4 results
Impact of Seasonality and Influenza Rates on Interventions to Reduce Hospital-Acquired Clostridioides difficile Rates
- Jenine Leal, Peter Faris, Ye Shen, Lauren Bresee, Kathryn Bush, Blanda Chow, Bruce Dalton, Jared Fletcher, Sara Hartman, Jaime Kaufman, Joseph Kim, Maitreyi Kothandaraman, Scott Kraft, Nicole Lamont, Oscar Larios, Braden Manns, Bayan Missaghi, Wrechelle Ocampo, Paule Poulin, Deana Sabuda, Jayna Holroyd-Leduc, Thomas Louie, John Conly
-
- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s265-s266
- Print publication:
- October 2020
-
- Article
-
- You have access Access
- Export citation
-
Background: Hospital-acquired Clostridioides difficile infection (HA-CDI) rates are highly variable over time, posing problems for research assessing interventions that might improve rates. By understanding seasonality in HA-CDI rates and the impacts that other factors such as influenza admissions might have on these rates, we can account for them when establishing the relationship between interventions and infection rates. We assessed whether there were seasonal trends in HA-CDI and whether they could be accounted for by influenza rates. Methods: We assessed HA-CDI rates per 10,000 patient days, and the rate of hospitalized patients with influenza per 1,000 admissions in 4 acute-care facilities (n = 2,490 beds) in Calgary, Alberta, from January 2016 to December 2018. We used 4 statistical approaches in R (version 3.5.1 software): (1) autoregressive integrated moving average (ARIMA) to assess dependencies and trends in each of the monthly HA-CDI and influenza series; (2) cross correlation to assess dependencies between the HA-CDI and influenza series lagged over time; (3) Poisson harmonic regression models (with sine and cosine components) to assess the seasonality of the rates; and (4) Poisson regression to determine whether influenza rates accounted for seasonality in the HA-CDI rates. Results: Conventional ARIMA approaches did not detect seasonality in the HA-CDI rates, but we found strong seasonality in the influenza rates. A cross-correlation analysis revealed evidence of correlation between the series at a lag of zero (R = 0.41; 95% CI, 0.10–0.65) and provided an indication of a seasonal relationship between the series (Fig. 1). Poisson regression suggested that influenza rates predicted CDI rates (P < .01). Using harmonic regression, there was evidence of seasonality in HA-CDI rates (2 [2 df] = 6.62; P < .05) and influenza rates (2 [2 df] = 1,796.6; P < .001). In a Poisson model of HA-CDI rates with both the harmonic components and influenza admission rates, the harmonic components were no longer predictive of HA-CDI rates. Conclusions: Harmonic regression provided a sensitive means of identifying seasonality in HA-CDI rates, but the seasonality effect was accounted for by influenza admission rates. The relationship between HA-CDI and influenza rates is likely mediated by antibiotic prescriptions, which needs to be assessed. To improve precision and reduce bias, research on interventions to reduce HA-CDI rates should assess historic seasonality in HA-CDI rates and should account for influenza admissions.
Funding: None
Disclosures: None
Implementation Strategies of a Quality Improvement Initiative for Hospital-Acquired Clostridioides difficile Infection Prevention
- Nicole Lamont, Lauren Bresee, Kathryn Bush, Blanda Chow, Bruce Dalton, Cody Doolan, Peter Faris, Jared Fletcher, Sara Hartman, Jaime Kaufman, Maida Khan, Joseph Kim, Maitreyi Kothandaraman, Scott Kraft, Oscar Larios, Jenine Leal, Braden Manns, Bayan Missaghi, Wrechelle Ocampo, Dylan Pillai, Paule Poulin, Deana Sabuda, Ye Shen, Thomas Louie, Jayna Holroyd-Leduc, John Conly
-
- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s279-s280
- Print publication:
- October 2020
-
- Article
-
- You have access Access
- Export citation
-
Background:Clostridioides difficile infection (CDI) is the most common cause of infectious diarrhea in hospitalized patients. Probiotics have been studied as a measure to prevent CDI. Timely probiotic administration to at-risk patients receiving systemic antimicrobials presents significant challenges. We sought to determine optimal implementation methods to administer probiotics to all adult inpatients aged 55 years receiving a course of systemic antimicrobials across an entire health region. Methods: Using a randomized stepped-wedge design across 4 acute-care hospitals (n = 2,490 beds), the probiotic Bio-K+ was prescribed daily to patients receiving systemic antimicrobials and was continued for 5 days after antimicrobial discontinuation. Focus groups and interviews were conducted to identify barriers, and the implementation strategy was adapted to address the key identified barriers. The implementation strategy included clinical decision support involving a linked flag on antibiotic ordering and a 1-click order entry within the electronic medical record (EMR), provider and patient education (written/videos/in-person), and local site champions. Protocol adherence was measured by tracking the number of patients on therapeutic antimicrobials that received BioK+ based on the bedside nursing EMR medication administration records. Adherence rates were sorted by hospital and unit in 48- and 72-hour intervals with recording of percentile distribution of time (days) to receipt of the first antimicrobial. Results: In total, 340 education sessions with >1,800 key stakeholders occurred before and during implementation across the 4 involved hospitals. The overall adherence of probiotic ordering for wards with antimicrobial orders was 78% and 80% at 48 and 72 hours, respectively over 72 patient months. Individual hospital adherence rates varied between 77% and 80% at 48 hours and between 79% and 83% at 72 hours. Of 246,144 scheduled probiotic orders, 94% were administered at the bedside within a median of 0.61 days (75th percentile, 0.88), 0.47 days (75th percentile, 0.86), 0.71 days (75th percentile, 0.92) and 0.67 days (75th percentile, 0.93), respectively, at the 4 sites after receipt of first antimicrobial. The key themes from the focus groups emphasized the usefulness of the linked flag alert for probiotics on antibiotic ordering, the ease of the EMR 1-click order entry, and the importance of the education sessions. Conclusions: Electronic clinical decision support, education, and local champion support achieved a high implementation rate consistent across all sites. Use of a 1-click order entry in the EMR was considered a key component of the success of the implementation and should be considered for any implementation strategy for a stewardship initiative. Achieving high prescribing adherence allows more precision in evaluating the effectiveness of the probiotic strategy.
Funding: Partnerships for Research and Innovation in the Health System, Alberta Innovates/Health Solutions Funding: Award
Disclosures: None
Assessing nutritional quality as a ‘vital sign’ of cardiometabolic health
- Dorothée Buteau-Poulin, Paul Poirier, Jean-Pierre Després, Natalie Alméras
-
- Journal:
- British Journal of Nutrition / Volume 122 / Issue 2 / 28 July 2019
- Published online by Cambridge University Press:
- 25 June 2019, pp. 195-205
- Print publication:
- 28 July 2019
-
- Article
-
- You have access Access
- HTML
- Export citation
-
High overall nutritional quality (NQ) is an important component of ideal cardiovascular health, a concept introduced in 2010 by the American Heart Association. However, data on the independent contribution of overall NQ to the variation in the cardiometabolic risk (CMR) profile are limited. This observational study aimed to investigate the association between overall NQ and the CMR profile in 4785 participants (65⋅4 % of men, age 43⋅3 (sd 10⋅8) years) who underwent a cardiometabolic health evaluation, including lifestyle habits, anthropometric measurements, blood pressure, lipid profile and HbA1c concentrations. In addition, a submaximal exercise test was conducted to assess cardiorespiratory fitness (CRF). Using a standardised NQ questionnaire (twenty-five items food-based questionnaire), participants were classified into three subgroups: (1) low, (2) moderate or (3) high NQ and variance and multiple linear regression analyses were performed. Results showed that less than 15 % of participants presented a high NQ. A high NQ was associated with a healthier lifestyle habits and a more favourable CMR profile (lower values of waist circumference and cholesterol:HDL-cholesterol ratio, lower concentrations of non-HDL-cholesterol, TAG and HbA1c). Some of these associations were independent of age, physical activity level (PAL) and CRF. A better NQ was also associated with a lower proportion of participants presenting the hypertriacylglycerolaemic waist phenotype independently of both PAL and CRF. The present study suggests that overall NQ can be assessed with a short food-based questionnaire and should be considered in clinical practice as a new ‘vital sign’ associated with other health behaviours and cardiometabolic health.
Nutrients, algal biomass and communities in land-fast ice and seawater off Adélie Land (Antarctica)
- Catherine Riaux-Gobin, Paul Tréguer, Michel Poulin, Gilles Vétion
-
- Journal:
- Antarctic Science / Volume 12 / Issue 2 / June 2000
- Published online by Cambridge University Press:
- 06 May 2004, pp. 160-171
-
- Article
- Export citation
-
Land-fast ice in the vicinity of Adélie Land was sampled during spring 1995. The ice was annual, thin, with no consistent snow cover, and exposed to oceanic conditions. Temporal and spatial variations of the vertical pigment distribution were studied in relation to environmental factors, during the break up of the ice. Different levels were sampled in the congelation ice and the platelet ice-like layer (PLI). Under-ice water and open water masses were also sampled. The algal biomass was greater in the PLI (24 ±14 μg chl a l−1 offshore and up to 9 mg chl a l−1 near-shore), than in the under-ice water, and fell to 0.9 ± 0.64 μg chl al−1 in open water masses. Homogenous low pigment concentrations were detected in the upper levels of congelation ice. A gradient was identified along a 7 km seaward transect, sampled in November, with the lowest biomass offshore. The integrated pigment concentrations in fast ice reached very high levels 500 mg chl a m−2 near the coast and 0.8 mg m−2 offshore), with apparently no relationship with either the ice thickness or snow cover. In the congelation ice nutrient concentrations were low and their distribution homogenous, whereas in the PLI high concentrations of nitrate (up to 100–300 μM NO3) and silicic acid [30–100 μM Si(OH)4] were detected, often related to high pigment concentrations and proximity to islands. The sea ice algae communities were diverse, but mostly composed of chain-forming and tube-dwelling pennate diatoms (Amphiprora, Berkeleya, Nitzschia and Navicula). Cell densities in PLI reached up to 1010 cells l−1. At very low biomass and cell densities 2 104 cells l−1) the phytoplankton also had a low diversity; some species were similar to those of the PLI, such as Navicula glaciei, but other were typically planktonic (Chaetoceros). At sea ice break-up it is estimated that a significant proportion of particulate matter (up to 0.5 g chl a m−2 near-shore) was transferred to the underlying water masses (on an average 15 t POC km−1 shoreline).