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Infection Control Clinical Reference ListINDEXWriterJancin BSubjectAntibiotic –Resistant PathogensPublicationPageCardiology News. 2004 Mar;2(3):n.p.22Found on 77% of ECG LeadWiresRoberts RRThe Use of Economic ModelingClinical Infections Diseases. 2003 Jun 1;36(11):1424-32et al.to Determine the Hospital Costshttp://www.ncbi.nlm.nih.gov/pubmed/?term The Use of Economic ModAssociated with Nosocomialeling to Determine the Hospital Costs Associated with Nosocomial IInfectionsnfectionsKlevens RMEstimating Health Care-Public Health Report. 2007 Mar-Apr;122(2):160-6.et al.Associated Infections and Deathshttp://www.ncbi.nlm.nih.gov/pubmed/?term Estimating Health Care-in U.S. Hospitals, 2002Associated Infections and Deaths in U.S. Hospitals%2C 2002Disposable vs reusableCritical Care Nurse. 2011 Jun;31(3):62-8.electrocardiography leads inhttp://www.ncbi.nlm.nih.gov/pubmed/21632593Brown DQ23development of and crosscontamination by resistantbacteria.GoldmannStrategies to Prevent and ControlJAMA. 1996 Jan 17;275(3):234-40.DA et al.the Emergence and Spread ofhttp://www.ncbi.nlm.nih.gov/pubmed/?term . Strategies to prevent andAntimicrobial-Resistant control the emergence and spread of antimicrobial-Microorganisms in Hospitals. Aresistant microorganisms in hospitals%3A a challenge to hospital lechallenge to hospital leadership.adership.Haley RW etThe efficacy of infectionAmerican Journal of Epidemiology. 1985 Feb;121(2):182-al.surveillance and control205.programs in 1534nosocomial infections in UShospitals.Kohn,To Err is Human: Building a SaferCommittee on Quality of Health Care in America, InstituteCorrigan, andHealth System.of Medicine (2000) Washington, DC: National m.nih.gov/books/NBK22518214

Jancin BAntibiotic –Resistant Pathogens Found on 77% ofCardiology News. 2004 Mar;2(3):n.p.ECG Lead WiresCHICAGO – Reusable ECG leads have come under scrutiny as reservoirs for multidrug-resistant bacterial pathogensthat may potentially play an important role in serious nosocomial infections in hospitalized patients.Roberts R et al.The Use of Economic Modeling to Determine theClinical Infections Diseases. 2003Hospital Costs Associated with Nosocomial InfectionsJun 1;36(11):1424-32Abstract: Hospital-associated infection is well recognized as a patient safety concern requiring preventive interventions.However, hospitals are closely monitoring expenditures and need accurate estimates of potential cost savings from suchprevention programs. We used a retrospective cohort design and economic modeling to determine the excess cost fromthe hospital perspective for hospital-associated infection in a random sample of adult medical patients. Study patientswere classified as being not infected (n 139), having suspected infection (n 8), or having confirmed infection (n 17).Severity of illness and intensive unit care use were both independently associated with increased cost. After controllingfor these confounding effects, we found an excess cost of 6767 for suspected infection and 15,275 for confirmedhospital-acquired infection. The economic model explained 56% of the total variability in cost among patients. Hospitalscan use these data when evaluating potential cost savings from effective infection-control measures.Klevens R et al.Estimating Health Care-Associated Infections andPublic Health Report. 2007 Mar-Deaths in U.S. Hospitals, 2002Apr;122(2):160-6.Objective: The purpose of this study was to provide a national estimate of the number of healthcare-associatedinfections (HAI) and deaths in United States hospitals.Method: No single source of nationally representative data on HAIs is currently available. The authors used a multi-stepapproach and three data sources. The main source of data was the National Nosocomial Infections Surveillance (NNIS)system, data from 1990-2002, conducted by the Centers for Disease Control and Prevention. Data from the NationalHospital Discharge Survey (for 2002) and the American Hospital Association Survey (for 2000) were used to supplementNNIS data. The percentage of patients with an HAI whose death was determined to be caused or associated with theHAI from NNIS data was used to estimate the number of deaths.Results: In 2002, the estimated number of HAIs in U.S. hospitals, adjusted to include federal facilities, wasapproximately 1.7 million: 33,269 HAIs among newborns in high-risk nurseries, 19,059 among newborns in well-babynurseries, 417,946 among adults and children in ICUs, and 1,266,851 among adults and children outside of ICUs. Theestimated deaths associated with HAIs in U.S. hospitals were 98,987: of these, 35,967 were for pneumonia, 30,665 forbloodstream infections, 13,088 for urinary tract infections, 8,205 for surgical site infections, and 11,062 for infections ofother sites.Conclusion: HAIs in hospitals are a significant cause of morbidity and mortality in the United States. The methoddescribed for estimating the number of HAIs makes the best use of existing data at the national level.2

Brown DQDisposable vs reusable electrocardiography leads inCritical Care Nurse. 2011development of and cross-contamination by resistantJun;31(3):62-8.bacteria.Abstract: Hospital-acquired infections caused by antibacterial-resistant microorganisms are associated with highmortality and morbidity rates and markedly affect hospital economics. The expense became greater in 2008 whenreimbursement for treatment of hospital-acquired infections was no longer provided by Medicare. Infections caused bycross-contamination with resistant bacteria can be eliminated by 3 methods: kill the bacteria before resistance develops,stop bacteria from communicating and acquiring resistance, and eliminate the pathway from one patient to another.Because electrocardiography wires cannot be completely disinfected 100% of the time, they may be contributing to thegrowth of resistant bacteria. The many pathways provided by reusable wires for cross-contamination with resistantbacteria increase the risk for hospital-acquired infection when these wires are used. Disposable electrocardiographyleads eliminate risk of infection through these pathways. Adoption of disposable electrocardiography leads as an adjunctto an overall infection control program can decrease infection rates in acute health care facilities.Goldmann DA et al.Strategies to Prevent and Control the Emergence andJAMA. 1996 Jan 17;275(3):234-40.Spread of Antimicrobial-Resistant Microorganisms inHospitals. A challenge to hospital leadership.Objective: To provide hospital leaders with strategic goals or actions likely to have a significant impact on antimicrobialresistance, outline outcome and process measures for evaluating progress toward each goal, describe potential barriersto success, and suggest countermeasures and novel improvement strategies.Participants: A multidisciplinary group of experts was drawn from the following areas: hospital epidemiology and infectioncontrol, infectious diseases (including graduate training programs), clinical practice (including nursing, surgery, internalmedicine, and pediatrics), pharmacy, administration, quality improvement, appropriateness evaluation, behaviormodification, practice guideline development, medical informatics, and outcomes research. Representatives fromappropriate federal agencies, the Joint Commission on Accreditation of Healthcare Organizations, and thepharmaceutical industry also participated.Evidence: Published literature, guidelines, expert opinion, and practical experience regarding efforts to improve antibioticutilization and prevent and control the emergence and dissemination of antimicrobial-resistant microorganisms inhospitals.Consensus Process: Participants were divided into two quality improvement teams: one focusing on improvingantimicrobial usage and the other on preventing and controlling transmission of resistant microorganisms. The teamsmodeled the process a hospital might use to develop and implement a strategic plan to combat antimicrobial resistance.Conclusions: Ten strategic goals and related process and outcome measures were agreed on. The five strategic goalsto optimize antimicrobial use were as follows: optimizing antimicrobial prophylaxis for operative procedures; optimizingchoice and duration of empiric therapy; improving antimicrobial prescribing by educational and administrative means;3

monitoring and providing feedback regarding antibiotic resistance; and defining and implementing health care deliverysystem guidelines for important types of antimicrobial use. The five strategic goals to detect, report, and preventtransmission of antimicrobial resistant organisms were as follows: to develop a system to recognize and report trends inantimicrobial resistance within the institution; develop a system to rapidly detect and report resistant microorganisms inindividual patients and ensure a rapid response by caregivers; increase adherence to basic infection control policies andprocedures; incorporate the detection, prevention, and control of antimicrobial resistance into institutional strategic goalsand provide the required resources; and develop a plan for identifying, transferring, discharging, and readmitting patientscolonized with specific antimicrobial-resistant pathogens.Haley RW et al.The efficacy of infection surveillance and controlAmerican Journal of Epidemiology.programs in preventing nosocomial infections in US1985 Feb;121(2):182-205.hospitals.Abstract: In a representative sample of US general hospitals, the authors found that the establishment of intensiveinfection surveillance and control programs was strongly associated with reductions in rates of nosocomial urinary tractinfection, surgical wound infection, pneumonia, and bacteremia between 1970 and 1975-1976, after controlling for othercharacteristics of the hospitals and their patients. Essential components of effective programs included conductingorganized surveillance and control activities and having a trained, effectual infection control physician, an infectioncontrol nurse per 250 beds, and a system for reporting infection rates to practicing surgeons. Programs with thesecomponents reduced their hospitals' infection rates by 32%. Since relatively few hospitals had very effective programs,however, only 6% of the nation's approximately 2 million nosocomial infections were being prevented in the mid-1970s,leaving another 26% to be prevented by universal adoption of these programs. Among hospitals without effectiveprograms, the overall infection rate increased by 18% from 1970 to 1976.Kohn, Corrigan, andTo Err is Human: Building A Safer Health SystemDonaldson, EditorsCommittee on Quality of Health Carein America, Institute of Medicine(2000) Washington, DC: NationalAcademies Press.Excerpt: Experts estimate that as many as 98,000 people die in any given year from medical errors that occur inhospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDS--three causes that receive far morepublic attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financialcost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To ErrIs Human breaks the silence that has surrounded medical errors and their consequence--but not by pointing fingers atcaring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth anational agenda--with state and local implications--for reducing medical errors and improving patient safety through thedesign of a safer health system. This volume reveals the often startling statistics of medical error and the disparitybetween the incidence of error and public perception of it, given many patients' expectations that the medical professionalways performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, andmarket activity influence the quality of care provided by health care organizations and then looks at their handling ofmedical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes4

happen. A key theme is that legitimate liability concerns discourage reporting of errors--which begs the question, "Howcan we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts,the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership,improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err IsHuman asserts that the problem is not bad people in health care--it is that good people are working in bad systems thatneed to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level ofpatient safety in American health care. It also explains how patients themselves can influence the quality of care thatthey receive once they check into the hospital. This book will be vitally important to federal, state, and local health policymakers and regulators, health professional licensing officials, hospital administrators, medical educators and students,health caregivers, health journalists, patient advocates--as well as patients themselves.5

ECG Lead Wires Cardiology News. 2004 Mar;2(3):n.p. CHICAGO – Reusable ECG leads have come under scrutiny as reservoirs for multidrug-resistant bacterial pathogens that may potentially play an important role in serious nosocomial infections in hospitalized patients. Robert