The validity of the central line-associated bloodstream infection (CLABSI) measure is compromised by subjectivity. We observed significant decreases in both CLABSIs and total hospital-acquired bloodstream infections (BSIs) following a CLABSI prevention intervention in adult intensive care units. Total hospital-acquired BSIs could be explored as an adjunct, objective CLABSI measure.

We implemented a direct-observer hand hygiene audit program that used trained observers, wireless data entry devices, and an intranet portal. We improved the reliability and utility of the data by standardizing audit processes, regularly retraining auditors, developing an audit guidance tool, and reporting weighted composite hand hygiene compliance scores.

The diagnosis of smear-positive pulmonary tuberculosis in a medical officer working in a metropolitan Australian neonatal intensive care unit led to a contact investigation involving 125 neonates, 165 relatives, and 122 healthcare workers with varying degrees of exposure. There was no evidence of nosocomial tuberculosis transmission from the index case.

An estimated 400,000–800,000 sharps-related injuries occur among healthcare workers (HCWs) annually in the United States. The risk of needlestick exposure may be particularly high among emergency medicine (EM) residents, who are learning new procedures in a relatively uncontrolled environment. Despite the potentially serious consequences of percutaneous injuries (PCIs), practitioners in training often down-play the occurrence of PCIs and do not report exposures.

Current literature implies that underreporting of needlestick injuries is multifactorial. By not seeking care after needlesticks occur and thereby delaying treatment, residents incur more risk from exposures. We sought to elucidate the underlying issues that might contribute to this lack of reporting needlestick injuries. Using an anonymous survey, we collected information regarding factors that contributed to sustaining a PCI as well as perceived barriers that prevented residents from reporting these exposures. This information is desirable for both residency programs and employee health departments to reduce the occurrence of unreported exposures.

The survey contained 19 questions, and all subjects were EM residents from the 8 Accreditation Council for Graduate Medical Education–accredited programs in the state of Illinois during the period January–February 2011. The voluntary survey was distributed via e-mail and through a paper version distributed at a regional EM residency conference.

A 60-year-old American man who was hospitalized in India for 4 weeks after an intracranial bleed was transferred by air ambulance to a 249-bed community hospital in Maryland in January 2011. His clinical course is described elsewhere. Here, we describe the infection prevention considerations surrounding his care in the hospital. A sputum sample obtained from the patient grew a New Delhi metallo-β-lactamase-producing (NDM) Klebsiella pneumoniae (NDM-KP) strain and panresistant Acinetobacter species, among other pathogens. Two weeks later, a perirectal swab sample grew an NDM-1 Salmonella Senftenberg (NDM-SS) isolate, described elsewhere. Gut decolonization was attempted with rifaximin 300 mg every 12 hours for 12 days. The patient was discharged home 4.5 months later. He was readmitted to the hospital within 1 week and died shortly thereafter.

In recognition of his epidemiological risk factors, empiric contact isolation was instituted by the infectious disease physician who was consulted when the patient experienced a fever 24 hours after hospital admission. Once the NDM-KP strain was identified, a 1:1 nursing protocol was instituted for the patient; respiratory therapists, however, continued to care for other Patients. The patient's nurses were empowered to enforce strict contact isolation. Visitors were restricted to the patient's immediate family members. The hospital implemented an intensive education and communication program for the professional staff, nurses, respiratory therapists, ancillary personnel, and the patient's family.

Cleaning is an effective way to lower the bacterial burden (BB) on surfaces and minimize the infection risk to patients. However, BB can quickly return. Copper, when used to surface hospital bed rails, was found to consistently limit surface BB before and after cleaning through its continuous antimicrobial activity.

We assess the impact of revised International Classification of Diseases, Ninth Revision, codes on methicillin-resistant Staphylococcus aureus burden in California hospitals. Codes were rapidly adopted, demonstrating new capture of colonization and continued relatively stable capture of infections. Nevertheless, despite new colonization codes, coded data demonstrated poor retention between serial hospitalizations.

Across 36 US pediatric oncology centers, 576 central line-associated bloodstream infections (CLABSIs) were reported over a 21-month period. Most infections occurred in those with leukemia and/or profound neutropenia. The contribution of viridans streptococci infections was striking. Study findings depict the contemporary epidemiology of CLABSIs in hospitalized pediatric cancer patients.

Surveillance of healthcare-associated infections is labor intensive and complex. Discharge coding is an accessible source of information that may support detection of cases. For drain-related meningitis, however, discharge coding data had low sensitivity (32%) and positive predictive value (35%) and could neither replace nor improve existing complex surveillance systems.

We investigated an increase in Trichosporon asahii isolates among inpatients. We identified 63 cases; 4 involved disseminated disease. Trichosporon species was recovered from equipment cleaning rooms, washbasins, and fomites, which suggests transmission through washbasins. Patient washbasins should be single-patient use only; adherence to appropriate hospital disinfection guidelines was recommended.

We describe an outbreak of Pseudomonas aeruginosa respiratory tract infections related to intrinsically contaminated ultrasound gel used for intraoperative transesophageal echocardiograms in cardiovascular surgery patients. This investigation led to a product safety alert by the Food and Drug Administration and the development of guidelines for appropriate use of ultrasound gel.

A Clostridium difficile infection (CDI) stewardship initiative reduced inappropriate prescription of empirical CDI therapy and improved timeliness of treatment and adherence to clinical practice guidelines for management of CDI. The initiative required minimal resources and could easily be incorporated into traditional antimicrobial stewardship programs.

The Centers for Disease Control and Prevention (CDC) recommends annual screening for Mycobacterium tuberculosis infection using the tuberculin skin test (TST) for individuals working in hospitals with 200 or more inpatient beds that have at least 6 documented cases of active tuberculosis (TB) per year. The cost of annual TB screening programs is significant, but the cost per individual with TST conversion is unknown. Therefore, we evaluated the annual TB screening program at the Johns Hopkins Hospital and Medical School to determine (1) the proportion of individuals with TST conversion among individuals in the annual TB screening program with patient care exposure at the Johns Hopkins Hospital and Medical School, (2) which employment and demographic factors are associated with TST conversion, (3) the prevalence of active TB disease among those with TST conversion, and (4) the annual cost of subsequent screening of individuals with initial negative TST results and the screening cost per individual with TST conversion.

TST results were reviewed for individuals participating in the annual TB screening program during the previous 4 years (2007–2010) at the Johns Hopkins Hospital and Medical School, which has experienced an average of 12 documented cases of active TB per year. TST was performed before employment and then annually for healthcare providers according to CDC guidelines and the manufacturer's directions. Individuals in the testing program included anyone who had patient contact, such as physicians, nurses, technologists, students, phlebotomists, nutritionists, pharmacists, and clerks. All initial testing was 2-step testing if the individual was initially reactive.

Environmental surfaces in hospital rooms often become contaminated with microbes, and evidence has linked the patient care environment to transmission of potential pathogens. Despite attempts at standardization of training and cleaning techniques, there is great variation between housekeepers with regard to room cleaning practices. Environmental cleanliness can be assessed by direct observation, surface cultures, detection of adenosine triphosphate, or use of a fluorescent marking solution. Each monitoring technique has limitations.

We participated in a multicenter study that demonstrated improved cleaning of high-touch surfaces through the use of a fluorescent marking solution and rapid-cycle performance feedback. As part of an earlier study, housekeepers were instructed about the importance of environmental cleanliness and appropriate cleaning of high-touch surfaces, and a room cleaning checklist was introduced. In this study, we sought to examine the relationship between the amount of time that a housekeeper spent cleaning a hospital room and the thoroughness of surface cleaning.

Antimicrobial stewardship programs (ASPs) are critically important for combating the emergence of antimicrobial resistance. Despite this, there are no regulatory requirements at a national level, which makes initiatives at the state level critical. The objectives of this study were to identify existing antimicrobial stewardship practices, characterize barriers to antimicrobial stewardship implementation in acute care hospitals throughout Massachusetts, and evaluate the impact on these hospitals of a state-sponsored educational conference on antimicrobial stewardship.

In September 2011, a state-sponsored educational program entitled “Building Stewardship: A Team Approach Enhancing Antibiotic Stewardship in Acute Care Hospitals” was offered to interested practitioners from throughout the state. The program consisted of 2 audio conferences, reading materials, and a 1-day conference consisting of lectures focusing on the importance of ASPs, strategies for implementation, improvement strategies for existing programs, and panel discussions highlighting successful practices. Smaller breakout sessions focused on operational issues, including understanding of pharmacodynamics, business models, and electronic surveillance.

We sequentially increased the number of wall-mounted alcohol-based hand rub dispensers in a small medical unit to evaluate effects on hand hygiene performance. Above a certain point, addition of more dispensers did not increase hand hygiene frequency, which appeared to be influenced more by location than by total number of dispensers.

Contamination of inanimate surfaces contributes to the transmission of healthcare-associated infection, a phenomenon that is well documented for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The high rate of skin colonization with these bacteria among healthcare workers increases the risk of cross contamination via high-touch surfaces. Since gram-negative bacteria are believed to survive poorly on surfaces, their role in the transmission of infection has not been investigated as widely. Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are widespread and endemic in nosocomial settings. Given the increasing prevalence of infections involving ESBL-PE, the role of the environment in ESBL-PE transmission should be explored. This study reports the evaluation of 2 ESBL-PE recovery methods from typical hospital surface materials and their application for recovery of ESBL-PE adjacent to an ESBL-positive patient.