To determine the ability of a mobile UV light unit to reduce bacterial contamination of environmental surfaces in patient rooms.

An automated mobile UV light unit that emits UV-C light was placed in 25 patient rooms after patient discharge and operated using a 1- or 2-stage procedure. Aerobic colony counts were calculated for each of 5 standardized high-touch surfaces in the rooms before and after UV light decontamination (UVLD). Clostridium difficile spore log reductions achieved were determined using a modification of the ASTM (American Society for Testing and Materials) International E2197 quantitative disk carrier test method. In-room ozone concentrations during UVLD were measured.

For the 1-stage procedure, mean aerobic colony counts for the 5 high-touch surfaces ranged from 10.6 to 98.2 colony-forming units (CFUs) per Dey/Engley (D/E) plate before UVLD and from 0.3 to 24.0 CFUs per D/E plate after UVLD, with significant reductions for all 5 surfaces (all P<.02). Surfaces in direct line of sight were significantly more likely to yield negative culture results after UVLD than before UVLD (all P<.001). Mean C. difficile spore log reductions ranged from 1.8 to 2.9. UVLD cycle times ranged from 34.2 to 100.1 minutes. For the 2-stage procedure, mean aerobic colony counts ranged from 10.0 to 89.2 CFUs per D/E plate before UVLD and were 0 CFUs per D/E plate after UVLD, with significant reductions for all 5 high-touch surfaces. UVLD cycle times ranged from 72.1 to 146.3 minutes. In-room ozone concentrations during UVLD ranged from undetectable to 0.012 ppm.

The mobile UV-C light unit significantly reduced aerobic colony counts and C. difficile spores on contaminated surfaces in patient rooms.

Over the past 2 decades, multiple interventions have been developed to prevent catheter-associated urinary tract infections (CAUTIs). The CAUTI prevention guidelines of the Healthcare Infection Control Practices Advisory Committee were recently revised.

To examine changes in rates of CAUTI events in adult intensive care units (ICUs) in the United States from 1990 through 2007.

Data were reported to the Centers for Disease Control and Prevention (CDC) through the National Nosocomial Infections Surveillance System from 1990 through 2004 and the National Healthcare Safety Network from 2006 through 2007. Infection preventionists in participating hospitals used standard methods to identify all CAUTI events (categorized as symptomatic urinary tract infection [SUTI] or asymptomatic bacteriuria [ASB]) and urinary catheter–days (UC-days) in months selected for surveillance. Data from all facilities were aggregated to calculate pooled mean annual SUTI and ASB rates (in events per 1,000 UC-days) by ICU type. Poisson regression was used to estimate percent changes in rates over time.

Overall, 36,282 SUTIs and 22,973 ASB episodes were reported from 367 facilities representing 1,223 adult ICUs, including combined medical/surgical (505), medical (212), surgical (224), coronary (173), and cardiothoracic (109) ICUs. All ICU types experienced significant declines of 19%–67% in SUTI rates and 29%–72% in ASB rates from 1990 through 2007. Between 2000 and 2007, significant reductions in SUTI rates occurred in all ICU types except cardiothoracic ICUs.

Since 1990, CAUTI rates have declined significantly in all major adult ICU types in facilities reporting to the CDC. Further efforts are needed to assess prevention strategies that might have led to these decreases and to implement new CAUTI prevention guidelines.

To develop and validate an electronic surveillance tool for catheter-associated urinary tract infections (CAUTIs).

Retrospective cohort study.

413-bed university-affiliated urban teaching hospital.

An electronic surveillance tool was developed for CAUTI and urinary catheter utilization based on the objective components of the National Healthcare Safety Network (NHSN) definitions including fever, urinalysis, and urine culture. Results were compared to manual chart review by an infection preventionist (IP).

During January and February 2010, 204 positive urine cultures (≥103 colony-forming units/mL) were identified in 136 patients with indwelling urinary catheters during their hospitalization. The electronic surveillance tool detected 60 CAUTI cases and 7,098 catheter-days, yielding a CAUTI incidence rate of 8.5 per 1,000 catheter-days. Urinary catheter utilization ratios (Foley-days/patient-days) were: acute care units, 0.27 (3,637 of 13,229); intensive care units, 0.77 (3,461 of 4,469); and overall, 0.40 (7,098 of 17,698). In comparison, the IP identified 59 cases by manual review with a sensitivity of 51 of 59 (86.4%), specificity 136 of 145 (93.8%), and negative predictive value of 136 of 144 (94.4%). Fever was present in 54 of 59 (91.5%) of CAUTI cases identified manually, while subjective criteria were documented in only 6 of 59 (10.2%) infections. Agreement between the electronic surveillance and manual IP review was assessed as very good (k, 0.80; 95% confidence interval, 0.71–0.89).

We report an attempt at automating surveillance for CAUTI. With a high negative predictive value, the electronic tool allows for more efficient CAUTI surveillance and facilitates housewide trending of rates and catheter utilization. This approach should be validated in different patient populations.

To determine the prevalence of health care-associated infection (HAI) in older people in acute care hospitals, detailing the specific types of HAI and specialties in which these are most prevalent.

Secondary analysis of the Scottish National Healthcare Associated Infection Prevalence Survey data set.

All inpatients in acute care (n = 11,090) in all acute care hospitals in Scotland (n = 45).

The study found a linear relationship between prevalence of HAI and increasing age (P<.0001) in hospital inpatients in Scotland. Urinary tract infections and gastrointestinal infections represented the largest burden of HAI in the 75–84- and over-85-year age groups, and surgical-site infections represented the largest burden in inpatients under 75 years of age. The prevalence of urinary catheterization was higher in each of the over-65 age groups (P<.0001). Importantly, this study reveals that a high prevalence of HAI in inpatients over the age of 65 years is found across a range of specialties within acute hospital care. An increased prevalence of HAI was observed in medical, orthopedic, and surgical specialties.

HAI is an important outcome indicator of acute inpatient hospital care, and our analysis demonstrates that HAI prevalence increases linearly with increasing age (P<.0001). Focusing interventions on preventing urinary tract infection and gastrointestinal infections would have the biggest public health benefit. To ensure patient safety, the importance of age as a risk factor for HAI cannot be overemphasized to those working in all areas of acute care.

To develop a method for selecting health care–associated infection (HAI) measures for public reporting.

HAIs are common, serious, and costly adverse outcomes of medical care that affect 2 million people in the United States annually. Thirty-seven states have introduced or passed legislation requiring public reporting of HAI measures. State legislation varies widely regarding which HAIs to report, how the data are collected and reported, and public availability of results.

The Maryland Health Care Commission developed an HAI Technical Advisory Committee (TAC) that consisted of a group of experts in the field of healthcare epidemiology, infection prevention and control (IPC), and public health. This group reviewed public reporting systems in other states, surveyed Maryland hospitals to determine the current state of IPC programs, performed a literature review on HAI measures, and developed six criteria for ranking the measures: impact, unprovability, inclusiveness, frequency, functionality, and feasibility. The committee and experts in the field then ranked each of 18 proposed HAI measures. A composite score was determined for each measure.

Among outcome measures, the rate of central line–associated bloodstream infections ranked highest, followed by the rate of post–coronary artery bypass grafting surgical-site infections. Among process measures, perioperative antimicrobial prophylaxis, compliance with central-line bundles, compliance with hand hygiene, and healthcare-worker influenza vaccination ranked highest.

Our qualitative criteria facilitated consensus on the HAI TAC and provided a useful framework for public reporting of HAI measures. Validation will be important for such approaches to be supported by the scientific community.

To evaluate whether longitudinal insurer claims data allow reliable identification of elevated hospital surgical site infection (SSI) rates.

We conducted a retrospective cohort study of Medicare beneficiaries who underwent coronary artery bypass grafting (CABG) in US hospitals performing at least 80 procedures in 2005. Hospitals were assigned to deciles by using case mix–adjusted probabilities of having an SSI-related inpatient or outpatient claim code within 60 days of surgery. We then reviewed medical records of randomly selected patients to assess whether chart-confirmed SSI risk was higher in hospitals in the worst deciles compared with the best deciles.

Fee-for-service Medicare beneficiaries who underwent CABG in these hospitals in 2005.

We evaluated 114,673 patients who underwent CABG in 671 hospitals. In the best decile, 7.8% (958/12,307) of patients had an SSI-related code, compared with 24.8% (2,747/11,068) in the worst decile (P<.001). Medical record review confirmed SSI in 40% (388/980) of those with SSI-related codes. In the best decile, the chart-confirmed annual SSI rate was 3.2%, compared with 9.4% in the worst decile, with an adjusted odds ratio of SSI of 2.7 (confidence interval, 2.2–3.3; P<.001) for CABG performed in a worst-decile hospital compared with a best-decile hospital.

Claims data can identify groups of hospitals with unusually high or low post-CABG SSI rates. Assessment of claims is more reproducible and efficient than current surveillance methods. This example of secondary use of routinely recorded electronic health information to assess quality of care can identify hospitals that may benefit from prevention programs.

Electronic measures of surgical site infections (SSIs) are being used more frequently in place of labor-intensive measures. This study compares performance characteristics of 2 electronic measures of SSIs with a clinical measure and studies the implications of using electronic measures to estimate risk factors and costs of SSIs among surgery patients.

Data included 1,066 general and vascular surgery patients at a single academic center between 2007 and 2008. Clinical data were from the National Surgical Quality Improvement Program (NSQIP) database, which includes a nurse-derived measure of SSI. We compared the NSQIP SSI measure with 2 electronic measures of SSI: MedMined Nosocomial Infection Marker (NIM) and International Classification of Diseases, Ninth Revision (ICD-9) coding for SSIs. We compared infection rates for each measure, estimated sensitivity and specificity of electronic measures, compared effects of SSI measures on risk factors for mortality using logistic regression, and compared estimated costs of SSIs for measures using linear regression.

SSIs were observed in 8.8% of patients according to the NSQIP definition, 2.6% of patients according to the NIM definition, and 5.8% according to the ICD-9 definition. Logistic regression for each SSI measure revealed large differences in estimated risk factors. NIM and ICD-9 measures overestimated the cost of SSIs by 134% and 33%, respectively.

Caution should be taken when relying on electronic measures for SSI surveillance and when estimating risk and costs attributable to SSIs. Electronic measures are convenient, but in this data set they did not correlate well with a clinical measure of infection.

To determine whether preoperative nasal methicillin-resistant Staphylococcus aureus (MRSA) carriage is a significant predictor of postoperative infections, after accounting for surgical infection risk and surgical prophylaxis.

Retrospective cohort study.

Veterans Affairs (VA) Boston patients who had nasal MRSA polymerase chain reaction screening performed in the 31 days before clean or clean contaminated surgery in 2008–2009.

Postoperative MRSA clinical cultures and infections, total surgical site infections (SSIs), and surgical prophylaxis data were abstracted from administrative databases. MRSA infections were confirmed via chart review. Multivariate analysis of risk factors for each outcome was conducted using Poisson regression. SSI risk index was calculated for a subset of 1,551 patients assessed by the VA National Surgical Quality Improvement Program.

Among 4,238 eligible patients, 279 (6.6%) were positive for preoperative nasal MRSA. Postoperative MRSA clinical cultures and infections, including MRSA SSIs, were each significantly increased in patients with preoperative nasal MRSA. After adjustment for surgery type, vancomycin prophylaxis, chlorhexidine/alcohol surgical skin preparation, and SSI risk index, preoperative nasal MRSA remained significantly associated with postoperative MRSA cultures (relative risk [RR], 8.81; 95% confidence interval [CI], 3.01–25.82) and infections (RR, 8.46; 95% CI, 1.70–42.04). Vancomycin prophylaxis was associated with an increased risk of total SSI in those negative for nasal MRSA (RR, 4.34; 95% CI, 2.19–8.57) but not in patients positive for nasal MRSA.

In our population, preoperative nasal MRSA colonization was independently associated with MRSA clinical cultures and infections in the postoperative period. Vancomycin prophylaxis increased the risk of total SSI in nasal MRSA-negative patients.

To conduct an exploratory study to evaluate the clinical effectiveness and cost benefit of universal versus targeted screening for methicillin-resistant Staphylococcus aureus (MRSA) to prevent hospital-acquired MRSA infections.

Prospective, interventional study, using a case-control design, difference-in-differences, and cost-benefit analyses.

Two community hospitals in Wisconsin.

Consecutive sample of 15,049 adult admissions from April 2009 to July 2010.

MRSA surveillance performed by polymerase chain reaction (PCR) on samples collected from all adult patients (aged over 18 years) within 30 days before or upon an admission to the hospital. During a 9-month baseline period, targeted screening was conducted at both hospitals. During the 5-month intervention period, all patients admitted to the intervention hospital were screened for MRSA. Infection control measures were consistent at both hospitals.

Universal screening was associated with an increase in admission screening of 43.58 percentage points (P<.01), an increase in MRSA detection of 2.95 percentage points (P<.01), and a small, nonsignificant decline in hospital-acquired MRSA infections of 0.12 percentage points (P = .34). The benefit-to-cost ratio was 0.50, indicating that for every dollar spent on universal versus targeted screening, only $0.50 is recovered in avoided costs of hospital-acquired MRSA infection.

Compared with targeted screening, universal screening increased the rate of detection of MRSA upon hospital admission but did not significantly reduce the rate of hospital-acquired MRSA infection. Universal screening was associated with higher costs of care and was not cost beneficial.

To determine the source of Burkholderia cepacia complex associated with a hospital outbreak and describe the measures taken to identify and confirm the source.

A 250-bed, tertiary care pediatric hospital in Denver, Colorado.

An epidemiologic investigation was used to identify possible causes for an apparent outbreak of B. cepacia complex in pediatric patients who had new positive cultures with this organism from December 2003 to February 2004. Chart review, microbiology reports, surgical records, site visits, literature review, staff interviews, and cultures of common products and equipment were performed to determine a source of contamination. Random amplified polymorphic DNA and pulsed-field gel electrophoresis typing, performed by 2 independent laboratories, were used for molecular typing of patient and source isolates.

Five pediatric patients had new positive B. cepacia complex cultures from either the sinus or the respiratory tract, and all 5 patients had prior exposure to 0.05% oxymetazoline hydrochloride Major Twice-A-Day 12-hour nasal spray (Proforma, Miami, FL). Four of the 5 patients had isolates that were identical to the B. cepacia complex isolates recovered from the unopened Twice-A-Day 12-hour nasal spray.

Intrinsic contamination of Major Twice-A-Day 12-hour nasal spray with B. cepacia complex resulted in nosocomial transmission to 4 patients at our facility and resulted in a voluntary product recall by the manufacturer. B. cepacia complex species are common contaminants of an increasing variety of nonsterile medical products. Enhanced culture techniques may be useful in evaluating possible product contamination, suggesting additional measures that should be considered to assure the safety of products that may be used in high-risk patients.