To characterize antifungal stewardship among antimicrobial stewardship programs (ASPs) at a diverse range of hospitals and to correlate antifungal stewardship with hospital characteristics.

Cross-sectional survey.

ASP physician and/or pharmacist members at Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) hospitals.

An electronic survey administered August–September 2018 via the SRN to 111 hospitals. The χ2 test was used to test associations between ASP and hospital characteristics and use of antifungal stewardship strategies.

Of 111 hospitals, 45 (41%) responded; most were academic medical centers (65%) caring for stem-cell patients (73.3%) and solid-organ transplant patients (80.0%). Most hospitals have large, well-established ASPs: 60% had >5 team members and 68.9% had a duration ≥6 years. In 43 hospitals (95.6%), ASPs used antifungal stewardship strategies, most commonly prospective audit and feedback (73.3%) by a pharmacist (71.4%). Half of ASPs (51.1%) created guidelines for invasive fungal infection (IFI) management. Most hospitals (71.1%) offered rapid laboratory tests to diagnose IFI, but polymerase chain reaction (PCR) testing and antifungal susceptibility testing varied. Also, 29 ASPs (64.4%) perform surveillance of antifungal utilization, but only 9 (31%) reported to the CDC National Healthcare Safety Network. ASP size, duration, and presence of transplant populations were not associated with a higher likelihood of using antifungal stewardship strategies (P > .05 for all).

The use of antifungal stewardship strategies was high at SRN hospitals, but they mainly involved audit and feedback. ASPs should be encouraged (1) to disseminate guidelines for IFI management, (2) to promote access to laboratory tests for rapid and accurate IFI diagnosis, and (3) to perform surveillance for antifungal utilization with reporting to the CDC.

To evaluate trends in racial and ethnic disparities in weekly cumulative rates of coronavirus disease 2019 (COVID-19) cases and deaths in Connecticut nursing homes.

Longitudinal analysis of nursing-home COVID-19 reports and other databases. Multivariable negative binomial models were used to estimate disparities in COVID-19 incidence and fatality rates across nursing-home groups with varying proportions of racial and ethnic minority residents, defined as low-, medium-, medium-high-, and high-proportion groups. Trends in such disparities were estimated from week 1 (April 13) to week 10 (ending on June 19, 2020).

The study was conducted across 211 nursing homes.

The average number of cases ranged from 6.1 cases per facility for the low-proportion group to 11.7 cases per facility for the high-proportion group in week 1, and from 26.7 to 58.5 cases per facility in week 10. Compared to the low-proportion group, the adjusted incidence rate ratios (IRRs) for the high-proportion group were 1.18 (95% confidence interval [CI], 0.77–1.80; P > .10) in week 1 and 1.54 (95% CI, 1.05–2.25; P < .05) in week 10, showing a 30% (95% CI, 5%–62%) relative increase (P < .05). The average weekly number of COVID-19–related deaths ranged from 0 to 0.3 deaths per facility for different groups in week 1, and from 7.6 to 13.3 deaths per facility in week 10. Adjusted disparities in fatalities similarly increased over time.

Connecticut nursing homes caring for predominately racial and ethnic minority residents tended to have higher COVID-19 incidence and fatality rates. These across-facility disparities increased during the early periods of the pandemic.

To develop and validate a methodology for electronic surveillance of catheter-associated urinary tract infections (CAUTIs).

Diagnostic accuracy study.

A 425-bed university hospital.

A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI.

An algorithm was developed to identify incident CAUTIs from electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) surveillance definition. CAUTIs identified by electronic surveillance were compared with the reference standard of manual surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated.

Electronic surveillance identified 64 CAUTIs compared with manual surveillance, which identified 19 CAUTIs for 97% agreement, 79% sensitivity, 97% sensitivity, 23% PPV, 100% NPV, and κ of .33. Compared with the reference standard adjusted for misclassification, which identified 55 CAUTIs, electronic surveillance had 98% agreement, 80% sensitivity, 99% specificity, 69% PPV, 99% NPV, and κ of .71.

The electronic surveillance methodology had a high NPV and a low PPV compared with the reference standard, indicating a role of the electronic algorithm in screening data sets to exclude cases. However, the PPV markedly improved compared with the reference standard adjusted for misclassification, suggesting a future role in surveillance with improvements in EHRs.

Infect Control Hosp Epidemiol 2014;35(6):685–691

Endoscope-associated infections are reported despite following proper reprocessing methods. Microbiological testing can confirm the adequacy of endoscope reprocessing. Multiple controversies related to the method and interpretation of microbiological testing cultures have arisen that make their routine performance a complex target.

We conducted a pilot study using disposable bronchoscopes (DBs) to simulate different reprocessing times and soaking times and to compare high-level disinfection versus ethylene oxide sterilization. We also reviewed the time to reprocessing and duration of the procedures.

Bronchoscopes were chosen because an alternative disposable scope is commercially available and because bronchoscopes are more prone to delays in processing. Disposable bronchoscopes were contaminated using a liquid bacterial suspension and were then incubated for 1–4 hours. Standard processing and high-level disinfection were performed on 36 endoscopes. Ethylene oxide sterilization was performed on 21 endoscopes. Endoscope cultures were performed using the standard “brush, flush, brush” technique.

After brushing was performed, a final water-flush culture procedure was the most effective method of detecting bacterial persistence on the disposable scopes. Klebsiella pneumoniae was the most commonly recovered organism after reprocessing. Ethylene oxide sterilization did not result in total elimination of viable bacteria.

Routine endoscopy cultures may be required to assess the adequacy of endoscopic processing.

Infect Control Hosp Epidemiol 2017;38:136–142

To evaluate the reliability and validity of a standardized measure of healthcare personnel (HCP) influenza vaccination.

Acute care hospitals, long-term care facilities, ambulatory surgery centers, physician practices, and dialysis centers from 3 US jurisdictions.

Staff from 96 healthcare facilities randomly sampled from 234 facilities that completed pilot testing to assess the feasibility of the measure.

Reliability was assessed by comparing agreement between facility staff and project staff on the classification of HCP numerator (vaccinated at facility, vaccinated elsewhere, contraindicated, declined) and denominator (employees, credentialed nonemployees, other nonemployees) categories. To assess validity, facility staff completed a series of case studies to evaluate how closely classification of HCP groups aligned with the measure's specifications. In a modified Delphi process, experts rated face validity of the proposed measure elements on a Likert-type scale.

Percent agreement was high for HCP vaccinated at the facility (99%) and elsewhere (95%) and was lower for HCP who declined vaccination (64%) or were medically contraindicated (64%). While agreement was high (more than 90%) for all denominator categories, many facilities' staff excluded nonemployees for whom numerator and denominator status was difficult to determine. Validity was lowest for credentialed and other nonemployees.

The standardized measure of HCP influenza vaccination yields reproducible results for employees vaccinated at the facility and elsewhere. Adhering to true medical contraindications and tracking decimations should improve reliability. Difficulties in establishing denominators and determining vaccination status for credentialed and other nonemployees challenged the measure's validity and prompted revision to include a more limited group of nonemployees.

To investigate the infection control practices of general dentists in Ontario in 1994.

Confidential coded questionnaires were mailed to all general dental practitioners in Ontario (n=5,176), with three follow-up attempts. Data were analyzed using Pearson's chi-squared test and multiple logistic regression.

Offices of general dental practitioners in Ontario.

General dental practitioners actively involved in treating patients.

The response rate adjusted for nondelivery was 70%. A high proportion of respondents reported using gloves (always, 91.8%; sometimes, 7.8%), masks (always, 74.8%; sometimes, 21.1%), or protective eyewear (always, 83.6%; sometimes, 13%); heat sterilization of hand-pieces (83.9%); and hepatitis B (HBV) vaccination of dentists (92.3%). However, only 61.4% of respondents reported HBV vaccination of all clinical staff, and 87.7% used additional precautions for patients with human immunodeficiency virus (HIV). Significant predictors of the use of recommended infection control procedures (ie, always using gloves, masks, and eye protection; heat sterilization of handpieces; HBV vaccination for dentist and staff; and no extra precautions for patients with HIV) were age ?40 years (odds ratio [OR], 2.6), lack of concern regarding increased personal risk (OR, 2.0) or costs of infection control procedures (OR, 1.5), and knowledge of the low infectivity of HIV after a needlestick injury (OR, 2.0) and that infection control procedures for HBV are adequate for HIV (OR, 2.7).

Additional education is required to promote a more realistic perception of risk of HIV transmission in the dental office and the use of all recommended infection control practices, including Universal Precautions.