Since detection of asymptomatic bacteriuria among inpatients often leads to inappropriate antimicrobial treatment, we studied why urine cultures were ordered and correlates of treatment. Most cultures were obtained from patients without urinary complaints and a minority from asymptomatic patients. High-count bacteriuria, not clinical manifestations, appeared to trigger most antimicrobial use.

This report details an outbreak investigation conducted by the Los Angeles County Department of Public Health of 3 cases of bacterial infection among patients receiving hemodialysis who were treated at the same dialysis center in 2011. Improper disinfection of reusable dialyzers was hypothesized as the source of transmission.

Effective severity criteria are needed to guide management of Clostridium difficile infection (CDI). In this retrospective study, outcomes were compared between patients with mild-moderate versus severe CDI according to 3 different severity criteria: those included in the 2010 Society for Healthcare Epidemiology of America/Infectious Diseases Society of America guidelines, those from a recent clinical trial, and our hospital-specific guidelines.

Adult hospitalized patients with cystic fibrosis commonly receive nebulized medications. For single-patient-use nebulizers that are cleaned after each use, there is infrequent nebulizer contamination (0%–11%) with only low numbers of epidemiologically important pathogens (less than 100 colony-forming units), and this contamination is similar after 24, 48, and 72 hours of use.

Infect Control Hosp Epidemiol 2014;35(12):1553–1546

We aimed to determine the association between environmental exposure to carbapenem-resistant Acinetobacter baumannii and the subsequent risk of acquiring this organism. Patients exposed to a contaminated hospital environment had 2.77 times the risk of acquiring carbapenem-resistant A. baumannii than did unexposed patients (relative risk, 2.77 [95% confidence interval, 1.50–5.13]; P = .002).

Contact precautions policies in US emergency departments have not been studied. We surveyed a structured random sample and found wide variation; for example, 45% required contact precautions for stool incontinence or diarrhea, 84% for suspected Clostridium difficile, and 79% for suspected methicillin-resistant Staphylococcus aureus infection. Emergency medicine departments and organizations should enact policies.

We pilot tested a novel human factors–informed concept to identify infectious risk moments (IRMs) that occur with high frequency during routine intensive care. Following 30 observation-hours, 28 potential IRMs related to hand hygiene, gloves, and objects were expert rated. A comprehensive IRM inventory may provide valuable taxonomy for research, training, and intervention.

Infect Control Hosp Epidemiol 2014;35(8):1051–1055

The impact of community-associated Clostridium difficile infection (CA-CDI) on patients with spinal cord injuries and disorders (SCI/Ds) is not fully understood. We examined CA-CDI cases among veterans with SCI/D, comparing them with community-onset, healthcare facility-associated (CO-HCFA) cases. Generally, patients with CA-CDI had less comorbidity, less severe CDI, and lower likelihood of antibiotic exposure.

This study was designed to test the efficacy of a washer-disinfector in eliminating selected healthcare-associated pathogens from surgical instruments. Our results showed that a washer-disinfector was extremely effective in eliminating microorganisms (>7-log10 reduction), including vegetative and spore-forming bacteria, from experimentally contaminated instruments. The washer-disinfector remained effective in eliminating microorganisms in the absence of enzymatic cleaners and detergents.

Infect Control Hosp Epidemiol 2014;35(7):883–885