Early-Onset Ventilator-Associated Pneumonia in Pediatric Severe Traumatic Brain Injury.

BACKGROUND: Early-onset ventilator-associated pneumonia (VAP) is associated with poor outcomes in patients with severe traumatic brain injury (TBI). The primary aim of this study was to describe VAP, including the microbiology of VAP and differences in frequency of VAP when various definitions are applied. The secondary aim was to determine the clinical variables associated with the development of VAP in children with severe TBI. METHODS: This is a retrospective cohort study at a quaternary referral children's hospital with a level I trauma center designation. Inclusion criteria were patients aged 0-18 years admitted to the pediatric intensive care unit between 2015 and 2020 with severe TBI requiring at least 2 days of invasive ventilation. VAP was defined by using Center of Disease Control (CDC) definition or clinical VAP, based on physician diagnosis. We compared general demographics, reviewed trauma and injury data, and outcomes to assess any differences between patients with VAP and non-VAP patients. Associations were tested with regression models. RESULTS: After applying all inclusion and exclusion criteria, 90 patients were included in the analysis. Patients with VAP were older (8.5 vs. 5.6 years, P = 0.03). Patients with VAP were less likely to have suffered from abusive head trauma (P = 0.01). Patients who received continuous neuromuscular blockade or targeted temperature management did not have different frequencies of VAP. CDC-defined VAP was diagnosed in 27% of patients. Number of patients with VAP increased to 41% for physician-diagnosed or clinical VAP. Methicillin-sensitive Staphylococcus aureus was the most common isolate grown, followed by Hemophilus influenza, with most VAP occurring on days 2-5 of intubation. VAP was not associated with mortality but was associated with worse functional status scale in patients who survived to discharge (8 vs. 7.5, P = 0.048). Over a cumulative period of days, nebulized 3% and albuterol were associated with decreased incidence of VAP. CONCLUSIONS: Ventilator-associated pneumonia occurs commonly in children with severe TBI, with rates of 27-41%, depending on CDC-defined VAP or clinical VAP. The discrepancy between clinical VAP and CDC-defined VAP further illustrates the need for a standardized definition for VAP. Although most interventions were not associated with VAP, nebulized 3% saline and albuterol were associated with reduced incidence of VAP; future investigation is needed to determine whether mucolytic agents can decrease the rate of VAP in children with severe TBI.

Prevalence of healthcare-associated infections in public hospitals in New Zealand, 2021.

BACKGROUND: There are no contemporary data on healthcare-associated infections (HAIs) in New Zealand. AIMS: To determine the epidemiology of HAIs, prevalence of medical devices, and microbiology of HAIs in adults in public hospitals in New Zealand. METHODS: Point prevalence survey. Surveyors reviewed patients aged ≥18 years using the HAI definitions of the European Centres for Disease Prevention and Control. Device use and microbiology of HAIs were recorded. FINDINGS: In total, 5468 patients were surveyed; 361 patients (6.6%) had 423 HAIs (7.7 HAIs per 100 patients). The most common HAIs were: surgical site infections (N=104, 25%), urinary tract infections (N=80, 19%), pneumonia (N=75, 18%) and bloodstream infections (N=55, 13%). Overall, 3585 patients (66%) had at least one device, with 2922 (53%) patients having a peripheral intravenous catheter. Sixty-nine (16%) HAIs were device-associated. On multi-variable analysis, independent risk factors for HAIs included the presence of a peripheral [odds ratio (OR) 2.0] or central (OR 5.7) intravenous catheter and clinical service. HAI rates were higher in surgical patients (OR 1.8), intensive care unit patients (OR 2.6) and rehabilitation/older persons' health patients (OR 2.4) compared with general medicine patients (P≤0.01 for all groups). In total, 301 organisms were identified. Clostridioides difficile infection was uncommon, accounting for 1.7% of all HAIs. Forty-two isolates (14%) were drug-resistant, and most (N=33, 79%) were Enterobacterales. CONCLUSION: This study established the most common HAIs and their risk factors in New Zealand. The high prevalence of device use underscores the need to ensure that proven multi-modal prevention interventions are in place. However, as less than half of HAIs are device- or surgery-associated, other intervention strategies will be required to reduce their burden.

Device and surgical procedure-related infections in Canadian acute care hospitals, 2017-2021.

Background: Healthcare-associated infections (HAIs) are a significant healthcare burden in Canada. National surveillance of HAIs at sentinel acute care hospitals is conducted by the Canadian Nosocomial Infection Surveillance Program. This article describes device and surgical procedure-related HAI epidemiology in Canada from 2017 to 2021. Methods: Data were collected from over 60 Canadian sentinel acute care hospitals between January 1, 2017, and December 31, 2021, for central line-associated bloodstream infections (CLABSIs), hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt SSIs and paediatric cardiac SSIs. Case counts, rates, patient and hospital characteristics, pathogen distributions and antimicrobial resistance data are presented. Results: Between 2017 and 2021, 2,898 device and surgical procedure-related infections were reported, with CLABSIs in intensive care units representing 69% (n=2,002) of all reported infections under surveillance. Significant rate increases were observed in adult mixed intensive care unit CLABSIs (1.08-2.11 infections per 1,000 line days, p=0.014) while decreases were observed in SSIs following knee arthroplasty (0.34-0.27 infections per 100 surgeries, p=0.05). No changes in trends were observed in the other reported HAIs. Of the 3,089 pathogens identified, the majority were gram-positive (66%), followed by gram negative (23%) and fungi (11%). Coagulase-negative staphylococci (22%) and Staphylococcus aureus (17%) were the most frequently isolated pathogens. Conclusion: Epidemiological and microbiological trends among select device and surgical procedure-related HAIs are essential for benchmarking infection rates nationally and internationally, identifying any changes in infection rates or antimicrobial resistance patterns and helping inform hospital infection prevention and control and antimicrobial stewardship policies and programs.

The efficiency of cleaning in intensive care units: A systematic review.

OBJECTIVES: This review aims to analyze the studies on cleaning practices and the efficiency of the cleaning carried out in environments that have a great risk of resistant microorganism infection, such as intensive care units. METHODS: In this study, a retrospective literature review was undertaken of the relevant publications between the years 2005 and 2020, using the keywords "Cross Infection, Infection Control, Multidrug-Resistant Bacteria, Intensive Care, Room Cleaning, Environmental Cleaning, Hospital-Associated Infection"; using the international databases Pubmed, CINAHL and EBSCO and domestic database ULAKBIM on search engines. Titles and abstracts of all relevant articles found on electronic searches were reviewed by the researchers independently. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline and Patient, Intervention, Comparison, Outcomes, Study design model were used in analysing the studies. RESULTS: The selected studies were reviewed in four main categories: Materials used in cleaning, the period between taking environmental samples, cleaning methods, and the efficiency of cleaning. Among the studies included herein, eight were randomized controlled trials, three were retrospective intervention studies, two were case-control studies and one was a retrospective cohort study. CONCLUSIONS: Today, the assessment of cleaning in environments can be evaluated by different methods, but there are advantages and disadvantages of these methods. Therefore, in the relevant literature, it is suggested that cleaning must be evaluated by several methods, not only one. Also, training the staff that carries out the cleaning and rewarding correct behavior by giving feedback are important approaches to increase the efficiency of cleaning. It is suggested that cleaning must be carried out every day, regularly with effective methods and equipment; frequency of cleaning during epidemics must be increased, institutions must prepare cleaning manuals according to evidence-based guidelines that are recognized at an international level.

The efficiency of cleaning in intensive care units: A systematic review / Eficacia de la limpieza en las unidades de cuidados intensivos: revisión sistemática

Objectives: This review aims to analyze the studies on cleaning practices and the efficiency of the cleaning carried out in environments that have a great risk of resistant microorganism infection, such as intensive care units.Methods: In this study, a retrospective literature review was undertaken of the relevant publications between the years 2005 and 2020, using the keywords “Cross Infection, Infection Control, Multidrug-Resistant Bacteria, Intensive Care, Room Cleaning, Environmental Cleaning, Hospital-Associated Infection”; using the international databases Pubmed, CINAHL and EBSCO and domestic database ULAKBIM on search engines. Titles and abstracts of all relevant articles found on electronic searches were reviewed by the researchers independently. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline and Patient, Intervention, Comparison, Outcomes, Study design model were used in analysing the studies.Results: The selected studies were reviewed in four main categories: Materials used in cleaning, the period between taking environmental samples, cleaning methods, and the efficiency of cleaning. Among the studies included herein, eight were randomized controlled trials, three were retrospective intervention studies, two were case-control studies and one was a retrospective cohort study.Conclusions: Today, the assessment of cleaning in environments can be evaluated by different methods, but there are advantages and disadvantages of these methods. Therefore, in the relevant literature, it is suggested that cleaning must be evaluated by several methods, not only one. Also, training the staff that carries out the cleaning and rewarding correct behavior by giving feedback are important approaches to increase the efficiency of cleaning. It is suggested that cleaning must be carried out every day, regularly with effective methods and equipment; frequency of cleaning during epidemics must be increased, institutions

Objetivos: El objetivo de esta revisión es analizar los estudios sobre la práctica y la eficacia de la limpieza realizada en entornos con alto riesgo de infección por microorganismos resistentes, tales como las unidades de cuidados intensivos.Métodos: En este estudio se realizó una revisión retrospectiva de la literatura dentro de las publicaciones relacionadas entre los años 2005 y 2020, utilizando palabras clave tales como cross infection, infection control, multidrug-resistant bacteria, intensive care, room cleaning, environmental cleaning, hospital-associated infection (infección cruzada, control de infecciones, bacterias multirresistenes a los fármacos, cuidados intensivos, limpieza de habitaciones, limpieza ambiental, infección adquirida en los hospitales), utilizando bases de datos internacionales tales como Pubmed, CINAHL y EBSCO, y la base de datos nacional ULAKBIM en los motores de búsqueda. Los títulos y resúmenes de todos los artículos relacionados seleccionados en las búsquedas electrónicas fueron revisados por investigadores de manera independiente. Se utilizaron las directrices de The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols y el modelo del diseño Patient, Intervention, Comparison, Outcomes, Study para analizar los estudios.Resultados: Se revisaron los estudios seleccionados en 4 categorías principales: materiales utilizados en la limpieza, periodo transcurrido entre las tomas de muestras ambientales, métodos de limpieza y eficacia de la limpieza. Entre los estudios incluidos en la revisión 8 eran ensayos controlados aleatorizados, 3 eran estudios retrospectivos de intervención, 2 eran estudios de control de casos y uno era un estudio retrospectivo de cohorte.

A challenging response to a Lassa fever outbreak in a non endemic area of Sierra Leone in 2019 with export of cases to The Netherlands.

INTRODUCTION: On November 20, 2019, the Sierra Leone International Health Regulations (IHR) National Focal Point was notified of an exported case of Lassa fever in The Netherlands, by a Dutch doctor who previously practiced in a rural hospital in Sierra Leone. This report describes the extent of the outbreak, possible sources of infection, and the outbreak response measures taken. METHODS: Response measures implemented to control the outbreak included coordination across multiple countries and cities, outbreak investigation, active case finding, contact tracing and monitoring, laboratory investigation, and isolation and treatment of cases. RESULTS: We report a hospital-associated outbreak that resulted in 3 confirmed cases (health workers) and 2 probable cases (patients). The case fatality rate was 60%, whereas the secondary attack rate was 14%. Two cases involved exportations to The Netherlands. Failure to detect the index case and poor adherence to infection prevention and control (IPC) protocols contributed to disease spread. Pregnancy status and nonspecific signs and symptoms of the index case contributed to failure in early case detection. CONCLUSIONS: Rapid activation of national and subnational incident management systems resulted in rapid outbreak control. We recommend regular training for clinicians on surveillance and IPC protocols and strengthening in-country Lassa virus diagnostic capacity.

Device and surgical procedure-related infections in Canadian acute care hospitals from 2011 to 2020.

Background: Healthcare-associated infections (HAIs) continue to place a burden on patient health and safety as well as on the healthcare system. In Canada, national surveillance of HAIs at sentinel acute care hospitals is conducted by the Canadian Nosocomial Infection Surveillance Program. This article describes ten years of device and surgical procedure-related HAI epidemiology in Canada from 2011 to 2020. Methods: Data were collected from over 40 Canadian sentinel acute care hospitals between January 1, 2011, and December 31, 2020, for central line-associated bloodstream infections (CLABSIs), hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt SSIs and paediatric cardiac SSIs. Case counts, rates, patient and hospital characteristics, pathogen distributions, and antimicrobial resistance are presented. Results: Between 2011 and 2020, 4,751 device and surgical procedure-related infections were reported, with CLABSIs in intensive care units (ICUs) representing 67% (n=3,185) of all reported infections. Over the surveillance period, significant rate increases were observed in adult mixed ICU CLABSIs (0.8 to 1.6 per 1,000 line days, p=0.004) while decreases were observed in neonatal ICU CLABSIs (4.0 to 1.6 per 1,000 line days, p=0.002) and SSIs following knee arthroplasty (0.69 to 0.29 infections per 100 surgeries, p=0.002). No trends were observed in the other reported HAIs.Of the 5,071 pathogens identified, the majority were gram-positive (68%), followed by gram-negative (23%) and fungi (9%). Coagulase-negative staphylococci (27%) and Staphylococcus aureus (16%) were the most frequently isolated pathogens. Conclusion: This report describes epidemiological and microbiological trends among select device and surgical procedure-related HAIs, essential for benchmarking infection rates nationally and internationally, to identify any changes in infection rates or antimicrobial resistance patterns and to help inform hospital infection prevention and control and antimicrobial stewardship policies and programs.

Human and Porcine Transmission of Clostridioides difficile Ribotype 078, Europe.

Genomic analysis of a diverse collection of Clostridioides difficile ribotype 078 isolates from Ireland and 9 countries in Europe provided evidence for complex regional and international patterns of dissemination that are not restricted to humans. These isolates are associated with C. difficile colonization and clinical illness in humans and pigs.

Influence of surgical team activity on airborne bacterial distribution in the operating room with a mixing ventilation system: a case study at St. Olavs Hospital.

BACKGROUND: Operating rooms (ORs) have strict requirements regarding cleanliness. While existing standards concerning the ventilation and staff guidelines are theoretically sufficient to subvert the threats posed by micro-organisms within the room, there exist potential sources of contamination due to human activity around the area. Studies exploring this influence of human activity on distribution of micro-organism contamination in ORs have relied on manual observations, or indirect methods such as number of door openings. AIM: To utilize depth registration sensing technology to identify the activities of surgical staff and investigate their effect on the distribution of airborne micro-organism contamination in ORs. METHODS: A mock surgical experiment was performed using a depth registration technique for the dynamic capturing of human presence and activity levels. Field measurements were carried out in one real OR to analyse its influence on the bacterial distribution in ORs with mixing ventilation system. FINDINGS: Bacterial contamination levels tended to correlate with higher activity levels, albeit with some inconsistencies. The highest activity levels were around the surgical bed when the patient was placed, and around the instrument table during the surgical procedure. Locations with obstructions had the highest cfu densities, indicating that airflow patterns are important in such spaces. CONCLUSION: Our activity monitoring methods demonstrate a novel means of studying the influences of human activities in hospital rooms.

The efficiency of cleaning in intensive care units: A systematic review.

OBJECTIVES: This review aims to analyze the studies on cleaning practices and the efficiency of the cleaning carried out in environments that have a great risk of resistant microorganism infection, such as intensive care units. METHODS: In this study, a retrospective literature review was undertaken of the relevant publications between the years 2005 and 2020, using the keywords "Cross Infection, Infection Control, Multidrug-Resistant Bacteria, Intensive Care, Room Cleaning, Environmental Cleaning, Hospital-Associated Infection"; using the international databases Pubmed, CINAHL and EBSCO and domestic database ULAKBIM on search engines. Titles and abstracts of all relevant articles found on electronic searches were reviewed by the researchers independently. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline and Patient, Intervention, Comparison, Outcomes, Study design model were used in analysing the studies. RESULTS: The selected studies were reviewed in four main categories: Materials used in cleaning, the period between taking environmental samples, cleaning methods, and the efficiency of cleaning. Among the studies included herein, eight were randomized controlled trials, three were retrospective intervention studies, two were case-control studies and one was a retrospective cohort study. CONCLUSIONS: Today, the assessment of cleaning in environments can be evaluated by different methods, but there are advantages and disadvantages of these methods. Therefore, in the relevant literature, it is suggested that cleaning must be evaluated by several methods, not only one. Also, training the staff that carries out the cleaning and rewarding correct behavior by giving feedback are important approaches to increase the efficiency of cleaning. It is suggested that cleaning must be carried out every day, regularly with effective methods and equipment; frequency of cleaning during epidemics must be increased, institutions must prepare cleaning manuals according to evidence-based guidelines that are recognized at an international level.

Screening for Candida auris in patients admitted to eight intensive care units in England, 2017 to 2018.

BackgroundCandida auris is an emerging multidrug-resistant fungal pathogen associated with bloodstream, wound and other infections, especially in critically ill patients. C. auris carriage is persistent and is difficult to eradicate from the hospital environment.AimWe aimed to pilot admission screening for C. auris in intensive care units (ICUs) in England to estimate prevalence in the ICU population and to inform public health guidance.MethodsBetween May 2017 and April 2018, we screened admissions to eight adult ICUs in hospitals with no previous cases of C. auris, in three major cities. Swabs were taken from the nose, throat, axilla, groin, perineum, rectum and catheter urine, then cultured and identified using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). Patient records were linked to routine ICU data to describe and compare the demographic and health indicators of the screened cohort with a national cohort of ICU patients admitted between 2016 and 2017.ResultsAll C. auris screens for 921 adults from 998 admissions were negative. The upper confidence limit of the pooled prevalence across all sites was 0.4%. Comparison of the screened cohort with the national cohort showed it was broadly similar to the national cohort with respect to demographics and co-morbidities.ConclusionThese findings imply that C. auris colonisation among patients admitted to ICUs in England is currently rare. We would not currently recommend widespread screening for C. auris in ICUs in England. Hospitals should continue to screen high-risk individuals based on local risk assessment.

Does the removal of contact precautions for MRSA and VRE infected patients change health care-associated infection rate?: A systematic review and meta-analysis.

OBJECTIVE: Update existing meta-analysis to analyze if discontinuation of contact precautions (CPs) for Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin resistant Enterococcus (VRE) colonization or infection affects hospital-associated MRSA or VRE infection rates. METHODS: We conducted a systematic review of 17 studies evaluating discontinuation of CPs for MRSA and VRE. Random-effects and fixed-effects models were used to determine the pooled risk ratios (RR) of preincidence hospital-associated infection rate to postincidence rate. Subgroup analysis was used to assess sources of heterogeneity. RESULTS: No significant difference between rates of hospital-associated MRSA infection before and after stopping the CPs was observed (RR, 0.84; 95% confidence internal [CI], 0.71-1.01; P = .06). An inverse association was observed between discontinuation of CPs and rates of hospital-associated VRE infection (RR, 0.82; 95% CI, 0.72-0.94; P = .005). A subgroup analysis of 6 studies that used chlorhexidine, showed no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 0.83; 95% CI, 0.69-1.00; P = .05). In 5 studies that did not use chlorhexidine, there was no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 1.02; 95% CI, 0.55-1.88; P= .95). CONCLUSIONS: There was no significant difference in rates of hospital-associated MRSA infection before and after removing CPs. Additionally, there were decreased rates of hospital-associated VRE infection following stoppage of CPs.

Hospital Associated Respiratory Virus Infection in Children and Adults: It Does Not Just Occur During Cold and Flu Season.

Hospital-associated respiratory virus infections (HARVI) are an underappreciated source of morbidity and mortality. We examined HARVI incidence and clinical respiratory virus testing practices in a cohort of hospitalized patients with acute respiratory illness. HARVI were identified in patients of all ages, both during and outside of the influenza season.

Environmental contamination by SARS-CoV-2 in a designated hospital for coronavirus disease 2019.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is characterized by risk of nosocomial transmission; however, the extent of environmental contamination and its potential contribution of environmental contamination to SARS-CoV-2 transmission are poorly understood. This study aimed to investigate whether environmental contamination may play a role in SARS-CoV-2 transmission. METHODS: Air samples were collected by natural precipitation, and environmental surface samples were collected by conventional surface swabbing. SARS-CoV-2 RNA detection was performed using reverse transcription polymerase chain reaction. RESULTS: Viral RNA was not detected in the 44 air samples. The positive rates in 200 environmental surface samples in medical areas (24.83%) was higher than that in living quarters (3.64%), with a significant difference (P < .05). The positive rates were 25.00% and 37.50% for the general isolation ward and intensive care unit, respectively, and no significant difference was observed between them (P = .238). The top 5 sampling sites with a positive rate in medical areas were beepers (50.00%), water machine buttons (50.00%), elevator buttons (42.86%), computer mouses (40.00%), and telephones (40.00%). CONCLUSIONS: Most of the touchable surfaces in the designated hospital for COVID-19 were heavily contaminated, suggesting that the environment is a potential medium of disease transmission. These results emphasize the need for strict environmental surface hygiene practices and enhanced hand hygiene to prevent the spread of the virus.

Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Wuhan, China, 2020.

To determine distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards in Wuhan, China, we tested air and surface samples. Contamination was greater in intensive care units than general wards. Virus was widely distributed on floors, computer mice, trash cans, and sickbed handrails and was detected in air ≈4 m from patients.

Epidemiology and Impact of Healthcare-Associated Infections in Trauma Patients: A National Data Analysis.

Background: Traumatic injuries are a leading cause of death and morbidity. Despite their comprising a small (<5%) segment of all hospitalizations, the length of stay (LOS) is above average; and the cost of care for the more than 20 million trauma inpatients nears $30 billion per year. Adding insult to injury, risk factors for health-care-associated infections (HAI), including invasive devices and comprised integrity, may be particularly pronounced in this population, potentially exacerbating the clinical and economic burden. Our aim was to determine the distribution, determinants, and burden of HAI after traumatic injury using LOS as a surrogate for health-care-related expense. Patients and Methods: This retrospective cohort study used the Trauma Quality Improvement Project (TQIP) database (2013-2016). Patients 16 to 89 years of age were included. Those who developed at least one of the following were counted as cases: Catheter-related central blood stream infection, catheter-related urinary tract infection, ventilator-associated pneumonia, surgical site infection, osteomyelitis, and severe sepsis. Outcomes included the hospital LOS, intensive care unit (ICU) days, and ventilator days. Uni-variable and propensity-matched analyses were conducted to determine differences among patients with and without an HAI. Results: Of 806,066 patients, 5.6% (n = 44,844) developed an HAI. A higher proportion of patients with HAI had co-morbid risk factors of chronicity and history of blood transfusion and rated higher on the Abbreviated Injury Scale than those without HAI. After matching, those with HAI also had significantly longer (3 × ) overall LOS, ICU LOS, and prolonged mechanical ventilation (p < 0.05). Conclusions: This updated epidemiology study of trauma patients showed the HAI burden to be higher than past estimates and disproportionate of all patient estimates. The associated economic burden of a longer ICU stay with a tripling of the LOS and longer mechanical ventilation demands responsible administrative policies and support for infection prevention programs and interventions.

Device-associated infections in Canadian acute-care hospitals from 2009 to 2018.

BACKGROUND: Healthcare-associated infections (HAIs) pose a serious risk to patient safety and quality of care. The Canadian Nosocomial Infection Surveillance Program (CNISP) conducts national surveillance of HAIs at sentinel acute-care hospitals across Canada. This report provides an overview of 10 years of Canadian data on the epidemiology of select device-associated HAIs. METHODS: Over 40 hospitals submitted data between 2009 and 2018 for hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt SSIs, paediatric cardiac SSIs and/or central line-associated bloodstream infections (CLABSIs). Counts, rates, patient and hospital characteristics, as well as pathogen distributions and antimicrobial susceptibilities are presented. RESULTS: A total of 4,300 device-associated infections were reported. Central line-associated bloodstream infections were the most common device-associated HAI reported (n=2,973, 69%) and hip and knee arthroplasty infections were the most common SSIs reported (66% of SSIs). Our findings show decreasing CLABSI rates in neonatal intensive care units (4.2 to 1.9 per 1,000 line-days, p<0.0001) and decreasing knee SSI rates (0.69 to 0.30 infections per 100 surgeries, p=0.007). Rates of device-associated HAIs have remained relatively consistent over the 10-year surveillance period. Overall, 4,599 pathogens were identified from device-associated HAI; 70% of these were related to CLABSIs. Coagulase-negative staphylococci (29%) and Staphylococcus aureus (14%) were the most frequently reported pathogens. Gram-positive pathogens represented 68% of identified pathogens, gram-negative pathogens represented 22% and fungi represented 9%. CONCLUSION: Understanding the national burden of device-associated HAIs is essential for developing and maintaining benchmark rates for informing infection and prevention control and antimicrobial stewardship policies and programs.

Medicare' Hospital-Acquired Condition Reduction Program and Community Diversity in the United States: The Need to Account for Racial and Ethnic Segregation.

This study investigated the association between community diversity within hospitals' referral region (HRR) and hospital-acquired conditions (HACs) incident rate among adults ages ≥ 65 years. HRR level (n = 274) HACs were examined and the analysis showed that high diverse communities (OR 1.48, 95% CI [1.15,1.91]) had higher adjusted odds than low diverse communities to score poorly on Domain 2, and increased odds of scoring poor on overall total HAC score. Although hospital quality of care is not intentionally segregated, its surrounding community is impacting its performance, thus policymakers need to accommodate the diversity of communities when developing pay-for-performance or merit-based initiatives.

Genomic epidemiology of multidrug-resistant Gram-negative organisms.

The emergence and spread of antibiotic-resistant Gram-negative bacteria (rGNB) across global healthcare networks presents a significant threat to public health. As the number of effective antibiotics available to treat these resistant organisms dwindles, it is essential that we devise more effective strategies for controlling their proliferation. Recently, whole-genome sequencing has emerged as a disruptive technology that has transformed our understanding of the evolution and epidemiology of diverse rGNB species, and it has the potential to guide strategies for controlling the evolution and spread of resistance. Here, we review specific areas in which genomics has already made a significant impact, including outbreak investigations, regional epidemiology, clinical diagnostics, resistance evolution, and the study of epidemic lineages. While highlighting early successes, we also point to the next steps needed to translate this technology into strategies to improve public health and clinical medicine.

The effect of daily quality checklist on intensive care unit severe patients with hospital associated infection / 中国中西医结合急救杂志

Objective To investigate the effect of daily quality checklist on intensive care unit (ICU) the incidence of severe patients with hospital associated infection (HAI). Methods A historical control study was conducted. In Tianjin Fifth Center Hospital from June 2016 to May 2017, 286 severe patients with mechanical ventilation (MV) and using ICU daily quality checklist were assigned as the experimental group, and from June 2015 to May 2016, 291 severe patients who did not use the daily quality checklist were selected as the control group. In the control group, the routine treatment, nursing care and ward rounds were the daily ordinary work; in the experimental group, the severe disease ICU quality checklist system was strictly carried out, and every day the doctor and nurse on duty applied the checklist to assess and verify the medical quality given to the patient, including sedation, analgesia, MV, glycemic control, nutrition, etc 16 items. The incidences of ventilation associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI), catheter-associated urinary tract infection (CAUTI), 28-day mortality, time of MV and the length of ICU stay were compared between the two groups. Results Compared with the control group, the incidences of VAP, CRBSI and CAUTI of experimental group were obviously decreased (VAP: 1.78‰ vs. 5.09‰, CRBSI: 1.46‰vs. 5.21‰; CAUTI: 1.39‰ vs. 4.41‰, all P ＜ 0.05), the time of MV and the length of ICU stay in experimental group were significantly shorter than those in the control group [the time of MV (days): 7.81±2.74 vs. 10.62±3.67, the length of ICU stay (days): 8.40±1.94 vs. 11.35±2.47, both P ＜ 0.05]; there was a decreasing tendency of 28-day mortality in experimental group compared with that in control group [5.24% (15/286) vs. 6.19% (18/291)], but no statistical significant difference was seen (P ＞ 0.05). Conclusion Implementation of daily quality checklist can effectively decrease the incidence of HAI in ICU patients, reduce the time of MV and the length of ICU stay.