| 1. |
- Ahyow, LC, et al.
(författare)
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Bed occupancy rates and hospital-acquired Clostridium difficile infection: a cohort study
- 2013
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Ingår i: Infection control and hospital epidemiology. - : Cambridge University Press (CUP). - 1559-6834 .- 0899-823X. ; 34:10, s. 1062-1069
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Tidskriftsartikel (refereegranskat)abstract
- An emergent strain (ribotype 027) of Clostridium difficile infection (CDI) has been implicated in epidemics worldwide. Organizational factors such as bed occupancy have been associated with an increased incidence of CDI; however, the data are sparse, and the association has not been widely demonstrated. We investigated the association of bed occupancy and CDI within a large hospital organization in the United Kingdom.Objective.To establish whether bed occupancy rates are a significant risk factor for CDI in the general ward setting.Methods.A retrospective cohort study was carried out on data from 2006 to 2008. Univariate and multivariate Cox regression modeling was used to examine the strength and significance of the associations. Variables included patient characteristics, antibiotic policy exposure, case mix, and bed occupancy rates.Results.A total of 1,589 cases of hospital-acquired CDI were diagnosed (1.7% of admissions), with an overall infection rate of 2.16 per 1,000 patient-days. Median bed occupancy was 93.3% (interquartile range, 83.3%–100%) Univariate and multivariate analyses showed positive and statistically significant associations. In the adjusted model, patients on wards with occupancy rates of 80%–89.9% had rates of CDI that were 56% higher (hazard ratio, 1.56 [95% confidence interval, 1.18–2.04]; P<.001) compared with baseline (0%–69.9% occupancy). CDI rates were 55% higher for patients on wards with maximal bed occupancy (100%).Conclusions.There is strong evidence of an association between high bed occupancy and CDI. Without effective interventions at high levels of bed occupancy, the economic benefits sought from reducing bed numbers may be negated by the increased risk of CDI.
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| 2. |
- Biancari, F, et al.
(författare)
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Preoperative risk stratification of deep sternal wound infection after coronary surgery
- 2020
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Ingår i: Infection control and hospital epidemiology. - : Cambridge University Press (CUP). - 1559-6834 .- 0899-823X. ; 41:4, s. 444-451
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To develop a risk score for deep sternal wound infection (DSWI) after isolated coronary artery bypass grafting (CABG).Design:Multicenter, prospective study.Setting:Tertiary-care referral hospitals.Participants:The study included 7,352 patients from the European multicenter coronary artery bypass grafting (E-CABG) registry.Intervention:Isolated CABG.Methods:An additive risk score (the E-CABG DSWI score) was estimated from the derivation data set (66.7% of patients), and its performance was assessed in the validation data set (33.3% of patients).Results:DSWI occurred in 181 (2.5%) patients and increased 1-year mortality (adjusted hazard ratio, 4.275; 95% confidence interval [CI], 2.804–6.517). Female gender (odds ratio [OR], 1.804; 95% CI, 1.161–2.802), body mass index ≥30 kg/m2(OR, 1.729; 95% CI, 1.166–2.562), glomerular filtration rate <45 mL/min/1.73 m2(OR, 2.410; 95% CI, 1.413–4.111), diabetes (OR, 1.741; 95% CI, 1.178–2.573), pulmonary disease (OR, 1.935; 95% CI, 1.178–3.180), atrial fibrillation (OR, 1.854; 95% CI, 1.096–3.138), critical preoperative state (OR, 2.196; 95% CI, 1.209–3.891), and bilateral internal mammary artery grafting (OR, 2.088; 95% CI, 1.422–3.066) were predictors of DSWI (derivation data set). An additive risk score was calculated by assigning 1 point to each of these independent risk factors for DSWI. In the validation data set, the rate of DSWI increased along with the E-CABG DSWI scores (score of 0, 1.0%; score of 1, 1.8%; score of 2, 2.2%; score of 3, 6.9%; score ≥4: 12.1%;P< .0001). Net reclassification improvement, integrated discrimination improvement, and decision curve analysis showed that the E-CABG DSWI score performed better than other risk scores.Conclusions:DSWI is associated with poor outcome after CABG, and its risk can be stratified using the E-CABG DSWI score.Trial registration:clinicaltrials.gov identifier: NCT02319083
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| 3. |
- Chan, Derwin, et al.
(författare)
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Why people failed to adhere to COVID-19 preventive behaviors? Perspectives from an integrated behavior change model
- 2021
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Ingår i: Infection control and hospital epidemiology. - New York : Cambridge University Press. - 0899-823X .- 1559-6834. ; 42:3, s. 375-376
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Tidskriftsartikel (refereegranskat)abstract
- Many preventive behaviors such as the practice of hand, personal, and respiratory hygiene; maintaining social distance (eg, staying home); and cleaning and disinfection are recommended for the prevention of the new coronavirus (COVID-19). However, a growing number of reports have revealed individuals’ violations to these COVID-19 preventive behaviors.1 These violations might endanger the community by increasing the risk of an outbreak of COVID-19. The uptake of and adherence to health behaviors, including behaviors related to the prevention of infectious diseases (eg, COVID-19), are likely highly dependent on individuals’ motivation, intention, and other decision-making factors.2 We aim to apply an integrated behavior change model of health psychology to explain why individuals fail to comply and adhere to these behaviors. © 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.
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| 4. |
- Edman-Wallér, Jon, et al.
(författare)
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Clostridioides difficile outbreak detection: Evaluation by ribotyping and whole-genome sequencing of a surveillance algorithm based on ward-specific cutoffs
- 2023
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Ingår i: Infection control and hospital epidemiology. - 0899-823X. ; 44:12, s. 1948-1952
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Tidskriftsartikel (refereegranskat)abstract
- Objective:We evaluated the performance of an early-warning algorithm, based on ward-specific incidence cutoffs for detecting Clostridioides difficile transmission in hospitals. We also sought to determine the frequency of intrahospital Clostridioides difficile transmission in our setting. Design:Diagnostic performance of the algorithm was tested with confirmed transmission events as the comparison criterion. Transmission events were identified by a combination of high-molecular-weight typing, ward history, ribotyping, and whole-genome sequencing (WGS). Setting:The study was conducted in 2 major and 2 minor secondary-care hospitals with adjacent catchment areas in western Sweden, comprising a total population of & SIM;480,000 and & SIM;1,000 hospital beds. Patients:All patients with a positive PCR test for Clostridioides difficile toxin B during 2020 and 2021. Methods:We conducted culturing and high-molecular-weight typing of all positive clinical samples. Ward history was determined for each patient to find possible epidemiological links between patients with the same type. Transmission events were determined by PCR ribotyping followed by WGS. Results:We identified 4 clusters comprising a total of 10 patients (1.5%) among 673 positive samples that were able to be cultured and then typed by high-molecular-weight typing. The early-warning algorithm performed no better than chance; patient diagnoses were made at wards other than those where the transmission events likely occurred. Conclusions:In surveillance of potential transmission, it is insufficient to consider only the ward where diagnosis is made, especially in settings with high strain diversity. Transmission within wards occurs sporadically in our setting.
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| 5. |
- Fraenkel, Carl Johan, et al.
(författare)
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Incidence of Hospital Norovirus Outbreaks and Infections Using 2 Surveillance Methods in Sweden
- 2017
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Ingår i: Infection Control & Hospital Epidemiology. - : Cambridge University Press (CUP). - 0899-823X .- 1559-6834. ; 38:1, s. 96-102
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE To evaluate 2 different methods of surveillance and to estimate the incidence of norovirus (NoV) outbreaks in hospitals. DESIGN Prospective observational study. SETTING All 194 hospital wards in southern Sweden during 2 winter seasons (2010-2012). METHODS Clinical surveillance based on outbreak reports of 2 or more clinical cases, with symptom onset within 5 days, was compared with laboratory surveillance based on positive NoV results among inpatients. At least 2 NoV positive patients sampled within 5 days at a ward defined a cluster. Outbreak reports including at least 1 NoV positive case and clusters including at least 1 NoV positive patient with 5 or more days from ward admission to sampling were defined as NoV outbreaks. RESULTS During the study periods 135 NoV outbreaks were identified; 74 were identified by both clinical and laboratory surveillance, 18 were identified only by outbreak reports, and 43 were identified only by laboratory surveillance. The outbreak incidence was 1.0 (95% CI, 0.8-1.2) and 0.5 (95% CI, 0.3-0.6) per 1,000 admissions for the 2 different seasons, respectively. To correctly identify NoV outbreaks, the sensitivity and positive predictive value of the clinical surveillance were 68% and 88% and of the laboratory surveillance were 86% and 81%, respectively. CONCLUSION The addition of laboratory surveillance significantly improves outbreak surveillance and provides a more complete estimate of NoV outbreaks in hospitals. Laboratory surveillance can be recommended for evaluation of clinical surveillance.
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| 6. |
- Hamid, SS, et al.
(författare)
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Risk of transmission and features of hepatitis C after needlestick injuries
- 1999
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Ingår i: Infection control and hospital epidemiology. - : Cambridge University Press (CUP). - 0899-823X .- 1559-6834. ; 20:1, s. 63-64
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Tidskriftsartikel (refereegranskat)abstract
- The rate of transmission and management of needlestick injuries from hepatitis C virus (HCV) patients to healthcare workers is still a matter of debate. We used a stringent protocol using monthly transaminase levels and polymerase chain reaction for HCV RNA to monitor 53 healthcare workers prospectively for up to 6 months following needle injuries from HCV-positive patients. Evidence of transmission of HCV was found in only 2 workers (4%) with mild asymptomatic infection, one of which resolved spontaneously. Based on our experience, we now use a less-intensive follow-up protocol. Further investigation is required to determine the most cost-effective method to monitor individuals who suffer a needlestick injury from an HCV-positive patient.
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| 7. |
- Holmdahl, Torsten, et al.
(författare)
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A Head-to-Head Comparison of Hydrogen Peroxide Vapor and Aerosol Room Decontamination Systems.
- 2011
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Ingår i: Infection Control & Hospital Epidemiology. - : Cambridge University Press (CUP). - 0899-823X .- 1559-6834. ; 32:9, s. 831-836
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Tidskriftsartikel (refereegranskat)abstract
- Objective. New technologies have emerged in recent years for the disinfection of hospital rooms and equipment that may not be disinfected adequately using conventional methods. There are several hydrogen peroxide-based area decontamination technologies on the market, but no head-to-head studies have been performed. Design. We conducted a head-to-head in vitro comparison of a hydrogen peroxide vapor (HPV) system (Bioquell) and an aerosolized hydrogen peroxide (aHP) system (Sterinis). Setting. The tests were conducted in a purpose-built 136-m(3) test room. Methods. One HPV generator and 2 aHP machines were used, following recommendations of the manufacturers. Three repeated tests were performed for each system. The microbiological efficacy of the 2 systems was tested using 6-log Tyvek-pouched Geobacillus stearothermophilus biological indicators (BIs). The indicators were placed at 20 locations in the first test and 14 locations in the subsequent 2 tests for each system. Results. All BIs were inactivated for the 3 HPV tests, compared with only 10% in the first aHP test and 79% in the other 2 aHP tests. The peak hydrogen peroxide concentration was 338 ppm for HPV and 160 ppm for aHP. The total cycle time (including aeration) was 3 and 3.5 hours for the 3 HPV tests and the 3 aHP tests, respectively. Monitoring around the perimeter of the enclosure with a handheld sensor during tests of both systems did not identify leakage. Conclusion. One HPV generator was more effective than 2 aHP machines for the inactivation of G. stearothermophilus BIs, and cycle times were faster for the HPV system.
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| 8. |
- Holmdahl, Torsten, et al.
(författare)
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Hydrogen Peroxide Vapor Decontamination in a Patient Room Using Feline Calicivirus and Murine Norovirus as Surrogate Markers for Human Norovirus.
- 2016
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Ingår i: Infection Control & Hospital Epidemiology. - : Cambridge University Press (CUP). - 0899-823X .- 1559-6834. ; 37:5, s. 561-566
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE To determine whether hydrogen peroxide vapor (HPV) could be used to decontaminate caliciviruses from surfaces in a patient room. DESIGN Feline calicivirus (FCV) and murine norovirus (MNV) were used as surrogate viability markers to mimic the noncultivable human norovirus. Cell culture supernatants of FCV and MNV were dried in triplicate 35-mm wells of 6-well plastic plates. These plates were placed in various positions in a nonoccupied patient room that was subsequently exposed to HPV. Control plates were positioned in a similar room but were never exposed to HPV. METHODS Virucidal activity was measured in cell culture by reduction in 50% tissue culture infective dose titer for FCV and by both 50% tissue culture infective dose titer and plaque reduction for MNV. RESULTS Neither viable FCV nor viable MNV could be detected in the test room after HPV treatment. At least 3.65 log reduction for FCV and at least 3.67 log reduction for MNV were found by 50% tissue culture infective dose. With plaque assay, measurable reduction for MNV was at least 2.85 log units. CONCLUSIONS The successful inactivation of both surrogate viruses indicates that HPV could be a useful tool for surface decontamination of a patient room contaminated by norovirus. Hence nosocomial spread to subsequent patients can be avoided. Infect. Control Hosp. Epidemiol. 2016;1-6.
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| 9. |
- Johnston, B. C., et al.
(författare)
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Microbial Preparations (Probiotics) for the Prevention of Clostridium difficile Infection in Adults and Children: An Individual Patient Data Meta-analysis of 6,851 Participants
- 2018
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Ingår i: Infection Control and Hospital Epidemiology. - : Cambridge University Press (CUP). - 0899-823X .- 1559-6834. ; 39:7, s. 771-781
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE. To determine whether probiotic prophylaxes reduce the odds of Clostridium difficile infection (CDI) in adults and children. DESIGN. Individual participant data (IPD) meta-analysis of randomized controlled trials (RCTs), adjusting for risk factors. METHODS. We searched 6 databases and 11 grey literature sources from inception to April 2016. We identified 32 RCTs (n=8,713); among them, 18 RCTs provided IPD (n=6,851 participants) comparing probiotic prophylaxis to placebo or no treatment (standard care). One reviewer prepared the IPD, and 2 reviewers extracted data, rated study quality, and graded evidence quality. RESULTS. Probiotics reduced CDI odds in the unadjusted model (n=6,645; odds ratio [OR] 0.37; 95% confidence interval [CI], 0.25-0.55) and the adjusted model (n=5,074; OR, 0.35; 95% CI, 0.23-0.55). Using 2 or more antibiotics increased the odds of CDI (OR, 2.20; 95% CI, 1.11-4.37), whereas age, sex, hospitalization status, and high-risk antibiotic exposure did not. Adjusted subgroup analyses suggested that, compared to no probiotics, multispecies probiotics were more beneficial than single-species probiotics, as was using probiotics in clinical settings where the CDI risk is 5%. Of 18 studies, 14 reported adverse events. In 11 of these 14 studies, the adverse events were retained in the adjusted model. Odds for serious adverse events were similar for both groups in the unadjusted analyses (n=4,990; OR, 1.06; 95% CI, 0.89-1.26) and adjusted analyses (n=4,718; OR, 1.06; 95% CI, 0.89-1.28). Missing outcome data for CDI ranged from 0% to 25.8%. Our analyses were robust to a sensitivity analysis for missingness. CONCLUSIONS. Moderate quality (ie, certainty) evidence suggests that probiotic prophylaxis may be a useful and safe CDI prevention strategy, particularly among participants taking 2 or more antibiotics and in hospital settings where the risk of CDI is >= 5%.
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| 10. |
- Lindgren, Viktor, et al.
(författare)
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Deep infection after total hip replacement: a method for national incidence surveillance.
- 2014
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Ingår i: Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. - : Cambridge University Press (CUP). - 1559-6834 .- 0899-823X. ; 35:12, s. 1491-6
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The purpose of this study was to estimate the incidence of deep periprosthetic joint infections (PJIs) after primary total hip replacement (THR) in Sweden prior to the introduction of a national initiative to reduce these infections. Design. Prospective open cohort study with 2 years follow-up of each subject. Setting. All THR-performing clinics in Sweden. Methods. All patients registered for a primary THR in the Swedish Hip Arthroplasty Register between July 1, 2005, and December 31, 2008, were selected for the study (45,531 patients with 49,219 THRs) and were matched with the Swedish Prescribed Drug Register. All patients with a minimum of 4 weeks of continuous outpatient antibiotic treatment within 2 years after their primary THR (1,989 patients with 2,219 THRs) were selected for a medical records review, and the number of cases with PJI was determined. Results. The cumulative incidence of PJI within 2 years after primary THR was 0.9% (95% confidence interval, 0.85-1.02; n = 443), and 405 of these had been reoperated. The incidence rate of PJI for the first 3 months was 5 per 10,000 THR-weeks and, thereafter, 0.3 per 10,000 THR-weeks. Staphylococcus aureus and coagulase-negative staphylococci were the most common bacteria isolated. Conclusions. This study describes a new method of national postoperative infection surveillance. The incidence is similar to previous smaller reports and is useful for monitoring changes over time to evaluate the national initiative to reduce infections.
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