Optimizing the implementation of Enhanced Barrier Precautions in community-based nursing homes.

Background: Enhanced Barrier Precautions (EBPs) recommend using gowns and gloves for certain nursing home residents during specific high-contact care activities associated with multidrug-resistant organism (MDRO) transmission. Though EBP is included in published guidance as an MDRO control strategy, optimal implementation approaches remain unclear.

Methods: We implemented a quality improvement (QI) initiative using the 4E process model (engagement, education, execution, and evaluation) to optimize EBP implementation in 4 Maryland nursing homes.

Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study.

Background: Hospital-onset bacteraemia and fungaemia (HOB) is being explored as a surveillance and quality metric. The objectives of the current study were to determine sources and preventability of HOB in hospitalised patients in the USA and to identify factors associated with perceived preventability.

Methods: We conducted a cross-sectional study of HOB events at 10 academic and three community hospitals using structured chart review.

Factors associated with patient-to-healthcare personnel (HCP) and HCP-to-subsequent patient transmission of methicillin-resistant .

Background: Transient acquisition of methicillin-resistant (MRSA) on healthcare personnel (HCP) gloves and gowns following patient care has been examined. However, the potential for transmission to the subsequent patient has not been studied. We explored the frequency of MRSA transmission from patient to HCP, and then in separate encounters from contaminated HCP gloves and gowns to a subsequent simulated patient as well as the factors associated with these 2 transmission pathways.

Alcohol-based decontamination of gloved hands: A randomized controlled trial.

Objective: The gold standard for hand hygiene (HH) while wearing gloves requires removing gloves, performing HH, and donning new gloves between WHO moments. The novel strategy of applying alcohol-based hand rub (ABHR) directly to gloved hands might be effective and efficient.

Design: A mixed-method, multicenter, 3-arm, randomized trial.

Direct Gloving vs Hand Hygiene Before Donning Gloves in Adherence to Hospital Infection Control Practices: A Cluster Randomized Clinical Trial.

Importance: Current guidelines require hand hygiene before donning nonsterile gloves, but evidence to support this requirement is lacking.

Objective: To evaluate the effectiveness of a direct-gloving policy on adherence to infection prevention practices in a hospital setting.

Design, Setting, And Participants: This mixed-method, multicenter, cluster randomized clinical trial was conducted at 4 academic centers in Baltimore, Maryland, or Iowa City, Iowa, from January 1, 2016, to November 30, 2017.

Development and evaluation of a structured guide to assess the preventability of hospital-onset bacteremia and fungemia.

Objective: To assess preventability of hospital-onset bacteremia and fungemia (HOB), we developed and evaluated a structured rating guide accounting for intrinsic patient and extrinsic healthcare-related risks.

Design: HOB preventability rating guide was compared against a reference standard expert panel.

Participants: A 10-member panel of clinical experts was assembled as the standard of preventability assessment, and 2 physician reviewers applied the rating guide for comparison.

Impact of a C. difficile infection (CDI) reduction bundle and its components on CDI diagnosis and prevention.

Background: Published bundles to reduce Clostridioides difficile Infection (CDI) frequently lack information on compliance with individual elements. We piloted a computerized clinical decision support-based intervention bundle and conducted detailed evaluation of several intervention-related measures.

Methods: A quasi-experimental study of a bundled intervention was performed at 2 acute care community hospitals in Maryland.

Preventing Viral Contamination: Effects of Wipe and Spray-based Decontamination of Gloves and Gowns.

We conducted a laboratory simulation to evaluate the contamination of environmental surfaces when using wipe vs spray methods of personal protective equipment (PPE) decontamination. We did not observe any environmental contamination with the bacteriophage MS-2 when bleach solution spray or wipes were used for PPE disinfection.

Effect of Glove Decontamination on Bacterial Contamination of Healthcare Personnel Hands.

We examined the effect of glove decontamination prior to removal on bacterial contamination of healthcare personnel hands in a laboratory simulation study. Glove decontamination reduced bacterial contamination of hands following removal. However, hand contamination still occurred with all decontamination methods, reinforcing the need for hand hygiene following glove removal.

Hand hygiene before donning nonsterile gloves: Healthcareworkers' beliefs and practices.

Background: Understanding the perceptions and beliefs of health care workers (HCWs) regarding glove use and associated hand hygiene (HH) may be informative and ultimately improve practice. Research in this area is limited. This study examined the practices and beliefs of HCWs surrounding the use of nonsterile gloves and HH before gloving.

Comparing brief, covert, directly observed hand hygiene compliance monitoring to standard methods: A multicenter cohort study.

Hand hygiene compliance is subject to the Hawthorne effect, which may be attenuated by covert observers and brief observation periods. This study demonstrated that hand hygiene compliance rates were between 8% and 29% greater when reported by infection prevention programs than when reported by covert observers over brief observation periods.

Health care worker perceptions toward computerized clinical decision support tools for Clostridium difficile infection reduction: A qualitative study at 2 hospitals.

Background: Clostridium difficile infection (CDI) is associated with significant morbidity and mortality. Computerized clinical decision support (CCDS) tools can aid process improvement in infection prevention and antibiotic stewardship, but implementation and health care workers (HCWs) uptake of these tools is often variable. The objective of this study was to describe HCWs' perceptions of barriers and facilitators related to uptake of CCDS tools as part of a CDI reduction bundle.

Comparison of Two Glove-Sampling Methods to Discriminate Between Study Arms of a Hand Hygiene and Glove-Use Study.

In the absence of a gold standard, we compared two glove-sampling methodologies, direct imprint and the sponge stick, to detect a difference between two arms in our study relative to total amount and presence of bacteria.

Effect of meteorological factors and geographic location on methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci colonization in the US.

Background: Little is known about the effect of meteorological conditions and geographical location on bacterial colonization rates particularly of antibiotic-resistant Gram-positive bacteria. We aimed to evaluate the effect of season, meteorological factors, and geographic location on methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) colonization.

Methods: The prospective cohort included all adults admitted to 20 geographically-dispersed ICUs across the US from September 1, 2011 to October 4, 2012.

Carbapenem MICs in Escherichia coli and Klebsiella Species Producing Extended-Spectrum β-Lactamases in Critical Care Patients from 2001 to 2009.

Extended-spectrum β-lactamase (ESBL)-producing strains are increasing in prevalence worldwide. Carbapenem antibiotics are used as a first line of therapy against ESBL-producing We examined a cohort of critical care patients for gastrointestinal colonization with carbapenem-resistant ESBL-producing strains (CR-ESBL strains). We cultured samples from this cohort of patients for ESBL-producing spp.

Comparison of molecular typing methods for the analyses of Acinetobacter baumannii from ICU patients.

Acinetobacter baumannii has emerged as an important cause of healthcare-associated infections causing great morbidity and mortality. Despite its clinical importance, it is still unknown which molecular typing method is the best to determine or confirm institutional outbreaks as well as to identify epidemiologically related isolates from different geographical areas. To determine the most discriminatory molecular typing method, we isolated A.

Pseudomonas aeruginosa Colonization in the Intensive Care Unit: Prevalence, Risk Factors, and Clinical Outcomes.

Objective: To determine the prevalence of Pseudomonas aeruginosa colonization on intensive care unit (ICU) admission, risk factors for P. aeruginosa colonization, and the incidence of subsequent clinical culture with P. aeruginosa among those colonized and not colonized.

Evaluation of the FilmArray Blood Culture Identification Panel: Results of a Multicenter Controlled Trial.

Sepsis is a major cause of morbidity, mortality, and increased medical expense. Rapid diagnosis improves outcomes and reduces costs. The FilmArray blood culture identification panel (BioFire Diagnostics LLC, Salt Lake City, UT), a highly multiplexed PCR assay, can identify 24 etiologic agents of sepsis (8 Gram-positive, 11 Gram-negative, and 5 yeast species) and three antimicrobial resistance genes (mecA, vanA/B, and blaKPC) from positive blood culture bottles.

Comparative genomics of an IncA/C multidrug resistance plasmid from Escherichia coli and Klebsiella isolates from intensive care unit patients and the utility of whole-genome sequencing in health care settings.

The IncA/C plasmids have been implicated for their role in the dissemination of β-lactamases, including gene variants that confer resistance to expanded-spectrum cephalosporins, which are often the treatment of last resort against multidrug-resistant, hospital-associated pathogens. A bla(FOX-5) gene was detected in 14 Escherichia coli and 16 Klebsiella isolates that were cultured from perianal swabs of patients admitted to an intensive care unit (ICU) of the University of Maryland Medical Center (UMMC) in Baltimore, MD, over a span of 3 years. Four of the FOX-encoding isolates were obtained from subsequent samples of patients that were initially negative for an AmpC β-lactamase upon admission to the ICU, suggesting that the AmpC β-lactamase-encoding plasmid was acquired while the patient was in the ICU.

Characterization of Klebsiella sp. strain 10982, a colonizer of humans that contains novel antibiotic resistance alleles and exhibits genetic similarities to plant and clinical Klebsiella isolates.

A unique Klebsiella species strain, 10982, was cultured from a perianal swab specimen obtained from a patient in the University of Maryland Medical Center intensive care unit. Klebsiella sp. 10982 possesses a large IncA/C multidrug resistance plasmid encoding a novel FOX AmpC β-lactamase designated FOX-10.

Pediatric antimicrobial susceptibility trends across the United States.

Objective: Antimicrobial susceptibility patterns across US pediatric healthcare institutions are unknown. A national pooled pediatric antibiogram (1) identifies nationwide trends in antimicrobial resistance, (2) allows across-hospital benchmarking, and (3) provides guidance for empirical antimicrobial regimens for institutions unable to generate pediatric antibiograms.

Methods: In January 2012, a request for submission of pediatric antibiograms between 2005 and 2011 was sent to 233 US hospitals.

Genome sequence of Klebsiella oxytoca 11492-1, a nosocomial isolate possessing a FOX-5 AmpC β-lactamase.

Klebsiella oxytoca strain 11492-1 was isolated from a perianal swab culture from a patient at the University of Maryland Medical Center in 2005. The K. oxytoca 11492-1 draft genome contains multiple antibiotic resistance genes, including a FOX-5 AmpC β-lactamase encoded on a large IncA/C plasmid.

Survival of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus spp. for an extended period of transport.

This study determined the survivability of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) for extended periods of time and temperatures using a standard swab for assessment. Our study showed that transportation in Liquid Amies medium could be performed at room temperature or 4°C for up to 14 days without a decrease in recovery of MRSA or VRE.