Introduction: The Hawthorne effect, or behaviour change due to awareness of being observed, is believed to inflate directly observed hand hygiene compliance rates, but evidence is limited. Methods: A real-time location system tracked hospital hand hygiene auditors and recorded alcohol-based hand rub and soap dispenses. Rates of hand hygiene events per dispenser per hour within sight of auditors were compared to dispensers not exposed to auditors. Results: The event rate in dispensers visible to auditors (3.75/dispenser/hour) was significantly higher than unexposed dispensers at the same time (1.48) and in prior weeks (1.07). The rate increased significantly when auditors were present compared to five minutes prior to arrival. There were no significant changes inside patient rooms. Conclusions: Hand hygiene event rates increase in hallways when auditors are visible and the increase occurs after the auditors’ arrival, consistent with the existence of a Hawthorne effect localized to areas where auditors are visible.

Methicillin-Resistant Staphylococcus aureus (MRSA) began as a nosocomial infection due to overuse of antibiotics. Several previous studies have reported an increase in this infection in adult patients who have not been hospitalized. It has also been reported that there is an increase in MRSA in children. Some of these children became infected even though they were not at high risk for the infection. After approval from the All Children's Hospital Institutional Review Board (IRB), a cross sectional study was conducted with pediatric admissions and pediatric emergency room visits to determine the characteristics of Methicillin-Sensitive Staphylococcus aureus and MRSA. During this study, a review of 672 medical charts was conducted. The study participants ranged in age from newborns to 18 years of age. In order to be enrolled in the study, the subjects' cultures were collected either as outpatients or within 72 hours of admission. The data that was collected from each chart included age, race/ethnicity, gender, type of infection, preexisting medical conditions, and risk factors for infection. The potential risk factors include antibiotic use, previous surgery or outpatient procedure, previous MRSA infection, immunotherapy, community worn device, and residence in a facility. Statistical analysis was conducted using Epi Info and SAS software packages. In regards to demographic characteristics, black children are 2.98 times more likely to have an MRSA infection than white children. Gender and age were not risk factors for the development of the infection. The risk factors that were significant in whites were home health care (OR= 6.12, CI= 5.16, 7.08), community worn device (OR= 2.28, CI= 1.67, 2.89), previous hospitalization (OR= 2.43, CI= 1.95, 2.91), previous MRSA infection (OR= 3.69, CI= 2.90, 4.48), and previous surgery (OR= 2.02, CI= 1.51, 2.53). In blacks, females were more likely to have MRSA (OR= 2.57, CI= 1.73, 3.41). This finding may be due to the small sample size of black children in the study. Of the analyzed risk factors, home health care (OR= 2.95, CI= 1.11, 4.79), community worn device (OR= 2.85, CI= 1.71, 4.01), previous hospitalization (OR= 1.98, CI= 1.13, 2.83), previous surgery (OR= 2.79, CI= 1.79, 3.79), and previous antibiotic (OR= 5.60, CI= 4.66, 6.54) use were all significant risk factors in blacks. Effect modification was tested between race and all risk factors. Race was an effect modifier only for the risk factor of previous antibiotic use (pvalue =.02). Adjustment of confounding was performed for each race due to the presence of effect modification. After the adjustment for confounding in whites, only home health care (OR=4.37 CI= 1.55, 12.32), previous MRSA infection (OR= 2.86 CI= 1.16, 7.05), and previous hospitalization (OR= 2.00 CI= 1.14, 3.50) remained statistically significant. In blacks, after adjustment of confounding, only previous antibiotic use (OR= 5.13 CI= 1.75, 15.08) remained significant. Adjustment for confounding was also preformed on the total risk factors model. A dose response relationship was present with increasing risk factors present.

Orientador: Carlos Magno Castelo Branco Fortaleza / Resumo: Atualmente, estamos diante de uma notável presença de isolados de enterobactérias resistentes aos carbapenêmicos em um hospital público do município de Bauru-SP desde outubro de 2012. No entanto, não estão disponíveis estudos relacionando a epidemiologia e os fatores associados à aquisição de tais isolados. Este estudo teve como objetivo identificar fatores de risco para aquisição de Enterobactérias Resistentes aos Carbapenêmicos (CRE) em pacientes internados no Hospital Estadual Bauru, os fatores associados ao desenvolvimento de quadro infeccioso em uma coorte de pacientes colonizados por CRE e os fatores preditores de óbito. Foram incluídos pacientes do local de estudo que apresentaram colonização do trato digestório por CRE, de outubro de 2012 a dezembro de 2016, dos quais foram levantados dados clínicos e demográficos. Os isolados foram identificados por métodos fenotípicos e foram testadas as suscetibilidades por concentração inibitória mínima (MIC). Realizamos um estudo de caso-controle que incluiu 427 casos e igual número de controles. Os fatores de risco observados foram queimadura (HR 3,91; IC95% 2,36-6,46; p=<0,001), índice de Charlson (HR 1,12; IC95% 1,05-1,20; p=<0,001), uso prévio de esteróides (HR 2,79; IC95% 1,94-4,02; p=<0,001) e antimicrobianos como as penicilinas/inibidores de beta-lactamases (HR 2,01; IC95% 1,43-2,82; p=<0,001), cefalosporinas de 3ª. e 4ª. gerações (HR 2,45; IC95% 1,75-3,44; p=<0,001), quinolonas (HR 1,70; IC95% 1,75-2,45; p=0,003) e anaero... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Currently, we are facing a remarkable presence of isolates of carbapenem-resistant enterobacteriacea in Bauru city public hospital, São Paulo state, Brazil, since october 2012. However no studies are available relating the epidemiology and the factors associated with acquisition of such isolates. The purpose this study was to identify risk factors for acquisition of Carbapenem Resistant Enterobacteriaceae in patients hospitalized at the Bauru State Hospital, factors associated with the development of infectious disease in a cohort of patients colonized by CLP and factors predicting death. We included patients from the study site who presented colonization of the digestive tract by CRE, from October 2012 to December 2016, from which clinical and demographic data were collected. Isolates were identified by phenotypic methods and susceptibilities were tested by minimum inhibitory concentration (MIC). We performed a case-control study that included 427 cases and an equal number of controls. The risk factors observed were burn (HR 3.91, 95% CI 2.36-6.46, p = 0.001), Charlson index (HR 1.12, 95% CI 1.05-1.20, p = <0.001), previous use of steroids (HR 2.79, 95% CI 1.94-4.02, p = <0.001) and antimicrobials such as penicillins / beta-lactamase inhibitors (HR 2.01, 95% CI, 43-2.82, p = <0.001), cephalosporins of 3rd. and 4ª. (HR 2.45, IC 95% 1.75-3.44, p = 0.001), quinolones (HR 1.70, IC 95% 1.75-2.45, p = 0.003) and anaerobicides (HR 1, 63, 95% CI 1.04-2.56, p = 0.03). The cohort stud... (Complete abstract click electronic access below) / Doutor

Catheter associated urinary tract infection (CAUTI) incidence continue to rise despite all prevention efforts. The state of Georgia incidence of CAUTI between 2012 and 2013 showed an increase by 350 cases. The challenge is translating CAUTI prevention knowledge into practice by all physicians. The purpose of this correlational study was to improve the epidemiological understanding of CAUTI. Looking at physicians’ perception and practice of CAUTI preventions was necessary. A total of 336 physicians from the state of Georgia completed a 26-item survey. Additionally, a pilot study was conducted on a small sample of participants. The result of the Cronbach alpha for the pilot study analysis of the 26-item survey instrument indicated excellent reliability. The analysis revealed that participants’ frequency of training on proper catheterization and their perception of CAUTI risk factors and effective implementation of CAUTI prevention bundle elements, varied significantly. It also resulted that many of the participants were not knowledgeable of certain important CAUTI prevention elements. Only a few made changes in their practice despite knowledge of the Center for Medicare and Medicaid Services reimbursement policy. Results of the Pearson’s chi-square test for independence indicated a significant correlation (p < .05) between physicians’ perception and practice of CAUTI prevention elements and CAUTI incidence. The results of this study suggest that current CAUTI prevention practice may be inefficient without the effective implementation of proven bundled element. Improved understanding of CAUTI and its relation to effective implementation of bundled prevention elements may result in improved prevention efforts, decreased morbidity, mortality, and overall healthcare cost.

Les Acinetobacter sont des bactéries opportunistes impliquées dans les infections nosocomiales.Le but de ce travail était d’étudier leur épidémiologie et écologie au Liban.Tout d’abord, nous avons analysé 119 souches d’A.baumannii isolées de plusieurs hôpitaux. 76.5 % étaient résistantes aux carbapénèmes et le gène OXA-23 était le plus fréquemment trouvé. Le typage par Multilocus sequence typing a montré que le clone international II était majoritairement détecté. L’électrophorèse en champ pulsé a révélé que 72.6% des souches appartenant au ST2 ont été classées dans un même cluster qui semble être prédominant à Beirut et Tripoli. Ensuite, les réservoirs extrahospitaliers ont été investigués sur 2361 prélèvements collectés au Liban. Au total, 171 souches ont été isolées dans l’environnement, les produits alimentaires ainsi que chez l’homme et les animaux. La majorité de ces souches, globalement sensibles aux antibiotiques, était des Acinetobacter non baumannii, Seuls 15 A.baumannii, de 14 STs différents dont 10 nouveaux ont été isolés. Enfin, nous avons conduit une étude taxonomique approfondie sur plusieurs souches d’Acinetobacter non identifiées au rang d’espèce et retrouvées dans notre étude. Nous avons ainsi caractérisé une nouvelle espèce, nommée « Acinetobacter lebanonensis ».Ce travail a montré que le Liban était un pays à forte endémie d’A.baumannii résistants aux carbapénèmes. Nous n’avons toutefois pas mis en évidence de lien entre les souches cliniques et extrahospitalières, les clones correspondants étant globalement différents. D’autres études sont nécessaires pour élucider l’origine des souches multi-résistantes émergeant dans les hôpitaux. / Acinetobacter spp are opportunistic bacteria widely involved in nosocomial infections. The aim of this work was to study the epidemiology and the ecology of these bacteria in Lebanon. First, we have analyzed 119 clinical strains of A.baumannii. 76.5% of them were resistant to carbapenems and the production of OXA-23 was the main mechanism. Multi-locus sequence typing revealed the predominance of international clone II. Pulsed field gel electrophoresis showed that 72.6% of strains belonging to ST2 were classified in the same cluster which appeared to be predominant in Beirut and Tripoli. On the other hands, Acinetobacter reservoirs were investigated on 2361 samples collected in Lebanon. A total number of 171 strains have been isolated in the environment, food, humans and animals. The majority of these strains was identified as non baumannii Acinetobacter and was susceptible to antibiotics. Besides, typing of A.baumannii revealed the presence of 14 STs including 10 new ones. Finally, we have described a novel species called “Acinetobacter lebanonensis” by conducting a taxonomic study on several strains isolated in Lebanon and other countries. Although the data may be limited, this work has shown the endemic situation of carbapenem resistant A.baumannii circulating in the Lebanese hospitals while the extra hospital ones were different. However, further studies are needed to elucidate the origin of these emerging multidrug resistant strains.

Catheter associated urinary tract infection (CAUTI) incidence continue to rise despite all prevention efforts. The state of Georgia incidence of CAUTI between 2012 and 2013 showed an increase by 350 cases. The challenge is translating CAUTI prevention knowledge into practice by all physicians. The purpose of this correlational study was to improve the epidemiological understanding of CAUTI. Looking at physicians' perception and practice of CAUTI preventions was necessary. A total of 336 physicians from the state of Georgia completed a 26-item survey. Additionally, a pilot study was conducted on a small sample of participants. The result of the Cronbach alpha for the pilot study analysis of the 26-item survey instrument indicated excellent reliability. The analysis revealed that participants' frequency of training on proper catheterization and their perception of CAUTI risk factors and effective implementation of CAUTI prevention bundle elements, varied significantly. It also resulted that many of the participants were not knowledgeable of certain important CAUTI prevention elements. Only a few made changes in their practice despite knowledge of the Center for Medicare and Medicaid Services reimbursement policy. Results of the Pearson's chi-square test for independence indicated a significant correlation (p < .05) between physicians' perception and practice of CAUTI prevention elements and CAUTI incidence. The results of this study suggest that current CAUTI prevention practice may be inefficient without the effective implementation of proven bundled element. Improved understanding of CAUTI and its relation to effective implementation of bundled prevention elements may result in improved prevention efforts, decreased morbidity, mortality, and overall healthcare cost.

No description available.

The primary objective of this dissertation is to utilise, adapt and extend current stochastic models and statistical inference techniques to describe the transmission of nosocomial pathogens, i.e. hospital-acquired pathogens, and multiply-resistant organisms within the hospital setting. The emergence of higher levels of antibiotic resistance is threatening the long term viability of current treatment options and placing greater emphasis on the use of infection control procedures. The relative importance and value of various infection control practices is often debated and there is a lack of quantitative evidence concerning their effectiveness. The methods developed in this dissertation are applied to data of methicillin-resistant Staphylococcus aureus occurrence in intensive care units to quantify the effectiveness of infection control procedures. Analysis of infectious disease or carriage data is complicated by dependencies within the data and partial observation of the transmission process. Dependencies within the data are inherent because the risk of colonisation depends on the number of other colonised individuals. The colonisation times, chain and duration are often not visible to the human eye making only partial observation of the transmission process possible. Within a hospital setting, routine surveillance monitoring permits knowledge of interval-censored colonisation times. However, consideration needs to be given to the possibility of false negative outcomes when relying on observations from routine surveillance monitoring. SI (Susceptible, Infected) models are commonly used to describe community epidemic processes and allow for any inherent dependencies. Statistical inference techniques, such as the expectation-maximisation (EM) algorithm and Markov chain Monte Carlo (MCMC) can be used to estimate the model parameters when only partial observation of the epidemic process is possible. These methods appear well suited for the analysis of hospital infectious disease data but need to be adapted for short patient stays through migration. This thesis focuses on the use of Bayesian statistics to explore the posterior distributions of the unknown parameters. MCMC techniques are introduced to overcome analytical intractability caused by partial observation of the epidemic process. Statistical issues such as model adequacy and MCMC convergence assessment are discussed throughout the thesis. The new methodology allows the quantification of the relative importance of different transmission routes and the benefits of hospital practices, in terms of changed transmission rates. Evidence-based decisions can therefore be made on the impact of infection control procedures which is otherwise difficult on the basis of clinical studies alone. The methods are applied to data describing the occurrence of methicillin-resistant Staphylococcus aureus within intensive care units in hospitals in Brisbane and London