DOCSLIB.ORG

Cluster Randomized Trials in Comparative Effectiveness Research Randomizing Hospitals to Test Methods for Prevention of Healthcare-Associated Infections

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cluster Randomized Trials in Comparative Effectiveness Research Randomizing Hospitals to Test Methods for Prevention of Healthcare-Associated Infections COMPARATIVE EFFECTIVENESS Cluster Randomized Trials in Comparative Effectiveness Research Randomizing Hospitals to Test Methods for Prevention of Healthcare-Associated Infections Richard Platt, MD, MS,* Samuel U. Takvorian, AB,* Edward Septimus, MD,† Jason Hickok, MBA, RN,† Julia Moody, MS,† Jonathan Perlin, MD, PhD,† John A. Jernigan, MD, MS,‡ Ken Kleinman, ScD,* and Susan S. Huang, MD, MPH§ Results: Recruitment of hospitals is complete. Data collection will Background: The need for evidence about the effectiveness of end in Summer 2011. therapeutics and other medical practices has triggered new interest Conclusions: This trial takes advantage of existing personnel, pro- in methods for comparative effectiveness research. cedures, infrastructure, and information systems in a large integrated Objective: Describe an approach to comparative effectiveness re- hospital network to conduct a low-cost evaluation of prevention search involving cluster randomized trials in networks of hospitals, strategies under usual practice conditions. This approach is applica- health plans, or medical practices with centralized administrative ble to many comparative effectiveness topics in both inpatient and and informatics capabilities. ambulatory settings. Research Design: We discuss the example of an ongoing cluster randomized trial to prevent methicillin-resistant Staphylococcus Key Words: cluster randomization, comparative effectiveness, MRSA prevention aureus (MRSA) infection in intensive care units (ICUs). The trial randomizes 45 hospitals to: (a) screening cultures of ICU admis- (Med Care 2010;48: S52–S57) sions, followed by Contact Precautions if MRSA-positive, (b) screening cultures of ICU admissions followed by decolonization if MRSA-positive, or (c) universal decolonization of ICU admissions without screening. n 2007, the Institute of Medicine’s (IOM) Roundtable on Subjects: All admissions to adult ICUs. IEvidence Based Medicine described a “learning healthcare Measures: The primary outcome is MRSA-positive clinical cultures system” as one that both generates and uses evidence to guide occurring Ն2 days following ICU admission. Secondary outcomes clinical decision-making.1 For evidence generation, it called include blood and urine infection caused by MRSA (and, separately, for a diverse array of methodologies to find out what works, all pathogens), as well as the development of resistance to decolo- under what circumstances, and for whom. Since then, interest nizing agents. in methods for conducting comparative effective research has grown substantially—most recently with the legislative man- date to create a national Patient Centered Outcomes Research From the *Department of Population Medicine, Harvard Medical School and Institute. Some have argued that as much as 10% of this new Harvard Pilgrim Health Care Institute, Boston, MA; †Hospital Corpora- funding should be directed toward methodological guidance tion of America, Nashville, TN; ‡Division of Healthcare Quality Promo- and innovation.2 Moreover, with the recent publication of the tion, Centers for Disease Control and Prevention, Atlanta, GA; and list of national priorities for comparative effectiveness re- §Division of Infectious Diseases and Health Policy Research Institute, search, there is heightened interest in matching priority re- University of California Irvine School of Medicine, Irvine, CA. 3 Supported by the Agency for Healthcare Research and Quality (59 HMN search topics with appropriate methodologies. HHSA290-2005-0033ϭTO11), with supplemental funding from the Although methodological advances have improved the Centers for Disease Control and Prevention (CDC Prevention Epicenters validity of nonexperimental methods—including systematic Program, U01CI000344). reviews, and quasiexperimental observational studies—ex- R.P. has received research grants from Sanofi-Pasteur, GlaxoSmithKline, Pfizer, and TAP Pharmaceuticals in the past 2 years. perimental methods, in particular randomized clinical trials The findings and conclusions in this report are those of the authors, and do (RCTs), are still considered the most robust method for not necessarily represent the official position of the Centers for Disease generating comparative effectiveness evidence and will un- Control and Prevention. doubtedly remain an important component of an advanced Reprints: Richard Platt, MD, MS, Department of Population Medicine, 133 Brook- 4 line Avenue, 6th Floor, Boston, MA 02215. E-mail: [email protected]. comparative effectiveness research framework. The IOM Copyright © 2010 by Lippincott Williams & Wilkins corroborated this view in its national priorities list for com- ISSN: 0025-7079/10/4800-0052 parative effectiveness research by recommending the use of S52 | www.lww-medicalcare.com Medical Care • Volume 48, Number 6 Suppl 1, June 2010 Medical Care • Volume 48, Number 6 Suppl 1, June 2010 Cluster Randomization in Comparative Effectiveness Research RCTs for 49 of 100 research topics, by far the most fre- health information can be used to assess baseline status, quently recommended methodology.3 monitor implementation, and measure outcomes. Despite their strengths, conventional RCTs have impor- We illustrate some of the potential of cluster random- tant limitations. Although they are excellent tools for judging ization in comparative effectiveness research through a cur- efficacy (performance under ideal conditions), they often fail rent trial which compares strategies to prevent methicillin- to judge effectiveness (performance under conditions of ac- resistant Staphylococcus aureus (MRSA) infections in tual use). This is because most RCTs require more standard- hospital ICUs—one of the high priority topics identified by ization and a higher level of medical care than occurs in the IOM Committee on Comparative Effectiveness Research practice. In addition, generalizability may be lost because Prioritization. This example demonstrates several of the de- participants in RCTs are often not fully representative of the sign strengths of cluster randomized trials that make them eventual target group. Furthermore, RCTs are often very likely to generate comparative effectiveness evidence in an costly and time-consuming to implement. For example, the efficient and timely manner, thus enabling swift policy action. ALLHAT study of initial treatment of hypertension, some- Randomized Evaluation of Decolonization vs times cited as an example of a pragmatic clinical trial,2 cost over $80 million and took 8 years to complete.5 Universal Clearance to Eliminate Methicillin Cluster randomized trials are RCTs which randomize Resistant S. Aureus (REDUCE-MRSA) Trial groups (clusters) rather than individuals. Cluster randomiza- Background tion is the only feasible method for randomization when an MRSA has become the most common cause of hospi- intervention must be applied to an entire group, such as a tal-acquired infection in many US hospitals. Recent national community-based health promotion initiative. They are also surveys estimate that 5% to 7% of inpatients harbor the only method for evaluating interventions for which the MRSA,11–13 with higher prevalence in ICUs.14 Because status of individuals is linked, for instance when herd immu- MRSA infections are associated with increased mortality, nity for contagious illness is an important consideration. costs, and length of stay,15,16 hospitals have implemented a Cluster randomization may also be desirable in some in- variety of quality improvement strategies to reduce hospital- stances in which it would be possible to randomize individ- associated MRSA disease, usually targeting high-risk patients uals.6,7 For instance, many organizations use formularies to (eg, ICU or surgical patients). Three dominant prevention guide prescribing choices when there is more than one ther- strategies have emerged: apeutically equivalent agent. Specific agents may be included 1. Active screening and isolation. This involves obtaining or excluded for reasons unrelated to therapeutic effect; ex- anterior nares surveillance cultures from all patients at the amples include cost and streamlined contracting. Randomiza- time of ICU admission to identify carriers.14,17,18 Contact tion of formularies to include one or another preferred drug Precautions (private room, if available, and gloves and among those believed to be equivalent can yield balanced gowns for patient care) are instituted for patients with groups of individuals exposed to the different agents, allow- positive surveillance cultures and for those previously ing evaluation of comparative effectiveness under conditions identified as MRSA-positive during prior admissions. Sev- of actual use. Statistical techniques that use information from eral states mandate MRSA screening, although most do all participating individuals while accounting for the ten- not require subsequent contact isolation.19,20 A resource- dency of individuals in a cluster to respond similarly (intra- intensive alternative, practiced more widely in Europe, cluster correlation) minimize the loss of statistical power 7 uses Contact Precautions for all patients deemed at high associated with randomizing groups rather than individuals. risk (eg, recently hospitalized in a high MRSA-prevalence Cluster randomized trials have several advantages in country) until they are demonstrated to be culture-nega- comparative effectiveness studies, including those evaluating tive.21,22 8,9 therapeutic interventions and policies. First, by applying 2. Active screening
Load more

Recommended publications
  • Antibiotic Resistant Organisms Prevention and Control Guidelines for Healthcare Facilities
    Antibiotic Resistant Organisms Prevention and Control Guidelines for Healthcare Facilities Reference Document for use by Health Care Organizations for Internal Policy/Protocol Development Revised from Provincial Infection Control Network Antibiotic Resistant Organisms Prevention and Control Guidelines 2008 Provincial Infection Control Network 2013 PICNet Antibiotic Resistant Organism (ARO) Guidelines Table of Contents Revisions Working Group ................................................................................................................... 3 Acronyms .......................................................................................................................................... 4 1 Introduction ................................................................................................................................ 5 2 Purpose ....................................................................................................................................... 5 3 Scope .......................................................................................................................................... 5 4 Literature Search Strategy ............................................................................................................ 6 5 Methods ...................................................................................................................................... 6 6 Background ................................................................................................................................
    [Show full text]
  • Detecting Carbapenem-Resistant Acinetobacter Baumannii (CRAB) Carriage: Which Body Site Should Be Cultured?
    Infection Control & Hospital Epidemiology (2020), 41, 965–967 doi:10.1017/ice.2020.197 Concise Communication Detecting carbapenem-resistant Acinetobacter baumannii (CRAB) carriage: Which body site should be cultured? Amir Nutman MD, MPH1,2 , Elizabeth Temkin DrPH1, Jonathan Lellouche PhD1, Debby Ben David MD1,2, David Schwartz PhD1 and Yehuda Carmeli MD, MPH1,2 1National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel and 2Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Abstract We compared the yield of culturing various body sites to detect carriage of carbapenem-resistant Acinetobacter baumannii (CRAB). Culturing the skin using a premoistened sponge, with overnight enrichment and plating on CHROMagar MDR Acinetobacter, had the highest yield: 92%. Skin is satisfactory as a single site for active surveillance of CRAB. (Received 8 January 2020; accepted 28 April 2020; electronically published 19 June 2020) Acinetobacter baumannii is a multidrug-resistant pathogen caus- The primary outcome was screening yield for each body site ing severe infections in hospitals and long-term care facilities. sampled. Because there is no gold standard for CRAB screening, Detecting carriers is a mainstay of controlling nosocomial spread a patient was defined as a CRAB carrier if a culture from any of of resistant organisms. Screening for carbapenem-resistant the sites sampled was positive. Acinetobacter baumannii (CRAB) has been recommended to control outbreaks, but no specific recommendations have been Specimen collection methods made regarding which body sites to culture.1 In 2007, we studied the yield of culturing the nose, throat, axilla, groin, rectum, open Buccal mucosa and rectal specimens were collected using swabs wounds, and tracheal aspirates, and no site or combination of (Amies agar gel transport swab; Copan Italia S.P.A., Brescia, sites had high enough sensitivity to be recommended for CRAB Italy).
    [Show full text]
  • Oregon Multidrug-Resistant Organism (MDRO) Toolkit
    Ver. Oct 30, 2019 Oregon MDRO & C. difficile Toolkit OREGON MULTIDRUG-RESISTANT ORGANISM AND CLOSTRIDIOIDES DIFFICILE TOOLKIT Purpose Statement The purpose of this toolkit is to provide recommendations to Oregon healthcare facilities about strategies to prevent transmission of multidrug-resistant organisms (MDROs) and Clostridioides (formerly Clostridium) difficile during patient care. The toolkit recommendations provide general guidance and are not meant to replace facility-level policy or procedure. Local epidemiology as well as pertinent facility- or patient-level factors may affect the likelihood of MDRO transmission, and these factors should be taken into account when making decisions about transmission prevention strategies. The toolkit is intended to be a working document addressing high-impact organisms in Oregon hospitals. Given the continually evolving infection prevention and control landscape, including novel and emerging pathogens, this document will be updated as needed. Methods This toolkit was drafted by members of the Oregon Drug-Resistant Organism and Coordinated Regional Epidemiology (DROP-CRE) Network. To inform toolkit development, we convened a statewide Hospital Epidemiology Task Force to assist with two main objectives: 1) Optimize a practical approach to methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin- resistant enterococci (VRE) infection prevention and control; and 2) Establish statewide definitions for Gram-negative organisms in order to harmonize facility definitions, primarily for the purpose of uniform infection control practices. Over the course of 18 months, the Hospital Epidemiology Task Force reviewed existing drug- resistance definitions as published by collaboration of the European Centre for Disease Prevention and Control (eCDC) and the US Centers for Disease Control and Prevention (CDC).(1) In particular, the Task Force called attention to “possible extensively drug-resistant (XDR)” bacteria as those organisms harbor sufficiently broad drug resistance to substantially alter and limit treatment options.
    [Show full text]
  • Screening for Asymptomatic Bacteriuria in Adults: an Updated Systematic Review for the U.S
    Evidence Synthesis Number 183 Screening for Asymptomatic Bacteriuria in Adults: An Updated Systematic Review for the U.S. Preventive Services Task Force Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. HHSA-290-2015-00007-I, Task Order No. 3 Prepared by: Kaiser Permanente Research Affiliates Evidence-based Practice Center Kaiser Permanente Center for Health Research Portland, OR Investigators: Jillian T. Henderson, PhD, MPH Elizabeth M. Webber, MS Sarah I. Bean, MPH AHRQ Publication No. 19-05252-EF-1 September 2019 This report is based on research conducted by the Kaiser Permanente Research Affiliates Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (HHSA-290-2015-00007-I, Task Order No. 3). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).
    [Show full text]
  • (MRSA) Prevention Guidelines in Spinal Cord Injury Centers Using the PARIHS Framework: a Mixed Methods Study Salva N
    Balbale et al. Implementation Science (2015) 10:130 DOI 10.1186/s13012-015-0318-x Implementation Science RESEARCH Open Access Evaluating implementation of methicillin- resistant Staphylococcus aureus (MRSA) prevention guidelines in spinal cord injury centers using the PARIHS framework: a mixed methods study Salva N. Balbale1,2,3†, Jennifer N. Hill1,2†, Marylou Guihan1,2,4†, Timothy P. Hogan5,6,7†, Kenzie A. Cameron8,9†, Barry Goldstein10,11† and Charlesnika T. Evans1,2,3,9* Abstract Background: To prevent methicillin-resistant Staphylococcus aureus (MRSA) in Spinal Cord Injury and Disorder (SCI/D) Centers, the “Guidelines for Implementation of MRSA Prevention Initiative in the Spinal Cord Injury Centers” were released in July 2008 in the Veterans Affairs (VA) Health Care System. The purpose of this study was to use the Promoting Action on Research Implementation in Health Systems (PARiHS) framework to evaluate the experiences of implementation of SCI/D MRSA prevention guidelines in VA SCI/D Centers approximately 2–3 years after the guidelines were released. Methods: Mixed methods were used across two phases in this study. The first phase included an anonymous, web-based cross-sectional survey administered toprovidersatall24VASCI/DCenters.Thesecondphaseincludedsemi-structured telephone interviews with providers at 9 SCI/D Centers. The PARiHS framework was used as the foundation of both the survey questions and semi-structured interview guide. Results: The survey was completed by 295 SCI/D providers (43.8 % response rate) from 22 of the 24 SCI/D Centers (91.7 % participation rate). Respondents included nurses (57.3 %), therapists (24.4 %), physicians (11.1 %), physician assistants (3.4 %), and other health care professionals (3.8 %).
    [Show full text]
  • Healthcare Associated Infections 2013 Report to the Wasington State
    Healthcare Associated Infections 2013 Report to the Washington State Legislature April 2014 Division of Disease Control and Health Statistics Healthcare Associated Infections 2013 Report to the Washington State Legislature April 2014 DOH 420-113 For more information or additional copies of this report contact: Washington State Department of Health Division of Disease Control and Health Statistics 101 Israel Road S.E. P.O. Box 47811 Olympia WA 98504 Phone: 360-236-4202 Fax: 360-236-4245 John Wiesman, DrPH, MPH, CPH Secretary of Health Acknowledgements The Washington State Department of Health would like to thank past and current members of our Healthcare Associated Infections (HAI) Advisory Committee for their participation and expertise. Page i Table of Contents Executive Summary ...................................................................................................................... 1 I. Background ................................................................................................................................ 3 2013 Legislative Action on Healthcare Associated Infections ................................................................. 3 HAI Advisory Committee ......................................................................................................................... 4 National Activity ....................................................................................................................................... 4 The Washington State HAI Program .......................................................................................................
    [Show full text]
  • Study Protocol and Statistical Analysis Plan
    Treating Parents to Reduce NICU Transmission Of Staphylococcus aureus (TREAT PARENTS Trial) NCT02223520 November 30, 2018 1 Version 13-11/30/2018 Key Study Personnel Aaron M. Milstone, MD MHS Karen Carroll, MD Associate Professor of Pediatric Infectious Professor Of Pathology Diseases and Epidemiology Johns Hopkins University Johns Hopkins University Director Clinical Microbiology Laboratory Associate Hospital Epidemiologist Johns Hopkins Hospital Johns Hopkins Hospital Susan Aucott, MD Elizabeth Colantuoni, PhD Associate Professor of Pediatrics Johns Hopkins University Johns Hopkins University 615 N. Wolfe St., Room E3539 Medical Director, Neonatal ICU Johns Hopkins Hospital Annie Voskertchian, MPH Danielle Koontz, MAA Senior Research Program Coordinator II Research Program Coordinator Johns Hopkins University, School of Medicine Johns Hopkins University, School of Medicine Pediatrics, Infectious Disease Pediatrics, Infectious Disease Maureen M. Gilmore, MD Dina Khamash, MD Assistant Professor of Pediatrics, JHU Research Fellow Director of Neonatology, JHBMC Johns Hopkins University, School of Medicine Johns Hopkins Bayview Medical Center Pediatrics, Infectious Disease 2 Version 13-11/30/2018 TABLE OF CONTENTS Section/Title Page # 1. Synopsis 4 2. Background and Rationale 5 A. Background 5 B. Rationale 5 C. Significance of the Proposed Research 6 3. Study Purpose, Objectives and Hypotheses 6 A. Purpose 6 B. Objectives 6 C. Primary Hypothesis 6 D. Secondary Hypotheses 6 4. Study Procedures 6 A. Summary 6 B. Intervention 7 C. Enrollment 7 1. Population and Setting 7 2. Eligibility (withdrawal) 8 3. Recruitment 8 4. Consent 8 5. Screening 9 6. Allocation 10 7. Study Initiation and baseline data collection 11 8. Discontinuation of Treatment and Subject Withdrawal 11 9.
    [Show full text]
  • Guidelines for the Management of Multidrug-Resistant and Other Epidemiologically Important Organisms Along the Health Care Continuum
    Guidelines for the Management of Multidrug-Resistant and Other Epidemiologically Important Organisms along the Health Care Continuum Delaware Health and Social Services Division of Public Health Originally published January 2010 Updated August 2015 Guidelines for the Management of Multidrug-Resistant and Other Epidemiologically Important Organisms along the Health Care Continuum Table of Contents Topic Page Hospital Acquired Infections Advisory Sub-Committee Members 3 Hospital Acquired Infections Advisory Committee Members 4 Introduction 5 DPH Position Statement 5 Background 6 Risk Factors for MDROs 7 Diagnostic Testing 7 Infection Control Measures 7 Standard Precautions 8 Hand Hygiene 8 Respiratory Hygiene/Cough Etiquette 9 Room Placement 9 Staff Cohorting 10 Group Activities 10 Environmental Cleaning 11 Shared Bathrooms, Showers, Tubs 11 Dishes, Glasses, Cups and Eating Utensils 11 Laundry 11 Decolonization 12 Indications for Contact Precautions 12 Contact Precautions: Gloves 12 Contact Precautions: Gowns 13 Contact Precautions: Patient Care Equipment 13 Masks, Eye Protection, Face shields 13 Discontinuing Contact Precautions 14 Communication with Other Facilities 14 Staff Education 14 Resident, Family, Visitor Education 14 Surveillance 15 Discharge Home 15 Antimicrobial Use 16 Summary 16 Abbreviations 17 Additional Resources 17 Definitions 18 Attachment 1 (Standard Precautions) 20 References 22 Available on the DPH website at: http://www.dhss.delaware.gov/dhss/dph/index.html. 2 Hospital Acquired Infections Advisory Committee Subcommittee
    [Show full text]
  • Antibiotic Resistant Organisms
    Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual ANTIBIOTIC RESISTANT ORGANISMS Extended Spectrum Beta-Lactamase (ESBL) ESBL-producing gram negative bacteria can survive in the health care environment but the environment has rarely been implicated in outbreaks. Preventing transmission of ESBL-producing bacteria requires adherence to Routine Practices, with particular attention to hand hygiene. Additional Precautions are not required. Infection Prevention and Control Practices Maintain Routine Practices only; Contact Precautions are not required. Methicillin Resistant Staphylococcus aureus (MRSA) Staphylococcus aureus (S. aureus) is a bacterium that colonizes the skin and is present in the anterior nares in about 25-30% of healthy people. Colonization may also occur in the axillae, chronic or surgical wounds, decubitus ulcers, perineum, sputum, urine and invasive device exit sites such as intravascular catheters, gastrostomy and tracheostomy sites of hospitalized patients. S. aureus causes a variety of infections, ranging from localized skin lesions, such as impetigo, boils or wound infections, to severe invasive disease. Methicillin resistant Staphylococcus aureus (MRSA) refers to strains of S.aureus resistant to methicillin, oxacillin, cloxacillin, and all other β-lactam agents, including cephalosporins and carbapenems. MRSA is typically resistant to many classes of antimicrobials (e.g., aminoglycosides, erythromycin, quinolones). Infections caused by MRSA are not inherently more serious than infections caused by methicillin- sensitive strains of S. aureus (MSSA), but treatment options for the management of serious MRSA infections are limited. Most people with MRSA are carriers or colonized, and do not have infection, consistent with other strains of S. aureus. Strains of S. aureus that are intermediately (VISA) or completely resistant (VRSA) to vancomycin have been reported in North America, Europe and Asia, but are uncommon to date.
    [Show full text]
  • Newborn at Risk for Sepsis Executive Summary
    Why focus on “Newborns at Risk for Sepsis”? This CPM focuses on the identification and treatment recommendations for the Newborn at Risk for Early Neonatal Sepsis. The evidence-based recommendations outlined below address maternal screening and prophylaxis in the setting of a positive maternal Group B Streptococcus (GBS) infection, screening and prophylaxis for possible or suspected Intraamniotic Infection (formally chorioamnionitis), and the evaluation and treatment of the newborn at risk for early onset sepsis. GBS is known to be the leading cause of morbidity and mortality in infants with signs of sepsis presenting within the first 24- 48hrs. The initial diagnosis of sepsis can be difficult to determine because the early signs and symptoms of infection can be subtle. With the introduction of maternal antibiotic prophylaxis and appropriate neonatal screening and treatment, the incidence of invasive GBS disease has dramatically diminished over time.1 Although there is a need for early intervention and treatment, antibiotics carry risk when administered unnecessarily. Within this CPM, we seek to outline the evidence-based guidelines around evaluating and treating the Newborn at Risk for Early Onset sepsis as well as address antibiotic stewardship in the neonate when appropriate. Executive Summary RISK FACTORS FOR INFECTION Category and associated risk factor Maternal – antepartum Inadequate prenatal care Low socioeconomic status Recurrent abortion Chronic disease Substance abuse Maternal – intrapartum Group B Streptococcus infection,
    [Show full text]
  • An In-Depth Study of Staphylooccus Aureus Infections and Cases Of
    University of Connecticut OpenCommons@UConn UCHC Graduate School Masters Theses 2003 - University of Connecticut Health Center Graduate 2010 School 2010 An In-Depth Study of Staphylooccus aureus Infections and Cases of Colonization in the Inpatient Population at a University Teaching Hospital Nancy Russell Dupont University of Connecticut Health Center Follow this and additional works at: https://opencommons.uconn.edu/uchcgs_masters Part of the Public Health Commons Recommended Citation Dupont, Nancy Russell, "An In-Depth Study of Staphylooccus aureus Infections and Cases of Colonization in the Inpatient Population at a University Teaching Hospital" (2010). UCHC Graduate School Masters Theses 2003 - 2010. 160. https://opencommons.uconn.edu/uchcgs_masters/160 An In-depth Study of Staphylococcus aureus Infections and Cases of Colonization in ,the Inpatient Population at a University Teaching Hospital Nancy Russell Dupont B.S.N., University of Connecticut, 1985 A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Public Health at the University of Connecticut 20 10 APPROVAL PAGE Master of Public Health Thesis An In-depth Study of Staphylococcus aureus Infections and Cases of Colonization in the Inpatient Population at a University Teaching Hospital Presented by Nancy Russell Dupont, B.S.N. Major Advisor: Richard G. Stevens, Ph.D. Associate Advisor: Joan V. Segal, M.A. M.S. Associate Advisor: Helen Swede, Ph.D. University of Connecticut 2010 ACKNOWLEDGEMENTS This thesis is dedicated to Richard A. Garibaldi, M.D. (4123142-9/3/09), Hospital Epidemiologist, whose belief in me opened my professional life and mind to an incredible new world. Dr. Garibaldi, a mentor, friend, and confidant, was an inspiration with his kindness, gentleness and humanitarianism.
    [Show full text]
  • Preoperative Screening Cultures in the Identification of Staphylococci Causing Wound and Valvular Infections in Cardiac Surgery
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Erasmus University Digital Repository Journal of Hospital Infection (1990) 15, 55-63 Preoperative screening cultures in the identification of staphylococci causing wound and valvular infections in cardiac surgery E. J. Ridgway, A. P. R. Wilson and M. C. Kelsey Department of Microbiology, Whittington Hospital, London, UK Accepted for publication 21 September 1989 Summary: Cultures of nasal or presternal swabs form part of the routine preoperative screening of patients on the cardiac surgical ward. During a trial of antibiotic prophylaxis in 3 14 patients, preoperative isolates of Staphylococ- cus aureus and coagulase-negative staphylococci were compared with strains associated with postoperative sternal wound breakdown (24 patients) and prosthetic valve endocarditis (3 patients). Morphology, antibiotic sensitivity pattern, plasmid analysis and phage typing were used to differentiate strains. In only three cases of wound infection and one of prosthetic valve endocardi- tis were pathogenic staphylococci not distinguishable from preoperative isolates. The collection of superficial swabs for this purpose before cardiac surgery is therefore unlikely to be cost effective. Keywords: Wound infection; heart surgery; Staphylococcus aureus. Introduction Preoperative screening of nasal or presternal swabs is commonly performed on cardiac surgical wards to identify patients carrying Staphylococcus aureus, particularly methicillin-resistant strains, that might later be responsible for sternal wound infection or prosthetic valve endocarditis (Keighley & Burdon, 1979). In practice, preoperative isolation of Staphylococcus aureus has rarely, if ever, altered perioperative management and the commonest potential pathogen, Staphylococcus epidermidis, was often disregarded (Harris et al., 1984; Farrington et al., 1985, Wilson et al., 1988a).
    [Show full text]