After identifying a temporal cluster of urinary tract infections in patients who had undergone urodynamic procedures, we examined the techniques within the urodynamic laboratory and retrospectively reviewed charts of all 155 patients tested in the previous six months. The rate of acquired urinary tract infections was 18.7%. Risk factors for infection included undergoing cystometrograms and being subject to the first procedure performed in a day. Technical errors in the performance of the urodynamic studies included failure to completely disassemble the apparatus upon completion of a procedure, failure to use sterile components, and lapses in aseptic technique. Bacteria implicated in the outbreak were isolated from tubing, transducers, and flush solutions. After the institution of appropriate technique, all patients tested in the subsequent six months were followed. The rate of acquired urinary tract infection dropped to 5%. Urodynamic apparatus should be completely disassembled following the completion of a procedure; reassembly using sterile components should occur immediately prior to the next procedure; aseptic technique should be maintained; and patients should undergo routine urine screening before a procedure. Surveillance of urodynamic procedures may reveal correctable flaws in technique.

The laboratory plays a major role in the epidemiology program's efforts to minimize nosocomial infections in healthcare institutions. This article will describe some of the interactions between the laboratory and the epidemiology program, and will identify resources and procedures that the laboratory needs to achieve epidemiologic goals.

A cluster of serious Escherichia coli infections was identified among patients in a neonatal intensive-care unit. Infection control staff identified the outbreak because they realized that E coli rarely caused infections in this unit. Pulsed-field gel electrophoresis confirmed that one strain of E coli was transmitted among patients.

A total of 108 cases of candidemia detected in 3 tertiary care university hospitals in Hawaii between January 2001 and December 2002 were retrospectively reviewed. Candida albicans, Candida glabrata, and Candida tropicalis accounted for 28% of the cases. Mortality among Filipino patients was significantly higher than that among other ethnic groups (71% vs 48%; P<.05).

Afternoon aortic valve replacement surgery may provide perioperative myocardial protection and improve patient outcomes compared with morning surgery. The results of our large observational study based on Swiss cardiac surgical site infection surveillance data suggest that the current evidence is insufficient to generally promote afternoon cardiac surgeries.

Control charts are essential tools in the statistical process control armamentarium. Although designed for ease of use in highly structured production settings, they are in fact quite complex in nature; their proper use depends on numerous conditions that may not be clear to newer users. This article briefly contrasts the use of control charts in production and healthcare settings and highlights common sources of problems among novice users. These include misunderstandings of the type of data being charted, non-independence of samples, the influence of natural cycles, ignoring known special influences, overlooking clear signals that a process is out of control, and calculating control limits before adequate data are available.

We correlated antibiotic consumption measured by point prevalence survey with defined daily doses (DDD) across multiple hospitals. Point prevalence survey had a higher correlation (1) with monthly DDDs than annual DDDs, (2) in nonsurgical versus surgical wards, and (3) on high- versus low-utilization wards. Findings may be hospital specific due to hospital differences.

Wound contamination with endogenous bacterial scalp flora plays an important role in the pathogenesis of postoperative neurosurgical infections. To assess the effect of preoperative antiseptic shampoos on the emergence of resident scalp flora during surgery and subsequent wound contamination, we randomized 151 neurosurgical procedures into four study groups: group A—preoperative shampoos with chlorhexidine, surgical scalp preparation with chlorhexidine; group B-no shampoos, surgical preparation with chlorhexidine; group C-shampoos with iodophor, surgical preparation with iodophor; group D-no shampoos, surgical preparation with iodophor. Quantitative cultures of the scalp were obtained preoperatively and at the end of surgery, and qualitative wound cultures were taken prior to wound closure. Group A had the lowest concentration of bacteria on the scalp both preoperatively and postoperatively (median range = 30 [0-5.7 × 105] and 0 [0-2.5 x 103] respectively). Group A also had significantly fewer positive postoperative scalp cultures (29%) than groups B (51%), C (58%), and D (53%) (P<0.05), as well as fewer positive wound cultures (20% v 25%, 42%, and 30% respectively). A density of bacteria on the scalp of > 102/4cm2 best predicted the presence of bacteria in the wound. Repeated preoperative shampoos with chlorhexidine reduce intraoperative emergence of resident skin flora and subsequent contamination of the wound.

We investigated the frequency and determinants of guideline-discordant antibiotic prescribing in outpatients with respiratory infections or cystitis. Antibiotic prescribing was guideline discordant in 60% of patients. The most common reason for discordance was prescribing an antibiotic when not indicated. In a multivariate analysis, physicians in training had the highest likelihood of guideline-concordant antibiotic prescribing.

Infect Control Hosp Epidemiol 2017;38:724–728

In a multicenter surveillance of intensive care unit (ICU)–acquired infections, adjusted ventilator-associated pneumonia (VAP) incidence diminished by −1.0% per year (95% confidence interval [CI], −1.8 to −0.2; P = .02) in ICUs with continuous surveillance but increased by +16.1% (95% CI, 0.5%–34.1%; P = .04) in the year following surveillance disruption, suggesting a preventive effect of surveillance on VAP.

Infect Control Hosp Epidemiol 2014;35(10):1290–1293

Most recent infection outbreaks caused by unsafe injection practices in the United States have occurred in ambulatory settings. We utilized direct observation and a survey to assess injection practices at 31 clinics. Improper vial use was observed at 13 clinics (41.9%). Pharmacy support and healthcare worker education may improve injection practices.

Infect Control Hosp Epidemiol 2017;38:614–616