October 2013

Columbia Nursing Research Presented at Premier Infectious Disease Conference



Entrance View with Logo The need for effective monitoring of infection-control practices was a theme running through Columbia Nursing presentations at IDWeek 2013

Columbia Nursing presented a wide range of research at this year’s IDWeek meeting in San Francisco. IDWeek highlights the latest developments in prevention, diagnosis, treatment and epidemiology of infections disease. The meeting is sponsored by the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association and the Pediatric Infectious Diseases Society.

One major theme running through the Columbia Nursing presentations was the need for effective monitoring and enforcement of infection-control practices for the most vulnerable patients – such as infants in neonatal intensive care units and residents of long-term care facilities. Our researchers also focused on an electronic hand-hygiene monitoring system, the costs that can arise from healthcare-associated infections, strategies for preventing bloodstream infections, and the prevalence of multidrug resistant infections.

Following are capsule summaries of these presentations.

 

Comparison of Hospital Charges Associated With Healthcare-Associated Infections in Neonatal Intensive Care Units; Murray M., Ferng Y., Patel S., Alba L., Mis F., Zaoutis T., Coffin S.E., Leckerman K., Prasad P., Paul D., Gray K., DeLaMora P., Perlman J., Jia H., Glied S., Larson E., Saiman L.

The Association of Central-Line Associated Bloodstream Infection Rates and Compliance With Bundle Strategies in Pediatric ICUs; Edwards J., Liu H., Herzig C., Pogorzelska-Maziarz M., Zachariah P., Furuya E.Y., Dick A., Stone P., Saiman L.

Preventing infections in the neonatal intensive care unit (NICU) not only improves the odds of survival for these infants – it also has the potential to reduce the cost of their care. Surveillance Officer Meghan Murray, MPH pointed out in her poster presentation that previous research on infection-related charges hasn’t looked at this population. In one study, the research team found that average charges for NICU patients with bloodstream infections were significantly higher than for those with other types of infections.  The three-year review examined hospital records for more than 6,000 NICU patients and found that bloodstream infections made the average charge more than five times greater than the typical tab for infants who didn’t get infections. The findings show that bloodstream infections are a particular cause for concern and suggest that reduction of healthcare-acquired infections could reduce NICU costs. Another research project looked at central line insertion policies for pediatric intensive care units and found overall compliance with the recommended practices was low.

Compliance With Prevention Practices and Central Line Associated Bloodstream Infection Rates in Neonatal Intensive Care Units in the United States; Zachariah P., Furuya E.Y., Edwards J., Dick A., Liu H.,Herzig C., Pogorzelska-Maziarz M., Stone P., Saiman L.

In addition to examining the costs of infections in the NICU, another study demonstrated the importance of proper placement and handling of catheters to prevent bloodstream infections. Many of these vulnerable infants receive medicines, fluids, nutrients and blood through a catheter, also known as a central line. A research team that included Patricia Stone, PhD, MPH, professor, Monika Pogorzelska-Maziarz, PhD, MPH, associate research scientist and Carolyn Herzig, MS, PhD student, examined infection control efforts at 190 U.S NICUs and found that most facilities had plenty of room to improve monitoring and compliance. Less than one third of the NICUs surveyed reported at least 95 percent compliance with all prevention policies – a level associated with a significant reduction in infections.

Epidemiology and Risk Factors for Primary Bloodstream Infection (pBSI) in Solid Organ Transplant Recipients; Pouch S., Liu J., Larson E.

Bloodstream infections are particularly common among transplant recipients, increasing risk of organ rejection and death. Associated Dean for Research Elaine Larson, PhD, contributed to a study of infection rates that underscores the need for more stringent prevention efforts. While previous research has examined the risks for infections that spread to the bloodstream from elsewhere in the body, little has been published on infections that start in the blood. The work, which reviewed outcomes for more than 1,600 transplant recipients at New York-Presbyterian Hospital, found risk varied by organ, with the highest incidence among intestinal transplant recipients. Inpatient procedures done after the transplant increased the infection risk, underscoring the importance of prevention.

Infection Prevention Resources and Policies in Acute Care Hospitals: Results From a National Study; Stone P.W., Pogorzelska-Maziarz M., Herzig C.T.A., Furuya E.Y., Dick A.W., Larson E.

Patricia Stone PhD, FAAN, director of the Center for Health Policy, reviewed programs in place at acute care hospitals. Hospital-based infections cost U.S. hospitals approximately $33 billion a year, yet it isn’t clear how to best organize prevention programs. The study, supported by the National Institute of Nursing Research, looked at infections linked to devices such as catheters and ventilators used in intensive care units (ICUs). While prevention measures were widespread, adherence varied widely. Most hospitals, for example, recommended raising the head of patients’ beds to avert pneumonia associated with ventilators, but less than half of adult ICUs followed this guideline. Additional study is needed to analyze associations between the work of infection-control departments and compliance.

Assessing an Automated Group Monitoring and Feedback System for Hand Hygiene; Conway L., Riley L., Cohen B., Saiman L., Alper P., Larson E.

Hand hygiene is one of the most effective methods to control infection in health-care settings, yet compliance remains inconsistent. In her poster presentation, PhD student Laurie J. Conway, RN, Center for Health Policy, reviewed an emerging technology that electronically monitors hand hygiene and generates reports to help track and improve adherence.  Managers, department heads and executives at a 140-bed community hospital received monthly reports on how often dispensers for alcohol hand rub and soap were used. In inpatient units, hand hygiene improved significantly, while there wasn’t a marked change in the emergency department or outpatient units.

Burden of Multidrug Resistant Infections in Long-Term Care Settings: A Systematic Review of the Literature; Pogorzelska-Maziarz M., Alvarez K., Larson E.

Respiratory Illness Among Residents of Pediatric Long-Term Care Facilities During Influenza Season; Murray M., Cohen B., Buet A., Keenan M., Pavia M., Hutcheon G., Simpser E., Mosiello L., Larson E., Saiman L., Neu N.

Long-term care facilities are another setting where more research is needed on infections. One literature review led by Monika Pogorzelska-Maziarz, tried to pin down the prevalence of multidrug resistant infections in this setting and found a lack of standardized surveillance methods and varied definitions of antibiotic resistance made it difficult to draw conclusions. Another study led by Meghan Murray and PhD student Bevin Cohen, MPH, Program Director, Center for Interdisciplinary Research to Prevent Infections (CIRI), highlighted the need for rapid viral diagnostic testing to detect and treat infections among residents of pediatric long-term care facilities. The study followed children during flu season and found that one in five of them had at least one respiratory infection over the five-month period. Rapid testing could show where use of antimicrobials or isolation might be warranted, the study suggests.