scholarly journals Residence in Skilled Nursing Facilities Is Associated with Tigecycline Nonsusceptibility in Carbapenem-Resistant Klebsiella pneumoniae

2015 ◽  
Vol 36 (8) ◽  
pp. 942-948 ◽  
Author(s):  
David van Duin ◽  
Eric Cober ◽  
Sandra S. Richter ◽  
Federico Perez ◽  
Robert C. Kalayjian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Susceptibility Testing ◽  
Skilled Nursing Facility ◽  
Positive Culture ◽  
Hospitalized Patients ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Carbapenem Resistant

OBJECTIVETo determine the rates of and risk factors for tigecycline nonsusceptibility among carbapenem-resistant Klebsiella pneumoniae (CRKPs) isolated from hospitalized patientsDESIGNMulticenter prospective observational studySETTINGAcute care hospitals participating in the Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRaCKle)PATIENTSA cohort of 287 patients who had CRKPs isolated from clinical cultures during hospitalizationMETHODSFor the period from December 24, 2011 to October 1, 2013, the first hospitalization of each patient with a CRKP during which tigecycline susceptibility for the CRKP isolate was determined was included. Clinical data were entered into a centralized database, including data regarding pre-hospital origin. Breakpoints established by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were used to interpret tigecycline susceptibility testing.RESULTSOf 287 patients included in the final cohort, 155 (54%) had tigecycline-susceptible CRKPs. Of all index isolates, 81 (28%) were tigecycline-intermediate and 51 (18%) were tigecycline resistant. In multivariate modeling, independent risk factors for tigecycline nonsusceptibility were (1) admission from a skilled nursing facility (OR, 2.51; 95% CI, 1.51–4.21; P=.0004), (2) positive culture within 2 days of admission (OR, 1.82; 95% CI, 1.06–3.15; P=.03), and (3) receipt of tigecycline within 14 days (OR, 4.38, 95% CI, 1.37–17.01, P=.02).CONCLUSIONSIn hospitalized patients with CRKPs, tigecycline nonsusceptibility was more frequently observed in those admitted from skilled nursing facilities and occurred earlier during hospitalization. Skilled nursing facilities are an important target for interventions to decrease antibacterial resistance to antibiotics of last resort for treatment of CRKPs.Infect Control Hosp Epidemiol 2015;36(8):942–948

scholarly journals Carbapenemase-Producing, Carbapenem-Resistant Acinetobacter baumannii: Summary of CDC Consultations, 2017–2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s151-s152
Author(s):  
Lauren Epstein ◽  
Alicia Shugart ◽  
David Ham ◽  
Snigdha Vallabhaneni ◽  
Richard Brooks ◽  
...  
Keyword(s):  
Public Health ◽  
Acinetobacter Baumannii ◽  
Median Number ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Healthcare Facilities ◽  
Carbapenem Resistant ◽  
Number Of Patients ◽  
Single Facility

Background: Carbapenemase-producing carbapenem-resistant Acinetobacter baumannii (CP-CRAB) are a public health threat due to potential for widespread dissemination and limited treatment options. We describe CDC consultations for CP-CRAB to better understand transmission and identify prevention opportunities. Methods: We defined CP-CRAB as CRAB isolates with a molecular test detecting KPC, NDM, VIM, or IMP carbapenemases or a plasmid-mediated oxacillinase (OXA-23, OXA-24/40, OXA-48, OXA-58, OXA-235/237). We reviewed the CDC database of CP-CRAB consultations with health departments from January 1, 2017, through June 1, 2019. Consultations were grouped into 3 categories: multifacility clusters, single-facility clusters, and single cases. We reviewed the size, setting, environmental culturing results, and identified infection control gaps for each consultation. Results: We identified 29 consultations involving 294 patients across 19 states. Among 9 multifacility clusters, the median number of patients was 12 (range, 2–87) and the median number of facilities was 2 (range, 2–6). Among 9 single-facility clusters, the median number of patients was 5 (range, 2–50). The most common carbapenemase was OXA-23 (Table 1). Moreover, 16 consultations involved short-stay acute-care hospitals, and 6 clusters involved ICUs and/or burn units. Also, 8 consultations involved skilled nursing facilities. Environmental sampling was performed in 3 consultations; CP-CRAB was recovered from surfaces of portable, shared equipment (3 consultations), inside patient rooms (3 consultations) and nursing stations (2 consultations). Lapses in environmental cleaning and interfacility communication were common across consultations. Among 11 consultations for single CP-CRAB cases, contact screening was performed in 7 consultations and no additional CP-CRAB was identified. All 4 patients with NDM-producing CRAB reported recent international travel. Conclusions: Consultations for clusters of oxacillinase-producing CP-CRAB were most often requested in hospitals and skilled nursing facilities. Healthcare facilities and public health authorities should be vigilant for possible spread of CP-CRAB via shared equipment and the potential for CP-CRAB spread to connected healthcare facilities.Funding: NoneDisclosures: None

scholarly journals REDUCING AVOIDABLE FACILITY TRANSFERS: THE RAFT MODEL

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S769-S770
Author(s):  
Daniel Stadler
Keyword(s):  
Medical Center ◽  
Skilled Nursing Facility ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Life Sustaining Treatment ◽  
Acute Care Facilities ◽  
Dartmouth Hitchcock Medical

Abstract Reducing Avoidable Facility Transfers (RAFT) is a Dartmouth-developed program that identifies and honors “what matters most” to patients residing in skilled nursing facilities in a value-based, sustainable way. RAFT aims to reduce avoidable facility transfers of older adults from long-term care and post-acute care facilities to emergency departments (ED). Key components of RAFT presently include (1) systematically eliciting goals of care for all skilled nursing facility residents, (2) translating these goals into orders using the Physician Orders for Life-Sustaining Treatment form, (3) documenting patient wishes about hospitalization, and (4) ensuring that these wishes inform decision-making during acute crises. Data from a pilot program, begun in 2016 with three rural skilled nursing facilities in collaboration with the Dartmouth-Hitchcock Medical Center geriatric practice, showed a 35% reduction in monthly ED transfers, a 30.5% reduction in monthly hospitalizations, and a 50.7% reduction in monthly ED and hospitalization-related charges.

scholarly journals Discharge Communication of Dementia-Related Neuropsychiatric Symptoms and Care Management Strategies During Hospital to Skilled Nursing Facility Transitions

2020 ◽  
pp. 089198872094424 ◽  
Author(s):  
Andrea L. Gilmore-Bykovskyi ◽  
Melissa Hovanes ◽  
Jacquelyn Mirr ◽  
Laura Block
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Management Strategies ◽  
Skilled Nursing Facility ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Care Needs ◽  
Skilled Nursing ◽  
Poor Outcomes ◽  
Omission Rate ◽  
Discharge Communication

Provided the complexity of managing dementia-related neuropsychiatric symptoms (NPS), accurate communication about these symptoms at hospital discharge is critical to facilitating safe and effective transitions, particularly transitions from hospitals to skilled nursing facilities (SNF), which are often poorly managed. Skilled nursing facilities providers have cited undercommunication regarding NPS as a major challenge that contributes to poor outcomes including rehospitalization. This multisite retrospective cohort study identified omission rates for NPS and associated management strategies in discharge communication as compared to medical record documentation in the 72 hours preceding discharge among hospitalized patients with dementia. High rates of omission were found across NPS and management strategies: anxiety (94%), agitation/aggression (77%), hallucinations (85%), 1:1 supervision (90%), high fall risk (89%), use of restraints (91%). Omission rate for new or modified antipsychotic medication was 12.9%. Findings underscore the need for additional research on cross-setting communication regarding care needs of patients with dementia—who often cannot communicate these needs on their own—in facilitating high-quality transitions.

Risk Factors for the Acquisition of Carbapenem-Resistant Klebsiella pneumoniae among Hospitalized Patients

2005 ◽  
Vol 11 (2) ◽  
pp. 165-169 ◽  
Author(s):  
Yee Gyung Kwak ◽  
Sang-Ho Choi ◽  
Eun Ju Choo ◽  
Jin-Won Chung ◽  
Jin-Yong Jeong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Hospitalized Patients ◽  
Carbapenem Resistant

scholarly journals A Case Report in Health Information Exchange for Inter-organizational Patient Transfers

2014 ◽  
Vol 05 (03) ◽  
pp. 642-650 ◽  
Author(s):  
S. Malhotra ◽  
R. Kaushal ◽  
J.E. Richardson ◽  
Keyword(s):  
Case Report ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Skilled Nursing Facility ◽  
Patient Transfer ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Patient Transfers

SummaryObjective: To provide a case report of barriers and promoters to implementing a health information exchange (HIE) tool that supports patient transfers between hospitals and skilled nursing facilities.Methods: A multi-disciplinary team conducted semi-structured telephone and in-person interviews in a purposive sample of HIE organizational informants and providers in New York City who implemented HIE to share patient transfer information. The researchers conducted grounded theory analysis to identify themes of barriers and promoters and took steps to improve the trustworthiness of the results including vetting from a knowledgeable study participant.Results: Between May and October 2011, researchers recruited 18 participants: informaticians, healthcare administrators, software engineers, and providers from a skilled nursing facility. Subjects perceived the HIE tool’s development a success in that it brought together stakeholders who had traditionally not partnered for informatics work, and that they could successfully share patient transfer information between a hospital and a skilled nursing facility. Perceived barriers included lack of hospital stakeholder buy-in and misalignment with clinical workflows that inhibited use of HIE-based patient transfer data. Participants described barriers and promoters in themes related to organizational, technical, and user-oriented issues.The investigation revealed that stakeholders could develop and implement health information technology that technically enables clinicians in both hospitals and skilled nursing facilities to exchange real-time information in support of patient transfers. User level barriers, particularly in the emergency department, should give pause to developers and implementers who plan to use HIE in support of patient transfers.Conclusions: Participants’ experiences demonstrate how stakeholders may succeed in developing and piloting an electronic transfer form that relies on HIE to aggregate, communicate, and display relevant patient transfer data across health care organizations. Their experiences also provide insights for others seeking to develop HIE applications to improve patient transfers between emergency departments and skilled nursing facilities.Citation: Richardson JE, Malhotra S, Kaushal R. A case report in health information exchange for inter-organizational patient transfers. Appl Clin Inf 2014; 5: 642–650http://dx.doi.org/10.4338/ACI-2014-02-CR-0016

Risk factors for hip fracture in skilled nursing facilities: who should be evaluated?

2003 ◽  
Vol 14 (6) ◽  
pp. 484-489 ◽  
Author(s):  
Cathleen S. Col�n-Emeric ◽  
David P. Biggs ◽  
Anna P. Schenck ◽  
Kenneth W. Lyles
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing

scholarly journals Risk Factors for Colistin Resistance among Gram-Negative Rods andKlebsiella pneumoniaeIsolates

2018 ◽  
Vol 56 (9) ◽  
Author(s):  
Stefan E. Richter ◽  
Loren Miller ◽  
Daniel Z. Uslan ◽  
Douglas Bell ◽  
Karol Watson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skilled Nursing Facility ◽  
Resistant Organism ◽  
Neurologic Disease ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Gram Negative ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Prior Infection

ABSTRACTInfections due to colistin-resistant (Colr) Gram-negative rods (GNRs) and colistin-resistantKlebsiella pneumoniaeisolates in particular result in high associated mortality and poor treatment options. To determine the risk factors for recovery on culture of ColrGNRs and ColrK. pneumoniae, analyses were chosen to aid decisions at two separate time points: the first when only Gram stain results are available without any bacterial species information (corresponding to the ColrGNR model) and the second when organism identification is performed but prior to reporting of antimicrobial susceptibility testing results (corresponding to the ColrK. pneumoniaemodel). Cases were retrospectively analyzed at a major academic hospital system from 2011 to 2016. After excluding bacteria that were intrinsically resistant to colistin, a total of 28,512 GNR isolates (4,557K. pneumoniaeisolates) were analyzed, 128 of which were Colr(i.e., MIC > 2 μg/ml), including 68 of which that were ColrK. pneumoniae. In multivariate analysis, risk factors for ColrGNRs were neurologic disease, residence in a skilled nursing facility prior to admission, receipt of carbapenems in the last 90 days, prior infection with a carbapenem-resistant organism, and receipt of ventilatory support (c-statistic = 0.81). Risk factors for ColrK. pneumoniaespecifically were neurologic disease, residence in a skilled nursing facility prior to admission, receipt of carbapenems in the last 90 days, receipt of an anti-methicillin-resistantStaphylococcus aureusantimicrobial in the last 90 days, and prior infection with a carbapenem-resistant organism (c-statistic = 0.89). A scoring system derived from these models can be applied by providers to guide empirical antimicrobial therapy in patients with infections with suspected ColrGNR and ColrK. pneumoniaeisolates.

scholarly journals Hospital Readmissions in Patients With Carbapenem-Resistant Klebsiella pneumoniae

2015 ◽  
Vol 37 (3) ◽  
pp. 281-288 ◽  
Author(s):  
Julia A. Messina ◽  
Eric Cober ◽  
Sandra S. Richter ◽  
Federico Perez ◽  
Robert A. Salata ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Odds Ratio ◽  
Hospital Readmissions ◽  
Positive Culture ◽  
Hospitalized Patients ◽  
Great Lakes Region ◽  
Index Hospitalization ◽  
Carbapenem Resistant ◽  
History Of ◽  
Multivariable Models

BACKGROUNDVarious transmission routes contribute to spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospitalized patients. Patients with readmissions during which CRKP is again isolated (“CRKP readmission”) potentially contribute to transmission of CRKP.OBJECTIVETo evaluate CRKP readmissions in the Consortium on Resistance against Carbapenems in K. pneumoniae (CRaCKLe).DESIGNCohort study from December 24, 2011, through July 1, 2013.SETTINGMulticenter consortium of acute care hospitals in the Great Lakes region.PATIENTSAll patients who were discharged alive during the study period were included. Each patient was included only once at the time of the first CRKP-positive culture.METHODSAll readmissions within 90 days of discharge from the index hospitalization during which CRKP was again found were analyzed. Risk factors for CRKP readmission were evaluated in multivariable models.RESULTSFifty-six (20%) of 287 patients who were discharged alive had a CRKP readmission. History of malignancy was associated with CRKP readmission (adjusted odds ratio [adjusted OR], 3.00 [95% CI, 1.32–6.65], P<.01). During the index hospitalization, 160 patients (56%) received antibiotic treatment against CRKP; the choice of regimen was associated with CRKP readmission (P=.02). Receipt of tigecycline-based therapy (adjusted OR, 5.13 [95% CI, 1.72–17.44], using aminoglycoside-based therapy as a reference in those treated with anti-CRKP antibiotics) was associated with CRKP readmission.CONCLUSIONHospitalized patients with CRKP—specifically those with a history of malignancy—are at high risk of readmission with recurrent CRKP infection or colonization. Treatment during the index hospitalization with a tigecycline-based regimen increases this risk.Infect. Control Hosp. Epidemiol. 2016;37(3):281–288

Care Management and the Transition of Older Adults From a Skilled Nursing Facility Back Into the Community

2011 ◽  
Vol 12 (2) ◽  
pp. 54-59 ◽  
Author(s):  
Adam G. Golden ◽  
Shanique Martin ◽  
Melanie da Silva ◽  
Bernard A. Roos
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Nursing Care ◽  
Care Management ◽  
Skilled Nursing Facility ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Management Interventions

After hospitalization, many older adults require skilled nursing care. Although some patients receive services at home, others are admitted to a skilled nursing facility. In the current fragmented health care system, hospitals are financially incentivized to discharge frail older adults to a facility for postacute care as soon as possible. Similarly, many skilled nursing facilities are incentivized to extend the posthospitalization period of care and to transition the patient to custodial nursing home care. The resulting overuse of institution-based skilled nursing care may be associated with various adverse medical, social, and financial consequences. Care management interventions for more efficient and effective skilled nursing facility use must consider the determinants involved in the decisions to admit and maintain patients in skilled nursing facilities. As we await health care reform efforts that will address these barriers, opportunities already exist for care managers to improve the current postacute transition processes.

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