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Publisher: Elsevier   (Total: 3031 journals)

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Showing 1 - 200 of 3031 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 79, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 22, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 302, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 195, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 21, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 119, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 24, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 38, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 41, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 18, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 33, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 7, SJR: 0.764, h-index: 15)
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: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 6, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 20, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 14)
Advances in Pharmacology     Full-text available via subscription   (Followers: 13, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 17, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 56)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 1, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 332, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 7)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 28, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 14)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 12)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 42, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 303, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 4, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 389, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 29, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 36, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 48, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 3, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 5)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 7, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 45, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 45, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 25, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 48, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 173, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 51, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 22, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 32, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 13, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 52, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 3)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 152, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 7, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 141, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of Infection Control
  [SJR: 1.259]   [H-I: 81]   [25 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0196-6553
   Published by Elsevier Homepage  [3031 journals]
  • Clean your hands on May 5, 2017: Fight antibiotic resistance—it's in
           your hands
    • Authors: Ermira Tartari; Daniela Pires; Didier Pittet
      First page: 342
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Ermira Tartari, Daniela Pires, Didier Pittet


      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2017.02.003
       
  • Preoperative bathing of the surgical site with chlorhexidine for infection
           prevention: Systematic review with meta-analysis
    • Authors: Lúcia Maciel de Castro Franco; Gláucia Fernandes Cota; Tatiana Saraiva Pinto; Flávia Falci Ercole
      Pages: 343 - 349
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Lúcia Maciel de Castro Franco, Gláucia Fernandes Cota, Tatiana Saraiva Pinto, Flávia Falci Ercole
      Background Preoperative bathing with 4% chlorhexidine is recommended as a measure to prevent surgical site infection (SSI) despite uncertainty regarding the effectiveness of the intervention. This review aimed to assess the effect of bathing with 4% chlorhexidine on the prevention of SSIs in clean surgeries compared with bathing with placebo solution or soap. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and the Cochrane manual were followed. Sources were MEDLINE and Latin American and Caribbean Health Sciences Literature databases and manual search of references from evaluated studies. We included randomized studies evaluating clean surgical wounds and reporting SSIs after preoperative bathing with 4% chlorhexidine. Results A total of 243 primary studies were identified and 8 were considered methodologically appropriate based on the Jadad Scale. Data were gathered from 10,655 patients. The global SSI rate was 7.2%. The SSI rate for chlorhexidine bathing, placebo, and soap without antiseptic groups was 7.1%, 9.1%, and 5.1%, respectively. A significant reduction in the infection rates was not found in the comparison between patients subjected to preoperative bathing with 4% chlorhexidine versus placebo solution (relative risk, 0.91; 95% confidence interval, 0.76-1.09). The same absence of benefit was observed comparing chlorhexidine bathing with soap (relative risk, 1.06; 95% confidence interval, 0.68-1.66). Conclusions Controlled clinical trials are needed to assess the effect of preoperative chlorhexidine bathing on infection rates following clean surgery before the incorporation of this intervention in health care services.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.12.003
       
  • Isopropyl alcohol is as efficient as chlorhexidine to prevent
           contamination of blood cultures
    • Authors: Jovanna Martínez; Juan H. Macías; Virginia Arreguín; Jose A. Álvarez; Alejandro E. Macías; Juan L. Mosqueda-Gómez
      Pages: 350 - 353
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Jovanna Martínez, Juan H. Macías, Virginia Arreguín, Jose A. Álvarez, Alejandro E. Macías, Juan L. Mosqueda-Gómez
      Background False-positive blood cultures can lead to unnecessary risks and misuse of antibiotics; to reduce rates of false-positives, it would be useful to determine whether use of an antiseptic with a prolonged effect is required. Methods Clinical study of efficacy (blinded and randomized) to compare the rate of blood culture contamination when skin antisepsis was performed with 70% isopropyl alcohol or 2% chlorhexidine gluconate in 70% isopropyl alcohol in 2 hospitals. Patients aged 16 years or older with suspected bloodstream infection who were allocated in the emergency room, internal medicine ward, or intensive care unit were included. Results Five of 563 (0.9%) blood cultures from the isopropyl arm and 10 of 539 (1.9%) from the chlorhexidine arm were contaminated. No significant differences were observed among the rate of contamination (χ 2 = 1.27; P = .3) or the relative risk of contamination (relative risk = 2.09; 95% confidence interval, 0.72-6.07; P = .2). Conclusions The rates of blood contamination were not different when isopropyl alcohol and chlorhexidine were compared. Isopropyl alcohol could be used for skin antisepsis before blood collection.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.027
       
  • Methodology for analyzing environmental quality indicators in a dynamic
           operating room environment
    • Authors: Thomas Gormley; Troy A. Markel; Howard W. Jones; Jennifer Wagner; Damon Greeley; James H. Clarke; Mark Abkowitz; John Ostojic
      Pages: 354 - 359
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Thomas Gormley, Troy A. Markel, Howard W. Jones, Jennifer Wagner, Damon Greeley, James H. Clarke, Mark Abkowitz, John Ostojic
      Background Sufficient quantities of quality air and controlled, unidirectional flow are important elements in providing a safe building environment for operating rooms. Methods To make dynamic assessments of an operating room environment, a validated method of testing the multiple factors influencing the air quality in health care settings needed to be constructed. These include the following: temperature, humidity, particle load, number of microbial contaminants, pressurization, air velocity, and air distribution. The team developed the name environmental quality indicators (EQIs) to describe the overall air quality based on the actual measurements of these properties taken during the mock surgical procedures. These indicators were measured at 3 different hospitals during mock surgical procedures to simulate actual operating room conditions. EQIs included microbial assessments at the operating table and the back instrument table and real-time analysis of particle counts at 9 different defined locations in the operating suites. Air velocities were measured at the face of the supply diffusers, at the sterile field, at the back table, and at a return grille. Results The testing protocol provided consistent and comparable measurements of air quality indicators between institutions. At 20 air changes per hour (ACH), and an average temperature of 66.3°F, the median of the microbial contaminants for the 3 operating room sites ranged from 3-22 colony forming units (CFU)/m3 at the sterile field and 5-27 CFU/m3 at the back table. At 20 ACH, the median levels of the 0.5-µm particles at the 3 sites were 85,079, 85,325, and 912,232 in particles per cubic meter, with a predictable increase in particle load in the non–high-efficiency particulate air-filtered operating room site. Using a comparison with cleanroom standards, the microbial and particle counts in all 3 operating rooms were equivalent to International Organization for Standardization classifications 7 and 8 during the mock surgical procedures. Conclusions The EQI protocol was measurable and repeatable and therefore can be safely used to evaluate air quality within the health care environment to provide guidance for operational practices and regulatory requirements.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.001
       
  • Duodenoscope hang time does not correlate with risk of bacterial
           contamination
    • Authors: Riley Heroux; Michelle Sheppard; Sharon B. Wright; Mandeep Sawhney; Elizabeth B. Hirsch; Robin Kalaidjian; Graham M. Snyder
      Pages: 360 - 364
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Riley Heroux, Michelle Sheppard, Sharon B. Wright, Mandeep Sawhney, Elizabeth B. Hirsch, Robin Kalaidjian, Graham M. Snyder
      Background Current professional guidelines recommend a maximum hang time for reprocessed duodenoscopes of 5-14 days. We sought to study the association between hang time and risk of duodenoscope contamination. Methods We analyzed cultures of the elevator mechanism and working channel collected in a highly standardized fashion just before duodenoscope use. Hang time was calculated as the time from reprocessing to duodenoscope sampling. The relationship between hang time and duodenoscope contamination was estimated using a calculated correlation coefficient between hang time in days and degree of contamination on the elevator mechanism and working channel. Results The 18 study duodenoscopes were cultured 531 times, including 465 (87.6%) in the analysis dataset. Hang time ranged from 0.07-39.93 days, including 34 (7.3%) with hang time ≥7.00 days. Twelve cultures (2.6%) demonstrated elevator mechanism and/or working channel contamination. The correlation coefficients for hang time and degree of duodenoscope contamination were very small and not statistically significant (−0.0090 [P = .85] for elevator mechanism and −0.0002 [P = 1.00] for working channel). Odds ratios for hang time (dichotomized at ≥7.00 days) and elevator mechanism and/or working channel contamination were not significant. Conclusions We did not find a significant association between hang time and risk of duodenoscope contamination. Future guidelines should consider a recommendation of no limit for hang time.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.021
       
  • The value of participatory development to support antimicrobial
           stewardship with a clinical decision support system
    • Authors: Nienke Beerlage-de Jong; Jobke Wentzel; Ron Hendrix; Lisette van Gemert-Pijnen
      Pages: 365 - 371
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Nienke Beerlage-de Jong, Jobke Wentzel, Ron Hendrix, Lisette van Gemert-Pijnen
      Background Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily practice. Our aim was to demonstrate why and how participatory development (involving end-users and other stakeholders) can contribute to the success of CDSSs in ASPs. Methods A mixed-methods approach was applied, combining scenario-based prototype evaluations (to support verbalization of work processes and out-of-the-box thinking) among 6 medical resident physicians with an online questionnaire (to cross-reference findings of the prototype evaluations) among 54 Dutch physicians. Results The prototype evaluations resulted in insight into the end-users and their way of working, as well as their needs and expectations. The online questionnaire that was distributed among a larger group of medical specialists, including lung and infection experts, complemented the findings of the prototype evaluations. It revealed a say/do problem concerning the unrecognized need of support for selecting diagnostic tests. Conclusions Low-fidelity prototypes of a technology allow researchers to get to know the end-users, their way of working, and their work context. Involving experts allows technology developers to continuously check the fit between technology and clinical practice. The combination enables the participatory development of technology to successfully support ASPs.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.12.001
       
  • Bloodborne pathogen exposures: Difference in reporting rates and
           individual predictors among health care personnel
    • Authors: Cynthia Bush; Kendra Schmid; Mark E. Rupp; Shinobu Watanabe-Galloway; Barbara Wolford; Uriel Sandkovsky
      Pages: 372 - 376
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Cynthia Bush, Kendra Schmid, Mark E. Rupp, Shinobu Watanabe-Galloway, Barbara Wolford, Uriel Sandkovsky
      Background Employees in health care settings are at varying risk for bloodborne pathogen (BBP) exposures. We compared differences in reporting rates of BBP exposures among health care personnel during 2 different time periods, assessing job category, years of experience, and sex as potential predictors for exposure. Methods A retrospective review of the employee health department BBP database at 2 time periods (September 1, 2012-April 30, 2013, and September 1, 2013-April 30, 2014) in which 2 different reporting protocols (call center vs pager) was used. A survey was administered to assess reported and unreported exposures within a 12-month period. Results BBP exposures were highest among residents and lowest among students. Physicians' reporting rate doubled when the call center was no longer used (relative risk, 2.40; 95% confidence interval [CI], 1.04-5.52). Percutaneous injuries were the most common (78.3%), and most occurred in the operating room or postanesthesia unit (30.8%) and patient rooms (28.9%). Of 1,105 survey respondents, 103 (9.3%) recalled some type of exposure, but only 80 (77.7%) reported these exposures. When accounting for years of experience and sex, job category was significantly associated with injury or exposure within the previous 12 months (P < .001). Risk of exposure among residents was 3 times higher (odds ratio, 3.10; 95 CI, 1.60-6.00) than nurses. Conclusions Risk and reporting behaviors of BBP exposures vary widely across different providers. Training and education to prevent BBP exposures may need to be tailored toward different provider types.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.028
       
  • Risk of sharps injuries among home care aides: Results of the Safe Home
           Care survey
    • Authors: Natalie M. Brouillette; Margaret M. Quinn; David Kriebel; Pia K. Markkanen; Catherine J. Galligan; Susan R. Sama; Rebecca J. Gore; Angela K. Laramie; Letitia Davis
      Pages: 377 - 383
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Natalie M. Brouillette, Margaret M. Quinn, David Kriebel, Pia K. Markkanen, Catherine J. Galligan, Susan R. Sama, Rebecca J. Gore, Angela K. Laramie, Letitia Davis
      Objectives Home care (HC) aides constitute an essential, rapidly growing workforce. Technology advances are enabling complex medical care at home, including procedures requiring the percutaneous use of sharp medical devices, also known as sharps. Objectives were to quantify risks of sharps injuries (SI) in a large HC aide population, compare risks between major occupational groups, and evaluate SI risk factors. Methods A questionnaire survey was administered to aides hired by HC agencies and directly by clients. One thousand one hundred seventy-eight aides completed questions about SI and potential risk factors occurring in the 12 months before the survey. SI rates were calculated and Poisson regression models identified risk factors. Results Aides had a 2% annual risk of experiencing at least 1 SI (95% confidence interval [CI], 1.1-2.6). Client-hired aides, men, and immigrants had a higher risk than their counterparts. Risk factors among all HC aides included helping a client use a sharp device (rate ratio [RR], 5.62; 95% CI, 2.75-11.50), observing used sharps lying around the home (RR, 2.68; 95% CI, 1.27-5.67), and caring for physically aggressive clients (RR, 2.82; 95% CI, 1.36-5.85). Conclusions HC aides experience serious risks of SI. Preventive interventions are needed, including safety training for clients and their families, as well as aides.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.018
       
  • Antibiotic knowledge and self-medication practices in a developing
           country: A cross-sectional study
    • Authors: Antoun Jamhour; Ammar El-Kheir; Pascale Salameh; Pierre Abi Hanna; Hanine Mansour
      Pages: 384 - 388
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Antoun Jamhour, Ammar El-Kheir, Pascale Salameh, Pierre Abi Hanna, Hanine Mansour
      Background Self-medication is identified by the World Health Organization as a major factor leading to antibiotics overuse, misuse and resistance. This study's objectives were to evaluate the knowledge and self-medication with antibiotics in a sample of the population of Lebanon. Methods This study surveyed a sample of adults (over 18 years of age) residing in 2 major cities in Lebanon about their knowledge and self-medication with antibiotics. Health care professionals were excluded from the study. Results Four hundred questionnaires were completed. Of the responders, 72% were between 18 and 45 years of age with an overall 86% having completed at least high school. For their knowledge about antibiotics, 61% thought that antibiotics should be taken for common cold and 83% knew that misuse of antibiotics could result in microbial resistance. Self-medication significantly correlated with a lower educational level (P = .036). Those with lower knowledge about antibiotics stopped antibiotics at the inappropriate time (P = .002). Socioeconomic status, gender and age did not correlate with self-medication. Conclusion Self-medication was associated with a person's educational level and knowledge of antibiotics. Awareness campaigns and enforcing medication dispensing laws are needed in to avoid self-medication with antibiotics.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.026
       
  • Effects of a mixed media education intervention program on increasing
           knowledge, attitude, and compliance with standard precautions among
           nursing students: A randomized controlled trial
    • Authors: Peng Xiong; Jun Zhang; Xiaohui Wang; Tat Leong Wu; Brian J. Hall
      Pages: 389 - 395
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Peng Xiong, Jun Zhang, Xiaohui Wang, Tat Leong Wu, Brian J. Hall
      Background Standard precautions (SPs) are considered fundamental protective measures to manage health care-associated infections and to reduce occupational health hazards. This study intended to assess the effectiveness of a mixed media education intervention to enhance nursing students' knowledge, attitude, and compliance with SPs. Method A randomized controlled trial with 84 nursing students was conducted in a teaching hospital in Hubei, China. The intervention group (n = 42) attended 3 biweekly mixed media education sessions, consisting of lectures, videos, role-play, and feedback with 15-20 minutes of individual online supervision and feedback sessions following each class. The control group learned the same material through self-directed readings. Pre- and posttest assessments of knowledge, attitudes, and compliance were assessed with the Knowledge with Standard Precautions Questionnaire, Attitude with Standard Precautions Scale, and the Compliance with Standard Precautions Scale, respectively. The Standard Bacterial Colony Index was used to assess handwashing effectiveness. Results At 6-week follow-up, performance on the Knowledge with Standard Precautions Questionnaire, Attitude with Standard Precautions Scale, and Compliance with Standard Precautions Scale were significantly improved in the intervention group compared with the control group (P < .01). The hand hygiene standard in the intervention group (38 passed) outperformed the control group (23 passed) (P < .01). Conclusions A mixed media education intervention is effective in improving knowledge, attitude, and compliance with SPs.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.006
       
  • Predicting and explaining behavioral intention and hand sanitizer use
           among US Army soldiers
    • Authors: Naiqing Lin; Kevin R. Roberts
      Pages: 396 - 400
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Naiqing Lin, Kevin R. Roberts
      Background Using hand sanitizers can reduce bacterial contamination and is an efficient and inexpensive method of preventing infections. The purpose of this study was to explore the behavioral intention (low and absolute), attitudes, subjective norms, and perceived behavioral control of hand sanitizer use among US Army soldiers. Methods A questionnaire was developed following an expert panel (N = 5) review and 2 pilot studies (N = 35) to ensure questionnaire validity and clarity. Surveys were distributed among nontrainee soldiers during lunch periods. A total of 201 surveys were collected. Results Results indicated that attitudes, subjective norms, and perceived behavioral controls explained 64% of the variance in behavioral intention. Attitude remained the strongest predictor of behavior (β = 0.70, P < .01), followed by subjective norms (β = 0.18; P < .01), with significant differences between low and absolute intenders. Conclusions Soldiers with absolute intention to use hand sanitizers hold significantly different behavioral and normative beliefs than low intenders. Other soldiers create negative social pressure about using hand sanitizers, indicating that if other soldiers use hand sanitizers, they will refuse to do so. Intervention to ensure use of hand sanitizer should focus on strengthening behavioral and normative beliefs among low intenders. This should increase the overall well being of the military.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.008
       
  • Reduction of health care–associated infection indicators by copper
           oxide–impregnated textiles: Crossover, double-blind controlled study in
           chronic ventilator-dependent patients
    • Authors: Esther-Lee Marcus; Hana Yosef; Gadi Borkow; Yehezkel Caine; Ady Sasson; Allon E. Moses
      Pages: 401 - 403
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Esther-Lee Marcus, Hana Yosef, Gadi Borkow, Yehezkel Caine, Ady Sasson, Allon E. Moses
      Background Copper oxide has potent wide-spectrum biocidal properties. The purpose of this study is to determine if replacing hospital textiles with copper oxide–impregnated textiles reduces the following health care–associated infection (HAI) indicators: antibiotic treatment initiation events (ATIEs), fever days, and antibiotic usage in hospitalized chronic ventilator-dependent patients. Methods A 7-month, crossover, double-blind controlled trial including all patients in 2 ventilator-dependent wards in a long-term care hospital. For 3 months (period 1), one ward received copper oxide–impregnated textiles and the other received untreated textiles. After a 1-month washout period of using regular textiles, for 3 months (period 2) the ward that received the treated textiles received the control textiles and vice versa. The personnel were blinded to which were treated or control textiles. There were no differences in infection control measures during the study. Results There were reductions of 29.3% (P = .002), 55.5% (P < .0001), 23.0% (P < .0001), and 27.5% (P < .0001) in the ATIEs, fever days (>37.6°C), days of antibiotic treatment, and antibiotic defined daily dose per 1,000 hospitalization days, respectively, when using the copper oxide–impregnated textiles. Conclusions Use of copper oxide–impregnated biocidal textiles in a long-term care ward of ventilator-dependent patients was associated with a significant reduction of HAI indicators and antibiotic utilization. Using copper oxide–impregnated biocidal textiles may be an important measure aimed at reducing HAIs in long-term care medical settings.
      Graphical abstract image

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.022
       
  • Prevalence of and outcomes from Staphylococcus aureus pneumonia among
           hospitalized patients in the United States, 2009-2012
    • Authors: David M. Jacobs; Amy Shaver
      Pages: 404 - 409
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): David M. Jacobs, Amy Shaver
      Background The burden of Staphylococcus aureus pneumonia is unknown despite being a major cause of mortality. We investigated national estimates of methicillin-resistant S aureus (MRSA) and methicillin-susceptible S aureus (MSSA) pneumonias and predictors of in-hospital mortality and hospital length of stay (LOS). Methods This was a retrospective analysis of the National Inpatient Sample from 2009-2012. Adult patients with an ICD-9-CM primary diagnosis code for MRSA or MSSA pneumonia were included. Data weights were used to derive national estimates. Prevalence rates were reported per 100,000 hospital discharges, with trends presented descriptively. Results There were 104,562 patients who had a primary diagnosis of S aureus pneumonia, with 81,275 from MRSA. MRSA pneumonia prevalence decreased steadily from 2009 (75.6 cases per 100,000 discharges) to 2012 (56.6 cases per 100,000 discharges), with MSSA pneumonia experiencing a slight decrease. Mortality rates decreased between 2009 and 2012 for MRSA pneumonia (7.9% to 6.4%) and MSSA pneumonia (6.9% to 4.7%; P = .008). LOS was higher for MRSA (6.9-7.8 days) compared with MSSA (6.1-6.4 days). Conclusions The prevalence of MRSA pneumonia has decreased among hospitalized adults in the United States in recent years accompanied by improvements in mortality and LOS. Although the prevalence of MRSA pneumonia is declining, national vigilance is still warranted.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.014
       
  • Influenza vaccination among workers—21 U.S. states, 2013
    • Authors: Alissa C. O'Halloran; Peng-jun Lu; Walter W. Williams; Pamela Schumacher; Aaron Sussell; Jan Birdsey; Winifred L. Boal; Marie Haring Sweeney; Sara E. Luckhaupt; Carla L. Black; Tammy A. Santibanez
      Pages: 410 - 416
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Alissa C. O'Halloran, Peng-jun Lu, Walter W. Williams, Pamela Schumacher, Aaron Sussell, Jan Birdsey, Winifred L. Boal, Marie Haring Sweeney, Sara E. Luckhaupt, Carla L. Black, Tammy A. Santibanez
      Background Influenza illnesses can result in missed days at work and societal costs, but influenza vaccination can reduce the risk of disease. Knowledge of vaccination coverage by industry and occupation can help guide prevention efforts and be useful during influenza pandemic planning. Methods Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry-occupation module were analyzed. Influenza vaccination coverage was reported by select industry and occupation groups, including health care personnel (HCP) and other occupational groups who may have first priority to receive influenza vaccination during a pandemic (tier 1). The t tests were used to make comparisons between groups. Results Influenza vaccination coverage varied by industry and occupation, with high coverage among persons in health care industries and occupations. Approximately half of persons classified as tier 1 received influenza vaccination, and vaccination coverage among tier 1 and HCP groups varied widely by state. Conclusions This report points to the particular industries and occupations where improvement in influenza vaccination coverage is needed. Prior to a pandemic event, more specificity on occupational codes to define exact industries and occupations in each tier group would be beneficial in implementing pandemic influenza vaccination programs and monitoring the success of these programs.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2017.01.005
       
  • Differential declines in syphilis-related mortality in the United States,
           2000-2014
    • Authors: Noel C. Barragan; Kristin Moschetti; Lisa V. Smith; Frank Sorvillo; Tony Kuo
      Pages: 417 - 420
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Noel C. Barragan, Kristin Moschetti, Lisa V. Smith, Frank Sorvillo, Tony Kuo
      Background After reaching an all time low in 2000, the rate of syphilis in the United States has been steadily increasing. Parallel benchmarking of the disease's mortality burden has not been undertaken. Methods Using ICD-10 classification, all syphilis-related deaths in the national Multiple Cause of Death dataset were examined for the period 2000-2014. Descriptive statistics and age-adjusted mortality rates were generated. Poisson regression was performed to analyze trends over time. A matched case-control analysis was conducted to assess the associations between syphilis-related deaths and comorbid conditions listed in the death records. Results A total of 1,829 deaths were attributed to syphilis; 32% (n = 593) identified syphilis as the underlying cause of death. Most decedents were men (60%) and either black (48%) or white (39%). Decedents aged ≥85 years had the highest average mortality rate (0.47 per 100,000 population; 95% confidence interval [CI], 0.42-0.52). For the sampled period, the average annual decline in mortality was −2.90% (95% CI, −3.93% to −1.87%). However, the average annual percent change varied across subgroups of interest. Conclusions Declines in U.S. syphilis mortality suggest early detection and improved treatment access likely helped attenuate disease progression; however, increases in the disease rate since 2000 may be offsetting the impact of these advancements.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.003
       
  • A meta-analysis of the rates of Staphylococcus aureus and
           methicillin-resistant S aureus contamination on the surfaces of
           environmental objects that health care workers frequently touch
    • Authors: Dongxin Lin; Qianting Ou; Jialing Lin; Yang Peng; Zhenjiang Yao
      Pages: 421 - 429
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Dongxin Lin, Qianting Ou, Jialing Lin, Yang Peng, Zhenjiang Yao
      Background Health care workers may potentially spread Staphylococcus aureus and methicillin-resistant S aureus (MRSA) to patients by contaminated high-touch items. We aimed to determine the pooled rates of S aureus and MRSA contamination and influencing factors. Methods A literature search of the PubMed, ScienceDirect, Embase, Ovid, and Scopus databases was performed. Pooled contamination rates were determined using random effect models. Subgroup and meta-regression analyses were conducted to identify factors potentially influencing the rates of S aureus and MRSA contamination. Sensitivity and publication bias analyses were performed. Results Thirty-eight studies were included in the meta-analysis. The pooled contamination rates were 15.0% (95% confidence interval [CI], 9.8%-21.1%) for S aureus and 5.0% (95% CI, 2.7%-7.7%) for MRSA. The subgroup analyses indicated that the pooled rate of S aureus contamination was significantly higher for studies conducted in South America, in developing countries, and during 2010-2015. The pooled rate of MRSA contamination was significantly higher for studies conducted in Africa. The meta-regression analysis suggested that the pooled rate of S aureus contamination was lower for studies conducted in developed countries (odds ratio, 0.664; 95% CI, 0.509-0.867; P = .004). No bias was found in the publication of the rates of S aureus and MRSA contamination. Conclusions S aureus and MRSA contamination statuses of high-touch items are worrisome and should be paid greater attention. Developing country status was a risk factor for S aureus contamination.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.004
       
  • A real-time surgical site infections surveillance mode to monitor surgery
           classification−specific, hospital-wide surgical site infections in a
           Chinese tertiary hospital
    • Authors: Mingmei Du; Meng Li; Kexin Liu; Jijiang Suo; Yubin Xing; Bowei Liu; Rui Huo; Chunping Chen; Yunxi Liu
      Pages: 430 - 432
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Mingmei Du, Meng Li, Kexin Liu, Jijiang Suo, Yubin Xing, Bowei Liu, Rui Huo, Chunping Chen, Yunxi Liu
      We introduced a real-time surgical site infections surveillance mode (SSISM) to monitor hospital-wide surgical site infections (SSIs) based on the ICD-9-CM Volume 3 operational codes and the ICD-10 disease codes. Compared with the gold standard, the SSISM confirmed 71.9% (82/114) of SSIs from 3,048 operations with a 60-fold time-savings. The SSISM could obtain the SSI rates for each type of surgery or disease among hospital-wide inpatients in a tertiary hospital with 3,800 beds.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.12.002
       
  • An outbreak of surgical site infections following craniotomy procedures
           associated with a change in the ultrasonic surgical aspirator
           decontamination process
    • Authors: Caroline Sheitoyan-Pesant; Isabelle Alarie; Christian Iorio-Morin; David Mathieu; Alex Carignan
      Pages: 433 - 435
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Caroline Sheitoyan-Pesant, Isabelle Alarie, Christian Iorio-Morin, David Mathieu, Alex Carignan
      We investigated an outbreak of surgical site infections that occurred in a tertiary care hospital in Quebec, Canada. This investigation revealed that a change in the sterilization process of the ultrasonic surgical aspirator may have caused this outbreak. It emphasizes the fact that the complex designs of surgical power tools may restrict access to cleaning and sterilization agents. Health care professionals should review manufacturers' assembly/disassembly instructions and sterilization/decontamination procedures before use of such tools.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.020
       
  • Despite awareness of recommendations, why do health care workers not
           immunize pregnant women'
    • Authors: Anat Gesser-Edelsburg; Yaffa Shir-Raz; Samah Hayek; Sharon Aassaraf; Lior Lowenstein
      Pages: 436 - 439
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Anat Gesser-Edelsburg, Yaffa Shir-Raz, Samah Hayek, Sharon Aassaraf, Lior Lowenstein
      Studies indicate uncertainty surrounding vaccination safety and efficacy for pregnant women, causing a central problem for health authorities. In this study, approximately 26% of participants do not recommend the tetanus, diphtheria, and acellular pertussis and influenza vaccines to their patients, although being aware of the health ministry recommendations. We found significant statistical discrepancies between the knowledge about the recommendations and their actual implementation, revealing the concerns of health care workers regarding vaccine safety.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.025
       
  • Transmission of Salmonella enteritidis after endoscopic retrograde
           cholangiopancreatography because of inadequate endoscope decontamination
    • Authors: Paul Robertson; Andrew Smith; Margaret Anderson; Jackie Stewart; Kate Hamilton; Sandra McNamee; Evonne T. Curran
      Pages: 440 - 442
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Paul Robertson, Andrew Smith, Margaret Anderson, Jackie Stewart, Kate Hamilton, Sandra McNamee, Evonne T. Curran
      We report a historic nosocomial outbreak of Salmonella enteritidis affecting 4 inpatients who underwent endoscopic retrograde cholangiopancreatography. The cause was attributed to inadequate decontamination of an on-loan endoscope used over a weekend. This report highlights the risks of using on-loan endoscopes, particularly regarding their commissioning and adherence to disinfection protocols. In an era of increasing antibiotic resistance, transmission of Enterobacteriaceae by endoscopes remains a significant concern.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.024
       
  • Wound and soft tissue infections of Serratia marcescens in patients
           receiving wound care: A health care–associated outbreak
    • Authors: Ebru Us; Huseyin H. Kutlu; Alper Tekeli; Duygu Ocal; Sevilay Cirpan; Kemal O. Memikoglu
      Pages: 443 - 447
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Ebru Us, Huseyin H. Kutlu, Alper Tekeli, Duygu Ocal, Sevilay Cirpan, Kemal O. Memikoglu
      We described a health care–associated Serratia marcescens outbreak of wound and soft tissue infection lasting approximately 11 months at Ankara University Ibni Sina Hospital. After identification of S marcescens strains from the clinical and environmental samples, and their susceptibility testing to antimicrobial agents, pulsed-field gel electrophoresis (PFGE) was performed to detect molecular epidemiologic relationships among these isolates. The strains which were isolated from the saline bottles used for wound cleansing in the wound care unit were found to be 100% interrelated by PFGE to the strains from the samples of the outbreak patients. Reuse of the emptied bottles has no longer been allowed since the outbreak occurred. Besides, more efficient and frequent infection control training for hospital staff has been conducted.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.015
       
  • No bacterial growth found in spiked intravenous fluids over an 8-hour
           period
    • Authors: Richard E. Haas; Edwin Beitz; Amy Reed; Howard Burtnett; Jason Lowe; Arthur E. Crist; Kevin A. Stierer; Allan M. Birenberg
      Pages: 448 - 450
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Richard E. Haas, Edwin Beitz, Amy Reed, Howard Burtnett, Jason Lowe, Arthur E. Crist, Kevin A. Stierer, Allan M. Birenberg
      Protocol changes prompted by the Joint Commission mandating intravenous (IV) fluid bags to be used within 1 hour of spiking because of possible bacterial contamination have sparked clinical and economic concerns. This study investigated the degree of bacterial growth in which samples were obtained from spiked IV fluid bags at the time of spiking and 1, 2, 4, and 8 hours after spiking. No bacterial growth occurred in any of the 80 bags of Lactated Ringer's (LR) IV solutions sampled. This study demonstrated that LR IV bags do not support any bacterial growth for up to 8 hours after spiking.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.011
       
  • Antimicrobial stewardship practices in Virginia
    • Authors: Kimberly B. Lee; Jesus Aaron Ramirez; Rebeccah Collins; John Bucheit; Kakotan Sanogo; Michael P. Stevens
      Pages: 451 - 452
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Kimberly B. Lee, Jesus Aaron Ramirez, Rebeccah Collins, John Bucheit, Kakotan Sanogo, Michael P. Stevens
      The Society of Healthcare Epidemiology of America, the Centers for Disease Control and Prevention, and the President's Council of Advisors on Science and Technology recognize the need to combat antimicrobial resistance through the promotion of antimicrobial stewardship programs. Health care facilities in Virginia were surveyed using a 23-item survey focused on facility characteristics and antimicrobial stewardship strategies. Antimicrobial stewardship activities were highly variable and many are missing key personnel and resources.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.009
       
  • Nosocomial outbreak of extensively drug-resistant Pseudomonas aeruginosa
           associated with aromatherapy
    • Authors: Astrid Mayr; Guido Hinterberger; Ingo H. Lorenz; Peter Kreidl; Wolfgang Mutschlechner; Cornelia Lass-Flörl
      Pages: 453 - 455
      Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4
      Author(s): Astrid Mayr, Guido Hinterberger, Ingo H. Lorenz, Peter Kreidl, Wolfgang Mutschlechner, Cornelia Lass-Flörl
      An increase of extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) in various clinical specimens among intensive care unit patients (n = 7) initiated an outbreak investigation consisting of patient data analyses, control of adherence to infection control guidelines, microbiologic surveys, and molecular-based studies. XDR-PA was detected in a jointly used aroma-oil nursing bottle for aromatherapy. We implemented the restriction of oil sharing among patients. Hence, the outbreak was controlled successfully.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2016.11.002
       
  • Mumps 2017: The role of educational institutes in preventing the spread of
           the disease
    • Authors: Saba Ahmed; Iqra Aziz
      Abstract: Publication date: Available online 19 April 2017
      Source:American Journal of Infection Control
      Author(s): Saba Ahmed, Iqra Aziz


      PubDate: 2017-04-21T05:27:00Z
      DOI: 10.1016/j.ajic.2017.03.027
       
  • Ultraviolet-C light as a means of disinfecting anesthesia workstations
    • Authors: Matthew Nottingham; Gene Peterson; Christopher Doern; Michelle Doll; Nadia Masroor; Kakotan Sanogo; Michael Stevens; Gonzalo Bearman
      Abstract: Publication date: Available online 18 April 2017
      Source:American Journal of Infection Control
      Author(s): Matthew Nottingham, Gene Peterson, Christopher Doern, Michelle Doll, Nadia Masroor, Kakotan Sanogo, Michael Stevens, Gonzalo Bearman
      Background Anesthesia workstations (AWs) are a reservoir for pathogenic organisms potentially associated with surgical site infections. This study examined the effectiveness of the Tru-D SmartUVC device (Tru-D LLC, Nashville, TN) on bioburden reduction (BR) on AWs. Methods Strips of tissue inoculated with a known concentration of either Staphylococcus aureus, Enterococcus faecalis, or Acinetobacter sp were placed on 22 high-touch surfaces of an AW. Half of the AW surfaces received direct ultraviolet (UV) light exposure and half received indirect exposure. Two inoculated strips, in sterile tubes outside of the room, represented the control. Trials were conducted on AWs in an operating room and a small room. Strips were placed in a saline solution, vortexed, and plated on blood agar to assess BR by the number of colony forming units. Results All experimental trials, compared with controls, exhibited a BR >99%. There was a significantly greater reduction of E faecalis colony forming units in the operating room AW under direct exposure (P = .019) compared with indirect exposure. There was no significant difference in reduction when comparing AWs between rooms. Conclusion Regardless of room size and exposure type, automated UV-C treatment greatly influences BR on AW high-touch surfaces. Hospitals instituting an automated UV-C system as an infection prevention adjunct should consider utilizing it in operating rooms for BR as part of a horizontal infection prevention surgical site infection-reduction strategy.

      PubDate: 2017-04-21T05:27:00Z
      DOI: 10.1016/j.ajic.2017.02.016
       
  • How well does transfer of bacterial pathogens by culture swabs correlate
           with transfer by hands?
    • Authors: Anubhav Kanwar; Thriveen S.C. Mana; Jennifer L. Cadnum; Heba Alhmidi; Sreelatha Koganti; Curtis J. Donskey
      Abstract: Publication date: Available online 18 April 2017
      Source:American Journal of Infection Control
      Author(s): Anubhav Kanwar, Thriveen S.C. Mana, Jennifer L. Cadnum, Heba Alhmidi, Sreelatha Koganti, Curtis J. Donskey
      In laboratory testing and in isolation rooms, pickup and transfer of health care-associated pathogens by premoistened rayon swabs correlated well with pickup and transfer by bare hands or moistened gloves. These results suggest that swab cultures provide a useful surrogate indicator of the risk for pathogen pickup and transfer by hands.

      PubDate: 2017-04-21T05:27:00Z
      DOI: 10.1016/j.ajic.2017.03.001
       
  • Guideline compliance and clinical outcomes among patients with
           Staphylococcus aureus bacteremia with infectious diseases consultation in
           addition to antimicrobial stewardship-directed review
    • Authors: Kevin Buehrle; Jennifer Pisano; Zhe Han; Natasha N. Pettit
      Abstract: Publication date: Available online 18 April 2017
      Source:American Journal of Infection Control
      Author(s): Kevin Buehrle, Jennifer Pisano, Zhe Han, Natasha N. Pettit
      Objective Previous studies have shown infectious diseases consultation (IDC) for Staphylococcus aureus bacteremia (SAB) improves management and outcomes. The influence of IDC on outcomes for SAB in addition to an antimicrobial stewardship program (ASP) review for adult inpatients with SAB has not been evaluated. The purpose of this study was to investigate the effect of IDC on SAB management with concomitant ASP review and resulting outcomes. Methods Adult inpatients with SAB admitted December 2012-October 2014 were included. The primary end point compared adherence to Infectious Disease Society of America guideline recommendations between patients receiving an IDC versus those not receiving an IDC. We also evaluated adherence to the individual components of the primary end point and clinical outcomes, including time to microbiologic clearance, recurrence of bacteremia, mortality, and length of stay. Results This study included 154 patients (115 IDC and 39 non-IDC). Guideline adherence was significantly greater in the IDC group 78% versus 46% in the non-IDC group (P < .001). Significantly more patients in the IDC group had echocardiography (91% vs 67%; P < .001) and follow-up blood cultures (92% vs 64%; P > .001). Mortality was also greater in the non-IDC group (23%) versus 5% for the IDC group (P = .001). Conclusions Patients with SAB receiving an IDC were more likely to receive guideline-congruent management and had significantly reduced mortality. No improvements in antibiotic choice or dosing were observed, likely a result of ASP review.

      PubDate: 2017-04-21T05:27:00Z
      DOI: 10.1016/j.ajic.2017.02.030
       
  • Prospective cluster controlled crossover trial to compare the impact of an
           improved hydrogen peroxide disinfectant and a quaternary ammonium-based
           disinfectant on surface contamination and health care outcomes
    • Authors: John M. Boyce; Kerri A. Guercia; Linda Sullivan; Nancy L. Havill; Renee Fekieta; Janet Kozakiewicz; David Goffman
      Abstract: Publication date: Available online 18 April 2017
      Source:American Journal of Infection Control
      Author(s): John M. Boyce, Kerri A. Guercia, Linda Sullivan, Nancy L. Havill, Renee Fekieta, Janet Kozakiewicz, David Goffman
      Background Quaternary ammonium–based (Quat) disinfectants are widely used, but they have disadvantages. Methods This was a 12-month prospective cluster controlled crossover trial. On 4 wards, housekeepers performed daily cleaning using a disinfectant containing either 0.5% improved hydrogen peroxide (IHP) or Quat. Each month, 5-8 high-touch surfaces in several patient rooms on each ward were tagged with a fluorescent marker and cultured before and after cleaning. Hand hygiene compliance rates and antimicrobial usage on study wards were obtained from hospital records. Outcomes included aerobic colony counts (ACCs), percent of wiped surfaces yielding no growth after cleaning, and a composite outcome of incidence densities of nosocomial acquisition and infection caused by vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and Clostridium difficile infection. Statistical analysis was performed using χ2 test, Fisher exact test, Welch test, and logistic regression methods. Results Mean ACCs per surface after cleaning were significantly lower with IHP (14.0) than with Quat (22.2) (P = .003). The proportion of surfaces yielding no growth after cleaning was significantly greater with IHP (240/500; 48%) than with Quat (182/517; 35.2%) (P < .0001). Composite incidence density of nosocomial colonization or infection with IHP (8.0) was lower than with Quat (10.3) (incidence rate ratio, 0.77; P = .068; 95% confidence interval, 0.579-1.029). Conclusions Compared with a Quat disinfectant, the IHP disinfectant significantly reduced surface contamination and reduced a composite colonization or infection outcome.

      PubDate: 2017-04-21T05:27:00Z
      DOI: 10.1016/j.ajic.2017.03.010
       
  • Epidemiology of device-associated infections in an intensive care unit of
           a teaching hospital in Nepal: A prospective surveillance study from a
           developing country
    • Authors: Narayan Prasad Parajuli; Subhash Prasad Acharya; Santosh Dahal; Jaya Prasad Singh; Shyam Kumar Mishra; Hari Prasad Kattel; Basista Prasad Rijal; Bharat Mani Pokhrel
      Abstract: Publication date: Available online 18 April 2017
      Source:American Journal of Infection Control
      Author(s): Narayan Prasad Parajuli, Subhash Prasad Acharya, Santosh Dahal, Jaya Prasad Singh, Shyam Kumar Mishra, Hari Prasad Kattel, Basista Prasad Rijal, Bharat Mani Pokhrel
      Background Device-associated health care-acquired infections (DA-HAIs) in intensive care unit patients are a major cause of morbidity, mortality, and increased health care costs. Methods A prospective, structured clinicomicrobiological surveillance was carried out for 3 common DA-HAIs: ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) present in the patients of an intensive care unit of a teaching hospital in Nepal. DA-HAIs were identified using the Centers for Disease Control and Prevention definitions, and their rates were expressed as number of DA-HAIs per 1,000 device-days. Results Overall incidence rate of DA-HAIs was 27.3 per 1,000 patient-days occurring in 37.1% of patients. The device utilization ratio for mechanical ventilation, central line catheter, and urinary catheter was 0.83, 0.63, and 0.78, respectively. The rates of VAP, CLABSI, and CAUTI were 21.40, 8.64, and 5.11 per 1,000 device-days, respectively. Acinetobacter spp (32.7%), Klebsiella spp (23.6%), Burkholderia cepacia complex (12.7%), and Escherichia coli (10.9%) were the common bacterial pathogens. Most of the bacterial isolates associated with DA-HAIs were found to be multidrug-resistant. Conclusions Incidence of DA-HAIs in the study intensive care unit was high compared with that of developed countries. Formulation and implementation of standard infection control protocols, active surveillance of DA-HAIs, and antimicrobial stewardship are urgently needed in our country.

      PubDate: 2017-04-21T05:27:00Z
      DOI: 10.1016/j.ajic.2017.02.040
       
  • Implementation of daily chlorhexidine bathing to reduce colonization by
           multidrug-resistant organisms in a critical care unit
    • Authors: Jackson S. Musuuza; Ajay K. Sethi; Tonya J. Roberts; Nasia Safdar
      Abstract: Publication date: Available online 18 April 2017
      Source:American Journal of Infection Control
      Author(s): Jackson S. Musuuza, Ajay K. Sethi, Tonya J. Roberts, Nasia Safdar
      Background Colonized patients are a reservoir for transmission of multidrug-resistant organisms (MDROs). Not many studies have examined the effectiveness of daily chlorhexidine gluconate (CHG) bathing under routine care conditions. We present a descriptive analysis of the trends of MDRO colonization following implementation of daily CHG bathing under routine clinical conditions in an intensive care unit (ICU). Methods From May 2010-January 2011, we screened patients admitted to a 24-bed ICU for and methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and fluoroquinolone-resistant gram-negative bacilli (FQRGNB). We calculated and plotted monthly incidence and prevalence of colonization of these MDROs. Results Prevalence decreased in the immediate aftermath of daily CHG bathing implementation and generally remained at that level throughout the observation period. We observed low rates of incidence of MDRO colonization with VRE>FQRGNB>MRSA. Monthly prevalence of colonization and incidence for the composite of MRSA, VRE, and/or FQRGNB was 1.9%-27.9% and 0-1.1/100 patient-days, respectively. Conclusions Following the implementation of daily CHG bathing, the incidence of MDROs remained low and constant over time, whereas the prevalence decreased immediately after the implementation.

      PubDate: 2017-04-21T05:27:00Z
      DOI: 10.1016/j.ajic.2017.02.038
       
  • Transmission of methicillin-resistant Staphylococcus aureus to health care
           worker gowns and gloves during care of residents in Veterans Affairs
           nursing homes
    • Authors: Lisa Pineles; Daniel J. Morgan; Alison Lydecker; J. Kristie Johnson; John D. Sorkin; Patricia Langenberg; Natalia Blanco; Alan Lesse; John Sellick; Kalpana Gupta; Luci Leykum; Jose Cadena; Nickie Lepcha; Mary-Claire Roghmann
      Abstract: Publication date: Available online 18 April 2017
      Source:American Journal of Infection Control
      Author(s): Lisa Pineles, Daniel J. Morgan, Alison Lydecker, J. Kristie Johnson, John D. Sorkin, Patricia Langenberg, Natalia Blanco, Alan Lesse, John Sellick, Kalpana Gupta, Luci Leykum, Jose Cadena, Nickie Lepcha, Mary-Claire Roghmann
      Background This was an observational study designed to estimate the frequency of methicillin-resistant Staphylococcus aureus (MRSA) transmission to gowns and gloves worn by health care workers (HCWs) interacting with Veterans Affairs Community Living Center (VA nursing home) residents to inform MRSA prevention policies. Methods Participants included residents and HCWs from 7 VA nursing homes in 4 states and Washington, DC. Residents were cultured for MRSA at the anterior nares, perianal skin, and wound (if present). HCWs wore gowns and gloves during usual care activities. After each activity, a research coordinator swabbed the HCW's gown and gloves. Swabs were cultured for MRSA. Results There were 200 residents enrolled; 94 (46%) were MRSA colonized. Glove contamination was higher than gown contamination (20% vs 11%, respectively; P < .01). Transmission varied greatly by type of care from 0%-19% for gowns and 7%-37% for gloves. High-risk care activities (odds ratio [OR] > 1.0, P < .05) for gown contamination included changing dressings (eg, wound), dressing, providing hygiene (eg, brushing teeth), and bathing. Low-risk care activities (OR < 1.0, P < .05 or no transmission) for gown contamination included glucose monitoring, giving medications, and feeding. Conclusions MRSA transmission from colonized residents to gloves was higher than transmission to gowns. Transmission to gloves varies by type of care, but all care had a risk of contamination, demonstrating the importance of hand hygiene after all care. Transmission to gowns was significantly higher with certain types of care. Optimizing gown and glove use by targeting high-risk care activities could improve resident-centered care for MRSA-colonized residents by promoting a home-like environment.

      PubDate: 2017-04-21T05:27:00Z
      DOI: 10.1016/j.ajic.2017.03.004
       
  • Health care–associated infections studies project: An American Journal
           of Infection Control and National Healthcare Safety Network data quality
           collaboration
    • Authors: Henrietta Smith; Janet E. Brooks; Denise Leaptrot; Katherine Allen-Bridson; Angela Anttila; Cindy Gross; Joan N. Hebden; Georganne Ryan; Eileen Scalise; Marc-Oliver Wright
      Abstract: Publication date: Available online 18 April 2017
      Source:American Journal of Infection Control
      Author(s): Henrietta Smith, Janet E. Brooks, Denise Leaptrot, Katherine Allen-Bridson, Angela Anttila, Cindy Gross, Joan N. Hebden, Georganne Ryan, Eileen Scalise, Marc-Oliver Wright
      This case study is part of a series centered on the Centers for Disease Control and Prevention's National Healthcare Safety Network's (NHSN) health care–associated infection (HAI) surveillance definitions. The intent of the case study series is to foster standardized application of the NHSN's HAI surveillance definitions among infection preventionists and accurate determination of HAI events. This specific case study focuses on the definitions found within the surgical site infection (SSI) protocol. It aims to reflect the real life and complex patient scenario surrounding a bloodstream infection that is secondary to an SSI and the application of the Present at the Time of Surgery event detail. An online survey link is provided where participants may confidentially answer questions related to the case study and receive immediate feedback in the form of correct answers and explanations and rationales. Details of the case study, answers, and explanations have been reviewed and approved by NHSN staff. We hope that participants take advantage of this educational offering and thereby gain a greater understanding of the NHSN's HAI surveillance definitions.

      PubDate: 2017-04-21T05:27:00Z
      DOI: 10.1016/j.ajic.2017.01.031
       
  • Infection prevention and control and the refugee population: Experiences
           from the University of Louisville Global Health Center
    • Authors: Ruth M. Carrico; Linda Goss; Timothy L. Wiemken; Rahel S. Bosson; Paula Peyrani; William A. Mattingly; Allison Pauly; Rebecca A. Ford; Stanley Kotey; Julio A. Ramirez
      Abstract: Publication date: Available online 18 April 2017
      Source:American Journal of Infection Control
      Author(s): Ruth M. Carrico, Linda Goss, Timothy L. Wiemken, Rahel S. Bosson, Paula Peyrani, William A. Mattingly, Allison Pauly, Rebecca A. Ford, Stanley Kotey, Julio A. Ramirez
      Background During 2016, approximately 140,000 individuals entered the United States as part of the federal government refugee resettlement program and established themselves in communities in virtually every state. No national database regarding refugee health currently exists; therefore, little is known about existing infectious diseases, conditions, and cultural practices that impact successful acculturation. The objective of this report is to identify what is currently known about refugees and circumstances important to infection prevention and control with respect to their roles as new community members, employees, and consumers of health care. Methods Using data from the University of Louisville Global Health Center's Newly Arriving Refugee Surveillance System, health issues affecting refugees from the perspective of a community member, an employee, and a patient were explored. Results Lack of immunity to vaccine-preventable diseases is the most widespread issue impacting almost every adult, adolescent, and child refugee resettled in Kentucky. Health issues of concern from an infection prevention and control perspective include latent tuberculosis infection, HIV, hepatitis B, hepatitis C, syphilis, and parasites. Other health conditions that may also be important include anemia, obesity, oral health, diabetes, and cardiovascular disease. Conclusions Refugee resettlement provides motivation for collaborative work among those responsible for infection prevention and control in all settings, their public health partners, and those responsible for and interested in community workforce concerns.

      PubDate: 2017-04-21T05:27:00Z
      DOI: 10.1016/j.ajic.2017.02.032
       
  • Klebsiella pneumoniae carbapenemase-producing Serratia marcescens outbreak
           in a university hospital
    • Authors: Felipe Francisco Tuon; Kassia Cordova; Thayrine Mayara Dario; Luciana de Souza Nunes; Afonso Luís Barth; Andreza Francisco Martins
      Abstract: Publication date: Available online 18 April 2017
      Source:American Journal of Infection Control
      Author(s): Felipe Francisco Tuon, Kassia Cordova, Thayrine Mayara Dario, Luciana de Souza Nunes, Afonso Luís Barth, Andreza Francisco Martins


      PubDate: 2017-04-21T05:27:00Z
      DOI: 10.1016/j.ajic.2017.03.002
       
  • Comparing knowledge and self-reported hand hygiene practices with direct
           observation among Iranian hospital nurses
    • Authors: Seyed Sadeq Seyed Nematian; Charles John Palenik; Seyed Kousha Mirmasoudi; Nahid Hatam; Mehrdad Askarian
      Abstract: Publication date: Available online 18 April 2017
      Source:American Journal of Infection Control
      Author(s): Seyed Sadeq Seyed Nematian, Charles John Palenik, Seyed Kousha Mirmasoudi, Nahid Hatam, Mehrdad Askarian
      We compared knowledge and self-reported hand hygiene practices with direct observations among Shiraz Nemazee Hospital nurses. Overall hand hygiene compliance was low (39.6%). Use and appreciation for alcohol-based handrubs were suboptimal. Some reluctance was due to religious concerns. Most nurses self-reported performing proper hand hygiene more than 75% of the time, whereas direct observation indicated much lower levels of compliance. It appears that additional training and improved monitoring are needed.

      PubDate: 2017-04-21T05:27:00Z
      DOI: 10.1016/j.ajic.2017.03.007
       
  • Active offer of vaccinations during hospitalization improves coverage
           among splenectomized patients: An Italian experience
    • Authors: Maria Serena Gallone; Carmen Martino; Michele Quarto; Silvio Tafuri; Margari Antonio; Memeo Vincenzo; Palasciano Nicola; Pezzolla Angela; Testini Mario; Vincenti Leonardo
      Abstract: Publication date: Available online 11 April 2017
      Source:American Journal of Infection Control
      Author(s): Maria Serena Gallone, Carmen Martino, Michele Quarto, Silvio Tafuri
      In 2014, an Italian hospital implemented a protocol for pneumococcal, meningococcal, and Haemophilus influenzae type b vaccines offer to splenectomized patients during their hospitalization. After 1 year, coverage for recommended vaccinations increased from 5.7%-66.7% and the average time between splenectomy and vaccines administration decreased from 84.7-7.5 days.

      PubDate: 2017-04-14T06:42:29Z
      DOI: 10.1016/j.ajic.2017.02.039
       
  • Staphylococcus aureus surface contamination of mobile phones and presence
           of genetically identical strains on the hands of nursing personnel
    • Authors: Akiko Katsuse Kanayama; Hiroshi Takahashi; Sadako Yoshizawa; Kazuhiro Tateda; Akihiro Kaneko; Intetsu Kobayashi
      Abstract: Publication date: Available online 11 April 2017
      Source:American Journal of Infection Control
      Author(s): Akiko Katsuse Kanayama, Hiroshi Takahashi, Sadako Yoshizawa, Kazuhiro Tateda, Akihiro Kaneko, Intetsu Kobayashi
      We investigated the genetic relatedness of Staphylococcus aureus isolates recovered from mobile phones and palms and fingers of users. Genetically identical isolates were detected from mobile phones and their user and multiple users, which is consistent with mobile phones serving as reservoirs of infection in the health care environment. These findings reinforce the need for hand hygiene prior to patient contact as the most effective intervention for preventing health care–associated infection.

      PubDate: 2017-04-14T06:42:29Z
      DOI: 10.1016/j.ajic.2017.02.011
       
  • Crimean-Congo hemorrhagic fever: A neglected infectious disease with
           potential nosocomial infection threat
    • Authors: Hakan Leblebicioglu; Resat Ozaras; Mustafa Sunbul
      Abstract: Publication date: Available online 11 April 2017
      Source:American Journal of Infection Control
      Author(s): Hakan Leblebicioglu, Resat Ozaras, Mustafa Sunbul


      PubDate: 2017-04-14T06:42:29Z
      DOI: 10.1016/j.ajic.2016.05.039
       
  • Treated-and-released urinary catheterization in the emergency department
           by sex
    • Authors: Scott Martin Vouri; Margaret A. Olsen; Daniel Theodoro; Seth A. Strope
      Abstract: Publication date: Available online 11 April 2017
      Source:American Journal of Infection Control
      Author(s): Scott Martin Vouri, Margaret A. Olsen, Daniel Theodoro, Seth A. Strope
      Background The prevalence and difference in likely indications of urinary catheterization (UC) in treated-and-released emergency department (ED) visits between men and women are currently unknown. Methods This was a cross-sectional analysis using the 2013 National Emergency Department Sample for all treated-and-released visits in persons aged ≥18 years. The prevalence of conditions associated with UC visits in men and women were identified. A hierarchical ranking was used to categorize diagnosis codes identified during ED visits into clinically meaningful categories to assess conditions for UC. Results In 2013, there were 87,797,062 treated-and-released ED visits in adults. The rate of UC in treated-and-released ED visits in adults was 4.3 per 1,000 visits, with 6.5 per 1,000 visits in men and 2.7 per 1,000 visits in women. Using the hierarchal ranking, a higher proportion of UC visits in men were coded for acute urinary retention, and a higher proportion of UC visits in women were coded for neurologic, cognitive, and psychiatric conditions. Conclusions The rate of UC in treated-and-released ED visits was higher in men than women, and UC rate increased with age. The heterogeneity of conditions coded in UC visits in women compared with men may suggest more potentially avoidable UC in women in the treated-and-released ED population. If confirmed, this would suggest opportunities for quality improvement in the ED to prevent overutilization of urinary catheters.

      PubDate: 2017-04-14T06:42:29Z
      DOI: 10.1016/j.ajic.2017.02.025
       
  • Self-reported behaviors and perceptions of Australian paramedics in
           relation to hand hygiene and gloving practices in paramedic-led health
           care
    • Authors: Nigel Barr; Mark Holmes; Anne Roiko; Peter Dunn; Bill Lord
      Abstract: Publication date: Available online 3 April 2017
      Source:American Journal of Infection Control
      Author(s): Nigel Barr, Mark Holmes, Anne Roiko, Peter Dunn, Bill Lord
      Background Noncompliance with recommended hand hygiene and gloving practices by workers in the emergency medical services may contribute to the transmission of health care–associated infections and lead to poor patient outcomes. The aim of this study was to explore the self-reported behaviors and perceptions of Australian paramedics in relation to their hand hygiene and gloving practices in paramedic-led health care. Methods A national online survey (n = 417; 17% response rate) and 2 semistructured focus groups (6 per group) were conducted with members of Paramedics Australasia. Results Although most of the study participants perceived hand hygiene and gloving to be important, the findings suggest poor compliance with both practices, particularly during emergency cases. All participants reported wearing gloves throughout a clinical case, changing them either at the completion of patient care or when visibly soiled or broken. Hand hygiene was missed at defined moments during patient care, possibly from the misuse of gloves. Conclusions Paramedic hand hygiene and gloving practices require substantial improvement to lower potential transmission of pathogens and improve patient safety and clinical care. Further research is recommended to explore how to alleviate the barriers to performing in-field hand hygiene and the misuse of gloves during paramedic-led health care.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2017.02.020
       
  • Middle East respiratory syndrome risk perception among students at a
           university in South Korea, 2015
    • Authors: Seongwoo Yang; Sung-Il Cho
      Abstract: Publication date: Available online 3 April 2017
      Source:American Journal of Infection Control
      Author(s): Seongwoo Yang, Sung-Il Cho
      Background The 2015 Middle East respiratory syndrome (MERS) outbreak in South Korea was a serious threat to public health, and was exacerbated by the inappropriate responses of major institutions and the public. This study examined the sources of confusion during the MERS outbreak and identified the factors that can affect people's behavior. Methods An online survey of the risk perception of university students in South Korea was performed after the epidemic had peaked. The questionnaire addressed the major social determinants in South Korea during the MERS epidemic. The analysis included data from 1,470 subjects who provided complete answers. Results The students had 53.5% of the essential knowledge about MERS. Women showed higher risk perception than men, and trust in the media was positively associated with risk perception (P < .001). Additionally, risk perception was positively associated with overreaction by the public (odds ratio, 2.80; 95% confidence interval, 2.17-3.60; P < .001). These findings suggest that media content affected the public's perception of MERS risk and that perception of a high level of risk led to overreaction. Conclusions Risk perception was associated with most of the social factors examined and overreaction by the public. Therefore, providing accurate information and data to the public, establishing trust, and facilitating the development of an attitude will all be important in future crises.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2017.02.013
       
  • Clinical and social barriers to antimicrobial stewardship in pulmonary
           medicine: A qualitative study
    • Authors: Jennifer K. Broom; Alex F. Broom; Emma R. Kirby; Alexandra F. Gibson; Jeffrey J. Post
      Abstract: Publication date: Available online 3 April 2017
      Source:American Journal of Infection Control
      Author(s): Jennifer K. Broom, Alex F. Broom, Emma R. Kirby, Alexandra F. Gibson, Jeffrey J. Post
      Background The treatment of pulmonary infections is one of the largest indications for antibiotics in human health care, offering significant potential for antibiotic optimization internationally. This study explores the perspectives of pulmonary clinicians on antibiotic use in hospital pulmonary infections. Methods Twenty-eight pulmonary doctors and nurses from 2 hospitals participated in semi-structured interviews focusing on their experiences of antibiotic use. Results Barriers to antibiotic optimization in pulmonary infections were identified. Clinical barriers are as follows. The first is differentiating pneumonia vs chronic obstructive pulmonary disease: differentiating pulmonary diagnoses was reported as challenging, leading to overtreatment. The second is differentiating viral vs bacterial: diagnostic differentiation was perceived to contribute to excess antibiotic use. The third is differentiating colonization vs pathogen: the interpretation of ambiguous results was reported to lead to under- or overprescribing depending on the perspective of the treating team. Social barriers are as follows. The first is the perception of resistance: antibiotic resistance was not perceived as an immediate threat. The second is the perceived value of antibiotic clinical guidelines: there was mistrust in antibiotic guidelines. The third is hospital hierarchies: hierarchical structures had a significant influence on prescribing. Conclusions Substantial barriers to antibiotic optimization in pulmonary infections were identified. To facilitate change in antibiotic use there must be a systematic understanding and interventions to address specific clinical issues. In the case of pulmonary medicine, significant identified issues, such as mistrust in clinical guidelines and diagnostic challenges, need to be addressed.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2017.03.003
       
  • Microbiology of surgical site infections in patients with cancer: A 7-year
           review
    • Authors: Juan Carlos Hernaiz-Leonardo; Maria Fernanda Golzarri; Patricia Cornejo-Juárez; Patricia Volkow; Consuelo Velázquez; Mauricio Ostrosky-Frid; Diana Vilar-Compte
      Abstract: Publication date: Available online 3 April 2017
      Source:American Journal of Infection Control
      Author(s): Juan Carlos Hernaiz-Leonardo, Maria Fernanda Golzarri, Patricia Cornejo-Juárez, Patricia Volkow, Consuelo Velázquez, Mauricio Ostrosky-Frid, Diana Vilar-Compte
      Background Health care–associated infections (HAIs) have arisen as major sources of multidrug-resistant bacteria. Surgical site infections (SSIs) are the most frequent HAIs in many countries, with high antimicrobial-resistant prevalence. Methods A 7-year retrospective review (2008-2014) of microbiologic data within a prospective surveillance program on patients with SSI at a cancer hospital in Mexico. Results There were 23,421 surgeries performed during the study period. The SSI rate was 7.9%. Gram-negative bacilli (GNB) were found in 56.5% of samples. Escherichia coli was the most frequent microorganism (27.5%), followed by Staphylococcus aureus (16.3%). SSI caused by S aureus showed a decreasing trend (P = .04). Extended-spectrum β-lactamase (ESBL)–producing E coli increased from 39.5% in 2008 to 72.5% in 2014 (P < .001). Fluoroquinolone resistance also increased in all members of the Enterobacteriaceae. Methicillin-resistant S aureus (MRSA) was isolated in 32% of cases with no significant increase (P value is not significant). Conclusions GNB caused most SSIs, with an increase of ESBL E coli strains. In breast and thoracic surgery, S aureus remained the most frequent isolate. MRSA remained stable throughout the study period. We observed a decreasing trend in S aureus. These findings show the differences in the microbiology of SSIs in a middle-income country and the increasing trend of ESBL enterobacteria and other multidrug-resistant organisms, such as Enterococcus faecium.

      PubDate: 2017-04-07T06:54:27Z
      DOI: 10.1016/j.ajic.2017.02.023
       
  • APIC Masthead
    • Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4


      PubDate: 2017-04-07T06:54:27Z
       
  • Information for Readers
    • Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4


      PubDate: 2017-04-07T06:54:27Z
       
  • Information for Authors
    • Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4


      PubDate: 2017-04-07T06:54:27Z
       
  • APIC 2017 to feature hot topics in infection prevention
    • Abstract: Publication date: 1 April 2017
      Source:American Journal of Infection Control, Volume 45, Issue 4


      PubDate: 2017-04-07T06:54:27Z
       
 
 
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