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Publisher: Elsevier   (Total: 3182 journals)

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Showing 1 - 200 of 3182 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 103, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 42, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 440, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 29, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 318, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 187, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 34, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 12)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 52, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 66, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 7, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 15, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 8, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 25)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 68)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 2, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 425, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 38, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 54, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 386, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 481, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 44, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 53, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 65, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 47, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 12)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 37, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 36, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 263, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 210, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 227, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 7, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Similar Journals
Journal Cover
American Journal of Infection Control
Journal Prestige (SJR): 1.062
Citation Impact (citeScore): 2
Number of Followers: 29  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0196-6553
Published by Elsevier Homepage  [3182 journals]
  • Investigation into the cleaning methods of smartphones and wearables from
           infectious contamination in a patient care environment (I-SWIPE)
    • Abstract: Publication date: Available online 7 November 2019Source: American Journal of Infection ControlAuthor(s): Stephanie Huffman, Carly Webb, Sean P. SpinaBackgroundMany health care workers are using smartphones and wearable devices without an enforced cleaning standard to prevent the spread of bacteria to patients. To our, no real-world trials have been performed to date, examining bacterial elimination on these devices in a hospital setting. The primary objective was to determine if ultraviolet wavelength C (UV-C) was more effective at eliminating bacteria on smartphones and wearable devices when compared with usual care.MethodsThis prospective before-and-after study included clinicians who used smartphones or wearable devices during their daily clinical practice. Devices underwent two 30-second UV-C disinfection cycles, at the beginning and end of clinician shifts. Swabs were collected at predetermined intervals both prior to and following a UV-C disinfection cycle to determine the extent of bacterial growth.ResultsFollowing a run-in period of twice-daily UV-C disinfection, 20% of devices grew pathogenic bacteria prior to UV-C use. Comparatively, only 4% of devices grew bacteria post-UV-C; therefore, the decrease in bacterial growth was statistically significant (P = .002).ConclusionsUV-C appears to be more effective at eliminating bacteria on smartphones and wearable devices when compared with usual care and is a useful disinfection device in a hospital setting. Further studies are needed to determine the interval at which UV-C should be used to prevent bacterial growth and spread.
       
  • Impact of patient and visitor hand hygiene interventions at a pediatric
           hospital: A stepped wedge cluster randomized controlled trial
    • Abstract: Publication date: Available online 7 November 2019Source: American Journal of Infection ControlAuthor(s): Matthew W.H. Wong, Yan Zhu Xu, Jeffrey Bone, Jocelyn A. SrigleyBackgroundPatient and visitor hand hygiene has the potential to prevent health care–associated infections, but there are few data on the efficacy of interventions to improve patient/visitor hand hygiene.ObjectiveTo determine whether conventional and front-line ownership (FLO) patient/visitor hand hygiene interventions improve patient/visitor and health care worker (HCW) hand hygiene rates.MethodsA stepped wedge cluster randomized controlled trial was conducted on inpatient units and the emergency department. A conventional intervention included pediatric-focused posters, which also served as reminders for HCWs. This was compared to a FLO intervention aimed at finding “positive deviants,” staff who were already taking steps to improve patient/visitor hand hygiene. Patient/visitor and HCW hand hygiene rates were measured covertly by trained medical students.ResultsPatient/visitor hand hygiene rates increased from 9.2% at baseline to 13.9% in the post-intervention period. Hand hygiene rates on units randomized to the standard intervention changed from 7.3% to 10.9% (P = .46), but FLO intervention units significantly changed from 14.3% to 25% (P = .03). The baseline HCW hand hygiene rate was 68.2%, which increased to a greater extent in the FLO group (79.1%) than in the standard intervention (73.1%), but the change was not statistically significant for either intervention compared to control (P = .18 and P = .64, respectively).ConclusionsHand hygiene interventions in hospitals can improve patient/visitor and HCW hand hygiene rates, and a FLO intervention appears to be more effective than a conventional intervention.
       
  • Management of Candida auris in an inpatient acute rehabilitation
           setting
    • Abstract: Publication date: Available online 7 November 2019Source: American Journal of Infection ControlAuthor(s): Emily Walits, Gopi Patel, Selina Lavache, Rose-Marie Faotto, Adam Pobliner, Sheron Wilson, Sarah SchaeferCandida auris is an emerging, multidrug-resistant yeast that is considered a threat to patients and health care facilities worldwide. As the incidence of C auris increases, the management of patients with C auris will expand beyond acute care hospitals and long-term care facilities. We discuss the infection prevention measures implemented to prevent the transmission of Candida auris on an inpatient acute rehabilitation unit while ensuring that appropriate patient care was provided.
       
  • Comparison of infection control practices in a Dutch and US hospital using
           the infection risk scan (IRIS) method
    • Abstract: Publication date: Available online 6 November 2019Source: American Journal of Infection ControlAuthor(s): Ina Willemsen, Julie Jefferson, Leonard Mermel, Jan KluytmansBackgroundThe infection risk scan (IRIS) is a tool to measure the quality of infection control (IC) and antimicrobial use in a standardized way. We describe the feasilibility of the IRIS in a Dutch hospital (the Netherlands, NL) and a hospital in the United States (US).MethodsCross-sectional measurements were performed. Variables included a hand hygiene indicator, environmental contamination, IC preconditions, personal hygiene of health care workers, use of indwelling medical devices, and use of antimicrobials.ResultsIRIS was performed in 2 wards in a US hospital and 4 wards in a Dutch hospital. Unjustified use of medical devices: none in the US hospital, 2.2% in the Dutch hospital; inappropriate use of antibiotics: 11.7% (US), 19% (NL); items considered not clean: 10% (US); 36% (NL); shortcomings preconditions: 6 of 20 (US), 6 of 40 (NL); health care workers with rings, watches, or long sleeves: 34 of 43 (US), none in the NL hospital; and hand hygiene actions per patient/day: 41 (US) and 10 (NL). US data judged against the Dutch guidelines and vice versa revealed remarkable differences.ConclusionsWe showed the feasibility of using the IRIS in a US hospital. The method provided insight in IC local performance. This method could be the first step to standardize the measurement of the quality of IC and antimicrobial use. However, if the IRIS is used for benchmarking between hospitals in different regions, this should be done in the context of regional guidelines and policies.
       
  • The challenges of antimicrobial resistance surveillance in China
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Jiancong Wang
       
  • Beyond the abacus: Leveraging the electronic medical record for central
           line day surveillance
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Patrick C. Burke, Lori Eichmuller, Michele Messam, Deborah A. Duffy, Raymond G. Borkowski, Steven M. Gordon, Thomas G. FraserManual counting is considered the gold standard for device day recording by the National Health Safety Network. We describe the development of a process for an electronic count of central line days across our ten-hospital health care system. Our validation process identified discordance between the electronic count and the manual count for 71% of patient care units. Adjudication of the count differences by chart review identified the electronic count to be correct 97% of the time.
       
  • Merging health care systems: An example of utilizing quality principles in
           infection prevention standardization
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Brenda Ehlert, Anthony ZeimetWhen Ascension Wisconsin was formed, it merged 4 long-established health systems: Ministry Health Care, Affinity Health System, Wheaton Franciscan Healthcare, and Columbia St Mary's. One of the challenges encountered during the first year was redundancy in many policies and processes. Setting a structure, establishing goals, and evaluating progress led to success for Ascension Wisconsin's Infection Prevention Council.
       
  • The efficacy of a simulated tunnel washer process on removal and
           destruction of Clostridioides difficile spores from health care textiles
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Kevin McLaren, Edward McCauley, Brendan O'Neill, Steven Tinker, Nancy Jenkins, Lynne SehulsterBackgroundResearch on reducing Clostridioides difficile spore contamination of textiles via laundering is needed. We evaluated the sporicidal properties of 5 laundry chemicals and then determined the ability of a peracetic acid (PAA) laundry cycle to inactivate and/or remove spores from cotton swatches during a simulated tunnel washer (TW) process.MethodsIn phase I, spore-inoculated swatches were immersed in alkaline detergent, sodium hypochlorite, hydrogen peroxide, or PAA for 8 minutes. In phase II, inoculated swatches were passed through a simulated 24-minute TW process employing 5 wash liquids. Spore survivors on swatches and in test chemical fluids in both studies were enumerated using standard microbiologic assay methods.ResultsIn phase I, hypochlorite solutions achieved>5 log10 spore reductions on swatches and>3 log10 reductions for wash solutions. PAA achieved minimal spore reduction in the wash solution (0.26 log10). In phase II, the PAA equilibrium-containing process achieved a>5 log10 spore reduction on swatches. In wash solution tests, the cumulative spore reduction peaked at>3.08 log10 in the final module.ConclusionsSodium hypochlorite as a laundry additive is sporicidal. The cumulative effects of a TW process, coupled with a PAA bleach agent at neutral pH, may render textiles essentially free of C difficile spore contamination.
       
  • Bundles for the central sterile supply department
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Heloisa H.K. Hoefel, Carmen Pozzer, Andrea Acunã, Marcia Arsego, Ronaldo Bernardo, Maria Edutânia Castro, Alexia Carla Wachholz Dossa, Jeane Aparecida Gonzatti, Celia Rabaioli, Margareth Pfitsher, Terezinha Neide Oliveira, Daniela Silva dos Santos SchneiderBackgroundTraditional resources, such as bundles, can help experts define essential steps of health product processing to prevent infections. The present study developed bundle content construction and validation criteria for central sterile supply departments (CSSDs).MethodsThe present study employed a Delphi technique modified for content evaluation. Eleven professionals with at least 4 years of experience in sterilization were enlisted. Participants discussed main stages of the process virtually and compiled a list of items based on scientific references justified by law and/or logical reasoning. Agreement, disagreement, and/or suggestions on each step resulted in bundles for a CSSD. Items were then reassessed by experts using a Likert scale with a 90% approval criterion.ResultsSix bundles were developed: cleaning, inspection, preparation and packaging, sterilization, and storage resulting from 384 responses and 373 agreements (Interassessor coefficient = 97%).DiscussionsItems obtained from the criteria assessment received majority agreement from the first document.ConclusionsAgreement among varying professionals was achieved, and bundles were successfully developed to evaluate the processing of goods in CSSDs.
       
  • Factors influencing the adherence of nurses to standard precautions in
           South Korea hospital settings
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Eunja Oh, Jeong Sil ChoiBackgroundStandard precautions (SPs) serve as the first line of defense against exposure to blood and body fluids. The objective of this study was to explore the adherence of nurses to SPs and to identify factors influencing adherence to SPs.MethodsThis study was an exploratory cross-sectional survey. A total of 339 nurses from 9 general hospitals and 3 tertiary hospitals located in 3 South Korean cities were selected. Hierarchical regression was used to examine the effects of sociodemographic, individual, and institutional factors.ResultsA higher, or positive, attitude was the strongest influencing factor in adherence to SPs in the final model, followed by administrative support, hospital types, and safety climate, in descending order. These 4 variables accounted for 26.0% of the variance in adherence to SPs.ConclusionsThe attitudes of nurses toward SPs is important for increasing the adherence to SP best practices. The adherence of nurses to SPs will improve if safe environments are created in different hospital types and if managerial support and administrative efforts are supportive and sustained.
       
  • The impact of tooth brushing versus tooth brushing and chlorhexidine
           application to avoid postoperative pneumonia in children
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Priscila González-Rubio Aguilar, Verónica Ávalos Arenas, Nancy Anahí Vega Gudiño, Samantha Daniela Moreno Herrera, Mónica Villa Guillén, Diana Moyao-García, Rodolfo Fragoso Ríos, Vicente Cuairán Ruidíaz, Arturo Castro Díaz, Daniela De la Rosa ZamboniBackgroundThe pathogenesis of postsurgical pneumonia is a complicated and multifactorial process, in which elements like oral bacteria, orotracheal intubation, and dental hygiene play an important role. The objective of this study was to evaluate the efficacy of 2 types of oral hygiene interventions in decreasing cases of postsurgical pneumonia.MethodsIn pediatric patients scheduled for surgery, a quasi-experimental study was carried out over a 2-year period to evaluate the efficacy of 2 types of oral hygiene interventions. There were 2 groups of intervention with 1 group for comparison. Intervention groups were tooth brushing by a dentist (intervention group 1) and dental brushing by parents + chlorhexidine gluconate (intervention group 2). Data from the year with no oral hygiene interventions were used as the baseline group.ResultsA total of 2,535 surgical procedures were followed. Baseline group incidence of postoperative pneumonia was 10 per 1,000 surgeries, 0.2 per 1,000 surgeries in the intervention group 1 (P = .04), and 0.8 per 1,000 surgeries in the intervention group 2. Intervention group 1 was protective against postoperative pneumonia (odds ratio, 0.06; P = .02; 95% confidence interval, 0.033-0.079), but there was no benefit with intervention group 2 (odds ratio, 0.87; P = .599; 95% confidence interval, 0.52-1.46).ConclusionsDental brushing performed before surgery by a pediatric dentist was effective in reducing the incidence of postoperative pneumonia in pediatric patients.
       
  • Prevalence and clinical impact of methicillin-resistant Staphylococcus
           aureus colonization among infants at a level III neonatal intensive care
           unit
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Karen Lavie-Nevo, Jocelyn A. Srigley, Ghada N. Al-Rawahi, Jeffrey Bone, Horacio Osiovich, Ashley Roberts, Joseph Y. TingBackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is a well-known nosocomial pathogen in neonatal intensive care unit (NICU) patients. Studies on the impact of MRSA colonization on neonatal morbidities are scarce.MethodsWe conducted a 1:3 matched cohort study among infants with and without MRSA colonization, born between January 2010 and June 2014, in a tertiary NICU to review their demographic characteristics and outcomes.ResultsDuring the study period, rates of MRSA colonization and bacteremia were found to be 0.68% and 0.10%, respectively. No differences in demographic characteristics, mortality, and major morbidities were identified among infants with and without MRSA colonization.ConclusionsWe reported a low rate of MRSA colonization in infants admitted to our NICU, without impact on mortality and inhospital morbidity. Further large-scale studies are needed to understand the implications and cost-effectiveness of active MRSA surveillance.
       
  • Eliminating MRSA transmission in a tertiary neonatal unit–A quality
           improvement initiative
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Srabani Bharadwaj, Selina Ky Ho, Kum Chue Khong, Audrey Seet, Kee Cheng Yeo, Xin Ying Chan, Lok Lin Wong, Rubiyah Binte Karlin, Daisy KL Chan, Moi Lin LingBackgroundHealth care facility-onset methicillin-resistant Staphylococcus aureus (HO-MRSA) colonization or infection is a major cause of health care–associated infection (HAI) worldwide. HAIs are preventable and considered a health care quality outcome indicator. A quality improvement project to eliminate HO-MRSA transmission was conducted in a tertiary care neonatal unit over a 9-month period, and sustainability data were monitored. The primary aim of this project was to achieve zero transmission of MRSA among all neonatal unit admissions, and secondary aims were to improve hand hygiene (HH) and environmental hygiene compliance to 100%.MethodsExisting inpatient admission processes, staff HH, and environmental hygiene practices were critically analyzed. Sequential interventions were implemented, including reinforcing staff awareness on infection control practices through regular education and updates, providing “just in time” feedback, ensuring easy availability of cleaning equipment, individualizing items for all patients, keeping personal belongings away from clinical areas, and revising admission work flow for ex-utero transferred babies from other hospitals.ResultsThe neonatal unit achieved zero MRSA transmission to previously noninfected and noncolonized patients over the 9-month period, and HH and environmental hygiene compliance improved from a preintervention median of 87.1% and 82.2%, respectively, to 100%, which has been sustained to date.ConclusionsIntensive reinforcement of infection control practices, strict cohorting of ex-utero transfers, universal surveillance on admission, and improvement in HH and environmental hygiene compliance were key to infection prevention and control measures, resulting in elimination of MRSA transmission in our neonatal unit.
       
  • Prevalence of mupirocin and chlorhexidine resistance among
           methicillin-resistant coagulase-negative staphylococci isolated during
           methicillin-resistant Staphylococcus aureus decolonization strategies
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Emad M. Eed, Mabrouk M. Ghonaim, Amany S. Khalifa, Khalid J. Alzahrani, Khalaf F. Alsharif, Aza A. TahaBackgroundThe widespread of methicillin-resistant Staphylococcus aureus (MRSA) antimicrobial decolonization in the clinical setting may lead to an increase in the prevalence of multiresistance to coagulase-negative staphylococci (CoNS) owing to their selection. This study aimed to investigate the impact of MRSA decolonization strategies, using mupirocin and chlorhexidine, on their CoNS susceptibility.MethodsA total of 312 CoNS isolates were collected before starting the decolonization protocols “baseline strains” (BLS) group, 330 isolates were collected after application of the targeted decolonization protocol “targeted decolonization strains” group, and 355 isolates were collected after application of the universal decolonization protocol “universal decolonization strains” group. Methicillin-resistant CoNS (MR-CoNS) were identified and tested for mupirocin and chlorhexidine susceptibilities. Heptaplex polymerase chain reaction assay was applied for simultaneous screening for chlorhexidine (CHX-R) and mupirocin resistance (Mu-R) genes.ResultsMu-R prevalence of MR-CoNS among the BLS group was considered moderate (9.1%); however, CHX-R in the BLS group was 5.8%, the rate of which significantly increased among the universal decolonization strains group.DiscussionBoth MRSA decolonization strategies have an additional benefit in reducing the prevalence of MR-CoNS. The prevalence Mu-R rate didn't change significantly during either of the MRSA decolonization practices that may be due to the local nature of mupirocin application on the nasal mucosa only. In contrast CHX-R that was found to be significantly higher among the UDS group.ConclusionsOur findings indicate that both MRSA decolonization strategies have an additional benefit in reducing the prevalence of MR-CoNS. Although the universal MRSA decolonization has superior efficacy in decolonization of CoNS, it may increase the risk of selecting CHX-R and Mu-R. In addition, other potential resistance genes should be studied.
       
  • Standing orders program of pneumococcal vaccination for hospitalized
           elderly patients in Hong Kong: A cost-effectiveness analysis
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Nianli Xing, Wing-yin Cheung, Minghuan Jiang, Joyce H.S. YouBackgroundClinical studies support a standing orders program (SOP) to improve vaccine uptake. We aimed to examine the potential cost-effectiveness of a pneumococcal vaccination SOP for Hong Kong elderly in a hospital setting.MethodsA decision-analytic model was designed to compare the outcomes of inpatients 65 years of age or older who were eligible for pneumococcal vaccination. Two vaccination approaches were evaluated: (1) vaccination SOP, and (2) no program (control group). Outcome measures included direct medical costs, invasive pneumococcal disease–associated mortality rates, quality-adjusted life year (QALY) losses, and incremental cost per QALY saved (ICER).ResultsIn the base-case analysis, mortality and QALY losses were lower and costs were higher in the SOP group when compared to the control group. The base-case ICER of the SOP group was $59,762 (all dollar amounts are in US$) per QALY saved. One-way sensitivity analyses found ICER to be sensitive to the probability of invasive pneumococcal disease among the unvaccinated elderly. Using 1× the gross domestic product per capita of Hong Kong ($43,497) and the United States ($150,000) as willingness-to-pay thresholds, SOPs were the preferred option in 37.2% and 97.5% of 10,000 Monte Carlo simulations, respectively.ConclusionsThe pneumococcal vaccination SOP for hospitalized elderly patients appeared to reduce QALY losses at a higher cost. The cost-effective acceptance of SOPs is highly dependent on the willingness-to-pay threshold.
       
  • Readability of influenza information online: Implications for consumer
           health
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Corey H. Basch, Joseph Fera, Phillip GarciaBackgroundInfluenza (flu) is pervasive and burdensome. The purpose of this study was to determine the readability levels of online articles related to flu.MethodsUsing the search term “influenza,” the URL's of the first 100 English language Web sites were vetted for content to ascertain that the article met inclusion criteria. Five recommended readability tests were conducted using an online service to calculate readability. Overall, the analysis indicates that flu material found on the web is not being written at a level that is widely readable.ResultsNone of the 100 sites included in the analysis received an acceptable score on all 5 assessments. One-sample independent t tests (α = 0.05, df = 99) indicated that it is highly unlikely that flu Web sites are being written at the desirable level. Of the 100 sampled sites, 33 had a .com, 29 had a .org, and 22 had a .gov extension. Extension type did not play a role in readability level of these sites.ConclusionsWhen creating content for the masses, health professionals should maximize their efforts by testing the readability as well as other factors that influence the likelihood that it will be understood.
       
  • Risk factors for endemic Acinetobacter Baumannii colonization: A
           case–case study
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Amanda Thorne, Ting Luo, Navin Kumar Durairajan, Keith S. Kaye, Betsy FoxmanBackgroundAcinetobacter baumannii causes increasingly resistant nosocomial infections worldwide. Although some patients are already colonized with A baumannii on hospital admission, others become colonized with endemic strains that are more likely to be antibiotic-resistant. Colonization increases risk of infection and transmission to others. This study aimed to identify risk factors for colonization with endemic compared to sporadic A baumannii among hospitalized patients.MethodsThe study population were patients colonized with A baumannii at a single medical center during a 17-month period of active surveillance. Endemic A baumannii (cases) had a repetitive extragenic palindromic (REP) type that occurred 10 or more times during the surveillance period. Cases carrying 1 of the 5 endemic REP types were matched to comparison cases (controls) carrying sporadic strains by facility and time.ResultsThere were 69 cases with REP-1, and 64 with REP-2-5. After adjustment, each unit increase in Schmid score was associated with a 70% increase in REP-1 carriage (P = .04) and a 50% increase in REP-2-5 (P = .07). Days in the intensive care unit prior to colonization, longer length of stay, immunosuppression, and the Charlson comorbidity index were not significantly associated with carriage of endemic strains.ConclusionsFollowing best practices for antibiotic stewardship and hygiene will help minimize the emergence and persistence of A baumannii strains adapted to the health care environment.
       
  • Perceptions of Patients, Health Care Workers, and Environmental Services
           Staff Regarding Ultraviolet Light Room Decontamination Devices
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Aaron N. Dunn, Pavel Vaisberg, Thomas G. Fraser, Curtis J. Donskey, Abhishek DeshpandeBackgroundMobile ultraviolet C (UV-C) room decontamination devices are widely used in health care facilities; however, there is limited information on the perceptions of patients, health care workers (HCWs), and environmental services staff (EVS-staff) regarding their use for environmental decontamination.MethodsAn anonymous questionnaire was administered to participants in 4 medical/surgical units of a tertiary care hospital where UV-C devices were deployed for a 6-month period. Survey questions assessed perceptions regarding the importance of environmental disinfection, effectiveness of UV-C decontamination, willingness to delay hospital admission in order to use UV-C, and safety of UV-C devices.ResultsQuestionnaires were completed by 102 patients, 130 HCWs, and 47 EVS-staff. All of the HCWs and EVS-staff and 99% of the patients agreed that environmental disinfection is important to reduce the risk of exposure from contaminated surfaces. Ninety-eight percent of the EVS-staff, 89% of the HCWs, and 96% of the patients felt that the use of UV-C as an adjunct to routine cleaning increased confidence that rooms are clean. Ninety-four percent of the EVS-staff, 85% of the HCWs, and 90% of the patients expressed a willingness to delay being admitted to a room in order to have UV-C decontamination completed. Seventy-nine percent of the EVS-staff, 76% of the HCWs, and 86% of the patients had no concerns about the safety of UV-C devices.ConclusionsPatients, HCWs, and EVS-staff agreed that environmental disinfection is important and that UV-C devices are efficacious and safe. Educational tools are needed to allay safety concerns expressed by a minority of HCWs and EVS-staff.
       
  • APIC/SHEA Joint Leadership Development Course
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s):
       
  • Information for Authors
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s):
       
  • Information for Readers
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s):
       
  • APIC Masthead
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s):
       
  • Central line–associated bloodstream infections and completion of the
           central line insertion checklist: A descriptive analysis comparing a
           dedicated procedure team to other providers
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Emily Styslinger, Huong Nguyen, Olivia Hess, Tara Srivastava, Diane Heipel, Amie Patrick, Manpreet Malik, Michelle Doll, Emily Godbout, Michael P. Stevens, Kaila Cooper, Robin Hemphill, Gonzalo BearmanA primary strategy of central line–associated bloodstream infection (CLABSI) prevention is standardized, aseptic insertion of central lines. We compared hospital-wide CLABSI rate pre- and post-implementation of a dedicated procedure team as well as central line checklist completion and patient-specific variables between the procedure team and other providers. No significant differences were found. Further CLABSI prevention should focus on central line maintenance.
       
  • Benefit of systematic selection of pairs of cases matched by surgical
           specialty for surveillance of bacterial transmission in operating rooms
    • Abstract: Publication date: Available online 1 November 2019Source: American Journal of Infection ControlAuthor(s): Franklin Dexter, Richard H. Epstein, Andrew L. Gostine, Donald H. Penning, Randy W. LoftusBackgroundBacterial transmission within and between successive surgical cases occurs in operating rooms (ORs), often includes anesthesia equipment as a reservoir, and can be monitored by collecting samples and identifying bacteria by genetic testing. We evaluated how to choose cases for active surveillance to quantify the effectiveness of interventions in 2 groups of ORs (eg, rooms with germicidal lighting vs those without).MethodsData were from a 7 OR single-specialty gastrointestinal endoscopy suite and from a typical 8 OR multispecialty surgical suite.ResultsAt the multispecialty hospital, 40.3% (SE 1.2%) of the total number of cases could be used for surveillance (ie, followed by another case of the same specialty and matched with a corresponding pair of cases from the other OR group). Random selection obtained fewer matched pairs than deliberate selection: mean ratio of random/deliberate = 0.64 (0.01) for the single-specialty and 0.51 (0.02) for the multispecialty suite (P 
       
  • Exploring a new trend in the use of antibiotics in dermatologic procedures
    • Abstract: Publication date: November 2019Source: American Journal of Infection Control, Volume 47, Issue 11Author(s): Sangrag Ganguli
       
  • Near-zero ventilator-associated pneumonia rates after implementation of a
           multimodal preventive strategy in a Mexican hospital
    • Abstract: Publication date: Available online 31 October 2019Source: American Journal of Infection ControlAuthor(s): Eric Ochoa-Hein, Su J. Choi, Jonathan A. Gómez-Santillán, José A. Oyervides-Alvarado, Arturo Galindo-Fraga, Eduardo Rivero-Sigarroa, Thierry Hernández-Gilsoul, José G. Domínguez-CheritA multimodal preventive strategy consisting of a ventilator-associated pneumonia (VAP) preventive bundle plus 3 additional sequential interventions (noninvasive ventilation, reeducation of health care workers, and early weaning) was associated with a marked reduction in VAP rates in a Latin American hospital, including 6 consecutive months without VAP cases. A positive association between the percentage of intubated patients and VAP rates was observed.
       
  • Increased adhesion of methicillin-resistant Staphylococcus aureus to the
           surface of personal protective clothing damaged by friction during nursing
           action
    • Abstract: Publication date: Available online 31 October 2019Source: American Journal of Infection ControlAuthor(s): Fuminori Tanabe, Yukiko Uchida, Soichi Arakawa, Michiko MorimotoBackgroundHealth care workers wear protective clothing when caring for patients with infectious diseases. However, during the action of patient care, the generated contact pressure may damage the surface of the protective clothing.MethodsFabrics of protective clothing were damaged by a machine using a force similar to the contact pressure that occurs during nursing care. A total of 50 μL of blood containing methicillin-resistant Staphylococcus aureus (MRSA) (5 × 106 colony-forming units/mL) was dropped onto the pressed or rubbed fabrics. After removing the blood, the residual bacterial count on the surface of the clothing was measured.ResultsIn the undamaged fabrics, the number of adherent MRSA was significantly higher on class 6 protective clothing than on the other tested clothing. The number of adherent MRSA significantly increased on the rubbed surgical gown and rubbed class 3 protective clothing than on the undamaged clothing.ConclusionsBecause the damaged fabrics of protective clothing may cause bacterial carryover, health care workers should pay attention to preventing self-contamination when doffing the protective clothing.
       
  • Renovation in hospitals: Training construction crews to work in health
           care facilities
    • Abstract: Publication date: Available online 31 October 2019Source: American Journal of Infection ControlAuthor(s): Ehsan S. Mousavi, Dennis Bausman, Mahammadsoroush TafazzoliBackgroundHealth care facilities require frequent renovations to maintain or enhance their service, and to meet the dynamic demands of their patients. Construction activities in active health care facilities are a significant contributor to various challenges that range from infection to death. It is therefore essential to minimize the adverse impacts of construction activities on health care units as well as their adjacent sites.MethodsA questionnaire was developed to study current training modules to prepare construction crews to work in health care environments. The survey was disseminated among professionals of the top 15 health care contractors. A total of 129 individuals participated, and their responses were analyzed using descriptive and categorical statistics.ResultsThis study investigates current training practices regarding (1) the level of training, (2) the frequency of training, and (3) the impact that the sensitivity of the project has on the training. To effectively prepare construction crews, special training must be provided to them.ConclusionsThere are uncertainties about the sufficiency and impact of the existing training. Existing trainings are tailored for upper management positions, and the amount/frequency of training for construction crews are substantially low. Findings of this study contribute to characterizing the activities and conditions pertaining to training of construction crews.
       
  • Challenges in achieving effective high-level disinfection in endoscope
           reprocessing
    • Abstract: Publication date: Available online 31 October 2019Source: American Journal of Infection ControlAuthor(s): Cori L. Ofstead, Krystina M. Hopkins, Brandy L. Buro, John E. Eiland, Harry P. WetzlerEndoscope reprocessing is often ineffective, and microbes frequently remain on endoscopes after the use of high-level disinfectants (HLDs). Several factors impact reprocessing effectiveness, including non-adherence to guidelines, use of damaged endoscopes, use of insoluble products during endoscopy, insufficient cleaning, contaminated rinse water, and inadequate drying before storage. Our team suspected that issues with HLD chemistries and monitoring could also contribute to reprocessing failures. We conducted a mixed-methods analysis of published literature, our interviews with frontline personnel, and evidence from our previous studies. The evidence showed that reusable HLDs commonly failed tests for minimum effective concentration (MEC) before their maximum usage periods. MEC tests also detected failures associated with single-use HLDs that did not fully deploy. These failures were due to product issues, process complexities, and personnel non-adherence with guidelines and manufacturer instructions. HLDs will likely continue to be used for the foreseeable future. More research is needed to assess real-world practice patterns related to the high-level disinfection step and MEC testing and to establish more realistic usage periods for reusable HLD chemistries. Manufacturers and researchers should evaluate the ability of technological solutions and engineered safeguards to overcome human error. Recognition of the need for quality improvement is growing, and infection preventionists should take action to build on this momentum and collaborate with manufacturers, endoscopists, and reprocessing personnel to improve the effectiveness of high-level disinfection.
       
  • Efficacy of covert closed-circuit television monitoring of the hand
           hygiene compliance of health care workers caring for patients infected
           with multidrug-resistant organisms in an intensive care unit
    • Abstract: Publication date: Available online 31 October 2019Source: American Journal of Infection ControlAuthor(s): Ilana Livshiz-Riven, Leonid Koyfman, Ronit Nativ, Asaf Danziger, Alexander Shalman, Dmitry Frank, Boris Shvarts, Ofira Azulay, Evgeniya Ivanova, Tomer Ziv-Baran, Moti Klein, Matthew Boyko, Alexander Zlotnik, Abraham Borer, Evgeni BrotfainBackgroundTo compare covert closed-circuit television (CCTV) monitoring to standard overt observation in assessing the hand hygiene (HH) conduct of health care workers (HCWs) caring for patients infected with multidrug-resistant organisms (MDROs). This was a cross-sectional study in a general intensive care unit of a 1,000-bed university hospital.MethodsForty-six general intensive care unit HCWs (staff physicians, registered nurses, and auxiliary workers) caring for contact isolation MDRO-infected patients. The study incorporated the following 3 phases: phase 1, establishment of interrater reliability between 2 simultaneous observers using the overt observation method; phase 2, establishment of interrater reliability between 2 simultaneous observers using the CCTV method; and phase 3, simultaneous monitoring of HH by both methods to evaluate the suitability of CCTV as an alternative to direct observation of the HH conduct of HCWs caring for MDRO-infected patients.ResultsOverall, 1,104 opportunities to perform HH were documented during 49 observation sessions. The compliance rate observed by the overt method (37.3%) was significantly higher than that observed when only the covert method was used (26.5%). However, simultaneous overt-covert observations were found to have intraclass correlation coefficients of>0.85.ConclusionsCovert CCTV observation of HCW HH compliance appears to provide a truer and more realistic picture than overt observation, probably because of its ability to neutralize the Hawthorne effect of overt observation. The high intraclass correlation coefficients between covert observation and overt observation supports this conclusion.
       
  • Comparison of estimated norovirus infection risk reductions for a single
           fomite contact scenario with residual and nonresidual hand sanitizers
    • Abstract: Publication date: Available online 29 October 2019Source: American Journal of Infection ControlAuthor(s): Amanda M. Wilson, Kelly A. Reynolds, Lee-Ann Jaykus, Blanca Escudero-Abarca, Charles P. GerbaBackgroundThe purpose of this study was to relate experimentally measured log10 human norovirus reductions for a nonresidual (60% ethanol) and a residual (quaternary ammonium-based) hand sanitizer to infection risk reductions.MethodsHuman norovirus log10 reductions on hands for both sanitizers were experimentally measured using the ASTM International Standard E1838-10 method, with modification. Scenarios included product application to: (1) inoculated fingerpads with 30- and 60-second contact times, and (2) hands followed by inoculation with human norovirus immediately and 4 hours later. Hand sanitizer efficacies were used in a mathematical model estimating norovirus infection risk from a single hand-to-fomite contact under low and high environmental contamination conditions.ResultsThe largest log10 reductions for the residual and nonresidual hand sanitizers were for a 60-second contact time, reducing infection risk by approximately 99% and 85%, respectively. Four hours after application, the residual hand sanitizer reduced infection risks by 78.5% under high contamination conditions, whereas the nonresidual hand sanitizer offered no reduction.DiscussionLog10 virus and infection risk reductions were consistently greater for the residual hand sanitizer under all scenarios. Further data describing residual hand sanitizer efficacy with additional contamination or tactile events are needed.ConclusionsResidual antinoroviral hand sanitizers may reduce infection risks for up to 4 hours.
       
  • A proposal for eradicating CA-MRSA in Jordan: A global health approach
    • Abstract: Publication date: Available online 29 October 2019Source: American Journal of Infection ControlAuthor(s): Alaa Al Amiry
       
  • Patients’ capability, opportunity, motivation, and perception of
           inpatient hand hygiene
    • Abstract: Publication date: Available online 29 October 2019Source: American Journal of Infection ControlAuthor(s): Shanina C. Knighton, Marian Richmond, Trina Zabarsky, Mary Dolansky, Herleen Rai, Curtis J. DonskeyBackgroundStudies that examine the perceptions and behaviors of patients regarding patient hand hygiene rarely examine the viewpoint of patients about their hand hygiene behavior relative to current resources provided in the hospital.MethodsVoluntary interviews that employed a 16-item survey tool were used among patients (N = 107) in outpatient clinics at post-admission visits. The survey was created using the Behavior Change Wheel, Capability, Opportunity, Motivation Behavior model. Patients were asked whether they brought hand sanitizer to the hospital, used hospital resources to clean their hands, and their perspective on patient hand hygiene importance compared with hospital staff, as well as their satisfaction or lack of satisfaction with hand hygiene independence.ResultsMost of the participants (65, 60.7%) reported that prior to being admitted to the hospital, they were able to maintain cleaning their hands with little or no difficulty. During their admission, only 21 (19.6%) of the participants reported needing little or no assistance. More than one-half of the participants, 34 (31.8%) and 23 (21.5%), respectively, reported, mostly or completely agreeing that the hand hygiene of the health care staff was more important than their own. Close to one-half of the participants (50, 46.7%) reported not being satisfied at all with their ability to maintain their hand hygiene in the hospital, whereas only 10 (9.3%) were very satisfied with their ability to maintain hand hygiene.ConclusionsFindings from this study will enhance our understanding of how to incorporate inpatient hand hygiene into existing infection control programs in inpatient settings.
       
  • Comparing inpatient versus emergency department clinician perceptions of
           personal protective equipment for different isolation precautions
    • Abstract: Publication date: Available online 29 October 2019Source: American Journal of Infection ControlAuthor(s): Sarah L. Krein, Steven L. Kronick, Vineet Chopra, Leah L. Shever, Lauren E. Weston, Lynn Gregory, Molly HarrodAdherence to isolation precaution practices, including use of personal protective equipment (PPE), remains a challenge in most hospitals. We surveyed inpatient and emergency department clinicians about their experiences and opinions of various isolation policies, specifically those related to wearing PPE. Our findings show several differences between inpatient and emergency department clinicians involving perceptions related to safety, and the difficulty associated with using PPE for certain types of organisms.
       
  • Point-of-use filters for prevention of health care–acquired
           Legionnaires’ disease: Field evaluation of a new filter product and
           literature review
    • Abstract: Publication date: Available online 25 October 2019Source: American Journal of Infection ControlAuthor(s): Jeanique Parkinson, Julianne L. Baron, Beth Hall, Harrie Bos, Patrick Racine, Marilyn M. Wagener, Janet E. Stout BackgroundThe Centers for Medicare & Medicaid Services requires that health care facilities assess their building water systems and minimize the risk of growth and spread of Legionella and other waterborne pathogens. Increasingly, point-of-use (POU) filters are being used to prevent exposure to these pathogens. This study provides efficacy and performance specifications (membrane size, pore size, and use restrictions), which will aid in selecting POU filters.MethodsNew faucet and shower filters rated for 62 days of use were evaluated at an acute care facility in Southwestern Ontario, Canada. Five faucets and 5 showers served as controls or were equipped with filters. Hot water samples were collected weekly for 12 weeks and cultured for Legionella, heterotrophic plate count, and Pseudomonas. Literature searches for articles on POU filters used in health care settings were performed using PubMed and Google Scholar. Filter specifications from 5 manufacturers were also compared.ResultsThe 62-day POU filters installed on both faucets and showers eliminated Legionella and reduced heterotrophic plate count concentrations for 12 weeks. No Pseudomonas was recovered during this study. Twenty peer-reviewed studies are summarized, and 21 features of 53 POU filters have been compiled.ConclusionsThe information provides infection preventionists and facility engineers with information to verify claims from manufacturers and compare differences among POU products, including validated efficacy, filter design, and operational specifications.
       
  • Evaluation of a benzalkonium chloride hand sanitizer in reducing transient
           
    • Abstract: Publication date: Available online 25 October 2019Source: American Journal of Infection ControlAuthor(s): Sidney Bondurant, Tanya McKinney, Liza Bondurant, Lisa FitzpatrickBackgroundThis study was performed to evaluate the effectiveness of a new commercially available hand sanitizer using 0.12% benzalkonium chloride (BZK) as the active ingredient in reducing transient skin contamination with Staphylococcus aureus in health care workers (HCWs), as compared with the effectiveness of a 70% ethanol-based hand sanitizer.MethodsFingertip touch culture plates were obtained from 40 HCWs in which all HCWs used antimicrobial soap containing 0.6% chloroxylenol for handwashing according to the Centers for Disease Control and Prevention guidelines for the entire study, while continuing to use the 70% ethanol-based hand sanitizer according to the Centers for Disease Control and Prevention guidelines for the first week. After the first week, the test subjects used the BZK hand sanitizer in place of the ethanol sanitizer. A paired sample t test was conducted to compare the mean bacterial colonies grown from HCWs fingertips during the use of the BZK and ethanol hand sanitizer.ResultsThe results showed a significant reduction in total bacterial colony counts of S aureus during the week of BZK use as compared with the week of 70% ethanol sanitizer use.ConclusionsThere was a significant decrease in transient S aureus on the fingertips of HCWs in the BZK hand sanitizer use week as compared with the 70% ethanol hand sanitizer use week.
       
  • Importance of operating room case scheduling on analyses of observed
           reductions in surgical site infections from the purchase and installation
           of capital equipment in operating rooms
    • Abstract: Publication date: Available online 19 October 2019Source: American Journal of Infection ControlAuthor(s): Franklin Dexter, Johannes Ledolter, Richard H. Epstein, Randy W. LoftusBackgroundWe review the impact of the consequences of operating room (OR) management decision making on power analyses for observational studies of surgical site infections (SSIs) among patients receiving care in ORs with interventions versus without interventions involving physical changes to ORs. Examples include ventilation systems, bactericidal lighting, and physical alterations to ORs.MethodsWe performed a narrative review of operating room management and surgical site infection articles. We used 10-years of operating room data to estimate parameters for use in statistical power analyses.ResultsCreating pivot tables or monthly control charts of SSI per case by OR and comparing among ORs with or without intervention is not recommended. This approach has low power to detect a difference in SSI rates among the ORs with or without the intervention. The reason is that appropriate OR case scheduling decision making causes risk factors for SSI to differ among ORs, even when stratifying by surgical specialty. Such risk factors include case duration, urgency, and American Society of Anesthesiologists’ Physical Status. Instead, analyze SSI controlling for the OR, where the patient had surgery, and matching patients using these variables is preferable. With α = 0.05, 600 cases per OR, 5 intervention ORs, and 5 or 1 control patients for each intervention patient, reasonable power (≅94% or 78%, respectively) can be achieved to detect reductions (3.6% to 2.4%) in the incidence of SSI between ORs with or without the intervention.ConclusionsBy using this matched cohort design, the effect of the purchase and installation of capital equipment in ORs on SSI can be evaluated meaningfully.
       
  • Clinical experiences with a new system for automated hand hygiene
           monitoring: A prospective observational study
    • Abstract: Publication date: Available online 18 October 2019Source: American Journal of Infection ControlAuthor(s): Anne-Mette Iversen, Christiane Pahl Kavalaris, Rosa Hansen, Marco Bo Hansen, Rebekah Alexander, Krassimir Kostadinov, Jette Holt, Brian Kristensen, Jenny Dahl Knudsen, Jens Kjølseth Møller, Svend Ellermann-EriksenBackgroundHand hygiene compliance (HHC) among health care workers remains suboptimal, and good monitoring systems are lacking. We aimed to evaluate HHC using an automated monitoring system.MethodsA prospective, observational study was conducted at 2 Danish university hospitals employing a new monitoring system (Sani nudge). Sensors were located on alcohol-based sanitizers, health care worker name tags, and patient beds measuring hand hygiene opportunities and sanitations.ResultsIn total, 42 nurses were included with an average HHC of 52% and 36% in hospitals A and B, respectively. HHC was lowest in patient rooms (hospital A: 45%; hospital B: 29%) and highest in staff toilets (hospital A: 72%; hospital B: 91%). Nurses sanitized after patient contact more often than before, and sanitizers located closest to room exits and in hallways were used most frequently. There was no association found between HHC level and the number of beds in patient rooms. The HHC level of each nurse was consistent over time, and showed a positive correlation between the number of sanitations and HHC levels (hospital A: r = 0.69; hospital B: r = 0.58).ConclusionsThe Sani nudge system can be used to monitor HHC at individual and group levels, which increases the understanding of compliance behavior.Graphical abstractImage, graphical abstract
       
  • Maximizing the impact of, and sustaining standing orders protocols for
           adult immunization in outpatient clinics
    • Abstract: Publication date: Available online 18 October 2019Source: American Journal of Infection ControlAuthor(s): L.J. Tan, Robin VanOss, Cori L. Ofstead, Harry P. WetzlerBackgroundLow adult immunization rates leave adults at risk from infectious disease, and the resulting complications of vaccine-preventable diseases. Standing orders protocols (SOPs) for adult immunization have not been implemented widely in clinics serving adult patients. Our purpose was to evaluate the impact of SOPs on adult immunization rates and identify challenges to sustaining adult immunization coverage rates after implementation of SOPs.MethodsBaseline adult vaccination rates were calculated for the year prior to SOPs implementation in 5 diverse clinics. Vaccines included in the implemented standing orders included Tdap, influenza, pneumococcal, human papillomavirus, herpes zoster, and hepatitis B. Adult vaccination rates were tracked for 1 year after SOPs implementation.ResultsSites generally sustained modest gains in coverage rates (4%-8% increase) after SOP implementation, but greater success was found in practices that used SOPs as a foundation on which additional interventions were built. Challenges to increasing coverage rates included prioritization of acute and chronic conditions over adult vaccination, Medicare Part D reimbursement policies, electronic medical record issues related to data reporting and programming for patient alerts, and the lack of interoperability between the state immunization information system (missing patient vaccination history) and electronic medical record.ConclusionsSOPs may provide a good starting point for increasing adult immunization coverage rates. Using additional interventions, quality-based metrics, or incentives could lead to sustained adult immunization prioritization.
       
  • Effectiveness of manual versus automated cleaning on Staphylococcus
           epidermidis biofilm removal from the surface of surgical instruments
    • Abstract: Publication date: Available online 17 October 2019Source: American Journal of Infection ControlAuthor(s): Síntia de Souza Evangelista, Natália Rocha Guimaraes, Naiara Bussolotti Garcia, Simone Gonçalves dos Santos, Adriana Cristina de OliveiraBackgroundBiofilm removal is a challenge during surgical instrument processing. We analyzed the time required for Staphylococcus epidermidis to form biofilms on surgical instruments, and how cleaning methods removed them.MethodsDifferent areas (ratchet, shank, and jaw) of straight crile forceps were contaminated by soaking in Tryptic Soy Broth containing 106 colony forming units (CFU)/mL of S epidermidis for 1, 2, 4, 6, 8, and 12 hours. S epidermidis adhesion and removal, after manual or automated ultrasonic cleaning, was evaluated by microbiological culture and scanning electron microscopy.ResultsMicrobial load increased with time (101-102 CFU/cm2 after 1 hour; 104 CFU/cm2 after 12 hours). Exopolysaccharide was detected after 2 hours and gradually increased thereafter. Bacterial load was reduced by 1-2 log10 after manual cleaning and 1-3 log10 after automated cleaning, but biofilms were not completely eliminated. In general, bacterial load was lower in shank fragments. This difference was significant at 6 hours.ConclusionsRapid adhesion of S epidermidis and exopolysaccharide formation was observed on surgical instruments. Automated cleaning was more effective than manual cleaning, but neither method removed biofilms completely. The precleaning conditions and the forceps design are critical factors in processing quality.
       
  • Effect of pulsed xenon ultraviolet disinfection on methicillin-resistant
           Staphylococcus aureus contamination of high-touch surfaces in a Japanese
           hospital
    • Abstract: Publication date: Available online 15 October 2019Source: American Journal of Infection ControlAuthor(s): Hiroki Kitagawa, Minako Mori, Seiya Kashiyama, Yayoi Sasabe, Kiyoko Ukon, Naomi Shimokawa, Nobuaki Shime, Hiroki OhgeBackgroundThe hospital environment is an important source of multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA). Here, we evaluated the efficacy of pulsed xenon ultraviolet (PX-UV) disinfection in addition to manual cleaning in a Japanese hospital.MethodsEnvironmental samples were collected from inpatient rooms that had been occupied for at least 48 hours by patients infected or colonized with MRSA. High-touch surfaces from 11 rooms were sampled before and after manual cleaning and then after PX-UV disinfection. Changes in bacterial counts and in the number of aerobic bacteria (AB)- and MRSA-positive samples between sampling points were assessed. The time taken to complete PX-UV treatment of patient rooms was also recorded.ResultsA total of 306 samples were collected. PX-UV disinfection resulted in a significant decrease in abundance of AB and MRSA (mean colony-forming units 14.4 ± 38.7 to 1.7 ± 6.1, P < .001 and 1.1 ± 3.9 to 0.3 ± 2.0, P < .001, respectively) and in the number of AB- and MRSA-positive samples (58.8%-28.4%, P = .001 and 19.6%-3.9%, P < .001, respectively) compared with manual cleaning. The median time of in-room use of the PX-UV device was 20 minutes.ConclusionsThe addition of PX-UV disinfection to the manual cleaning process significantly reduced AB and MRSA contamination of high-touch surfaces in hospital inpatient rooms.
       
  • A qualitative study of factors affecting personal protective equipment use
           among health care personnel
    • Abstract: Publication date: Available online 11 October 2019Source: American Journal of Infection ControlAuthor(s): Molly Harrod, Lauren E. Weston, Lynn Gregory, Laura Petersen, Jeanmarie Mayer, Frank A. Drews, Sarah L. KreinBackgroundHealth care personnel (HCP) use of personal protective equipment (PPE) reduces infectious disease transmission. However, PPE compliance remains low. The objective of this study was to better understand how HCP perceptions factor into PPE decision making as well as how organizational processes and the environment impact behavior.MethodsThis qualitative study used observation and focus groups at 2 medical centers. Data were analyzed using thematic analysis.ResultsThe decision to use PPE and to follow precaution practices was influenced by risk perception as well as organizational and environmental factors. Perceived risk, related to certain organisms and work tasks, was considered by HCP when deciding to use PPE. Organizational processes, such as policies that were not applied uniformly, and environmental factors, such as clean versus contaminated space, also played a role in HCP PPE use.DiscussionBecause HCP seemed focused on organisms and work tasks, education on specific organisms and helping HCP think through their workflow may be more effective in conveying the importance of PPE in reducing transmission. Additionally, isolation practices should be compared across disciplines to ensure they complement, rather than contradict, one another. Assessment of the environment may help protect HCP and patients from infectious organisms.ConclusionPreventing the spread of infectious organisms should not depend solely on PPE use, but should also be recognized as an organizational responsibility.
       
  • Journal Club: Surveillance of home health central venous catheter care
           outcomes: Challenges and future directions
    • Abstract: Publication date: Available online 2 October 2019Source: American Journal of Infection ControlAuthor(s): Adebisi A. Adeyeye, James Davis
       
  • Urine test stewardship for catheterized patients in the critical care
           setting: Provider perceptions and impact of electronic order set
           interventions
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s): Grace Lin, Shelley Knowlson, Huong Nguyen, Kaila Cooper, Rachel J. Pryor, Michelle Doll, Emily J. Godbout, Robin Hemphill, Michael P. Stevens, Gonzalo BearmanWe implemented an electronic medical record (EMR) decision support tool for ordering urine cultures per evidence-based guidelines. Following the EMR change, we found a significant increase in proportion of cultures ordered for catheterized intensive care unit (ICU) patients meeting guidelines. We surveyed providers and found poor understanding of urine culture guidelines for catheterized ICU patients. EMR-based interventions and educational opportunities have potential to improve urine culture guideline adherence and reduce unnecessary testing and antibiotic use.
       
  • Incidence and risk factors of surgical site infection after total knee
           arthroplasty: Results of a retrospective cohort study
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s): Claas Baier, Simon Adelmund, Frank Schwab, Christoph Lassahn, Iris Freya Chaberny, Frank Gossé, Ralf-Peter Vonberg, Ella EbadiKnee arthroplasty is commonly performed in the case of advanced osteoarthritis, and deep joint infections represent a severe complication following surgery. A 4-year retrospective cohort study was conducted to determine the incidence and risk factors for such surgical site infections. Of the 2439 patients included in the study, 84 of them (3.4%) developed infections. Postoperative bleeding, Ahlbäck's disease, obesity, smoking, and male gender were independent risk factors that should be considered when caring for those patients.
       
  • Value of certification in infection prevention and control
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s): James F. Marx, Sandra Callery, Roy BoukidjianThe Certification Board of Infection Control and Epidemiology conducted a marketing research study to determine the perceived value of the certification in infection prevention and control among infection prevention professionals and other stakeholders. Four thematic categories were identified: certification process and standards; professionalism, competency, and career growth; patient care, safety, infection prevention and control; and regulatory compliance. Respondents stated that certification demonstrated professional competency, increased career growth, improved regulatory compliance, was important in influencing legislation, and improved the practice of infection prevention and control. Opportunities were to reevaluate eligibility criteria and examination difficulty; demonstrate how certification increases financial compensation and organizational recognition; and offer recertification through continuing education based on the study findings, strategic recommendations and next steps were incorporated into the strategic plan. This article is an overview and summarizes the study findings.
       
  • Effect of a shielded continuous ultraviolet-C air disinfection device on
           reduction of air and surface microbial contamination in a pediatric
           oncology outpatient care unit
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s): Hana Hakim, Craig Gilliam, Li Tang, Jiahui Xu, Linda D. LeeBackgroundFor a clean hospital environment, we evaluated whether ultraviolet-C (UV-C) air disinfection reduces airborne and surface microbial contamination in an outpatient pediatric oncology center.MethodsA pre- and post-intervention study compared 6 test locations, where continuous shielded UV-C air disinfection devices were installed, with 10 control locations without UV-C. Pre- and post-intervention air and surface samples were collected for bacterial and fungal cultures. Percent changes in colony forming unit (CFU) counts in the test and control locations were compared.ResultsMean bacterial CFU count per cubic meter air and per surface contact plates decreased by 27% (P = .219) and 37% (P = .01), respectively, in test locations compared to 40% (P = .054) and 30% (P = .006) reductions in control locations. Mean fungal CFU count per cubic meter air and per surface contact plates increased by 14% (P = .156) and 19% (P = .048), respectively, in test locations compared to 24% (P = .409) and 2% (P = .34) increases in control locations.ConclusionsThere were no consistent statistically significant differences in the air and surface culture results between test locations where UV-C devices were installed and control locations. The effectiveness of UV-C air disinfection in reducing air and surface microbial contamination in outpatient clinical areas where immunocompromised children are encountered was not proven.
       
  • Enhanced manual cleaning efficacy of duodenoscope in endoscopy units:
           Results of a multicenter comprehensive quality control program
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s): Wei-Kuo Chang, Tao-Chieh Liu, Tzu-Ling Liu, Chen-Ling Peng, Hsiu-Po WangBackgroundMultiple outbreaks from contaminated duodenoscopes have been reported since 2008. This study assessed results of a multicenter comprehensive quality control (QC) program to enhance manual cleaning efficacy of duodenoscopes in endoscopy units.MethodsDigestive Endoscopy Society of Taiwan implemented a QC program with adenosine triphosphate (ATP) testing of patient-used duodenoscopes in 2 rounds of on-site audit in endoscopy units. ATP samples were obtained from 5 different locations of the duodenoscope after manual cleaning. Duodenoscope exceeding ATP benchmark of 200 relative light units indicated inadequate manual cleaning.ResultsDuring the first round on-site audit, 12 hospitals and 27 patient-used duodenoscopes were analyzed. Distal end outer surface (29.6%), elevator mechanism (51.9%), distal attachment cap (59.3%), elevator wire channel (37.0%), and suction biopsy channel (37.0%) were inadequately cleaned. Overall, 19 (70.4%) duodenoscopes had inadequate manual cleaning, ranging widely from 0%-100% among endoscopy units. During the follow-up on-site audit, 32 patient-used duodenoscopes were analyzed, and 6 (18.8%) had inadequate manual cleaning.ConclusionsATP tests may provide real-time feedback on the cleaning efficacy of patient-used duodenoscopes. Implementing a comprehensive QC program could enhance the efficacy of manual cleaning in endoscopy units.
       
  • Antimicrobial stewardship: Staff nurse knowledge and attitudes
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s): Katreena Merrill, Sandra Forsyth Hanson, Sharon Sumner, Todd Vento, John Veillette, Brandon WebbBackgroundRegistered nurses are uniquely qualified to augment antimicrobial stewardship (AS) processes. However, the role of nursing in AS needs further development. More information is needed regarding gaps in registered nurse knowledge, attitudes toward AS, and how infection preventionists can help.MethodsAn online descriptive survey was deployed to a convenience sample of approximately 2,000 nurses at the bedside. The survey included 15 questions addressing: (1) overall knowledge of AS; (2) antimicrobial delivery; (3) knowledge and attitudes regarding antimicrobial use; (4) antimicrobial resistance; and (5) antimicrobial resources and education.ResultsThree hundred sixteen staff nurses from 3 hospitals (15.8%) responded to the survey. Fifty-two percent of nurses were not familiar with the term “antimicrobial stewardship,” although 39.6% of nurses indicated that an AS program was moderately or extremely important in their health care setting. Almost all nurses (95%) believed that they should be involved in AS interventions.DiscussionThese findings suggest gaps in nursing knowledge rearding AS. However, nurses believed AS programs were important and were eager to be involved.ConclusionsThis study showed that many nurses are not aware of AS, or do not understand their role in contributing to AS endeavors. Infection preventionist education should focus on increasing staff nurse awareness and demonstrating how nurses can make specific AS interventions.
       
  • Adequacy of empiric gram-negative coverage for septic patients at an
           academic medical center
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s): DaleMarie Vaughan, Amy Pakyz, Michael Stevens, Kimberly Lee, Shaina BernardBackgroundGram-negative organisms (GNOs) have increasing resistance rates to levofloxacin at Virginia Commonwealth University Health System (VCUHS), where levofloxacin is the most common agent added to provide double coverage of gram-negative infections. The goal of this study was to determine the adequacy of empiric gram-negative coverage for septic patients at our institution.MethodsA retrospective review of patients admitted to VCUHS, from January 1, 2014, to December 31, 2014, with a diagnosis of sepsis, severe sepsis, or septic shock and documented infection, was performed to determine the adequacy of various empiric antibiotic combinations.ResultsOf 219 patients who met the inclusion criteria, 56% of patients received monotherapy and 21% of patients received combination therapy (2 antibiotics) covering GNOs. GNOs (84%) were susceptible to piperacillin-tazobactam. When used in combination with cefepime and meropenem, levofloxacin did not increase coverage. However, levofloxacin provided an 8% increase in coverage and gentamicin provided an additional 13% increase in coverage, respectively, when used in combination with piperacillin-tazobactam.ConclusionsAmong septic patients at VCUHS, gentamicin provided increased gram-negative coverage when compared with levofloxacin. Although susceptibility to piperacillin-tazobactam alone was relatively low, the combination of piperacillin-tazobactam and gentamicin provided nearly equivalent coverage to meropenem and gentamicin.
       
  • Evaluation of disinfectant efficacy against multidrug-resistant bacteria:
           A comprehensive analysis of different methods
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s): Anne T. Köhler, Arne C. Rodloff, Manja Labahn, Mario Reinhardt, Uwe Truyen, Stephanie SpeckBackgroundMultidrug-resistant gram-negative bacteria (MDR-GNB) constitute a threat to health care worldwide. Disinfectants are used to prevent and control the spread of MDR-GNB in a hospital setting but their efficacy might be impaired by bacterial mechanisms that may act on both antimicrobials and disinfectants. Determination of minimum inhibitory concentrations is mainly used to determine bacterial susceptibility against disinfectants, but practical tests on surfaces might be more suitable to predict in-use conditions. Our objective was to compare and evaluate 4 different methods widely used to assess surface disinfectant efficacy.MethodsThe efficacy of benzalkonium chloride (BAC), peracetic acid (PAA), and ethanol (ETH) against multidrug-resistant Acinetobacter, Pseudomonas, and Klebsiella strains was assessed by minimum inhibitory concentration determinations, quantitative suspension tests, qualitative suspension tests, and carrier tests. Test results were compared to ascertain the most appropriate method.ResultsETH, PAA, and BAC were highly effective against MDR-GNB, but we observed marked differences in efficacious concentrations (up to 100-fold) as a function of the test method applied. Minimum inhibitory concentration determination was not reliable for evaluating susceptibility or resistance to BAC.ConclusionsSurface tests should be used to determine bacterial susceptibility against disinfectants. Moreover, suitable guidelines are needed that allow for the standardization and comparison of bactericidal values obtained by different investigators.
       
  • Variation in surface decontamination practices among Michigan child care
           centers compared to state and national guidelines
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s): Peter DeJonge, Emily T. Martin, Michael Hayashi, Andrew N. Hashikawa BackgroundEnvironmental decontamination is one of the most effective methods to prevent transmission of infectious pathogens in child care centers (CCCs). Alongside state recommendations, national organizations—including the American Academy of Pediatrics (AAP)—offer best-practice policies. In Michigan, these sets of guidelines differ, and the extent to which CCC practices agree with either set of protocols is unknown.MethodsA survey of environmental decontamination practices was administered at a professional meeting of CCC directors (N = 24) in a single Michigan county. CCC practices (eg, products, locations, frequencies) were compared to state and AAP guidelines. Bivariate analyses investigated CCC characteristics as predictors of decontamination policy agreement.ResultsCCC agreement with established policy was slightly higher for national AAP guidelines (66%) than Michigan standards (59%). The use of an outside child care health consultant was strongly associated with a significantly higher level of agreement with state decontamination policy (P = .01).ConclusionWe noted substantial disagreement between county CCC practices and state/national guidelines, regardless of CCC size or director experience. Results highlight opportunities to improve CCC director familiarity with current state and nationally advised protocols, to consolidate state licensing and AAP guidelines, and to promote the use of child care health consultants.
       
  • Acinetobacter baumannii can be transferred from contaminated nitrile
           examination gloves to polypropylene plastic surfaces
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s): Hiroyuki Takoi, Kazue Fujita, Hiroka Hyodo, Miki Matsumoto, Sae Otani, Misato Gorai, Yoko Mano, Yoshinobu Saito, Masahiro Seike, Nobuhiko Furuya, Akihiko GemmaBackgroundSeveral observational studies suggest that gloves of health care workers are major routes of multidrug-resistant Acinetobacter baumannii transmission. However, limited experimental data are available assessing Acinetobacter transmission from gloves to environmental surfaces. This study determined whether A baumannii was easily transferred from nitrile gloves to polypropylene plastic compared with other gram-negative bacteria that cause health care–associated infections in laboratory-controlled experiments.MethodsGloved fingerpad-to-fomite transfer efficiency was determined for drug-resistant and -sensitive strains of A baumannii, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Pseudomonas aeruginosa.ResultsOnly A baumannii transferred from gloves to fomites 3 minutes after the bacterial transfer event. Transfer efficiency of A baumannii was 0.1%-33% at that time point.DiscussionBacterial transfer from contaminated gloves to the hospital environment may be related to the type of contaminating bacteria, inoculated bacterial level, fomites, and glove materials. Therefore, it is important to need a comprehensive assessment of the transfer efficiency.ConclusionsA baumannii can transfer easily from nitrile gloves to fomite compared with other gram-negative bacteria that cause health care–associated infections. These findings support data from previous observational studies that gloves of health care workers can be major routes of A baumannii transmission in clinical settings.
       
  • Health care workers’ perceptions and reported use of respiratory
           protective equipment: A qualitative analysis
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s): Gemmae M. Fix, Heather Schacht Reisinger, Anna Etchin, Sarah McDannold, Aaron Eagan, Kimberly Findley, Allen L. Gifford, Kalpana Gupta, D. Keith McInnesBackgroundLittle is known about health care workers’ (HCW) perceptions of, or experiences using, respiratory protective equipment (RPE). We sought to characterize their perceptions and identify reasons underlying inappropriate use.MethodsWe conducted 12 focus groups with nurses and nursing assistants at 4 medical centers. We analyzed the thematic content of 73 discrete “stories” told by focus group participants.ResultsWe identified 5 story types surrounding RPE use: 1) policies are known and seen during work routines; 2) during protocol lapses, use is reinforced through social norms; 3) clinical experiences sometimes supersede protocol adherence; 4) when risk perception is high, we found concern regarding accessing RPE; and 5) HCWs in emergency departments were viewed as not following protocol because risk was ever-present.DiscussionHCWs were aware of the importance of RPE and protocols for using it, and these supported use when protocol lapses occurred. However, protocol adherence was undermined by clinical experience, perceived risk, and the distinct context of the emergency department where patients continually arrive with incomplete or delayed diagnoses.ConclusionsProtocols, visual cues, and social norms contribute to a culture of safety. This culture can be undermined when HCWs experience diagnostic uncertainty or they mistrust the protocol and instead rely on their clinical experiences.Graphical Image, graphical abstract
       
  • International Infection Prevention Week 2019: “Vaccines are
           everybody's business”
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s):
       
  • Information for Authors
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s):
       
  • Information for Readers
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s):
       
  • APIC Masthead
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s):
       
  • An in-room observation study of hand hygiene and contact precaution
           compliance for Clostridioides difficile patients
    • Abstract: Publication date: October 2019Source: American Journal of Infection Control, Volume 47, Issue 10Author(s): Anna K. Barker, Elise S. Cowley, Linda McKinley, Marc-Oliver Wright, Nasia SafdarUsing an innovative, covert, in-room observer method to evaluate infection control practices for patients with Clostridioides difficile infection, we found no difference between physician and nursing hand hygiene compliance and contact precaution usage. There was also no diurnal variation in hand hygiene practices, but decreased contact precaution usage at night. Conversely, hospital-wide data from overt observations collected over the same time period showed significantly higher hand hygiene compliance among nurses than physicians.
       
 
 
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