Search

Background An automated protocol was designed within our electronic medical record (EMR) to help curb the Clostridium difficile problem at our institution. The protocol will identify patients at high risk for C difficile, improve the timing of testing of patients infected on admission, and enhance the appropriateness of C difficile testing throughout the patient's hospitalization. Methods Admitted patients with 2 of the following 3 criteria were labeled as high risk for C difficile: admission to a medical institution in the preceding 90 days, administration of antibiotics in the preceding 90 days, or a history of C difficile. High-risk patients with diarrhea in the first 3 days of admission are identified in the EMR, and prompt testing for C difficile is done. After day 3, if diarrhea develops, a series of questions is presented to help test the appropriate patients for C difficile. Results A statistically significant reduction in rates of hospital-onset C difficile was achieved after implementation of the protocol. Conclusions Implementation of an automated protocol for targeted testing of high-risk patients for C difficile was successful at reducing rates of hospital-onset C difficile by improving timing and appropriateness of testing.

Mercy Hospital Springfield is a tertiary care facility with 32 000 discharges and 15 000 inpatient surgeries in 2011. From June 2009 through January 2011, a stable inpatient elective neurosurgery infection rate of 2.15% was observed. The failure mode and effects analysis (FMEA) methodology to reduce inpatient neurosurgery infections was utilized. Following FMEA implementation, overall elective neurosurgery infection rates were reduced to 1.51% and sustained through May 2012. Compared with baseline, the post-FMEA deep-space and organ infection rate was reduced by 41% (P = .052). Overall hospital inpatient clean surgery infection rates for the same time frame did not decrease to the same extent, suggesting a specific effect of the FMEA. The study team believes that the FMEA interventions resulted in 14 fewer expected infections, $270 270 in savings, a 168-day reduction in expected length of stay, and 22 fewer readmissions. Given the serious morbidity and cost of health care-associated infections, the study team concludes that FMEA implementation was clinically cost-effective.

We report a case of a 62-year-old female with seizures and encephalitis. Molecular testing of the patient's cerebrospinal fluid was positive for both herpes simplex virus 1 and 2 (HSV-1 and HSV-2). To our knowledge, this is the first report of simultaneous detection of HSV-1 and HSV-2 in cerebrospinal fluid.

Debridement and retention of the prosthesis was the initial treatment modality in 30 patients with 33 Staphylococcus aureus prosthetic joint infections (PJIs) who presented to the Mayo Clinic between 1980 and 1991. Treatment failure, defined as relapse of S. aureus PJI or occurrence of culture-negative PJI during continuous antistaphylococcal therapy, occurred in 21 of 33 prosthetic joints. The 1-year and 2-year cumulative probabilities of treatment failure were 54% (95% confidence interval [CI], 36%-71%) and 69% (95% CI, 52%-86%), respectively. A median of 4 additional surgical procedures (range, 1-9) were required to control the infection in the 21 prosthetic joints for which treatment failed. Prostheses that were debrided >2 days after onset of symptoms were associated with a higher probability of treatment failure than were those debrided within 2 days of onset (relative risk, 4.2; 95% CI, 1.6-10.3). These data suggest that debridement and retention of the prosthesis as the initial therapy for PJI due to S. aureus is associated with a high cumulative probability of treatment failure and that the probability of treatment failure may be related to the duration of symptoms.

Pacemaker vendor was contacted and confirmed there were no reported Mycobacterium infections related to the device. No further Mycobacterium Fortuitum infections have been identified. LESSON LEARNED: The use of cardiac implantable electrophysiological device (CIED) implantation for the management of cardiac disease is increasing as are infections associated with these procedures. Mitigation of infection risk can be accomplished through teamwork and sustained follow up of instituted Infection Prevention measures. Supplemental cleaning support by Electrophysiology Lab staff is useful in high-volume procedure rooms. Forging interdepartmental collaborative teams to identify and address opportunities for improvement can result in enhanced patient outcomes.

LESSON LEARNED: Using the electronic hand-hygiene system enabled real-time data collection allowing education centered around lapses in compliance. The robust data per person, for the entire time worked, allowed staff to be held accountable for individual performance and behavior. Using incentives for high compliance fostered a non-punitive culture. The combination of accountability and incentives had a dramatic impact on the compliance rates. Peer pressure, competition, continuous feedback, collaboration and a non-punitive culture supported by leadership were key to this successful program. The correlation between compliance and infection will be explored.

The 3 harvesters tested provided about the same harvest efficiency. Harvesters did not show significant differences in sound, broken, and bruised pods harvested from 2 fields. More pod clusters and less trash were obtained in the field with more mature pods. Under the same field conditions, 2.6 times more snap beans could be harvested with the FMC model GB-110 and Chisholm-Ryder Multi-Density than with the Chisholm-Ryder Hi-Boy. Quality differences of canned beans harvested with the machines were too small to differentiate by the USDA standards for grades of canned snap beans.

After 6 years, when no example of florid congenital syphilis was seen in a hospital service with 10,000 live births annually, 7 babies with congenital syphilis were admitted within a year. This experience undoubtedly reflects an increased incidence of acquired syphilis in this area. Since several “generations” of pediatric residents had never seen florid congenital syphilis, this entity was not considered in the differential diagnosis at admission. With the use of case protocols of some of these infants, the common problems presented by infantile congenital syphilis are discussed.

In the Cultivar and Germplasm Release article “‘Allgold’ and ‘Goldilocks’ Peaches” by J.N. Moore, Roy C. Rom, Stanley A. Brown, and William A. Sistrunk [HortScience 19(6):891–892, 1984], the captions of Figures 2 and 3 were reversed. The selection test numbers given in the text for these cultivars (‘Allgold’ = A-142; ‘Goldilocks’ = A-15) are correct.