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Central line...associated bloodstream infection rates increased during the Omicron surge at our rural academic medical center. To identify potential drivers of this increase, we investigated period- and patient-specific factors associated with the increase in central line...associated bloodstream infection. Increased central line utilization, decreased central line bundle compliance monitoring, increased proportion of traveling nurses, increased short-term venous catheter use in the internal jugular vein, increased multilumen catheter use, decreased port...associated infection, and increased patient acuity were significantly associated with the surge. Our results helped us target our local infection prevention efforts. ... CLABSI rates increased during COVID-19 Omicron surge.... Patients with CLABSI were more acutely ill during the surge.... Central line utilization and proportion of traveling nurses increased during the surge.... Infection prevention bundle compliance monitoring decreased during the surge. [ABSTRACT FROM AUTHOR]

To characterize and assess the effects of a preoperative, nurse-driven penicillin allergy risk stratification tool on rates of perioperative cefazolin and second-line antibiotic use. Quasi-experimental quality improvement study of penicillin-allergic surgical patients undergoing procedures for which cefazolin is indicated. Outpatient Perioperative Care Clinic (PCC) for preoperative surgical patients at a tertiary care center. 670 and 1371 adult penicillin-allergic PCC attendants and non-attendants, respectively. A paper penicillin allergy risk stratification questionnaire was administered during the PCC visit. Nurses were educated on its use. Antibiotic (cefazolin, clindamycin, vancomycin) use rates in the 24 months before and 17 months after intervention implementation in November 2020 (November 2018 – April 2022) were assessed in penicillin-allergic PCC attendants with statistical process control charts. Multivariable logistic regression assessed antibiotic use rates pre- and post-intervention adjusting for age, sex, surgical specialty and penicillin allergy history severity. Similar analyses were done in penicillin-allergic PCC non-attendants. Of 670 penicillin-allergic PCC attendants, 451 (median [IQR] age, 66 (Sousa-Pinto et al., 2021 [ 14 ])) were analyzed pre-intervention and 219 (median [IQR] age, 66 (Mine et al., 1970 [ 13 ])) post-intervention. One month after implementation, process measures demonstrated an upward shift in cefazolin use for PCC attendants versus no shift or other special cause variation for PCC non-attendants. There were increased odds of cefazolin use (aOR 1.67, 95% CI [1.09–2.57], P = 0.019), decreased odds of clindamycin use (aOR 0.61, 95% CI [0.42–0.89], P = 0.010) and decreased odds of vancomycin use (aOR 0.56, 95% CI [0.35–0.88], P = 0.013) in PCC attendants post-intervention. This effect did not occur in PCC non-attendants. There was no increase in perioperative anaphylaxis post-intervention. A simple penicillin allergy risk stratification tool implemented in the preoperative setting was associated with increased use of cefazolin and decreased rates of second-line agents post implementation. • A nurse-driven, penicillin allergy risk tool was added to the preoperative clinic. • This penicillin allergy risk tool was associated with increased odds of cefazolin use. • There was no increase in perioperative anaphylaxis. [ABSTRACT FROM AUTHOR]