Development of an antimicrobial stewardship program in an integrated healthcare system.

Purpose: The development of an inpatient antimicrobial stewardship program (ASP) in an integrated healthcare system is described.

Summary: With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop ASPs. In 2015, BJC HealthCare, a multihospital health system, developed a system-level, multidisciplinary ASP team to assist member hospitals with ASP implementation.

Consensus conference on prevention of central line-associated bloodstream infections: 2009.

Health care-acquired infections are a significant cause of morbidity and mortality in all patient care settings. In 2009, a consensus conference was held to evaluate practices and recommendations for the prevention and control of one specific type of health care-acquired infections, those associated with central catheter use. The conference had 2 purposes--to provide a tool for quality changes within health care institutions regarding central catheter infections and to empower those who are responsible for implementing policies needed to reduce the risk of these infections.

Zeroing in on zero tolerance for central line-associated bacteremia.

Background: Central line-associated bacteremia (CLAB) is associated with increased intensive care unit (ICU) length of stay (LOS) of up to 6 days, increased hospital LOS of approximately 21 days, attributable mortality of approximately 35%, and incremental costs of approximately $56,000 per infection.

Need: In 1999 in the surgical-burn-trauma ICU at Barnes Jewish Hospital (BJH), the CLAB rate was 10.8/1000 central venous catheter (CVC) line-days, substantially higher than the National Nosocomial Infection Surveillance rate of 5.

The impact of a simple, low-cost oral care protocol on ventilator-associated pneumonia rates in a surgical intensive care unit.

Objective: The purpose of this study was to determine the effects of a simple low-cost oral care protocol on ventilator-associated pneumonia rates in a surgical intensive care unit.

Design: Preintervention and postintervention observational study.

Setting: Twenty-four bed surgical/trauma/burn intensive care units in an urban university hospital.

Effect of chlorhexidine/silver sulfadiazine-impregnated central venous catheters in an intensive care unit with a low blood stream infection rate after implementation of an educational program: a before-after trial.

Background: Current guidelines recommend using antiseptic- or antibiotic-impregnated central venous catheters (CVCs) if, following a comprehensive strategy to prevent catheter-related blood stream infection (CR-BSI), infection rates remain above institutional goals based on benchmark values. The purpose of this study was to determine if chlorhexidine/silver sulfadiazine-impregnated CVCs could decrease the CR-BSI rate in an intensive care unit (ICU) with a low baseline infection rate.

Methods: Pre-intervention and post-intervention observational study in a 24-bed surgical/trauma/burn ICU from October, 2002 to August, 2005.

Effectiveness of an educational program to reduce ventilator-associated pneumonia in a tertiary care center in Thailand: a 4-year study.

Background: Ventilator-associated pneumonia (VAP) is considered to be an important cause of infection-related death and morbidity in intensive care units (ICUs). We sought to determine the long-term effect of an educational program to prevent VAP in a medical ICU (MICU).

Methods: A 4-year controlled, prospective, quasi-experimental study was conducted in an MICU, surgical ICU (SICU), and coronary care unit (CCU) for 1 year before the intervention (period 1), 1 year after the intervention (period 2), and 2 follow-up years (period 3).

Use of hypochlorite solution to decrease rates of Clostridium difficile-associated diarrhea.

An increased rate of Clostridium difficile-associated diarrhea (CDAD) was noted in 2 intensive care units of a university-affiliated tertiary care facility. One unit instituted enhanced environmental cleaning with a hypochlorite solution in all rooms, whereas the other unit used hypochlorite solution only in rooms of patients with CDAD. The CDAD rates decreased in both units.

Impact of a methicillin-resistant Staphylococcus aureus active surveillance program on contact precaution utilization in a surgical intensive care unit.

Objective: To determine the impact of an active surveillance for methicillin-resistant Staphylococcus aureus (MRSA) on contact precaution utilization, as measured by additional number of contact precaution days attributable to the active surveillance program.

Design: Prospective cohort study.

Setting: Twenty-four-bed surgical intensive care unit (ICU).

Epidemiology of methicillin-resistant Staphylococcus aureus colonization in a surgical intensive care unit.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of healthcare-associated infections among surgical intensive care unit (ICU) patients, though transmission dynamics are unclear.

Objective: To determine the prevalence of MRSA nasal colonization at ICU admission, to identify associated independent risk factors, to determine the value of these factors in active surveillance, and to determine the incidence of and risk factors associated with MRSA acquisition.

Design: Prospective cohort study.

Efficacy and safety of an insulin infusion protocol in a surgical ICU.

Background: Hyperglycemia is associated with complications in the surgical intensive care unit. The purpose of this study was to determine the efficacy and safety of nurse-driven insulin infusion protocols in lowering blood glucose (BG) in critical illness.

Study Design: All patients in a 24-bed surgical intensive care unit who required i.

The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU.

Objective: To determine whether an education initiative could decrease the rate of catheter-associated bloodstream infection.

Design: Preintervention and postintervention observational study.

Setting: The 19-bed medical ICU in a 1,400-bed university-affiliated urban teaching hospital.

An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects.

Study Objectives: To determine whether an educational initiative could decrease rates of ventilator-associated pneumonia in a regional health-care system.

Setting: Two teaching hospitals (one adult, one pediatric) and two community hospitals in an integrated health system.

Design: Preintervention and postintervention observational study.

The impact of bedside behavior on catheter-related bacteremia in the intensive care unit.

Hypothesis: The success of an educational program in July 1999 that lowered the catheter-related bloodstream infection (CRBSI) rate in our intensive care unit (ICU) 3-fold is correlated with compliance with "best-practice" behaviors.

Design: Before-after trial.

Setting: Surgical ICU in a referral hospital.

Ventilator-associated pneumonia in a multi-hospital system: differences in microbiology by location.

Objective: To determine whether there were differences in the microbiologic etiologies of ventilator-associated pneumonia in different clinical settings.

Design: Observational retrospective cohort study of microbiologic etiologies of ventilator-associated pneumonia from 1998 to 2001 in a multi-hospital system. Microbiologic results were compared between hospitals and between different intensive care units (ICUs) within hospitals.

An educational intervention to prevent catheter-associated bloodstream infections in a nonteaching, community medical center.

Objective: To evaluate the effectiveness of an evidence-based intervention to prevent catheter-associated bloodstream infections among intensive care unit patients at a nonteaching, community hospital.

Design: Nonrandomized pre/post observational trial.

Setting: Two intensive care units at Missouri Baptist Medical Center, Saint Louis, MO.

Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia.

Objective: The purpose of the study was to determine whether an education initiative could decrease the hospital rate of ventilator-associated pneumonia.

Design: Pre- and postintervention observational study.

Setting: Five intensive care units in Barnes-Jewish Hospital, an urban teaching hospital.

Routine screening for methicillin-resistant Staphylococcus aureus among patients newly admitted to an acute rehabilitation unit.

Background: Following an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in our acute rehabilitation unit in 1987, all patients except in-house transfers (because of their low prevalence of MRSA colonization) underwent MRSA screening cultures on admission.

Objectives: To better characterize the current profile of patients with positive MRSA screening cultures at the time of admission to our acute rehabilitation unit, and to determine the relative yield of nares, perianal, and wound screening cultures in this population.

Methods: Prospective chart review with ongoing active surveillance for infections associated with the acute rehabilitation unit

Results: The rate of MRSA isolation from one or more body sites increased significantly from 5% (1987-1988) to 12% (1999-2000) (P = .

Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit.

Objective: The purpose of the study was to determine whether an education initiative aimed at improving central venous catheter insertion and care could decrease the rate of primary bloodstream infections.

Design: Pre- and postintervention observational study.

Setting: Eighteen-bed surgical/burn/trauma intensive care unit (ICU) in an urban teaching hospital.