scholarly journals Traditional Definition of Healthcare-Associated Influenza Underestimates Cases Associated with Other Healthcare Exposures

2021 ◽  
Vol 1 (S1) ◽  
pp. s12-s13
Author(s):  
Erin Gettler ◽  
Thomas Talbot ◽  
H. Keipp Talbot ◽  
Bryan Harris ◽  
Danielle Ndi ◽  
...  
Keyword(s):  
Acute Care ◽  
Chronic Care ◽  
Care Facility ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Acute Care Facility ◽  
Traditional Definition ◽  
Chronic Care Facility ◽  
Definition Of ◽  
Healthcare Associated

Background: Healthcare-associated transmission of influenza leads to significant morbidity, mortality, and cost. Most studies classify healthcare-associated viral respiratory infections (HA-VRI) as those with a positive test result after the first 3 days following admission, which does not account for healthcare exposures prior to admission. Utilizing an expanded definition of healthcare-associated influenza, we aimed to improve the estimates of disease prevalence on a population level. Methods: This study included laboratory-confirmed cases of influenza in adult and pediatric patients admitted to any acute-care hospital in a catchment area of 8 counties Tennessee identified between October 1, 2012, and April 30, 2019. Surveillance information was abstracted from hospital and state laboratory databases, hospital infection control practitioner databases, reportable condition databases, and electronic health records as a part of the Influenza Hospitalization Surveillance Network (FluSurv-NET) by the Centers for Disease Control and Prevention (CDC) Emerging Infections Program (EIP). Cases were defined as healthcare-associated influenza laboratory confirmation of infection occurred (1) on or after hospital day 4 (“traditional definition”), or (2) between hospital days 0 and 3 in patients transferred from a chronic care facility or with a recent discharge from another acute-care facility in the 7 days preceding the current index admission (ie, enhanced definition). The proportion of laboratory-confirmed influenza designated as HA-VRI using both the traditional definition as well as with the added enhanced definition were compared. Data were imported into Stata software for analysis. Results: We identified 5,904 cases of laboratory-confirmed influenza in hospitalized patients over the study period. Using the traditional definition for HA-VRI, only 147 (2.5%, seasonal range 1.3%–3.4%) were deemed healthcare associated (Figure 1). Adding the cases identified using the enhanced definition, an additional 317 (5.4%, range 2.3%–6.7%) cases were noted in patients transferred from a chronic care facility for the current acute-care admission and 336 cases (5.7%; range, 4.1%–7.4%) were noted in patients with a prior acute-care facility admission in the preceding 7 days. Using our expanded definition, the total proportion of healthcare-associated influenza in this cohort was 772 of 5,904 (13.1%; range, 10.6%–14.8%). Conclusion: HA-VRI due to influenza is an underrecognized infection in hospitalized patients. Limiting surveillance assessment of this important outcome to just those patients with a positive influenza test after hospital day 3 captured only 19% of possible healthcare-associated influenza infections across 7 influenza seasons. These results suggest that the traditionally used definitions of healthcare-associated influenza underestimate the true burden of cases.Funding: NoDisclosures: None

scholarly journals Respiratory Syncytial Virus: An Underrecognized Healthcare-Associated Infection

2021 ◽  
Vol 1 (S1) ◽  
pp. s76-s77
Author(s):  
Erin Gettler ◽  
Thomas Talbot ◽  
H. Keipp Talbot ◽  
Danielle Ndi ◽  
Edward Mitchel ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Acute Care ◽  
Chronic Care ◽  
Care Facility ◽  
Surveillance Network ◽  
Traditional Definition ◽  
Hospital Infection Control ◽  
Chronic Care Facility ◽  
Syncytial Virus ◽  
Healthcare Associated

Background: Despite significant morbidity and mortality, estimates of the burden of healthcare-associated viral respiratory infections (HA-VRI) for noninfluenza infections are limited. Of the studies assessing the burden of respiratory syncytial virus (RSV), cases are typically classified as healthcare associated if a positive test result occurred after the first 3 days following admission, which may miss healthcare exposures prior to admission. Utilizing an expanded definition of healthcare-associated RSV, we assessed the estimates of disease prevalence. Methods: This study included laboratory-confirmed cases of RSV in adult and pediatric patients admitted to acute-care hospitals in a catchment area of 8 counties in Tennessee identified between October 1, 2016, and April 30, 2019. Surveillance information was abstracted from hospital and state laboratory databases, hospital infection control databases, reportable condition databases, and electronic health records as a part of the Influenza Hospitalization Surveillance Network by the Emerging Infections Program. Cases were defined as healthcare-associated RSV if laboratory confirmation of infection occurred (1) on or after hospital day 4 (ie, “traditional definition”) or (2) between hospital day 0 and 3 in patients transferred from a chronic care facility or with a recent discharge from another acute-care facility in the 7 days preceding the current index admission (ie, “enhanced definition”). The proportion of laboratory-confirmed RSV designated as HA-VRI using both the traditional definition as well as with the added enhanced definition were compared. Results: We identified 900 cases of RSV in hospitalized patients over the study period. Using the traditional definition for HA-VRI, only 41 (4.6%) were deemed healthcare associated. Adding the cases identified using the enhanced definition, an additional 12 cases (1.3%) were noted in patients transferred from a chronic care facility for the current acute-care admission and 17 cases (1.9%) were noted in patients with a prior acute-care admission in the preceding 7 days. Using our expanded definition, the total proportion of healthcare-associated RSV in this cohort was 69 (7.7%) of 900 compared to 13.1% of cases for influenza (Figure 1). Although the burden of HA-VRI due to RSV was less than that of influenza, when stratified by age, the rate increased to 11.7% for those aged 50–64 years and to 10.1% for those aged ≥65 years (Figure 2). Conclusions: RSV infections are often not included in estimates of HA-VRI, but the proportion of cases that are healthcare associated are substantial. Typical surveillance methods likely underestimate the burden of disease related to RSV, especially for those aged ≥50 years.Funding: NoDisclosures: None

scholarly journals A predictive score to identify hospitalized patients' risk of discharge to a post-acute care facility

2008 ◽  
Vol 8 (1) ◽  
Author(s):  
Martine Louis Simonet ◽  
Michel P Kossovsky ◽  
Pierre Chopard ◽  
Philippe Sigaud ◽  
Thomas V Perneger ◽  
...  
Keyword(s):  
Acute Care ◽  
Care Facility ◽  
Hospitalized Patients ◽  
Predictive Score ◽  
Acute Care Facility ◽  
Post Acute Care

A Prospective Registry on Venous Thromboembolic Events: Findings from PROVE.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1769-1769
Author(s):  
Alexander G.G. Turpie ◽  
Keyword(s):  
Acute Care ◽  
Chronic Care ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Care Hospital ◽  
Vte Prophylaxis ◽  
Patient Status ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Precipitating Factor

Abstract Introduction Venous thromboembolism (VTE) is a major health problem, especially in the elderly. A variety of intrinsic factors, acute medical illnesses and surgery have been shown to increase VTE risk. Despite this, VTE has not been adequately described in terms of clinical history, clinical risk factors and VTE prophylaxis. The objective of the Prospective Registry On Venous thromboembolic Events (PROVE) is to characterize the profile of patients with ultrasound-confirmed deep-vein thrombosis (DVT), the prior use and type of VTE prophylaxis and its relationship to demographic and comorbid factors. Methods PROVE is a multinational, multi-center, observational study. Patients were recruited during a 3 month period, beginning in February 2003, in centers possessing an ultrasound laboratory. Patients with ultrasound-confirmed DVT were consecutively enrolled. There were no exclusion criteria once DVT was diagnosed. Results Of 3527 enrolled patients in 254 centers in 19 countries (48% Asian and 52% non-Asian), data from 3508 (99%) were analyzable. Patients were: 51% male, mean age 53±18 years, mean BMI 26.0±5.1 kg/m2, 46.7% Caucasian, 47.1% Asian, 1.6% African and 4.4% other ethnicity. Patient status when DVT was diagnosed was: 59.7% home, 35.7% acute care hospital, 3.3% chronic care facility, 1.3% other. Locations of DVT were 25.0% calf only, 20.8% proximal without calf, and 58.9% proximal and calf. The incidences of idiopathic DVT, DVT following a precipitating factor, and recurrent DVT according to patient status at the time of diagnosis are shown in Table 1. Of patients who had a precipitating factor for DVT (see Table 2), 16% had received prior VTE prophylaxis. Types of VTE prophylaxis were: 53% low-molecular-weight heparin, 10% unfractionated heparin, 17% vitamin K antagonist, 29% elastic stockings, 2% venal caval filter, and 17% other. Conclusion Overall, the incidence of idiopathic DVT was similar to the incidence of DVT occurring after a precipitating event, as observed in other published studies. However, the incidence of idiopathic DVT was higher in patients at home at the time of diagnosis, while the incidence of DVT in patients with a precipitating factor was higher in acute care hospitals and chronic care facilities. The occurrence of DVT in patients who had received VTE prophylaxis may be due, at least in part, to the use of inadequate prophylaxis regimens. Table 1 Type of DVT according to patient status when DVT was diagnosed Patient status Idiopathic DVT,* n (%) DVT after a precipitating event,* n (%) Recurrent DVT,* n (%) * DVT was recorded as more than one type in some patients Home (N=2091) 1092 (52) 818 (39) 221 (11) Acute care hospital (N=1250) 396 (32) 807 (65) 74 (6) Chronic care facility (N=115) 35 (30) 64 (56) 16 (14) Other (N=45) 19 (42) 24 (53) 3 (7) Total 1542 (44) 1713 (49) 314 (9) Table 2 VTE prophylaxis received by patients with a precipitating factor for DVT (N=1715) Precipitating factor for DVT Patients with precipitating factor, n (%) Patients who had received VTE prophylaxis, n (%) Acute medical condition 775 (45) 92 (12) Surgery 498 (29) 124 (25) Trauma without surgery 239 (14) 44 (18) Pregnancy/postpartum 158 (5) 10 (6) Long airplane travel 56 (2) 3 (5)

scholarly journals Outbreak of Adenovirus Genome Type 7d2 Infection in a Pediatric Chronic-Care Facility and Tertiary-Care Hospital

2001 ◽  
Vol 32 (5) ◽  
pp. 694-700 ◽  
Author(s):  
S. I. Gerber ◽  
D. D. Erdman ◽  
S. L. Pur ◽  
P. S. Diaz ◽  
J. Segreti ◽  
...  
Keyword(s):  
Chronic Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Facility ◽  
Care Hospital ◽  
Genome Type ◽  
Chronic Care Facility

Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the Quality Outcomes Database

2020 ◽  
Vol 32 (4) ◽  
pp. 523-532 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Mohamad Bydon ◽  
John Knightly ◽  
Mohammed Ali Alvi ◽  
Anshit Goyal ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Acute Care ◽  
Body Mass ◽  
Care Facility ◽  
Older Age ◽  
Quality Outcomes ◽  
Acute Care Facility ◽  
Factors Associated ◽  
Patient Reported ◽  
The Impact

OBJECTIVEDischarge to an inpatient rehabilitation facility or another acute-care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to healthcare costs. In this era of changing dynamics of healthcare payment models in which cost overruns are being increasingly shifted to surgeons and hospitals, it is important to better understand outcomes such as discharge disposition. In the current article, the authors sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis who underwent a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multisite study investigating the impact of fusion on clinical and patient-reported outcomes among patients with grade I spondylolisthesis were evaluated. Nonroutine discharge was defined as those who were discharged to a postacute or nonacute-care setting in the same hospital or transferred to another acute-care facility.RESULTSOf the 608 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute-care facility). Compared to patients who were discharged to home, patients who had a nonroutine discharge were more likely to have diabetes (26.3%, n = 15 vs 15.7%, n = 86, p = 0.039); impaired ambulation (26.3%, n = 15 vs 10.2%, n = 56, p < 0.001); higher Oswestry Disability Index at baseline (51 [IQR 42–62.12] vs 46 [IQR 34.4–58], p = 0.014); lower EuroQol-5D scores (0.437 [IQR 0.308–0.708] vs 0.597 [IQR 0.358–0.708], p = 0.010); higher American Society of Anesthesiologists score (3 or 4: 63.2%, n = 36 vs 36.7%, n = 201, p = 0.002); and longer length of stay (4 days [IQR 3–5] vs 2 days [IQR 1–3], p < 0.001); and were more likely to suffer a complication (14%, n = 8 vs 5.6%, n = 31, p = 0.014). On multivariable logistic regression, factors found to be independently associated with higher odds of nonroutine discharge included older age (interquartile OR 9.14, 95% CI 3.79–22.1, p < 0.001), higher body mass index (interquartile OR 2.04, 95% CI 1.31–3.25, p < 0.001), presence of depression (OR 4.28, 95% CI 1.96–9.35, p < 0.001), fusion surgery compared with decompression alone (OR 1.3, 95% CI 1.1–1.6, p < 0.001), and any complication (OR 3.9, 95% CI 1.4–10.9, p < 0.001).CONCLUSIONSIn this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included older age, higher body mass index, presence of depression, and occurrence of any complication.

scholarly journals 868. Investigations of Healthcare-Associated Elizabethkingia Infections – United States, 2013-2019

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S472-S472
Author(s):  
Matthew B Crist ◽  
John R McQuiston ◽  
Maroya Spalding Walters ◽  
Elizabeth Soda ◽  
Heather Moulton-Meissner ◽  
...  
Keyword(s):  
Water Management ◽  
Infection Control ◽  
Acute Care ◽  
Local Health ◽  
Care Hospital ◽  
Patient Exposure ◽  
Management Plans ◽  
Water Management Plans ◽  
Healthcare Associated ◽  
Ventilated Patients

Abstract Background Elizabethkingia (EK) are non-motile gram-negative rods found in soil and water and are an emerging cause of healthcare-associated infections (HAIs). We describe Centers for Disease Control and Prevention (CDC) consultations for healthcare-associated EK infections and outbreaks. Methods CDC maintains records of consultations with state or local health departments related to HAI outbreaks and infection control breaches. We reviewed consultations involving EK species as the primary pathogen of concern January 1, 2013 to December 31, 2019 and summarized data on healthcare settings, infection types, laboratory analysis, and control measures. Results We identified 9 consultations among 8 states involving 73 patient infections. Long-term acute-care hospitals (LTACHs) accounted for 4 consultations and 32 (43%) infections, and skilled nursing facilities with ventilated patients (VSNFs) accounted for 2 consultations and 31 (42%) infections. Other settings included an acute care hospital, an assisted living facility, and an outpatient ear, nose, and throat clinic. Culture sites included the respiratory tract (n=7 consultations), blood (n=4), and sinus tract (n=1), and E. anophelis was the most commonly identified species. Six consultations utilized whole genome sequencing (WGS); 4 identified closely related isolates from different patients and 2 also identified closely related environmental and patient isolates. Mitigation measures included efforts to reduce EK in facility water systems, such as the development of water management plans, consulting water management specialists, flushing water outlets, and monitoring water quality, as well as efforts to minimize patient exposure such as cleaning of shower facilities and equipment, storage of respiratory therapy supplies away from water sources, and use of splash guards on sinks. Conclusion EK is an important emerging pathogen that causes HAI outbreaks, particularly among chronically ventilated patients. LTACHs and VSNFs accounted for the majority of EK consultations and patient infections. Robust water management plans and infection control practices to minimize patient exposure to contaminated water in these settings are important measures to reduce infection risk among vulnerable patients. Disclosures All Authors: No reported disclosures

Facility of Origin Predicts Mortality After Colonic Perforation

2020 ◽  
pp. 000313482097162
Author(s):  
Samuel D. Butensky ◽  
Emma Gazzara ◽  
Gainosuke Sugiyama ◽  
Gene F. Coppa ◽  
Antonio Alfonso ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Chronic Care ◽  
Care Facility ◽  
Colonic Perforation ◽  
Risk Of Death ◽  
Increased Risk ◽  
Chronic Care Facility ◽  
Partial Colectomy ◽  
Emergent Surgery ◽  
Perforated Viscus

Introduction Colonic perforation often requires emergent intervention and carries high morbidity and mortality. The objective of this study was to determine whether nonclinical factors, such as transition of care from outpatient facilities to inpatient settings, are associated with increased risk of mortality in patients who underwent emergent surgical intervention for colonic perforation. Materials and Methods Using the 2006-2015 ACS National Surgical Quality Improvement Program database, we identified adult patients who underwent emergent partial colectomy with primary anastomosis ± protecting ostomy or partial colectomy with ostomy with intraoperative finding of wound class III or IV for a diagnosis of perforated viscus. The outcome of interest was 30-day postoperative mortality. Univariate and multivariate analyses using logistic regression were performed. Results 4705 patients met criteria, of which 841 (17.9%) died. Univariate analysis showed that patients who died after emergent surgery for perforated viscus were more likely to present from a chronic care facility (13.4% vs. 4.4%, P < .0001) and had longer time from admission to undergoing surgery (mean 4.1 vs. 2.0 days, P < .0001. Logistic regression demonstrated that septic shock vs. none (OR 3.60, P < .0001), sepsis vs. none (OR 1.57, P = .00045), transfer from chronic care facility vs. home (OR 1.87, P < .0001), and increased time from admission vs. operation (OR 1.01, P = .0055) were independently associated with increased risk of death. Discussion Transfer from a chronic care facility was independently associated with increased mortality in patients undergoing emergent surgery for perforated viscus.

Use of alcohol hand sanitizer as an infection control strategy in an acute care facility

2003 ◽  
Vol 31 (2) ◽  
pp. 109-116 ◽  
Author(s):  
Jessica Hilburn ◽  
Brian S. Hammond ◽  
Eleanor J. Fendler ◽  
Patricia A. Groziak
Keyword(s):  
Infection Control ◽  
Acute Care ◽  
Control Strategy ◽  
Care Facility ◽  
Acute Care Facility ◽  
Hand Sanitizer

INCONTINENCE-ASSOCIATED DERMATITIS IN A LONG TERM ACUTE CARE FACILITY

2008 ◽  
Vol 35 (Supplement) ◽  
pp. S58 ◽  
Author(s):  
Mary Arnold-Long ◽  
LuAnn Reed ◽  
Kari Dunning ◽  
Jun Ying
Keyword(s):  
Acute Care ◽  
Care Facility ◽  
Acute Care Facility

Delirium among elderly patients admitted to a post-acute care facility and 3-months outcome

2015 ◽  
Vol 16 (5) ◽  
pp. 586-592 ◽  
Author(s):  
Doris Ka Ying Miu ◽  
Ching Wai Chan ◽  
Ching Kok
Keyword(s):  
Elderly Patients ◽  
Acute Care ◽  
Care Facility ◽  
Acute Care Facility ◽  
Post Acute Care
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