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Integration of genomic and clinical data augments surveillance of healthcare-acquired infections
- Doyle V. Ward, Andrew G. Hoss, Raivo Kolde, Helen C. van Aggelen, Joshua Loving, Stephen A. Smith, Deborah A. Mack, Raja Kathirvel, Jeffery A. Halperin, Douglas J. Buell, Brian E. Wong, Judy L. Ashworth, Mary M. Fortunato-Habib, Liyi Xu, Bruce A. Barton, Peter Lazar, Juan J. Carmona, Jomol Mathew, Ivan S. Salgo, Brian D. Gross, Richard T. Ellison III
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 40 / Issue 6 / June 2019
- Published online by Cambridge University Press:
- 23 April 2019, pp. 649-655
- Print publication:
- June 2019
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Background:
Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates.
Objective:To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review.
Methods:Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification.
Results:Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance.
Conclusions:Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.
Contributors
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- By Francesco Acerbi, Ayca Akgoz, Matthew R. Amans, Ramsey Ashour, Mohammed Ali Aziz-Sultan, H. Hunt Batjer, Donnie Bell, Bernard R. Bendok, Giovanni Broggi, Morgan Broggi, Charles A. Bruno, Steven D. Chang, In Sup Choi, Omar Choudhri, Douglas J. Cook, William P. Dillon, Peter Dirks, Rose Du, Travis M. Dumont, Tarek Y. El Ahmadieh, Najib E. El Tecle, Mohamed Samy Elhammady, Paolo Ferroli, Alana M. Flexman, John C. Flickinger, Kai U. Frerichs, Sasikhan Geibprasert, Adrian W. Gelb, Y. Pierre Gobin, Bradley A. Gross, Seunggu J. Han, Tomoki Hashimoto, Juha Hernesniemi, Roberto C. Heros, Steven W. Hetts, Randall T. Higashida, Joshua A. Hirsch, Nikolai J. Hopf, L. Nelson Hopkins, Maziyar A. Kalani, M. Yashar S. Kalani, Hideyuki Kano, Syed Aftab Karim, Robert M. Koffie, Douglas S. Kondziolka, Timo Krings, Aki Laakso, Giuseppe Lanzino, Michael T. Lawton, Elad I. Levy, L. Dade Lunsford, Adel M. Malek, Michael P. Marks, George A. C. Mendes, Philip M. Meyers, Jacques Morcos, Nitin Mukerji, Christian Musahl, Ludmila Pawlikowska, Matthew B. Potts, Ross Puffer, James D. Rabinov, Jonathan J. Russin, Mina G. Safain, Duke Samson, Marco Schiariti, R. Michael Scott, Jason P. Sheehan, Paul Singh, Edward R. Smith, Scott G. Soltys, Robert F. Spetzler, Gary K. Steinberg, Philip E. Stieg, Hua Su, Karel terBrugge, Kiron Thomas, Tarik Tihan, Babu Welch, Jonathan White, H. Richard Winn, Chun-Po Yen, Jacky T. Yeung, Byron Yip, Samer G. Zammar
- Edited by Robert F. Spetzler, Douglas S. Kondziolka, Randall T. Higashida, University of California, San Francisco, M. Yashar S. Kalani
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- Book:
- Comprehensive Management of Arteriovenous Malformations of the Brain and Spine
- Published online:
- 05 January 2015
- Print publication:
- 08 January 2015, pp x-xiv
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- By J. William Allwood, Eleni T. Bairaktari, Jean-Pierre Bellocq, Malika A. Benahmed, Hanne Christine Bertram, Zaver M. Bhujwalla, Ulrich Braumann, Juan Casado-Vela, Marta Cascante, Arancha Cebrián, Albert Chen, Man Ho Choi, Bong Chul Chung, Yuen-Li Chung, Morten Rahr Clausen, Patrick J. Cozzone, Ralph J. DeBerardinis, Julien Detour, Santiago Díaz-Moralli, Warwick B. Dunn, Karim Elbayed, Udo Engelke, Teresa W.-M. Fan, Ana M. Gil, Kristine Glunde, Markus Godejohann, Teresa Gómez del Pulgar, Royston Goodacre, Angelina Goudswaard, Gonçalo Graça, Richard W. Gross, Herbert H. Hill, Ralph E. Hurd, Alessio Imperiale, Kimberly A. Kaplan, Neil L. Kelleher, Michael A. Kiebish, Ann M. Knolhoff, Christina E. Kostara, Juan Carlos Lacal, Andrew N. Lane, Martin O. Leach, Norbert W. Lutz, Elizabeth Maher, Craig R. Malloy, Isaac Marin-Valencia, Laura Menchén, Bruce Mickey, Fanny Mochel, Éva Morava, François-Marie Moussallieh, Izzie J. Namer, Peter Nemes, Ioanna Ntai, Geoffrey S. Payne, Marie-France Penet, Martial Piotto, Stanislav S. Rubakhin, Elsa Sánchez-López, A. Dean Sherry, Bindesh Shrestha, Jonathan V. Sweedler, Akos Vertes, Mark R. Viant, Ralf J. M. Weber, Ron Wehrens, Ron A. Wevers, Catherine L. Winder, David S. Wishart, Kui Yang, Yi-Fen Yen
- Edited by Norbert W. Lutz, Jonathan V. Sweedler, University of Illinois, Urbana-Champaign, Ron A. Wevers
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- Book:
- Methodologies for Metabolomics
- Published online:
- 05 January 2013
- Print publication:
- 21 January 2013, pp viii-xii
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- By Aakash Agarwala, Linda S. Aglio, Rae M. Allain, Paul D. Allen, Houman Amirfarzan, Yasodananda Kumar Areti, Amit Asopa, Edwin G. Avery, Patricia R. Bachiller, Angela M. Bader, Rana Badr, Sibinka Bajic, David J. Baker, Sheila R. Barnett, Rena Beckerly, Lorenzo Berra, Walter Bethune, Sascha S. Beutler, Tarun Bhalla, Edward A. Bittner, Jonathan D. Bloom, Alina V. Bodas, Lina M. Bolanos-Diaz, Ruma R. Bose, Jan Boublik, John P. Broadnax, Jason C. Brookman, Meredith R. Brooks, Roland Brusseau, Ethan O. Bryson, Linda A. Bulich, Kenji Butterfield, William R. Camann, Denise M. Chan, Theresa S. Chang, Jonathan E. Charnin, Mark Chrostowski, Fred Cobey, Adam B. Collins, Mercedes A. Concepcion, Christopher W. Connor, Bronwyn Cooper, Jeffrey B. Cooper, Martha Cordoba-Amorocho, Stephen B. Corn, Darin J. Correll, Gregory J. Crosby, Lisa J. Crossley, Deborah J. Culley, Tomas Cvrk, Michael N. D'Ambra, Michael Decker, Daniel F. Dedrick, Mark Dershwitz, Francis X. Dillon, Pradeep Dinakar, Alimorad G. Djalali, D. John Doyle, Lambertus Drop, Ian F. Dunn, Theodore E. Dushane, Sunil Eappen, Thomas Edrich, Jesse M. Ehrenfeld, Jason M. Erlich, Lucinda L. Everett, Elliott S. Farber, Khaldoun Faris, Eddy M. Feliz, Massimo Ferrigno, Richard S. Field, Michael G. Fitzsimons, Hugh L. Flanagan Jr., Vladimir Formanek, Amanda A. Fox, John A. Fox, Gyorgy Frendl, Tanja S. Frey, Samuel M. Galvagno Jr., Edward R. Garcia, Jonathan D. Gates, Cosmin Gauran, Brian J. Gelfand, Simon Gelman, Alexander C. Gerhart, Peter Gerner, Omid Ghalambor, Christopher J. Gilligan, Christian D. Gonzalez, Noah E. Gordon, William B. Gormley, Thomas J. Graetz, Wendy L. Gross, Amit Gupta, James P. Hardy, Seetharaman Hariharan, Miriam Harnett, Philip M. Hartigan, Joaquim M. Havens, Bishr Haydar, Stephen O. Heard, James L. Helstrom, David L. Hepner, McCallum R. Hoyt, Robert N. Jamison, Karinne Jervis, Stephanie B. Jones, Swaminathan Karthik, Richard M. Kaufman, Shubjeet Kaur, Lee A. Kearse Jr., John C. Keel, Scott D. Kelley, Albert H. Kim, Amy L. Kim, Grace Y. Kim, Robert J. Klickovich, Robert M. Knapp, Bhavani S. Kodali, Rahul Koka, Alina Lazar, Laura H. Leduc, Stanley Leeson, Lisa R. Leffert, Scott A. LeGrand, Patricio Leyton, J. Lance Lichtor, John Lin, Alvaro A. Macias, Karan Madan, Sohail K. Mahboobi, Devi Mahendran, Christine Mai, Sayeed Malek, S. Rao Mallampati, Thomas J. Mancuso, Ramon Martin, Matthew C. Martinez, J. A. Jeevendra Martyn, Kai Matthes, Tommaso Mauri, Mary Ellen McCann, Shannon S. McKenna, Dennis J. McNicholl, Abdel-Kader Mehio, Thor C. Milland, Tonya L. K. Miller, John D. Mitchell, K. Annette Mizuguchi, Naila Moghul, David R. Moss, Ross J. Musumeci, Naveen Nathan, Ju-Mei Ng, Liem C. Nguyen, Ervant Nishanian, Martina Nowak, Ala Nozari, Michael Nurok, Arti Ori, Rafael A. Ortega, Amy J. Ortman, David Oxman, Arvind Palanisamy, Carlo Pancaro, Lisbeth Lopez Pappas, Benjamin Parish, Samuel Park, Deborah S. Pederson, Beverly K. Philip, James H. Philip, Silvia Pivi, Stephen D. Pratt, Douglas E. Raines, Stephen L. Ratcliff, James P. Rathmell, J. Taylor Reed, Elizabeth M. Rickerson, Selwyn O. Rogers Jr., Thomas M. Romanelli, William H. Rosenblatt, Carl E. Rosow, Edgar L. Ross, J. Victor Ryckman, Mônica M. Sá Rêgo, Nicholas Sadovnikoff, Warren S. Sandberg, Annette Y. Schure, B. Scott Segal, Navil F. Sethna, Swapneel K. Shah, Shaheen F. Shaikh, Fred E. Shapiro, Torin D. Shear, Prem S. Shekar, Stanton K. Shernan, Naomi Shimizu, Douglas C. Shook, Kamal K. Sikka, Pankaj K. Sikka, David A. Silver, Jeffrey H. Silverstein, Emily A. Singer, Ken Solt, Spiro G. Spanakis, Wolfgang Steudel, Matthias Stopfkuchen-Evans, Michael P. Storey, Gary R. Strichartz, Balachundhar Subramaniam, Wariya Sukhupragarn, John Summers, Shine Sun, Eswar Sundar, Sugantha Sundar, Neelakantan Sunder, Faraz Syed, Usha B. Tedrow, Nelson L. Thaemert, George P. Topulos, Lawrence C. Tsen, Richard D. Urman, Charles A. Vacanti, Francis X. Vacanti, Joshua C. Vacanti, Assia Valovska, Ivan T. Valovski, Mary Ann Vann, Susan Vassallo, Anasuya Vasudevan, Kamen V. Vlassakov, Gian Paolo Volpato, Essi M. Vulli, J. Matthias Walz, Jingping Wang, James F. Watkins, Maxwell Weinmann, Sharon L. Wetherall, Mallory Williams, Sarah H. Wiser, Zhiling Xiong, Warren M. Zapol, Jie Zhou
- Edited by Charles Vacanti, Scott Segal, Pankaj Sikka, Richard Urman
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- Book:
- Essential Clinical Anesthesia
- Published online:
- 05 January 2012
- Print publication:
- 11 July 2011, pp xv-xxviii
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Field astrobiology research in Moon–Mars analogue environments: instruments and methods
- B.H. Foing, C. Stoker, J. Zavaleta, P. Ehrenfreund, C. Thiel, P. Sarrazin, D. Blake, J. Page, V. Pletser, J. Hendrikse, S. Direito, J.M. Kotler, Z. Martins, G. Orzechowska, C. Gross, L. Wendt, J. Clarke, A.M. Borst, S.T.M. Peters, M.-B. Wilhelm, G.R. Davies, ILEWG EuroGeoMars 2009 Team
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- Journal:
- International Journal of Astrobiology / Volume 10 / Issue 3 / July 2011
- Published online by Cambridge University Press:
- 14 March 2011, pp. 141-160
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We describe the field demonstration of astrobiology instruments and research methods conducted in and from the Mars Desert Research Station (MDRS) in Utah during the EuroGeoMars campaign 2009 coordinated by ILEWG, ESA/ESTEC and NASA Ames, with the contribution of academic partners. We discuss the entire experimental approach from determining the geological context using remote sensing, in situ measurements, sorties with sample collection and characterization, analysis in the field laboratory, to the post sample analysis using advanced laboratory facilities.
We present the rationale for terrestrial field campaigns to strengthen astrobiology research and the link between in situ and orbital remote sensing data. These campaigns are supporting the preparation for future missions such as Mars Science Laboratory, ExoMars or Mars Sample Return. We describe the EuroGeoMars 2009 campaign conducted by MDRS crew 76 and 77, focused on the investigation of surface processes in their geological context. Special emphasis was placed on sample collection and pre-screening using in-situ portable instruments. Science investigations included geological and geochemical measurements as well as detection and diagnostic of water, oxidants, organic matter, minerals, volatiles and biota.
EuroGeoMars 2009 was an example of a Moon–Mars field research campaign dedicated to the demonstration of astrobiology instruments and a specific methodology of comprehensive measurements from selected sampling sites. We discuss in sequence: the campaign objectives and trade-off based on science, technical or operational constraints. This includes remote sensing data and maps, and geological context; the monitoring of environmental parameters; the geophysical context and mineralogy studies; geology and geomorphology investigations; geochemistry characterization and subsurface studies.
We describe sample handling (extraction and collection) methods, and the sample analysis of soils and rocks performed in the MDRS laboratory using close inspection, initial petrological characterization, microscopy, Visible-NIR spectrometry, Raman spectrometry, X-ray diffraction/X-ray fluorescence spectrometry, soil analysis, electrochemical and biological measurements.
The results from post-mission analysis of returned samples using advanced facilities in collaborator institutes are described in companion papers in this issue. We present examples of in-situ analysis, and describe an example investigation on the exploration and analysis of endolithic microbial mats (from reconnaissance, in-situ imaging, sampling, local analysis to post-mission sample analysis).
177 - Real-Time Imaging of the Endothelium
- from PART IV - DIAGNOSIS AND TREATMENT
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- By Peter L. Gross, St. Michael's Hospital, University of Toronto, Ontario, Canada
- Edited by William C. Aird, Harvard University, Massachusetts
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- Book:
- Endothelial Biomedicine
- Published online:
- 04 May 2010
- Print publication:
- 03 September 2007, pp 1654-1658
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Summary
Real-time imaging offers a powerful diagnostic tool to evaluate the many endothelial functions in an organism. Although the clinical use of real-time imaging of the endothelium is in its infancy, the use of this tool in diagnosing endothelial dysfunction in animal models is widespread and, in many cases, state-of-the-art.
The initial attraction of real-time imaging was the “wow factor.” A picture tells a thousand words – and a movie is even better! Seeing images that put in place concepts that previously were only imagined is a powerful tool.
But the real attraction of real-time imaging of the endothelium is that it allows for the spatial and temporal evaluation of experimental systems that are at a higher order of complexity (1) compared with traditional static assays. Historically, ignoring such complexity has impeded progress in endothelial research. Although studying protein structure in a crystal is complex and no doubt yields useful information, the function of that protein in a membrane, let alone in a cultured cell, is not always predictable. Similarly, the response to a stimulant of endothelial cells (ECs) in culture does not predict the response of ECs in vivo. Real-time imaging provides a window into functioning endothelium in the context of its native microenvironment (Table 177–1).
The aim of advancing technology is to allow observations in the natural, undisturbed environment. Until this is optimal, imaging of the endothelium has tended to suffer “the observer's paradox,” in which the observation affects the outcome. To obfuscate this has often meant that real-time imaging of the endothelium is limited to the microcirculation of organ surfaces or thin tissues, with a few exceptions.
Requirements for Infrastructure and Essential Activities of Infection Control and Epidemiology in Hospitals: A Consensus Panel Report
- William E. Scheckler, Dennis Brimhall, Alfred S. Buck, Barry M. Farr, Candace Friedman, Richard A. Garibaldi, Peter A. Gross, Jo-Ann Harris, Walter J. Hierholzer, Jr, William J. Martone, Linda L. McDonald, Steven L. Solomon
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 19 / Issue 2 / February 1998
- Published online by Cambridge University Press:
- 02 January 2015, pp. 114-124
- Print publication:
- February 1998
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The scientific basis for claims of efficacy of nosocomial infection surveillance and control programs was established by the Study on the Efficacy of Nosocomial Infection Control project. Subsequent analyses have demonstrated nosocomial infection prevention and control programs to be not only clinically effective but also cost-effective. Although governmental and professional organizations have developed a wide variety of useful recommendations and guidelines for infection control, and apart from general guidance provided by the Joint Commission on Accreditation of Healthcare Organizations, there are surprisingly few recommendations on infrastructure and essential activities for infection control and epidemiology programs. In April 1996, the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in hospitals. The following report represents the consensus panel's best assessment of needs for a healthy and effective hospital-based infection control and epidemiology program. The recommendations fall into eight categories: managing critical data and information; setting and recommending policies and procedures; compliance with regulations, guidelines, and accreditation requirements; employee health; direct intervention to prevent transmission of infectious diseases; education and training of healthcare workers; personnel resources; and nonpersonnel resources. The consensus panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Prevention's Hospital Infection Control Practices Advisory Committee.
Quality Standard for the Treatment of Bacteremia
- Peter A. Gross, Trisha L. Barrett, E. Patchen Dellinger, Peter J. Krause, William J. Martone, John E. McGowan, Jr, Richard L. Sweet, Richard P. Wenzel
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 3 / March 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 189-192
- Print publication:
- March 1994
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Objective:
The objective of this quality standard is to optimize the treatment of bacteremia in hospitalized patients by ensuring that the antibiotic given is appropriate in terms of the blood culture susceptibility of the pathogen. Although this standard may appear to be minimal in scope, it is needed because appropriate antimicrobial treatment is not given in 5% to 17% of cases. To implement the standard, physicians, pharmacists, and microbiologists will need to devise a coordinated strategy.
Options:We considered criteria for appropriate dosing, most cost-effective selection, proper antibiotic levels in serum, least toxicity, narrowest spectrum, specific clinical indications, and optimal duration of treatment. All these criteria were rejected as the basis for the standard because they were too controversial and too difficult to be applied by a nonphysician chart reviewer. In contrast, the selection of an antibiotic to which the pathogen is sensitive is a non-controversial criterion and easy for a chart reviewer to apply.
Outcomes:The standard is designed to reduce the incidence of adverse outcomes of septicemia such as renal failure, prolonged hos-pitalization, and death.
Evidence:Several well-designed clinical trials without randomization as well as case-controlled studies have confirmed the benefit of using an antibiotic that is appropriate in light of the susceptibility of the isolate in blood culture. Prospective, randomized, placebo-controlled trials are not available.
Values:Our premise is that the presence of bacteremia is a risk factor for serious adverse outcomes. We also believe that the administration of antibiotics must always be guided by the susceptibility report for the pathogen(s) obtained from blood cultures. This concern is more critical for pathogens from the blood than for those from most other body sites. We had evidence that susceptibility reports for pathogens from positive blood cultures were not always used properly. We used group discussion to reach a consensus among the members of the Quality Standards Subcommittee.
Benefits, Harms, and Costs:Through the implementation of this standard, at least 5% of bacteremias could be treated more appropriately. An unknown number of deaths would likely be prevented, and mortality from bacteremia treated inappropriately would probably be reduced. The primary undesirable feature of the standard is an increased workload of pharmacists and microbiologists.
Recommendations:Treatment of bacteremia with an antibiotic that is appropriate in terms of the pathogen's blood-culture susceptibility is a minimal standard of care for all patients.
Validation:We consulted more than 50 experts in infectious diseases from the fields of medicine, surgery, pediatrics, obstetrics and gynecology, nursing, epidemiology, pharmacology, and government. In addition, the methods for its implementation were reviewed by the American Society of Hospital Pharmacists and were tested by one of the members of the Quality Standards Subcommittee.
Sponsors:The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Diseases Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (Drs. Gross and McGowan), the Society for Hospital Epidemiology of America (Dr. Wenzel), the Surgical Infection Society (Dr. Dellinger), the Pediatric Infectious Diseases Society (Dr. Krause), the Centers for Disease Control and Prevention (Dr. Martone), the Obstetrics and Gynecology Infectious Diseases Society (Dr. Sweet), and the Association of Practitioners of Infection Control (Ms. Barrett). Funding was provided by the IDSA and the other cooperating organizations. This standard is endorsed by the IDSA.
Consensus Development of Quality Standards
- Peter A. Gross, Trisha L. Barrett, E. Patchen Dellinger, Peter J. Krause, William J. Martone, John E. McGowan, Jr, Richard L. Sweet, Richard P. Wenzel
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 3 / March 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 180-181
- Print publication:
- March 1994
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Quality Standard for Antimicrobial Prophylaxis in Surgical Procedures
- E. Patchen Dellinger, Peter A. Gross, Trisha L. Barrett, Peter J. Krause, William J. Martone, John E. McGowan, Jr, Richard L. Sweet, Richard P. Wenzel
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 3 / March 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 182-188
- Print publication:
- March 1994
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Objective:
The objectives of this quality standard are 1) to provide an implementation mechanism that will facilitate the reliable administration of prophylactic antimicrobial agents to patients undergoing operative procedures in which such a practice is judged to be beneficial and 2) to provide a guideline that will help local hospital committees formulate policies and set up mechanisms for their implementation. Although standards in the medical literature spell out recommendations for specific procedures, agents, schedules, and doses, other reports document that these standards frequently are not followed in practice.
Options:We have specified the procedures in which the administration of prophylactic antimicrobial agents has been shown to be beneficial, those in which this practice is widely thought to be beneficial but in which compelling evidence is lacking, and those in which this practice is controversial. We have examined the evidence regarding the optimal timing of drug administration, the optimal dose, and the optimal duration of prophylaxis.
Outcomes:The intended outcome is more uniform and reliable administration of prophylactic antibiotics in those circumstances where their value has been demonstrated or their use has been judged by the local practicing medical community to be desirable. The result should be a reduction in rates of postoperative wound infection with a limitation on the quantities of antimicrobial agents used in circumstances where they are not likely to help.
Evidence:Many prospective, randomized, controlled trials comparing placebo with antibiotic and comparing one antibiotic with another have been conducted. In addition, some trials have compared the efficacy of different doses or methods of administration. Other papers have reported on the apparent efficacy of administration at different times and on actual practice in specific communities. Only a small group of relevant articles found through 1993 are cited herein. When authoritative reviews are available, these-rather than an exhaustive list of original references-are cited.
Values:We assumed that reducing rates of postoperative infection was valuable but that reducing the total amount of antimicrobial agents employed was also worthwhile. The cost of and morbidity attributable to postoperative wound infections should be weighed against the cost and potential morbidity associated with excessive use of antimicrobial agents.
Benefits, Harms, and Costs:More reliable administration of antimicrobial agents according to recognized guidelines should prevent some postoperative wound infections while lowering the total quantity of these drugs used. No harms are anticipated. The costs involved are those of the efforts needed on a local basis to design and implement the mechanism that supports uniform and reliable administration of prophylactic antibiotics.
Recommendations:All patients for whom prophylactic antimicrobial agents are recommended should receive them. The agents given should be appropriate in light of published guidelines. A short duration of prophylaxis (usually < 24 hours) is recommended.
Validation:More than 50 experts in infectious disease and 10 experts in surgical infectious disease and surgical subspecialties reviewed the standard. In addition, the methods for its implementation were reviewed by the American Society of Hospital Pharmacists.
Sponsors:The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Disease Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (Drs. Gross and McGowan), the Society for Hospital Epidemiology of America (Dr. Wenzel), the Surgical Infection Society (Dr. Dellinger), the Pediatric Infectious Disease Society (Dr. Krause), the Centers for Disease Control and Prevention (Dr. Martone), the Obstetrics and Gynecology Infectious Diseases Society (Dr. Sweet), and the Association of Practitioners of Infection Control (Ms. Barrett). Funding was provided by the IDSA and the other cooperating organizations. The standard is endorsed by the IDSA.
Quality Standard for Assurance of Measles Immunity Among Health Care Workers
- Peter J. Krause, Peter A. Gross, Trisha L. Barrett, E. Patchen Dellinger, William J. Martone, John E. McGowan, Jr, Richard L. Sweet, Richard P. Wenzel
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 3 / March 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 193-199
- Print publication:
- March 1994
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Objective:
The objective of this quality standard is to prevent nosocomial transmission of measles by assuring universal measles-mumps-rubella (MMR) vaccination of all healthcare workers who lack immunity to measles. Although the primary emphasis is on healthcare workers in hospitals, those at other sites, such as clinics, nursing homes, and schools, are also included. It will be the responsibility of designated individuals at these institutions to implement the standard.
Options:We considered advocating the use of measles vaccine rather than MMR but chose the latter because it also protects against mumps and rubella and because it is more readily available.
Outcomes:The desired outcome is a reduction in the nosocomial transmission of measles.
Evidence:Although direct comparative studies are lacking, nosocomial outbreaks of measles have been reported (as recently as 1992) in institutions where measles immunization of nonimmune healthcare workers is not universal, whereas such outbreaks have not been reported in institutions with universal immunization.
Values and Validation:We consulted more than 50 infectious-disease experts in epidemiology, government, medicine, nursing, obstetrics and gynecology pediatrics, and surgery. In light of disagreement regarding the implementation of the standard, we used group discussions to reach a consensus.
Benefits, Harms, and Cost:The consequences of the transmission of measles (and of mumps and rubella) in a healthcare institution include not only the morbidity and mortality attributable to the disease, but also the significant cost of evaluating and containing an outbreak and the serious disruption of regular hospital routines when control measures are instituted. The potential harm to healthcare workers after the implementation of the standard consists of untoward effects of MMR vaccine, although the reactions of vaccines should be minimal with adherence to recommended vaccination procedures. Implementation of the standard should entail no expense to healthcare workers; the precise cost to institutions is unknown, but the expense would be mitigated by prevention of measles outbreaks.
Recommendations:We recommend MMR vaccination of all healthcare workers who lack immunity to measles.
Sponsors:The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Diseases Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (Drs. Gross and McGowan), the Society for Hospital Epidemiology of America (Dr. Wenzel), the Surgical Infection Society (Dr. Dellinger), the Pediatric Infectious Diseases Society (Dr. Krause), the Centers for Disease Control and Prevention (Dr. Martone), the Obstetrics and Gynecology Infectious Diseases Society (Dr. Sweet), and the Association of Practitioners of Infection Control (Ms. Barrett). Funding was provided by the IDSA and the other cooperating organizations. The standard is endorsed by the IDSA.