To evaluate the risk of phlebitis associated with chlorhexidine-coated polyurethane catheters in peripheral veins.

A randomized, double-blinded trial comparing chlorhexidine-coated polyurethane catheters with uncoated polyurethane catheters.

A university hospital.

Adult medicine and surgery patients.

Certified registered nurse anesthetists or an infusion team consisting of nurses and physicians inserted the catheters. Catheter insertion sites were scored twice daily for evidence of phlebitis. At the time catheters were removed, a quantitative blood culture was performed, and catheters were sonicated for quantitative culture.

Of 221 evaluable catheters, phlebitis developed in 18 (17%) of 105 coated catheters, compared to 27 (23%) of 116 uncoated catheters (relative risk [RR], 0.74; 95% confidence interval [CI95], 0.43-1.26; P=.32). By survival analysis, chlorhexidine-coated catheters had a lower risk of phlebitis during the first 3 days (P=.06), but not when all catheters were considered in both patient groups (P=.31). In the absence of catheter colonization, the incidence of phlebitis was 21% (16/76) and 24% (20/86) for coated and uncoated catheters, respectively (P=.85), whereas in the presence of catheter colonization, the incidence of phlebitis was 14% (1/7) and 80% (4/5) for coated and uncoated catheters, respectively (RR, 0.18; CI95, 0.03-1.15; P=.07).

The risk of phlebitis in the presence of catheter colonization was 82% lower for chlorhexidinecoated polyurethane catheters compared to otherwise identical uncoated catheters.

Detection of colonized patients is important for implementing control measures for methicillin-resistant Staphylococcus aureus (MRSA). Laboratory detection of MRSA carriers is increased by the use of selective screening media, helping control dissemination of such organisms.

To evaluate three different media, including selective and nonselective media, in the detection of MRSA from clinical specimens of patients of an intensive care unit (ICU).

Adult patients in the ICU of the Hospital Mae de Deus, Porto Alegre, Brazil.

A total of 224 specimens were obtained from the nares of patients and plated on blood agar, mannitol sait agar containing 2 μg/mL of oxacillin (MSAO), and oxacillin resistance screening agar base (ORSAB). The presence of MRSA was investigated in typical colonies growing on the three types of media. Discrepant results were resolved by detection of the mecA gene by polymerase chain reaction and the modified penicillin binding protein known as PBP2'.

MRSA was detected in 32 (14.3%) of 224 specimens. Blood agar, MSAO, and ORSAB detected MRSA in 17, 31, and 28 specimens, respectively. After the coagulase test, no false resistance was observed.

MSAO and ORSAB performed equivalently in the detection of MRSA of colonized patients and require a single supplementary test (coagulase) to confirm MRSA.

Antibiotic time-outs (ATOs) have been advocated to improve antibiotic use without dedicated stewardship resources, but their utility is poorly defined. We sought to evaluate the effectiveness of an ATO led by a team-based pharmacist.

Cluster randomized controlled trial.

Six medicine teams at an academic medical facility.

Inpatients who received antibiotics and were cared for by a medicine team.

In phase A (2 months) pharmacist-led ATOs were implemented on 3 medicine teams (ATO-A) while 3 teams maintained usual care (UC-A). In phase B (2 months), ATOs were continued in the ATO group (ATO-B) and ATOs were initiated in the UC group (UC ATO-B). We targeted 2 ATO points: early (<72 hours after antibiotics were initiated) and late (after the early period but ≤5 days after antibiotic initiation).

In total, 290 ATOs were documented (181 early, 87 late, and 22 subsequent) among 538 admissions. The most common ATO recommendations were narrow therapy (148 of 290), no change (124 of 290), and change to oral (30 of 290). ATO initiation was lower in the UC ATO-B group than in either ATO group (21.8% UC ATO-B vs 69.2% ATO-A and -B). Overall antibiotic use was not different between the groups (P = .51), although intravenous (IV) levofloxacin use decreased in the UC group after ATO implementation (49 DOT/1,000 PD vs 20 DOT/1,000 PD; P = .022). The ratio of oral (PO) to intravenous (IV) DOT was lower in the UC group than in any of the ATO groups (P = .032). We detected no differences in mortality, length of stay, readmission, C. difficile infection, or antibiotic adverse events.

Implementation of a pharmacist-led ATO was feasible and well accepted but did not change overall antibiotic use. An ATO may promote increased use of oral antibiotics, but more effective strategies for self-stewardship are needed.

We performed a return-on-investment analysis comparing the investment in surgical site infection (SSI) prevention programs in a hospital setting to the savings from averted SSI cases.

A retrospective case costing study using aggregated patient data to determine the incidence and costs of SSI infection in surgical departments over time. We calculated return on investment to the hospital and conducted several sensitivity and scenario analyses.

Data were compiled for the Ottawa Hospital (TOH), a Canadian tertiary-care teaching institution.

We used aggregated records for all hospital patients who underwent surgical procedures between April 2010 and January 2015.

We estimated the potential cost savings of the hospital’s surgical quality improvement program, namely the Surgeons National Surgical Quality Improvement Program (NSQIP) and the Comprehensive Unit-based Safety Program (CUSP).

From 2010 to 2016, TOH invested C$826,882 (US$624,384) in surgical quality improvement programs targeting SSI incidence and accrued C$1,885,110 (US$1,423,460) in cumulative savings from averted SSI cases, generating a return of $2.28 (US$3.02) per dollar invested (95% confidence interval [CI], −0.67 to 7.37). The study findings are sensitive to the estimated cost to the hospital per SSI case and the rate reduction attributable to the prevention program.

The NSQIP and CUSP have produced a positive return on investment at TOH; however, the result rests on several assumptions. This positive return on investment is expected to continue if the hospital can continue to reduce SSI incidence at least 0.25% annually without new investments. Findings from this study highlight the need for continuous program evaluation of the quality improvement initiatives.