BackgroundAn academic safety-net hospital leveraged the federally funded state Delivery System Reform Incentive Payment programme to implement a hospital-wide initiative to reduce healthcare-associated infections (HAIs) and improve sepsis care.MethodsThe study period was from 2013 to 2017. The setting is a 770-bed urban hospital with six intensive care units and a large emergency department. Key interventions implemented were (1) awareness campaign and clinician engagement, (2) implementation of HAI and sepsis bundles, (3) education of clinical personnel using standardised curriculum on bundles, (4) training of key managers, leaders and personnel in quality improvement methods, and (5) electronic medical record-based clinical decision support. Throughout the 5-year period, staff received frequent, clear, visible and consistent messages from leadership regarding the importance of their participation in this initiative, performing hand hygiene and preventing potential regulatory failures. Several process measures including bundle compliance, hand hygiene and culture of safety were monitored. The primary outcomes were rates of central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI) and sepsis mortality.ResultsFrom 2013 to 2017, the hospital-wide rates of HAI reduced: CLABSI from 1.6 to 0.8 per 1000 catheter-days (Poisson regression estimate: −0.19; 95% CI −0.29 to −0.09; p=0.0002), CAUTI from 4.7 to 1.3 per 1000 catheter-days (−0.34; −0.43 to −0.26; p<0.0001) and SSI after 18 types of procedures from 3.4% to 1.3% (−0.29; −0.34 to −0.24; p<0.0001). Mortality of patients presenting to emergency department with sepsis reduced from 9.4% to 2.9% (−0.42; −0.49 to −0.36; p<0.0001). Adherence to bundles of care and hand hygiene and the hospital culture of patient safety improved. Results were sustained through 2019.ConclusionA hospital-wide initiative incentivised by the Delivery System Reform Incentive Payment programme succeeded in reducing HAI and sepsis mortality over 5 years in a sustainable manner.

Background: In the modern era, the spread of disease is very fast with the transportation allowing more than a million people a day to cross international borders. To control this spreading of disease, the health officials may have various pharmaceutical and non-pharmaceutical (wearing masks, closing schools, isolation, staying at home etc.) options. Media plays a very important role to communicate awareness in public for use of non-pharmaceutical interventions (NPIs) to control the epidemics.Methods & Materials: Determine the basic reproduction number by using a next generation matrix operator. Discuss stability criterion of the equilibrium points of the model with bifurcation theory. Carry out parameter sensitivity analysis by using the normalized forward sensitivity index. Perform the numerical simulation of the model to verify the results of qualitative analysis using MATLAB.Results: Result 1. The disease free equilibrium (DFE) is locally asymptotically stable, if R 0 <1 and unstable, if R 0 >1.Result 2. The endemic equilibrium (EE) is locally asymptotically stable for R 0 >1, but close to 1.Result 3. The coefficient of media awareness m does not effect R 0.Result 4. The level of endemic equilibrium is significantly affected by media coefficient m. Conclusion:In this paper, we proposed a SIRS epidemic model incorporating media awareness as control strategy and investigated the asymptotic stability of the model in both disease-free equilibrium and endemic equilibrium states. The disease free equilibrium is locally asymptotically stable for basic reproduction number R 0 < 1, a transcritical bifurcation occurs at R 0 = 1 and a unique locally asymptotically stable endemic equilibrium exists for R 0 > 1. We observed that the coefficient of media awareness m does not effect R 0 and hence the qualitative features of the model remain unaltered, but the level of endemic equilibrium is significantly affected by media coefficient. We calculate normalized forward sensitivity indices for the basic reproduction number and state variables at endemic equilibrium with respect to various parameters and identified respective sensitive parameters. Numerical simulations of the system justify the analytic findings and we also observed that the level of endemic equilibrium is significantly affected by media coefficient m.

Background Pseudomonas aeruginosa infection can lead to morbidity, mortality and increased hospital length of stay especially in Burn Intensive Care Units (BICU) patients. Reports of multi-drug-resistant Pseudomonas aeruginosa outbreaks in the BICU are increasing. We investigated the epidemiology of Carbapenem-Resistant Pseudomonas aeruginosa (CRPA) in our BICU.MethodsClinical and laboratory characteristics of all CRPA isolates identified between 5/8/16 and 3/14/19, in an 11-bed BICU in an academic 870-bed public safety-net hospital were reviewed and defined as Meropenem MIC 4 or greater. Retained isolates were sent for pulse-field gel electrophoresis (PFGE). Infection prevention (IP) observations and interventions were intensified and environmental cultures were collected. Patient charts were reviewed.Results27 patients between ages 5–61 years old were found to have CRPA (only 2 patients < 18 years). 21/27 (77.7%) were male. 21/27 (77.7%) had >40% total body surface area (TBSA) burns, 3/27 (11.1%) had 20–39% TBSA burn and 1/27 (3.7%) had < 20% TBSA burn. 19/27 (70.3%) patients had bacteremia, 6 had respiratory infections with 3 (11.1%) Infection-related Ventilator-Associated Complications (IVAC), 3 had urinary tract infection, and 1 had CRPA from a central venous catheter tip. There were very few co-morbidities. Twenty isolates from 11 different patients were typed and revealed 2 different clonal strains. 5/11 (45%) patients had strain A, and 2/11 (18%) patients had strain B. 3/11 (27.2%) patients had unique strains. CRPA was isolated from 5 different rooms. Water cultures did not reveal CRPA. Failure of hand hygiene, non-adherence to isolation/PPE protocols and clutter were found. Each failure was corrected. No new CRPA patient isolates have been identified.ConclusionTransmission was halted by reinforcement of IP measures. Importantly water was not a source of CRPA in this setting and the data suggest transmission due to environmental contamination.DisclosuresTrish M. Perl, MD; MSc, 7–11: Advisory Board; medimmune: Research Grant