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Automated outbreak detection of hospital-associated pathogens: Value to infection prevention programs
- Meghan A. Baker, Deborah S. Yokoe, John Stelling, Ken Kleinman, Rebecca E. Kaganov, Alyssa R. Letourneau, Neha Varma, Thomas O’Brien, Martin Kulldorff, Damilola Babalola, Craig Barrett, Marci Drees, Micaela H. Coady, Amanda Isaacs, Richard Platt, Susan S. Huang, for the CDC Prevention Epicenters Program
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue 9 / September 2020
- Published online by Cambridge University Press:
- 10 June 2020, pp. 1016-1021
- Print publication:
- September 2020
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- Article
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Objective:
To assess the utility of an automated, statistically-based outbreak detection system to identify clusters of hospital-acquired microorganisms.
Design:Multicenter retrospective cohort study.
Setting:The study included 43 hospitals using a common infection prevention surveillance system.
Methods:A space–time permutation scan statistic was applied to hospital microbiology, admission, discharge, and transfer data to identify clustering of microorganisms within hospital locations and services. Infection preventionists were asked to rate the importance of each cluster. A convenience sample of 10 hospitals also provided information about clusters previously identified through their usual surveillance methods.
Results:We identified 230 clusters in 43 hospitals involving Gram-positive and -negative bacteria and fungi. Half of the clusters progressed after initial detection, suggesting that early detection could trigger interventions to curtail further spread. Infection preventionists reported that they would have wanted to be alerted about 81% of these clusters. Factors associated with clusters judged to be moderately or highly concerning included high statistical significance, large size, and clusters involving Clostridioides difficile or multidrug-resistant organisms. Based on comparison data provided by the convenience sample of hospitals, only 9 (18%) of 51 clusters detected by usual surveillance met statistical significance, and of the 70 clusters not previously detected, 58 (83%) involved organisms not routinely targeted by the hospitals’ surveillance programs. All infection prevention programs felt that an automated outbreak detection tool would improve their ability to detect outbreaks and streamline their work.
Conclusions:Automated, statistically-based outbreak detection can increase the consistency, scope, and comprehensiveness of detecting hospital-associated transmission.
Contributors
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- By Ashok Agarwal, Joseph P Alukal, Deborah J Anderson, Linda D Applegarth, Saleh Binsaleh, Elizabeth M Bloom, Karen E Boyle, Nancy L Brackett, Robert E Brannigan, James V Bruckner, Victor M Brugh, Ettore Caroppo, Grace M Centola, Aleksander Chudnovsky, Susan L Crockin, Fnu Deepinder, David M. Fenig, Aaron B Grotas, Matthew P. Hardy, Wayne J. G. Hellstrom, Stanton C Honig, Stuart S Howards, Keith Jarvi, Rajasingam S Jeyendran, William E Kaplan, Edward Karpman, Sanjay S Kasturi, Mohit Khera, Nancy A Klein, Dolores J Lamb, Jane M Lewis, Larry I Lipshultz, Kirk C Lo, Charles M Lynne, R. Dale McClure, Antoine A Makhlouf, Myles Margolis, Clara I. Marín-Briggiler, Randall B Meacham, Jesse N Mills, John P Mulhall, Alexander Müller, Christine Mullin, Harris M Nagler, Craig S Niederberger, Robert D Oates, Dana A Ohl, E. Charles Osterberg, Rodrigo L Pagani, Vassilios Papadopoulos, Joseph A Politch, Gail S Prins, Angela A Reese, Susan A Rothmann, Edmund S Sabanegh, Denny Sakkas, Jay I Sandlow, Richard A Schoor, Paulo C Serafini, Mark Sigman, Suresh C Sikka, Rebecca Z Sokol, Jens Sønksen, Miguel Srougi, James Stelling, Justin Tannir, Anthony J Thomas, Paul J Turek, Terry T Turner, Mónica H. Vazquez-Levin, Moshe Wald, Thomas J Walsh, Thomas M Wheeler, Daniel H Williams, Armand Zini, Barry R Zirkin
- Edited by Larry I. Lipshultz, Stuart S. Howards, University of Virginia, Craig S. Niederberger, University of Illinois, Chicago
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- Book:
- Infertility in the Male
- Published online:
- 19 May 2010
- Print publication:
- 24 September 2009, pp vii-x
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16 - The built environment 1300–1540
- from Part III - The later middle ages 1300–1540
- Edited by D. M. Palliser, University of Leeds
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- Book:
- The Cambridge Urban History of Britain
- Published online:
- 28 March 2008
- Print publication:
- 21 December 2000, pp 371-394
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Summary
‘Coming into Canterbury’, wrote Charles Dickens in David Copperfield, ‘I loitered through the old streets with a sober pleasure that calmed my spirits and eased my heart. There were the old signs, the old names over the shops … the venerable Cathedral towers … the battered gateways.’ For Dickens, and for the modern visitor to towns where medieval fabric can still be seen (such as Norwich, which claims to have more surviving medieval churches than any other town in western Europe), the built environment creates a powerful sense of place and a reassuring frame of reference. We can try to reconstruct the former townscape and delve behind it to study the relationship between physical settings and the attitudes which influenced the conduct of medieval life.
The construction of the built environment in medieval British towns reflected both social values and personal initiatives or personal monument making, be it repairing a bridge, erecting a conduit or adding a chapel to the local parish church. But the period was not static. Over the two and a half centuries covered by this chapter, certain developments and underlying trends can be seen.
During the medieval period, several features of construction and amenity first appeared in towns: jetties for the first floor and higher by 1300 (already in London by 1246), dormer windows by 1450 and the flooring over of halls which probably happened in profusion in towns during the fifteenth century before it was necessary or thought fashionable in the countryside. The underlying motors were the conjunction of pressure on space and the availability of cash, generated by trade and other urban pursuits (such as rents), which created the climate for innovation and display, both at the level of grand patronage in a church or the ordinary house.