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Publisher: Elsevier   (Total: 3049 journals)

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Showing 1 - 200 of 3089 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 7)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 25, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 86, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, 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: 363, 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   (Followers: 1)
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: 229, 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: 10, 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: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 24, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, 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: 4, 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)
Acute Pain     Full-text available via subscription   (Followers: 13)
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: 6)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 21)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 132, 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: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, 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: 26, 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: 11, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, 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: 25, 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 Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
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: 27, 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: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, 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 Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 7)
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: 45, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 26, 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: 43, 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: 51, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
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: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
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: 36, 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: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
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: 6, 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: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 8, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
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: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, 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: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 62)
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: 2, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 360, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 44, 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: 331, 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: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 417, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 16, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 40, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 55, 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: 5, 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: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
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   (Followers: 1)
Algal Research     Partially Free   (Followers: 8, 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: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 46, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 49, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 40, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, 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: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, 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: 199, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 59, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
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: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 25, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 35, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 58, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 12)
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: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 167, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  

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Journal Cover American Journal of Infection Control
  [SJR: 1.259]   [H-I: 81]   [26 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0196-6553
   Published by Elsevier Homepage  [3049 journals]
  • Emergence of carbapenem-resistant Enterobacteriaceae in Orange County,
           California, and support for early regional strategies to limit spread
    • Authors: Shruti K. Gohil; Raveena Singh; Justin Chang; Adrijana Gombosev; Tom Tjoa; Matthew Zahn; Patti Steger; Susan S. Huang
      Pages: 1177 - 1182
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Shruti K. Gohil, Raveena Singh, Justin Chang, Adrijana Gombosev, Tom Tjoa, Matthew Zahn, Patti Steger, Susan S. Huang
      Background The east-to-west spread of carbapenem-resistant Enterobacteriaceae (CRE) represents an opportunity to explore strategies to limit spread in nonendemic areas. We evaluated CRE emergence and regional support for containment strategies. Methods A 17-question cross-sectional survey was administered to infection prevention programs in Orange County, CA (31 hospitals serving 3 million residents), between January and September 2014. Questions addressed newly detected hospital- and community-onset CRE cultures (2008-2013), current CRE control strategies, and support for prevention strategies for a hypothetical regional intervention. Results Among 31 hospitals, 21 (68%, representing 17 infection prevention programs) completed the survey. CRE was scarcely detected between 2009-2010; within 4 years, 90% of hospitals reported CRE, with 2.5-fold higher community-onset than hospital-onset CRE. Between 2011 and 2013, annual CRE incidence increased 4.7-fold (1.4-6.3 cases/10,000 admissions). Support for a regional CRE prevention bundle was unanimous. Although 22% bathed patients positive for CRE with chlorhexidine gluconate and 11% actively screened for CRE, 86% and 57%, respectively, would consider these strategies in a regional intervention. Conclusions CRE epidemiology in Orange County parallels early progression previously seen in now-endemic areas, representing an opportunity to consider interventions to prevent endemic spread. Many facilities would consider proactive strategies, such as chlorhexidine bathing, in the setting of a regional collaborative.

      PubDate: 2017-11-17T18:43:53Z
      DOI: 10.1016/j.ajic.2017.06.004
       
  • Multidrug-resistant Acinetobacter: Risk factors and outcomes in veterans
           with spinal cord injuries and disorders
    • Authors: Swetha Ramanathan; Katie J. Suda; Margaret A. Fitzpatrick; Linda Poggensee; Sherri L. LaVela; Stephen P. Burns; Charlesnika T. Evans
      Pages: 1183 - 1189
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Swetha Ramanathan, Katie J. Suda, Margaret A. Fitzpatrick, Linda Poggensee, Sherri L. LaVela, Stephen P. Burns, Charlesnika T. Evans
      Background Multidrug-resistant (MDR) Acinetobacter is a growing concern and has been identified as a serious threat by the Centers for Disease Control and Prevention. However, there is little information on MDR Acinetobacter in individuals with spinal cord injuries and disorders (SCI/Ds). Therefore, the objective of this study was to identify risk factors for, and assess outcomes of, MDR Acinetobacter in veterans with SCI/Ds. Methods This was a retrospective cohort study from January 1, 2012-December 31, 2013, using national Veterans Affairs medical encounter and microbiology data. Results A total of 773 Acinetobacter cultures were identified in 571 patients, of which 58.9% were MDR. Inpatient culture, sputum and other specimen type, receipt of antibiotics within 90 days before culture date, and pressure ulcers were identified as independent predictors of MDR Acinetobacter. Highest odds of MDR Acinetobacter were seen with previous antibiotic use (odds ratio, 7.27; 95% confidence interval, 2.59-20.54). Thirty-day mortality was 5.3% in this study. Multidrug resistance, previous mechanical ventilation 90 days before the culture, and cancer were all independent risk factors for 30-day mortality. Conclusions There should be increased efforts to highlight the importance of antimicrobial stewardship to improve infection control to help limit spread of Acinetobacter in health care settings.

      PubDate: 2017-11-17T18:43:53Z
      DOI: 10.1016/j.ajic.2017.06.016
       
  • Characteristics of methicillin-resistant Staphylococcus aureus in patients
           on admission to a teaching hospital in Rio de Janeiro, Brazil
    • Authors: Fernanda Sampaio Cavalcante; Marcos Vinicius Pinheiro; Dennis de Carvalho Ferreira; Celina Vieira da Cunha Guedes Alvarenga; Ana Carolina Fonseca Guimarães; Simone Aranha Nouér; Kátia Regina Netto dos Santos
      Pages: 1190 - 1193
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Fernanda Sampaio Cavalcante, Marcos Vinicius Pinheiro, Dennis de Carvalho Ferreira, Celina Vieira da Cunha Guedes Alvarenga, Ana Carolina Fonseca Guimarães, Simone Aranha Nouér, Kátia Regina Netto dos Santos
      Background Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are associated with greater mortality and morbidity; however, risk factors for community-acquired infections caused by MRSA have not been established. Therefore, community patients who are admitted to hospitals without the necessary contact precautions and are infected with community-acquired lineages eventually cause these lineages to spread to these settings. The aim of this study was to detect community-acquired lineages of MRSA in patients on admission to a Brazilian teaching hospital. Methods The antimicrobial susceptibility of the MRSA isolates from nasal swabs was evaluated as was the molecular characteristics of the staphylococcal cassette chromosome mec (SCCmec). The clonality was determined using pulsed-field gel electrophoresis and multilocus sequence type analysis. Results A total of 702 patients were evaluated between March 2012 and March 2013; 180 (25%) of them were colonized by S aureus, and 21 (3%) were MRSA. The SCCmec IV/USA1100/sequence type (ST) 30 was the predominant MRSA lineage (42.8%), followed by SCCmec IV/USA800/ST5 (23.8%). Conclusions The occurrence of MRSA colonization was very low, and only 1 patient from cardiac surgery developed an infection, which was caused by an SCCmec II/USA100/ST5 isolate. Screening for MRSA colonization on admission does not seem to be productive; however, for populations submitted to specific surgeries, active surveillance should be implemented.

      PubDate: 2017-11-17T18:43:53Z
      DOI: 10.1016/j.ajic.2017.06.003
       
  • Decreased mortality in patients prescribed vancomycin after implementation
           of antimicrobial stewardship program
    • Authors: Erin L. Conway; John A. Sellick; Amy Horey; Kristen Fodero; Michael C. Ott; Michael P. Krajewski; Kari A. Mergenhagen
      Pages: 1194 - 1197
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Erin L. Conway, John A. Sellick, Amy Horey, Kristen Fodero, Michael C. Ott, Michael P. Krajewski, Kari A. Mergenhagen
      Background The impact of an antimicrobial stewardship program (ASP) on 30-day mortality rates was evaluated in patients prescribed vancomycin in a Veterans Affairs hospital. Methods A retrospective chart review of patients receiving a minimum of 48 hours of vancomycin during October 2006-July 2014. A multivariate logistic regression analysis was used to determine predictors of mortality. Interventions of the ASP consist of appropriate antibiotic selection, dosing, microbiology, and treatment duration. Results Death occurred in 12.4% of 453 patients. Of the 56 deaths, 64.3% occurred during prestewardship versus 35.7% during stewardship (P = .021). Increased mortality was associated with pre-ASP (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.13-4.27), age (unit OR, 1.08; 95% CI, 1.05-1.12), nephrotoxicity (OR, 3.24; 95% CI, 1.27-8.01), and hypotension (OR, 3.28; 95% CI, 1.42-7.44). Patients treated in the intensive care unit were associated with increased mortality. Patients in the stewardship group experienced lower rates of mortality, which may be caused by interventions initiated by the stewardship team, including minimizing nephrotoxicity and individualized chart review. Conclusions Mortality in patients treated with vancomycin was decreased after antimicrobial stewardship was implemented. As anticipated, older age, hypotension, nephrotoxicity, and intensive care unit admission were associated with an increased incidence of mortality.

      PubDate: 2017-11-17T18:43:53Z
      DOI: 10.1016/j.ajic.2017.06.012
       
  • Working at the intersection of context, culture, and technology: Provider
           perspectives on antimicrobial stewardship in the emergency department
           using electronic health record clinical decision support
    • Authors: Phillip Chung; Jean Scandlyn; Peter S. Dayan; Rakesh D. Mistry
      Pages: 1198 - 1202
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Phillip Chung, Jean Scandlyn, Peter S. Dayan, Rakesh D. Mistry
      Background Antibiotic stewardship programs (ASPs) have not been fully developed for the emergency department (ED), in part the result of the barriers characteristic of this setting. Electronic health record–based clinical decision support (EHR CDS) represents a promising strategy to implement ASPs in the ED. We aimed to determine the cultural beliefs and structural barriers and facilitators to implementation of antimicrobial stewardship in the pediatric ED using EHR CDS. Methods Interviews and focus groups were conducted with hospital and ED leadership, attending ED physicians, nurse practitioners, physician assistants, and residents at a single health system in Colorado. We reviewed and coded the data using constant comparative analysis and framework analysis until a final set of themes emerged. Results Two dominant perceptions shaped providers' perspectives on ASPs in the ED and EHR CDS: (1) maintaining workflow efficiency and (2) constrained decision-making autonomy. Clinicians identified structural barriers to ASPs, such as pace of the ED, and various beliefs that shaped patterns of practice, including accommodating the prescribing decisions of other providers and managing parental expectations. Recommendations to enhance uptake focused on designing a simple yet flexible user interface, providing clinicians with performance data, and on-boarding clinicians to enhance buy-in. Conclusions Developing a successful ED-based ASP using EHR CDS should attend to technologic needs, the institutional context, and the cultural beliefs of practice associated with providers' antibiotic prescribing.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.06.005
       
  • Antimicrobial stewardship in the treatment of skin and soft tissue
           infections
    • Authors: Julie A. Gibbons; Hayden L. Smith; Sudhir C. Kumar; Katherine Johnson Duggins; Amanda M. Bushman; Jayme M. Danielson; William J. Yost; Jonathan J. Wadle
      Pages: 1203 - 1207
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Julie A. Gibbons, Hayden L. Smith, Sudhir C. Kumar, Katherine Johnson Duggins, Amanda M. Bushman, Jayme M. Danielson, William J. Yost, Jonathan J. Wadle
      Background Research on treating skin and soft tissue infections (SSTI) has shown improved patient outcomes with effective pharmaceutic prescribing. Antimicrobial stewardship programs can reduce consequences of broad-spectrum antimicrobial administration in SSTI treatment. Methods Prospective and historic control data were collected during two 7-month periods. Intervention consisted of implementing a new SSTI evidence-based treatment algorithm and provider education, including calls and medical record notes targeted at physicians. Results Of 412 patients, 76 and 86 were found eligible from the historic and intervention groups, respectively. The intervention group had a higher prevalence of appropriate antibiotic usage (33% vs 19%, respectively; P = .04). There was a lower median number of days from intravenous antibiotic therapy to oral conversion (3 vs 5; P < .0001) and a lower median number of days of antipseudomonal antibiotic use (3 vs 5; P = .03) in the intervention group, respectively. The intervention group also had fewer documented SSTI treatment complications (1% vs 8%, respectively; P = .04). The positive outcomes outlined demonstrate potential impacts made from the use of multidisciplinary antibiotic stewardship initiatives. Conclusions Appropriate use of antimicrobial agents under the direction of an antimicrobial stewardship program can lead to improved outcomes for patients being treated for SSTIs.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.05.013
       
  • Effect of automated ultraviolet C–emitting device on decontamination of
           hospital rooms with and without real-time observation of terminal room
           disinfection
    • Authors: Katie Penno; Roman A. Jandarov; Madhuri M. Sopirala
      Pages: 1208 - 1213
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Katie Penno, Roman A. Jandarov, Madhuri M. Sopirala
      Background We studied the effectiveness of an ultraviolet C (UV-C) emitter in clinical settings and compared it with observed terminal disinfection. Methods We cultured 22 hospital discharge rooms at a tertiary care academic medical center. Phase 1 (unobserved terminal disinfection) included cultures of 11 high-touch environmental surfaces (HTSs) after terminal room disinfection (AD) and after the use of a UV-C–emitting device (AUV). Phase 2 (observed terminal disinfection) included cultures before terminal room disinfection (BD), AD, and AUV. Zero-inflated Poisson regression compared mean colony forming units (CFU) between the groups. Two-sample proportion tests identified significance of the observed differences in proportions of thoroughly cleaned HTSs (CFU < 5). Significant P value was determined using the Bonferroni corrected threshold of α = .05/12 = .004. Results We obtained 594 samples. Risk of overall contamination was 0.48 times lower in the AUV group than in the AD group (P < .001), with 1.04 log10 reduction. During phase 1, overall proportion of HTSs with <5 CFUs increased in AUV versus AD by 0.12 (P = .001). During phase 2, it increased in AD versus BD by 0.45 (P < .001), with no significant difference between AD and AUV (P = .02). Conclusions Use of UV-C with standard cleaning significantly reduced microbial burden and improved the thoroughness of terminal disinfection. We found no further benefit to UV-C use if standard terminal disinfection was observed.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.06.015
       
  • Long-acting water-stable organosilane agent and its sustained effect on
           reducing microbial load in an intensive care unit
    • Authors: Katie Fitton; Kimberly R. Barber; Alison Karamon; Nate Zuehlke; Sara Atwell; Susan Enright
      Pages: 1214 - 1217
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Katie Fitton, Kimberly R. Barber, Alison Karamon, Nate Zuehlke, Sara Atwell, Susan Enright
      Background Contaminated hospital surfaces contribute significantly to the transmission of health care-associated infections. Although disinfectants reduce bioburden by up to 99%, bacterial growth can rebound within hours to precleaning levels. We tested the effectiveness of an innovative, long-acting water-stable organosilane (WSO) to achieve sustained decreases in bioburden on hard surfaces. Methods A 5-month prospective, randomized, double-blind controlled study was performed. Eighteen intensive care unit rooms were randomly divided into placebo or treatment groups. Hard surfaces in all rooms were cleaned using the same protocol, except the placebo surfaces were cleaned with an inert saline solution and the treatment surfaces were treated with the WSO. Binomial regression with repeated measures were used to assess mean reductions in total bioburden as measured by colony forming units. Results The placebo resulted in average reductions in total colony forming units of 35% to 40% (relative risk reduction [RRR], 0.65; P < .01) and the WSO group averaged reductions of colony forming units by 66% to 99% (RRR, 0.55; P < .001). Total Staphylococcus aureus increased among the placebo rooms 30% (RRR, 0.69; P < .001), whereas in treatment rooms there was a reduction of 50%-60% (RRR, 0.57; P < .01). Although both sets of rooms saw reductions in bioburden or colony forming units, application of the WSO resulted in larger reductions. There was also greater variability in reductions in the placebo arm. Conclusion This is the first randomized, double-blind controlled study of an innovative WSO on high-touch hard surfaces at risk for high bioburdens. Sustained reductions of bioburden with the monthly application of this unique WSO may be associated with significant reductions in the risk of health care-associated infections.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.06.014
       
  • Exposure Survey of Trends in Occupational Practice (EXPO-S.T.O.P.) 2015: A
           national survey of sharps injuries and mucocutaneous blood exposures among
           health care workers in US hospitals
    • Authors: T. Grimmond; L. Good
      Pages: 1218 - 1223
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): T. Grimmond, L. Good
      Background National blood exposure (BE) surveys are valuable to health care facilities striving to reduce percutaneous sharps injuries (SIs) or mucocutaneous (MC) exposures among their health care workers (HCWs). In the Exposure Survey of Trends in Occupational Practice (EXPO-S.T.O.P.) 2015 we surveyed hospital BE incidence among members of the Association of Occupational Health Professionals in Healthcare. Methods A 23-item electronic survey requested 2015 data on total SI and MC; SI in nurses, doctors, and surgery; staffed beds; teaching status; full time equivalent staff (FTE), nurse FTE, average daily census (ADC), and adjusted patient days (APD). Results One hundred eighty-one hospitals in 34 states reported 9,343 BE (71% SI and 29% MC exposures). SI rates were 25.2/100 ADC (17.5 in nonteaching hospitals and 30.4 in teaching hospitals), 2.1/100 FTE (significantly less than that in 2001), 3.2/100 nurse FTE, 0.36/1,000 APD, and 38% occurred during surgery. MC exposure incidence rates were 10.5/100 ADC (8.6 in nonteaching hospitals and 11.7 in teaching hospitals), 0.86/100 FTE, and 0.14/1000 APD. Conclusions BE incidence rates have fallen slowly but significantly since 2001, but the reduction is far less than hoped. Occupied beds (ie, ADC) has become a less-useful denominator. We estimate more than 300,000 HCWs sustain SIs annually in hospital and nonhospital settings. Greater resources are needed for more frequent and correct use of safety devices, training to competency, and root-cause investigation of all SIs.

      PubDate: 2017-11-17T18:43:53Z
      DOI: 10.1016/j.ajic.2017.05.023
       
  • Improving central line maintenance to reduce central line-associated
           bloodstream infections
    • Authors: Frank A. Drews; Jonathan Z. Bakdash; Jeremy R. Gleed
      Pages: 1224 - 1230
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Frank A. Drews, Jonathan Z. Bakdash, Jeremy R. Gleed
      Objective A human factors engineering-based intervention aimed at the modification of task behavior to increase adherence to best practices and the reduction of central line-associated bloodstream infections (CLABSI). The hypothesis was tested that a central line maintenance kit would improve adherence and reduce CLABSI compared with a standard, nonkit-based method of performing central line maintenance. Design The study design was a 29-month prospective, interventional, nonrandomized, observational, and clinical research study using a pre–post implementation assessment. Setting The study was conducted at a tertiary hospital in the southwestern United States, with participants recruited from a total of 6 patient units (including intensive care units and general wards). Participants A total of 95 nurses and 151 patients volunteered to participate in the study. Intervention A central line maintenance kit was developed that incorporated human factors engineering design principles. This kit was implemented hospitalwide during the clinical study to assess the intervention's influence on protocol adherence and clinical outcomes compared with a preimplementation control condition (no kit use). Results The results of this clinical observations study suggest that a human factors engineering-based kit improved adherence to best practices during central line maintenance. In addition, the number of CLABSIs was significantly reduced during the postimplementation period. Conclusions The application of human factors engineering design principles in the development of medical kits can improve protocol adherence and clinical outcomes.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.05.017
       
  • Assessing the functionality of temporary isolation rooms
    • Authors: Brett G. Mitchell; Anthony Williams; Zorana Wong
      Pages: 1231 - 1237
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Brett G. Mitchell, Anthony Williams, Zorana Wong
      Background Challenges with limited single rooms and isolation facilities in hospitals have created an opportunity for temporary, portable isolation technology. This article describes the process used to evaluate the prototype of a new isolation room (RediRoom; CareStrategic Ltd, Brisbane, Queensland, Australia) that can be installed in existing hospital ward areas. Our aim is to assess the functionality of this new room, and in so doing, to evaluate the methods used. Methods We employed a mixed-methods approach involving video recording, interviews, and objective temperature and humidity measurements within a crossover interventional study. Participants completed a range of clinical activities in the RediRoom and a control. The setting for the study was a clinical ward environment at an Australian higher education institution. Results There were similarities between the RediRoom and the control using a range of measures. The time taken to complete a range of clinical activities in both rooms was broadly consistent. Network analysis also suggested broad similarities in the movement of nurses undertaking activities in both rooms. Conclusion Our study attempted to simulate a clinical environment and clinical activities and provide the best possible comparison by completing activities sequentially, with immediate feedback to researchers. Video recording added significant value to the process because it provided some objectivity. A form of reflexive ethnography with participants could be of value in similar studies in the future.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.05.019
       
  • The association between self-perceived proficiency of personal protective
           equipment and objective performance: An observational study during a
           bioterrorism simulation drill
    • Authors: Itay Fogel; Osant David; Chaya H. Balik; Arik Eisenkraft; Lion Poles; Omri Shental; Michael Kassirer; Tal Brosh-Nissimov
      Pages: 1238 - 1242
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Itay Fogel, Osant David, Chaya H. Balik, Arik Eisenkraft, Lion Poles, Omri Shental, Michael Kassirer, Tal Brosh-Nissimov
      Background The recent Ebola virus disease outbreak emphasized the potential misuse of personal protective equipment (PPE) by health care workers (HCWs) during such an event. We aimed to compare self-perceived proficiency of PPE use and objective performance, and identify predictors of low compliance and PPE misuse. Methods An observational study combined with subjective questionnaires were carried out during a bioterror simulation drill. Forty-two observers evaluated performance under PPE. Mistakes were recorded and graded using a structured observational format and were correlated with the subjective questionnaires and with demographic parameters. Results One hundred seventy-eight HCWs from community clinics and hospitals were included. The mean self-perceived proficiency was high (6.1 out of 7), mean level of comfort was moderate (4.0 out of 7), and mean objective performance was intermediate (9.5 out of 13). There was no correlation between comfort and objective performance scores. Self-perceived proficiency was in correlation with donning and continuous performance with PPE but not with doffing. Clinic personnel performed better than personnel in hospitals (40.3% vs 67.8% with 3 or more mistakes, respectively; P = .001). Demographic characteristics had no correlation with objective or self-perceived performance. Conclusions Self-perceived proficiency is a poor predictor of appropriate PPE use. The results suggest poor awareness of the possibility of PPE misuse.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.05.018
       
  • Workplace interventions associated with influenza vaccination coverage
           among health care personnel in ambulatory care settings during the
           2013-2014 and 2014-2015 influenza seasons
    • Authors: Xin Yue; Carla Black; Sarah Ball; Sara Donahue; Marie A. De Perio; A. Scott Laney; Stacie Greby
      Pages: 1243 - 1248
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Xin Yue, Carla Black, Sarah Ball, Sara Donahue, Marie A. De Perio, A. Scott Laney, Stacie Greby
      Background Vaccination of health care personnel (HCP) can reduce influenza-related morbidity and mortality among HCP and their patients. This study investigated workplace policies associated with influenza vaccination among HCP who work in ambulatory care settings without influenza vaccination requirements. Methods Data were obtained from online surveys conducted during April 2014 and April 2015 among nonprobability samples of HCP recruited from 2 preexisting national opt-in Internet panels. Respondents were asked about their vaccination status and workplace policies and interventions related to vaccination. Logistic regression models were used to assess the independent associations between each workplace intervention and influenza vaccination while controlling for occupation, age, and race or ethnicity. Results Among HCP working in ambulatory care settings without a vaccination requirement (n = 866), 65.7% reported receiving influenza vaccination for the previous influenza season. Increased vaccination coverage was independently associated with free onsite vaccination for 1 day (prevalence ratio [PR], 1.38; 95% confidence interval [CI], 1.07-1.78 or >1 day PR, 1.58; 95% CI, 1.29-1.94) and employers sending personal vaccination reminders (PR, 1.20; 95% CI, 0.99-1.46). Age ≥65 years (PR, 1.30; 95% CI, 1.07-1.56) and working as a clinical professional (PR, 1.26; 95% CI, 1.06-1.50) or clinical nonprofessional (PR, 1.28; 95% CI, 1.03-1.60) were also associated with higher coverage. Vaccination coverage increased with increasing numbers of workplace interventions. Conclusions Implementing workplace vaccination interventions in ambulatory care settings, including free onsite influenza vaccination that is actively promoted, could help increase influenza vaccination among HCP.

      PubDate: 2017-11-17T18:43:53Z
      DOI: 10.1016/j.ajic.2017.05.016
       
  • Outbreaks of health care–associated influenza-like illness in France:
           Impact of electronic notification
    • Authors: Elodie Munier-Marion; Thomas Bénet; Cédric Dananché; Sophan Soing-Altach; Sylvie Maugat; Sophie Vaux; Philippe Vanhems
      Pages: 1249 - 1253
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Elodie Munier-Marion, Thomas Bénet, Cédric Dananché, Sophan Soing-Altach, Sylvie Maugat, Sophie Vaux, Philippe Vanhems
      Background Mandatory notification of health care–associated (HA) infections, including influenza-like illness (ILI) outbreaks, has been implemented in France since 2001. In 2012, the system moved to online electronic notification of HA infections (e-SIN). The objectives of this study are to describe ILI outbreak notifications to Santé publique France (SPF), the French national public health agency, and to evaluate the impact of notification dematerialization. Methods All notifications of HA ILI outbreaks between July 2001 and June 2015 were included. Notifications before and after e-SIN implementation were compared regarding notification delay and information exhaustiveness. Results Overall, 506 HA ILI outbreaks were reported, accounting for 7,861 patients and health care professionals. Median delay between occurrence of the first case and notification was, respectively, 32 and 13 days before and after e-SIN utilization (P < .001). Information exhaustiveness was improved by electronic notification regarding HA status (8.5% of missing data before and 2.3% after e-SIN, P = .003), hypotheses of cause (25.4% of missing data before vs 8.0% after e-SIN, P < .001), and level of event control (23.7% of missing data before vs 7.5% after e-SIN, P < .001). Conclusions HA influenza notifications, including HA ILI or influenza, to health authorities are essential to guide decisional instances and health care practices. Electronic notifications have improved the timeliness and quality of information transmitted.

      PubDate: 2017-11-17T18:43:53Z
      DOI: 10.1016/j.ajic.2017.05.012
       
  • Working with influenza-like illness: Presenteeism among US health care
           personnel during the 2014-2015 influenza season
    • Authors: Sophia Chiu; Carla L. Black; Xin Yue; Stacie M. Greby; A. Scott Laney; Angela P. Campbell; Marie A. de Perio
      Pages: 1254 - 1258
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Sophia Chiu, Carla L. Black, Xin Yue, Stacie M. Greby, A. Scott Laney, Angela P. Campbell, Marie A. de Perio
      Background Health care personnel (HCP) working while experiencing influenza-like illness (ILI) contribute to influenza transmission in health care settings. Studies focused on certain HCP occupations or work settings have demonstrated that some HCP often continue to work while ill. Methods Using a national nonprobability Internet panel survey of 1,914 HCP during the 2014-2015 influenza season, we calculated the frequency of working with self-reported ILI (ie, fever and cough or sore throat) and examined reasons for working with ILI by occupation and work setting. Results Overall, 414 (21.6%) HCP reported ILI, and 183 (41.4%) reported working with ILI (median, 3 days; range, 0-30 days). Pharmacists (67.2%) and physicians (63.2%) had the highest frequency of working with ILI. By work setting, hospital-based HCP had the highest frequency of working with ILI (49.3%). The most common reasons for working while ill included still being able to perform job duties and not feeling bad enough to miss work. Among HCP at long-term care facilities, the most common reason was inability to afford lost pay. Conclusions More than 40% of HCP with ILI work while ill. To reduce HCP-associated influenza transmission, potential interventions could target HCP misconceptions about working while ill and paid sick leave policies.

      PubDate: 2017-11-17T18:43:53Z
      DOI: 10.1016/j.ajic.2017.04.008
       
  • Considering a new domain for antimicrobial stewardship: Topical
           antibiotics in the open surgical wound
    • Authors: Charles E. Edmiston; David Leaper; Maureen Spencer; Karen Truitt; Loretta Litz Fauerbach; Denise Graham; Helen Boehm Johnson
      Pages: 1259 - 1266
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Charles E. Edmiston, David Leaper, Maureen Spencer, Karen Truitt, Loretta Litz Fauerbach, Denise Graham, Helen Boehm Johnson
      The global push to combat the problem of antimicrobial resistance has led to the development of antimicrobial stewardship programs (ASPs), which were recently mandated by The Joint Commission and the Centers for Medicare and Medicaid Services. However, the use of topical antibiotics in the open surgical wound is often not monitored by these programs nor is it subject to any evidence-based standardization of care. Survey results indicate that the practice of using topical antibiotics intraoperatively, in both irrigation fluids and powders, is widespread. Given the risks inherent in their use and the lack of evidence supporting it, the practice should be monitored as a core part of ASPs, and alternative agents, such as antiseptics, should be considered.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.04.012
       
  • Environment of care: Is it time to reassess microbial contamination of the
           operating room air as a risk factor for surgical site infection in total
           joint arthroplasty'
    • Authors: Javad Parvizi; Sue Barnes; Noam Shohat; Charles E. Edmiston
      Pages: 1267 - 1272
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Javad Parvizi, Sue Barnes, Noam Shohat, Charles E. Edmiston
      In the modern operating room (OR), traditional surgical mask, frequent air exchanges, and architectural barriers are viewed as effective in reducing airborne microbial populations. Intraoperative sampling of airborne particulates is rarely performed in the OR because of technical difficulties associated with sampling methodologies and a common belief that airborne contamination is infrequently associated with surgical site infections (SSIs). Recent studies suggest that viable airborne particulates are readily disseminated throughout the OR, placing patients at risk for postoperative SSI. In 2017, virtually all surgical disciplines are engaged in the implantation of selective biomedical devices, and these implants have been documented to be at high risk for intraoperative contamination. Approximately 1.2 million arthroplasties are performed annually in the United States, and that number is expected to increase to 3.8 million by the year 2030. The incidence of periprosthetic joint infection is perceived to be low (<2.5%); however, the personal and fiscal morbidity is significant. Although the pharmaceutic and computer industries enforce stringent air quality standards on their manufacturing processes, there is currently no U.S. standard for acceptable air quality within the OR environment. This review documents the contribution of air contamination to the etiology of periprosthetic joint infection, and evidence for selective innovative strategies to reduce the risk of intraoperative microbial aerosols.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.06.027
       
  • A cold hard menace: A contaminated ice machine as a potential source for
           transmission of carbapenem-resistant Acinetobacter baumannii
    • Authors: Anubhav Kanwar; T. Nicholas Domitrovic; Sreelatha Koganti; Peter Fuldauer; Jennifer L. Cadnum; Robert A. Bonomo; Curtis J. Donskey
      Pages: 1273 - 1275
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Anubhav Kanwar, T. Nicholas Domitrovic, Sreelatha Koganti, Peter Fuldauer, Jennifer L. Cadnum, Robert A. Bonomo, Curtis J. Donskey
      During an investigation of potential sources of transmission of multidrug-resistant gram-negative bacilli on a spinal cord injury unit, we recovered genetically related carbapenem-resistant Acinetobacter baumannii isolates from the stool of 3 patients, the hands of a nurse, and an ice machine water outlet spout and drain. Our findings suggest that contaminated ice machines could serve as a potential reservoir for dissemination of multidrug-resistant gram-negative bacilli.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.05.007
       
  • Quantitative assessment of interactions between hospitalized patients and
           portable medical equipment and other fomites
    • Authors: Nuntra Suwantarat; Laura A. Supple; Jennifer L. Cadnum; Thriveen Sankar; Curtis J. Donskey
      Pages: 1276 - 1278
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Nuntra Suwantarat, Laura A. Supple, Jennifer L. Cadnum, Thriveen Sankar, Curtis J. Donskey
      In an observational study, we demonstrated that hospitalized patients frequently had direct or indirect interactions with medical equipment and other fomites that are shared among patients, and these items were often contaminated with health care–associated pathogens. There is a need for protocols to ensure routine cleaning of shared portable equipment.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.05.003
       
  • Dipping into the Clostridium difficile pool: Are alcohol-based dispensers
           fomites for C difficile'
    • Authors: James A. Hall; Ryan R. Keul; Justin D. Shanks; Robert Fader; Jon D. Herrington
      Pages: 1279 - 1280
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): James A. Hall, Ryan R. Keul, Justin D. Shanks, Robert Fader, Jon D. Herrington
      The purpose of this study was to evaluate alcohol-based dispensers as potential fomites for Clostridium difficile. A convenience sample of 120 alcohol-based dispensers was evaluated for the presence of C difficile either by culture or polymerase chain reaction for C difficile toxin. The results demonstrated that C difficile was not cultured, and C difficile toxin was not detected using polymerase chain reaction; however, gram-positive rods, Clostridium perfringens, Pantoea agglomerans, coagulase-negative Staphylococcus, Peptostreptococcus, Bacillus spp, and microaerophilic Streptococcus were present within the overflow basins of the alcohol-based dispensers.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.04.284
       
  • Risk factors of catheter-related bloodstream infection caused by Bacillus
           cereus: Case-control study in 8 teaching hospitals in Japan
    • Authors: Satoshi Kutsuna; Kayoko Hayakawa; Kazuya Kita; Yuichi Katanami; Natsuko Imakita; Kei Kasahara; Masami Seto; Kenichiro Akazawa; Minoru Shimizu; Toshikazu Kano; Takahito Nei; Tetsuro Hayashi; Nobuaki Mori; Taku Yabuki; Norio Ohmagari
      Pages: 1281 - 1283
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Satoshi Kutsuna, Kayoko Hayakawa, Kazuya Kita, Yuichi Katanami, Natsuko Imakita, Kei Kasahara, Masami Seto, Kenichiro Akazawa, Minoru Shimizu, Toshikazu Kano, Takahito Nei, Tetsuro Hayashi, Nobuaki Mori, Taku Yabuki, Norio Ohmagari
      In this multicenter, matched case-control study, patients diagnosed with catheter-related bloodstream infection (CRBSI) caused by Bacillus cereus (n = 108) were matched to controls (n = 269). In the multivariable analysis, administration of an amino acid preparation and an indwelling peripheral catheter were significant variables for B cereus–related CRBSI.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.04.281
       
  • Effects of contact time and concentration on bactericidal efficacy of 3
           disinfectants on hard nonporous surfaces
    • Authors: Yingying Hong; Peter J. Teska; Haley F. Oliver
      Pages: 1284 - 1285
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Yingying Hong, Peter J. Teska, Haley F. Oliver
      This study investigated the influence of contact time and concentration on bactericidal efficacy of 3 types of disinfectants (accelerated hydrogen peroxide [AHP], quaternary ammonium compounds [Quats], and sodium hypochlorite) on stainless steel surfaces using Environmental Protection Agency procedure MB-25-02. We found that bactericidal efficacy was not reduced at contact times or concentrations immediate lower than label use values, but all 3 disinfectants were significantly less bactericidal at significantly lower than label use contact times and concentrations. Overall, the bactericidal efficacy of the sodium hypochlorite disinfectant was most tolerant to the decreases of contact times and concentrations, followed closely by AHP disinfectant, and Quat disinfectant was most affected by contact time and concentration.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.04.015
       
  • Carbapenem-resistant Enterobacteriaceae at a low prevalence tertiary care
           center: Patient-level risk factors and implications for an infection
           prevention strategy
    • Authors: Michelle Doll; Nadia Masroor; Yvette Major; Michele Fleming; Christopher Doern; Kaila Cooper; Michael Stevens; Gonzalo Bearman
      Pages: 1286 - 1288
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Michelle Doll, Nadia Masroor, Yvette Major, Michele Fleming, Christopher Doern, Kaila Cooper, Michael Stevens, Gonzalo Bearman
      Limited treatment options and a growing global threat from carbapenem-resistant Enterobacteriaceae (CRE) infections illustrate the importance of understanding the epidemiology of CRE. Using a retrospective chart review and point prevalence testing demonstrated specific patient risk factors for CRE-positive clinical cultures in a tertiary medical center with a low CRE prevalence.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.04.013
       
  • Clinical outcome of dual colistin- and carbapenem-resistant Klebsiella
           pneumoniae bloodstream infections: A single-center retrospective study of
           75 cases in India
    • Authors: Amarjeet Kaur; Sumanth Gandra; Priyanka Gupta; Yatin Mehta; Ramanan Laxminarayan; Sharmila Sengupta
      Pages: 1289 - 1291
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Amarjeet Kaur, Sumanth Gandra, Priyanka Gupta, Yatin Mehta, Ramanan Laxminarayan, Sharmila Sengupta
      In this study, we retrospectively evaluated clinical outcomes of 75 patients with dual colistin- and carbapenem-resistant Klebsiella pneumoniae bloodstream infections over a 5-year period in a single tertiary care hospital in India. We observed a high in-hospital mortality rate of 69.3%. Our findings indicate the urgent need for new antibiotics to treat these infections.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.06.028
       
  • A practical guide to systematic literature reviews and meta-analyses in
           infection prevention: Planning, challenges, and execution
    • Authors: Marin L. Schweizer; Rajeshwari Nair
      Pages: 1292 - 1294
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Marin L. Schweizer, Rajeshwari Nair
      Systematic literature reviews and meta-analyses are important research designs used to summarize and derive conclusions about the collective evidence on a focused research question in a structured, reproducible manner. The goal of this Methodology Minute is to describe how to conduct a systematic literature review and meta-analysis using a step-by-step approach to help infection preventionists (IPs) and others in the field perform their own systematic literature review and meta-analysis, and to critically evaluate published systematic literature reviews and meta-analyses.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.08.004
       
  • Nasal methicillin-resistant Staphylococcus aureus screening in patients
           with pneumonia: A powerful antimicrobial stewardship tool
    • Authors: Ethan A. Smith; Howard S. Gold; Monica V. Mahoney; Elizabeth B. Hirsch; Stephanie E. Giancola; Graham M. Snyder; Gregory Marks; Hai Tran; Angela Hirai-Yang; Christopher McCoy
      Pages: 1295 - 1296
      Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11
      Author(s): Ethan A. Smith, Howard S. Gold, Monica V. Mahoney, Elizabeth B. Hirsch, Stephanie E. Giancola, Graham M. Snyder, Gregory Marks, Hai Tran, Angela Hirai-Yang, Christopher McCoy


      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.06.032
       
  • Antimicrobial stewardship in pediatric post-acute care facilities
    • Authors: Candace L. Johnson; Meaghan Jain; Lisa Saiman; Natalie Neu
      Abstract: Publication date: Available online 15 November 2017
      Source:American Journal of Infection Control
      Author(s): Candace L. Johnson, Meaghan Jain, Lisa Saiman, Natalie Neu
      Providers in pediatric post-acute care facilities were surveyed about knowledge of and resources for antimicrobial stewardship. All agreed that antibiotics were overused in such pediatric facilities, but 60% had not implemented stewardship strategies. Lack of treatment guidelines (47%) was identified as the most common barrier to antimicrobial stewardship.

      PubDate: 2017-11-17T18:43:53Z
      DOI: 10.1016/j.ajic.2017.09.031
       
  • Booster influenza vaccination confers additional immune responses in an
           elderly, rural community-dwelling population
    • Authors: Masahide Matsushita; Seisho Takeuchi; Naoko Kumagai; Masaaki Morio; Chise Matsushita; Kazumi Arise; Toshihide Awatani
      Abstract: Publication date: Available online 14 November 2017
      Source:American Journal of Infection Control
      Author(s): Masahide Matsushita, Seisho Takeuchi, Naoko Kumagai, Masaaki Morio, Chise Matsushita, Kazumi Arise, Toshihide Awatani
      This study aimed to examine the effects of a booster vaccination in elderly people using 2 doses of trivalent inactivated influenza vaccine during the 2012-2013 influenza epidemic. Seroprotection rates against the A(H1N1)pdm09 strain in younger elderly people (aged 61-75 years) and the A(H3N2) and B strains in both younger elderly people (aged 61-75 years) as well as very elderly people (aged 76-102 years) did not decrease at 22 weeks after vaccination. This approach confers long-lasting antibody responses and may be useful in clinical practice.

      PubDate: 2017-11-17T18:43:53Z
      DOI: 10.1016/j.ajic.2017.09.034
       
  • Thai clinicians' attitudes toward antimicrobial stewardship programs
    • Authors: Nantanit Sutthiruk; Julie Considine; Ana Hutchinson; Andrea Driscoll; Kumthorn Malathum; Mari Botti
      Abstract: Publication date: Available online 10 November 2017
      Source:American Journal of Infection Control
      Author(s): Nantanit Sutthiruk, Julie Considine, Ana Hutchinson, Andrea Driscoll, Kumthorn Malathum, Mari Botti
      Background Effective hospital-wide antimicrobial stewardship (AMS) programs need multidisciplinary engagement; however, clinicians' attitudes have not been investigated in Thailand where AMS is in early development. The aim of this study was to explore Thai clinicians' (doctors, nurses, and pharmacists) perceptions and attitudes toward AMS. Methods A paper-based survey was distributed in a 1,000-bed university hospital in Bangkok, Thailand, between November 9, 2015, and December 21, 2015. A total of 1,087 clinicians participated: 392 doctors, 613 nurses, and 82 pharmacists. Results Most participants agreed that improving antimicrobial prescribing would decrease antimicrobial resistance (AMR) and should be a priority of hospital policy. Doctors were less likely to agree with policies that limit antimicrobial prescribing (P < .001) than nurses or pharmacists, and were less likely to be interested in participating in AMS education than other clinicians (P < .001). Pharmacists indicated higher agreement with the statement, recommending that a specialist team provide individualized antimicrobial prescribing advice (P < .01) and that feedback improves antimicrobial selection (P < .001). Nurses were less likely to agree that community antibiotic use (P < .001) or patient pressure for antibiotics contribute to AMR (P < .001). Conclusions AMS programs are vital to improving antimicrobial use by clinicians. Understanding clinicians' attitudes and perceptions related to AMS is important to ensure that AMS programs developed address areas relevant to local clinical needs.

      PubDate: 2017-11-17T18:43:53Z
      DOI: 10.1016/j.ajic.2017.09.022
       
  • Incidence and risk factors for infection in spine surgery: A prospective
           multicenter study of 1764 instrumented spinal procedures
    • Authors: Wenfei Gu; Laiyong Tu; Zhiquan Liang; Zhenbin Wang; Kahaer Aikenmu; Ge Chu; Enfeng Zhang; Jiang Zhao
      Abstract: Publication date: Available online 9 November 2017
      Source:American Journal of Infection Control
      Author(s): Wenfei Gu, Laiyong Tu, Zhiquan Liang, Zhenbin Wang, Kahaer Aikenmu, Ge Chu, Enfeng Zhang, Jiang Zhao
      Background Surgical site infection (SSI) is a common complication in spinal surgery, imposing a high burden on patients and society. However, information about its characteristics and related risk factors is limited. We designed this prospective, multicenter study to address this issue. Methods : From January 2015 through February 2016, a total of 1764 patients who had spinal trauma or degenerative spinal diseases were treated with instrumented surgeries and followed up for 1 year with complete data. Data on all patients were abstracted from electronic medical records, and SSIs were prospectively inspected and diagnosed by surgeons in our department. Any disagreement among them was settled by the leader of this study. SPSS 19.0 was used to perform the analyses. Results A total of 58 patients (3.3%, 58 of 1764) developed SSI; 1.1% had deep SSI, and 2.2% had superficial SSI. Of these, 60.6% (21 of 33) had a polymicrobial cause. Most of them (51 of 58) occurred during hospitalization. The median occurrence time was 3 days after operation (range: 1–123 days). SSI significantly prolonged hospital stays, by 9.3 days on average. The univariate analysis revealed reason for surgery as the only significant risk factor. The multivariate analysis, however, revealed 8 significant risk factors, including higher BMI, surgical site (cervical), surgical approach (posterior), surgery performed in summer, reasons for surgery (degenerative disease), autograft for fusion and fixation, and higher preoperative platelet level. Conclusion Identification of these risk factors aids in stratifying preoperative risk to reduce SSI incidence. In addition, the results could be used in counseling patients and their families during the consent process.

      PubDate: 2017-11-17T18:43:53Z
      DOI: 10.1016/j.ajic.2017.09.025
       
  • Shift to community-onset Clostridium difficile infection in the national
           Veterans Health Administration, 2003-2014
    • Authors: Kelly R. Reveles; Mary Jo V. Pugh; Kenneth A. Lawson; Eric M. Mortensen; Jim M. Koeller; Jacqueline R. Argamany; Christopher R. Frei
      Abstract: Publication date: Available online 7 November 2017
      Source:American Journal of Infection Control
      Author(s): Kelly R. Reveles, Mary Jo V. Pugh, Kenneth A. Lawson, Eric M. Mortensen, Jim M. Koeller, Jacqueline R. Argamany, Christopher R. Frei
      Background Clostridium difficile infection (CDI) occurs frequently in inpatient settings; however, community-onset cases have been reported more frequently in recent years. This study evaluated hospital-onset and community-onset CDI in the national Veterans Health Administration (VHA) population over a 12-year period. Methods This was a retrospective cohort study of all adult VHA beneficiaries with CDI between October 1, 2002, and September 30, 2014. Data were obtained from the Veterans Affairs Informatics and Computing Infrastructure. CDI was categorized into community-associated CDI (CA-CDI); community-onset, health care facility-associated CDI; and health care facility-onset CDI (HCFO-CDI). Each type was described longitudinally and was assessed as an independent risk factor for health outcomes using multivariable logistic regression. Results Overall, 30,326 patients with a first CDI episode were included. HCFO-CDI was the predominant type (60.2%), followed by CO-HCFA-CDI (20.6%) and CA-CDI (19.2%). The proportion of patients with HCFO-CDI decreased from 73.5% during fiscal year 2003 to 53.2% during fiscal year 2014, whereas CA-CDI increased from 8.3% to 26.7%. HCFO-CDI was a positive predictor of severe CDI (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.59-1.84) and 30-day mortality (OR, 1.46; 95% CI, 1.32-1.61), but a negative predictor of 60-day recurrence (OR, 0.41; 95% CI, 0.37-0.46). Conclusions HCFO-CDI was the predominant CDI type. The proportion of patients with CA-CDI increased and HCFO-CDI decreased in recent years. Patients with HCFO-CDI experienced higher rates of severe CDI and mortality.

      PubDate: 2017-11-17T18:43:53Z
      DOI: 10.1016/j.ajic.2017.09.020
       
  • Hospital length of stay and cost burden of HIV, tuberculosis, and
           HIV-tuberculosis coinfection among pregnant women in the United States
    • Authors: Adeola Falana; Vanessa Akpojiyovwi; Esther Sey; Andika Akpaffiong; Olive Agumbah; Samara Chienye; Jamie Banks; Erin Jones; Kiara K. Spooner; Jason L. Salemi; Omonike A. Olaleye; Sherri D. Onyiego; Hamisu M. Salihu
      Abstract: Publication date: Available online 3 November 2017
      Source:American Journal of Infection Control
      Author(s): Adeola Falana, Vanessa Akpojiyovwi, Esther Sey, Andika Akpaffiong, Olive Agumbah, Samara Chienye, Jamie Banks, Erin Jones, Kiara K. Spooner, Jason L. Salemi, Omonike A. Olaleye, Sherri D. Onyiego, Hamisu M. Salihu
      Background We sought to determine hospital length of stay (LOS) and cost burden associated with hospital admissions among pregnant women with HIV monoinfection, tuberculosis (TB) monoinfection, or HIV-TB coinfection in the United States. Methods Analysis covered the period from 2002-2014 using data from the Nationwide Inpatient Sample. Relevant ICD-9-CM codes were used to determine HIV and TB status. Costs associated with hospitalization were calculated and adjusted to 2010 dollars using the medical care component of the Consumer Price Index. Results We found modest annual average reduction in HIV, TB, and HIV-TB coinfection rates over the study period. The mean LOS was lowest among mothers free of HIV or TB disease and highest among those with HIV-TB coinfection. The average LOS among mothers diagnosed with TB monoinfection was 60% higher than for those with HIV monoinfection. The cost associated with pregnancy-related hospital admissions among mothers with HIV was approximately 30% higher than disease-free mothers, and the cost more than doubled among patients with TB monoinfection or HIV-TB coinfection. Conclusions TB significantly increased hospital care cost among HIV-positive and HIV-negative pregnant women.

      PubDate: 2017-11-17T18:43:53Z
      DOI: 10.1016/j.ajic.2017.09.016
       
  • Development and validation of an automated ventilator-associated event
           electronic surveillance system: A report of a successful implementation
    • Authors: Courtney Hebert; Jennifer Flaherty; Justin Smyer; Jing Ding; Julie E. Mangino
      Abstract: Publication date: Available online 10 November 2017
      Source:American Journal of Infection Control
      Author(s): Courtney Hebert, Jennifer Flaherty, Justin Smyer, Jing Ding, Julie E. Mangino
      Background Surveillance is an important tool for infection control; however, this task can often be time-consuming and take away from infection prevention activities. With the increasing availability of comprehensive electronic health records, there is an opportunity to automate these surveillance activities. The objective of this article is to describe the implementation of an electronic algorithm for ventilator-associated events (VAEs) at a large academic medical center Methods This article reports on a 6-month manual validation of a dashboard for VAEs. We developed a computerized algorithm for automatically detecting VAEs and compared the output of this algorithm to the traditional, manual method of VAE surveillance. Results Manual surveillance by the infection preventionists identified 13 possible and 11 probable ventilator-associated pneumonias (VAPs), and the VAE dashboard identified 16 possible and 13 probable VAPs. The dashboard had 100% sensitivity and 100% accuracy when compared with manual surveillance for possible and probable VAP. We report on the successfully implemented VAE dashboard. Workflow of the infection preventionists was simplified after implementation of the dashboard with subjective time-savings reported. Conclusions Implementing a computerized dashboard for VAE surveillance at a medical center with a comprehensive electronic health record is feasible; however, this required significant initial and ongoing work on the part of data analysts and infection preventionists.

      PubDate: 2017-11-10T18:29:42Z
      DOI: 10.1016/j.ajic.2017.09.006
       
  • Comparison of keyboard colonization before and after use in an inpatient
           setting and the effect of keyboard covers
    • Authors: Anirudha Das; Jennifer Conti; Jennifer Hanrahan; David C. Kaelber
      Abstract: Publication date: Available online 9 November 2017
      Source:American Journal of Infection Control
      Author(s): Anirudha Das, Jennifer Conti, Jennifer Hanrahan, David C. Kaelber
      Computer keyboards may contribute to patient infections. We cultured new keyboards, with/without keyboard covers, before placing them in adult inpatient rooms and recultured after 6 months. Nonpathogenic bacteria were present initially but potentially pathogenic bacteria were cultured only after use. Coagulase negative Staphylococcus colonization increased after use (P < .001). Keyboards with a cover had more potentially pathogenic bacteria (22% vs 16%), which although not significant statistically (P = .72), likely due to sample size, trended against covers offering protection.

      PubDate: 2017-11-10T18:29:42Z
      DOI: 10.1016/j.ajic.2017.09.012
       
  • How do professional relationships influence surgical antibiotic
           prophylaxis decision making' A qualitative study
    • Authors: Jennifer K. Broom; Alex F. Broom; Emma R. Kirby; Jeffrey J. Post
      Abstract: Publication date: Available online 7 November 2017
      Source:American Journal of Infection Control
      Author(s): Jennifer K. Broom, Alex F. Broom, Emma R. Kirby, Jeffrey J. Post
      Background Surgical antibiotic prophylaxis (SAP) is a critical area to optimize to reduce the escalation of antimicrobial resistance. This article explores the ways by which interpersonal relationships influence SAP decision making. Methods Twenty surgeons and anesthetists participated in in-depth semistructured interviews on SAP prescribing. Results were analyzed using the framework approach. Results Analysis revealed 3 ways by which interpersonal relationships influence SAP: relationship dynamics between the surgeon and the anesthetist determine appropriateness of SAP, particularly operative risk ownership; perceived hierarchies within, and between, surgical and anesthetist specialties influence antibiotic prescribing decisions; and surgical distance from the antimicrobial stewardship team, which influences use of antimicrobial stewardship principles. Conclusions Interventions to optimize SAP are more likely to be effective in enacting sustained change if they consider the interpersonal and social contexts, including issues of familiarity and cohesiveness, hierarchical patterns, and sense of place within a team. Significant relational dynamics in SAP decision making are centered around risk; that is, personal/reputational risk to different professional groups and ownership of risk for individual patient outcomes. Risk must therefore be considered for sustainable SAP optimization interventions.

      PubDate: 2017-11-10T18:29:42Z
      DOI: 10.1016/j.ajic.2017.09.004
       
  • Improving knowledge and compliance with infection control Standard
           Precautions among undergraduate nursing students in Jordan
    • Authors: Zeinab M. Hassan
      Abstract: Publication date: Available online 6 November 2017
      Source:American Journal of Infection Control
      Author(s): Zeinab M. Hassan
      Introduction The recent emergence and reemergence of infectious diseases have made the knowledge and practice of standard infection control precautions in developing countries more important than ever. However, schools of nursing in Jordan do not have a prescribed curriculum in Standard Precautions. Purpose To test the effectiveness of using of an online education module and a learning contract on knowledge and compliance with infection control Standard Precautions among undergraduate nursing students in Jordan. Methods A sample of 256 undergraduate nursing students participated in an online education module in infection control Standard Precautions. A pretest–posttest design tested effectiveness using an online questionnaire (Questionnaires for Knowledge and Compliance with Standard Precautions) before and after the online instruction. Results Initially, subjects reported low levels of knowledge and compliance with Standard Precaution practices and relatively few (15.2%) had high scores. Compliance with Standard Precautions was somewhat better (27%). Significant differences in the mean scores of knowledge and compliance between pretest and posttest were found. Conclusion Online instruction offers a consistent and effective method to include Standard Precautions into nursing education. Organizations that oversee nursing in Jordan have the option to strengthen all nursing curricula by mandating a standardized infection control curricula across all schools of nursing.

      PubDate: 2017-11-10T18:29:42Z
      DOI: 10.1016/j.ajic.2017.09.010
       
  • Differences in psychosocial determinants of hand hygiene between health
           care professional groups: Insights from a mixed-methods analysis
    • Authors: Muhamad Alif Bin Ibrahim; Chengzi Chow; Bee Fong Poh; Brenda Ang; Angela Chow
      Abstract: Publication date: Available online 6 November 2017
      Source:American Journal of Infection Control
      Author(s): Muhamad Alif Bin Ibrahim, Chengzi Chow, Bee Fong Poh, Brenda Ang, Angela Chow
      Background Good hand hygiene (HH) prevents health care-associated infections. We compared psychosocial and organizational factors associated with HH compliance and perceived need for improvement among physicians, nurses, and allied health professionals (AHPs). Methods We conducted a mixed-methods study in a 1,600-bed adult tertiary-care hospital in Singapore. Seven focus group discussions were conducted and data were analyzed using thematic analysis. The subsequent cross-sectional survey involved 1,064 staff members. Principal components analysis was performed to derive the latent factor structure that was applied in multivariable analyses. Results All staff members acknowledged that HH was an integral part of their work, but were noncompliant due to competing priorities. Physicians were forgetful but appreciated reminders. Nurses were intrinsically motivated for HH. After adjusting for gender, staff category, seniority, and dermatitis history, having positive knowledge-attitudes-behaviors (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.23-1.69), personal motivators-enablers (OR, 1.60; 95% CI, 1.38-1.86), and emotional motivators (OR, 1.62; 95% CI 1.40-1.88) were positively associated with good HH compliance. Women (OR, 3.91; 95% CI, 1.37-11.11), seniors (OR, 2.88; 95% CI, 1.08-7.68), nurses (OR, 4.05; 95% CI, 1.51-10.87), and staff with personal motivators-enablers for HH (OR, 1.60; 95% CI, 1.08-2.37) were more likely to perceive a need for improvement. Conclusions Factors influencing self-reported HH differed between health care professional groups. Group-specific interventions are needed to improve compliance.

      PubDate: 2017-11-10T18:29:42Z
      DOI: 10.1016/j.ajic.2017.09.014
       
  • Collaborative efforts, collective impact
    • Authors: Linda R. Greene; Sara Cosgrove
      Abstract: Publication date: Available online 3 November 2017
      Source:American Journal of Infection Control
      Author(s): Linda R. Greene, Sara Cosgrove


      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.08.033
       
  • Knowledge and practices of isolation precautions among nurses in Jordan
    • Authors: Mohammad Suliman; Sami Aloush; Maen Aljezawi; Mohammed AlBashtawy
      Abstract: Publication date: Available online 3 November 2017
      Source:American Journal of Infection Control
      Author(s): Mohammad Suliman, Sami Aloush, Maen Aljezawi, Mohammed AlBashtawy
      Background Implementation of isolation precautions from the Centers for Disease Control and Prevention (CDC) has been justified through research and clinical evidence. However, nurses' understanding and compliance with these precautions is still unknown. The aim of this study was to assess nurses' knowledge and practices in relation to isolation precautions in Jordan. Methods A cross-sectional, descriptive design was used. The study took place in 8 hospitals in Jordan. A self-reported questionnaire and an observational checklist were developed based on the CDC (2007) isolation precautions guidelines. Results A total of 247 questionnaires were returned out of 400, for a response rate of 61.7%. The results show that most nurses (90%) have good knowledge of isolation precautions. However, only 65% of nurses reported good compliance with isolation precautions. The results of a t test revealed that nurses with Bachelor's degrees perform better in knowledge examinations than nurses with 2-year diplomas (P < .001). However, there was no significant difference in knowledge and self-report practices scores based on nurses' previous training and existence of isolation guidelines in their units or wards (P > .05). The results of the checklists confirm that there is a low compliance with standard isolation practice. In addition, the checklist shows that a high percentage of units and wards do not use isolation signs (46.4%) and posters (34.5%). Conclusions This study revealed that educating nurses about isolation is not enough strategy to improve their compliance. It is important to adapt other strategies, such as supporting nurses by giving them a manageable workload, and providing more supplies and reminders of isolation precautions in the hospitals.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.09.023
       
  • Deployment of a touchless ultraviolet light robot for terminal room
           disinfection: The importance of audit and feedback
    • Authors: Michele Fleming; Amie Patrick; Mark Gryskevicz; Nadia Masroor; Lisa Hassmer; Kevin Shimp; Kaila Cooper; Michelle Doll; Michael Stevens; Gonzalo Bearman
      Abstract: Publication date: Available online 3 November 2017
      Source:American Journal of Infection Control
      Author(s): Michele Fleming, Amie Patrick, Mark Gryskevicz, Nadia Masroor, Lisa Hassmer, Kevin Shimp, Kaila Cooper, Michelle Doll, Michael Stevens, Gonzalo Bearman
      Touchless ultraviolet disinfection (UVD) devices effectively reduce the bioburden of epidemiologically relevant pathogens, including Clostridium difficile. During a 25-month implementation period, UVD devices were deployed facilitywide for the terminal disinfection of rooms that housed a patient who tested positive for C difficile. The deployment was performed with structured education, audit and feedback, and resulted in a multidisciplinary practice change that maximized the UVD capture rate from 20% to 100%.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.09.027
       
  • Socioeconomic differences in self- and family awareness of viral hepatitis
           status among carriers of hepatitis B or C in rural Korea
    • Authors: Hye-Ran Ahn; Sung-Bum Cho; Ik Joo Chung; Sun-Seog Kweon
      Abstract: Publication date: Available online 3 November 2017
      Source:American Journal of Infection Control
      Author(s): Hye-Ran Ahn, Sung-Bum Cho, Ik Joo Chung, Sun-Seog Kweon
      Background Hepatitis is the most important cause of hepatocellular carcinoma in Korea. This study evaluated the socioeconomic differences in self- and family awareness of hepatitis status among hepatitis B and C carriers and their cohabitants in rural Korea. Methods In total, 5,017 randomly selected rural residents participated in a seroepidemiologic and questionnaire survey. We found 326 hepatitis B surface antigen carriers or hepatitis C antibody carriers and 310 family members cohabiting with members of this group. Results Among the hepatitis B carriers and their family members, 48.1% were aware of their own status and 36.7% were aware of their cohabitant's hepatitis status, respectively. Only 28.1% of the hepatitis C carriers were aware of their own status, and only 23.3% of their cohabiting family members knew about their family member's hepatitis C status. A multivariate analysis including health-related factors, such as alcohol consumption, family history of liver disease, and recent acupuncture history, found that self-awareness was significantly lower in the older group and significantly higher in the more educated and higher-income groups. Family awareness was also increased in those working in salaried jobs. Conclusions Socioeconomic disparities in awareness of hepatitis status were found among hepatitis carriers and their families.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.09.001
       
  • A needs assessment of infection control training for American Red Cross
           personnel working in shelters
    • Authors: Jocelyn J. Herstein; Janice Springer; Jono Anzalone; Sharon Medcalf; John J. Lowe
      Abstract: Publication date: Available online 3 November 2017
      Source:American Journal of Infection Control
      Author(s): Jocelyn J. Herstein, Janice Springer, Jono Anzalone, Sharon Medcalf, John J. Lowe
      This pilot needs assessment aimed to identify gaps in infection prevention and control (IPC) training of American Red Cross shelter staff through an electronic survey of IPC background, knowledge, and perceived training needs. Respondents (n = 471) noted a greater need for training in several IPC areas, although no significant differences were found in IPC knowledge between those who had recently deployed to a shelter (n = 70) and trained personnel who had never deployed (n = 178).

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.09.018
       
  • Surveillance-guided selective digestive decontamination of
           carbapenem-resistant Enterobacteriaceae in the intensive care unit: A
           cost-effectiveness analysis
    • Authors: Joyce H.S. You; Hong-kiu Li; Margaret Ip
      Abstract: Publication date: Available online 2 November 2017
      Source:American Journal of Infection Control
      Author(s): Joyce H.S. You, Hong-kiu Li, Margaret Ip
      Background Clinical findings have shown effectiveness and safety of selective digestive decontamination (SDD) for eradication of carbapenem-resistant Enterobacteriaceae (CRE) in high-risk carriers. We aimed to evaluate the cost-effectiveness of SDD guided by CRE surveillance in the intensive care unit (ICU). Methods Outcomes of surveillance-guided SDD (test-guided SDD) and no screening (control) in the ICU were compared by Markov model simulations. Model outcomes were CRE infection and mortality rates, direct costs, and quality-adjusted life year (QALY) loss. Model inputs were estimated from clinical literature. Sensitivity analyses were conducted to examine the robustness of base case results. Results Test-guided SDD reduced infection (4.8% vs 5.0%) and mortality (1.8% vs 2.1%) rates at a higher cost ($1,102 vs $1,074) than the control group in base case analysis, respectively. Incremental cost per QALY saved (incremental cost-effectiveness ratio [ICER]) by the test-guided SDD group was $557 per QALY. Probabilistic sensitivity analysis showed that test-guided SDD was effective in saving QALYs in 100% of 10,000 Monte Carlo simulations, and cost-saving 59.1% of time. The remaining 40.9% of simulations found SDD to be effective at an additional cost, with ICERs accepted as cost-effective per the willingness-to-pay threshold. Conclusions Surveillance-guided SDD appears to be cost-effective in reducing CRE infection and mortality with QALYs saved.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.09.003
       
  • Leadership rounds to reduce health care–associated infections
    • Authors: Mary Jo Knobloch; Betty Chewning; Jackson Musuuza; Susan Rees; Christopher Green; Erin Patterson; Nasia Safdar
      Abstract: Publication date: Available online 2 November 2017
      Source:American Journal of Infection Control
      Author(s): Mary Jo Knobloch, Betty Chewning, Jackson Musuuza, Susan Rees, Christopher Green, Erin Patterson, Nasia Safdar
      Background Evidence-based guidelines exist to reduce health care–associated infections (HAIs). Leadership rounds are one tool leaders can use to ensure compliance with guidelines, but have not been studied specifically for the reduction of HAIs. This study examines HAI leadership rounds at one facility. Methods We explored unit-based HAI leadership rounds led by 2 hospital leaders at a large academic hospital. Leadership rounds were observed on 19 units, recorded, and coded to identify themes. Themes were linked to the Consolidated Framework for Implementation Research and used to guide interviews with frontline staff members. Results Staff members disclosed unit-specific problems and readily engaged in problem-solving with top hospital leaders. These themes appeared over 350 times within 22 rounds. Findings revealed that leaders used words that demonstrated fallibility and modeled curiosity, 2 factors associated with learning climate and psychologic safety. These 2 themes appeared 115 and 142 times, respectively. The flexible nature of the rounds appeared to be conducive for reflection and evaluation, which was coded 161 times. Conclusions Each interaction between leaders and frontline staff can foster psychologic safety, which can lead to open problem-solving to reduce barriers to implementation. Discovering specific communication and structural factors that contribute to psychologic safety may be powerful in reducing HAIs.

      PubDate: 2017-11-04T18:17:09Z
      DOI: 10.1016/j.ajic.2017.08.045
       
  • APIC Masthead
    • Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11


      PubDate: 2017-11-04T18:17:09Z
       
  • Information for Readers
    • Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11


      PubDate: 2017-11-04T18:17:09Z
       
  • Information for Authors
    • Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11


      PubDate: 2017-11-04T18:17:09Z
       
  • Congratulations to the 2017 APIC fellows
    • Abstract: Publication date: 1 November 2017
      Source:American Journal of Infection Control, Volume 45, Issue 11


      PubDate: 2017-11-04T18:17:09Z
       
 
 
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