Sustainability of a well-established hand hygiene program during the coronavirus disease 2019 (COVID-19) pandemic

Overall, engagement and compliance from the crowd-sourced hand hygiene observation program, Clean-In-Clean-Out (CICO), were similar between 2019 (96.6%) and 2020 (96.7%) despite fluctuations within 2020 that reflected our hospital's coronavirus disease 2019 (COVID-19) experience. Shared responsibility and just-in-time reminders can allow manual hand hygiene observation models to be sustainable

High Levels of Hand-Hygiene Compliance Are a Worthwhile Pursuit

To the Editor—We read with great interest the excellent review of evidence-based recommendations for the prevention of Clostridium difficile infection (CDI) by Louh et al.1 In this article, the authors reviewed 4 studies that assessed the impact of hand-hygiene campaigns to reduce CDI. Based on these papers, the authors did not recommend any hand-hygiene interventions to reduce CDI

Epidemiologic characteristics of health care–associated outbreaks and lessons learned from multiple outbreak investigations with a focus on the usefulness of routine molecular analysis

Background: Single outbreaks have often been reported in health care settings, but the frequency of outbreaks at a hospital over time has not been described. We examined epidemiologic features of all health care–associated outbreak investigations at an academic hospital during a 5-year period. Methods: Health care–associated outbreak investigations at an academic hospital (2012-2016) were retrospectively reviewed through data on comprehensive hospital-wide surveillance and pulsed-field gel electrophoresis (PFGE) analysis. Results: Fifty-one health care–associated outbreaks (annual range, 8-15), including 26 (51%) outbreaks in intensive care units (ICUs), and 263 infected-colonized patients involved in these outbreaks were identified. The frequency of pathogens varied by affected location, specifically multidrug-resistant organisms (20/26 outbreaks, 77% in ICUs vs 2/25 outbreaks, 8% in non-ICUs; P <.0001) and gastroenteritis because of Clostridium difficile, norovirus, or adenovirus (1/26 outbreaks, 4% in ICUs vs 17/25 outbreaks, 68% in non-ICUs; P <.0001). Outbreaks occurred in approximately one-third of all units (37%) with some repeated instances of the same pathogens. Of 16 outbreaks caused by a bacterial pathogen evaluated by PFGE, 12 (75%) included some indistinguishable strains, suggesting person-to-person transmission or a common source. Conclusions: This study demonstrated epidemiologic characteristics of multiple outbreaks between ICUs and non-ICUs and the value of molecular typing in understanding the epidemiology of health care–associated outbreaks

The compliance coach: A bedside observer, auditor, and educator as part of an infection prevention department's team approach for improving central line care and reducing central line-associated bloodstream infection risk

A compliance coach who audits central line maintenance and provides feedback and education to bedside nurses through timely, nonpunitive conversation is an effective addition to busy infection prevention departments. Staff nurses and nurse managers reported receiving clearly communicated and actionable information from the coach and compliance improved over time in multiple areas of central line maintenance

Reducing health care-associated infections by implementing a novel all hands on deck approach for hand hygiene compliance

Hand hygiene is a key intervention for preventing health care-associated infections; however, maintaining high compliance is a challenge, and accurate measurement of compliance can be difficult. A novel program that engaged all health care personnel to measure compliance and provide real-time interventions overcame many barriers for compliance measurement and proved effective for sustaining high compliance and reducing health care-associated infections

Systems-based Practice in Burn Care: Prevention, Management, and Economic Impact of Health Care–associated Infections

Health care–associated infections in burn patients, from ventilator-associated pneumonia to skin and soft tissue infections, can substantially compromise outcomes, because these complications are associated with longer lengths of stay, increased morbidity and mortality, and greater direct medical costs. Health care–associated infections are largely preventable, through surveillance, education, appropriate hand hygiene, and culture change, especially for device-related infections. Systems-based practice, which allows individuals and clinical microsystems to navigate and improve the macro health care system, may be one of the most powerful skill sets to effect change, permitting a shift in culture toward patient safety and quality improvement

Incidence and risk factors of non-device-associated urinary tract infections in an acute-care hospital

Objective: To update current estimates of non-device-associated pneumonia (ND pneumonia) rates and their frequency relative to ventilator associated pneumonia (VAP), and identify risk factors for ND pneumonia.Design: Cohort study.Setting: Academic teaching hospital.Patients: All adult hospitalizations between 2013 and 2017 were included. Pneumonia (device associated and non-device associated) were captured through comprehensive, hospital-wide active surveillance using CDC definitions and methodology.Results: From 2013 to 2017, there were 163,386 hospitalizations (97,485 unique patients) and 771 pneumonia cases (520 ND pneumonia and 191 VAP). The rate of ND pneumonia remained stable, with 4.15 and 4.54 ND pneumonia cases per 10,000 hospitalization days in 2013 and 2017 respectively (P =.65). In 2017, 74% of pneumonia cases were ND pneumonia. Male sex and increasing age we both associated with increased risk of ND pneumonia. Additionally, patients with chronic bronchitis or emphysema (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.40-3.06), congestive heart failure (HR, 1.48; 95% CI, 1.07-2.05), or paralysis (HR, 1.72; 95% CI, 1.09-2.73) were also at increased risk, as were those who were immunosuppressed (HR, 1.54; 95% CI, 1.18-2.00) or in the ICU (HR, 1.49; 95% CI, 1.06-2.09). We did not detect a change in ND pneumonia risk with use of chlorhexidine mouthwash, total parenteral nutrition, all medications of interest, and prior ventilation.Conclusion: The incidence rate of ND pneumonia did not change from 2013 to 2017, and 3 of 4 nosocomial pneumonia cases were non-device associated. Hospital infection prevention programs should consider expanding the scope of surveillance to include non-ventilated patients. Future research should continue to look for modifiable risk factors and should assess potential prevention strategies

Impact of safety-engineered devices on the incidence of occupational blood and body fluid exposures among healthcare personnel in an Academic Facility, 2000-2014

background. Legislative actions and advanced technologies, particularly dissemination of safety-engineered devices, have aided in protecting healthcare personnel from occupational blood and body fluid exposures (BBFE). objective. To investigate the trends in BBFE among healthcare personnel over 15 years and the impact of safety-engineered devices on the incidence of percutaneous injuries as well as features of injuries associated with these devices. methods. Retrospective cohort study at University of North Carolina Hospitals, a tertiary care academic facility. Data on BBFE in healthcare personnel were extracted from Occupational Health Service records (2000'2014). Exposures associated with safety-engineered and conventional devices were compared. Generalized linear models were applied to measure the annual incidence rate difference by exposure type over time. results. A total of 4,300 BBFE, including 3,318 percutaneous injuries (77%), were reported. The incidence rate for overall BBFE was significantly reduced during 2000'2014 (incidence rate difference, 1.72; P=.0003). The incidence rate for percutaneous injuries was also dramatically reduced during 2001'2006 (incidence rate difference, 1.37; P= .0079) but was less changed during 2006'2014. Percutaneous injuries associated with safety-engineered devices accounted for 27% of all BBFE. BBFE was most commonly due to injecting through skin, placing intravenous catheters, and blood drawing. conclusions. Our study revealed significant overall reduction in BBFE and percutaneous injuries likely due in part to the impact of safetyengineered devices but also identified that a considerable proportion of percutaneous injuries is now associated with these devices. Additional prevention strategies are needed to further reduce percutaneous injuries and improve design of safety-engineered devices

Incidence and risk factors of non-device-associated pneumonia in an acute-care hospital

Objective: To update current estimates of non-device-associated pneumonia (ND pneumonia) rates and their frequency relative to ventilator associated pneumonia (VAP), and identify risk factors for ND pneumonia. Design: Cohort study. Setting: Academic teaching hospital. Patients: All adult hospitalizations between 2013 and 2017 were included. Pneumonia (device associated and non-device associated) were captured through comprehensive, hospital-wide active surveillance using CDC definitions and methodology. Results: From 2013 to 2017, there were 163,386 hospitalizations (97,485 unique patients) and 771 pneumonia cases (520 ND pneumonia and 191 VAP). The rate of ND pneumonia remained stable, with 4.15 and 4.54 ND pneumonia cases per 10,000 hospitalization days in 2013 and 2017 respectively (P =.65). In 2017, 74% of pneumonia cases were ND pneumonia. Male sex and increasing age we both associated with increased risk of ND pneumonia. Additionally, patients with chronic bronchitis or emphysema (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.40-3.06), congestive heart failure (HR, 1.48; 95% CI, 1.07-2.05), or paralysis (HR, 1.72; 95% CI, 1.09-2.73) were also at increased risk, as were those who were immunosuppressed (HR, 1.54; 95% CI, 1.18-2.00) or in the ICU (HR, 1.49; 95% CI, 1.06-2.09). We did not detect a change in ND pneumonia risk with use of chlorhexidine mouthwash, total parenteral nutrition, all medications of interest, and prior ventilation. Conclusion: The incidence rate of ND pneumonia did not change from 2013 to 2017, and 3 of 4 nosocomial pneumonia cases were non-device associated. Hospital infection prevention programs should consider expanding the scope of surveillance to include non-ventilated patients. Future research should continue to look for modifiable risk factors and should assess potential prevention strategies

From VAP to VAE: Implications of the new CDC definitions on a burn intensive care unit population

Ventilator-associated pneumonia (VAP) is a frequent complication of severe burn injury. Comparing the current ventilator-associated event-possible VAP definition to the pre-2013 VAP definition, we identified considerably fewer VAP cases in our burn ICU. The new definition does not capture many VAP cases that would have been reported using the pre-2013 definition