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Physicians: .25 AMA PRA Category I CreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours

Release Date: December 3, 2014
Expiration Date: December 3, 2015

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon above.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:

1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD
Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Executive Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP
Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company


Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 9, has been reviewed and is acceptable for up to 15.25 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 5, 2014. Term of approval is for one year from this date. Each EBM Focus is approved for .25 Prescribed credits. Credit may be claimed for one year from the date of each update. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour(s) of continuing education by the American Association of Nurse Practitioners. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

Program ID: 1405237C2

Last week 384 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 104 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article was selected by the DynaMed Editorial Team.

Addition of Nonsterile Glove Use to Hand Hygiene May Reduce Gram-Positive and Central Line-Associated Blood Stream Infections in Premature Infants in the Neonatal Intensive Care Unit
Reference: JAMA Pediatr 2014 Oct 1;168(10):909 (level 2 [mid-level] evidence)

Preterm birth is estimated to occur in 11.1% of all live births worldwide and is the most frequent cause of infant death in the United States (Lancet 2012 Jun 9;379(9832):2162, Pediatrics 2006 Oct;118(4):1566). Infection is a major cause of morbidity and mortality in preterm neonates and infection prevention measures are therefore extremely important when treating patients in neonatal intensive care units. Hand hygiene and glove use are simple measures that have been shown to reduce infections in cohort studies of preterm neonates and other pediatric populations (Arch Dis Child Fetal Neonatal Ed 2004 Jul;89(4):F336, Pediatrics 2013 May;131(5):e1515). A recent randomized trial compared nonsterile glove use plus hand hygiene vs. hand hygiene alone for all patient, bed, or catheter contact with 124 premature neonates < 8 days old in the neonatal intensive care unit. All included neonates had a birth weight < 1,000 grams or were born before 29 weeks gestation.

The trial defined hand hygiene as the use of alcohol hand sanitizer or handwashing with antimicrobial soap. Late onset infection was defined as ≥ 1 episode of bloodstream infection, urinary tract infection, meningitis, or necrotizing enterocolitis with clinical signs and symptoms at > 72 hours after birth. Hand hygiene compliance was 79%. Nonsterile glove use was associated with significantly fewer gram-positive blood stream infections (15% vs. 32%, p = 0.03 NNT 6) and a decreased rate of possible central line-associated blood stream infections (3.4 per 1,000 line days vs. 9.4 per 1,000 line days, p = 0.01), but there was no significant difference in late-onset infections overall (32% vs. 45%, p = 0.13). There were also no significant differences gram-positive urinary tract infections, gram-negative blood stream or urinary tract infections, coagulase-negative Staphylococcus blood stream infection, antibiotic treatment, length of hospital stay, or death.

The results of this trial suggest that some late-onset infections may be prevented by using nonsterile gloves in addition to hand hygiene when contacting the patient, bed, or catheter of extremely low birth weight and very preterm neonates. Although there was no significant difference in the rate of overall late-onset infections between groups, the rate of late-onset infections was lower than expected resulting in the trial being underpowered to detect differences between groups for this outcome. Nonsterile glove use was optional for parents and extending glove use to include parent contact may further decrease the rate of infection. Hand hygiene compliance was also lower than expected, however, and increasing compliance may impact the rate of infection in all preterm neonates.

For more information, see the Prematurity topic in DynaMed.

DynaMed Careers

The DynaMed editorial team is seeking specialist editors in the following fields: ENT, Gastroenterology, Hematology, Oncology (especially Breast cancer, Head and neck cancer, Pancreatic cancer), Ophthalmology, Orthopedics, Pediatric Neurology, and Vascular.

If interested, please send a recent copy of your CV to Rachel Brady at rbrady@ebsco.com.

PEMSoft Mobile

Free Trial of PEMSoft Mobile Available For iPhone, iPad, and Android Devices

The PEMSoft Mobile app, a pediatric evidence-based point-of-care medical reference tool for hospitals, emergency departments, clinics, pediatric group practices, transport services, and medical schools, is now available from EBSCO Health. Designed by pediatricians, emergency physicians and other medical specialists, the vast content in PEMSoft addresses the entire spectrum of neonatal, infant, child, adolescent and young adult health. PEMSoft authors adhere to a strict evidence-based editorial policy focused on systematic identification, evaluation and consolidation of practice-changing clinical literature.

Content in the PEMSoft Mobile app covers more than 3,000 conditions and includes a similar number of medical illustrations, clinical images and videos. PEMSoft Mobile also includes explicit step-by-step emergency critical care procedures, information about common pediatric signs and symptoms, and topics covering pediatric injuries and management approaches.

Visit the PEMSoft Mobile App Trial page to access a free trial for both Apple and Android devices.

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