Descriptive Analysis of Healthcare-Associated Infections Other than Bloodstream, Respiratory, Urinary Tract, or Surgical Site Infections, 2001–2011

It is estimated that healthcare-associated infections (HAIs) account for approximately 1.7 million infections and 99,000 deaths in US hospitals each year. The Centers for Disease Control and Prevention (CDC) and the National Healthcare Safety Network (NHSN) have developed standardized surveillance definitions of HAIs including surgical site infection (SSI), pneumonia, bloodstream infection (BSI), and urinary tract infection (UTI).2 All HAIs except for these "big four" infection types are categorized as "other" types of HAI. Of the estimated numbers of total HAIs (1,195,142) and deaths associated with HAI (98,987) in US hospitals among adults and children outside of intensive care units (ICUs), other types of HAI accounted for 22% (263,810) and 11% (11,062) of deaths, respectively, which suggests that other HAIs represent a substantial burden in US healthcare facilities

Potential impact of infant feeding recommendations on mortality and HIV-infection in children born to HIV-infected mothers in Africa: a simulation

Abstract Background Although breast-feeding accounts for 15–20% of mother-to-child transmission (MTCT) of HIV, it is not prohibited in some developing countries because of the higher mortality associated with not breast-feeding. We assessed the potential impact, on HIV infection and infant mortality, of a recommendation for shorter durations of exclusive breast-feeding (EBF) and poor compliance to these recommendations. Methods We developed a deterministic mathematical model using primarily parameters from published studies conducted in Uganda or Kenya and took into account non-compliance resulting in mixed-feeding practices. Outcomes included the number of children HIV-infected and/or dead (cumulative mortality) at 2 years following each of 6 scenarios of infant-feeding recommendations in children born to HIV-infected women: Exclusive replacement-feeding (ERF) with 100% compliance, EBF for 6 months with 100% compliance, EBF for 4 months with 100% compliance, ERF with 70% compliance, EBF for 6 months with 85% compliance, EBF for 4 months with 85% compliance Results In the base model, reducing the duration of EBF from 6 to 4 months reduced HIV infection by 11.8% while increasing mortality by 0.4%. Mixed-feeding in 15% of the infants increased HIV infection and mortality respectively by 2.1% and 0.5% when EBF for 6 months was recommended; and by 1.7% and 0.3% when EBF for 4 months was recommended. In sensitivity analysis, recommending EBF resulted in the least cumulative mortality when the a) mortality in replacement-fed infants was greater than 50 per 1000 person-years, b) rate of infection in exclusively breast-fed infants was less than 2 per 1000 breast-fed infants per week, c) rate of progression from HIV to AIDS was less than 15 per 1000 infected infants per week, or d) mortality due to HIV/AIDS was less than 200 per 1000 infants with HIV/AIDS per year. Conclusion Recommending shorter durations of breast-feeding in infants born to HIV-infected women in these settings may substantially reduce infant HIV infection but not mortality. When EBF for shorter durations is recommended, lower mortality could be achieved by a simultaneous reduction in the rate of progression from HIV to AIDS and or HIV/AIDS mortality, achievable by the use of HAART in infants

Longitudinal Trends in All Healthcare-Associated Infections through Comprehensive Hospital-wide Surveillance and Infection Control Measures over the Past 12 Years: Substantial Burden of Healthcare-Associated Infections Outside of Intensive Care Units and “Other” Types of Infection

OBJECTIVE Targeted surveillance has focused on device-associated infections and surgical site infections (SSIs) and is often limited to healthcare-associated infections (HAIs) in high-risk areas. Longitudinal trends in all HAIs, including other types of HAIs, and HAIs outside of intensive care units (ICUs) remain unclear. We examined the incidences of all HAIs using comprehensive hospital-wide surveillance over a 12-year period (2001–2012). METHODS This retrospective observational study was conducted at the University of North Carolina (UNC) Hospitals, a tertiary care academic facility. All HAIs, including 5 major infections with 14 specific infection sites as defined using CDC criteria, were ascertained through comprehensive hospital-wide surveillance. Generalized linear models were used to examine the incidence rate difference by infection type over time. RESULTS A total of 16,579 HAIs included 6,397 cases in ICUs and 10,182 cases outside ICUs. The incidence of overall HAIs decreased significantly hospital-wide (−3.4 infections per 1,000 patient days), in ICUs (−8.4 infections per 1,000 patient days), and in non-ICU settings (−1.9 infections per 1,000 patient days). The incidences of bloodstream infection, urinary tract infection, and pneumonia in hospital-wide settings decreased significantly, but the incidences of SSI and lower respiratory tract infection remained unchanged. The incidence of Clostridium difficile infection (CDI) increased remarkably. The outcomes were estimated to include 700 overall HAIs prevented, 40 lives saved, and cost savings in excess of $10 million. CONCLUSIONS We demonstrated success in reducing overall HAIs over a 12-year period. Our data underscore the necessity for surveillance and infection prevention interventions outside of the ICUs, for non–device-associated HAIs, and for CDI. Infect Control Hosp Epidemiol 2015;36(10):1139–114

Reduction of Healthcare-Associated Infections by Exceeding High Compliance with Hand Hygiene Practices

Improving hand hygiene from high to very high compliance has not been documented to decrease healthcare-associated infections. We conducted longitudinal analyses during 2013–2015 in an 853-bed hospital and observed a significantly increased hand hygiene compliance rate (p<0.001) and a significantly decreased healthcare-associated infection rate (p = 0.0066)

Emerging infectious diseases: Focus on infection control issues for novel coronaviruses (Severe Acute Respiratory Syndrome-CoV and Middle East Respiratory Syndrome-CoV), hemorrhagic fever viruses (Lassa and Ebola), and highly pathogenic avian influenza viruses, A(H5N1) and A(H7N9)

Over the past several decades, we have witnessed the emergence of many new infectious agents, some of which are major public threats. New and emerging infectious diseases which are both transmissible from patient-to-patient and virulent with a high mortality include novel coronaviruses (SARS-CoV, MERS-CV), hemorrhagic fever viruses (Lassa, Ebola), and highly pathogenic avian influenza A viruses, A(H5N1) and A(H7N9). All healthcare facilities need to have policies and plans in place for early identification of patients with a highly communicable diseases which are highly virulent, ability to immediately isolate such patients, and provide proper management (e.g., training and availability of personal protective equipment) to prevent transmission to healthcare personnel, other patients and visitors to the healthcare facility

Fitted Filtration Efficiency of Double Masking During the COVID-19 Pandemic

Although global vaccination efforts against SARS-CoV-2 are underway, the public is urged to continue using face masks as a primary intervention to control transmission. Recently, US public health officials have also encouraged doubling masks as a strategy to counter elevated transmission associated with infectious SARS-CoV-2 variants. US Centers for Disease Control and Prevention investigators reported that doubling masks increased effectiveness, but their assessment was limited in type and combinations of masks tested, as well as by the use of head forms rather than humans. To address these limitations, this study compared the fitted filtration efficiency (FFE) of commonly available masks worn singly, doubled, or in combinations

Staphylococcus aureus bloodstream infection due to contaminated hematopoietic stem-cell graft

To the Editor—The Foundation for the Accreditation of Cellular Therapy and the American Association of Blood Banks publish guidelines to ensure the quality and safety of hematopoietic stem-cell (HSC) products. These HSC products are generally cultured after procurement by the collection facility and following processing at the transplant center. Reported contamination rates of HSC grafts range from 1% to 45%. The clinical significance of infusion of contaminated HSC products is unclear. When fresh products are used, contamination is often not identified prior to HSC infusion. Bacterial contamination is not an absolute contraindication to HSC infusion, as options are limited following a myeloablative preparative regimen. In a review of 12 studies, 91% of contaminated grafts contained bacterial species of low pathogenicity (eg, Staphylococcus epidermidis and Propionibacterium acnes). Of 26 patients who received grafts contaminated with highly pathogenic bacteria (eg, S. aureus), none developed symptoms or had a positive culture matching an organism found in the HSC graft. In prior reports of infections putatively caused by graft contamination, confirmation that the graft was the source of infection was based solely on the finding of identical species. Contrary to these prior reports, we present a case of catheter-related bloodstream infection with methicillin-susceptible S. aureus due to a contaminated HSC graft in which pulsed-field gel electrophoresis (PFGE) confirmed that the graft and patient isolates were identical

Invasive cutaneous rhizopus infections in an immunocompromised patient population associated with hospital laundry carts

Mucormycosis is an invasive fungal infection with high morbidity and mortality that most commonly occurs in immunocompromised hosts.1–5 Cutaneous mucormycosis is rare and can be acquired through direct contact of the fungi with non-intact skin or mucous membranes.3,4,7–9 Outbreaks of mucormycosis associated with contaminated adhesive bandages, ostomy supplies, wooden tongue depressors, and linen have been published.1,6–9 This is a report of a cluster of cutaneous mucormycosis with Rhizopus that occurred in 4 immunocompromised inpatients housed primarily in the same intensive care unit (ICU) prior to infection

Would a rose by any other name really smell as sweet? Framing our work in infection prevention

To the Editor—From consumerism to politics to health care, the way we label or frame an issue plays a huge role in how we understand and respond to it. This is why we now shop for “preowned” cars and “dried plums” rather than used cars and prunes and buy “tall” (not small) coffees at Starbucks. Realtors are also excellent at framing. A cottage home seems more marketable when described as “cozy” or “charming” than as “tiny” or “cramped.” Cognitive linguist and professor George Lakoff has pointed out how critical framing is in politics as well, from how initiatives are named (eg, “The Clear Skies Initiative” or “No Child Left Behind”) to how concepts are described (eg, “drilling for oil” vs “exploring for energy” or “undocumented workers” vs “illegal aliens”)

A bronchoscopy-associated pseudo-outbreak of Mycobacterium mucogenicum traced to use of contaminated ice used for bronchoalveolar lavage

Clonal Mycobacterium mucogenicum isolates (determined by molecular typing) were recovered from 19 bronchoscopic specimens from 15 patients. None of these patients had evidence of mycobacterial infection. Laboratory culture materials and bronchoscopes were negative for Mycobacteria. This pseudo-outbreak was caused by contaminated ice used to provide bronchoscopic lavage. Control was achieved by transitioning to sterile ice