Publisher: Elsevier   (Total: 3161 journals)

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Showing 1 - 200 of 3161 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 106, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 43, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 448, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 30, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 322, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2, SJR: 1.793, CiteScore: 6)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access   (Followers: 1)
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 13, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 189, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 13, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 1, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 35, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 21, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 16)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 14)
Advances in Digestive Medicine     Open Access   (Followers: 13)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 45, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 30, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 52, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 2)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 68, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 12, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 8, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 17, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 26)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 6, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 11)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 69)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 3, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 7)
Advances in Space Research     Full-text available via subscription   (Followers: 430, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 6)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 37, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 56, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 395, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 487, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 46, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 55, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 67, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 48, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 39, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 37, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 264, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 67, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 30, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 6, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 215, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 238, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 7, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 3, SJR: 0.451, CiteScore: 1)

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Similar Journals
Journal Cover
American Journal of Infection Control
Journal Prestige (SJR): 1.062
Citation Impact (citeScore): 2
Number of Followers: 29  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0196-6553
Published by Elsevier Homepage  [3161 journals]
  • Previous peripherally inserted central catheter (PICC) placement as a risk
           factor for PICC-associated bloodstream infections
    • Abstract: Publication date: Available online 11 January 2020Source: American Journal of Infection ControlAuthor(s): Kwangmin Kim, Youngkyun Kim, Kyong Ran PeckBackgroundPeripherally inserted central catheter (PICC) -associated bloodstream infection (BSI) is a concern.MethodsA case-control study was conducted to assess risk factors for PICC-associated BSI.ResultsA total of 1,215 cases and 31,874 catheter days were analyzed. In total, 54 cases of PICC-associated BSI were detected giving an infection rate of 1.69 per 1,000 catheter-days. The most frequently isolated pathogens were coagulase-negative staphylococci (26%), followed by Enterococcus species (22%), Candida species (17%), and Staphylococcus aureus (11%). Multivariable analysis identified the significant risk factors for PICC-associated BSI as a prior PICC placement (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.36-4.53), medical department admission (OR, 1.89; 95% CI, 1.03-3.46), and older age (OR, 1.03; 95% CI, 1.00-1.05). With increasing frequency of previous PICC placement, the rates of PICC-associated BSI increased: 3.5% (31/883) without previous placement, 7.6% (13/171) in once, and 9.9% (9/32) in twice or more.DiscussionThe previous PICC placement was an independent risk factor for PICC-associated BSI and the risk proportionally rose with the increasing frequency of prior PICC placement.ConclusionsPatients with repeatedly inserted PICC should be managed more carefully for prevention and should be monitored for the development of PICC-associated BSI.
       
  • Can a nasal and skin decolonization protocol safely replace contact
           precautions for MRSA-colonized patients'
    • Abstract: Publication date: Available online 11 January 2020Source: American Journal of Infection ControlAuthor(s): Jacqueline Christie, Don Wright, Jacalyn Liebowitz, Paul StefanacciContact precautions (CP) are employed in United States hospitals in order to prevent transmission of pathogens via supplies, equipment, and health care worker hands. CP is required in many hospitals for both colonized and infected methicillin-resistant Staphylococcus aureus (MRSA) patients. The isolation of colonized patients often results in a high rate of CP, leading some hospitals to abandon CP for MRSA-colonized patients without adding any safety measure to address transmission risk. Understanding this risk, 7 network hospitals in a US health care system made the decision to replace CP for high-risk MRSA-colonized patients with targeted nasal and body decolonization, leading to significant cost savings and staff satisfaction without any increase in MRSA transmission.
       
  • Journal Club: Could the prevention of health care–associated infections
           increase hospital cost' The financial impact of health
           care–associated infections from a hospital management perspective
    • Abstract: Publication date: Available online 11 January 2020Source: American Journal of Infection ControlAuthor(s): Patti G. Grota, Lynn Fine
       
  • Peripheral intravenous catheter needleless connector decontamination
           study—Randomized controlled trial
    • Abstract: Publication date: Available online 10 January 2020Source: American Journal of Infection ControlAuthor(s): Karen Slater, Marie Cooke, Fiona Fullerton, Michael Whitby, Jennine Hay, Scott Lingard, Joel Douglas, Claire M. RickardBackgroundNeedleless connectors (NCs) were introduced to reduce health care work needlestick injuries (NSIs). If not decontaminated prior to use, NCs can be a portal for patient blood stream infections. The optimal disinfectant, and its application duration, for NC decontamination has not been empirically established.MethodsFactorial design randomized controlled trial comparing 70% isopropyl alcohol (IPA) and 2% chlorhexidine gluconate (CHG) in 70% IPA for 5, 10, or 15 seconds, in adult medical patients with peripheral intravenous catheters.ResultsAt baseline, 153 of 300 NCs (51%) grew microorganisms commonly found on the skin. Decontamination was successful in 150/153 (98%). There was no significant difference in decontamination between 70% IPA or 2% CHG in 70% IPA (P = .62), or decontamination for 5, 10, or 15 seconds (P = .21).ConclusionsThere was no difference in the effectiveness of 70% IPA and 2% CHG in 70% IPA for NC decontamination for peripheral intravenous catheters in the clinical environment. Successful decontamination was not different for applications of 5, 10, and 15 seconds; 15 seconds did not always remove all microorganisms. Factors such as cost, feasibility of compliance, and low risk of allergy support 5 seconds decontamination with 70% IPA as an acceptable approach.
       
  • Nurses as antimicrobial stewards: Recognition, confidence, and
           organizational factors across nine hospitals
    • Abstract: Publication date: Available online 9 January 2020Source: American Journal of Infection ControlAuthor(s): Elizabeth Monsees, Jennifer Goldman, Amy Vogelsmeier, Lori PopejoyBackgroundThere are national calls to engage nurses as antimicrobial stewards, but it is unknown how patient safety culture influences nurses’ antimicrobial stewardship (AS) involvement.MethodsCross-sectional survey to determine bedside nurses’ recognition and performance confidence in AS. Nine hospitals ranged in size from 42 to 562 beds serving pediatric and adult populations in 2 different metropolitan areas. Composite scores for nursing practices, performance confidence, and organizational factors were developed and correlated. Analysis of variance (ANOVA) with Tukey HSD post-hoc tests and nonparametric (Kruskal-Wallis) tests with Bonferroni adjusted P values for multiple comparisons were used to evaluate differences by clinical unit and years of clinical experience. Free text comments were categorized by theme.ResultsA total of 558 nurses participated (13% response rate). A significant positive association rs = 0.454, P < .001 was found between nurses’ beliefs about nursing practices that contribute to AS processes and their confidence to perform. Ninety one nurses provided comments with 50 statements indicating the primary barrier to stewardship were organizational factors including perceived lack of a safety culture.ConclusionsNurses identified a professional role in AS processes, though safety culture inhibited their involvement. These findings can help enhance the inclusion of nurses in AS efforts.
       
  • Variability in practice patterns regarding protective isolation measures
           after heart transplantation: A secondary analysis of the international
           BRIGHT study
    • Abstract: Publication date: Available online 9 January 2020Source: American Journal of Infection ControlAuthor(s): Ellen Alaerts, Carolien Dreesen, Kris Denhaerynck, Sabine Gryp, Johan Van Cleemput, Annette Schuermans, Cynthia L. Russell, Fabienne Dobbels, Sabina De Geest, for the BRIGHT study teamBackgroundInfection control is a cornerstone of post-heart transplantation (HTx) in-hospital management when immunosuppression is highest. The use of protective isolation persists despite its questionable effectiveness. We describe and compare practice patterns internationally and assessed correlates of protective isolation.MethodsUsing the BRIGHT-study data, a cross-sectional intercontinental study, we assessed 12 protective isolation measures in 4 continents, 11 countries, and 36 HTx centers. Data were summarized descriptively, as appropriate. Comparisons between countries and continents and association testing between center characteristics and number of isolation measures used were also explored by general linear modeling.ResultsA total of 89% (32/36) of HTx centers used protective isolation measures with an average of 4.5 protective isolation measures per center (SD, 2.6; range 1-10). Most often applied were disinfecting high-touch surfaces (n = 27/34; 79.4%), use of private room (n = 27/36; 75.0%), and changing linen daily (n = 25/36; 69.4%). Least applied were wearing a cap (n = 6/35; 17.1%) and high-efficiency particulate air filtration (N = 5/32; 15.6 %). Larger centers and those with dedicated beds for HTx applied more isolation measures.ConclusionsProtective isolation measures are still widely applied within heart transplant centers across the world persists notwithstanding its doubtful effectiveness. Future clinical guidelines for heart transplant management should include a statement of the need for strict adherence to standard infection prevention measures.
       
  • Improving patients’ hand hygiene in the acute care setting: Is staff
           education enough'
    • Abstract: Publication date: Available online 9 January 2020Source: American Journal of Infection ControlAuthor(s): Yanet Manresa, Lilian Abbo, Kathleen Sposato, Dennise de Pascale, Adriana JimenezPatients’ hand hygiene (PHH) has been associated with reduction of healthcare-associated infections. We compared staff education about the importance of PHH versus providing patients with alcohol wipes for PHH. Our study found that staff education increased the percentage of patients reporting that they had been educated/encouraged to perform PHH but this intervention alone did not resulted in a statistically significant increase of the average frequency of PHH per day.
       
  • Nurse survey, knowledge gaps and the creation of an environmental hygiene
           protocol for patient transport and removing linen from patient rooms
    • Abstract: Publication date: Available online 9 January 2020Source: American Journal of Infection ControlAuthor(s): Amie Patrick, Patrick Murphy, Rachel Pryor, Kaila Cooper, Emily Godbout, Michael P. Stevens, Michelle Doll, Robin R. Hemphill, Gonzalo BearmanGeneral guidance for personal protective equipment (PPE) is provided by the Occupational Safety and Health Administration and the United States Centers for Disease Control and Prevention. Previous research of PPE demonstrates the ability of gloves to harbor infectious pathogens. We surveyed health care workers to investigate current PPE practices during linen removal from patient rooms and during patient transport. The results suggest a possible risk for cross-contamination of the environment from overuse of gloves.
       
  • Risk factors for central venous catheter-related bloodstream infection in
           neonates
    • Abstract: Publication date: Available online 8 January 2020Source: American Journal of Infection ControlAuthor(s): Janita Ferreira, Paulo Augusto Moreira Camargos, Viviane Rosado, Paulo Henrique Orlandi Mourão, Roberta Maia de Castro RomanelliWe found that low birth weight and type of central venous catheter were associated with catheter-related bloodstream infection in neonates. In the multivariate analysis, only central venous catheter type (dissected veins, tunneled catheters, and short-term nontunneled catheters) remained significantly associated with catheter-related bloodstream infection.
       
  • Evaluation of patient risk factors for infection with carbapenem-resistant
           Enterobacteriaceae
    • Abstract: Publication date: Available online 8 January 2020Source: American Journal of Infection ControlAuthor(s): Marko Predic, John P. Delano, Elizabeth Tremblay, Nicole Iovine, Scott Brown, Cindy PrinsBackgroundTo evaluate risk factors for infection or colonization with carbapenem-resistant Enterobacteriaceae (CRE) to develop an algorithm for targeted CRE screening.MethodsWe conducted a case-control study of 50 CRE-positive cases and 100 CRE-negative controls to identify risk factors that were significant for CRE infection or colonization. The setting was at an acute care academic hospital. Patients who tested positive for CRE or other microbiological laboratory tests during the study period were included. We reviewed medical records of 50 patients who were CRE-positive and 100 matched controls who had a non-CRE culture at a similar anatomic site within the closest time period to the case's culture date. Risk factors were assessed using logistic regression with SAS 9.4, observing the 95% confidence interval (CI) to determine significance.ResultsSignificant risk factors for CRE infection or colonization included the use of fluoroquinolones (odds ratio [OR], 3.75; 95% CI, 1.35, 10.38) and cephalosporins (OR, 2.37; 95% CI, 1.17, 4.86). In addition, undergoing an invasive procedure with a scope device was also a significant risk factor for our participants (OR, 4.57; 95% CI, 1.31, 16.02). Significance of these risk factors varied within the community-acquired and hospital-acquired cases.ConclusionsOur results suggest that exposure to certain antimicrobials and invasive procedures with a scope device (endoscopic retrograde cholangiopancreatography, duodenal endoscope) are risk factors for CRE. The findings of significant differences in antimicrobials received highlight the necessity to understand antimicrobial stewardship in the development of CRE colonization and infection. Along with antibiotics, inaccessibility to components within scope devices may be increasing the risk of CRE spread.
       
  • Product dose considerations for real-world hand sanitiser efficacy
    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of Infection ControlAuthor(s): N. Kenters, A. Eikelenboom-Boskamp, J. Hines, A. McGeer, E.G.W. Huijskens, A. VossBackgroundAlcohol based hand rubs (ABHR) are extremely effective at reducing microbial contamination and have an essential role in best practice hand hygiene described by the World Health Organization.MethodsWe determined ABHR drying time when performing hand hygiene in a laboratory setting. Which was followed by identifying the amount of ABHR needed for complete hand coverage. When the aforementioned was analyzed real-time data were gathered to examine the amount used for hand hygiene in a hospital setting. In parallel hands of healthcare workers (HCWs) were monitored for drying time and perception on ABHR use.ResultsIn 86% (24,446,397/28,280,383) of the events a single dose of ABHR was used on clinical wards. Twenty-four HCWs expected hand hygiene to take 7.5 seconds (median; range 3-30 seconds). Forty-three HCWs show that 1.5 mL ABHR dose achieves the desired drying time according to World Health Organization guidelines (av. median 26 seconds), but is consistently perceived to have a longer drying time than expected (av. median 18 seconds). In-vivo results (n = 10) indicate that 2.25 mL ABHR is required for adequate coverage (82%-90%) of both sides of the hand.ConclusionsResults indicate that set standards for the use of ABHR do not match “in-vivo” behaviour of HCWs. Perceived drying times are shorter than actual drying time. The needed drying time to reach acceptable antimicrobial efficacy of ABHRs should be revisited.
       
  • Multicenter cross-sectional study on the reporting status and influencing
           factors of needlestick injuries caused by insulin injection devices among
           nurses in Peking, China
    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of Infection ControlAuthor(s): Yingyue Dong, Fangfang Li, Jing Li, Rui Li, Qun WangBackgroundNeedlestick injuries (NSIs) most commonly occur in conjunction with insulin injections, and nurses had the highest rate of NSIs among different occupational groups. However, only few nurses have the awareness to report these incidents. We aimed to investigate the current reporting status and influencing factors of NSIs caused by insulin injection pen devices among nurses and nursing interns in Peking, China.MethodsThe study consisted of 4,609 nurses and nursing interns in different hospital departments, namely endocrinology wards, medical (except endocrinology) and surgical departments, emergency, outpatient departments, operation theaters, intensive care units, and other departments from 16 districts of Peking, China. A researcher-devised questionnaire was designed to assess the rate of reporting of accidental NSIs and its influencing factors. Descriptive statistics, the χ2 tests, and univariate and multivariate regression were used to analyze the independent influencing factors of reports on NSIs caused by insulin injection pen devices.ResultsAmong all participants, most of them were women (97.61%). More than half of the participants had been working as nurses over 5 years (59.58%). Approximately 63.66% of participants had been trained to prevent and deal with accidental NSIs within 1 year. Approximately 19.33% of the participants experienced NSIs before, but only 30.30% of them reported the injury to the management department or director. The main reasons for not reporting were complex/cumbersome reporting procedure (317 of 621; 51.05%), being too busy at work at the time of injury (301 of 621; 48.47%), and low-risk for personal health (197 of 621; 31.72%). Multivariate analysis showed that age (P = .014; odds ratios [OR; 1.063, 1.736]), prior needlestick training education (P = .018; OR [0.406, 0.917]), and written system for preventing (P < .001; OR [0.289, 0.622]) were independent factors associated with reporting of NSIs caused by insulin injection pen devices.ConclusionsNSIs caused by insulin injection pen devices are common among nurses and are often not reported. It is necessary to provide nurses with regular training to prevent and deal with NSIs. Hospital management departments should adopt a simpler reporting procedure to understand the actual occurrence of NSIs to develop better prevention and improvement measures.Graphical abstractImage, graphical abstract
       
  • Examining the inclusion of patients and their family members in infection
           prevention and control policies and guidelines across Bangladesh,
           Indonesia, and South Korea
    • Abstract: Publication date: Available online 7 January 2020Source: American Journal of Infection ControlAuthor(s): Ji Yeon Park, Jerico Franciscus Pardosi, Holly SealeBackgroundAlthough familial involvement during inpatient care is not uncommon in western countries, the types of caring activities that family members in Asian countries provide are significantly different. These activities may place the family member at risk from a health care–associated infection. This study aimed to examine whether the role of patients’ families has been accounted for in the infection prevention and control (IPC) guidelines and policy, using examples from Bangladesh (low-income country), Indonesia (middle-income country), and South Korea (high-income country).MethodsThe World Health Organization website and Institutional Repository for Information Sharing, Centers for Disease Control and Prevention website, Australian Government Web Archive, Open Grey, Grey Matters, World Bank, and advanced Google search, as well as the Health Department/Ministry of Health websites for each target country and 4 western countries (Australia, Canada, England, and the United States) were searched. Other databases, such as Embase, Medline, CINAHL, Global Health, ProQuest databases, Google scholar, Web of Science, and Scopus were also searched. This was to review the reflection of the cultural influence in IPC policies/guidelines by reviewing those from the global organizations, which are often used as a blueprint for policy development, as well as those from western countries, which hold different cultures in care arrangement. Search was conducted with attention to the key areas: definition and role of carer in the acute health care facility, involvement of patients/family members in IPC activities, patient and family member hand hygiene, and IPC education.ResultsNinety-two articles were identified based on the criteria for the study. Only 6 acknowledged that care is provided to hospitalized patients by their family members, and only 1 recommended that family members receive the same level of training as health care workers on IPC precautions. Other guides recommended the provision of information on IPC measures as means of patient involvement in the IPC program. Recognition of family caregivers or inclusion of them in the IPC strategies was not included in the target countries’ guidelines.ConclusionsAlthough health care workers are the primary actors when it comes to providing care in acute health care settings, it is important to expand the IPC guides by considering the role of other caregivers. Policies and guidelines should reflect the cultural influence over healthcare. This is especially true when cultural values strongly influence over healthcare arrangements and the healthcare accommodates these cultural influences in the practice. Further work needs to be undertaken on the level of training/education provided to family members in Bangladesh, Indonesia, and South Korea.
       
  • A new approach to infection prevention: A pilot study to evaluate a hand
           hygiene ambassador program in hospitals and clinics
    • Abstract: Publication date: Available online 6 January 2020Source: American Journal of Infection ControlAuthor(s): David J. Birnbach, Taylor C. Thiesen, Lisa F. Rosen, Maureen Fitzpatrick, Kristopher L. ArheartBackgroundA pilot study was conducted to assess the perceptions of visitors, patients, and staff to the presence of a hand hygiene ambassador (HHA).MethodsTwo hundred and twenty-five entrants to various health care settings were surveyed. Only entrants who failed to clean their hands at the alcohol-based handrub (ABHR) station on entry to the lobby were offered application of ABHR by an HHA. Several questions were also asked to assess their attitudes about the presence of an HHA.ResultsWhen asked whether they think it is a good idea to have an HHA place ABHR on an entrant's hands, the majority of staff, visitors, and patients agreed. No one refused administration of handrub by the HHA.DiscussionHHA programs have direct and indirect benefits. Although the cost of such an initiative should be considered prior to implementation, it should be weighed against the annual spending for health care–associated infections.ConclusionsConsidering that hand hygiene compliance and health care–associated infection are clearly linked, a new approach using an HHA may help reduce infection, acting as a source of hand hygiene on entry to the hospital and possibly as a reminder to perform hand hygiene elsewhere in the hospital and clinics.
       
  • Failure of central venous catheter insertion and care bundles in a high
           central line–associated bloodstream infection rate, high bed occupancy
           hospital
    • Abstract: Publication date: Available online 3 January 2020Source: American Journal of Infection ControlAuthor(s): Amalia Karapanou, Anna-Maria Vieru, Michail A. Sampanis, Angeliki Pantazatou, Ioannis Deliolanis, George L. Daikos, Michael SamarkosBackgroundOur hospital has several characteristics different from the settings in which the central venous catheter (CVC) care bundle has been implemented so far, that is, care bundles or protocols are not systematically used, and the prevalence of central line–associated bloodstream infections (CLABSI) is high, as is bed occupancy rate. We examined the effectiveness of CVC care bundles.MethodsModified CVC bundles were implemented across all settings of our hospital. During both phases of the study, we collected data on CLABSI, and we monitored CVC insertion and management practices with direct observation audits.ResultsWe have studied 913 CVC insertions (454 in PRE and 459 in POST) for 11,871 catheter-days. The incidence of CLABSI was 8.3 per 1,000 catheter-days PRE, and 7.6 per 1,000 catheter-days POST (incidence rate ratio, 0.92; 95% confidence interval, 0.60-1.40). Compliance with the CVC insertion bundle increased from 8.4%-74.3% (P 
       
  • Washer disinfector and alkaline detergent efficacy against C.
           difficile
    on plastic bedpans
    • Abstract: Publication date: Available online 3 January 2020Source: American Journal of Infection ControlAuthor(s): Savannah Hatt, Bryan Schindler, Diana Bach, Christine GreeneBackgroundClostridioides difficile is a major cause of infectious antibiotic resistant diarrhea. C. difficile spores are shed in patient stool, are hearty and difficult to kill. Bedpans are often used by patients with C. difficile infections and require proper handling and cleaning or disposal to prevent the transmission of C. difficile spores and other infectious microorganisms into the environment. Disposable bedpans are often used for convenience, which has consequences from an environmental sustainability perspective.AimThis study evaluates the ability for a washer-disinfector device (WD) to efficaciously clean and disinfect C. difficile spores and Escherichia coli from bedpans for sanitary reuse.MethodsA commercially available WD device was evaluated for both efficacy and thermal disinfection against C. difficile spores and Escherichia coli using one disinfection cycle per test. Bedpans were not rinsed or dumped prior to placement in the WD. Bedpans were sampled using swabs. Microorganisms were eluted from the swabs and log-kill was calculated.FindingsThe average log-kill for C. difficile spores was 3.99 and>7.69 for E. coli. Thermal disinfection results showed an average log kill of 4.31 for C. difficile and>7.23 for E. coli.ConclusionsThe WD was efficacious against both C. difficile spores and E. coli when used according to manufacturer's instructions for use, suggesting a viable alternative to disposable bedpan waste management.
       
  • Patient motivational dialogue: A novel approach to improve hand hygiene
           through patient empowerment in ambulatory care
    • Abstract: Publication date: Available online 3 January 2020Source: American Journal of Infection ControlAuthor(s): Patti G. Grota, Tony Eng, Carol A. JenkinsA novel patient empowerment strategy called Patient Motivational Dialogue purposed to improve hand hygiene compliance is described. Two barriers to sustainability of patients asking health care providers (HCP) to clean their hands were noted in this study: (1) the HCP responding negatively to the patient asking, and (2) the patient misunderstanding that wearing gloves does not replace hand hygiene. Both barriers may be addressed through education of HCP and of consumer.
       
  • Particle control reduces fine and ultrafine particles greater than HEPA
           filtration in live operating rooms and kills biologic warfare surrogate
    • Abstract: Publication date: Available online 3 January 2020Source: American Journal of Infection ControlAuthor(s): Mark H. Ereth, Donald H. Hess, Abigail Driscoll, Mark Hernandez, Frank StamatatosBackgroundControlling indoor air quality and the airborne transmission of infectious agents in hospitals is critical. The most hazardous particles and pathogens are not easily eliminated by traditionally passive air cleansing.MethodsWe studied the effect of a novel particle control technology on airborne particulate matter in 2 live real-world operating room settings and on pathogen survival in a microbiology laboratory.ResultsParticle control technology reduced operating room particle and pathogen loads by 94.4% in a community hospital operating room, and by 95% in an academic medical center operating room. The addition of particle control technology to a collector loaded with a biologic warfare surrogate resulted in a 95% kill rate of an anthrax surrogate (Bacillus subtilis) within 3 hours.DiscussionDeployment of this emerging technology could significantly reduce indoor air contamination and associated infections in operating rooms, hospital isolation rooms, and intensive care settings, as well as reduce inflammatory responses to airborne particles.ConclusionsThe particle control technology studied may protect patients from hospital-acquired infections, reduce inflammatory pulmonary disease, and mitigate exposure to biologic weapons.Graphics Image, graphical abstract
       
  • Assessing sustainability of hand hygiene adherence 5 years after a
           contest-based intervention in 3 Japanese hospitals
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s): Tomoko Sakihama, Naomi Kayauchi, Toru Kamiya, Sanjay Saint, Karen E. Fowler, David Ratz, Yumiko Sato, Ritsuko Iuchi, Hitoshi Honda, Yasuharu TokudaBackgroundOur goal was to evaluate the 5-year sustainability of a multimodal intervention that included a prize to the hospital with the highest overall hand hygiene adherence rates among health care workers.MethodsWe conducted an observational study in 3 Japanese tertiary care hospitals using unobtrusive direct observation of physician and nurse hand hygiene adherence. Observations were performed by a trained observer on inpatient medical, surgical, intensive care, and emergency units. The primary outcome was hand hygiene adherence rates before patient contact. Secondary outcomes were health care worker survey responses to a World Health Organization (WHO) questionnaire on hand hygiene practices.ResultsHand hygiene adherence rates had improved significantly after the introduction of a multimodal intervention (based on principles recommend by the WHO) in 2012 and 2013 (from 18.0% pre-intervention to 32.7% 6 months post-intervention; P < .001). No significant changes were found in hand hygiene adherence in these hospitals 5 years after the original intervention (31.9% 5 years after intervention; P = .53); however, substantial variability in hand hygiene adherence by unit and health care worker type was noted.ConclusionsA multimodal hand hygiene initiative achieved sustained improvement in hand hygiene adherence in 3 Japanese hospitals 5 years after the original intervention.Graphical abstractImage, graphical abstract
       
  • Moving beyond hand hygiene monitoring as a marker of infection prevention
           performance: Development of a tailored infection control continuous
           quality improvement tool
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s): Annette Jeanes, Pietro G. Coen, Nicolas S. Drey, Dinah J. GouldBackgroundInfection control practice compliance is commonly monitored by measuring hand hygiene compliance. The limitations of this approach were recognized in 1 acute health care organization that led to the development of an Infection Control Continuous Quality Improvement tool.MethodsThe Pronovost cycle, Barriers and Mitigation tool, and Hexagon framework were used to review the existing monitoring system and develop a quality improvement data collection tool that considered the context of care delivery.ResultsBarriers and opportunities for improvement including ambiguity, consistency and feasibility of expectations, the environment, knowledge, and education were combined in a monitoring tool that was piloted and modified in response to feedback. Local adaptations enabled staff to prioritize and monitor issues important in their own workplace.The tool replaced the previous system and was positively evaluated by auditors. Challenges included ensuring staff had time to train in use of the tool, time to collect the audit, and the reporting of low scores that conflicted with a target-based performance system.ConclusionsHand hygiene compliance monitoring alone misses other important aspects of infection control compliance. A continuous quality improvement tool was developed reflecting specific organizational needs that could be transferred or adapted to other organizations.
       
  • Discourse on hygiene between hospitalized patients and health care workers
           as an accepted norm: Making it legitimate to remind health care workers
           about hand hygiene
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s): Anat Gesser-Edelsburg, Ricky Cohen, Mina Zemach, Adva Mir HalaviAbstractBackgroundDespite World Health Organization recommendations that patients should play a role in encouraging hand hygiene (HH) as a means of preventing infection, patient engagement remains an underused method. From the perspectives of hospitalized patients (HPs) and health care workers (HCWs) at 2 major public hospitals in Haifa, Israel, this research investigated (1) HP barriers to reminding HCWs to maintain HH, (2) HCW barriers to giving HPs instruction on proper hygiene, (3) what could help HPs and HCWs overcome these barriers, and (4) how video clips can be used to devise tailored strategies governing discourse on HH between HCWs and HPs.MethodsIntervention type 2 design and examination of 2 population groups—HPs and HCWs—before and after intervention by means of mixed methods research.ResultsBoth HPs and HCWs reported partial knowledge, embarrassment, and fears regarding commenting to staff, as well as a lack of cultural adaptation. The interviewees indicated that the video clips granted legitimacy to reminding HCWs about hygiene through strategies designed to identify and solve barriers, authenticity, and cultural adaptation.ConclusionsTo overcome HP and HCW barriers to maintaining HH, tailored video clips on HH should specify barriers and solutions with which they can both identify, thus turning discourse on HH into an accepted norm.
       
  • Bacterial contamination of surgical scrubs in the operating theater
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s): Yonatan Ilibman Arzi, Marc V. Assous, Kashat Livnat, Amos M. Yinnon, Yonit Wiener-WellBackgroundMeasures for the prevention of postsurgical infections include issuing special scrubs for the operating room (OR) and prohibiting walking out of the OR complex wearing these scrubs. The aim of this study was to provide further data on bacterial contamination of surgical scrubs.MethodsSpecimens were collected at the entrance to the OR from surgical scrubs worn by surgeons. Participants completed a questionnaire regarding the times, places, and activities in which they were involved during the time interval they were wearing the scrubs.ResultsAmong the 133 surgeons who participated, the median colony-forming unit (CFU) count was higher (39 CFU/plate) for their scrubs than for clean scrubs worn by the control group (3 CFU/plate; n = 11; P < .001), but there was no significant difference between the study and control groups in the rate of carriage of pathogenic bacteria (13% and 9%, respectively). The majority of the bacteria isolated were considered commensals. Fifty-five (41%) of the surgeons stated that before sampling they took part in medical activities, and 45 (34%) participated in non-medical activities. Practicing these activities was associated with a higher number of CFUs compared to not being involved in such activities (P < .05).ConclusionsOur data show that, even in less than optimal situations when scrubs are worn outside the OR, surgical scrubs are contaminated with a low bacterial load and only a small number of pathogenic bacteria.
       
  • A systematic risk-based strategy to select personal protective equipment
           for infectious diseases
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s): Rachael M. Jones, Susan C. Bleasdale, Dayana Maita, Lisa M. Brosseau, CDC Prevention Epicenters ProgramBackgroundPersonal protective equipment (PPE) is a primary strategy to protect health care personnel (HCP) from infectious diseases. When transmission-based PPE ensembles are not appropriate, HCP must recognize the transmission pathway of the disease and anticipate the exposures to select PPE. Because guidance for this process is extremely limited, we proposed a systematic, risk-based approach to the selection and evaluation of PPE ensembles to protect HCP against infectious diseases.MethodsThe approach used in this study included the following 4 steps: (1) job hazard analysis, (2) infectious disease hazard analysis, (3) selection of PPE, and (4) evaluation of selected PPE. Selected PPE should protect HCP from exposure, be usable by HCP, and fit for purpose.ResultsThe approach was demonstrated for the activity of intubation of a patient with methicillin-resistant Staphylococcus aureus or Severe Acute Respiratory Syndrome coronavirus. As expected, the approach led to the selection of different ensembles of PPE for these 2 pathogens.DiscussionA systematic risk-based approach to the selection of PPE will help health care facilities and HCP select PPE when transmission-based precautions are not appropriate. Owing to the complexity of PPE ensemble selection and evaluation, a team with expertise in infectious diseases, occupational health, the health care activity, and related disciplines, such as human factors, should be engaged.ConclusionsParticipation, documentation, and transparency are necessary to ensure the decisions can be communicated, critiqued, and understood by HCP.
       
  • Patricia Stone, PhD, MPH, RN, FAAN, Takes the Helm at AJIC
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s):
       
  • Information for Authors
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s):
       
  • Information for Readers
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s):
       
  • APIC Masthead
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s):
       
  • Clostridioides difficile nurse driven protocol: A cautionary tale
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s): Ariana Kavazovic, Michele S. Fleming, Shelley Knowlson, Michelle Doll, Kaila D. Cooper, Robin R. Hemphill, Rachel J. Pryor, Emily J. Godbout, Michael P. Stevens, Gonzalo BearmanIn a 12-month study, a nurse driven protocol was implemented at a tertiary academic medical center. The purpose of the nurse driven protocol was to identify community-onset Clostridioides difficile infections, expeditiously isolate patients with presumed C difficile diarrheal illness, and prevent transmission while simultaneously decreasing the incidence of hospital-onset C difficile. The overall adherence to fidelity of the protocol was poor and failed to have a significant impact on infection rates.
       
  • Germicidal irradiation of portable medical equipment: Mitigating microbes
           and improving the margin of safety using a novel, point of care,
           germicidal disinfection pod
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s): Deb Reid, Karen Ternes, Linda Winowiecki, Cheryl Yonke, Brian Riege, Fabian Fregoli, Deborah Passey, Mark Stibich, Russell N OlmstedPortable medical equipment (PME) can be an important reservoir of pathogens causing health care–associated infections. To address this, a novel, portable ultraviolet disinfection pod (UVDP) that allows for full 360-degree disinfection was developed. This investigation examined efficacy of the UVDP against microorganisms on clean, patient-ready PME. We found that the UVDP significantly reduced the number of recoverable bacteria on PME.Image, graphical abstract
       
  • Efficacy of a novel ultraviolet light-emitting diode device for
           decontamination of shared pens in a health care setting
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s): Erica Emig, Heba Alhmidi, Yilen K. Ng-Wong, Thriveen S.C. Mana, Jennifer L. Cadnum, Curtis J. DonskeyShared pens and styluses are a potential source for transmission of health care–associated pathogens and respiratory viruses in health care facilities. A novel ultraviolet light-emitting diode device was effective in reducing bacteria and viruses inoculated on pens and in reducing methicillin-resistant Staphylococcus aureus transferred to pens by colonized patients. The device could be useful in reducing the risk of transmission of pathogens by shared writing utensils.
       
  • Tales from the auditors: What we learned from endoscope auditing
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s): Rebecca Washburn, Eman Chami, Abigail Keskimaki, Patricia StarrEndoscope auditing is unique from other types of auditing normally completed as part of ongoing quality initiatives. When auditors walk into an endoscopy processing area, they are confronted with a variety of complex processes generally packed into a small space. Auditors are challenged to become experts on the processes they are evaluating, and must stay current with changes in practice and equipment. In our 10 years of endoscope processing assessments completed by infection prevention and accreditation staff, we learned a great deal regarding how to approach auditing and interact with staff to improve the quality of endoscope processing.
       
  • Addressing the threat from within: Investigation of respiratory symptoms
           in a health care worker with untreated latent tuberculosis infection
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s): Anita R. Modi, Cyndee C. Miranda, Gary W. Procop, Charles B. Foster, Susan Harrington, David Evans, Lucileia Teixeira Johnson, Steven M. GordonTuberculosis (TB) in the health care worker demands orchestrated efforts from health care institutions to promptly identify cases and address community risk. We describe a pediatric intensive care unit nurse with latent TB infection who developed hemoptysis and a lung infiltrate concerning for active TB. Her evaluation and contact investigation were facilitated by our institution's command center. Although TB was ultimately ruled out, this case tested our team-based care in response to a suspected high-consequence pathogen.
       
  • Prophylactic antibiotics prior to dental procedures: A cross-disciplinary
           survey of dentists and medical providers
    • Abstract: Publication date: January 2020Source: American Journal of Infection Control, Volume 48, Issue 1Author(s): Morgan McCarthy, Rebecca Andrews, David B. BanachThe prescription of prophylactic antibiotics prior to dental procedures is common, although factors influencing prescribing are poorly understood. We surveyed general and specialist medical providers and dentists on beliefs and attitudes regarding prophylactic antibiotic prescribing prior to dental procedures. There were significant differences in factors influencing decisions and perceived responsibility regarding prophylactic antibiotic prescribing between groups, although interest in additional education on the subject was high across both groups.
       
  • Re: Saltzman et al study on probiotics and prevention of CDI-the
           importance of probiotic strain specificity
    • Abstract: Publication date: Available online 30 December 2019Source: American Journal of Infection ControlAuthor(s): Lynne V. McFarland
       
  • Hand hygiene knowledge, attitudes, and practices among hospital
           inpatients: A descriptive study
    • Abstract: Publication date: Available online 27 December 2019Source: American Journal of Infection ControlAuthor(s): Jocelyn A. Srigley, Sung Min Cho, Cindy O'Neill, Anne Bialachowski, R. Ayesha Ali, Christine Lee, Dominik MertzBackgroundPathogens may be transmitted in hospitals via patients’ own hands, but little is known about the facilitators and barriers of hand hygiene among inpatients. This study aimed to assess the hand hygiene knowledge, attitudes, and practices of adult inpatients at 5 hospitals.MethodsThe study consisted of a cross-sectional survey distributed followed by structured interviews with randomly selected inpatients. Qualitative data were analyzed independently by 2 researchers using the Theoretical Domains Framework.ResultsA total of 268 surveys were completed, with 66.4% of patients reporting always performing hand hygiene after toileting and 49.2% before eating. The majority of patients (74.6%) stated that they did not want to receive more information about hand hygiene while in the hospital. Key themes identified from 23 interviews include knowledge; environmental context and resources; memory, attention, and decision processes; and social influences.ConclusionsSelf-reported patient hand hygiene rates are suboptimal and there are knowledge gaps among patients as to when to perform hand hygiene, but patients are not receptive to receiving traditional educational interventions. Future interventions to improve patient hand hygiene should focus on other behavior change domains, including environmental context and resources (eg, access to hand sanitizer at the bedside), memory, attention, and decision processes (eg, posters or other reminders), and social influences (eg, role modeling).
       
  • Monitoring the effectiveness of daily cleaning practices in an intensive
           care unit (ICU) setting using an adenosine triphosphate (ATP)
           bioluminescence assay
    • Abstract: Publication date: Available online 26 December 2019Source: American Journal of Infection ControlAuthor(s): Abhishek Deshpande, Aaron N. Dunn, Jacqueline Fox, Jennifer L. Cadnum, Thriveen S.C. Mana, Annette Jencson, Thomas G. Fraser, Curtis J. Donskey, Steven M. GordonBackgroundThe degree to which daily intensive care unit (ICU) cleaning practices impacts bacterial burden is controversial. The study aimed to assess the utility of using adenosine triphosphate (ATP) bioluminescence assays for monitoring effectiveness of daily cleaning in ICU environments.MethodsWe sampled 364 total samples from 57 patient rooms and 18 common areas in 3 medical ICUs over 12 weeks, before and after routine daily cleaning. Endpoints were ATP levels (relative light units, RLU) and bacterial bioburden (colony forming units, CFU).ResultsHigh-touch surfaces in ICU patient rooms and common areas were contaminated before and after cleaning. Routine cleaning significantly reduced bacterial burden in patient rooms (0.14 log10 CFU reduction, P = .008; 0.21 log10 RLU reduction, P < .001) and in ICU common areas (1.18 log10 CFU reduction, P < .001; 0.72 log10 RLU reduction, P < .001). Among sites with colony counts>20 CFUs, the proportion of sites with ATP readings>250 RLU was significantly higher than those with ATP readings ≤250 RLU (90.0% vs 10.0%, P < .05).ConclusionRoutine cleaning significantly reduced bacterial burden on ICU environment surfaces. Although not an alternative to culture methods, ATP assays may be a useful technique to provide rapid feedback on surface cleanliness in ICU settings.
       
  • Efficacy of a multi-purpose high level disinfection cabinet against
           Candida auris and other health care-associated pathogen
    • Abstract: Publication date: Available online 24 December 2019Source: American Journal of Infection ControlAuthor(s): Jessica A. Kumar, Jennifer L. Cadnum, Annette L. Jencson, Curtis J. DonskeyPortable equipment and other small devices used in health care are a potential source for dissemination of pathogens. We demonstrated that a high-level disinfection cabinet using ultrasonic submicron droplets of peracetic acid and hydrogen peroxide was effective against methicillin-resistant Staphylococcus aureus, Clostridiodes difficile spores, the nonenveloped virus bacteriophage MS2, and Candida auris on steel disk carriers. The device also eliminated Candida auris inoculated on real-world items of portable equipment.
       
  • Use of an automated hand hygiene compliance system by emergency room
           nurses and technicians is associated with decreased employee absenteeism
    • Abstract: Publication date: Available online 20 December 2019Source: American Journal of Infection ControlAuthor(s): Jessica Strauch, Thomas M. Braun, Harold ShortFew studies have examined the use of hand hygiene interventions among health care personnel and employee absenteeism. To improve the hand hygiene practices of emergency room nurses and technicians, we implemented mandatory use of an automated hand hygiene compliance system. After implementation, we found reductions in employee absenteeism and the number of overtime hours worked by substitute staff. These unanticipated results demonstrate a return on investment that benefits the health of employees.
       
  • Letter to the Editor regarding “Connectors as a risk factor for
           blood-associated infections (3-way stopcock and needleless connector): A
           randomized-experimental study”
    • Abstract: Publication date: Available online 19 December 2019Source: American Journal of Infection ControlAuthor(s): İlker Devrim
       
  • Use of a simple colorimetric assay to provide monitoring and feedback on
           adherence to chlorhexidine bathing protocols
    • Abstract: Publication date: Available online 19 December 2019Source: American Journal of Infection ControlAuthor(s): Jennifer L. Cadnum, Laura Supple, Daniel Supple, Mark Osborne, Curtis J. Donskey
       
  • Information for Readers
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s):
       
  • Regarding “Risks and benefits of using chlorhexidine gluconate in
           handwashing: a systematic literature review”
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Dathan Hamann, Curt Hamann
       
  • ‘‘Methods for microbial needleless connector decontamination: A
           
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Ludwig Serge Aho Glélé, Adrien Guilloteau, Karine Astruc, Yolene Carre, Pascal Chaize, Olivia Keita-Perse, Yves Lurton, Didier Lepelletier
       
  • A call for improved occupational surveillance for measles in the United
           States
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Christopher K. Brown
       
  • Effects of environmental disinfection on the isolation of
           vancomycin-resistant Enterococcus after a hospital-associated outbreak of
           Middle East respiratory syndrome
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Jae-Hoon Ko, Si-Ho Kim, Nam Yong Lee, Yae-jin Kim, Sun Young Cho, Cheol-In Kang, Doo Ryeon Chung, Kyong Ran PeckEnvironmental disinfection with sodium hypochlorite and hydrogen peroxide vapor was performed after a hospital-associated outbreak of Middle East respiratory syndrome. Although only 11% of total beds were disinfected, the isolation and vancomycin-resistance rates of Enterococcus spp significantly decreased for 2 months, whereas other multidrug-resistant organisms did not.
       
  • An outbreak of Pseudomonas aeruginosa urinary tract infections following
           outpatient flexible cystoscopy
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Elodie Sorbets, Marine Evrevin, Estelle Jumas-Bilak, Agnès Masnou, Anne Lotthé, Rodolphe Thuret, Pascale Chaize, Frederic Peyremorte, Sara Romano-Bertrand, Sylvie ParerThe investigation of an outbreak of Pseudomonas aeruginosa urinary tract infections after ambulatory cystoscopies identified a damaged cystoscope contaminated by P aeruginosa and acting as a relay object. This outbreak urges us not to trivialize urinary tract infections occurring after an elective cystoscopy. Patients should be advised to signal the occurrence of urologic symptoms after urologic exploration.
       
  • Is 2-person urinary catheter insertion effective in reducing CAUTI'
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Susan Fletcher-Gutowski, Janice CecilThis study focused on implementation of the 2-person urinary catheter insertion protocol as a way to decrease catheter-associated infection (CAUTI) rates. Whereas the CAUTI prevention bundle is important to implement, additional focus on specific parts of the bundle are imperative. The results of this study indicate implementation of the 2-person urinary catheter insertion protocol with a checklist decreased the risk of CAUTI for our patient population.
       
  • Strategies for the successful implementation of disinfecting port
           protectors to reduce CLABSI in a large tertiary care teaching hospital
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Cole Beeler, Denise Kerley, Carmen Davis, Dana Hazen, William Snyderman, Kathy Lyons, Josh Sadowski, Jennifer Sweeney, Lana Dbeibo, Kristen Kelley, Douglas H. WebbDisinfecting port protectors are a supplement to the central line–associated bloodstream infection prevention bundle as an optional recommendation from the Centers for Disease Control and Prevention. Despite evidence of effectiveness, few centers have successfully reported systematic, sustained implementation of these devices. In this article, we discuss a successful implementation in a large tertiary care teaching hospital, using an evidence-based, multidisciplinary approach.Infection prevention; Bacteremia; Ethanol caps; Bundle measures; Quality improvement; Hub infection
       
  • Screening asymptomatic households for Streptococcus pyogenes pharyngeal
           carriage as a part of in-hospital investigation of puerperal sepsis
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Regev Cohen, Shoshana Cohen, Marina Afraimov, Talya Finn, Frida Babushkin, Keren Geller, Svetlana Paikin, Irena Yoffe, Lea Valinsky, Merav Ron, Assaf RokneyBackgroundInvasive group A streptococcal (iGAS) infection in the peripartum setting is a rare but devastating disease occasionally occurring as a health care–associated infection (HAI). Current guidelines suggest enhanced surveillance and streptococcal isolate storage after a single case of iGAS, as well as a full epidemiological investigation that includes screening health care workers (HCWs) from several sites after 2 cases. Current guidelines do not recommend routine screening of household members of a patient with iGAS.MethodsWe conducted studies of 3 patients with iGAS puerperal sepsis and related epidemiologic and molecular investigations.ResultsIdentical GAS emm gene types were found in pharyngeal cultures of 3 asymptomatic spouses of patients with iGAS puerperal sepsis. HCWs screened negative for GAS, and emm typing indicated that other iGAS cases from this hospital were sporadic and not related to the puerperal cases.ConclusionsThe concurrent presence of the same emm type in a household member practically excludes the option of an inadvertent HAI or facility outbreak. Hence, we suggest that screening close family members for asymptomatic GAS carriage should be performed early as a part of infection prevention measures, as doing so would have significant utility in saving time and resources related to a full epidemiological inquiry.
       
  • Microbial colonization of intravascular catheter connectors in
           hospitalized patients
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Richard Hankins, O. Denisa Majorant, Mark E. Rupp, R. Jennifer Cavalieri, Paul D. Fey, Elizabeth Lyden, Kelly A. CawcuttBackgroundCentral line–associated bloodstream infections may be due to catheter connector colonization and intraluminal migration of pathogens. We assessed the colonization of the split septum catheter connector system, and subsequently the luer lock catheter connector system.MethodsThis was a prospective, 2 phase, quality improvement study at a tertiary referral center. Each phase of the study was performed over 3 consecutive days in hospitalized patients receiving an active infusion; first with a split septum lever lock connector and second with a luer lock connector and alcohol port protector. The connectors were inoculated onto blood agar plates and incubated. Plates were assessed for microbial growth after 48-72 hours.ResultsIn phase I, 98 (41.9%) of 234 split septum connectors yielded microbial growth. In phase II, 56 (23.1%) of 243 luer lock connectors yielded microbial growth. In phase II only, there was a significant increased rate of contamination in peripheral catheters compared with all other catheters, and the rate of contamination on the acute care wards was significantly higher when compared with the intensive care units.ConclusionsBacterial colonization of the lever lock system was unacceptably high among all catheter types and hospital locations. Transition to luer lock catheter connectors and alcohol port protectors decreased the colonization; however, colonization still remained substantial. Causation of colonization cannot be determined with these results.
       
  • Skin colonization at peripheral intravenous catheter insertion sites
           increases the risk of catheter colonization and infection
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Md Abu Choudhury, Hanna E. Sidjabat, Hosam M. Zowawi, Nicole Marsh PhD, Emily Larsen, Naomi Runnegar PhD, David L. Paterson, David J. McMillan, Claire M. RickardBackgroundPeripheral intravenous catheters (PIVCs) break the skin barrier, and preinsertion antiseptic disinfection and sterile dressings are used to reduce risk of catheter-related bloodstream infection (CRBSI). In this study, the impact of PIVC skin site colonization on tip colonization and the development of CRBSI was investigated.MethodsA total of 137 patients’ PIVC skin site swabs and paired PIVC tips were collected at catheter removal, cultured, and bacterial species and clonality were identified.ResultsOf 137 patients, 45 (33%) had colonized skin sites and/or PIVC tips. Of 16 patients with paired colonization of both the skin site and PIVC tips, 11 (69%) were colonized with the same bacterial species. Of these, 77% were clonally related, including 1 identical clone of Pseudomonas aeruginosa in a patient with systemic infection and the same organism identified in blood culture.ConclusionsThe results demonstrate that opportunistic pathogen colonization at the skin site poses a significant risk for PIVC colonization and CRBSI. Further research is needed to improve current preinsertion antiseptic disinfection of PIVC skin site and the sterile insertion procedure to potentially reduce PIVC colonization and infection risk.
       
  • Factors associated with multidrug-resistant bacteria in a cohort of
           patients with asymptomatic bacteriuria who underwent urological surgery
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Jorge A. Ramos-Castaneda, Alberto Ruano-Ravina, Diego F. Salinas, Javier Osorio-Manrique, Angela M. Segura-Cardona, Elkin V. Lemos-LuengasBackgroundAlthough the factors associated to bacterial resistance in patients with asymptomatic bacteriuria (ASB) have been studied in pregnant, fertile age women, patients with spinal cord injury, and those with urogynecological disorders, nothing is known about the factors associated with multidrug-resistant (MDR) bacteria in patients with ASB and planned urological procedures. This study therefore sought to identify the sociodemographic and clinical factors associated with MDR bacteria in a cohort of patients with ASB scheduled for urological procedures.MethodsWe conducted a nested case–control study on a cohort of patients with ASB and planned urological procedures at 3 Colombian medical centers. Cases were patients with MDR bacteria and controls were patients without MDR bacteria.ResultsA total of 184 patients were included, 41.8% (n = 77) of whom presented ASB with MDR bacteria. The factors linking ASB with MDR bacteria were: advanced age (odds ratio, 1.03; 95% confidence interval, 1.01-1.06) and hospitalization within the 3-month period before surgery (odds ratio, 2.35; 95% confidence interval, 1.08-5.21).ConclusionsBacterial resistance is frequent among patients with ASB and planned urological procedures. Advanced age and prior hospitalization should be borne in mind for patients with planned urological procedures because they are factors associated with the presence of MDR bacteria.
       
  • Risk of infection in patients undergoing urologic surgery based on the
           presence of asymptomatic bacteriuria: A prospective study
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Jorge A. Ramos-Castaneda, Alberto Ruano-Ravina, L. Silvia Munoz-Price, Rodrigo Toro-Bermúdez, David Ruiz-Londoño, Angela M. Segura-Cardona, Elkin V. Lemos-LuengasBackgroundTreatment of asymptomatic bacteriuria (ASB) is recommended in pregnant women and prior to urologic procedures with anticipated mucosal disruption. However, there is still insufficient evidence of the usefulness of treating ASB prior to urologic procedures. Therefore, the aim of this study was to ascertain the risk of infections in patients undergoing urologic surgery based on the presence of ASB.MethodsWe conducted a cohort study among patients undergoing urologic surgery at a single center located in Medellín, Colombia. All patients were screened for ASB prior to their procedures. Patients were evaluated for the development of any postoperative infectious complications for up to 30 days after the procedure.ResultsA total of 149 patients were included in this cohort. Incidence of ASB was 14.8%. Thirteen patients (8.72%) developed infectious complications: 3 (13.64%) with ASB and 10 (7.87%) without ABS. Factors associated with postoperative infectious complications included urologic cancers (hazard ratio [HR], 5.26; 95% confidence intervals [CI], 1.24-22.37), urologic interventions in the preceding 3 months (HR, 3.72; 95% CI, 1.02-13.51), and use of antibiotics 3 months prior to surgery (HR, 3.83; 95% CI, 1.01-15.49). Presence of ASB was not associated with postsurgical infectious complications (HR, 1.02; 95% CI, 0.26-3.96).ConclusionsThere was no association between ASB and postoperative infectious complications. There were other factors associated with infectious complications, such as urologic cancer, previous history of urologic manipulation, and antibiotic use.
       
  • You get back what you give: Decreased hospital infections with improvement
           in CHG bathing, a mathematical modeling and cost analysis
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Kelly A. Reagan, David M. Chan, Ginger Vanhoozer, Michael P. Stevens, Michelle Doll, Emily J. Godbout, Kaila Cooper, Rachel J. Pryor, Robin R. Hemphill, Gonzalo BearmanBackgroundMultiple studies have shown that bathing with chlorhexidine gluconate (CHG) wipes reduces hospital-acquired infections (HAIs). We employed a mathematical model to assess the impact of CHG patient bathing on central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and hospital-onset Clostridium difficile (C diff) infections and the associated costs.MethodsUsing a Markov chain, we examined the effect of CHG bathing compliance on HAI outcomes and the associated costs. Using estimates from 2 different studies on CHG bathing effectiveness for CLABSI, CAUTI, and C diff, the number of HAIs per year were estimated along with associated costs. The simulations were conducted, assuming CHG bathing at varying compliance rates.ResultsAt 32% reduction in HAI incidence, increasing CHG bathing compliance from 60% to 90% results in 20 averted infections and $815,301.75 saved cost.ConclusionsAs CHG bathing compliance increases, yearly HAIs decrease, and the overall cost associated with the HAIs also decreases.
       
  • Effect of a school-based hand hygiene program for Malawian children: A
           cluster randomized controlled trial
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Balwani Chingatichifwe Mbakaya, Paul Lee, Regina Lai Tong LeeBackgroundProper handwashing technique can reduce the mortality of a child. This study aimed to evaluate the impact of a school-based hand hygiene program on the handwashing compliance of children and school absenteeism in Southern Africa.MethodsWe conducted a 2-arm cluster randomized trial in which 6 private primary schools were allocated randomly to either intervention (3 schools) or control (3 schools) groups. The intervention group consisted of implementing a series of planned activities and measures of hand hygiene program over 9 months. Parameters of primary and secondary outcomes were estimated with generalized estimating equations.ResultsThere were no significant between-group differences in demographic characteristics. The knowledge scores in the intervention group were significantly higher than the scores in the control group, and the technique scores in the intervention group were significantly higher than the scores in the control group after baseline. Further, after the third month, the cleanliness scores in the intervention group were significantly higher than the scores in the control group. In addition, the number of sick leave days decreased in the intervention group.ConclusionsThe impact of the school-based hand hygiene program was positive. It can be used in both the planning and development of a hand hygiene protocol to increase the handwashing compliance rate of schoolchildren and to reduce school absenteeism in developing countries.
       
  • Estimating the effect of hand hygiene compliance and surface cleaning
           
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Amanda M. Wilson, Kelly A. Reynolds, Robert A. CanalesBackgroundQuantitative tools are needed to relate infection control interventions to infection risk reductions.MethodsA model for predicting virus concentrations on hands was used to predict rotavirus, rhinovirus, and influenza A virus doses. Variability in behaviors, transfer efficiencies for various contact types, and surface areas of contact were included. Dose-response curves were used to relate estimated doses to infection risks. Percent reductions from baseline in average rotavirus, rhinovirus, and influenza A virus dose and infection risk were calculated for interventions.ResultsBaseline average infection risks for rotavirus, rhinovirus, and influenza A virus were 0.43, 0.20, and 5.51 × 10−6, respectively. One and 2 cleaning events decreased average viral infection risks by 6.98%-17.06% and 13.95%-34.66%, respectively. A 15% increase in hand compliance decreased average infection risks by 6.98%-20.51%. A 15% increase in hand hygiene compliance paired with 2 cleaning events decreased average infection risks by 20.93%-47.55%.DiscussionThis study demonstrates the infection risk benefits of combined interventions.ConclusionsModels such as the one in this study could be used to optimize timing and frequency of cleaning events and to create hand hygiene compliance goals to achieve infection risk targets.
       
  • Hand hygiene compliance surveillance with time series anomaly detection
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Timothy L. Wiemken, Lori Hainaut, Heather Bodenschatz, Ruby VargheseBackgroundHand hygiene is the most important intervention to reduce the risk of transmission of pathogens in health care. Assurance of effective hand hygiene improvement campaigns includes adequate data analytics for reporting compliance. Traditional analytical approaches for monitoring hand hygiene compliance suffer from several limitations, including autocorrelation. The objective of this study was to use a novel time series anomaly detection algorithm to analyze routine hand hygiene compliance data.MethodsHand hygiene compliance data were collected daily by trained observers in a large academic medical center. Statistical process control p-charts were used as a comparison method of analysis per facility protocol. Time series anomaly detection was carried out using the seasonal and trend decomposition using LOESS (STL) algorithm.ResultsA total of 34 months of hand hygiene compliance data were analyzed. Traditional statistical process control p-charts identified over 76% of rates as special-cause variation, whereas STL identified 18% of rates as anomalous.ConclusionsThis study supports the use of time series anomaly detection for the routine surveillance of hand hygiene compliance data. This method will facilitate specific and accurate feedback, helping to improve this critical approach for improving patient safety.
       
  • Challenges encountered and lessons learned during a trial of an electronic
           hand hygiene monitoring system
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): John M. Boyce, Timothea Cooper, Jun Yin, Fang-Yong Li, James W. ArbogastBackgroundAutomated hand hygiene monitoring systems (AHHMS) are being developed to supplement direct observations of hand hygiene (HH). We compared compliance rates generated by direct observations and by a badge-based AHHMS.MethodsObservations of HH compliance were conducted in a surgical intensive care unit (SICU) and a general medical ward (GMW) during a 7-month baseline period and a 13-week intervention period, when compliance was also estimated using an AHHMS. Compliance rates were analyzed using time-series analysis.ResultsDuring the entire pre- and postintervention period, univariate analysis of observations revealed significant improvement in overall HH compliance in the SICU (P = .001) and the GMW (P = .03), beginning before implementation of the AHHMS. Initiation of the AHHMS was associated with a transient drop in entry and exit compliance on both units. During the intervention period, observations suggested that compliance on entry and exit continued to increase in the SICU, but not in the GMW. Time series analysis of AHHMS data revealed that entry and exit compliance did not change significantly in the SICU but decreased significantly in the GMW (P = .001). The average accuracy of the AHHMS was 60%.ConclusionsBased on observations, HH compliance increased during the baseline period. Observations and the AHHMS yielded different trends in compliance. The AHHMS's accuracy of HH events and health care personnel location were suboptimal.
       
  • Network analysis of cases with methicillin-resistant Staphylococcus aureus
           and controls in a large tertiary care facility
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Ioana Doina Moldovan, Kathryn Suh, Erin Yiran Liu, Ann JollyBackgroundDespite increased awareness of infection control precautions, methicillin-resistant Staphylococcus aureus (MRSA) still spreads through patients and contaminated objects, causing a substantial burden of illness and cost. Our objective was to define risk factors for contracting MRSA in a tertiary health care facility using a historic case-control study and to validate health care network changes during pre-outbreak and outbreak periods.MethodsWe conducted a case-control study using secondary data on hospitalizations where infected or colonized cases were compared with matched controls who tested negative by age, sex, and campus over 1 year. Social networks of all cases and controls were built from links joining patients to rooms, roommates, and health care providers over time.ResultsMatched controls were similar to cases in comorbidity, lengths of stay, mortality, and number of roommates, rooms, and health care providers. As expected, the number of rooms and roommates increased in the outbreak by more than 50%. A timed animation of the network at one campus identified potential source patients linked to 2 rooms and many roommates, after which cases connected to those same rooms proliferated.ConclusionsOnly the network animation over time revealed possible transmission of MRSA through the network, rather than attributes measured in the traditional case control study.
       
  • Prevalence of Staphylococcus aureus and methicillin-resistant S aureus on
           environmental surfaces in Ohio nursing homes
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Shanice Cheatham, Dipendra Thapaliya, Mohammed Taha, Katherine Milliken, Mark R. Dalman, Jhalka Kadariya, Dylan Grenier, Tara C. SmithBackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is common in medical institutions. We sought to examine the prevalence of S aureus on environmental surfaces in nursing homes and to obtain molecular information on contaminating strains.MethodsA total of 259 environmental samples were collected from 7 different nursing homes in Northeast Ohio (NEO), from suburban, urban, and rural settings. The presence of the mecA and PVL genes was determined, and spa typing was performed in order to identify molecular types.ResultsThe prevalence of S aureus was 28.6% (74/259). The prevalence of MRSA and methicillin-susceptible S aureus was 20.1% (52/259) and 8.5% (22/259), respectively. S aureus contamination in suburban, urban, and rural sites was 25.7% (38/148), 45.9% (34/74), and 5.4% (2/37), respectively. MRSA was detected in 16.9% (25/148) of suburban samples and 36.5% (27/74) of urban samples. No MRSA was found in rural samples. Nursing homes from urban areas had a significantly higher (P < .001) prevalence of S aureus compared to nursing homes from suburban and rural sites. Areas with high nurse touch rates were the most commonly contaminated.ConclusionsWe found differences in the prevalence of S aureus and MRSA in nursing homes in different regions of NEO. Part of these differences may result from transfers from hospitals; the urban nursing homes had 4 to 15 hospitals nearby, whereas suburban and rural locations had 1 to 3 hospitals within the area.Graphical Image, graphical abstract
       
  • Influencing duration of antibiotic therapy: A behavior change analysis in
           long-term care
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Bradley J. Langford, Jacquelyn Quirk, Stacie Carey, Nick Daneman, Gary E. GarberBackgroundProlonged antibiotic duration of therapy is common in long-term care (LTC) settings and associated with increased risk of harm for residents. To identify potential antibiotic stewardship opportunities aimed at prolonged duration of therapy, this study examined barriers and enablers to using shorter courses of antibiotic therapy in the LTC setting.MethodsSemistructured interviews were conducted with prescribers in LTC home settings, and a total of 8 LTC clinicians participated in the study. Questions and clinical scenarios explored the factors influencing the decisions of prescribers about duration of therapy. Using the Theoretical Domains Framework, interview data were analyzed deductively.ResultsThe themes identified that influence duration of antibiotic therapy in LTC were environmental context and resources, knowledge, beliefs about consequences, social influences, and behavioral regulation. Specific concerns described by participants included the perceived lack of evidence to support shorter courses in LTC residents, the misconception that shorter courses could lead to greater rates of resistance, and the strong role of habit and prior experience in selecting antibiotic duration.DiscussionThere are several factors affecting antimicrobial duration prescribing behavior aside from the clinical scenario itself. Tackling misconceptions and providing educational support may be helpful approaches.ConclusionsThese findings provide theory-informed evidence to support the development of antimicrobial stewardship interventions aimed at improving duration of antibiotic therapy.
       
  • Transitions and Looking Ahead
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Elaine L. Larson
       
  • Mission critical partnership for infection prevention success
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Karen Hoffmann, Hilary M. Babcock
       
  • Registration for the APIC 47th Annual Conference is now open. Join us in
           Phoenix, Arizona, and be a part of the largest gathering of IPC
           professionals in the world
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s):
       
  • Information for Authors
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s):
       
  • Response to the Letter to the Editor regarding “Methods for microbial
           needleless connector decontamination: A systematic review and
           meta-analysis”
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Julie M. Flynn, Emily Larsen, Samantha Keogh, Amanda Ullman, Claire M. Rickard
       
  • APIC Masthead
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s):
       
  • Instillation of disinfectant behind a temporary obstruction created by an
           inflated urinary catheter balloon improves sink drain disinfection
    • Abstract: Publication date: December 2019Source: American Journal of Infection Control, Volume 47, Issue 12Author(s): Lucas D. Jones, Thriveen S.C. Mana, Jennifer L. Cadnum, Annette L. Jencson, Heba Alhmidi, Sandra Y. Silva, Brigid M. Wilson, Curtis J. Donskey
       
 
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