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,1 leading to substantial morbidity, mortality, and excess healthcare expenditures,1 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 outcomes2 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.3 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.
Hospitalized premature infants are particularly vulnerable to morbidity and mortality from pertussis. Effective prevention and investigative and control measures are not well described.
To identify ...the source of nosocomial pertussis in a 2-month-old premature infant in a neonatal intermediate care nursery (ICN) and to critically review the investigation and outbreak control measures.
An ICN and a neonatal intensive care unit.
We queried healthcare workers (HCWs) and family members about cough illness and contacted potentially exposed patients to determine whether they had symptoms of pertussis. Culture and polymerase chain reaction (PCR) testing for Bordetella pertussis were performed by the hospital laboratory with specimens collected from symptomatic patients and HCWs. Levels of pertussis toxin immunoglobulin G antibodies were measured in HCWs with cough of at least 14 days' duration at a public health laboratory. Extensive control measures were instituted.
Four ICN HCWs met the clinical case definition for presence of pertussis. Serologic test results were positive for 3 of the HCWs. The primary case patient was a 36-year-old HCW with a cough illness of 3-weeks' duration that was accompanied by paroxysms, whoop, posttussive emesis, and pneumothorax. Among the 4 affected HCWs, the duration of cough illness prior to identification of the infant index patient ranged from 11 to 25 days. Outbreak control measures included isolation of the infant case patient, furlough and treatment of symptomatic HCWs, administration of chemoprophylaxis to contacts, and surveillance for additional cases. Seventy-two infant patients and 72 HCWs were exposed and were given antibiotic prophylaxis. One additional case of pertussis, confirmed by PCR and culture, occurred in a resident physician who declined prophylaxis; she had cared for the index patient but had no contact with symptomatic HCWs.
HCWs or patients may serve as the source of pertussis in nosocomial outbreaks, which can result in substantial morbidity and outlay of resources for control measures. Our review suggested that a diagnosis of pertussis should be an early consideration for HCWs with cough illness. Targeted pertussis immunization of HCWs, employee health policies that provide for testing and furlough of HCWs with prolonged cough, and monitoring of HCWs for compliance with infection control measures could reduce the morbidity and costs associated with pertussis outbreaks. These measures will require evaluation of their effectiveness.
Central line-associated bloodstream infections cause morbidity and mortality in children. We explore the evidence for prevention of central line-associated bloodstream infections in children, assess ...current practices, and propose research topics to improve prevention strategies.
Pediatric Infectious Diseases Meets the Future Gilsdorf, Janet R; Spearman, Paul; Englund, Janet A ...
Journal of the Pediatric Infectious Diseases Society,
03/2019, Letnik:
8, Številka:
1
Journal Article
Pediatric infectious diseases physicians are dedicated to the diagnosis, prevention, and management of infections in children. As such, we play large, and important, roles in the clinical care of ...children from birth to late adolescence and in infection prevention, antimicrobial stewardship, research pertaining to infections, public health, international and global health, and advocacy for children's health. Furthermore, we are critical to the education of future physicians (in general), pediatricians, and infectious diseases doctors. In addition to diagnosing and treating bacterial, fungal, viral, and parasitic infections known through the ages, we have been at the forefront of meeting today's new infectious threats to children's health, which include the following: antibiotic-resistant organisms; hospital-acquired infections; global outbreaks such as Ebola, Zika, human immunodeficiency virus-acquired immune deficiency syndrome, and new strains of influenza; infections in immunocompromised children; vaccine-preventable infections; the inefficient use of medical resources; and the high cost of medical care.
Pediatric infectious diseases (ID) fellows are required to receive training in hospital epidemiology and infection control and prevention. We sought to assess the current state of healthcare ...epidemiology training for fellows and to determine which topics are considered important by key stakeholders.
US pediatric ID fellowship program directors and hospital epidemiologists.
We conducted an anonymous Web-based survey in February 2012. We assessed the presence and content of curricula, perceived importance of specific topics, and barriers to career development.
Of 97 eligible participants, 76 (78%) completed the survey, representing 54 programs. Respondents were program directors (60%), hospital epidemiologists (25%), or both (15%). A total of 82% of programs with didactic curricula have infection control sessions, most commonly 1-2 hours in total duration. Of 17 identified topics, only 3 were covered by more than 50% of programs: isolation precautions (54%), central line-associated bloodstream infection (CLABSI; 53%), and hand hygiene (51%). Of the 76 respondents, 35% indicated that fellows participate in a dedicated infection control rotation. Six topics were considered very important by more than 75% of respondents: antimicrobial stewardship (94%), isolation precautions (93%), hand hygiene (90%), CLABSI (90%), surveillance for resistant bacteria (81%), and communicable disease exposure management (81%).
Pediatric ID fellowship programs dedicate little time to didactic or experiential learning in healthcare epidemiology. There are a wide array of topics that the majority of programs do not cover, including several subjects that are considered to be very important by program directors and hospital epidemiologists. Creating a standardized pediatric infection control curriculum would likely benefit fellows in training.
Multidrug resistant organisms (MDROs) and healthcare-associated infections (HAIs) are associated with increased lengths of hospital stay, increased costs, and increased mortality. We explore the ...scope of MDRO HAIs in children, current MDRO HAI prevention practices and data to support these practices, and we propose research topics targeting MDRO HAI prevention in children.
Microscopic colitis (MC) has rarely been described to be the cause of watery diarrhea in those with established inflammatory bowel disease (IBD), and instead has been presented as a herald syndrome ...to eventual IBD or incidentally found in asymptomatic IBD patients. We report a case series of 7 patients with IBD who presented with a watery diarrheal exacerbation due to new-onset MC. We propose that new-onset MC should be considered in the differential diagnosis of watery diarrhea occurring in patients with long-standing IBD and that evaluation should include colonoscopy with biopsies obtained throughout the colon.
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