- Email: [email protected]
255 Effect of Antimicrobial Disinfectant Wipes on Bacteria on Computer Equipment in the Emergency Department
Research Forum Abstracts Methods: A structured retrospective review of medical records was conducted at an academic urban emergency department (annual visits >85,000) of patients who initially met systemic inflammatory response syndrome (SIRS) criteria after an electronic BPA was implemented (March 1, 2014 to March 30, 2014 and the first 7-day monthly period of April 1, 2014 to September 30, 2014). The BPA Sepsis Risk Scoring System was created based on the SSC guidelines and guided by the Detecting and Treating Sepsis manual from Epic Systems. A score >2.5 meant that a patient met SIRS criteria, is potentially septic, and triggered the BPA. The definitive diagnosis of sepsis for ED SIRS visits was based upon final diagnostic related group (DRG) coding and further established by imaging modalities, urinalysis, and physical exam findings on chart review. BPAs’ sensitivity, specificity, PPV, NPV was calculated and 95% confidence intervals (CI) established. Results: Over the course of the study period, 13,906 records were screened, 565 BPAs fired and 313 cases of sepsis were confirmed (2.3% prevalence). The BPAs’ sensitivity and specificity was 74.5% (95% CI 69.2-79.1%) and 97.6% (95% CI 97.3-97.8%) respectively, with positive and negative predictive values of 41.2% (95% CI 37.2-45.4%) and 99.4% (95% CI 99.3-99.5%) respectively. The BPA’s positive and negative likelihood ratios (LR) (weighted for prevalence) were 0.70 (95% CI 0.62-0.79) and 0.006 (95% CI 0.005-0.008). No significant changes were noted in the BPA sensitivity or specificity when confined to severe sepsis or septic shock. Conclusion: BPAs were an effective EHR-based tool that detected potentially septic patients with moderate sensitivity and high specificity in our ED. The test’s high negative LR and negative predictive value make it valuable in excluding sepsis as differential diagnosis in a general ED population. Future directions for follow-up studies include cost analysis, morbidity/mortality studies, and multicenter comparisons of other quality metrics that can be improved by having a system such as BPA that reduces time to appropriate medical intervention.
254
Identification of Adults With Cerebrospinal Fluid Pleocytosis at Low Risk For Bacterial Meningitis
McArthur R, Edlow J, Nigrovic L/Beth Israel Deaconess Medical Center, Boston, MA; Children’s Hospital Boston, Boston, MA
Background: The Bacterial Meningitis Score classifies children with cerebrospinal fluid (CSF) pleocytosis and none of the following predictors as very low risk for bacterial meningitis: positive CSF gram stain, CSF absolute neutrophil count (ANC) 1000 cells/mm3, CSF protein 80mg/dL, peripheral blood ANC 10,000 cells/ mm3, or a history of seizure prior to or at time of presentation. The performance of this clinical prediction rule in adults has not been evaluated. Study Objectives: To determine the performance of the Bacterial Meningitis Score in adults with CSF pleocytosis. Methods: We conducted a single-center retrospective study of all adult emergency department (ED) patients with a CSF pleocytosis [defined as a CSF white blood cells (WBC) 10 cells/mm3] between November 2003 and October 2013. We classified a case of bacterial meningitis with a positive CSF or blood culture and aseptic meningitis with negative cultures. We then report the performance of the Bacterial Meningitis Score in the study population. Results: We identified 711 patients with CSF pleocytosis of which 440 (62%) were eligible for study inclusion. Of these, 4 (1%) of cases had bacterial meningitis and 435 (99%) had aseptic meningitis. The Bacteria Meningitis Score had a sensitivity of 100% [95% confidence interval (CI) 40.3-100%], specificity 53% (95% CI 46.7-56.4%) and negative predictive value of 100% (95% CI 98.3-100%). If very low risk patients were discharged from the ED, hospital admission rates would have dropped from 85% to 49%. Conclusions: Bacterial meningitis was very uncommon in adult ED patients with CSF pleocytosis. The Bacterial Meningitis Score accurately identified patients at low risk of bacterial meningitis, and might be helpful to assist clinical decisionmaking for adults with CSF pleocytosis.
255
Effect of Antimicrobial Disinfectant Wipes on Bacteria on Computer Equipment in the Emergency Department
Merritt M, Brown R, Glenn A, Chudasama Y, Eberhardt M/St Lukes University Health Network, Bethlehem, PA
Study Objectives: Shared computers serve as a potential fomite for the spread of infection in the emergency department between health care workers and patients. The
S92 Annals of Emergency Medicine
object of this study is to determine the duration of effect of disinfectant wipes on bacteria on computer mice in the emergency department (ED). Methods: This was an exploratory study of five computer mice in an ED. Physician, nursing and unit clerk computer mice were initially swabbed for a baseline bacteria count. The mice were cleaned with antibacterial wipes. They were then swabbed at 5, 120, and 300 minutes after sanitization period. Results: All computers showed a decrease in colony forming units (CFUs) immediately post cleaning with 4 out of 5 computers showing no bacterial growth. The number of CFUs varied among the computers from post cleaning and 2 hours and between 2 and 5 hours. All computers sampled showed an increase in bacterial growth after the 5 hours of use. Four out of 5 computers did not show CFUs as high as the pre-cleaning values after 5 hours. Overall there was a higher number of CFUs on the physician computers initially, with a total of 108 compared to nursing and unit clerk computers with 8 and 0, respectively. Post-cleaning cultures at 5 hours were similar between nursing and physician computers. Conclusion: In this small study there appears to be a lasting benefit to sanitization at the beginning of a shift to lessen transmission of bacteria between patients and health care workers and vice versa.
256
A Descriptive Analysis of Patients Who Opt Out of Routine HIV Screening in the Emergency Department
Mauntel-Medici C, Basnet S, Lin J/University of Illinois Hospital, Chicago, IL; University of Illinois at Chicago, Chicago, IL
Study Objectives: The objective of this study was to describe the demographic characteristics of patients who opt out of routine HIV screening and their reasons for opting out. Routine HIV screening in emergency departments (EDs) is recommended by the Centers for Disease Control and Prevention (CDC) and the American College of Emergency Physicians (ACEP) in order to increase early diagnosis and treatment of HIV infected individuals. Many patients at risk of acquiring HIV, however, may still be opting out of routine screening. This study will help to develop educational initiatives and screening models that are better tailored to these individuals. Methods: A routine opt-out HIV screening program was implemented in an urban academic ED in November 2014. An electronic medical record (EMR) algorithm automatically screens ED patients and determines their eligibility for routine HIV screening based on the following criteria: ages 13-64, no documented HIV diagnosis, no documentation of recent HIV test, and have blood drawn during their visit. Eligible patients are informed they will be screened for HIV unless they decline. Nurses report whether patients consent to testing or opt out of testing in a specially designed HIV EMR PowerForm. For all patients who opt out of testing, nurses select the patient’s indicated reason for declining testing out of a list of 8 possible preset answers or by entering a free-text answer. We conducted a retrospective chart review of PowerForm data for the period of November 2014 through March 2015. The patient variables analyzed included age, race, zip code, marital status, declination of screening, and, for those who opted out, the reason for declining screening. Patients’ sexual orientation is infrequently documented in the EMR and thus was not included in this analysis. Results: Medical records of 4,200 patients determined to be eligible for routine screening were reviewed, of whom 35.4% opted out of screening. 39.7% and 28.8% of patients aged 13-19 and 20-29 opted out, respectively. Among non-Hispanic whites 42.6% opted out, compared to 34.9% among non-Hispanic Blacks and 30.2% among Hispanics. Based on national HIV surveillance data, over 47% of those who opted out of screening reside in a high HIV prevalence (>1.0%) zip code. Among those who declined screening, 33.3% indicated they did not consider themselves to be at risk, 29.5% reported they had recently been tested for HIV, and 20.5% refused to provide a reason for declining. 16.7% of patients provided other reasons for declining testing, such as cost, known HIV positive diagnosis, parental refusal, doesn’t want to know, unnecessary, and not interested. A quarter (25.5%) of patients aged 20-29 and 56.8% of unmarried patients who opted out of screening did not consider themselves to be at risk. Additionally, almost half (45.2%) of Hispanic patients, 37.6% of non-Hispanic whites, and 26.3% of non-Hispanic blacks who declined screening did not consider themselves to be at risk. Conclusion: Despite high HIV prevalence rates among the demographic groups represented by the patient population, many patients still do not perceive themselves to be at risk of acquiring HIV. Screening models and educational initiatives should be tailored to reach those groups known to frequently opt out of routine screening.
Volume 66, no. 4s : October 2015
254
Identification of Adults With Cerebrospinal Fluid Pleocytosis at Low Risk For Bacterial Meningitis
McArthur R, Edlow J, Nigrovic L/Beth Israel Deaconess Medical Center, Boston, MA; Children’s Hospital Boston, Boston, MA
Background: The Bacterial Meningitis Score classifies children with cerebrospinal fluid (CSF) pleocytosis and none of the following predictors as very low risk for bacterial meningitis: positive CSF gram stain, CSF absolute neutrophil count (ANC) 1000 cells/mm3, CSF protein 80mg/dL, peripheral blood ANC 10,000 cells/ mm3, or a history of seizure prior to or at time of presentation. The performance of this clinical prediction rule in adults has not been evaluated. Study Objectives: To determine the performance of the Bacterial Meningitis Score in adults with CSF pleocytosis. Methods: We conducted a single-center retrospective study of all adult emergency department (ED) patients with a CSF pleocytosis [defined as a CSF white blood cells (WBC) 10 cells/mm3] between November 2003 and October 2013. We classified a case of bacterial meningitis with a positive CSF or blood culture and aseptic meningitis with negative cultures. We then report the performance of the Bacterial Meningitis Score in the study population. Results: We identified 711 patients with CSF pleocytosis of which 440 (62%) were eligible for study inclusion. Of these, 4 (1%) of cases had bacterial meningitis and 435 (99%) had aseptic meningitis. The Bacteria Meningitis Score had a sensitivity of 100% [95% confidence interval (CI) 40.3-100%], specificity 53% (95% CI 46.7-56.4%) and negative predictive value of 100% (95% CI 98.3-100%). If very low risk patients were discharged from the ED, hospital admission rates would have dropped from 85% to 49%. Conclusions: Bacterial meningitis was very uncommon in adult ED patients with CSF pleocytosis. The Bacterial Meningitis Score accurately identified patients at low risk of bacterial meningitis, and might be helpful to assist clinical decisionmaking for adults with CSF pleocytosis.
255
Effect of Antimicrobial Disinfectant Wipes on Bacteria on Computer Equipment in the Emergency Department
Merritt M, Brown R, Glenn A, Chudasama Y, Eberhardt M/St Lukes University Health Network, Bethlehem, PA
Study Objectives: Shared computers serve as a potential fomite for the spread of infection in the emergency department between health care workers and patients. The
S92 Annals of Emergency Medicine
object of this study is to determine the duration of effect of disinfectant wipes on bacteria on computer mice in the emergency department (ED). Methods: This was an exploratory study of five computer mice in an ED. Physician, nursing and unit clerk computer mice were initially swabbed for a baseline bacteria count. The mice were cleaned with antibacterial wipes. They were then swabbed at 5, 120, and 300 minutes after sanitization period. Results: All computers showed a decrease in colony forming units (CFUs) immediately post cleaning with 4 out of 5 computers showing no bacterial growth. The number of CFUs varied among the computers from post cleaning and 2 hours and between 2 and 5 hours. All computers sampled showed an increase in bacterial growth after the 5 hours of use. Four out of 5 computers did not show CFUs as high as the pre-cleaning values after 5 hours. Overall there was a higher number of CFUs on the physician computers initially, with a total of 108 compared to nursing and unit clerk computers with 8 and 0, respectively. Post-cleaning cultures at 5 hours were similar between nursing and physician computers. Conclusion: In this small study there appears to be a lasting benefit to sanitization at the beginning of a shift to lessen transmission of bacteria between patients and health care workers and vice versa.
256
A Descriptive Analysis of Patients Who Opt Out of Routine HIV Screening in the Emergency Department
Mauntel-Medici C, Basnet S, Lin J/University of Illinois Hospital, Chicago, IL; University of Illinois at Chicago, Chicago, IL
Study Objectives: The objective of this study was to describe the demographic characteristics of patients who opt out of routine HIV screening and their reasons for opting out. Routine HIV screening in emergency departments (EDs) is recommended by the Centers for Disease Control and Prevention (CDC) and the American College of Emergency Physicians (ACEP) in order to increase early diagnosis and treatment of HIV infected individuals. Many patients at risk of acquiring HIV, however, may still be opting out of routine screening. This study will help to develop educational initiatives and screening models that are better tailored to these individuals. Methods: A routine opt-out HIV screening program was implemented in an urban academic ED in November 2014. An electronic medical record (EMR) algorithm automatically screens ED patients and determines their eligibility for routine HIV screening based on the following criteria: ages 13-64, no documented HIV diagnosis, no documentation of recent HIV test, and have blood drawn during their visit. Eligible patients are informed they will be screened for HIV unless they decline. Nurses report whether patients consent to testing or opt out of testing in a specially designed HIV EMR PowerForm. For all patients who opt out of testing, nurses select the patient’s indicated reason for declining testing out of a list of 8 possible preset answers or by entering a free-text answer. We conducted a retrospective chart review of PowerForm data for the period of November 2014 through March 2015. The patient variables analyzed included age, race, zip code, marital status, declination of screening, and, for those who opted out, the reason for declining screening. Patients’ sexual orientation is infrequently documented in the EMR and thus was not included in this analysis. Results: Medical records of 4,200 patients determined to be eligible for routine screening were reviewed, of whom 35.4% opted out of screening. 39.7% and 28.8% of patients aged 13-19 and 20-29 opted out, respectively. Among non-Hispanic whites 42.6% opted out, compared to 34.9% among non-Hispanic Blacks and 30.2% among Hispanics. Based on national HIV surveillance data, over 47% of those who opted out of screening reside in a high HIV prevalence (>1.0%) zip code. Among those who declined screening, 33.3% indicated they did not consider themselves to be at risk, 29.5% reported they had recently been tested for HIV, and 20.5% refused to provide a reason for declining. 16.7% of patients provided other reasons for declining testing, such as cost, known HIV positive diagnosis, parental refusal, doesn’t want to know, unnecessary, and not interested. A quarter (25.5%) of patients aged 20-29 and 56.8% of unmarried patients who opted out of screening did not consider themselves to be at risk. Additionally, almost half (45.2%) of Hispanic patients, 37.6% of non-Hispanic whites, and 26.3% of non-Hispanic blacks who declined screening did not consider themselves to be at risk. Conclusion: Despite high HIV prevalence rates among the demographic groups represented by the patient population, many patients still do not perceive themselves to be at risk of acquiring HIV. Screening models and educational initiatives should be tailored to reach those groups known to frequently opt out of routine screening.
Volume 66, no. 4s : October 2015