Long-term care certification in infection prevention: The time is…now!

The complexity and risks of long-term care (LTC) resident care has continued to increase, including infection risk, as regulatory agencies and the LTC industry seek credible and knowledgeable infection preventionists for their facilities. Developing an LTC infection prevention and control certification exam indicates infection preventionists can proficiently manage infection prevention and control programs.

Beyond flu: Trends in respiratory infection outbreaks in Ontario healthcare settings from 2007 to 2017, and implications for non-influenza outbreak management.

Background: Outbreaks cause significant morbidity and mortality in healthcare settings. Current testing methods can identify specific viral respiratory pathogens, yet the approach to outbreak management remains general.

Objectives: Our aim was to examine pathogen-specific trends in respiratory outbreaks, including how attack rates, case fatality rates and outbreak duration differ by pathogen between hospitals and long-term care (LTC) and retirement homes (RH) in Ontario.

Value of certification in infection prevention and control.

The Certification Board of Infection Control and Epidemiology conducted a marketing research study to determine the perceived value of the certification in infection prevention and control among infection prevention professionals and other stakeholders. Four thematic categories were identified: certification process and standards; professionalism, competency, and career growth; patient care, safety, infection prevention and control; and regulatory compliance. Respondents stated that certification demonstrated professional competency, increased career growth, improved regulatory compliance, was important in influencing legislation, and improved the practice of infection prevention and control.

Acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in contacts of patients newly identified as colonized or infected with MRSA in the immediate postexposure and postdischarge periods.

The acquisition of methicillin-resistant Staphylococcus aureus (MRSA) after exposure to patients colonized or infected with MRSA was assessed. Among contacts with complete surveillance screening, the rate of acquisition was 5.7% and was lower in those identified postdischarge (17/683, 2.

Do physicians clean their hands? Insights from a covert observational study.

Physicians are notorious for poor hand hygiene (HH) compliance. We wondered if lower performance by physicians compared with other health professionals might reflect differences in the Hawthorne effect. We introduced covert HH observers to see if performance differences between physicians and nurses decreased and to gain further insights into physician HH behaviors.

Indwelling urinary catheter surveillance using a Task-oriented nurse acuity system.

The task-oriented nurse acuity system (TONAS) has long been used to calculate nursing care needs on hospital patient units, and include nursing documentation on indwelling urinary catheter use. We performed a 2500-patient validation study of our organization's TONAS, which demonstrated high interrater reliability with manual audits (κ >0.92).

Risk factors for Staphylococcus aureus surgical site infection during an outbreak in patients undergoing cardiovascular surgery.

Background: This study examined the epidemiology of an outbreak of Staphylococcus aureus surgical site infections (SSI) after cardiovascular surgery, and analyzed risk factors for S aureus SSIs.

Methods: This was a retrospective case-control study to determine risk factors for S aureus SSI in 38 patients who developed S aureus SSI during the outbreak period, compared with age-, sex-, and procedure-matched controls. S aureus strains were typed by pulsed-field gel electrophoresis.

Nosocomial transmission of New Delhi metallo-β-lactamase-1-producing Klebsiella pneumoniae in Toronto, Canada.

Design: An analysis of a cluster of New Delhi metallo-β-lactamase-1-producing Klebsiella pneumoniae (NDM1-Kp) and a retrospective case-cohort analysis of risk factors for acquisition in contacts of NDM1-Kp-positive patients.

Setting: A 1,100-bed Canadian academic tertiary care center.

Patients: Two index patients positive for NDM1-Kp as well as 45 contacts (roommates, ward mates, or environmental contacts) were investigated.

Validation of administrative population-based data sets for the detection of cesarean delivery surgical site infection.

We validated population-based hospital, emergency room, and physician claim databases for the detection of surgical site infections against the reference standard of clinical surveillance. Although these data sets are highly specific and could be used to define research cohorts, their low sensitivity and positive predictive value make them inadequate for use as quality indicators.

Reducing the risk of severe complications among patients with Clostridium difficile infection.

Background: The incidence and severity of Clostridium difficile infections are increasing, and there is a need to optimize the prevention of complicated disease.

Objective: To identify modifiable processes of care associated with an altered risk of C difficile complications.

Methods: A retrospective cohort study (with prospective case ascertainment) of all C difficile infections during 2007⁄2008 at a tertiary care hospital was conducted.

The impact of treatment modality on infection-related hospitalization rates in peritoneal dialysis and hemodialysis patients.

Background And Objectives: Infection is a major cause of morbidity and mortality in the dialysis population. This study compares the rates of infection-related hospitalization (IRH) in incident chronic dialysis patients initiating outpatient peritoneal dialysis (PD) and hemodialysis (HD).

Methods And Patients: This was a retrospective cohort study at the dialysis program of a tertiary-care center in Toronto, Canada.

Utility of environmental sampling for the prevention of transmission of vancomycin resistant enterococci (VRE) in hospitals.

Background: Although vancomycin resistant enterococci (VRE) have been shown to contaminate environmental surfaces in the room of a patient infected or colonized with VRE there is limited evidence that links environmental contamination with acquisition.

Objectives: To determine whether a policy of environmental sampling and room closure is more effective than cleaning and visual inspection of the room without culturing, in preventing the transmission of VRE to the next admitted patient.

Methods: The rooms of consecutive patients with VRE were alternatively managed according to either Protocol I (terminal cleaning, inspection and admission of new patient(s)) or Protocol II (terminal cleaning, environmental cultures and closing of the room pending negative results).

The role of colonization pressure in nosocomial transmission of methicillin-resistant Staphylococcus aureus.

Background: Colonized or infected patients are a major reservoir for patient-to-patient transmission of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals. Despite attempted adherence to recommended infection prevention and control procedures, a general medicine unit in our hospital continued to experience ongoing transmission of MRSA. The role that colonization pressure (CP) plays in nosocomial transmission of MRSA on a general medicine unit was assessed, and a threshold CP above which additional IP&C practices should be implemented was proposed.

Training costs and investment payback of implementing molecular diagnostics for identification of vancomycin resistant enterococci in a clinical microbiology laboratory.

Molecular diagnostics may be a more efficient method to manage resources; but most Microbiology laboratories have not introduced them into routine use due to the specialized training required. Using vancomycin resistant enterococci (VRE) screening during a comparison of a multiplex PCR (MPCR) and conventional biochemical testing (CBT) we studied 3 objectives: 1) to develop a molecular diagnostics in-house training program, 2) to assess the training program outcomes for competency and confidence, and 3) to determine laboratory payback. A training program for 14 technologists using multiple adult learning methods was implemented.