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Publisher: Elsevier   (Total: 3185 journals)

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Showing 1 - 200 of 3185 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 37, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 25, 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: 37, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 427, 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: 10, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 293, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 6, 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: 27, 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: 17, 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: 179, 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: 16, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, 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: 32, 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: 28, 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: 11)
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: 49, 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: 62, 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: 20, 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: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 24, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
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: 8, 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: 19, 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: 7, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 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: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 17, 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: 25, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 17)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, 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: 5)
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: 414, 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: 36, 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: 51, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 364, 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: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 469, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 44, 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: 6, 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: 52, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 57, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 62, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 45, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 11)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 13, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, 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: 35, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 49)
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: 232, 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: 30, 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: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 20, 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: 201, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 12, 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: 24, 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: 207, 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  [3185 journals]
  • Prevalence of mupirocin and chlorhexidine resistance among
           methicillin-resistant coagulase-negative staphylococci isolated during
           methicillin-resistant Staphylococcus aureus decolonization strategies
    • Abstract: Publication date: Available online 13 June 2019Source: American Journal of Infection ControlAuthor(s): Emad M. Eed, Mabrouk M. Ghonaim, Amany S. Khalifa, Khalid J. Alzahrani, Khalaf F. Alsharif, Aza A. TahaBackgroundThe widespread of methicillin-resistant Staphylococcus aureus (MRSA) antimicrobial decolonization in the clinical setting may lead to an increase in the prevalence of multiresistance to coagulase-negative staphylococci (CoNS) owing to their selection. This study aimed to investigate the impact of MRSA decolonization strategies, using mupirocin and chlorhexidine, on their CoNS susceptibility.MethodsA total of 312 CoNS isolates were collected before starting the decolonization protocols “baseline strains” (BLS) group, 330 isolates were collected after application of the targeted decolonization protocol “targeted decolonization strains” group, and 355 isolates were collected after application of the universal decolonization protocol “universal decolonization strains” group. Methicillin-resistant CoNS (MR-CoNS) were identified and tested for mupirocin and chlorhexidine susceptibilities. Heptaplex polymerase chain reaction assay was applied for simultaneous screening for chlorhexidine (CHX-R) and mupirocin resistance (Mu-R) genes.ResultsMu-R prevalence of MR-CoNS among the BLS group was considered moderate (9.1%); however, CHX-R in the BLS group was 5.8%, the rate of which significantly increased among the universal decolonization strains group.DiscussionBoth MRSA decolonization strategies have an additional benefit in reducing the prevalence of MR-CoNS. The prevalence Mu-R rate didn't change significantly during either of the MRSA decolonization practices that may be due to the local nature of mupirocin application on the nasal mucosa only. In contrast CHX-R that was found to be significantly higher among the UDS group.ConclusionsOur findings indicate that both MRSA decolonization strategies have an additional benefit in reducing the prevalence of MR-CoNS. Although the universal MRSA decolonization has superior efficacy in decolonization of CoNS, it may increase the risk of selecting CHX-R and Mu-R. In addition, other potential resistance genes should be studied.
       
  • Health care workers’ perceptions and reported use of respiratory
           protective equipment: A qualitative analysis
    • Abstract: Publication date: Available online 7 June 2019Source: American Journal of Infection ControlAuthor(s): Gemmae M. Fix, Heather Schacht Reisinger, Anna Etchin, Sarah McDannold, Aaron Eagan, Kimberly Findley, Allen L. Gifford, Kalpana Gupta, D. Keith McInnesBackgroundLittle is known about health care workers’ (HCW) perceptions of, or experiences using, respiratory protective equipment (RPE). We sought to characterize their perceptions and identify reasons underlying inappropriate use.MethodsWe conducted 12 focus groups with nurses and nursing assistants at 4 medical centers. We analyzed the thematic content of 73 discrete “stories” told by focus group participants.ResultsWe identified 5 story types surrounding RPE use: 1) policies are known and seen during work routines; 2) during protocol lapses, use is reinforced through social norms; 3) clinical experiences sometimes supersede protocol adherence; 4) when risk perception is high, we found concern regarding accessing RPE; and 5) HCWs in emergency departments were viewed as not following protocol because risk was ever-present.DiscussionHCWs were aware of the importance of RPE and protocols for using it, and these supported use when protocol lapses occurred. However, protocol adherence was undermined by clinical experience, perceived risk, and the distinct context of the emergency department where patients continually arrive with incomplete or delayed diagnoses.ConclusionsProtocols, visual cues, and social norms contribute to a culture of safety. This culture can be undermined when HCWs experience diagnostic uncertainty or they mistrust the protocol and instead rely on their clinical experiences.Graphical Image, graphical abstract
       
  • Reducing Unnecessary Pediatric Tracheal Aspirate Cultures Using a Quality
           Improvement Approach
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Jennifer Ormsby, Paula ConradBACKGROUNDPediatric patients managed on mechanical ventilation via artificial airway are at risk for respiratory infections (Wilson et al., 2014). Although there is a gap in the literature regarding the diagnostic benefit of frequent repeat respiratory cultures, routine infection prevention (IP) surveillance shows this is a common practice in the Medical Intensive Care Unit (MICU). This quality improvement (QI) initiative describes the impact of implementing a standardized process for using tracheal aspirate culture for detection of respiratory infections.METHODSUtilizing Plan-Do-Study-Act (PDSA) cycles, MICU patients requiring mechanical ventilation via an artificial airway (endotracheal or tracheostomy tube) from 11/1/17 to 10/31/18 were included. Tracheal aspirate sampling was standardized and a guideline was created in collaboration with IP, Antimicrobial Stewardship, and the Infectious Diseases Diagnostic Laboratory. The primary outcome measures were tracheal aspirate culture rate per 100 ventilator days and the number of repeat tracheal aspirate cultures within 3'days. The process measure was compliance with the indications for obtaining a culture.RESULTSDuring the study period, 251 tracheal aspirate cultures'were collected; 78% were obtained via tracheostomy tube. Within 3 months, a 20% reduction in the tracheal aspirate culture rate was achieved and maintained. The culture rate ranged from 3.8 to 13.3 per 100 ventilator days (mean 7.4). The tracheostomy culture rate had a larger decrease over time compared to the ETT culture rate. Repeat cultures within 3'days decreased to from 4.4 to 0.7 per 100 ventilator days. Compliance with the guideline increased from 27% to 73% over the study period. Ninety-one percent of the positive cultures were obtained from tracheostomies.CONCLUSIONSImplementing a guideline to standardize collection of'tracheal aspirate cultures in ventilated patients with an artificial'airway reduces the culture rate and repeat sampling, especially in patients with tracheostomy. A multidisciplinary approach applied over several PDSA cycles is required to change practice.
       
  • Compliance with evidence-based guidelines for the prevention of central
           line–associated bloodstream infections in a Belgian home care setting:
           An observational study
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Ester Steffens, Isabel Spriet, Johan Van Eldere, Annette SchuermansThis study assessed the compliance of Belgian home care nurses with good practice recommendations to prevent central line–associated bloodstream infections. The compliance to 3 care bundles was 0% (0 out of 7), 13.3% (2 out of 15), and 22.2% (2 out of 9), respectively. This finding is important given the increasing number of home care patients with an intravascular catheter and underscores the need for quality improvement strategies to prevent central line–associated bloodstream infections in home care.
       
  • Antimicrobial stewardship and infection prevention and control in atopic
           dermatitis in children
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Mataya Kilpatrick, Stéphane L. Bouchoucha, Ana HutchinsonAtopic dermatitis is a chronic, recurrent inflammatory skin disease, characterized by frequent exacerbations that can necessitate increased antibiotic use. A qualitative study was conducted at a specialist pediatric hospital to explore the perceptions of dermatology nurses on their role in antimicrobial stewardship when caring for children with atopic dermatitis. Thematic and content analysis derived that the awareness of nurses on antimicrobial stewardship was low, although they were implementing key elements in their clinical practice.
       
  • Infection prevention and enhanced recovery after surgery: A partnership
           for implementation of an evidence-based bundle to reduce colorectal
           surgical site infections
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Heather Albert, Will Bataller, Nadia Masroor, Michelle Doll, Kaila Cooper, Paula Spencer, Donna Winborne, Elaine M. Zierden, Michael P. Stevens, Michael Scott, Gonzalo BearmanTo reduce surgical site infections (SSIs) in colorectal surgeries we introduced a bundle of care elements in partnership with the Enhanced Recovery after Surgery (ERAS) multidisciplinary team. We measured the incidence of National Healthcare Safety Network-defined SSIs, along with adherence to bundle care elements. Despite opportunities for improvement in adherence to some key components, implementation of the ERAS protocol may have facilitated a reduction in the rate of colorectal SSIs at our institution.
       
  • Factors associated with preventive behaviors in the overuse and misuse of
           antibiotics in Korean nursing students
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Jeong Sil Choi, Ka Young KimThis study was performed to investigate the factors associated with preventive behaviors in the overuse and misuse of antibiotics in Korean nursing students. Knowledge was found to be an important variable in eliciting preventive behaviors in antibiotic overuse and misuse; however, information in one's family or personal medical history negatively affected such behaviors. Preventive behaviors in the overuse and misuse of antibiotics are important for nursing students, as future health professionals.
       
  • Risks and benefits of using chlorhexidine gluconate in handwashing: A
           systematic literature review
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Marcia Maria Baraldi, Juliana Rizzo Gnatta, Maria Clara PadovezeBackgroundAntimicrobial soaps containing chlorhexidine gluconate (CHG) are indicated for hand hygiene (HH) in specific situations. This study aimed to identify whether the continuous use of CHG for HH affects the reduction of healthcare-associated infections (HAI), the selection of microorganisms resistant to CHG, or hands skin damage.MethodsSystematic review was performed using the protocol of the Joanna Briggs Institute, including clinical trials and observational comparative studies. Search was conducted via PubMed, Medline, CINAHL, LILACS, Embase, Cochrane Library, Scopus, Web of Science, ProQuest, Google Scholar, and gray literature. To evaluate outcomes, 3 independent reviews were conducted: HAI rates, presence of resistance genes or higher minimum inhibitory or bactericidal concentration, and damage to skin integrity.ResultsStudies showed no significant difference in HAI rates when using CHG for HH. Among 13 studies, 10 suggested an association with use of and tolerance to CHG. The use of CHG was associated with skin reaction events.ConclusionsStrong evidence regarding the risks and benefits of CHG for HH is still lacking. Due to potential risk of selecting mutants carrying genes for cross-resistance to CHG and antibiotics, it is advisable to reserve the use of CHG for purposes other than HH.
       
  • How often are health care personnel hands colonized with multidrug-
           resistant organisms' A systematic review and meta-analysis
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Ana Montoya, Richard Schildhouse, Anupama Goyal, Jason D. Mann, Ashley Snyder, Vineet Chopra, Lona ModyBackgroundHands of health care personnel (HCP) can transmit multidrug-resistant organisms (MDROs), resulting in infections. Our aim was to determine MDRO prevalence on HCP hands in adult acute care and nursing facility settings.MethodsA systematic search of PubMed/MEDLINE, Web of Science, CINAHL, Embase, and Cochrane CENTRAL was performed. Studies were included if they reported microbiologic culture results following HCP hands sampling; included prevalent MDROs, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, Clostridium difficile, Acinetobacter baumannii, or Pseudomonas aeruginosa, and were conducted in acute care or nursing facility settings.ResultsFifty-nine articles comprising 6,840 hand cultures were included. Pooled prevalence for MRSA, P aeruginosa, A baumannii, and vancomycin-resistant Enterococcus were 4.26%, 4.59%, 6.18%, and 9.03%, respectively. Substantial heterogeneity in rates of pathogen isolation were observed across studies (I2 = 81%-95%). Only 4 of 59 studies sampled for C difficile, with 2 of 4 finding no growth. Subgroup analysis of MRSA revealed the highest HCP hand contamination rates in North America (8.28%). Sample collection methods used were comparable for MRSA isolation (4%-7%) except for agar direct contact (1.55%).ConclusionsPrevalence of common MDROs on HCP hands vary by pathogen, care setting, culture acquisition method, study design, and geography. When obtained at an institutional level, these prevalence data can be utilized to enhance knowledge, practice, and research to prevent health care–associated infections.
       
  • Dissemination and implementation science for infection prevention: A
           primer
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Heather M. Gilmartin, Amanda J. HesselsDissemination and implementation science (D&I) is a rapidly growing area of investigation. Although many evidence-based guidelines for infection prevention are available, not all are systematically implemented into clinical practice. This evidence-to-practice gap has been linked to poor health outcomes. D&I science bridges the gap between research and everyday practice by providing a knowledge base about how health information, interventions, and new clinical practices and policies are translated for use in specific settings. D&I science can expedite and sustain the successful integration of evidence into practice to improve care delivery, population health, and health outcomes. This article offers an introductory overview of D&I and addresses issues such as variation in terminology, finding and appraising evidence, theories and models, implementation strategies, and the future of D&I. Examples from the infection prevention literature are presented throughout.
       
  • The impact of carbapenem-resistant Pseudomonas aeruginosa on clinical and
           economic outcomes in a Chinese tertiary care hospital: A propensity
           score–matched analysis
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Zhihui Chen, Ziqin Xu, Hongmei Wu, Le Chen, Shengchun Gao, Yangfang ChenBackgroundThis study aimed to estimate the impact of carbapenem-resistant Pseudomonas aeruginosa (CRPA) on clinical and economic outcomes in a Chinese tertiary care hospital.MethodsPatients were assigned to a carbapenem-susceptible P aeruginosa group or to a CRPA group and matched using propensity score matching. In-hospital mortality, length of stay (LOS), LOS after culture, total hospital costs, daily hospital cost, and 30-day readmission were comparatively analyzed. Subgroup analysis was performed to determine the associations between the subgrouping factors and in-hospital mortality in patients with CRPA isolates.ResultsWithin the propensity-matched cohort, in-hospital mortality (12.6% vs 7.8%; P   =   .044), LOS (median 29.0 vs 25.5 days; P   =   .026), LOS after culture (median 18.5 vs 14.0 days; P   =   .029), total hospital costs (median $6,082.0 vs $4,954.2; P  =  .015), and daily hospital cost (median $236.1 vs $223.6; P  =  .045) were significantly higher in CRPA patients than in carbapenem-susceptible P aeruginosa patients. Subgroup analysis revealed a significant interaction between CRPA and age (P  =  .009).ConclusionPrevention and control of CRPA among hospitalized patients, especially among those over the age of 65 years, is a good measurement for the reduction of mortality and medical costs derived from CRPA infection or colonization.
       
  • Comparing bacterial, fungal, and human cell concentrations with rapid
           adenosine triphosphate measurements for indicating microbial surface
           contamination
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Sarah E. Kwan, Jordan Peccia, Jonathan Simonds, Ulla Haverinen-Shaughnessy, Richard J. ShaughnessyBackgroundThe goal of this study was to test for associations between adenosine triphosphate (ATP) content and microbial concentrations on desk surfaces in school classrooms.MethodsATP bioluminescence and quantitative polymerase chain reaction (qPCR) techniques were employed to measure total bacterial, fungal, and human cell concentrations on 66 high-traffic desks spread across 9 schools: 3 in Connecticut (CT) and 6 in Oklahoma (OK). In CT, 6 samples were taken from each desk, 1 precleaning and 5 postcleaning (after 30 minutes, 1 day, 3 days, 7 days, and 21 days). In OK, samples were taken immediately before and after cleaning each desk.ResultsBased on simple linear regression analyses, ATP values were good predictors of microbial concentrations (r = 0.8, P = .003) in both CT school postcleaning samples and OK pre- and postcleaning samples (r = 0.7, P = .00002). However, biomass reductions measured after cleaning were 1.5-2 times greater when measured by ATP than by qPCR (P = .007).ConclusionsOverall, ATP bioluminescence measurements correlate with qPCR-based surface measurements on school desks but may overestimate the physical removal of bacteria and fungi due to cleaning.Graphical Image, graphical abstract
       
  • Widespread clinical use of simethicone, insoluble lubricants, and tissue
           glue during endoscopy: A call to action for infection preventionists
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Cori L. Ofstead, Krystina M. Hopkins, John E. Eiland, Harry P. WetzlerBackgroundCurrent methods for reprocessing flexible endoscopes do not consistently eliminate organic soil. The off-label use of simethicone as a defoaming agent may contribute to reprocessing failures, and endoscope manufacturers have cautioned against its use.MethodsWe sought evidence of simethicone use by interviewing hospital personnel, conducting audits, inspecting endoscopes, and conducting tests.ResultsResearchers examined 69 fully reprocessed endoscopes in 4 hospitals. Microbial cultures were positive for ≥50% of endoscopes. Researchers observed cloudy, shimmery fluid resembling simethicone inside channels and under a duodenoscope elevator mechanism. Crystallized white fragments were observed protruding from a gastroscope water jet outlet. Oily, sticky residue was found on endoscopes, and a 3-dimensional mass was found inside an endoscopic ultrasound endoscope. Hospital personnel reported the use of simethicone, cooking oil and silicone sprays, and tissue glue during endoscopy.DiscussionThe off-label use of defoaming agents, lubricants, and tissue glue is common and many endoscopists consider these products essential. Our findings suggest these substances are not removed during reprocessing and may impact reprocessing effectiveness.ConclusionsInfection preventionists should determine whether these products are used in their institutions and evaluate methods for removing them. New policies may be needed to support procedural success and effective endoscope reprocessing.
       
  • Successful control of a methicillin-resistant Staphylococcus aureus
           outbreak in a burn intensive care unit by addition of universal
           decolonization with intranasal mupirocin to basic infection prevention
           measures
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Justin J. Kim, Maria W. Blevins, Deborah J. Brooks, John R. Stehle Jr, Christopher J. McLouth, James P. Viviano, James H. Holmes IV, Werner E. BischoffBackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is frequently implicated in health care–associated outbreaks in burn intensive care units, incurring substantial morbidity and mortality to these high-risk patients and excess costs to health care systems.MethodsMRSA health care–associated infections (HAIs) were noted before and after the implementation of basic infection prevention measures and the subsequent implementation of universal decolonization with intranasal mupirocin. Pulsed-field gel electrophoresis was used to determine the relatedness of clinical isolates. A case-control study was conducted to characterize the risk factors for MRSA HAIs.ResultsBasic interventions failed to decrease the rate of MRSA HAIs, although compliance with these interventions was high throughout the study. MRSA HAIs decreased from 8.53 HAIs per 1,000 patient days before the implementation of intranasal mupirocin to 3.61 HAIs per 1,000 patient days after the implementation of intranasal mupirocin (P = .033). Pulsed-field gel electrophoresis disclosed 10 unique clones with no large clusters. The case-control study revealed a significant association between MRSA HAIs and lengths of stay, body surface area burned, intubation, pressor requirement, leukocytosis, lactic acidosis, development of pneumonia, MRSA colonization, and death.ConclusionsBasic environmental and behavioral interventions fell short of controlling a low-count, sporadic, and multiclonal MRSA outbreak in the burn intensive care unit of a tertiary medical center. However, the added implementation of universal decolonization with intranasal mupirocin was effective. Burn victims with greater disease severity were at higher risk for MRSA HAIs.
       
  • Consumer knowledge and attitudes toward public reporting of health
           care–associated infection data
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Philip L. Russo, Robin Digby, Tracey BucknallBackgroundThere is little information regarding consumer knowledge of health care–associated infection (HAI). Furthermore, it is unclear how meaningful publicly reported HAI data is to consumers, how they may use it, and the most appropriate format for data presentation. The purpose of this study was to explore consumer knowledge and attitudes toward HAI and public reporting.MethodsA qualitative study design, characterized by a series of semistructured interviews, was undertaken with purposively selected, adult elective surgical inpatients at a large metropolitan acute hospital. Interviews were digitally recorded and transcribed verbatim. Analysis of the data were conducted using thematic analysis.ResultsTwenty interviews were conducted. The 5 major themes identified were: (1) awareness through experience, (2) focus on current illness, (3) patient contribution to infection prevention, (4) sources and mode of information, and (5) influence on choice of hospital.DiscussionWe found broad variation in knowledge, sources of information, and preferences for the type and delivery of information. A significant cohort of participants preferred not to be informed, whereas others were neutral or only mildly interested.ConclusionsIf public reporting of HAI data is to be aimed at consumers, further engagement with consumers is crucial to ensure the information provided is fit for purpose.
       
  • User acceptance of reusable respirators in health care
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Stella E. Hines, Clayton Brown, Marc Oliver, Patricia Gucer, Melissa Frisch, Regina Hogan, Tracy Roth, James Chang, Melissa McDiarmidBackgroundInclusion of reusable respirators, such as elastomeric half-face respirators (EHFRs) and powered air-purifying respirators (PAPRs), in hospital respiratory protection inventories may represent 1 solution to the problem of N95 respirator shortages experienced during pandemics. User acceptance of these devices is 1 potential barrier to implementing such a strategy in respiratory protection programs.MethodsTo assess user attitudes toward various respirators, health care workers enrolled in respiratory protection programs in a medical system using EHFRs, N95s, and PAPRs and completed an online questionnaire that addressed attitudes, beliefs, and respirator preferences under different risk scenarios. Responses were compared between user groups.ResultsOf 1,152 participants, 53% currently used N95s, 24% used EHFRs, and 23% used PAPRs. N95 users rated their respirators more favorably compared with EHFR and PAPR users (P < .001) regarding comfort and communication, however, EHFR users rated their respirators much more highly regarding sense of protection (P < .001). For all user groups, reusable respirators were significantly more likely (odds ratios 2.3-7.7) to be preferred over N95 filtering facepiece respirators in higher risk scenarios compared to “usual circumstance” scenarios.ConclusionsDespite somewhat less favorable ratings on comfort and communication, experienced EHFR and PAPR users still prefer reusable respirators over N95s in certain higher risk scenarios. This suggests that reusable respirators are an acceptable alternative to N95 respirators in health care and offer 1 viable solution to prevent pandemic-generated respirator shortages.
       
  • Current practice of infection control in Dutch primary care: Results of an
           online survey
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Nataliya Hilt, Marlies E.J.L. Hulscher, Laura Antonise-Kamp, Alfons OldeLoohuis, Andreas VossBackgroundGood infection prevention is an important aspect of quality of medical care. The aim was to evaluate infection prevention and control (IPC) performance among Dutch general practitioners (GPs).MethodsBased on the current national IPC guidelines for GPs, a self-administered anonymous online questionnaire was developed and sent to GPs in the Nijmegen region of the Netherlands. Thirty-two questions were constructed to survey characteristics of GPs’ offices and assess current performance of IPC measures.ResultsOne hundred questionnaires were included in our analysis. The preferred method of hand hygiene was soap and water (56%) versus alcohol-based handrub (44%). The cleaning of nondisposable, noncritical, semicritical, and critical instruments was consistent with national guideline recommendations or superior to them in 100%, 49%, and 97% of cases, respectively. An average of 57% of GPs reported environmental cleaning frequencies that were compliant with the national guidelines or superior to them. Personal protective equipment was available in 62% of GPs’ practices but used in only 25% of home visits to patients.ConclusionsNot all national IPC guidelines seem to be followed to the fullest extent. The current situation indicates there is room for potential improvement regarding implementation of IPC measures in GPs’ offices. Area-specific guidelines and continuous medical education regarding IPC may help improve the situation.
       
  • The emerging role of the corporate or system-level infection prevention
           director for integrated delivery networks
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Sue Barnes, Chris Zirges, Dawn Tomac, Kathleen Hall-Meyer, Linda Stein, Marsha Barnden, Marsha Studer, Tim Bowers, Vicki BrinskoBackgroundOne position in integrated delivery networks (IDNs) that provides centralized oversight to optimize patient safety is the corporate-level infection prevention (IP) director. After noting variability in their roles, responsibilities, and IP programs, a national network of IDN IP directors planned a member survey to better understand common and variable elements. Nine network members volunteered to design a survey to describe the current role, responsibilities, and resourcing of all members of the corporate IP director group.MethodsA 17-question survey was designed using the Survey Monkey multiple-choice format with a comment option. The questions were reviewed by the entire network to ensure content validity. The survey was delivered to all 72 network members by e-mail, and a 44% response rate was achieved.ResultsSurvey responses revealed variation and commonalities relative to role structure, responsibilities, resourcing, and level of physician support for corporate IP directors. In addition, advantages of the position were described.ConclusionsThe results of the survey will serve as a foundation on which to build, supporting standardization and reliable design for the role, responsibilities, and resourcing of corporate IP directors, with the ultimate goal of improving patient safety.
       
  • Exploring leadership within a systems approach to reduce health
           care–associated infections: A scoping review of one work system model
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Mary Jo Knobloch, Kevin V. Thomas, Jackson Musuuza, Nasia SafdarBackgroundDespite efforts to prevent health care–associated infections (HAIs), these infections continue to challenge health care systems. The Centers for Disease Control and Prevention emphasizes implementation of evidence-based practices. Within the complex health care environment, sustained implementation calls for work systems that harness expertise of interprofessional teams, which, in turn, calls for suitable executive, mid-level, and local leadership. The purpose of this review is to highlight the need to study leadership when using a systems approach to reduce HAIs.MethodsThis is a scoping review of HAI studies that used a systems engineering model called the Systems Engineering Initiative for Patient Safety model. We examined if and how leadership was addressed within 1 systems approach.ResultsWe found 15 studies using the Systems Engineering Initiative for Patient Safety model and, of these, leadership was directly mentioned in 3 studies. In the remaining studies, reference to leadership may be inferred by use of terms such as teamwork, managerial oversight, climate and culture, staffing support, and institutional/administrative support.ConclusionsResearch is needed to bring recognition of the role of leadership within a work systems approach to reducing HAIs. We need further examination of leadership attributes and communication behaviors that allow staff to diffuse and sustain best practices to prevent HAIs.Graphical abstractGraphical abstract for this article
       
  • Forming a successful public health collaborative: A qualitative study
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Jeanmarie Mayer, Stacey Slager, Peter Taber, Lindsay Visnovsky, Charlene WeirBackgroundCoordinated approaches are needed to optimally control the spread of resistant organisms across facilities that share patients. Our goal was to understand social tensions that may inhibit public health–led community partnerships and to identify factors for success.MethodsA collaborative to control transmission of multidrug-resistant organisms (MDROs) was formed in Utah following a regional outbreak, with members from public health, hospitals, laboratories, and transport services. We conducted and qualitatively analyzed 3 focus groups among collaborative stakeholders to discuss their experiences.ResultsVia 3 focus groups and additional interviews, we found the collaborative made institutional tensions between stakeholders explicit. We identified 4 factors that facilitated the ability to overcome institutional tensions: public health leadership to establish a safe space, creation of cross-institutional group identity with mutual respect and support, standardized communication, and group cohesiveness through shared mental models of interdependencies.DiscussionStakeholders’ concerns regarding being blamed for MDRO transmission versus contributing to shared health care community MDRO control efforts resembled a “prisoner's dilemma.” Four social components mitigated tensions and facilitated cooperation in this public health–led collaborative.ConclusionsThis study identified strategies that public health-led coordinated approaches can use to facilitate cooperation.
       
  • The expansion of National Healthcare Safety Network enrollment and
           reporting in nursing homes: Lessons learned from a national qualitative
           study
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Patricia W. Stone, Ashley M. Chastain, Richard Dorritie, Aluem Tark, Andrew W. Dick, Jeneita M. Bell, Nimalie D. Stone, Denise D. Quigley, Melony E. SorberoBackgroundThis study explored nursing home (NH) personnel perceptions of the National Healthcare Safety Network (NHSN).MethodsNHs were purposively sampled based on NHSN enrollment and reporting status, and other facility characteristics. We recruited NH personnel knowledgeable about the facility's decision-making processes and infection prevention program. Interviews were conducted over-the-phone and audio-recorded; transcripts were analyzed using conventional content analysis.ResultsWe enrolled 14 NHs across the United States and interviewed 42 personnel. Six themes emerged: Benefits of NHSN, External Support and Motivation, Need for a Champion, Barriers, Risk Adjustment, and Data Integrity. We did not find substantive differences in perceptions of NHSN value related to participants' professional roles or enrollment category. Some participants from newly enrolled NHs felt well supported through the NHSN enrollment process, while participants from earlier enrolled NHs perceived the process to be burdensome. Among participants from non-enrolled NHs, as well as some from enrolled NHs, there was a lack of knowledge of NHSN.ConclusionsThis qualitative study helps fill a gap in our understanding of barriers and facilitators to NHSN enrollment and reporting in NHs. Improved understanding of factors influencing decision-making processes to enroll in and maintain reporting to NHSN is an important first step towards strengthening infection surveillance in NHs.
       
  • Advancing the profession: An updated future-oriented competency model for
           professional development in infection prevention and control
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s): Corrianne Billings, Heather Bernard, Lisa Caffery, Susan A. Dolan, John Donaldson, Ericka Kalp, Angel Mueller
       
  • Earn Your EPI® Intensive Certificate In 2019
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s):
       
  • Information for Authors
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s):
       
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    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s):
       
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    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6Author(s):
       
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    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s):
       
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    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s):
       
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    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s):
       
  • Mining Real World Data: Leveraging an Infection Surveillance System to
           Quantify the Impact of Clinical Interventions
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Timothy Kelly, David Sellers, Jaime RitterBACKGROUNDReal world data (RWD) is playing an increasing role in health care decisions. Employing RWD collected by electronic health records and other healthcare applications allows researchers the ability to evaluate treatment effects efficiently and upon broad populations. Applying a RWD approach to analyzing the impact of infection prevention programs can provide useful insights in cases where prospective studies are not initiated.METHODSAs a use case, we examined the impact of hospital-wide Foley catheterization tray (FCT) conversions. 32 hospitals converted from one of three types of Foley catheterization trays (FCTs) – types B, C and D – to an FCT designed to foster aseptic technique (type A). Those conversions were implemented in conjunction with a refocus on catheter insertion and maintenance practices. The impact upon catheter-associated urinary tract infections (CAUTIs) and an algorithmically-derived measure of healthcare-associated infections (HAIs) were analyzed using an electronic infection surveillance system as the RWD source.RESULTSA total of 1,835,370 admissions, 530,485 urinary catheter-days and 3,400,873 patient-days were analyzed. A combination of subjective and objective HAI metrics was used to assess the conversions. Statistically significant CAUTI reductions were observed in a single type of Foley tray conversion (D-to-A). Statistically significant reductions in the algorithmically-derived HAI measure were observed across all three conversion types.CONCLUSIONSRWD analysis can provide useful insights as to the impact of infection prevention programs, particularly when analyzing endpoints that are electronically derived from existing data. The strengths of RWD analysis include relative ease of analysis and minimization of the Hawthorne effect. Those strengths must be balanced against the inability to control for all potential variables that may contribute to the observed results including the inability to quantify the individual impacts of product conversion and human factors effects.
       
  • Development of a Screening Tool to Improve Infectious Disease Detection: A
           Pilot
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Kayla C. Warner, Jeana Houseman, Samantha Saunders, Susan Kline, Kayla C. WarnerBACKGROUNDHigh consequence infectious diseases (HCIDs) have potential to cause a high mortality rate among otherwise healthy populations. In partnership with the state department of health, a universal disease screening algorithm was developed to detect HCIDs and other infectious diseases. This screening tool was piloted in several locations, and staff provided feedback through pre- and post-pilot surveys.METHODSThe new screening algorithm was piloted at three sites, an emergency department at a tertiary hospital, a specialty outpatient facility, and a family medicine clinic. Pre- and post-pilot surveys were completed by frontline staff to identify potential barriers, knowledge gaps, and comfort with the tool. Each site completed the novel screening alongside the current travel screening process at check-in for two weeks. Upon completion, surveys and screening results were compared to the existing process for time expenditure, staff perceptions, and sensitivity and specificity of the tools.RESULTSDuring the pilot, 1894 surveys were completed; of this number, 69 (3.64%) of the patients reported a fever, which prompted assessment for possible exposure and recent travel. Of the patients who reported a fever, 3/1894 (0.16%) had travel or exposure and were classified as “at risk” and 1/1894 (0.05%) had additional symptoms along with travel/exposure and were classified as “suspect” for an HCID. Per survey results, staff reported no significant time increase with the new process, but felt that additional education on HCIDs was needed.CONCLUSIONSThe goals of this pilot were to develop a screening tool that efficiently detects HCIDs in healthcare settings and identify barriers to best practice. The results demonstrate a need for simple, effective screening tools, workflows, and staff education on infectious disease management. Using a universal screening model, facilities can improve their capability to prevent exposures, decrease response time, and reduce morbidity /mortality related to HCIDs.
       
  • Quantitative Measurement of Hand Hygiene Behavior in Hospice Environments
           Using An Automated Personal Hand Hygiene System
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Maria L. GreskowiakBACKGROUNDDespite regulatory, accreditation, and federal agencies requirements for hand hygiene (HH) across the continuum of care to prevent the spread of healthcare associated infections, the ability to monitor HH performance and provide feedback in hospice settings (home, skilled nursing facility, assisted living, free standing in-patient unit) has been limited to direct observation which is inherently biased by the Hawthorne Effect. To date, there has been no automated method to measure and report hand hygiene events (HHE) that occur in home health settings. The purpose for this study was to measure HHE during patient care with the implementation of an automated personal hand hygiene system (APHHS).METHODSThe APHHS (personal devices with alcohol gel sanitizer, wireless data transfer, and web-based reporting), was deployed to 16 home hospice care professionals over a 3-week period. The system measured total HHE and HHE per hour of clinical time. A multi-modal approach included a shared group performance dashboard, periodic individual email performance summaries, leadership communication, ongoing positive feedback via the personal device, HH education, and recognition of sustained individual performance.RESULTSPrior to automation, 60 HHE were observed per month utilizing the direct observation method and an opportunity-based approach. Following system deployment, 1,387 HHE were captured per week on average. Average hourly HHE rates for the home hospice care team were measured at: Medical Doctor 8.6, Nurse Practitioner 3.4, Registered Nurse 3.7, Certified Nursing Assistant 6.5, Social Worker 5.2, and Chaplain 4.8.CONCLUSIONSImplementing an APHHS in home hospice care with an evidenced based approach provides robust data sets of HHE with continuous individualized performance feedback and provides unbiased measurement of HH performance.
       
  • Proposed ATP Benchmark Values by Patient Care Area
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Nidal A. Halimeh, Christopher Truitt, Rodney Madsen, Wesley GoldwaterBACKGROUNDOptimal cleaning and disinfection of environmental surfaces in healthcare facilities is paramount to limit the impact of healthcare-associated infections (HAIs). Adenosine triphosphate (ATP) bioluminescence assay systems are widely used as a method for objectively measuring environmental cleanliness. However, there is no current consensus on standardized pass/fail values. The objective of this study was to establish benchmark ATP assay values in specific care areas to be used as a measure to improve environmental disinfection in healthcare settings.METHODSEnvironmental samples were collected in a 115-bed acute care community hospital in Texas over a 68-month period. Surface samples were collected for the presence of ATP using an ATP bioluminescence monitor and reported as Relative Light Units (RLU). Sampled surfaces were selected at random from locations within the hospital that included emergency department (ED), operating rooms (OR), and near patient areas. All results were entered into a Microsoft Excel database to determine arithmetic means.RESULTSA total of 1300 samples were collected: 172, 177, 951 in ED, OR, and near patient areas respectively. Measurements were taken when no patients or medical staff were in the areas and after the locations had been cleaned by hospital environmental service (EVS) personnel. The mean values were, 70 RLU for ED, 25 RLU for OR, and 92 RLU for near patient areas.CONCLUSIONSMaintaining a high standard of cleanliness and lowering the risk of HAIs is essential in all healthcare facilities. This study has provided provisional benchmarks by care area that may be used for monitoring and improving environmental disinfection.
       
  • Can You Hear Me Now' … Optimized Communication to Reduce Hospital
           Acquired Central Line Bloodstream Infection
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Savanna Stout, Cathy PaulusBACKGROUNDEffective communication that is timely, accurate, and unambiguous results in improved patient safety. Central venous catheters are the most frequent cause of healthcare-associated bloodstream infections. Central line associated blood stream infection (CLABSI) events increased during FY16. The hospital CLABSI improvement team identified uncoordinated efforts of multiple disciplines simultaneously working on central line bloodstream improvements as a significant root cause for lack of improved CLABSI performance.METHODSA unified communication strategy was created with oversight from the CLABSI committee. Essential communication building blocks included standardized metrics and data display, custom improvement tools and 24/7 access to unit level performance via a “one-stop-shop” team site. Once the team site was implemented, it was used as a regular mode to deliver consistent CLABSI information to all levels of staff and leadership.RESULTSOn demand access to metrics and improvement tools enabled stakeholders to have resources available regardless of time, day or shift. Continuous availability to frontline staff created hyperawareness and urgency around CLABSI prevention. Subsequently, staff were engaged and empowered to monitor and act on their own unit's performance. Since implementing the communication strategy there has been a gradual decrease in both Standardized Infection Ratios (SIR) and Standardized Utilization Ratios (SUR). FY17 SIR of 0.80 decreased to 0.72 during FY18 and FY17 SUR of 0.98 decreased to 0.88 during FY18.CONCLUSIONSEffective communication is essential when coordinating any type of sustainable improvements. A multi-pronged communication plan around CLABSI can assist Infection Prevention with a shift towards shared ownership of unit performance.
       
  • Creation of an Evidence-based Operating Room Observation Tool to Improve
           Infection Prevention Perioperative Practices
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Patrick S. Gordon, Robin Kalaidjian, Sharon WrightBACKGROUNDDirect observation has been effective in improving many behaviors critical to infection prevention, such as hand hygiene, but is applied infrequently in the operating room (OR) setting. National Patient Safety Goal 07.05.01 recommended direct observation of evidence-based practices within the OR to reduce surgical site infections (SSIs) but provided little guidance for implementation. We created a standardized OR observation tool for use by infection preventionists (IPs) and perioperative staff to identify variation in practices with an aim toward reducing SSIs. A pilot was performed on cardiac surgery and orthopedic procedures to evaluate reliability and ease of use.METHODSLiterature review was performed using keywords “SSI,” “direct observation,” “observation tool,” “infection prevention,” and “quality improvement” to create a list of evidence-based practices that could be monitored by observation in the OR. This list was cross-matched with our institutional SSI prevention bundle and additional procedure-specific variables were added. The tool was shared with IPs with less OR infection prevention experience to help determine ease of use.RESULTS14 items were identified for inclusion in the OR observation tool in three categories: pre-operative/environmental (chlorhexidine bathing, perioperative antibiotics, environmental cleanliness, air pressure/humidity/temperature), prep and drape (alcohol-based skin prep, OR attire compliance, surgical hand scrub for scrubbed staff, sterile gown/gloving, long/artificial nails), and intraoperative (antibiotic re-dosing, traffic, aseptic technique, sterile field maintained, hand hygiene non-scrubbed staff). Additional items included glucose control and use of negative pressure wound therapy (cardiac surgery) and lower leg prep procedure and postoperative dressing choice (orthopedics). The two IPs that piloted the tool reported improved understanding of each metric and ease of use overall.CONCLUSIONSUse of a standardized, evidence-based OR observation tool improved the quality and consistency of data collected on OR infection prevention practices while serving as a training tool for IPs new to the OR setting.
       
  • Utilizing Performance Improvement methodologies to create a central
           line-associated bloodstream infection surveillance process for ambulatory
           pediatric patients
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Hillary Hei, Marisse Plaras, Lauren Satchell, Lori HandyBACKGROUNDCentral line-associated bloodstream infections (CLABSI) are the most common device-associated infections in hospitalized children. Surveillance and prevention are standard in inpatient hospital settings, but comparable processes are less robust for ambulatory patients with central lines. Our institution lacked a unified and consistent process for surveillance and review of ambulatory CLABSI. Utilizing performance improvement (PI) methodologies, we sought to create a comprehensive and sustainable process for collecting CLABSI surveillance and event review data on complex patient populations across ambulatory disciplines.METHODSWe assembled key stakeholders by identifying services with the majority of patients discharged with central lines and utilized the Six Sigma methodology of DMADV (Define, Measure, Analyze, Design, and Verify) to understand and improve current processes. We performed current state analysis of infection tracking and data collection through process-mapping and utilized fishbone diagrams to identify root causes of inefficacies. Following value analysis, the team developed a future state process map and utilized Failure Modes Effects Analysis to identify and mitigate potential risks to the process.RESULTSWe identified variable CLABSI data collection methods between our stakeholder ambulatory divisions. Upon completion, our PI work resulted in one process that: 1) provides CLABSI surveillance for ambulatory divisions; 2) creates a singular data infrastructure for confirmed infections; 3) streamlines communication to all divisions and homecare providers involved in the'patient's ambulatory care; and 4) promotes responsive learning through a multidisciplinary event review that highlights potential risk factors and generates proactive infection prevention measures.CONCLUSIONSUtilizing PI methodology, we created a lean and standardized process to consistently track ambulatory CLABSI and support effective communication across divisions and providers. Next steps include optimization of the event review tool, integration with inpatient CLABSI PI efforts, and tests of change based on event review data that ultimately shift attention to patient safety in the ambulatory setting.
       
  • Presentation Number QA-97 (Withdrawn)
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s):
       
  • A Multi-Disciplinary Initiative to Streamline and Expedite the Pulmonary
           Tuberculosis Rule Out Process
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Jos Cooper-Sterling, Alexandra S. Madison, Sheryl Michelson, Norina Agulo, Dave Scott, Marisa Holubar, Lucy Tompkins, John Hahesy, Kristen MerrimanBACKGROUNDMulti-factorial problems were encountered in ruling patients out for Tuberculosis in a healthcare facility located in one of the highest incidence areas in the United States. These problems led to increased time spent in Airborne Isolation as well as extended in-patient stays. The objective of the team was to streamline the process through education, protocol change, increased communication and collaboration, and real-time resolution of barriers. Other objectives included decreasing sputum collection time to under 20'hours and to decrease the length of time spent in negative airflow by 20%.METHODSA Task Force was convened to review the challenges of efficiently ruling out patients with risk factors for Tuberculosis. The Tuberculosis log was reviewed for 3 months to determine the duration of time spent in Airborne Isolation rooms and how long it took for the completion of specimen collection. The group developed/implemented a combination of structured/unstructured education, protocol changes, creating a physician order-set, standard work and real-time fixes to reinforce practice change. Charting of sputum collection time and discontinuation of Airborne Isolation in the electronic medical record was utilized to determine percentage of change.RESULTSResults indicated that there was an improvement in the rule out process over a 15-month period, and increased timely discontinuation of Airborne Isolation. Results demonstrated an increase from 31.17% to 70% in the completion of specimen collection under 20'hours. The average number of days spent in Airborne Isolation decreased from 3.09'days to 2.35 days(24%).CONCLUSIONSThe study found that a combination of education, protocol change, increased communication and collaboration, as well as real-time resolution of barriers streamlined the rule out process, improved patient throughput and efficiency. While the authors did not measure patient or staff satisfaction, it must be noted that there were less complaints by the health care team and patients.
       
  • When a pandemic influenza lands in your community: A planned response to
           maintain a safe facility
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Mary Kay Foster, Jane ForniBACKGROUNDOur healthcare system's pandemic plan, although reviewed annually, had remained an antiquated process originally designed for the 2009 H1N1 pandemic outbreak. Our healthcare system has grown to 17 facilities with 2.7'million outpatient visits per year and 2,600 inpatient beds. State and local health departments recommend response plans for healthcare settings related to the number of cases, clinical severity and how the outbreak spreads; however, facilities should have their own risk-based mitigation strategies that can be promptly initiated when indicated. We realized we needed a more localized response as our facilities cross four health preparedness districts within the state.METHODSData analyzed within a large health system showed that the outbreak of influenza peaked at different times yearly across the state. We developed a standardized plan defining the safety measures necessary for pandemic planning that allowed for phased and tailored implementation of various strategies such as fever clinics, masking all personnel, and cancelling non-essential procedures. Interventions can By sharing the same plan across the system, we are better able to leverage resources and quickly implement strategies to minimize the spread of the disease.RESULTSThis tailored approach allows for a more focused, regional approach with interventions that are based on how the pandemic expands. With large healthcare systems spread across multiple state or counties, this method provides a flexible method to rolling out interventions where resources can be easily flexed up, down or across sites.CONCLUSIONSAs healthcare systems continue to grow, a more flexible, regional approach to pandemic planning with structured interventions that can be tailored to each site is vital to maintain a safe environment.
       
  • Norovirus Outbreak at a Small Acute Care Hospital
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Jamie M. Pelletier, Michael E. Sebert, Patricia JacksonBACKGROUNDOur 35-bed acute care pediatric hospital with a specialization in therapy and rehabilitation services experienced an outbreak of norovirus. We describe the measures implemented to prevent secondary transmission.METHODSOnce laboratory testing confirmed that norovirus was responsible for the outbreak, additional cases were identified using clinical criteria of either abrupt onset of vomiting followed by diarrhea, or acute diarrhea without vomiting.RESULTSIn total 38 staff members, 14 patients, and 5 family members were affected over a period of 17'days. All patients, whether symptomatic or not, were placed on contact precautions. New admissions were postponed and visitor restrictions were implemented. Only soap and water was used for hand hygiene. The environmental disinfectants were confirmed to have Environmental Protection Agency kill claims for norovirus. Cleaning was done three times daily on high-touch surfaces, patient rooms, hallways, bathrooms, and staff work stations. Supplemental ultraviolet light disinfection (UVD) was deployed. Congregating in the cafeteria was discouraged by providing meals to patients and families in their rooms. We eliminated group activities in common spaces. Staff were instructed not to share food and to utilize disposable lunch containers. Symptomatic staff were furloughed for 48 hours; food handlers were furloughed for seven days. Auditing by infection prevention was initiated to assess personal protective equipment (PPE) use and hand hygiene. Measured compliance with PPE use was 96% and with hand hygiene was 95%.CONCLUSIONSWhile the route by which infection was introduced was not identified, factors that may have contributed to the spread of disease include: sharing of food among staff, close contact during therapy, hardiness of norovirus in the environment, and low infectious dose. Lessons learned include: importance of frequent environmental cleaning, ensuring disinfectants have norovirus kill claims, staff understanding precautions and having one staff member dedicated to UVD.
       
  • Outbreak of Mycobacterium chelonae associated with use of jet injector and
           receiving injections at an outpatient podiatry clinic, Indiana
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Rachel L. CatheyBACKGROUNDRecent outbreak investigations in nonhospital settings have identified infection control breaches and concerns with injection safety. Infections due to Mycobacterium chelonae were identified in six patients who received injections at a podiatry clinic. Prior to injection, all patients received lidocaine via needleless/jet injector to reduce pain associated with the injection. An investigation was initiated to determine the extent of infection, assess risk factors, and implement infection control measures.METHODSAll identified patients received an injection within one month. Upon patient identification, data was collected on all patients with a positive laboratory result or clinical symptoms associated with receiving an injection within that month. Patient case classification was determined from medical chart review. A confirmed case was defined as having symptoms of redness, swelling, and abscess at the injection site, with a positive culture indicating Mycobacterium 'chelonae. Because of the ubiquity of Mycobacterium chelonae in the environment, various samples were taken from water sources at the clinic, including a device flush of sterile water from the needleless/jet injector. Infection control was assessed using the “Infection Prevention and Control Assessment Tool for Outpatient Settings” (ICAR) from the Center for Disease Control and Prevention.RESULTSOf the six patients that met the confirmed case definition, the average time between injection and illness onset was 15'days. Common symptoms included redness, swelling, and abscess. Pulsed-field gel electrophoresis results were indistinguishable. Environmental samples of tap water grew Mycobacterium phocaicum/mucogenicum and the device flush grew Bacillus cereus group species. The ICAR identified numerous infectious control breaches.CONCLUSIONSThis investigation found that a breach in infection control took place, specifically associated with improper aseptic technique, inadequate disinfection and sterilization of equipment, batch compounding, and environmental cleaning. Because the jet injector was consistently cleaned with tap water, the cultured organisms support the possibility of an infection control breach, namely Mycobacterium chelonae.
       
  • Career Advancement for Infection Preventionists; Innovative Recruitment
           and Retention Tool
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Merima Sestovic, Paula Castellano-FlynnBACKGROUNDWith the current national shortage of Infection Preventionists (IP), we struggle to recruit new and experienced IP practitioners. At the same time, retention of our seasoned IP staff by providing them opportunities for growth, engagement, and value is a challenge. IPs at many institutions in our area feel frozen in their position without opportunities for advancement or financial gain despite many years of practice. We examined options to address these challenging issues at our 305 bed community hospital with a staff of 3 existing IPs.METHODSWe designed a process to support the goals of recruitment and retention to strengthen our IP program. Using the APIC Competency Model as a guide we created our own Career Advancement Application. A minimum of 2'years satisfactory employment was needed to apply. The Career path was designed to span from Level 1 (Entry level) to Level IV (Expert), with 10 specific skill and knowledge-based requirements for each advancement level. Supporting evidence for each requirement had to be met. Written recommendation from the IP manager was the final step in the approval process.RESULTSThe application was submitted to our IP manager, Director of Infectious Diseases and Human Resources for approval and to assign financial increments. The financial benefits were attached to'each level and budgeted by the Infectious Diseases Department. Two of our employed IP practitioners applied and were approved for advancement to level III and IV respectively, and received their status upgrades as expected. The Career Advancement tool aided in new IP recruitment; was disclosed to new job applicants during their interview process; and helped us add another highly experienced IP to the department.CONCLUSIONSCreation of a formal Career Advancement program for Infection Prevention practitioners proved to be an advantageous recruitment and retention tool which can help other organizations attract and retain experienced IPs.
       
  • A Motion-Detection Electronic Hand Hygiene Verbal Reminder Increases
           Adherence in a Standard Precaution Room
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Cindy M. Hou, Mitchell C. Rosenberg, Robert A. Steer, Corinne Cricco, Kevin CamposBACKGROUNDHand hygiene rates remain suboptimal. We previously reported the effect of a motion-detection verbal hand hygiene reminder installed at the door of a contact isolation room and on hand hygiene for nurses, versus all others. This study evaluates the device's effect on the hand hygiene rate for a standard precaution hospital room.METHODSA wireless motion sensor was installed above a standard precaution room door. When an individual entered or exited the room, the device's speaker announced a verbal hand hygiene reminder. The individual was credited with adherence by secret observers only if observed to wash hands at both entry and exit. This prospective study included 174 baseline measurements (before motion-detection sensor deployed) and 111 measurements during the intervention period (the period during which the sensor was installed), for a total of 285 observations.RESULTSBefore the wireless sensor was deployed, we found that without the verbal reminder, 6% (n=11) washed their hands at both entry and exit and 94% (n=163) did not. During the intervention, adherence increased to 38% (n=42), while 62% (n=69) did not. As different individuals might be observed before and after sensor installation, we performed a chi-square test for independence using Yates’ correction for continuity with SPSS 25 to compare rates of adherence. With the sensor, there was a statistically significant (X(squared)Yates(1) = 42.41, φ = .40, p
       
  • Appropriate Patient Selection Leads to Improvement in Healthcare
           Facility-Onset C. diff Rates
    • Abstract: Publication date: June 2019Source: American Journal of Infection Control, Volume 47, Issue 6, SupplementAuthor(s): Ana Payne, Allison Folkerts, Karolina ValaitisBACKGROUNDHealthcare facility-onset Clostridium difficile infections (HO CDI) are potentially preventable events associated with increased cost, morbidity, and mortality in adult patients. Struggling with a high HO CDI rate, our facility identified appropriate patient selection for testing as an improvement opportunity. Careful patient selection for C. diff testing is vital to improve the sensitivity and specificity of HO CDI diagnosis.METHODSA dyad approach was developed to improve CDI testing practices. A rule was built into the electronic medical record that automatically cancelled C. diff orders if the sample was not 'collected within 24'hours of order. A C. diff Ticket-to-Lab (TTL) form with an accompanying testing algorithm was developed to guide clinicians through determining whether or not a patient should be tested for C. diff based on clinical criteria. All C. diff tests were required to have a TTL form filled out before submission to the laboratory.RESULTSCancellation of outdated results reduced the average amount of C. diff tests performed monthly by 40%. After implementation of TTL, our HO CDI standardized infection ratio (SIR) dropped by 42% from 1.29 during the baseline period to 0.552 post intervention (p-value 0.0094, 95% confidence interval 0.209, 0.821).CONCLUSIONSA combination of electronic and manual tools can be used to assist providers in identifying patients with clinical criteria that warrants C. diff testing. Improving patient selection for C. diff testing is an effective strategy to reduce HO CDI. Detection of C. diff colonization is prevented along with unnecessary antibiotic use, prolonged length of stay and hospital penalties associated with falsely inflated HO CDI rates.
       
 
 
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