Quality improvement in hospitals: barriers and facilitators.

Purpose The purpose of this paper is to examine quality improvement (QI) initiatives in acute care hospitals, the factors associated with success, and the impacts on patient care and safety. Design/methodology/approach An extensive online survey was completed by senior managers responsible for QI. The survey assessed QI project types, QI methods, staff engagement, and barriers and factors in the success of QI initiatives.

Herpes simplex virus lymphadenitis: the elusive doppelganger in immunocompromised patients.

Herpes simplex virus has protean manifestations and is an important cause of morbidity in the immunocompromised host. We report a case of recurrent lymphadenopathy and rash in a patient with chronic lymphocytic leukemia. The elusive clinical diagnosis eventually required core biopsy of a lymph node with immunohistochemistry and confirmation by polymerase chain reaction.

Environmental cleaning resources and activities in Canadian acute care hospitals.

Background: Environmental cleaning interventions have increased cleaning effectiveness and reduced antibiotic-resistant organisms in hospitals. This study examined cleaning in Canadian acute care hospitals with the goal of developing strategies to improve cleaning and reduce antibiotic-resistant organism rates.

Methods: Managers most responsible for environmental services (EVS) completed an extensive online survey that assessed EVS resources and cleaning practices.

Working relationships of infection prevention and control programs and environmental services and associations with antibiotic-resistant organisms in Canadian acute care hospitals.

Background: Environmental contamination in hospitals with antibiotic-resistant organisms (AROs) is associated with patient contraction of AROs. This study examined the working relationship of Infection Prevention and Control (IPAC) and Environmental Services and the impact of that relationship on ARO rates.

Methods: Lead infection control professionals completed an online survey that assessed the IPAC and Environmental Services working relationship in their acute care hospital in 2011.

Chikungunya-related arthritis: case report and review of the literature.

Introduction: Chikungunya fever often presents with severe arthritis/arthralgias, high fever, myalgias, headache, and maculopapular rash (Chow et al., 2011 [1]; Das et al., 2010 [2]; Mizuno et al.

Effectiveness of a novel ozone-based system for the rapid high-level disinfection of health care spaces and surfaces.

Background: Vapor-based fumigant systems for disinfection of health care surfaces and spaces is an evolving technology. A new system (AsepticSure) uses an ozone-based process to create a highly reactive oxidative vapor with broad and high-level antimicrobial properties.

Methods: Ozone gas at 50-500 ppm was combined with 3% hydrogen peroxide vapor in a test chamber and upscaled in rooms measuring 82 m3 and 90 m3 in area.

Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada.

Background: In the 2003 Toronto SARS outbreak, SARS-CoV was transmitted in hospitals despite adherence to infection control procedures. Considerable controversy resulted regarding which procedures and behaviours were associated with the greatest risk of SARS-CoV transmission.

Methods: A retrospective cohort study was conducted to identify risk factors for transmission of SARS-CoV during intubation from laboratory confirmed SARS patients to HCWs involved in their care.

Molecular epidemiology of Acinetobacter baumannii in central intensive care unit in Kosova Teaching Hospital.

Infections caused by bacteria of genus Acinetobacter pose a significant health care challenge worldwide. Information on molecular epidemiological investigation of outbreaks caused by Acinetobacter species in Kosova is lacking. The present investigation was carried out to enlight molecular epidemiology of Acinetobacter baumannii in the Central Intensive Care Unit (CICU) of a University hospital in Kosova using pulse field gel electrophoresis (PFGE).

The pandemic influenza planning process in Ontario acute care hospitals.

Background: There will be little time to prepare when an influenza pandemic strikes; hospitals need to develop and test pandemic influenza plans beforehand.

Methods: Acute care hospitals in Ontario were surveyed regarding their pandemic influenza preparedness plans.

Results: The response rate was 78.

Exposure to hospital roommates as a risk factor for health care-associated infection.

Background: Numerous patient- and hospital-level characteristics have been established as risk factors for the transmission of health care-associated infections (HAIs). Few studies have quantitatively assessed the impact of exposure to hospital roommates on the acquisition of infections. This study evaluated the association between roommate exposures and the risk of HAIs.

A comparison of infection control program resources, activities, and antibiotic resistant organism rates in Canadian acute care hospitals in 1999 and 2005: pre- and post-severe acute respiratory syndrome.

Introduction: The Resources for Infection Control in Hospitals (RICH) project assessed infection control programs and rates of antibiotic-resistant organisms (AROs) in Canadian acute care hospitals in 1999. In the meantime, the Severe Acute Respiratory Syndrome (SARS) outbreak and the concern over pandemic influenza have stimulated considerable government and healthcare institutional efforts to improve infection control systems in Canada.

Methods: In 2006, a version of the RICH survey similar to the original RICH instrument was mailed to infection control programs in all Canadian acute care hospitals with 80 or more beds.

A cross-Canada survey of infection prevention and control in long-term care facilities.

Background: Residents in long-term care facilities (LTCFs) are at considerable risk for developing infections. This is the first comprehensive examination of infection control programs in Canadian LTCFs in almost 20 years.

Methods: A survey designed to assess resident and LTCF characteristics; personnel, laboratory, computer, and reference resources; and surveillance and control activities of infection prevention and control programs was sent in 2005 to all eligible LTCFs across Canada.

A comparison of infection control program resources, activities, and antibiotic resistant organism rates in Canadian acute care hospitals in 1999 and 2005: pre- and post-severe acute respiratory syndrome.

Background: The Resources for Infection Control in Hospitals (RICH) project assessed infection control programs and rates of antibiotic-resistant organisms (AROs) in Canadian acute care hospitals in 1999. In the meantime, the severe acute respiratory syndrome (SARS) outbreak and the concern over pandemic influenza have stimulated considerable government and health care institutional efforts to improve infection control systems in Canada.

Methods: In 2006, a version of the RICH survey similar to the original RICH instrument was mailed to infection control programs in all Canadian acute care hospitals with 80 or more beds.

An integrative review of the current evidence on the relationship between hand hygiene interventions and the incidence of health care-associated infections.

Background: The objectives of this integrative review were to critically examine the overall state of the current evidence on the relationship between hand hygiene interventions and the incidence of health care-associated infections (HCAIs) in acute care and long-term care settings, and offer recommendations for future directions in the field based on our findings.

Methods: We searched for original research and reviews of research published between January 1, 1996, and July 31, 2006. Studies were identified through the electronic databases Medline, CINAHL, EMBASE, PUBMED, the Cochrane Library, and through expert consultation.

Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial.

Objective: To assess whether a multifaceted intervention can reduce the number of prescriptions for antimicrobials for suspected urinary tract infections in residents of nursing homes.

Design: Cluster randomised controlled trial.

Setting: 24 nursing homes in Ontario, Canada, and Idaho, United States.

Evaluation of hospital and patient factors that influence the effective administration of surgical antimicrobial prophylaxis.

Objective: To analyze and model the patient and healthcare system factors that may interfere with the appropriate administration of surgical antimicrobial prophylaxis.

Design: Between 1994 and 1998, surgical-site surveillance data were collected prospectively for a cohort of eligible surgical patients. For all cases, and each individual procedure (cardiothoracic, colonic, gynecologic, orthopedic, or vascular), forward stepwise multiple logistic regression was applied to relate key hospital and patient factors to an effective first prophylactic dose (ie, appropriate administration time, dose, route, and drug).

The relationship between hospital infection surveillance and control activities and antibiotic-resistant pathogen rates.

Background: Antibiotic-resistant pathogen rates are rising in Canada and the United States with significant health and economic costs. The examination of the relationship of surveillance and control activities in hospitals with rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile -associated diarrhea (CDAD), and vancomycin-resistant Enterococcus (VRE) may identify strategies for controlling this growing problem.

Methods: Surveys were sent to infection control programs in hospitals that participated in an earlier survey of infection control practices in Canadian acute care hospitals.

Health effects of anthrax vaccination in the Canadian forces.

Objective: The objective of this study was to determine whether anthrax vaccine resulted in adverse health effects in Canadian Forces members 8 months after vaccination.

Methods: A quasi-experimental, retrospective chart review was undertaken for two groups within the Canadian Forces, one group that received anthrax vaccination and another that did not. Information on symptoms, diagnoses, and injuries for 848 persons for which there were approximately 35,000 chart entries was abstracted from charts over a 4.

The state of infection surveillance and control in Canadian acute care hospitals.

Background: Nosocomial infections and antibiotic-resistant pathogens cause significant morbidity, mortality, and economic costs. The infection surveillance and control resources and activities in Canadian acute care hospitals had not been assessed in 20 years.

Methods: In 2000, surveys were mailed to infection control programs in all Canadian hospitals with more than 80 acute care beds.

Effect of lidocaine and epinephrine on Staphylococcus aureus in a guinea pig model of surgical wound infection.

Postoperative wound infection, most often with, is of ubiquitous concern in surgical practice, occurring in an average of 1.5 to 5 percent of all procedures. The antimicrobial properties of local anesthetics have been documented over the past 25 years by in vitro studies.

Optimizing antibiotics in residents of nursing homes: protocol of a randomized trial.

Background: Antibiotics are frequently prescribed for older adults who reside in long-term care facilities. A substantial proportion of antibiotic use in this setting is inappropriate. Antibiotics are often prescribed for asymptomatic bacteriuria, a condition for which randomized trials of antibiotic therapy indicate no benefit and in fact harm.