Becker's Clinical Quality & Infection Control

6 INFECTION CONTROL Miami hospital reduces HAIs by 40% with 2 changes By Mariah Taylor M iami-based Jackson Memorial Hospital has reduced its hospital acquired infections by 40% in about nine months with two changes. e system implemented two new processes: line rounds and "ticket to test." "e first step was eliminating any tubes or lines that are unnecessary," Hany Atallah, MD, chief medical officer at the hospital, told Becker's. "e second part involves nursing care: taking good care of the lines we have, questioning physicians about the necessity of a tube or line and determining when it can come out." Line rounds have reduced the use of unnecessary tubes and lines, which are potential sources for infection. is method has had the biggest impact on preventing HAIs, Dr. Atallah said. e "ticket to test" process is designed to ensure there is a reason behind each culture test ordered. Orders must meet certain criteria and in many cases are discussed between physicians and nurses. In some cases, the tests are canceled upon reconsideration but if there is a disagreement, the test is escalated to a physician leader to review. "is process has helped eliminate unnecessary cultures that sometimes catch incidental infections," Dr. Atallah said. "It's also helped us be good stewards of our resources." Both efforts began about nine months ago and have resulted in a 40% reduction in HAIs across the board, "and some infections show even higher reduction," Dr. Atallah said. "is collaborative effort, although time-consuming, is well worth it as it significantly benefits our patients." ere was some hesitancy among physicians when implementing these changes, though Dr. Atallah said the patient outcomes have mitigated those concerns. "Initially, we heard concerns from physicians who felt we were limiting their ability to order cultures," he said. "We clarified that this system is not meant to inhibit ordering cultures but to ensure thoughtful consideration before doing so. e same applies to line rounds, where we assess whether a patient truly needs a line or tube. e results speak for themselves." n Drug-resistant infections up 20% from 2019-22: CDC By Mariah Taylor Six bacterial antimicrobial-resistant hospital-onset infections have increased by a combined 20% since 2019, a CDC report found. e report compared infection rates for 2019 through 2022 for seven infections: Carbapenem-resistant Enterobacterales, Carbapenem-resistant Acinetobacter, Candida auris, Methicillin- resistant Staphylococcus aureus, Vancomycin-resistant Enterococcus, Extended-spectrum beta-lactamase and Multidrug-resistant Pseudomonas aeruginosa. Of the seven infections, six have seen an increase over cases in 2019. Comparing 2021 with 2022, five of the infections were stable and only C. auris increased. C. auris saw one of the most dramatic increases at nearly five-fold from 2019 to 2022. Notably, Methicillin-resistant Staphylococcus aureus saw the only decrease in 2022 compared with 2021. n A new emerging fungal threat By Paige Twenter R esearchers in New York have found an emerging threat of ringworm fungus, Trichophyton indotineae, which is often resistant to standard therapy, according to a study published May 15 in JAMA Dermatology. The fungus has been detected worldwide, but data is sparse for its spread in the U.S., the researchers said. In May 2023, public health officials reported the first two confirmed T. indotineae cases in the U.S., but antifungal susceptibility testing data uncovered more infections, spanning back to 2017. From May 2022 to May 2023, 11 patients in New York City had confirmed T. indotineae infections, and nine reported previous travel to Bangladesh. All had widespread lesions, diagnostic delays and did not respond to antifungal monotherapies. Terbinafine, the preferred treatment, was ineffective for seven patients. Patients treated with fluconazole and griseofulvin improved in two of four and two of five instances, respectively, and itraconazole was effective for five of seven treated patients. Since these cases happened before May 2023, dermatologists were often unaware of T. indotineae at the time of treatment, the researchers said. The fungal infection has the opportunity to become more widespread, they concluded, because they detected hundreds of single nucleotide variations, "which could indicate several independent introductions of T. indotineae or variants of T. indotineae isolates within New York City." CIDRAP said the findings represent a new, emerging public health threat. n

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