Showing papers by "Donald A. Goldmann published in 2014"

Approaches for Preventing Healthcare-Associated Infections: Go Long or Go Wide?

Abstract: Affiliations: 1. Texas AM 2. Stroger Hospital and Rush University Medical Center, Chicago, Illinois; 3. Johns Hopkins University School of Medicine, Baltimore, Maryland; 4. Institute for Healthcare Improvement, Cambridge, Massachusetts; 5. Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts; 6. Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts. Received March 17, 2014; accepted March 18, 2014; electronically published June 9, 2014. Infect Control Hosp Epidemiol 2014;35(7):797-801 2014 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2014/3507-0003$15.00. DOI: 10.1086/676535 In this issue, the continuing “A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates” series presents updated recommendations for preventing central line–associated bloodstream infections and preventing transmission and infection due to methicillin-resistant Staphylococcus aureus. During revision of these articles, several reviewers raised a critical question: What is the relative effectiveness (and cost-effectiveness) of vertical versus horizontal approaches to infection prevention? As multidrug-resistant organisms such as extendedspectrum b-lactamase–producing and carbapenem-resistant Enterobacteriaceae emerge and spread, it will become increasingly important to understand the relative benefits and costs of pathogen-specific screening and intervention strategies compared with reliable application of more “generic” methods to mitigate transmission and infection. Over the last decade, the general approaches to healthcareassociated infection (HAI) prevention have taken two conceptually different paths: (1) vertical approaches that aim to reduce colonization, infection, and transmission of specific pathogens, largely through use of active surveillance testing (AST) to identify carriers, followed by implementation of measures aimed at preventing transmission from carriers to other patients, and (2) horizontal approaches that aim to reduce the risk of infections due to a broad array of pathogens through implementation of standardized practices that do not depend on patient-specific conditions. Examples of horizontal infection prevention strategies include minimizing the unnecessary use of invasive medical devices, enhancing hand hygiene, improving environmental cleaning, and promoting antimicrobial stewardship (Table 1). Although vertical and horizontal approaches are not mutually exclusive and are often intermixed, some experts believe that the horizontal approach under usual endemic situations may offer the best overall value given the diversity of microorganisms that can cause HAIs and the constrained resources available for infection prevention efforts. When informed by local knowledge of microbial epidemiology and ecology and supported by a strong quality improvement program, this strategy allows healthcare facilities to focus on approaches that target all rather than selected organisms in the absence of an organismspecific epidemic. In addition to comparing the strength of evidence supporting each approach, it is also important to take into account financial costs and potential consequences associated with various infection prevention strategies, including the impact on hospital personnel effort and on aspects of patient care; for example, placing patients on isolation precautions may lead to fewer healthcare provider visits. These comparisons are difficult to make because of conflicting study results, at least partly reflecting the heterogeneity of study designs and settings (ie, where the prevalence of the target pathogen ranges from rare to endemic to epidemic) and the paucity of high-quality cost-effectiveness analyses that are needed to estimate the economic impact of specific HAI prevention interventions.

Health Care-Associated Infections Among Critically Ill Children in the US, 2007–2012

Abstract: BACKGROUND: Health care–associated infections (HAIs) are harmful and costly and can result in substantial morbidity for hospitalized children; however, little is known about national trends in HAIs in neonatal and pediatric populations. Our objective was to determine the incidence of HAIs among a large sample of hospitals in the United States caring for critically ill children from 2007 to 2012. METHODS: In this cohort study, we included NICUs and PICUs located in hospitals reporting data to the Centers for Disease Control and Prevention’s National Healthcare Safety Network for central line–associated bloodstream infections (CLABSIs), ventilator-associated pneumonias, and catheter-associated urinary tract infections. We used a time-series design to evaluate changes in HAI rates. RESULTS: A total of 173 US hospitals provided data from NICUs, and 64 provided data from PICUs. From 2007 to 2012, rates of CLABSIs decreased in NICUs from 4.9 to 1.5 per 1000 central-line days (incidence rate ratio (IRR) per quarter = 0.96, 95% confidence interval 0.94–0.97) and in PICUs from 4.7 to 1.0 per 1000 central-line days (IRR per quarter = 0.96 [0.94–0.98]). Rates of ventilator-associated pneumonias decreased in NICUs from 1.6 to 0.6 per 1000 ventilator days (IRR per quarter = 0.97 [0.93–0.99]) and PICUs from 1.9 to 0.7 per 1000 ventilator-days (IRR per quarter = 0.95 [0.92–0.98]). Rates of catheter-associated urinary tract infections did not change significantly in PICUs. CONCLUSIONS: Between 2007 and 2012 there were substantial reductions in HAIs among hospitalized neonates and children.

A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates

Abstract: Since the publication of "A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals" in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts. They are the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS).

Developing a Pathway for High-value, Patient-centered Total Joint Arthroplasty

Abstract: Background Total joint arthroplasty (TJA) is one of the most widely performed elective procedures; however, there are wide variations in cost and quality among facilities where the procedure is performed.

Did a quality improvement collaborative make stroke care better? A cluster randomized trial

Abstract: Background: Stroke can result in death and long-term disability. Fast and high-quality care can reduce the impact of stroke, but UK national audit data has demonstrated variability in compliance with recommended processes of care. Though quality improvement collaboratives (QICs) are widely used, whether a QIC could improve reliability of stroke care was unknown. Methods: Twenty-four NHS hospitals in the Northwest of England were randomly allocated to participate either in Stroke 90:10, a QIC based on the Breakthrough Series (BTS) model, or to a control group giving normal care. The QIC focused on nine processes of quality care for stroke already used in the national stroke audit. The nine processes were grouped into two distinct care bundles: one relating to early hours care and one relating to rehabilitation following stroke. Using an interrupted time series design and difference-in-difference analysis, we aimed to determine whether hospitals participating in the QIC improved more than the control group on bundle compliance. Results: Data were available from nine interventions (3,533 patients) and nine control hospitals (3,059 patients). Hospitals in the QIC showed a modest improvement from baseline in the odds of average compliance equivalent to a relative improvement of 10.9% (95% CI 1.3%, 20.6%) in the Early Hours Bundle and 11.2% (95% CI 1.4%, 21.5%) in the Rehabilitation Bundle. Secondary analysis suggested that some specific processes were more sensitive to an intervention effect. Conclusions: Some aspects of stroke care improved during the QIC, but the effects of the QIC were modest and further improvement is needed. The extent to which a BTS QIC can improve quality of stroke care remains uncertain. Some aspects of care may respond better to collaboratives than others. Trial registration: ISRCTN13893902.

Coping with college and inflammatory bowel disease: implications for clinical guidance and support

Abstract: Background Studies have shown that young adults with chronic diseases, including inflammatory bowel disease (IBD), experience greater difficulty during the transition to college, reaching lower levels of educational attainment and reporting greater levels of perceived stress than their otherwise-healthy peers. We performed a qualitative study to better understand how underlying illness shapes the college experience for patients with IBD and how the college experience, in turn, impacts disease management. Methods Fifteen college students with IBD were recruited from the Boston Children's Hospital Center for IBD. We conducted an approximately 1 hour semistructured qualitative interview with each participant, and the interviews were thematically analyzed after an iterative and inductive process. Results Four primary themes were identified: (1) The transition experience of college students with IBD is shaped by their health status, perceived readiness, and preparedness, (2) Elements of the college environment pose specific challenges to young adults with IBD that require adaptive strategies, (3) College students with IBD integrate their underlying illness with their individual and social identity, and (4) College students navigate health management by conceptualizing themselves, their families, and providers as serving particular roles. Conclusions For young adults with IBD, college is a proving ground for demonstrating self-care and disease management practices. Future initiatives aimed at this population should recognize the evolving roles of patients, parents, and providers in disease management. Increased attention should also be paid to the promotion of patient's self-management and the unique challenges of the structural and psychosocial college environment.

Impact of Medicare's payment policy on mediastinitis following coronary artery bypass graft surgery in US hospitals.

Abstract: Background. The Centers for Medicare and Medicaid Services (CMS) implemented a policy in October 2008 to eliminate additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) surgery.Objective. To evaluate the impact of this policy on mediastinitis rates, using Medicare claims and National Healthcare Safety Network (NHSN) prospective surveillance data.Methods. We used an interrupted time series design to compare mediastinitis rates before and after the policy, adjusted for secular trends. Billing rates came from Medicare inpatient claims following 638,761 CABG procedures in 1,234 US hospitals (January 2006–September 2010). Prospective surveillance rates came from 151 NHSN hospitals in 29 states performing 94,739 CABG procedures (January 2007–September 2010). Logistic regression mixed-effects models estimated trends for mediastinitis rates.Results. We found a sudden drop in coding for index admission mediastinitis at the time of policy implementation (odds ratio, 0.36 [95% c...

Commentary: Approaches for Preventing Healthcare-Associated Infections: Go Long or Go Wide?

Abstract: Wide? Author(s): Edward Septimus, MD; Robert A. Weinstein, MD; Trish M. Perl, MD, MSc; Donald A. Goldmann, MD; Deborah S. Yokoe, MD, MPH Source: Infection Control and Hospital Epidemiology, Vol. 35, No. 7 (July 2014), pp. 797-801 Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America Stable URL: http://www.jstor.org/stable/10.1086/676535 . Accessed: 11/06/2014 07:15