Public Health Oversight of Interfacility Transfers During a Candida auris Outbreak—Orange County, California, 2019

Background: In February 2019, the Orange County Health Care Agency (OCHCA) identified an outbreak of Candida auris, an emerging fungus that spreads rapidly in healthcare facilities. Patients in long-term acute-care hospitals (LTACHs) and skilled nursing facilities that provide ventilator care (vSNFs) are at highest risk for C. auris colonization. With assistance from the California Department of Public Health and the Centers for Disease Control and Prevention, OCHCA instituted enhanced surveillance, communication, and screening processes for patients colonized with or exposed to C. auris. Method: OCHCA implemented enhanced surveillance by conducting point-prevalence surveys (PPSs) at all 3 LTACHs and all 14 vSNFs in the county. Colonized patients were identified through axilla/groin skin swabbing with C. auris detected by PCR and/or culture. In facilities where >1 C. auris colonized patient was found, PPSs were repeated every 2 weeks to identify ongoing transmission. Retrospective case finding was instituted at 2 LTACHs with a high burden of colonized patients; OCHCA contacted patients discharged after January 1, 2019, and offered C. auris screening. OCHCA tracked the admission or discharge of all colonized patients, and facilities with ongoing transmission were required to report transfers of any patient, regardless of colonization status. OCHCA tracked all patients discharged from facilities with ongoing transmission to ensure that accepting facilities conducted admission surveillance testing of exposed patients and implemented appropriate environmental and contact precautions. Result: From February–October 2019, 192 colonized patients were identified. All 3 LTACHs and 6 of 14 VSNFs had at least 1 C. auris–colonized patient identified on initial PPS, and 2 facilities had ongoing transmission identified on serial PPS. OCHCA followed 96 colonized patients transferred a total of 230 times (an average of 2.4 transfers per patient) (Fig. 1) and 677 exposed patients discharged from facilities with ongoing transmission (Fig. 2). Admission screening of 252 exposed patients on transfer identified 13 (5.2%) C. auris–colonized patients. As of November 1, 2019, these 13 patients were admitted 21 times to a total of 6 acute-care hospitals, 2 LTACHs, and 3 vSNFs. Transferring facilities did not consistently communicate the colonized patient’s status and the requirements for isolation and testing of exposed patients. Conclusion: OCHCA oversight of interfacility transfer, though labor-intensive, improved identification of patients colonized with C. auris and implementation of appropriate environmental and contact precautions, reducing the risk of transmission in receiving healthcare facilities.Funding: NoneDisclosures: None

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LB1. Regional Assessment and Containment of Candida auris Transmission in Post-Acute Care Settings—Orange County, California, 2019

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz415.2484 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S993-S993 ◽

Cited By ~ 2

Author(s):

Ellora Karmarkar ◽

Kathleen O’Donnell ◽

Christopher Prestel ◽

Kaitlin Forsberg ◽

...

Keyword(s):

Acute Care ◽

Orange County ◽

Invasive Disease ◽

Nucleotide Polymorphisms ◽

Nursing Facilities ◽

Candida Auris ◽

Single Nucleotide ◽

Skilled Nursing ◽

And Control

Abstract Background Patients in long-term acute care hospitals (LTACHs) and skilled nursing facilities with ventilator units (VSNFs) are at high risk for Candida auris colonization; among patients colonized with this emerging pathogen, 5%–10% develop invasive disease with >45% mortality. In September 2018, a California LTACH-affiliated laboratory began enhanced C. auris surveillance by classifying species of Candida isolated from routine urine specimens. In February 2019, the first known Southern California case was detected in an Orange County (OC) LTACH; the patient had not traveled outside the region, indicating local acquisition. We performed point prevalence surveys (PPS) and infection prevention (IP) assessments at all OC LTACHs and VSNF subacute units to identify patients colonized with C. auris and control transmission. Methods During March–August 2019, we conducted PPS at facilities by collecting composite axilla and groin swabs for C. auris polymerase chain reaction testing and reflex culture from all patients who assented. Facilities with ≥1 C. auris-colonized patient repeated a PPS every 2 weeks to assess for new transmission. Isolate relatedness was assessed by whole-genome sequencing (WGS). We evaluated hand hygiene (HH) adherence, access to alcohol-based hand rubs (ABHR), and cleaning of high-touch surfaces to guide IP recommendations. Results The first PPS at all OC LTACHs (n = 3) and adult VSNFs (n = 14) identified 45 C. auris-colonized patients in 3 (100%) LTACHs and 6 (43%) VSNFs; after repeated PPS, the total count reached 124. Most patients (70%) were at 2 facilities (Table 1). Three of 124 patients developed candidemia. To date, isolates from 48 patients have completed WGS; all were highly related (<11 single-nucleotide polymorphisms) in the African clade. Of 9 facilities with C. auris, 5 had HH adherence < 50%, 3 had limited ABHR, and at 2, <60% of assessed high-touch surfaces were clean. We recommended regular HH and cleaning audits, and increased ABHR. Conclusion Our investigation, prompted by enhanced surveillance, identified C. auris at 9 OC facilities. WGS indicated a single introduction and local transmission. Early detection, followed by rapid county-wide investigation and IP support, enabled containment efforts for C. auris in OC. Disclosures All authors: No reported disclosures.

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Social Network Analysis across Healthcare Entities, Orange County, FL, 2016

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v10i1.8963 ◽

2018 ◽

Vol 10 (1) ◽

Author(s):

Danielle Rankin

Keyword(s):

Public Health ◽

Social Network ◽

Social Network Analysis ◽

Network Analysis ◽

Disease Control ◽

Acute Care ◽

Orange County ◽

Acute Care Hospitals ◽

Patient Movement

Objective: To create a baseline social network analysis to assess connectivity of healthcare entities through patient movement in Orange County, Florida.Introduction: In the realm of public health, there has been an increasing trend in exploration of social network analyses (SNAs). SNAs are methodological and theoretical tools that describe the connections of people, partnerships, disease transmission, the interorganizational structure of health systems, the role of social support, and social capital1. The Florida Department of Health in Orange County (DOH-Orange) developed a reproducible baseline social network analysis of patient movement across healthcare entities to gain a county-wide perspective of all actors and influences in our healthcare system. The recognition of the role each healthcare entity contributes to Orange County, Florida can assist DOH-Orange in developing facility-specific implementations such as increased usage of personal protective equipment, environmental assessments, and enhanced surveillance.Methods: DOH-Orange received Centers for Medicare and Medicaid Services data from the Centers for Disease Control and Prevention Division of Health Care Quality Promotion. The dataset contains the frequency of patients transferred across Medicare accepting healthcare entities during 2016. We constructed a directional sociogram using R package statnet version 2016.9, built under R version 3.3.3. Node colors are categorized by the type of healthcare entity represented (e.g., long-term care facilities, acute care hospitals, post-acute care hospitals, and other) and depict the frequency of patients transferred with weighted edges. Node sizes are proportional to the log reduction of the total degree of patients transferred, and are arranged with the Fruchterman-Reingold layout. We calculated standard network indices to assess the magnitude of connectedness across healthcare entities in Orange County, Florida. Additionally, we calculated node-level indices to gain a perspective of the strength of each individual entity.Results: A total of 48 healthcare entities were included in the sociogram, with 44% representing Orange County, Florida. Although the majority of the healthcare entities are located in nearby counties, 90% of patient movement occurred across Orange County entities. The range of patient movement was 1 to 5196 with a median of 15 patients transferred in 2016. The network in Orange County is sparse with a density of 0.05, but the movement of patients across the healthcare entities is predominately symmetric (reciprocity=97%). The sociogram is centralized (degree centrality= 0.70) and contains a vast amount of entities that serve as connectors (betweenness centrality=0.53). The node-level indices identified our acute care hospitals and long term acute care hospitals are the connectors of our county health system.Conclusions: The SNA of patient movement across healthcare entities in Orange County, Florida provides public health with knowledge of the influences entities contribute to the county healthcare system. This will contribute to identifying changes in the network in future research on the transmission risks of specific diseases/conditions, which will enhance prioritization of targeted interventions within healthcare entities. In addition, SNAs can assist in targeting disease control efforts during outbreak investigations and support health communication. A SNA toolkit will be distributed to other local county health departments for reproduction to determine baseline data and integrate county-specific SNAs.

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174. Increase in Candida auris cases in New Jersey healthcare facilities during the COVID-19 pandemic — 2017–2020

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.174 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S106-S107

Author(s):

Reed Magleby ◽

Gabriel Innes ◽

Diya Cherian ◽

Jessica Arias ◽

Jason Mehr ◽

...

Keyword(s):

New Jersey ◽

Acute Care ◽

Acute Care Hospitals ◽

Point Prevalence ◽

Candida Auris ◽

Healthcare Facilities ◽

Clinical Specimens ◽

Department Of Health ◽

Percent Positivity

Abstract Background Candida auris is a fungal pathogen associated with multidrug resistance, high mortality, and healthcare transmission. Since its U.S. emergence in 2017, to March 19, 2021, 1708 clinical infections were reported nationwide, of which 235 (13.8%) were reported in New Jersey. The New Jersey Department of Health (NJDOH) maintains C. auris surveillance in healthcare facilities (HCF) such as acute care hospitals, long-term acute care hospitals (LTACHs), and skilled nursing facilities, to monitor clinical infections and patient colonization. We aimed to characterize the epidemiology of C. auris infection and colonization among HCF patients during 2017–2020. Methods HCFs report C. auris cases identified from clinical specimens and surveillance activities such as admission screenings and point prevalence surveys (PPS) to NJDOH. Cases are classified as either infection or colonization using National Notifiable Diseases Surveillance System case definitions. We analyzed cases reported during 2017–2020 to describe types of cases, facilities reporting cases, and demographics of affected patients. We analyzed PPS results to calculate percent positivity of tests from patients without previously identified infection and compared percent positivity between types of facilities. We examined quarterly trends for all variables before and after the COVID-19 pandemic peak in the second quarter of 2020. Results During 2017–2020, 614 C. auris cases identified from clinical specimens were reported to NJDOH [243 (39.6%) infection, 371 (60.4%) colonization]; of these, 139 (57.2%) and 301 (81.1%) , respectively, were identified at long-term acute care hospitals (LTACHs). PPS percent positivity was higher at LTACHs (mean 7.6%) compared with all other facility types (mean 3.6%) for 13 of 16 quarters during 2017–2020. Case reports increased 2.6-fold from the Q2 2020 peak of the COVID-19 pandemic to Q3 2020.From Q1 to Q4 2020, PPS percent positivity increased from 4.8% to 10.5%. Figure 1. Candida auris cases reported to New Jersey Department of Health, 2017–2020 Figure 2. Candida auris test percent positivity among healthcare facility patients sampled for point prevalence surveys* and total number of C. auris point prevalence tests performed, New Jersey, 2017–2020. *Excluding individuals already known to be cases Conclusion The COVID-19 pandemic may have exacerbated C. auris transmission in HCF and potential causes should be further explored. LTACHs carry a disproportionate burden of patients colonized with C. auris and should be prioritized for surveillance and containment efforts. Disclosures All Authors: No reported disclosures

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90. Impact of Infection Control Assessment and Response (ICAR) Visit on Candida auris Colonization Rates at Seven Long Term Acute Care Hospitals (LTACH) in Los Angeles County

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.090 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S57-S57

Author(s):

Kiran Bhurtyal ◽

Jennifer Nguyen ◽

Anthony Clarke ◽

Kelsey OYong ◽

Sandeep Bhaurla ◽

...

Keyword(s):

Public Health ◽

Los Angeles ◽

Infection Control ◽

Acute Care ◽

Los Angeles County ◽

Acute Care Hospitals ◽

Candida Auris ◽

Colonization Rates ◽

Environmental Disinfection

Abstract Background Public health authorities often use Infection Control Assessment and Response (ICAR) visits during Candida auris (C. auris) outbreak investigation to identify facility-level infection prevention and control (IPC) practice gaps and make recommendations to address those gaps. As an adjunct to ICAR visit, point prevalence surveys (PPS) provide an objective measure to determine if IPC recommendations are implemented. Because they require significant public health resources to perform, we evaluated the impact of ICAR visits on C. auris colonization rates. Methods PPS were conducted at seven long-term acute-care hospitals (LTACH) with C. auris outbreaks in Los Angeles County from July 2020 to May 2021. Skin swabs collected at PPS were tested for C. auris colonization by PCR technique. Pre-ICAR PPS results were compared with the average of two serial post-ICAR PPS results using repeated measures ANOVA test. Linear regression was used to estimate associations between individual ICAR domains and C. auris colonization. Results 54 PPS were conducted at seven LTACHs with at least one ICAR visit made for every two PPS. On average, PPS were conducted 14 days (range 1-15 days) before and 10 days (range 4-33 days) after an ICAR visit. PPS positive rates with ICAR visit dates for each LTACH are shown in figure 1. Overall, ICAR visits were associated with a significant decrease (p=0.035) in the average of the positive rates in two serial post-ICAR PPS. When individual domain (hand hygiene, contact precautions, and environmental disinfection) of ICAR tool was analyzed, only adherence to environmental disinfection was significantly associated (p=0.038) with decrease in C. auris colonization rates. There was a moderate negative correlation (R2 = 0.26, β= -0.33) between environmental disinfection adherence and the magnitude of decrease in the colonization rates across all LTACHs (Figure 2). Figure 1 Figure 2 Conclusion ICAR visits were found to be significantly associated with a decrease in the average PPS positive rate on serial PPS. Parts of the ICAR tool that assessed environmental disinfection at the facility seemed most correlated with decrease in C. auris colonization rate. Streamlining the ICAR process to focus on the most impactful parts of ICAR tool may be a more efficient intervention to control C. auris outbreaks. Disclosures All Authors: No reported disclosures

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Identification of Colonized Patients During an Outbreak of Candida auris Using a Regional Health Information Exchange

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.819 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s255-s256

Author(s):

Richard Brooks ◽

Elisabeth Vaeth ◽

Heather Saunders ◽

Tim Blood ◽

Brittany Grace ◽

...

Keyword(s):

Health Information ◽

Acute Care ◽

Information Exchange ◽

Health Information Exchange ◽

Acute Care Hospitals ◽

Regional Health ◽

Candida Auris ◽

Notification System ◽

Healthcare Facilities ◽

Care Facilities

Background: In June 2019, the Maryland Department of Health (MDH) was notified of a hospitalized patient with Candida auris bloodstream infection. The MDH initiated a contact investigation to identify additional patients with C. auris colonization. Many of the contacts had been discharged home from the hospital and were therefore not available for screening. Healthcare facilities in Maryland, Virginia, and Washington, DC, submit patient data to a regional health information exchange (HIE) called the Chesapeake Regional Information System for our Patients (CRISP). CRISP includes a notification system that alerts providers when flagged patients have healthcare encounters. We aimed to use this system to identify discharged C. auris contacts on their next inpatient encounter to rapidly screen them and to detect new cases. Methods:C. auris contacts were defined as patients located on an inpatient unit on the same day, receiving wound care from the same team, or having a procedure in the same operating room on the same day as the index patient or any patients subsequently identified as having C. auris infection or colonization detected either during the normal course of clinical care or through screening. Contacts who remained hospitalized were screened during inpatient point prevalence surveys (PPSs). Contacts discharged to postacute-care facilities were screened by facility staff. Contacts who had been discharged home were flagged in CRISP, and MDH staff received CRISP encounter alerts when these patients were readmitted. MDH staff then contacted the admitting facilities to recommend screening for C. auris. Axilla and groin swabs were collected and tested by rt-PCR at the Mid-Atlantic Regional Antibiotic Resistance Laboratory Network laboratory. Results: As of October 8, 2019, 4,017 contacts were identified. Among these, 936 (23%) contacts at 56 healthcare facilities (33 acute-care hospitals and 23 postacute-care facilities) were screened for C. auris, and 10 patients with C. auris colonization were identified (1.1% of contacts who underwent C. auris screening). Of these, 6 (60%) were identified through CRISP notification and 4 (40%) were identified by PPSs conducted in acute-care hospitals. Conclusions: In this ongoing C. auris outbreak, a large proportion of colonized patients was identified using an electronic encounter notification system within a regional HIE. This approach was effective for identifying opportunities to screen contacts at their next healthcare encounter and can augment other means of case detection, like PPSs. HIEs should incorporate mechanisms to facilitate contact tracing for public health investigations.Funding: NoneDisclosures: None

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Assessment of Potential Clostridioides difficile Public Health Notification Thresholds in Acute-Care Hospitals

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.644 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s132-s132

Author(s):

Ariella Dale ◽

Meghana Parikh ◽

Wendy Bamberg ◽

Marion Kainer

Keyword(s):

Public Health ◽

Acute Care ◽

Acute Care Hospitals ◽

The United States ◽

Health Departments ◽

Healthcare Facilities ◽

Public Health Departments ◽

Threshold Levels ◽

Clostridioides Difficile ◽

Alert Threshold

Background:Clostridioides difficile remains a pervasive issue throughout healthcare facilities in the United States. Currently, no national guidelines exist for healthcare facilities to notify public health about suspected C. difficile transmission. Identification of a threshold for public health notification is needed to improve efforts to target prevention in facilities and to contain the spread of C. difficile.Methods: We analyzed C. difficile data reported by acute-care hospitals (ACHs) during October 2017–September 2018 via the CDC NHSN in Colorado and Tennessee. Threshold levels of ≥2, ≥3, and ≥4 C. difficile infections per calendar month per unit were assessed to identify ACH units that would trigger facility reporting to public health. Values meeting thresholds were defined as “alerts.” Facilities were further stratified by size and medical teaching status. Recurrent alerts were defined as meeting the threshold at least twice within 12 months. Presence and recurrence of facility alerts were compared to facility-specific standardized infection ratios (SIRs) and cumulative attributable differences (CADs). Results: Of 105 ACHs in Tennessee and 50 in Colorado, 46 in Tennessee (44%) and 28 in Colorado (56%) had alerts with a threshold of ≥2 cases per calendar month per unit; 20 in Tennessee (19%) and 19 in Colorado (38%) had ≥3 cases per calendar month per unit; and 7 in Tennessee (7%) and 10 in Colorado (20%) had ≥4 cases per calendar month per unit. Most alerts with each threshold were in facilities with ≥400 beds and in major teaching hospitals. Using a threshold of ≥2, 64% of Tennessee and 79% of Colorado alerts were associated with recurrent alerting units. Using an alert threshold of ≥3, 85% of Tennessee facilities (17 of 20) and 75% of Colorado facilities (15 of 20) with the highest CAD values had at least 1 alert. Using state-based CAD values, 79% of the CAD value for Tennessee (356 of 449) and 91% of the CAD value for Colorado (309 of 340) were attributable to facilities with at least 1 alert. Facilities above a threshold of ≥3 had a pooled SIR of 0.92 in Tennessee (range, 0.46–7.94) and 1.07 in Colorado (range, 0.74–1.74). Conclusions: Using alert threshold levels identified ACHs with higher levels of C. difficile. Recurrent alerts account for a substantial proportion of the total alerts in ACHs, even as thresholds increased. Alerts were strongly correlated with high CAD values. Because NHSN C. difficile data are not available to public health departments until several months after cases are identified, public health departments should consider working with ACHs to implement a threshold model for public health notification, enabling earlier intervention than those prompted by SIR and CAD calculations.Disclosures: NoneFunding: None

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.670 ◽

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

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Prevalence and Trend in the Use of Hospital-Based Standing Orders Programs for Influenza and Pneumococcal Vaccination

Infection Control and Hospital Epidemiology ◽

10.1086/519208 ◽

2007 ◽

Vol 28 (8) ◽

pp. 899-904 ◽

Cited By ~ 1

Author(s):

Sri Ram Pentakota ◽

William Halperin

Keyword(s):

New Jersey ◽

Influenza Vaccination ◽

Acute Care ◽

State Government ◽

Pneumococcal Vaccination ◽

Acute Care Hospitals ◽

Health Department ◽

The State ◽

Healthcare Facilities ◽

Hospital Characteristics

Background.In 2002, federal regulations authorized the use of standing orders programs (SOPs) for promoting influenza and pneumococcal vaccination. In 2003, the New Jersey Hospital Association conducted a demonstration project illustrating the efficacy of SOPs, and the state health department informed healthcare facilities of their benefits. We describe the prevalence of reported use of SOPs in New Jersey hospitals in 2003 and 2005 and identify hospital characteristics associated with the use of SOPs.Methods.A survey was mailed to the directors of infection control at 117 New Jersey hospitals during the period from January to May 2005 (response rate, 90.6%). Data on hospital characteristics were obtained from hospital directories and online resources.Results.The prevalence of use of SOPs for influenza vaccination was 50% (95% confidence interval [CI], 40.1%-59.9%) in 2003, and it increased to 78.3% (95% CI, 69.2%-85.7%) in 2005. The prevalence of SOP use for pneumococcal vaccination was similar. In 2005, the reported rate of use of SOPs for inpatients (influenza vaccination, 76.4%; pneumococcal vaccination, 75.5%) was significantly higher than that for outpatients (influenza vaccination, 9.4%; pneumococcal vaccination, 8.5%). Prevalence ratios for SOP use comparing acute care and non-acute care hospitals were 1.71 (95% CI, 1.2-2.5) for influenza vaccination SOPs and 1.8 for (95% CI, 1.2-2.7) pneumococcal vaccination SOPs. Acute care hospitals with a ratio of admissions to total beds greater than 36.7 reported greater use of SOPs for pneumococcal vaccination, compared with those that had a ratio of less than 36.7.Conclusion.The increase in the prevalence of reported use of SOPs among New Jersey hospitals in 2005, compared with 2003, was contemporaneous with SOP-related actions taken by the federal government, the state government, and the New Jersey Hospital Association. Opportunities persist for increased use of SOPs among non-acute care hospitals and for outpatients.

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Methicillin-Resistant Staphylococcus aureus (MRSA): A Briefing for Acute Care Hospitals and Nursing Facilities

Infection Control and Hospital Epidemiology ◽

10.1086/646870 ◽

1994 ◽

Vol 15 (2) ◽

pp. 105-115 ◽

Cited By ~ 49

Author(s):

John M. Boyce ◽

Marguerite M. Jackson ◽

Gina Pugliese ◽

Murray D. Batt ◽

David Fleming ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Acute Care ◽

Methicillin Resistant Staphylococcus Aureus ◽

Acute Care Hospitals ◽

Nursing Facilities ◽

Methicillin Resistant

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The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California

Clinical Infectious Diseases ◽

10.1093/cid/ciz119 ◽

2019 ◽

Vol 69 (9) ◽

pp. 1566-1573 ◽

Cited By ~ 16

Author(s):

James A McKinnell ◽

Raveena D Singh ◽

Loren G Miller ◽

Ken Kleinman ◽

Gabrielle Gussin ◽

...

Keyword(s):

Nursing Homes ◽

Acute Care ◽

Orange County ◽

Multidrug Resistant ◽

Resistant Organism ◽

Healthcare Intervention ◽

Healthcare Facilities ◽

Care Facilities ◽

Acute Care Facilities

Abstract Background Multidrug-resistant organisms (MDROs) spread between hospitals, nursing homes (NHs), and long-term acute care facilities (LTACs) via patient transfers. The Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County is a regional public health collaborative involving decolonization at 38 healthcare facilities selected based on their high degree of patient sharing. We report baseline MDRO prevalence in 21 NHs/LTACs. Methods A random sample of 50 adults for 21 NHs/LTACs (18 NHs, 3 LTACs) were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum β-lactamase–producing organisms (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE) using nares, skin (axilla/groin), and peri-rectal swabs. Facility and resident characteristics associated with MDRO carriage were assessed using multivariable models clustering by person and facility. Results Prevalence of MDROs was 65% in NHs and 80% in LTACs. The most common MDROs in NHs were MRSA (42%) and ESBL (34%); in LTACs they were VRE (55%) and ESBL (38%). CRE prevalence was higher in facilities that manage ventilated LTAC patients and NH residents (8% vs <1%, P < .001). MDRO status was known for 18% of NH residents and 49% of LTAC patients. MDRO-colonized adults commonly harbored additional MDROs (54% MDRO+ NH residents and 62% MDRO+ LTACs patients). History of MRSA (odds ratio [OR] = 1.7; confidence interval [CI]: 1.2, 2.4; P = .004), VRE (OR = 2.1; CI: 1.2, 3.8; P = .01), ESBL (OR = 1.6; CI: 1.1, 2.3; P = .03), and diabetes (OR = 1.3; CI: 1.0, 1.7; P = .03) were associated with any MDRO carriage. Conclusions The majority of NH residents and LTAC patients harbor MDROs. MDRO status is frequently unknown to the facility. The high MDRO prevalence highlights the need for prevention efforts in NHs/LTACs as part of regional efforts to control MDRO spread.

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