In This Edition
Literature At A Glance
A guide to this month’s studies
- Nearly all CDIs Related to Exposure in Healthcare Setting
- In Suspected Acute Coronary Syndrome, CT Angiography Identifies Patients Safe for Discharge
- Impending Physiological Deterioration Can Be Predicted Using Data from a Comprehensive EHR
- Rapid Influenza Diagnostic Tests Have Low Sensitivity and High Specificity
- Multifaceted QI Intervention Increases Adherence to Evidence-Based Therapy in Acute Coronary Syndrome
- Rivaroxaban for the Treatment of Acute Pulmonary Embolism
- Coronary Stent Implantation Provides No Additional Benefit when Compared with Medical Therapy Alone in Patients with Stable Coronary Artery Disease
- Prolonged Versus Standard Duration Venous Thromboprophylaxis after Major Orthopedic Surgery
Nearly all CDIs Related to Exposure in Healthcare Setting
Clinical question: What is the contribution of non-hospital healthcare exposures to the burden of Clostridium difficile infection (CDI)?
Background: CDI is common among hospitalized patients and is associated with high rates of morbidity. Most CDI prevention programs are aimed at hospital-based risk factors. However, non-hospital healthcare exposures might contribute significantly to the burden of CDI, and hospital-based prevention programs might not address these risks.
Study design: Retrospective analysis of three population-based data sets.
Setting: Three population data sets tracking infections on a national and state level in the U.S.
Synopsis: This study analyzed two data sets to determine the contribution of non-hospital healthcare exposure to CDIs, and examined a third to determine whether a program addressing hospital-based exposures reduced the rate of CDI.Using data from the CDC’s Emerging Infections Program, 10,342 CDI cases from 111 hospitals were examined. Each case was classified as hospital onset (i.e. occurring three days after admission), nursing home onset, or community onset. A total of 94% of cases were associated with recent exposure to healthcare, 75% were classified as non-hospital onset, and 20% of hospital-onset cases were in patients who had recently been in a nursing home, suggesting that non-hospital-based healthcare exposures play a significant role. The second analysis used data from the National Healthcare Safety Network to examine 42,157 CDIs in 711 hospitals.
The authors found that 52% of CDIs were present on admission. The pooled rate of hospital-onset CDI was low (7.4 per 10,000 patient-days). The final analysis examined hospital-onset CDI rates across three hospital-based prevention programs over a period of nearly two years. The interventions were associated with a 20% decrease in CDI rates (to 7.5 from 9.3 per 10,000 patient days).
Bottom line: Nearly all CDIs are related to exposure in healthcare settings. Exposure to nursing home and ambulatory care seem to play a major role, and infection-control measures in addition to hospital-based strategies need to target these areas. Hospital-based interventions moderately decreased overall rates of CDI.
Citation: Centers for Disease Control and Prevention. Vital signs: preventing Clostridium difficile infections. MMWR Morb Mortal Wkly Rep. 2012;61:157-162.
In Suspected Acute Coronary Syndrome, CT Angiography Identifies Patients Safe for Discharge
Clinical question: Is a strategy utilizing CT angiography safe to allow discharge from the emergency department low- to intermediate-risk patients with possible acute coronary syndrome (ACS)?
Background: Admission rates for patients with possible acute coronary syndrome are high, but the majority of patients will not have cardiac causes of the symptoms. Coronary computed tomographic angiography (CCTA) has a high negative predictive value for the detection of coronary artery disease, but its utility in determining if a patient can be safely discharged from the emergency department has not been established.