Search

Background: The objective of this study was to understand how aged care home health professionals perceive antimicrobial use near the end of life and how they perceive potential antimicrobial stewardship activities near the end of life in aged care homes., Methods: Qualitative semi-structured interviews were undertaken with general practitioners, nurses, and pharmacists who provide routine care in aged care homes in Victoria, Australia. Interviews were coded using frameworks for understanding behavior change., Results: Themes were established within 14 interviews, and an additional 6 interviews were undertaken to ensure thematic saturation. Two major themes emerged: (i) Antimicrobial stewardship activities near the end of life in aged care homes need to enable aged care home nurses to make decisions substantiated by evidence-based clinical knowledge. Antimicrobial stewardship should clearly be part of an aged care home nurse's role, and accreditation standards provide powerful motivation for behavior change. (ii) Antimicrobial stewardship activities near the end of life in aged care homes must address family confidence in resident wellbeing. Antimicrobial stewardship activities should be inclusive of family involvement, and messages should highlight the point that antimicrobial stewardship improves care., Conclusions: Antimicrobial stewardship activities that reinforce evidence-based clinical decision-making by aged care home nurses and address family confidence in resident wellbeing are required near the end of life in aged care homes. Accreditation standards are important motivators for behavior change in aged care homes., (Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Since 2015 the Aged Care National Antimicrobial Prescribing Survey has collected and reported data on antibiotic use in Australian aged care homes (ACHs) as part of the Australian Commission on Safety and Quality in Health Care's Antimicrobial Use and Resistance in Australia project. The objective of this study was to analyze this data source with regards to prescribing for urinary tract infections (UTIs) to improve the use of antibiotics., Methods: This cross-sectional study analyzed the 2016 and 2017 survey data. Antibiotic prescribing for urinary tract indications was compared with national guideline recommendations., Results: A total of 662 antibiotic prescriptions from 247 ACHs were analyzed. For all prophylactic antibiotics for UTI, 51.8% were prescribed for longer than 6 months, contrary to the guideline recommendation. Most antibiotics prescribed for treatment (71.6%) were for cystitis. Cefalexin was most frequently selected for treatment of cystitis, with 10.4% of these prescriptions being concordant with the recommendations. Prescribing additional daily doses of cefalexin occurred in 63.2% of prescriptions., Conclusions: Antimicrobial stewardship activities targeting UTI prophylaxis for durations longer than 6 months, and excessive daily doses of cefalexin to treat cystitis could yield significant reductions in unnecessary antibiotic consumption among Australian residents of ACHs., (Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.)

Background: Diagnostic testing using polymerase chain reaction (PCR) is infrequently initiated for diagnosis of respiratory tract infections (RTIs) in nursing homes. The objectives of this study were to determine the feasibility of implementing nurse-initiated PCR testing of respiratory specimens in nursing home settings and to compare antibiotic prescribing prior to and during the implementation., Methods: This was a pragmatic, historically controlled study in 3 nursing homes (181 total beds) in Melbourne, Australia., Results: The number of PCR tests of respiratory specimens (over 12 months) increased from 5 to 67 when nurses could initiate the tests. Residents with RTI symptoms had a virus identified by PCR in 50.7% of tests, including 14 positive for influenza. Six outbreaks were identified. When clustering was taken into consideration, incidence rates of antibiotic days of therapy did not change (incidence rate ratio = 0.94, 95% confidence interval, 0.25-3.35, P = .92) despite identification of more viral pathogens., Conclusions: In nursing homes, nurse-initiated PCR testing of respiratory specimens is feasible and useful in terms of identifying the cause of many RTIs and outbreaks, and viruses are common in this context. However, the current study suggests the availability of these test results alone does not impact antibiotic prescribing., (Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Residents of residential aged care facilities (RACFs) are at risk of colonization and infection with multidrug-resistant bacteria, and antibiotic prescribing is often inappropriate and not based on culture-proven infection. We describe low levels of resident colonization and environmental contamination with resistant gram-negative bacteria in RACFs, but high levels of empirical antibiotic use not guided by microbiologic culture. This research highlights the importance of antimicrobial stewardship and environmental cleaning in aged care facilities., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Environmental contamination is a reservoir for vancomycin-resistant enterococcus (VRE) in hospitals., Methods: Environmental sampling of surfaces was undertaken anytime before disinfection and 1 hour after disinfection utilizing a sodium dichloroisocyanurate-based, 3-staged protocol (phase 1) or benzalkonium chloride-based, single-stage clean (phase 2). VRE colonization and infection rates are presented from 2010 to 2011, and audits of cleaning completeness were also analyzed., Results: Environmental samples collected before disinfection were significantly more likely to be contaminated with VRE during phase 1 than phase 2: 25.2% versus 4.6%, respectively; odds ratio (OR), 7.01 (P < .01). Environmental samples collected after disinfection were also significantly more likely to yield VRE during phase 1 compared with phase 2: 11.2% versus 1.1%, respectively; OR, 11.73 (P < .01). Rates of VRE colonization were higher during 2010 than 2011. Cleaning audits showed similar results over both time periods., Conclusion: During use of a chlorine-based, 3-staged protocol, significantly higher residual levels of VRE contamination were identified, compared with levels detected during use of a benzalkonium chloride-based product for disinfection. This reduction in VRE may be due to a new disinfection product, more attention to the thoroughness of cleaning, or other supplementary efforts in our institution., (Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: Surgical antibiotic prophylaxis (SAP) is one practice proven to prevent surgical site infections., Methods: Compliance of SAP choice, timing, and duration with guidelines was assessed utilizing prospectively collected surgical site infection (SSI) surveillance data from January 2008 through September 2010., Results: Antibiotic choice was adequate or optimal in 97% of cardiac and orthopedic joint replacement procedures and 89% of colorectal procedures. In 6% to 8% of surgical procedures, SAP was not administered within 1 hour of the incision. SAP was continued beyond 24 hours in 20% of cardiac operations and 13% of colorectal procedures. Numerous combinations of antibiotics were used for prophylaxis, including ticarcillin/clavulanic acid in 67% of colorectal procedures. Many choices were not in keeping with both local and international recommendations. Deep SSI rates for cardiac procedures were above the state aggregate rate in 2010 only, whereas SSI rates for colorectal surgery were in excess of the state aggregate rate for all quarters. Antimicrobial-resistance data indicate a gradual increase in extended-spectrum β-lactamase-producing bacteria., Conclusion: In cardiac and colorectal surgery, the optimal choice of SAP is seldom administered, and duration of SAP is excessively long. More education and communication are required to improve these practices., (Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: This study examined predictors of in-hospital mortality and time to extubation among patients with acute, severe hospital-acquired pneumonia (HAP) managed in the intensive care unit (ICU)., Methods: Patients with HAP prospectively identified between June 2001 and May 2003 were included in the study if they (1) met the Centers for Disease Control and Prevention's definition for HAP, (2) were treated in the ICU within 1 day of the HAP diagnosis, and (3) required intubation acutely or had a bloodstream infection within 48 hours of the HAP diagnosis., Results: The cohort included 219 patients, 83 of whom died (37.9%). Independent predictors of mortality included cancer (odds ratio [OR] = 4.2; 95% confidence interval [CI] = 1.7 to 10.5), age over 60 years (OR = 2.7; 95% CI = 1.3 to 5.6), APACHE-II score >15 (OR = 2.0; 95% CI = 1.0 to 4.1), and receiving care in the medical ICU (OR = 3.0; 95% CI = 1.1 to 8.2). The following predictors were associated with an increased time to extubation: receipt of vancomycin (1.81-fold increase; P = .001), immunocompromised status (1.92-fold increase; P = .07), and treatment in the surgical or neurosurgical ICU (1.95-fold increase, P = .01; 1.83-fold increase, P = .03)., Conclusion: Vancomycin was associated with increased time to extubation. Alternatives to vancomycin for treating patients with acute, severe HAP should be studied.

Background: In March 2004, infection or colonization with Serratia marcescens affected one third of all neonates in a newborn services unit (NBS)., Methods: We performed a case-control study and automated ribotyping., Results: Forty-nine cases were compared with 64 controls. The overall mean length of stay (LOS) in the NBS was 67 days for cases and 36 days for controls, P = .005. Cases were of lower mean birth weight than controls (1566 g vs 1968 g, respectively, P = .02). Risk factors that trended toward significance for S marcescens acquisition included the following: premature rupture of membranes (odds ratio [OR], 2.7; 95% confidence interval [95% CI]: 1.0-7.1; P = .05), vaginal delivery at our hospital (OR, 2.1; 95% CI: 0.9-4.6; P = .06), intubation at delivery (OR, 2.3; 95% CI: 0.9-5.2; P = .05), mechanical ventilation (OR, 2.1; 95% CI: 0.9-4.4; P = .06), and theophylline treatment (OR, 2.5; 95% CI: 1.1-5.4; P = .02). Multiple logistic regression analysis revealed vaginal delivery at our hospital (OR, 3.4; 95% CI: 1.4-8.2; P = .007) and LOS >30 days (OR, 4.4; 95% CI: 1.8-10.6; P = .001) as independent risk factors for S marcescens acquisition. Ribotyping of specimens revealed 5 restriction patterns., Conclusion: Cases were of lower birth weight than controls, were born by vaginal delivery at our hospital, had longer LOS in NBS, and had greater requirements for respiratory support. Ribotyping of specimens revealed that this outbreak was not clonal.

Background: A 1998 survey of acute Victorian public hospitals (VPH) revealed that surveillance of hospital-acquired infections (HAI) was underdeveloped, definitions and methodology varied considerably, and results disseminated inconsistently. The survey identified the need for an effective surveillance system for HAI., Objective: To develop and support a standardized surveillance program for HAIs in large acute VPH and to provide risk-adjusted, procedure-specific, HAI rates., Methods: In 2002, the independent Victorian Nosocomial Infection Surveillance System (VICNISS) Coordinating Centre (VCC) was established to develop and support the standardized surveillance program. A multidisciplinary team was recruited. A communication strategy, surveillance manual, user groups, and Web site were developed. Formal education sessions were provided to participating infection control nurse consultants (ICCs). Surveillance activities were based on the US Centers for Diseases Control and Prevention's National Nosocomial Infection Surveillance System (NNIS) surgical site infection and intensive care unit (ICU) components. NNIS methods were modified to suit local needs. Data collection was paper based or through existing hospital software. An advisory committee of key stakeholders met every second month., Results: The surveillance program was rolled out over 12 months to all 28 large adult VPH. Data on over 20,000 surgical procedures performed at participating sites between November 11, 2002, and December 31, 2004, were submitted. Thirteen hospitals contributed to the ICU surveillance activities. Following aggregation and analysis by the VCC, hospital- and state-level results were posted on the Web page for hospitals to review., Conclusion: A standardized approach for surveillance of HAI was established in a short time frame in over 28 VPH. VICNISS is a tool that will continue to provide participating hospitals with a basis for continuous quality improvement.

Serratia sp have only rarely been reported as isolates from leg ulcers. We describe the case of a middle-aged man with a medical history significant for alcohol-induced cirrhosis who presented with rapidly progressive skin ulcers initially starting as purple nodules. These skin ulcers and underlying dermal abscesses were found to be a result of S marcescens, with the presumed portal of entry being a toe-web infection.