12 results on '"Moody, Julia"'
Search Results
2. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update.
- Author
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Calfee DP, Salgado CD, Milstone AM, Harris AD, Kuhar DT, Moody J, Aureden K, Huang SS, Maragakis LL, and Yokoe DS
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- Disease Transmission, Infectious prevention & control, Humans, Intensive Care Units, Staphylococcal Infections transmission, Cross Infection prevention & control, Infection Control methods, Methicillin-Resistant Staphylococcus aureus isolation & purification, Staphylococcal Infections prevention & control
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- 2014
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3. Targeted versus universal decolonization to prevent ICU infection.
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Huang SS, Septimus E, Kleinman K, Moody J, Hickok J, Avery TR, Lankiewicz J, Gombosev A, Terpstra L, Hartford F, Hayden MK, Jernigan JA, Weinstein RA, Fraser VJ, Haffenreffer K, Cui E, Kaganov RE, Lolans K, Perlin JB, and Platt R
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- Adult, Aged, Bacteremia psychology, Baths, Chlorhexidine adverse effects, Chlorhexidine therapeutic use, Comparative Effectiveness Research, Cross Infection transmission, Disease Transmission, Infectious prevention & control, Female, Humans, Male, Middle Aged, Mupirocin adverse effects, Mupirocin therapeutic use, Nasal Cavity microbiology, Staphylococcal Infections diagnosis, Staphylococcal Infections transmission, Carrier State diagnosis, Cross Infection prevention & control, Disinfection methods, Infection Control methods, Intensive Care Units, Methicillin-Resistant Staphylococcus aureus isolation & purification, Staphylococcal Infections prevention & control
- Abstract
Background: Both targeted decolonization and universal decolonization of patients in intensive care units (ICUs) are candidate strategies to prevent health care-associated infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA)., Methods: We conducted a pragmatic, cluster-randomized trial. Hospitals were randomly assigned to one of three strategies, with all adult ICUs in a given hospital assigned to the same strategy. Group 1 implemented MRSA screening and isolation; group 2, targeted decolonization (i.e., screening, isolation, and decolonization of MRSA carriers); and group 3, universal decolonization (i.e., no screening, and decolonization of all patients). Proportional-hazards models were used to assess differences in infection reductions across the study groups, with clustering according to hospital., Results: A total of 43 hospitals (including 74 ICUs and 74,256 patients during the intervention period) underwent randomization. In the intervention period versus the baseline period, modeled hazard ratios for MRSA clinical isolates were 0.92 for screening and isolation (crude rate, 3.2 vs. 3.4 isolates per 1000 days), 0.75 for targeted decolonization (3.2 vs. 4.3 isolates per 1000 days), and 0.63 for universal decolonization (2.1 vs. 3.4 isolates per 1000 days) (P=0.01 for test of all groups being equal). In the intervention versus baseline periods, hazard ratios for bloodstream infection with any pathogen in the three groups were 0.99 (crude rate, 4.1 vs. 4.2 infections per 1000 days), 0.78 (3.7 vs. 4.8 infections per 1000 days), and 0.56 (3.6 vs. 6.1 infections per 1000 days), respectively (P<0.001 for test of all groups being equal). Universal decolonization resulted in a significantly greater reduction in the rate of all bloodstream infections than either targeted decolonization or screening and isolation. One bloodstream infection was prevented per 54 patients who underwent decolonization. The reductions in rates of MRSA bloodstream infection were similar to those of all bloodstream infections, but the difference was not significant. Adverse events, which occurred in 7 patients, were mild and related to chlorhexidine., Conclusions: In routine ICU practice, universal decolonization was more effective than targeted decolonization or screening and isolation in reducing rates of MRSA clinical isolates and bloodstream infection from any pathogen. (Funded by the Agency for Healthcare Research and the Centers for Disease Control and Prevention; REDUCE MRSA ClinicalTrials.gov number, NCT00980980).
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- 2013
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4. A bundled approach to reduce methicillin-resistant Staphylococcus aureus infections in a system of community hospitals.
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Perlin JB, Hickok JD, Septimus EJ, Moody JA, Englebright JD, and Bracken RM
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- Adolescent, Adult, Aged, Cross Infection drug therapy, Cross Infection microbiology, Disinfection methods, Disinfection standards, Female, Hand Hygiene, Hospitals, Community, Housekeeping, Hospital methods, Housekeeping, Hospital standards, Humans, Male, Methicillin-Resistant Staphylococcus aureus pathogenicity, Middle Aged, Multi-Institutional Systems, Nasal Mucosa microbiology, Risk Assessment, Staphylococcal Infections drug therapy, Staphylococcal Infections microbiology, United States, Young Adult, Cross Infection prevention & control, Infection Control methods, Methicillin-Resistant Staphylococcus aureus isolation & purification, Staphylococcal Infections prevention & control
- Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infections pose a significant challenge to U.S. healthcare facilities, but there has been limited study of initiatives to reduce infection and increase patient safety in community hospitals. To address this need, a multifaceted program for MRSA infection prevention was developed for implementation in 159 acute care facilities. This program featured five distinct tools-active MRSA surveillance of high-risk patients, enhanced barrier precautions, compulsive hand hygiene, disinfection and cleaning, and executive champions and patient empowerment-and was implemented during 1Q-2Q 2007. Postintervention (3Q 2007-2Q 2008), 10.2% of patients with high-risk for infection or complications due to MRSA had nasal colonization. Volume of disposable gown and alcohol-based hand sanitizer use increased substantially following program implementation. Self-reported rates, based on NHSN definitions, of healthcare-associated central line-associated bloodstream infections and ventilator-associated pneumonia due to MRSA decreased 39% (p < .001) and 54% (p < .001), respectively. Infection rates continued to decrease during the follow-up period (1Q-4Q 2009). This sustained improvement demonstrates that reducing healthcare-associated MRSA infections in a large number of diverse facilities is possible and that a "bundled" approach that translates science into clinical and executive performance expectations may aid in overcoming traditional barriers to implementation., (© 2013 National Association for Healthcare Quality.)
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- 2013
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5. Infection prevention practices in adult intensive care units in a large community hospital system after implementing strategies to reduce health care-associated, methicillin-resistant Staphylococcus aureus infections.
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Moody J, Septimus E, Hickok J, Huang SS, Platt R, Gombosev A, Terpstra L, Avery T, Lankiewicz J, and Perlin JB
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- Cross Infection microbiology, Guideline Adherence statistics & numerical data, Hospitals, Community, Humans, Infection Control standards, Intensive Care Units, Staphylococcal Infections microbiology, Surveys and Questionnaires, Cross Infection epidemiology, Cross Infection prevention & control, Infection Control methods, Methicillin-Resistant Staphylococcus aureus isolation & purification, Staphylococcal Infections epidemiology, Staphylococcal Infections prevention & control
- Abstract
Background: A range of strategies and approaches have been developed for preventing health care-associated infections. Understanding the variation in practices among facilities is necessary to improve compliance with existing programs and aid the implementation of new interventions., Methods: In 2009, HCA Inc administered an electronic survey to measure compliance with evidence-based infection prevention practices as well as identify variation in products or methods, such as use of special approach technology for central vascular catheters and ventilator care. Responding adult intensive care units (ICUs) were those considering participation in a clinical trial to reduce health care-associated infections., Results: Responses from 99 ICUs in 55 hospitals indicated that many evidenced-based practices were used consistently, including methicillin-resistant Staphylococcus aureus (MRSA) screening and use of contact precautions for MRSA-positive patients. Other practices exhibited wide variability including discontinuation of precautions and use of antimicrobial technology or chlorhexidine patches for central vascular catheters. MRSA decolonization was not a predominant practice in ICUs., Conclusion: In this large, community-based health care system, there was substantial variation in the products and methods to reduce health care-associated infections. Despite system-wide emphasis on basic practices as a precursor to adding special approach technologies, this survey showed that these technologies were commonplace, including in facilities where improvement in basic practices was needed., (Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)
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- 2013
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6. Antimicrobial stewardship: a collaborative partnership between infection preventionists and healthcare epidemiologists.
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Moody J, Cosgrove SE, Olmsted R, Septimus E, Aureden K, Oriola S, Patel GW, and Trivedi KK
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- Cooperative Behavior, Epidemiologic Methods, Humans, Organizational Policy, Societies, Medical, Anti-Infective Agents therapeutic use, Drug Utilization Review methods, Drug Utilization Review organization & administration, Epidemiology, Infection Control methods, Infection Control organization & administration
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- 2012
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7. Cluster randomized trials in comparative effectiveness research: randomizing hospitals to test methods for prevention of healthcare-associated infections.
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Platt R, Takvorian SU, Septimus E, Hickok J, Moody J, Perlin J, Jernigan JA, Kleinman K, and Huang SS
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- Humans, Methicillin-Resistant Staphylococcus aureus, Comparative Effectiveness Research methods, Cross Infection prevention & control, Infection Control methods, Intensive Care Units organization & administration, Randomized Controlled Trials as Topic methods
- Abstract
Background: The need for evidence about the effectiveness of therapeutics and other medical practices has triggered new interest in methods for comparative effectiveness research., Objective: Describe an approach to comparative effectiveness research involving cluster randomized trials in networks of hospitals, health plans, or medical practices with centralized administrative and informatics capabilities., Research Design: We discuss the example of an ongoing cluster randomized trial to prevent methicillin-resistant Staphylococcus aureus (MRSA) infection in intensive care units (ICUs). The trial randomizes 45 hospitals to: (a) screening cultures of ICU admissions, followed by Contact Precautions if MRSA-positive, (b) screening cultures of ICU admissions followed by decolonization if MRSA-positive, or (c) universal decolonization of ICU admissions without screening., Subjects: All admissions to adult ICUs., Measures: The primary outcome is MRSA-positive clinical cultures occurring >or=2 days following ICU admission. Secondary outcomes include blood and urine infection caused by MRSA (and, separately, all pathogens), as well as the development of resistance to decolonizing agents., Results: Recruitment of hospitals is complete. Data collection will end in Summer 2011., Conclusions: This trial takes advantage of existing personnel, procedures, infrastructure, and information systems in a large integrated hospital network to conduct a low-cost evaluation of prevention strategies under usual practice conditions. This approach is applicable to many comparative effectiveness topics in both inpatient and ambulatory settings.
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- 2010
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8. A Trial of Automated Outbreak Detection to Reduce Hospital Pathogen Spread.
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Baker, Meghan A, Septimus, Edward, Kleinman, Ken, Moody, Julia, Sands, Kenneth E, Varma, Neha, Isaacs, Amanda, McLean, Laura E, Coady, Micaela H, Blanchard, Eunice J, Poland, Russell E, Yokoe, Deborah S, Stelling, John, Haffenreffer, Katherine, Clark, Adam, Avery, Taliser R, Sljivo, Selsebil, Weinstein, Robert A, Smith, Kimberly N, Carver, Brandon, Meador, Brittany, Lin, Michael Y, Lewis, Sarah S, Washington, Chamaine, Bhattarai, Megha, Shimelman, Lauren, Kulldorff, Martin, Reddy, Sujan C, Jernigan, John A, Perlin, Jonathan B, Platt, Richard, and Huang, Susan S
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Health Services and Systems ,Biomedical and Clinical Sciences ,Clinical Sciences ,Health Sciences ,Clinical Research ,Coronaviruses ,Clinical Trials and Supportive Activities ,Infectious Diseases ,Prevention ,Emerging Infectious Diseases ,Infection ,Good Health and Well Being ,Humans ,Disease Outbreaks ,COVID-19 ,Cross Infection ,Infection Control ,SARS-CoV-2 ,Hospitals ,Community - Abstract
BackgroundDetection and containment of hospital outbreaks currently depend on variable and personnel-intensive surveillance methods. Whether automated statistical surveillance for outbreaks of health care-associated pathogens allows earlier containment efforts that would reduce the size of outbreaks is unknown.MethodsWe conducted a cluster-randomized trial in 82 community hospitals within a larger health care system. All hospitals followed an outbreak response protocol when outbreaks were detected by their infection prevention programs. Half of the hospitals additionally used statistical surveillance of microbiology data, which alerted infection prevention programs to outbreaks. Statistical surveillance was also applied to microbiology data from control hospitals without alerting their infection prevention programs. The primary outcome was the number of additional cases occurring after outbreak detection. Analyses assessed differences between the intervention period (July 2019 to January 2022) versus baseline period (February 2017 to January 2019) between randomized groups. A post hoc analysis separately assessed pre-coronavirus disease 2019 (Covid-19) and Covid-19 pandemic intervention periods.ResultsReal-time alerts did not significantly reduce the number of additional outbreak cases (intervention period versus baseline: statistical surveillance relative rate [RR]=1.41, control RR=1.81; difference-in-differences, 0.78; 95% confidence interval [CI], 0.40 to 1.52; P=0.46). Comparing only the prepandemic intervention with baseline periods, the statistical outbreak surveillance group was associated with a 64.1% reduction in additional cases (statistical surveillance RR=0.78, control RR=2.19; difference-in-differences, 0.36; 95% CI, 0.13 to 0.99). There was no similarly observed association between the pandemic versus baseline periods (statistical surveillance RR=1.56, control RR=1.66; difference-in-differences, 0.94; 95% CI, 0.46 to 1.92).ConclusionsAutomated detection of hospital outbreaks using statistical surveillance did not reduce overall outbreak size in the context of an ongoing pandemic. (Funded by the Centers for Disease Control and Prevention; ClinicalTrials.gov number, NCT04053075. Support for HCA Healthcare's participation in the study was provided in kind by HCA.).
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- 2024
9. Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): a cluster-randomised trial.
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Huang, Susan S, Septimus, Edward, Kleinman, Ken, Moody, Julia, Hickok, Jason, Heim, Lauren, Gombosev, Adrijana, Avery, Taliser R, Haffenreffer, Katherine, Shimelman, Lauren, Hayden, Mary K, Weinstein, Robert A, Spencer-Smith, Caren, Kaganov, Rebecca E, Murphy, Michael V, Forehand, Tyler, Lankiewicz, Julie, Coady, Micaela H, Portillo, Lena, Sarup-Patel, Jalpa, Jernigan, John A, Perlin, Jonathan B, Platt, Richard, and ABATE Infection trial team
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ABATE Infection trial team ,Humans ,Staphylococcus aureus ,Bacteremia ,Staphylococcal Infections ,Chlorhexidine ,Mupirocin ,Anti-Infective Agents ,Local ,Baths ,Administration ,Intranasal ,Carrier State ,Infection Control ,Drug Resistance ,Multiple ,Bacterial ,Aged ,Middle Aged ,Intensive Care Units ,Female ,Male ,Methicillin-Resistant Staphylococcus aureus ,Outcome Assessment ,Health Care ,Anti-Infective Agents ,Local ,Administration ,Intranasal ,Drug Resistance ,Multiple ,Bacterial ,Outcome Assessment ,Health Care ,General & Internal Medicine ,Medical and Health Sciences - Abstract
BACKGROUND:Universal skin and nasal decolonisation reduces multidrug-resistant pathogens and bloodstream infections in intensive care units. The effect of universal decolonisation on pathogens and infections in non-critical-care units is unknown. The aim of the ABATE Infection trial was to evaluate the use of chlorhexidine bathing in non-critical-care units, with an intervention similar to one that was found to reduce multidrug-resistant organisms and bacteraemia in intensive care units. METHODS:The ABATE Infection (active bathing to eliminate infection) trial was a cluster-randomised trial of 53 hospitals comparing routine bathing to decolonisation with universal chlorhexidine and targeted nasal mupirocin in non-critical-care units. The trial was done in hospitals affiliated with HCA Healthcare and consisted of a 12-month baseline period from March 1, 2013, to Feb 28, 2014, a 2-month phase-in period from April 1, 2014, to May 31, 2014, and a 21-month intervention period from June 1, 2014, to Feb 29, 2016. Hospitals were randomised and their participating non-critical-care units assigned to either routine care or daily chlorhexidine bathing for all patients plus mupirocin for known methicillin-resistant Staphylococcus aureus (MRSA) carriers. The primary outcome was MRSA or vancomycin-resistant enterococcus clinical cultures attributed to participating units, measured in the unadjusted, intention-to-treat population as the HR for the intervention period versus the baseline period in the decolonisation group versus the HR in the routine care group. Proportional hazards models assessed differences in outcome reductions across groups, accounting for clustering within hospitals. This trial is registered with ClinicalTrials.gov, number NCT02063867. FINDINGS:There were 189 081 patients in the baseline period and 339 902 patients (156 889 patients in the routine care group and 183 013 patients in the decolonisation group) in the intervention period across 194 non-critical-care units in 53 hospitals. For the primary outcome of unit-attributable MRSA-positive or VRE-positive clinical cultures (figure 2), the HR for the intervention period versus the baseline period was 0·79 (0·73-0·87) in the decolonisation group versus 0·87 (95% CI 0·79-0·95) in the routine care group. No difference was seen in the relative HRs (p=0·17). There were 25 (
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- 2019
10. Effect of body surface decolonisation on bacteriuria and candiduria in intensive care units: an analysis of a cluster-randomised trial
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Huang, Susan S, Septimus, Edward, Hayden, Mary K, Kleinman, Ken, Sturtevant, Jessica, Avery, Taliser R, Moody, Julia, Hickok, Jason, Lankiewicz, Julie, Gombosev, Adrijana, Kaganov, Rebecca E, Haffenreffer, Katherine, Jernigan, John A, Perlin, Jonathan B, Platt, Richard, Weinstein, Robert A, and Program, and the CDC Prevention Epicenters Program Agency for Healthcare Research and Quality DEcIDE Network and Healthcare-Associated Infections
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Biomedical and Clinical Sciences ,Clinical Sciences ,Emerging Infectious Diseases ,Clinical Research ,Infectious Diseases ,Health Services ,Clinical Trials and Supportive Activities ,Urologic Diseases ,Prevention ,Infection ,Adult ,Aged ,Anti-Bacterial Agents ,Anti-Infective Agents ,Local ,Bacteriuria ,Candida ,Candidiasis ,Carrier State ,Chlorhexidine ,Cluster Analysis ,Disinfection ,Female ,Humans ,Infection Control ,Intensive Care Units ,Male ,Methicillin-Resistant Staphylococcus aureus ,Middle Aged ,Mupirocin ,Sex Factors ,Urinary Tract Infections ,Agency for Healthcare Research and Quality (AHRQ) DEcIDE Network and Healthcare-Associated Infections Program ,and the CDC Prevention Epicenters Program ,Medical Microbiology ,Public Health and Health Services ,Microbiology ,Clinical sciences ,Medical microbiology ,Epidemiology - Abstract
BackgroundUrinary tract infections (UTIs) are common health-care-associated infections. Bacteriuria commonly precedes UTI and is often treated with antibiotics, particularly in hospital intensive care units (ICUs). In 2013, a cluster-randomised trial (REDUCE MRSA Trial [Randomized Evaluation of Decolonization vs Universal Clearance to Eradicate MRSA]) showed that body surface decolonisation reduced all-pathogen bloodstream infections. We aim to further assess the effect of decolonisation on bacteriuria and candiduria in patients admitted to ICUs.MethodsWe did a secondary analysis of a three-group, cluster-randomised trial of 43 hospitals (clusters) with patients in 74 adult ICUs. The three groups included were either meticillin-resistant Staphylococcus aureus (MRSA) screening and isolation, targeted decolonisation (screening, isolation, and decolonisation of MRSA carriers) with chlorhexidine and mupirocin, and universal decolonisation (no screening, all patients decolonised) with chlorhexidine and mupirocin. Protocol included chlorhexidine cleansing of the perineum and proximal 6 inches (15·24 cm) of urinary catheters. ICUs within the same hospital were assigned the same strategy. Outcomes included high-level bacteriuria (≥50 000 colony forming units [CFU]/mL) with any uropathogen, high-level candiduria (≥50 000 CFU/mL), and any bacteriuria with uropathogens. Sex-specific analyses were specified a priori. Proportional hazards models assessed differences in outcome reductions across groups, comparing an 18-month intervention period to a 12-month baseline period.Findings122 646 patients (48 390 baseline, 74 256 intervention) were enrolled. Intervention versus baseline hazard ratios (HRs) for high-level bacteriuria were 1·02 (95% CI 0·88-1·18) for screening or isolation, 0·88 (0·76-1·02) for targeted decolonisation, and 0·87 (0·77-1·00) for universal decolonisation (no difference between groups, p=0·26), with no sex-specific reductions (HRs for men: 1·09 [95% CI 0·85-1·40] for screening or isolation, 1·01 [0·79-1·29] for targeted decolonisation, and 0·78 [0·63-0·98] for universal decolonisation, p=0·12; HRs for women: 0·97 [0·80-1·17] for screening and isolation, 0·83 [0·70-1·00] for targeted decolonisation, and 0·93 [0·79-1·09] for universal decolonisation, p=0·49). HRs for high-level candiduria were 1·14 (0·95-1·37) for screening and isolation, 0·99 (0·83-1·18) for targeted decolonisation, and 0·83 (0·70-0·99) for universal decolonisation (p=0·05). Differences between sexes were due to reductions in men in the universal decolonisation group (HRs: 1·21 [95% CI 0·88-1·68] for screening or isolation, 1·01 [0·73-1·39] for targeted decolonisation, and 0·63 [0·45-0·89] for universal decolonisation, p=0·02). Bacteriuria with any CFU/mL was also reduced in men in the universal decolonisation group (HRs 1·01 [0·81-1·25] for screening or isolation, 1·04 [0·83-1·30] for targeted decolonisation, and 0·74 [0·61-0·90] for universal decolonisation, p=0·04).InterpretationUniversal decolonisation of patients in the ICU with once a day chlorhexidine baths and short-course nasal mupirocin could be a potential preventive strategy in male patients because it significantly decreases candiduria and any bacteriuria, but not for women.FundingHAI Program from AHRQ, US Department of Health and Human Services as part of the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) program, CDC Prevention Epicenters Program.
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- 2016
11. Reply to Diekema et al.
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Popovich, Kyle J, Aureden, Kathy, Ham, D Cal, Harris, Anthony D, Hessels, Amanda J, Huang, Susan S, Maragakis, Lisa L, Milstone, Aaron M, Moody, Julia, Yokoe, Deborah, and Calfee, David P
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STAPHYLOCOCCAL disease prevention ,PREVENTION of infectious disease transmission ,CROSS infection prevention ,INFECTION control ,HAND washing ,METHICILLIN-resistant staphylococcus aureus ,CRITICAL care medicine - Published
- 2024
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12. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update
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Calfee, David P, Salgado, Cassandra D, Milstone, Aaron M, Harris, Anthony D, Kuhar, David T, Moody, Julia, Aureden, Kathy, Huang, Susan S, Maragakis, Lisa L, Yokoe, Deborah S, and Society for Healthcare Epidemiology of America
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Methicillin-Resistant Staphylococcus aureus ,Cross Infection ,Infection Control ,Intensive Care Units ,Disease Transmission ,Epidemiology ,Infectious ,Humans ,Society for Healthcare Epidemiology of America ,Staphylococcal Infections ,Medical and Health Sciences - Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their methicillin-resistant Staphylococcus aureus (MRSA) prevention efforts. This document updates "Strategies to Prevent Transmission of Methicillin-Resistant Staphylococcus aureus in Acute Care Hospitals,"1 published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.2. © 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.
- Published
- 2014
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