Nursing Home Infection Control Program Characteristics, CMS Citations, and Implementation of Antibiotic Stewardship Policies: A National Study.

Recently, the Centers for Medicare & Medicaid Services (CMS) final rule required that nursing homes (NHs) develop an infection control program that includes an antibiotic stewardship component and employs a trained infection preventionist (IP). The objectives of this study were to provide a baseline assessment of (1) NH facility and infection control program characteristics associated with having an infection control deficiency citation and (2) associations between IP training and the presence of antibiotic stewardship policies, controlling for NH characteristics. A cross-sectional survey of 2514 randomly sampled US NHs was conducted to assess IP training, staff turnover, and infection control program characteristics (ie, frequency of infection control committee meetings and the presence of 7 antibiotic stewardship policies). Responses were linked to concurrent Certification and Survey Provider Enhanced Reporting data, which contain information about NH facility characteristics and citations. Descriptive statistics and multivariable regression analyses were conducted to account for NH characteristics. Surveys were received from 990 NHs; 922 had complete data. One-third of NHs in this sample received an infection control deficiency citation. The NHs that received deficiency citations were more likely to have committees that met weekly/monthly versus quarterly ( P \u3c .01). The IPs in 39% of facilities had received specialized training. Less than 3% of trained IPs were certified in infection control. The NHs with trained IPs were more likely to have 5 of the 7 components of antibiotic stewardship in place (all P \u3c .05). The IP training, although infrequent, was associated with the presence of antibiotic stewardship policies. Receiving an infection control citation was associated with more frequent infection control committee meetings. Training and support of IPs is needed to ensure infection control and antibiotic stewardship in NHs. As the CMS rule becomes implemented, more research is warranted. There is a need for increase in trained IPs in US NHs. These data can be used to evaluate the effectiveness of the CMS final rule on infection management processes in US NHs

Differences in work environment for staff as an explanation for variation in central line bundle compliance in intensive care units.

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals. PURPOSE: The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs). METHODOLOGY/APPROACH: A cross-sectional study of hospital medical-surgical ICUs in the United States was done. Data on work environment and bundle compliance were obtained from the Prevention of Nosocomial Infections and Cost-Effectiveness Refined Survey completed in 2011 by infection prevention directors, and data on ICU and hospital characteristics were obtained from the National Healthcare Safety Network. Factor and multilevel regression analyses were conducted. FINDINGS: Reasonable workload and prioritization of quality were positively associated with maximal CLABSI bundle compliance. High-quality relationships, although a significant predictor when evaluated apart from workload and prioritization of quality, had no significant effect after accounting for these two factors. PRACTICE IMPLICATIONS: Aspects of the staff work environment are associated with maximal CLABSI bundle compliance in ICUs. Our results suggest that hospitals can foster improvement in ensuring maximal CLABSI bundle compliance-a crucial precursor to reducing CLABSI infection rates-by establishing reasonable workloads and prioritizing quality

The Mass Transfer on the Slag - Liquid Metal Interphases

In the work the results of thermodynamic analysis and laboratory investigations of the formation of slag-metal interphases layer during reducing copper melting conditions have been shown. A considerable intensifying of the reduction processes proves that only refining of the metal is not possible. The extraction of non-metallic inclusions from copper or its alloys leads to formation of many another chemical compounds and inclusions. The results of the slag-copper surface scanning analysis shows, that during the reducing the Al2O3 - B2O3 - Na2O or SiO2 - B2O3 - Na2O slag, effect of silica, aluminium and sodium precipitation may appear.U radu su prikazani rezultati termodinamičke analize laboratorijskog ispitivanja obrazovanja međufaznog sloja troska - metal tijekom uvjeta reduciranja pri taljenju bakra. Značajna pojačanja redukcijskih procesa pokazuje da je moguće ne samo pročišćavanje metala. Izdvajanje nemetalnih uključaka iz bakra ili njegovih slitina vodi do obrazovanja mnogih drugi kemijskih spojeva i uključaka. Rezultati analize skeniranja površine troske - bakar pokazuje da se tijekom reduciranja troske Al2O3 - B2O3 - Na2O ili SiO2 - B2O3 - Na2O može pojaviti efekt nastajanja precipitata silicijske kiseline, aluminija i natrija

Hospital Staffing and Health Care–Associated Infections: A Systematic Review of the Literature

Background Previous literature has linked the level and types of staffing of health facilities to the risk of acquiring a health care–associated infection (HAI). Investigating this relationship is challenging because of the lack of rigorous study designs and the use of varying definitions and measures of both staffing and HAIs. Methods The objective of this study was to understand and synthesize the most recent research on the relationship of hospital staffing and HAI risk. A systematic review was undertaken. Electronic databases MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for studies published between January 1, 2000, and November 30, 2015. Results Fifty-four articles were included in the review. The majority of studies examined the relationship between nurse staffing and HAIs (n = 50, 92.6%) and found nurse staffing variables to be associated with an increase in HAI rates (n = 40, 74.1%). Only 5 studies addressed non-nurse staffing, and those had mixed results. Physician staffing was associated with an increased HAI risk in 1 of 3 studies. Studies varied in design and methodology, as well as in their use of operational definitions and measures of staffing and HAIs. Conclusion Despite the lack of consistency of the included studies, overall, the results of this systematic review demonstrate that increased staffing is related to decreased risk of acquiring HAIs. More rigorous and consistent research designs, definitions, and risk-adjusted HAI data are needed in future studies exploring this area

The Impact of State Mandated Healthcare-Associated Infection Reporting on Infection Prevention and Control Departments in Acute Care Hospitals: Results from a National Survey

Background: In addition to federally mandated reporting, most US states have adopted legislation requiring hospitals to submit healthcare-associated infection (HAI) data. Evidence that state HAI laws have increased patient safety and reduced HAI rates is inconsistent, however, and resources needed to comply are considerable. We evaluated the impact of state HAI laws on infection prevention and control departments (IPCD). Methods: Web-based survey of a national sample of hospital IPCD was conducted in Fall 2011; all non-VA hospitals enrolled in the National Healthcare Safety Network were eligible to participate. States with HAI laws effective prior to Fall 2011 were identified using systematic legal review. Variations in IPCD resources and characteristics in states with and without laws were compared using χ2or Wilcoxon-Mann-Whitney tests. Multinomial logistic regression was used to identify increases or decreases, vs no change, in resources and characteristics. Results: 1,038 IPCD provided complete data (30% response rate); 756 (73%) were located in states with laws. When asked how mandatory reporting affected their IPCD, more respondents in states with laws reported differences in resources (42% vs 33%, p \u3c 0.01), time for routine activities other than for mandatory reporting (79% vs 71%, p \u3c 0.01), influence in hospital decision making (55% vs 48%, p \u3c 0.05), and visibility of their department (75% vs 65%, p \u3c 0.001); they also spent more hours per week fulfilling mandatory reporting requirements (17 vs 13, p \u3c 0.0001). Based on regression analysis, respondents in states with laws were more likely to report increased resources (p = 0.02) and influence (p = 0.04) and decreased time for routine activities (p \u3c 0.01). Perception of visibility in the hospital was mixed with reports of both increased (p \u3c 0.001) and decreased (p = 0.01) visibility vs the same. Conclusion: Respondents in states with laws reported a significantly higher burden to their IPCD, beyond what was required by federally mandated HAI reporting alone. However, they also reported receiving increased resources to offset demands on time for routine activities and fulfilling reporting requirements. Further research is needed to investigate resources necessary to comply with state HAI laws, and to evaluate their unintended consequences

State law mandates for reporting of healthcare-associated Clostridium difficile infections in hospitals.

US state and territorial laws were reviewed to identify Clostridium difficile infection reporting mandates. Twenty states require reporting either under state law or by incorporating federal Centers for Medicare & Medicaid Services\u27 reporting requirements. Although state law mandates are more common, the incorporation of federal reporting requirements has been increasing

Multi-scale settlement patterns of a migratory songbird in a European primeval forest

The drivers of animal settlement are core topics in ecology. Studies from primaeval habitats provide valuable but rare insights into natural settlement behaviour, where species are unconstrained by habitat fragmentation and modification. We examined whether territorial male songbirds (wood warblers Phylloscopus sibilatrix) exhibited clustered distributions when settling in extensive primaeval forest. We tested whether settlement patterns were consistent between years, the influence of habitat preference and the spatial extent of these processes. Remote sensing (airborne LiDAR and satellite multi-spectral) and field survey data were combined to investigate settlement at the landscape (tens of km2), plot (46–200 ha) and microhabitat (20 m diameter) scales, by sampling across 5.9 × 4.5 km of the Białowieża National Park (Poland) during 2018–2019. We assessed bird distribution patterns using nearest neighbour analyses, and habitat preference with generalized linear mixed models. Variation in bird density between plots and years was suggestive of large-scale clustering at the landscape scale. At the local plot scale, any clustering was masked by territoriality, with birds appearing dispersed or randomly distributed. At the microhabitat scale within territories, birds preferred a tall, closed canopy forest structure and avoided a dense herb layer of wild garlic patches. Settlement appeared unconstrained by the availability of preferred habitat at the plot scale, which remained unsaturated. Wood warbler settlement apparently involved hierarchical decisions at multiple spatial scales, compatible with potential social attraction, territoriality, habitat preference or predator avoidance. Selecting an appropriate scale of analysis is an important consideration when assessing the clustering of territorial species

Implementation of antimicrobial stewardship policies in U.S. hospitals: findings from a national survey.

OBJECTIVE: To describe the use of antimicrobial stewardship policies and to investigate factors associated with implementation in a national sample of acute care hospitals. DESIGN: Cross-sectional survey. PARTICIPANTS: Infection Control Directors from acute care hospitals participating in the National Healthcare Safety Network (NHSN). METHODS: An online survey was conducted in the Fall of 2011. A subset of hospitals also provided access to their 2011 NHSN annual survey data. RESULTS: Responses were received from 1,015 hospitals (30% response rate). The majority of hospitals (64%) reported the presence of a policy; use of antibiograms and antimicrobial restriction policies were most frequently utilized (83% and 65%, respectively). Respondents from larger, urban, teaching hospitals and those that are part of a system that shares resources were more likely to report a policy in place (P CONCLUSION: This study provides a snapshot of the implementation of antimicrobial stewardship policies in place in U.S. hospitals and suggests that statewide efforts in California are achieving their intended effect. Further research is needed to identify factors that foster the adoption of these policies