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BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) causes life-threating hospital-acquired infections in critically-ill patients. Due to a limited number of Intensive-Care-Unit (ICU) beds, these patients are often treated in high-dependency (HD) non-ICUs within internal-medicine wards (IMW) in Israel. We aimed to assess the effectiveness of a multi-layered infection-control intervention on CRAB infection-rate in IMWs, especially in its HD non-ICUs with ongoing CRAB transmission. METHODS: A quasi-experimental, before-and-after, interrupted time-series study with control outcomes conducted from January 2019 through June 2022. We conducted a multi-layered intervention over 3.5 years which included 4 phases: 1) Pre-intervention; 2) Intervention-introduction: introduced enhanced environment cleaning; 3) Intervention phase 1: introduced active surveillance; 4) Intervention phase 2: introduced CRAB-positive patient cohorting, in addition to previous ongoing measures taken. RESULTS: CRAB was isolated from 204 patients aged 69.8y/o ± 15.86y, 59.8% male. CRAB-positive clinical samples were found in 34.3% of these patients. Mean hospital length-of-stay was 30.5 days, with a 30-day post-discharge mortality-rate of 55.9%. Mean CRAB clinical cases decreased from 0.89 in pre-intervention to 0.11 at the end of Phase 2, with a change in slope and level after the intervention of p= 0.02 (CI: -0.204- to -0.040) and p=0.004 (CI: -0.013 to -0.003), respectively. CONCLUSIONS: This multi-layered intervention, including enhanced environment cleaning, active surveillance, and patient cohorting, successfully reduced CRAB acquisition in IMWs and their HD non-ICUs.
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Carbapenemase-producing enterobacterales (CPE) poses an increasing threat in hospitals worldwide. Recently, the prevalence of different carbapenemases conferring carbapenem resistance in enterobacterales changed in our country, including an increase in New Delhi Metallo-beta-lactamase (NDM)-CPE. We conducted a comparative historical study of adult patients colonized with Klebsiella pneumoniae carbapenemase (KPC)-CPE (July 2016 to June 2018, a historical cohort) vs. NDM-CPE (July 2016 to January 2023). We identified patients retrospectively through the microbiology laboratory and reviewed their files, extracting demographics, underlying diseases, Charlson Comorbidity Index (CCI) scores, treatments, and outcomes. This study included 228 consecutive patients from whom a CPE rectal swab screening was obtained: 136 NDM-CPE positive and 92 KPC-CPE positive. NDM-CPE-colonized patients had a shorter hospitalization length and a significantly lower 30-day post-discharge mortality rate (p = 0.002) than KPC-CPE-colonized patients. Based on multivariate regression, independent risk factors predicting CPE-NDM colonization included admission from home and CCI < 4 (p < 0.001, p = 0.037, respectively). The increase in NDM-CPE prevalence necessitates a modified CPE screening strategy upon hospital admission tailored to the changing local CPE epidemiology. In our region, the screening of younger patients residing at home with fewer comorbidities should be considered, regardless of a prior community healthcare contact or hospital admission.
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BACKGROUND: Hand hygiene compliance (HHC) is recognised as a major factor in the prevention of healthcare-associated infections. Healthcare workers (HCWs) compliance is still suboptimal. Simulation as an educational strategy may contribute to improved performance. OBJECTIVE: This study aimed to assess the effect of simulation interventions led by nursing students on HCWs' HHC. METHOD: A prospective quasi-experimental design with before and after intervention measurements was implemented in an 1150-bed tertiary hospital. Four consecutive periods, measuring before and after HHC, were examined in four hospital divisions. For each division, unique simulation activities were developed and led by nursing students, educators, and hospital leaders. Sixty seven students and 286 healthcare workers, along with two nurse educators, participated in the simulation sessions. HHC of all HCWs in the divisions was assessed by hospital infection control personnel. RESULTS: Hospital HHC rose across the four periods in all four divisions during this study. In three out of four periods and divisions, HHC increased significantly more in the simulation intervention groups compared to the overall hospital improvement. CONCLUSION: Student-led simulation for HCWs is an additional effective method to improve HHC. Nursing managers should consider joining forces with nursing educators to enable students to become agents of change in healthcare settings and encourage further collaboration.
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Fidelidade a Diretrizes , Higiene das Mãos , Estudantes de Enfermagem , Humanos , Estudantes de Enfermagem/psicologia , Estudantes de Enfermagem/estatística & dados numéricos , Higiene das Mãos/normas , Higiene das Mãos/métodos , Higiene das Mãos/estatística & dados numéricos , Estudos Prospectivos , Fidelidade a Diretrizes/estatística & dados numéricos , Feminino , Adulto , Masculino , Treinamento por Simulação/métodos , Infecção Hospitalar/prevenção & controle , Pessoa de Meia-Idade , Pessoal de Saúde/educação , Pessoal de Saúde/psicologiaRESUMO
BACKGROUND: Surgical site infection (SSI) is a frequent health care-associated infection. We aimed to reduce SSI risk after joint arthroplasty and spine surgery by reducing Staphylococcus aureus colonization burden with presurgery intranasal povidone-iodine (PVP-I) application in conjunction with skin antisepsis ("the intervention"). METHODS: Retrospective case-control study; postintervention cohort versus a historical cohort. Adults who underwent joint arthroplasty or spine surgery during February 2018 through October 2021 ("post-intervention cohort") included. In the analysis cases any patient who underwent surgery and developed SSI within 90 days postsurgery, controls had no SSI. Postintervention cohort data were compared with a similar retrospective 2016 to 2017 patient cohort that did not use intranasal PVP-I. RESULTS: The postintervention cohort comprised 688 consecutive patients aged 65y/o, 48.8% male, 28 cases, and 660 controls. Relatively more cases than controls had diabetes mellitus (P = .019). There was a 39.6% eradication rate of S aureus nasal colonization post intranasal PVP-I (P < .0001). SSI rate was higher in patients positive versus those negative for S aureus on a 24-hour postsurgery nasal culture (P < .0001). The deep SSI rate per 100 operations postintervention versus the historical cohort decreased for all surgical procedures. CONCLUSIONS: Semiquantitative S aureus nasal colony reduction using intranasal PVP-I is effective for decreasing SSI rate in joint arthroplasty and spine surgery. In patients with presurgery S aureus nasal colonization additional intranasal PVP-I postsurgery application should be considered.
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Povidona-Iodo , Infecções Estafilocócicas , Staphylococcus aureus , Infecção da Ferida Cirúrgica , Humanos , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Masculino , Idoso , Feminino , Estudos Retrospectivos , Infecções Estafilocócicas/prevenção & controle , Infecções Estafilocócicas/microbiologia , Estudos de Casos e Controles , Pessoa de Meia-Idade , Povidona-Iodo/administração & dosagem , Procedimentos Ortopédicos/efeitos adversos , Nariz/microbiologia , Idoso de 80 Anos ou mais , Anti-Infecciosos Locais/administração & dosagem , Administração IntranasalRESUMO
OBJECTIVE: To examine the appropriateness of the decision to quarantine healthcare workers (HCWs) exposed to coronavirus disease 2019 (COVID-19). DESIGN: Retrospective cohort study. SETTING: A tertiary-care medical center in Israel. PARTICIPANTS: HCWs exposed to a coworker infected with severe acute respiratory coronavirus virus 2 (SARS-CoV-2). METHODS: Quarantined and nonquarantined HCWs were followed for up to 1 month following exposure and their COVID-19 status was determined. The validity of the decision to quarantine was assessed. RESULTS: In total, 2,595 HCWs exposed to 419 confirmed index cases were studied. Of the contact cases, 752 HCWs were quarantined and 1,843 HCWs were not. Of those quarantined, 36 became SARS-CoV-2 positive (4.7%). Among those who were not quarantined, only 13 (0.7%) became SARS-CoV-2 positive, which translated to a sensitivity of 73.5% and a specificity of 71.9% for the decision to quarantine (positive and negative predictive values: 4.7% and 99.3%, respectively). Controlling for confounders, the decision to quarantine the HCW by the Israeli Ministry of Health guidelines was associated with a significant risk of becoming SARS-CoV-2 positive (RR, 3.83; 95% CI, 1.98-7.36; P = .001). If a nonselective policy was used, 11,700 working days would have been lost (902 working days lost per positive case). CONCLUSIONS: An efficient and tight system of HCW contact investigations served its purpose in our hospital during the COVID-19 pandemic. This study was based on HCW reports and reported adherence to safety regulations, and these findings are relevant to the massive pandemic waves due to the SARS-CoV-2 α (alpha) variant. These Methods demonstrate an effective way of handling risk without causing damage due to arbitrary risk-control measures.
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COVID-19 , Viroses , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , SARS-CoV-2 , Quarentena , Pandemias/prevenção & controle , Estudos Retrospectivos , Centros de Atenção Terciária , Pessoal de SaúdeRESUMO
BACKGROUND: Clostridioides difficile causes healthcare-associated infections. Environmental spore acquisition is a major mode of transmission. Patient cohorting to prevent cross-transmission in healthcare-institutions is a reasonable component of an enhanced infection control strategy. OBJECTIVE: The purpose of the study was to assess the effect of two different contact isolation modes on the quality of care of hospitalised patients with Clostridioides difficile infection (CDI). METHODS: A retrospective cohort-study of patients with CDI hospitalised under one of two contact isolation modes: contact isolation in a multi-patient room without a dedicated nursing team vs. contact isolation in a permanent cohort isolation unit with a dedicated nursing team. Patients' files were reviewed for demographics, clinical characteristics, risk-assessment scores, clinical quality measures including the number of blood tests collected per day, the number of radiological tests applied per day and the time at which a radiological test was conducted, as process measurements, along with the length of stay and mortality, as outcome measures. The STROBE checklist for reporting observational studies was followed. RESULTS: One hundred and seventy-eight patients with CDI were included; 100 in a permanent cohort isolation unit and 78 under contact isolation in a multi-patient room. No difference was found in all clinical quality process measures and in all outcome measures. Multivariable logistic regression showed that nursing home residence was associated with in-hospital mortality (OR, 2.51; CI, 1.29-4.97; p = .007), whereas the mode of hospitalisation was not. CONCLUSIONS: The different contact isolation modes of hospitalisation did not compromise the quality of care of patients with CDI. RELEVANCE TO CLINICAL PRACTICE: Cohorting of patients with CDI is used to prevent cross-transmission, though it raises a major concern regarding quality of care. In this study we show there was no compromise in patient care, therefore it is a reasonable component of an enhanced infection control strategy in a hospital setting.
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Clostridioides difficile , Infecções por Clostridium , Infecção Hospitalar , Humanos , Estudos Retrospectivos , Infecções por Clostridium/prevenção & controle , Controle de Infecções , Infecção Hospitalar/prevenção & controleRESUMO
BACKGROUND: Hand hygiene compliance by health care workers (HCWs) is pivotal in controlling and preventing health care associated infections. The aim of this interventional study is to assess the long-term impact of personal verbal feedback on hand hygiene compliance of HCWs in an intensive care unit (ICU) immediately after overt observation by an infection control nurse. METHODS: An infection control nurse overtly observed HCWs' hand hygiene compliance and immediately gave personal verbal feedback with emphasis on aseptic technique. Overt non-interventional sessions were also performed. We measured compliance rates using covert continuous closed-circuit television (CCTV) monitoring. We compared these rates to previously-published hand hygiene compliance data. RESULTS: Overall compliance rates in the first (41.5%) and third phases (42%) of the study, before and after the intervention were similar. The two moments that were lowest in the first phase, "before aseptic contact" and "after exposure to body fluids", showed significant improvement, but two moments showed a significant decline in compliance: "before patient contact" and "after contact with patient surrounding". The compliance rates during the intervention phase were 64.8% and 63.8% during the sessions with and without immediate verbal personal feedback, respectively. CONCLUSION: The overall hand hygiene compliance rate of HCWs did not show an improvement after immediate verbal personal feedback. Covert CCTV observational sessions yielded much lower hand hygiene compliance rates then overt interventional and non-interventional observations. We suggest that a single intervention of personal feedback immediately after an observational session is an ineffective strategy to change habitual practices.
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Diabetic foot infections (DFIs) are associated with major morbidity, reduced quality of life and increased mortality. Osteomyelitis is a leading cause of lower-extremity amputation in diabetic patients. We aimed to examine whether a multifaceted strategy for treating hospitalized patients with a DFI effectively influenced microbiological culture results and outcomes. A retrospective cohort-study in a 1100-bed, tertiary-care university hospital was conducted. Adult patients with a DFI admitted to the orthopedics department between 2015 and 2019 were included. During the pre-intervention period (2015-2016), one general orthopedic department was in operation. In the post-intervention period (2017-2019), a second department was created with a designated "complicated wound unit". The multifaceted strategy included revising local guidelines for DFI culturing emphasizing bone cultures, correct sample handling, and adjusting antibiotic treatment to culture results. Additionally, a weekly multidisciplinary-team grand round was instigated and post-discharge outpatient follow-up was scheduled. 652 patients with DFIs were included; 101 during the pre-intervention period and 551 during the post-intervention period. Compared to the pre-intervention, during the post-intervention period mainly bone or deep-tissue cultures were performed (9.7% vs. 98.2%, P < 0.001). Bacteriology cultures in the pre-intervention versus post-intervention period revealed: among staphylococcus isolates, fewer methicillin-resistant Staphylococcus aureus detected (20.4% vs. 9.8%, P = 0.010); within Enterobacteriaceae isolates, fewer extended-spectrum ß-lactamase producing bacteria detected (51.6% vs. 23.6%, P < 0.001); a decrease in Pseudomonas aeruginosa isolates (28% vs. 10.6%, P < 0.001) and an increase in anaerobic bacterial isolates (0 vs. 11.1%, P < 0.001). On multivariate regression, the post-intervention period (ie multifaceted strategy) was a protective measure against readmissions (P = 0.007 OR 0.50 95% CI 0.30-0.82). We conclude that our interventive multifaceted strategy led to accurate bacterial diagnosis, de-escalation of antibiotic treatment and readmission reduction.
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Infections caused by multidrug-resistant Gram-negative bacteria increase hospitalizations and mortality rates; antibiotic pressure increases resistance rates. We evaluated the impact of the antibiotics stewardship program (ASP) on Escherichia coli resistance rates, evaluating all antibiotic use and patients with positive cultures hospitalized between 2011 and 2018. Data on antibiotics were collected quarterly as the defined daily dose (DDD)/100 days hospitalization. In 2014, an intervention was introduced, targeting the reduction of overall antibiotic use as well as specifically targeting quinolones and other broad-spectrum antibiotics. Using interrupted time series analysis (ITS), we compared the rates and trends of antibiotic use and resistant E. coli. We included 6001 patients, 3182 pre-ASP and 2819 post-ASP. We observed significant changes in absolute numbers as well as in trends for use of DDD/100 days of all antibiotics by 31% from 76 to 52, and by 52% from 10.4 to 4.9 for quinolones. ITS demonstrated that before the ASP intervention, there was a slope pattern for increased E. coli resistance to antibiotics. This slope was reversed following the intervention for quinolones -1.52, aminoglycosides -2.04, and amoxicillin clavulanate (amox/clav) -1.76; the effect of the intervention was observed as early as three months after the intervention and continued to decrease over time until the end of the study, at 48 months. We conclude that the ASP can positively impact the resistance rate of Gram-negative infections over time, regardless of the targeted combination of antibiotics, if the overall use is reduced.
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OBJECTIVE: To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department. DESIGN: Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention. SETTING: A 1,000-bed, tertiary-care, university hospital. PATIENTS: Adult patients admitted to the orthopedics department between January 2015 and December 2018. METHODS: During the preintervention period (2015-2016), 1 general orthopedic department was in operation. In the postintervention period (2017-2018), 2 separate departments were created: one designated for elective "clean" surgeries and another that included a "complicated wound" unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed. RESULTS: The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6-9) to the postintervention period (median, 4 days; IQR, 2-7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum ß-lactams (P < .001) and decreased use of ß-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001). CONCLUSIONS: Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.
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Gestão de Antimicrobianos , Higiene das Mãos , Adulto , Antibacterianos/uso terapêutico , Humanos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
OBJECTIVE: To compare risk factors and outcome of patients colonized with carbapenemase-producing (CP) carbapenem-resistant Enterobactereaceae (CRE) and non-CP-CRE. DESIGN: A comparative historical study. SETTING: A 1,000-bed tertiary-care university hospital. PATIENTS: Adults with CP-CRE positive rectal swab cultures, non-CP-CRE positive rectal swab cultures, and negative rectal swab cultures (non-CRE). METHODS: CP-CRE and non-CP-CRE colonized adult patients versus patients not colonized with CRE hospitalized during 24 months were included. We identified patients retrospectively through the microbiology laboratory, and we reviewed their files for demographics, underlying diseases, Charlson Index, treatment, and outcome. RESULTS: This study included 447 patients for whom a rectal swab for CRE was obtained: 147 positive for CP-CRE, 147 positive for non-CP-CRE, and 147 negative for both. Patients with CP-CRE and non-CP-CRE versus no CRE more frequently resided in nursing homes (P<0.001), received antibiotics 3 months prior to admission (P < .001), and received glucocorticosteroids 3 months prior to admission (P = .047 and P < .001, respectively). Risk factors unique for non-CP-CRE versus CP-CRE colonization included mechanical ventilation and patient movement between hospital departments. Non-CP-CRE was a predictor for mechanical ventilation 2.5 that of CP-CRE colonization. In-hospital mortality was highest among non-CP-CRE-colonized patients. On COX multivariate regression for mortality prediction age, Charlson index and steroid treatment 3 months before admission influenced mortality (P = .027, P = .023, and P = .013, respectively). CONCLUSIONS: Overlapping and unique risk factors are associated with CP-CRE and non-CP-CRE colonization. Non-CP-CRE colonized patients had a higher in-hospital mortality rate.
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Enterobacteriáceas Resistentes a Carbapenêmicos , Infecções por Enterobacteriaceae , Adulto , Antibacterianos/uso terapêutico , Proteínas de Bactérias , Carbapenêmicos/uso terapêutico , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/epidemiologia , Humanos , Lactente , Estudos Retrospectivos , Fatores de Risco , beta-LactamasesRESUMO
BACKGROUND: To compare covert closed-circuit television (CCTV) monitoring to standard overt observation in assessing the hand hygiene (HH) conduct of health care workers (HCWs) caring for patients infected with multidrug-resistant organisms (MDROs). This was a cross-sectional study in a general intensive care unit of a 1,000-bed university hospital. METHODS: Forty-six general intensive care unit HCWs (staff physicians, registered nurses, and auxiliary workers) caring for contact isolation MDRO-infected patients. The study incorporated the following 3 phases: phase 1, establishment of interrater reliability between 2 simultaneous observers using the overt observation method; phase 2, establishment of interrater reliability between 2 simultaneous observers using the CCTV method; and phase 3, simultaneous monitoring of HH by both methods to evaluate the suitability of CCTV as an alternative to direct observation of the HH conduct of HCWs caring for MDRO-infected patients. RESULTS: Overall, 1,104 opportunities to perform HH were documented during 49 observation sessions. The compliance rate observed by the overt method (37.3%) was significantly higher than that observed when only the covert method was used (26.5%). However, simultaneous overt-covert observations were found to have intraclass correlation coefficients of >0.85. CONCLUSIONS: Covert CCTV observation of HCW HH compliance appears to provide a truer and more realistic picture than overt observation, probably because of its ability to neutralize the Hawthorne effect of overt observation. The high intraclass correlation coefficients between covert observation and overt observation supports this conclusion.
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Técnicas de Observação do Comportamento/estatística & dados numéricos , Infecção Hospitalar/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Higiene das Mãos/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Adulto , Técnicas de Observação do Comportamento/métodos , Estudos Transversais , Resistência a Múltiplos Medicamentos , Modificador do Efeito Epidemiológico , Feminino , Higiene das Mãos/normas , Pessoal de Saúde/normas , Humanos , Controle de Infecções/normas , Controle de Infecções/estatística & dados numéricos , Infecções/microbiologia , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , TelevisãoRESUMO
[This corrects the article DOI: 10.1155/2015/531021.].
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BACKGROUND: Overuse of antibiotics in end-of-life patients with advanced directives increases bacterial resistance and causes morbidity and mortality. Consultations with infectious disease (ID) physicians and burnout, which can affect antibiotic days of therapy (DOT) prescribed by physicians, have not been examined so far. OBJECTIVES: To assess antibiotic use by physicians in end-of-life (EOL) patients with advanced directives and to investigate the association between ID consultations, physician burnout, and antibiotic DOT in those patients. DESIGN: A descriptive correlational study. SETTING: Acute-care and post-acute-care hospitals. PARTICIPANTS: The study included 213 physicians and 932 their hospitalized patients in the last 2 weeks of life. METHODS: We distributed questionnaires and analyzed the data collected regarding ID consultation, EOL antibiotics prescription with and without an advanced directive, and physician burnout to 278 physicians, and 213 were completed (response rate 76%). RESULTS: Of the 932 deaths, 435 of 664 (>50%) were EOL patients with advanced directives. Of these patients, 74% received antibiotics, 29.9% had bacterial resistance cultures, and antibiotics were discontinued in only 5%. Half of the physicians lacked knowledge concerning antibiotics use issues and had significantly fewer consultations with ID physicians in EOL patients with advanced directives (mean rate, 0.27) than those without advanced directives (mean rate, 0.47). ID physicians reported significantly higher emotional exhaustion levels (mean rate, 29) than other medical specialties (mean rate, 19.2). Antibiotic DOT was significantly higher when patients had ID consultations (mean rate, 21.6) than in patients who did not (mean rate, 16.2). In post-acute-care hospitals and/or geriatric wards, antibiotic DOT was significantly higher than in other types of hospitals and/or wards. Depersonalization level was negatively related to antibiotic DOT (P < .05). CONCLUSIONS: Antibiotics are overused in EOL patients with advanced directives. ID physician burnout and impact of ID consultation should be further assessed.
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Diretivas Antecipadas/estatística & dados numéricos , Antibacterianos/uso terapêutico , Esgotamento Profissional , Uso Excessivo de Medicamentos Prescritos/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Idoso , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Infectologia , Israel , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Análise de Regressão , Especialização , Inquéritos e Questionários , Assistência Terminal/métodosRESUMO
OBJECTIVE: To assess the impact of incorporating early rapid influenza diagnosis on antimicrobial usage, nosocomial influenza transmission, length of stay, and occupancy rates among hospitalized patients. SETTING: A 1,100 bed tertiary-care hospital in southern Israel. METHODS: We implemented early rapid detection of influenza with immediate communication of results. Using Orion methods, we compared the 2017-2018 influenza season to the prior season in our hospital and to the 2017-2018 occupancy rates at other Israeli hospitals. RESULTS: During the intervention season, 5,006 patients were admitted; 1,824 were tested for influenza, of whom 437 (23.9%) were positive. In the previous season, 4,825 patients were admitted; 1,225 were tested and 288 (23.5%) were positive. Time from admission to test report decreased from 35.5 to 18.4 hours (P < .001). Early discharge rates significantly increased, from 21.5% to 41.6% at 36 hours, from 37.2% to 54.5% at 48 hours, and from 66% to 73.2% at 72 hours. No increase in repeat ER visits, readmission, or mortality rates was observed. Hospital occupancy decreased by 10% compared to the previous year and was 26% lower than the national rate. Hospital-acquired influenza cases were reduced from 37 (11.4%) to 12 (2.7%) (P < .001). Antibiotic usage was reduced both before and after notification of test results by 16% and 12%, respectively. CONCLUSIONS: Implementing this intervention led to earlier discharge of patients, lower occupancy in medical wards, reduced antibiotic administration, and fewer hospital-acquired influenza events. This strategy is useful for optimizing hospital resources, and its implementation should be considered for upcoming influenza seasons.
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Infecção Hospitalar , Hospitalização , Influenza Humana/diagnóstico , Tempo de Internação , Kit de Reagentes para Diagnóstico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Estudos RetrospectivosRESUMO
Septic arthritis of native joints is a potentially life-threatening disease. The most frequently isolated pathogens are Gram-positive cocci. Bacteroides fragilis is a rare pathogen in joint infections and is usually associated with immunocompromised and debilitated patients. Most cases of B. fragilis joint infection are related to skin or local perineal infections or are secondary to B. fragilis bacteraemia from another source, for example from the gastrointestinal tract. We present a clinical case of B. fragilis septic arthritis involving a native hip joint in a previously healthy paraplegic patient.
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BACKGROUND: Information is inconsistent regarding the clinical role of acute elevations of blood glucose level secondary to hospital-acquired infections in nondiabetic critically ill patients during an intensive care unit stay. In this study we investigated the clinical significance of hyperglycemia related to new episodes of ventilator-associated pneumonia in nondiabetic critically ill multiple trauma intensive care unit patients. MATERIALS AND METHODS: We analyzed the clinical data of 202 critically ill multiple trauma patients with no history of previous diabetes who developed a new ventilator-associated pneumonia episode during their intensive care unit stay. We used a time-from-event analysis method to assess whether acute changes in blood glucose levels that occurred prior to the onset of ventilator-associated pneumonia episodes had a different prognostic significance from those that occurred during such episodes. Glucose levels and other laboratory data were recorded for up to 5 days before ventilator-associated pneumonia events and for 5 days following these events. RESULTS: Patients who required insulin therapy for persistent hyperglycemia related to a new ventilator-associated pneumonia event had a longer period of intensive care unit stay and a higher intensive care unit mortality rate than patients who did not require insulin for blood glucose control (p < 0.008 and <0.001 respectively). In addition, older age, administration of parenteral nutrition, and elevated mean blood glucose level parameters on the day following the day of diagnosis of a new ventilator-associated pneumonia episode were found to be independent risk factors for intensive care unit mortality. CONCLUSION: Our study suggests that persistent hyperglycemia in nondiabetic critically ill patients, even treated by early insulin therapy, is an adverse prognostic factor of considerable clinical significance.