Marci L. Drees, M.D., MS, FACP, DTMH

Chief Infection Prevention Officer, Continum of Care Management

Publications

Evaluation of N95 respirator ultraviolet decontamination and clinical reuse with quantitative fit testing
Evaluation of N95 respirator ultraviolet decontamination and clinical reuse with quantitative fit testing
Wanner GK, Ader D, Caplan R, Padaki AS, Ravert D, Drees M

Infect Control Hosp Epidemiol 2021 May;():1-3

PMID: 33934738

Abstract

The supply of N95 respirators has been severely strained by the coronavirus disease 2019 (COVID-19) pandemic. We used quantitative fit-testing to evaluate 16 participants and 45 respirators through up to 4 rounds of ultraviolet decontamination and clinical reuse. The mean fit-test failure rate was 29.7%, and the probability of failure increased through N95 reuse.
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Identifying community spread of COVID-19 via a free drive-through screening event
Identifying community spread of COVID-19 via a free drive-through screening event
Drees ML, Papas MA, Corbo TE, Williams KD, Kurfuerst ST

Infect Control Hosp Epidemiol 2021 06;42(6):778-780

PMID: 32684180

Abstract

No abstract available.
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Using the Comprehensive Unit-based Safety Program model for sustained reduction in hospital infections
Using the Comprehensive Unit-based Safety Program model for sustained reduction in hospital infections
Miller K, Briody C, Casey D, Kane JK, Mitchell D, Patel B, Ritter C, Seckel M, Wakai S, Drees M

Am J Infect Control 2016 Sep;44(9):969-76

PMID: 27184208

Abstract

BACKGROUND: Prompted by the high number of central line-associated bloodstream infections (CLABSIs), our institution joined the national On the CUSP: Stop BSI initiative. We not only report the significant impact that the Comprehensive Unit-based Safety Program (CUSP) had in reducing CLABSI, but also report catheter-associated urinary tract infections (CAUTIs) and ventilator-associated pneumonia (VAP) in 2 intensive care units (ICUs).
METHODS: At our community-based academic health care system, 2 ICUs implemented CUSP tools and developed local interventions to reduce CLABSI and other safety problems. We measured CLABSI, CAUTI, and VAP during baseline, the CUSP period, and a post-CUSP period.
RESULTS: CLABSIs decreased from 3.9 per 1,000 catheter days at baseline to 1.2 during the CUSP period to 0.6 during the post-CUSP period (rate ratio, 0.16; 95% confidence interval [CI], 0.07-0.35). CAUTIs decreased from 2.4 per 1,000 patient days to 1.2 during the post-CUSP period (rate ratio, 0.4; 95% CI, 0.24-0.65). VAP rate decreased from 2.7 per 1,000 ventilator days to 1.6 during the CUSP and post-CUSP periods (rate ratio, 0.58; 95% CI, 0.30-1.10). Device utilization decreased significantly in both ICUs.
CONCLUSIONS: Implementation of CUSP was associated with significant decreases in CLABSI, CAUTI, and VAP. The CUSP model, allowing for implementation of evidence-based practices and engagement of frontline staff, creates sustainable improvements that reach far beyond the initial targeted problem.
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Carrots and Sticks: Achieving High Healthcare Personnel Influenza Vaccination Rates without a Mandate
Carrots and Sticks: Achieving High Healthcare Personnel Influenza Vaccination Rates without a Mandate
Drees M, Wroten K, Smedley M, Mase T, Schwartz JS

Infect Control Hosp Epidemiol 2015 Jun;36(6):717-24

PMID: 25721404

Abstract

OBJECTIVE Achieving high healthcare personnel (HCP) influenza vaccination rates has typically required mandating vaccination, which is often challenging to implement. Our objective was to achieve >90% employee influenza vaccination without a mandate. DESIGN Prospective quality improvement initiative SETTING AND PARTICIPANTS All employees of a 2-hospital, 1,100-bed, community-based academic healthcare system. METHODS The multimodal HCP vaccination campaign consisted of a mandatory declination policy, mask-wearing for non-vaccinated HCP, highly visible "I'm vaccinated" hanging badges, improved vaccination tracking, weekly compliance reports to managers and vice presidents, disciplinary measures for noncompliant HCP, vaccination stations at facility entrances, and inclusion of a target employee vaccination rate (>75%) metric in the annual employee bonus program. The campaign was implemented in the 2011-2012 influenza season and continued throughout the 2012-2013 through 2014-2015 influenza seasons. Employee compliance, vaccination, exemption and declination rates were calculated and compared with those of the seasons prior to the intervention. RESULTS Compared with vaccination rates of 57%-72% in the 3 years preceding the intervention, employee influenza vaccination increased to 92% in year 1 and 93% in years 2-4 (P<.001). The proportion of employees declaring medical/religious exemptions or declining vaccination decreased during the 4 years of the program (respectively, 1.2% to 0.5%, P<.001; 4.4% to 3.8%, P=.001). CONCLUSIONS An integrated multimodal approach incorporating peer pressure, accountability, and financial incentives was associated with increased employee vaccination rate from ≤72% to ≥92%, which has been sustained for 4 influenza seasons. Such programs may provide a model for behavioral change within healthcare organizations. Infect Control Hosp Epidemiol 2015;00(0): 1-8.
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Antibiotic prescribing by telephone in primary care
Antibiotic prescribing by telephone in primary care
Ewen E, Willey VJ, Kolm P, McGhan WF, Drees M

Pharmacoepidemiol Drug Saf 2015 Feb;24(2):113-20

PMID: 25079292

Abstract

OBJECTIVES: Little is known about the contribution of telephone-based prescribing on overall antibiotic utilization. The objective of this study was to determine the extent and characteristics of telephone-based antibiotic prescribing in teaching and non-teaching primary care practices.
METHODS: This retrospective cohort study included all patients (n = 114 610) cared for by teaching and non-teaching internal medicine, pediatrics, family practice, and obstetrics/gynecology practices (n = 19) affiliated with a large US healthcare system during 2006-2010 and using a common electronic medical record. Rates and types of antibiotics prescribed by teaching and non-teaching practices via telephone contact and office visit were compared among the overall cohort. All telephone-related prescriptions during 2008 underwent chart review to determine indications for antibiotic prescribing.
RESULTS: Overall, 28.9 antibiotic prescriptions were issued per 100 patient-years, with 63 418 total antibiotic prescriptions and 7876 (12.4%) generated after telephone contact. Telephone-based prescribing increased steadily from 2.2 to 4.2 per 100 patient-years during the study period. Both telephone-based and office-based antibiotic prescribing were higher in non-teaching practices. Of 1790 antibiotics prescribed by telephone during 2008, the majority were for urinary tract infection (28.3%), sinusitis (20.1%), and unspecified upper respiratory infection (URI, 15.0%).
CONCLUSIONS: Overall, one in every eight antibiotics was prescribed via telephone encounter. These data highlight the need to include the impact of this practice in analysis of outcomes associated with outpatient antibiotic prescribing and to incorporate telephonic prescribing into guidelines facilitating appropriate antibiotic use.
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Clinical, patient experience and cost impacts of performing active surveillance on known methicillin-resistant Staphylococcus aureus positive patients admitted to medical-surgical units
Clinical, patient experience and cost impacts of performing active surveillance on known methicillin-resistant Staphylococcus aureus positive patients admitted to medical-surgical units
Goldsack JC, DeRitter C, Power M, Spencer A, Taylor CL, Kim SF, Kirk R, Drees M

Am J Infect Control 2014 Oct;42(10):1039-43

PMID: 25278390

Abstract

BACKGROUND: There is a large and growing body of evidence that methicillin-resistant Staphylococcus aureus (MRSA) screening programs are cost effective, but such screening represents a significant cost burden for hospitals. This study investigates the clinical, patient experience and cost impacts of performing active surveillance on known methicillin-resistant S aureus positive (MRSA+) patients admitted to 7 medical-surgical units of a large regional hospital, specifically to allow discontinuation of contact isolation.
METHODS: We conducted mixed-methods retrospective evaluation of a process improvement project that screened admitted patients with known MRSA+ status for continued MRSA colonization.
RESULTS: Of those eligible patients on our institution's MRSA+ list who did complete testing, 80.2% (130/162) were found to be no longer colonized, and only 19.8% (32/162) were still colonized. Forty-one percent (13/32) of interviewed patients in contact isolation for MRSA reported that isolation had affected their hospital stay, and 28% (9/32) of patients reported emotional distress resulting from their isolation. Total cost savings of the program are estimated at $101,230 per year across the 7 study units.
CONCLUSION: Our findings provide supporting evidence that a screening program targeting patients with a history of MRSA who would otherwise be placed in isolation has the potential to improve outcomes and patient experience and reduce costs.
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The evolving landscape of healthcare-associated infections: recent advances in prevention and a road map for research
The evolving landscape of healthcare-associated infections: recent advances in prevention and a road map for research
Safdar N, Anderson DJ, Braun BI, Carling P, Cohen S, Donskey C, Drees M, Harris A, Henderson DK, Huang SS, Juthani-Mehta M, Lautenbach E, Linkin DR, Meddings J, Miller LG, Milstone A, Morgan D, Sengupta S, Varman M, Yokoe D, Zerr DM

Infect Control Hosp Epidemiol 2014 May;35(5):480-93

PMID: 24709716

Abstract

This white paper identifies knowledge gaps and new challenges in healthcare epidemiology research, assesses the progress made toward addressing research priorities, provides the Society for Healthcare Epidemiology of America (SHEA) Research Committee's recommendations for high-priority research topics, and proposes a road map for making progress toward these goals. It updates the 2010 SHEA Research Committee document, "Charting the Course for the Future of Science in Healthcare Epidemiology: Results of a Survey of the Membership of SHEA," which called for a national approach to healthcare-associated infections (HAIs) and a prioritized research agenda. This paper highlights recent studies that have advanced our understanding of HAIs, the establishment of the SHEA Research Network as a collaborative infrastructure to address research questions, prevention initiatives at state and national levels, changes in reporting and payment requirements, and new patterns in antimicrobial resistance.
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Variation in definitions and isolation procedures for multidrug-resistant Gram-negative bacteria: a survey of the Society for Healthcare Epidemiology of America Research Network
Variation in definitions and isolation procedures for multidrug-resistant Gram-negative bacteria: a survey of the Society for Healthcare Epidemiology of America Research Network
Drees M, Pineles L, Harris AD, Morgan DJ

Infect Control Hosp Epidemiol 2014 Apr;35(4):362-6

PMID: 24602940

Abstract

OBJECTIVE: To assess definitions, experience, and infection control practices for multidrug-resistant gram-negative bacteria (MDR-GNB), including Enterobacteriaceae, Acinetobacter, and Pseudomonas species, in acute care hospitals.
DESIGN: Cross-sectional survey.
PARTICIPANTS: US and international members of the Society for Healthcare Epidemiology of America (SHEA) Research Network.
METHODS: Online survey that included definitions, infection control procedures, and microbiology capability related to MDR-GNB and other MDR bacteria.
RESULTS: From November 2012 through February 2013, 66 of 170 SHEA Research Network members responded (39% response rate), representing 26 states and 15 countries. More than 80% of facilities reported experience with each MDR-GNB isolate, and 78% had encountered GNB resistant to all antibiotics except colistin (62% Acinetobacter, 59% Pseudomonas, and 52% Enterobacteriaceae species). Participants varied regarding their definitions of "multidrug resistant," with 14 unique definitions for Acinetobacter, 18 for Pseudomonas, and 22 for Enterobacteriaceae species. Substantial variation also existed in isolation practices. Although isolation was commonly used for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and carbapenem-resistant Enterobacteriaceae (CRE), approximately 20% of facilities did not isolate for MDR Pseudomonas or Acinetobacter. The majority of those that isolated MDR organisms also removed isolation using a wide variety of criteria.
CONCLUSION: Facilities vary significantly in their approach to preventing MDR-GNB transmission. Although practices for MRSA and VRE are relatively standardized, emerging pathogens CRE and other MDR-GNB have highly varied definitions and management. This confusion makes communication difficult, and varied use of isolation may contribute to emergence of these organisms. Public health agencies need to promote standard definitions and management to enable broader initiatives to limit emergence of MDR-GNB.
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