AJIC: American Journal of Infection Control

APIC's 2013 Heroes of Infection Prevention Award Winners

2013-06-01

Ten individuals and 2 teams of infection preventionists who have improved the health and well-being of patients, health care workers, and the public through infection prevention and control have been selected as APIC's 2013 Heroes of Infection Prevention.

Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections

Jaffar A. Al-Tawfiq, Mahmoud S. Abed, Nashma Al-Yami, Richard B. Birrer — 2012-12-26

Background: Hand hygiene is the single most important intervention to combat infections in any health care setting. However, adherence to hand hygiene practice remains low among health care workers.Objectives: Our objective was to assess compliance with hand hygiene over time utilizing a multifaceted approach to hand hygiene. In addition, we assessed the rate of device-associated infections.Methods: This is a descriptive time series study with a multitude of interventions from October 2006 to December 2011 set in a 350-bed community hospital in Saudi Arabia. We utilized a multimodal program to promote hand hygiene activities. We also calculated device-associated infection rates as outcome measures.Results: Over the study, the overall hand hygiene compliance rate increased from a baseline of 38% in second quarter 2006 to 65% in 2010 and then to 85% in 2011 (P < .001). The compliance rates increased among all professions and different hospital units. The compliance rates were 87% for physicians, 89% for nursing staff, and 93% for nutritionist. The rate of health care-associated methicillin-resistant Staphylococcus aureus per 1,000 patient-days decreased from 0.42 in 2006 to 0.08 in 2011. Ventilator-associated infection rates decreased from 6.12 to 0.78, central line-associated bloodstream infections rates decreased from 8.23 to 4.8, and catheter-associated urinary tract infection rates decreased from 7.08 to 3.5.Conclusion: This intervention used a multitude of interventions and resulted in an institution-wide increase and sustained improvement in compliance rates.

Patient hand hygiene practices in surgical patients

2012-11-29

Background: Little is known about the hand hygiene practices of surgical patients. Most of the research has been directed at the health care worker, and this may discount the role that hand hygiene of the surgical patient might play in surgical site infections.Methods: A quasiexperimental, pretest/post-test study was conducted in which patients (n = 72) and nurses (n = 42) were interviewed to examine perceptions and knowledge about patient hand hygiene. Concurrently, observations were conducted to determine whether surgical patients were offered assistance by the nursing staff. Following an initial observation period, nursing staff received an educational session regarding general hand hygiene information and observation results. One month after the education session, patient/nurse dyads were observed for an additional 6 weeks to determine the impact of the educational intervention.Results: Eighty observations, 72 patient interviews, and 42 nurse interviews were completed preintervention, and 83 observations were completed postintervention. In response to the survey, more than half of patients (n = 41, 55%) reported that they were not offered the opportunity to clean their hands, but a majority of the nursing staff reported (n = 25, 60%) that they offered patients the opportunity to clean their hands. Prior to the educational intervention, nursing staff assisted patients in 14 of 81 hand hygiene opportunities. Following the intervention, nursing staff assisted patients 37 out of 83 opportunities (17.3% vs 44.6%, respectively, [χ21 = 13.008, P = .0003]).Conclusion: This study suggests that efforts to increase hand hygiene should be directed toward patients as well as health care workers.

Parent willingness to remind health care workers to perform hand hygiene

Genevieve L. Buser, Brian T. Fisher, Judy A. Shea, Susan E. Coffin — 2012-12-20

Background: Health care worker (HCW) hand hygiene (HH) is the core strategy to prevent health care-associated infections (HAI). Suboptimal HCW HH rates continue despite hospital efforts to increase compliance.Objectives: To determine whether parents of hospitalized children perceive they have a role in preventing HAI and whether they are willing to remind HCW to perform HH, with and without an invitation.Methods: We conducted structured interviews of parents of children admitted to a pediatric hospital. Questions assessed knowledge, attitudes, and behaviors about HAI and HH. The primary outcome was willingness to remind a HCW to do HH (5-point Likert scale).Results: We interviewed 115 parents, of whom 84% were aware of HAI. Most parents (78%) perceived HH as the most important practice to prevent HAI. However, only 67% would definitely remind a HCW to perform HH. Importantly, 92% said that an invitation from a HCW would make them more likely to remind a HCW to do HH in the future.Conclusion: Our results suggest that parents of hospitalized children are willing to help prevent HAI; however one-third are still reluctant to remind HCW to perform HH. An invitation by HCW to parents to remind HCW to perform HH might effectively engage parents as partners in HAI prevention.

Hand hygiene compliance and environmental determinants in child day care centers: An observational study

2012-09-10

Background: Children attending day care centers (DCCs) are at high risk for contracting infections, for which hand hygiene (HH) is an effective prevention measure. The study objectives were to assess caregivers’ compliance to HH guidelines in DCCs and to identify environmental determinants of HH behavior.Methods: We observed caregivers’ compliance to HH guidelines and collected data on environmental determinants (ie, number of sinks, number and type of towel and soap facilities, availability of alcohol-based hand sanitizers). Using multilevel logistic regression analyses, odds ratios (OR) with 95% confidence intervals (CI) were obtained for environmental determinants of HH behavior.Results: In 122 participating DCCs, 350 caregivers and 2,003 HH opportunities were observed. The overall compliance was 42% (95% CI: 40%-44%). Compliance for different activities for which HH was indicated ranged from 20% to 79%. In the multivariable model, the number of towel facilities per caregiver (OR, 2.33; 95% CI: 1.40-3.88) and type of towel facilities were significantly associated with HH. Hands were most frequently washed when only paper towels were available compared to only fabric towels (OR, 1.47; 95% CI: 1.00-2.16) or a combination of both paper and fabric towels (OR, 2.13; 95% CI: 1.32-3.44).Conclusion: HH compliance of caregivers in Dutch child DCCs can be improved. Interventions for this should take into account environmental determinants such as the number and type of towel facilities.

Hand hygiene compliance in transplant and other special patient groups: An observational study

2013-01-21

Background: This study evaluates hand hygiene behavior of health care workers in a German university hospital stratified for treatment of special patient groups (eg, transplant patients).Methods: From 2008 to 2010, comprehensive education and training of all health care workers was implemented to improve hand hygiene compliance. Consumption rates of alcohol-based hand rub and gloves were collected and evaluated.Results: Of the 5,647 opportunities of hand disinfection evaluated, 1,607 occurred during care for transplant patients. To our knowledge, this is the largest survey of hand hygiene compliance in special patient groups on intensive care units in a university hospital in Germany. Health care workers on surgical intensive care units showed lower hand hygiene compliance compared with health care workers on other types of intensive care units. Compliance toward hand hygiene was significantly higher on hemato-oncologic and pediatric wards. In general, hand disinfection was performed significantly more frequently after an intervention than before (P < .05, 95% confidence interval: 1.24-1.84). Overall, there was no significant difference in hand hygiene compliance when caring for transplant patients or other patients (odds ratio, 1.16; 95% confidence interval: 0.95-1.42). Nurse’s and physician’s hand hygiene compliance improved because of education.Conclusion: Hand hygiene compliance is not increased in the care for transplant patients (despite their predisposition for nosocomial infections) compared with other patients. Additional studies will be necessary to further investigate these findings.

Risk factors for Staphylococcus aureus surgical site infection during an outbreak in patients undergoing cardiovascular surgery

2012-12-26

Background: This study examined the epidemiology of an outbreak of Staphylococcus aureus surgical site infections (SSI) after cardiovascular surgery, and analyzed risk factors for S aureus SSIs.Methods: This was a retrospective case-control study to determine risk factors for S aureus SSI in 38 patients who developed S aureus SSI during the outbreak period, compared with age-, sex-, and procedure-matched controls. S aureus strains were typed by pulsed-field gel electrophoresis.Results: A total of 38 patients had S aureus SSI. Pulsed-field gel electrophoresis identified transmission of 3 S aureus clones (2 MSSA clones and 1 MRSA clone). Twenty-one health care workers were carriers of outbreak strains. In multivariate analysis, the significant risk factors for S aureus SSI were previous cardiac surgery (odds ratio, 7.41; 95% confidence interval, 1.05–52.16) and long procedure duration (odds ratio, 1.49; 95% confidence interval, 1.00–2.21).Conclusions: This outbreak demonstrates evidence of nosocomial transmission of 3 clones of S aureus in the setting of incomplete compliance with recommended standard perioperative infection control measures, associated with a high prevalence of staff carriage of the predominant outbreak strains.

Embracing collaboration: A novel strategy for reducing bloodstream infections in outpatient hemodialysis centers

2012-12-10

Background: The incidence of access-related bloodstream infections (AR-BSIs) in US outpatient hemodialysis centers is unacceptably high. This paper presents the implementation and results achieved from a multi-pronged strategy to reduce AR-BSIs in 1 outpatient hemodialysis center.Methods: The intervention, which took place between 2009 and 2011, involved membership in the Centers for Disease Control and Prevention Hemodialysis Bloodstream Infection Prevention Collaborative, implementation of a panel of infection prevention interventions, and use of positive deviance (PD) to engage staff. Changes in the incidence of AR-BSIs and infection prevention process measures between the pre- and postintervention time periods, as well as alterations in the center's social networks, were examined to assess impact.Results: The incidence of all AR-BSIs dropped from 2.04 per 100 patient-months preintervention to 0.75 (P = .03) after employing the Collaborative interventions and to 0.24 (P < .01) after augmenting the Collaborative interventions with PD. Adherence rates increased significantly in 4 of 5 infection prevention process measure categories. The dialysis center's social networks became more inclusive and connected after implementation of PD.Conclusion: Participating in a Collaborative, employing a panel of infection prevention strategies, and engaging employees through PD resulted in a significant decline in AR-BSIs in this facility. Other hemodialysis facilities should consider a similar approach.

Successful multifaceted intervention aimed to reduce short peripheral venous catheter-related adverse events: A quasiexperimental cohort study

2012-10-18

Background: Data concerning the effectiveness of strategies implemented to reduce short peripheral vein catheter (PVC)-related adverse events are scarce.Methods: A quasiexperimental study (2004-2011) was conducted to evaluate an intervention to reduce peripheral vein phlebitis (PVP) and PVC-related bloodstream infections (BSIs). Bundle intervention consisted of health care worker education and training, withdrawal of unnecessary catheters, exchange catheter policy, withdrawal of catheters at early stages of PVP, use of scales as a measuring tool, and repeated period-prevalence surveillance of PVC adverse events on wards. A Poisson exponentially weighted moving average control chart was used to assess time series analysis.Results: One thousand six hundred thirty-one patients with 2,325 short catheters inserted were prospectively followed. PVP decreased by 48% (12.1% [95% confidence interval (CI): 10.7-13.2] during the intervention period versus 23.3% [95% CI: 16.4-30.1] in preintervention period; P .05). A significant incidence reduction in PVC-related BSIs and health care-acquired Staphylococcus aureus BSIs was also achieved.Conclusion: A comprehensive multifaceted hospital approach was successful in reducing PVC-related adverse effects. Poisson exponentially weighted moving average control chart fits well as time series using Poisson data when very few events are present.

Risk factors, clinical features, and outcome of Pseudomonas aeruginosa bacteremia in patients with hematologic malignancies: A case-control study

2012-12-10

Background: We observed an increased rate of Pseudomonas aeruginosa bacteremia in our hematology unit in 2004-2007 without an identified environmental source.Methods: We conducted a matched case-control study to investigate factors associated with P aeruginosa bacteremia in patients with hematologic malignancies.Results: Forty-two episodes of P aeruginosa bacteremia were identified. At presentation, 26 patients (62%) had pneumonia and 9 patients (21%) were in shock. Twenty-five patients (60%) were aplastic. The clinical cure rate was 40%. Comparing the 42 cases with 84 matched controls identified the following independent risk factors for P aeruginosa bacteremia: hospitalization in the previous 3 months (odds ratio [OR], 12.84; 95% confidence interval [CI], 2.98-55.18), antibiotic therapy in the previous 3 months (OR, 5.34; 95% CI, 2.14-13.30), receipt of ceftriaxone in the previous 3 months (OR, 2.38; 95% CI, 1.08-5.27), receipt of aminoglycosides in the previous 3 months (OR, 6.65; 95% CI, 1.15-38.25) and receipt of fluoroquinolones in the previous 3 months (OR, 3.22; 95% CI, 1.48-7.00).Conclusions: Local antibiotic therapy algorithms were modified to decrease prescriptions of ceftriaxone and combination therapy with aminoglycosides and fluoroquinolones in an effort to decrease the risk of P aeruginosa bacteremia.

Peripheral venous catheter care in the emergency department: Education and feedback lead to marked improvements

2012-12-10

Background: Peripheral venous catheters (PVCs) can be associated with serious complications. We evaluated the effect of education and feedback on processes related to PVC placement.Methods: We implemented an educational intervention in a 72-bed Emergency Department (ED) over 12 months (4 periods, each a quarter). During preimplementation period, we evaluated PVC placement, condition, accurate documentation, and demonstration of aseptic steps for medication infusion. With implementation, ED nurses had formal education, with direct observations and feedback. For postimplementation periods 1 and 2, we continued direct observations and feedback, reducing the number of audits per week.Results: Of 2,568 PVCs evaluated in the ED, accurate documentation on dressing improved from 83 of 803 (10.3%) preimplementation to 300 of 476 (63%) at the end of the study (P < .0001). Correct documentation in ED records improved from 498 of 803 (62%) preimplementation to 409 of 476 (85.9%) at the end of study (P < .0001). We observed 273 attempts to place PVC; of them, 220 (80.6%) were completed. The overall compliance with the procedure steps was very poor preimplementation (n = 3/63, 4.8%) and improved in implementation (n = 17/55, 30.9%) and postimplementation periods 1 (n = 19/60, 31.7%) and 2 (n = 14/42, 33.3%, P < .0001). ED health care workers showed significant improvement in knowledge with education.Conclusion: Education and real-time feedback to ED health care workers are associated with an increased and sustained compliance with processes to reduce the risk of infection from PVCs.

Implementation of hospital-wide enhanced terminal cleaning of targeted patient rooms and its impact on endemic Clostridium difficile infection rates

Farrin A. Manian, Sandra Griesnauer, Alex Bryant — 2012-12-10

Background: Implementation of a hospital-wide program of terminal cleaning of patient rooms revolving around hydrogen peroxide vapor (HPV) technology and evaluation of its impact on endemic nosocomial Clostridium difficile-associated diarrhea (CDAD) have not been previously reported.Methods: This was a retrospective quasiexperimental study involving a 900-bed community hospital. During the preintervention period (January 2007-November 2008), rooms vacated by patients with CDAD or on contact precautions for other targeted pathogens underwent 1 or more rounds of cleaning with bleach. During the intervention period (January-December 2009), targeted newly evacuated rooms underwent “enhanced cleaning” consisting of use of bleach followed by HPV decontamination utilizing a priority scale based on the pathogen and room location. Rooms vacated by patients with CDAD but for which HPV decontamination was not possible the same day underwent 4 rounds of cleaning with bleach instead.Results: During the intervention period, 1,123 HPV decontamination rounds were performed involving 96.7% of hospital rooms. Of 334 rooms vacated by patients with CDAD (May-December 2009), 180 (54%) underwent HPV decontamination. The rate of nosocomial CDAD rate dropped significantly from 0.88 cases/1,000 patient-days to 0.55 cases/1,000 patient-days (rate ratio, 0.63; 95% confidence interval: 0.50-0.79, P < .0001).Conclusion: A hospital-wide program of enhanced terminal cleaning of targeted patient rooms revolving around HPV technology was practical and was associated with a significant reduction in CDAD rates.

Understanding factors that impact on public and patient’s risk perceptions and responses toward Clostridium difficile and other health care-associated infections: A structured literature review

2012-11-30

Background: Clostridium difficile is the most common health care-associated infection and a major cause of death and increased morbidity. It is vital that patients and the public are provided with the right information and communication to assist them to understand their role in preventative measures. Successful implementation of communication and management strategies hinges on individuals’ risk perceptions.Methods: We performed a structured literature review to examine the evidence regarding public and patients’ risk perceptions and responses toward Clostridium difficile and other health care-associated infections. Fourteen studies were included.Results: Only 1 study was specific to Clostridium difficile, and 7 were related to other health care-associated infections. Many reported limited understanding of the technical issues of the infection, concerns of transmission to family and friends, inadequate information available, and distrust. The media were one of the main sources of information. Both emotional and physical responses highlighted the level of confusion, fear, anxiety, and anger.Conclusion: Empirical research of risk perceptions toward Clostridium difficile is limited. Without well-researched studies examining risk perceptions and responses, there is a danger of developing and implementing communication and management strategies that do not meet the needs of our patients or the public.

Postdischarge surveillance following delivery: The incidence of infections and associated factors

Aida Bianco, Simona Roccia, Carmelo G.A. Nobile, Claudia Pileggi, Maria Pavia — 2012-12-10

Background: To assess the effectiveness of a postdischarge surveillance system to reveal cases of postpartum infections that could be missed by the current in-hospital routine surveillance and to identify predictors of postpartum infections.Methods: The prospective surveillance included obstetrics patients. The information recorded included sociodemographic characteristics, infection-predisposing conditions, documentation of extrinsic risk factors, variables related to pregnancy and delivery, and variables related to each patient’s newborn. A telephone interview on Day 30 after hospital discharge was performed to retrieve information related to signs and symptoms of infection.Results: One thousand seven hundred five patients agreed to participate for a response rate of 93%. One hundred forty-nine (8.9%) patients contacted by telephone reported at least 1 episode of infection within 30 days of discharge. There were 24 infections occurring during hospitalization, representing only 16.1% of all infections. There was an increased risk of postpartum infections in women with complications during labor, in those who had a caesarean delivery, and in those who reported alcohol consumption during pregnancy.Conclusion: Our study demonstrated the need for implementing postdischarge surveillance programs for obstetrics patients that also identify infections following vaginal delivery. Postdischarge surveillance by telephone contact proved to be a feasible and effective method.

A national survey of infection control and antimicrobial stewardship structures in Irish long-term care facilities

2012-11-12

Background: Information on infection prevention and control (IPC) and antimicrobial stewardship activities in Irish long-term care facilities (LTCFs) is limited.Methods: A survey detailing IPC and antimicrobial stewardship activities, including staffing and bed capacity, was circulated to Irish LTCFs.Results: Sixty-nine LTCFs (61 public, 8 private) were surveyed, 56 (81%) of which had an IPC practitioner. Thirty-five (51%) LTCFs had an IPC committee that met on average 5 times (range, 1-10) during the previous year. LTCFs with IPC practitioners based solely in the facility (n = 17) were more likely to have an IPC committee (P = .027). Antimicrobial guidelines were available in 28% (n = 19) and 16% (n = 11) had an antimicrobial stewardship committee in place. Medical care was provided by general practitioners in 51% (n = 35), by physicians employed by the LTCFs in 35% (n = 24), or by both in 14% (n = 10). Medical care and activities were coordinated in 45% (n = 31) of LTCFs. These LTCFs were more likely to have an IPC committee (P < .001), medical staff training (P < .001), and antimicrobial guidelines (P = .005) in place.Conclusion: There are significant gaps in Irish LTCFs’ IPC and antibiotic stewardship programs and governance structures, highlighting the need for specific LTCF national initiatives.

The effect of contact precautions on hand hygiene compliance

2012-12-26

Hand hygiene is one of the most important interventions to prevent health care-associated infections. We compared hand hygiene compliance among health care workers when patients were in contact precautions to compliance when patients were not in contact precautions. Our study failed to show differences in adherence to hand hygiene practices in the care of contact isolation versus noncontact isolation patients.

Compliance with hand hygiene recommendations during neuromotor rehabilitation procedures in an Italian rehabilitation hospital: An observational study

2013-02-13

This report examines hand hygiene practices among 171 therapists from an Italian hospital for neuromotor rehabilitation, the Fondazione Santa Lucia of Rome. Compliance with hand hygiene measures was assessed by direct observation during daily neurorehabilitative activities. This study highlights that attention to this task is generally poor among therapists.

Early identification and control of carbapenemase-producing Klebsiella pneumoniae, originating from contaminated endoscopic equipment

2012-11-20

Klebsiella producing carbapenemase is an emerging pathogen. We report transmission of this organism by contaminated endoscopic instruments. Quick identification of source, staff education, contact precautions, and emphasis on hand and environmental hygiene led to case control and prevention of outbreak.

Differential laundering practices of white coats and scrubs among health care professionals

2012-12-10

The role played by health care worker's uniforms on the horizontal transmission of organisms within the hospital is still controversial. To determine the differential laundering practices in regards to white coats and scrubs, we surveyed physicians present at the 3 weekly academic conferences with largest attendance at our hospital (medicine, pediatrics, and anesthesiology). Out of 160 providers, white coats were washed every 12.4 ± 1.1 days and scrubs every 1.7 ± 0.1 days (mean ± standard error; P < .001). Faculty physicians washed their scrubs more frequently than house staff (1.0 vs 1.9 days, respectively, P = .018), and no differences were observed among specialties.

Twitter as a source of vaccination information: Content drivers and what they are saying

Brad Love, Itai Himelboim, Avery Holton, Kristin Stewart — 2013-06-01

Twitter is a popular source of health information. This study reports a content analysis of posts about vaccinations, documenting sources, tone, and medical accuracy. Results can help explain patient knowledge and directions for educational campaigns. A set of 6,827 tweets indicates professional sources were shared most and treated positively. Two-thirds of shared medical content were substantiated. One-third of messages were positive, counter to other research and suggesting that users apply critical thinking when evaluating content.

Journal Club: Twitter as a source of vaccination information: Content drivers and what they're saying

Mary Lou Manning, James Davis — 2013-06-01

This Journal Club reviews a study on the use of Twitter as a source of health-related information.

Implementing an effective hand hygiene program: Current thought leader perspectives: June 3rd, 12:00 p.m. to 3:00 p.m.

Didier Pittet, David R. Macinga, William Jarvis, John Boyce, Nimalie Stone — 2013-06-01

Thought leading experts in Hand Hygiene will be together at this June 3, 2012 Continuing Education-accredited session to provide their insights on the latest developments within the hand hygiene category. Key objectives are to review the science of alcohol-based hand rubs (ABHR) and the critical variables that influence their antimicrobial efficacy and clinical effectiveness; to understand the key principles of point of care hand hygiene implementation; to review strategies and recent advances in hand hygiene compliance monitoring; and to understand the challenges & opportunities of hand hygiene implementation in long-term care settings. Attendees will also have the opportunity to speak with the experts.

Health care versus non-health care businesses’ experiences during the 2009 H1N1 pandemic: Financial impact, vaccination policies, and control measures implemented

2013-01-31

Background: Only limited data are available on businesses’ experiences related to the 2009 H1N1 pandemic in terms of interventions implemented, staffing shortages, employees working while ill, and H1N1 vaccination policy.Methods: A questionnaire was administered to human resource professionals during May-July 2011 to assess US businesses’ experiences related to the 2009 pandemic. Logistic regressions were used to describe factors associated with providing H1N1 and respiratory hygiene training and offering H1N1 vaccine to staff. Linear regression was used to describe factors associated with higher infection prevention intervention scores (ie, number of interventions implemented).Results: In all, 471 human resource professionals participated. Most (85.1%, n = 401) did not work while ill. Twelve percent (n = 57) reported staffing shortages, 2.1% (n = 10) needed to hire temporary staff, and fewer than 1% (0.8%, n = 4) reduced workload or closed during the pandemic. From logistic and linear regressions, determinants of providing employees H1N1 influenza training, respiratory hygiene education, offering H1N1 vaccine to employees, and higher infection prevention intervention scores were size of the business (with larger businesses implementing more interventions, such as providing education and vaccine, than smaller businesses) and being a health care agency.Conclusion: Businesses should continue to improve business continuity and pandemic plans to prepare for the next biologic event (ie, pandemic, bioterrorism attack, or emerging infectious disease outbreak).

Impact of health care worker policy awareness on hand hygiene and urinary catheter care in nursing homes: Results of a self-reported survey

Ana Montoya, Shu Chen, Andrzej Galecki, Sara McNamara, Bonnie Lansing, Lona Mody — 2013-06-01

Utilizing a self-administered questionnaire in 440 health care workers (81% response rate), we evaluated the impact of health care workers policy awareness on hand hygiene and urinary catheter care in nursing homes. We show that health care workers aware of their nursing home policies are more likely to report wearing gloves and practicing hand hygiene as per evidence-based recommendations during urinary catheter care compared with those who are unaware of their facility policies.

2013-06-01

Editorial Board

2013-06-01

APIC Masthead

2013-06-01

Information for Readers

2013-06-01

Information for Authors

2013-06-01

AJIC: American Journal of Infection Control

APIC's 2013 Heroes of Infection Prevention Award Winners

Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections

Patient hand hygiene practices in surgical patients

Parent willingness to remind health care workers to perform hand hygiene

Hand hygiene compliance and environmental determinants in child day care centers: An observational study

Hand hygiene compliance in transplant and other special patient groups: An observational study

Risk factors for Staphylococcus aureus surgical site infection during an outbreak in patients undergoing cardiovascular surgery

Embracing collaboration: A novel strategy for reducing bloodstream infections in outpatient hemodialysis centers

Successful multifaceted intervention aimed to reduce short peripheral venous catheter-related adverse events: A quasiexperimental cohort study

Risk factors, clinical features, and outcome of Pseudomonas aeruginosa bacteremia in patients with hematologic malignancies: A case-control study

Peripheral venous catheter care in the emergency department: Education and feedback lead to marked improvements

Implementation of hospital-wide enhanced terminal cleaning of targeted patient rooms and its impact on endemic Clostridium difficile infection rates

Understanding factors that impact on public and patient’s risk perceptions and responses toward Clostridium difficile and other health care-associated infections: A structured literature review

Postdischarge surveillance following delivery: The incidence of infections and associated factors

A national survey of infection control and antimicrobial stewardship structures in Irish long-term care facilities

The effect of contact precautions on hand hygiene compliance

Compliance with hand hygiene recommendations during neuromotor rehabilitation procedures in an Italian rehabilitation hospital: An observational study

Early identification and control of carbapenemase-producing Klebsiella pneumoniae, originating from contaminated endoscopic equipment

Differential laundering practices of white coats and scrubs among health care professionals

Twitter as a source of vaccination information: Content drivers and what they are saying

Journal Club: Twitter as a source of vaccination information: Content drivers and what they're saying

Implementing an effective hand hygiene program: Current thought leader perspectives: June 3rd, 12:00 p.m. to 3:00 p.m.

Health care versus non-health care businesses’ experiences during the 2009 H1N1 pandemic: Financial impact, vaccination policies, and control measures implemented

Impact of health care worker policy awareness on hand hygiene and urinary catheter care in nursing homes: Results of a self-reported survey

Table of Contents

Editorial Board

APIC Masthead

Information for Readers

Information for Authors