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Utilizing a multidisciplinary approach to identify catheter-associated urinary tract infection (CAUTI) risks in Neuroscience intensive care patients admitted for aneurysmal subarachnoid hemorrhage, our CAUTI rate decreased from 5.903 per 1,000 catheter days (June 2020-June 2021) to 0.371 per 1,000 catheter days in our postintervention time period (July 2021-March 2023). A review of our clinical treatment guideline to optimize the timing of indwelling urinary catheters and medication management related to bowel regimens has resulted in a sustained CAUTI reduction, particularly in postaneurysmal subarachnoid hemorrhage patients in the Neuroscience intensive care unit. • Multidisciplinary approach to CAUTI prevention is essential. • Emphasis on clinically necessary IUC use can reduce CAUTI risk. • Minimizing medication effects can help prevent CAUTI in complex patients. [ABSTRACT FROM AUTHOR]

• N95 respirators were decontaminated with vaporous hydrogen peroxide 25 times. • No alterations to respiratory integrity or filtration efficiency seen by 25 cycles. • Vaporous hydrogen peroxide does not appear to impact fit or filtration efficiency using this defined process. • However, implementation requires significant interdisciplinary coordination. N95 respirators were reprocessed using vaporized hydrogen peroxide to supplement limited supplies during the COVID-19 pandemic. In this study, we found no statistically significant differences in qualitative and quantitative fit or filtration efficiency with reprocessing. Filtration efficiency remained above 95% even at 25 cycles of reprocessing without statistically significant change from cycle 20-25 compared to cycle 0 (P =.10, P =.05, respectively). Vaporous hydrogen peroxide is an effective option to augment N95 respirator supplies. [ABSTRACT FROM AUTHOR]

Patients with end-stage renal disease (ESRD) are at increased risk for Hepatitis B virus (HBV) exposure and subsequent infection. Waning immunity, despite strong initial vaccination efforts, is increasingly common and leads to serial testing and repeated vaccination efforts. In partnership with our colleagues in hemodialysis (HD), we sought to develop comprehensive, screening, testing, clinical, and infection prevention and control (IPC) guidelines for HBV in the inpatient hemodialysis unit. We performed a detailed literature review using Medline and PubMed with specific key words regarding HBV exposure, vaccination, infection prevention and clinical testing guidance. Using the Delphi method and an iterative review process, we developed an algorithm that was reviewed and refined with hemodialysis staff, nephrologists, the IPC team and clinical infectious disease experts. All possible combinations of HBV test results were reviewed and then paired with testing interpretation guidance, immediate clinical steps, and IPC guidance. Implementation of the tool resulted in improved communication between the HD unit and IPC team around isolation precaution needs, physical placement of the patient and dialysis machine disinfection. However, we also identified several gaps including a lack of closed-loop communication between outpatient HD facilities and our inpatient dialysis unit, difficulty in screening for HBV re-activation risk, lack of standard guidance regarding the frequency of screening leading to confusion for IPC and HD staff, and difficulty in discharge communication with outpatient dialysis facilities. The use of a standardized evidence-based algorithm improved adherence to HBV screening, vaccination, as well as machine disinfection and isolation practices. However, additional areas for improvement were identified through the implementation process. Future interdisciplinary guidance should address screening ambiguities and how that may lead to mixed IPC practices in both inpatient and outpatient HD settings. [ABSTRACT FROM AUTHOR]

Hand hygiene (HH) is a critical part of Infection Prevention and one of the most difficult interventions to measure. In 2021, a reputational organization required a significant increase with up to 200 HH observations per unit per month. Without electronic HH monitoring in place, our large academic medical center had to upscale our existing program quickly to comply. The HH program at our institution used a 'secret shopper' direct observation, with observations collected by part-time employees using a real-time REDCap data entry form, with no limit on number of opportunities observed and collected during a single session. Multiple additional HH observers were hired and trained rapidly to support increased observation volume. An additional REDCap tool was added to more accurately capture observations in procedural and ambulatory care areas. Data is extracted daily using an Application Programming Interface (API) from REDCap, from which we built a hospital dashboard in Microsoft PowerBI. Our hospital-wide HH dashboard is universally accessible, and displays the percent compliance institution-wide and by unit. The interactive dashboard shows the number of observations by unit and percent compliance by type of healthcare provider and type of HH opportunity. This allowed the Infection Control team to create real time, institutional awareness for HH compliance, allowing for targeted interventions and helped achieve 200 observations per month. The ease of use and ability to purpose-build the REDCap tool enabled expansion of the HH program into ambulatory care areas with additional trained ambulatory observers. This cost-effective approach allows us to scale up or down our HH program without capital expenditures nor physical modifications to the institution. Our data visualization dashboard is a simple intervention that provides real time data for hospital employees and leadership to emphasize the importance of HH, as well as assists Infection Control in tracking HH compliance and opportunities. [ABSTRACT FROM AUTHOR]

Isolated congenital complete heart block (CCHB) is a rare disease with significant associated morbidity and mortality. A diagnosis is often made in fetal life, but data regarding long-term outcomes are limited, and fetal therapy to improve prognosis is controversial. In our institution, 85 fetuses were diagnosed with CCHB from 1981 to 2013 in 80 mothers. There were 37 anti-Ro-positive pregnancies, 36 both anti-Ro and anti-La positive, 10 antibody negative, and 2 of unknown antibody status. Antenatal treatments were given in 14 fetuses, with 8 given fluorinated steroids, 4 beta sympathomimetics, and both in 2. Of the original 85, 74 babies survived to delivery. Fetal hydrops was the only risk factor found to be significantly associated with intrauterine death (p <0.001). Four babies died before pacemaker implantation, 56 have had pacemakers implanted, and 14 are pacemaker free. The Kaplan-Meier estimate for median time to pacemaker implantation was 2.6 years, with 15 implanted in the neonatal period. There have been 14 postnatal deaths, with a Kaplan-Meier estimate of survival at 30 years of 76.8% (95% confidence interval 65% to 90%). Dilated cardiomyopathy was uncommon, occurring in 6 patients. Prematurity and hydrops were associated with increased postnatal mortality (p = 0.02 and 0.005, respectively). In conclusion, we present the largest single-unit experience of prenatally diagnosed CCHB in the published literature. Our cohort was conservatively managed, with survival similar to those previously published. These data offer insight into the long-term natural history of CCHB. [ABSTRACT FROM AUTHOR]

Direct observation has been effective in improving many behaviors critical to infection prevention, such as hand hygiene, but is applied infrequently in the operating room (OR) setting. National Patient Safety Goal 07.05.01 recommended direct observation of evidence-based practices within the OR to reduce surgical site infections (SSIs) but provided little guidance for implementation. We created a standardized OR observation tool for use by infection preventionists (IPs) and perioperative staff to identify variation in practices with an aim toward reducing SSIs. A pilot was performed on cardiac surgery and orthopedic procedures to evaluate reliability and ease of use. Literature review was performed using keywords "SSI," "direct observation," "observation tool," "infection prevention," and "quality improvement" to create a list of evidence-based practices that could be monitored by observation in the OR. This list was cross-matched with our institutional SSI prevention bundle and additional procedure-specific variables were added. The tool was shared with IPs with less OR infection prevention experience to help determine ease of use. 14 items were identified for inclusion in the OR observation tool in three categories: pre-operative/environmental (chlorhexidine bathing, perioperative antibiotics, environmental cleanliness, air pressure/humidity/temperature), prep and drape (alcohol-based skin prep, OR attire compliance, surgical hand scrub for scrubbed staff, sterile gown/gloving, long/artificial nails), and intraoperative (antibiotic re-dosing, traffic, aseptic technique, sterile field maintained, hand hygiene non-scrubbed staff). Additional items included glucose control and use of negative pressure wound therapy (cardiac surgery) and lower leg prep procedure and postoperative dressing choice (orthopedics). The two IPs that piloted the tool reported improved understanding of each metric and ease of use overall. Use of a standardized, evidence-based OR observation tool improved the quality and consistency of data collected on OR infection prevention practices while serving as a training tool for IPs new to the OR setting. [ABSTRACT FROM AUTHOR]

Non-visible haematuria (NVH) is a common finding and may indicate undiagnosed urological cancer. The optimal investigation of NVH is unclear, given the incidence of cancer and the public health implications of testing all individuals with this finding. We review contemporary literature to determine the association of NVH with the diagnosis of bladder cancer (BC), upper tract urothelial carcinoma (UTUC), and kidney cancer (KC). A systematic review of original articles in English was completed in May 2019. Meta-analyses for the diagnostic accuracy of NVH and urine cytology were performed. We screened 1529 articles and selected 78 manuscripts that fulfilled our inclusion criteria for narrative synthesis. Forty manuscripts were eligible for a meta-analysis (reporting 19 193 persons). The likelihood of a urological cancer in patients with NVH increased with age (<1% in those aged <40 yr), male sex, and cigarette smoking. Less than 1% of patients are found to have a urological cancer after a negative NVH evaluation. Cancer detection rates in individuals evaluated for NVH ranged from 0% to 16% for BC in 37 studies, 0% to 3.5% for UTUC in 30 studies, and 0% to 9.7% for KC in 29 studies. Substantial statistical heterogeneity was present for the meta-analysis of detection rates. We present an up-to-date review of the association of NVH with the diagnosis of BC, UTUC, and KC. Individuals with dipstick positive haematuria aged ≥40 yr, who have had potential precipitating causes excluded, should undergo an evaluation. Re-evaluation of patients with unremarkable initial investigations should be performed in high-risk patients or if new symptoms occur. One in five people have microscopic traces of blood in their urine. This is an important indicator of urological cancer. Investigating all patients is uncomfortable and expensive. We evaluate the risk of cancer and estimate risks to groups of individuals. Up to 20% of the general population have non-visible haematuria (NVH). NVH is an important indicator of urological malignancy, particularly in individuals ≥40 yr of age. Evaluation should include cystoscopy and upper tract imaging in the form of ultrasound or computed tomography urogram. [ABSTRACT FROM AUTHOR]

Abstract: Bacterial contamination of the uterine lumen after parturition occurs in most dairy cattle. The presence of clinical endometritis beyond three weeks post partum depends on the balance between microbes, host immunity, and other environmental or animal factors. The present study tested the hypothesis that clinical endometritis is associated with animal factors, such as retained fetal membranes, assisted calving and twins, as well as fecal contamination of the environment. The association between selected risk factors and the lactational incidence risk of clinical endometritis was examined in 293 animals from four dairy herds. Multivariate analysis was used to identify risk factors and quantify their relative risk (RR) and population attributable fraction (PAF) based on the proportion of cows exposed to each factor. The lactational incidence of clinical endometritis was 27% and significant risk factors for clinical endometritis were retained fetal membranes (RR=3.6), assisted calving (RR=1.7), stillbirth (RR=3.1), vulval angle (RR=1.3), primparity (RR=1.8), and male offspring (RR=1.5) but not the cleanliness of the environment or the animal. The highest PAF was associated with male offspring (0.6) so the use of sexed semen has the greatest potential to reduce the incidence of clinical endometritis. The dominant association between retained fetal membranes and clinical endometritis was supported by an expert panel of clinicians. The risk factors for clinical endometritis appear to be associated with trauma of the female genital tract and disruption of the physical barriers to infection rather than fecal contamination. [Copyright &y& Elsevier]