographic, clinical, laboratory and pharmacological data was abstracted from our EHR (Electronic Health Records). The data was analyzed using standard statistical methods and JMP14 software. We divided patients into two groups based on in-hospital mortality. Results: In our study we included a total of 314 individual who met the inclusion criteria. We observed no difference in the outcomes of the patients based on their gender. The mean age of patients who died was 64.5 years while the mean age of those who survived was 57.5 (p value = 0.016). Furthermore, the mean CCI of the patients who died was 7.37 while of those who survived was 4.4 (p value = 0.0001 ) (Table 1).We also compared the Charlson Comorbidity Index(CCI) in mild-moderate, severe and complicated CDI which corresponded with disease severity (6.20, 5.70 and 4.06 respectively (p value = Conclusion: Current CDI outcome prediction models are based on disease severity. Our study sheds light into a new area of CCI and mortality in individuals with CDI. We observed known risk factors like age, severity of disease correlated with mortality. However, we noticed higher CCI score in relation to mortality during hospitalization. As CCI is a quick and readily available tool, we hope this finding will help healthcare professionals to predict outcomes in patients with CDI to manage them more efficiently for better outcomes.2743 Figure 1 No Caption available.

Prevalence, genetic relatedness and antibiotic resistance of hospital-acquired clostridium difficile PCR ribotype 018 strains

Clostridium difficile infection (CDI) is a major healthcare-associated infection. The aim of this study was to investigate the genetic relatedness of the endemic C. difficile PCR ribotype 018 strains in an institution and changes to their characteristics during a five-year period.A total of 207 isolates from inpatients at Hanyang University Hospital from 2009 to 2013 were analysed using multilocus variable-number tandem-repeat analysis (MLVA). Minimum inhibitory concentrations (MICs) of several antibiotics were determined.In total, 204 (98.6%) were genetically related, with a summed tandem-repeat distance (STRD) ≤ 10. Minimum-spanning-tree analysis identified 78 MLVA types, categorized into six clonal complexes (CCs). The largest cluster, CC-I, included 51 MLVA types from 148 isolates (71.5%) and the second largest cluster, CC-II, included 10 MLVA types from 36 isolates (17.4%). Resistance rates for antibiotics were: clindamycin (CLI), 97.6%; moxifloxacin (MXF), 98.6%; vancomycin (VAN), 1.4%; and rifaximin (RFX), 8.2%. All isolates were susceptible to piperacillin/tazobactam (TZP) and metronidazole (MTZ). Comparing the MICs of antibiotics for the isolates each year from 2009 to 2013, MICs of antibiotics that promote CDI, such as CLI, MXF, TZP and RFX, increased over the five-year period (P–value by Kruskal-Wallis test: < 0.0001, <0.0001, <0.0001, and <0.0001 respectively); however, MICs of VAN or MTZ, antibiotics for treatment of CDI, did not increase or decreased over the same time period (P–value by Kruskal-Wallis test: 0.166, <0.0001).C. difficile RT018 isolates in a tertiary hospital over a five-year period presented a close clonal relationship. MICs of antibiotics promoting CDI increased with this clonal expansion.

Clostridium difficile infection in solid organ transplant recipients.

Clostridium difficile infection (CDI) is a major healthcare-associated infection that causes significant morbidity and an economic impact in the United States. In this review, we provide an overview of Clostridium difficile infection in solid organ transplant recipients with an emphasis on recent literature. C. difficile in solid organ transplant population has unique risk factors. Fecal microbiota transplantation has shown favorable results in treatment of recurrent C. difficile in this population. Preliminary data from animal studies suggests excellent efficacy with immunization against C. difficile toxins. Over the last decade, number of individuals receiving solid organ transplants has increased exponentially making peri-transplant complications a common occurrence.C. difficile is a frequent cause of morbidity in solid organ transplant recipients. Early and accurate diagnosis of C. difficile requires a stepwise approach. Differentiating between asymptomatic carriage and infection is a diagnostic challenge. Microbial diversity is inversely proportional to risk of C. difficile infection. Antimicrobial stewardship programs help to retain microbial diversity in individuals susceptible to CDI. Recurrent or relapsing C. difficile infection require fecal microbiota transplantation for definitive cure.

Impact of Enhanced Recovery After Surgery and Fast Track Surgery Pathways on Healthcare-associated Infections: Results From a Systematic Review and Meta-analysis.

The aim of this study was to establish if enhanced recovery after surgery (ERAS) and fast track surgery (FTS) protocols are associated with reduction in healthcare-associated infection (HAIs). Evidence suggests that prevention strategies for HAIs should be multifaceted and transdisciplinary. ERAS and FTS protocols are collaborative approaches to perioperative care which reduce length of stay but may also be an effective strategy for reducing HAIs. We performed a meta-analysis of randomized trials involving either ERAS or FTS for abdominal or pelvic surgery. Primary outcome included postoperative incidence of 3 major HAIs: lung infection (LI), urinary tract infection (UTI), and surgical site infection (SSI). Among all included trials, ERAS/FTS was associated with a significant reduction in postoperative LI [risk ratio (RR) = 0.38; 95% confidence interval (CI) = 0.23-0.61; P < 0.0001; I = 0%], UTI (RR = 0.42; 95% CI = 0.23-0.76; P = 0.004; I = 0%), and SSI (RR = 0.75; 95% CI = 0.58-0.98; P = 0.04; I = 0%) compared with conventional controls. Sensitivity analysis performed following the exclusion of high risk of bias publications did not appreciably affect these results. ERAS/FTS was also associated with a significant decrease in hospital length of stay (standard mean difference = -0.83; 95% CI = -0.92 to -0.75; P < 0.0001; P for heterogeneity <0.0001, I = 93%). Subgroup analysis of trials involving colorectal surgery and open incision also resulted in significant reduction in all 3 HAIs among ERAS/FTS compared with conventional counterparts. Our results suggest ERAS/FTS protocols are powerful tools to prevent HAIs. Further study is needed to establish the mechanism. Providers should consider adoption of similar transdisciplinary programs to reduce perioperative HAIs and at the same time improve the value of surgical care.

Infection Prevention in Transplantation.

The number of patients undergoing hematopoietic cell and solid organ transplantation are increasing every year, as are the number of centers both transplanting and caring for these patients. Improvements in transplant procedures, immunosuppressive regimens, and prevention of transplant-associated complications have led to marked improvements in survival in both populations. Infections remain one of the most important sources of excess morbidity and mortality in transplant, and therefore, infection prevention strategies are a critical element for avoiding these complications in centers caring for high-risk patients. This manuscript aims to provide an update of recent data on prevention of major healthcare-associated infections unique to transplantation, reviews the emergence of antimicrobial resistant infections, and discusses updated strategies to both identify and prevent transmission of these pathogens in transplant recipients.

The bacterial profile of surgical site infection occurring within one week after surgery in a tertiary care centre

Background and Objectives: Surgical site infection (SSI) continues to be a major healthcare-associated infection. The objective of the study was to find the bacterial profile of SSI occurring within one week of surgery and to determine their antibiotic sensitivity pattern in a tertiary care centre. Materials and Methods: Pus from the surgical sites was cultured, the organisms were identified and their antibiotic sensitivity was found by conventional methods. Data were collected to assess the risk factors. The infection rate was compared with the available standards. Results: During the one-year study period, 2472 post-operative patients were followed up, of whom 227 got infected. The infection rate was 9.2% which was high compared to the Centers for Disease Control statistics of 1.9%. The predominant isolate was Staphylococcus aureus 50 (28.2%), followed by Escherichia coli 48 (27.1%). Interpretation and Conclusion: Inpatients were studied for the first one week only because this was the optimum period for contracting infections. Moreover, majority of the patients got discharged from the hospital after one week. S. aureus was the predominant pathogen in Class I wounds, and E. coli was predominant in Class III wounds.

Decrease ventilator-associated pneumonia by bundle care in cardiac surgery intensive care unit

Ventilator-associated pneumonia (VAP) is major healthcare-associated infections in intensive care unit (ICU), which increases length of stay, medical cost and mortality.

Costs associated with healthcare-associated infections in cardiacsurgery.

Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited. This research was designed to determine the cost associated with major types of HAIs during the first 2months after cardiac surgery. Prospectively collected data from a multicenter, observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, with adjustments for patient demographics, clinical history, baseline laboratory values, and surgery type. Among 4,320 cardiac surgery patients (mean age: 64 ± 13 years), 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%), and Clostridium difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions; among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAIs was, on average, nearly threefold that of readmissions not related to HAIs. Hospital cost, LOS, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. (Management Practices and the Risk of Infections Following Cardiac Surgery; NCT01089712).

Improving patient safety through prevention of healthcare associated infections

Prevention of healthcare-associated infection (HAI) is an essential part of patient safety. HAIs are associated with significant mortality, morbidity, and increasing healthcare cost. Major HAIs include urinary tract infection, pneumonia, surgical site infection, bacteremia, and C. difficile colitis. Surveillance for HAIs is essential to prevent these infections. Active strategies, such as the 'bundle' approach, should be implemented for the effective prevention of HAIs. The Korean regulatory certification system for hospitals is a powerful driver in the maintenance of the infection surveillance, control and prevention process. Additional driving forces for the reduction of HAIs include financial incentives and convincing clinical practice guidelines. Therefore, there is a need for solid regulatory and financial support and a suitable cultural environment for the prevention of HAIs.

Assessing the burden of healthcare-associated infections through prevalence studies: what is the best method?

To explore differences in the prevalence of healthcare-associated infections (HAIs) according to survey methodology. Repeated point and period prevalence survey strategies. University-affiliated primary and tertiary care center. Analysis of data collected from 2006 to 2012 from annual HAI prevalence surveys using definitions proposed by the US Centers for Disease Control and Prevention. The study design allowed the analysis of the same data in the format of a point or a period prevalence survey. Pooled point and period HAI prevalence was 7.46% and 9.84% (+32%), respectively. This additional 32% was mainly attributable to infections of the lower respiratory tract (2.42% vs 3.20% [+32%]) and the urinary tract (1.76% vs 2.62% [+49%]). Differences in surgical site infections (1.02% vs 1.20% [+19%]) and bloodstream infections (0.76% vs 0.86% [+13%]) were smaller. HAI prevalence for the point and period methodology in acute and long-term care were 7.47% versus 9.38 (+26%) and 8.37% versus 11.89% (+42%), respectively. Differences were stable over time. Focusing on the 4 major HAIs (respiratory tract, urinary tract, surgical site, and bloodstream infections) misses one-quarter of all HAIs. More HAIs are identified by the period prevalence method, especially those of shorter duration (lower respiratory and urinary tract), which would make this method more suitable to be used in long-term care. Results of the 2 study methods cannot be benchmarked against each other.

P222: Period vs point prevalence – what is the difference?

Prevalence surveys serve as a rapid and simple means of obtaining healthcare associated infection (HAI) data. There is variability in following either the point or the period prevalence strategy, and whether the four major HAI categories (urinary tract infection [UTI], lower respiratory tract infection [LRI], bloodstream infection [BSI], surgical site infection [SSI]) should be reported rather than all HAI.

Engaging patients in the prevention of health care-associated infections: A survey of patients' awareness, knowledge, and perceptions regarding the risks and consequences of infection with methicillin-resistant Staphylococcus aureus and Clostridium difficile

Methicillin-resistant Staphylococcus aureus (MRSA) infections and Clostridium difficile infections (CDI) are major health care-associated infections (HAIs). Little is known about patients' knowledge of these HAIs. Therefore, we surveyed patients to determine awareness, knowledge, and perceptions of MRSA infections and CDI. An interviewer-administered questionnaire. A tertiary care academic medical center. Adult patients who met at least one of the following criteria: at risk of CDI or MRSA infection, current CDI or colonization or current MRSA infection or colonization, or history of CDI or MRSA infection. Two unique surveys were developed and administered to 100 patients in 2011. Overall, 76% of patients surveyed were aware of MRSA, whereas 44% were aware of C difficile. The strongest predictor of patients' awareness of these infections was having a history of HAI. Patients with a history of HAI were significantly more likely to have heard of both MRSA (odds ratio, 13.29; 95% confidence interval, 2.84-62.14; P = .001) and C difficile (odds ratio, 9.78; 95% confidence interval, 2.66-35.95; P = .001), than those patients without a history of HAI. There was also a significant positive association between having a history of HAI and greater knowledge of the risk factors, health consequences, and prevention techniques relative to CDI and MRSA infections. There are additional opportunities to engage patients about the risks and consequences of MRSA and CDIs, particularly those without a history of HAI.