A Multifaceted Approach to Reduction of Catheter-Associated Urinary Tract Infections in the Intensive Care Unit With an Emphasis on "Stewardship of Culturing".

BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications. OBJECTIVE To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture.

Durable improvement in hand hygiene compliance following implementation of an automated observation system with visual feedback.

Automated observations systems for monitoring hand hygiene facilitate more measurements than feasible with direct observation and may enhance performance. We report that an automated observation system with immediate feedback was associated with a rapid and durable improvement in hand hygiene compliance.

Hospital-acquired Staphylococcus aureus primary bloodstream infection: A comparison of events that do and do not meet the central line-associated bloodstream infection definition.

Background: This study was done to describe the incidence and outcomes of primary hospital-acquired bloodstream infection (HABSI) secondary to Staphylococcus aureus (SA) that did and did not meet the National Healthcare Safety Network's (NHSN's) definition for central line-associated bloodstream infection (CLABSI).

Methods: Consecutive hospitalized patients during a 48-month study period with an SA HABSI were categorized according to those who did and did not meet the NHSN's definitions for CLABSI and non-CLABSI. Primary outcomes were mortality at 30 days and 1 year.

The impact of multidrug resistance on outcomes in ventilator-associated pneumonia.

Multidrug-resistant (MDR) organisms in ventilator-associated pneumonia were found in 49 of 107 patients and were associated with home antibiotics, pre-ventilator-associated pneumonia hospital stay, and health care exposure. Overall, MDR organisms were associated with increased mortality (P = .006).

The descriptive epidemiology of central line-associated bloodstream infection among patients in non-intensive care unit settings.

Objective: To review and describe device utilization and central line-associated bloodstream (CLABSI) events among patients in a non-intensive care unit (ICU) setting and to examine the morbidity and mortality associated with these events.

Design: One-year descriptive review.

Setting: A single tertiary center with a 1,200-bed hospital and 209 adult ICU beds.

Development of a modified surveillance definition of central line-associated bloodstream infections for patients with hematologic malignancies.

Objective: To develop a modified surveillance definition of central line-associated bloodstream infection (mCLABSI) specific for our population of patients with hematologic malignancies to better support ongoing improvement efforts at our hospital.

Design: Retrospective cohort study.

Patients: Hematologic malignancies population in a 1,200-bed tertiary care hospital on a 22-bed bone marrow transplant (BMT) unit and a 22-bed leukemia unit.

Decrease in Staphylococcus aureus colonization and hospital-acquired infection in a medical intensive care unit after institution of an active surveillance and decolonization program.

Objective: To evaluate the effects of an active surveillance program for Staphylococcus aureus linked to a decolonization protocol on the incidence of healthcare-associated infection and new nasal colonization due to S. aureus.

Design: Retrospective quasi-experimental study.

Necessary but not sufficient: a comparison of surveillance definitions of Clostridium difficile-associated diarrhea.

In this article, we describe our comparison of the Cleveland Clinic surveillance definition of Clostridium difficile-associated diarrhea and the definition mandated by the Ohio Department of Health. We found the definitions to be concordant only 71% of the time; the Ohio Department of Health definition identified 278 of the 391 cases identified by the Cleveland Clinic definition. Surveillance definitions mandated by the Ohio Department of Health overrepresented the number of cases attributable to nosocomial transmission at our institution.

Predictors of long-term mortality in patients with ventilator-associated pneumonia.

Purpose: To determine the long-term outcome of ventilator-associated pneumonia (VAP) and identify factors associated with increased mortality.

Methods: We retrospectively studied 671 patients with VAP admitted to an intensive care unit between 1994 and 2000. We determined long-term and out-of-hospital mortality for these patients.

Weekly versus daily changes of in-line suction catheters: impact on rates of ventilator-associated pneumonia and associated costs.

Background: An earlier randomized, controlled trial showed that weekly or as-needed (as opposed to daily) changes of in-line suction catheters were associated with substantial cost savings, without a higher rate of ventilator-associated pneumonia (VAP). To examine the impact of decreasing the frequency of in-line suction catheter changes in our medical intensive care unit, we conducted an observational study, comparing the catheter costs and frequency of VAP during (1) a control period, during which in-line suction catheters were changed daily, and (2) a treatment period, during which the catheters were changed every 7 days or sooner if needed, for mechanical failure or soilage.

Methods: All adult patients admitted to our 18-bed medical intensive care unit were evaluated for the 3-month interval 1 year prior to the practice change (May through July 1998) and for the 3 months after implementing the new policy (May through July 1999).

The role of preoperative antibiotic prophylaxis in cosmetic surgery.

An estimated 2.7 million cosmetic procedures were performed in the United States in 1998, yet the role of preoperative antibiotic prophylaxis for cosmetic surgery is not clearly defined. Routine antibiotic prophylaxis for cosmetic procedures was discontinued by the senior author at the authors' institution in an effort to reduce use and cost in June of 1999.