Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America
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Infect Control Hosp Epidemiol · Oct 2008
Multicenter StudyPreventing ventilator-associated pneumonia in the United States: a multicenter mixed-methods study.
To determine what practices are used by hospitals to prevent ventilator-associated pneumonia (VAP) and, through qualitative methods, to understand more fully why hospitals use certain practices and not others. ⋯ The survey response rate was 72%; 83% of hospitals reported using semirecumbent positioning, and only 21% reported using subglottic secretion drainage. Multivariable analyses indicated collaborative initiatives were associated with the use of semirecumbent positioning but provided little guidance regarding the use of subglottic secretion drainage. Qualitative analysis, however, revealed 3 themes: (1) collaboratives strongly influence the use of semirecumbent positioning but have little effect on the use of subglottic secretion drainage; (2) nurses play a major role in the use of semirecumbent positioning, but they are only minimally involved with the use of subglottic secretion drainage; and (3) there is considerable debate about the evidence supporting subglottic secretion drainage, despite a meta-analysis of 5 randomized trials of subglottic secretion drainage that generally supported this preventive practice, compared with only 2 published randomized trials of semirecumbent positioning, one of which concluded that it was ineffective at preventing the development of VAP. CONCLUSION. Semirecumbent positioning is commonly used to prevent VAP, whereas subglottic secretion drainage is used far less often. We need to understand better how evidence related to prevention practices is identified, interpreted, and used to ensure that research findings are reliably translated into clinical practice.
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Infect Control Hosp Epidemiol · Oct 2008
Complex surgical site infections and the devilish details of risk adjustment: important implications for public reporting.
To validate the National Nosocomial Infection Surveillance (NNIS) risk index as a tool to account for differences in case mix when reporting rates of complex surgical site infection (SSI). ⋯ Some experts recommend reporting rates of complex SSI to overcome the widely acknowledged detection bias associated with superficial incisional infection. Furthermore, it is necessary to compensate for case-mix differences in patient populations, to ensure that intrahospital comparisons are meaningful. Our results indicate that the NNIS risk index is a reasonable method for the risk stratification of complex SSIs for several commonly performed procedures.
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Infect Control Hosp Epidemiol · Oct 2008
Case-control study of clinical features of influenza in hospitalized patients.
The symptoms of influenza infection in outpatients are well described. The Centers for Disease Control and Prevention (CDC) definition of an influenza-like illness (ILI) includes fever and cough or sore throat. Few data exist on the clinical presentation of influenza in hospitalized patients, which may be distinct from the clinical presentation of influenza in ambulatory patients because of underlying medical conditions and medications. ⋯ The CDC's definition of an ILI lacks sensitivity among hospitalized patients, and the presence of an ILI is not associated with influenza infection in asthmatic patients.
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Infect Control Hosp Epidemiol · Oct 2008
Matched case-control analysis of polymicrobial bloodstream infection in a neonatal intensive care unit.
To compare and contrast the epidemiology of polymicrobial and monomicrobial bloodstream infections (BSIs) in newborn intensive care unit (NICU) patients. ⋯ Changes in the microbiology and epidemiology of NICU-related polymicrobial BSI have occurred since the last North American review. In the present study, although differences were observed, most risk factors and outcomes were similar between monomicrobial BSI and polymicrobial BSI. Epidemiologic surveillance is critical to identify trends associated with neonatal polymicrobial BSI, particularly those that may impact preventative strategies, diagnostic measures, and therapeutic interventions.