American journal of infection control
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Outpatient prescriptions comprise 60% of antibiotic use. This study prospectively identified inappropriate antibiotic use enabling a focused approach to outpatient antimicrobial stewardship. ⋯ Poor antibiotic prescribing was found in the outpatient setting. This study identifies areas for improvement via stewardship.
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Am J Infect Control · Jul 2019
Risk factors for ventilator-associated events: A prospective cohort study.
In January 2013, the Centers for Disease Control and Prevention released new surveillance definitions for ventilator-associated event (VAE) to replace ventilator-associated pneumonia (VAP) in adult patients. VAEs are associated with prolonged mechanical ventilation and hospital death, but little is known about their risk factors and how best to prevent them. ⋯ Positive daily fluid balances of ≥50 mL, sedatives administered, and gastric retention of ≥200 mL are risk factors for VAEs. Intervention studies are needed to determine if targeting these risk factors can lower VAE rates.
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Am J Infect Control · Jul 2019
Meta AnalysisChest physiotherapy for the prevention of ventilator-associated pneumonia: A meta-analysis.
Ventilator-associated pneumonia (VAP) remains a frequent and severe complication in mechanically ventilated patients. We undertook a meta-analysis to evaluate the efficacy of chest physiotherapy (CPT) for the prevention of VAP. ⋯ CPT may not significantly reduce the incidence of VAP and alter other important clinical outcomes in adult patients receiving mechanical ventilation. However, the results should be interpreted cautiously owing to the heterogeneity and the limited trials. Further large-scale, well-designed randomized controlled trials are needed.
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Am J Infect Control · Jul 2019
Reducing blood culture contamination using an initial specimen diversion device.
False positive blood cultures result from contamination, consuming laboratory resources and causing unnecessary antibiotic treatment and prolonged hospital stay. Skin disinfection reduces contamination; however, bacteria colonizing human skin are also found in tissues deep into the skin surface. A diversion device diverts the initial 1-2 mL of blood to remove any potentially contaminated skin plug. This study investigates the effect of the device on culture contamination in hospitalized patients. ⋯ The use of a diversion device was associated with reduced culture contamination in hospitalized patients over a 6-month period, without concomitant reduction in true-positive cultures. This intervention may result in a reduction in costs, antibiotic use, and duration of hospital stay.
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Application of antiseptic products to the skin plays an important role in prevention of a variety of health care-associated infections. Preoperative bathing or showering is widely recommended to reduce the risk of surgical site infections. Evidence of the impact of this measure on surgical site infection rates is mixed, and further prospective trials comparing standardized protocols for showering with plain soap or chlorhexidine gluconate (CHG)-containing soap, or bathing with 2% CHG-impregnated cloths are needed to establish the most effective approach. ⋯ Antiseptics are applied to the skin for a variety of purposes in health care. Common scenarios in which topical antiseptics are used include preoperative bathing, surgical site preparation, surgical hand hygiene, daily bathing of intensive care unit patients, and prevention of intravascular catheter-associated BSI. The purpose of this article is to review recent evidence regarding the best products for skin antisepsis.