Right-sizing expectations for hand hygiene observation collection.

Background: Hand Hygiene (HH) monitoring is essential for patient and staff safety, but the optimal number of observations remains elusive. This project aimed to determine a statistically comparable number below the current standard of 100 to 200 per month per unit.

Methods: HH observations from various hospitals were grouped in strata by facility, unit, and month, then resampled into sets of 25, 50, 100, and 150 for comparison with 200.

Factors Associated With Longer Than Recommended Durations of Antibiotic Therapy for Uncomplicated Ambulatory Infections in an Integrated Healthcare System.

Across the ambulatory care network of an integrated health care system, durations of antibiotic therapy prescribed for uncomplicated infections were longer than recommended in 39% of cases. By logistic regression, site of care, prescriber characteristics, and type of infection were independently associated with longer than recommended durations of therapy.

Risk Factors Associated with 30-Day Readmission in Patients with Diabetic Foot Infections.

Background: Diabetic foot infections (DFIs) are the most common cause of hospitalization for patients with diabetes. Studies have shown diabetic patients have high readmission rates. It is important to identify variables that contribute to readmission.

Impact of an automated hand hygiene monitoring system combined with a performance improvement intervention on hospital-acquired infections.

Objective: Hand hygiene adherence has been associated with reductions in nosocomial infection. We assessed the effect of improvements in electronically measured hand hygiene adherence on the incidence of hospital-acquired infections.

Methods: This quasi-experimental study was conducted in a 555-bed urban safety-net level I trauma center.

Implementation of colon surgical site infection prevention bundle-The successes and challenges.

Background: Surgical site infection (SSI) prevention bundles have proven successful in decreasing infections. Surgeon and nurse engagement and endorsement are essential for success. The objective of this quality improvement project was to develop, implement and sustain a colon SSI prevention bundle and determine which bundle components are most strongly associated with prevention of SSI.

Antibiotic Prescribing Patterns for Acute Otitis Media for Children 2 Years and Older.

Objective: To determine the frequency that non-first-line antibiotics, safety-net antibiotic prescriptions (SNAPS), and longer than recommended durations of antibiotics were prescribed for children ≥2 years of age with acute otitis media and examine patient and system level factors that contributed to these outcomes.

Study Design: Children age ≥2 years with acute otitis media seen at Denver Health Medical Center outpatient locations from January to December 2018 were included. The percentages of patients who received first-line antibiotics, SNAPs, and recommended durations of antibiotics were determined.

Effectiveness of Shorter Versus Longer Durations of Therapy for Common Inpatient Infections Associated With Bacteremia: A Multicenter, Propensity-Weighted Cohort Study.

Background: National guidelines for pneumonia (PNA), urinary tract infection (UTI), and acute bacterial skin and skin structure infection (ABSSSI) do not address treatment duration for infections associated with bacteremia. We evaluated clinical outcomes of patients receiving shorter (5-9 days) versus longer (10-15 days) duration of antibiotics.

Methods: This was a multicenter retrospective cohort study of inpatients with uncomplicated PNA, UTI, or ABSSSI and associated bacteremia.

Patterns of use and perceptions of an institution-specific antibiotic stewardship application among emergency department and urgent care clinicians.

We surveyed emergency department and urgent care clinicians to assess patterns of use and perceived usefulness of a local antibiotic stewardship application to deliver institution-specific prescribing guidance. Among 114 eligible respondents, the application was widely utilized, and it was perceived to be a useful clinical resource that improved prescribing.

Prepping for Prevention: An Intervention to Optimize Skin Antisepsis and Peri-Operative Antibiotic Prophylaxis.

The U.S. Centers for Disease Control and Prevention recommend bathing prior to surgery, surgical skin antisepsis, peri-operative antibiotic administration, normothermia throughout the procedure, serum glucose concentration <200 mg/dL throughout the procedure, and hyperoxygenation in the immediate post-operative period to prevent surgical site infection (SSI).

A Novel Approach to Evaluate Antibiotic Utilization Across the Spectrum of Inpatient and Ambulatory Care and Implications for Prioritization of Antibiotic Stewardship Efforts.

Background: Antibiotic overuse remains a significant problem. The objective of this study was to develop a methodology to evaluate antibiotic use across inpatient and ambulatory care sites in an integrated healthcare system to prioritize antibiotic stewardship efforts.

Methods: We conducted an epidemiologic study of antibiotic use across an integrated healthcare system on 12 randomly selected days from 2017 to 2018.

Risk Factors for Below-the-Knee Amputation in Diabetic Foot Osteomyelitis After Minor Amputation.

Background: Below-the-knee amputation (BKA) can be a detrimental outcome of diabetic foot osteomyelitis (DFO). Ideal treatment of DFO is controversial, but studies suggest minor amputation reduces the risk of BKA. We evaluated risk factors for BKA after minor amputation for DFO.

Epidemiology of Community-Onset Bacteremia.

Introduction: bacteremia (SAB) is the second-most common cause of community-onset (CO) bacteremia. The incidence of methicillin-resistant (MRSA) has recently decreased across much of the United States, and we seek to describe risk factors for CO-MRSA bacteremia, which will aid emergency providers in their choice of empiric antibiotics.

Methods: This is a retrospective cohort study of all patients with SAB at a 500-bed safety net hospital.

Implementation of cleaning and evaluation process for mobile patient equipment using adenosine triphosphate.

We implemented a cleaning process for mobile patient equipment (MPE) and determined its success using adenosine trisphosphate (ATP) monitoring and data feedback. Following education for staff and ATP data feedback, the data suggest that the MPE cleaning program we implemented was successful.

The effect of eye images and a social norms message on healthcare provider hand hygiene adherence.

Background: Depictions of eye images and messages encouraging compliance with social norms have successfully motivated behavioral change in a variety of experimental and applied settings. We studied the effect of these 2 visual cues on hand hygiene adherence in a cohort of hospital-based healthcare providers participating in an electronic monitoring and feedback program.

Methods: Prospective, quasi-experimental study utilizing an interrupted time-series design.

Antimicrobial resistance patterns in urinary E. coli isolates after a change in a single center's guidelines for uncomplicated cystitis in ambulatory settings.

Recommending nitrofurantoin to treat uncomplicated cystitis was associated with increased nitrofurantoin use from 3.53 to 4.01 prescriptions per 1,000 outpatient visits, but nitrofurantoin resistance in E.

Implementation of an institution-specific antimicrobial stewardship smartphone application.

Smartphones are increasingly used to access clinical decision support, and many medical applications provide antimicrobial prescribing guidance. However, these applications do not account for local antibiotic resistance patterns and formularies. We implemented an institution-specific antimicrobial stewardship smartphone application and studied patterns of use over a 1-year period.

Appropriateness of antibiotic prescriptions for acute sinusitis and pharyngitis in an integrated healthcare system.

We evaluated the appropriateness of antibiotic prescriptions for acute sinusitis and pharyngitis. Overall, 81% of antibiotic prescriptions for acute sinusitis were inappropriate and 48% of antibiotic prescriptions for pharyngitis were inappropriate. Types of prescribing errors differed between the 2 infections, including lack of an indication for antibiotics and excessive duration in ~50% of sinusitis cases and incorrect antibiotic dose in ~33% of pharyngitis cases.

A Statewide Antibiotic Stewardship Collaborative to Improve the Diagnosis and Treatment of Urinary Tract and Skin and Soft Tissue Infections.

Background: Colorado hospitals participated in a statewide collaborative to improve the management of inpatient urinary tract infections (UTIs) and skin and soft tissue infections (SSTIs). We evaluated the effects of the intervention on diagnostic accuracy and antibiotic use.

Methods: The main collaborative outcomes were proportion of UTI diagnoses that met criteria for symptomatic UTI; exposure to fluoroquinolones (UTI only); duration of therapy (UTIs and SSTIs); and exposure to antibiotics with broad gram-negative activity (SSTIs only).

Managing public health data: mobile applications and mass vaccination campaigns.

In response to data collection challenges during mass immunization events, Denver Public Health developed a mobile application to support efficient public health immunization and prophylaxis activities. The Handheld Automated Notification for Drugs and Immunizations (HANDI) system has been used since 2012 to capture influenza vaccination data during Denver Health's annual employee influenza campaign. HANDI has supported timely and efficient administration and reporting of influenza vaccinations through standardized data capture and database entry.

Development of a surgical site infection prediction model in orthopaedic trauma: The Denver Health Model.

Background: The CDC's National Healthcare Safety Network's (NHSN) current risk adjustment model for surgical site infections (SSI) following open reduction internal fixation (ORIF) of long bone fractures is a suboptimal predictor of risk. We hypothesized that by including variables known to be associated with SSI following ORIF, we would develop a model that would increase the accuracy and predictability of SSI risk.

Methods: Patients who underwent ORIF of a long bone between January 1, 2012 and December 31, 2014 were included in the study (n=1543).

Intervention to Reduce Broad-Spectrum Antibiotics and Treatment Durations Prescribed at the Time of Hospital Discharge: A Novel Stewardship Approach.

OBJECTIVE For most common infections requiring hospitalization, antibiotic treatment is completed after hospital discharge. Postdischarge therapy is often unnecessarily broad spectrum and prolonged. We developed an intervention to improve antibiotic selection and shorten treatment durations.

Hospital-wide chlorhexidine gluconate bed bathing protocol: A cross-sectional study in a single hospital.

The objective of this study was to determine understanding of bed bathing practices over time after the implementation of a standardized bed bathing protocol. An online survey addressing bathing practices was administered preintervention and 6 and 18 months postintervention to all nurses and technicians caring for adult patients. Survey responses suggested that the intervention resulted in sustained understanding of the standardized bed bathing protocol.

Preferential Use of Nitrofurantoin Over Fluoroquinolones for Acute Uncomplicated Cystitis and Outpatient Escherichia coli Resistance in an Integrated Healthcare System.

OBJECTIVES To evaluate changes in outpatient fluoroquinolone (FQ) and nitrofurantoin (NFT) use and resistance among E. coli isolates after a change in institutional guidance to use NFT over FQs for acute uncomplicated cystitis. DESIGN Retrospective preintervention-postintervention study.