To evaluate the impact of a mobile-app-based central line-associated bloodstream infection (CLABSI) prevention program in oncology clinic patients with peripherally inserted central catheters (PICCs).

Pre-post prospective cohort study with baseline (July 2015–December 2016), phase-in (January 2017–April 2017), and intervention (May 2017–November 2018). Generalized linear mixed models compared intervention with baseline frequency of localized inflammation/infection and dressing peeling. Cox proportional hazards models compared days-to-removal of lines with localized inflammation/infection. Chi-square test compared bacteremia rates before and after intervention.

Oncology clinic at a large medical center.

Oncology clinic adult patients with PICCs.

CLABSI prevention program consisting of an actionable scoring system for identifying insertion site infection/inflammation coupled with a mobile-app enabling photo-assessments and automated physician alerting for remote response.

We completed 5,343 assessments of 569 PICCs in 401 patients (baseline: 2,924 assessments, 300 PICCs, 216 patients; intervention: 2,419 assessments, 269 PICCs, 185 patients). The intervention was associated with a 92% lower likelihood of having a dressing with peeling (OR 0.08, 95%CI 0.04-0.17, P < 0.001), 53% lower local inflammation/infection (OR 0.47, 95%CI 0.27-0.84, P < 0.011), and 24% (non-significant) lower CLABSI rates (P = .63). Physician mobile-app alerting and response enabled 80% lower risk of lines remaining in place after inflammation/infection was identified (HR 0.20, 95%CI:0.14-0.30, P < 0.001) and 85% faster removal of infected lines from mean (SD) 11.1 (9.7) to 1.7 (2.4) days.

A mobile-app-based CLABSI prevention program decreased frequency of inflamed/infected central line insertion sites and increased speed of removal when inflammation/infection was found.

To identify risk factors for surgical site infections (SSIs) following C-sections in an underserved, urban population.

Retrospective case-control study and multivariable regression analyses.

Multicenter urban hospital system.

All women undergoing C-sections during 2023.

To identify risk factors for SSIs, patients suffering SSIs were compared to a propensity-matched control group (controlled for the following variables: age, body mass index, diabetes mellitus, American Society of Anesthesia (ASA) score, wound class, and duration of surgery). In addition, multivariable logistic regression analysis was performed to identify independent risks for SSIs.

Of 4,642 C-sections performed, 73 SSIs were identified; 90% were detected after hospital discharge. Compared to a propensity-matched group, more patients in the SSI cohort received gentamicin with clindamycin (vs a cefazolin-based regimen); gentamicin dosing was consistently below recommended levels. Also, significantly more patients in the SSI group were recent immigrants to the United States compared to the control group (20.5% vs 4.1%, P = .004). Multivariate regression analysis revealed 3 independent risk factors for SSIs: ASA score, surgery at a hospital without an Obstetrics-Gynecology residency program, and residence in the borough of the Bronx, NY.

For women living in areas of low socioeconomic status, most SSIs after C-sections are detected following hospital discharge. Women who are recent immigrants and living in areas of high poverty are particularly at higher risk. Addressing the broader social determinants of health, particularly in underserved areas, will be crucial in reducing SSIs and improving overall maternal health outcomes.

Antibiotic stewardship programs (ASPs) target hospitalized children, but most do not routinely review antibiotic prescriptions at discharge, despite 30% of discharged children receiving additional antibiotics. Our objective is to describe discharge antibiotic prescribing in children hospitalized for uncomplicated community-acquired pneumonia (CAP), skin/soft tissue infection (SSTI), and urinary tract infection (UTI).

Retrospective cohort study.

Four academic children’s hospitals with established ASPs.

ICD-10 codes identified 3,847 encounters for children <18 years admitted from January 1, 2021 to December 31, 2021 and prescribed antibiotics at discharge for uncomplicated CAP, SSTI, or UTI. After excluding children with medical complexity and encounters with concomitant infections, >7 days hospital stay, or intensive care unit stay, 1,206 encounters were included.

Primary outcomes were the percentage of subjects prescribed optimal (1) total (inpatient plus outpatient) duration of therapy (DOT) and (2) antibiotic choice based on current national guidelines and available evidence.

Of 226 encounters for CAP, 417 for UTI, and 563 for SSTI, the median age was 4 years, 52% were female, and the median DOT was 9 days (8 for CAP, 10 for UTI, and 9 for SSTI). Antibiotic choice was optimal for 77%, and DOT was optimal for 26%. Only 20% of antibiotic courses included both optimal DOT and antibiotic choice.

At 4 children’s hospitals with established ASPs, 80% of discharge antibiotic courses for CAP, UTI, and SSTI were suboptimal either by choice of antibiotic or DOT. Discharge antibiotic prescribing represents an opportunity to improve antibiotic use in children.

To identify Surgical Site Infection (SSI) risk factors for abdominal hysterectomy patients and report the results of a performance improvement initiative.

Retrospective case-control.

Parkland Hospital, an 882-bed academic, safety-net, tertiary referral center and a level 1 trauma center serving a diverse population of primarily uninsured patients in North Texas.

Patients over 18 who underwent abdominal hysterectomy and were diagnosed with SSIs within 30 days of surgery between 2019 and 2021.

Cases were matched to controls from the same or closest calendar month in a 1:2 ratio. Chart review of electronic medical records (EMR) was performed comparing variables using Pearson’s χ2 test for categorical variables and Student’s t-test for continuous variables followed by logistic regression for multivariate analysis. Upon identifying vaginal preparation technique as an area of improvement while investigating SSI bundle compliance, we implemented an OR staff training intervention.

Diabetes was identified as a significant risk factor while Hispanic or Latino ethnicity was associated with significantly lower rates of infection. Most organisms identified were enteric pathogens. Following the intervention, Parkland’s deep and organ-space Standardized Infection Ratio (SIR) decreased from 1.46 in 2021 to 0.519 for the rolling 12 months as of June 2024.

Our multidisciplinary intervention improving the quality and consistency of pre-operative vaginal preparation was associated with a reduction in abdominal hysterectomy SSI.

Patients with Opioid Use Disorder (OUD) are prone to Multidrug-Resistant Organism (MDRO) colonization and infections, thus at risk for worse outcomes during critical illness. Understanding the prevalence and predictors of MDRO infections is essential to optimize interventions and treatments.

Retrospective cohort study.

The study evaluated the prevalence of MDRO isolation among adults with OUD admitted to an intensive care unit (ICU) between January 1, 2018, and July 31, 2023. It included adults admitted to an ICU with bacterial infections and positive cultures obtained within 48 hours of admission. Demographics, clinical traits, and MDRO isolation rates were analyzed using descriptive statistics, univariate methods, and Least Absolute Shrinkage and Selection Operator (LASSO) regression.

MDRO isolation occurred in 178 of 790 patients (22.5%), with methicillin-resistant Staphylococcus aureus as the most frequently isolated organism. LASSO regression identified housing insecurity (OR: 1.79, 95% CI 1.09–2.93, P = .022), no receipt of medications for OUD treatment (OR: 1.56, 95% CI 1.06–2.29, P = .023), positive hepatitis C virus (HCV) status (OR: 2.19, 95% CI 1.19–4.03, P = .012), and intravenous antibiotic use in the prior 90 days (OR: 1.04 per 24 h, 95% CI 1.01–1.07, P = .007) as significant predictors of MDRO isolation.

The study highlights a high prevalence of MDRO isolation in critically ill OUD patients admitted for infection-related issues with positive cultures obtained within 48 hours of admission, influenced by factors like housing insecurity, no receipt of medications for OUD treatment, HCV status, and prior antibiotic use.

Medicare claims are frequently used to study Clostridioides difficile infection (CDI) epidemiology. However, they lack specimen collection and diagnosis dates to assign location of onset. Algorithms to classify CDI onset location using claims data have been published, but the degree of misclassification is unknown.

We linked patients with laboratory-confirmed CDI reported to four Emerging Infections Program (EIP) sites from 2016–2021 to Medicare beneficiaries with fee-for-service Part A/B coverage. We calculated sensitivity of ICD-10-CM codes in claims within ±28 days of EIP specimen collection. CDI was categorized as hospital, long-term care facility, or community-onset using three different Medicare claims-based algorithms based on claim type, ICD-10-CM code position, duration of hospitalization, and ICD-10-CM diagnosis code presence-on-admission indicators. We assessed concordance of EIP case classifications, based on chart review and specimen collection date, with claims case classifications using Cohen’s kappa statistic.

Of 12,671 CDI cases eligible for linkage, 9,032 (71%) were linked to a single, unique Medicare beneficiary. Compared to EIP, sensitivity of CDI ICD-10-CM codes was 81%; codes were more likely to be present for hospitalized patients (93.0%) than those who were not (56.2%). Concordance between EIP and Medicare claims algorithms ranged from 68% to 75%, depending on the algorithm used (κ = 0.56–0.66).

ICD-10-CM codes in Medicare claims data had high sensitivity compared to laboratory-confirmed CDI reported to EIP. Claims-based epidemiologic classification algorithms had moderate concordance with EIP classification of onset location. Misclassification of CDI onset location using Medicare algorithms may bias findings of claims-based CDI studies.

Many post-acute and long-term care settings (PALTCs) struggle to measure antibiotic use via the standard metric, days of therapy (DOT) per 1000 days of care (DOC). Our objective was to develop antibiotic use metrics more tailored to PALTCs.

Retrospective cohort study with a validation cohort.

PALTC settings within the same network.

We obtained census data and pharmacy dispensing data for 13 community PALTCs (January 2020–December 2023). We calculated antibiotic DOT/1000 DOC, DOT per unique residents, and antibiotic starts per unique residents, at monthly intervals for community PALTCs. The validation cohort was 135 Veterans Affairs Community Living Centers (VA CLCs). For community PALTCs only, we determined the DOT and antibiotics starts per unique residents cared for by individual prescribers.

For community PALTCs, the correlation between facility-level antibiotic DOT/1000 DOC and antibiotic DOT/unique residents and antibiotic courses/unique residents was 0.97 (P < 0.0001) and 0.84 (P < 0.0001), respectively. For VA CLCs, those values were 0.96 (P < 0.0001) and 0.85 (P < 0.0001), respectively. At community PALTCs, both novel metrics permitted assessment and comparison of antibiotic prescribing among practitioners.

At the facility level, the novel metric antibiotic DOT/unique residents demonstrated strong correlation with the standard metric. In addition to supporting tracking and reporting of antibiotic use among PALTCs, antibiotic DOT/unique residents permits visualization of the antibiotic prescribing rates among individual practitioners, and thus peer comparison, which in turn can lead to actionable feedback that helps improve antibiotic use in the care of PALTC residents.

To assess the association between social vulnerability index (SVI) and surgical site infections (SSIs) using National Healthcare Safety Network (NHSN) criteria.

Retrospective cohort study between August 1, 2022, and August 31, 2023.

In total, 20 acute care hospitals in the Southeast United States.

Totally, 23,768 total hip arthroplasty, total knee arthroplasty, abdominal hysterectomy, colon, and spinal fusion surgeries in 22,239 patients were included. Procedures with infection present at the time of surgery or incomplete geographic tracking data were excluded.

Patient addresses as noted in the electronic health record were geocoded to determine census tract of residence and determine SVI. Demographic and clinical data were linked with SVI scores. SSIs were identified according to NHSN criteria. SVI was categorized into quartiles, and logistic regression was used to evaluate the association between SVI quartile (overall and for each SVI theme) and SSI risk. Subgroup analyses by procedure type and race were performed. Multivariable models of the association between overall SVI and SSI were adjusted for demographic and clinical factors.

Patients in the top SVI quartiles had significantly higher odds of developing SSIs after adjusting for other clinical and demographic factors. Increased risk was found for socioeconomic status and household characteristics themes, but not for the racial/ethnic minority theme. Association between SVI and SSI risk varied by type of surgery.

Living in an area with a higher SVI is associated with increased SSI risk. Targeted interventions are needed to mitigate these disparities and improve outcomes.

An association between weekend/off-hour care and unfavorable clinical outcomes has been observed, commonly called the “weekend effect.” In the present study, we examined whether there was a weekend effect associated with blood culture (BC) contamination, which can lead to inappropriate medical resource consumption.

We conducted a single-center retrospective observational study using data from BC tests performed on adult patients. The primary outcome was the incidence of BC contamination, which was compared between weekend and weekday sampling groups. In a multivariable logistic analysis, we evaluated the association between weekend sampling and the incidence of BC contamination.

The analysis included 7,597 weekend and 50,655 weekday BC sets from 1 January 2013 to 31 December 2019. The proportion of BC contamination during the study period was 1.15% (87/7,597) and 0.80% (405/50,655) in the weekend and weekday groups, respectively. In the logistic regression analysis adjusted for blood sampling settings, weekend sampling was significantly associated with increased BC contamination (odds ratio, 1.36; 95% confidence interval, 1.06–1.71).

This study highlighted a significant association between weekend blood sampling for BC and an increased incidence of contamination. To provide better-quality care, further studies evaluating the differences in staffing and blood collection processes on weekends and weekdays are warranted.

To identify global research priorities for improving hand hygiene in healthcare settings and develop a 2023–2030 research agenda to guide funding, coordinate research, promote investment, and inform policy for enhanced healthcare quality and safety.

Expert consensus study using a modified Delphi process.

A 105-member panel of international hand hygiene experts including the World Health Organization (WHO) Technical Advisory Group of Experts on Hand Hygiene in Healthcare representing all WHO regions and World Bank income levels.

The research priorities were identified through a multiphase approach including a meta-review to establish knowledge gaps and inform initial priorities, followed by expert consultations using a modified Delphi process. 192 preliminary priorities were included in a two-round Delphi survey. Experts rated each priority in the first round, and then reviewed and adjusted responses based on the panel’s aggregated, anonymous responses in the second round. Ratings were collected on a five-point Likert scale. Consensus was defined as a combined “strongly agree” and “agree” frequency of at least 70%.

Consensus was achieved for 178 of 192 priorities (92.7%), categorized into six domains: system change; training and education; evaluation and feedback; reminders and communications; institutional safety climate; and hand hygiene improvement impact on healthcare-associated infections and antimicrobial resistance. Of these, 121 priorities reached >80% consensus. The Delphi process, maintained a 92% response rate over two rounds.

A structured consensus process yielded a research agenda to address gaps in hand hygiene improvement, supporting enhanced healthcare quality and safety globally.