AJIC: American Journal of Infection Control

Save the Date for APIC 2012

2012-02-01

The CDC recently reported improvement in health care provider adherence to proven prevention measures and released evidence that showed a commensurate decrease in 4 common health care-associated infections—CLABSI, CAUTI, SSI, and MRSA—in 2010.

Frequency of outbreak investigations in US hospitals: Results of a national survey of infection preventionists

Emily Rhinehart, Scott Walker, Denise Murphy, Karen O’Reilly, Patty Leeman — 2012-02-01

Background: A survey of infection preventionists was conducted to determine the frequency of outbreak investigations in US hospitals.Methods: A 2-part electronic survey was sent to Association for Professionals in Infection Control and Epidemiology, Inc, members in US hospitals in January 2010. Part 1 of the survey tool involved hospital demographics and the infection prevention/control program. Part 2 explored specific outbreak investigations allowing responses for up to 8 investigations within the previous 24 months.Results: A final sample of 822 responses was analyzed representing 386 outbreak investigations in 289 US hospitals. Nearly 60% of the outbreaks were caused by 4 organisms: norovirus (18%), Staphylococcus aureus (17%), Acinetobactor spp (14%), and Clostridium difficile (10%). Norovirus occurred most often in behavioral health and rehabilitation/long-term acute care units, whereas the other organisms occurred in medical/surgical units. Unit/department closure was reported in 22.6% of investigations and most often associated with norovirus. Outbreak investigations are triggered by unusual organisms, rate above baseline for specific site of infection, and rate above baseline for specific unit. Investigations were most frequently conducted in community/nonteaching hospitals and facilities with 201 to 300 beds. Mean number of confirmed cases was 10; mean duration was 58 days.Conclusion: Norovirus is emerging as an increasingly common hospital-associated organism causing outbreaks in nonacute settings and may lead to unit/department closures.

Outbreak or coincidental cases of tuberculosis? Genotyping provides the clue

2011-05-30

We illustrate how genotyping of mycobacterial strains contributed to the discovery of an undetected outbreak of tuberculosis in a hospital ward, ruling out misleading assumptions of transmission chains. Genotyping should be taken into account in routine tests for the control of tuberculosis.

Outbreak of bloodstream infections because of Serratia marcescens in a pediatric department

2011-08-19

Background: Serratia marcescens can cause health care-associated infections. We herewith report the investigation and control of an outbreak of S marcescens bloodstream infections (BSI) in a general pediatric department.Methods: From April to May 2009, temporally related cases of S marcescens BSI occurred in a 40-bed general pediatric department of a tertiary care hospital. An outbreak investigation including case identification, review of medical records, environmental cultures, patients’ surveillance cultures, personnel hand cultures, pulsed-field gel electrophoresis, and a case-control study were conducted. Controls were patients without S marcescens BSI but hospitalized in the department for at least 48 hours during the outbreak. Enhanced infection control measures were immediately implemented by the Infection Control Committee.Results: During the study period, 4 patients developed BSI because of a S marcescens strain demonstrating the same antimicrobial susceptibility pattern as well as the same molecular profile. Patients’ surveillance cultures and personnel hand cultures were negative. In 1 case-patient, S marcescens grew from cultures of intravenous infusion systems. In the case-control study performed, there were no differences in demographics, intravenously administered medications, or place of hospital stay. Case patients had changes in vascular access significantly more frequently than controls. No S marcescens infections occurred in the department during the 18 months following implementation of the enhanced infection control measures.Conclusion: Prompt recognition and strict adherence to infection control measures are of paramount importance in combating an outbreak of S marcescens bloodstream infection.

Outbreak of acute hepatitis B virus infections associated with podiatric care at a psychiatric long-term care facility

2011-08-12

Background: Effective measures exist to prevent health care–associated hepatitis B virus (HBV) transmission, yet outbreaks continue to occur. In 2008, the Los Angeles County Department of Public Health identified an outbreak of HBV infections among psychiatric long-term care facility residents.Methods: Residents underwent HBV serologic testing and were classified as acutely infected, chronically infected, susceptible, or immune. Persons residing in the facility during 2008 were enrolled in a retrospective cohort study to identify risk factors for acute HBV infection. We assessed infection control practices at the facility.Results: Nine of 81 residents (11%) enrolled in the cohort study had acute HBV infection. Five of 15 residents (33%) undergoing podiatric care on a single day subsequently developed acute infection (rate ratio, 4.33; 95% confidence interval, 1.18-15.92). Infection control observations of the consulting podiatrist revealed opportunities for cross-contamination of instruments with blood. Other potential health care and behavioral modes of transmission were identified as well. Residents were offered HBV vaccination, and infection control recommendations were implemented by the podiatrist and facility.Conclusions: Of the multiple potential transmission modes identified, exposure to HBV during podiatry was likely the dominant mode in this outbreak. Long-term care facilities should ensure compliance with infection control standards among staff and consulting health care providers.

Risk factors for coronary artery bypass graft chest surgical site infections in New York State, 2008

2011-11-21

Background: All hospitals in New York State (NYS) are required to report surgical site infections (SSIs) occurring after coronary artery bypass graft surgery. This report describes the risk adjustment method used by NYS for reporting hospital SSI rates, and additional methods used to explore remaining differences in infection rates.Methods: All patients undergoing coronary artery bypass graft surgery in NYS in 2008 were monitored for chest SSI following the National Healthcare Safety Network protocol. The NYS Cardiac Surgery Reporting System and a survey of hospital infection prevention practices provided additional risk information. Models were developed to standardize hospital-specific infection rates and to assess additional risk factors and practices.Results: The National Healthcare Safety Network risk score based on duration of surgery, American Society of Anesthesiologists score, and wound class were not highly predictive of chest SSIs. The addition of diabetes, obesity, end-stage renal disease, sex, chronic obstructive pulmonary disease, and Medicaid payer to the model improved the discrimination between procedures that resulted in SSI and those that did not by 25%. Hospital-reported infection prevention practices were not significantly related to SSI rates.Conclusions: Additional risk factors collected using a secondary database improved the prediction of SSIs, however, there remained unexplained variation in rates between hospitals.

Reducing health care-associated infections (HAIs): Lessons learned from a national collaborative of regional HAI programs

2011-07-21

Background: Health care-associated infections (HAIs) are a leading cause of death in United States health care settings, with an overall estimated annual incidence of 1.7 million. As antimicrobial resistance has increased, so too have efforts to reduce HAI rates. The objective of this study was to identify commonly cited lessons learned across a wide variety of HAI projects and hospital settings.Methods: Thirty-three hospitals participated in 5 different regional collaboratives supported by the Agency for Healthcare Research and Quality (AHRQ). Data on hospitals’ successes, challenges, and lessons learned were collected via key informant interviews and structured, standardized case report forms.Results: Seven commonly cited themes were identified: foster change by first understanding resistance; commit to regular strategic communication and join a collaborative; start small and tailor implementation to local needs and cultures; engage frontline staff by involving them in the project and enlisting champions; educate and reeducate; convince administration to provide leadership, funds, and dedicated staff and assign accountability; and provide timely, relevant feedback and celebrate successes.Conclusion: Despite the diversity of hospital settings, cultures, personnel, and HAI reduction projects, we found that hospitals encounter similar challenges and facilitators across projects. We offer a model of 7 process elements shown to be important to successful implementation.

Infection control through the ages

Philip W. Smith, Kristin Watkins, Angela Hewlett — 2011-07-25

To appreciate the current advances in the field of health care epidemiology, it is important to understand the history of hospital infection control. Available historical sources were reviewed for 4 different historical time periods: medieval, early modern, progressive, and post–World War II. Hospital settings for the time periods are described, with particular emphasis on the conditions related to hospital infections.

Femoral central venous catheters are not associated with higher rates of infection in the pediatric critical care population

Joel A. Reyes, Michelle L. Habash, Richard P. Taylor — 2011-06-27

Background: Adult data show a difference in central venous catheter (CVC) infection rates between 3 major sites: subclavian (SC), internal jugular (IJ), and femoral veins. We hypothesized that in patients in pediatric intensive care units (PICUs), there is no difference in rates of CVC infection among these three sites, but specifically the femoral compared to all other sites.Methods: In this retrospective cohort study, data from January 1999 to January 2008 were collected prospectively for internal review and quality assurance. All PICU patients with a CVC were enrolled. The rate of CVC infection was determined using Cox regression survival analysis to account for various durations of CVC placement at the various sites, then adjusted for severity of illness, number of lumens, and patient age. Mortality was compared in patients with a CVC infection versus those without.Results: A total of 4,512 patients with a CVC were enrolled. No site was associated with an increased risk of infection compared with the other sites, with hazard ratios of 0.951 (95% confidence interval [CI], 0.612-1.478) for the SC site, 0.956 (95% CI, 0.593-1.541) for the IJ site, and 1.120 (95% CI, 0.753-1.665) for the femoral site. No significant association between mortality and presence of CVC infection was found when adjusted for age, severity of illness, and duration of CVC placement. An association was found between the presence of a CVC infection and prolonged PICU length of stay (3.98 days longer; P < .001).Conclusion: Femoral CVCs are not associated with higher rates of infection in the PICU. In addition, the presence of CVC infection does not affect mortality, but is associated with longer PICU admission.

An unexpected increase in catheter-associated bloodstream infections at a children’s hospital following introduction of the Spiros closed male connector

2011-07-22

Background: Catheter-associated bloodstream infections (CA-BSIs) are associated with increased morbidity and mortality. Previous investigations have reported outbreaks of CA-BSI temporally associated with the use of needleless connector valves or similar devices.Methods: We observed an unexpected increase in the rate of CA-BSI at our institution during August 2009. We used statistical process control and quality improvement methodology to identify the factor(s) associated with this increased rate of CA-BSI.Results: We reviewed the overall hospital Shewhart U chart for CA-BSI, which indicated special cause variation with an unexpected cluster (6/9; 67%) of CA-BSIs localized to the oncology ward and the bone marrow transplant unit. An event-cause analysis review showed that 5 of these 9 infections were caused by Staphylococcus aureus. We discovered that the Spiros Closed Male Connector (ICU Medical, San Clemente, CA) had been introduced in these 2 units around the same time as the cluster of infections occurred. Based on this information, we discontinued the use of this device, and the CA-BSI rate and distribution of causative microorganisms returned to previous baseline values.Conclusion: This case study highlights the utility of statistical process control in the surveillance and investigation of CA-BSI.

Inappropriate use of urinary catheters: A prospective observational study

2011-08-01

Background: Despite the well-recognized role of urinary catheters in nosocomial urinary tract infections, data on risk factors associated with inappropriate urinary catheter use are scarce.Methods: A prospective review of electronic medical records of 436 patients admitted to an adult medical-surgical unit between October and December 2007 was performed to examine the appropriateness of urinary catheter use.Results: The use of 157 urinary catheters in 144 patients was observed. A total of 557 urinary catheter-days were recorded in these patients, of which 175 (31.4%) were found to be inappropriate based on the study criteria. The total number of catheters used and the total duration of catheterization were risk factors for inappropriate urinary catheter use (P < .05). Inappropriate catheter use was not associated with such adverse events as mortality, readmission, intensive care unit admission, catheter complications, or urine culture rates, but was associated with a trend toward longer duration of hospitalization.Conclusions: Significant rates of inappropriate urinary catheter use and a trend toward longer duration of hospitalization with inappropriate catheter use were observed. These findings underscore the importance of establishing guidelines and effective policy implementation for the appropriate use of urinary catheters in hospitalized patients.

Accuracy of a urinary catheter surveillance protocol

2011-08-04

Background: Many hospitals are increasing surveillance for catheter-associated urinary tract infections, which requires documentation of urinary catheter device-days. However, device-days are usually obtained by chart review or nursing reports. The aim of this study was to demonstrate that chart review can provide accurate urinary catheter data compared with physical inspection of the urinary catheter at the bedside.Methods: We compared 2 methods for collecting urinary catheter data over a 6-month period on 10 wards at our VA hospital. For the chart reviews, we created a daily bed-occupancy roster from the electronic medical record. Catheter data were extracted from the daily progress notes for each patient using a standardized review process. Bedside reviews were conducted by visiting the ward and verifying the presence and type of urinary catheters. Agreement between the 2 methods was calculated.Results: We obtained urinary catheter data by both methods in 621 cases. The presence or type of urinary catheter differed between chart and bedside review in only 10 cases (1.6%). Chart review had a sensitivity of 100%, a specificity of 97.7%, raw agreement of 98.4%, and a κ value of 0.96.Conclusions: Individual chart review in the electronic medical record provided very accurate data on urinary catheter use.

Catheter management in neonates with bloodstream infection and a percutaneously inserted central venous catheter in situ: Removal or not?

2011-08-16

Background: This study investigated whether removal of a percutaneously inserted central venous catheter (PICC) is compulsory in neonates with bloodstream infection (BSI), and also examined the risk factors for infectious complications when a PICC is retained in these patients.Methods: This was a cohort study of neonates with a PICC who developed a BSI between 2001 and 2007. BSI was defined according to Centers for Disease Control and Prevention criteria.Results: Of the 234 neonates in the cohort, 99 had early removal of PICC (ER-PICC, defined as removal within 3 days after the onset of clinical sepsis), and 135 had late removal of PICC (LR-PICC, defined as retention for more than 3 days after the onset of clinical sepsis). Resolution of clinical sepsis within 2 days was more frequent in the ER-PICC group compared with the LR-PICC group (80.8% vs 57.8%; P < .001). There was no significant difference between the 2 groups in terms of infectious complications and case fatalities, but the LR-PICC group had a significantly higher incidence of recurrence within 1 month after BSI (P = .002). Inappropriate initial antibiotic treatment was the only variable independently associated with infectious complications (odds ratio, 11.4; 95% confidence interval, 3.34∼39.2; P < .001).Conclusions: PICCs should be removed in neonates with BSI, because retention of PICCs for more than 3 days is associated with delayed resolution of clinical sepsis and a higher incidence of recurrence within 1 month.

A prospective study of central venous catheters placed in a tertiary care emergency department: Indications for use, infectious complications, and natural history

Katrina Diaz, Sean G. Kelly, Barbara Smith, Preeti N. Malani, John G. Younger — 2011-07-11

Despite successful efforts to improve overall central line-associated bloodstream infections (CLABSI) rates, little is known about CLABSI rates or even central venous catheter insertion practices in the Emergency Department. We sought to determine the baseline CLABSI rate for Emergency Department-inserted central venous catheters and to describe indications for placement, duration of use, and the natural history of these devices.

Practice of universal precautions and risk of occupational blood-borne viral infection among Congolese health care workers

2011-05-18

The extent of occupational injuries among health care workers in central Africa, particularly in the Democratic Republic of Congo, is not documented. We sought to determine the incidence of percutaneous injury and exposure to blood and other body fluids in Congolese urban and rural hospitals in the previous year. Our data show high rates of percutaneous injury and exposure to blood and other body fluids, reflecting poor safety conditions for most Congolese health care workers.

Horizontal transmission of Streptococcus pneumoniae in the surgical ward: A rare source of nosocomial wound infection

2011-07-18

Streptococcus pneumoniae is rarely isolated from nosocomial infections. We report an outbreak of 4 nosocomial-acquired surgical site infections due to S pneumoniae after retropubic simple prostatectomy. The likely source was detected in the rhinopharynx of the surgeon. After the implementation of recommendations, no new cases have been recorded.

Successful control of a norovirus outbreak among attendees of a hospital teaching conference

Christopher Vinnard, Ingi Lee, Darren Linkin — 2011-08-05

We report an outbreak of norovirus gastroenteritis after a hospital teaching conference, and describe the specific measures instituted by the infection control team. No secondary cases of norovirus infection were identified among hospital staff or patients. In a case-control study, we identified multiple food source contamination as the source of the outbreak. Our report highlights the potential success of a multifaceted infection control strategy in preventing the transmission of norovirus in health care settings.

Post‒cataract surgery endophthalmitis outbreak caused by multidrug-resistant Pseudomonas aeruginosa

2011-07-08

In June 2010, a severe outbreak of 13 cases of post–cataract surgery endophthalmitis caused by multidrug-resistant Pseudomonas aeruginosa occurred. Pulse-field gel electrophoresis in eye isolates found 95% genetic similarity; however, extensive environmental and carriage investigation revealed no source of infection.

Disinfection of an infrared coagulation device used to treat hemorrhoids

William A. Rutala, Maria F. Gergen, David J. Weber — 2011-08-12

Infrared coagulation devices are used to treat internal hemorrhoids, and as semicritical items should undergo high-level disinfection between patients. We developed and validated a method for disinfecting an infrared coagulation device that cannot be immersed in disinfectant solution.

Compliance with standard precautions among gastrointestinal endoscopists and endoscopy nurses in Japan

2011-12-09

Gastrointestinal endoscopists (GEs) and gastrointestinal endoscopy nurses (GENs) are exposed to many potential hazards during endoscopy procedures. Standard precautions (SPs) are important, given that knowledge of a patient’s infection status is only presumptive. It is also impossible to predict when accidents might occur. Therefore, we examined the level of compliance with SPs in Japanese GEs and GENs.

A call for consideration of needlestick injury data in evaluating staffing effectiveness

Glen A. Jett — 2011-12-08

Dr Larson, I applaud the effort to promote improved understanding of contributing factors to occupational injuries and bloodborne pathogen exposures that Patrician, Prior, Fridman, and Loan discussed in their June 2011 article. As the authors posit, the impact of staffing on the prevalence of needlesticks and other injuries among nurses has received limited attention to date. In my experience in occupational health nursing and infection prevention, the primary targets of needlestick injury follow-up investigations are typically individual behavioral factors and the use of engineered safety devices. This approach is an appropriate initial step but fails to determine potential root causes for the injury event. Other research has demonstrated scheduling and work factors such as extended-hour shifts, sequential shifts with inadequate time away from work, and night or weekend shifts to significantly increase the risk of needlestick injuries. We must place significantly greater attention on the multifactorial contributors to needlestick injuries. This includes consideration of workforce injuries and exposure event data in evaluating staffing effectiveness in health care organizations. Infection preventionists, occupational health nurses, and health care leaders should incorporate nursing workload indicators into their analysis of injury data to better understand and decrease the prevalence of needlestick injuries.

Response to “A call for consideration of needlestick injury data in evaluating staffing effectiveness”

Patricia A. Patrician, Erica Pryor, Moshe Fridman, Lori Loan — 2011-12-12

Mr Jett, my coauthors and I thank you for your thoughtful letter concerning our June 2011 paper on the association of needlestick injuries among inpatient staff nurses and nurse staffing. We particularly applaud your regard for the multifactorial nature of needlestick injuries. Despite advances in needleless devices, needlestick injuries continue to occur, and, as our data show, contaminated needles are still a serious threat to the occupational safety of nursing personnel, not to mention others who work in hospitals (eg, housekeeping staff) whom we did not study. Just as with the patient safety movement, we need to seriously consider not only the actions of the individual nurses but the systems in which they provide nursing care, or the context of their respective work environments, if we are to better understand the multifactorial nature of such adverse events.

Over-the-counter delivery of antibiotics: Are we sending the right message?

Arif Al-Hamad — 2011-12-05

In the preantibiotic era, infection syndromes had been treated with antibody-based therapy. Although effective, these forms of therapy were pathogen specific and were limited by adverse effects such as serum sickness and viral contamination and supplanted by the development of antibiotics in the 1940s. Antibiotics have probably saved more lives than any other group of drugs. However, the efficacy of antimicrobial chemotherapy is diminishing because of the rapidly escalating resistance. In the 70 years of the antibiotic era in the treatment of human infectious diseases, pathogenic bacteria have developed relentlessly with clinically significant resistances to one class of antibiotic after another.

Rapid screening method for multiple gastroenteric pathogens also detects novel enterohemorrhagic Escherichia coli O104:H4

2011-11-21

We have read a current article by Frank et al reporting the preliminary data on the current outbreak of a new aggressive enterohemorrhagic Escherichia coli (EHEC) strain in Germany with great interest. During the last phase of the outbreak, our hospital also treated several patients suspected of being infected with said novel EHEC strain E coli O104:H4. The patients were suffering from hemorrhagic diarrhea and at the risk of developing the serious and life-threatening hemolytic-uremic syndrome and thus needed a rapid differential diagnosis. To avoid misdiagnosis potentially leading to incorrect initial therapy or infection control measures, rapid screening diagnostic methods were required because it was difficult to contact specialized laboratories for rapid confirmation of suspected strains. However, the hype of the mass media led to an exponential increase in the number of newly suspected cases, the majority of laboratories were overloaded, and the risk of delayed diagnosis increased proportionally, respectively.

Vancomycin-resistant enterococci rectal colonization in an intensive care unit: A report from Turkey

Gul Karagoz, Ayten Kadanali, Oznur Ak, Serdar Ozer — 2011-11-07

The prevalance of vancomycin-resistant enterococcus (VRE) nosocomial infections has dramatically increased in recent years throughout the world. Current recommendations for hospital infection control include VRE fecal surveillance cultures obtaining from high-risk patients, such as those in intensive care units, hematology-oncology wards, and transplant units.

Factors affecting nursing students' knowledge of HIV/AIDS in Singapore

Moon Fai Chan, RunBing Madeleine Lam, Jeff Thayala — 2011-09-26

Nursing students in Singapore are taught about HIV/AIDS during their course of training and also have the opportunity to interact with and care for patients living with HIV/AIDS during their clinical posting. As the next generation of health care professionals, these student nurses need to increase their knowledge as well as their self-awareness of fears and concerns related to caring for patients living with HIV/AIDS. The prevalence of HIV/AIDS in Singapore is increasing, and every nurse will care for these patients at some point in her career. Nursing students need sufficient knowledge and self-awareness to provide quality care for thse patients. Limited information is available on the knowledge level regarding HIV/AIDS of nursing students in Singapore. We aimed to identify factors associated with these students' knowledge of HIV/AIDS.

Treatment of tuberculosis: Timely or accurately?

Che-Kim Tan, Chih-Cheng Lai — 2011-09-26

We read with great interest the article by Chen et al in the June 2011 issue of the American Journal of Infection Control. In this study, the authors found that the implementation of an expedited acid-fast bacilli (AFB) smear laboratory procedure and an automatic, real-time laboratory notification system by short message with mobile phones can significantly decrease delay in the diagnosis and isolation of patients with active tuberculosis (TB). Despite recent progress in infection control efforts, TB remains one of the greatest challenges to global public health, and Taiwan is not exempt from this threat. The estimated prevalence of TB infection in Taiwan was 111 per 100,000 population in 2007, and there were 14,265 new cases (62.0 per 100,000 population) in 2008. Therefore, patients with AFB-positive specimen, especially respiratory samples, were generally presumed to be Mycobacterium tuberculosis (MTB) unless proven otherwise. Infection control measures in Taiwan required patient isolation to prevent outbreak of the disease, and, probably, anti-TB treatment will be commenced at the same time. However, with increased isolation of nontuberculous mycobacterium (NTM) from AFB-positive samples, either as a colonizer or true pathogen, we are concerned that more and more patients with AFB-positive samples would receive inappropriate or unnecessary anti-TB management, including isolation and anti-mycobacterial antimicrobials.

Standard for using a fluorescent marker

Elizabeth Gillespie — 2011-09-22

In Australia, there is no commercially available fluorescent marker that can be used to demonstrate where cleaning has been undertaken. To overcome this, a fluorescent marker standard has been developed with instructions for using an existing and readily available product.

Home health agency’s pandemic preparedness

Somsri Wiwanitkit, Viroj Wiwanitkit — 2011-09-16

The report on the problem of home health agency’s pandemic preparedness is very interesting. It seems that the small size agency might have the problem in preparedness and can be the problematic foci in case of outbreak of 2009 H1N1 influenza. It is no use to know only that the present problem exists, but it is more useful to find the solution for the problem. A recent concept of telehealth infection control might be a possible solution. This is concordant with the fact that “health care transitions to the home environment.”

Mobile phone usage in the clinical setting: Evidence-based guidelines for all users is urgently required

Akila Visvanathan, Mark A. Rodrigues, Richard Brady, Alan P. Gibb — 2011-09-12

We commend the recent article that adds to the compelling body of evidence that suggests mobile phones as communication devices in the clinical environment are popular and regularly utilized by patients and health care workers.

Patient awareness of the risks of central venous catheters in the outpatient setting

Nasia Safdar, Kurt Mittelstadt, Elizabeth A. Jacobs, Martha E. Gaines — 2011-09-09

Bloodstream infection remains the most common life-threatening complication of central venous access. Central venous catheters (CVCs) are the most frequent cause of nosocomial bloodstream infection with 250,000 to 500,000 episodes occurring in the United States annually. In the last several years, widespread implementation of evidence-based interventions to prevent central line-associated bloodstream infection (CLABSI) in the intensive care unit has been undertaken with commensurate reduction in CLABSI rates. Nonetheless, CLABSI remains one of the most important life-threatening complications of central venous access. Patient education regarding CVC insertion and risk of CLABSI has been recommended, as outlined in the 2011 Patient Safety goals from the Joint Commission. However, data on patient education regarding CLABSI are scant. We undertook a survey to assess patients’ awareness of the risk and consequences of CLABSI at the University of Wisconsin hospital, a 592-bed acute care tertiary referral hospital.

Assessment beyond central line bundle: Audits for line necessity in infected central lines in a surgical intensive care unit

Seth Rotz, Madhuri M. Sopirala — 2011-09-12

Central line-associated bloodstream infection (CLABSI) is a major health care burden in the intensive care unit (ICU) setting. Many risk factors associated with central lines have been studied with mixed results. Although it has long been accepted that increased duration of a central line leads to higher infection rates, little attention beyond central line bundle is paid to the factors contributing to CLABSI development. Recently, more attention has focused on reminding staff to remove lines that are not medically necessary using a daily goals checklist. Audits of line necessity with feedback to staff may have a desirable impact on staff behavior but are not routinely performed. We performed a retrospective audit of patients with CLABSI in a surgical ICU at a large academic teaching center to assess the burden of infected lines that were left in longer than medically necessary. To determine medical necessity, we established criteria for conditions requiring a central line as follows: irritant and vesicant medication use, total parenteral nutrition administration, dialysis, and hemodynamic instability (defined as use of a vasopressor or inotrope, mean arterial pressure < 60 or heart rate > 100). If no documented indication could be found in the paper or electronic medical record for greater than 48 hours, it was assumed that the line was unnecessary (see ).

Viral study on a ventilation filter from a public building

Somsri Wiwanitkit, Viroj Wiwanitkit — 2011-09-07

We read the recent article by Goyal et al reporting a viral study on a ventilation filter from a public building with great interest. The authors concluded that “existing building HVAC filters may be used as a method of detection for airborne viruses” and proposed that the assessement “can inform the development of methods to prevent airborne transmission of viruses and possible deterrents against the spread of bioterrorism agents.” Indeed, the finding of virus in filters can be expected. Further investigations should address the possibility of spreading the virus to people in the building. Also, detection of the virus at high levels also spells danger for the general population in the area around the building.

Epidemiologic surveillance of postoperative endophthalmitis in a specialized ophthalmologic center in São Paulo, Brazil

Reginaldo Adalberto de Luz, Maria Clara Padoveze, Tadeu Cvintal — 2011-09-02

This article describes a postoperative endophthalmitis (POE) surveillance system in place in a specialized ophthalmologic center in São Paulo, Brazil. The study involved a review of medical records from 2004-2009, during which a total of 31,999 intraocular surgeries were performed. Nineteen of these cases fulfilled the criteria for POE, for an infection rate of 0.06%. The main etiologic agent causing POE was Pseudomonas aeruginosa, identified in 42.1% of the cases (8/19).

2012-02-01

Editorial Board

2012-02-01

APIC Masthead

2012-02-01

Information for Readers

2012-02-01

Information for Authors

2012-02-01

AJIC: American Journal of Infection Control

Save the Date for APIC 2012

Frequency of outbreak investigations in US hospitals: Results of a national survey of infection preventionists

Outbreak or coincidental cases of tuberculosis? Genotyping provides the clue

Outbreak of bloodstream infections because of Serratia marcescens in a pediatric department

Outbreak of acute hepatitis B virus infections associated with podiatric care at a psychiatric long-term care facility

Risk factors for coronary artery bypass graft chest surgical site infections in New York State, 2008

Reducing health care-associated infections (HAIs): Lessons learned from a national collaborative of regional HAI programs

Infection control through the ages

Femoral central venous catheters are not associated with higher rates of infection in the pediatric critical care population

An unexpected increase in catheter-associated bloodstream infections at a children’s hospital following introduction of the Spiros closed male connector

Inappropriate use of urinary catheters: A prospective observational study

Accuracy of a urinary catheter surveillance protocol

Catheter management in neonates with bloodstream infection and a percutaneously inserted central venous catheter in situ: Removal or not?

A prospective study of central venous catheters placed in a tertiary care emergency department: Indications for use, infectious complications, and natural history

Practice of universal precautions and risk of occupational blood-borne viral infection among Congolese health care workers

Horizontal transmission of Streptococcus pneumoniae in the surgical ward: A rare source of nosocomial wound infection

Successful control of a norovirus outbreak among attendees of a hospital teaching conference

Post‒cataract surgery endophthalmitis outbreak caused by multidrug-resistant Pseudomonas aeruginosa

Disinfection of an infrared coagulation device used to treat hemorrhoids

Compliance with standard precautions among gastrointestinal endoscopists and endoscopy nurses in Japan

A call for consideration of needlestick injury data in evaluating staffing effectiveness

Response to “A call for consideration of needlestick injury data in evaluating staffing effectiveness”

Over-the-counter delivery of antibiotics: Are we sending the right message?

Rapid screening method for multiple gastroenteric pathogens also detects novel enterohemorrhagic Escherichia coli O104:H4

Vancomycin-resistant enterococci rectal colonization in an intensive care unit: A report from Turkey

Factors affecting nursing students' knowledge of HIV/AIDS in Singapore

Treatment of tuberculosis: Timely or accurately?

Standard for using a fluorescent marker

Home health agency’s pandemic preparedness

Mobile phone usage in the clinical setting: Evidence-based guidelines for all users is urgently required

Patient awareness of the risks of central venous catheters in the outpatient setting

Assessment beyond central line bundle: Audits for line necessity in infected central lines in a surgical intensive care unit

Viral study on a ventilation filter from a public building

Epidemiologic surveillance of postoperative endophthalmitis in a specialized ophthalmologic center in São Paulo, Brazil

Table of Contents

Editorial Board

APIC Masthead

Information for Readers

Information for Authors