We developed a bedside instrument to predict carbapenem resistance in complicated urinary tract infections. A model assigning weighted points for admission from an extended care facility (1), history of weight loss (1), early mechanical ventilation (1), age <50 years (2), male gender (3), catheter-associated urinary tract infection (4), prior antibiotics treatment (4), and prior carbapenem-resistant infection (8) exhibited good discrimination (C statistic, 0.721).

We evaluated the impact of the Epic antimicrobial stewardship module (EAM) on the number of interventions, antimicrobial usage, and clinical outcomes. Use of the EAM allowed us to significantly increase the number of ASP antimicrobial reviews and interventions while maintaining a sustained impact on antimicrobial utilization.

We studied healthcare-associated and community-associated Clostridium difficile infection (CDI) in Jersey, Channel Islands (2008–2012). The Island’s stable population has reliable denominator data, a clearly defined at-risk population, and healthcare contact that is easily followed. The vast majority of CDI cases had had recent healthcare contact, and true community-associated disease is extremely rare.

Infect Control Hosp Epidemiol 2018;39:603–607

Mobile ultraviolet-C (UV-C) light room decontamination devices are frequently used as an adjunct to standard cleaning in healthcare facilities, but their efficacy in killing Candida species is not clear. In laboratory testing, the emerging multidrug-resistant Candida auris and 2 other Candida species were significantly less susceptible to killing by UV-C than methicillin-resistant Staphylococcus aureus.

Infect Control Hosp Epidemiol 2018;39:94–96

Rapid diagnostic technologies can assist Antimicrobial Stewardship Programs (ASPs) in achieving the goals of reducing unnecessary antimicrobial exposure and optimizing patient care. The Society of Infectious Diseases Pharmacists supports all members of the ASP team as essential components of optimal use of these technologies for management of antibiotic prescribing and cost-reduction strategies.

Infect Control Hosp Epidemiol 2018;39:473–475

In 2017, we surveyed 101 SHEA Research Network hospitals regarding Legionnaires’ disease (LD). Of 29 respondents, 94% have or are developing a water management plan with varying characteristics and personnel engaged. Most LD diagnostic testing is limited to urine antigen testing. Many opportunities to improve LD prevention and diagnosis exist.

Infection preventionists at Minnesota hospitals were surveyed to determine whether they had Legionella water management plans. Of 137 hospitals, 84 (61%) responded. Among them, 27% hospitals had a water management plan, 21% regularly sampled for Legionella, and 51% had knowledge of ASHRAE Legionella prevention standards. Significant changes are needed to protect patients from nosocomial infection.

Infect Control Hosp Epidemiol 2018;39:336–338

Traditional antibiograms can guide empiric antibiotic therapy, but they may miss differences in resistance across patient subpopulations. In this retrospective descriptive study, we constructed and validated antibiograms using International Classification of Disease, Tenth Revision (ICD-10) codes and other discrete data elements to define a cohort of previously healthy children with urinary tract infections. Our results demonstrate increased antibiotic susceptibility. This methodology may be modified to create other syndrome-specific antibiograms.

From 2000 to 2009, rates of multidrug-resistant Acinetobacter baumanii increased 10-fold to 0.2 per 1,000 patient days. From 2010 to 2015, however, rates markedly declined and have stayed below 0.05 per 1,000 patient days. Herein, we present a 15-year trend analysis and discuss interventions that may have led to the decline.

Infect Control Hosp Epidemiol 2018;39:608–611

We assessed various locations and frequency of environmental sampling to maximize information and maintain efficiency when sampling for Acinetobacter baumannii. Although sampling sites in closer proximity to the patient were more likely positive, to fully capture environmental contamination, we found value in sampling all sites and across multiple days.

Infect Control Hosp Epidemiol 2018;39:339–342

In a cohort of inpatients with hematologic malignancy and positive enzyme immunoassay (EIA) or polymerase chain reaction (PCR) Clostridium difficile tests, we found that clinical characteristics and outcomes were similar between these groups. The method of testing is unlikely to predict infection in this population, and PCR-positive results should be treated with concern.

Infect Control Hosp Epidemiol 2018;863–866

Of 500 hospital-onset Staphylococcus aureus bacteremia events (58% methicillin-susceptible S. aureus [MSSA]; 42% methicillin-resistant S. aureus [MRSA]), we found no significant differences in S. aureus bacteremia rates between medium-sized and large hospitals. However, the proportion of S. aureus bacteremia caused by MSSA was greater in medium-sized hospitals and did not correlate with MRSA bacteremia.

Infect Control Hosp Epidemiol 2018;39:476–478

Based on a surgical site infection (SSI) cohort at an academic center, we showed a median potentially preventable loss per non-SSI case of $17,916 in colon surgery and of $34,741 in coronary artery bypass grafting.

We evaluated the rate of central venous catheter (CVC) removal in 283 cancer patients with bloodstream infections (BSIs). Removal of CVCs occurred unnecessarily in 57% of patients with non-central-line-associated BSI (non-CLABSI), which was equivalent to the rate of CVC removal in patients with CLABSIs. Physician education and safe interventions to salvage the vascular access are warranted.

Infect Control Hosp Epidemiol 2018;39:222–225

We compared the etiologic organisms of bloodstream infections (BSIs) in cancer patients with central venous catheters (CVCs) between 2 cohorts separated by more than a decade.

Gram-negative organisms have become the predominant etiologic organisms of BSIs (52%); they now contribute to 41% of catheter-related BSIs (CRBSIs).

Infect Control Hosp Epidemiol 2018;39:727–729

We analyzed clinical microbiology laboratory practices for detection of multidrug-resistant Enterobacteriaceae in US short-stay acute-care hospitals using data from the National Healthcare Safety Network (NHSN) Annual Facility Survey. Half of hospitals reported testing for carbapenemases, and 1% performed routine polymyxin susceptibility testing using reference broth microdilution.

In this multicenter observational study, medical and surgical inpatient rooms were randomized to receive 1 hour of continuous direct observation to determine hand hygiene opportunities (HHOs). After multivariable adjustment, HHOs were similar across inpatient units and hospitals. This estimate could serve to calibrate electronic hand hygiene monitoring systems for Canadian medical and surgical units.

Understanding provider perceptions of antimicrobial use (AU) feedback is important for optimal implementation. A survey addressing AU attribution scenarios, feedback methods, and implementation barriers was distributed to inpatient providers. As AU scenarios became more complex, disagreement regarding AU attribution arose. All providers were highly concerned about barriers to AU reporting.

In a randomized trial, a gown designed to allow easy removal at the neck and with increased skin coverage and snugness of fit at the wrist significantly reduced contamination of personnel during personal protective equipment (PPE) removal. Our results suggest that simple modifications of PPE can reduce contamination of personnel.

Infect Control Hosp Epidemiol 2018;39:97–100