162 results on '"Talbot TR"'
Search Results
2. Systems initiatives reduce healthcare-associated infections: a study of 22,928 device days in a single trauma unit.
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Miller RS, Norris PR, Jenkins JM, Talbot TR 3rd, Starmer JM, Hutchison SA, Carr DS, Kleymeer CJ, and Morris JA Jr
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- 2010
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3. Providers' beliefs, attitudes, and behaviors before implementing a computerized pneumococcal vaccination reminder.
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Dexheimer JW, Jones I, Chen Q, Talbot TR, Mason D, and Aronsky D
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- 2006
4. Asthma as a risk factor for invasive pneumococcal disease.
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Talbot TR, Hartert TV, Mitchel E, Halasa NB, Arbogast PG, Poehling KA, Schaffner W, Craig AS, and Griffin MR
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- 2005
5. Community-associated methicillin-resistant Staphylococcus aureus: the way to the wound is through the nose.
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Creech CB 2nd, Talbot TR, and Schaffner W
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- 2006
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6. Consultations & comments. Any evidence of an asthma-pneumonia link?
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Talbot TR
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- 2006
7. Clinical consultation.
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Pletcher SD, Metson R, and Talbot TR
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- 2006
8. Healthcare-associated infections: your role in prevention.
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Creech CB, Schaffner W, and Talbot TR
- Abstract
Fighting nosocomial infections is the responsibility of every member of the hospital community, from administrators to visitors. As healthcare facilities struggle to stay one step ahead of resistant pathogens, the role of physicians is critical. Are you doing all you can? [ABSTRACT FROM AUTHOR]
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- 2007
9. Asthma and invasive pneumococcal disease.
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Kuschner WG, Kuschner RA, Talbot TR, Hartert TV, and Griffin MR
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- 2005
10. Rapid implementation of blood culture stewardship: institutional response to an acute national blood culture bottle shortage.
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Humphries RM, Wright PW, Banerjee R, Dulek DE, Champion JC, Gaston DC, and Talbot TR
- Abstract
We describe our approach to addressing a nation-wide supply issue for blood culture bottles. Aerobic blood culture bottles received from our distributor July 1-15, 2024 was <1% of typical usage. Through education and ordering restrictions blood culture designed to minimize risk, orders were reduced by 49% over a one-week period., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
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- 2024
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11. A multi-species outbreak of VIM-producing carbapenem-resistant bacteria in a burn unit and subsequent investigation of rapid development of cefiderocol resistance.
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Freiberg JA, Tao L, Manuel C, Mike LA, Nelson GE, Harris BD, Mathers AJ, Talbot TR, Skaar EP, and Humphries RM
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- Humans, Ceftazidime, Anti-Bacterial Agents pharmacology, beta-Lactamases genetics, beta-Lactamases metabolism, Klebsiella pneumoniae, Drug Combinations, Azabicyclo Compounds, Carbapenems pharmacology, Disease Outbreaks, Microbial Sensitivity Tests, Cefiderocol, Burn Units
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Carbapenem resistance due to metallo-β-lactamases (MBLs) such as the Verona integron-encoded metallo-β-lactamase (VIM) is particularly problematic due to the limited treatment options. We describe a case series of bacterial infections in a tertiary care hospital due to multi-species acquisition of a VIM gene along with our experience using novel β-lactam antibiotics and antibiotic combinations to treat these infections. Four patients were treated with the combination of ceftazidime-avibactam and aztreonam, with no resistance to the combination detected. However, cefiderocol-resistant Klebsiella pneumoniae isolates were detected in two out of the five patients who received cefiderocol within 3 weeks of having started the antibiotic. Strain pairs of sequential susceptible and resistant isolates from both patients were analyzed using whole-genome sequencing. This analysis revealed that the pairs of isolates independently acquired point mutations in both the cirA and fiu genes, which encode siderophore receptors. These point mutations were remade in a laboratory strain of K. pneumoniae and resulted in a significant increase in the MIC of cefiderocol, even in the absence of a beta-lactamase enzyme or a penicillin-binding protein 3 (PBP3) mutation. While newer β-lactam antibiotics remain an exciting addition to the antibiotic armamentarium, their use must be accompanied by diligent monitoring for the rapid development of resistance., Competing Interests: T.R.T. is on the Board of Directors for OmniSolve R.M.H. has provided consulting for AbbVie E.P.S. is on the Scientific Advisory Board for Pfizer Vaccines
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- 2024
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12. Decolonization Strategies to Prevent Staphylococcal Infections: Mupirocin by a Nose.
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Talbot TR
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- Humans, Chlorhexidine therapeutic use, Nose drug effects, Nose microbiology, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Methicillin-Resistant Staphylococcus aureus drug effects, Methicillin-Resistant Staphylococcus aureus isolation & purification, Mupirocin administration & dosage, Mupirocin therapeutic use, Staphylococcal Infections drug therapy, Staphylococcal Infections microbiology, Staphylococcal Infections prevention & control
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- 2023
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13. Traditional definition of healthcare-associated influenza underestimates cases associated with other healthcare exposures in a population-based surveillance system.
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Gettler EB, Talbot HK, Zhu Y, Ndi D, Mitchel E, Markus TM, Schaffner W, Harris B, and Talbot TR
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- Humans, Cross-Sectional Studies, Retrospective Studies, Hospitalization, Population Surveillance, Influenza, Human diagnosis, Influenza, Human epidemiology, Influenza, Human complications
- Abstract
Objective: To provide comprehensive population-level estimates of the burden of healthcare-associated influenza., Design: Retrospective cross-sectional study., Setting: US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2012-2013 through 2018-2019 influenza seasons., Patients: Laboratory-confirmed influenza-related hospitalizations in an 8-county catchment area in Tennessee., Methods: The incidence of healthcare-associated influenza was determined using the traditional definition (ie, positive influenza test after hospital day 3) in addition to often underrecognized cases associated with recent post-acute care facility admission or a recent acute care hospitalization for a noninfluenza illness in the preceding 7 days., Results: Among the 5,904 laboratory-confirmed influenza-related hospitalizations, 147 (2.5%) had traditionally defined healthcare-associated influenza. When we included patients with a positive influenza test obtained in the first 3 days of hospitalization and who were either transferred to the hospital directly from a post-acute care facility or who were recently discharged from an acute care facility for a noninfluenza illness in the preceding 7 days, we identified an additional 1,031 cases (17.5% of all influenza-related hospitalizations)., Conclusions: Including influenza cases associated with preadmission healthcare exposures with traditionally defined cases resulted in an 8-fold higher incidence of healthcare-associated influenza. These results emphasize the importance of capturing other healthcare exposures that may serve as the initial site of viral transmission to provide more comprehensive estimates of the burden of healthcare-associated influenza and to inform improved infection prevention strategies.
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- 2023
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14. Rhizobium radiobacter pseudo-outbreak linked to tissue-processing contamination.
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Stern RA, Byrge KC, and Talbot TR
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A cluster of Rhizobium radiobacter isolates isolated from six unique surgical tissue cultures prompted an investigation ultimately identifying a pseudo-outbreak linked to errant laboratory tissue processing with contaminated, nonsterile saline. Timely response and multidisciplinary collaboration led to tangible system-level interventions and avoidance of unnecessary antibiotic exposures., Competing Interests: Dr. Stern and Dr. Byrge have no conflicts of interest to disclose. Dr. Talbot serves on the Board of Directors for OmniSolve., (© The Author(s) 2023.)
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- 2023
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15. Identifying barriers to compliance with a universal inpatient protocol for Staphylococcus aureus nasal decolonization with povidone-iodine.
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Stern RA, Harris BD, DeVault M, and Talbot TR
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- Humans, Povidone-Iodine therapeutic use, Staphylococcus aureus, Inpatients, Nose, Anti-Bacterial Agents, Mupirocin, Carrier State, Staphylococcal Infections drug therapy, Staphylococcal Infections prevention & control, Methicillin-Resistant Staphylococcus aureus
- Abstract
Academic hospital nurses were surveyed to assess adherence barriers to a universal povidone-iodine nasal decolonization protocol to prevent Staphylococcus aureus infection. Low training rates, inadequate supplies, documentation and tracking challenges, patient refusal, and burnout contributed to suboptimal adherence. Prioritizing education is essential but alone is insufficient for successful protocol adoption.
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- 2023
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16. Asymptomatic screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) as an infection prevention measure in healthcare facilities: Challenges and considerations.
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Talbot TR, Hayden MK, Yokoe DS, Malani AN, Amer HA, Kalu IC, Logan LK, Moehring RW, Munoz-Price S, Palmore TN, Weber DJ, and Wright SB
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- Humans, Respiratory Aerosols and Droplets, Health Facilities, Infection Control methods, SARS-CoV-2, COVID-19 diagnosis, COVID-19 prevention & control
- Abstract
Testing of asymptomatic patients for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (ie, "asymptomatic screening) to attempt to reduce the risk of nosocomial transmission has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls. In addition, the logistic challenges and costs related to screening program implementation, data noting the lack of substantial aerosol generation with elective controlled intubation, extubation, and other procedures, and the adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention. Consequently, the Society for Healthcare Epidemiology of America (SHEA) recommends against routine universal use of asymptomatic screening for SARS-CoV-2 in healthcare facilities. Specifically, preprocedure asymptomatic screening is unlikely to provide incremental benefit in preventing SARS-CoV-2 transmission in the procedural and perioperative environment when other infection prevention strategies are in place, and it should not be considered a requirement for all patients. Admission screening may be beneficial during times of increased virus transmission in some settings where other layers of controls are limited (eg, behavioral health, congregate care, or shared patient rooms), but widespread routine use of admission asymptomatic screening is not recommended over strengthening other infection prevention controls. In this commentary, we outline the challenges surrounding the use of asymptomatic screening, including logistics and costs of implementing a screening program, and adverse patient and facility consequences. We review data pertaining to the lack of substantial aerosol generation during elective controlled intubation, extubation, and other procedures, and we provide guidance for when asymptomatic screening for SARS-CoV-2 may be considered in a limited scope.
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- 2023
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17. Universal admission laboratory screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) asymptomatic infection across a large health system.
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Cihlar JL, Harris BD, Wright PW, Humphries RM, Taylor CK, Cherry BR, and Talbot TR
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- Humans, SARS-CoV-2, Asymptomatic Infections epidemiology, COVID-19 Testing, Hospitalization, COVID-19 diagnosis, COVID-19 epidemiology
- Abstract
Background: Admission laboratory screening for asymptomatic coronavirus disease 2019 (COVID-19) has been utilized to mitigate healthcare-associated severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission. An understanding of the impact of such testing across a variety of patient populations is needed., Methods: SARS-CoV-2 nucleic acid amplification admission testing results for all asymptomatic patients across 4 distinct inpatient facilities between April 20, 2020, and June 14, 2021, were analyzed. Positivity rates and the number needed to test (NNT) to identify 1 asymptomatic infected patient were calculated. Admission results were compared to COVID-19 community incidence rates for the system's surrounding metropolitan service area. Using a national survey of hospital epidemiologists, a clinically meaningful NNT of 1:100 was identified., Results: In total, 51,187 tests were collected (positivity rate, 1.8%). During periods of high transmission, the NNT met the clinically relevant threshold in all populations. The NNT approached or met the threshold for most locations during periods of lower transmission. For all transmission levels, the NNT for fully vaccinated patients did not meet the threshold., Conclusions: Implementing an asymptomatic patient admission testing program can provide clinically relevant data based on the NNT, even during periods of lower transmission and among different patient populations. Limiting admission testing to non-fully vaccinated patients during periods of lower transmission may be a strategy to address resource concerns around this practice. Although the impact of such testing on healthcare-associated COVID-19 among patients and healthcare workers could not be clearly determined, these data provide important information as facilities weigh the costs and benefits of such testing.
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- 2023
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18. Approaches to healthcare personnel exemption requests from coronavirus disease 2019 (COVID-19) vaccination: Results of a national survey.
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Talbot TR, Beekmann SE, Babcock HM, and Polgreen PM
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- Humans, COVID-19 Vaccines therapeutic use, Cross-Sectional Studies, Vaccination, Delivery of Health Care, COVID-19 prevention & control, Vaccines
- Abstract
Objective: Although a growing number of healthcare facilities are implementing healthcare personnel (HCP) coronavirus disease 2019 (COVID-19) vaccination requirements, vaccine exemption request management as a part of such programs is not well described., Design: Cross-sectional survey., Participants: Infectious disease (ID) physician members of the Emerging Infections Network with infection prevention or hospital epidemiology responsibilities., Methods: Eligible persons were sent a web-based survey focused on hospital plans and practices around exemption allowances from HCP COVID-19 vaccine requirements., Results: Of the 695 ID physicians surveyed, 263 (38%) responded. Overall, 160 respondent institutions (92%) allowed medical exemptions, whereas 132 (76%) allowed religious exemptions. In contrast, only 14% (n = 24) allowed deeply held personal belief exemptions. The types of medical exemptions allowed varied considerably across facilities, with allergic reactions to the vaccine or its components accepted by 145 facilities (84%). For selected scenarios commonly used as the basis for religious and deeply held personal belief exemption requests, 144 institutions (83%) would not approve exemptions focused on concerns regarding right of consent or violations of freedom of personal choice, and 140 institutions (81%) would not approve exemptions focused on introducing foreign substances into one's body or the sanctity of the body. Most respondents noted plans for additional infection prevention interventions for HCP who received an exemption for COVID-19 vaccination., Conclusions: Although many respondent institutions allowed exemptions from HCP COVID-19 vaccination requirements, the types of exemptions allowed and how the exemption programs were structured varied widely.
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- 2022
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19. Coronavirus disease 2019 (COVID-19) vaccination preparedness policies in US hospitals.
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Beekmann SE, Babcock HM, Rasnake MS, Talbot TR, and Polgreen PM
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- COVID-19 Vaccines, Hospitals, Humans, Policy, Vaccination, COVID-19 prevention & control
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We surveyed infectious disease specialists about early coronavirus disease 2019 (COVID-19) vaccination preparedness. Almost all responding institutions rated their facility's preparedness plan as either excellent or adequate. Vaccine hesitancy and concern about adverse reactions were the most commonly anticipated barriers to COVID-19 vaccination. Only 60% believed that COVID-19 vaccination should be mandatory.
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- 2022
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20. Coronavirus disease 2019 (COVID-19) research agenda for healthcare epidemiology.
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Mody L, Akinboyo IC, Babcock HM, Bischoff WE, Cheng VC, Chiotos K, Claeys KC, Coffey KC, Diekema DJ, Donskey CJ, Ellingson KD, Gilmartin HM, Gohil SK, Harris AD, Keller SC, Klein EY, Krein SL, Kwon JH, Lauring AS, Livorsi DJ, Lofgren ET, Merrill K, Milstone AM, Monsees EA, Morgan DJ, Perri LP, Pfeiffer CD, Rock C, Saint S, Sickbert-Bennett E, Skelton F, Suda KJ, Talbot TR, Vaughn VM, Weber DJ, Wiemken TL, Yassin MH, Ziegler MJ, and Anderson DJ
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- Delivery of Health Care, Health Personnel, Humans, Pandemics, Personal Protective Equipment, SARS-CoV-2, COVID-19
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This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
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- 2022
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21. Characteristics of Inpatient Units Associated With Sustained Hand Hygiene Compliance.
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Wolfe JD, Domenico HJ, Hickson GB, Wang D, Dubree M, Feistritzer N, Wells N, and Talbot TR
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- Adult, Guideline Adherence, Health Personnel, Humans, Infection Control, Inpatients, Cross Infection prevention & control, Hand Hygiene
- Abstract
Objectives: Following institution of a hand hygiene (HH) program at an academic medical center, HH compliance increased from 58% to 92% for 3 years. Some inpatient units modeled early, sustained increases, and others exhibited protracted improvement rates. We examined the association between patterns of HH compliance improvement and unit characteristics., Methods: Adult inpatient units (N = 35) were categorized into the following three tiers based on their pattern of HH compliance: early adopters, nonsustained and late adopters, and laggards. Unit-based culture measures were collected, including nursing practice environment scores (National Database of Nursing Quality Indicators [NDNQI]), patient rated quality and teamwork (Hospital Consumer Assessment of Healthcare Provider and Systems), patient complaint rates, case mix index, staff turnover rates, and patient volume. Associations between variables and the binary outcome of laggard (n = 18) versus nonlaggard (n = 17) were tested using a Mann-Whitney U test. Multivariate analysis was performed using an ordinal regression model., Results: In direct comparison, laggard units had clinically relevant differences in NDNQI scores, Hospital Consumer Assessment of Healthcare Provider and Systems scores, case mix index, patient complaints, patient volume, and staff turnover. The results were not statistically significant. In the multivariate model, the predictor variables explained a significant proportion of the variability associated with laggard status, (R2 = 0.35, P = 0.0481) and identified NDNQI scores and patient complaints as statistically significant., Conclusions: Uptake of an HH program was associated with factors related to a unit's safety culture. In particular, NDNQI scores and patient complaint rates might be used to assist in identifying units that may require additional attention during implementation of an HH quality improvement program., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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22. Health Care-Acquired Viral Respiratory Diseases.
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Petrie JG and Talbot TR
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- COVID-19 epidemiology, COVID-19 prevention & control, COVID-19 transmission, Cross Infection epidemiology, Cross Infection transmission, Guideline Adherence, Health Personnel standards, Humans, Infection Control standards, Respiratory Tract Infections epidemiology, Respiratory Tract Infections transmission, SARS-CoV-2 pathogenicity, Vaccination, Viruses classification, Viruses pathogenicity, Cross Infection prevention & control, Cross Infection virology, Respiratory Tract Infections prevention & control, Respiratory Tract Infections virology
- Abstract
Health care-acquired viral respiratory infections are common and cause increased patient morbidity and mortality. Although the threat of viral respiratory infection has been underscored by the coronavirus disease 2019 (COVID-19) pandemic, respiratory viruses have a significant impact in health care settings even under normal circumstances. Studies report decreased nosocomial transmission when aggressive infection control measures are implemented, with more success noted when using a multicomponent approach. Influenza vaccination of health care personnel furthers decrease rates of transmission; thus, mandatory vaccination is becoming more common. This article discusses the epidemiology, transmission, and control of health care-associated respiratory viral infections., Competing Interests: Disclosure J.G. Petrie and T.R. Talbot have no disclosures., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2021
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23. COVID-19 Vaccination of Health Care Personnel as a Condition of Employment: A Logical Addition to Institutional Safety Programs.
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Talbot TR
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- COVID-19 prevention & control, Disease Transmission, Infectious prevention & control, Humans, Safety Management, COVID-19 Vaccines, Employment, Health Facility Administration, Health Personnel, Mandatory Programs, Organizational Policy, Vaccination
- Published
- 2021
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24. Use of a comprehensive program to review religious and personal seasonal influenza vaccination exemption requests by healthcare personnel.
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Boone BC, Johnson RT, Rolando LA, and Talbot TR
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- Delivery of Health Care, Health Personnel, Humans, Seasons, Vaccination, Influenza Vaccines, Influenza, Human prevention & control
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Objective: Vanderbilt University Medical Center (VUMC) requires that all faculty and staff receive the seasonal influenza vaccine annually or receive an approved vaccine exemption, either for a medical or deeply held religious or personal belief. We sought to understand the underlying principles behind these exemption requests and their interaction with a multidisciplinary exemption review process., Design: All of the personal and religious exemption requests at VUMC for 3 consecutive influenza seasons from 2015 to 2018 were analyzed, categorizing these requests by 1 of 12 standardized employee categories and 1 of 18 unique reasons for vaccine exemption., Setting: Tertiary-care academic medical center., Participants: Healthcare personnel (HCP)., Results: Among the 3 influenza seasons, 1.1%-2.1% of all VUMC HCP requested religious or personal exemption from vaccination. The frequency of religious and personal exemption approval increased annually from 296 of 452 (65.5%) to 196 of 248 (80.2%) to 283 of 323 (87.6%) over the 3 seasons, representing a statistically significant increase each year. Of the 5 most common reasons against vaccination, 4 were explicitly religious in nature; the most common reason was that the "body is a temple or sacred." Nonclinical staff submitted the most religious and personal exemption requests of any job category, submitting approximately one-third of all requests every year., Conclusions: These results demonstrate how detailed the personal or religious convictions behind vaccine avoidance can be among HCP and how vaccine avoidance stems from much more than simple misinformation regarding vaccination. The intersection between misinformation and personal or religious beliefs provides a unique opportunity to address HCP opinions toward vaccination in an exemption and appeals process like the one described here.
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- 2021
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25. Expanding mandatory healthcare personnel immunization beyond influenza: Impact of a broad immunization program with enhanced accountability.
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Talbot TR, Schimmel R, Swift MD, Rolando LA, Johnson RT, Muscato J, Sternberg P, Dubree M, McGown PW, Yarbrough MI, and Hickson GB
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- Delivery of Health Care, Humans, Immunization Programs, Social Responsibility, Vaccination, Influenza, Human prevention & control
- Abstract
Objective: Evaluation of a mandatory immunization program to increase and sustain high immunization coverage for healthcare personnel (HCP)., Design: Descriptive study with before-and-after analysis., Setting: Tertiary-care academic medical center., Participants: Medical center HCP., Methods: A comprehensive mandatory immunization initiative was implemented in 2 phases, starting in July 2014. Key facets of the initiative included a formalized exemption review process, incorporation into institutional quality goals, data feedback, and accountability to support compliance., Results: Both immunization and overall compliance rates with targeted immunizations increased significantly in the years after the implementation period. The influenza immunization rate increased from 80% the year prior to the initiative to >97% for the 3 subsequent influenza seasons (P < .0001). Mumps, measles and varicella vaccination compliance increased from 94% in January 2014 to >99% by January 2017, rubella vaccination compliance increased from 93% to 99.5%, and hepatitis B vaccination compliance from 95% to 99% (P < .0001 for all comparisons). An associated positive effect on TB testing compliance, which was not included in the mandatory program, was also noted; it increased from 76% to 92% over the same period (P < .0001)., Conclusions: Thoughtful, step-wise implementation of a mandatory immunization program linked to professional accountability can be successful in increasing immunization rates as well as overall compliance with policy requirements to cover all recommended HCP immunizations.
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- 2021
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26. Assessing coronavirus disease 2019 (COVID-19) transmission to healthcare personnel: The global ACT-HCP case-control study.
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Lentz RJ, Colt H, Chen H, Cordovilla R, Popevic S, Tahura S, Candoli P, Tomassetti S, Meachery GJ, Cohen BP, Harris BD, Talbot TR, and Maldonado F
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- Adult, Aged, COVID-19 prevention & control, Case-Control Studies, Female, Global Health statistics & numerical data, Humans, Infectious Disease Transmission, Patient-to-Professional statistics & numerical data, Logistic Models, Male, Middle Aged, Occupational Exposure prevention & control, Occupational Exposure statistics & numerical data, Personal Protective Equipment statistics & numerical data, Personal Protective Equipment virology, Respiratory Protective Devices statistics & numerical data, Respiratory Protective Devices virology, Young Adult, COVID-19 transmission, Infectious Disease Transmission, Patient-to-Professional prevention & control
- Abstract
Objective: To characterize associations between exposures within and outside the medical workplace with healthcare personnel (HCP) SARS-CoV-2 infection, including the effect of various forms of respiratory protection., Design: Case-control study., Setting: We collected data from international participants via an online survey., Participants: In total, 1,130 HCP (244 cases with laboratory-confirmed COVID-19, and 886 controls healthy throughout the pandemic) from 67 countries not meeting prespecified exclusion (ie, healthy but not working, missing workplace exposure data, COVID symptoms without lab confirmation) were included in this study., Methods: Respondents were queried regarding workplace exposures, respiratory protection, and extra-occupational activities. Odds ratios for HCP infection were calculated using multivariable logistic regression and sensitivity analyses controlling for confounders and known biases., Results: HCP infection was associated with non-aerosol-generating contact with COVID-19 patients (adjusted OR, 1.4; 95% CI, 1.04-1.9; P = .03) and extra-occupational exposures including gatherings of ≥10 people, patronizing restaurants or bars, and public transportation (adjusted OR range, 3.1-16.2). Respirator use during aerosol-generating procedures (AGPs) was associated with lower odds of HCP infection (adjusted OR, 0.4; 95% CI, 0.2-0.8, P = .005), as was exposure to intensive care and dedicated COVID units, negative pressure rooms, and personal protective equipment (PPE) observers (adjusted OR range, 0.4-0.7)., Conclusions: COVID-19 transmission to HCP was associated with medical exposures currently considered lower-risk and multiple extra-occupational exposures, and exposures associated with proper use of appropriate PPE were protective. Closer scrutiny of infection control measures surrounding healthcare activities and medical settings considered lower risk, and continued awareness of the risks of public congregation, may reduce the incidence of HCP infection.
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- 2021
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27. Policy statement from the Society for Healthcare Epidemiology of America (SHEA): Only medical contraindications should be accepted as a reason for not receiving all routine immunizations as recommended by the Centers for Disease Control and Prevention.
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Weber DJ, Talbot TR, Weinmann A, Mathew T, Heil E, Stenehjem E, Duncan R, Gross A, Stinchfield P, Baliga C, Wagner J, Schaffner W, Echevarria K, and Drees M
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- Adult, Centers for Disease Control and Prevention, U.S., Child, Contraindications, Humans, Policy, United States, Delivery of Health Care, Immunization
- Abstract
SHEA endorses adhering to the recommendations by the CDC and ACIP for immunizations of all children and adults. All persons providing clinical care should be familiar with these recommendations and should routinely assess immunization compliance of their patients and strongly recommend all routine immunizations to patients. All healthcare personnel (HCP) should be immunized against vaccine-preventable diseases as recommended by the CDC/ACIP (unless immunity is demonstrated by another recommended method). SHEA endorses the policy that immunization should be a condition of employment or functioning (students, contract workers, volunteers, etc) at a healthcare facility. Only recognized medical contraindications should be accepted for not receiving recommended immunizations.
- Published
- 2021
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28. Reducing inappropriate urine cultures through a culture standardization program.
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Dougherty DF, Rickwa J, Guy D, Keesee K, Martin BJ, Smith J, and Talbot TR
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- Academic Medical Centers, Adult, Child, Emergency Service, Hospital, Humans, Reference Standards, Urinalysis, Urinary Catheterization, Catheter-Related Infections diagnosis, Catheter-Related Infections epidemiology, Catheter-Related Infections prevention & control, Urinary Tract Infections diagnosis
- Abstract
Background: The objective of this study was to evaluate the impact of a urine culture standardization program that included order indications and urinalysis (U/A) with reflexive culture. The program applied to all adult and pediatric inpatients at an academic medical center; emergency department and ambulatory clinic patients were excluded., Methods: The analysis compared outcomes in the pre-implementation (January 2015-May 2016) and post-implementation (July 2016-September 2017) periods. The primary outcomes were urine culture and U/A orders per 1,000 patient days, catheter-associated urinary tract infection (CAUTI) rate per 1,000 catheter days, and urine culture contamination rate per 1,000 patient days. Catheter standardized utilization ratios (SURs) were also examined., Results: The intervention was associated with a significant decrease in urine culture rates by 6.9 cultures per 1,000 patient days (95% CI -4.44, -9.44; P < .0001). The U/A testing rate per 1,000 patient days significantly increased pre-intervention, was not affected acutely by the intervention institution, and significantly decreased post-implementation. The CAUTI rate was not significantly changed by the intervention but did significantly increase post-implementation by 0.2 per 1,000 catheter days (95% CI 0.01, 0.47; P = .04); SURs significantly decreased (0.03; 95% CI -0.003, -0.05; P = .03); and the urine culture contamination rate per month showed no significant change. Sixty-four percent of urine cultures ordered using the reflexive test did not reflex to culture by U/A criteria., Conclusions: A urine culture standardization program led to a significant reduction in urine cultures and did not lead to an increase in U/A testing rates. CAUTI rates increased post-implementation, which may have been confounded by reduced catheter utilization., (Copyright © 2019. Published by Elsevier Inc.)
- Published
- 2020
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29. Use of airborne infection isolation in potential cases of pulmonary tuberculosis.
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England JH, Byrne DW, Harris BD, and Talbot TR
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- Adult, Aged, Air Pollutants, Occupational, Case-Control Studies, Cross Infection microbiology, Female, Humans, Male, Middle Aged, Tennessee, Tertiary Care Centers, Tuberculosis, Pulmonary diagnosis, Cross Infection prevention & control, Infection Control methods, Occupational Exposure prevention & control, Patient Isolation methods, Tuberculosis, Pulmonary prevention & control
- Abstract
Objective: To identify risk factors of patients placed in airborne infection isolation (AII) for possible pulmonary tuberculosis (TB) to better predict TB diagnosis and allow more judicious use of AII., Methods: Case-control, retrospective study at a single tertiary-care academic medical center. The study included all adult patients admitted from October 1, 2014, through October 31, 2017, who were placed in AII for possible pulmonary TB. Cases were defined as those ultimately diagnosed with pulmonary TB. Controls were defined as those not diagnosed with pulmonary TB. Those with TB diagnosed prior to admission were excluded. In total, 662 admissions (558 patients) were included., Results: Overall, 15 cases of pulmonary TB were identified (2.7%); of these, 2 were people living with human immunodeficiency virus (HIV; PLWH). Statistical analysis was limited by low case number. Those diagnosed with pulmonary TB were more likely to have been born outside the United States (53% vs 13%; P < .001) and to have had prior positive TB testing, regardless of prior treatment (50% vs 19%; P = .015). A multivariate analysis using non-US birth and prior positive TB testing predicted an 18.2% probability of pulmonary TB diagnosis when present, compared with 1.0% if both factors were not present., Conclusions: The low number of pulmonary TB cases indicated AII overuse, especially in PLWH, and more judicious use of AII is warranted. High-risk groups, including those born outside the United States and those with prior positive TB testing, should be considered for AII in the appropriate clinical setting.
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- 2020
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30. A Process for Assessing Products for Infection Prevention in Health Care Settings: A Framework From the Healthcare Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention.
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Chopra V, Janssen L, Bryant K, Fauerbach L, Talbot TR 3rd, and Babcock HM
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- Advisory Committees, Centers for Disease Control and Prevention, U.S., Disinfection statistics & numerical data, Humans, Infection Control standards, Technology Assessment, Biomedical methods, Technology Assessment, Biomedical standards, United States, Cross Infection prevention & control, Disinfection methods, Infection Control methods
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Infection control is a complex task that spans people, products, and practices in diverse settings. For years, the Healthcare Infection Control Practices Advisory Committee (HICPAC) has provided advice and guidance to the Centers for Disease Control and Prevention (CDC) on how best to prevent infections. These recommendations have focused largely on health care delivery practices and occasionally on general categories of products. With an influx of novel infection control products and growing use of these products by frontline clinicians, an efficient process for developing transparent, rigorous product recommendations that includes myriad data sources was necessary. To address this gap, the CDC asked HICPAC to develop a process that would help inform committees considering product-related recommendations. This article describes the process to develop this approach and provides an outline of how the tool may be used when products with infection control claims are recommended in guidelines or recommendations for infection prevention.
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- 2020
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31. Respiratory Protection of Health Care Personnel to Prevent Respiratory Viral Transmission.
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Talbot TR and Babcock HM
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- Health Personnel, Humans, Masks, Influenza, Human
- Published
- 2019
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32. Reply to Wasko et al.
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Dare RK, Van Driest SL, and Talbot TR
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- Humans, Daptomycin, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Muscular Diseases
- Published
- 2019
- Full Text
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33. Universal Influenza Vaccination Among Healthcare Personnel: Yes We Should.
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Perl TM and Talbot TR
- Published
- 2019
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34. Effect of Statin Coadministration on the Risk of Daptomycin-Associated Myopathy.
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Dare RK, Tewell C, Harris B, Wright PW, Van Driest SL, Farber-Eger E, Nelson GE, and Talbot TR
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- Adult, Aged, Anti-Bacterial Agents administration & dosage, Case-Control Studies, Creatine Kinase blood, Daptomycin administration & dosage, Drug Therapy, Combination adverse effects, Electronic Health Records, Female, Humans, Logistic Models, Male, Middle Aged, Retrospective Studies, Risk Factors, Tennessee, Anti-Bacterial Agents adverse effects, Daptomycin adverse effects, Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage, Muscular Diseases chemically induced, Rhabdomyolysis chemically induced
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Background: Daptomycin-associated myopathy has been identified in 2%-14% of patients, and rhabdomyolysis is a known adverse effect. Although risk factors for daptomycin-associated myopathy are poorly defined, creatine phosphokinase (CPK) monitoring and temporary discontinuation of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or "statins," has been recommended., Methods: We conducted a single-center, retrospective, matched case-control risk factor analysis in adult and pediatric patients from 2004 to 2015. Patients in whom myopathy (defined as CPK values above the upper limit of normal) developed during daptomycin treatment were matched 1:1 to no-myopathy controls with at least the same duration of therapy. Risk factors independently associated with myopathy were determined using multivariable conditional logistic regression. Secondary analysis was performed in patients with rhabdomyolysis, defined as CPK values ≥10 times the upper limit of normal., Results: Of 3042 patients reviewed, 128 (4.2%) were identified as having daptomycin-associated myopathy, 25 (0.8%) of whom had rhabdomyolysis; 121 (95%) of the 128 were adults, and the mean duration of therapy before CPK elevation was 16.7 days (range, 1-58 days). In multivariate analysis, deep abscess treatment (odds ratio, 2.80; P = .03), antihistamine coadministration (3.50; P = .03), and statin coadministration (2.60; P = .03) were independent risk factors for myopathy. Obesity (odds ratio, 3.28; P = .03) and statin coadministration (4.67; P = .03) were found to be independent risk factors for rhabdomyolysis, and older age was associated with reduced risk (0.97; P = .05)., Conclusions: Statin coadministration with daptomycin was independently associated with myopathy and rhabdomyolysis. This is the first study to provide strong evidence supporting this association. During coadministration, we recommend twice-weekly CPK monitoring and consideration of withholding statins.
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- 2018
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35. Risk Factors and Outcomes Associated With Acquisition of Daptomycin and Linezolid-Nonsusceptible Vancomycin-Resistant Enterococcus.
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Greene MH, Harris BD, Nesbitt WJ, Watson ML, Wright PW, Talbot TR, and Nelson GE
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Background: Vancomycin-resistant enterococcus (VRE) causes substantial health care-associated infection with increasing reports of resistance to daptomycin or linezolid. We conducted a case-control study reporting 81 cases of daptomycin and linezolid-nonsusceptible VRE (DLVRE), a resistance pattern not previously reported., Methods: We reviewed VRE isolates from June 2010 through June 2015 for nonsusceptibility to both daptomycin (minimum inhibitory concentration [MIC] > 4) and linezolid (MIC ≥ 4). We matched cases by year to control patients with VRE susceptible to both daptomycin and linezolid and performed retrospective chart review to gather risk factor and outcome data., Results: We identified 81 DLVRE cases. Resistance to both daptomycin and linezolid was more common than resistance to either agent individually. Compared with susceptible VRE, DLVRE was more likely to present as bacteremia without focus ( P < 0.01), with DLVRE patients more likely to be immune suppressed ( P = .04), to be neutropenic ( P = .03), or to have had an invasive procedure in the prior 30 days ( P = .04). Any antibiotic exposure over the prior 30 days conferred a 4-fold increased risk for DLVRE (odds ratio [OR], 4.25; 95% confidence interval [CI], 1.43-12.63; P = .01); multivariate analysis implicated daptomycin days of therapy (DOT) over the past year as a specific risk factor (OR, 1.10; 95% CI, 1.01-1.19; P = .03). DLVRE cases had longer hospitalizations ( P = .04) but no increased risk for in-hospital death., Conclusions: DLVRE is an emerging multidrug-resistant pathogen associated with immune suppression, neutropenia, and recent invasive procedure. Prior antibiotic exposure, specifically daptomycin exposure, confers risk for acquisition of DLVRE.
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- 2018
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36. Ventilator Bundle Compliance and Risk of Ventilator-Associated Events.
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Harris BD, Thomas GA, Greene MH, Spires SS, and Talbot TR
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- Academic Medical Centers, Aged, Case-Control Studies, Chlorhexidine therapeutic use, Disinfectants therapeutic use, Female, Humans, Intensive Care Units, Logistic Models, Male, Middle Aged, Pneumonia, Ventilator-Associated epidemiology, Risk Factors, Tennessee epidemiology, Cross Infection prevention & control, Guideline Adherence statistics & numerical data, Infection Control methods, Pneumonia, Ventilator-Associated prevention & control, Ventilators, Mechanical adverse effects
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OBJECTIVEVentilator bundles encompass practices that reduce the risk of ventilator complications, including ventilator-associated pneumonia. The impact of ventilator bundles on the risk of developing ventilator-associated events (VAEs) is unknown. We sought to determine whether decreased compliance to the ventilator bundle increases the risk for VAE development.DESIGNNested case-control study.SETTINGThis study was conducted at 6 adult intensive care units at an academic tertiary-care center in Tennessee.PATIENTSIn total, 273 patients with VAEs were randomly matched in a 1:4 ratio to controls by mechanical ventilation duration and ICU type.METHODSControls were selected from the primary study population at risk for a VAE after being mechanically ventilated for the same number of days as a specified case. Using conditional logistic regression analysis, overall cumulative compliance, and compliance with individual components of the bundle in the 3 and 7 days prior to VAE development (or the control match day) were examined.RESULTSOverall bundle compliance at 3 days (odds ratio [OR], 1.15; P=.34) and 7 days prior to VAE diagnosis (OR, 0.96; P=.83) were not associated with VAE development. This finding did not change when limiting the outcome to infection-related ventilator-associated complications (IVACs) and after adjusting for age and gender. In the examination of compliance with specific bundle components increased compliance with chlorhexidine oral care was associated with increased risk of VAE development in all analyses.CONCLUSIONSVentilator bundle compliance was not associated with a reduced risk for VAEs. Higher compliance with chlorhexidine oral care was associated with a greater risk for VAE development.Infect Control Hosp Epidemiol 2018;39:637-643.
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- 2018
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37. An Evidence-Based Protocol for Antibiotic Use Prior to Cystoscopy Decreases Antibiotic Use without Impacting Post-Procedural Symptomatic Urinary Tract Infection Rates.
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Gregg JR, Bhalla RG, Cook JP, Kang C, Dmochowski R, Talbot TR, and Barocas DA
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- Aged, Anti-Bacterial Agents therapeutic use, Antibiotic Prophylaxis standards, Bacterial Infections epidemiology, Bacterial Infections microbiology, Drug Resistance, Bacterial, Escherichia coli drug effects, Escherichia coli isolation & purification, Evidence-Based Medicine standards, Female, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Practice Guidelines as Topic, Treatment Outcome, Urinary Tract Infections epidemiology, Urinary Tract Infections microbiology, Urology methods, Urology standards, Antibiotic Prophylaxis methods, Bacterial Infections prevention & control, Clinical Protocols, Cystoscopy adverse effects, Evidence-Based Medicine methods, Urinary Tract Infections prevention & control
- Abstract
Purpose: Symptomatic urinary tract infection is a complication of office based cystourethroscopy. Studies are mixed regarding the efficacy of antibiotic prophylaxis to prevent urinary tract infections. Our aim was to develop and evaluate an evidence-based protocol that reduces unnecessary antibiotic use while avoiding an increase in urinary tract infections., Materials and Methods: We created a clinic antibiogram based on all urology office visits performed during a 2-year period. Bacterial resistance rates, institutional risk related data and clinical guidelines were applied to create a protocol for antibiotic administration before cystourethroscopy. We then analyzed 1,245 consecutive patients without a renal transplant who underwent outpatient cystourethroscopy, including 610 after protocol initiation. Urinary tract infection rates and antibiotic use were analyzed for an association with the protocol change using the Fisher exact test., Results: Cultures had an overall 20% rate of resistance to fluoroquinolones, representing 40% of the cultures that grew Escherichia coli. Before the protocol change 602 of 635 patients (94.8%) received a preprocedural antibiotic compared to 426 of 610 (69.9%) after protocol initiation (p <0.01). A total of 19 patients (3.0%) had a symptomatic urinary tract infection prior to the protocol change while 16 (2.6%) had a urinary tract infection after the change (p = 0.69). Regarding resistance, fluoroquinolone resistant organisms grew in the cultures of 12 of 19 patients (63.2%) with a urinary tract infection before the protocol change compared to 5 of 16 (31.3%) with a urinary tract infection after the change. Recent antibiotic administration, hospitalization and chronic catheterization were associated with urinary tract infection in the entire cohort (all p ≤0.01)., Conclusions: A local antibiogram with infection related risk data effectively risk stratifies patients before cystourethroscopy, decreasing the use of antibiotics without increasing the rate of symptomatic urinary tract infection., (Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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38. Medically Attended Catheter Complications Are Common in Patients With Outpatient Central Venous Catheters.
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Spires SS, Rebeiro PF, Miller M, Koss K, Wright PW, and Talbot TR
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- Female, Humans, Male, Middle Aged, Outpatients statistics & numerical data, Parenteral Nutrition, Home methods, Parenteral Nutrition, Home statistics & numerical data, Quality Improvement, Risk Factors, Sex Factors, Tennessee epidemiology, Catheter-Related Infections epidemiology, Catheter-Related Infections therapy, Central Venous Catheters adverse effects, Home Care Services standards, Home Care Services statistics & numerical data, Medical Overuse prevention & control, Medical Overuse statistics & numerical data, Patient Readmission statistics & numerical data
- Abstract
OBJECTIVE Outpatient central venous catheters (CVCs) are being used more frequently; however, data describing mechanical complications and central-line-associated bloodstream infections (CLABSI) in the outpatient setting are limited. We performed a retrospective observational cohort study to understand the burden of these complications to elucidate their impact on the healthcare system. METHODS Data were retrospectively collected on patients discharged from Vanderbilt University Medical Center with a CVC in place and admitted into the care of Vanderbilt Home Care Services. Risk factors for medically attended catheter-associated complications (CACs) and outpatient CLABSIs were analyzed. RESULTS A CAC developed in 143 patients (21.9%), for a total of 165 discrete CAC events. Among these, 76 (46%) required at least 1 visit to the emergency department or an inpatient admission, while the remaining 89 (54%) required an outpatient clinic visit. The risk for developing a CAC was significantly increased in female patients, patients with a CVC with >1 lumen, and patients receiving total parenteral nutrition. The absolute number of CLABSIs identified in the study population was small at 16, or 2.4% of the total cohort. CONCLUSIONS Medically attended catheter complications were common among outpatients discharged with a CVC, and reduction of these events should be the focus of outpatient quality improvement programs. Infect Control Hosp Epidemiol 2018;39:439-444.
- Published
- 2018
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39. Reducing Inappropriate Testing for the Evaluation of Diarrhea Among Hospitalized Patients.
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Tewell CE, Talbot TR, Nelson GE, Harris BD, Jones WA, Midha NM, Mulherin DP, Stephens EB, Thirwani A, and Wright PW
- Subjects
- Adult, Algorithms, Cost Savings, Diarrhea parasitology, Hospitalization, Humans, Interrupted Time Series Analysis, Medical Order Entry Systems economics, Procedures and Techniques Utilization, Quality Improvement, Retrospective Studies, Cross Infection diagnosis, Decision Support Techniques, Diarrhea microbiology, Medical Order Entry Systems standards, Unnecessary Procedures statistics & numerical data
- Abstract
Background: Diarrhea is one of the most common illnesses in the United States. Evaluation frequently does not follow established guidelines. The objective of this study was to evaluate the effectiveness of a computerized physician order entry-based test guidance algorithm with regard to the clinical, financial, and operational impacts., Methods: Our population was patients with diarrheal illness at a tertiary academic medical center. The intervention was a computerized physician order entry-based test guidance algorithm that restricted the use of stool cultures and ova and parasites testing of diarrhea in the adult inpatient location vs nonintervention sites, which were the emergency department, pediatric inpatient and adult and pediatric outpatient locations. We measured stool culture, ova and parasites, and Clostridium difficile testing rates from July 1, 2012 to January 31, 2016. Additionally, we calculated advisor usage, consults generated, accuracy of information, and cost savings., Results: There was a significant decrease in stool culture and ova and parasites testing rates at the adult inpatient (P = .001 for both), pediatric (P < .001 for both), and adult emergency department (P < .001; P = .009) locations. The decrease at the intervention site was immediate, whereas the other locations showed a delayed but sustained decrease that suggests a collateral impact. A significant increase in the rate of stool culture and ova and parasites testing was observed in the outpatient setting (P = .02 and P = .001). We estimate that $21,931 was saved annually., Conclusions: A point-of-order test restriction algorithm for hospitalized adults with diarrhea reduced stool testing. Similar programs should be considered at other institutions and for the evaluation of other conditions., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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40. Moving to a More Level Playing Field: The Need for Risk Adjustment of Publicly Reported Hospital CLABSI Performance.
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Talbot TR
- Subjects
- Catheterization, Central Venous, Cross Infection, Hospitals, Humans, Catheter-Related Infections, Risk Adjustment
- Published
- 2017
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41. Symptomatic Urinary Tract Infections in Renal Transplant Recipients after Cystoscopy for Ureteral Stent Removal.
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Gregg JR, Kang CL, Talbot TR, Moore D, Herrell SD, Dmochowski R, and Barocas DA
- Abstract
Introduction: Symptomatic urinary tract infection (UTI) is a known complication of cystoscopy with ureteral stent removal. However, little is known about the incidence and risk factors for post-cystoscopy UTI in renal transplant recipients, who likely represent a high-risk cohort. Our aim was to determine the infection rate following cystoscopy with stent removal in this population and identify opportunities for care improvement., Methods: We performed a retrospective cohort study of office cystoscopies with stent removal in renal transplant recipients performed at a single institution from April 2012 through May 2014. Strict criteria were used to determine presence of symptomatic UTI within one month of the procedure. Fisher's exact tests were completed to examine associations between patient characteristics and post-transplant outcomes with UTI., Results: A total of 324 patients were included. Mean age was 50.0 (SD 13.1) years, and 187 (57.7%) patients were male. Within this group,165 (52.5%) patients received a pre-procedural oral fluoroquinolone antibiotic dose prior to the procedure. Nine patients had symptomatic UTIs (2.8%), of which three infections (33.3%) were due to quinolone-resistant organisms. Female sex ( P =0.04), but no other patient or post-operative characteristic was associated with symptomatic UTI, including the use of peri-procedural antibiotics., Conclusions: The incidence of symptomatic UTI after cystoscopy with ureteral stent removal in renal transplant recipients is less than three percent and comparable to post-cystoscopy UTI risk in the general population. Female sex is associated with symptomatic UTI. Further investigation is needed to identify groups most at risk for UTI and other complications.
- Published
- 2017
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42. The Use of a Computerized Provider Order Entry Alert to Decrease Rates of Clostridium difficile Testing in Young Pediatric Patients.
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Nicholson MR, Freswick PN, Di Pentima MC, Wang L, Edwards KM, Wilson GJ, and Talbot TR
- Subjects
- Child, Preschool, Decision Support Systems, Clinical, Diagnostic Tests, Routine methods, Female, Hospitals, Pediatric, Humans, Infant, Infant, Newborn, Male, Practice Guidelines as Topic, Regression Analysis, Tennessee, Clostridioides difficile isolation & purification, Diagnostic Tests, Routine statistics & numerical data, Medical Order Entry Systems
- Abstract
BACKGROUND Infants and young children are frequently colonized with C. difficile but rarely have symptomatic disease. However, C. difficile testing remains prevalent in this age group. OBJECTIVE To design a computerized provider order entry (CPOE) alert to decrease testing for C. difficile in young children and infants. DESIGN An interventional age-targeted before-after trial with comparison group SETTING Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, Tennessee. PATIENTS All children seen in the inpatient or emergency room settings from July 2012 through July 2013 (pre-CPOE alert) and September 2013 through September 2014 (post-CPOE alert) INTERVENTION In August of 2013, we implemented a CPOE alert advising against testing in infants and young children based on the American Academy of Pediatrics recommendations with an optional override. We further offered healthcare providers educational seminars regarding recommended C. difficile testing. RESULTS The average monthly testing rate significantly decreased after the CPOE alert for children 0-11 months old (11.5 pre-alert vs 0 post-alert per 10,000 patient days; P<.001) and 12-35 months old (61.6 pre-alert vs 30.1 post-alert per 10,000 patients days; P<.001), but not for those children ≥36 months old (50.9 pre-alert vs 46.4 post-alert per 10,000 patient days; P=.3) who were not targeted with a CPOE alert. There were no complications in those children who testing positive for C. difficile. CONCLUSIONS The average monthly testing rate for C. difficile for children <35 months old decreased without complication after the use of a CPOE alert in those who tested positive for C. difficile. Infect Control Hosp Epidemiol 2017;38:542-546.
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- 2017
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43. Paramyxovirus Outbreak in a Long-Term Care Facility: The Challenges of Implementing Infection Control Practices in a Congregate Setting.
- Author
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Spires SS, Talbot HK, Pope CA, and Talbot TR
- Subjects
- Aged, 80 and over, Dementia nursing, Hospitalization, Humans, Long-Term Care, Metapneumovirus, Paramyxoviridae Infections diagnosis, Paramyxoviridae Infections epidemiology, Paramyxoviridae Infections prevention & control, Respiratory Syncytial Virus Infections diagnosis, Disease Outbreaks, Homes for the Aged, Infection Control methods, Nursing Homes, Respiratory Syncytial Virus Infections epidemiology, Respiratory Syncytial Virus Infections prevention & control, Respiratory Syncytial Viruses
- Abstract
OBJECTIVE We report an outbreak of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) infections in a dementia care ward containing 2 separately locked units (A and B) to heighten awareness of these pathogens in the older adult population and highlight some of the infection prevention challenges faced during a noninfluenza respiratory viral outbreak in a congregate setting. METHODS Cases were defined by the presence of new signs or symptoms that included (1) a single oral temperature ≥ 37.8°C (100.0°F) and (2) the presence of at least 2 of the following symptoms: cough, dyspnea, rhinorrhea, hoarseness, congestion, fatigue, and malaise. Attempted infection-control measures included cohorting patients and staff, empiric isolation precautions, and cessation of group activities. Available nasopharyngeal swab specimens were sent to the Tennessee Department of Health for identification by rT-PCR testing. RESULTS We identified 30 of the 41 (73%) residents as cases over this 16-day outbreak. Due to high numbers of sick personnel, we were unable to cohort staff to 1 unit. Unit B developed its first case 8 days after infection control measures were implemented. Of the 14 cases with available specimens, 6 patients tested positive for RSV-B, 7 for HMPV and 1 patient test positive for influenza A. Overall, 15 cases (50%) required transfer to acute care facilities; 10 of these patients (34%) had chest x-ray confirmed pulmonary infiltrates; and 5 residents (17%) died. CONCLUSIONS This case report highlights the importance of RSV and HMPV in causing substantial disease in the older adult population and highlights the challenges in preventing transmission of these viruses. Infect Control Hosp Epidemiol 2017;38:399-404.
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- 2017
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44. Health Care-Acquired Viral Respiratory Diseases.
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Dare RK and Talbot TR
- Subjects
- Coronavirus Infections, Humans, Influenza, Human, Cross Infection, Respiratory Tract Infections, Virus Diseases
- Abstract
Health care-acquired viral respiratory infections are common and cause increased patient morbidity and mortality. Respiratory syncytial virus and influenza virus are frequently transmitted in the hospital setting. Studies report decreased nosocomial transmission when aggressive infection control measures are implemented with more success using a multicomponent approach. Influenza vaccination of health care personnel has been shown to further decrease rates of transmission, thus mandatory vaccination is becoming more common. This article focuses on the epidemiology, transmission, and control of health care-associated respiratory viral infections., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
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45. The influence of contaminated urine cultures in inpatient and emergency department settings.
- Author
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Klausing BT, Tillman SD, Wright PW, and Talbot TR
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Cohort Studies, Emergency Service, Hospital, Humans, Inpatients, Middle Aged, Morbidity, Retrospective Studies, Urinalysis, Urinary Tract Infections diagnosis, Young Adult, Urinary Tract Infections epidemiology, Urine microbiology, Urine Specimen Collection standards
- Abstract
We retrospectively evaluated 131 patients with contaminated urine cultures during a 12-month period. Sixty-four patients (48.8%) experienced 139 potential complications related to these specimens. The most common complication was inappropriate antibiotic administration (noted in 58 patients [44.3%]). Contaminated urine cultures led to additional diagnostic evaluation and unnecessary antibiotic use., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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46. Injection Rhymes with Infection?
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Sandberg WS and Talbot TR
- Subjects
- Female, Humans, Male, Anesthetics, Intravenous, Drug Contamination statistics & numerical data, Operating Rooms
- Published
- 2016
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47. Recent Antibiotic Treatment Increases the Risk of Urinary Tract Infection after Outpatient Cystoscopy.
- Author
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Gregg JR, Lai C, Dmochowski R, Talbot TR, and Barocas DA
- Abstract
Introduction: Symptomatic urinary tract infection is a complication of office based cystoscopy. AUA guidelines recommend prophylactic antibiotics for patients with an increased risk of urinary tract infection. However, study results are mixed regarding the efficacy of prophylaxis for urinary tract infection prevention. We evaluate predictors of infection to identify groups at increased risk for urinary tract infection after cystoscopy., Methods: We identified all office cystoscopies performed at a single institution from April 2012 through May 2014. Patients with a positive urine culture within 30 days of the procedure were reviewed for symptomatic urinary tract infection. Those with a urinary tract infection were matched to 4 controls. Patient characteristics were extracted and examined for association with urinary tract infection. A multivariable logistic regression model was fit to identify associations between composite clinical variables and urinary tract infection., Results: During the study period 5,488 patients underwent cystoscopy, of whom 29 (0.53%) had a urinary tract infection. Cultures showed quinolone resistant organisms in 13 of 29 (45%) urinary tract infections. The use of an external catheter or intermittent catheterization (p=0.04), hospitalization within 4 weeks (p=0.04) and the use of antibiotics within 6 months of cystoscopy (p=0.01) were associated with urinary tract infection. Recent antibiotic exposure, recent nongenitourinary infection or recent hospitalization was associated with urinary tract infection on multivariable analysis (OR 5.26, 95% CI 1.87-14.8, p <0.01)., Conclusions: Recent antibiotic exposure, infection or hospitalization is associated with an increased risk of urinary tract infection after cystoscopy. Most symptomatic urinary tract infections are due to quinolone resistant organisms in this population. The optimal prophylactic regimen should be tailored to regional antibiotic susceptibility patterns and individual patient risk factors.
- Published
- 2016
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48. Carbapenems versus alternative antibiotics for the treatment of bloodstream infections caused by Enterobacter, Citrobacter or Serratia species: a systematic review with meta-analysis.
- Author
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Harris PN, Wei JY, Shen AW, Abdile AA, Paynter S, Huxley RR, Pandeya N, Doi Y, Huh K, O'Neal CS, Talbot TR, and Paterson DL
- Subjects
- Bacteremia mortality, Cefepime, Cephalosporins therapeutic use, Enterobacteriaceae Infections mortality, Humans, Quinolones therapeutic use, Serratia Infections mortality, Survival Analysis, Treatment Outcome, beta-Lactamase Inhibitors therapeutic use, Anti-Bacterial Agents therapeutic use, Bacteremia drug therapy, Carbapenems therapeutic use, Enterobacteriaceae Infections drug therapy, Serratia Infections drug therapy
- Abstract
Objectives: This systematic review and meta-analysis compared effects of different antibiotics on mortality in patients with bloodstream infections caused by Enterobacteriaceae with chromosomal AmpC β-lactamase., Methods: Databases were systematically searched for studies reporting mortality in patients with bloodstream infections caused by AmpC producers treated with carbapenems, broad-spectrum β-lactam/β-lactamase inhibitors (BLBLIs), quinolones or cefepime. Pooled ORs for mortality were calculated for cases that received monotherapy with these agents versus carbapenems., Registration: PROSPERO international prospective register of systematic reviews (CRD42014014992; 18 November 2014)., Results: Eleven observational studies were included. Random-effects meta-analysis was performed on studies reporting empirical and definitive monotherapy. In unadjusted analyses, no significant difference in mortality was found between BLBLIs versus carbapenems used for definitive therapy (OR 0.87, 95% CI 0.32-2.36) or empirical therapy (OR 0.48; 95% CI 0.14-1.60) or cefepime versus carbapenems as definitive therapy (OR 0.61; 95% CI 0.27-1.38) or empirical therapy (0.60; 95% CI 0.17-2.20). Use of a fluoroquinolone as definitive therapy was associated with a lower risk of mortality compared with carbapenems (OR 0.39; 95% CI 0.19-0.78). Three studies with patient-level data were used to adjust for potential confounders. The non-significant trends favouring non-carbapenem options in these studies were diminished after adjustment for age, sex and illness severity scores, suggestive of residual confounding., Conclusions: Despite limitations of available data, there was no strong evidence to suggest that BLBLIs, quinolones or cefepime were inferior to carbapenems. The reduced risk of mortality observed with quinolone use may reflect less serious illness in patients, rather than superiority over carbapenems., (© The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2016
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49. Respirator Use in a Hospital Setting: Establishing Surveillance Metrics.
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Yarbrough MI, Ficken ME, Lehmann CU, Talbot TR, Swift MD, McGown PW, Wheaton RF, Bruer M, Little SW, and Oke CA
- Abstract
Information that details use and supply of respirators in acute care hospitals is vital to prevent disease transmission, assure the safety of health care personnel, and inform national guidelines and regulations., Objective: To develop measures of respirator use and supply in the acute care hospital setting to aid evaluation of respirator programs, allow benchmarking among hospitals, and serve as a foundation for national surveillance to enhance effective Personal Protective Equipment (PPE) use and management., Methods: We identified existing regulations and guidelines that govern respirator use and supply at Vanderbilt University Medical Center (VUMC). Related routine and emergency hospital practices were documented through an investigation of hospital administrative policies, protocols, and programs. Respirator dependent practices were categorized based on hospital workflow: Prevention (preparation), patient care (response), and infection surveillance (outcomes). Associated data in information systems were extracted and their quality evaluated. Finally, measures representing major factors and components of respirator use and supply were developed., Results: Various directives affecting multiple stakeholders govern respirator use and supply in hospitals. Forty-seven primary and secondary measures representing factors of respirator use and supply in the acute care hospital setting were derived from existing information systems associated with the implementation of these directives., Conclusion: Adequate PPE supply and effective use that limit disease transmission and protect health care personnel are dependent on multiple factors associated with routine and emergency hospital practices. We developed forty-seven measures that may serve as the basis for a national PPE surveillance system, beginning with standardized measures of respirator use and supply for collection across different hospital types, sizes, and locations to inform hospitals, government agencies, manufacturers, and distributors. Despite involvement of multiple hospital stakeholders, regulatory guidance prescribes workplace practices that are likely to result in similar workflows across hospitals. Future work will explore the feasibility of implementing the collection and reporting of standardized measures in multiple facilities.
- Published
- 2016
50. Sustained Reduction of Ventilator-Associated Pneumonia Rates Using Real-Time Course Correction With a Ventilator Bundle Compliance Dashboard.
- Author
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Talbot TR, Carr D, Parmley CL, Martin BJ, Gray B, Ambrose A, and Starmer J
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Interrupted Time Series Analysis, Male, Middle Aged, Young Adult, Cross Infection prevention & control, Guideline Adherence, Infection Control methods, Intensive Care Units standards, Pneumonia, Ventilator-Associated prevention & control, Respiration, Artificial adverse effects
- Abstract
Background: The effectiveness of practice bundles on reducing ventilator-associated pneumonia (VAP) has been questioned., Objective: To implement a comprehensive program that included a real-time bundle compliance dashboard to improve compliance and reduce ventilator-associated complications. DESIGN Before-and-after quasi-experimental study with interrupted time-series analysis. SETTING Academic medical center., Methods: In 2007 a comprehensive institutional ventilator bundle program was developed. To assess bundle compliance and stimulate instant course correction of noncompliant parameters, a real-time computerized dashboard was developed. Program impact in 6 adult intensive care units (ICUs) was assessed. Bundle compliance was noted as an overall cumulative bundle adherence assessment, reflecting the percentage of time all elements were concurrently in compliance for all patients., Results: The VAP rate in all ICUs combined decreased from 19.5 to 9.2 VAPs per 1,000 ventilator-days following program implementation (P<.001). Bundle compliance significantly increased (Z100 score of 23% in August 2007 to 83% in June 2011 [P<.001]). The implementation resulted in a significant monthly decrease in the overall ICU VAP rate of 3.28/1,000 ventilator-days (95% CI, 2.64-3.92/1,000 ventilator-days). Following the intervention, the VAP rate decreased significantly at a rate of 0.20/1,000 ventilator-days per month (95% CI, 0.14-0.30/1,000 ventilator-days per month). Among all adult ICUs combined, improved bundle compliance was moderately correlated with monthly VAP rate reductions (Pearson correlation coefficient, -0.32)., Conclusion: A prevention program using a real-time bundle adherence dashboard was associated with significant sustained decreases in VAP rates and an increase in bundle compliance among adult ICU patients.
- Published
- 2015
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