Assessing the status of infection control programs in small rural hospitals in the western United States

Demographic-based disparities in outcomes for adults with central line-associated bloodstream infections in the United States: a National Inpatient Sample database study (2016-2020)

Introduction

Central line-associated bloodstream infections (CLABSI) are prevalent and preventable hospital-acquired infections associated with high morbidity and costs. Disparities based on race, ethnicity, and hospital factors remain underexplored. This study compares cost, length of stay, and mortality for adults with CLABSI by race-ethnicity, hospital location-teaching status, and geographic region in the United States using data from the National Inpatient Sample (NIS) database from 2016 to 2020.

Methods

The hospitalization cohort included adults diagnosed with CLABSI, excluding those with primary CLABSI diagnoses, cancer, immunosuppressed states, or neonatal conditions. Primary outcomes were in-hospital mortality, length of stay, and hospital costs, adjusted to mid-year 2020 US dollars. Independent variables included race-ethnicity, hospital location-teaching status, and geographic region. All analyses accounted for NIS sampling design.

Results

From 2016 to 2020, there were approximately 19,835 CLABSI hospitalizations. The overall in-hospital mortality rate was 9.1%, with a median hospital stay of 16.9 days and median cost of $44,810. Hispanic patients experienced significantly higher mortality, longer length of stay, and higher costs compared to non-Hispanic Black and White patients. Urban teaching hospitals had longer stays and higher costs than rural and urban non-teaching hospitals. Regionally, the Northeast and West had higher costs and longer stays than the Midwest and South, but mortality rates did not differ significantly.

Conclusion

This study highlights significant disparities in CLABSI outcomes based on demographic factors. Addressing these disparities is crucial for improving CLABSI management and healthcare equity. Further research should explore the underlying causes of these differences to inform targeted interventions.

Desempenho dos programas de prevenção e controle de infecções em pequenos hospitais

RESUMO Objetivo Avaliar a conformidade de estrutura e processo dos programas de prevenção e controle de infecções relacionadas à assistência à saúde. Método Estudo prospectivo, transversal, realizado de 2015 a 2016, em pequenos hospitais de até 70 leitos de uma região do estado de São Paulo. Foram avaliados 4 indicadores previamente validados, expressos em índice de conformidade (porcentagem em relação aos itens avaliados). Resultados Dentre os 27 hospitais recrutados, 14 consentiram em participar. Os valores médios de conformidade para cada indicador foram: Estrutura dos programas 61,0%; Diretrizes operacionais 84,5%; Vigilância epidemiológica 57,9%; Atividades de prevenção 74,5%. Maior conformidade foi observada em hospitais privados (73,9%) e com presença de unidade de terapia intensiva (90,3%). Os hospitais possuíam enfermeiros designados para o programa (92,9%), mas somente 23,1% das instituições privadas atuavam com dedicação exclusiva de seis horas. Conclusão Apenas o indicador referente às Diretrizes Operacionais dos programas avaliados esteve acima de 90% de conformidade na mediana dos hospitais. A maior dispersão dos resultados de conformidade entre os hospitais estudados foi referente ao indicador de Vigilância Epidemiológica.

Organisation and governance of infection prevention and control in Australian residential aged care facilities: A national survey

BACKGROUND

Individuals in residential and aged care facilities (RACFs) are at risk of developing health care-associated infections (HAIs) due to factors such as age-related changes in physiology, immunity, comorbid illness and functional disability. The recent establishment of an Australian Royal Commission into the Quality of Residential and Aged Care Services highlights the challenges of providing care in this sector. This national study identified infection prevention and control (IPC) services, practice and priorities in Australian RACFs.

METHODS

A cross-sectional study of 158 Australian RACFs comprising a 42-question survey incorporating five key domains relating to IPC namely governance, education, practice, surveillance, competency and capability was undertaken in 2018.

RESULTS

Of the 131 respondents, the majority 92.4% of respondents reported having a documented IPC program, 22.9% (n = 30) operated with a dedicated infection control committee The majority of RACFs reported lacking specialist and qualified experienced IPC professionals (n = 67). The majority of RACFs (90.1%, n = 118) reported the existence of a designated employee with IPC responsibilities. Of these 118 staff members with IPC responsibilities, 42.5% had a qualification in IPC. The reported average funded hours per month for IPC professional or an external provider of IPC activities was 14 (95% CI 9.6-18.9 h).

CONCLUSION

The overwhelming majority of RACFs deliver IPC services and report doing so in ways that meet the needs of their own specific contexts in the absence of the lack of formal guidelines when compared to the hospital sector. Quality residential and aged care free from HAIs requires formal structure and organization strategies.

Risk factors for neonatal group B streptococcus vertical transmission: a prospective cohort study of 1815 mother-baby pairs

BACKGROUND

The potential factors associated with group B streptococcus (GBS) vertical transmission have not been studied in detail.

STUDY DESIGN

A prospective cohort study was conducted to recruit 1815 mother-neonate pairs for GBS analysis. Pearson's chi-squared tests and generalized linear models were used to explore the risk factors for neonatal GBS colonization.

RESULTS

The rate of GBS vertical transmission was 14.1%. GBS colonization in all neonates was significantly associated with maternal GBS colonization, mode of delivery, episiotomy, number of prenatal vaginal exams, parity, and hypertension. For neonates born to GBS-positive mothers, GBS vertical transmission was associated with the mode of delivery, episiotomy, and sexually transmitted diseases. For neonates born to GBS-negative mothers, neonatal GBS colonization was associated with the number of prenatal vaginal exams, parity, and hypertension.

CONCLUSION

These findings suggest the need for prenatal GBS screening for pregnant women and intrapartum antimicrobial prophylaxis for GBS-colonized women.

Characteristics of antimicrobial stewardship programmes in rural East Texas hospitals

INTRODUCTION

Antimicrobial stewardship programmes (ASPs) serve as the primary method to prevent and manage the development of antimicrobial resistance. Rural settings may lack the recommended personnel and resources needed to provide antimicrobial stewardship services.

METHODS

An electronic survey was distributed via e-mail to pharmacy directors or antimicrobial stewardship programme directors of licensed hospitals within Public Health Region 4/5N of East Texas.

RESULTS

Sixty percent of ASPs were established <12 months prior to the survey administration. All ASPs had pharmacist involvement, with only one (5%) having formal infectious diseases (ID) training through postgraduate education. Ninety percent of ASPs had a physician champion, with five (27.8%) physicians having formal ID training. Most institutions lacked one or more recommended antimicrobial stewardship practices. When compared with ASPs established for <12 months, ASPs existing for at least 12 months were more likely to have protocols to change antimicrobials from intravenous to enteral forms (100% vs 50%, P = 0.042), provide education to patients and families on appropriate antimicrobial use (87.5% vs 33.3%, P = 0.028), and track antimicrobial purchasing costs (87.5% vs 33.3%, P = 0.028).

CONCLUSIONS

Institutions in rural settings require additional resources, personnel, and time to implement ASPs and perform various antimicrobial stewardship practices.

Molecular characteristics of Streptococcus agalactiae in a mother-baby prospective cohort study: Implication for vaccine development and insights into vertical transmission

BACKGROUND

Streptococcus agalactiae (GBS) is a leading cause of neonatal sepsis and meningitis in many countries. This study aimed to determine the molecular characteristics of GBS colonized in mothers and their infants so as to provide implication for vaccine strategies and confirm vertical transmission.

METHODS

A prospective cohort study was conducted to recruit 1815 mother-neonate pairs. All GBS isolates from pregnant women and her infants were tested for serotypes, multilocus sequence types and virulence genes. The relationship between multiple molecular characteristics of GBS isolates was tested by the correspondence analysis, and the agreement between mother-neonate paired data in molecular characteristics was analyzed using Kappa tests.

RESULTS

The predominant serotypes were III, Ia and V, and the most prevalent sequence types (STs) were ST19, ST17, ST10, and ST12. All isolates carried at least one pilus island (PI). The most common combination of PIs was PI-2b alone, followed by PI-1+PI-2a and PI-2a alone, and the most prevalent alpha-like protein (alp) genes were rib, epsilon and alphaC. Moreover, a strong relationship was noted between STs, serotypes, alp genes and PIs, including ST17 associated with serotype-III/rib/PI-2b, ST19 with serotype-III/rib/PI-1+PI-2a, and ST485 with serotype-Ia/epsilon/PI-2b. The rate of GBS vertical transmission was 14.1%, and the kappa test revealed good agreement in multiple molecular characteristics among GBS-positive mother-neonate pairs. Notably, the switching of molecular characteristics was found during vertical transmission.

CONCLUSIONS

Our findings underscore the value of monitoring multiple molecular characteristics so as to provide implication for multivalent strategies and gain insights into GBS vertical transmission and vertical characteristic switching.

Exploring the context for effective clinical governance in infection control

BACKGROUND

Effective clinical governance is necessary to support improvements in infection control. Historically, the focus has been on ensuring that infection control practice and policy is based on evidence, and that there is use of surveillance and auditing for self-regulation and performance feedback. There has been less exploration of how contextual and organizational factors mediate an infection preventionists (IP's) ability to engage with evidence-based practice and enact good clinical governance.

METHODS

A cross sectional Web-based survey of IPs in Australia and New Zealand was undertaken. Questions focused on engagement in evidence-based practice and perceptions about the context, culture, and leadership within the infection control team and organization. Responses were mapped against dimensions of Scally and Donaldson's clinical governance framework.

RESULTS

Three hundred surveys were returned. IPs appear well equipped at an individual level to undertake evidence-based practice. The most serious set of perceived challenges to good clinical governance related to a lack of leadership or active resistance to infection control within the organization. Additional challenges included lack of information technology solutions and poor access to specialist expertise and financial resources.

CONCLUSIONS

Focusing on strengthening contextual factors at the organizational level that otherwise undermine capacity to implement evidence-based practice is key to sustaining current infection control successes and promoting further practice improvements.

Credentialing of Australian and New Zealand infection control professionals: An exploratory study

BACKGROUND

Despite evidence from overseas that certification and credentialing of infection control professionals (ICPs) is important to patient outcomes, there are no standardized requirements for the education and preparation of ICPs in Australia. A credentialing process (now managed by the Australasian College of Infection Prevention and Control) has been in existence since 2000; however, no evaluation has occurred.

METHODS

A cross-sectional study design was used to identify the perceived barriers to credentialing and the characteristics of credentialed ICPs.

RESULTS

There were 300 responses received; 45 (15%) of participants were credentialed. Noncredentialed ICPs identified barriers to credentialing as no employer requirement and no associated remuneration. Generally credentialed ICPs were more likely to hold higher degrees and have more infection control experience than their noncredentialed colleagues.

CONCLUSIONS

The credentialing process itself may assist in supporting ICP development by providing an opportunity for reflection and feedback from peer review. Further, the process may assist ICPs in being flexible and adaptable to the challenging and ever-changing environment that is infection control.

Hospital infection control units: staffing, costs, and priorities

BACKGROUND

This article describes infection prevention and control professionals' (ICPs') staffing levels, patient outcomes, and costs associated with the provision of infection prevention and control services in Australian hospitals. A secondary objective was to determine the priorities for infection control units.

METHODS

A cross-sectional study design was used. Infection control units in Australian public and private hospitals completed a Web-based anonymous survey. Data collected included details about the respondent; hospital demographics; details and services of the infection control unit; and a description of infection prevention and control-related outputs, patient outcomes, and infection control priorities.

RESULTS

Forty-nine surveys were undertaken, accounting for 152 Australian hospitals. The mean number of ICPs was 0.66 per 100 overnight beds (95% confidence interval, 0.55-0.77). Privately funded hospitals have significantly fewer ICPs per 100 overnight beds compared with publicly funded hospitals (P < .01). Staffing costs for nursing staff in infection control units in this study totaled $16,364,392 (mean, $380,566). Infection control units managing smaller hospitals (<270 beds) identified the need for increased access to infectious diseases or microbiology support.

CONCLUSION

This study provides valuable information to support future decisions by funders, hospital administrators, and ICPs on service delivery models for infection prevention and control. Further, it is the first to provide estimates of the resourcing and cost of staffing infection control in hospitals at a national level.

Healthcare-associated pathogens and nursing home policies and practices: results from a national survey

OBJECTIVE To examine the prevalence of healthcare-associated pathogens and the infection control policies and practices in a national sample of nursing homes (NHs). METHODS In 2012, we conducted a national survey about the extent to which NHs follow suggested infection control practices with regard to 3 common healthcare-associated pathogens: methicillin-resistant Staphylococcus aureus, Clostridium difficile, and extended-spectrum β-lactamase producers, and their prevalence in NHs. We adapted a previously used and validated NH infection control survey, including questions on prevalence, admission and screening policies, contact precautions, decolonization, and cleaning practices. RESULTS A total of 1,002 surveys were returned. Of the responding NHs, 14.2% were less likely to accept residents with methicillin-resistant Staphylococcus aureus, with the principal reason being lack of single or cohort rooms. NHs do not routinely perform admission screening (96.4%) because it is not required by regulation (56.2%) and would not change care provision (30.7%). Isolation strategies vary substantially, with gloves being most commonly used. Most NHs (75.1%) do not decolonize carriers of methicillin-resistant Staphylococcus aureus, but some (10.6%) decolonize more than 90% of residents. Despite no guidance on how resident rooms on contact precautions should be cleaned, 59.3% of NHs report enhanced cleaning for such rooms. CONCLUSION Overall, NHs tend to follow voluntary infection control guidelines only if doing so does not require substantial financial investment in new or dedicated staff or infrastructure.

Expanding Roles of Healthcare Epidemiology and Infection Control in Spite of Limited Resources and Compensation

Objective.

Data on the resources and staff compensation of hospital epidemiology and infection control (HEIC) departments are limited and do not reflect current roles and responsibilities, including the public reporting of healthcare-associated infections. This study aimed to obtain information to assist HEIC professionals in negotiating resources.

Methods.

A 28-question electronic survey was sent via e-mail to all Society for Healthcare Epidemiology of America (SHEA) members in October 2006 with the use of enterprise feedback management solution software. The survey responses were analyzed using Microsoft Excel.

Results.

Responses were received from 526 (42%) of 1,255 SHEA members. Of the respondents, 84% were doctors of medicine (MDs) or doctors of osteopathy (DOs), 6% were registered nurses, and 21% had a master of public health or master of science degree. Sixty-two percent were male (median age range, 50-59 years). Their practice locations varied across the United States and internationally. Two-thirds of respondents practiced in a hospital setting, and 63% were the primary or associate hospital epidemiologist. Although 91% provided HEIC services, only 65% were specifically compensated. In cases of antimicrobial management, patient safety, employee health, and emergency preparedness, 75%-80% of respondents provided expertise but were compensated in less than 25% of cases. Of the US-based MD and DO respondents, the median range of earnings was $151,000-$200,000, regardless of their region (respondents selected salary ranges instead of specifying their exact salaries). Staffing levels varied: the median number of physician full-time equivalents (FTEs) was 1.0 (range, 1-5); only about 25% of respondents had 3 or more infection control practitioner FTEs.

Conclusions.

Most professionals working in HEIC have had additional training and provide a wide, growing range of services. In general, only traditional HEIC work is compensated and at levels much less than the time dedicated to those services. Most HEIC departments are understaffed. These data are essential to advocate for needed funding and resources as the roles of HEIC departments expand.

Infection prevention needs assessment in Colorado hospitals: rural and urban settings

BACKGROUND

The purpose of our study was to conduct a needs assessment for infection prevention programs in both rural and urban hospitals in Colorado.

METHODS

Infection control professionals (ICPs) from Colorado hospitals participated in an online survey on training, personnel, and experience; ICP time allocation; and types of surveillance. Responses were evaluated and compared based on hospital status (rural or urban). Additionally, rural ICPs participated in an interview about resources and training.

RESULTS

Surveys were received from 62 hospitals (77.5% response); 33 rural (75.0% response) and 29 urban (80.6% response). Fifty-two percent of rural ICPs reported multiple job responsibilities compared with 17.2% of urban ICPs. Median length of experience for rural ICPs was 4.0 years compared with 11.5 years for urban ICPs (P = .008). Fifty-one percent of rural ICPs reported no access to infectious disease physicians (0.0% urban) and 81.8% of rural hospitals reported no antimicrobial stewardship programs (31.0% urban). Through the interviews it was revealed that priorities for rural ICPs were training and communication.

CONCLUSIONS

Our study revealed numerous differences between infection prevention programs in rural versus urban hospitals. An infection prevention outreach program established in Colorado could potentially address the challenges faced by rural hospital infection prevention departments.

Infection control interventions in small rural hospitals with limited resources: results of a cluster-randomized feasibility trial

Background

There are few reports on the feasibility of conducting successful infection control (IC) interventions in rural community hospitals.

Methods

Ten small rural community hospitals in Idaho and Utah were recruited to participate in a cluster-randomized trial of multidimensional IC interventions to determine their feasibility in the setting of limited resources. Five hospitals were randomized to develop individualized campaigns to promote HH, isolation compliance, and outbreak control. Five hospitals were randomized to continue with current IC practices. Regular blinded observations of hand hygiene (HH) compliance were conducted in all hospitals as the primary outcome measure. Additionally, periodic prevalence studies of patient colonization with resistant pathogens were performed. The 5-months intervention time period was compared to a 4-months baseline period, using a multi-level logistic regression model.

Results

The intervention hospitals implemented a variety of strategies. The estimated average absolute change in “complete HH compliance” in intervention hospitals was 20.1% (range, 7.8% to 35.5%) compared to −3.1% (range −6.3% to 5.9%) in control hospitals (p = 0.001). There was an estimated average absolute change in “any HH compliance” of 28.4% (range 17.8% to 38.2%) in intervention hospitals compared to 0.7% (range −16.7 to 20.7%) in control hospitals (p = 0.010). Active surveillance culturing demonstrated an overall prevalence of MRSA carriage of 9.7%.

Conclusions

A replicable intervention significantly improved hand hygiene as a primary outcome measure despite barriers of geographic distance and lack of experience with study protocols. Active surveillance culturing identified unsuspected reservoirs of MRSA colonization and further promoted IC activity.

Prevention of Clostridium difficile infection in rural hospitals

BACKGROUND

Prevention of Clostridium difficile infection (CDI) remains challenging across the spectrum of health care. There are limited data on prevention practices for CDI in the rural health care setting.

METHODS

An electronic survey was administered to 21 rural facilities in Wisconsin, part of the Rural Wisconsin Health Cooperative. Data were collected on hospital characteristics and practices to prevent endemic CDI.

RESULTS

Fifteen facilities responded (71%). Nearly all respondent facilities reported regular use of dedicated patient care items, use of gown and gloves, private patient rooms, hand hygiene, and room cleaning. Facilities in which the infection preventionist thought the support of his/her leadership to be "Very good" or "Excellent" employed significantly more CDI practices (13.3 ± 2.4 [standard deviation]) compared with infection preventionists who thought there was less support from leadership (9.8 ± 3.0, P = .033). Surveillance for CDI was highly variable. The most frequent barriers to implementation of CDI prevention practices included lack of adequate resources, lack of a physician champion, and difficulty keeping up with new recommendations.

CONCLUSION

Although most rural facilities in our survey reported using evidence-based practices for prevention of CDI, surveillance practices were highly variable, and data regarding the impact of these practices on CDI rates were limited. Future efforts that correlate CDI prevention initiatives and CDI incidence will help develop evidence-based practices in these resource-limited settings.

State of infection prevention in US hospitals enrolled in the National Health and Safety Network

BACKGROUND

This report provides a national cross-sectional snapshot of infection prevention and control programs and clinician compliance with the implementation of processes to prevent health care-associated infections (HAIs) in intensive care units (ICUs).

METHODS

All hospitals, except Veterans Affairs hospitals, enrolled in the National Healthcare Safety Network (NHSN) were eligible to participate. Participation involved completing a survey assessing the presence of evidence-based prevention policies and clinician adherence and joining our NHSN research group. Descriptive statistics were computed. Facility characteristics and HAI rates by ICU type were compared between respondents and nonrespondents.

RESULTS

Of the 3,374 eligible hospitals, 975 provided data (29% response rate) on 1,653 ICUs, and there were complete data on the presence of policies in 1,534 ICUs. The average number of infection preventionists (IPs) per 100 beds was 1.2. Certification of IP staff varied across institutions, and the average hours per week devoted to data management and secretarial support were generally low. There was variation in the presence of policies and clinician adherence to these policies. There were no differences in HAI rates between respondents and nonrespondents.

CONCLUSIONS

Guidelines for IP staffing in acute care hospitals need to be updated. In future work, we will analyze the associations between HAI rates and infection prevention and control program characteristics, as well as the inplementation of and clinician adherence to evidence-based policies.

Assessment of the quality of publicly reported central line-associated bloodstream infection data in Colorado, 2010

BACKGROUND

Validation of self-reported health care-associated infection data is essential to verify correct understanding of definition criteria, surveillance practices, and reporting integrity. Recent studies have found significant under-reporting of central line-associated bloodstream infections (CLABSI) leading Colorado Department of Public Health and Environment to examine the quality of Colorado's CLABSI data.

METHODS

Trained Colorado Department of Public Health and Environment staff members performed onsite validation visits that included interviews with infection preventionists to assess surveillance practices and retrospective chart reviews of patients with positive blood cultures in specific intensive care units (adult and neonatal) and long-term acute care hospitals during the first quarter of 2010.

RESULTS

Fifty-five CLABSIs from the original sample were identified; 33 (60%) in the adult intensive care unit, 7 (12.7%) in the neonatal intensive care unit, and 15 (27.3%) in the long-term acute care hospital. Of the 55 CLABSIs identified by reviewers, 18 (32.7%) were not reported by the hospitals, 37 CLABSIs (67.3%) were reported correctly into the National Healthcare Safety Network, and 1 CLABSI was over-reported.

CONCLUSIONS

There was wide variation noted in surveillance practices as well as in application of definition criteria. With 33% under-reported cases, it was concluded that ongoing validation of health care-associated infection data is necessary.

Knowledge sharing among healthcare infection preventionists: the impact of public health professionals in a rural state

Background

Healthcare-associated infections are a major source of morbidity and mortality in the United States. Infection Preventionists (IPs) are healthcare workers tasked at overseeing the prevention and control of these infections, but they may have difficulties obtaining up-to-date information, primarily in rural states. The objective of this study was to evaluate the importance of public health involvement on the knowledge-sharing network of IPs in a rural state.

Findings

A total of 95 attendees completed our survey. The addition of public health professionals increased the density of the network, reduced the number of separate components of the network, and reduced the number of key players needed to contact nearly all of the other network members. All network metrics were higher for public health professionals than for IPs without public health involvement.

Conclusions

The addition of public health professionals involved in healthcare infection prevention activities augmented the knowledge sharing potential of the IPs in Iowa. Rural states without public health involvement in healthcare-associated infection (HAI) prevention efforts should consider the potential benefits of adding these personnel to the public health workforce to help facilitate communication of HAI-related information.

Long-term care facilities in Utah: a description of human and information technology resources applied to infection control practice

BACKGROUND

Little is known about the implementation of infection control (IC) programs and information technology (IT) infrastructure in long-term care facilities (LTCFs). We assessed the IC human resources, IT infrastructure, and IC scope of practice at LTCFs in Utah.

METHODS

All LTCFs throughout Utah (n = 80) were invited to complete a written survey in 2005 regarding IC staffing, policies and practices, and IT infrastructure and capacity.

RESULTS

Responses were received from 62 facilities (77.5%). Most infection preventionists (IPs) were registered nurses (71%) with on-the-job training (81.7%). Most had other duties besides their IC work (93.5%), which took up the majority of their time. Most facilities provided desktop computers (96.8%) and all provided Internet access, but some of the infrastructure was not current. A minority (14.5%) used sophisticated software packages to support their IC activities. Less than 20% of the facilities had integrated radiology, diagnostic laboratory, or microbiology data with their facility computer system. The Internet was used primarily as a reference tool (77.4%). Most IPs reported taking responsibility for routine surveillance and monitoring tasks, but a substantial number did not perform all queried tasks. They may have difficulty with feedback of specific unit and physician infection rates (43.2% and 67.7%, respectively).

CONCLUSIONS

Our findings underscore what has previously been reported about LTCFs' IC human resources and IP scope of practice. We also found that some IT infrastructure was outdated, and that existing resources were underutilized for IC purposes.

How to educate health care professionals in developing countries? A Brazilian experience

E-learning is an important tool to bring health care professionals updated information, especially in a large, developing country like Brazil, where teaching resources are limited. It allows the exchange of experiences between professionals, promotes simultaneous knowledge acquisition by a large number of participants, and reaches some remote areas.

The pandemic influenza planning process in Ontario acute care hospitals

BACKGROUND

There will be little time to prepare when an influenza pandemic strikes; hospitals need to develop and test pandemic influenza plans beforehand.

METHODS

Acute care hospitals in Ontario were surveyed regarding their pandemic influenza preparedness plans.

RESULTS

The response rate was 78.5%, and 95 of 121 hospitals participated. Three quarters (76.8%, 73 of 95) of hospitals had pandemic influenza plans. Only 16.4% (12 of 73) of hospitals with plans had tested them. Larger (chi(2) = 6.7, P = .01) and urban hospitals (chi(2) = 5.0, P = .03) were more likely to have tested their plans. 70.4% (50 of 71) Of respondents thought the pandemic influenza planning process was not adequately funded. No respondents were "very satisfied" with the completeness of their hospital's pandemic plan, and only 18.3% were "satisfied."

CONCLUSION

Important challenges were identified in pandemic planning: one quarter of hospitals did not have a plan, few plans were tested, key players were not involved, plans were frequently incomplete, funding was inadequate, and small and rural hospitals were especially disadvantaged. If these problems are not addressed, the result may be increased morbidity and mortality when a virulent influenza pandemic hits.

Factors affecting performance of hospital infection control in Japan

BACKGROUND

In Japan, hospital infection control (IC) programs are frequently underresourced, and their improvement is considered a pressing issue.

METHODS

In 2005, we conducted a questionnaire survey of 638 teaching hospitals (most with 300 or more beds) and 882 nonteaching hospitals (most with fewer than 300 beds) in Japan. We analyzed associations among resources, infrastructures, activities, and performance related to IC.

RESULTS

A total of 423 teaching hospitals (66.3%) and 377 nonteaching hospitals (50.2%) responded to the survey. The teaching hospitals had more IC infrastructure, such as full-time infection control practitioners (ICPs), link nurses, and infection control teams (ICTs), compared with the nonteaching hospitals. Infection surveillance was more likely to be implemented in hospitals with more ICP full-time equivalents (FTEs). IC performance scores were significantly higher in the teaching hospitals than in the nonteaching hospitals. In multivariate analyses, greater IC infrastructure, such as ICP FTEs, full-time IC nurses, and regular ICT rounds were significantly associated with IC performance. Hospital accreditation and hospital size also were significantly associated with higher IC performance scores.

CONCLUSION

Given the strong associations found among IC infrastructure and performance, a new framework for evaluating IC infrastructure and for providing financial support may be effective in enhancing IC programs.

The Certification Board of Infection Control and Epidemiology white paper: the value of certification for infection control professionals

In its Vision 2012: A Strategic Plan, the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) states that APIC will be recognized as the leader in infection prevention and control. However, if the APIC Strategic Plan is to be advanced by its members, infection control professionals must choose a leadership role by becoming certified, validating their competency and setting a standard of excellence. Certification by the Certification Board of Infection Control and Epidemiology, Inc. (CBIC) validates an infection control professional's competence to the public, the profession, employers, and regulators. The White Paper presented here by the CBIC provides a rationale for certification and recertification in infection prevention and control practice.

Reading habits of infection control coordinators in the United States: peer-reviewed or non-peer-reviewed evidence?

BACKGROUND

Because evidence-based health care is taking on increasing importance, we surveyed a national sample of infection control coordinators on their reading habits to discern which and how often various media are utilized.

METHODS

Infection control coordinators at 797 hospitals in the United States were mailed a survey asking which peer-reviewed journals and other publications they subscribe to, their perception of the quality of the infection control articles provided by each, and the extent to which they use various resources for their work.

RESULTS

The survey response rate was 74%. Infection control coordinators spend a mean of 3.6 hours/week reading journals or periodicals. Resources identified as most useful included the Centers for Disease Control and Prevention (CDC) Web site (52%), the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) text (11%), and the APIC e-mail list (8%). Proportion of subscribers was highest for the American Journal of Infection Control (84%) and Infection Control Today (72%). The top 3 journals ranked on a scale of 1 to 10 for quality of infection control articles were Infection Control & Hospital Epidemiology (8.0), the American Journal of Infection Control (7.5), and the New England Journal of Medicine (7.4). The American Journal of Infection Control (85%) and Infection Control & Hospital Epidemiology (72%) were the most frequently used peer-reviewed sources of information, whereas Morbidity and Mortality Weekly Report (85%) and Hospital Infection Control (63%) ranked at the top for non-peer-reviewed periodicals.

CONCLUSION

Infection control coordinators devote limited time to reading and critically appraising published evidence and rely heavily on sources that provide rapid access to information or evidence summaries, suggesting a growing need for easy-to-read, reliable sources of information about evidence-based infection prevention and control practices.

Measurement of infection control department performance: state of the science

BACKGROUND

The Study of the Efficacy of Nosocomial Infection Control (SENIC) conducted in 1975-1976 is the gold standard for judging the resource needs of infection control departments; however, the scope of responsibilities of infection control and the patient populations served have changed dramatically over the last 30 years.

OBJECTIVES

The objective of this paper is to explore the state of the science for performance measurement of infection control departments.

METHODS

A search of English language literature was conducted using the PubMed, Medline, and CINAHL databases. The terms "infection control" and "department" along with the words "performance," "measurement," "staffing," "effectiveness," and "requirements" were used to search for relevant articles. Reference lists of selected articles were also searched for other papers of interest.

RESULTS

Twelve articles were deemed relevant to infection control department performance since the SENIC study. These fell into four main categories: time management studies, expert opinion, outcome studies, and reports about international infection control departments.

CONCLUSION

The SENIC study remains the most thorough assessment of the relationship between infection control department activities and patient outcomes. However, the scope of infection control practice has broadened, and the health care delivery system has changed dramatically since that study was performed. Few new studies have assessed infection control department performance and its relationship to patient outcomes, compliance with accepted standards of patient care, or cost of care. A current assessment of infection control department resources, functions and scope of responsibility linked to patient outcomes and cost is needed to give health care institutions a relevant benchmark for infection control resource needs and the return to be expected from that investment.

Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci in rural communities, western United States

The impact and prevalence of antimicrobial drug resistance in rural community healthcare settings is uncertain. Prospective surveillance in 51 rural hospitals in Idaho and Utah examined the epidemiologic features of clinical cases of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Thirty-two cases of VRE were reported; for 6, the patient had no prior healthcare exposure or coexisting condition. Among the 724 MRSA cases available for evaluation, 405 (56%) were healthcare-associated (HA-MRSA), and 319 (44%) were community-associated (CA-MRSA). The characteristics of HA-MRSA and CA-MRSA patients with coexisting factors were similar, which suggests community transmission of healthcare strains. CA-MRSA cases without coexisting factors, however, demonstrated features previously reported for community strains. MRSA infections were substantially more frequent than VRE in rural communities in the western United States. Based on epidemiologic criteria, a large proportion of MRSA cases were community-associated. CA-MRSA rates were predictive of institutional MRSA rates.