Search

Background Large-scale, prospective, evaluation of sampling for central line–associated bloodstream infection (CLABSI) denominator data was necessary prior to National Healthcare Safety Network (NHSN) implementation. Methods In a sample of volunteer hospitals from states in the Emerging Infections Program, prospective collection of CLABSI denominators (patient days, central line days [CLDs]) was performed in eligible locations for ≥6 and ≤12 consecutive months using the current NHSN method (daily collection) and also by a second data collector who sampled the denominator data 1 d/wk. The quality of the sampled data was evaluated and used to calculate estimated CLDs and CLABSI rates, which were compared with actual CLDs and CLABSI rates (daily counts). Results In total, 89 locations in 66 acute care hospitals participated. Sampled data were collected as intended 88% of the time; the quality of the data was comparable with the data collected daily. In locations with higher CLDs per month (≥75), estimated CLDs and CLABSI rates were similar to actual CLDs and CLABSI rates; however, there were significant differences in actual and estimated values among locations with lower (≤74) CLDs per month.Sampling was successfully implemented, but significant differences in the accuracy of estimated CLDs and CLABSI rates, based on the actual number of CLDs per month, were noted. Conclusion For locations with a higher number of CLDs per month, sampling 1 d/wk is a valid and accurate alternative to daily collection of CLABSI denominator data.

Background Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as an important cause of staphylococcal infections, but there have been little data on whether CA-MRSA causes health care-associated infections. Methods A case-control study was performed to identify risk factors for prosthetic joint infections (PJI). Antibiograms of isolates associated with PJI were reviewed. Molecular typing of available MRSA isolates was done using pulsed field gel electrophoresis (PFGE). Nares cultures of health care workers who provided care to those orthopedic patients were obtained. Results Over a 13-month period (January 2003-January 2004), 9.5% of patients with prosthetic hip (THA) or knee (TKA) joint surgery developed PJI (7 TKA and 2 THA). The mean time to development of PJI was 20 days. Five infections were caused by CA-MRSA and 3 by methicillin-susceptible S aureus ; one was culture negative. All CA-MRSA isolates had identical antibiograms (resistant to β-lactams and erythromycin; susceptible to clindamycin, trimethoprim-sulfamethoxazole, rifampin, gentamicin, levofloxacin, and vancomycin). Molecular typing of 2 available CA-MRSA isolates revealed that these were the USA300 clone; these isolates were PVL+ and carried SCCmec IV. CA-MRSA was not recovered from nares cultures from 31 health care workers. In multivariate analysis, TKA (OR, 8.1; 95% CI: 1.3-48.1) and surgery time >180 minutes (OR, 7.4; 95% CI: 1.4-39.6) were associated with PJI. Conclusion We have demonstrated that the CA-MRSA USA300 clone is no longer just a cause of community-aquired infections but has also emerged as a cause of health care-associated infections, causing PJI at our institution.