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Publisher: Elsevier   (Total: 3043 journals)

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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 18, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 83, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 333, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 225, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, 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: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 134, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 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: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 47, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 35, 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: 5)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 60)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 345, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, 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: 310, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 408, 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: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 53, 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: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 38, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 33, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 187, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 3)
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: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, 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: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 9)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 164, 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: 11)
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: 158, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Journal Cover American Journal of Infection Control
  [SJR: 1.259]   [H-I: 81]   [24 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0196-6553
   Published by Elsevier Homepage  [3043 journals]
  • Effectiveness of cleaning-disinfection wipes and sprays against
           multidrug-resistant outbreak strains
    • Authors: Nikki Kenters; Elisabeth G.W. Huijskens; Sophie C.J. de Wit; Joost van Rosmalen; Andreas Voss
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Nikki Kenters, Elisabeth G.W. Huijskens, Sophie C.J. de Wit, Joost van Rosmalen, Andreas Voss
      Background Hospital rooms play an important role in the transmission of several health care–associated pathogens. During the last few years, a number of innovative cleaning-disinfecting products have been brought to market. In this study, commercially available products combining cleaning and disinfection were compared, using 2 different application methods. The aim was to determine which product was most effective in simultaneous cleaning and disinfection of surfaces. Methods Seven cleaning-disinfecting wipes and sprays based on different active ingredients were tested for their efficacy in removal of microbial burden and proteins. Efficacy was tested with known Dutch outbreak strains: vancomycin-resistant enterococci (VRE), Klebsiella pneumoniae OXA-48, or Acinetobacter baumannii. Results For all bacteria, ready-to-use cleaning-disinfecting products reduced the microbial count with a log10 reduction >5 with a 5-minute exposure time, with the exception of a spray based on hydrogen peroxide. Omitting the aforementioned hydrogen peroxide spray, there were no significant differences between use of a wipe or spray in bacterial load reduction. Using adenosine triphosphate (ATP) measurements, a significant difference in log10 relative light units (RLU) reduction between various bacteria (P ≤ .001) was observed. Conclusions In general, a >5 log10 reduction of colony forming units (CFU) for tested wipes and sprays was obtained for all tested bacteria strains, with exception of hydrogen peroxide spray and VRE. Although ATP may show a difference between pre- and postcleaning, RLU reduction does not correlate with actual CFU reductions.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.04.290
       
  • Longitudinal nosocomial outbreak of Pseudomonas fluorescens bloodstream
           infection of 2 years' duration in a coronary care unit
    • Authors: Yuichiro Oba; Takahiro Nakajima; Chiyo Ogida; Miyuki Kawanami; Mamoru Fujiwara; Ikuko Matsumura
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Yuichiro Oba, Takahiro Nakajima, Chiyo Ogida, Miyuki Kawanami, Mamoru Fujiwara, Ikuko Matsumura
      Background Outbreaks of bloodstream infections (BSI) of nonfermenting bacteria are a critical issue and often associated with hospital environments. We experienced a long-lasting outbreak of Pseudomonas fluorescens BSI limited to a coronary care unit (CCU). Methods We conducted a retrospective epidemiologic investigation and a case-control study for Pseudomonas fluorescens BSI from April 2011-July 2014. Environmental sample culture was conducted to detect the specific environmental source of transmission. Results Hospital-wide microbiology data from the term identified 13 case patients with P fluorescens BSI and 32 control patients with BSI due to organisms other than P fluorescens in the CCU. The case-control study revealed that the case group had significantly higher odds of exposure to only cardiac output (CO) measurement with thermodilution method (odds ratio, 22.0; 95% confidence interval, 2.4-202.3). The organism was identified only from an ice bath used for CO measurement. The susceptibility patterns were identical among all strains derived from the cases and the environment. Conclusions The nosocomial outbreak of P fluorescens BSI in our CCU over 2 years was associated with a contaminated ice bath used for CO measurement within the unit. Detection and elimination of the specific source was essential to stop the outbreak.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.05.008
       
  • Alcohol fixation of bacteria to surgical instruments increases cleaning
           difficulty and may contribute to sterilization inefficacy
    • Authors: Dayane de Melo Costa; Lillian Kelly de Oliveira Lopes; Honghua Hu; Anaclara Ferreira Veiga Tipple; Karen Vickery
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Dayane de Melo Costa, Lillian Kelly de Oliveira Lopes, Honghua Hu, Anaclara Ferreira Veiga Tipple, Karen Vickery
      Background Alcohol is frequently inappropriately used on surgical instruments to reduce bacterial contamination, but fixes protein to stainless steel. Here we compare the effect of air drying, prolonged soaking in water, and alcohol treatment on cleaning difficulty of contaminated forceps. Methods Haltsted-mosquito forceps were contaminated with only Staphylococcus aureus. Instruments were air-dried for 10 (control), 75, or 240 minutes, soaked in water, or air dried then treated with ethanol or isopropanol for 10 seconds. All instruments were prewashed for 15 minutes. Forceps contaminated with blood and S aureus or Pseudomonas aeruginosa were dried and then sprayed or wiped with ethanol, and prewashed. Bacterial viability and soiling were determined by standard plate culture and crystal violet staining, respectively. Results Soaking or spraying instruments with alcohol significantly reduced viable bacterial numbers, but significantly increased soil attached to forceps, as did air drying. Wiping instruments with alcohol had little effect on bacterial viability, but increased cleaning difficulty. Soaking in water for 75 or 240 minutes increased cleaning difficulty perhaps due to bacterial attachment to forceps. Conclusions Treating contaminated instruments with alcohol, allowing them to dry, or allowing them to soak in water for prolonged periods increases cleaning difficulty and should be discouraged.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.04.286
       
  • Active offer of vaccinations during hospitalization improves coverage
           among splenectomized patients: An Italian experience
    • Authors: Maria Serena Gallone; Carmen Martino; Michele Quarto; Silvio Tafuri; Margari Antonio; Memeo Vincenzo; Palasciano Nicola; Pezzolla Angela; Testini Mario; Vincenti Leonardo
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Maria Serena Gallone, Carmen Martino, Michele Quarto, Silvio Tafuri
      In 2014, an Italian hospital implemented a protocol for pneumococcal, meningococcal, and Haemophilus influenzae type b vaccines offer to splenectomized patients during their hospitalization. After 1 year, coverage for recommended vaccinations increased from 5.7%-66.7% and the average time between splenectomy and vaccines administration decreased from 84.7-7.5 days.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.02.039
       
  • Journal Club: Hand hygiene compliance in a universal gloving setting
    • Authors: Timothy Landers; Jeanette Harris
      Pages: 820 - 821
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Timothy Landers, Jeanette Harris


      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.03.030
       
  • Journal Club: Developing a user-friendly report for electronically
           assisted surveillance of catheter-associated urinary tract infections
    • Authors: Michael Fritz Estinville; Amanda Hessels; James Davis
      Pages: 822 - 823
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Michael Fritz Estinville, Amanda Hessels, James Davis
      The article chosen for this Journal Club commentary describes the development and testing of a report format using automated data to report urinary catheter utilization and catheter-associated urinary tract infections (CAUTIs). 1 This research sought to address a gap in knowledge regarding the optimal display and content of data reports, communicating to diverse audiences, which used surveillance data from Department of Veterans Affairs' electronic health records. The specific research aim of this project was to develop and pilot test report formats deemed usable and trustworthy by the end user, and discover the best way to deliver to the ideal audience automated data, which is formatted and presented in a way that is acceptable to the end user.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.06.008
       
  • Use of a patient empowerment tool for hand hygiene
    • Authors: Allison Lastinger; Kayeromi Gomez; Ellen Manegold; Rashida Khakoo
      Pages: 824 - 829
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Allison Lastinger, Kayeromi Gomez, Ellen Manegold, Rashida Khakoo
      Background Patient empowerment is recognized as an important component of a multimodal strategy to improve hand hygiene adherence. We examined the attitudes of adult patients and parents of pediatric patients toward a new patient empowerment tool (PET) at our hospital. We also surveyed physicians to determine their perceptions about the PET. Methods A cross-sectional survey was performed of hospitalized children's parents and adult patients in a 531-bed tertiary care teaching hospital in West Virginia. Surveys were anonymous and self-administered. A separate survey was administered via e-mail to resident and attending physicians from the departments of internal medicine, pediatrics, and family medicine. Results Most parents and adult patients felt it was their role to speak up if a provider did not perform hand hygiene, but a smaller number actually felt comfortable using the PET. Only 54.9% of physicians felt that patients should be involved in reminding providers to perform hand hygiene. Overall, physicians indicated that they would prefer a patient to use words rather than the PET to remind them to perform hand hygiene. Conclusions In our study, parents and adult patients supported use of the PET, but physicians were less supportive. As the patient empowerment movement grows, we should work to improve physician acceptance of patient involvement if it is to be successful.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.02.010
       
  • Hand hygiene compliance in a universal gloving setting
    • Authors: Noriko Kuruno; Kei Kasahara; Keiichi Mikasa
      Pages: 830 - 834
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Noriko Kuruno, Kei Kasahara, Keiichi Mikasa
      Background The use of gloves for every patient contact (ie, universal gloving) has been suggested as an infection prevention adjunct and alternative to contact precautions. However, gloves may carry organisms unless they are changed properly. In addition, hand hygiene is required before donning and after removing gloves, and there are scarce data regarding glove changing and hand hygiene in a universal gloving setting. Methods This nonrandomized observational before-after study evaluated the effect of education and feedback regarding hand hygiene. Compliance with hand hygiene and glove use was directly observed in a universal gloving setting at a 10-bed intensive care unit in a Japanese tertiary care university teaching hospital. Results A total of 6,050 hand hygiene opportunities were identified. Overall, hand hygiene compliance steadily increased from study period 1 (16.1%) to period 5 (56.8%), although there were indication-specific differences in the baseline compliance, the degree of improvement, and the reasons for noncompliance. There were decreases in the compliance with universal gloving and the incidence of methicillin-resistant Staphylococcus aureus. Conclusion It is difficult to properly perform glove use and hand hygiene in a universal gloving setting, given its complexity. Direct observation with specific feedback and education may be effective in improving compliance.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.02.024
       
  • Effect of hand lotion on the effectiveness of hygienic hand antisepsis:
           Implications for practicing hand hygiene
    • Authors: Helga Paula; Nils-Olaf Hübner; Ojan Assadian; Katja Bransmöller; Romy Baguhl; Harald Löffler; Axel Kramer
      Pages: 835 - 838
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Helga Paula, Nils-Olaf Hübner, Ojan Assadian, Katja Bransmöller, Romy Baguhl, Harald Löffler, Axel Kramer
      Background Skin protection products should be used after washing hands with soap, during breaks, after work, and during leisure time. Aside from their beneficial effects, skin care products may also interact with alcohol-based hand disinfectants by reducing their efficacy. The aim of this study was to investigate the effect of a hand lotion on the effectiveness of hygienic hand antisepsis using an alcohol-based handrub. Methods The effect of a protective hand lotion against an isopropyl alcohol-based handrub was investigated in 20 healthy volunteers according to the European standard test procedure EN 1500 in the following combinations: handwashing and application of hand lotion, only application of hand lotion, and no washing and no hand lotion (control), each for 5 minutes or 1 hour before hand antisepsis. The difference in microbiologic before-and-after values were expressed as log reduction factor. Results The effectiveness of hand antisepsis was not significantly affected in any of the groups using the tested hand lotion. Conclusions Hand antisepsis may be delayed for 5 minutes after hand lotion application. Shorter time intervals might be possible but were not tested.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.05.020
       
  • Identification of low, high, and super gelers and barriers to hand hygiene
           among intensive care unit nurses
    • Authors: Sharon Lea Kurtz
      Pages: 839 - 843
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Sharon Lea Kurtz
      Background The purpose of this article was to provide information identified during hand hygiene (HH) surveillance periods at 5 intensive care units (ICUs) (4 hospitals) in Texas. Methods Using room entry and room exit, overt observation periods were 8 consecutive hours for 3-5 days on 64 ICU nurses. Results A total of 3,620 HH opportunities were recorded during 18 days of observation (144 hours). The average hand hygiene compliance (HHC) rate was 64%, with 19% of the nurses participating in HH in the 60%-69% range. Male nurses had a rate of 67%, whereas female nurses had a rate of 62%. Having a HHC rate of <29%, 6% of the nurses were identified as low gelers, whereas 14% were identified as high gelers (HHC rate 80%-89%), and 13% were classified as super gelers (HHC rate 90%-100%). Four barriers to HHC were identified: carrying something in their hands, talking on mobile phones, donning gloves or personal protective equipment, and pushing or pulling the workstation on wheels; all were statistically significant. Accounting for 18% noncompliance, barriers identified present teaching opportunities to increase compliance. Conclusions Average HHC rates recorded during 10- to 20-minute periods with random sampling may not show the complete picture of HHC. Barriers to HHC were identified that can be used as teaching interventions.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.04.004
       
  • Efficacy of the World Health Organization–recommended handwashing
           technique and a modified washing technique to remove Clostridium difficile
           from hands
    • Authors: Philippe Deschênes; Frédéric Chano; Léa-Laurence Dionne; Didier Pittet; Yves Longtin
      Pages: 844 - 848
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Philippe Deschênes, Frédéric Chano, Léa-Laurence Dionne, Didier Pittet, Yves Longtin
      Background The efficacy of the World Health Organization (WHO)–recommended handwashing technique against Clostridium difficile is uncertain, and whether it could be improved remains unknown. Also, the benefit of using a structured technique instead of an unstructured technique remains unclear. Methods This study was a prospective comparison of 3 techniques (unstructured, WHO, and a novel technique dubbed WHO shortened repeated [WHO-SR] technique) to remove C difficile. Ten participants were enrolled and performed each technique. Hands were contaminated with 3 × 106 colony forming units (CFU) of a nontoxigenic strain containing 90% spores. Efficacy was assessed using the whole-hand method. The relative efficacy of each technique and of a structured (either WHO or WHO-SR) vs an unstructured technique were assessed by Mann-Whitney U test and Wilcoxon signed-rank test. Results The median effectiveness of the unstructured, WHO, and WHO-SR techniques in log10 CFU reduction was 1.30 (interquartile range [IQR], 1.27-1.43), 1.71 (IQR, 1.34-1.91), and 1.70 (IQR, 1.54-2.42), respectively. The WHO-SR technique was significantly more efficacious than the unstructured technique (P = .01). Washing hands with a structured technique was more effective than washing with an unstructured technique (median, 1.70 vs 1.30 log10 CFU reduction, respectively; P = .007). Conclusions A structured washing technique is more effective than an unstructured technique against C difficile.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.04.001
       
  • Monitoring the hand hygiene compliance of health care workers in a general
           intensive care unit: Use of continuous closed circle television versus
           overt observation
    • Authors: Evgeni Brotfain; Ilana Livshiz-Riven; Alexander Gushansky; Alexander Erblat; Leonid Koyfman; Tomer Ziv; Lisa Saidel-Odes; Moti Klein; Abraham Borer
      Pages: 849 - 854
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Evgeni Brotfain, Ilana Livshiz-Riven, Alexander Gushansky, Alexander Erblat, Leonid Koyfman, Tomer Ziv, Lisa Saidel-Odes, Moti Klein, Abraham Borer
      Introduction A variety of hand hygiene monitoring programs (HHMPs) have come into use in hospitals throughout the world. In the present study, we compare continuous closed circle television (CCTV) with overt observation for monitoring the hand hygiene compliance of health care workers (HCWs) in a general intensive care unit (GICU). Methods This is a cross-sectional and comparative study. In this study, we use a novel hand hygiene CCTV monitoring system for hand hygiene performance monitoring. The study population incorporated all the GICU HCWs, including registered nurses, staff physicians, and auxiliary workers. Results All HCWs of our GICU were observed, including ICU registered nurses, ICU staff physicians, and auxiliary workers participated in the present study. Overall, each observer team did 50 sessions in each arm of the study. Total number of hand hygiene opportunities was approaching 500 opportunities. The compliance rates when only overt observations were performed was higher than when only covert observations were performed with a delta of approximately 10% (209 out of 590 [35.43%] vs 130 out of 533 [24.39%]; P < .001). Both methods of observations (overt and covert [CCTV]) demonstrated excellent reliability (intraclass correlation coefficient [ICC], 0.96 [0.93-0.98] of overt and ICC, 0.81 [0.69-0.89] for covert, respectively). However, the correlation between both methods was found weak in simultaneous sessions (ICC, 0.40 [0.62-0.107]). Conclusion We demonstrated that CCTV is an appropriate, reliable, and neutral method for observation of hand hygiene. However, there is no clear basis for incorporating a CCTV observation modality into a health care system that already operates an overt observation program. We have shown that CCTV methodology records a different distribution of opportunities for performing hand hygiene and of actual performances of hand hygiene compared with overt observation.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.03.015
       
  • Challenges to sustainability of hand hygiene at a rural hospital in Rwanda
    • Authors: Ian C. Holmen; Dan Niyokwizerwa; Berthine Nyiranzayisaba; Timothy Singer; Nasia Safdar
      Pages: 855 - 859
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Ian C. Holmen, Dan Niyokwizerwa, Berthine Nyiranzayisaba, Timothy Singer, Nasia Safdar
      Background Many hand hygiene (HH) programs have been implemented across Sub-Saharan Africa (SSA); however, most of these have been in large, referral hospitals. Our objective was to assess the impact of HH programs aimed at improving compliance at a rural hospital, and to identify unique challenges to HH sustainability. Methods Interventions to improve HH through providing handwashing stations, health care worker (HCW) training, and alcohol handrub were completed in 2014 and 2015. HH infrastructure, compliance, and glove use were assessed among HCWs after the intervention in 2015 and 2016. HCWs were interviewed about challenges to sustainability of HH compliance. Results Total HH compliance decreased 32.1% between 2015 and 2016 (P < .001). HH for patient protection was completed significantly less than HH for HCW protection in 2016, and HCWs appeared to substitute HH for patient protection with glove use. A high rate of physician turnover was associated with a larger decrease in HH compliance compared with nurses, and interviews suggested recruiting and retention of key personnel might play a role in HH sustainability. Availability of alcohol-based handrub in patient rooms decreased from 100% in 2015 to 79.5% in 2016 (P < .01). Conclusions Many challenges exist to sustaining HH compliance in SSA. In rural settings, difficulty recruiting and retaining trained personnel, inconsistent availability in HH infrastructure, and variability in HCW HH training may be contributing factors.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.04.006
       
  • Implementing an electronic hand hygiene monitoring system: Lessons learned
           from community hospitals
    • Authors: Catherine Edmisten; Charles Hall; Lorna Kernizan; Kimberly Korwek; Aaron Preston; Evan Rhoades; Shalin Shah; Lori Spight; Silvia Stradi; Sonia Wellman; Scott Zygadlo
      Pages: 860 - 865
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Catherine Edmisten, Charles Hall, Lorna Kernizan, Kimberly Korwek, Aaron Preston, Evan Rhoades, Shalin Shah, Lori Spight, Silvia Stradi, Sonia Wellman, Scott Zygadlo
      Background Measuring and providing feedback about hand hygiene (HH) compliance is a complicated process. Electronic HH monitoring systems have been proposed as a possible solution; however, there is little information available about how to successfully implement and maintain these systems for maximum benefit in community hospitals. Methods An electronic HH monitoring system was implemented in 3 community hospitals by teams at each facility with support from the system vendor. Compliance rates were measured by the electronic monitoring system. The implementation challenges, solutions, and drivers of success were monitored within each facility. Results The electronic HH monitoring systems tracked on average more than 220,000 compliant HH events per facility per month, with an average monthly compliance rate >85%. The sharing of best practices between facilities was valuable in addressing challenges encountered during implementation and maintaining a high rate of use. Discussion Drivers of success included a collaborative environment, leadership commitment, using data to drive improvement, consistent and constant messaging, staff empowerment, and patient involvement. Conclusions Realizing the full benefit of investments in electronic HH monitoring systems requires careful consideration of implementation strategies, planning for ongoing support and maintenance, and presenting data in a meaningful way to empower and inspire staff.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.03.033
       
  • Risk factors of cardiac device infection: Glove contamination during
           device procedures
    • Authors: Isabella Kozon; Sam Riahi; Søren Lundbye-Christensen; Anna Margrethe Thøgersen; Tove Ejlertsen; Dorthe Aaen; Kirsten I. Paulsen; Søren Hjortshøj
      Pages: 866 - 871
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Isabella Kozon, Sam Riahi, Søren Lundbye-Christensen, Anna Margrethe Thøgersen, Tove Ejlertsen, Dorthe Aaen, Kirsten I. Paulsen, Søren Hjortshøj
      Background Infections in cardiac implantable electronic devices (CIEDs) constitute a serious complication. We sought to identify contamination of gloves before handling the device in primary and replacement CIED procedures. Methods Two groups of 30 patients underwent primary CIED implantation or replacement. Before the device entered the surgical field, surgeon and assistant imprinted their outer gloves on aerobe and anaerobe agar plates, and a wound swab was performed. Samples were cultured, and the presence of bacteria was identified, counted as the number of colony forming units, and characterized to the level of genus and species. Results Samples from 40 (67%) procedures revealed bacteria on surgeons' or assistants' gloves. Contamination occurred in 80% of replacements and 67% of primary implantations (risk difference, 13%; 95% confidence interval [CI], −8.8 to 35.5). Contamination of surgeons' and assistants' gloves occurred in 55% and 44% of procedures, respectively. Coagulase-negative Staphylococcus (CNS) occurred in 52%, and Propionibacterium spp (PS) occurred in 84% of positive cases. For every 15 minutes of procedure time, colony levels increased by 7.4% (95% CI, 1.4%-13.4%). Conclusions Contamination of gloves is common during CIED procedures before handling the device. Therefore, devices are often handled with contaminated gloves. The most prevalent bacteria were PS and CNS, which are associated with clinical CIED infections. Changing outer gloves before handling the device might improve sterile state and lower infection risk.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.03.019
       
  • Antimicrobial stewardship for hospitalized patients with viral respiratory
           tract infections
    • Authors: Christopher F. Lowe; Michael Payne; David Puddicombe; Allison Mah; Davie Wong; Allison Kirkwood; Mark W. Hull; Victor Leung
      Pages: 872 - 875
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Christopher F. Lowe, Michael Payne, David Puddicombe, Allison Mah, Davie Wong, Allison Kirkwood, Mark W. Hull, Victor Leung
      Background The purpose of this study was to implement a targeted antimicrobial stewardship intervention for patients with a viral respiratory tract infection. Methods This was a quasi-experimental before and after audit and feedback intervention of adult inpatients with a positive polymerase chain reaction for a respiratory virus in 2 acute care hospitals in Vancouver, Canada. Audit and feedback was implemented based on 2 criteria: microbiology (no positive bacterial cultures) and chest imaging (absence of pneumonia or consolidation on radiology dictation). A chart review was conducted to assess for days of antibiotics postviral diagnosis. Outcomes including length of stay, intensive care unit admission within 14 days, mechanical ventilation within 14 days, antibiotics prescribed within 14 days, Clostridium difficile infection diagnosed within 30 days, and readmission within 30 days were also reviewed in comparison with the previous year. Results Antimicrobial stewardship recommendations for hospitalized patients with viral respiratory tract infections were accepted for 77% of cases. This targeted approach based on easily assessed parameters translated into a 1.3-day (95% confidence interval, 0.3-2.3; P < .01) decrease in mean days of antibiotics postviral diagnosis compared with the previous year without systematic interventions. Compared with the previous year, no differences were identified for adverse outcomes associated with the intervention. Conclusions A targeted antimicrobial stewardship intervention integrating virology testing with the treating physician facilitated a reduction in duration of antibiotic treatment for viral respiratory tract infections.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.03.025
       
  • The Project Protect Infection Prevention Fellowship: A model for advancing
           infection prevention competency, quality improvement, and patient safety
    • Authors: Janine D. Reisinger; Anna Wojcik; Ian Jenkins; Barbara Edson; David A. Pegues; Linda Greene
      Pages: 876 - 882
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Janine D. Reisinger, Anna Wojcik, Ian Jenkins, Barbara Edson, David A. Pegues, Linda Greene
      Background The Centers for Disease Control and Prevention 2016 Healthcare-Associated Infections (HAI) Progress Report documented no change in catheter-associated urinary tract infections (CAUTIs) between 2009 and 2014. There is a need for investment in additional efforts to reduce HAIs, specifically CAUTI. Quality improvement fellowships are 1 approach to expand the capacity of dedicated leaders and infection prevention champions. Methods The fellowship used a model that expanded collaboration among disciplines and focused on partnership by recruiting a diverse cohort of fellows and by providing 1-on-1 mentoring to enhance leadership development. The curriculum supported the Association for Professionals in Infection Control and Prevention Competency Model in 2 domains: leadership and performance improvement and implementation science. Results The fellowship was successful. The fellows and mentors had self-reported high level of satisfaction, fellows' knowledge increased, and they demonstrated leadership, quality improvement, and implementation science competency within the completed capstone projects. Conclusions A model encompassing diverse educational topics, discussions, workshops, and mentorship can serve as a template for developing infection prevention champions. Although this project focused on CAUTI, this template can be used in a variety of settings and applied to a range of other HAIs and performance improvement projects.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.03.031
       
  • Animal-assisted interventions: A national survey of health and safety
           policies in hospitals, eldercare facilities, and therapy animal
           organizations
    • Authors: Deborah E. Linder; Hannah C. Siebens; Megan K. Mueller; Debra M. Gibbs; Lisa M. Freeman
      Pages: 883 - 887
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Deborah E. Linder, Hannah C. Siebens, Megan K. Mueller, Debra M. Gibbs, Lisa M. Freeman
      Background Animal-assisted intervention (AAI) programs are increasing in popularity, but it is unknown to what extent therapy animal organizations that provide AAI and the hospitals and eldercare facilities they work with implement effective animal health and safety policies to ensure safety of both animals and humans. Our study objective was to survey hospitals, eldercare facilities, and therapy animal organizations on their AAI policies and procedures. Methods A survey of United States hospitals, eldercare facilities, and therapy animal organizations was administered to assess existing health and safety policies related to AAI programs. Results Forty-five eldercare facilities, 45 hospitals, and 27 therapy animal organizations were surveyed. Health and safety policies varied widely and potentially compromised human and animal safety. For example, 70% of therapy animal organizations potentially put patients at risk by allowing therapy animals eating raw meat diets to visit facilities. In general, hospitals had stricter requirements than eldercare facilities. Discussion This information suggests that there are gaps between the policies of facilities and therapy animal organizations compared with recent guidelines for animal visitation in hospitals. Conclusions Facilities with AAI programs need to review their policies to address recent AAI guidelines to ensure the safety of animals and humans involved.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.04.287
       
  • The effectiveness of sterilization for flexible ureteroscopes: A
           real-world study
    • Authors: Cori L. Ofstead; Otis L. Heymann; Mariah R. Quick; Ellen A. Johnson; John E. Eiland; Harry P. Wetzler
      Pages: 888 - 895
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Cori L. Ofstead, Otis L. Heymann, Mariah R. Quick, Ellen A. Johnson, John E. Eiland, Harry P. Wetzler
      Background There are no guidelines or quality benchmarks specific to ureteroscope reprocessing, and patient injuries and infections have been linked to ureteroscopes. This prospective study evaluated ureteroscope reprocessing effectiveness. Methods Reprocessing practices at 2 institutions were assessed. Microbial cultures, biochemical tests, and visual inspections were conducted on sterilized ureteroscopes. Results Researchers examined 16 ureteroscopes after manual cleaning and sterilization using hydrogen peroxide gas. Every ureteroscope had visible irregularities, such as discoloration, residual fluid, foamy white residue, scratches, or debris in channels. Tests detected contamination on 100% of ureteroscopes (microbial growth 13%, adenosine triphosphate 44%, hemoglobin 63%, and protein 100%). Contamination levels exceeded benchmarks for clean gastrointestinal endoscopes for hemoglobin (6%), adenosine triphosphate (6%), and protein (100%). A new, unused ureteroscope had hemoglobin and high protein levels after initial reprocessing, although no contamination was found before reprocessing. Conclusions Flexible ureteroscope reprocessing methods were insufficient and may have introduced contamination. The clinical implications of residual contamination and viable microbes found on sterilized ureteroscopes are unknown. Additional research is needed to evaluate the prevalence of suboptimal ureteroscope reprocessing, identify sources of contamination, and determine clinical implications of urinary tract exposure to reprocessing chemicals, organic residue, and bioburden. These findings reinforce the need for frequent audits of reprocessing practices and the routine use of cleaning verification tests and visual inspection as recommended in reprocessing guidelines.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.03.016
       
  • Seroconversion rate among health care workers exposed to HIV-contaminated
           body fluids: The University of Pittsburgh 13-year experience
    • Authors: Chibueze A. Nwaiwu; Francesco M. Egro; Saundra Smith; Jay D. Harper; Alexander M. Spiess
      Pages: 896 - 900
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Chibueze A. Nwaiwu, Francesco M. Egro, Saundra Smith, Jay D. Harper, Alexander M. Spiess
      Background The studies enumerating the risk of HIV transmission to health care workers (HCWs) as 0.3% after percutaneous exposure to HIV-positive blood, and 0.09% after a mucous membrane exposure, are weakened by dated literature. Our study aims to demonstrate the seroconversion rate after exposure to HIV-contaminated body fluids in a major academic center in the United States. Methods A prospectively maintained database of reported occupational injuries occurring between 2002 and 2015 at an academic medical center was analyzed. Data collected included the type of injury, injured body part, type of fluid, contamination of sharps, involvement of resident physicians, use of postexposure prophylaxis, and patients' HIV, hepatitis B virus, and hepatitis C virus status. Results A total of 266 cases were included in the study. Most exposures were caused by percutaneous injuries (52.6%), followed by 43.2% mucocutaneous injuries. Of the injuries, 52.6% were to the hand and 33.5% to the face and neck. Blood exposure accounted for 64.3% of all cases. Of the patients, 21.1% received postexposure prophylaxis. None of the HCWs exposed to HIV-contaminated body fluids seroconverted (seroconversion rate, 0%). Conclusions HIV does not seem to be as easily transmitted by needlestick, laceration, or splash injuries as previously surmised. Further large-scale and multicenter studies are needed for a more accurate estimation of the risk of transmission of HIV in U.S. health care workers.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.03.012
       
  • National trends in the frequency of bladder catheterization and
           physician-diagnosed catheter-associated urinary tract infections: Results
           from the Medicare Patient Safety Monitoring System
    • Authors: Mark L. Metersky; Noel Eldridge; Yun Wang; Eric M. Mortensen; Jennifer Meddings
      Pages: 901 - 904
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Mark L. Metersky, Noel Eldridge, Yun Wang, Eric M. Mortensen, Jennifer Meddings
      Background It is unclear if bladder catheterization and catheter-associated urinary tract infection (CAUTI) rates have changed since the implementation of public reporting in 2011. Methods We analyzed data from the Medicare Patient Safety Monitoring System, a national, chart abstraction–based surveillance system, for hospitalized adults with a principal discharge diagnosis of heart failure (HF), acute myocardial infarction (AMI), or pneumonia and patients who had undergone certain major surgeries. We assessed bladder catheterization frequency (percentage of patients catheterized) and risk-adjusted CAUTI frequency (percentage of catheterized patients developing CAUTI) from 2009-2014. Results Bladder catheterization frequency declined significantly (6.6% for AMI patients, 8.0% for HF patients, and 5.7% for surgical patients). For pneumonia patients, there was a nonsignificant increase of 1.1%. The risk-adjusted CAUTI rate among AMI patients decreased by 9.7% each year relative to the year before. For surgical patients, the decrease was 9.1% per year. There was no significant decline among HF or pneumonia patients. The overall burden of CAUTI among surgical patients was higher than for the other conditions because surgical patients were more likely to be catheterized. Conclusions There were statistically significant declines in observed bladder catheterization frequency and adjusted CAUTI frequency in some patient populations between 2009 and 2014.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.03.008
       
  • Treated-and-released urinary catheterization in the emergency department
           by sex
    • Authors: Scott Martin Vouri; Margaret A. Olsen; Daniel Theodoro; Seth A. Strope
      Pages: 905 - 910
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Scott Martin Vouri, Margaret A. Olsen, Daniel Theodoro, Seth A. Strope
      Background The prevalence and difference in likely indications of urinary catheterization (UC) in treated-and-released emergency department (ED) visits between men and women are currently unknown. Methods This was a cross-sectional analysis using the 2013 National Emergency Department Sample for all treated-and-released visits in persons aged ≥18 years. The prevalence of conditions associated with UC visits in men and women were identified. A hierarchical ranking was used to categorize diagnosis codes identified during ED visits into clinically meaningful categories to assess conditions for UC. Results In 2013, there were 87,797,062 treated-and-released ED visits in adults. The rate of UC in treated-and-released ED visits in adults was 4.3 per 1,000 visits, with 6.5 per 1,000 visits in men and 2.7 per 1,000 visits in women. Using the hierarchal ranking, a higher proportion of UC visits in men were coded for acute urinary retention, and a higher proportion of UC visits in women were coded for neurologic, cognitive, and psychiatric conditions. Conclusions The rate of UC in treated-and-released ED visits was higher in men than women, and UC rate increased with age. The heterogeneity of conditions coded in UC visits in women compared with men may suggest more potentially avoidable UC in women in the treated-and-released ED population. If confirmed, this would suggest opportunities for quality improvement in the ED to prevent overutilization of urinary catheters.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.02.025
       
  • Clinical and social barriers to antimicrobial stewardship in pulmonary
           medicine: A qualitative study
    • Authors: Jennifer K. Broom; Alex F. Broom; Emma R. Kirby; Alexandra F. Gibson; Jeffrey J. Post
      Pages: 911 - 916
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Jennifer K. Broom, Alex F. Broom, Emma R. Kirby, Alexandra F. Gibson, Jeffrey J. Post
      Background The treatment of pulmonary infections is one of the largest indications for antibiotics in human health care, offering significant potential for antibiotic optimization internationally. This study explores the perspectives of pulmonary clinicians on antibiotic use in hospital pulmonary infections. Methods Twenty-eight pulmonary doctors and nurses from 2 hospitals participated in semi-structured interviews focusing on their experiences of antibiotic use. Results Barriers to antibiotic optimization in pulmonary infections were identified. Clinical barriers are as follows. The first is differentiating pneumonia vs chronic obstructive pulmonary disease: differentiating pulmonary diagnoses was reported as challenging, leading to overtreatment. The second is differentiating viral vs bacterial: diagnostic differentiation was perceived to contribute to excess antibiotic use. The third is differentiating colonization vs pathogen: the interpretation of ambiguous results was reported to lead to under- or overprescribing depending on the perspective of the treating team. Social barriers are as follows. The first is the perception of resistance: antibiotic resistance was not perceived as an immediate threat. The second is the perceived value of antibiotic clinical guidelines: there was mistrust in antibiotic guidelines. The third is hospital hierarchies: hierarchical structures had a significant influence on prescribing. Conclusions Substantial barriers to antibiotic optimization in pulmonary infections were identified. To facilitate change in antibiotic use there must be a systematic understanding and interventions to address specific clinical issues. In the case of pulmonary medicine, significant identified issues, such as mistrust in clinical guidelines and diagnostic challenges, need to be addressed.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.03.003
       
  • Staff nurses as antimicrobial stewards: An integrative literature review
    • Authors: Elizabeth Monsees; Jennifer Goldman; Lori Popejoy
      Pages: 917 - 922
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Elizabeth Monsees, Jennifer Goldman, Lori Popejoy
      Background Guidelines on antimicrobial stewardship emphasize the importance of an interdisciplinary team, but current practice focuses primarily on defining the role of infectious disease physicians and pharmacists; the role of inpatient staff nurses as antimicrobial stewards is largely unexplored. Methods An updated integrative review method guided a systematic appraisal of 13 articles spanning January 2007-June 2016. Quantitative and qualitative peer-reviewed publications including staff nurses and antimicrobial knowledge or stewardship were incorporated into the analysis. Results Two predominant themes emerged from this review: (1) nursing knowledge, education, and information needs; and (2) patient safety and organizational factors influencing antibiotic management. Discussion Focused consideration to empower and educate staff nurses in antimicrobial management is needed to strengthen collaboration and build an interprofessional stewardship workforce. Conclusions Further exploration on the integration and measurement of nursing participation is needed to accelerate this important patient safety initiative.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.03.009
       
  • How well does transfer of bacterial pathogens by culture swabs correlate
           with transfer by hands'
    • Authors: Anubhav Kanwar; Thriveen S.C. Mana; Jennifer L. Cadnum; Heba Alhmidi; Sreelatha Koganti; Curtis J. Donskey
      Pages: 923 - 925
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Anubhav Kanwar, Thriveen S.C. Mana, Jennifer L. Cadnum, Heba Alhmidi, Sreelatha Koganti, Curtis J. Donskey
      In laboratory testing and in isolation rooms, pickup and transfer of health care-associated pathogens by premoistened rayon swabs correlated well with pickup and transfer by bare hands or moistened gloves. These results suggest that swab cultures provide a useful surrogate indicator of the risk for pathogen pickup and transfer by hands.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.03.001
       
  • Effects of mandatory continuing education related to infection control on
           the infection control practices of dental hygienists
    • Authors: Noel Kelsch; Cheryl A. Davis; Gwen Essex; Lory Laughter; Dorothy J. Rowe
      Pages: 926 - 928
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Noel Kelsch, Cheryl A. Davis, Gwen Essex, Lory Laughter, Dorothy J. Rowe
      The infection control (IC) practices of dental hygienists, who were practicing in states with and without mandatory continuing education (CE) related to IC, were compared using a nationwide survey approach. The percentages of respondents from states with mandated IC CE, who reported compliance with 8 practices described in the current IC guidelines and acquiring more CE units and taking more recent IC CE, were greater (P < .005) than the percentages of respondents from states without the requirement.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.02.018
       
  • Staphylococcus aureus surface contamination of mobile phones and presence
           of genetically identical strains on the hands of nursing personnel
    • Authors: Akiko Katsuse Kanayama; Hiroshi Takahashi; Sadako Yoshizawa; Kazuhiro Tateda; Akihiro Kaneko; Intetsu Kobayashi
      Pages: 929 - 931
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Akiko Katsuse Kanayama, Hiroshi Takahashi, Sadako Yoshizawa, Kazuhiro Tateda, Akihiro Kaneko, Intetsu Kobayashi
      We investigated the genetic relatedness of Staphylococcus aureus isolates recovered from mobile phones and palms and fingers of users. Genetically identical isolates were detected from mobile phones and their user and multiple users, which is consistent with mobile phones serving as reservoirs of infection in the health care environment. These findings reinforce the need for hand hygiene prior to patient contact as the most effective intervention for preventing health care–associated infection.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.02.011
       
  • Microorganisms present on peripheral intravenous needleless connectors in
           the clinical environment
    • Authors: Karen Slater; Marie Cooke; Michael Whitby; Fiona Fullerton; Joel Douglas; Jennine Hay; Claire Rickard
      Pages: 932 - 934
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Karen Slater, Marie Cooke, Michael Whitby, Fiona Fullerton, Joel Douglas, Jennine Hay, Claire Rickard
      The aim of this study was to quantify culturable microorganisms on needleless connectors (NCs) attached to peripheral intravenous catheters in hospitalized adult medical patients. Half (50%) of 40 NCs were contaminated with microorganisms commonly found on the skin or mouth. Staphylococcus capitis and Staphylococcus epidermidis were most commonly isolated. Emergency department insertion and higher patient dependency were statistically associated with positive NC microorganism growth. These results reaffirm the need for NC decontamination prior to access.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.02.008
       
  • Surgical site infections in very small hospitals in inner Brazil:
           Unveiling a relevant issue for developing countries
    • Authors: Viviane Cristina Bastos Armede; Lígia Maria Abraão; Carlos Magno Castelo Branco Fortaleza
      Pages: 935 - 936
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Viviane Cristina Bastos Armede, Lígia Maria Abraão, Carlos Magno Castelo Branco Fortaleza


      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.04.289
       
  • Control of Middle East respiratory syndrome
    • Authors: Sora Yasri; Viroj Wiwanitkit
      First page: 937
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Sora Yasri, Viroj Wiwanitkit


      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.03.026
       
  • Sterilization of dental handpieces
    • Authors: Enrique Acosta-Gio; Helene Bednarsh; Eve Cuny; Kathy Eklund; Shannon Mills; Douglas Risk
      Pages: 937 - 938
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): Enrique Acosta-Gio, Helene Bednarsh, Eve Cuny, Kathy Eklund, Shannon Mills, Douglas Risk


      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.04.294
       
  • Public health masking mandates improve hospital healthcare personnel
           vaccination rates
    • Authors: James F. Marx
      First page: 938
      Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8
      Author(s): James F. Marx


      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.05.006
       
  • Environment of care: Is it time to reassess microbial contamination of the
           operating room air as a risk factor for surgical site infection in total
           joint arthroplasty'
    • Authors: Javad Parvizi; Sue Barnes; Noam Shohat; Charles E. Edmiston
      Abstract: Publication date: Available online 14 August 2017
      Source:American Journal of Infection Control
      Author(s): Javad Parvizi, Sue Barnes, Noam Shohat, Charles E. Edmiston
      In the modern operating room (OR), traditional surgical mask, frequent air exchanges, and architectural barriers are viewed as effective in reducing airborne microbial populations. Intraoperative sampling of airborne particulates is rarely performed in the OR because of technical difficulties associated with sampling methodologies and a common belief that airborne contamination is infrequently associated with surgical site infections (SSIs). Recent studies suggest that viable airborne particulates are readily disseminated throughout the OR, placing patients at risk for postoperative SSI. In 2017, virtually all surgical disciplines are engaged in the implantation of selective biomedical devices, and these implants have been documented to be at high risk for intraoperative contamination. Approximately 1.2 million arthroplasties are performed annually in the United States, and that number is expected to increase to 3.8 million by the year 2030. The incidence of periprosthetic joint infection is perceived to be low (<2.5%); however, the personal and fiscal morbidity is significant. Although the pharmaceutic and computer industries enforce stringent air quality standards on their manufacturing processes, there is currently no U.S. standard for acceptable air quality within the OR environment. This review documents the contribution of air contamination to the etiology of periprosthetic joint infection, and evidence for selective innovative strategies to reduce the risk of intraoperative microbial aerosols.

      PubDate: 2017-08-19T14:16:00Z
      DOI: 10.1016/j.ajic.2017.06.027
       
  • A national collaborative approach to reduce catheter-associated urinary
           tract infections in nursing homes: A qualitative assessment
    • Authors: Sarah L. Krein; Molly Harrod; Sue Collier; Kristina K. Davis; Andrew J. Rolle; Karen E. Fowler; Lona Mody
      Abstract: Publication date: Available online 12 August 2017
      Source:American Journal of Infection Control
      Author(s): Sarah L. Krein, Molly Harrod, Sue Collier, Kristina K. Davis, Andrew J. Rolle, Karen E. Fowler, Lona Mody
      Background Reducing health care-associated infections (HAIs), such as catheter-associated urinary tract infection (CAUTI), is a critical performance improvement target in nursing homes. The Agency for Healthcare Research and Quality Safety Program for Long-term Care: Health Care-Associated Infections/Catheter-Associated Urinary Tract Infection, a national performance improvement program, was designed to promote implementation of a CAUTI prevention program through state-based or regional collaboratives in more than 500 nursing homes across the United States. Methods Qualitative interviews were conducted with 8 purposefully selected organizational leads (who led implementation activities for a group of facilities) and 8 facility leads (who led implementation activities at a given facility) to understand implementation successes and challenges and experiences of participants involved in the program. Key themes were identified using a rapid analysis approach. Results Key themes related to general perceptions, changes due to program participation, and factors influencing program implementation were identified. In general, the program was viewed positively by organizational and facility leads with changes in catheter care practices, staff empowerment, and improvements in knowledge identified as benefits. Implementation challenges included the time required for program start-up as well as issues with staff and physician support, logistic barriers, and staffing turnover. Conclusions Despite some challenges, the observed program success and positive views of those participating suggest that collaboratives are an important strategy for providing nursing homes with enhanced expertise and support to prevent HAIs and ensure resident safety.

      PubDate: 2017-08-19T14:16:00Z
      DOI: 10.1016/j.ajic.2017.07.006
       
  • 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
      Abstract: Publication date: Available online 12 August 2017
      Source:American Journal of Infection Control
      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: 2017-08-19T14:16:00Z
      DOI: 10.1016/j.ajic.2017.06.030
       
  • Clinical outcome of dual colistin- and carbapenem-resistant Klebsiella
           pneumoniae bloodstream infections: A single-center retrospective study of
           75 cases in India
    • Authors: Amarjeet Kaur; Sumanth Gandra; Priyanka Gupta; Yatin Mehta; Ramanan Laxminarayan; Sharmila Sengupta
      Abstract: Publication date: Available online 12 August 2017
      Source:American Journal of Infection Control
      Author(s): Amarjeet Kaur, Sumanth Gandra, Priyanka Gupta, Yatin Mehta, Ramanan Laxminarayan, Sharmila Sengupta
      In this study, we retrospectively evaluated clinical outcomes of 75 patients with dual colistin- and carbapenem-resistant Klebsiella pneumoniae bloodstream infections over a 5-year period in a single tertiary care hospital in India. We observed a high in-hospital mortality rate of 69.3%. Our findings indicate the urgent need for new antibiotics to treat these infections.

      PubDate: 2017-08-19T14:16:00Z
      DOI: 10.1016/j.ajic.2017.06.028
       
  • Daily bathing strategies and cross-transmission of multidrug-resistant
           organisms: Impact of chlorhexidine-impregnated wipes in a
           multidrug-resistant gram-negative bacteria endemic intensive care unit
    • Authors: Jesus Ruiz; Paula Ramirez; Esther Villarreal; Monica Gordon; Inmaculada Saez; Alfonso Rodríguez; María Jesús Castañeda; Álvaro Castellanos-Ortega
      Abstract: Publication date: Available online 10 August 2017
      Source:American Journal of Infection Control
      Author(s): Jesus Ruiz, Paula Ramirez, Esther Villarreal, Monica Gordon, Inmaculada Saez, Alfonso Rodríguez, María Jesús Castañeda, Álvaro Castellanos-Ortega
      Background Health–care associated infections are a major cause of morbidity and mortality in critical care units. The aim of this study is to evaluate the effectiveness of chlorhexidine gluconate (CHG)–impregnated wipes in the daily bathing of patients in an intensive care unit (ICU) to prevent cross-transmission and colonization by multidrug-resistant organisms (MDROs) Methods Prospective cohort study with an intervention of 11 months. The intervention consisted of using CHG-impregnated wipes for the daily bathing of patients on mechanical ventilation or colonized by MDROs. Monthly trends in the number of patients colonized by MDROs and the incidence of nosocomial infections were evaluated. Results A total of 1,675 patients were admitted to the unit during the intervention period, and 430 (25.7%) were bathed with chlorhexidine wipes. A significant decrease was observed in the incidence of colonization by MDROs over the months (β = −0.209; r 2 = 0.549; P = .027), and in the number of patients colonized compared with the equivalent period of the previous year (22.0% vs 18.4%; P = .01). No significant decrease was observed in the incidence of nosocomial infection between the two periods (4.11% vs 4.57%; P = .355). No dermatologic problems were observed in the treated patients. Conclusions The use of CHG-impregnated wipes reduces cross-transmission and colonization by MDROs in the ICUs in an endemic situation because of multidrug-resistant Enterobacteriaceae.

      PubDate: 2017-08-19T14:16:00Z
      DOI: 10.1016/j.ajic.2017.06.029
       
  • 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
      Abstract: Publication date: Available online 8 August 2017
      Source:American Journal of Infection Control
      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: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.06.033
       
  • Antimicrobial resistance of 3 types of gram-negative bacteria isolated
           from hospital surfaces and the hands of health care workers
    • Authors: Hui-Ping Wang; Hong-Jiang Zhang; Jie Liu; Qi Dong; Shan Duan; Jun-Qi Ge; Zhong-Hua Wang; Zheng Zhang
      Abstract: Publication date: Available online 2 August 2017
      Source:American Journal of Infection Control
      Author(s): Hui-Ping Wang, Hong-Jiang Zhang, Jie Liu, Qi Dong, Shan Duan, Jun-Qi Ge, Zhong-Hua Wang, Zheng Zhang
      Background There has been an increased focus in recent years on antimicrobial resistance of bacteria isolated from clinical samples. However, resistance of bacteria from hospital environments has been less frequently investigated. Methods According to hygienic standard for disinfection in hospitals, samples were collected from hospital inanimate surfaces and the hands of health care workers after daily cleaning. An automatic microorganism analyzer was used to identify bacteria and test for antimicrobial susceptibility. Polymerase chain reaction was used to detect antimicrobial resistance genes. Results The detection rate of bacteria in general wards was significantly higher than that in intensive care units. The isolates were predominantly gram-negative (GN) bacteria, with Pseudomonas aeruginosa, Enterobacter cloacae, and Klebsiella pneumoniae being the most common. P aeruginosa isolates from other surfaces were much higher than those from medical instruments. E cloacae was isolated more frequently from the hands of other staff than medical staff. Most P aeruginosa and K pneumoniae were resistant to sulfonamides and β-lactam antimicrobials. Only 1 strain of P aeruginosa and 1 strain of K pneumoniae showed multiple antimicrobials resistance. Conclusions The GN bacteria isolated from hospital environments demonstrate variable resistance to antimicrobials.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.06.002
       
  • APIC Masthead
    • Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8


      PubDate: 2017-08-09T15:14:24Z
       
  • Information for Readers
    • Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8


      PubDate: 2017-08-09T15:14:24Z
       
  • Information for Authors
    • Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8


      PubDate: 2017-08-09T15:14:24Z
       
  • New from APIC: ASC Intensive offers 4 days of concentrated training for
           ambulatory care practice settings
    • Abstract: Publication date: 1 August 2017
      Source:American Journal of Infection Control, Volume 45, Issue 8


      PubDate: 2017-08-09T15:14:24Z
       
  • Implementation in the midst of complexity: Using ethnography to study
           health care–associated infection prevention and control
    • Authors: Mary Jo Knobloch; Kevin V. Thomas; Erin Patterson; Michele L. Zimbric; Jackson Musuuza; Nasia Safdar
      Abstract: Publication date: Available online 31 July 2017
      Source:American Journal of Infection Control
      Author(s): Mary Jo Knobloch, Kevin V. Thomas, Erin Patterson, Michele L. Zimbric, Jackson Musuuza, Nasia Safdar
      Background Contextual factors associated with health care settings make reducing health care–associated infections (HAIs) a complex task. The aim of this article is to highlight how ethnography can assist in understanding contextual factors that support or hinder the implementation of evidence-based practices for reducing HAIs. Methods We conducted a review of ethnographic studies specifically related to HAI prevention and control in the last 5 years (2012-2017). Results Twelve studies specific to HAIs and ethnographic methods were found. Researchers used various methods with video-reflexive sessions used in 6 of the 12 studies. Ethnography was used to understand variation in data reporting, identify barriers to adherence, explore patient perceptions of isolation practices and highlight the influence of physical design on infection prevention practices. The term ethnography was used to describe varied research methods. Most studies were conducted outside the United States, and authors indicate insights gained using ethnographic methods (whether observations, interviews, or reflexive video recording) as beneficial to unraveling the complexities of HAI prevention. Conclusions Ethnography is well-suited for HAI prevention, especially video-reflexive ethnography, for activating patients and clinicians in infection control work. In this era of increasing pressure to reduce HAIs within complex work systems, ethnographic methods can promote understanding of contextual factors and may expedite translation evidence to practice.

      PubDate: 2017-08-09T15:14:24Z
      DOI: 10.1016/j.ajic.2017.06.024
       
  • Emergence of carbapenem-resistant Enterobacteriaceae in Orange County,
           California, and support for early regional strategies to limit spread
    • Authors: Shruti K. Gohil; Raveena Singh; Justin Chang; Adrijana Gombosev; Tom Tjoa; Matthew Zahn; Patti Steger; Susan S. Huang
      Abstract: Publication date: Available online 27 July 2017
      Source:American Journal of Infection Control
      Author(s): Shruti K. Gohil, Raveena Singh, Justin Chang, Adrijana Gombosev, Tom Tjoa, Matthew Zahn, Patti Steger, Susan S. Huang
      Background The east-to-west spread of carbapenem-resistant Enterobacteriaceae (CRE) represents an opportunity to explore strategies to limit spread in nonendemic areas. We evaluated CRE emergence and regional support for containment strategies. Methods A 17-question cross-sectional survey was administered to infection prevention programs in Orange County, CA (31 hospitals serving 3 million residents), between January and September 2014. Questions addressed newly detected hospital- and community-onset CRE cultures (2008-2013), current CRE control strategies, and support for prevention strategies for a hypothetical regional intervention. Results Among 31 hospitals, 21 (68%, representing 17 infection prevention programs) completed the survey. CRE was scarcely detected between 2009-2010; within 4 years, 90% of hospitals reported CRE, with 2.5-fold higher community-onset than hospital-onset CRE. Between 2011 and 2013, annual CRE incidence increased 4.7-fold (1.4-6.3 cases/10,000 admissions). Support for a regional CRE prevention bundle was unanimous. Although 22% bathed patients positive for CRE with chlorhexidine gluconate and 11% actively screened for CRE, 86% and 57%, respectively, would consider these strategies in a regional intervention. Conclusions CRE epidemiology in Orange County parallels early progression previously seen in now-endemic areas, representing an opportunity to consider interventions to prevent endemic spread. Many facilities would consider proactive strategies, such as chlorhexidine bathing, in the setting of a regional collaborative.

      PubDate: 2017-07-30T18:56:12Z
      DOI: 10.1016/j.ajic.2017.06.004
       
  • Effect of automated ultraviolet C–emitting device on decontamination of
           hospital rooms with and without real-time observation of terminal room
           disinfection
    • Authors: Katie Penno; Roman A. Jandarov; Madhuri M. Sopirala
      Abstract: Publication date: Available online 27 July 2017
      Source:American Journal of Infection Control
      Author(s): Katie Penno, Roman A. Jandarov, Madhuri M. Sopirala
      Background We studied the effectiveness of an ultraviolet C (UV-C) emitter in clinical settings and compared it with observed terminal disinfection. Methods We cultured 22 hospital discharge rooms at a tertiary care academic medical center. Phase 1 (unobserved terminal disinfection) included cultures of 11 high-touch environmental surfaces (HTSs) after terminal room disinfection (AD) and after the use of a UV-C–emitting device (AUV). Phase 2 (observed terminal disinfection) included cultures before terminal room disinfection (BD), AD, and AUV. Zero-inflated Poisson regression compared mean colony forming units (CFU) between the groups. Two-sample proportion tests identified significance of the observed differences in proportions of thoroughly cleaned HTSs (CFU < 5). Significant P value was determined using the Bonferroni corrected threshold of α = .05/12 = .004. Results We obtained 594 samples. Risk of overall contamination was 0.48 times lower in the AUV group than in the AD group (P < .001), with 1.04 log10 reduction. During phase 1, overall proportion of HTSs with <5 CFUs increased in AUV versus AD by 0.12 (P = .001). During phase 2, it increased in AD versus BD by 0.45 (P < .001), with no significant difference between AD and AUV (P = .02). Conclusions Use of UV-C with standard cleaning significantly reduced microbial burden and improved the thoroughness of terminal disinfection. We found no further benefit to UV-C use if standard terminal disinfection was observed.

      PubDate: 2017-07-30T18:56:12Z
      DOI: 10.1016/j.ajic.2017.06.015
       
  • Multidrug-resistant Acinetobacter: Risk factors and outcomes in veterans
           with spinal cord injuries and disorders
    • Authors: Swetha Ramanathan; Katie J. Suda; Margaret A. Fitzpatrick; Linda Poggensee; Sherri L. LaVela; Stephen P. Burns; Charlesnika T. Evans
      Abstract: Publication date: Available online 27 July 2017
      Source:American Journal of Infection Control
      Author(s): Swetha Ramanathan, Katie J. Suda, Margaret A. Fitzpatrick, Linda Poggensee, Sherri L. LaVela, Stephen P. Burns, Charlesnika T. Evans
      Background Multidrug-resistant (MDR) Acinetobacter is a growing concern and has been identified as a serious threat by the Centers for Disease Control and Prevention. However, there is little information on MDR Acinetobacter in individuals with spinal cord injuries and disorders (SCI/Ds). Therefore, the objective of this study was to identify risk factors for, and assess outcomes of, MDR Acinetobacter in veterans with SCI/Ds. Methods This was a retrospective cohort study from January 1, 2012-December 31, 2013, using national Veterans Affairs medical encounter and microbiology data. Results A total of 773 Acinetobacter cultures were identified in 571 patients, of which 58.9% were MDR. Inpatient culture, sputum and other specimen type, receipt of antibiotics within 90 days before culture date, and pressure ulcers were identified as independent predictors of MDR Acinetobacter. Highest odds of MDR Acinetobacter were seen with previous antibiotic use (odds ratio, 7.27; 95% confidence interval, 2.59-20.54). Thirty-day mortality was 5.3% in this study. Multidrug resistance, previous mechanical ventilation 90 days before the culture, and cancer were all independent risk factors for 30-day mortality. Conclusions There should be increased efforts to highlight the importance of antimicrobial stewardship to improve infection control to help limit spread of Acinetobacter in health care settings.

      PubDate: 2017-07-30T18:56:12Z
      DOI: 10.1016/j.ajic.2017.06.016
       
  • A proposal for the eradication of Middle East respiratory syndrome
    • Authors: Seok-Ju Yoo; Kwan Lee
      Abstract: Publication date: Available online 27 July 2017
      Source:American Journal of Infection Control
      Author(s): Seok-Ju Yoo, Kwan Lee


      PubDate: 2017-07-30T18:56:12Z
      DOI: 10.1016/j.ajic.2017.06.001
       
 
 
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