American journal of infection control
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Am J Infect Control · Jan 2018
Hospital Acquired Pneumonia Prevention Initiative-2: Incidence of nonventilator hospital-acquired pneumonia in the United States.
Because nonventilator hospital-acquired pneumonia (NV-HAP) is understudied, our purpose was to determine the incidence, overall burden, and level of documented pneumonia preventive interventions of NV-HAP in 24 U.S. hospitals. ⋯ This multicenter, nationwide study highlights the significant burden of NV-HAP in the U.S. acute care hospital setting. We found that NV-HAP occurred on every hospital unit, including in younger, healthy patients. This indicates that although some patients are clearly at higher risk, all patients carry some NV-HAP risk. Therapeutic interventions aimed at NV-HAP prevention are frequently not provided for patients in acute care hospitals.
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Am J Infect Control · Dec 2017
Successful strategy to decrease indwelling catheter utilization rates in an academic medical intensive care unit.
Duration of indwelling urinary catheterization is an important risk factor for urinary tract infections. We devised a strategy to decrease the utilization of indwelling urinary catheters (IUCs). We also highlight the challenges of managing critically ill patients without IUCs and demonstrate some of the initiatives that we undertook to overcome these challenges. ⋯ Our interventions demonstrated that aggressive and comprehensive IUC restriction protocol and provider training can lead to a successful decrease in IUC use, leading to a lower IUC utilization ratio and CAUTI rate in a large complex academic ICU setting.
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Am J Infect Control · Nov 2017
Effects of contact time and concentration on bactericidal efficacy of 3 disinfectants on hard nonporous surfaces.
This study investigated the influence of contact time and concentration on bactericidal efficacy of 3 types of disinfectants (accelerated hydrogen peroxide [AHP], quaternary ammonium compounds [Quats], and sodium hypochlorite) on stainless steel surfaces using Environmental Protection Agency procedure MB-25-02. We found that bactericidal efficacy was not reduced at contact times or concentrations immediate lower than label use values, but all 3 disinfectants were significantly less bactericidal at significantly lower than label use contact times and concentrations. Overall, the bactericidal efficacy of the sodium hypochlorite disinfectant was most tolerant to the decreases of contact times and concentrations, followed closely by AHP disinfectant, and Quat disinfectant was most affected by contact time and concentration.
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Am J Infect Control · Nov 2017
Working at the intersection of context, culture, and technology: Provider perspectives on antimicrobial stewardship in the emergency department using electronic health record clinical decision support.
Antibiotic stewardship programs (ASPs) have not been fully developed for the emergency department (ED), in part the result of the barriers characteristic of this setting. Electronic health record-based clinical decision support (EHR CDS) represents a promising strategy to implement ASPs in the ED. We aimed to determine the cultural beliefs and structural barriers and facilitators to implementation of antimicrobial stewardship in the pediatric ED using EHR CDS. ⋯ Developing a successful ED-based ASP using EHR CDS should attend to technologic needs, the institutional context, and the cultural beliefs of practice associated with providers' antibiotic prescribing.
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Am J Infect Control · Oct 2017
ReviewImplementation in the midst of complexity: Using ethnography to study health care-associated infection prevention and control.
Contextual factors associated with health care settings make reducing health care-associated infections (HAIs) a complex task. The aim of this article is to highlight how ethnography can assist in understanding contextual factors that support or hinder the implementation of evidence-based practices for reducing HAIs. ⋯ Ethnography is well-suited for HAI prevention, especially video-reflexive ethnography, for activating patients and clinicians in infection control work. In this era of increasing pressure to reduce HAIs within complex work systems, ethnographic methods can promote understanding of contextual factors and may expedite translation evidence to practice.