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  • 1
    Online Resource
    Online Resource
    Impact of Phlebotomist-Only Venipuncture and Central Line Avoidance for Blood Culture in a Large Tertiary Care University Hospital
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Infectious Diseases in Clinical Practice Vol. 26, No. 2 ( 2018-3), p. 91-96
    Details
    In: Infectious Diseases in Clinical Practice, Ovid Technologies (Wolters Kluwer Health), Vol. 26, No. 2 ( 2018-3), p. 91-96
    Abstract: Drawing blood for culture from central vascular access sites may increase rates of blood culture contamination and central line–associated bloodstream infection. Methods We examined the impact of phlebotomist-only blood draws and central line avoidance for blood culture in a large university hospital that also cares for patients with cancer, stem cell transplants, and solid-organ transplants. Policy enforcement began in September 2013. The preimplementation era was defined from January 2012 to June 2013, and the postimplementation era was defined from January 2014 to September 2015. Outcomes in preimplementation and postimplementation eras were compared using time-series analyses, t tests, and Wilcoxon rank sum tests. Results Policy implementation led to 29%, 31%, and 38% decreases in blood culture performance, positivity, and contamination, respectively; an 86% decrease in blood cultures drawn from central lines; and a 66% decrease in central line–associated bloodstream infections. Our policy coincided with an 11% decrease in intravenous vancomycin, daptomycin, or linezolid use, whereas there was no change in piperacillin-tazobactam, cefepime/ceftazidime, or carbapenem use. Hospital lengths of stay and mortality rates were unchanged in the general hospital population and were stable or improved in patients with kidney disease, liver disease, cancer, and abdominal solid-organ transplants. Conclusions Our findings suggest that having phlebotomists draw blood for culture almost exclusively by venipuncture resulted in decreased blood culture positivity that did not translate into harm as measured by length of stay or inpatient death even among immunocompromised hosts.
    Type of Medium: Online Resource
    ISSN: 1536-9943 , 1056-9103
    URL: Article
    DOI: 10.1097/IPC.0000000000000584
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2062211-9
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  • 2
    Online Resource
    Online Resource
    Impact of Avoiding Central Vascular Catheter-Drawn Blood Samples for Culture in a Large Tertiary Care University Hospital
    Oxford University Press (OUP) ; 2016
    In:  Open Forum Infectious Diseases Vol. 3, No. suppl_1 ( 2016-12-01)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 3, No. suppl_1 ( 2016-12-01)
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofw172.1182
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2016
    detail.hit.zdb_id: 2757767-3
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  • 3
    Online Resource
    Online Resource
    Active screening and interfacility communication of carbapenem-resistant Enterobacteriaceae (CRE) in a tertiary-care hospital
    Cambridge University Press (CUP) ; 2018
    In:  Infection Control & Hospital Epidemiology Vol. 39, No. 9 ( 2018-09), p. 1058-1062
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 39, No. 9 ( 2018-09), p. 1058-1062
    Abstract: Hospitals may implement admission screening cultures and may review transfer documentation to identify patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) to implement isolation precautions; however, outcomes and logistical considerations have not been well described. Methods At an academic hospital in Chicago, we retrospectively studied the implementation and outcomes of CRE admission screening from 2013 to 2016 during 2 periods. During period 1, we implemented active CRE rectal culture screening for all adults patients admitted to intensive care units (ICUs) and for those transferred from outside facilities to general wards. During period 2, screening was restricted only to adults transferred from outside facilities. For a subset of transferred patients who were previously reported to the health department as CRE positive, we reviewed transfer paperwork for appropriate documentation of CRE. Results Overall, 11,757 patients qualified for screening; rectal cultures were performed for 8,569 patients (73%). Rates of CRE screen positivity differed by period, previous facility type (if transferred), and current inpatient location. A higher combined CRE positivity rate was detected in the medical and surgical ICUs among period 2 patients (3.3%) versus all other ward-period comparisons ( P 〈 .001). Among 13 transferred patients previously known to be CRE colonized, appropriate CRE transfer documentation was available for only 4 patients (31%). Conclusions Active screening for CRE is feasible, and screening patients transferred from outside facilities to the medical or surgical ICU resulted in the highest screen positivity rate. Furthermore, CRE carriage was inconsistently documented in transfer paperwork, suggesting that admission screening or enhanced inter-facility communication are needed to improve the identification of CRE-colonized patients.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1017/ice.2018.150
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2018
    detail.hit.zdb_id: 2106319-9
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  • 4
    Online Resource
    Online Resource
    Impact of Mandatory Infectious Disease Specialist Approval on Hospital-Onset Clostridioides difficile Infection Rates and Testing Appropriateness
    Oxford University Press (OUP) ; 2023
    In:  Clinical Infectious Diseases Vol. 77, No. 3 ( 2023-08-14), p. 346-350
    Details
    In: Clinical Infectious Diseases, Oxford University Press (OUP), Vol. 77, No. 3 ( 2023-08-14), p. 346-350
    Abstract: Inappropriate Clostridioides difficile testing is common in the hospital setting, leading to potential overdiagnosis of infection when single-step nucleic acid amplification testing is used. The potential role of infectious diseases (ID) specialists in enforcing appropriate C. difficile testing is unclear. Methods At a single 697-bed academic hospital, we performed a retrospective study from 1 March 2012 to 31 December 2019 comparing hospital-onset C. difficile infection (HO-CDI) rates during 3 consecutive time periods: baseline 1 (37 months, no decision support), baseline 2 (32 months, computer decision support), and intervention period (25 months, mandatory ID specialist approval for all C. difficile testing on hospital day 4 or later). We used a discontinuous growth model to assess the impact of the intervention on HO-CDI rates. Results During the study period, we evaluated C. difficile infections across 331 180 admission and 1 172 015 patient-days. During the intervention period, a median of 1 HO-CDI test approval request per day (range, 0–6 alerts/day) was observed; adherence by providers with obtaining approval was 85%. The HO-CDI rate was 10.2, 10.4, and 4.3 events per 10 000 patient-days for each consecutive time period, respectively. In adjusted analysis, the HO-CDI rate did not differ significantly between the 2 baseline periods (P = .14) but did differ between the baseline 2 period and intervention period (P & lt; .001). Conclusions An ID-led C. difficile testing approval process was feasible and was associated with a & gt;50% decrease in HO-CDI rates, due to enforcement of appropriate testing.
    Type of Medium: Online Resource
    ISSN: 1058-4838 , 1537-6591
    URL: Article
    DOI: 10.1093/cid/ciad250
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2002229-3
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  • 5
    Online Resource
    Online Resource
    974. Impact of Mandatory Infectious Disease (ID) Specialist Approval on Hospital-Onset Clostridium difficile (HO-CDI) Testing and Infection Rates: Results of a Pilot Study
    Oxford University Press (OUP) ; 2018
    In:  Open Forum Infectious Diseases Vol. 5, No. suppl_1 ( 2018-11-26), p. S38-S39
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 5, No. suppl_1 ( 2018-11-26), p. S38-S39
    Abstract: The 2017 IDSA C. difficile guidelines recommend the use of nucleic acid amplification testing alone for detection of HO-CDI if appropriate stool specimens are collected (e.g., patients not receiving laxatives and ≥3 unformed stools in 24 hours). The potential role of ID specialists in enforcing appropriate C. difficile testing is unclear. Methods At a single academic hospital, we performed a pilot study of an ID specialist-led approval process for C. difficile testing. During the baseline period (January 2016 and November 2017), HO-CDI testing appropriateness was enforced using a computerized decision support tool that discouraged inappropriate testing based on detected laxative use and stool frequency criteria; however, clinicians frequently ignored the computer alerts. During the intervention period (December 2017 and March 2018), all HO-CDI testing on hospital day 4 or later triggered a computer alert requesting mandatory testing approval by an ID specialist. Approvals were provided via telephone consultation 7 days a week between 8 a.m. and 5 p.m. (in both periods, CDI testing was not performed overnight). We analyzed differences HO-CDI testing and infection rates (defined by CDC’s LabID event) per 10,000 patient days using Poisson models. We also analyzed the number of approval pager calls, rates of C. difficile testing approval, and time burden. Results Two infectious diseases specialists (M.Y.L.; J.S.) primarily answered C. difficile pager approval requests; the remainder of approvals were provided by ID specialists already consulted on the patients. During the intervention period, ordering providers made 159 calls to the approval pager; 119 (75%) received approval. HO-CDI testing and infection rates declined between the baseline and intervention periods (figure). There was a mean of 1.3 pager approval requests per day (range, 0–4) with an average of 3 minutes of time spent per request. Conclusion An ID specialist-led C. difficile testing approval process was feasible and associated with a significant decrease in HO-CDI testing and infection rates, due to enforcement of appropriate testing. ID specialists can provide a key role in enforcing appropriate C. difficile testing, but more experience is needed with respect to sustainability. Disclosures M. Y. Lin, Stryker (Sage Products): Research support in the form of contributed product, Research support. OpGen, Inc: Research support in the form of contributed products, Research support. CareFusion Foundation (now BD): Grant Investigator, Research grant.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofy209.090
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
    detail.hit.zdb_id: 2757767-3
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