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Publisher: Elsevier   (Total: 3184 journals)

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Showing 1 - 200 of 3184 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 37, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 100, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 40, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 6)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 433, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 28, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 305, 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: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 25, 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  
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: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 181, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, 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: 29, 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: 11, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, 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: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 33, 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: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, 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: 20, 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: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 12)
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: 43, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 51, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 65, 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: 10, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 7, 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: 24)
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: 36, 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: 12, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 8, 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: 24)
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: 5, 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: 18)
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: 9, 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: 10)
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: 66)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, 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: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 418, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
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: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 53, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 380, 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: 471, 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: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 45, 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: 7, 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: 11)
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: 10, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 54, 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: 63, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 46, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 12)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 37, 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: 36, 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: 247, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, 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: 28, 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: 66, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 24, 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: 5, 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: 207, 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: 217, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 6, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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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  [3184 journals]
  • How clean is clean enough' An observational pilot study to assess
           central sterilization processing efficacy with adenosine triphosphate
           levels
    • Abstract: Publication date: Available online 11 September 2019Source: American Journal of Infection ControlAuthor(s): Lauren N. Fitts, Jeanne Yegge, Ashleigh Goris, Sara Vinson, Erik DubberkeBackgroundThere is strong evidence showing the need for quantitative assessment of the efficacy of cleaning medical devices. Studies comparing visual and microscopic analysis have demonstrated that visual inspection alone is insufficient to determine cleanliness.Our objective was tocollect baseline adenosine triphosphate testing data for surgical instruments to inform future quality improvement programs, and to develop a process to comply with standards recommended by the Association for the Advancement of Medical Instrumentation.MethodsThe central sterilization processing department (CSPD) identified difficult to clean tools in hip, spinal fusion, and colon procedures. Instruments used during the procedures were swabbed at arrival to the CSPD, after manual washing, and after a standard 24-minute machine wash cycle. Each instrument was swabbed in a uniform manner on surface areas including hinged joints and teeth, consistent with manufacturer recommendations. Instruments were tagged to ensure accuracy of tracking.ResultsThe mean relative light unit (RLU) readout of all instruments on entry to the CSPD, postmanual wash, and postmachine wash was 240,416, 3,352, and 47, respectively. A total of 97.7% of all instruments had a passable final RLU readout. One Rongeur had a failed final RLU readout of 171.ConclusionsThis study suggests that the current cleaning process is adequate for the instruments tested. Ongoing quality assessment would be beneficial to validate other instruments.
       
  • High proportion of multidrug-resistant organisms in children hospitalized
           abroad
    • Abstract: Publication date: Available online 10 September 2019Source: American Journal of Infection ControlAuthor(s): Kazuhiro Uda, Takanori Funaki, Kensuke Shoji, Akira Kato, Isao MiyairiOur infection control team initiated active screening for multidrug-resistant organisms (MDROs) among children who had been hospitalized abroad before their admission to our hospital. MDROs were detected in 19 of 34 cases (56%), including 3 isolates of Enterobacteriaceae harboring carbapenemase genes still rare in Japan. Early recognition of MDROs by screening this population may be required to avoid the introduction of new modes of resistance into the hospital environment.
       
  • Sterile field contamination from powered air-purifying respirators (PAPRs)
           versus contamination from surgical masks
    • Abstract: Publication date: Available online 10 September 2019Source: American Journal of Infection ControlAuthor(s): Rex A. Howard, George W. Lathrop, Nathaniel PowellBackgroundCurrently, powered air-purifying respirators (PAPRs) are not recommended for usage in close proximity to sterile fields owing to concerns that exhaled, unfiltered air potentially may cause contamination; however, this has not been confirmed by experimental study.MethodsAfter establishing background levels of airborne contamination, our team placed settling plates in a sterile field and collected contamination from participants who were performing particulate-generating actions. Participants performed the actions while wearing various forms of respiratory protection, including: (1) a full facepiece PAPR, (2) a full facepiece PAPR with a shoulder-length hood, (3) a surgical mask, and (4) no facial covering (as a positive control to determine contamination-reduction effectiveness). Specimens were collected at the end of a 10-minute sampling time frame. After incubation at 36.5˚C for 72 hours, we tabulated colony forming units as a marker of contamination.ResultsSurgical masks and the 2 PAPR configurations all drastically reduced aerosolized droplet contamination. Surgical masks reduced contamination by 98.48%, and both PAPRs reduced contamination by 100% (compared with the usage of no facial covering). There was no statistical difference between their effectiveness (surgical mask vs both PAPRs, P value = .588 and no hood PAPR vs hood PAPR, P value>.999).Discussion/ConclusionsBased on these findings, the tested PAPR configurations are effective at reducing aerosolized droplet contamination into a sterile field, and further testing is warranted to assess other PAPR configurations as well as PAPR suitability in an operating room.
       
  • Assessing burden of central line–associated bloodstream infections
           present on hospital admission
    • Abstract: Publication date: Available online 9 September 2019Source: American Journal of Infection ControlAuthor(s): Hannah Leeman, Sara E. Cosgrove, Deborah Williams, Sara C. KellerFew data exist on the incidence of central line–associated bloodstream infection present on hospital admission (CLABSI-POA), although the practice of patients maintaining central lines outside of hospitals is increasing. We describe patients presenting to an academic medical center with CLABSI-POA over 1 year. Of the 130 admissions, half presented from home infusion (47%), followed by oncology clinic (22%), hemodialysis (14%), and skilled nursing facility (8%). Efforts to reduce CLABSIs should address patients across the entire health care system.
       
  • Front-line education by infection preventionists helps reduce
           Clostridioides difficile infections
    • Abstract: Publication date: Available online 9 September 2019Source: American Journal of Infection ControlAuthor(s): Megan E. Read, Alyssa J. Olson, Michael S. CalderwoodWhen implementing the latest innovations to reduce health care–associated infections, it is important not to overlook basic infection prevention principles such as hand hygiene, isolation precautions, use of personal protective equipment, and cleaning and low-level disinfection. Like many facilities, we implemented a multifaceted approach to reduce hospital-onset Clostridioides difficile infections. In this paper, we share simple tools that we found helpful in improving infection prevention practices by addressing knowledge gaps among staff, visitors, and patients.
       
  • Overview and comparison of Legionella regulations worldwide
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Elisa Van Kenhove, Karla Dinne, Arnold Janssens, Jelle LavergeBackgroundLegionnaires disease occurs worldwide. Many authorities have guidelines and regulations to prevent and control Legionella in water systems. These regulations are based on often very limited field and laboratory observations and measurements. They are, therefore, very different from country to country. This article aims to map the existing regulatory framework of worldwide Legionella control to assess the feasibility of regulatory unification.MethodsThis article gives an overview of the different standards, guidelines, and recommendations as well as how various authorities and/or countries deal with Legionella infection. A 3-step process is followed to identify current regulations.ResultsAlthough Legionella is a global concern with a common scientific base, the regulatory framework is different from country to country. The current guidelines and standards are not the best possible. Despite different regulatory frameworks, there is still broad unification of underlying principles. Common principles across regulations are avoiding and monitoring critical spots, avoiding water stagnation, and maintaining sufficiently high temperature (above 60°C, below 25°C). Differences between regulations are target group and dangerous Legionella concentration levels.ConclusionsThe comparative analysis of the framework is a good starting point for reaching future regulatory unification based on common ground.Graph Image, graphical abstract
       
  • Benchmarking infection control training and practice in Africa: A
           long-term strategy needed now
    • Abstract: Publication date: Available online 5 September 2019Source: American Journal of Infection ControlAuthor(s): Rodgers Rodriguez Ayebare, Faridah Mayanja
       
  • High prevalence of contamination of sink drains with
           carbapenemase-producing Enterobacteriaceae in 4 intensive care units apart
           from any epidemic context
    • Abstract: Publication date: Available online 5 September 2019Source: American Journal of Infection ControlAuthor(s): Carole Lemarié, Clément Legeay, Achille Kouatchet, Rafael Mahieu, Sigismond Lasocki, Pamela Holecska, Laura Onillon, Maxime Corre, Marie Kempf, Matthieu EveillardWe report a high prevalence (28%) of sink drains contaminated with carbapenemase-producing Enterobacteriaceae (CPE) in 4 intensive care units with a history of CPE carriage in hospitalized patients within the previous 5 years, but apart from any current epidemic context. Carbapenemase genes, particularly blaVIM and blaNDM, were identified by polymerase chain reaction in sink drains in which no CPE was detected, but very few data are available in the literature concerning their presence in sink drains.
       
  • 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: Available online 5 September 2019Source: American Journal of Infection ControlAuthor(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
       
  • Response to the Letter to the Editor regarding “Methods for microbial
           needleless connector decontamination: A systematic review and
           meta-analysis”
    • Abstract: Publication date: Available online 3 September 2019Source: American Journal of Infection ControlAuthor(s): Julie M. Flynn, Emily Larsen, Samantha Keogh, Amanda Ullman, Claire M. Rickard
       
  • Efficacy of an ultraviolet-A lighting system for continuous
           decontamination of health care–associated pathogens on surfaces
    • Abstract: Publication date: Available online 3 September 2019Source: American Journal of Infection ControlAuthor(s): Scott H. Livingston, Jennifer L. Cadnum, Kevin J. Benner, Curtis J. DonskeyWe found that ultraviolet-A (UV-A) light exposure resulted in a modest reduction in recovery of methicillin-resistant Staphylococcus aureus (MRSA), Candida auris, bacteriophage MS2, and bacteriophage Phi X174, but not Clostridioides difficile spores, on steel disk carriers. Four hours of UV-A exposure from a ceiling light fixture resulted in a significant reduction in pathogenic microorganisms recovered from in-use medical equipment. These findings suggest that UV-A could be useful as a means to provide continuous low-level decontamination of surfaces in health care facilities.
       
  • Vancomycin-resistant Enterococcus faecium sensitivity to isopropyl alcohol
           before and after implementing alcohol hand rubbing in a hospital
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Consuelo G. Tinajero, Miriam Bobadilla-Del Valle, Jose A. Alvarez, Juan L. Mosqueda, Alfredo Ponce De Leon, Alejandro E. MaciasA recent study reported enterococci that developed alcohol tolerance. We measured minimum inhibitory concentrations (MICs) of isopropyl alcohol against 55 vancomycin-resistant Enterococcus faecium. We did not find an increase in MICs when comparing the periods before and after the use of alcohol for hand hygiene in a hospital, and we did not find a single isolate with a MIC higher than 11.5%. We consider alcohol to still be an effective measure for hand antisepsis.
       
  • Survival of Staphylococcus aureus on therapeutic ultrasound heads
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Henry G. Spratt, David Levine, Susan McDonald, Sarah Drake, Katherine Duke, Casey Kluttz, Kate NoonanTherapeutic ultrasound (US) is commonly used in the rehabilitation of soft tissue injuries including wounds. US heads and coupling gel come into direct contact with patient skin, increasing the risk for health care-associated infections owing to cross contamination. In this study, nearly 80% of Staphylococcus aureus placed on US heads in gel survived for 1 hour, with survival of 3 days possible in other types of organic matter.
       
  • Extended drip infusion of peripheral parental nutrition containing amino
           acids might be associated with Bacillus cereus bloodstream infection
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Arufumi Shiota, Nobuhiro Asai, Yusuke Koizumi, Hiroki Watanabe, Miki Sakata, Ai Kurumiya, Tomoko Takahashi, Yuki Muramatsu, Mao Hagihara, Hiroyuki Suematsu, Yuka Yamagishi, Hiroshige MikamoIn some Japanese hospitals, patients using infusion bags for parenteral nutrition containing amino acids have developed Bacillus cereus bloodstream infections. We considered that proliferation of contaminated B cereus in the bag during prolonged drip infusion might be one of the causes of infection. This study indicated that 8 h is the maximum appropriate drip infusion time for peripheral parental nutrition containing amino acids to prevent B cereus bloodstream infections.
       
  • Outpatient antibiotic prescribing patterns in pediatric academic and
           community practices
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Mayssa Abuali, Andrea Zivot, Sandra Guerguis, Enrique Valladares, Samia Aleem, Francisco Gonzalez-Salazar, Brittany Rouchou, Nicolas Mottola, Leonard Braitman, Andrew PaolettiLittle is known about antibiotic prescribing differences between academic and community outpatient settings. This retrospective, cross-sectional chart review compares compliance with Infectious Diseases Society of America and American Academy of Pediatrics prescribing guidelines for otitis media, sinusitis, and pharyngitis in academic and affiliated community practices. The study results for correct antibiotic prescribing rate in the academic setting (67%) compared with the community setting (21%) demonstrate the urgent need for stewardship in community outpatient clinics.
       
  • Outbreak investigation of Pseudomonas aeruginosa infections in a neonatal
           intensive care unit
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Mark K. Weng, Richard B. Brooks, Janet Glowicz, M. Shannon Keckler, Bryan E. Christensen, Victoria Tsai, Clifford S. Mitchell, Lucy E. Wilson, Ron Laxton, Heather Moulton-Meissner, Ryan FaganA Pseudomonas aeruginosa outbreak was investigated in a neonatal intensive care unit that had experienced a prior similar outbreak. The 8 cases identified included 2 deaths. An investigation found the cause of the outbreak: tap water from contaminated hospital plumbing which was used for humidifier reservoirs, neonatal bathing, and nutritional preparation. Our findings reinforce a recent Centers for Medicare & Medicaid Services memo recommending increased attention to water management to improve awareness, identification, mitigation, and prevention of water-associated, health care–associated infections.
       
  • Frequent and unexpected deviations from personal protective equipment
           guidelines increase contamination risks
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Diane Mulvey, Jeanmarie Mayer, Lindsay Visnovsky, Matthew Samore, Frank DrewsPersonal protective equipment (PPE) training aims to reinforce the Centers for Disease Control and Prevention guidelines for donning and doffing; however, many health care and ancillary personnel use non-guideline methods to don and doff their PPE gowns and gloves. We found that hospital personnel commonly deviated from the guidelines, increasing the likelihood of self-contamination. Furthermore, securing the gown ties inappropriately was an especially common problem that consequently increased doffing missteps.
       
  • Comparative effectiveness of rapid-cycle ultraviolet decontamination to
           chemical decontamination on high-touch communication devices
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Marisol Resendiz, Timothy S. Horseman, Michael B. Lustik, Abu Nahid, Gordon F. WestBackgroundThis quantitative, comparative-descriptive study of inpatient units in a large military medical center was designed to compare the effectiveness of compact ultraviolet (UV-C) decontamination to standard chemical decontamination in reducing the microbial burden on Vocera (San Jose, CA) communication devices and to characterize changes in staff cleaning practices following UV-C device implementation.MethodsAerobic and anaerobic swabs were used to collect microbial samples from Vocera devices (n = 60) before and after chemical decontamination (first sampling) and before and after UV decontamination (second sampling). Cleaning behaviors were assessed by observation and oral inquiry during the baseline sampling and surveyed 8 weeks after UV-C device implementation. Outcomes included aerobic and anaerobic colony-forming units and prevalence of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, or Clostridium difficile, as determined by standard microbiological methods.ResultsNo differences were found between the two cleaning methods in their ability to reduce aerobic bacteria; however, UV-C was significantly more effective at reducing bacteria grown anaerobically (P < .01). This study elucidated an 8.3% prevalence of methicillin-resistant Staphylococcus aureus on Vocera devices in the inpatient environment. Initially, 42% of respondents reported deviations from manufacturer's cleaning guidelines, and 16.7% reported daily or more frequent cleaning of the Vocera devices.ConclusionsAfter implementation, UV-C decontamination reduced average cleaning time by 43% and increased the rate of daily Vocera cleaning to 86.5%. Respondents reported an overall 98% user satisfaction with the UV-C device.
       
  • A demonstration project on the impact of safety culture on infection
           control practices in hemodialysis
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Tara Millson, Diana Hackbarth, Heather L. BernardBackgroundInfections among hemodialysis patients continues to be major causes of morbidity and mortality despite advances in the science of infection prevention. Many infections are potentially preventable, yet research suggests that evidence-based interventions are not uniformly practiced in dialysis settings. The purpose of the project was to reduce the risk of infection among hemodialysis patients in an outpatient dialysis clinic in upstate New York through the development of an enhanced patient safety culture.MethodsA survey was used to assess the safety culture of a large outpatient dialysis program. A Comprehensive Unit-based Safety Program was instituted to enhance infection prevention practices. Evidence-based checklists and audit tools were used to track staff adherence to protocols.ResultsScores on the survey were strongly correlated with bloodstream infection rates. Adherence to infection control standards improved when the End Stage Renal Disease Safety Program was implemented, with audits improving from 27%-82% of procedures performed correctly. Bloodstream infection rates decreased from 2.33-1.07 events per 100 patient months, and the standardized infection ratios decreased from 1.960-0.985 in the 12-months after implementation.ConclusionsThe Comprehensive Unit-based Safety Program model and implementation of the safety program may be effective in improving the culture of safety and adherence to evidence-based practices in hemodialysis. Enhanced patient safety culture is correlated with improved patient outcomes.
       
  • Infection free midline catheter implementation at a community hospital (2
           years)
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Michelle DeVries, Janice Lee, Lisa HoffmanBackgroundTo reduce excess central line use and provide an option for difficult venous access patients through the introduction of a midline catheter.MethodsDesign included prospective monitoring of the implementation of a quality improvement project. The setting was a 576 bed, urban, community, nonprofit, Magnet recognized, level 3 trauma center serving primarily adult patients. Midline and peripherally inserted central catheters were inserted by a specialty nursing team; care and maintenance of all devices were provided by front line staff.ResultsZero midline catheter infections were observed in the 24 months after implementation of the fixed length, power injectable device. Completion of therapy was 80%, the most frequently encountered complication was device dislodgement.ConclusionsAdoption of a vascular access nurse led midline catheter program, coupled with device selection algorithms expanded the ability to select the right device for the patient, while decreasing excess central line usage without additional increased risks to the patient.
       
  • Effect of surgical safety checklist on colorectal surgical site infection
           rates in 2 countries: Brazil and Canada
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Camila Sarmento Gama, Chantal Backman, Adriana Cristina de OliveiraBackgroundThe effectiveness of the surgical safety checklist (SSC) in countries with different socioeconomic backgrounds is uncertain. To evaluate the effect of the SSC in 2 different socioeconomic settings, we compared surgical site infection (SSI) rates before and after its implementation in colorectal procedures.MethodsAn epidemiological retrospective study was conducted in the university hospitals in Ottawa, Canada, and Belo Horizonte, Brazil. Data were collected through chart review from the period before and after the SSC implementation.ResultsThe SSI rate decreased from 27.7%-25.9% (P = .625) and from 17.0%-14.4% in Canada and Brazil, respectively (P = .448) after the SSC implementation. In Canada, there was no SSI in incomplete SSC, and in Brazil, SSI was 20.0% (P = .026).DiscussionDespite high and regular completion of the SSC in the Canadian and Brazilian hospitals, respectively, there was no significant reduction of SSI after the SSC implementation in any setting. However, in Brazil, the association between incomplete SSC and higher SSI rates demonstrated the potential impact of the SSC in developing countries.ConclusionsThe effect of the SSC on SSI may be greater in developing countries due to minor investment and consolidation of policies in SSI prevention.
       
  • Pitfalls and Unexpected Benefits of an Electronic Hand Hygiene Monitoring
           System
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Abigail Benudis, Samuel Stone, Afrah S Sait, Ian Mahoney, Lori Lyn Price, Alejandro Moreno-Koehler, Eric Anketell, Shira DoronBackgroundNo single strategy is more effective than proper hand hygiene (HH) in reducing the spread of nosocomial infections. Unfortunately, health care worker compliance with HH is imperfect. We sought to improve HH compliance using an electronic hand hygiene monitoring system (EHHMS) in 2 units to collect unbiased data and provide feedback.MethodsIn this prospective, quasi-experimental study, the Hyginex EHHMS was installed in 2 units at Tufts Medical Center. Ninety-one bracelets were assigned, and electronic data were collected over 8 months. Human observations continued. We compared HH compliance as measured by human observation before, during, and after EHHMS implementation. Pre- and post-implementation surveys were distributed to staff.ResultsThe number of electronically captured HH compliance observations was small due to infrequent bracelet use after month 2 of the intervention. HH compliance, as determined by human observation, increased by an average of 1.3 percentage points per month (P = .0005). Survey responses revealed negative attitudes about the EHHMS before and after its implementation.ConclusionsDespite poor EHHMS participation and negative attitudes toward its implementation, HH compliance, as measured by human observation, significantly improved. Hospitals considering implementing an EHHMS should look to refine the intervention to encourage health care worker participation.
       
  • Cystic fibrosis program characteristics associated with adoption of 2013
           infection prevention and control recommendations
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): William Stoudemire, Xiaotong Jiang, Juyan J. Zhou, Philip Maykowski, Michael R. Kosorok, Marianne S. Muhlebach, Lisa SaimanBackgroundThe Cystic Fibrosis (CF) Foundation disseminated an updated guideline for infection prevention and control (IP&C) practices for CF care programs in 2013. Assessing adoption rates of IP&C recommendations is crucial to evaluate their impact.MethodsCF care programs provided their written IP&C policies for CF. Policies were analyzed to determine adoption of selected recommendations new in 2013, as well as recommendations made in both 2003 and 2013. Weighted adoption scores were analyzed for association with program characteristics.ResultsThe median number of new recommendations adopted by each program was 7 (mean 6.3, range 0-9). The most commonly adopted new recommendations were universal mask use by patients in both inpatient and outpatient settings (85% and 87%, respectively) and contact precautions for CF patients in inpatient and outpatient settings (90% for both). The least frequently adopted new recommendations were the “6-foot rule” in inpatient settings (n = 66, 53%) and auditing disinfection of surfaces in clinic (n = 64, 49%). Larger program size was associated with a higher weighted adoption score (odds ratio [OR] 1.9, P =.02).ConclusionsWhereas most programs adopted more than one-half of the selected IP&C recommendations assessed, adoption was variable. Efforts to improve adoption of IP&C recommendations should focus on smaller programs with fewer resources.
       
  • Endoscope reprocessing: Comparison of drying effectiveness and microbial
           levels with an automated drying and storage cabinet with forced filtered
           air and a standard storage cabinet
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Ryan B. Perumpail, Neil B. Marya, Betty L. McGinty, V. Raman MuthusamyBackgroundAutomated drying may help prevent endoscopically transmitted infections. We aimed to assess the efficacy of an automated drying and storage cabinet compared to a standard storage cabinet in achieving endoscope dryness postreprocessing and in reducing the risk of microbial growth.MethodsDrying times of bronchoscopes, colonoscopes, and duodenoscopes using 2 drying platforms (an automated drying and storage cabinet vs a standard storage cabinet) were measured using cobalt chloride paper. Drying assessments occurred at: 30 minutes, 1 hour, 2 hours, 3 hours, and 24 hours. A simple linear regression analysis compared rates of microbial growth after inoculation with Pseudomonas aeruginosa following high-level disinfection at: 0, 3 hours, 12 hours, 24 hours, and 48 hours.ResultsUsing the automated drying and storage cabinet, internal channels were dry at 1 hour and external surfaces at 3 hours in all endoscopes. With the standard storage cabinet, there was residual internal fluid at 24 hours, whereas external surfaces were dry at 24 hours. For bronchoscopes, colonoscopes, and duodenoscopes, the standard cabinet allowed for an average rate of colony forming unit growth of 8.1 × 106 per hour, 8.3 × 106 per hour, and 7.0 × 107 per hour, respectively; the automated cabinet resulted in colony forming unit growth at an average rate of –28.4 per hour (P = .02), –38.5 per hour (P = .01), and –200.2 per hour (P = .02), respectively.ConclusionsAn automated cabinet is advantageous for rapid drying of endoscope surfaces and in reducing the risk of microbial growth postreprocessing.
       
  • Antipseudomonal monotherapy or combination therapy for older adults with
           community-onset pneumonia and multidrug-resistant risk factors: a
           retrospective cohort study
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Obiageri O. Obodozie-Ofoegbu, Chengwen Teng, Eric M. Mortensen, Christopher R. FreiBackgroundInfectious Diseases Society of America guidelines recommend empiric antipseudomonal combination therapy when Pseudomonas is suspected. However, combination antipseudomonal therapy is controversial. This study compares all-cause 30-day mortality in older patients who received antipseudomonal monotherapy (PMT) or antipseudomonal combination therapy (PCT) for the treatment of community-onset pneumonia.MethodsThis population-based, retrospective cohort study used data from over 150 Veterans Health Administration hospitals. Patients were classified as being at low, medium, or high risk of drug-resistant pathogens. In total, 31,027 patients were assigned to PCT or PMT treatment arms based on antibiotics received in the first 48 hours of hospital admission.ResultsThe unadjusted 30-day mortality difference between PCT and PMT was most pronounced in the low-risk group (18% vs 8%), followed by the medium-risk group (24% vs 18%) and then the high-risk group (39% vs 33%). PCT was associated with higher 30-day mortality than PMT overall (adjusted odds ratio [aOR], 1.54; 95% confidence interval [CI], 1.43-1.66) in all 3 risk groups: low (aOR, 1.69; 95% CI, 1.50-1.89), medium (aOR, 1.30; 95% CI, 1.14-1.48), and high (aOR, 1.21; 95% CI, 1.04-1.40).ConclusionsOlder adults who received combination antipseudomonal therapy for community-onset pneumonia fared worse than those who received monotherapy. Empiric combination antipseudomonal therapy should not be routinely offered to all patients suspected of having pseudomonal pneumonia.
       
  • Preliminary analysis of the antimicrobial activity of a postoperative
           wound dressing containing chlorhexidine gluconate against
           methicillin-resistant Staphylococcus aureus in an in vivo porcine
           incisional wound model
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Thriveen Sankar Chittoor Mana, Curtis Donskey, Neal Carty, Larry Perry, David Leaper, Charles E. EdmistonBackgroundSurgical site infection is a major postoperative complication after surgical procedures. The effectiveness of postoperative antimicrobial dressings in reducing surgical site infections is unclear and limited information is available on the efficacy of chlorhexidine gluconate (CHG)-impregnated postoperative dressings.MethodsA pilot study was conducted to examine the efficacy of an innovative CHG-impregnated postoperative dressing in reducing the burden of methicillin-resistant Staphylococcus aureus (MRSA) in an in vivo porcine, incisional-wound model. Sutured incisional wounds were contaminated with MRSA and then covered with a CHG wound dressing, a placebo control, or a nonantimicrobial gauze. The surviving MRSA population was quantitatively cultured 3 days postprocedure.ResultsMRSA was not recovered from any of the 8 wounds that were treated with the CHG dressing (limit of detection, approximately 1.7 log10 colony-forming units [cfu]/g tissue). In contrast, the average microbial recovery from wounds treated with the placebo dressing was 4.2 log10 cfu/g and the average microbial recovery from wounds treated with the gauze dressing was 3.2 log10 cfu/g.ConclusionsAn innovative CHG dressing provided significant antimicrobial activity against MRSA contaminating a surgical wound in a porcine, incisional-wound model. Future clinical studies are needed to assess the efficacy of the CHG dressing to reduce the bacterial burden in postoperative wounds of surgical patients.
       
  • Attributable mortality from extensively drug-resistant gram-negative
           infections using propensity-matched tracer antibiotic algorithms
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s): Sameer S. Kadri, Jeffrey R. Strich, Bruce J. Swihart, Samuel Hohmann, John P. Dekker, Tara Palmore, Stephanie Bonne, Bradley Freeman, Jillian Raybould, Nirav G. Shah, Devang Patel, Jennifer Husson, Mitchell D. Jacobs, Lan Duong, Dean Follmann, David C. Hooper, Joseph Timpone, Robert L. DannerBackgroundTracer antibiotic algorithms using administrative data were investigated to estimate mortality attributable to extensively drug-resistant gram-negative infections (GNIs).MethodsAmong adult inpatients coded for GNIs, colistin cases and 2 comparator cohorts (non-carbapenem β-lactams or carbapenems) treated for ≥4 consecutive days, or died while receiving the antibiotic, were separately propensity score-matched (1:2). Attributable mortality was the in-hospital mortality difference among propensity-matched groups. Infection characteristics and sepsis severity influences on attributable mortality were examined. Algorithm accuracy was assessed by chart review.ResultsOf 232,834 GNIs between 2010 and 2013 at 79 hospitals, 1,023 per 3,350 (30.5%) colistin and 9,188 per 105,641 (8.7%) β-lactam (non-carbapenem) comparator cases died. Propensity-matched colistin and β-lactam case mortality was 29.2% and 16.6%, respectively, for an attributable mortality of 12.6% (95% confidence interval 10.8-14.4%). Attributable mortality varied from 11.0% (7.5%-14.7%) for urinary to 15.5% (12.6%-18.4%) for respiratory (P < .0001), and 4.6% (2.1%-7.4%) for early (≤4 days) to 16.6% (14.3%-18.9%) for late-onset infections (P < .0001). Attributable mortality decreased to 7.5% (5.6%-9.4%) using a carbapenem comparator cohort but increased 9-fold in patients coded for severe sepsis or septic shock (P < .0001). Our colistin algorithm had a positive predictive value of 60.4% and sensitivity of 65.3%.ConclusionsMortality attributable to treatment-limiting resistance during GNIs varied considerably by site, onset, and severity of infection.
       
  • APIC Awards: Recognition for Those Advancing Infection Prevention
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s):
       
  • Information for Authors
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s):
       
  • Information for Readers
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s):
       
  • APIC Masthead
    • Abstract: Publication date: September 2019Source: American Journal of Infection Control, Volume 47, Issue 9Author(s):
       
  • Addressing the threat from within: Investigation of respiratory symptoms
           in a health care worker with untreated latent tuberculosis infection
    • Abstract: Publication date: Available online 20 August 2019Source: American Journal of Infection ControlAuthor(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.
       
  • Efficacy of a novel ultraviolet light-emitting diode device for
           decontamination of shared pens in a health care setting
    • Abstract: Publication date: Available online 20 August 2019Source: American Journal of Infection ControlAuthor(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.
       
  • A scoping review to assess the impact of public education campaigns to
           affect behavior change pertaining to antimicrobial resistance
    • Abstract: Publication date: Available online 20 August 2019Source: American Journal of Infection ControlAuthor(s): Hayley Fletcher-Miles, John Gammon, Sharon Williams, Julian HuntBackgroundYears of global antibiotic misuse has led to the progression of antimicrobial resistance (AMR), posing a direct threat to public health. To impact AMR and maintain antimicrobial viability, educational interventions toward fostering positive AMR behavior change have been employed with some success.MethodsThis scoping review sought to identify research-supporting use of public educational AMR campaigns, and their efficacy toward informing positive AMR behaviors to inform current debate. To enable credible and reflexive examination of a wide variety of literature, Arksey and O'Malley's (2005) methodological framework was used.ResultsThree primary themes were identified: (1) behavior change and theoretical underpinnings, (2) intervention paradigm, and (3) educational engagement. From 94 abstracts identified, 31 articles were chosen for review. More attention is required to identify elements of intervention design that inform and sustain behavior change, and the impact of how an intervention is delivered and targeted is needed to limit assumptions of population homogeneity, which potentially limits intervention efficacy. Moreover, research on the impact of hospital-based inpatient interventions is needed.ConclusionsThe existing body of research fails to provide robust evidence to support sound evidential interventions supported by theoretical justifications. Furthermore, interventions to ensure long-term sustained behavior change are unclear and not addressed.
       
  • ‘‘Methods for microbial needleless connector decontamination: A
           
    • Abstract: Publication date: Available online 17 August 2019Source: American Journal of Infection ControlAuthor(s): Ludwig Serge Aho Glélé, Adrien Guilloteau, Karine Astruc, Yolene Carre, Pascal Chaize, Olivia Keita-Perse, Yves Lurton, Didier Lepelletier
       
  • Instillation of disinfectant behind a temporary obstruction created by an
           inflated urinary catheter balloon improves sink drain disinfection
    • Abstract: Publication date: Available online 8 August 2019Source: American Journal of Infection ControlAuthor(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
       
  • You get back what you give: Decreased hospital infections with improvement
           in CHG bathing, a mathematical modeling and cost analysis
    • Abstract: Publication date: Available online 7 August 2019Source: American Journal of Infection ControlAuthor(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.
       
  • Tales from the auditors: What we learned from endoscope auditing
    • Abstract: Publication date: Available online 2 August 2019Source: American Journal of Infection ControlAuthor(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.
       
  • Risk factors for Staphylococcus aureus colonization in a
           presurgical orthopedic population
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Suzanne E. Kent, Gary B Schneider, Brian L. Hollenbeck, Steven C. VladBackgroundPreoperative colonization with Staphylococcus aureus (SA) increases risk of surgical site infection. Screening for SA followed by skin and nasal decolonization can help to reduce the risk of postoperative infections. Risk factors for colonization are, however, not completely understood.MethodsA case-control study using questionnaires and patient demographics specifically designed to observe SA colonization risk factors in a presurgical orthopedic population. A total of 115 subjects with a positive preoperative screen for SA nasal colonization prior to orthopedic surgery completed a questionnaire to assess for SA risk factors: these subjects served as our cases. An additional 476 controls completed similar questionnaires. Data collected included demographic, health, and lifestyle information. Multivariable logistic regression was used to generate odds ratios (OR) for risk of SA colonization.ResultsSeveral risk factors were identified. Male sex (OR 2.3; 95% confidence interval [CI], [1.4-3.8]) and diabetes (OR 3.8 [1.8-7.8]) significantly increased the risk of SA colonization. Older age, visiting public places (OR 0.2 [0.1-0.3]), recent antibiotic use (OR 0.2 [0.1-0.6]), and the presence of facial hair (OR 0.3 [0.1-0.6]) significantly lowered the risk of SA colonization.ConclusionsBy identifying patients who may be at greater risk of SA colonization, we can better streamline our presurgical techniques to help reduce risk of surgical site infections and improve patient outcomes.
       
  • Effect of carbapenem restriction on prescribing trends for
           immunocompromised wards at an academic medical center
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Andrew Kirk, Jacob Pierce, Michelle Doll, Kimberly Lee, Amy Pakyz, Jihye Kim, Daniel Markley, Oveimar De la Cruz, Gonzalo Bearman, Michael P. StevensThe recently described proportion of carbapenem consumption metric was used to assess the effectiveness of formulary restriction for carbapenems for 2 units housing predominantly immunocompromised patients at a large academic medical center. Interrupted time series analysis revealed a significant decrease in meropenem use for hematology-oncology and bone marrow transplant units after restriction.
       
  • Impact of a novel mobile high-efficiency particulate air–ultraviolet air
           recirculation system on the bacterial air burden during routine care
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Werner Bischoff, Gregory Russell, Elisabeth Willard, John StehleAerosol transmission of pathogens can result in the rapid spread of disease. Introduction of a mobile air recirculation system based on high-efficiency particulate air filtration, photochemical oxidation, and germicidal ultraviolet light significantly decreased the bacterial load by over 40% under routine care in an emergency department. Application of this new technology promises to reduce the aerosol pathogen burden, thereby decreasing exposure risk and providing a safer environment for patient care.
       
  • Switching from expectorated to induced sputum cultures for tuberculosis
           diagnosis reduces cost without increasing risk
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Qasim A. Mohiuddin, Leighanne Parkes, Michael GardamActive pulmonary tuberculosis testing with 3 expectorated sputa can increase isolation days and expenditures compared with 1 induced sputum. Six-month retrospective and prospective chart reviews were conducted, and a screening algorithm was phased into 2 hospital sites. With induced sputum testing, isolation decreased from 7 to 4 days (interquartile range, 4-3, P = .0135), and there was a cost savings of $7,275 per case, with no added harm.
       
  • Determining the organic matter burden of exercise-tracking devices using
           adenosine triphosphate surveillance
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Morgan B. Vorwald, Lisa C. LetzkusThe aim of this project is to determine the amount of organic matter burden focused on exercise-tracking devices worn by heath care professionals in the clinical setting. It was completed by using adenosine triphosphate surveillance, which measures the residual organic matter that remains on a device. Because all but 1 of the devices sampled were considered contaminated, health care professionals should be aware of the potential risk associated with wearing exercise-tracking devices in the clinical setting.
       
  • Hand hygiene and needleless connector decontamination for peripheral
           intravenous catheter care—time and motion observational study
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Karen Slater, Marie Cooke, Emma Scanlan, Claire M. RickardGood hand hygiene and “scrub the hub” practices are important to prevent bloodstream infections. This observational study (n = 108) found high compliance with “scrubbing the hub,” although scrub time was shorter than the recommended duration (average 6.1 seconds). Compliance with hand hygiene before medication preparation (33%) and before medication administration (43%) showed room for improvement compared with postadministration (65%), the emergency setting and glove use were associated with poorer compliance (P < .01).
       
  • The impact of chlorhexidine gluconate on the skin microbiota of children
           and adults: A pilot study
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Ashley E. Kates, Michele L. Zimbric, Kaitlin Mitchell, Joseph Skarlupka, Nasia SafdarWe examined the effect of chlorhexidine gluconate (CHG) bathing on the skin microbiota of adult and pediatric patients. We observed no differences in pediatric patients; however, multiple genera of bacteria were observed to be significantly less abundant in the adults bathing with CHG. Further research is needed to determine the long-term impact of CHG use on the skin microbiota.
       
  • Seasonal differences in central line–associated bloodstream infection
           incidence rates in a Central European setting: Results from prospective
           surveillance
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Peter W. Schreiber, Mesida Dunic, Aline Wolfensberger, Lauren Clack, Christian Falk, Hugo Sax, Stefan P. KusterUsing prospectively collected surveillance data at a tertiary care hospital in Central Europe, we investigated seasonal differences in central line–associated bloodstream infection incidence. Central line–associated bloodstream infection incidence rates were highest during the third quarter over an observation period of 24 months. Investigating influence of meteorological parameters identified a significant correlation with precipitation (r = 0.460, P = .023).
       
  • Simplifying Disinfectant Choices to Improve Safety in Contact Precaution
           Rooms
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Daniel Goldish, Stephanie Hendrick, Max Hurwitz, Daniel Sisk, Darren LeeBoth quaternary ammonium and bleach-based cleaning products are effective in reducing the transmission of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in hospitals, but bleach-based compounds demonstrate better control of Clostridium difficile infections. Our pilot study demonstrates the potential to reduce C. difficile transmission in an acute care hospital by eliminating the need for providers to choose the appropriate cleaning product from isolation precaution carts.
       
  • Assessing the Feasibility of a Focused Multivector Ultraviolet System
           Between Surgery Cases with a Parallel Protocol for Enhanced Disinfection
           Capabilities
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Donna Armellino, Thomas J. Walsh, Vidmantas Petraitis, Wladyslaw KowalskiA focused multivector ultraviolet (FMUV) light system was used in a parallel process with manual chemical disinfection during operating room (OR) turnovers to assess the impact on cleaning time. The average time to disinfect an OR using only chemical wipes and mops was 19.0 minutes (n = 68); for the FMUV process, the average time was 18.8 minutes (n = 61). The mean cleaning times were equivalent within a 7% margin (P < .17), and total turnover time was not significantly affected.
       
  • Clinical practice guidelines for creating an acute care hospital-based
           antimicrobial stewardship program: A systematic review
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Elissa Rennert-May, Derek S. Chew, John Conly, Micheal Guirguis, Jeremy Slobodan, Susan Fryters, Lauren BreseeBackgroundAntimicrobial stewardship programs (ASPs) are dedicated to improving antimicrobial use. Although clinical practice guidelines (CPGs) are available for the development of ASPs, it is unclear what the quality of these guidelines are. We therefore systematically reviewed published CPGs for the development of acute care hospital-based ASPs.MethodsPrimary literature, CPG and health technology assessment databases, and infectious diseases society websites were searched. Abstract and full-text review of the search results for inclusion were performed independently by 2 assessors. Overall quality of included CPGs was assessed using the Appraisal of Guidelines for Research and Evaluation II instrument.ResultsWe identified 1,064 unique publications; 18 warranted full-text review. Five publications were included in the final review. The National Institute for Care and Excellence from the United Kingdom, the Dutch Working Party on Antibiotic Policy, and the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America from the United States all had high quality guidelines on the Appraisal of Guidelines for Research and Evaluation II scale.DiscussionWe identified 5 CPGs for creating a hospital-based ASP. Prior authorization and/or restriction policies that appeared in all 5 guidelines should be considered essential for the development of an effective hospital-based ASP.ConclusionsHigh quality CPGs are available for implementation of ASPs in acute care hospitals.
       
  • Health care–associated infection surveillance system in Iran:
           Reporting and accuracy
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Arash Seifi, Nahid Dehghan-Nayeri, Leili Rostamnia, Shokoh Varaei, Ali Akbari Sari, Hamid Haghani, Vahid GhanbariBackgroundValid data are a crucial aspect of infection prevention and control programs. The aim of this study was to examine the accuracy of routine reporting in the Iranian Nosocomial Infection Surveillance System in intensive care units.MethodsA blinded retrospective review of general intensive care unit medical records was performed with a standard case-finding form. Infection control nurses (ICNs) were also interviewed to explore possible reasons for differences.ResultsThe results of 951 events in 856 medical records were assessed. Sensitivity, specificity, and positive and negative predictive values of routine surveillance were 27.5%, 97.2%, 69%, and 85.3%, respectively. The results indicate 82.2%, 68.4%, 62.7%, and 57.3% under-reporting of surgical site infections, urinary tract infections, bloodstream infections, and pneumonia, respectively. Over-reporting of approximately 8%-15% was detected in 4 types of health care–associated infections (HAIs). Misinterpretation of HAI definition, high ICN workload, and inactivity of infection control link nurses were the main causes of inaccurate reporting.ConclusionsUnder and over-reporting of HAIs are main challenges of HAIs reporting in Iran. Developing guidelines, empowering ICNs through specialized training and activating infection control link nurses are necessary to achieve more accurate data in the Iranian Nosocomial Infection Surveillance System.
       
  • Modified glove use for contact precautions: Health care workers’
           perceptions and acceptance
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Susan Jain, Kate Clezy, Mary-Louise McLawsBackgroundPatients colonized or infected with methicillin-resistant Staphylococcus aureus and or vancomycin-resistant Enterococcus are placed under contact precautions. Contact precautions require patients to be placed in single rooms and their health care workers (HCWs) to wear gowns, aprons and gloves on entry and doffing on exit. Glove use is widely accepted to be associated with poor hand hygiene compliance. We trailed the removal of gloves for contact precautions for contacts not expected to involve body fluids to improve hand hygiene between multiple contacts of the patient and patient zone.MethodsWe have conducted a 5 phase study of the removal of gloves for contacts without body fluids in 250 HCWs using pretrial focus groups (N = 12), hand microbiology (N = 40) (reported elsewhere), development of a modified contact precautions poster, trial of modified poster (n = 100), posttrial focus group discussion (n = 22), and a survey of HCWs postrollout in additional locations (n = 76).ResultsPretrial focus groups identified 4 themes, and the leading theme identified as the facilitator for glove use as self-protection. HCWs viewed current contact precaution guidelines as preventing them from making their own judgement regarding the need for gloving for patient contacts, leading continuous glove use without changing gloves between multiple contacts.Participants believed that the trial empowered them to make their own clinical judgment for gloves and to consciously use hand hygiene between dry (no body fluid) contacts.Four themes were discussed during the posttrial focus groups and although self-protection remained the central theme, hand hygiene replaced glove use. Participants spoke of an appreciation of and increased trust in hand hygiene during nonglove use for dry contacts.The survey responses from additional sites were mostly positive for the safety of nonglove use for dry contacts, it improved hand hygiene and that the adoption of the modified guidelines was empowering.ConclusionsThe trial of nonglove use for expected dry contact, while caring for patients under contact precautions for methicillin-resistant S aureus and or vancomycin-resistant Enterococcus, was successful in refocusing HCWs reliance on hand hygiene for self-protection. Mandatory glove use for contact precautions was believed to contribute to their failure to change gloves between procedures on the same patient and patient zone, with HCWs now recognizing multiple contacts with the same gloves as a risk for contamination.
       
  • Health care worker sensitivity to chlorhexidine-based hand hygiene
           solutions: A cross-sectional survey
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Sara Barnes, Rhonda Stuart, Bernice RedleyBackgroundHealth service hand hygiene programs have seen widespread use of chlorhexidine solutions. Reports of both immediate and delayed hypersensitivity to chlorhexidine are increasing among health care workers. This study examined the prevalence of self-reported symptoms of sensitivity to chlorhexidine solutions among health care workers.MethodsThis study was a cross-sectional online anonymous survey of all workers at a single health service.ResultsOf the 1,050 completed responses, 76.3% were female, 35.3% were nurses and midwives, 28% were medical staff, and 8.7% were working in nonclinical areas. Over 95% used chlorhexidine-based hand hygiene products in their workplace. Nurses and midwives most frequently reported asthma (13.7%), contact dermatitis (27.8%), and previous testing for allergy to chlorhexidine (4.9%). There was a correlation between both the presence of atopy, eczema, or dermatitis and the self-reporting of dry skin, eczema, or dermatitis attributed to chlorhexidine use.DiscussionOccupational chlorhexidine allergy is an important risk to health care workers. Self-reported symptoms of sensitivity to chlorhexidine solutions revealed high reported use and presence of skin symptoms among health care workers.ConclusionsScreening programs need to identify nurses who develop chlorhexidine sensitivity due to occupational exposure. Strategies to mitigate risk should provide alternatives for those with sensitization.
       
  • Demonstrating the persistent antibacterial efficacy of a hand sanitizer
           containing benzalkonium chloride on human skin at 1, 2, and 4 hours after
           application
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Sidney W. Bondurant, Collette M. Duley, John W. HarbellBackgroundUse of hand sanitizers has become a cornerstone in clinical practice for the prevention of disease transmission between practitioners and patients. Traditionally, these preparations have relied on ethanol (60%-70%) for bactericidal action.MethodsThis study was conducted to measure the persistence of antibacterial activity of 2 preparations. One was a non-alcohol-based formulation using benzalkonium chloride (BK) (0.12%) and the other was an ethanol-based formulation (63%) (comparator product). The persistence of antibacterial activity was measured against Staphylococcus aureus using a technique modification prescribed in American Society for Testing and Materials protocol E2752-10 at up to 4 hours after application.ResultsThe test product (BK) produced a marked reduction in colony-forming units at each of the 3 time points tested (3.75-4.16-log10 reductions), whereas the comparator produced less than 1-log10 reduction over the same time. The differences were highly significant.DiscussionIn the course of patient care or examination, there are instances where opportunities exist for the practitioner's hands to become contaminated (eg, key boards and tables). Persistent antibacterial activity would reduce the chances of transfer to the patient.ConclusionsThese results show a major improvement in persistent antibacterial activity for the BK formulation compared to the comparator ethanol-based formulation.
       
  • High 30-day readmission rates associated with
           Clostridiumdifficile infection
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Elijah Verheyen, Vijay Dalapathi, Shilpkumar Arora, Kalpesh Patel, Pavan Kumar Mankal, Varun Kumar, Edward Lung, Donald P. Kotler, Ari GrinspanBackgroundClostridium difficile infection (CDI) is a leading cause of community-onset and healthcare–associated infection, with high recurrence rates, and associated high morbidity and mortality. We report national rates, leading causes, and predictors of hospital readmission for CDI.MethodsRetrospective study of data from the 2013 Nationwide Readmissions Database of patients with a primary diagnosis of CDI and re-hospitalization within 30-days. A multivariate regression model was used to identify predictors of readmission.ResultsOf 38,409 patients admitted with a primary diagnosis of CDI, 21% were readmitted within 30-days, and 27% of those patients were readmitted with a primary diagnosis of CDI. Infections accounted for 47% of all readmissions. Female sex, anemia/coagulation defects, renal failure/electrolyte abnormalities and discharge to home (versus facility) were 12%, 13%, 15%, 36%, respectively, more likely to be readmitted with CDI.ConclusionsWe found that 1-in-5 patients hospitalized with CDI were readmitted to the hospital within 30-days. Infection comprised nearly half of these readmissions, with CDI being the most common etiology. Predictors of readmission with CDI include female sex, history of renal failure/electrolyte imbalances, anemia/coagulation defects, and being discharged home. CDI is associated with a high readmission risk, with evidence of several predictive risks for readmission.
       
  • Colonization by fecal extended-spectrum β-lactamase-producing
           Enterobacteriaceae and surgical site infections in patients with cancer
           undergoing gastrointestinal and gynecologic surgery
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): María Fernanda Golzarri, Jesús Silva-Sánchez, Patricia Cornejo-Juárez, Humberto Barrios-Camacho, Luis David Chora-Hernández, Consuelo Velázquez-Acosta, Diana Vilar-CompteBackgroundCancer patients are at increased risk of infection. Fecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) may increase this risk. There are few studies on the prevalence of ESBL-PE colonization and surgical site infections (SSIs).MethodsThis prospective cohort study included patients with gastrointestinal and gynecological malignancies who were admitted to the hospital for elective surgery. Rectal swab cultures were obtained on the day of admission and during the postoperative period every 5 days. Prevalence of ESBL-PE fecal colonization and risk factors for the development of SSI were assessed.ResultsWe included 171 patients, 30 (17.5%) of whom were colonized with ESBL-PE at admission. This proportion increased to 21% (37 of 171) of the samples during the hospital stay. Incidence of SSI was 14.6% (n = 25). Ten of 37 (27%) patients colonized by ESBL-PE developed SSI versus 15 of 134 (11%) of the non-ESBL-PE (relative risk [RR], 2.163; 95% confidence interval [CI], 1.201-3.897; P = .016). Five patients developed a bloodstream infection, and 4 patients were colonized with ESBL-PE (RR = 4.02; 95% CI, 1.2-3.89; P = .008).ConclusionsThe rate of ESBL-PE fecal colonization in surgical patients was 17.5%. Colonization of ESBL-PE duplicated the risk of SSI by the same strain and, by a factor of 4, the risk of bloodstream infections.
       
  • Optimizing treatment of respiratory tract infections in nursing homes:
           Nurse-initiated polymerase chain reaction testing
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Leslie Dowson, Caroline Marshall, Kirsty Buising, N. Deborah Friedman, David C.M. Kong, Rhonda L. StuartBackgroundDiagnostic testing using polymerase chain reaction (PCR) is infrequently initiated for diagnosis of respiratory tract infections (RTIs) in nursing homes. The objectives of this study were to determine the feasibility of implementing nurse-initiated PCR testing of respiratory specimens in nursing home settings and to compare antibiotic prescribing prior to and during the implementation.MethodsThis was a pragmatic, historically controlled study in 3 nursing homes (181 total beds) in Melbourne, Australia.ResultsThe number of PCR tests of respiratory specimens (over 12 months) increased from 5 to 67 when nurses could initiate the tests. Residents with RTI symptoms had a virus identified by PCR in 50.7% of tests, including 14 positive for influenza. Six outbreaks were identified. When clustering was taken into consideration, incidence rates of antibiotic days of therapy did not change (incidence rate ratio = 0.94, 95% confidence interval, 0.25-3.35, P = .92) despite identification of more viral pathogens.ConclusionsIn nursing homes, nurse-initiated PCR testing of respiratory specimens is feasible and useful in terms of identifying the cause of many RTIs and outbreaks, and viruses are common in this context. However, the current study suggests the availability of these test results alone does not impact antibiotic prescribing.
       
  • APIC Masthead
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s):
       
  • Central line infections in United States hospitals: An exploration of
           variation in central line device days and infection rates across hospitals
           that serve highly complex patient populations
    • Abstract: Publication date: August 2019Source: American Journal of Infection Control, Volume 47, Issue 8Author(s): Jennifer L. Hefner, Naleef Fareed, Daniel M. Walker, Timothy R. Huerta, Ann Scheck McAlearneyOur descriptive analyses show a wide distribution in rates of central line device days and central line–associated bloodstream infections for a given standardized infection ratio—the measure linked to federal payment penalties—among 215 US hospitals serving highly complex patient populations. We established that the standardized infection ratio masks hospital-level variation in device use and associated patient safety.
       
  • What do patients say about their experience with urinary catheters and
           peripherally inserted central catheters'
    • Abstract: Publication date: Available online 16 July 2019Source: American Journal of Infection ControlAuthor(s): Barbara W. Trautner, Sanjay Saint, Karen E. Fowler, John Van, Tracey Rosen, John Colozzi, Vineet Chopra, Erica Lescinskas, Sarah L. KreinBackgroundLittle is known about the patient experience with urinary catheters or peripherally inserted central catheters (PICCs). We sought to better understand patient perspectives on having a urinary catheter or a PICC by reviewing open-ended comments made by patients about having either of these 2 devices.MethodsAs part of a larger study, we asked patients about certain catheter-related complications at the time of catheter placement and on days 14, 30, and 70 (PICCs only). In this larger project, we performed a structured assessment that included an open-ended question about other comments (initial interview) or problems (follow-up interview) associated with the device. For the current study, we conducted a descriptive analysis of these open-ended comments, classifying them as positive, negative, or neutral.ResultsPositive comments about urinary catheters accounted for 9 of 147 comments (6%), whereas positive comments about PICCs accounted for 10 of 100 comments (10%). Positive comments for both catheter types were mostly related to convenience. More than 80% of comments about both types of devices were negative and fell into the following areas: catheter malfunction; pain, irritation, or discomfort; interference with activities of daily living; provider error; and other.ConclusionsOur findings underscore the need to optimize the patient experience with placement, ongoing use, and removal of urinary catheters and PICCs.Graphical Image, graphical abstract
       
  • Pope Francis’ last dilemma: To kiss or not to kiss the Piscatory
           Ring'
    • Abstract: Publication date: Available online 9 July 2019Source: American Journal of Infection ControlAuthor(s): Antonio Perciaccante, Alessia Coralli, Philippe Charlier
       
 
 
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