Browsing by Author "Lewis, Sarah S"
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Item Open Access Clinical utility of indium 111-labeled white blood cell scintigraphy for evaluation of suspected infection.(Open Forum Infect Dis, 2014-09) Lewis, Sarah S; Cox, Gary M; Stout, Jason EBACKGROUND: We sought to characterize the clinical utility of indium 111 ((111)In)-labeled white blood cell (WBC) scans by indication, to identify patient populations who might benefit most from this imaging modality. METHODS: Medical records for all patients who underwent (111)In-labeled WBC scans at our tertiary referral center from 2005 to 2011 were reviewed. Scan indication, results, and final diagnosis were assessed independently by 2 infectious disease physicians. Reviewers also categorized the clinical utility of each scan as helpful vs not helpful with diagnosis and/or management according to prespecified criteria. Cases for which clinical utility could not be determined were excluded from the utility assessment. RESULTS: One hundred thirty-seven scans were included in this analysis; clinical utility could be determined in 132 (96%) cases. The annual number of scans decreased throughout the study period, from 26 in 2005 to 13 in 2011. Forty-one (30%) scans were positive, and 85 (62%) patients were ultimately determined to have an infection. Of the evaluable scans, 63 (48%) scans were deemed clinically useful. Clinical utility varied by scan indication: (111)In-labeled WBC scans were more helpful for indications of osteomyelitis (35/50, 70% useful) or vascular access infection (10/15, 67% useful), and less helpful for evaluation of fever of unknown origin (12/35, 34% useful). CONCLUSIONS: (111)In-labeled WBC scans were useful for patient care less than half of the time at our center. Targeted ordering of these scans for indications in which they have greater utility, such as suspected osteomyelitis and vascular access infections, may optimize test utilization.Item Open Access Early experience with universal preprocedural testing for SARS-CoV-2 in a relatively low-prevalence area.(Infection control and hospital epidemiology, 2020-08-03) Lewis, Sarah S; Smith, Becky A; Akinboyo, Ibukunoluwa C; Seidelman, Jessica; Wolfe, Cameron; Kirk, Allan B; Martin, Gavin; Denny, Thomas; Lobaugh, Bruce; Rehder, Catherine; Cardona, Diana; Lee, Mark J; Polage, Christopher R; Datto, Michael BWe implemented universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing of patients undergoing surgical procedures as a means to conserve personal protective equipment (PPE). The rate of asymptomatic coronavirus disease 2019 (COVID-19) was <0.5%, which suggests that early local public health interventions were successful. Although our protocol was resource intensive, it prevented exposures to healthcare team members.Item Open Access Early recognition and response to increases in surgical site infections using optimised statistical process control charts-The early 2RIS trial: A multicentre stepped wedge cluster randomised controlled trial.(EClinicalMedicine, 2022-12) Baker, Arthur W; Ilieş, Iulian; Benneyan, James C; Lokhnygina, Yuliya; Foy, Katherine R; Lewis, Sarah S; Wood, Brittain; Baker, Esther; Crane, Linda; Crawford, Kathryn L; Cromer, Andrea L; Padgette, Polly; Roach, Linda; Adcock, Linda; Nehls, Nicole; Salem, Joseph; Bratzler, Dale; Dellinger, E Patchen; Greene, Linda R; Huang, Susan S; Mantyh, Christopher R; Anderson, Deverick JBackground
Traditional approaches for surgical site infection (SSI) surveillance have deficiencies that delay detection of SSI outbreaks and other clinically important increases in SSI rates. We investigated whether use of optimised statistical process control (SPC) methods and feedback for SSI surveillance would decrease rates of SSI in a network of US community hospitals.Methods
We conducted a stepped wedge cluster randomised trial of patients who underwent any of 13 types of common surgical procedures across 29 community hospitals in the Southeastern United States. We divided the 13 procedures into six clusters; a cluster of procedures at a single hospital was the unit of randomisation and analysis. In total, 105 clusters were randomised to 12 groups of 8-10 clusters. All participating clusters began the trial in a 12-month baseline period of control or "traditional" SSI surveillance, including prospective analysis of SSI rates and consultative support for SSI outbreaks and investigations. Thereafter, a group of clusters transitioned from control to intervention surveillance every three months until all clusters received the intervention. Electronic randomisation by the study statistician determined the sequence by which clusters crossed over from control to intervention surveillance. The intervention was the addition of weekly application of optimised SPC methods and feedback to existing traditional SSI surveillance methods. Epidemiologists were blinded to hospital identity and randomisation status while adjudicating SPC signals of increased SSI rates, but blinding was not possible during SSI investigations. The primary outcome was the overall SSI prevalence rate (PR=SSIs/100 procedures), evaluated via generalised estimating equations with a Poisson regression model. Secondary outcomes compared traditional and optimised SPC signals that identified SSI rate increases, including the number of formal SSI investigations generated and deficiencies identified in best practices for SSI prevention. This trial was registered at ClinicalTrials.gov, NCT03075813.Findings
Between Mar 1, 2016, and Feb 29, 2020, 204,233 unique patients underwent 237,704 surgical procedures. 148,365 procedures received traditional SSI surveillance and feedback alone, and 89,339 procedures additionally received the intervention of optimised SPC surveillance. The primary outcome of SSI was assessed for all procedures performed within participating clusters. SSIs occurred after 1171 procedures assigned control surveillance (prevalence rate [PR] 0.79 per 100 procedures), compared to 781 procedures that received the intervention (PR 0·87 per 100 procedures; model-based PR ratio 1.10, 95% CI 0.94-1.30, p=0.25). Traditional surveillance generated 24 formal SSI investigations that identified 120 SSIs with deficiencies in two or more perioperative best practices for SSI prevention. In comparison, optimised SPC surveillance generated 74 formal investigations that identified 458 SSIs with multiple best practice deficiencies.Interpretation
The addition of optimised SPC methods and feedback to traditional methods for SSI surveillance led to greater detection of important SSI rate increases and best practice deficiencies but did not decrease SSI rates. Additional research is needed to determine how to best utilise SPC methods and feedback to improve adherence to SSI quality measures and prevent SSIs.Funding
Agency for Healthcare Research and Quality.Item Open Access Enhancement of infection prevention case review process to optimize learning from defects.(Journal of infection prevention, 2022-05) Reynolds, Staci S; Sova, Christopher; Lozano, Halie; Bhandari, Kalpana; Taylor, Bonnie; Lobaugh-Jin, Erica; Carriker, Charlene; Lewis, Sarah S; Smith, Becky A; Kalu, Ibukunoluwa CHospitals continue to struggle with preventable healthcare-associated infections. Whereas the focus is generally on proactive prevention processes, performing retrospective case reviews of infections can identify opportunities for quality improvement and maximize learning from defects. This brief article provides practical information for structuring the case review process using readily available health system platforms. Using a structured approach for case reviews can help identify trends and opportunities for improvement.Item Open Access Epidemiologic Trends in Clostridioides difficile Infections in a Regional Community Hospital Network(JAMA Network Open) Turner, Nicholas A; Grambow, Steven C; Woods, Christopher W; Fowler, Vance G; Moehring, Rebekah W; Anderson, Deverick J; Lewis, Sarah SItem Open Access Identification of novel risk factors for community-acquired Clostridium difficile infection using spatial statistics and geographic information system analyses.(PLoS One, 2017) Anderson, Deverick J; Rojas, Leoncio Flavio; Watson, Shera; Knelson, Lauren P; Pruitt, Sohayla; Lewis, Sarah S; Moehring, Rebekah W; Sickbert Bennett, Emily E; Weber, David J; Chen, Luke F; Sexton, Daniel J; CDC Prevention Epicenters ProgramBACKGROUND: The rate of community-acquired Clostridium difficile infection (CA-CDI) is increasing. While receipt of antibiotics remains an important risk factor for CDI, studies related to acquisition of C. difficile outside of hospitals are lacking. As a result, risk factors for exposure to C. difficile in community settings have been inadequately studied. MAIN OBJECTIVE: To identify novel environmental risk factors for CA-CDI. METHODS: We performed a population-based retrospective cohort study of patients with CA-CDI from 1/1/2007 through 12/31/2014 in a 10-county area in central North Carolina. 360 Census Tracts in these 10 counties were used as the demographic Geographic Information System (GIS) base-map. Longitude and latitude (X, Y) coordinates were generated from patient home addresses and overlaid to Census Tracts polygons using ArcGIS; ArcView was used to assess "hot-spots" or clusters of CA-CDI. We then constructed a mixed hierarchical model to identify environmental variables independently associated with increased rates of CA-CDI. RESULTS: A total of 1,895 unique patients met our criteria for CA-CDI. The mean patient age was 54.5 years; 62% were female and 70% were Caucasian. 402 (21%) patient addresses were located in "hot spots" or clusters of CA-CDI (p<0.001). "Hot spot" census tracts were scattered throughout the 10 counties. After adjusting for clustering and population density, age ≥ 60 years (p = 0.03), race (<0.001), proximity to a livestock farm (0.01), proximity to farming raw materials services (0.02), and proximity to a nursing home (0.04) were independently associated with increased rates of CA-CDI. CONCLUSIONS: Our study is the first to use spatial statistics and mixed models to identify important environmental risk factors for acquisition of C. difficile and adds to the growing evidence that farm practices may put patients at risk for important drug-resistant infections.Item Open Access Multi-faceted strategies improve collection compliance and sample acceptance rate for carbapenem-resistant Enterobacteriaceae (CRE) active surveillance testing.(American journal of infection control, 2021-08) Sova, Christopher; Lewis, Sarah S; Smith, Becky A; Reynolds, StaciBackground
Active surveillance testing (AST) is one element of a comprehensive Carbapenem-resistant Enterobacteriaceae (CRE) prevention strategy. However, the utility of AST may be impacted by compliance with sample collection and the quality of specimens. Here, we describe strategies used to optimize a CRE AST program at a large academic medical center.Methods
Tests ordered, collected, rejected, and processed were tracked weekly for each participating unit. Sample collection compliance and acceptance rates were calculated and tracked weekly. Strategies were implemented to improve collection compliance and sample acceptance rates, including computerized provider order entry, printed educational materials, and audit and feedback. Weekly dedicated Infection Preventionist (IP) time was estimated.Results
Over 35 months, mean collection compliance increased from 82.7% to 91.2%, and then decreased to 86.2%. Over 27 months, sample acceptance rate increased from 57.7% to 83.6%, and then remained stable at 83.4%. Over 39 months, dedicated weekly IP time decreased 92%.Discussion
Use of evidence-based quality improvement strategies optimized our CRE AST program. Optimizing the AST process aids in early CRE detection, leading to timely isolation and preventing the spread of CRE to other patients. Other hospitals may benefit from these lessons and enhance local AST programs.Item Open Access Mycobacterium avium pseudo-outbreak associated with an outpatient bronchoscopy clinic: Lessons for reprocessing.(Infection control and hospital epidemiology, 2019-01) Seidelman, Jessica L; Wallace, Richard J; Iakhiaeva, Elena; Vasireddy, Ravikiran; Brown-Elliott, Barbara A; McKnight, Celeste; Chen, Luke F; Smith, Terry; Lewis, Sarah SWe identified a pseudo-outbreak of Mycobacterium avium in an outpatient bronchoscopy clinic following an increase in clinic procedure volume. We terminated the pseudo-outbreak by increasing the frequency of automated endoscope reprocessors (AER) filter changes from quarterly to monthly. Filter changing schedules should depend on use rather than fixed time intervals.Item Open Access Novel and emerging sources of Clostridioides difficile infection.(PLoS pathogens, 2019-12-19) Turner, Nicholas A; Smith, Becky A; Lewis, Sarah SItem Open Access Sustained reduction in catheter-associated urinary tract infections using multi-faceted strategies led by champions: A quality improvement initiative.(Infection control and hospital epidemiology, 2022-07) Reynolds, Staci S; Sova, Chris D; Lewis, Sarah S; Smith, Becky A; Wrenn, Rebekah H; Turner, Nicholas A; Advani, Sonali DWe reviewed the sustainability of a multifaceted intervention on catheter-associated urinary tract infection (CAUTI) in 3 intensive care units. During the 4-year postintervention period, we observed reductions in urine culture rates (from 80.9 to 47.5 per 1,000 patient days; P < .01), catheter utilization (from 0.68 to 0.58; P < .01), and CAUTI incidence rates (from 1.7 to 0.8 per 1,000 patient days; P = .16).Item Open Access Universal masking is an effective strategy to flatten the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) healthcare worker epidemiologic curve.(Infection control and hospital epidemiology, 2020-12) Seidelman, Jessica L; Lewis, Sarah S; Advani, Sonali D; Akinboyo, Ibukunoluwa C; Epling, Carol; Case, Matthew; Said, Kristen; Yancey, William; Stiegel, Matthew; Schwartz, Antony; Stout, Jason; Sexton, Daniel J; Smith, Becky AItem Open Access Using clinical decision support to improve urine testing and antibiotic utilization.(Infection control and hospital epidemiology, 2023-03) Yarrington, Michael E; Reynolds, Staci S; Dunkerson, Tray; McClellan, Fabienne; Polage, Christopher R; Moehring, Rebekah W; Smith, Becky A; Seidelman, Jessica L; Lewis, Sarah S; Advani, Sonali DObjective
Urine cultures collected from catheterized patients have a high likelihood of false-positive results due to colonization. We examined the impact of a clinical decision support (CDS) tool that includes catheter information on test utilization and patient-level outcomes.Methods
This before-and-after intervention study was conducted at 3 hospitals in North Carolina. In March 2021, a CDS tool was incorporated into urine-culture order entry in the electronic health record, providing education about indications for culture and suggesting catheter removal or exchange prior to specimen collection for catheters present >7 days. We used an interrupted time-series analysis with Poisson regression to evaluate the impact of CDS implementation on utilization of urinalyses and urine cultures, antibiotic use, and other outcomes during the pre- and postintervention periods.Results
The CDS tool was prompted in 38,361 instances of urine cultures ordered in all patients, including 2,133 catheterized patients during the postintervention study period. There was significant decrease in urine culture orders (1.4% decrease per month; P < .001) and antibiotic use for UTI indications (2.3% decrease per month; P = .006), but there was no significant decline in CAUTI rates in the postintervention period. Clinicians opted for urinary catheter removal in 183 (8.5%) instances. Evaluation of the safety reporting system revealed no apparent increase in safety events related to catheter removal or reinsertion.Conclusion
CDS tools can aid in optimizing urine culture collection practices and can serve as a reminder for removal or exchange of long-term indwelling urinary catheters at the time of urine-culture collection.