Is there a correlation between infection control performance and other hospital quality measures?

Quality measures are increasingly reported by hospitals to the Centers for Medicare and Medicaid Services (CMS), yet there may be tradeoffs in performance between infection control (IC) and other quality measures. Hospitals that performed best on IC measures did not perform well on most CMS non–IC quality measures

Epidemiology of ventilator-associated pneumonia in a long-term acute care hospital

objective. To characterize the epidemiology and microbiology of ventilator-associated pneumonia (VAP) in a long-term acute care hospital (LTACH). design. Retrospective study of prospectively identified cases of VAP. setting. Single-center, 207-bed LTACH with the capacity to house 42 patients requiring mechanical ventilation, evaluated from April 1, 2006, through January 31, 2008 methods. Data on the occurrence of VAP were collected prospectively as part of routine infection surveillance at Radius Specialty Hospital. After March 2006, Radius Specialty Hospital implemented a bundle of interventions for the prevention of VAP (hereafter referred to as the VAP-bundle approach). A case of VAP was defined as a patient who required mechanical ventilation at Radius Specialty Hospital for at least 48 hours before any symptoms of pneumonia appeared and who met the Centers for Disease Control and Prevention criteria for VAP. Sputum samples were collected from a tracheal aspirate if there was clinical suspicion of VAP, and these samples were semiquantitatively cultured. results. During the 22-month study period, 23 cases of VAP involving 19 patients were associated with 157 LTACH admissions (infection rate, 14.6%), corresponding to a rate of 1.67 cases per 1,000 ventilator-days, which is a 56% reduction from the VAP rate of 3.8 cases per 1,000 ventilator-days reported before the implementation of the VAP-bundle approach ( ). Microbiological data were available for P ! .001 21 (91%) of 23 cases of VAP. Cases of VAP in the LTACH were frequently polymicrobial (mean number ‫ע‬ SD, pathogens per 1.78 ‫ע‬ 1.0 case of VAP), and 20 (95%) of 21 cases of VAP had at least 1 pathogen (Pseudomonas species, Acinetobacter species, gram-negative bacilli resistant to more than 3 antibiotics, or methicillin-resistant Staphylococcus aureus) cultured from a sputum sample. LTACH patients with VAP were more likely to have a neurological reason for ventilator dependence, compared with LTACH patients without VAP (69.6% of cases of VAP vs 39% of cases of respiratory failure; ). In addition, patients with VAP had a longer length of LTACH stay, compared P p .014 with patients without VAP (median length of stay, 131 days vs 39 days; ). In 6 (26%) of 23 cases of VAP, the patient was eventually P p .002 weaned from use of mechanical ventilation. Of the 19 patients with VAP, 1 (5%) did not survive the LTACH stay. conclusions. The VAP rate in the LTACH is lower than the VAP rate reported in acute care hospitals. Cases of VAP in the LTACH were frequently polymicrobial and were associated with multidrug-resistant pathogens and increased length of stay. The guidelines from the Centers for Disease Control and Prevention that are aimed at reducing cases of VAP appear to be effective if applied in the LTACH setting. Ventilator-associated pneumonia (VAP) is the second most common nosocomial infection in the critical care setting. Infect Control Hosp Epidemiol 1 It is associated with increased morbidity and increased use of healthcare resources. 2 The epidemiology of VAP in intensive care units (ICUs) of acute care hospitals has been widely characterized

Epidemiology of ventilator-associated pneumonia in a long-term acute care hospital

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Possible Association between Obesity and Clostridium difficile Infection

Inflammatory bowel disease (IBD) is a risk factor for Clostridium difficile infections (CDIs). Because of similar disruptions to the intestinal microbiome found in IBD and in obesity, we conducted a retrospective study to clarify the role of obesity in CDI. We reviewed records of patients with laboratory-confirmed CDIs in a tertiary care medical center over a 6-month period. Of 132 patients, 43% had community onset, 30% had health care facility onset, and 23% had community onset infections after exposure to a health care facility. Patients with community onset infections had higher body mass indices than the general population and those with community onset after exposure to a health care facility, had higher rates of IBD, and lower prior antibacterial drug exposure than patients who had CDI onset in a health care facility. Obesity may be associated with CDI, independent of antibacterial drug or health care exposures

Effect of Chlorhexidine Bathing and Other Infection Control Practices on the Benefits of Universal Glove and Gown (BUGG) Trial: A Subgroup Analysis

We report the results of a subgroup analysis of the Benefits of Universal Glove and Gown (BUGG) trial. In 20 ICUs, the reduction in acquisition of methicillin-resistant Staphylococcus aureus observed in the BUGG trial was observed in units also using chlorhexidine bathing and in those that previously performed active surveillance