Guidance for Health Care Leaders During the Recovery Stage of the COVID-19 Pandemic: A Consensus Statement.

Importance: The COVID-19 pandemic is the greatest global test of health leadership of our generation. There is an urgent need to provide guidance for leaders at all levels during the unprecedented preresolution recovery stage.

Objective: To create an evidence- and expertise-informed framework of leadership imperatives to serve as a resource to guide health and public health leaders during the postemergency stage of the pandemic.

"Call Me by My Name": Improving Communication with Family Members at the Bedside via the Caregiver Identification Badge.

Background: Patient and family experience are integral to the care that we provide. In the pediatric hospital setting, multiple family members are directly involved in patient care. We identified the need for greater caregiver name recognition at The Hospital for Sick Children, Toronto, ON.

Physician Experience at the Leading Edge of the Digital Healthcare Transformation.

Physicians as a group have a highly variable love/hate relationship with digital technology: there is no doubt that digital technology has the potential to dramatically improve the care that we provide to our patients; however, it also has the potential to negatively disrupt how we work and interact with one another and may even cause harm, albeit rarely (Wachter 2015). One suspects that this trade-off is similar to what has been experienced by society as a whole as we have undergone the digital revolution over the past two decades. For example, although digital platforms have allowed us to stream more music than could ever be purchased by one individual, it comes at the cost of sound quality.

Switching from expectorated to induced sputum cultures for tuberculosis diagnosis reduces cost without increasing risk.

Active pulmonary tuberculosis testing with 3 expectorated sputa can increase isolation days and expenditures compared with 1 induced sputum. Six-month retrospective and prospective chart reviews were conducted, and a screening algorithm was phased into 2 hospital sites. With induced sputum testing, isolation decreased from 7 to 4 days (interquartile range, 4-3, P = .

The Efficacy of Computed Tomography-Guided Percutaneous Spine Biopsies in Determining a Causative Organism in Cases of Suspected Infection: A Systematic Review.

Purpose: In suspected spondylodiscitis and vertebral osteomyelitis, computed tomography (CT)-guided biopsies are often performed to determine a causative organism and guide antimicrobial therapy. The aim of this study is to determine the diagnostic culture yield of CT-guided biopsies performed in cases of suspected spinal infections.

Methods: A literature search of PubMed and MEDLINE up to April 2017 was performed for keywords "CT guided vertebral biopsy infection," "CT-guided spine biopsy infection," "CT guided spine biopsy yield," and "CT guided vertebral biopsy yield.

Healthcare Quality Improvement Requires Many Approaches.

It is a pleasure to respond to the commentaries and we thank the authors for the thought, time and effort they so obviously put into their writing. We are excited that documenting our experience has resulted in such a wide range of opinion.

Five years of Experience using Front-Line Ownership to Improve Healthcare Quality and Safety.

Front-line ownership (FLO) is a complexity science-based approach to leading change initiatives that is built upon a foundation of Positive Deviance and the use of Liberating Structures to engage others. In this paper, we outline the use of FLO in four successful patient safety or quality improvement projects in four countries. While the underlying principles guiding the use of FLO were the same for each of these projects, project goals, the types of roles involved and how the projects evolved, spread and were sustained, varied considerably between settings.

Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement.

Background: Four cluster randomized controlled trials (cRCTs) conducted in long-term care facilities (LTCFs) have reported reductions in patient risk through increased healthcare worker (HCW) influenza vaccination. This evidence has led to expansive policies of enforcement that include all staff of acute care hospitals and other healthcare settings beyond LTCFs. We critique and quantify the cRCT evidence for indirect patient benefit underpinning policies of mandatory HCW influenza vaccination.

Longitudinal Multicenter Analysis of Outcomes After Cessation of Control Measures for Vancomycin-Resistant Enterococci.

OBJECTIVE To assess clinically relevant outcomes after complete cessation of control measures for vancomycin-resistant enterococci (VRE). DESIGN Quasi-experimental ecological study over 3.5 years.

The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study.

Background: Isolation precautions have negative effects on patient safety, psychological well-being, and healthcare worker contact. However, it is not known whether isolation precautions affect certain hospital-related outcomes.

Objective: To examine the effect of isolation precautions on hospital-related outcomes and cost of care.

Domestic impact of tuberculosis screening among new immigrants to Ontario, Canada.

Background: All Canadian immigrants undergo screening for tuberculosis (TB) before immigration, and selected immigrants must undergo postimmigration surveillance for the disease. We sought to quantify the domestic health impact of screening for TB in all new immigrants and to identify mechanisms to enhance effectiveness and efficiency of this screening.

Methods: We linked preimmigration medical examination records from 944,375 immigrants who settled in Ontario between 2002 and 2011 to active TB reporting data in Ontario between 2002 and 2011.

Infection related to ultrasound-guided single-injection peripheral nerve blockade: a decade of experience at toronto Western hospital.

The use of ultrasound guidance has revolutionized regional anesthesia practice. Ultrasound equipment disinfection techniques vary between institutions. To date, there are no large data set publications or evidence-based guidelines that describe risk-reduction techniques for infectious complications related to the use of ultrasound guidance for peripheral nerve blockade.

Measurement of patient hand hygiene in multiorgan transplant units using a novel technology: an observational study.

Objective: Healthcare worker hand hygiene is known to prevent healthcare-associated infections, but there are few data on patient hand hygiene despite the fact that nosocomial pathogens may be acquired by patients via their own unclean hands. The purpose of this study was to measure patient hand hygiene behavior in the hospital after visiting a bathroom, before eating, and on entering and leaving their rooms.

Design: Cross-sectional study.

Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study.

Background: The Hawthorne effect, or behaviour change due to awareness of being observed, is assumed to inflate hand hygiene compliance rates as measured by direct observation but there are limited data to support this.

Objective: To determine whether the presence of hand hygiene auditors was associated with an increase in hand hygiene events as measured by a real-time location system (RTLS).

Methods: The RTLS recorded all uses of alcohol-based hand rub and soap for 8 months in two units in an academic acute care hospital.

A pragmatic approach to infection prevention and control guidelines in an ambulatory care setting.

The vast majority of infection prevention and control (IPAC) experience and practice guidance relates to the inpatient setting. We have taken a pragmatic approach to applying IPAC guidance in our ambulatory setting, and here we identify and describe the 4 key areas where we modified our IPAC program and adapted current guidelines to fit with our setting.

Patient-as-observer approach: an alternative method for hand hygiene auditing in an ambulatory care setting.

A survey pilot asked patients to observe the hand hygiene compliance of their health care providers. Patients returned 75.1% of the survey cards distributed, and the overall hand hygiene compliance was 96.

Integration and proliferation of Pseudomonas aeruginosa PA01 in multispecies biofilms.

Despite an increased awareness of biofilm formation by pathogens and the role of biofilms in human infections, the potential role of environmental biofilms as an intermediate stage in the host-to-host cycle is poorly described. To initiate infection, pathogens in biofilms on inanimate environmental surfaces must detach from the biofilm and be transmitted to a susceptible individual in numbers large enough to constitute an infectious dose. Additionally, while detachment has been recognized as a discrete event in the biofilm lifestyle, it has not been studied to the same extent as biofilm development or biofilm physiology.

Mild isoniazid-induced liver injury in humans is associated with an increase in Th17 cells and T cells producing IL-10.

Isoniazid (INH) remains a mainstay for the treatment of tuberculosis despite the fact that it can cause liver failure. The mechanism of INH-induced liver injury remains controversial. It had been proposed that the mechanism involves metabolic idiosyncrasy based on the observations that liver injury is not usually associated with fever, rash, or prompt increase in alanine aminotransferase (ALT) upon rechallenge.

Hand hygiene monitoring technology: protocol for a systematic review.

Background: Healthcare worker hand hygiene is thought to be one of the most important strategies to prevent healthcare-associated infections, but compliance is generally poor. Hand hygiene improvement interventions must include audits of compliance (almost always with feedback), which are most often done by direct observation - a method that is expensive, subjective, and prone to bias. New technologies, including electronic and video hand hygiene monitoring systems, have the potential to provide continuous and objective monitoring of hand hygiene, regular feedback, and for some systems, real-time reminders.

Prophylaxis for latent tuberculosis infection prior to anti–tumor necrosis factor therapy in low-risk elderly patients with rheumatoid arthritis: a decision analysis.

Objective: To determine if low-risk elderly patients with rheumatoid arthritis (RA) who screen positive for latent tuberculosis (TB) infection prior to anti–tumor necrosis factor (anti-TNF) therapy should be given isoniazid (INH).

Methods: A Markov model was developed. The base case was a patient age 65 years with RA starting anti-TNF therapy with a positive tuberculin skin test (TST) finding of 5–9 mm, who was born in a country with low TB prevalence and had no other TB risk factors.

Front-line ownership: generating a cure mindset for patient safety.

Great advances have been made in standardization and human factors engineering that have reduced variability and increased reliability in healthcare. As important as these advances are, the authors believe there is another important but largely ignored layer to the safety story in healthcare that has prevented us from progressing. In the field of infection prevention and control (IPAC), despite great attempts over several decades to improve compliance with hand hygiene, surveillance, environmental cleaning, isolation protocols and other control measures, very significant challenges remain.

Fifty years of infection control and healthcare design.

The examination of 1962 perspectives on healthcare provided by Ross Graham and Shannon Sibbald in their article "Looking Back 50 Years in Hospital Administration" provides an opportunity to see not only what happened 50 years ago, but how modern attitudes and concerns both match and differ from those of the past. Focusing on infection prevention and hospital design, this commentary explores the changes in procedure, policy and attitudes since 1962, and how they are affecting healthcare today.