AJIC: American Journal of Infection Control

Prevention of the spread of infection: The need for a family-centered approach to hygiene promotion

2010-02-01

Infectious diseases (IDs) continue to be a significant health and economic burden on the community, and the emergence of new pathogens, including antimicrobial resistant strains, demand new prevention strategies, which involve not only health care settings but the community as a whole. The situation is exacerbated by social, demographic, and other changes, which means that people with reduced immunity to infection now make up an increasing proportion of the global population. Technologic and policy changes are introduced to save costs or reduce environmental effects without regard to their potential impact on ID risks. Governments are under pressure to fund health care. One solution is increased home care, but the gains are likely to be undermined by inadequate infection control at home.

The pandemic influenza planning process in Ontario acute care hospitals

Dick E. Zoutman, B. Douglas Ford, Matt Melinyshyn, Brian Schwartz — 2009-12-21

Background: There will be little time to prepare when an influenza pandemic strikes; hospitals need to develop and test pandemic influenza plans beforehand.Methods: Acute care hospitals in Ontario were surveyed regarding their pandemic influenza preparedness plans.Results: The response rate was 78.5%, and 95 of 121 hospitals participated. Three quarters (76.8%, 73 of 95) of hospitals had pandemic influenza plans. Only 16.4% (12 of 73) of hospitals with plans had tested them. Larger (χ2 = 6.7, P = .01) and urban hospitals (χ2 = 5.0, P = .03) were more likely to have tested their plans. 70.4% (50 of 71) Of respondents thought the pandemic influenza planning process was not adequately funded. No respondents were “very satisfied” with the completeness of their hospital's pandemic plan, and only 18.3% were “satisfied.”Conclusion: Important challenges were identified in pandemic planning: one quarter of hospitals did not have a plan, few plans were tested, key players were not involved, plans were frequently incomplete, funding was inadequate, and small and rural hospitals were especially disadvantaged. If these problems are not addressed, the result may be increased morbidity and mortality when a virulent influenza pandemic hits.

Evaluation of the survivability of MS2 viral aerosols deposited on filtering face piece respirator samples incorporating antimicrobial technologies

Samy Rengasamy, Edward Fisher, Ronald E. Shaffer — 2009-11-06

Background: Respiratory protective devices exposed to pathogenic microorganisms present a potential source of transmission of infection during handling. In this study, the efficacy of 4 antimicrobial respirators to decontaminate MS2, a surrogate for pathogenic viruses, was evaluated and compared with control N95 filtering face piece respirators, which did not contain any known antimicrobial components.Methods: MS2 containing droplet nuclei were generated using a Collison nebulizer and loaded onto respirator coupons at a face velocity of 13.2cm/seconds for 30minutes. The coupons were incubated at 2 different temperature and relative humidity (RH) conditions and analyzed for viable MS2 at different time intervals.Results: Results showed that log10 reduction of MS2 was not statistically significant (P > .05) between the control and antimicrobial respirator coupons, when stored at 22°C and 30% RH up to 20hours. Coupons from 1 of the 4 antimicrobial respirators showed an average MS2log10 reduction of 3.7 at 37°C and 80% RH for 4hours, which was statistically significant (P ≤ .05) compared with coupons from the control respirators.Conclusion: Results from this study suggest that MS2 virus decontamination efficacy of antimicrobial respirators is dependent on the antimicrobial agent and storage conditions.

Health care workers' views about respirator use and features that should be included in the next generation of respirators

Aliya S. Baig, Caprice Knapp, Aaron E. Eagan, Lewis J. Radonovich — 2009-12-28

Background: Numerous studies have demonstrated that health care workers are, in general, poorly compliant with respiratory protection guidelines, especially when a N95 respirator is recommended. The purpose of this study was to assess health care workers' views about respirator use and the features they prefer to be included in the next generation of respirators.Methods: A 63-item survey was distributed to health care workers in 27 units of 2 tertiary care medical centers.Results: From a total of 559 surveys distributed at both hospitals, 159 responses were returned (response rate, 28%). Survey results indicated that health care workers seek respirators that are more comfortable, interfere less with breathing, diminish heat buildup, are disposable, and permit the user to have facial hair. Multivariate analyses suggest that emergency department staff had 12.3 greater odds of wanting a new respirator (P = .031) as compared with their referent group. Males were more likely to indicate that the N95 respirator was comfortable to wear versus females (P = .003).Conclusion: To increase substantially the acceptance of respiratory protective equipment and improve compliance rates, respirators should be modified to meet the specific needs of health care workers.

Virucidal efficacy of disinfectant actives against feline calicivirus, a surrogate for norovirus, in a short contact time

Kelly Whitehead, Karen A. McCue — 2009-07-21

Background: Among other measures, handwashing and targeted disinfection are important in preventing and controlling norovirus outbreaks. Presently, there are a limited number of disinfectants effective against norovirus. There is a need to develop alternatives to bleach that are effective against norovirus, and, in particular, fast-acting disinfectants are desired. The aim of this study was to determine the disinfectant actives and formulation factors necessary to achieve efficacy against norovirus in a short contact time.Methods: Feline calicivirus (FCV) was used as a surrogate for norovirus. In a carrier test method, common disinfectant actives including alcohol, acid, quaternary compound, and phenol both alone and as formulated disinfectants were contacted with dried FCV virus for 1minute. The virus treatment was neutralized and assayed in Crandell-Reese kidney cells for cytopathic effect. Log10 virus inactivation was calculated comparing treatment results to virus control titer.Results: Bleach and acid-based disinfectants inactivate FCV in 1minute. Inactivation of FCV by alcohol and quaternary actives depends on how these actives are formulated as disinfectants. Actives and extreme pH are determined predictive of efficacy. Ethanol and quaternary compounds formulated at appropriate concentration and alkaline pH inactivates FCV in 1-minute contact.Conclusion: Acid cleaners, ethanol, and quaternary compounds formulated at appropriate concentration and pH can be fast-acting antimicrobial choices and alternatives to bleach for the consumer and health care providers to use to inactivate FCV, a surrogate for norovirus, and protect against this important pathogen.

Internet survey of Foley catheter practices and knowledge among Minnesota nurses

Dimitri M. Drekonja, Michael A. Kuskowski, James R. Johnson — 2009-09-02

Background: Although nurses insert and care for many Foley catheters, little is known about nurses' attitudes and knowledge regarding indications for catheter use or methods to prevent catheter-associated urinary tract infection (CAUTI).Methods: An Internet-based survey was sent to a random sample of registered nurses (RNs) in Minnesota. The survey contained demographic questions and 5-point Likert-scale questions regarding indications for Foley catheter placement and effectiveness of various interventions for preventing CAUTI.Results: Nurses perceived early catheter removal as the most effective intervention to prevent CAUTI (mean score, 4.5; range 1-5). Compared with other RNs, those reporting additional catheter education were more likely to rate interventions to prevent CAUTI as effective, regardless of whether the interventions actually reduce the incidence of symptomatic CAUTI or asymptomatic bacteriuria/funguria. Intensive care unit RNs were significantly more likely than other RNs to endorse that a Foley catheter was indicated for any given clinical scenario and to endorse antimicrobial-coated catheters as effective in preventing CAUTI. Most respondents reported no institutional guidance regarding catheterization.Conclusion: Although the surveyed Minnesota RNs demonstrated high-level awareness of the utility of early Foley catheter removal for preventing CAUTI, other aspects of their catheter-related knowledge were concerning. Improving these deficits may help improve catheter-related practice.

Effectiveness of drug use evaluation and antibiotic authorization on patients' clinical outcomes, antibiotic consumption, and antibiotic expenditures

Pinyo Rattanaumpawan, Patama Sutha, Visanu Thamlikitkul — 2009-08-21

Background: Piperacillin/tazobactam, imipenem, and meropenem were inappropriately used in 50% of hospitalized patients at Siriraj Hospital. Siriraj Hospital administrators implemented drug use evaluation (DUE) and antibiotic authorization for the aforementioned antibiotics beginning in August 2007. The objective of the study was to determine the effectiveness of antibiotic authorization on patients' clinical outcomes, antibiotic consumption, and antibiotic expenditures.Methods: Hospitalized patients who were prescribed piperacillin/tazobactam, imipenem, or meropenem from August to November 2007 were randomly allocated to antibiotic authorization group and no-authorization group. The data on clinical outcomes, antibiotic consumption, and antibiotic expenditures of the patients who received and who did not receive antibiotic authorization were compared.Results: The patients who received antibiotic authorization (512 prescriptions) had more favorable clinical outcomes (68.9% vs 60.5%, respectively, P < .01), shorter duration of target antibiotics (7.5 days vs 9.3 days, respectively, P < .01), shorter duration of all antibiotics (12.7 days vs 16.4 days, respectively, P < .01), and lower mortality because of infections (29.4% vs 35.4%, respectively, P=.05) than those who did not receive antibiotic authorization (516 prescriptions). The costs of target antibiotics and all antibiotics in the authorization group were much less than those in the no-authorization group. The annual antibiotic cost savings from DUE and antibiotic authorization requirement could be extrapolated to US $862,704.Conclusion: DUE and antibiotic authorization are effective strategies in reducing antibiotic consumption and antibiotic expenditures without compromising the patients' clinical outcomes.

Inpatient treatment patterns, outcomes, and costs of skin and skin structure infections because of Staphylococcus aureus

2009-09-18

Background: Staphylococcus aureus (SA) is a common bacterial pathogen in skin and skin structure infections (SSSIs). Limited data exist on hospital treatment patterns and costs for SA-SSSIs.Methods: This retrospective analysis examined the lengths of stay, treatment patterns, and costs of hospitalized patients with an SA-SSSI diagnosis using a nationally representative inpatient database. Patients were selected if they had an ICD-9-CM diagnosis of an SSSI with SA noted between January 2005 and June 2006, received a study antibiotic (ie, intravenous [IV] vancomycin, IV or oral linezolid, and IV daptomycin), and were not in the intensive care unit before receiving a study antibiotic. Generalized linear models assessed predictors of length of stay and costs. Costs are expressed in 2005 US dollars.Results: Thirteen thousand four hundred thirty-three patients met the selection criteria and mean (±SD) age was 48.2 (±18.3) years. Forty percent of patients received a nonstudy antibiotic before receiving their first study antibiotic. Ninety-five percent were prescribed vancomycin as their first study antibiotic. Study antibiotics were administered for an average of 4.3 days, and 8% of patients switched study antibiotics. Nineteen percent of patients receiving IV linezolid stepped down to oral linezolid. Mean (±SD) lengths of hospital stay and costs were 6.1 (±6.0) days and $6830 (±$7100). In-hospital mortality, switching antibiotics, and diagnoses of selected complications or comorbidities were associated with increased lengths of stay and costs. Younger age, location outside the Northeast, and use of oral linezolid were associated with lower lengths of stay and costs.Conclusion: The costs of treating inpatient SA-SSSIs are substantial and vary by patient demographics and treatment characteristics.

Legionella species colonization in cooling towers: Risk factors and assessment of control measures

2009-08-21

Background: Cooling towers can be colonized by Legionella spp, and inhalation of aerosols generated by their operation may cause Legionnaires' disease in susceptible hosts. Environmental investigations of Legionnaires' disease outbreaks linked with cooling towers have revealed poorly maintained systems, lack of control measures, and failure of system equipment. The purpose of this study was to identify Legionella-contaminated cooling towers, identify risk factors for contamination, and assess the effectiveness of control measures.Methods: A total of 96 cooling towers of public buildings were registered and inspected, and 130 samples were collected and microbiologically tested. Microbiological test results were associated with characteristics of cooling towers, water samples, inspection results, and maintenance practices.Results: Of the total 96 cooling towers examined, 47 (48.9%) were colonized by Legionella spp, and 22 (22.9%) required remedial action. A total of 65 samples (50.0%) were positive (≥ 500 cfu L−1), and 30 (23%) were heavily contaminated (≥ 104 cfu L−1). Of the 69 isolates identified, 55 strains (79.7.%) were L pneumophila. Legionella colonization was positively associated with the absence of training on Legionella control (relative risk [RR]=1.66; P=.02), absence of regular Legionella testing (RR=2.07: P=.002), absence of sunlight protection (RR=1.63: P=.02), with samples in which the free residual chlorine level in the water sample was<0.5mg/L (RR=2.23; P=.01), and with total plate count (P=.001). Colonization was negatively associated with chemical disinfection (RR=0.2; P=.0003) and with the presence of a risk assessment and management plan (RR=0.12; P=.0005). A statistically significant higher age (P=.01) was found in legionellae-positive cooling towers (median, 17 years; interquartile range [IQR]=5.0 to 26.0 years) compared with noncolonized cooling towers (median age, 6 years; IQR=1.0 to 13.5 years). After the 22 legionellae-positive cooling towers were disinfected with chlorine, 2 (9%) of them remained positive for Legionella spp with a concentration≥1000 cfu L−1.Conclusions: Cooling towers can be heavily colonized by Legionella spp and thus present a potential risk for infection. This study demonstrates the importance of a risk assessment and management plan. Water chlorination effectively reduces legionellae contamination. Proper training of cooling tower operators is paramount.

Preventive effect of meningococcal vaccination in Israeli military recruits

2009-08-26

Background: Meningococcal disease remains a major concern in populations living under crowded conditions. Following the 1995 report of several cases of meningococcal disease in Israeli soldiers, the Department of Epidemiology of the Army Health Branch, Israel Defense Forces (IDF) adopted an immunization policy for all recruits. The aim of the study was to summarize the IDF experience to date.Methods: The study population included all compulsory and permanent personnel of both sexes serving in the IDF from 1983 to 2007. Ages ranged from 18 to 55 years, although the majority of subjects was younger than 22 years. Meningococcal disease was defined as the isolation of Neisseria meningitidis from blood or cerebrospinal fluid.Results: The person-time incidence rate of vaccine-preventable meningococcal disease dropped from 1.31 cases per 100,000 person-years in 1983-1994, the period preceding the start of immunization, to 0 in 1995-2007 (P < .001).Conclusion: The meningococcal immunization policy of the IDF led to a dramatic drop in the incidence of vaccine-preventable meningococcal disease.

Perceptions and attitudes of the professional staff concerning infection surveillance and control programs in Brazilian hospitals

2009-09-14

Background: Several countries have conducted studies to assess the status of their infection control programs (ICP) with the objective of improving quality of infection control practices.Methods: To assess the perceptions and attitudes of the health care workers (HCW) concerning ICP in Brazilian hospitals, we conducted a cross-sectional survey using a self-administered online questionnaire during a Web-based course (WBC) on infection control (IC) and antimicrobial resistance (AR).Results: Of 6256 Brazilian HCW registered for the WBC, 1998 were members of infection control committees (ICC) and answered the survey. Eight hundred six (40.4%) respondents said that an ICP was established for more than 10 years in their institutions. Most professionals reported that their hospitals perform microbiologic surveillance targeted at epidemiologically important multidrug-resistant organisms, but the majority underestimated the prevalence of AR.Conclusion: Our survey highlights important information about the perceptions and attitudes of ICC members that may be used to tailor key interventions for implementing effective ICP. It suggests, additionally, that, to achieve countrywide standardized IC mechanisms in a developing country, authorities should consider the social, cultural, and economical disparities between regions and identify specific regional needs to make available the resources required to minimize such disparities.

Antibiotic resistance determinants in Acinetobacter spp and clinical outcomes in patients from a major military treatment facility

2009-09-25

We explored the association of antibiotic-resistant phenotypes and genotypes in Acinetobacter spp with clinical outcomes and characteristics in 75 patients from a major military treatment facility. Amikacin resistance was associated with nosocomial acquisition of A baumannii, and carbapenem resistance and blaOXA-23 were associated with the need for mechanical ventilation. The presence of blaOXA-23 also correlated with longer hospital and ICU stay. Associations between blaOXA-23 and complexity, duration, and changes made to antibiotic regimens also existed.

Virucidal activity of 2 alcohol-based formulations proposed as hand rubs by the World Health Organization

2009-11-09

The virucidal activity of 2 hand rubs proposed by the World Health Organization was studied in a quantitative suspension test for chemical disinfectants and antiseptics in human medicine (EN 14476). These formulations are recommended if no hand rubs with declared microbiological activity are available in health care settings. Formulation I, based on ethanol, inactivated bovine viral diarrhea virus (BVDV), hepatitis C virus (HCV), adenovirus, and murine norovirus as a surrogate for human norovirus. Formulation II, based on isopropyl alcohol, was active only against adenovirus and enveloped viruses, such as BVDV and HCV. Both formulations failed to inactivate poliovirus by 4log10 steps within 300 seconds.

Preventive efficacy and cost-effectiveness of point-of-use water filtration in a subacute care unit

Charity Holmes, Joseph S. Cervia, Girolamo A. Ortolano, Francis P. Canonica — 2009-08-26

Infections with Pseudomonas aeruginosa and other waterborne pathogens (WBPs) are major contributors to serious morbidity and mortality in hospitals. We sought to determine whether point-of-use (POU) water filtration might result in decreased risk of infection in the subacute care unit (SACU) of a 208-bed medical center. Our findings indicate that POU water filtration can significantly and cost-effectively reduce colonization of and infection with WBPs, including ventilator-associated pneumonia, in an SACU.

Frequency of detection of methicillin-resistant Staphylococcus aureus from rectovaginal swabs in pregnant women

C. Buddy Creech, Brandon Litzner, Thomas R. Talbot, William Schaffner — 2009-10-19

Clinical samples from 250 pregnant women undergoing screening for rectovaginal group B streptococcus colonization were evaluated concurrently for the presence of methicillin-resistant Staphylococcus aureus (MRSA). Overall, S aureus was detected in 21.6% of the women; 53.7% of the isolates were MRSA. Despite a lack of risk factors for MRSA colonization, rectovaginal MRSA was detected in 10.4% of pregnant women in this study.

A comparison of the hand hygiene knowledge, beliefs, and practices of Greek nursing and medical students

Thea F. van de Mortel, Eleni Apostolopoulou, Georgios Petrikkos — 2009-09-14

Studies indicate that health care workers' adherence to hand hygiene (HH) guidelines is poor (∼40%) and that physician status is a risk factor for nonadherence. Disciplinary differences in HH education and assessment during undergraduate training may impact on graduates' behavior upon entering the workforce.

Comparison of costs, length of stay, and mortality associated with Candida glabrata and Candida albicans bloodstream infections

2009-10-19

We compared costs, length of stay, and mortality between adults with Candida albicans and Candida glabrata bloodstream infections. Early evidence of C glabrata, as defined by a positive culture within 2 days of admission, was associated with higher costs ($56,026 vs $32,810; P = .04) and longer hospital stays (19.7 vs 14.5 days; P = .05) compared with early evidence of C albicans. Mortality was similar between the groups.

Recent changes in the NHSN Definition for UTI: For better AND worse

Deverick J. Anderson, Joshua Freeman, Daniel J. Sexton — 2010-02-01

To the Editor: The NHSN surveillance definitions for urinary tract infection (UTI) have been changed twice in the last 6 months. In January 2009, the NHSN removed “asymptomatic bacteriuria” (ASB) from criteria used to diagnose UTIs. The NHSN added a new surveillance category known as “Asymptomatic Bacteremic UTI” (ABUTI) in March 2009.

Response to letter to the editor: “Recent changes in the NHSN definition for UTI: for better AND worse”

Katherine Allen-Bridson, Teresa Horan — 2010-02-01

To the Editor: Thank you for the opportunity to respond to the letter titled, “Recent Changes in the NHSN Definition for UTI: For Better AND Worse.” We value the opinions of the authors and would like to respectfully address a few of their points.

Colonization of central venous catheters in intensive care patients: A 1-year survey in a Portuguese university hospital

2010-02-01

To the Editor: Patients admitted at intensive care units (ICUs) often require central venous catheterization. Catheter colonization may lead to bacteremia and, eventually, end up as a catheter-related bloodstream infection. To review the etiology and antimicrobial susceptibility pattern of central venous catheter (CVC) isolates from ICU patients, a retrospective study of the clinical database of Hospital of S. João, in Porto, was performed during a 12-month period. All positive results from the culture of distal tips of CVCs removed from ICU patients and antimicrobial susceptibility pattern of isolates were reviewed.

Erratum

2010-02-01

At the request of Neghat Lakdawala, the journal wishes to revise our February article, “Decontamination of laundry at low temperature with CuWB50, a novel copper-based biocidal compound,” (Am J Infect Control 2009;37:478-83) by removing Ms. Lakdawala's name from the section of the text that recognizes her assistance. The authors have consented to this revision.

2010-02-01

Editorial Board

2010-02-01

APIC Masthead

2010-02-01

Information for Readers

2010-02-01

AJIC: American Journal of Infection Control

Prevention of the spread of infection: The need for a family-centered approach to hygiene promotion

The pandemic influenza planning process in Ontario acute care hospitals

Evaluation of the survivability of MS2 viral aerosols deposited on filtering face piece respirator samples incorporating antimicrobial technologies

Health care workers' views about respirator use and features that should be included in the next generation of respirators

Virucidal efficacy of disinfectant actives against feline calicivirus, a surrogate for norovirus, in a short contact time

Internet survey of Foley catheter practices and knowledge among Minnesota nurses

Effectiveness of drug use evaluation and antibiotic authorization on patients' clinical outcomes, antibiotic consumption, and antibiotic expenditures

Inpatient treatment patterns, outcomes, and costs of skin and skin structure infections because of Staphylococcus aureus

Legionella species colonization in cooling towers: Risk factors and assessment of control measures

Preventive effect of meningococcal vaccination in Israeli military recruits

Perceptions and attitudes of the professional staff concerning infection surveillance and control programs in Brazilian hospitals

Antibiotic resistance determinants in Acinetobacter spp and clinical outcomes in patients from a major military treatment facility

Virucidal activity of 2 alcohol-based formulations proposed as hand rubs by the World Health Organization

Preventive efficacy and cost-effectiveness of point-of-use water filtration in a subacute care unit

Frequency of detection of methicillin-resistant Staphylococcus aureus from rectovaginal swabs in pregnant women

A comparison of the hand hygiene knowledge, beliefs, and practices of Greek nursing and medical students

Comparison of costs, length of stay, and mortality associated with Candida glabrata and Candida albicans bloodstream infections

Recent changes in the NHSN Definition for UTI: For better AND worse

Response to letter to the editor: “Recent changes in the NHSN definition for UTI: for better AND worse”

Colonization of central venous catheters in intensive care patients: A 1-year survey in a Portuguese university hospital

Erratum

Table of Contents

Editorial Board

APIC Masthead

Information for Readers