To develop a modified surveillance definition of central line-associated bloodstream infection (mCLABSI) specific for our population of patients with hematologic malignancies to better support ongoing improvement efforts at our hospital.

Retrospective cohort study.

Hematologic malignancies population in a 1,200-bed tertiary care hospital on a 22-bed bone marrow transplant (BMT) unit and a 22-bed leukemia unit.

An mCLABSI definition was developed, and pathogens and rates were compared against those determined using the National Healthcare Safety Network (NHSN) definition.

By the NHSN definition the CLABSI rate on the BMT unit was 6.0 per 1,000 central line-days, and by the mCLABSI definition the rate was 2.0 per 1,000 line-days (P < .001). On the leukemia unit, the NHSN CLABSI rate was 14.4 per 1,000 line-days, and the mCLABSI rate was 8.2 per 1,000 line-days (P = .009). The top 3 CLABSI pathogens by the NHSN definition were Enterococcus species, Klebsiella species, and Escherichia coli. The top 3 CLABSI pathogens by the mCLABSI definition were coagulase-negative Staphylococcus (CONS), Pseudomonas aeruginosa, and Staphylococcus aureus. The difference in the incidence of CONS as a cause of CLABSI under the 2 definitions was statistically significant (P < .001).

A modified surveillance definition of CLABSI was associated with an increase in the identification of staphylococci as the cause of CLABSIs, as opposed to enteric pathogens, and a decrease in CLABSI rates.

The success of central line-associated bloodstream infection (CLABSI) prevention programs in intensive care units (ICUs) has led to the expansion of surveillance at many hospitals. We sought to compare non-ICU CLABSI (nCLABSI) rates with national reports and describe methods of surveillance at several participating US institutions.

An electronic survey of several medical centers about infection surveillance practices and rate data for non-ICU Patients.

Ten tertiary care hospitals.

In March 2011, a survey was sent to 10 medical centers. The survey consisted of 12 questions regarding demographics and CLABSI surveillance methodology for non-ICU patients at each center. Participants were also asked to provide available rate and device utilization data.

Hospitals ranged in size from 238 to 1,400 total beds (median, 815). All hospitals reported using Centers for Disease Control and Prevention (CDC) definitions. Denominators were collected by different means: counting patients with central lines every day (5 hospitals), indirectly estimating on the basis of electronic orders (n = 4), or another automated method (n = 1). Rates of nCLABSI ranged from 0.2 to 4.2 infections per 1,000 catheter-days (median, 2.5). The national rate reported by the CDC using 2009 data from the National Healthcare Surveillance Network was 1.14 infections per 1,000 catheter-days.

Only 2 hospitals were below the pooled CLABSI rate for inpatient wards; all others exceeded this rate. Possible explanations include differences in average central line utilization or hospital size in the impact of certain clinical risk factors notably absent from the definition and in interpretation and reporting practices. Further investigation is necessary to determine whether the national benchmarks are low or whether the hospitals surveyed here represent a selection of outliers.

The diagnosis of central line-associated bloodstream infections (CLABSIs) is often controversial, and existing guidelines differ in important ways.

To determine both the range of practices involved in obtaining blood culture samples and how central line-associated infections are diagnosed and to obtain members' opinions regarding the process of designating bloodstream infections as publicly reportable CLABSIs.

Electronic and paper 11-question survey of infectious-diseases physician members of the Infectious Diseases Society of America Emerging Infections Network (IDSA EIN).

All 1,364 IDSA EIN members were invited to participate.

692 (51%) members responded; 52% of respondents with adult practices reported that more than half of the blood culture samples for intensive care unit (ICU) patients with central lines were drawn through existing lines. A sizable majority of respondents used time to positivity, differential time to positivity when paired blood cultures are used, and quantitative culture of catheter tips when diagnosing CLABSI or determining the source of that bacteremia. When determining whether a bacteremia met the reportable CLABSI definition, a majority used a decision method that involved clinical judgment.

Our survey documents a strong preference for drawing 1 set of blood culture samples from a peripheral line and 1 from the central line when evaluating fever in an ICU patient, as recommended by IDSA guidelines and in contrast to current Centers for Disease Control and Prevention recommendations. Our data show substantial variability when infectious-diseases physicians were asked to determine whether bloodstream infections were primary bacteremias, and therefore subject to public reporting by National Healthcare Safety Network guidelines, or secondary bacteremias, which are not reportable.

To determine the prevalence of Acinetobacter baumannii, an important healthcare-associated pathogen, among mechanically ventilated patients in Maryland.

The Maryland MDRO Prevention Collaborative performed a statewide cross-sectional active surveillance survey of mechanically ventilated patients residing in acute care and long-term care (LTC) facilities. Surveillance cultures (sputum and perianal) were obtained from all mechanically ventilated inpatients at participating facilities during a 2-week period.

All healthcare facilities in Maryland that provide care for mechanically ventilated patients were invited to participate.

Mechanically ventilated patients, known to be at high risk for colonization and infection with A. baumannii, were included.

Seventy percent (40/57) of all eligible healthcare facilities participated in the survey, representing both acute care (n = 30) and LTC (n = 10) facilities in all geographic regions of Maryland. Surveillance cultures were obtained from 92% (358/390) of eligible Patients. A. baumannii was identified in 34% of all mechanically ventilated patients in Maryland; multidrug-resistant A. baumannii was found in 27% of all Patients. A. baumannii was detected in at least 1 patient in 49% of participating facilities; 100% of LTC facilities had at least 1 patient with A. baumannii, compared with 31% of acute care facilities. A. baumannii was identified from all facilities in which 10 or more patients were sampled.

A. baumannii is common among mechanically ventilated patients in both acute care and LTC facilities throughout Maryland, with a high proportion of isolates demonstrating multidrug resistance.

Previous work has shown that daily skin cleansing with Chlorhexidine gluconate (CHG) is effective in preventing infection in the medical intensive care unit (MICU). A colorimetric, semiquantitative indicator was used to measure CHG concentration on skin (neck, antecubital fossae, and inguinal areas) of patients bathed daily with CHG during their MICU stay and after discharge from the MICU, when CHG bathing stopped.

MICU patients at Rush University Medical Center.

CHG concentration on skin was measured and skin sites were cultured quantitatively. The relationship between CHG concentration and microbial density on skin was explored in a mixed-effects model using gram-positive colony-forming unit (CFU) counts.

For 20 MICU patients studied (240 measurements), the lowest CHG concentrations (0–18.75 μg/mL) and the highest gram-positive CFU counts were on the neck (median, 1.07 log10 CFUs; P = .014). CHG concentration increased postbath and decreased over 24 hours (P < .001). In parallel, median log10 CFUs decreased pre- to postbath (0.78 to 0) and then increased over 24 hours to the baseline of 0.78 (P = .001). A CHG concentration above 18.75 μg/mL was associated with decreased gram-positive CFUs (P = .004). In all but 2 instances, CHG was detected on patient skin during the entire interbath (approximately 24-hour) period (18 [90%] of 20 patients). In 11 patients studied after MICU discharge (80 measurements), CHG skin concentrations fell below effective levels after 1–3 days.

In MICU patients bathed daily with CHG, CHG concentration was inversely associated with microbial density on skin; residual antimicrobial activity on skin persisted up to 24 hours. Determination of CHG concentration on the skin of patients may be useful in monitoring the adequacy of skin cleansing by healthcare workers.

Potential transmission of organisms from the environment to patients is a concern, especially in enclosed settings, such as operating rooms, in which there are multiple and frequent contacts between patients, provider's hands, and environmental surfaces. Therefore, adequate disinfection of operating rooms is essential. We aimed to determine the change in both the thoroughness of environmental cleaning and the proportion of environmental surfaces within operating rooms from which pathogenic organisms were recovered.

Prospective environmental study using feedback with UV markers and environmental cultures.

A 1,500-bed county teaching hospital.

Environmental service personnel, hospital administration, and medical and nursing leadership

The proportion of UV markers removed (cleaned) increased from 0.47 (284 of 600 markers; 95% confidence interval [CI], 0.42-0.53) at baseline to 0.82 (634 of 777 markers; 95% CI, 0.77-0.85) during the last month of observations (P < .0001). Nevertheless, the percentage of samples from which pathogenic organisms (gram-negative bacilli, Staphylococcus aureus, and Enterococcus species) were recovered did not change throughout our study. Pathogens were identified on 16.6% of surfaces at baseline and 12.5% of surfaces during the follow-up period (P = .998). However, the percentage of surfaces from which gram-negative bacilli were recovered decreased from 10.7% at baseline to 2.3% during the follow-up period (P = .015).

Feedback using Gram staining of environmental cultures and UV markers was successful at improving the degree of cleaning in our operating rooms.

To determine whether multidrug-resistant (MDR) gram-negative organisms are present in Afghanistan or Iraq soil samples, contaminate standard deployed hospital or modular operating rooms (ORs), or aerosolize during surgical procedures.

Active surveillance.

US military hospitals in the United States, Afghanistan, and Iraq.

Soil samples were collected from sites throughout Afghanistan and Iraq and analyzed for presence of MDR bacteria. Environmental sampling of selected newly established modular and deployed OR high-touch surfaces and equipment was performed to determine the presence of bacterial contamination. Gram-negative bacteria aerosolization during OR surgical procedures was determined by microbiological analysis of settle plate growth.

Subsurface soil sample isolates recovered in Afghanistan and Iraq included various pansusceptible members of Enterobacteriaceae, Vibrio species, Pseudomonas species, Acinetobacter Iwojfii, and coagulase-negative Staphylococcus (CNS). OR contamination studies in Afghanistan revealed 1 surface with a Micrococcus luteus. Newly established US-based modular ORs and the colocated fixed-facility ORs revealed no gram-negative bacterial contamination prior to the opening of the modular OR and 5 weeks later. Bacterial aerosolization during surgery in a deployed fixed hospital revealed a mean gram-negative bacteria colony count of 12.8 colony-forming units (CFU)/dm2/h (standard deviation [SD], 17.0) during surgeries and 6.5 CFU/dm2/h (SD, 7.5; P = .14) when the OR was not in use.

This study demonstrates no significant gram-negative bacilli colonization of modular and fixed-facility ORs or dirt and no significant aerosolization of these bacilli during surgical procedures. These results lend additional support to the role of nosocomial transmission of MDR pathogens or the colonization of the patient themselves prior to injury.

To evaluate the feasibility of implementation of the refined window for routine antimicrobial prophylaxis (RAP) of 30-74 minutes before skin incision compared to the World Health Organization (WHO) standard of 0-60 minutes.

Prospective study on timing of routine antimicrobial prophylaxis in 2 different time periods.

Tertiary referral university hospital with 30,000 surgical procedures per year.

In all consecutive vascular, visceral, and trauma procedures, the timing was prospectively recorded during a first time period of 2 years (A; baseline) and a second period of 1 year (B; after intervention). An intensive intervention program was initiated after baseline. The primary outcome parameter was timing; the secondary outcome parameter was surgical site infection (SSI) rate in the subgroup of patients undergoing cholecystectomy/colon resection.

During baseline time period A (3,836 procedures), RAP was administered 30–74 minutes before skin incision in 1,750 (41.0%) procedures; during time period B (1,537 procedures), it was administered in 914 (56.0%; P < .001). The subgroup analysis did not reveal a significant difference in SSI rate.

This bundle of interventions resulted in a statistically significant improvement of timing of RAP even at a shortened window compared to the WHO standard.

Effective implementation of infection control programs and adherence to standard precautions are challenging in resource-limited settings. The objective of this study was to describe infection control knowledge, attitudes, and practices among healthcare workers (HCWs) in Uganda.

We conducted a survey of hospital employees who had direct contact with patients or their immediate environment. We also performed an environmental assessment of resource availability and utilization within hospital wards.

Surgical, medicine, and obstetrics wards at a national referral hospital in Kampala, Uganda.

One hundred eighty-three randomly selected HCWs.

Almost all HCWs knew to wash their hands, although nursing and support staff were less likely to perceive that HCWs' hands can be a vector of disease transmission. Hand washing was valued more as a means of self-protection than as a means to prevent patient-to-patient transmission, consistent with the prevailing belief that infection control was important for occupational safety. Sinks were not readily accessible, and soap at sinks was uncommon throughout the medicine and obstetrics wards but more commonly available in the surgery wards. Alcohol gel was rarely available.

Changing infection control practices in developing countries will require a multifaceted approach that addresses resource availability, occupational safety, and local understanding and attitudes about infection control.

The main objectives of our study were to explore reasons for seasonal influenza vaccine acceptance and declination in employees of a large integrated healthcare system and to identify underlying constructs that influence acceptance versus declination. Secondary objectives were to determine whether vaccine acceptance varied by hospital location and to identify facility-level measures that explained variability.

A national health promotion survey of employees was conducted that included items on vaccination in the 2009-2010 influenza season. The survey was administered with two other institutional surveys in a stratified fashion: approximately 40% of participating employees were randomly assigned to complete the health promotion survey.

National single-payer healthcare system with 152 hospitals.

Employees of the healthcare system in 2010 who responded to the survey.

Factor analysis was used to identify underlying constructs that influenced vaccine acceptance versus declination. Mean factor scores were examined in relation to demographic characteristics and occupation. Multilevel logistic regression models were used to determine whether vaccine acceptance varied by location and to identify facility-level measures that explained variability.

Four factors were identified related to vaccine declination and were labeled as (1) “don't care,” (2) “don't want,” (3) “don't believe,” and (4) “don't know.” Significant differences in mean factor scores existed by demographic characteristics and occupation. Vaccine acceptance varied by location, and vaccination rates in the previous year were an important facility-level predictor.

Results should guide interventions that tailor messages on the basis of particular reasons for declination. Occupation-specific and culturally appropriate messaging should be considered. Continued efforts will be taken to better understand how workplace context influences vaccine acceptance.