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Publisher: Elsevier   (Total: 3123 journals)

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Showing 1 - 200 of 3120 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 26, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, 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: 379, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 26, 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   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 237, 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: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, 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: 5)
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: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 139, 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: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 4)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 9, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 23, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 6, 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: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, 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: 12)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 6)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 47, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 52, 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: 17, 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: 27)
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: 10)
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: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9, 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: 2)
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: 16, 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: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, 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: 370, 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: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, 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: 6, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 45, 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: 338, 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: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 432, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 42, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, 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: 9, 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: 49, 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: 48, 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: 42, 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: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, 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: 208, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 61, 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: 24, 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: 26, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 36, 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: 60, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
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: 36, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 171, 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  
Animal Behaviour     Hybrid Journal   (Followers: 176, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)

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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  [3123 journals]
  • Hospital Acquired Pneumonia Prevention Initiative-2: Incidence of
           nonventilator hospital-acquired pneumonia in the United States
    • Authors: Dian Baker; Barbara Quinn
      Pages: 2 - 7
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Dian Baker, Barbara Quinn
      Background Because nonventilator hospital-acquired pneumonia (NV-HAP) is understudied, our purpose was to determine the incidence, overall burden, and level of documented pneumonia preventive interventions of NV-HAP in 24 U.S. hospitals. Methods This retrospective chart review extracted NV-HAP cases as per the 2014 ICD-9-CM codes for pneumonia not present on admission and the 2013 Centers for Disease Control and Prevention case definition. Patient demographic data, outcomes, and documented preventive interventions were also collected. Results We found 1,300 NV-HAP patients who acquired NV-HAP (rate, 0.12-2.28 per 1,000 patient days) across the 21 hospitals that completed the data collection. Most NV-HAP infections (70.8%) were acquired outside of intensive care units (ICUs); 18.8% required transfer into the ICU. In the 24 hours prior to diagnosis, most of the patients did not have fundamental hospital care associated with pneumonia prevention. Conclusions This multicenter, nationwide study highlights the significant burden of NV-HAP in the U.S. acute care hospital setting. We found that NV-HAP occurred on every hospital unit, including in younger, healthy patients. This indicates that although some patients are clearly at higher risk, all patients carry some NV-HAP risk. Therapeutic interventions aimed at NV-HAP prevention are frequently not provided for patients in acute care hospitals.

      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.08.036
       
  • 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
      Pages: 8 - 13
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      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: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.09.025
       
  • Does surgical site infection after Caesarean section in Polish hospitals
           reflect high-quality patient care or poor postdischarge surveillance'
           Results from a 3-year multicenter study
    • Authors: Anna Różańska; Andrzej Jarynowski; Katarzyna Kopeć-Godlewska; Jadwiga Wójkowska-Mach; Agnieszka Misiewska-Kaczur; Marzena Lech; Małgorzata Rozwadowska; Marlena Karwacka; Joanna Liberda; Joanna Domańska
      Pages: 20 - 25
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Anna Różańska, Andrzej Jarynowski, Katarzyna Kopeć-Godlewska, Jadwiga Wójkowska-Mach, Agnieszka Misiewska-Kaczur, Marzena Lech, Małgorzata Rozwadowska, Marlena Karwacka, Joanna Liberda, Joanna Domańska
      Background Caesarean sections (CSs) are associated with a high infection risk. Surgical site infection (SSI) incidence is among the markers of effectiveness of infection prevention efforts. The aim of this study was to analyze risk factors for SSI, incidence, and microbiology in patients who underwent CS. Methods The study was conducted during 2013-2015 using active infection surveillance in 5 Polish hospitals according to the European Centre for Disease Prevention and Control surveillance network known as HAI-Net. For each procedure, the following data were registered: age, American Society of Anesthesiologists score, procedure time, elective or emergency procedure, use of perioperative antibiotic prophylaxis, microbiology, the treatment used, and other information. Results SSI incidence was 0.5% and significant differences were noted among hospitals (between 0.1% and 1.8%), for different American Society of Anesthesiologists scales (between 0.2% and 4.8%) and different values of standardized SSI risk index (between 0.0% and 0.8%). In 3.1% of procedures, with no antibiotic prophylaxis, SSI risk was significantly higher. Deep infections dominated: 61.5% with superficial infections in only approximately 30% of cases and 2.6% of infections were detected postdischarge without readmissions. Conclusions Results showed high incidence of SSI in Poland without perioperative antibiotic prophylaxis, and secondly, ineffective surveillance according to CS status, considering outpatient obstetric care. Without postdischarge surveillance, it is not possible to recognize the epidemiologic situation, and further, to set priorities and needs when it comes to infection prophylaxis, especially because such low incidence may indicate no need for improvement in infection control.

      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.07.025
       
  • Stalking a lethal superbug by whole-genome sequencing and phylogenetics:
           Influence on unraveling a major hospital outbreak of carbapenem-resistant
           Klebsiella pneumoniae
    • Authors: Thorsten Kaiser; Knut Finstermeier; Madlen Häntzsch; Sarah Faucheux; Martin Kaase; Tim Eckmanns; Sven Bercker; Udo X. Kaisers; Norman Lippmann; Arne C. Rodloff; Joachim Thiery; Christoph Lübbert
      Pages: 54 - 59
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Thorsten Kaiser, Knut Finstermeier, Madlen Häntzsch, Sarah Faucheux, Martin Kaase, Tim Eckmanns, Sven Bercker, Udo X. Kaisers, Norman Lippmann, Arne C. Rodloff, Joachim Thiery, Christoph Lübbert
      Background From July 2010-April 2013, Leipzig University Hospital experienced the largest outbreak of a Klebsiella pneumoniae carbapenemase 2 (KPC-2)-producing Klebsiella pneumoniae (KPC-2-Kp) strain observed in Germany to date. After termination of the outbreak, we aimed to reconstruct transmission pathways by phylogenetics based on whole-genome sequencing (WGS). Methods One hundred seventeen KPC-2-Kp isolates from 89 outbreak patients, 5 environmental KPC-2-Kp isolates, and 24 K pneumoniae strains not linked to the outbreak underwent WGS. Phylogenetic analysis was performed blinded to clinical data and based on the genomic reads. Results A patient from Greece was confirmed as the source of the outbreak. Transmission pathways for 11 out of 89 patients (12.4%) were plausibly explained by descriptive epidemiology, applying strict definitions. Five of these and an additional 15 (ie, 20 out of 89 patients [22.5%]) were confirmed by phylogenetics. The rate of phylogenetically confirmed transmissions increased significantly from 8 out of 66 (12.1% for the time period before) to 12 out of 23 patients (52.2% for the time period after; P < .001) after implementation of systematic screening for KPC-2-Kp (33,623 screening investigations within 11 months). Using descriptive epidemiology, systematic screening showed no significant effect (7 out of 66 [10.6%] vs 4 out of 23 [17.4%] patients; P = .465). The phylogenetic analysis supported the assumption that a contaminated positioning pillow served as a reservoir for the persistence of KPC-2-Kp. Conclusions Effective phylogenetic identification of transmissions requires systematic microbiologic screening. Extensive screening and phylogenetic analysis based on WGS should be started as soon as possible in a bacterial outbreak situation.

      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.07.022
       
  • Improper positioning of the elevator lever of duodenoscopes may lead to
           sequestered bacteria that survive disinfection by automated endoscope
           reprocessors
    • Authors: Michelle J. Alfa; Harminder Singh; Donald R. Duerksen; Gale Schultz; Carol Reidy; Pat DeGagne; Nancy Olson
      Pages: 73 - 75
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Michelle J. Alfa, Harminder Singh, Donald R. Duerksen, Gale Schultz, Carol Reidy, Pat DeGagne, Nancy Olson
      Background Some outbreaks associated with contaminated duodenoscopes have been attributed to biofilm formation. The objective of this study was to determine whether bacteria within an organic matrix could survive if the elevator lever was improperly positioned in the automated endoscope reprocessor (AER) after 1 round of reprocessing. Methods Duodenoscope lever cavities with an open or sealed elevator wire channel were inoculated with 6-7 Log10 of both Escherichia coli and Enterococcus faecalis in ATS2015 (Healthmark Industries, Fraser, MI) and dried for 2 hours. The duodenoscopes with the lever in the horizontal position were processed through 2 makes of AERs. The cavity was sampled using a flush-brush-flush method to determine the quantity of surviving bacteria. Results E faecalis (range, 21-6 Log10 CFU) and E coli (range, 0-3 Log10 CFU) survived disinfection of sealed or unsealed elevator wire channel duodenoscopes in 2 different AERs with and without cleaning cycles. Conclusion If bacteria in organic residue are under the improperly positioned lever, then just 1 round of use is sufficient for bacteria to survive both liquid chemical sterilization and liquid chemical HLD regardless of whether or not the AER had a cleaning cycle.
      Graphical abstract image

      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.07.021
       
  • Low prevalence of colonization with multidrug-resistant gram-negative
           bacteria in long-term care facilities in Graz, Austria
    • Authors: Eva Leitner; Elisabeth Zechner; Elisabeth Ullrich; Gernot Zarfel; Josefa Luxner; Christian Pux; Gerald Pichler; Walter Schippinger; Robert Krause; Ines Zollner-Schwetz
      Pages: 76 - 80
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Eva Leitner, Elisabeth Zechner, Elisabeth Ullrich, Gernot Zarfel, Josefa Luxner, Christian Pux, Gerald Pichler, Walter Schippinger, Robert Krause, Ines Zollner-Schwetz
      Background Residents in long-term care facilities (LTCFs) are increasingly found to be an important reservoir of multidrug-resistant gram-negative (MRGN) bacteria. Aims We aimed to determine colonization by MRGN bacteria over 6 months in LTCFs and geriatric wards in Graz, Austria, and to evaluate risk factors for such colonization. Methods During August 2015, we conducted a point-prevalence survey at LTCFs and geriatric wards of the Geriatric Health Centers of the City of Graz. Inguinal and perianal swabs were taken from 137 patients and screened for MRGN using standard procedures. Six months after the initial investigation all colonized patients were sampled again and use of antibiotics, hospital admissions, and mortality was registered. Genetic relatedness of MRGN bacteria was evaluated. Results We detected 12 patients harboring MRGN isolates (prevalence, 8.7%). Overall inguinal colonization was 5.1%. After 6 months, only 2 out of 12 patients were still colonized. Presence of a urinary catheter was associated with a higher risk of MRGN colonization (odds ratio [OR], 17.5; 95% CI, 1.6-192). Chronic wounds and gastrostomy were also risk factors of MRGN colonization (OR, 10.7; 95% CI, 1.6-69.3 and OR, 18.3; 95% CI, 2.4-139.4, respectively). There was no difference in mortality between colonized and noncolonized patients. Conclusions Prevalence of colonization with MRGN bacteria was low in patients in LTCFs and geriatric wards in Graz, Austria.

      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.07.004
       
  • Comments on risk factors for health care-associated infections: From
           better knowledge to better prevention
    • Authors: Saeid Safiri; Erfan Ayubi
      Abstract: Publication date: Available online 9 January 2018
      Source:American Journal of Infection Control
      Author(s): Saeid Safiri, Erfan Ayubi


      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.11.025
       
  • Observed variation in N95 respirator use by nurses demonstrating isolation
           care
    • Authors: Elizabeth L. Beam; Elizabeth L. Hotchkiss; Shawn G. Gibbs; Angela L. Hewlett; Peter C. Iwen; Suzanne L. Nuss; Philip W. Smith
      Abstract: Publication date: Available online 9 January 2018
      Source:American Journal of Infection Control
      Author(s): Elizabeth L. Beam, Elizabeth L. Hotchkiss, Shawn G. Gibbs, Angela L. Hewlett, Peter C. Iwen, Suzanne L. Nuss, Philip W. Smith
      Video review and scoring was used to evaluate the behaviors of nurses wearing N95 filtering face piece respirators while providing isolation care in a simulated patient care environment. This study yielded a detailed description of behaviors related to N95 respirator use in a health care setting. Developing a more robust and systematic behavior analysis tool for use in demonstration, simulation, and clinical care would allow for improved respiratory protection of health care workers.

      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.11.019
       
  • Trends in incidence of long-term-care facility onset Clostridium difficile
           infections in 10 US geographic locations during 2011-2015
    • Authors: Alice Y. Guh; Yi Mu; James Baggs; Lisa G. Winston; Wendy Bamberg; Carol Lyons; Monica M. Farley; Lucy E. Wilson; Stacy M. Holzbauer; Erin C. Phipps; Zintars G. Beldavs; Marion A. Kainer; Maria Karlsson; Dale N. Gerding; Ghinwa Dumyati
      Abstract: Publication date: Available online 9 January 2018
      Source:American Journal of Infection Control
      Author(s): Alice Y. Guh, Yi Mu, James Baggs, Lisa G. Winston, Wendy Bamberg, Carol Lyons, Monica M. Farley, Lucy E. Wilson, Stacy M. Holzbauer, Erin C. Phipps, Zintars G. Beldavs, Marion A. Kainer, Maria Karlsson, Dale N. Gerding, Ghinwa Dumyati
      During 2011-2015, the adjusted long-term-care facility onset Clostridium difficile infection incidence rate in persons aged ≥65 years decreased annually by 17.45% (95% confidence interval, 14.53%-20.43%) across 10 US sites. A concomitant decline in inpatient fluoroquinolone use and the C difficile epidemic strain NAP1/027 among persons aged ≥65 years may have contributed to the decrease in long-term-care facility-onset C difficile infection incidence rate.

      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.11.026
       
  • A multistate investigation of health care–associated Burkholderia
           cepacia complex infections related to liquid docusate sodium
           contamination, January-October 2016
    • Authors: Janet Glowicz; Matthew Crist; Carolyn Gould; Heather Moulton-Meissner; Judith Noble-Wang; Tom J.B. de Man; K. Allison Perry; Zachary Miller; William C. Yang; Stephen Langille; Jessica Ross; Bobbiejean Garcia; Janice Kim; Erin Epson; Stephanie Black; Massimo Pacilli; John J. LiPuma; Ryan Fagan
      Abstract: Publication date: Available online 9 January 2018
      Source:American Journal of Infection Control
      Author(s): Janet Glowicz, Matthew Crist, Carolyn Gould, Heather Moulton-Meissner, Judith Noble-Wang, Tom J.B. de Man, K. Allison Perry, Zachary Miller, William C. Yang, Stephen Langille, Jessica Ross, Bobbiejean Garcia, Janice Kim, Erin Epson, Stephanie Black, Massimo Pacilli, John J. LiPuma, Ryan Fagan
      Background Outbreaks of health care–associated infections (HAIs) caused by Burkholderia cepacia complex (Bcc) have been associated with medical devices and water-based products. Water is the most common raw ingredient in nonsterile liquid drugs, and the significance of organisms recovered from microbiologic testing during manufacturing is assessed using a risk-based approach. This incident demonstrates that lapses in manufacturing practices and quality control of nonsterile liquid drugs can have serious unintended consequences. Methods An epidemiologic and laboratory investigation of clusters of Bcc HAIs that occurred among critically ill, hospitalized, adult and pediatric patients was performed between January 1, 2016, and October 31, 2016. Results One hundred and eight case patients with Bcc infections at a variety of body sites were identified in 12 states. Two distinct strains of Bcc were obtained from patient clinical cultures. These strains were found to be indistinguishable or closely related to 2 strains of Bcc obtained from cultures of water used in the production of liquid docusate, and product that had been released to the market by manufacturer X. Conclusions This investigation highlights the ability of bacteria present in nonsterile, liquid drugs to cause infections or colonization among susceptible patients. Prompt reporting and thorough investigation of potentially related infections may assist public health officials in identifying and removing contaminated products from the market when lapses in manufacturing occur.

      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.11.018
       
  • Comments on incidence and risk factors for infection in spine surgery: A
           prospective multicenter study of 1,764 instrumented spine procedures
    • Authors: Saeid Safiri; Erfan Ayubi
      Abstract: Publication date: Available online 9 January 2018
      Source:American Journal of Infection Control
      Author(s): Saeid Safiri, Erfan Ayubi


      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.11.027
       
  • Comments on decreased mortality in patients prescribed vancomycin after
           implementation of an antimicrobial stewardship program
    • Authors: Saeid Safiri; Erfan Ayubi
      Abstract: Publication date: Available online 9 January 2018
      Source:American Journal of Infection Control
      Author(s): Saeid Safiri, Erfan Ayubi


      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.11.022
       
  • The efficacy of infection prevention and control committees in Lesotho: A
           qualitative study
    • Authors: Eltony Mugomeri
      Abstract: Publication date: Available online 9 January 2018
      Source:American Journal of Infection Control
      Author(s): Eltony Mugomeri
      Background The implementation of the core components of infection prevention and control (IPC) recommended by the World Health Organization faces severe challenges, particularly in developing countries. Given that hospital IPC committees in these countries are the key implementers of IPC, there is a need to evaluate their effectiveness. This study qualitatively evaluated the effectiveness of IPC committees in the southern African country of Lesotho with the aim of identifying themes for policy discourse on improving IPC practice in the country. Methods Data gathering was conducted through open interviews with purposefully selected key informant IPC committee members and relevant officials at the Ministry of Health, whereas data analysis was based on grounded theory. Results Despite their commitment, IPC committees were largely ineffective because of 5 major barriers, namely poor sense of competence, administrative constraints, inadequate financial support, role uncertainty, and negative staff attitudes. Poor IPC governance was found to be a central barrier to the effectiveness of IPC committees in Lesotho. Conclusions The import of this study is that effective IPC governance is key to improving the IPC program in Lesotho. Effective leadership with the necessary competencies is needed to steer the IPC program in the country.

      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.11.028
       
  • Assessment of test methods for evaluating effectiveness of cleaning
           flexible endoscopes
    • Authors: Rebecca E. Washburn; Jennifer J. Pietsch
      Abstract: Publication date: Available online 9 January 2018
      Source:American Journal of Infection Control
      Author(s): Rebecca E. Washburn, Jennifer J. Pietsch
      Background Strict adherence to each step of reprocessing is imperative to removing potentially infectious agents. Multiple methods for verifying proper reprocessing exist; however, each presents challenges and limitations, and best practice within the industry has not been established. Our goal was to evaluate endoscope cleaning verification tests with particular interest in the evaluation of the manual cleaning step. The results of the cleaning verification tests were compared with microbial culturing to see if a positive cleaning verification test would be predictive of microbial growth. Methods This study was conducted at 2 high-volume endoscopy units within a multisite health care system. Each of the 90 endoscopes were tested for adenosine triphosphate, protein, microbial growth via agar plate, and rapid gram-negative culture via assay. The endoscopes were tested in 3 locations: the instrument channel, control knob, and elevator mechanism. Results This analysis showed substantial level of agreement between protein detection postmanual cleaning and protein detection post–high-level disinfection at the control head for scopes sampled sequentially. Conclusions This study suggests that if protein is detected postmanual cleaning, there is a significant likelihood that protein will also be detected post–high-level disinfection. It also infers that a cleaning verification test is not predictive of microbial growth.

      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.11.014
       
  • Health care-associated infections in Iran: A national update for the year
           2015
    • Authors: Babak Eshrati; Hossein Masoumi Asl; Shirin Afhami; Zahra Pezeshki; Arash Seifi
      Abstract: Publication date: Available online 9 January 2018
      Source:American Journal of Infection Control
      Author(s): Babak Eshrati, Hossein Masoumi Asl, Shirin Afhami, Zahra Pezeshki, Arash Seifi
      Background A national surveillance system for health care-associated infections (HAIs) in Iran is relatively new, and an update on incidence and mortality rates can aid clinicians and stakeholders in development of new guidelines and imperative modifications to be made. Methods Data were extracted from the national HAIs surveillance software for more than 7 million hospitalizations during 2015. Data regarding age, gender, deaths, ward of admission, and microbiologic findings were collected and analyzed. Results From 491 hospitals, 7,018,393 hospitalizations were reported during 2015; 82,950 patients had been diagnosed with at least 1 HAI, 6,355 of whom died (crude fatality rate, 7.7). Men comprised 51.4% of the patients. The incidence rate was calculated to be 1.18. Urinary tract infections and pneumonia were the most commonly reported infections (27.9% and 23.8%) and 33% of patients were older than age 65 years. Intensive care units had the highest incidence rates, followed by burn units with incidence rates close to 9. Highest percentages of deaths were reported among patients with an HAI in the intensive care unit (20.6%) and those with pneumonia (39.6%). Conclusion Although the underreporting of HAIs hinders accurate calculation of incidence, the present study provides a general update. The results can help in modification of national guidelines and appropriate choice of antimicrobial agents in the management of HAIs.

      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.11.017
       
  • Impact of the International Nosocomial Infection Control Consortium's
           multidimensional approach on rates of ventilator-associated pneumonia in
           14 intensive care units in 11 hospitals of 5 cities within Argentina
    • Authors: Victor Daniel Rosenthal; Javier Desse; Diego Marcelo Maurizi; Gustavo Jorge Chaparro; Pablo Wenceslao Orellano; Viviana Chediack; Rafael Cabrera; Daniel Golschmid; Cristina Graciela Silva; Julio Cesar Vimercati; Juan Pablo Stagnaro; Ivanna Perez; María Laura Spadaro; Adriana Miriam Montanini; Dina Pedersen; Teresa Laura Paniccia; Ana María Ríos Aguilera; Raul Cermesoni; Juan Ignacio Mele; Ernesto Alda; Analía Edith Paldoro; Agustín Román Ortta; Bettina Cooke; María Cecilia García; Mora Nair Obed; Cecilia Verónica Domínguez; Pablo Alejandro Saúl; María Cecilia Rodríguez del Valle; Alberto Claudio Bianchi; Gustavo Alvarez; Ricardo Pérez; Carolina Oyola
      Abstract: Publication date: Available online 9 January 2018
      Source:American Journal of Infection Control
      Author(s): Victor Daniel Rosenthal, Javier Desse, Diego Marcelo Maurizi, Gustavo Jorge Chaparro, Pablo Wenceslao Orellano, Viviana Chediack, Rafael Cabrera, Daniel Golschmid, Cristina Graciela Silva, Julio Cesar Vimercati, Juan Pablo Stagnaro, Ivanna Perez, María Laura Spadaro, Adriana Miriam Montanini, Dina Pedersen, Teresa Laura Paniccia, Ana María Ríos Aguilera, Raul Cermesoni, Juan Ignacio Mele, Ernesto Alda, Analía Edith Paldoro, Agustín Román Ortta, Bettina Cooke, María Cecilia García, Mora Nair Obed, Cecilia Verónica Domínguez, Pablo Alejandro Saúl, María Cecilia Rodríguez del Valle, Alberto Claudio Bianchi, Gustavo Alvarez, Ricardo Pérez, Carolina Oyola
      Background To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in 11 hospitals within 5 cities of Argentina from January 2014-April 2017. Methods A multicenter, prospective, before–after surveillance study was conducted through the use of International Nosocomial Infection Control Consortium Surveillance Online System. During baseline, we performed outcome surveillance of VAP applying the definitions of the Centers for Disease Control andPrevention's National Healthcare Safety Network. During intervention, we implemented the IMA, which included a bundle of infection prevention practice interventions, education, outcome surveillance, process surveillance, feedback on VAP rates and consequences, and performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention. Results We recorded 3,940 patients admitted to 14 intensive care units. At baseline, there were 19.9 VAPs per 1,000 mechanical ventilator (MV)-days—with 2,920 MV-days and 58 VAPs, which was reduced during intervention to 9.4 VAPs per 1,000 MV-days—with 9,261 MV-days and 103 VAPs. This accounted for a 52% rate reduction (incidence density rate, 0.48; 95% confidence interval, 0.3-0.7; P .001). Conclusions Implementing the IMA was associated with significant reductions in VAP rates in intensive care units within Argentina.

      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.11.021
       
  • A systematic approach to quantifying infection prevention staffing and
           coverage needs
    • Authors: Rebecca Bartles; Angela Dickson; Oluwatomiwa Babade
      Abstract: Publication date: Available online 4 January 2018
      Source:American Journal of Infection Control
      Author(s): Rebecca Bartles, Angela Dickson, Oluwatomiwa Babade
      Background This article describes a large nonprofit health care system's approach at quantifying the actual number of infection preventionist (IP) and relative support staff required to build and sustain effective infection prevention programs. Methods A list of all physical locations within the organization requiring infection prevention coverage were identified via survey, including department-level detail for 34 hospitals, 583 ambulatory sites, and 26 in-home and long-term care programs across 5 states. Required IP activities for each physical location were also tallied by task. Type of activity, frequency (times per year), hours per activity, and total number of locations in which each activity should occur were determined. From this, the number of hours per week of infection prevention labor resources needed was calculated. Results Quantitative needs assessment revealed actual labor need to be 31%-66% above current benchmarks of 0.5-1.0 IP per 100 occupied beds. When aggregated across the organization, the comprehensive review results yielded a new benchmark of 1.0 infection prevention full-time equivalent per 69 beds if ambulatory, long-term care, or home care are included. Conclusions Size, scope, services offered, populations cared for, and type of care settings all impact the actual need for IP coverage, making the survey benchmarks available in the literature invalid. A comprehensive assessment of health care organization composition and structure is necessary prior to determining the IP staffing needs for that organization.

      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.11.006
       
  • Virtual Zika transmission after the first U.S. case: who said what and how
           it spread on Twitter
    • Authors: Santosh Vijaykumar; Glen Nowak; Itai Himelboim; Yan Jin
      Abstract: Publication date: Available online 4 January 2018
      Source:American Journal of Infection Control
      Author(s): Santosh Vijaykumar, Glen Nowak, Itai Himelboim, Yan Jin
      Background This paper goes beyond detecting specific themes within Zika-related chatter on Twitter, to identify the key actors who influence the diffusive process through which some themes become more amplified than others. Methods We collected all Zika-related tweets during the 3 months immediately after the first U.S. case of Zika. After the tweets were categorized into 12 themes, a cross-section were grouped into weekly datasets, to capture 12 amplifier/user groups, and analyzed by 4 amplification modes: mentions, retweets, talkers, and Twitter-wide amplifiers. Results We analyzed 3,057,130 tweets in the United States and categorized 4997 users. The most talked about theme was Zika transmission (~58%). News media, public health institutions, and grassroots users were the most visible and frequent sources and disseminators of Zika-related Twitter content. Grassroots users were the primary sources and disseminators of conspiracy theories. Conclusions Social media analytics enable public health institutions to quickly learn what information is being disseminated, and by whom, regarding infectious diseases. Such information can help public health institutions identify and engage with news media and other active information providers. It also provides insights into media and public concerns, accuracy of information on Twitter, and information gaps. The study identifies implications for pandemic preparedness and response in the digital era and presents the agenda for future research and practice.
      Graphical abstract

      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.10.015
       
  • A 2-year comparative study of mold and bacterial counts in air samples
           from neutral and positive pressure rooms in 2 tertiary care hospitals
    • Authors: Laura Ryan; Niall O'Mara; Sana Tansey; Tom Slattery; Belinda Hanahoe; Akke Vellinga; Maeve Doyle; Martin Cormican
      Abstract: Publication date: Available online 4 January 2018
      Source:American Journal of Infection Control
      Author(s): Laura Ryan, Niall O'Mara, Sana Tansey, Tom Slattery, Belinda Hanahoe, Akke Vellinga, Maeve Doyle, Martin Cormican
      Immunocompromised patients are at risk of invasive fungal infection. These high-risk patients are nursed in protective isolation to reduce the risk of nosocomial aspergillosis while in hospital—ideally in a positive pressure single room with high-efficiency particulate air filtration. However, neutral pressure rooms are a potential alternative, especially for patients requiring both protective and source isolation. This study examined mold and bacterial concentrations in air samples from positive and neutral pressure rooms to assess whether neutral pressure rooms offer a similar environment to that of positive pressure rooms in terms of mold concentrations in the air. Mold concentrations were found to be similar in the positive and neutral pressure room types examined in this study. These results add to the paucity of literature in this area.

      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.10.019
       
  • Efficacy of manual cleaning and an ultraviolet C room decontamination
           device in reducing health care–associated pathogens on hospital floors
    • Authors: Aishat Mustapha; Heba Alhmidi; Jennifer L. Cadnum; Annette L. Jencson; Curtis J. Donskey
      Abstract: Publication date: Available online 4 January 2018
      Source:American Journal of Infection Control
      Author(s): Aishat Mustapha, Heba Alhmidi, Jennifer L. Cadnum, Annette L. Jencson, Curtis J. Donskey
      Recent studies suggest that floors may be an underappreciated source for transmission of health care–associated pathogens. However, there are limited data on the effectiveness of current cleaning and disinfection methods in reducing floor contamination. We demonstrated that manual postdischarge cleaning by environmental services personnel significantly reduced floor contamination, and an automated ultraviolet C room disinfection device was effective as an adjunct to manual cleaning.

      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.10.025
       
  • Methicillin-resistant Staphylococcus aureus has greater risk of
           transmission in the operating room than methicillin-sensitive S aureus
    • Authors: Randy W. Loftus; Franklin Dexter; Alysha D.M. Robinson
      Abstract: Publication date: Available online 4 January 2018
      Source:American Journal of Infection Control
      Author(s): Randy W. Loftus, Franklin Dexter, Alysha D.M. Robinson
      Background Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogenic S aureus strain characteristic associated with increased patient morbidity and mortality. The health care system needs to understand MRSA transmissibility in all settings to improve basic preventive measures to generate sustained reductions in invasive MRSA infections. Our primary aim was to compare intraoperative transmissibility of MRSA versus methicillin-sensitive S aureus (MSSA) isolates. Methods S aureus isolates (N = 173) collected from 274 randomly selected operating room environments (first and second case of the day in each operating room, a case pair) at 3 hospitals underwent systematic-phenotypic and genomic processing to identify clonally related transmission events. Confirmed transmission events were defined as at least 2 S aureus isolates obtained from ≥2 distinct intraoperative reservoirs sampled within or between cases in a study unit that were epidemiologically and clonally related. We explored the relationship between clonal transmission and methicillin resistance with Poisson regression analysis. Results We identified 58 clonal transmission events. MRSA isolates were associated with increased risk of clonal transmission compared with MSSA isolates (adjusted incidence risk ratio [IRR], 1.68; 95% confidence interval [CI], 1.13-2.49; P = .010; unadjusted IRR, 1.85; 95% CI, 1.23-2.77; P = .003, respectively). Conclusions MRSA isolates are associated with increased risk of intraoperative transmission. Future work should examine the impact of the attenuation of intraoperative MRSA transmission on the incidence of invasive MRSA infections.

      PubDate: 2018-01-10T08:43:06Z
      DOI: 10.1016/j.ajic.2017.11.002
       
  • Challenges for environmental hygiene practices in Australian paramedic-led
           health care: A brief report
    • Authors: Nigel Barr; Mark Holmes; Anne Roiko; Peter Dunn; Bill Lord
      Abstract: Publication date: Available online 3 January 2018
      Source:American Journal of Infection Control
      Author(s): Nigel Barr, Mark Holmes, Anne Roiko, Peter Dunn, Bill Lord
      This study explored the self-reported behaviors and perceptions of Australian paramedics in relation to their environmental hygiene practices. A national online survey was conducted with Paramedics Australasia members (N = 417). Participants reported working in ambulances often contaminated with body fluids. Widespread noncompliance with routine and deep cleaning of ambulances, and misunderstandings about environmental hygiene practices were apparent. Improvements to environmental hygiene practices of Australian paramedics are recommended to avoid pathogen transmission and ensure patient safety.

      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.11.007
       
  • Impact of real-time notification of Clostridium difficile test results and
           early initiation of effective antimicrobial therapy
    • Authors: Christian B. Polen; William R. Judd; Patrick D. Ratliff; Gregory S. King
      Abstract: Publication date: Available online 3 January 2018
      Source:American Journal of Infection Control
      Author(s): Christian B. Polen, William R. Judd, Patrick D. Ratliff, Gregory S. King
      Background Clostridium difficile is a prominent nosocomial pathogen and is the most common causative organism of health care–associated diarrhea. To our knowledge, no studies have investigated the impact of real-time notification of culture results with rapid antimicrobial stewardship program (ASP) intervention in the setting of C difficile infection (CDI). The purpose of this study was to assess the impact of real-time notification of detection of toxigenic C difficile by DNA amplification results in patients with confirmed CDI. Methods This is a single-center, retrospective cohort study at a 433-bed tertiary medical center in central Kentucky. The study consisted of 2 arms: patients treated for CDI prior to implementation of real-time provider notification and patients postimplementation. The primary outcome was time to initiation of effective antimicrobial therapy. Results The median time to initiation of effective antimicrobial therapy decreased from 5.75 hours in the preimplementation cohort to 2.05 hours in the postimplementation cohort (P = .001). ASP intervention also resulted in a shorter time from detection of CDI to order entry of effective antimicrobial therapy in the patient's electronic medical record (3.0 vs 0.6 hours; P = .001). Conclusions The implementation of a real-time notification system to alert a pharmacist-led ASP of toxigenic CDI resulted in statistically significant shorter times to order entry and subsequent initiation of effective antimicrobial therapy and contact precautions.

      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.11.010
       
  • Neonatal colonization of group B Streptococcus in China: Prevalence,
           antimicrobial resistance, serotypes, and molecular characterization
    • Authors: Dan Guo; Xuelian Cao; Shunming Li; Qianting Ou; Dongxin Lin; Zhenjiang Yao; Sidong Chen; Chuan'an Wu; Guoming Wen; Xiaohua Ye
      Abstract: Publication date: Available online 3 January 2018
      Source:American Journal of Infection Control
      Author(s): Dan Guo, Xuelian Cao, Shunming Li, Qianting Ou, Dongxin Lin, Zhenjiang Yao, Sidong Chen, Chuan'an Wu, Guoming Wen, Xiaohua Ye
      Background Group B Streptococcus (GBS) remains a leading cause of neonatal mortality and morbidity. This study aimed to determine the prevalence, antimicrobial susceptibility, serotypes, and molecular characterization of GBS colonized in neonates. Methods A cross-sectional study was conducted using a multistage sampling method. Swabs for GBS identification were taken from infants' ear, oral cavity, and umbilicus immediately after birth. All GBS isolates were tested for antimicrobial susceptibility, resistance genes, serotyping, multilocus sequence typing, and virulence genes. Results Of the 1,814 neonates, 1.3% tested positive for GBS, with 66.7% tested as multidrug resistant. All GBS isolates were susceptible to penicillin, but rates of resistance to tetracycline and erythromycin were high (70.8%), with the predominant resistance genes being tetM and ermB. The predominant serotype was III, followed by Ia and Ib, and the most common genotypes were sequence type (ST) 19, ST10, and ST485. Notably, we found that ST19 and ST17 isolates were associated with serotype III, resistant to tetracycline, erythromycin, and clindamycin, and carrying ermB, tetM, and rib; ST10 and ST12 isolates were associated with serotype Ib, resistant to erythromycin and clindamycin, and carrying ermB and alphaC; and ST485 isolates were associated with serotype Ia and carrying mefA/E, tetM, and epsilon. Conclusions These findings indicate a high prevalence of multidrug-resistant GBS and specific phenotype-genotype combinations for GBS clones.

      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.10.020
       
  • Amplification of perceived risk among users of a national travel health
           Web site during the 2013-2016 West African Ebola virus outbreak
    • Authors: Jakob Petersen; Hilary Simons; Dipti Patel
      Abstract: Publication date: Available online 2 January 2018
      Source:American Journal of Infection Control
      Author(s): Jakob Petersen, Hilary Simons, Dipti Patel
      Timely outbreak information was paramount to public health bodies issuing travel advisories during the 2013-2016 West Africa Ebola virus outbreak. This article explores the potential for a syndromic system/Shewhart control chart based on the online interaction with a national travel health Web site in comparison with searches on the Google UK search engine. The study showed an amplification of perceived risk among users of a national travel health Web site months before the World Health Organization declared the outbreak a Public Health Emergency of International Concern and the initial surge in public interest on Google UK in August 2014.

      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.11.012
       
  • Evaluation of hospital-grade disinfectants on viral deposition on surfaces
           after toilet flushing
    • Authors: Hannah P. Sassi; Kelly A. Reynolds; Ian L. Pepper; Charles P. Gerba
      Abstract: Publication date: Available online 2 January 2018
      Source:American Journal of Infection Control
      Author(s): Hannah P. Sassi, Kelly A. Reynolds, Ian L. Pepper, Charles P. Gerba
      Background Past studies have shown that infectious aerosols created during toilet flushing result in surface contamination of the restroom. The goals of this study were to quantify viral contamination of surfaces in restrooms after flushing and the impact of disinfectants added to the toilet bowl prior to flushing on reducing surface contamination. Methods The degree of contamination of surfaces in the restroom was assessed with and without the addition of coliphage MS2 to the toilet bowl before flushing. The bowl water and various surfaces in the restroom were subsequently tested for the presence of the virus. Results The toilet bowl rim, toilet seat top, and toilet seat underside were contaminated in all trials without a disinfectant added to the bowl water before flushing. All disinfectants significantly reduced concentrations on surfaces when the contact time was ≥15 minutes. Hydrogen peroxide resulted in very little reduction of virus in the toilet bowl (<1 log10). Peracetic acid and quaternary ammonium had the greatest log reductions on virus in the organic matter in the toilet. Conclusions Toilet flushing resulted in extensive contamination of surfaces within the restroom. Addition of disinfectant to the toilet bowl prior to flushing reduced the level of contamination in the bowl and fomites after flushing.

      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.11.005
       
  • Importance of implementation level when evaluating the effect of the Hi
           Five Intervention on infectious illness and illness-related absenteeism
    • Authors: Anne Maj Denbæk; Anette Andersen; Lotus Sofie Bast; Camilla Thørring Bonnesen; Annette Kjær Ersbøll; Pernille Due; Anette Johansen
      Abstract: Publication date: Available online 2 January 2018
      Source:American Journal of Infection Control
      Author(s): Anne Maj Denbæk, Anette Andersen, Lotus Sofie Bast, Camilla Thørring Bonnesen, Annette Kjær Ersbøll, Pernille Due, Anette Johansen
      Background There is limited research on the importance of implementation when evaluating the effect of hand hygiene interventions in school settings in developed countries. The aim of this study was to examine the association between an implementation index and the effect of the intervention. The Hi Five Intervention was evaluated in a 3-armed cluster randomized controlled trial involving 43 randomly selected Danish schools. Methods Analyses investigating the association between implementation of the Hi Five Intervention and infectious illness days, infectious illness episodes, illness-related absenteeism, and hand hygiene were carried out in a multilevel model (school, class, and child). Results The level of implementation was associated with hand hygiene and potentially associated with number of infectious illness days and infectious illness episodes among children. This association was not found for illness-related absenteeism. Conclusions Classes that succeeded in achieving a high level of implementation of the Hi Five Intervention had a lower number of infectious illness days and infectious illness episodes, suggesting that the Hi Five Intervention, if implemented adequately, may be relevant as a tool to decrease infectious illness in a Danish school setting.

      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.10.021
       
  • Adenovirus-related epidemic keratoconjunctivitis outbreak at a
           hospital-affiliated ophthalmology clinic
    • Authors: Matthew P. Muller; Naureen Siddiqui; Rose Ivancic; David Wong
      Abstract: Publication date: Available online 2 January 2018
      Source:American Journal of Infection Control
      Author(s): Matthew P. Muller, Naureen Siddiqui, Rose Ivancic, David Wong
      Adenovirus-associated epidemic keratoconjunctivitis (A-EKC) is a cause of large and prolonged outbreaks in ophthalmology clinics and can result in substantial morbidity. A-EKC outbreaks are often the result of contaminated ophthalmologic equipment, surfaces, or hands. Contaminated multidose eye drops are also a likely culprit, but few prior studies provide clear epidemiologic evidence that adenovirus transmission resulted from contamination of eye drops. We describe an A-EKC outbreak at a large, hospital-affiliated eye clinic that affected 44 patients. The unique epidemiology of the outbreak provides strong evidence that contaminated multidose dilating eye drops resulted in adenovirus transmission. Removal of multidose eye medication from the clinic, combined with case finding, enhanced infection control and enhanced environmental cleaning, led to rapid control of the outbreak.

      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.11.011
       
  • Evidence-based guidelines for prevention of ventilator-associated
           pneumonia: Evaluation of intensive care unit nurses' adherence
    • Authors: Muhammad W. Darawad; Mohammad Abu Sa'aleek; Taghreed Shawashi
      Abstract: Publication date: Available online 2 January 2018
      Source:American Journal of Infection Control
      Author(s): Muhammad W. Darawad, Mohammad Abu Sa'aleek, Taghreed Shawashi
      Using self-reported questionnaires, this descriptive study assessed nurses' adherence to ventilator-associated pneumonia (VAP) guidelines, which was found to be 81.3%. Although items concerning infection control achieved the highest scores, items concerning the suctioning process achieved the lowest scores. Participants' score of VAP care knowledge had a significant positive correlation with their score of VAP guidelines adherence. Addressing the strength and weakness domains that affect nurses' adherence is crucial for health care administrators at different managerial levels, which may help in executing different strategies to improve nurses' adherence to VAP strategies.

      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.11.020
       
  • Prospective evaluation of risk factors and clinical influence of
           carbapenem resistance in children with gram-negative bacteria infection:
           Methodologic issues
    • Authors: Saeid Safiri; Erfan Ayubi
      Abstract: Publication date: Available online 2 January 2018
      Source:American Journal of Infection Control
      Author(s): Saeid Safiri, Erfan Ayubi


      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.11.004
       
  • National Healthcare Safety Network laboratory-identified Clostridium
           difficile event reporting: A need for diagnostic stewardship
    • Authors: Clare Rock; Zoi Pana; Surbhi Leekha; Polly Trexler; Jennifer Andonian; Avinash Gadala; Karen C. Carroll; Lisa L. Maragakis
      Abstract: Publication date: Available online 2 January 2018
      Source:American Journal of Infection Control
      Author(s): Clare Rock, Zoi Pana, Surbhi Leekha, Polly Trexler, Jennifer Andonian, Avinash Gadala, Karen C. Carroll, Lisa L. Maragakis
      We describe the proportion of health care facility-onset Clostridium difficile infection (HO-CDI) National Healthcare Safety Network laboratory-identified events at our facility that were deemed nontrue HO-CDIs. Reasons included testing in a patient without significant diarrhea or with recent laxative use, or delayed testing. Standardized infection ratios using only true HO-CDI in the numerator were improved compared with publically reported standardized infection ratios. A prioritization matrix identifies which clinical services could benefit most from directed diagnostic stewardship interventions.

      PubDate: 2018-01-03T08:37:30Z
      DOI: 10.1016/j.ajic.2017.10.011
       
  • Noncompliance with surgical antimicrobial prophylaxis guidelines: A
           Jordanian experience in cesarean deliveries
    • Authors: Mariam Hantash Abdel Jalil; Khawla Abu Hammour; Mervat Alsous; Rand Hadadden; Wedad Awad; Faris Bakri; Kamil Fram
      Pages: 14 - 19
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Mariam Hantash Abdel Jalil, Khawla Abu Hammour, Mervat Alsous, Rand Hadadden, Wedad Awad, Faris Bakri, Kamil Fram
      Background Surgical site infections are common, especially in developing countries. Nevertheless, up to 60% of surgical site infections can be prevented with appropriate perioperative care, which includes among other measures using suitable surgical antimicrobial prophylaxis (SAP). Methods After a short interview with patients and retrospective review of medical charts, compliance with 6 SAP parameters was assessed for appropriateness; those parameters are indication, choice, dose, time of administration, intraoperative redosing interval, and duration of prophylaxis in 1,173 operations. Results Overall compliance was poor; nevertheless, certain components showed high compliance rates, such as indication and choice of antibiotics. The most frequent error noted was extended administration of prophylactic antibiotics, which was observed in 88.2% of the study population. Emergency operations were associated with a lower risk of noncompliance in administering the correct dose at the correct time (odds ratio, 0.63; 95% confidence interval, 0.47-0.83 and odds ratio, 0.21; 95% confidence interval, 0.14-0.3, respectively). On the other hand, women who underwent an emergency operation were associated with a 6-fold higher risk of receiving prophylactic therapy following surgery. Conclusions The present study demonstrated the existence of a surprisingly low level of overall compliance with the hospital-adapted SAP guidelines. Factors implicated in noncompliance were investigated, and the present results create a starting point to improve the current practice.

      PubDate: 2017-12-27T08:22:23Z
      DOI: 10.1016/j.ajic.2017.06.033
       
  • Antibacterial effect and proposed mechanism of action of a topical
           surgical adhesive
    • Authors: Daniel Prince; Zankhna Solanki; Remy Varughese; Jozef Mastej; Derek Prince
      Pages: 26 - 29
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Daniel Prince, Zankhna Solanki, Remy Varughese, Jozef Mastej, Derek Prince
      Background Medical adhesives effectively hold closed approximated skin edges of wounds from surgical incisions, including punctures from minimally invasive surgery. In addition, they have been reported to be antibacterial against gram-positive bacteria. Methods Using membrane filtration to capture all organisms after contact with 2-octyl cyanoacrylate product for 3 minutes, we quantified the number of survivors. Controls were performed to rule out that the noted level of kill was caused by carryover product in the test system. Results We found that the product kills >7 logs of gram-positive and gram-negative bacteria. The mechanism of action for the antibacterial effect is described as a function of very low water content. Conclusions As an antibacterial agent, the risk of nosocomial infection is greatly diminished, and an uneventful clinical result is facilitated. Bacterial growth cannot occur in the formulation and on contact death rapidly ensues as cellular water diffuses from the cell into the product.

      PubDate: 2017-12-27T08:22:23Z
      DOI: 10.1016/j.ajic.2017.07.008
       
  • Evaluation of surgical glove integrity and factors associated with glove
           defect
    • Authors: Mohamed Ayoub Tlili; Amina Belgacem; Haifa Sridi; Maha Akouri; Wiem Aouicha; Sonia Soussi; Faten Dabbebi; Mohamed Ben Dhiab
      Pages: 30 - 33
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Mohamed Ayoub Tlili, Amina Belgacem, Haifa Sridi, Maha Akouri, Wiem Aouicha, Sonia Soussi, Faten Dabbebi, Mohamed Ben Dhiab
      Background Surgical glove perforation may expose both patients and staff members to severe complications. This study aimed to determine surgical glove perforation rate and the factors associated with glove defect. Material and methods This descriptive cross-sectional study was conducted between January and March 2017 at a Tunisian university hospital center in 3 different surgical departments: urology, maxillofacial, and general and digestive. The gloves were collected and tested to detect perforations using the water-leak test as described in European Norm NF EN 455-1. For percentage comparisons, the χ2 test was used with a significance threshold of 5%. Results A total of 284 gloves were collected. Of these, 47 were found to be perforated, a rate of 16.5%. All perforations were unnoticed by the surgical team members. The majority of perforated gloves (61.7%) were collected after urology procedures (P = .00005), 77% of perforated gloves were detected when the duration of the procedure exceeded 90 minutes (P = .001), and 96% were from brand A, which were the thicker gloves (P = .015). Conclusions This study highlighted an important problem neglected by surgical teams. The findings reaffirm the importance of double-gloving and changing gloves in surgeries of more than 90 minutes' duration.

      PubDate: 2017-12-27T08:22:23Z
      DOI: 10.1016/j.ajic.2017.07.016
       
  • Evaluating the direct economic burden of health care–associated
           infections among patients with colorectal cancer surgery in China
    • Authors: Yunhong Liu; Wei Xiao; Shuhui Wang; Carmen W.H. Chan
      Pages: 34 - 38
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Yunhong Liu, Wei Xiao, Shuhui Wang, Carmen W.H. Chan
      Background Little is known about the direct economic burden associated with health care–associated infection (HAI) in patients undergoing colorectal cancer surgery in China. This study aims to fill this knowledge gap. Methods This study was a prospective monitoring case-control study. The direct economic burden was presented as the median of the 1:1 pair differences of various hospitalization fees and hospital length of stay. Wilcoxon signed-rank tests were used to explore the differences in the direct economic burden. Results Out of 448 patients, 38 had acquired HAIs, with the infection incidence being 8.93%. The total direct economic burden of HAIs was $1,589.30 (P < .05). Among various infection sites, deep surgical site infection had the highest direct economic burden of $8,654.44, followed by multisite infections ($5,946.52). When it comes to various hospitalization costs, the cost for Western medicine ($846.13) constituted the highest proportion of economic burden followed by treatment cost ($145.73) and bed charge ($126.75). On average, the length of hospital stay in the infection group was 6 days longer than that in the control group (P < .05). Conclusions HAI was associated with considerable economic burden for patients who underwent colorectal cancer surgery in China. The study highlights the necessity of taking effective measures to decrease incidence of HAIs to reduce economic burden.

      PubDate: 2017-12-27T08:22:23Z
      DOI: 10.1016/j.ajic.2017.08.003
       
  • Tracking and controlling soft surface contamination in health care
           settings
    • Authors: Jonathan D. Sexton; Amanda M. Wilson; Hannah P. Sassi; Kelly A. Reynolds
      Pages: 39 - 43
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Jonathan D. Sexton, Amanda M. Wilson, Hannah P. Sassi, Kelly A. Reynolds
      Background Study objectives were to track the transfer of microbes on soft surfaces in health care environments and determine the efficiency of an Environmental Protection Agency (EPA)–registered soft surface sanitizer in the health care environment. Methods Soft surfaces at 3 health care facilities were sampled for heterotrophic plate count (HPC) bacteria, Staphylococcus spp, Streptococcus pyogenes, and Escherichia coli followed by a tracer study with a virus surrogate seeded onto volunteer hands and commonly touched surfaces. The occurrence of microbial contaminants was determined along with microbial reductions using the soft surface sanitizer. Soft surfaces were swabbed pre- and postintervention. Results Tracer viruses spread to 20%-64% and 13%-41% of surfaces in long-term health care facilities and physicians' offices, respectively. Only 1 pathogen, methicillin-resistant Staphylococcus aureus, was recovered. The waiting room chairs had the highest concentration of HPC bacteria before disinfection (145.4 ± 443.3 colony forming units [cfu]/cm2), and the privacy curtains had the lowest (39.5 ± 84.2 cfu/cm2). Reductions of up to 98.5% were achieved with the sanitizer in health care settings and up to 99.99% under controlled laboratory conditions. Conclusions Soft surfaces are involved in the spread of microbes throughout health care facilities. Routine application of an EPA-registered sanitizer for soft surfaces can help to reduce the microbial load and minimize exposure risks.

      PubDate: 2017-12-27T08:22:23Z
      DOI: 10.1016/j.ajic.2017.08.002
       
  • Efficacy testing of novel chemical disinfectants on clinically relevant
           microbial pathogens
    • Authors: Elaine Meade; Mary Garvey
      Pages: 44 - 49
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Elaine Meade, Mary Garvey
      Background There has been a dramatic increase in the number of hospital-acquired infections, which is linked to the pandemic of multidrug resistance. Clinical environments provide an ideal reservoir for the growth, proliferation, and transmission of pathogenic organisms, including bacterial and yeast species. Consequently, the need for improved, effective disinfectants is of paramount importance. Methods Studies were conducted to assess the efficacy of chemical disinfectants—peracetic acid and triameen—on microbial strains. Testing included the assessment of antimicrobial and antisporicidal activity of disinfection solutions performed on a range of clinical isolates that pose a high risk for patient morbidity in clinical settings. Results Both chemical disinfectants successfully inactivated all test strains, with peracetic acid showing a greater level of antimicrobial activity. Escherichia coli proved most susceptible when assessed by the Kirby disk diffusion, suspension, and medical suspension assays with the greatest reduction in cell viability achieved. Antibiotic-resistant Enterococcus and Staphylococcus aureus strains showed greatest resistance to both disinfectants. Discussion and conclusions Test chemicals show potential to act as intermediate-level disinfectants inactivating vegetative microorganisms and bacterial spores on clinically relevant strains where they show potential as a preventative measure in relation to nosocomial infections.

      PubDate: 2017-12-27T08:22:23Z
      DOI: 10.1016/j.ajic.2017.07.001
       
  • Long-term metabolic persistence of gram-positive bacteria on health
           care-relevant plastic
    • Authors: Loree C. Heller; Chelsea M. Edelblute
      Pages: 50 - 53
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Loree C. Heller, Chelsea M. Edelblute
      Background Health care-associated opportunistic pathogens Staphylococcus aureus and Enterococcus faecium persist on dry environments and can contribute to organism transmission through contact. These organisms can be monitored on surfaces by culture, molecular methods, or metabolic assays. This study was designed to determine the kinetics of bacterial persistence on acrylonitrile butadiene styrene, a plastic commonly used in the manufacture of bedrails. Materials and methods Polymerase chain reaction for genomic DNA was used to confirm the presence of bacteria cells on this plastic irrespective of viability. Bacterial viability was measured by culture, ATP quantification, and a metabolic assay at time points up to and longer than 1 year. Results Polymerase chain reaction confirmed the presence of bacteria on the plastic for the entire time period studied. However, S aureus culturability was reduced after 3 and 7 weeks; neither organism was culturable after 1 year. At 7 weeks, ATP levels were reduced for both organisms, paralleling S aureus culturability but indicating that ATP quantification did not predict E faecium culturability. S aureus-reducing potential was reduced after 7 weeks, whereas E faecium-reducing potential reached the level of fresh inoculum after 12 hours in broth culture. Low but significant levels of metabolic activity were detected for each organism after 1 year. Conclusions S aureus and E faecium cells may retain viability on plastic for longer than 1 year.

      PubDate: 2017-12-27T08:22:23Z
      DOI: 10.1016/j.ajic.2017.07.027
       
  • Control of multidrug-resistant Acinetobacter baumannii in Hong Kong: Role
           
    • Authors: Vincent C.C. Cheng; Shuk-Ching Wong; Jonathan H.K. Chen; Simon Y.C. So; Sally C.Y. Wong; Pak-Leung Ho; Kwok-Yung Yuen
      Pages: 60 - 66
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Vincent C.C. Cheng, Shuk-Ching Wong, Jonathan H.K. Chen, Simon Y.C. So, Sally C.Y. Wong, Pak-Leung Ho, Kwok-Yung Yuen
      Background Environmental reservoir is an important source of multidrug-resistant Acinetobacter baumannii (MRAB) outbreaks. The role of postoutbreak environmental surveillance for guiding sustained infection control effort has not been examined. Methods Enhanced environmental disinfection and regular environmental surveillance of ward communal areas after an outbreak were performed in a university-affiliated hospital. To assess the usefulness of environmental culture in predicting patients with MRAB, weekly surveillance of communal areas was continued for 3 months after the outbreak in intervention wards. The incidence of MRAB in intervention and nonintervention wards (control) was compared, whereas the other infection control measures remained identical. Results Postoutbreak weekly surveillance of communal areas showed that identification of newly diagnosed MRAB patients was significantly correlated with preceding environmental contamination with MRAB (P = .001). The incidence of nosocomial MRAB infection was significantly lower in the intervention compared with nonintervention wards (0.55 vs 2.28 per 1,000 patient days, respectively; P = .04). All MRAB isolated from the environmental and patients' samples belonged to multilocus sequence typing ST457 and were blaOXA23-like positive. Conclusions Environmental surveillance may serve as a surrogate marker for the presence of MRAB carriers. Implementation of timely infection control measures should be guided by environmental culture for MRAB to minimize the risk of MRAB outbreak.

      PubDate: 2017-12-27T08:22:23Z
      DOI: 10.1016/j.ajic.2017.07.010
       
  • Urinary tract infection surveillance in residential aged care
    • Authors: Susan Ryan; Elizabeth Gillespie; Rhonda L. Stuart
      Pages: 67 - 72
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Susan Ryan, Elizabeth Gillespie, Rhonda L. Stuart
      Objectives The aim of this research was to determine the prevalence of urinary tract infections (UTIs) in 2 aged care homes (ACHs) and examine the extent to which presumed UTIs met the 2012 McGeer infection surveillance definitions. Design Retrospective observational study. Setting Two ACHs: a 30-bed facility and a 100-bed facility Participants Residents of the 2 ACHs diagnosed with UTI. Methods A retrospective review was conducted of UTIs clinically diagnosed at the 2 facilities over a 16-month period, utilizing surveillance and microbiologic data, resident progress notes, and medication charts. This data was reviewed to determine how many diagnosed UTIs met the revised McGeer definitions. Results Overall, 119 UTIs were diagnosed in 57 residents over 16 months. Only 7 of the diagnosed UTIs met the McGeer definitions. Forty-seven did not meet the clinical evidence, 17 did not meet the microbiologic evidence, and 48 did not meet either surveillance criteria. Conclusions This study demonstrated the disparity between the clinical diagnosis of UTI and the surveillance definitions for UTI, and highlights the limitations of the McGeer definitions in those with cognitive or communication deficits. There is an urgent need for antimicrobial stewardship programs and education in the ACH setting.

      PubDate: 2017-12-27T08:22:23Z
      DOI: 10.1016/j.ajic.2017.07.002
       
  • Clinical usefulness of catheter-drawn blood samples and catheter tip
           cultures for the diagnosis of catheter-related bloodstream infections in
           neonatology: A systematic review
    • Authors: Janita Ferreira; Paulo Augusto Moreira Camargos; Wanessa Trindade Clemente; Roberta Maia de Castro Romanelli
      Pages: 81 - 87
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Janita Ferreira, Paulo Augusto Moreira Camargos, Wanessa Trindade Clemente, Roberta Maia de Castro Romanelli
      Objectives Neonatal sepsis is the most frequent health care-associated infection in neonatal units. This study aimed to analyze articles on the clinical usefulness of catheter-drawn blood samples and catheter tip cultures for the diagnosis of intravascular catheter-related bloodstream infection (CRBSI) in neonates. Methods A systematic search was performed for studies published from 1987-2017, without language restriction. Observational studies carried out in neonates with CRBSI diagnosed using catheter-drawn blood samples or catheter tip cultures were included. Results A total of 412 articles were identified in the databases and 10 articles were included. The 7 studies that evaluated central venous catheter tip cultures and cultures of catheter fragments presented sensitivities ranging from 58.5%-100% and specificities ranging from 60%-95.7%. Three studies that evaluated catheter-drawn blood cultures, paired with peripheral blood cultures, reported sensitivity and specificity of 94% and 71% when evaluated for the differential time to positivity. When quantitative evaluation was performed, the sensitivity and specificity were 80% and 99.4%. Conclusions Most of the studies analyzed cultures from the central venous catheter tip and catheter fragments for the diagnosis of CRBSI in neonatal populations. The results of this review suggest that the analysis of the catheter-drawn blood samples and catheter tip cultures, paired with peripheral blood cultures, are efficient methods for the diagnosis of CRBSI in neonates.

      PubDate: 2017-12-27T08:22:23Z
      DOI: 10.1016/j.ajic.2017.06.030
       
  • Risk factors for development of surgical site infections among liver
           transplantation recipients: An integrative literature review
    • Authors: Ramon Antônio Oliveira; Ruth Natália Teresa Turrini; Vanessa de Brito Poveda
      Pages: 88 - 93
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Ramon Antônio Oliveira, Ruth Natália Teresa Turrini, Vanessa de Brito Poveda
      Background Surgical site infection (SSI) is an important complication in the postoperative period of recipients of liver transplantation. The purpose of this integrative literature review is to summarize the knowledge available about the risk factors contributing to the development SSI among adults undergoing liver transplantation. Methods We reviewed the Medical Literature Analysis and Retrieval System Online/PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Latin American and Caribbean Health Sciences Literature, Scopus, and Web of Science databases. Results Two hundred sixteen articles were identified and the final sample of 9 articles was analyzed in full length. The SSI rate found in the investigations ranged between 9.6% and 35.5%. Risk factors for SSI were grouped into categories related to the preoperative period, such as Model for End-Stage Renal Disease score > 35 and ventilated support on day of transplant; to the intraoperative period activity, such as transfusion of packed red blood cells, extended surgical time, hyperglycemia >200 mg/dL, use of vasopressor drugs, and ascites flow >1 L; and to the donor/recipient relationship, such as age differences >10 years, ratio of donor liver mass to recipient body mass < 0.01. Additionally, centers that annually perform <50 transplants appear to have higher rates of SSI. Conclusions Few studies have addressed the subject of SSI in relation to liver transplantation in the scientific literature. Risk factors for SSI in patients who underwent liver transplantation vary between institutions.

      PubDate: 2017-12-27T08:22:23Z
      DOI: 10.1016/j.ajic.2017.05.021
       
  • Infection prevention strategies for procedures performed outside operating
           rooms: A conceptual integrated model
    • Authors: Vincent Masse; Michael B. Edmond; Daniel J. Diekema
      Pages: 94 - 96
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): Vincent Masse, Michael B. Edmond, Daniel J. Diekema
      No comprehensive guidelines or classification exist for infection prevention strategies for medical procedures performed outside operating rooms. We reviewed the available literature and used our clinical experience to develop a progressive, 5-tiered classification of procedures, encompassing clean, aseptic, sterile-superficial, sterile-invasive, and surgical-like procedures to address this need. We provide a description of these categories, along with relevant examples. We fully acknowledge the limitations of our work, which is intended as a starting point for future efforts and not to be definitive.

      PubDate: 2017-12-27T08:22:23Z
      DOI: 10.1016/j.ajic.2017.07.030
       
  • Patient-driven hand hygiene audit process at a regional cancer center
    • Authors: E.J. Bow; V. Bourrier; J. Trudel; N. Kostiuk; J.M. McLeod
      Pages: 97 - 99
      Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1
      Author(s): E.J. Bow, V. Bourrier, J. Trudel, N. Kostiuk, J.M. McLeod
      A patient-driven hand hygiene compliance audit strategy was piloted in a Canadian provincial cancer agency during routine provision of cancer outpatient care by health care providers (physicians, nurses, and health care aides) under conditions where the deployment of an independent external auditor was not feasible. The results of the audit suggest the feasibility of this approach as a routine institutional performance metric.

      PubDate: 2017-12-27T08:22:23Z
      DOI: 10.1016/j.ajic.2017.06.011
       
  • APIC Masthead
    • Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1


      PubDate: 2017-12-27T08:22:23Z
       
  • Information for Readers
    • Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1


      PubDate: 2017-12-27T08:22:23Z
       
  • Information for Authors
    • Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1


      PubDate: 2017-12-27T08:22:23Z
       
  • Launch of the APIC® Program of Distinction
    • Abstract: Publication date: January 2018
      Source:American Journal of Infection Control, Volume 46, Issue 1


      PubDate: 2017-12-27T08:22:23Z
       
 
 
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