Is central line type an independent risk factor of central line-associated bloodstream infection in a neonatal intensive care unit population? Experiences at a pediatric hospital in South Texas.

Background: Central line-associated bloodstream infection (CLABSI) causes significant harm in neonatal intensive care unit (NICU) patients. However, data regarding risk factors and prevention strategies for CLABSI in NICU patients is limited. Objective: To examine risk factors for CLABSI in a NICU population, with particular interest in central line type and site placement. Design: Retrospective case-control study. Setting: NICU (Level IV, 67 bed) at a pediatric hospital in South Texas. Participants: All central line insertions and subsequent CLABSI cases were extracted from the EHR for NICU admissions occurring from January 1, 2018, to November 3, 2022 (N = 1,356), along with potential CLABSI risk factors. Methods: Central line insertions resulting in CLABSI (N = 35) were compared to instances without CLABSI (N = 1,321) using bivariate and multivariate analysis, with propensity score matching. Results: Multivariate risk factors include implantable device (odds ratio [OR] = 14.5, P < .001), neck site placement (OR = 7.2, P < .001), and device dwell time (OR = 5.6, P = .001), as well as years 2021 (OR = 5.1, P = .017) and 2022 (OR = 5.9, P = .011). This indicates the odds of contracting CLABSI are 14.5 times higher when an implantable central line is used compared to the reference category (PICC devices). When cases are paired with matched controls, likelihood of CLABSI is 7.1% higher in patients with an implantable device than in similar patients with other central lines (p = 0.034). Conclusions: Implantable central lines are an independent risk factor for CLABSI in NICU patients at this facility.

A Free Mobile Application Improves the Efficiency of Hand Hygiene Observation Collection: Experiences at a Pediatric Hospital in South Texas.

Hand hygiene (HH) is the most important means of reducing hospital-acquired infections. However, compliance at health care facilities remains deficient. A process improvement study was conducted at a 191-bed, pediatric hospital in South Texas evaluating a free mobile application for HH surveillance, compared to traditional pen-and-paper methods. Using a series of Plan-Do-Study-Act (PDSA) cycles, the application was piloted on a small scale and then trialed facilitywide from June to November 2021. The number of HH audits was compared to the preceding period using percentage change analysis. The mobile application resulted in 7,388 HH observations collected, compared with 3,082 previously, representing a 140% increase. Two staff roles in the process (data entry and analysis) were eliminated, as observations were pushed directly to the infection preventionist, eliminating approximately eight hours of staff time monthly. The application enabled almost real-time updates to the HH surveillance dashboard and improved the detailedness of the data as more variables were collected during each HH observation. This is a practical alternative for innovating HH observation compared with more sophisticated and expensive HH surveillance technology.

Evaluation of a statewide collaborative focused on antibiotic usage surveillance and stewardship in New York State Hospitals.

BACKGROUND: To prepare NYS hospitals for reporting in The National Health Care Safety Network's Antimicrobial Use and Resistance (AUR) Module, the Health care Association of New York State (HANYS) launched a voluntary Antibiotic Stewardship Collaborative (ASC) in late 2015 with 2 aims (1) assist hospitals in developing the infrastructure necessary to track and report antibiotic usage; (2) educate hospitals on antibiotic stewardship. This study evaluates the characteristics of hospitals opting to participate in the ASC and their experiences in the program, as well as the effects of one year of participation (2016) on hospital-acquired C. difficile infection (HA-CDI) rates. METHODS: Difference in means testing of clinical and non-clinical characteristics were performed to understand the "type" of hospital joining the ASC; semi-structured interviews were conducted to understand reasons for opting in or out of the ASC and experiences in the program; and a multivariate regression analysis with a difference-in-differences approach was used to assess the impact on HA-CDI rates. RESULTS: Hospitals with a greater number of annual discharges (P < .001) located in urban areas (P = .03) were more likely to join the ASC. All participants in the ASC (N = 44/184) successfully implemented the necessary infrastructure to track and report antibiotic usage data, despite this being the most cited challenge and main reason hospitals opted not to participate. While HA-CDI rates decreased to a greater extent for participating hospitals (ß = -0.153), this was not statistically significant (P = .191). CONCLUSIONS: HANYS' ASC proved an effective and well-received strategy for encouraging hospitals, particularly large, urban facilities, to take concrete steps to strengthen their antibiotic stewardship efforts and prepare for potential mandates requiring antibiotic usage tracking and reporting. However, a reduction in HA-CDI resulting from these efforts remains to be seen.

Can Emergency Department Wait Times Predict Rates of Hospital-Acquired Clostridioides difficile Infection? A Study of Acute Care Facilities in New York State.

OBJECTIVE: Clostridioides difficile is the most common hospital-acquired pathogen and persists in the environment for extended periods. As a common entry point for patients with diarrhea, and a setting providing fast-paced, high-volume care, emergency departments (EDs) are often sites of C. difficile contamination. This study examined the relationship between average patient wait times in the ED before admission and overall hospital-acquired C. difficile infection (HA-CDI) rates in New York State acute care hospitals. METHODS: A random-effects regression analysis compared each facility's annual average ED wait time for admitted patients with that facility's average (HA-CDI) rates for patients entering through the ED. This model controlled for known clinical and nonclinical predictors of HA-CDI: average length of stay; case mix index; total discharges, a measure of hospital size; and percent Medicare discharges, a proxy for advanced age. RESULTS: Emergency department wait times had a significant and positive relationship with HA-CDI rates. Facilities experience an additional 0.002 cases of HA-CDI per 1000 patient discharges with every additional minute patients spend in the ED (P = 0.003), on average. Emergency department wait times also had the largest effect size (0.210), indicating that they explain more of the variance in HA-CDI rates for patients entering through the ED than some of the best-known predictors of HA-CDI. CONCLUSIONS: The relationship between ED wait times and eventual HA-CDI warrants further exploration. These findings suggest efforts to reduce ED wait times for admitted patients or more rigorous environmental cleanliness strategies in the ED, as possible avenues for HA-CDI prevention.

Can patient-reported room cleanliness measures predict hospital-acquired C. difficile infection? A study of acute care facilities in New York state.

BACKGROUND: Patient experience measures, like those form the Hospital Consumer Assessment of Healthcare providers and Systems survey, are increasingly used in healthcare policy decisions. However, it remains unclear if these reflect quality of care, like rates of hospital-acquired infections (HAIs). This study examined the relationship between patient-reported room cleanliness, from the Hospital Consumer Assessment of Healthcare providers and Systems survey, and hospital-acquired C. difficile infection (HA-CDI) rates in NYS acute care hospitals. METHODS: A random-effects regression analysis compared the percentage of patients indicating their room was "always" and "sometimes/never" kept clean to that facility's average HA-CDI rates, controlling for known predictors. RESULTS: A higher percentage of patients reporting their room was "always" kept clean was associated with significantly lower rates of HA-CDI. Facilities experience 0.031 fewer cases of HA-CDI/1,000 discharges for every percentage point increase in the number of patients rating their room as "always" clean (P = .006). A higher percentage of patients reporting their room was "sometimes/never" kept clean was associated with higher rates of HA-CDI (ß = 0.033), but this was not significant (P = .096). CONCLUSIONS: These findings suggest patient perceptions of cleanliness may reflect microbial cleanliness and these measures could assist in the prevention of HAIs. However, further research is needed.

Adoption of electronic hand hygiene monitoring systems in New York state hospitals and the associated impact on hospital-acquired C. difficile infection rates.

BACKGROUND: Approximately 721,800 hospital acquired infections occur annually, generating an estimated $10 billion in provider costs. Proper hand hygiene (HH) prevents hospital acquired infections, yet compliance is low. Electronic hand hygiene monitoring systems (EHHMS) are a potential solution, tracking and signaling HH events. METHODS: We explored adoption of EHHMS in New York State acute care hospitals through a survey and interviews. Trend analysis was used to evaluate the impact of EHHMS on hospital-acquired Clostridium difficile infection (HA-CDI) rates. RESULTS: Survey respondents represented approximately 30% (N = 56) of the total population of hospitals (N = 184) and EHHMS adoption was low (N = 2). The primary reason for nonadoption was cost (79.6%). HH compliance increased 20%-30% and HA-CDI decreased 70% for one hospital after an EHHMS, though not sustained; robust HH culture was mentioned as a necessary accompaniment. The trend analysis showed negligible impact on HA-CDI post-EHHMS for the second hospital. A critical access hospital without an EHHMS reported HH compliance of 90% attributed to strong HH culture. CONCLUSIONS: Proliferation of EHHMS is low in New York State acute care hospitals and its impact on HH compliance and infection rates is questionable. Putting technology aside, strong HH culture seems essential for high compliance.

Changes in Sugary Beverage Consumption and Public Perceptions in Upstate New York After Implementation of a Community Awareness Campaign and Healthier Vending Strategies.

OBJECTIVE: We evaluated the impact of a community-based healthy beverage procurement and serving practices program, and educational media campaign, on residents' behaviors and beliefs regarding sugary beverages. DESIGN: Repeated cross-sectional population surveys in 2013 and 2014 were conducted, as well as semistructured interviews with key informants. We employed multivariate differences-in-differences regression analysis, adjusting for demographics and weight status, using the survey data. Key informant interviews were reviewed for common themes. SETTING: Three rural counties in upstate New York with high prevalence of children living in poverty and childhood obesity. PARTICIPANTS: Residents of Broome, Cattaraugus, and Chautauqua, with Chemung as a control, reached through cross-sectional random-digit-dial landline and cellular telephones, and practitioners involved in intervention implementation. INTERVENTION: Community organizations were encouraged through presentations to leadership to adopt healthier vending policies, providing more low- and no-sugar options, and were provided assistance with implementation. In addition, a media campaign supported by presentations to the public aimed to educate residents regarding the health consequences of sugary beverage consumption. OUTCOME MEASURES: The survey measured population demographics and sugary beverage consumption frequency, availability, beliefs about harmfulness, and support for regulation, pre- and postintervention. Key informant interviews elicited perceived program challenges and successes. RESULTS: Compared with temporal trends in the control county, availability of regular soda in the intervention counties decreased (differences-in-differences estimator: ß = -.341, P = .04) and support for regulation increased (differences-in-differences estimator: ß = .162, P = .02). However, there were no differences regarding beliefs about harmfulness or consumption. Practitioners confirmed that the intervention increased awareness but was insufficient to spur action. CONCLUSION: Although public education on the harmfulness of sugary beverages and provision of healthier options in some vending machines successfully impacted soda availability and support for regulation, it did not reduce consumption. This intervention seems promising but should be paired with other community-based interventions for a more comprehensive approach.

Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: A systematic review.

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are one of the most common hospital-acquired conditions and no longer reimbursable from Medicare as of 2008. Nurse-driven protocols (NDPs), which provide a medically approved rubric for professional nurses to make autonomous care decisions, can facilitate appropriate catheter use and timely removal, as advised in the Centers for Disease Control and Prevention's 2009 CAUTI prevention guidelines. However, little attempt has been made to systematically evaluate their effect on clinical outcomes. METHODS: A systematic review of studies published in the United States since 2006 was performed, following guidelines from the Institute of Medicine. Sources included CINAHL, Medline, professional agencies, hand-searching, and expert consultation. Clinical predictors and prevalence of CAUTI were examined and synthesized qualitatively; heterogeneity of outcomes made a statistical meta-analysis inappropriate. RESULTS: Twenty-nine studies were found eligible for inclusion. All used a case-control (pre-post) approach, and all reported reductions in clinical predictors of CAUTI, particularly indwelling-urinary catheter utilization and CAUTI rates. However, the number of CAUTIs remained unchanged in 1 study. A formal quality assessment revealed a high risk of bias; included studies met an average of 4.9 out of 11 quality indicators. Specifically, many did not use standardized measures. CONCLUSIONS: NDPs appear to have a positive impact on the clinical predictors and prevalence of CAUTI. However, this review identified need for improving the study design of quality improvement projects conducted within the patient care setting.