Laraine Washer - Academia.edu (original) (raw)

Papers by Laraine Washer

Changing from Passive to Active Surveillance and Intervention to Increase Hand Hygiene Compliance... more Changing from Passive to Active Surveillance and Intervention to Increase Hand Hygiene Compliance Background: With the implementation of hand hygiene (HH) as a national patient safety goal and the Joint Commission's expected compliance of 90%, health care institutions are under pressure to develop HH programs and to demonstrate improved adherence. Health care providers need continuous reminders, encouragement and monitoring to maintain adequate HH. To meet the Joint Commission's expected compliance rate, the University of Michigan Health System (UMHS) has used many approaches such as education, posting of signs, dissemination of videos, and monthly feedback reports on HH compliance. Objective: To increase HH compliance of health care workers to 100% throughout the UMHS. Methods: The UMHS relies primarily on nurse observers to collect HH compliance data. Currently, 79 observers collect observation data from 46 different inpatient floors and outpatient clinics. When UMHS began...

Infection Control & Hospital Epidemiology, 2015

American Journal of Infection Control, 2014

Surgical Infections, 2013

International Archives of Medicine, 2015

Drugs & aging, 2008

Surgical site infections (SSIs) represent a major source of morbidity and mortality among older a... more Surgical site infections (SSIs) represent a major source of morbidity and mortality among older adults. In this review we discuss the epidemiology and risk factors for SSIs among older adults. We also offer an overview of current treatment and management strategies for several common SSIs. Our comments focus on the following areas in order to illustrate issues of clinical importance in the older patient: (i) cardiac surgery; (ii) vascular grafts; (iii) total joint arthroplasty; (iv) breast surgery; and (v) spinal surgeries. Besides being common and relatively specific to older adults, several of these surgical procedures require the use of prosthetic materials or devices, which present unique treatment challenges in the context of infection. When an older adult does develop an SSI, it is critical for clinicians to establish an overall treatment goal for each patient. In the majority of patients, this will be either complete cure or remission followed by suppressive therapy. However,...

Infectious Disease Reports, 2013

The prevalence of carbapenemase-producing Enterobacteriaceae (CPE) in our hospital increased begi... more The prevalence of carbapenemase-producing Enterobacteriaceae (CPE) in our hospital increased beginning in 2009. We aimed to study the clinical and molecular epidemiology of these emerging isolates. We performed a retrospective review of all adult patients with clinical cultures confirmed as CPE by positive modified Hodge test from

Infection Control & Hospital Epidemiology, 2015

Treatment of asymptomatic bacteriuria contributes to antimicrobial overuse in hospitalized patien... more Treatment of asymptomatic bacteriuria contributes to antimicrobial overuse in hospitalized patients. Indications for urine culture, treatment, and targets for improvement were evaluated in 153 patients. Drivers of antimicrobial overuse included fever with an alternative source, altered mental status, and leukocytosis, which led 435 excess days of antimicrobial therapy. Infect Control Hosp Epidemiol 2014;00(0): 1-4.

Journal of clinical microbiology, 2014

Rapid diagnostic testing with matrix-assisted laser desorption ionization-time of flight (MALDI-T... more Rapid diagnostic testing with matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) decreases the time to organism identification by 24 to 36 h compared to the amount of time required by conventional methods. However, there are limited data evaluating the impact of MALDI-TOF with real-time antimicrobial stewardship team (AST) review and intervention on antimicrobial prescribing and outcomes for patients with bacteremia and blood cultures contaminated with coagulase-negative Staphylococcus (CoNS). A quasiexperimental study was conducted to analyze the impact of rapid diagnostic testing with MALDI-TOF plus AST review and intervention for adult hospitalized patients with blood cultures positive for CoNS. Antibiotic prescribing patterns and clinical outcomes were compared before and after implementation of MALDI-TOF with AST intervention for patients with CoNS bacteremia and CoNS contamination. A total of 324 patients with a positive CoNS blood culture were included; 24...

Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2013

To analyze the impact of a comprehensive care bundle directed by an antimicrobial stewardship tea... more To analyze the impact of a comprehensive care bundle directed by an antimicrobial stewardship team (AST) on the management of candidemia. Single-center, quasi-experimental study. A 930-bed academic hospital. Seventy-eight patients with candidemia were evaluated; 41 patients received the candidemia care bundle (AST group), and 37 did not (historical control group). A candidemia care bundle was developed by an interdisciplinary AST, incorporating key elements from the Infectious Diseases Society of America's Clinical Practice Guidelines for the Management of Candidemia. The AST made prospective recommendations in accordance with the care bundle. Bundle elements were utilization of appropriate antifungal agents with appropriate duration of use, removal of intravenous catheters, repeat blood cultures, monitoring of time until clearance of candidemia, and performance of ophthalmologic examinations. Compliance with all candidemia care bundle elements was significantly higher in the AST group versus the control group (78.0% vs 40.5%, p=0.0016). Implementation of the care bundle significantly improved rates of ophthalmologic examination (97.6% vs 75.7%, p=0.0108), selection of appropriate antifungal therapy (100% vs 86.5%, p=0.0488), and compliance with an appropriate duration of therapy (97.6% vs 67.7%, p=0.0012). In addition, the AST group had fewer excess total days of therapy beyond the recommended duration than the control group (5 vs 83 total antifungal days). Length of hospitalization (20 vs 21 days, p=0.9184), time until clearance of candidemia (3 vs 3 days p=0.610), rate of persistent candidemia (22% vs 40.5%, p=0.126), and rate of recurrent candidemia (4.9% vs 5.4%, p=0.916) were similar in the AST group versus the control group. A comprehensive candidemia care bundle directed by our institution's AST improved the management of patients with candidemia. We encourage further exploration into the use of care bundles by ASTs as part of their multifaceted approach to promoting appropriate antimicrobial utilization and optimizing the management of patients with infectious diseases.

Journal of Clinical Microbiology, 2008

The Klebsiella pneumoniae carbapenemase (KPC) was detected in carbapenem-resistant isolates of Ci... more The Klebsiella pneumoniae carbapenemase (KPC) was detected in carbapenem-resistant isolates of Citrobacter freundii and Klebsiella oxytoca recovered from different patients in a Michigan hospital. Restriction analysis and hybridization with a KPC-specific probe showed the bla KPC-2 genes of these two genera of the family Enterobacteriaceae are carried on a common plasmid.

Infection Control and Hospital Epidemiology, 2013

Urine cultures are frequently obtained for hospitalized patients. We reviewed documented indicati... more Urine cultures are frequently obtained for hospitalized patients. We reviewed documented indications for culture and compared these with professional society guidelines. Lack of documentation and important clinical scenarios (before orthopedic procedures and when the patient has altered mental status without a urinary catheter) are highlighted as areas of use outside of current guidelines.

Infection Control and Hospital Epidemiology, 2007

objective. To describe the rate of infection, associated organisms, and potential risk factors fo... more objective. To describe the rate of infection, associated organisms, and potential risk factors for ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation at home.

Critical Care Medicine, 2010

The challenges in managing patients with infection in the intensive care unit are increased in an... more The challenges in managing patients with infection in the intensive care unit are increased in an era where there are dwindling antimicrobial choices for multidrug-resistant pathogens. Clinicians in the intensive care unit must balance between choosing appropriate antimicrobial treatment for patients with suspected infection and utilizing antimicrobials in a judicious fashion. Improving antimicrobial utilization is a critical component to reducing antimicrobial resistance. Although providing effective antimicrobial therapy and improving antimicrobial utilization may seem to be competing goals, there are effective strategies to accomplish both. Antimicrobial stewardship programs provide an organized way to implement these strategies and can enhance the intensive care unit physician's success in improving patient outcomes and combating antimicrobial resistance in the intensive care unit.

Clinical Infectious Diseases, 2012

Studies of Clostridium difficile outbreaks suggested that certain ribotypes (eg, 027 and 078) cau... more Studies of Clostridium difficile outbreaks suggested that certain ribotypes (eg, 027 and 078) cause more severe disease than other ribotypes. A growing number of studies challenge the validity of this hypothesis. We conducted a cross-sectional study of C. difficile infection (CDI) to test whether ribotype predicted clinical severity when adjusted for the influence of other predictors. Toxigenic C. difficile isolates were cultured from stool samples, screened for genes encoding virulence factors by polymerase chain reaction (PCR) and ribotyped using high-throughput, fluorescent PCR ribotyping. We collected data for 15 covariates (microbiologic, epidemiologic, and laboratory variables) and determined their individual and cumulative influence on the association between C. difficile ribotype and severe disease. We then validated this influence using an independent data set. A total of 34 severe CDI cases were identified among 310 independent cases of disease (11.0%). Eleven covariates, including C. difficile ribotype, were significant predictors of severe CDI in unadjusted analysis. However, the association between ribotypes 027 and 078 and severe CDI was not significant after adjustment for any of the other covariates. After full adjustment, severe cases were significantly predicted only by patients' white blood cell count and albumin level. This result was supported by analysis of a validation data set containing 433 independent CDI cases (45 severe cases; 10.4%). Ribotype is not a significant predictor of severe CDI when adjusted for the influence of any other variables separately or in combination. White blood cell count and albumin level are the most clinically relevant predictors of severe CDI cases.

Clinical Infectious Diseases, 2013

Background. Integration of rapid diagnostic testing via matrix-assisted laser desorption/ionizati... more Background. Integration of rapid diagnostic testing via matrix-assisted laser desorption/ionization timeof-flight (MALDI-TOF) with antimicrobial stewardship team (AST) intervention has the potential for early organism identification, customization of antibiotic therapy, and improvement in patient outcomes. The objective of this study was to assess the impact of this combined approach on clinical and antimicrobial therapy-related outcomes in patients with bloodstream infections.

Clinical Infectious Diseases, 2013

Clinical Infectious Diseases, 2007

We describe a cluster of 4 bloodstream infections with Mycobacterium neoaurum and 5 additional ca... more We describe a cluster of 4 bloodstream infections with Mycobacterium neoaurum and 5 additional cases from the literature. Infections occurred mainly in immunocompromised hosts who had central venous catheters. Fever was universal at presentation, but local signs of inflammation were rare. Combination antimicrobial therapy and catheter removal resulted in clinical cure.

Clinical Infectious Diseases, 2013

Changing from Passive to Active Surveillance and Intervention to Increase Hand Hygiene Compliance... more Changing from Passive to Active Surveillance and Intervention to Increase Hand Hygiene Compliance Background: With the implementation of hand hygiene (HH) as a national patient safety goal and the Joint Commission's expected compliance of 90%, health care institutions are under pressure to develop HH programs and to demonstrate improved adherence. Health care providers need continuous reminders, encouragement and monitoring to maintain adequate HH. To meet the Joint Commission's expected compliance rate, the University of Michigan Health System (UMHS) has used many approaches such as education, posting of signs, dissemination of videos, and monthly feedback reports on HH compliance. Objective: To increase HH compliance of health care workers to 100% throughout the UMHS. Methods: The UMHS relies primarily on nurse observers to collect HH compliance data. Currently, 79 observers collect observation data from 46 different inpatient floors and outpatient clinics. When UMHS began...

Infection Control & Hospital Epidemiology, 2015

American Journal of Infection Control, 2014

Surgical Infections, 2013

International Archives of Medicine, 2015

Drugs & aging, 2008

Surgical site infections (SSIs) represent a major source of morbidity and mortality among older a... more Surgical site infections (SSIs) represent a major source of morbidity and mortality among older adults. In this review we discuss the epidemiology and risk factors for SSIs among older adults. We also offer an overview of current treatment and management strategies for several common SSIs. Our comments focus on the following areas in order to illustrate issues of clinical importance in the older patient: (i) cardiac surgery; (ii) vascular grafts; (iii) total joint arthroplasty; (iv) breast surgery; and (v) spinal surgeries. Besides being common and relatively specific to older adults, several of these surgical procedures require the use of prosthetic materials or devices, which present unique treatment challenges in the context of infection. When an older adult does develop an SSI, it is critical for clinicians to establish an overall treatment goal for each patient. In the majority of patients, this will be either complete cure or remission followed by suppressive therapy. However,...

Infectious Disease Reports, 2013

The prevalence of carbapenemase-producing Enterobacteriaceae (CPE) in our hospital increased begi... more The prevalence of carbapenemase-producing Enterobacteriaceae (CPE) in our hospital increased beginning in 2009. We aimed to study the clinical and molecular epidemiology of these emerging isolates. We performed a retrospective review of all adult patients with clinical cultures confirmed as CPE by positive modified Hodge test from

Infection Control & Hospital Epidemiology, 2015

Treatment of asymptomatic bacteriuria contributes to antimicrobial overuse in hospitalized patien... more Treatment of asymptomatic bacteriuria contributes to antimicrobial overuse in hospitalized patients. Indications for urine culture, treatment, and targets for improvement were evaluated in 153 patients. Drivers of antimicrobial overuse included fever with an alternative source, altered mental status, and leukocytosis, which led 435 excess days of antimicrobial therapy. Infect Control Hosp Epidemiol 2014;00(0): 1-4.

Journal of clinical microbiology, 2014

Rapid diagnostic testing with matrix-assisted laser desorption ionization-time of flight (MALDI-T... more Rapid diagnostic testing with matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) decreases the time to organism identification by 24 to 36 h compared to the amount of time required by conventional methods. However, there are limited data evaluating the impact of MALDI-TOF with real-time antimicrobial stewardship team (AST) review and intervention on antimicrobial prescribing and outcomes for patients with bacteremia and blood cultures contaminated with coagulase-negative Staphylococcus (CoNS). A quasiexperimental study was conducted to analyze the impact of rapid diagnostic testing with MALDI-TOF plus AST review and intervention for adult hospitalized patients with blood cultures positive for CoNS. Antibiotic prescribing patterns and clinical outcomes were compared before and after implementation of MALDI-TOF with AST intervention for patients with CoNS bacteremia and CoNS contamination. A total of 324 patients with a positive CoNS blood culture were included; 24...

Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2013

To analyze the impact of a comprehensive care bundle directed by an antimicrobial stewardship tea... more To analyze the impact of a comprehensive care bundle directed by an antimicrobial stewardship team (AST) on the management of candidemia. Single-center, quasi-experimental study. A 930-bed academic hospital. Seventy-eight patients with candidemia were evaluated; 41 patients received the candidemia care bundle (AST group), and 37 did not (historical control group). A candidemia care bundle was developed by an interdisciplinary AST, incorporating key elements from the Infectious Diseases Society of America's Clinical Practice Guidelines for the Management of Candidemia. The AST made prospective recommendations in accordance with the care bundle. Bundle elements were utilization of appropriate antifungal agents with appropriate duration of use, removal of intravenous catheters, repeat blood cultures, monitoring of time until clearance of candidemia, and performance of ophthalmologic examinations. Compliance with all candidemia care bundle elements was significantly higher in the AST group versus the control group (78.0% vs 40.5%, p=0.0016). Implementation of the care bundle significantly improved rates of ophthalmologic examination (97.6% vs 75.7%, p=0.0108), selection of appropriate antifungal therapy (100% vs 86.5%, p=0.0488), and compliance with an appropriate duration of therapy (97.6% vs 67.7%, p=0.0012). In addition, the AST group had fewer excess total days of therapy beyond the recommended duration than the control group (5 vs 83 total antifungal days). Length of hospitalization (20 vs 21 days, p=0.9184), time until clearance of candidemia (3 vs 3 days p=0.610), rate of persistent candidemia (22% vs 40.5%, p=0.126), and rate of recurrent candidemia (4.9% vs 5.4%, p=0.916) were similar in the AST group versus the control group. A comprehensive candidemia care bundle directed by our institution's AST improved the management of patients with candidemia. We encourage further exploration into the use of care bundles by ASTs as part of their multifaceted approach to promoting appropriate antimicrobial utilization and optimizing the management of patients with infectious diseases.

Journal of Clinical Microbiology, 2008

The Klebsiella pneumoniae carbapenemase (KPC) was detected in carbapenem-resistant isolates of Ci... more The Klebsiella pneumoniae carbapenemase (KPC) was detected in carbapenem-resistant isolates of Citrobacter freundii and Klebsiella oxytoca recovered from different patients in a Michigan hospital. Restriction analysis and hybridization with a KPC-specific probe showed the bla KPC-2 genes of these two genera of the family Enterobacteriaceae are carried on a common plasmid.

Infection Control and Hospital Epidemiology, 2013

Urine cultures are frequently obtained for hospitalized patients. We reviewed documented indicati... more Urine cultures are frequently obtained for hospitalized patients. We reviewed documented indications for culture and compared these with professional society guidelines. Lack of documentation and important clinical scenarios (before orthopedic procedures and when the patient has altered mental status without a urinary catheter) are highlighted as areas of use outside of current guidelines.

Infection Control and Hospital Epidemiology, 2007

objective. To describe the rate of infection, associated organisms, and potential risk factors fo... more objective. To describe the rate of infection, associated organisms, and potential risk factors for ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation at home.

Critical Care Medicine, 2010

The challenges in managing patients with infection in the intensive care unit are increased in an... more The challenges in managing patients with infection in the intensive care unit are increased in an era where there are dwindling antimicrobial choices for multidrug-resistant pathogens. Clinicians in the intensive care unit must balance between choosing appropriate antimicrobial treatment for patients with suspected infection and utilizing antimicrobials in a judicious fashion. Improving antimicrobial utilization is a critical component to reducing antimicrobial resistance. Although providing effective antimicrobial therapy and improving antimicrobial utilization may seem to be competing goals, there are effective strategies to accomplish both. Antimicrobial stewardship programs provide an organized way to implement these strategies and can enhance the intensive care unit physician's success in improving patient outcomes and combating antimicrobial resistance in the intensive care unit.

Clinical Infectious Diseases, 2012

Studies of Clostridium difficile outbreaks suggested that certain ribotypes (eg, 027 and 078) cau... more Studies of Clostridium difficile outbreaks suggested that certain ribotypes (eg, 027 and 078) cause more severe disease than other ribotypes. A growing number of studies challenge the validity of this hypothesis. We conducted a cross-sectional study of C. difficile infection (CDI) to test whether ribotype predicted clinical severity when adjusted for the influence of other predictors. Toxigenic C. difficile isolates were cultured from stool samples, screened for genes encoding virulence factors by polymerase chain reaction (PCR) and ribotyped using high-throughput, fluorescent PCR ribotyping. We collected data for 15 covariates (microbiologic, epidemiologic, and laboratory variables) and determined their individual and cumulative influence on the association between C. difficile ribotype and severe disease. We then validated this influence using an independent data set. A total of 34 severe CDI cases were identified among 310 independent cases of disease (11.0%). Eleven covariates, including C. difficile ribotype, were significant predictors of severe CDI in unadjusted analysis. However, the association between ribotypes 027 and 078 and severe CDI was not significant after adjustment for any of the other covariates. After full adjustment, severe cases were significantly predicted only by patients' white blood cell count and albumin level. This result was supported by analysis of a validation data set containing 433 independent CDI cases (45 severe cases; 10.4%). Ribotype is not a significant predictor of severe CDI when adjusted for the influence of any other variables separately or in combination. White blood cell count and albumin level are the most clinically relevant predictors of severe CDI cases.

Clinical Infectious Diseases, 2013

Background. Integration of rapid diagnostic testing via matrix-assisted laser desorption/ionizati... more Background. Integration of rapid diagnostic testing via matrix-assisted laser desorption/ionization timeof-flight (MALDI-TOF) with antimicrobial stewardship team (AST) intervention has the potential for early organism identification, customization of antibiotic therapy, and improvement in patient outcomes. The objective of this study was to assess the impact of this combined approach on clinical and antimicrobial therapy-related outcomes in patients with bloodstream infections.

Clinical Infectious Diseases, 2013

Clinical Infectious Diseases, 2007

We describe a cluster of 4 bloodstream infections with Mycobacterium neoaurum and 5 additional ca... more We describe a cluster of 4 bloodstream infections with Mycobacterium neoaurum and 5 additional cases from the literature. Infections occurred mainly in immunocompromised hosts who had central venous catheters. Fever was universal at presentation, but local signs of inflammation were rare. Combination antimicrobial therapy and catheter removal resulted in clinical cure.

Clinical Infectious Diseases, 2013