1.Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review.
气溶胶的产生和医护人员的急性呼吸道感染传播的风险：系统评价
Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J.PLoS One. 2012;7(4):e35797. Epub 2012 Apr 26.
SourceCanadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Ontario, Canada.
AbstractAerosol generating procedures (AGPs) may expose health care workers (HCWs) to pathogens causing acute respiratory infections (ARIs), but the risk of transmission of ARIs from AGPs is not fully known. We sought to determine the clinical evidence for the risk of transmission of ARIs to HCWs caring for patients undergoing AGPs compared with the risk of transmission to HCWs caring for patients not undergoing AGPs. We searched PubMed, EMBASE, MEDLINE, CINAHL, the Cochrane Library, University of York CRD databases, EuroScan, LILACS, Indian Medlars, Index Medicus for SE Asia, international health technology agencies and the Internet in all languages for articles from 01/01/1990 to 22/10/2010. Independent reviewers screened abstracts using pre-defined criteria, obtained full-text articles, selected relevant studies, and abstracted data. Disagreements were resolved by consensus. The outcome of interest was risk of ARI transmission. The quality of evidence was rated using the GRADE system. We identified 5 case-control and 5 retrospective cohort studies which evaluated transmission of SARS to HCWs. Procedures reported to present an increased risk of transmission included [n; pooled OR(95%CI)] tracheal intubation [n = 4 cohort; 6.6 (2.3, 18.9), and n = 4 case-control; 6.6 (4.1, 10.6)], non-invasive ventilation [n = 2 cohort; OR 3.1(1.4, 6.8)], tracheotomy [n = 1 case-control; 4.2 (1.5, 11.5)] and manual ventilation before intubation [n = 1 cohort; OR 2.8 (1.3, 6.4)]. Other intubation associated procedures, endotracheal aspiration, suction of body fluids, bronchoscopy, nebulizer treatment, administration of O2, high flow O2, manipulation of O2 mask or BiPAP mask, defibrillation, chest compressions, insertion of nasogastric tube, and collection of sputum were not significant. Our findings suggest that some procedures potentially capable of generating aerosols have been associated with increased risk of SARS transmission to HCWs or were a risk factor for transmission, with the most consistent association across multiple studies identified with tracheal intubation.
2.Infect Control Hosp Epidemiol. 2012 Jun;33(6):565-71. Epub 2012 Apr 20.
Use of administrative data in efficient auditing of hospital-acquired surgical site infections, new york state 2009-2010.
Haley VB, Van Antwerpen C, Tserenpuntsag B, Gase KA, Hazamy P, Doughty D, Tsivitis M, Stricof RL.
SourceNew York State Department of Health, Bureau of Healthcare Associated Infections, Albany, New York.
AbstractObjective. To efficiently validate the accuracy of surgical site infection (SSI) data reported to the National Healthcare Safety Network (NHSN) by New York State (NYS) hospitals. Design. Validation study. Setting. 176 NYS hospitals. Methods. NYS Department of Health staff validated the data reported to NHSN by review of a stratified sample of medical records from each hospital. The four strata were (1) SSIs reported to NHSN; (2) records with an indication of infection from diagnosis codes in administrative data but not reported to NHSN as SSIs; (3) records with discordant procedure codes in NHSN and state data sets; (4) records not in the other three strata. Results. A total of 7,059 surgical charts (6% of the procedures reported by hospitals) were reviewed. In stratum 1, 7% of reported SSIs did not meet the criteria for inclusion in NHSN and were subsequently removed. In stratum 2, 24% of records indicated missed SSIs not reported to NHSN, whereas in strata 3 and 4, only 1% of records indicated missed SSIs; these SSIs were subsequently added to NHSN. Also, in stratum 3, 75% of records were not coded for the correct NHSN procedure. Errors were highest for colon data; the NYS colon SSI rate increased by 7.5% as a result of hospital audits. Conclusions. Audits are vital for ensuring the accuracy of hospital-acquired infection (HAI) data so that hospital HAI rates can be fairly compared. Use of administrative data increased the efficiency of identifying problems in hospitals' SSI surveillance that caused SSIs to be unreported and caused errors in denominator data.
3.
Antimicrob Agents Chemother. 2012 Apr 30. [Epub ahead of print]
Impact of cefepime therapy on mortality among patients with blood stream infections caused by extended spectrum β-lactamase-producing Klebsiella pneumoniae and Escherichia coli.Chopra T, Marchaim D, Veltman J, Johnson P, Zhao JJ, Tansek R, Hatahet D, Chaudhry K, Pogue JM, Rahbar H, Chen TY, Truong T, Rodriguez V, Ellsworth J, Bernabela L, Bhargava A, Yousuf A, Alangaden G, Kaye KS.
SourceDivision of Infectious Diseases.
AbstractBackground: Extended-spectrum beta lactamase (ESBL)-producing pathogens are associated with extensive morbidity, mortality, and rising healthcare costs. Scant data exist on the impact of antimicrobial therapy on clinical outcomes in patients with ESBL bloodstream infections (BSI) and no large studies have examined the impact of cefepime therapy. Methods: A retrospective 3 year study was performed at the Detroit Medical Center on adult patients with ESBL-producing K. pneumoniae or E. coli BSI. Data were collected from the medical records of study patients at five hospitals between January 2005 and December 2007. Multivariate analysis was performed using logistic regression. Results: One-hundred and forty-five patients with BSI due to ESBL-producing pathogens were studied, including K. pneumoniae (83%), and E. coli(16.5%). The mean age of the patients was 66 years, 51% were female and 79.3% were African-American. 53 patients (37%) died in the hospital and 92 survived to discharge. In bivariate analysis, the following variables were associated with mortality (p<0.05): presence of a rapidly fatal condition at the time of admission, use of gentamicin as a consolidative therapeutic agent, and presence of one or more of the following prior to culture date: mechanical ventilation, stay in the intensive care unit (ICU), and presence of a central venous catheter. In multivariate analysis, the predictors of in-hospital mortality included: intensive care unit stay (OR=2.17, 95% CI 0.98-4.78), presence of a central line prior to positive culture (OR=2.33, 95%CI 0.77-7.03) presence of a rapidly fatal condition at the time of admission (OR=5.13,95%CI 2.13-12.39) and recent prior hospitalization (OR=1.92,95%CI 0.83-4.09). When carbapenems were added as empiric therapy to the predictor model, there was a trend between empiric carbapenem therapy and decreased mortality (OR=0.61,95% CI 0.26-1.50). When added to the model, receipt of empiric cefepime alone (n=43) was associated with increased mortality, although this association did not reach statistical significance (OR= 1.66, 95% CI 0.71-3.87). Median length of hospital stay was shorter for patients receiving empiric cefepime and longer for those receiving empiric or consolidated carbapenem therapy. Conclusions: In multivariate analysis, empiric therapy with cefepime for BSI due to an ESBL-producing pathogen was associated with a trend towards an increased mortality risk and empiric carbapenem therapy was associated with a trend towards decreased mortality risk.
4 Clin Infect Dis. 2012 Apr 26. [Epub ahead of print]
Agreement in Classifying Bloodstream Infections Among Multiple Reviewers Conducting Surveillance.
Mayer J, Greene T, Howell J, Ying J, Rubin MA, Trick WE, Samore MH; for the CDC Prevention Epicenters Program.
SourceUniversity of Utah School of Medicine, Salt Lake City, UT.
AbstractBackgroundMandatory reporting of healthcare associated infections (HAI) is increasing. Evidence for agreement among different reviewers applying HAI surveillance criteria is limited. We aim to characterize agreement among Infection Preventionists (IPs) conducting surveillance for central line-associated bloodstream infection (CLABSI) with each other and as compared to simplified laboratory-based definitions.MethodsAbstracted electronic health records were assembled from in-patients with positive blood cultures at a tertiary care Veterans Affairs (VA) hospital over a 5-year period. Identical patient records were made available to VA IPs from different facilities to report on CLABSI using their usual surveillance methods. Positive blood cultures were also evaluated using laboratory-based definitions. Standard indices of inter-rater agreement, expressed as a kappa statistic, were computed between IPs, and between IPs and simplified laboratory-based methods.ResultsOverall, 114 patient records were reviewed by 18 IPs, the majority of whom specified they followed National Healthcare Safety Network (NHSN) criteria. The overall agreement amongst IPs by kappa was 0.42 (SE 0.06). IPs had better agreement with a simple laboratory-based definition with an average kappa of 0.55 (SE 0.05). The proportion of patient records that 18 IPs reported with CLABSI ranged from 14% to 39% (overall mean 28% with a CV of 25%). When simple laboratory-based methods were applied to different sets of patient records, classification was more consistent with CLABSI assigned in a proportion ranging from 36% to 42% (overall mean 39%).ConclusionReliability of IP-conducted surveillance to identify HAI may not be ideal for public reporting goals of inter-hospital comparisons.
5.Clin Infect Dis. 2012 May 9. [Epub ahead of print]
The Power of Policy Change, Federal Collaboration and State Coordination in HAI Prevention.
Srinivasan A, Craig M, Cardo D.
SourceCenters for Disease Control and Prevention, National Center for Emerging, Zoonotic, and Infectious Diseases, Division of Healthcare Quality Promotion, Atlanta, GA.
AbstractPolicymakers have prioritized the prevention of healthcare-associated infections (HAIs) as a double-win that can both improve health outcomes and reduce healthcare costs. In the past few years, state and federal policymakers have developed policies to improve coordination and promote transparency and prevention. At the federal level, Congressional oversight, policy directives, and targeted funding have helped focus national HAI prevention efforts through the "Department of Health and Human Services (HHS) Action Plan to Prevent Healthcare-Associated Infections." The development of this Action Plan and the collaboration of its implementing agencies -- the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS), and the Agency for Healthcare Research and Quality (AHRQ) - has heightened nationwide awareness of HAIs and their preventability, and provided an infrastructure and tools to reduce HAIs. State policymakers have also acted to promote local transparency and tailor prevention efforts to local needs. The collaboration and action generated by these state and federal efforts have helped accelerate HAI prevention across the United States.
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