IntroductionSince 2012, the European Centre for Disease Prevention and Control (ECDC) promotes a point prevalence survey (PPS) of HAIs in European acute care hospitals. Through a retrospective ...analysis of 2012, 2015 and 2017 PPS of HAIs performed in a tertiary academic hospital in Italy, we developed a model to predict the risk of HAI. MethodsFollowing ECDC protocol we surveyed 1382 patients across three years. Bivariate logistic regression analyses were conducted to assess the relationship between HAI and several variables. Those statistically significant were included in a stepwise multiple regression model. The goodness of fit of the latter model was assessed with the Hosmer-Lemeshow test, ultimately constructing a probability curve to estimate the risk of developing HAIs. ResultsThree variables resulted statistically significant in the stepwise logistic regression model: length of stay (OR 1.03; 95% CI: 1.02-1.05), devices breaking the skin (i.e. peripheral or central vascular catheter, OR 4.38; 95% CI: 1.52-12.63), urinary catheter (OR 4.71; 95% CI: 2.78-7.98). ConclusionPPSs are a convenient and reliable source of data to develop HAIs prediction models. The differences found between our results and previously published studies suggest the need of developing hospital-specific databases and predictive models for HAIs.
Skin Cleansing with chlorhexidine gluconate (CHG) is an evidence-based practice to prevent hospital acquired infections (HAI) by reducing colonization of skin organisms. The patient population in an ...oncology ICU is at an increased risk of developing a HAI due to their immunocompromised and critically ill state. During HAI event reviews, CHG skin cleansing was identified as one of the top trending opportunities in the ICU. The ICU team subsequently established a series of interventions to address compliance and prevent further HAIs. CHG is effective for up to 24 hours, so consistent application of the product is required for continuous skin protection. The ICU and Infection Prevention (IP) team prioritized CHG skin cleansing compliance due to the high-risk patient population. Together, a CHG compliance goal of 90% was predetermined. IP historically shared ICU's CHG skin cleansing compliance on a monthly cadence, with compliance averaging between 60-70%. The ICU leadership team collaborated with frontline staff to understand the current workflow, drill-down on opportunities, and address the barriers identified. Based on the feedback, the team implemented a dedicated CHG skin cleansing time that was feasible for staff workflow, prioritized refusal escalation, rebranded terminology to avoid patient confusion, provided patients and family members with educational materials, and delegated CHG skin cleansing to patient care assistants (PCAs). This was rolled out as the first PCA quality improvement project and there was complete buy-in from the ancillary staff. Additionally, ICU leaders worked with IP to increase the CHG data sharing to weekly instead of monthly, resulting in increased awareness and improved progress tracking. This allowed for timely staff education and improved accountability. ICU set a CHG skin cleansing goal of 90% in an effort to improve compliance and decrease HAIs. The PCA CHG skin cleansing project started on July 1, 2021 and resulted in a significant sustained improvement of CHG skin cleansing compliance ranging between 84-92%. With the increase, there has been an improvement in the following Nurse Sensitive Indicators: 100 days without a Central Line Blood Stream Infections, outperformance of the Hospital Acquired Pressure Injury NDNQI benchmark for the last 4 quarters, and outperformance of the Catheter Associated Urinary Tract Infection NDNQI benchmark for 3 of the last 4 quarters. This collaboration is being replicated in other unit throughout the organization.
Summary
Carbapenem is an important therapy for serious hospital‐acquired infections and for the care of patients affected by multidrug‐resistant organisms, specifically Acinetobacter baumannii; ...however, with the global increase of carbapenem‐resistant A. baumannii, this pathogen has significantly threatened public health. Thus, there is a pressing need to better understand this pathogen in order to develop novel treatments and control strategies for dealing with A. baumannii. In this review, we discuss an overview of carbapenem, including its discovery, development, classification and biological characteristics, and its importance in hospital medicine especially in critical care units. We also describe the peculiarity of bacterial pathogen, A. baumannii, including its commonly reported virulence factors, environmental persistence and carbapenem resistance mechanisms. In closing, we discuss various control strategies for overcoming carbapenem resistance in hospitals and for limiting outbreaks. With the appearance of strains that resist carbapenem, the aim of this review is to highlight the importance of understanding this increasingly problematic healthcare‐associated pathogen that creates significant concern in the field of nosocomial infections and overall public health.
species are Gram-negative bacilli that were most recently linked to a cluster of infections in the Midwestern United States from 2016 to 2017. Inappropriate empirical and directed antibiotic ...selection for this organism is common among providers and is an independent risk factor for mortality. Trends in antimicrobial susceptibility profiles of
species from a referral laboratory over a 10-year period were reviewed. Identification methods used over time varied and included biochemical panels, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and 16S rRNA gene sequencing. Agar dilution was used to conduct antimicrobial susceptibility testing. One hundred seventy-four clinical isolates were included. The lower respiratory tract (20/37; 54%) was the most common specimen source in pediatric patients, whereas blood isolates (62/137; 45%) constituted the most prevalent source in adults. Among the identified species, Elizabethkingia meningoseptica (72/121; 59%) constituted the majority. All
species tested against minocycline were susceptible (18/18; 100%), and 90% of isolates tested against trimethoprim-sulfamethoxazole (TMP-SMX) (117/130) were susceptible. Of the 12 Elizabethkingia miricola isolates, most of the tested isolates were susceptible to piperacillin-tazobactam (11/12; 92%) and levofloxacin (11/12; 92%), whereas the Elizabethkingia anophelis isolates most often tested susceptible to piperacillin-tazobactam (13/14; 93%). In this study,
species showed high rates of
susceptibility to minocycline and TMP-SMX. Further studies are needed to investigate the clinical implications of species-level differences in antimicrobial susceptibilities in this genus.
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