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Boghdadly ZE, Liscynesky C, Lustberg M, Neal A, Dickman J, Choe H. Management of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections (MBI-LCBIs) in Stem Cell Transplant Recipients: A National Survey of Cancer Centers Practices. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kamboj M, Brite J, Aslam A, Kennington J, Babady NE, Calfee D, Furuya Y, Chen D, Augenbraun M, Ostrowsky B, Patel G, Mircescu M, Kak V, Tuma R, Karre TA, Fry DA, Duhaney YP, Moyer A, Mitchell D, Cantu S, Hsieh C, Warren N, Martin S, Willson J, Dickman J, Knight J, Delahanty K, Flood A, Harrington J, Korenstein D, Eagan J, Sepkowitz K. Artificial Differences in Clostridium difficile Infection Rates Associated with Disparity in Testing. Emerg Infect Dis 2019; 24:584-587. [PMID: 29460760 PMCID: PMC5823336 DOI: 10.3201/eid2403.170961] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In 2015, Clostridium difficile testing rates among 30 US community, multispecialty, and cancer hospitals were 14.0, 16.3, and 33.9/1,000 patient-days, respectively. Pooled hospital onset rates were 0.56, 0.84, and 1.57/1,000 patient-days, respectively. Higher testing rates may artificially inflate reported rates of C. difficile infection. C. difficile surveillance should consider testing frequency.
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Sopirala MM, Yahle-Dunbar L, Smyer J, Wellington L, Dickman J, Zikri N, Martin J, Kulich P, Taylor D, Mekhjian H, Nash M, Mansfield J, Pancholi P, Howard M, Chase L, Brown S, Kipp K, Lefeld K, Myers A, Pan X, Mangino JE. Infection control link nurse program: an interdisciplinary approach in targeting health care-acquired infection. Am J Infect Control 2014; 42:353-9. [PMID: 24548456 PMCID: PMC4104989 DOI: 10.1016/j.ajic.2013.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND We describe a successful interdisciplinary liaison program that effectively reduced health care-acquired (HCA), methicillin-resistant Staphylococcus aureus (MRSA) in a university hospital setting. METHODS Baseline was from January 2006 to March 2008, and intervention period was April 2008 to September 2009. Staff nurses were trained to be liaisons (link nurses) to infection prevention (IP) personnel with clearly defined goals assigned and with ongoing monthly education. HCA-MRSA incidence per 1,000 patient-days (PD) was compared between baseline and intervention period along with total and non-HCA-MRSA, HCA and non-HCA-MRSA bacteremia, and hand soap/sanitizer usage. Hand hygiene compliance was assessed. RESULTS A reduction in MRSA rates was as follows in intervention period compared with baseline: HCA-MRSA decreased by 28% from 0.92 to 0.67 cases per 1,000 PD (incidence rate ratio, 0.72; 95% confidence interval: 0.62-0.83, P < .001), and HCA-MRSA bacteremia rate was reduced by 41% from 0.18 to 0.10 per 1,000 PD (incidence rate ratio, 0.59; 95% confidence interval: 0.42-0.84, P = .003). Total MRSA rate and MRSA bacteremia rate also showed significant reduction with nonsignificant reductions in overall non-HCA-MRSA and non-HCA-MRSA bacteremia. Hand soap/sanitizer usage and compliance with hand hygiene also increased significantly during IP. CONCLUSION Link nurse program effectively reduced HCA-MRSA. Goal-defined metrics with ongoing re-education for the nurses by IP personnel helped drive these results.
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Affiliation(s)
- Madhuri M Sopirala
- Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH; Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Lisa Yahle-Dunbar
- Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Justin Smyer
- Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Linda Wellington
- Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jeanne Dickman
- Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nancy Zikri
- Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jennifer Martin
- Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Pat Kulich
- Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - David Taylor
- Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Hagop Mekhjian
- Health System Administration, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mary Nash
- Health System Nursing Administration, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jerry Mansfield
- Health System Nursing Administration, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Preeti Pancholi
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mary Howard
- Health System Nursing Administration, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Linda Chase
- Health System Nursing Administration, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Susan Brown
- Health System Nursing Administration, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kristopher Kipp
- Health System Nursing Administration, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kristen Lefeld
- Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Amber Myers
- Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Xueliang Pan
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Julie E Mangino
- Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH; Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH
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Kamboj M, Son C, Cantu S, Chemaly RF, Dickman J, Dubberke E, Engles L, Lafferty T, Liddell G, Lesperance ME, Mangino JE, Martin S, Mayfield J, Mehta SA, O'Rourke S, Perego CS, Taplitz R, Eagan J, Sepkowitz KA. Hospital-onset Clostridium difficile infection rates in persons with cancer or hematopoietic stem cell transplant: a C3IC network report. Infect Control Hosp Epidemiol 2012; 33:1162-5. [PMID: 23041818 DOI: 10.1086/668023] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A multicenter survey of 11 cancer centers was performed to determine the rate of hospital-onset Clostridium difficile infection (HO-CDI) and surveillance practices. Pooled rates of HO-CDI in patients with cancer were twice the rates reported for all US patients (15.8 vs 7.4 per 10,000 patient-days). Rates were elevated regardless of diagnostic test used.
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Affiliation(s)
- Mini Kamboj
- Memorial Sloan Kettering Cancer Center, New York, New York, USA.
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Stevenson KB, Khan Y, Dickman J, Gillenwater T, Kulich P, Myers C, Taylor D, Santangelo J, Lundy J, Jarjoura D, Li X, Shook J, Mangino JE. Administrative coding data, compared with CDC/NHSN criteria, are poor indicators of health care-associated infections. Am J Infect Control 2008; 36:155-64. [PMID: 18371510 DOI: 10.1016/j.ajic.2008.01.004] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 01/30/2008] [Accepted: 01/30/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND ICD-9-CM coding alone has been proposed as a method of surveillance for health care-associated infections (HAIs). The accuracy of this method, however, relative to accepted infection control criteria is not known. METHODS Retrospective analysis of patients at an academic medical center in 2005 who underwent surgical procedures or who were at risk for catheter-associated bloodstream infections or ventilator-associated pneumonia was performed. Patients previously identified with HAIs by Centers for Disease Control and Prevention's National Healthcare Safety Network surveillance methods were compared with those of the same risk group identified by secondary infection ICD-9-CM codes. Discordant cases identified by only coding were all rereviewed and adjusted prior to final analysis. When coding and surveillance were both negative, a sample of patients was used to estimate the proportion of false negatives in this group. RESULTS The positive predictive values (PPVs) ranged from 0.14 to 0.51 with an aggregate of 0.23, even after adjustment for additional cases detected on subsequent medical record review. The negative predictive values (NPVs) ranged from 0.91 to 1.00, with an aggregate of 0.96. The estimates of the true variance of PPVs and NPVs across surgical procedures were small (0.0129, standard error, 0.009; 0.000145, standard error, 0.00019, respectively) and could be mostly explained by variation in prevalence of surgical site infections. CONCLUSION Administrative coding alone appears to be a poor tool to be used as an infection control surveillance method. Its proposed use for routine HAI surveillance, public reporting of HAIs, interfacility comparisons, and nonpayment for performance should be seriously questioned.
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