Society For Healthcare Epidemiology Of America Research Articles

Implementation of Sepsis Prevention Guidelines for Nurses into a Clinical Practice

Background: Sepsis is one of the most serious complications in intensive care patients, which is associated with high mortality and morbidity of critically ill patients. Measures based on the effective prevention are one of the main strategies of treating patients. Aseptic procedures, barrier nursing techniques, selection of equipment used for the treatment as well as the replacement frequency of protective barriers are preferred nursing interventions of sepsis with regard to the prevention. The objective of this retrospective study was to assess the importance of nursing interventions and aspects of the incidence of sepsis and infectious complications in ICU patients, including analysis of erroneous nursing procedures that could affect the formation of sepsis. Methods: A retrospective study was conducted by data collection from medical records and observation of patients hospitalized at the Clinic of Anesthesiology and Intensive-care during the period from January 2019 to December 2022. The overall sample consisted of 736 patients who were diagnosed with sepsis by a doctor according to confirmed infectious etiology. Data were processed by descriptive statistics, frequency tables and x2 (chi-square) test were used for evaluating and the Fisher's exact test was used for small frequency (n <5). Statistical tests were assessed at the significance level of 5. There were identified 231 patients with sepsis, 106 patients with confirmed infectious etiology, 31 patients with confirmed non- infectious causes (SIRS) and 7 cases of other infectious cause was confirmed during hospitalization. Another category of patients was represented by cases, in which the positive sputum was found in injection site infection, in positive punctate in wound, in purulent secretion from the wound or bacterial findings in urine without general symptoms of infection. Nursing interventions were analyzed with regard to the prevention of sepsis patients in intensive care. Results: The largest number of sepsis was proved in 2019 (26.23%) and in 2020 (20.01%), while in 2021 (11.67%) and 202022 (14.02%) there was recognized a decrease in sepsis. According to the etiology there was significant share of VAP and catheter sepsis compared to uremic and early infection Out of the nursing procedures that have proven to be important for the prevention of VAP there were identified a closed suction method, the selection of the endotracheal tube, the use of semi recumbent position. Selection of the catheter, puncturesite selection, use of infusion filters or disinfection options were found as important examples in the prevention of catheter sepsis. Using a closed circuit system has proved to be the most effective in urinary tract infections. The results clearly show the effect of educational activities of working group on compliance with the rules of asepsis, compliance with barrier nursing activities and practices that are entirely in the hands of the nursing staff. Conclusions: All preventive measures are in accordance with the recommendations of CDC (The Centers for Disease Control and Prevention) and SHEA (The Society for Healthcare Epidemiology of America) that recommend the education and training of the staff. The objective is to increase awareness of the necessity of preventive measures which help to reduce the incidence of infection with subsequent sepsis in patients in intensive care. Regular education and practical training can not only improve the quality of care, but we can also implement new procedures into the practice with regard to the nursing staff awareness of the importance of sepsis prevention at intensive care units.

1660. Harnessing Handshake Rounds for Infection Prevention: Interventions and Great Catches in the First Year

Abstract Background There are national calls to engage Infection Preventionists (IPs) as antimicrobial stewards (AS), but it is unknown how this is translated into action and measurable outcomes. The Association of Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) 2012 joint position paper states that IPs can benefit ASPs. The paper summarizes key actions for IPs as promoting compliance with standard and transmission-based precautions, care bundle, hand hygiene, and educating staff, patients, and visitors. However, an initial review of the literature did not find any publications outlining IP actions or outcomes as participants in AS. Methods In August 2022 an IP was added as available to the existing handshake stewardship rounding team. During rounds the IP observed units for safe infection control practices, asked staff if there were any questions about IC policies or practices, and shared information about circulating illness and COVID-19 policy updates. Results Between August 2022 and March 2023, there were 201 interventions. The largest categories included environmental, education, and expired product. 42 (21%) were categorized as a “great catch”, defined as likely to have system-wide impact. Secure chat data was also collected as a baseline to assess change over time. IP interventions during ASP Handshake Rounds EHR Secure Chats to on call Infection Preventionists Conclusion The impact of including an IP during handshake stewardship was great. Impact includes environmental interventions: cleaning and disinfection processes, laundry, waste, damaged structures, construction, and ventilation issues. Educational impact: teaching providers how to access policies, answering questions about isolation and PPE, and the importance of standard precautions and policy changes surrounding COVID-19. Identifying and disposing of expired products and guidance on isolation precautions and PPE. Examples of a great catch included upgrading isolation status, identifying multiple expired products, correcting incorrect PPE or IC in real time, and educating large groups of staff members on critical IC topics. Health care teams and leadership expressed appreciation of education and support provided by the IP during rounds. Integration of IP into Handshake Stewardship will improve IC practices and Joint Commission readiness. Disclosures All Authors: No reported disclosures

Re: Demographic representation among speakers at the Society for Healthcare Epidemiology of America (SHEA) Spring conferences.

Re: Demographic representation among speakers at the Society for Healthcare Epidemiology of America (SHEA) Spring conferences.

Demographic representation among speakers at the Society for Healthcare Epidemiology of America (SHEA) spring conferences.

The Society for Healthcare Epidemiology of America (SHEA) is a leading medical society for infection prevention and antibiotic stewardship. This descriptive study evaluated speaker demographics at the annual SHEA Spring conferences from 2019 to 2022. This was a retrospective, descriptive analysis of the demographic composition of speakers at the annual SHEA Spring conferences between 2019 and 2022, excluding the cancelled 2020 conference. Self-reported demographics were available for gender, race, ethnicity, age, primary practice setting, and professional degrees in speaker and membership categories. In total, 447 speaker slots were filled by 305 unique speakers over 3 years. Average annual membership included 55.2% female, 44.8% male, 69.3% White, 21.4% Asian, 6.0% Hispanic/Latino, 2.9% Black, and 0.4% American Indian/Alaska Native or Native Hawaiian/Pacific Islander (AIAN/NHPI); 48.9% did not report a race or ethnicity. Speakers during the same period were 63.5% female, 36.5% male, 68.2% White, 13.3% Asian, 3.8% Black, 3.4% Hispanic/Latino, 0.8% AIAN/NHPI; 13.4% did not report race or ethnicity. In 2021, pharmacists represented 11.6% of speakers (and 2.9% of members) and members with nondoctoral degrees represented 11.6% of speakers (and 21.5% of members) (P < .0001). In each year, we detected underrepresentation of community and private-practice speakers relative to membership (eg, in 2022, 4.3% of speakers vs 15.7% of members; P < .05). The SHEA Spring conferences demonstrated an increase in pharmacist speakers over time, but speakers from community hospitals and with nondoctoral degrees remain underrepresented relative to membership. Racial and ethnic minoritized individuals remain underrepresented as members and speakers. Intentional interventions are needed to consistently achieve equitable speaker representation across multiple demographic groups.

Introduction to A Compendium of Strategies to Prevent Healthcare-Associated Infections In Acute-Care Hospitals: 2022 Updates.

Since the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals in 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthcare epidemiology, infection prevention, antimicrobial stewardship, and implementation science research has led to improvements in our understanding of effective strategies for HAI prevention. Despite these advances, HAIs continue to affect ∼1 of every 31 hospitalized patients, leading to substantial morbidity, mortality, and excess healthcare expenditures, and persistent gaps remain between what is recommended and what is practiced.The widespread impact of the coronavirus disease 2019 (COVID-19) pandemic on HAI outcomes in acute-care hospitals has further highlighted the essential role of infection prevention programs and the critical importance of prioritizing efforts that can be sustained even in the face of resource requirements from COVID-19 and future infectious diseases crises.The Compendium: 2022 Updates document provides acute-care hospitals with up-to-date, practical expert guidance to assist in prioritizing and implementing HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Pediatric Infectious Disease Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), the Surgical Infection Society (SIS), and others.

Monitoring health disparities in healthcare-associated infection surveillance: A Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) Survey.

We investigated whether and how infection prevention programs monitor for health disparities as part of healthcare-associated infection (HAI) surveillance through a survey of healthcare epidemiology leaders. Most facilities are not assessing for disparities in HAI rates. Professional society and national guidance should focus on addressing this gap.

[Diagnostic Stewardship - The right test for the right patient with the right consequences].

In 2023, the Society for Healthcare Epidemiology of America (SHEA) Task Force issued a practice recommendation on the integration of diagnostic stewardship into antibiotic stewardship (ABS) programs, which focuses on optimizing sample collection, processing, and reporting to ensure a correct test result on the one hand, and on the justifying indication to perform diagnostics on the other.Unnecessary microbiological or serological tests produce results that can then lead to unnecessary further tests for clarification or unnecessary antibiotic administration. A classic example is "routine" urine cultures before non-urological, surgical interventions, which often lead to the treatment of asymptomatic bacteriuria. Every microbiological diagnosis must therefore be preceded by a specific question, whereby screening examinations from epidemiological questions must be clearly distinguished from clinical requirements. A particular problem is the distinction between contamination, colonization and infection, especially when samples are taken from catheters or drains. These materials should always be evaluated with extreme caution and may only be accepted at all if the clinical question is clear and subject to this very reservation. This article summarizes the existing evidence on diagnostic stewardship interventions and recommendations on their implementation, extrapolating the international literature to the specifications of the German health care system.

The management of Clostridioides difficile infection: from empirism to evidence.

Clostridioides difficile infection (CDI) in clinical practice represents a challenge for its management and also prevention of recurrence. Even though there are updated guidelines for infection prevention, control and treatment, CDI remains a leading cause of healthcare acquired diarrhea with increasing incidence in the community. We present here a synthesis of the most recent international guidelines on the management of CDI. In 2021 updated guidelines on the treatment of CDI in adults were published by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA), American College of Gastroenterology (ACG) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). These guidelines focused on CDI management in adults, including new data on the clinical efficacy of Fidaxomicin (FDX) and Bezlotoxumab. The 2017 publication of IDSA and SHEA - Clinical Practice Guidelines for Clostridium difficile infection also included pediatric treatment recommendations that are not a part of the 2021 update. Vancomycin (VAN) treatment for an initial CDI episode remains an acceptable alternative to FDX, considering the monetary and logistical challenge of acquiring FDX. There is growing literature on fecal microbiota transplantation (FMT) and the 2021 guidelines describe its role in severe complicated refractory CDI cases and for which surgical management is not feasible. Moreover, there are new data on the secondary prophylaxis with VAN in refractory CDI in patients with risk factors who receive broad spectrum antibiotics.

SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update.

Previously published guidelines have provided comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing efforts to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. This document updates the "Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals" published in 2014.1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

Speaker demographics at the Society for Healthcare Epidemiology of America (SHEA) Spring Conference, 2019–2022

Background: The Society for Healthcare Epidemiology of America (SHEA) serves as a national platform for infection prevention and antibiotic stewardship. Like many professional healthcare societies over the last decade, the SHEA has pledged to provide equitable opportunities to individuals in the organization. The impact of these efforts remains undetermined. This study evaluated trends in speaker demographics at the annual SHEA Spring Conference from 2019 to 2022. Methods: SHEA leadership or staff provided demographic information on SHEA members and Spring conference speakers (excluding poster sessions) from 2019 to 2022. We excluded 2020 due to conference cancellation. Data were summarized using descriptive statistics, and χ2 analysis was used to evaluate changes over time. Individual speakers were compared with member demographics. Self-reported SHEA speaker and member demographics were available for sex, race or ethnicity, age, primary practice setting, and professional degrees. Speaker professional degree was not available for 2022. Results: In total, 447 speaker slots were filled by 218 unique speakers over the 3-year period. The SHEA average annual membership between 2019 and 2022 with self-reported demographics included 55.2% female and 44.8% male members, with race reported as follows: 69.3% White, 21.4% Asian, 6.0% Hispanic or Latino, 2.9% Black, 0.4% American Indian/Alaska Native/Native Hawaiian/Pacific Islander (AIAN/NHPI). However, almost half of the members did not report a race or ethnicity. The SHEA speakers during the same period were 63.5% female and 36.5% male, with 68.2% White, 13.3% Asian, 3.8% Black, 3.4% Hispanic/Latino, and 0.8% AIAN/NHPI. Only 13.4% of speakers did not report race or ethnicity. Every year, there were fewer than 6 speakers in each of the Black, Hispanic or Latino, AIAN/NHPI race or ethnicity categories. In 2019, 49.2% of speakers were aged 41–50 years, compared with 28.6% of members in that age group (P = 0.0029). By 2022, 35.6% of speakers were aged 41–50 years, compared with 29.3% of members in that age group (P = .074). In 2021, pharmacists represented 11.9% of speakers compared with 2.9% of members, and members with nondoctoral degrees represented 11.1% of speakers compared with 21.4% of members (P &lt; .0001). In each year, there was a statistically significant association between primary practice setting and speaker or member representation, with underrepresentation of community or private-practice speakers relative to their proportion of membership: 2019 (7.5% speakers vs 14.3% members), 2021 (6.5% speakers vs 15.2% members), 2022 (4.3% speakers vs 15.7% members) (P &lt; .05) . Conclusions: Although there has been more equitable speaker age representation and an increase in pharmacist speakers at the SHEA Spring Conference over time, practitioners from community settings and those with nondoctoral degrees remain underrepresented relative to the SHEA membership. Racial or ethnic minoritized individuals remain underrepresented as members and speakers compared with the general US population. Intentional interventions are needed to consistently achieve equitable speaker representation across multiple demographic groups at the SHEA Spring Conference.Disclosures: None

Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update.

The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing their surgical-site infection (SSI) prevention efforts. This document updates the Strategies to Prevent Surgical Site Infections in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

2022 adult immunization schedule updates

Each year, the U.S. Centers for Disease Control and Prevention (CDC) releases the adult vaccine schedule. The 2022 adult vaccine schedule has several changes which will be discussed in the following manuscript. The Advisory Committee on Immunization Practices reviews the preliminary schedules usually at their October or November meetings. The following professional societies also approve the adult schedules prior to the 2022 publications: American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), American College of Nurse-Midwives (ACNM), American Academy of Physician Assistants (AAPA) and the Society for Healthcare Epidemiology of America (SHEA). Once the final draft is approved by the CDC, it is published in the Morbidity and Mortality Weekly Report (MMWR) and released to healthcare providers and the general public with a cover page, tables, notes and—new for the 2022 schedule—an appendix with contraindications and precautions for the different approved vaccines.

Reporting behaviors and perceptions toward the National Healthcare Safety Network antimicrobial use (AU) and antimicrobial resistance (AR) modules.

To identify characteristics of US health systems and end users that report antimicrobial use and resistance (AUR) data, to determine how NHSN AUR data are used by hospitals and health systems and end users, and to identify barriers to AUR reporting. An anonymous survey was sent to Society of Infectious Diseases Pharmacists (SIDP) and Society for Healthcare Epidemiology of America (SHEA) Research Network members. Data were collected via Survey Monkey from January 21 to February 21, 2020. Respondent and hospital data were analyzed using descriptive statistics. We received responses from 238 individuals across 43 US states. Respondents were primarily pharmacists (84%), from urban areas, (44%), from nonprofit medical centers (81%), and from hospitals with >250 beds (72%). Also, 62% reported data to the AU module and 19% reported data to the AR module. Use of software for local AU or AR tracking was associated with increased reporting to the AU module (19% vs 64%) and the AR module (2% vs 30%) (P < .001 each). Only 36% of those reporting data to the AU module used NHSN AUR data analysis tools regularly and only 9% reported data to the AR module regularly. Technical challenges and time and/or salary support were the most common barriers to AUR participation cited by all respondents. Among those not reporting AUR data, increased local expectations to report and better software solutions were the most commonly identified solutions to increase AUR reporting. Efforts to increase AUR reporting should focus on software solutions and salary support for data-entry activities. Increasing expectations to report may incentivize local resource allocation to improve AUR reporting rates.

Antibiotic prophylaxis practices in neurosurgery: A Society for Healthcare Epidemiology of America (SHEA) survey.

Antibiotic prophylaxis practices in neurosurgery: A Society for Healthcare Epidemiology of America (SHEA) survey.

Adapting and thriving, the Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) partnership

Adapting and thriving, the Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) partnership

Antibiotic Therapies for Clostridioides difficile Infection in Children.

While rates of Clostridioides difficile infection (CDI) are increasing among children in the United States, studies assessing CDI treatment in children are severely lacking. Thus, treatment guidelines have historically relied on evidence from limited observational data in children and randomized controlled trials (RCTs) conducted in adults to form recommendations. Currently, the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) recommend metronidazole and/or vancomycin for pediatric CDI depending on disease severity. Recently however, the first and only RCT of CDI treatment in children demonstrated fidaxomicin to be non-inferior to vancomycin, proving its safety and efficacy in this population. Additionally, observational data published since the IDSA/SHEA guidelines were released suggest metronidazole has lower rates of clinical improvement when compared to vancomycin in hospitalized children with non-severe CDI. Given these recent publications, fidaxomicin and vancomycin, instead of metronidazole, appear to be more appropriate, evidence-based options for the treatment of CDI in children.

Cutting edges in Clostridioides difficile infections.

Clostridioides difficile is the most common cause of hospital-acquired diarrhoea and one of the most important causes of hospital-acquired infections. It results in significant morbidity, mortality and economic burden - especially in the context of recurrent infections. After initial antibiotic therapy of a C. difficile infection, recurrence occurs in about 20% of all patients, which increases the risk of further recurrence to about 45%. Traditional therapeutic options for treatment of C. difficile infection include metronidazole or vancomycin. Newer therapy options such as fidaxomicin, the administration of monoclonal antibodies or faecal microbiota transplantation demonstrate significant advantages over traditional therapies, particularly regarding the reduction of the recurrence rate. This article highlights the main differences between the recommendations of the Swiss Society for Infectious Diseases on the management of "Clostridioides difficile infection" and the IDSA/SHEA reference guideline "Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)" and discusses some important challenges in -treatment of C. difficile.

Prevention practices for nonventilator hospital-acquired pneumonia: A survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN).

Prevention practices for nonventilator hospital-acquired pneumonia: A survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN).

Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults.

This clinical practice guideline is a focused update on management of Clostridioides difficile infection (CDI) in adults specifically addressing the use of fidaxomicin and bezlotoxumab for the treatment of CDI. This guideline was developed by a multidisciplinary panel representing the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). This guideline is intended for use by healthcare professionals who care for adults with CDI, including specialists in infectious diseases, gastroenterologists, hospitalists, pharmacists, and any clinicians and healthcare providers caring for these patients. The panel's recommendations for the management CDI are based upon evidence derived from topic-specific systematic literature reviews. Summarized below are the recommendations for the management of CDI in adults. The panel followed a systematic process which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation). A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.

Surveillance practices and air-sampling strategies to address healthcare-associated invasive mold infections in Society for Healthcare Epidemiology of America (SHEA) Research Network hospitals-United States, 2020.

With this survey, we investigated healthcare-associated invasive mold infection (HA-IMI) surveillance and air sampling practices in US acute-care hospitals. More than half of surveyed facilities performed HA-IMI surveillance and air sampling. HA-IMI surveillance was more commonly performed in academic versus nonacademic facilities. HA-IMI case definitions and sampling strategies varied widely among respondents.