Browsing by Author "Smith, Becky A"

Now showing 1 - 9 of 9
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    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 B
    We 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.
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    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 C
    Hospitals 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.
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    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, Staci

    Background

    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.
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    Novel and emerging sources of Clostridioides difficile infection.
    (PLoS pathogens, 2019-12-19) Turner, Nicholas A; Smith, Becky A; Lewis, Sarah S
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    Reducing Clostridioides difficile Infections in a Medical Intensive Care Unit: A Multimodal Quality Improvement Initiative.
    (Dimensions of critical care nursing : DCCN, 2024-07) Barker, Lisa; Gilstrap, Daniel; Sova, Christopher; Smith, Becky A; Reynolds, Staci S

    Background

    Clostridioides difficile (C. diff) infection causes significant morbidity for hospitalized patients. A large medical intensive care unit had an increase in C. diff infection rates.

    Objectives

    The aim of this project was to reduce the C. diff polymerase chain reaction (PCR) test positivity rate and the rate of C. diff PCR tests ordered. Rates were compared between preintervention (July 2017 to December 2019) and postintervention (January 2021 to December 2022) timeframes.

    Methods

    Unit leadership led a robust quality improvement project, including use of quality improvement tools such as A3, Gemba walks, and plan-do-study-act cycles. Interventions were tailored to the barriers identified, including standardization of in-room supply carts; use of single-packaged oral care kits; new enteric precautions signage; education to staff, providers, and visitors; scripting for patients and visitors; and use of a C. diff testing algorithm. Statistical process control charts were used to assess for improvements.

    Results

    The average rate of C. diff PCR test positivity decreased from 34.9 PCR positive tests per 10 000 patient days to 12.3 in the postintervention period, a 66% reduction. The average rate of PCR tests ordered was 28 per 1000 patient days in the preintervention period; this decreased 44% to 15.7 in the postintervention period.

    Discussion

    We found clinically significant improvements in the rate of C. diff infection and PCR tests ordered as a result of implementing tailored interventions in a large medical intensive care unit. Other units should consider using robust quality improvement methods and tools to conduct similar initiatives to reduce patient harm and improve care and outcomes.
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    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 D
    We 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).
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    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 A
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    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 D

    Objective

    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.
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    Using the COM-B model to identify barriers to and facilitators of evidence-based nurse urine-culture practices.
    (Antimicrobial stewardship & healthcare epidemiology : ASHE, 2023-01) Advani, Sonali D; Winters, Ali; Turner, Nicholas A; Smith, Becky A; Seidelman, Jessica; Schmader, Kenneth; Anderson, Deverick J; Reynolds, Staci S
    Our surveys of nurses modeled after the Capability, Opportunity, and Motivation Model of Behavior (COM-B model) revealed that opportunity and motivation factors heavily influence urine-culture practices (behavior), in addition to knowledge (capability). Understanding these barriers is a critical step towards implementing targeted interventions to improving urine-culture practices.