Abstract:
OBJECTIVE:We aimed to rigorously evaluate the impact of prospective audit and feedback on broad-spectrum antimicrobial use among critical care patients. DESIGN:Prospective, controlled interrupted time series. SETTING:Single tertiary care center with 3 intensive care units. PATIENTS AND INTERVENTIONS:A formal review of all critical care patients on their third or tenth day of broad-spectrum antibiotic therapy was conducted, and suggestions for antimicrobial optimization were communicated to the critical care team. OUTCOMES:The primary outcome was broad-spectrum antibiotic use (days of therapy per 1000 patient-days; secondary outcomes included overall antibiotic use, gram-negative bacterial susceptibility, nosocomial Clostridium difficile infections, length of stay, and mortality. RESULTS:The mean monthly broad-spectrum antibiotic use decreased from 644 days of therapy per 1,000 patient-days in the preintervention period to 503 days of therapy per 1,000 patient-days in the postintervention period (P < .0001); time series modeling confirmed an immediate decrease (± standard error) of 119 ± 37.9 days of therapy per 1,000 patient-days (P = .0054). In contrast, no changes were identified in the use of broad-spectrum antibiotics in the control group (nonintervention medical and surgical wards) or in the use of control medications in critical care (stress ulcer prophylaxis). The incidence of nosocomial C. difficile infections decreased from 11 to 6 cases in the study intensive care units, whereas the incidence increased from 87 to 116 cases in the control wards (P = .04). Overall gram-negative susceptibility to meropenem increased in the critical care units. Intensive care unit length of stay and mortality did not change. CONCLUSIONS:Institution of a formal prospective audit and feedback program appears to be a safe and effective means to improve broad-spectrum antimicrobial use in critical care.
journal_name
Infect Control Hosp Epidemioljournal_title
Infection control and hospital epidemiologyauthors
Elligsen M,Walker SA,Pinto R,Simor A,Mubareka S,Rachlis A,Allen V,Daneman Ndoi
10.1086/664757subject
Has Abstractpub_date
2012-04-01 00:00:00pages
354-61issue
4eissn
0899-823Xissn
1559-6834journal_volume
33pub_type
杂志文章abstract:BACKGROUND:The role of coagulase-negative staphylococci (CNS) in bacteremias continues to be controversial. Until the 1970s, CNS were mostly recognized as contaminants, being part of the cutaneous flora. Since then, several studies have reported increasing incidence and severity of infections due to CNS. PURPOSE:To re...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章,评审
doi:10.1086/647878
更新日期:1998-08-01 00:00:00
abstract::An outbreak of central venous catheter-associated bloodstream infections was reported in a hospital in Ecuador. Commercially produced ampoules of water for injection were found to be contaminated with Burkholderia cepacia and Myroides odoratus. Removal of these ampoules yielded a 10-fold reduction in the incidence of ...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/533543
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVE:Prevalence of multidrug-resistant (MDR) gram-negative (GN) bacteria is increasing globally and is complicated by patient movement between acute and long-term care facilities (LTCFs). In Asia, the contribution of LTCFs as a source of MDR GN infections is poorly described. We aimed to define the association bet...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/675823
更新日期:2014-05-01 00:00:00
abstract:BACKGROUND:The diagnosis of central line-associated bloodstream infections (CLABSIs) is often controversial, and existing guidelines differ in important ways. OBJECTIVE:To determine both the range of practices involved in obtaining blood culture samples and how central line-associated infections are diagnosed and to o...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/667379
更新日期:2012-09-01 00:00:00
abstract::A series of handwashing experiments using a pigskin substrate and Serratia marcescens as the contaminant compared the residual activity of a chlorhexidine detergent handwash product alone and in combination with anionic and nonionic-based moisturizing products and surfactant systems. The anionic based moisturizing pro...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/646124
更新日期:1990-02-01 00:00:00
abstract:OBJECTIVE:To identify risk factors for surgical site infection (SSI) due to methicillin-resistant Staphylococcus aureus (MRSA). DESIGN:Prospective case-control study. SETTING:One tertiary and 6 community-based institutions in the southeastern United States. METHODS:We compared patients with SSI due to MRSA with 2 co...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/590124
更新日期:2008-09-01 00:00:00
abstract::OBJECTIVE To define how often methicillin-resistant Staphylococcus aureus (MRSA) is spread from resident to resident in long-term care facilities using whole-genome sequencing DESIGN Prospective cohort study SETTING A long-term care facility PARTICIPANTS Elderly residents in a long-term care facility METHODS Cultures ...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1017/ice.2016.41
更新日期:2016-06-01 00:00:00
abstract::From 2000 to 2009, rates of multidrug-resistant Acinetobacter baumanii increased 10-fold to 0.2 per 1,000 patient days. From 2010 to 2015, however, rates markedly declined and have stayed below 0.05 per 1,000 patient days. Herein, we present a 15-year trend analysis and discuss interventions that may have led to the d...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1017/ice.2018.52
更新日期:2018-05-01 00:00:00
abstract::We assess the impact of revised International Classification of Diseases, Ninth Revision, codes on methicillin-resistant Staphylococcus aureus burden in California hospitals. Codes were rapidly adopted, demonstrating new capture of colonization and continued relatively stable capture of infections. Nevertheless, despi...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/673444
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVE:Despite evidence to the contrary, many practitioners continue to inappropriately screen for and treat bacteria in the urine of clinically asymptomatic patients. The purpose of this study was to evaluate the impact of a new order set on the number of urine culture performed, antibiotic days of therapy (DOT), c...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1017/ice.2020.37
更新日期:2020-05-01 00:00:00
abstract::This article is the first in a two-part series discussing and illustrating the application of statistical process control (SPC) to processes often examined by hospital epidemiologists. The basic philosophical and theoretical foundations of statistical quality control and their relation to epidemiology are emphasized i...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章,评审
doi:10.1086/647795
更新日期:1998-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the incidence of nosocomial bacteremias related to the use of non-impregnated central venous catheters (CVCs) when only non-technologic strategies were used to prevent them. DESIGN:This was a prospective study of infectious complications of CVCs placed in intensive care unit (ICU) patients from A...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/502461
更新日期:2004-08-01 00:00:00
abstract:OBJECTIVE:To describe the epidemiology and spread of methicillin-resistant Staphylococcus aureus (MRSA) in three tertiary-care centers in Ottawa, Ontario, Canada, where MRSA is encountered infrequently. DESIGN:Retrospective review over a 6-year period, from January 1, 1990, through December 31, 1995. SETTING:Three te...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/647838
更新日期:1998-06-01 00:00:00
abstract:OBJECTIVE:In 2002, the Chicago Department of Public Health (CDPH; Chicago, Illinois) convened the Chicago-Area Neonatal MRSA Working Group (CANMWG) to discuss and compare approaches aimed at control of methicillin-resistant Staphylococcus aureus (MRSA) in neonatal intensive care units (NICUs). To better understand thes...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/501216
更新日期:2006-02-01 00:00:00
abstract::We quantified the time burden of alcohol-based handrub accompanying nonsterile-glove use among emergency physicians, through observation in controlled and clinical settings. We report gloving episodes per hour, gloving times with and without handrub, and handrub recommendations compliance. Handrub adds 46 seconds to e...
journal_title:Infection control and hospital epidemiology
pub_type: 临床试验,杂志文章
doi:10.1086/668781
更新日期:2013-01-01 00:00:00
abstract::Vancomycin is a commonly prescribed empiric antibiotic used when methicillin-resistant Staphylococcus aureus (MRSA) infection is suspected. In this study, we aimed to determine the rate of culture-positive infection requiring vancomycin therapy. ...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1017/ice.2018.123
更新日期:2018-08-01 00:00:00
abstract:OBJECTIVE:To devise a system for surveying the frequency of nosocomial infections in a tertiary care hospital in a developing country. DESIGN:Prospective selective surveillance by nurses of the charts of patients at high risk for nosocomial infections, as identified by a form completed by resident physicians. The sens...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/646715
更新日期:1993-04-01 00:00:00
abstract::This study was designed to test the efficacy of a washer-disinfector in eliminating selected healthcare-associated pathogens from surgical instruments. Our results showed that a washer-disinfector was extremely effective in eliminating microorganisms (>7-log(10) reduction), including vegetative and spore-forming bacte...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/676867
更新日期:2014-07-01 00:00:00
abstract::OBJECTIVE To elicit expert consensus on the likelihood of infectious outcomes (patient colonization or infection) following a broad range of infectious risk moments (IRMs) from observations in acute care. DESIGN Expert consensus study using modified Delphi technique. PARTICIPANTS Panel of 40 international experts incl...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1017/ice.2017.327
更新日期:2018-03-01 00:00:00
abstract::We report on COVID-19 risk among HCWs exposed to a patient diagnosed with COVID-19 on day 13 of hospitalization. There were 44 HCWs exposed to the patient before contact and droplet precautions were implemented: of these, 2 of 44 (5%) developed COVID-19 potentially attributable to the exposure. ...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1017/ice.2020.256
更新日期:2020-09-01 00:00:00
abstract::Surveillance for methicillin-resistant Staphylococcus aureus (MRSA) was implemented in Rio de Janeiro and Uberlândia University Hospitals, which had different policies on use of mupirocin. One hundred fourteen multiresistant MRSA strains were isolated from 62 patients. Mupirocin resistance was observed in 63% of strai...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:
更新日期:1996-12-01 00:00:00
abstract:OBJECTIVE:Flash sterilization is most commonly used for emergency sterilization of unwrapped items in a gravity displacement sterilizer for three minutes. Sterilization quality assurance is monitored by biological indicators that require a 24-hour incubation prior to reading. In this study, we compared a new biological...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/646767
更新日期:1993-07-01 00:00:00
abstract::An outbreak of invasive Mycobacterium chimaera infections associated with heater-cooler devices (HCDs) has now affected patients in several countries on different continents. Clinical infections are characterized by delayed diagnosis, inadequate treatment response to antimicrobial agents, and poor prognosis. Outbreak ...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章,评审
doi:10.1017/ice.2016.283
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Peripheral venous catheters (PVCs) can be associated with serious infectious complications. We evaluated the effect of education and feedback on process measures to improve PVC care and infectious complications. DESIGN:Quasi-experimental controlled crossover study with sampling before and aft...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章,随机对照试验
doi:10.1086/665322
更新日期:2012-05-01 00:00:00
abstract:OBJECTIVES:To determine whether hepatitis B virus (HBV) transmission occurred among patients visiting a physician's office and to evaluate potential transmission mechanisms. DESIGN:Serologic survey, retrospective cohort study, and observation of infection control practices. SETTING:Private medical office. PATIENTS:T...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/502612
更新日期:2005-09-01 00:00:00
abstract::Due to the rapid transfer of patients from the acute-care setting, the intensity of nursing care among residents in long-term-care facilities (LTCFs) has increased, transforming today's LTCFs into subacute healthcare facilities. Given the increased risk of infection among residents in LTCFs and the associated morbidit...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/501581
更新日期:1999-11-01 00:00:00
abstract::In a cross-sectional study of Thai medical students, we compared the seroprevalence of antibody to measles virus, rubella virus, varicella zoster virus, hepatitis A virus, and hepatitis B virus with self-reports of prior infection or vaccination. Self-report predicted immunity to varicella zoster virus only. These dat...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/597508
更新日期:2009-06-01 00:00:00
abstract:UNLABELLED:OBJECTIVE. To determine the impact of known observers on hand hygiene performance in inpatient care units with differing baseline levels of hand hygiene compliance. DESIGN:Observational study. SETTING:Three inpatient care units, selected on the basis of past hand hygiene performance, in a hospital where ha...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/595692
更新日期:2009-03-01 00:00:00
abstract::The impact of US-style infection control programs is global. There are many Asian countries that have translated US-style infection control programs into their own programs, but reports of those efforts are rarely published in English. This article describes the development of infection control in Taiwan and the devel...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/647126
更新日期:1995-06-01 00:00:00
abstract:OBJECTIVE:To explore how hand hygiene observer scheduling influences the number of events and unique individuals observed. DESIGN:We deployed a mobile sensor network to capture detailed movement data for 6 categories of healthcare workers over a 2-week period. SETTING: University of Iowa Hospital and Clinic medical ...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/666346
更新日期:2012-07-01 00:00:00