Browsing by Subject "Infection Control"
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Item Changes in Rate of Methicillin-Resistant Staphylococcus Infection in a Community Neonatal Intensive Care Unit Before and During the COVID-19 Pandemic(2024-01-30) Blumenfeld, Abby; Hagans, Michelle; Chan, ChristinaBACKGROUND: Methicillin-Resistant Staphylococcus aureus (MRSA) infections represent a significant healthcare challenge, particularly in neonatal intensive care units (NICUs) where patients experience increased morbidity and mortality. MRSA transmission has not been well studied in the setting of enhanced infection precautions (EIP) taken during the COVID-19 pandemic - such as universal masking and enhanced hand hygiene. OBJECTIVE: This retrospective cohort study compared rates of MRSA infection in a community NICU during two distinct time periods: January 2016 to March 2020 (Pre-EIP: before EIP was instituted) and April 2020 to December 2022 (With-EIP: after EIP was instituted). METHODS: During the study period, 74 neonates admitted to the NICU tested positive for MRSA (56 Pre-EIP and 18 With-EIP). MRSA cases were collected using laboratory and electronic medical record review. Cases were reported as infections per 1,000 patient days (IP-1000). Statistical analysis with two-sample t-tests assuming unequal variance and chi squared tests for independence were performed. RESULTS: There was a significant decrease in MRSA IP-1000 from 1.90 Pre-EIP to 0.93 With-EIP (p=0.0006). The prevalence of MRSA clusters, defined as three infections within a 30-day period, decreased from 0.27 Pre-EIP compared to 0.03 With-EIP (p=0.0004). However, The Pre-EIP cohort had a younger average gestational age (30.2 vs 33.8 weeks, p=0.001), higher rates of very low birth weight (59% vs 28%, p=0.021), and fewer inborn neonates (88% vs 100%, p=0.115) - factors known to increase risk of MRSA infection. CONCLUSION: These findings suggest that EIP may have contributed to the reduction in MRSA clusters observed in this community NICU. Findings are limited by differences in cohort risk factors, small study population, variabilities in infection precautions throughout the pandemic, and the inherent bias of retrospective cohort analysis. This underscores the importance of prevention strategies and highlights the potential benefits of continued enhanced infection precautions in reducing the transmission of MRSA in vulnerable inpatient populations.Item Exploring a Novel, Non-Invasive Treatment for Prosthetic Joint Infection(2018-01-23) Narayanan, Ajay; Wang, Qi; Pybus, Christine; Shaikh, Sumbul; Munaweera, Imalka; Sturge, Carolyn; Chopra, Rajiv; Greenberg, DavidPeriprosthetic joint infection (PJI) is a very prevalent consequence of implant surgery. The surface of the prosthesis provides a favorable environment for the growth of bacterial biofilms, which are notorious for being resistant to conventional antibiotics. The current treatment for PJI involves re-opening the surgical site and replacing the prosthesis, a very costly procedure that diminishes patient quality of life. Recently, a non-invasive procedure has been developed that utilizes high frequency alternating magnetic fields (AMF) to destroy biofilms via induction heating. Our research was focused on both optimizing and further characterizing the cytotoxicity of this treatment method on Staphylococcus aureus and Pseudomonas aeruginosa, two biofilm-forming pathogens commonly implicated in PJI. The organisms used for these experiments were Staphylococcus aureus and Pseudomonas aeruginosa. Biofilms were grown on stainless steel rings or washers, to model the surface of implanted prosthetics. P. aeruginosa was grown statically in MH2 media at 37°C for 48 hours. S. aureus was grown statically in Tryptic Soy Broth media supplemented with 0.5% glucose and 3.0% NaCl at 37°C for 48 hours. Soaking the stainless steel ring/washer in a 20% Human Plasma solution overnight at 4°C greatly enhanced S. aureus biofilm formation. AMF continuous dosing was performed at 20 watts, up to 15 minutes. AMF intermittent dosing was performed using 1 second duration, 670 watt pulses every 10 minutes, up to 6 hours. The results indicated that S. aureus biofilms were eradicated more effectively than P. aeruginosa biofilms when treated with intermittent AMF exposure. Specifically, there was a 2.6-log reduction in S. aureus biofilm CFU after 30 minutes of AMF exposure, with CFUs reaching the limit of detection after 3 hours. Corresponding studies in P. aeruginosa showed a 1.3-log reduction in biofilm CFU after 30 minutes of AMF exposure, with CFUs not reaching the limit of detection after 6 hours. In an ongoing study, ciprofloxacin was administered alongside AMF exposure to investigate any potential synergistic effects on P. aeruginosa biofilm eradication. While the data produced this summer was exclusively in vitro, the results give insight on how AMF might be applied in the clinical treatment of PJI. The observed cytotoxicity combined with the non-invasive nature of AMF suggest significant promise for a much more desired method of PJI treatment for common pathogens.Item Fever in a returning traveler ... from West Africa(2016-03-18) Lee, FrancescaItem Improving Protocol Adherence in Central Line Placements(2022-05-01T05:00:00.000Z) Roy, Mathews Francis; Goff, Kristina L.; Yager, Ashley; Reed, W. GaryBACKGROUND: The placement of central lines is a very common exercise in medicine. Central lines are required for everything from acute trauma scenarios to long term cancer treatments. However, this ubiquitous procedure has several morbid complications that are not uncommon. Possible complications include infection, catheter misplacement, arterial puncture, hematoma, pneumothorax, and death[1]. Not only are the complications severe they are also quite prevalent with a complication rate of 15 to 25 percent[2]. LOCAL PROBLEM: Due to a concern for the rates of central line infections across campuses at the University of Texas Southwestern Medical Center (UTSW) there was a project underway to create a standardized central line placement protocol for all departments in the system. This protocol was taught to all incoming residents on a simulation session day. However, because a significant period of time can pass between central line training and the clinical practice of placing central lines, the rate of resident retention and adherence to the standardized procedure for central line placement is unknown. This report describes the results of a QI experiment meant to reduce the rate of catheter associated blood stream infections and ensure better resident protocol adherence at UTSW medical center using checklists and visual aids to ensure implementation of the standardized protocols. METHODS: The study was split into three phases. The first phase examined the baseline knowledge of UTSW residents regarding the placement of central lines and found the nursing position regarding possible interventions. The residents were interviewed regarding the standardized UTSW protocol and asked to detail the steps of placing a central line. The results were used to analyses areas of weakness in protocol adherence. Based on the results of the interviews, a checklist and visual aid were created highlighting key steps to ensure the adherence to the protocol. In phase two, to evaluate the feasibility of incorporating a checklist and CVA into the original CVC insertion methodology, a simulated pilot was conducted, and a survey was completed by the participants to determine how staff perceived the use of these new tools. In phase three after analyzing the ability to integrate the checklist and visual aid in a simulated setting, the utility of using a checklist to improve CVC insertions was tested by conducting a pilot study on real patients. During the pilot, CVCs placed in the ICU were observed by a medical student with the bedside nurse's participation and real time completion of the checklist RESULTS: Phase 1: It was found that there were significant variations in the average adherence between departments and training years. On average, post graduate year (PGY)3s did better than PGY2s. Furthermore, it was found that 50% of missed steps were caused by only 8 out 36 questions and 75% of mistakes were caused by just 15 out of 36 questions. Phase 2: Simulated pilot Survey results showed that all participants felt that their team successfully followed the standardized placement method. The participants also said that the implemented huddle helped to create teamwork and organization, and that it could easily be incorporated into the normal workflow. Phase 3: In-practice pilot All trial participants were asked for feedback regarding the perceived benefit of the process. Results were very positive with most participants saying that they thought that the new workflow was helpful and easy to implement. Analysis of the completed checklists show that participants were able to complete the forms without issue ensuring that complete adherence to the standardized protocol was possible. CONCLUSIONS: By interviewing residents to understand areas of difficulties and going through a multistep approach to ensure safety and efficacy of interventions, this project provides insight into the possible gaps in resident procedure adherences and retention of the UTSW protocol. It then also provides an intervention that strengthen the memory of the preforming physician and a layer of oversight to ensure that even if a mistake is made it is quickly corrected. The general concepts of simulation trials prior to clinical application and utilization of a checklist and cognitive visual aid can be applied not only to central lines at UTSW, but to many different procedures across multiple hospital systems.Item Preventing healthcare-associated infections: beyond best practice(2011-07-15) Sreeramoju, PranaviItem Reduce infections together in everyone: a concept and a hospital program(2018-09-07) Sreeramoju, PranaviItem Rethinking contact isolation for multidrug-resistant organisms(2015-03-27) Cutrell, James (Brad)Item [Southwestern News](2005-07-20) Rian, RussellItem [UT News](1986-02-28) Rutherford, SusanItem [UT News](1985-10-30) Cason, Vicki