scholarly journals VIM-CRPA in West Texas: Developing a Regional Multidrug-Resistant Organism Containment Strategy for a Novel Bug

2020 ◽  
Vol 41 (S1) ◽  
pp. s432-s432
Author(s):  
Gillian Blackwell ◽  
Thi Dang ◽  
Abby Hoffman ◽  
Mary McConnell ◽  
Katherine Wells ◽  
...  
Keyword(s):  
Infection Control ◽  
Health Department ◽  
Multidrug Resistant ◽  
Local Health Department ◽  
Local Health ◽  
Health Departments ◽  
Environmental Cleaning ◽  
Healthcare Facilities ◽  
Multidrug Resistant Organisms ◽  
Containment Strategy

Background: The Texas Department of State Health Services Healthcare Safety (HCS) Investigation Team began investigating a cluster of positive carbapenem-resistant Pseudomonas aeruginosa (CRPA) results in August 2017. These CRPA isolates contained the novel carbapenemase Verona integron-encoded metallo-β-lactamase (VIM). This cluster became an outbreak that spanned >2 years and involved multiple healthcare facilities in and around northern Texas. In response to positive results, infection control assessments were conducted, which exposed common infection control gaps including inadequate hand hygiene performance, environmental cleaning issues, and poor communication during interfacility patient transfers. As part of the ongoing investigation efforts, a regional containment strategy was developed to prevent the spread of multidrug-resistant organisms. Methods: Beginning in October 2018, the HCS Investigation Team made site visits to participating facilities every 6 months to provide targeted infection control support and hand hygiene performance and environmental cleaning observations. An initial kick-off meeting was held in February 2019 for facilities to begin collaboration on the containment strategy. This strategy became known as BOOT, an acronym meaning: Being prompt in response to positive cases, Obtaining isolates for testing, Optimizing infection prevention, and Transferring patients using a designated form. An interfacility transfer form to reduce the risk of transmission of multidrug-resistant organisms when patients are transferred between healthcare facilities was developed by a work group that consisted of the local health department, the Public Health Region healthcare-associated infections epidemiologist, and multiple healthcare facilities. Results: Facilities have increased communication with other facilities and with the health departments since the implementation of the BOOT strategy. The local health department is contacted when facilities do not receive a transfer form, and follow-up is initiated to ensure appropriate understanding and compliance. Facility handwashing rates and environmental cleaning results have improved with each visit, and access to alcohol-based hand sanitizing dispensers has increased in select facilities. Conclusions: The regional containment strategy is dynamic and ongoing, and changes are implemented as obstacles are encountered. Implementation has resulted in a successful decrease of positive VIM results in the local area by ∼50% since the first half of 2019. This program has led to greater collaboration among healthcare facilities, health departments, and a neighboring state. This investigation and its products have been used as a model for the implementation of containment strategies in other regions of Texas. The HCS Investigation Team hopes to create and implement an interfacility transfer form that can be used in healthcare facilities statewide.Funding: NoneDisclosures: None

scholarly journals Evaluating Streetscape Modifications in Los Angeles, California with a Health Lens

2019 ◽  
Vol 17 (1) ◽  
pp. 10-23
Author(s):  
Gabrielle Green ◽  
Lauren N. Gase ◽  
Chandini Singh ◽  
Tony Kuo
Keyword(s):  
Los Angeles ◽  
Built Environment ◽  
Driver Behavior ◽  
Health Department ◽  
Local Health Department ◽  
Local Health ◽  
Health Departments ◽  
Local Health Departments ◽  
Health Practitioners

Background and Purpose: Despite growing evidence linking health and the built environment, local health departments are often not involved in the evaluation of a streetscape modification project. This paper describes an assessment conducted by a local health department to address this gap by using a health lens to evaluate the installation of painted curb extensions on a commercial corridor in Los Angeles. Methods: The local health department conducted an observational pre-post study of pedestrian and motorist data at both an intersection receiving the painted curb extension and a comparison intersection along the same corridor that had already received the extension. The study also analyzed streetscape features along the corridor related to walkability, to understand the painted curb extension in the context of the broader built environment. Results: The painted curb extension did not appear to significantly impact pedestrian and motorist behavior, though some slight changes were observed. Pedestrians along the corridor generally exhibited safe behavior at intersections, but encountered dangerous driver behavior and built environment barriers, which can discourage walking. Conclusion: This case study demonstrates how health considerations can be integrated into an evaluation of a streetscape modification project, and can provide guidance for other health practitioners developing such evaluation projects in their own jurisdictions.

Leveraging Limited Resources Through Cross-Jurisdictional Sharing: Influences on Breastfeeding Rates

2020 ◽  
pp. 089033442096363
Author(s):  
M. Elizabeth Gyllstrom ◽  
Marcia Burton McCoy ◽  
Gianfranco Pezzini ◽  
Adam Atherly
Keyword(s):  
Public Health ◽  
Community Health ◽  
Relative Rate ◽  
Health Department ◽  
Rate Of Change ◽  
Local Health Department ◽  
Breastfeeding Initiation ◽  
Local Health ◽  
Health Departments ◽  
Health Boards

Background Cross-jurisdictional sharing is gaining traction as an option for increasing the effectiveness and efficiency of public health services in local health departments. Research aim Assess whether breastfeeding initiation among participants in the Special Supplemental Nutrition Program for Women, Infants and Children changed with the addition of a trained breastfeeding specialist funded by cross-jurisdictional integration. Methods A longitudinal retrospective comparative difference in difference design using state-based program data, pre- and post-integration was undertaken. Three local county health departments ( n = 5) that fully integrated into one Community Health Board during January 2015, and four neighboring Community Health Boards ( n = 4) that did not integrate, were included. Results Controlling for confounders and interactions, the relative rate of change over time in breastfeeding initiation rates was greater in the integrated jurisdiction than neighboring Community Health Boards, but not statistically significant. When the integrated Community Health Board’s original three local health departments were considered separately, the relative rate of change over time in breastfeeding rates was greater for one local health department in comparison to three neighbor Community Health Boards ( p = .037, .048, and .034, respectively). Conclusions The addition of a specialized breastfeeding nutritionist led to improved breastfeeding initiation rates. The increase was significant only in the largest original local health department, which also had the lowest breastfeeding initiation rate pre-merger. The greatest positive change was seen in this local health department where the specialist staff was physically located. Public health staff specialization can lead to increases in economic efficiency and in improved delivery of public health services.

scholarly journals Regional Infection Control Assessment of Antibiotic Resistance Knowledge and Practice

2015 ◽  
Vol 36 (4) ◽  
pp. 381-386 ◽  
Author(s):  
Stephanie R. Black ◽  
Kingsley N. Weaver ◽  
Robert A. Weinstein ◽  
Mary K. Hayden ◽  
Michael Y. Lin ◽  
...  
Keyword(s):  
Infection Control ◽  
Acute Care ◽  
Bacterial Resistance ◽  
Multidrug Resistant ◽  
Nursing Facilities ◽  
Policy And Practice ◽  
Healthcare Facilities ◽  
Carbapenem Resistant ◽  
Perceived Importance ◽  
Multidrug Resistant Organisms

OBJECTIVEMultidrug-resistant organisms (MDROs) are an increasing burden among healthcare facilities. We assessed facility-level perceived importance of and responses to various MDROs.DESIGNA pilot survey to assess staffing, knowledge, and the perceived importance of and response to various multidrug resistant organisms (MDROs)SETTINGAcute care and long-term healthcare facilitiesMETHODSIn 2012, a survey was distributed to infection preventionists at ~300 healthcare facilities. Pathogens assessed were Clostridium difficile, carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, multidrug-resistant (defined as bacterial resistance to ≥3 antibiotic classes) Pseudomonas, and extended-spectrum β-lactamase-producing Escherichia coli.RESULTSA total of 74 unique facilities responded, including 44 skilled nursing facilities (SNFs) and 30 acute care facilities (ACFs). While ACFs consistently isolated patients with active infections or colonization due to these MDROs, SNFs had more variable responses. SNFs had more multi-occupancy rooms and reported less specialized training in infection control and prevention than did ACFs. Of all facilities with multi-occupancy rooms, 86% employed a cohorting practice for patients, compared with 50% of those without multi-occupancy rooms; 20% of ACFs and 7% of SNFs cohorted staff while caring for patients with the same MDRO. MRSA and C. difficile were identified as important pathogens in ACFs and SNFs, while CRE importance was unknown or was considered important in <50% of SNFs.CONCLUSIONWe identified stark differences in human resources, knowledge, policy, and practice between ACFs and SNFs. For regional control of emerging MDROs like CRE, there is an opportunity for public health officials to provide targeted education and interventions. Education campaigns must account for differences in audience resources and baseline knowledge.Infect Control Hosp Epidemiol 2015;00(0): 1–6

scholarly journals Health Department Authorities to Assist Healthcare Facilities with Outbreaks or High HAI Rates—Preliminary Assessment, 2018

2020 ◽  
Vol 41 (S1) ◽  
pp. s244-s244
Author(s):  
Nijika Shrivastwa ◽  
Joseph Perz ◽  
Jennifer C. Hunter
Keyword(s):  
Health Department ◽  
Annual Reports ◽  
Local Health ◽  
Health Departments ◽  
State Health ◽  
State Health Department ◽  
Healthcare Facilities ◽  
Facility Level ◽  
Targeted Assistance ◽  
Healthcare Associated

Background: Health departments have been increasingly called upon to monitor healthcare associated-infections (HAIs) at the hospital- or facility-level and provide targeted assistance when high rates are identified. Health department capacity to effectively respond to these types of signals depends not only on technical expertise but also the legal and regulatory authority to intervene. Methods: We reviewed annual reports describing HAI and antibiotic resistance (HAI/AR) activities from CDC-funded HAI/AR programs for August 2017 through July 2018. We performed a qualitative data analysis on all 50 state health department responses to a question about their regulatory and legal authority to intervene or assist facilities without invitation when outbreaks are suspected (as determined by the health department) or high HAI rates have been identified (eg, based on NHSN data). Results: When an outbreak is identified, 31 health departments (62%) indicated that they have the authority to intervene without invitation from a facility and 8 (16%) did not specify. Among the 11 health departments (22%) that indicated that they do not have this authority, 5 (45%) states noted that they operate under decentralized systems in which the local health department can intervene in outbreak situations and the state health department is available to assist. When a health department identifies high HAI rates, 14 health departments (28%) indicated that they have the authority to intervene without invitation, 22 (44%) indicated that they do not, and 14 (28%) did not specify. Among those in the latter categories, 3 stated they can work through their local health departments, which do have this authority and 8 described working through partners (eg, State Hospital Association, n = 3 or State Healthcare Licensing Agency, n = 5). Discussion: Assistance from state health departments (eg, HAI/AR programs) in the context of outbreaks and high HAI rates has value that is usually well recognized and welcomed by healthcare facilities. Nonetheless, there are occasions when a health department might need to exert its authority to intervene. The preliminary analysis described here indicated that this authority was more commonly self-reported in the context of outbreaks than when high HAI rates are identified. These 2 situations are connected, as high rates might be indicative of unrecognized or unreported outbreak activity, and these issues may benefit from further analysis.Funding: NoneDisclosures: None

Improving Public Health Preparedness Capacity Measurement: Development of the Local Health Department Preparedness Capacities Assessment Survey

2013 ◽  
Vol 7 (6) ◽  
pp. 578-584 ◽  
Author(s):  
Mary V. Davis ◽  
Glen P. Mays ◽  
James Bellamy ◽  
Christine A. Bevc ◽  
Cammie Marti
Keyword(s):  
Public Health ◽  
Factor Analysis ◽  
Health Department ◽  
Local Health Department ◽  
Kappa Statistics ◽  
Local Health ◽  
Health Departments ◽  
Public Health Preparedness ◽  
Assessment Survey ◽  
Legal Infrastructure

AbstractObjectiveTo address limitations in measuring the preparedness capacities of health departments, we developed and tested the Local Health Department Preparedness Capacities Assessment Survey (PCAS).MethodsPreexisting instruments and a modified 4-cycle Delphi panel process were used to select instrument items. Pilot test data were analyzed using exploratory factor analysis. Kappa statistics were calculated to examine rater agreement within items. The final instrument was fielded with 85 North Carolina health departments and a national matched comparison group of 248 health departments.ResultsFactor analysis identified 8 initial domains: communications, surveillance and investigation, plans and protocols, workforce and volunteers, legal infrastructure, incident command, exercises and events, and corrective action. Kappa statistics and z scores indicated substantial to moderate agreement among respondents in 7 domains. Cronbach α coefficients ranged from 0.605 for legal infrastructure to 0.929 for corrective action. Mean scores and standard deviations were also calculated for each domain and ranged from 0.41 to 0.72, indicating sufficient variation in the sample to detect changes over time.ConclusionThe PCAS is a useful tool to determine how well health departments are performing on preparedness measures and identify opportunities for future preparedness improvements. Future survey implementation will incorporate recent Centers for Disease Control and Prevention's Public Health Preparedness Capabilities: National Standards for State and Local Planning. (Disaster Med Public Health Preparedness. 2013;7:578–584)

scholarly journals Hospital-acquired infections due to multidrug-resistant organisms in Hungary, 2005-2010

2013 ◽  
Vol 18 (2) ◽  
Author(s):  
S Caini ◽  
A Hajdu ◽  
A Kurcz ◽  
K Böröcz
Keyword(s):  
Infection Control ◽  
Multidrug Resistant ◽  
Special Focus ◽  
Gram Negative ◽  
Hospital Acquired Infections ◽  
Health Authorities ◽  
Multidrug Resistant Organisms ◽  
Public Health Authorities ◽  
Gram Negative Organisms ◽  
Hospital Acquired

Healthcare-associated infections caused by multidrug-resistant organisms are associated with prolonged medical care, worse outcome and costly therapies. In Hungary, hospital-acquired infections (HAIs) due to epidemiologically important multidrug-resistant organisms are notifiable by law since 2004. Overall, 6,845 case-patients (59.8% men; median age: 65 years) were notified in Hungary from 2005 to 2010. One third of case-patients died in hospital. The overall incidence of infections increased from 5.4 in 2005 to 14.7 per 100,000 patient-days in 2010. Meticillin-resistant Staphylococcus aureus (MRSA) was the most frequently reported pathogen (52.2%), but while its incidence seemed to stabilise after 2007, notifications of multidrug-resistant Gram-negative organisms have significantly increased from 2005 to 2010. Surgical wound and bloodstream were the most frequently reported sites of infection. Although MRSA incidence has seemingly reached a plateau in recent years, actions aiming at reducing the burden of HAIs with special focus on Gram-negative multidrug-resistant organisms are needed in Hungary. Continuing promotion of antimicrobial stewardship, infection control methodologies, reinforced HAI surveillance among healthcare and infection control practitioners, and engagement of stakeholders, hospital managers and public health authorities to facilitate the implementation of existing guidelines and protocols are essential.

scholarly journals Role of the Local Health Department in a Crisis

1982 ◽  
Vol 72 (12) ◽  
pp. 1408-1408
Author(s):  
Richard A. Morgan
Keyword(s):  
Health Department ◽  
Local Health Department ◽  
Local Health
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