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To describe compliance with the central line (CL) insertion bundle overall and with individual bundle elements in US adult intensive care units (ICUs) and to determine the relationship between bundle compliance and central line–associated bloodstream infection (CLABSI) rates.
National sample of adult ICUs participating in National Healthcare Safety Network (NHSN) surveillance.
Hospitals were surveyed to determine compliance with CL insertion bundle elements in ICUs. Corresponding NHSN ICU CLABSI rates were obtained. Multivariate Poisson regression models were used to assess associations between CL bundle compliance and CLABSI rates, controlling for hospital and ICU characteristics.
A total of 984 adult ICUs in 632 hospitals were included. Most ICUs had CL bundle policies, but only 69% reported excellent compliance (≥95%) with at least 1 element. Lower CLABSI rates were associated with compliance with just 1 element (incidence rate ratio [IRR] 0.77; 95% confidence interval [CI], 0.64–0.92); however, ≥95% compliance with all 5 elements was associated with the greatest reduction (IRR, 0.67; 95% CI, 0.59–0.77). There was no association between CLABSI rates and simply having a written CL bundle policy nor with bundle compliance <75%. Additionally, better-resourced infection prevention departments were associated with lower CLABSI rates.
Our findings demonstrate the impact of transferring infection prevention interventions to the real-world setting. Compliance with the entire bundle was most effective, although excellent compliance with even 1 bundle element was associated with lower CLABSI rates. The variability in compliance across ICUs suggests that, at the national level, there is still room for improvement in CLABSI reduction.
US state and territorial laws were reviewed to identify Clostridium difficile infection reporting mandates. Twenty states require reporting either under state law or by incorporating federal Centers for Medicare & Medicaid Services’ reporting requirements. Although state law mandates are more common, the incorporation of federal reporting requirements has been increasing.
To determine the association between state legal mandates for data submission of central line–associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) with process and outcome measures.
Participants. National sample of level II/III and III NICUs participating in National Healthcare Safety Network (NHSN) surveillance.
State mandates for data submission of CLABSIs in NICUs in place by 2011 were compiled and verified with state healthcare-associated infection coordinators. A web-based survey of infection control departments in October 2011 assessed CLABSI prevention practices, ie, compliance with checklist/bundle components (process measures) in ICUs including NICUs. Corresponding 2011 NHSN NICU CLABSI rates (outcome measures) were used to calculate standardized infection ratios (SIRs). Association between mandates and process and outcome measures was assessed by multivariable logistic regression.
Among 190 study NICUs, 107 (56.3%) were located in states with mandates, with mandates in place >3 years in 52 (49%). More NICUs in states with mandates reported ≥95% compliance to at least 1 CLABSI prevention practice (52.3%–66.4%) than NICUs in states without mandates (28.9%–48.2%). Mandates were predictors of ≥95% compliance with all practices (odds ratio, 2.8; 95% confidence interval, 1.4–6.1). NICUs in states with mandates reported lower mean CLABSI rates in the ≤750-g birth weight group (2.4 vs 5.7 CLABSIs/1,000 central line–days) but not in others. Mandates were not associated with SIR <1.
State mandates for NICU CLABSI data submission were significantly associated with ≥95% compliance with CLABSI prevention practices, which declined with the duration of mandate but not with lower CLABSI rates.
Infect Control Hosp Epidemiol 2014;35(9):1133-1139
The Square Kilometre Array Radio Telescope is the next generation radio telescope. An international project is currently under way to design and build an instrument having an effective collecting area two orders of magnitude greater than that of any existing telescope. A number of separate studies are presently investigating how to design the Square Kilometre Array to best carry out the kinds of observations desired by the astronomical community. We present a summary of one of these studies, a workshop called The ‘Sub-microJansky Radio Sky’ held at the ATNF, Sydney, on 17 June 1998. This workshop addressed the nature of the radio sky at the very faint flux densities likely to be attainable by the Square Kilometre Array. In particular, each speaker investigated a separate population of radio sources and how the expected appearance of that population at such faint flux densities would dictate how to refine some of the design constraints for the Square Kilometre Array.
This book explores the power of print and the politics of the book in South Africa from a range of disciplinary perspectives—historical, bibliographic, literary-critical, sociological, and cultural studies. The essays collected here, by leading international scholars, address a range of topics as varied as: the role of print cultures in contests over the nature of the colonial public sphere in the nineteenth century; orthography; iimbongi, orature and the canon; book- collecting and libraries; print and transnationalism; Indian Ocean cosmopolitanisms; books in war; how the fates of South African texts, locally and globally, have been affected by their material instantiations; photocomics and other ephemera; censorship, during and after apartheid; books about art and books as art; local academic publishing; and the challenge of ‘book history’ for literary and cultural criticism in contemporary South Africa.