Infection Control & Hospital Epidemiology – July 2016 TOC

Articles in this issue include:

ICHE July 2016

Image source: ICHE

  • The Essential Role of Pharmacists in Antimicrobial Stewardship
  • Choosing Wisely in Healthcare Epidemiology and Antimicrobial Stewardship
  • The Role of Nursing Homes in the Spread of Antimicrobial Resistance Over the Healthcare Network
  • The Impact of Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) Flags on Hospital Operations
  • Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study

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Staphylococcus aureus and surgical site infection. The benefit of screening and decolonization before surgery

Humphreys, H. et al. Journal of Hospital Infection. Published online: 18 June 2016

Image shows Staphylococcus aureus on ChromID CPS chromogenic agar. Isolate from a urine sample from a 45 year old catheterised male awaiting surgery for a bladder stone.

Surgical site infections (SSIs) are amongst the most common healthcare-associated infections and significantly contribute to patient morbidity and healthcare costs. Staphylococcus aureus is the most common microbial cause.

The epidemiology of S. aureus is changing, with the dissemination of newer clones and the emergence of mupirocin resistance. The prevention and control of SSIs is multi-modal and we have reviewed the evidence for the value of screening for nasal carriage of S. aureus and the subsequent decolonization of patients pre-operatively who are positive. Pre-operative screening, using culture- or molecular-based methods and the subsequent decolonization of patients positive for methicillin-susceptible S. aureus and methicillin resistant S. aureus (MRSA) reduces SSI and hospital stay. This applies especially to major clean surgery, such as cardiothoracic and orthopaedic, involving the insertion of implanted devices.

However, it requires a multi-disciplinary approach coupled with patient education. Universal decolonization pre-operatively without screening for S. aureus potentially compromises the capacity to monitor for the emergence of new clones of S. aureus, contributes to mupirocin resistance, and prevents the adjustment of surgical prophylaxis for MRSA, i.e. the replacement of a beta-lactam agent with a glycopeptides or alternative.

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Evaluation of the association between Hospital Survey on Patient Safety Culture (HSOPS) measures and catheter-associated infections

Meddings, J. et al. BMJ Quality & Safety. Published Online: 24 May 2016

https://www.flickr.com/photos/64763706@N08/6850650385/

Image source: LaTransfo // CC BY-SA 2.0

Background: The Agency for Healthcare Research and Quality (AHRQ) has funded national collaboratives using the Comprehensive Unit-based Safety Program to reduce rates of two catheter-associated infections—central-line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI), using evidence-based intervention bundles to improve technical aspects of care and socioadaptive approaches to foster a culture of safety.

Objective: Examine the association between hospital units’ results for the Hospital Survey on Patient Safety Culture (HSOPS) and catheter-associated infection rates.

Methods: We analysed data from two prospective cohort studies from acute-care intensive care units (ICUs) and non-ICUs participating in the AHRQ CLABSI and CAUTI collaboratives. National Healthcare Safety Network catheter-associated infections per 1000 catheter-days were collected at baseline and quarterly postimplementation. The HSOPS was collected at baseline and again 1 year later. Infection rates were modelled using multilevel negative binomial models as a function of HSOPS components over time, adjusted for hospital-level characteristics.

Results: 1821 units from 1079 hospitals (CLABSI) and 1576 units from 949 hospitals (CAUTI) were included. Among responding units, infection rates declined over the project periods (by 47% for CLABSI, by 23% for CAUTI, unadjusted). No significant associations were found between CLABSI or CAUTI rates and HSOPS measures at baseline or over time.

Conclusions: We found no association between results of the HSOPS and catheter-associated infection rates when measured at baseline and postintervention in two successful large national collaboratives focused on prevention of CLABSI and CAUTI. These results suggest that it may be possible to improve CLABSI and CAUTI rates without making significant changes in safety culture, particularly as measured by instruments like HSOPS.

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The influence of contaminated urine cultures in inpatient and emergency department settings

Klausing, B.T. et al. American Journal of Infection Control. Published online: 13 June 2016

Highlights

  • Urine culture contamination results in substantial impact to patients.
  • Morbidity includes unnecessary testing and antibiotic exposure.
  • Reducing urine culture contamination is an important quality intervention.

We retrospectively evaluated 131 patients with contaminated urine cultures during a 12-month period. Sixty-four patients (48.8%) experienced 139 potential complications related to these specimens. The most common complication was inappropriate antibiotic administration (noted in 58 patients [44.3%]). Contaminated urine cultures led to additional diagnostic evaluation and unnecessary antibiotic use.

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Best Practices in Caring for Patients Infected With Clostridium difficile

Smith, S. & Taylor, J. Critical Care Nurse. June 2016. vol. 36 no. 3. pp. 71-72

crit care nurse

Image source: Critical Care Nurse

Q: What is the isolation protocol for patients infected with Clostridium difficile? How long should routine cultures be done once a patient has a confirmed diagnosis? Any special nursing interventions or treatment for this diagnosis? What is best practice in caring for these patients?

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Preventing and managing healthcare-associated infections: linking collective leadership, good management, good data, expertise, and culture change

Edwards, G. Journal of Hospital Infection. Published online: 2 June 2016

https://creativecommons.org/licenses/by/2.0/

Image source: Rachel Kramer // CC BY 2.0

From the mid to late 1990s, intense media coverage of meticillin-resistant Staphylococcus aureus (MRSA) in the UK National Health Service (NHS) brought the issue to prominence, accompanied by an extensive political response. Around 3000 articles on MRSA were published in 12 UK newspapers between 1994 and 2005, compared with 21 articles in six major US newspapers. The UK articles emphasized personal narratives and focused primarily on environmental cleaning as a solution.1 Although more recent media coverage has expanded to include Clostridium difficile, MRSA has remained highly prominent in popular consciousness.

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