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The learning hospital: From theory to practice in a hospital infection prevention program

  • Olivia C.R. Hess (a1), Meha Srivastava (a2), Rachel Pryor (a3), Amie Patrick (a3), Kaila Cooper (a3), Emily Godbout (a3), Katie Anderson (a3), Michelle Doll (a3), Michael P. Stevens (a3), Robin Hemphill (a3), Michael Edmond (a4), Richard Wenzel (a3) and Gonzalo Bearman (a3)...

Abstract

The learning hospital is distinguished by ceaseless evolution of erudition, enhancement, and implementation of clinical best practices. We describe a model for the learning hospital within the framework of a hospital infection prevention program and argue that a critical assessment of safety practices is possible without significant grant funding. We reviewed 121 peer-reviewed manuscripts published by the VCU Hospital Infection Prevention Program over 16 years. Publications included quasi-experimental studies, observational studies, surveys, interrupted time series analyses, and editorials. We summarized the articles based on their infection prevention focus, and we provide a brief summary of the findings. We also summarized the involvement of nonfaculty learners in these manuscripts as well as the contributions of grant funding. Despite the absence of significant grant funding, infection prevention programs can critically assess safety strategies under the learning hospital framework by leveraging a diverse collaboration of motivated nonfaculty learners. This model is a valuable adjunct to traditional grant-funded efforts in infection prevention science and is part of a successful horizontal infection control program.

Copyright

Corresponding author

Author for correspondence: Olivia C.R. Hess, Email: ohess@colgate.edu

References

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39. Edmond, MB, Masroor, N, Stevens, MP, Ober, J, Bearman, G. The impact of discontinuing contact precautions for VRE and MRSA on device-associated infections. Infect Control Hosp Epidemiol 2015;36:978980.
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45. Godbout, EJ, Masroor, N, Doll, M, Edmond, MB, Bearman, G, Stevens, MP. Bare below the elbows in an academic medical center. Am J Infect Control 2019;47:10301031.
46. Masroor, N, Doll, M, Sanogo, K, et al. Seasonal variation in bare-below-the-elbow compliance. Infect Control Hosp Epidemiol 2017;38:504506.
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49. Abbas, S, Bernard, S, Lee, KB, et al. Rapid respiratory panel testing: impact of active antimicrobial stewardship. Am J Infect Control 2019;47:224225.
50. Markley, JD, Bernard, S, Bearman, G, Stevens, MP. De-escalating antibiotic use in the inpatient setting: strategies, controversies, and challenges. Curr Infect Dis Rep 2017;19(4):17.
51. Kirk, A, Pierce, J, Doll, M, et al. Effect of carbapenem restriction on prescribing trends for immunocompromised wards at an academic medical center. Am J Infect Control 2019;47:10351037.
52. Doll, M, Masroor, N, Major, Y, et al. Carbapenem-resistant Enterobacteriaceae at a low prevalence tertiary care center: patient-level risk factors and implications for an infection prevention strategy. Am J Infect Control 2017;45:12861288.
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55. Wang, JS, Bearman, G, Edmond, M, Stevens, MP. Guarding the goods: an introduction to antimicrobial stewardship. Clin Microbiol Newslett 2012;34:9397.
56. Lee, KB, Ramirez, JA, Collins, R, Bucheit, J, Sanogo, K, Stevens, MP. Antimicrobial stewardship practices in Virginia. Am J Infect Control 2017;45:451452.
57. Van Parys, J, Stevens, MP, Moczygemba, LR, Pakyz, AL. Antimicrobial stewardship program members’ perspectives on program goals and national metrics. Clin Therapeut 2016;38:19141919.
58. Godbout, EJ, Pakyz, AL, Markley, JD, Noda, AJ, Stevens, MP. Pediatric antimicrobial stewardship: state of the art. Curr Infect Dis Rept 2018;20:39.
59. Markley, J, Pakyz, A, Sabo, R, Bearman, G, Hohmann, S, Stevens, M. Performance of a novel antipseudomonal antibiotic consumption metric among academic medical centers in the United States. Infect Control Hosp Epidemiol 2018;39:229232.
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61. Pellerin, J, Edmond, M, Bearman, G, Lee, K, Stevens, MP. An examination of stewardship interventions by major category in an urban academic medical center. Infect Control Hosp Epidemiol 2012;33:432434.
62. Pakyz, AL, Moczygemba, LR, VanderWielen, LM, Edmond, MB, Stevens, MP, Kuzel, AJ. Facilitators and barriers to implementing antimicrobial stewardship strategies: results from a qualitative study. Am J Infect Control 2014;42:S257S263.
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65. Emberger, J, Tassone, D, Stevens, MP, Markley, JD. The current state of antimicrobial stewardship: challenges, successes, and future directions. Curr Infect Dis Rep 2018;20(9):31.
66. Abbas, S, Stevens, MP. The role of the hospital epidemiologist in antibiotic stewardship. Med Clin N Am 2018;102:873882.
67. Wenzel, RP, Fowler, AA, Edmond, MB. Antibiotic prevention of acute exacerbations of COPD. N Engl J Med 2012;367:340347.
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69. Vanhoozer, G, Lovern, BS I, Masroor, N, et al. Chlorhexidine gluconate bathing: Patient perceptions, practices, and barriers at a tertiary care center. Am J Infect Control 2019;47:349350.
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71. Fleming, M, Patrick, A, Gryskevicz, M, et al. Deployment of a touchless ultraviolet light robot for terminal room disinfection: the importance of audit and feedback. Am J Infect Control 2018;46:241243.
72. Doll, M, Stevens, M, Bearman, G. Environmental cleaning and disinfection of patient areas. Int J Infect Dis 2018;67:5257.
73. Pedersen, L, Masroor, N, Cooper, K, et al. Barriers and perceptions of environmental cleaning: An environmental services perspective. Am J Infect Control 2018;46:14061407.
74. Nottingham, M, Peterson, G, Doern, C, et al. Ultraviolet-C light as a means of disinfecting anesthesia workstations. Am J Infect Control 2017;45:10111013.
75. Doll, M, Morgan, DJ, Anderson, D, Bearman, G. Touchless technologies for decontamination in the hospital: a review of hydrogen peroxide and UV devices. Curr Infect Dis Rep 2015;17(9):44.
76. Bowe, E, Srivastava, T, Masroor, N, et al. Disinfection of noncritical equipment on units with high hospital-onset Clostridium difficile infections. Am J Infect Control 2019;47:220221.
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78. Derber, C, Elam, K, Forbes, BA, Bearman, G. Achromobacter species endocarditis: a case report and literature review. Can J Infect Dis Med Microb 2011;22(3):e17e20.
79. Stevens, MP, Edmond, MB. Endocarditis due to vancomycin-resistant enterococci: case report and review of the literature. Clin Infect Dis 2005;41:11341142.
80. Edmond, MB, Wenzel, RP. Screening inpatients for MRSA—case closed. N Engl J Med 2013;368:23142315.
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82. Stevens, MP, Edmond, MB. The rising tide: skin and soft tissue infections due to community-associated methicillin-resistant Staphylococcus aureus. South Med J 2009;102:121122.
83. Stevens, MP, Bearman, G, Rosat, A, Edmond, M. Community-acquired methicillin-resistant Staphylococcus aureus in a women’s collegiate basketball team. South Med J 2008;101:10671068.
84. Edmond, MB, Ober, JF, Bearman, G. Active surveillance cultures are not required to control MRSA infections in the critical care setting. Am J Infect Control 2008;36:461463.
85. Bearman, GML, Rosato, AE, Assanasen, S, et al. Nasal carriage of inducible dormant and community-associated methicillin-resistant Staphylococcus aureus in an ambulatory population of predominantly university students. Int J Infect Dis 2010;14:e18e24.
86. Wenzel, RP, Bearman, G, Edmond, MB. Community-acquired methicillin-resistant Staphylococcus aureus (MRSA): new issues for infection control. Int J Antimicrob Agents 2007;30:210212.
87. Albert, H, Bataller, W, Masroor, N, et al. Infection prevention and enhanced recovery after surgery: a partnership for implementation of an evidence-based bundle to reduce colorectal surgical site infections. Am J Infect Control 2019;47:718719.
88. Heipel, D, Ober, JF, Edmond, MB, Bearman, GM. Surgical site infection surveillance for neurosurgical procedures: a comparison of passive surveillance by surgeons to active surveillance by infection control professionals. Am J Infect Control 2007;35:200202.
89. Pakyz, AL, Edmond, MB. Influence of state laws mandating reporting of healthcare-associated infections: the case of central line–associated bloodstream infections. Infect Control Hosp Epidemiol 2013;34:780784.
90. Vokes, RA, Bearman, G, Bazzoli, GJ. Hospital-acquired infections under pay-for-performance systems: an administrative perspective on management and change. Curr Infect Dis Rep 2018;20(9):35.
91. Wenzel, RP, Edmond, MB. The impact of hospital-acquired bloodstream infections. Emerg Infect Dis 2001;7:174177.
92. De Wit, M, Zilberberg, MD, Boehmler, JM, Bearman, GM, Edmond, MB. Outcomes of patients with alcohol use disorders experiencing healthcare-associated infections. Alcohol Clin Exper Res 2011;35:13681373.
93. Berhe, M, Edmond, MB, Bearman, GM. Practices and an assessment of health care workers’ perceptions of compliance with infection control knowledge of nosocomial infections. Am J Infect Control 2005;33:5557.
94. Rosato, AE, Tallent, SM, Edmond, MB, Bearman, GM. Susceptibility of coagulase-negative staphylococcal nosocomial bloodstream isolates to the chlorhexidine/silver sulfadiazine-impregnated central venous catheter. Am J Infect Control 2004;32:486488.
95. Marra, AR, Bearman, GM, Wenzel, RP, Edmond, MB. Comparison of the systemic inflammatory response syndrome between monomicrobial and polymicrobial Pseudomonas aeruginosa nosocomial bloodstream infections. BMC Infect Dis 2005;5:94.
96. Edmond, MB, White-Russell, MB, Ober, J, Woolard, CD, Bearman, GM. A statewide survey of nosocomial infection surveillance in acute care hospitals. Am J Infect Control 2005;33:480482.
97. Bearman, GM, Munro, C, Sessler, CN, Wenzel, RP. Infection control and the prevention of nosocomial infections in the intensive care unit. Respir Crit Care Med 2006;27:310324.
98. Marra, AR, Bar, K, Bearman, GM, Wenzel, RP, Edmond, MB. Systemic inflammatory response syndrome in nosocomial bloodstream infections with pseudomonas aeruginosa and enterococcus species: comparison of elderly and nonelderly patients. J Am Geriatr Soc 2006;54:804808.
99. Marra, AR, Bearman, GM, Wenzel, RP, Edmond, MB. Comparison of severity of illness scoring systems for patients with nosocomial bloodstream infection due to Pseudomonas aeruginosa . BMC Infect Dis 2006;6:132.
100. Bar, K, Wisplinghoff, H, Wenzel, RP, Bearman, GM, Edmond, MB. Systemic inflammatory response syndrome in adult patients with nosocomial bloodstream infections due to enterococci. BMC Infect Dis 2006;6:145.
101. Edmond, M, Eickhoff, TC. Who is steering the ship? External influences on infection control programs. Clin Infect Dis 2008;46:17461750.
102. Wenzel, RP, Edmond, MB. Infection control: the case for horizontal rather than vertical interventional programs. Int J Infect Dis 2010;14:S3S5.
103. Fleming, MS, Hess, O, Albert, HL, et al. Test stewardship, frequency and fidelity: Impact on reported hospital-onset Clostridioides difficile . Infect Control Hosp Epidemiol 2019;40:710712.
104. Lin, G, Knowlson, S, Nguyen, HJ, et al. Urine test stewardship for catheterized patients in the critical care setting: provider perceptions and impact of electronic order set interventions. Am J Infect Control 2019; 47:12771279.
105. Doll, M, Fleming, M, Stevens, MP, Bearman, G. Clostridioides difficile-associated diarrhea: infection prevention unknowns and evolving risk reduction strategies. Curr Infect Dis Rep 2019;21:1.
106. Marra, AR, Edmond, MB, Wenzel, RP, Bearman, GM. Hospital-acquired Clostridium difficile-associated disease in the intensive care unit setting: epidemiology, clinical course and outcome. BMC Infect Dis 2007;7:42.
107. Landsman, MJ, Sultan, M, Stevens, M, Charabaty, A, Mattar, MC. Diagnosis and management of common gastrointestinal tract infectious diseases in ulcerative colitis and crohn’s disease patients. Inflamm Bowel Dis 2014;20:25032510.
108. Kavazovic, A, Fleming, M, Knowlson, S, et al. Clostridioides difficile nurse-driven protocol: a cautionary tale. Am J Infect Control 2019;pii:S0196-6553(19)30623-6. doi: 10.1016/j.ajic.2019.06.010.
109. Markley, JD, Edmond, MB, Major, Y, Bearman, G, Stevens, MP. Are gym surfaces reservoirs for Staphylococcus aureus? A point prevalence survey. Am J Infect Control 2012;40:10081009.
110. Marra, AR, Edmond, MB, Forbes, BA, Wenzel, RP, Bearman, GM. Time to blood culture positivity as a predictor of clinical outcome of Staphylococcus aureus bloodstream infection. J Clin Microbiol 2006;44:13421346.
111. Masroor, N, Ferretti-Gallon, J, Cooper, K, et al. Universal staphylococcal decolonization for elective surgeries: the patient perspective. Am J Infect Control 2019;47:391393.
112. Masroor, N, Golladay, GJ, Williams, J, et al. Healthcare worker perceptions of and barriers to universal staphylococcal decolonization in elective orthopaedic joint surgeries. Infect Control Hosp Epidemiol 2016;37:355356.
113. Welc, CM, Nassiry, A, Elam, K, et al. Continued non-compliance with the American College of Surgeons recommendations to decrease infectious exposure in the operating room: why? Surg Infect 2013;14:288292.
114. Assanasen, S, Edmond, M, Bearman, G. Impact of 2 different levels of performance feedback on compliance with infection control process measures in 2 intensive care units. Am J Infect Control 2008;36:407413.
115. Berhe, M, Edmond, MB, Bearman, G. Measurement and feedback of infection control process measures in the intensive care unit: Impact on compliance. Am J Infect Control 2006;34:537539.
116. Stevens, MP, Edmond, MB. Health care-associated transmission of hepatitis B and C in oncology care. Clin Liver Dis 2010;14:6974.
117. Bearman, G. Infection probability score shows 59.4% specificity and 74.3% sensitivity for predicting infection in haematology-oncology patients. Evidence-Based Nurs 2011;14:54.
118. Wenzel, RP, Bearman, G, Edmond, MB. Lessons from severe acute respiratory syndrome (SARS): implications for infection control. Arch Med Res 2005;36:610616.
119. Bearman, G, Stevens, MP. Pushing beyond resistors and constipators: implementation considerations for infection prevention best practices. Curr Infect Dis Rep 2014;16:388.
120. Arquiette, JM, Karjane, NW, Masroor, N, Sanogo, K, Stevens, M, Bearman, GML. Survey of infection prevention best practices in a university ob/gyn service: barriers, obstacles, and uncertainties. Infect Control Hosp Epidemiol 2016;37:997999.
121. Ghazal, SS, Stevens, MP, Bearman, GM, Edmond, MB. Utility of surveillance blood cultures in patients undergoing hematopoietic stem cell transplantation. Antimicrob Resist Infect Control 2014;3:20.
122. Donovan, S, Bearman, GML. Use of intravenous immunoglobulin in critically ill patients. Curr Infect Dis Rep 2014;16:447.
123. Bearman, G, Doll, M, Cooper, K, Stevens, MP. Hospital infection prevention: how much can we prevent and how hard should we try? Curr Infect Dis Rep 2019;21:2.
124. Bearman, GM, Vokes, RA. Averting a betrayal of trust: system and individual accountability in healthcare infection prevention. Infect Control Hosp Epidemiol 2019. doi: 10.1017/ice.2019.137.
125. Doll, M, Hewlett, AL, Bearman, G. Infection prevention in the hospital from past to present: evolving roles and shifting priorities. Curr Infect Dis Rep 2016;18(5):16.
126. Banach, DB, Bearman, GM, Morgan, DJ, Munoz-Price, LS. Infection control precautions for visitors to healthcare facilities. Expert Rev Anti-Infect Ther 2015;13:10471050.
127. Bearman, G. An unconventional housecall. J Gen Intern Med 2013;28:160161.
128. Edmond, MB, Bearman, GML. Mandatory public reporting in the USA: an example to follow? J Hosp Infect 2007;65:182188.
129. Edmond, MB. Getting to zero: is it safe? Infect Control Hosp Epidemiol 2009;30:7476.

The learning hospital: From theory to practice in a hospital infection prevention program

  • Olivia C.R. Hess (a1), Meha Srivastava (a2), Rachel Pryor (a3), Amie Patrick (a3), Kaila Cooper (a3), Emily Godbout (a3), Katie Anderson (a3), Michelle Doll (a3), Michael P. Stevens (a3), Robin Hemphill (a3), Michael Edmond (a4), Richard Wenzel (a3) and Gonzalo Bearman (a3)...

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