Brett Sitzlar - Academia.edu (original) (raw)
Papers by Brett Sitzlar
Background: SHEA guidelines recommend deferring testing of patients without diarrhea for C. diffi... more Background: SHEA guidelines recommend deferring testing of patients without diarrhea for C. difficile infection (CDI). However, it is not known how accurate the medical record is in documenting diarrhea in hospitalized patients who are tested for CDI. We hypothesized that the medical record would be inferior to direct interviews in accuracy of documentation of diarrhea in an inpatient setting. Methods: We conducted a prospective cohort study of all inpatients tested for CDI over a 4-month period to compare the accuracy of documentation of diarrhea in the medical record with direct nursing and patient interviews in a 400-bed, tertiary care VA hospital. Fisher's exact was used to compare proportions and t-test was used to compare means. Results: Of 79 patients who had testing ordered for CDI over the study period, overall chart documentation of diarrhea was similar between physicians and nursing staff (56% versus 58% of the time, NS). Only 23% of charts contained data regarding fr...
Background: Contaminated environmental surfaces are an important source for transmission of healt... more Background: Contaminated environmental surfaces are an important source for transmission of healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). However, limited data are available on the frequency of environmental contamination with these pathogens and the effectiveness of environmental disinfection practices in hospitals that do not routinely screen patients for carriage. Methods: In 10 Ohio hospitals (7 community hospitals and 3 teaching hospitals), cultures for MRSA and VRE were collected from high-touch surfaces (bedside table/bed rail, toilet seat/bathroom handrail, and telephone/call button) in a convenience sample of Clostridium difficile infection (CDI) isolation rooms and non-isolation rooms after completion of terminal cleaning and disinfection by environmental services personnel. Results: Of 211 total rooms cultured, 36 (17%) had positive cultures for MRSA and/or VRE after completion of te...
Background: STERIPLEX SD is an EPA-registered cleaner and disinfectant with sporicidal activity. ... more Background: STERIPLEX SD is an EPA-registered cleaner and disinfectant with sporicidal activity. In addition to use as wipe, Steriplex can be applied to surfaces using a touchless spray device. Although spraying sporicidal disinfectants provides efficient surface application, limited data are available on the effectiveness of this form of disinfectant application. Methods: In the laboratory, we examined the efficacy of STERIPLEX solution versus a 1 to 10 dilution of household bleach for killing of Clostridium difficile spores, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) on stainless steel carriers. To assess the effectiveness of the spray application, reductions in pathogens inoculated onto benchtop surfaces were measured after spraying with STERIPLEX directly or 6 or 12 inches from the direct line of spray and effectiveness in eliminating pathogens from hospital equipment was assessed on hospital wards. Results: On steel carriers, ...
Background: Floors Clostridium difficile infection (CDI) isolation rooms may be contaminated with... more Background: Floors Clostridium difficile infection (CDI) isolation rooms may be contaminated with spores, but sporicidal disinfectants are not commonly used on floors in healthcare facilities. It is plausible that floors could contribute to C. difficile transmission because they are frequently contacted by surfaces that are subsequently touched by hands (e.g., shoes, socks, wheelchairs, portable equipment). OxyCide Daily Disinfectant CleanerTMis a sporicidal peracetic acid/hydrogen peroxide-based daily disinfectant cleaner that can be used on a wide range of surfaces including floors. Methods: In the laboratory, we examined the efficacy of Oxycide versus a 1 to 10 dilution of household bleach for killing of C. difficile spores, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA). In CDI isolation rooms, floors in bathrooms and adjacent to the patient bed were cultured for C. difficile, VRE, and MRSA. We compared the effectiveness of OxyCide...
Infection Control and Hospital Epidemiology, 2014
OxyCide Daily Disinfectant Cleaner, a novel peracetic acid/hydrogen peroxide-based sporicidal dis... more OxyCide Daily Disinfectant Cleaner, a novel peracetic acid/hydrogen peroxide-based sporicidal disinfectant, was as effective as sodium hypochlorite for in vitro killing of Clostridium difficile spores, methicillin-resistant Staphylococcus aureus, and vancomcyin-resistant enterococci. OxyCide was minimally affected by organic load and was effective in reducing pathogen contamination in isolation rooms.
PLoS ONE, 2013
Background: Recent reports suggest that community-associated Clostridium difficile infection (CDI... more Background: Recent reports suggest that community-associated Clostridium difficile infection (CDI) (i.e., no healthcare facility admission within 90 days) may be increasing in frequency. We hypothesized that outpatient clinics could be an important source for acquisition of community-associated CDI.
Journal of the American Geriatrics Society, 2013
To initiate a long-term care facility (LTCF) infectious disease (LID) service that provides on-si... more To initiate a long-term care facility (LTCF) infectious disease (LID) service that provides on-site consultations to LTCF residents to improve the care of residents with possible infections. Clinical demonstration project. A 160-bed LTCF affiliated with a tertiary care Veterans Affairs (VA) hospital. Residents referred to the LID team. The reason for and source of LTCF residents' referral to the LID team and their demographic characteristics, infectious disease diagnoses, interventions, and hospitalizations were determined. Between July 2009 and December 2010, the LID consultation service provided 291 consultations for 250 LTCF residents. Referrals came from LTCF staff (75%) or the VA hospital's ID consult service (25%). The most common diagnoses were Clostridium difficile infection (14%), asymptomatic bacteriuria (10%), and urinary tract infection (10%). More than half of referred residents were receiving antibiotic therapy when they first saw the LID team; 46% of residents required an intervention. The most common interventions, stopping (32%) or starting (26%) antibiotics, were made in accordance with principles of antibiotic stewardship. The LID team represents a novel and effective means to bring subspecialty care to LTCF residents.
Journal of Clinical Microbiology, 2013
Although rapid laboratory tests are available for diagnosis of Clostridium difficile infection (C... more Although rapid laboratory tests are available for diagnosis of Clostridium difficile infection (CDI), delays in completion of CDI testing are common in clinical practice. We conducted a cohort study of 242 inpatients tested for CDI to determine the timing of different steps involved in diagnostic testing and to identify modifiable factors contributing to delays in diagnosis. The average time from test order to test result was 1.8 days (range, 0.2 to 10.6), with time from order to stool collection accounting for most of the delay (mean, 1.0 day; range, 0 to 10). Several modifiable factors contributed to delays, including not providing stool collection supplies to patients in a timely fashion, rejection of specimens due to incorrect labeling or leaking from the container, and holding samples in the laboratory for batch processing. Delays in testing contributed to delays in initiation of treatment for patients diagnosed with CDI and to frequent prescription of empirical CDI therapy for patients with mild to moderate symptoms whose testing was ultimately negative. An intervention that addressed several easily modified factors contributing to delays resulted in a significant decrease in the time required to complete CDI testing. These findings suggest that health care facilities may benefit from a review of their processes for CDI testing to identify and address modifiable factors that contribute to delays in diagnosis and treatment of CDI.
Infection Control and Hospital Epidemiology, 2013
Infection Control and Hospital Epidemiology, 2013
A Clostridium difficile infection (CDI) stewardship initiative reduced inappropriate prescription... more A Clostridium difficile infection (CDI) stewardship initiative reduced inappropriate prescription of empirical CDI therapy and improved timeliness of treatment and adherence to clinical practice guidelines for management of CDI. The initiative required minimal resources and could easily be incorporated into traditional antimicrobial stewardship programs.
Infection Control and Hospital Epidemiology, 2013
OBJECTIVE. Effective disinfection of hospital rooms after discharge of patients with Clostridium ... more OBJECTIVE. Effective disinfection of hospital rooms after discharge of patients with Clostridium difficile infection (CDI) is necessary to prevent transmission. We evaluated the impact of sequential cleaning and disinfection interventions by culturing high-touch surfaces in CDI rooms after cleaning. DESIGN. Prospective intervention. SETTING. A Veterans Affairs hospital. INTERVENTIONS. During a 21-month period, 3 sequential tiered interventions were implemented: (1) fluorescent markers to provide monitoring and feedback on thoroughness of cleaning facility-wide, (2) addition of an automated ultraviolet radiation device for adjunctive disinfection of CDI rooms, and (3) enhanced standard disinfection of CDI rooms, including a dedicated daily disinfection team and implementation of a process requiring supervisory assessment and clearance of terminally cleaned CDI rooms. To determine the impact of the interventions, cultures were obtained from CDI rooms after cleaning and disinfection. RESULTS. The fluorescent marker intervention improved the thoroughness of cleaning of high-touch surfaces (from 47% to 81% marker removal; P < .0001). Relative to the baseline period, the prevalence of positive cultures from CDI rooms was reduced by 14% (P=.024), 48% (P <.001), and 89% (P=.006) with interventions 1, 2, and 3, respectively. During the baseline period, 67% of CDI rooms had positive cultures after disinfection, whereas during interventions periods 1, 2, and 3 the percentages of CDI rooms with positive cultures after disinfection were reduced to 57%, 35%, and 7%, respectively. CONCLUSIONS. An intervention that included formation of a dedicated daily disinfection team and implementation of a standardized process for clearing CDI rooms achieved consistent CDI room disinfection. Culturing of CDI rooms provides a valuable tool to drive improvements in environmental disinfection.
Infection Control and Hospital Epidemiology, 2012
JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, a... more JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.
Infection Control and Hospital Epidemiology, 2012
Infection Control and Hospital Epidemiology, 2014
ABSTRACT
American Journal of Infection Control, 2012
American Journal of Infection Control, 2012
American Journal of Infection Control, 2013
PLoS ONE, 2014
Background: The intestinal microbiota protect the host against enteric pathogens through a defens... more Background: The intestinal microbiota protect the host against enteric pathogens through a defense mechanism termed colonization resistance. Antibiotics excreted into the intestinal tract may disrupt colonization resistance and alter normal metabolic functions of the microbiota. We used a mouse model to test the hypothesis that alterations in levels of bacterial metabolites in fecal specimens could provide useful biomarkers indicating disrupted or intact colonization resistance after antibiotic treatment.
Background: SHEA guidelines recommend deferring testing of patients without diarrhea for C. diffi... more Background: SHEA guidelines recommend deferring testing of patients without diarrhea for C. difficile infection (CDI). However, it is not known how accurate the medical record is in documenting diarrhea in hospitalized patients who are tested for CDI. We hypothesized that the medical record would be inferior to direct interviews in accuracy of documentation of diarrhea in an inpatient setting. Methods: We conducted a prospective cohort study of all inpatients tested for CDI over a 4-month period to compare the accuracy of documentation of diarrhea in the medical record with direct nursing and patient interviews in a 400-bed, tertiary care VA hospital. Fisher's exact was used to compare proportions and t-test was used to compare means. Results: Of 79 patients who had testing ordered for CDI over the study period, overall chart documentation of diarrhea was similar between physicians and nursing staff (56% versus 58% of the time, NS). Only 23% of charts contained data regarding fr...
Background: Contaminated environmental surfaces are an important source for transmission of healt... more Background: Contaminated environmental surfaces are an important source for transmission of healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). However, limited data are available on the frequency of environmental contamination with these pathogens and the effectiveness of environmental disinfection practices in hospitals that do not routinely screen patients for carriage. Methods: In 10 Ohio hospitals (7 community hospitals and 3 teaching hospitals), cultures for MRSA and VRE were collected from high-touch surfaces (bedside table/bed rail, toilet seat/bathroom handrail, and telephone/call button) in a convenience sample of Clostridium difficile infection (CDI) isolation rooms and non-isolation rooms after completion of terminal cleaning and disinfection by environmental services personnel. Results: Of 211 total rooms cultured, 36 (17%) had positive cultures for MRSA and/or VRE after completion of te...
Background: STERIPLEX SD is an EPA-registered cleaner and disinfectant with sporicidal activity. ... more Background: STERIPLEX SD is an EPA-registered cleaner and disinfectant with sporicidal activity. In addition to use as wipe, Steriplex can be applied to surfaces using a touchless spray device. Although spraying sporicidal disinfectants provides efficient surface application, limited data are available on the effectiveness of this form of disinfectant application. Methods: In the laboratory, we examined the efficacy of STERIPLEX solution versus a 1 to 10 dilution of household bleach for killing of Clostridium difficile spores, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) on stainless steel carriers. To assess the effectiveness of the spray application, reductions in pathogens inoculated onto benchtop surfaces were measured after spraying with STERIPLEX directly or 6 or 12 inches from the direct line of spray and effectiveness in eliminating pathogens from hospital equipment was assessed on hospital wards. Results: On steel carriers, ...
Background: Floors Clostridium difficile infection (CDI) isolation rooms may be contaminated with... more Background: Floors Clostridium difficile infection (CDI) isolation rooms may be contaminated with spores, but sporicidal disinfectants are not commonly used on floors in healthcare facilities. It is plausible that floors could contribute to C. difficile transmission because they are frequently contacted by surfaces that are subsequently touched by hands (e.g., shoes, socks, wheelchairs, portable equipment). OxyCide Daily Disinfectant CleanerTMis a sporicidal peracetic acid/hydrogen peroxide-based daily disinfectant cleaner that can be used on a wide range of surfaces including floors. Methods: In the laboratory, we examined the efficacy of Oxycide versus a 1 to 10 dilution of household bleach for killing of C. difficile spores, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA). In CDI isolation rooms, floors in bathrooms and adjacent to the patient bed were cultured for C. difficile, VRE, and MRSA. We compared the effectiveness of OxyCide...
Infection Control and Hospital Epidemiology, 2014
OxyCide Daily Disinfectant Cleaner, a novel peracetic acid/hydrogen peroxide-based sporicidal dis... more OxyCide Daily Disinfectant Cleaner, a novel peracetic acid/hydrogen peroxide-based sporicidal disinfectant, was as effective as sodium hypochlorite for in vitro killing of Clostridium difficile spores, methicillin-resistant Staphylococcus aureus, and vancomcyin-resistant enterococci. OxyCide was minimally affected by organic load and was effective in reducing pathogen contamination in isolation rooms.
PLoS ONE, 2013
Background: Recent reports suggest that community-associated Clostridium difficile infection (CDI... more Background: Recent reports suggest that community-associated Clostridium difficile infection (CDI) (i.e., no healthcare facility admission within 90 days) may be increasing in frequency. We hypothesized that outpatient clinics could be an important source for acquisition of community-associated CDI.
Journal of the American Geriatrics Society, 2013
To initiate a long-term care facility (LTCF) infectious disease (LID) service that provides on-si... more To initiate a long-term care facility (LTCF) infectious disease (LID) service that provides on-site consultations to LTCF residents to improve the care of residents with possible infections. Clinical demonstration project. A 160-bed LTCF affiliated with a tertiary care Veterans Affairs (VA) hospital. Residents referred to the LID team. The reason for and source of LTCF residents' referral to the LID team and their demographic characteristics, infectious disease diagnoses, interventions, and hospitalizations were determined. Between July 2009 and December 2010, the LID consultation service provided 291 consultations for 250 LTCF residents. Referrals came from LTCF staff (75%) or the VA hospital's ID consult service (25%). The most common diagnoses were Clostridium difficile infection (14%), asymptomatic bacteriuria (10%), and urinary tract infection (10%). More than half of referred residents were receiving antibiotic therapy when they first saw the LID team; 46% of residents required an intervention. The most common interventions, stopping (32%) or starting (26%) antibiotics, were made in accordance with principles of antibiotic stewardship. The LID team represents a novel and effective means to bring subspecialty care to LTCF residents.
Journal of Clinical Microbiology, 2013
Although rapid laboratory tests are available for diagnosis of Clostridium difficile infection (C... more Although rapid laboratory tests are available for diagnosis of Clostridium difficile infection (CDI), delays in completion of CDI testing are common in clinical practice. We conducted a cohort study of 242 inpatients tested for CDI to determine the timing of different steps involved in diagnostic testing and to identify modifiable factors contributing to delays in diagnosis. The average time from test order to test result was 1.8 days (range, 0.2 to 10.6), with time from order to stool collection accounting for most of the delay (mean, 1.0 day; range, 0 to 10). Several modifiable factors contributed to delays, including not providing stool collection supplies to patients in a timely fashion, rejection of specimens due to incorrect labeling or leaking from the container, and holding samples in the laboratory for batch processing. Delays in testing contributed to delays in initiation of treatment for patients diagnosed with CDI and to frequent prescription of empirical CDI therapy for patients with mild to moderate symptoms whose testing was ultimately negative. An intervention that addressed several easily modified factors contributing to delays resulted in a significant decrease in the time required to complete CDI testing. These findings suggest that health care facilities may benefit from a review of their processes for CDI testing to identify and address modifiable factors that contribute to delays in diagnosis and treatment of CDI.
Infection Control and Hospital Epidemiology, 2013
Infection Control and Hospital Epidemiology, 2013
A Clostridium difficile infection (CDI) stewardship initiative reduced inappropriate prescription... more A Clostridium difficile infection (CDI) stewardship initiative reduced inappropriate prescription of empirical CDI therapy and improved timeliness of treatment and adherence to clinical practice guidelines for management of CDI. The initiative required minimal resources and could easily be incorporated into traditional antimicrobial stewardship programs.
Infection Control and Hospital Epidemiology, 2013
OBJECTIVE. Effective disinfection of hospital rooms after discharge of patients with Clostridium ... more OBJECTIVE. Effective disinfection of hospital rooms after discharge of patients with Clostridium difficile infection (CDI) is necessary to prevent transmission. We evaluated the impact of sequential cleaning and disinfection interventions by culturing high-touch surfaces in CDI rooms after cleaning. DESIGN. Prospective intervention. SETTING. A Veterans Affairs hospital. INTERVENTIONS. During a 21-month period, 3 sequential tiered interventions were implemented: (1) fluorescent markers to provide monitoring and feedback on thoroughness of cleaning facility-wide, (2) addition of an automated ultraviolet radiation device for adjunctive disinfection of CDI rooms, and (3) enhanced standard disinfection of CDI rooms, including a dedicated daily disinfection team and implementation of a process requiring supervisory assessment and clearance of terminally cleaned CDI rooms. To determine the impact of the interventions, cultures were obtained from CDI rooms after cleaning and disinfection. RESULTS. The fluorescent marker intervention improved the thoroughness of cleaning of high-touch surfaces (from 47% to 81% marker removal; P < .0001). Relative to the baseline period, the prevalence of positive cultures from CDI rooms was reduced by 14% (P=.024), 48% (P <.001), and 89% (P=.006) with interventions 1, 2, and 3, respectively. During the baseline period, 67% of CDI rooms had positive cultures after disinfection, whereas during interventions periods 1, 2, and 3 the percentages of CDI rooms with positive cultures after disinfection were reduced to 57%, 35%, and 7%, respectively. CONCLUSIONS. An intervention that included formation of a dedicated daily disinfection team and implementation of a standardized process for clearing CDI rooms achieved consistent CDI room disinfection. Culturing of CDI rooms provides a valuable tool to drive improvements in environmental disinfection.
Infection Control and Hospital Epidemiology, 2012
JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, a... more JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.
Infection Control and Hospital Epidemiology, 2012
Infection Control and Hospital Epidemiology, 2014
ABSTRACT
American Journal of Infection Control, 2012
American Journal of Infection Control, 2012
American Journal of Infection Control, 2013
PLoS ONE, 2014
Background: The intestinal microbiota protect the host against enteric pathogens through a defens... more Background: The intestinal microbiota protect the host against enteric pathogens through a defense mechanism termed colonization resistance. Antibiotics excreted into the intestinal tract may disrupt colonization resistance and alter normal metabolic functions of the microbiota. We used a mouse model to test the hypothesis that alterations in levels of bacterial metabolites in fecal specimens could provide useful biomarkers indicating disrupted or intact colonization resistance after antibiotic treatment.