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Effect of Removing Contact Precautions for Multidrug-Resistant Organisms on Hospital Infections in a Pediatric Health System
- Matthew Linam, Dorian Hoskins, Preeti Jaggi, Mark Gonzalez, Renee Watson, Andi Shane
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s199-s200
- Print publication:
- October 2020
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Background: Discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) have failed to show an increase in associated transmission or infections in adult healthcare settings. Pediatric experience is limited. Objective: We evaluated the impact of discontinuing contact precautions for MRSA, VRE, and extended-spectrum β-lactamase–producing gram-negative bacilli (ESBLs) on device-associated healthcare-associated infections (HAIs). Methods: In October 2018, contact precautions were discontinued for children with MRSA, VRE, and ESBLs in a large, tertiary-care pediatric healthcare system comprising 2 hospitals and 620 beds. Coincident interventions that potentially reduced HAIs included blood culture diagnostic stewardship (June 2018), a hand hygiene education initiative (July 2018), a handshake antibiotic stewardship program (December 2018) and multidisciplinary infection prevention rounding in the intensive care units (November 2018). Compliance with hand hygiene and HAI prevention bundles were monitored. Device-associated HAIs were identified using standard definitions. Annotated run charts were used to track the impact of interventions on changes in device-associated HAIs over time. Results: Average hand hygiene compliance was 91%. Compliance with HAI prevention bundles was 81% for ventilator-associated pneumonias, 90% for catheter-associated urinary tract infections, and 97% for central-line–associated bloodstream infections. Overall, device-associated HAIs decreased from 6.04 per 10,000 patient days to 3.25 per 10,000 patient days after October 2018 (Fig. 1). Prior to October 2018, MRSA, VRE and ESBLs accounted for 10% of device-associated HAIs. This rate decreased to 5% after October 2018. The decrease in HAIs was likely related to interventions such as infection prevention rounds and handshake stewardship. Conclusions: Discontinuation of contact precautions for children with MRSA, VRE, and ESBLs were not associated with increased device-associated HAIs, and such discontinuation is likely safe in the setting of robust infection prevention and antibiotic stewardship programs.
Funding: None
Disclosures: None
The ability of 29 barley cultivars to compete and withstand competition
- Paul R. Watson, Douglas A. Derksen, Rene C. Van Acker
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- Journal:
- Weed Science / Volume 54 / Issue 4 / August 2006
- Published online by Cambridge University Press:
- 20 January 2017, pp. 783-792
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Using competitive crops and cultivars can be an important integrated weed management (IWM) tool, useful in both conventional and low-external-input (LEI) farming systems. Barley is considered a competitive crop, but cultivar competitiveness varies. There are two aspects of cultivar competitive ability; the ability to compete (AC) and the ability to withstand competition (AWC). However, the relationship between these aspects has not been addressed in barley. A study was conducted to explore aspects of barley cultivar competitive ability with oats, and to examine the feasibility of ranking cultivars based on either, or both, AWC and AC. Field trials were undertaken in 2001 and 2002 to determine cultivar competitive ability for 29 barley cultivars commonly grown on the Canadian prairies. Cultivars were selected from semidwarf and full height, hulled and hull-less, 2- and 6-row, and feed and malt classes. Yield loss ranged from 6 to 79% while weed seed return ranged from 10 to 83% of gross yield. As a class, semidwarf and hull-less cultivars were less competitive than full height and hulled cultivars, respectively. However, considerable variation existed within these classes, and an absolute relationship between class membership and competitive ability did not exist. Ability to withstand competition was significantly correlated with ability to compete, but correlation coefficients were not strong enough to attempt reliable co-selection within a breeding program. Ability to compete was a more consistent measure of competitive ability than AWC. Ranking barley cultivar competitive ability would make it a valuable IWM tool for farmers and extension personnel.
A multistudy approach to understanding weed population shifts in medium- to long-term tillage systems
- A. Gordon Thomas, Douglas A. Derksen, Robert E. Blackshaw, Rene C. Van Acker, Anne Légère, Paul R. Watson, Gary C. Turnbull
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- Journal:
- Weed Science / Volume 52 / Issue 5 / October 2004
- Published online by Cambridge University Press:
- 20 January 2017, pp. 874-880
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Production systems based on reduced-tillage practices account for over 60% of the cropped land on the Canadian Prairies. Concerns have been expressed regarding potential shifts in weed communities as a result of changing tillage practices. Study objectives were to (1) determine the feasibility of combining and analyzing weed abundance data from 10 medium- to long-term studies on the Canadian Prairies that compared conventional-, reduced-, and zero-tillage systems, (2) identify species that are associated with specific tillage systems, and (3) place species into plant response groups according to the similarity of their tillage system response. Conventional-tillage systems were defined as including both a fall and spring sweep-plow operation before seeding spring crops, whereas reduced tillage consisted of only one sweep-plow operation shortly before seeding. Crops within zero-tillage systems were planted directly into the previous crop's stubble. The association between weed species and tillage systems was investigated using indicator species analysis. Species were assigned to tillage response groups on the basis of the results of the analysis and the expertise of the project scientists. Perennial species such as Canada thistle and perennial sowthistle were associated with reduced- and zero-tillage systems, but annual species were associated with a range of tillage systems. Field pennycress was placed in the conventional-tillage response group, Russian thistle in the zero-tillage group, and wild buckwheat and common lambsquarters were equally abundant in all tillage systems. The goal of classifying weed species based on common functional traits in relation to responses to tillage systems was not realized, in part, because the required information on species biology and ecology was either unavailable or not applicable to local conditions.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Chapter 25 - Policies for Capacity Development
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- By Lynn Mytelka, United Nations University-MERIT, Francisco Aguayo, El Colegio de México, Grant Boyle, McCarthy Tétrault LLP, Sylvia Breukers, Duneworks, Gabriel de Scheemaker, Conduit Ventures Ltd., Ibrahim Abdel Gelil, Arabian Gulf University, René Kemp, United Nations University-MERIT, Joachim Monkelbaan, International Centre for Trade and Sustainable Development, Carolina Rossini, University of São Paulo, Jim Watson, University of Sussex, Rosemary Wolson, Council for Scientific and Industrial Research, Staffan Jacobsson, Chalmers University of Technology, Upendra Tripathy, Government of India, John T. Wilbanks, The Ewing Marro Kauffman Foundation, Youba Sokona, United Nations Economic Commission
- Global Energy Assessment Writing Team
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- Book:
- Global Energy Assessment
- Published online:
- 05 September 2012
- Print publication:
- 27 August 2012, pp 1745-1802
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Summary
Executive Summary
This chapter focuses on capacities and capacity development for energy transitions. The transitions put forward in GEA require a transformation of energy systems that demand significant changes in the way energy is supplied and used today, irrespective of whether the technologies involved are new to the world or to a country, its producers or users.
Energy transitions are, by definition, long-term, socially embedded processes in the course of which capacities at the individual, organizational, and systems levels, as well as the policies for capacity development themselves, will inevitably change. From this perspective, capacity development can no longer be seen as a simple aggregation of individual skills and competences or the introduction of a new “technology.” Rather, it is a broad process of change in production and consumption patterns, knowledge, skills, organizational forms, and – most importantly – in the established practices and norms of the actors involved, or what are called informal institutions. In other words, a host of new and enhanced capacities will be needed over time. Informal institutions are reflected in a range of beliefs and boundaries that shape choices about new energy technologies. These can include engineering beliefs about what is feasible or worth attempting and boundaries that shape the processes of choice, such as lines of research to pursue, kinds of products to produce, or practices of consultation and dialogue. They also emerge as “path dependence” in contexts where earlier investments result in high sunk costs, habits and practices are entrenched, and “expert views” are shaped by earlier thinking that narrows the range of choices to established technologies and evaluation techniques.
Contributors
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- By Brian Abaluck, Imran M. Ahmed, Torbjörn Åkerstedt, Sonia Ancoli-Israel, Anna Anund, Donna L. Arand, Isabelle Arnulf, Fiona C. Baker, Thomas J. Balkin, Christian R. Baumann, Michel Billiard, Michael H. Bonnet, Meredith Broderick, Christian Cajochen, Scott S. Campbell, Sarah Laxhmi Chellappa, Fabio Cirignotta, Yves Dauvilliers, David F. Dinges, Christopher L. Drake, Neil T. Feldman, Catherine S. Fichten, Charles F. P. George, Namni Goel, Christian Guilleminault, Shelby F. Harris, Melinda L. Jackson, Joseph Kaleyias, Göran Kecklund, William D. S. Killgore, Sanjeev V. Kothare, Andrew D. Krystal, Clete A. Kushida, Luc Laberge, Gert Jan Lammers, Christopher P. Landrigan, Sandrine H. Launois, Patrick Levy, Eva Libman, Yinghui Low, Jennifer L. Martin, Una D. McCann, Renee Monderer, Patricia J. Murphy, Sona Nevsimalova, Seiji Nishino, Eric A. Nofzinger, Maurice M. Ohayon, Masashi Okuro, Jean-Louis Pepin, Fabio Pizza, Anil N. Rama, David B. Rye, Paula K. Schweitzer, Hideto Shinno, Renaud Tamsier, Michael J. Thorpy, Astrid van der Heide, Hans P. A. Van Dongen, Mari Viola-Saltzman, Jim Waterhouse, Nathaniel F. Watson, Rajive Zachariah
- Edited by Michael J. Thorpy, Michel Billiard
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- Book:
- Sleepiness
- Published online:
- 04 February 2011
- Print publication:
- 27 January 2011, pp vii-x
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Catheter-Related Polymicrobial Bloodstream Infections among Pediatric Bone Marrow Transplant Outpatients—Atlanta, Georgia, 2007
- Petra Wiersma, Sarah Schillie, Harry Keyserling, J. Renee Watson, Anindya De, Shailendra N. Banerjee, Cherie L. Drenzek, Kathryn E. Arnold, Christina Shivers, Lea Kendrick, Lydia Gonzalez Ryan, Bette Jensen, Judith Noble-Wang, Arjun Srinivasan
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 31 / Issue 5 / May 2010
- Published online by Cambridge University Press:
- 02 January 2015, pp. 522-527
- Print publication:
- May 2010
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Objective.
To identify risk factors for polymicrobial bloodstream infections (BSIs) in pediatric bone marrow transplant (BMT) outpatients attending a newly constructed clinic affiliated with a children's hospital.
Methods.All 30 outpatients treated at a new BMT clinic during September 10-21, 2007, were enrolled in a cohort study. The investigation included interviews, medical records review, observations, and bacterial culture and molecular typing of patient and environmental isolates. Data were analyzed using exact conditional logistic regression.
Results.Thirteen patients experienced BSIs caused by 16 different, predominantly gram-negative organisms. Presence of a tunneled catheter (odds ratio [OR], 19.9 [95% confidence interval {CI}, 2.4-∞), catheter access (OR, 13.7 [95% CI, 1.8-∞]), and flushing of a catheter with predrawn saline (OR, 12.9 [95% CI, 1.0-766.0]) were independently associated with BSI. The odds of experiencing a BSI increased by a factor of 16.8 with each additional injection of predrawn saline (95% CI, 1.8-827.0). Although no environmental source of pathogens was identified, interviews revealed breaches in recommended infection prevention practice and medication handling. Saline flush solutions were predrawn, and multiple doses were obtained from single-dose preservative-free vials to avoid delays in patient care.
Conclusion.We speculate that infection prevention challenges in the new clinic, combined with successive needle punctures of vials, facilitated extrinsic contamination and transmission of healthcare-associated pathogens. We recommend that preservative-free single-use vials not be punctured more than once. Use of single-use prefilled saline syringes might prevent multiuse of single-use saline vials. Storage of saline outside a medication supply system might be advisable. Before opening new clinic facilities, hospitals should consider conducting a mock patient flow exercise to identify infection control challenges.