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.

Contact precautions (CPs) may lead to adverse psychological effects, delays in access to services, and compromises in the quality of care and patient safety. These need to be balanced with the benefits in preventing transmission of resistant microorganisms. In this study, we aimed to quantify the effect of CPs on reported patient safety incidents.

The Alfred hospital is a tertiary referral hospital in Melbourne, Australia. Previous studies have shown that colonization with vancomycin-resistant enterococcus (VRE) is endemic in our hospital. Patients found to be colonized with VRE are placed in CPs immediately and during each subsequent admission. At our facility, modified CPs practiced during the study period include isolation in single rooms with a dedicated toilet, use of gloves when entering the room, and gloves and gown if contact with body fluids is anticipated. The hospital has a computerized risk management system where relevant patient safety incidents are reported to facilitate institutional review and response. We conducted a retrospective cohort study using these routinely collected data, comparing the incidence rate of documented adverse events in patients prior and subsequent to initiation of CPs among patients colonized or infected with VRE. Patients with incident VRE detection between January 2009 and October 2010 were included.

We determined the prevalence of mandatory influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination policies for staff in Michigan hospitals and factors affecting policy implementation. Forty-one percent of responders reported a mandatory influenza vaccination policy, and 11% reported a mandatory Tdap vaccination policy. The support of hospital leadership is critical to policy implementation and overcoming barriers.

Among strategies to reduce surgical site infection (SSI) risk, we concentrate on the optimization of the air quality through the heating, ventilation, and air conditioning (HVAC) system. Current ventilation standards applied by some European countries have been compared and show uncertainty in the criteria for dimensioning the HVAC system. The development of a comprehensive regulation needs further discussion.

We report on an influenza B outbreak in an Ontario long-term care facility in which 2 immunized residents receiving oseltamivir prophylaxis for at least 5 days developed laboratory-confirmed influenza B infection. All isolates were tested for the most common oseltamivir resistance, and none of them had resistance identified.

Basins, commonly used to bathe patients who are unable to bathe themselves, frequently become contaminated with potential pathogens and may serve as a source for nosocomial transmission. Chlorhexidine (CHG) has bactericidal activity against a broad spectrum of pathogens and is increasingly used in antiseptic patient baths. The purpose of this study was to ascertain whether basins used to administer CHG bed baths are likely to become contaminated.

Bed bath conditions were simulated by mixing 30 mL of a 4% CHG product or soap preparation to 1 L of warm (37°C) tap water in a 6-L plastic basin (Medical Action Industries). Two commercial brands of CHG (Hibiclens, Molnlycke Health Care [hereafter, CHG-A], or Scrub Care, Cardinal Health [hereafter, CHG-B]) and 1 brand of soap (SensiCare SeptiSoft, ConvaTec) were used. Basins were inoculated with 108 colony-forming units (CFUs) of 1 species of bacteria, mixed for 30 seconds, incubated for 20 minutes at room temperature, emptied, and allowed to dry for 1 hour. A 100-cm2 area on the bottom of the basin was sampled for 10 seconds in 2 directions with a cotton swab premoistened with normal saline. Swab tips were placed in 2 mL of trypticase soy broth (Difco) and vortex-mixed for 30 seconds, and the solution was quantitatively cultured on sheep blood agar (Remel). Cultures were incubated at 37°C for 24 hours, and colonies were counted and expressed as CFUs per square centimeter. Tap water with and without a bacterial inoculum served as positive and negative controls, respectively.

Essential in reducing hospital-acquired infections is adequate hand hygiene (HH) among healthcare workers (HCWs). International studies show, however, that HH guidelines are adhered to in less than 50% of required times. Research into HH behavior has shown that self-reported compliance is often higher than observed compliance, which seems to indicate that HCWs are unaware of their HH behavior. In addition, because of its frequency, HH behavior could be considered an automatic (or subconscious) behavior. Therefore, a (temporary) shift from the subconscious to the conscious could be a solution to change current HH behavior and create new habits. These insights formed the points of departure of the design project described here, which aimed to develop an alcohol-based hand rub (ABHR) dispenser to stimulate HCWs to better adhere to the international guidelines of HH. In order to increase the chance of success of the new dispenser, a participatory design approach was applied, meaning that all stakeholders of the dispenser (nurses, physicians, infection control practitioners, housekeeping) were actively involved in the different phases of the development process.

The development process of the new dispenser consisted of 5 phases: analysis, idea finding (identifying promising design directions), and 3 idea iterations. Interim ideas were evaluated using functional 3-dimensional prototypes and the results applied to further develop the final concept. Methods of user research included observations and individual and focus group interviews.

We evaluated 222 hospitalized patients whose clinical isolates were tested using standard methods and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF). MALDI-TOF could have reduced time to appropriate therapy for 28.8% and 44.6% patients based on the treating physician's choices and stewardship team recommendations, respectively. Clinicians should be aware of scenarios in which MALDI-TOF can optimize antibiotic therapy.

Central line–associated bloodstream infections (CLABSIs) have a considerable impact on morbidity, length of stay, and potential mortality. The estimated per-case cost of CLABSIs is $11,000–$56,167, and there is consensus that most are preventable. Publicly reported CLABSI data are also now used as a metric to compare hospitals.

There are published guidelines for the prevention of central line–associated infections, but these practices have not been studied in burn patients. Patients with severe burns pose unique and specific challenges and differ substantially from the typical medical or surgical intensive care unit (ICU) patient. Our objective was to assess CLABSI prevention practices in burn units.

We identified all American Burn Association (ABA)–certified adult burn centers through the ABA website (http://www.ameriburn.org) and contacted nursing leadership of each burn intensive care unit to conduct a telephone survey of CLABSI prevention practices in March 2012. The survey project was approved by the Johns Hopkins institutional review board.

We had 100% survey participation. There was substantial variation among burn units in the number of beds, the mix of patients, and the acuity of patients' illness. Bed size varied from 4 to 38. Eight units stated that their burn unit incorporated a step-down unit or floor-status beds in their bed count. Thirty (58.8%) of the 51 units defined themselves as mixed burn/surgical or trauma units. The percentage of burned patients seen in the burn units varied from 10% to 100%, with 8 (15.4%) of 51 units stating that their census consisted of fewer than 30% burned patients in their burn ICU.

Environmental contamination of hospital rooms is well recognized as a reservoir for highly resistant nosocomial pathogens such as methicillin-resistant Staphylococcus aureu (MRSA) and vancomycin-resistant Enterococcus (VRE), which can be transferred to patients through contact with healthcare providers and contaminated surfaces. Numerous studies dedicated to environmental cleaning and disinfection have found promising results with several novel technologies, including vaporized hydrogen peroxide and ultraviolet over-head lighting or wands. We conducted a pilot study of one such device, the Sterilray Disinfection Wand (Healthy Environment Innovations), a handheld ultraviolet (UV) room decontamination wand. The Sterilray device claims to generate UV radiation in the far-UV spectrum (185-230 nm), resulting in the rapid killing of contaminant bacteria. The goal of this pilot was to collect preliminary data on the efficacy of this device in reducing surface contamination, particularly of common nosocomial pathogens, in an active hospital setting.

We assessed characteristics associated with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) carriage among residents of 22 nursing homes. Of MRSA-positive swabs, 25% (208/824) were positive for CA-MRSA. Median facility CA-MRSA percentage was 22% (range, 0%–44%). In multivariate models, carriage was associated with age less than 65 years (odds ratio, 1.2; P < .001) and Hispanic ethnicity (odds ratio, 1.2; P = .006). Interventions are needed to target CA-MRSA.

Measurement of adenosine triphosphate (ATP) using portable bioluminometers has been adapted from the food manufacturing sector, and it has been suggested that it could be used as an indicator of surface soiling or cleanliness in hospital settings. Some healthcare authorities are considering the use of portable ATP bioluminometers as a tool for standard setting for surface cleanliness to improve cleaning standards. Central to this approach is the use of a commonly accepted level of detected ATP—expressed as relative light units (RLUs)—that may be used as a surrogate for underlying soiling, including the presence of pathogenic microorganisms.

It has been demonstrated that improvements can be made to cleaning processes with fluorescent markers through a simpler approach that provides a qualitative efficiency measurement of the cleaning process. Measurement of surface hygiene using ATP bioluminometers is thought to provide a more quantitative surrogate of surface cleanliness.

Hospital-acquired infections (HAIs) occur commonly, cause significant harm to patients, and result in excess healthcare expenditures. The urinary tract is frequently cited as the most common site of HAI, but these estimates were extrapolated from National Nosocomial Infection Surveillance (NNIS) data from the 1990s. Updated information regarding the relative burden of specific types of HAIs would help governmental agencies and other stakeholders within the field of infection prevention to prioritize areas for research and innovation. The objective of our study was to assess the relative proportion of HAIs attributed to each of the following 5 types of infection in a network of community hospitals: catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI), ventilator-associated pneumonia (VAP), central line–associated bloodstream infection (CLABSI), and Clostridium difficile infection (CDI).

We performed a retrospective cohort study using prospectively collected HAI surveillance data from hospitals participating in the Duke Infection Control Outreach Network (DICON). DICON hospital epidemiologists and liaison infection preventionists work directly with local hospital infection preventionists to provide surveillance data validation, benchmarking, and infection prevention consultation services to participating hospitals.