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Background: Carbapenem-resistant Enterobacteriaceae (CRE) are an urgent concern in health care in the United States because of high attributable mortality and versatile resistance mechanisms. CRE reporting was mandated in New York State (NYS) hospitals in July 2013., Methods: Infection preventionists from the NYS Department of Health audited hospital-reported CRE data by comparing laboratory records with cases reported to the National Healthcare Safety Network (NHSN). Information regarding microbiology laboratory testing methodologies was obtained through a survey in October 2013., Results: There were 1,151 CRE laboratory reports audited, with 13.6% determined not to have been reported to the NHSN when they should have been and 4.6% determined to be reported in error. There were a variety of errors, including lapses in surveillance and misinterpretation of the surveillance definition., Conclusion: Educational initiatives that include microbiology laboratory staff, improvements in the use of laboratory information systems to communicate with infection prevention, and updated NHSN definitions should improve the accuracy and consistency of CRE reporting in NYS., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Surveillance criteria for central line-associated bloodstream infections (CLABSIs) are continually being refined to more accurately reflect infections related to central lines. An audit of 567 medical records from adult, pediatric, and neonatal intensive care unit patients with a central line and a positive blood culture showed a 16% decrease in CLABSI rates after the 2013 National Healthcare Safety Network definitions compared with the 2012 definitions., (Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Since 2007, New York State (NYS) hospitals have been required to report surgical site infections (SSIs) following colon procedures to the NYS Department of Health, using the National Healthcare Safety Network (NHSN). The purpose of this study was to identify risk factors for the development of SSIs in patients undergoing colon procedures., Methods: NYS has been conducting validation studies at hospitals to assess the accuracy of the surveillance data reported by the participating hospitals. A sample of patients undergoing colon procedures in NYS hospitals were included in hospital-acquired infection program validation studies in 2009 and 2010. Medical chart reviews and on-site visits were performed to verify patient information reported and to evaluate additional risk factors for SSI. Bivariable and multivariable logistic regressions were performed., Results: A total of 2,656 colon procedures were included in this analysis, including 698 SSI cases. Multivariable analysis indicated that SSI following colon procedure was associated with body mass index greater than 30 (odds ratio [OR], 1.48 [95% confidence interval (CI), 1.21-1.80]), male sex (OR, 1.34 [95% CI, 1.10-1.64]), American Society of Anesthesiologists physical classification score greater than 3 (OR, 1.33 [95% CI, 1.08-1.64]), procedure duration, transfusion (OR, 1.32 [95% CI, 1.05-1.66]), left-side colon surgical procedures, other gastroenterologic procedures, irrigation, hospital bed size greater than 500, and medical school affiliation., Conclusions: Male sex, obesity, transfusion, type of procedure, and prolonged duration were significant factors associated with overall infection risk after adjusting other factors. Additional factors not collected in the NHSN slightly improved prediction of SSIs.

Background: In 2007, New York State (NYS) hospitals began mandatory public reporting of central line-associated bloodstream infection (CLABSI) data associated with intensive care units (ICUs) into the National Healthcare Safety Network (NHSN). Facilities were required to use the NHSN device-associated CLABSI criteria to identify laboratory-confirmed bloodstream infections., Methods: Onsite audits were conducted in ICUs by NYS hospital-acquired infection program staff using a standardized database. Hospitals provided ICU patient medical records with a positive blood culture during a selected time frame., Results: Between 2007 and 2010, an average of 79% of all reporting hospitals were audited annually. Of the 5,697 patients audited, 3,104 (54%) had a central line in place, and 650 of the patients with a central line (21%) were identified as having a CLABSI by the hospital-acquired infection program reviewer. Between 2007 and 2010, the specificity increased from 90% to 99%, whereas the sensitivity remained stable at approximately 71%. As a result of the audit process, the NYS 2010 CLABSI rate increased by 5.6%., Conclusions: A standardized audit process has helped improve the accuracy of CLABSI reporting. Data validation provides consistent data for measuring the progress of infection prevention strategies and allows for relevant comparison of ICU data., (Published by Mosby, Inc.)

Objective: To study the molecular epidemiology of vancomycin-resistant Enterococcus (VRE) colonization and to identify modifiable risk factors among patients with hematologic malignancies., Setting: A hematology-oncology unit with high prevalence of VRE colonization., Participants: Patients with hematologic malignancies and hematopoietic stem cell transplantation recipients admitted to the hospital., Methods: Patients underwent weekly surveillance by means of perianal swabs for VRE colonization and, if colonized, were placed in contact isolation. We studied the molecular epidemiology in fecal and blood isolates by pulsed-field gel electrophoresis over a 1-year period. We performed a retrospective case-control study over a 3-year period. Cases were defined as patients colonized by VRE, and controls were defined as patients negative for VRE colonization. Case patients and control patients were matched by admitting service and length of observation time., Results: Molecular genotyping demonstrated the primarily polyclonal nature of VRE isolates. Colonization occurred at a median of 14 days. Colonized patients were characterized by longer hospital admissions. Previous use of ceftazidime was associated with VRE colonization (P < .001), while use of intravenous vancomycin and antibiotics with anaerobic activity did not emerge as a risk factor. There was no association with neutropenia or presence of colonic mucosal disruption, and severity of illness was similar in both groups., Conclusion: Molecular studies showed that in the majority of VRE-colonized patients the strains were unique, arguing that VRE acquisition was sporadic rather than resulting from a common source of transmission. Patient-specific factors, including prior antibiotic exposure, rather than breaches in infection control likely predict for risk of fecal VRE colonization.

We report a linezolid-resistant Enterococcus faecalis infection in a cord blood stem cell transplant recipient previously treated with linezolid for bloodstream infections by vancomycin-resistant enterococci. Sequencing showed a G2576U mutation in the 23S rRNA gene. Because of the important niche of linezolid in cancer treatment, linezolid-resistant E. faecalis is noteworthy.

1. Needle recapping injuries, which individual employees have considerable ability to prevent, declined significantly following inservice education. 2. The problem of needles protruding into the opening of mechanical lids in needle disposal boxes persisted even after the inservice sessions. When clearlid, nonmechanical opening boxes were used, disposal injuries related to protruding needles declined significantly. 3. An educational program coupled with the appropriate placement of disposal boxes had a beneficial impact on some categories of needlestick injuries, although the total number of needlestick injuries did not decline.

Objectives: To determine whether an educational program had a beneficial impact on healthcare worker needlestick injuries, particularly those caused by recapping. Secondary goals were to evaluate the efficacy of in-room needle-boxes and to determine whether surveillance data were useful when evaluating new products., Design: Survey of employee health department reports., Setting: Tertiary care teaching hospital., Participants: Healthcare workers who reported needlestick injuries and other blood and body fluid exposures to the employee health department., Interventions: Exposure data from the 10 months prior to institution of the educational program and installation of disposal boxes were compared with data from the following 27 months. Additionally, the type of disposal box was changed for the last 9 months of the survey., Results: Needlestick injuries caused by recapping fell significantly following the educational program (p = .005). However, injuries caused by previously disposed needles protruding into the mechanical opening of the needleboxes increased significantly (p = .002). Following a change of needleboxes to a nonmechanical opening design, the latter type of injury declined (p = .052). Total needlestick injuries, most other categories of needlestick injury, and other exposures did not change significantly during the 37 months of the study., Conclusions: The educational programs appeared to have positive impact on reducing recapping injuries, but many other needlestick categories did not change significantly. Mechanical opening needle disposal boxes appear to present a hazard when compared with fixed opening boxes. Surveillance data appear to be useful in monitoring injuries as well as evaluating products.