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

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

Assessment of public health notification thresholds for Clostridioides difficile in acute-care hospitals—Colorado and Tennessee, 2018

2021 ◽  
pp. 1-6
Author(s):  
Meghana P. Parikh ◽  
Ariella P. Dale ◽  
Wendy M. Bamberg ◽  
Marion A. Kainer
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Descriptive Analysis ◽  
Acute Care Hospitals ◽  
Rapid Identification ◽  
High Burden ◽  
Public Health Agencies ◽  
Clostridioides Difficile ◽  
Unit Unit ◽  
Alert Threshold

Abstract Objectives: We aimed to identify a threshold number of Clostridioides difficile infections (CDI) for acute-care hospitals (ACHs) to notify public health agencies of outbreaks and we aimed to determine whether thresholds can be used with existing surveillance strategies to further infection reduction goals. Design: Descriptive analysis of laboratory-identified CDI reported to the National Healthcare Safety Network by Colorado and Tennessee ACH inpatient units in 2018. Methods: Threshold levels of ≥2, ≥3, and ≥4 CDI events per calendar month per unit (unit month) were assessed to identify units that would trigger facility reporting to public health. Values meeting thresholds were defined as alerts. Recurrent alerts were defined as alerts from units meeting the threshold ≥2 times within 12 months. The presence of alerts was compared to the number of excess infections to identify high-burden facilities. Results: At an alert threshold of ≥2 CDI events per unit month, 204 alerts occurred among 43 Colorado ACHs and 290 among 78 Tennessee ACHs. At a threshold of ≥3, there were 59 and 61 alerts, and at a threshold of ≥4, there were 17 and 10 alerts in Colorado and Tennessee, respectively. In both Colorado and Tennessee, at a threshold of ≥3 nearly 50% of alerts were recurrent, and facilities with at least one alert in 2018 accounted for ∼85% of the statewide excess infections. Conclusions: An alert threshold of ≥3 CDI events per unit month is feasible for rapid identification of outbreaks in ACHs. This threshold can facilitate earlier assessments and interventions in high-burden facilities.

scholarly journals 604. Gram-Negative Bacilli Carrying Multiple Carbapenemases: the United States, 2012–2018

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S283-S283
Author(s):  
David Ham ◽  
Garrett Mahon ◽  
Sandeep Bhaurla ◽  
Sam Horwich-Scholefield ◽  
Liore Klein ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Acute Care ◽  
Treatment Options ◽  
The United States ◽  
Culture Collection ◽  
Health Departments ◽  
Gram Negative ◽  
Healthcare Facilities ◽  
Acute Care Facilities

Abstract Background Gram-negative bacilli carrying multiple carbapenemase genes (multi-CP-GNB) present an emerging public health threat; to date, most isolates reported in the literature have been from outside the United States. We reviewed multi-CP-GNB reported to CDC. Methods Reports of multi-CP-GNB isolates carrying genes encoding >1 targeted carbapenemases (i.e., KPC, NDM, OXA-48-type, VIM, or IMP) were received from healthcare facilities, health departments, and public health laboratories, and included isolates tested through the AR Laboratory Network (ARLN) beginning in 2017 as well as isolates sent to CDC for reference testing. Epidemiologic data were gathered by health departments during public health investigations. Results From October 2012 to November 2018, 111 multi-CP-GNB isolates from 71 patients in 20 states were identified. Two patients had three different multi-CP-GNB and one patient had two different multi-CP-GNB. The majority of cases (76%) were reported in 2017 or later, after ARLN testing began. Among patients with multi-CP-GNB, the most common organism-mechanisms combination was Klebsiella pneumoniae carrying NDM and OXA-48-type enzymes (table). Urine (44%) and rectal (20%) were the most frequent specimen sources for isolates. The median age of patients was 63 years (range 2–89 years); most had specimens collected at acute care hospitals (87%) or post-acute care facilities (9%). Of 50 patients with information available, 37 traveled internationally in the 12 months prior to culture collection. Among these, 88% were hospitalized for ≥1 night while outside the United States with 10 countries reported, of which India was most common (n = 18). All 5 patients with Pseudomonas aeruginosa co-carrying carbapenemases reported recent hospitalization outside the United States. Conclusion The multi-CP-GNB reported to CDC include diverse organisms and carbapenemase combinations and often harbored carbapenemases from different β-lactamase classes, which may severely limit treatment options. Healthcare exposures outside the United States were common; providers should ask about this exposure at healthcare admission and, when present, institute interventions to stop transmission in order to slow further US emergence. Disclosures All authors: No reported disclosures.

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

2020 ◽  
Vol 41 (S1) ◽  
pp. s76-s77
Author(s):  
Kathleen O'Donnell ◽  
Ellora Karmarkar ◽  
Brendan R Jackson ◽  
Erin Epson ◽  
Matthew Zahn
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Orange County ◽  
Acute Care Hospitals ◽  
Nursing Facilities ◽  
Candida Auris ◽  
Retrospective Case ◽  
California Department ◽  
Healthcare Facilities ◽  
Contact Precautions

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

scholarly journals Chemical Weapon Functional Exercise—Cincinnati: Observations and Lessons Learned from a “Typical Medium-Sized” City's Response to Simulated Terrorism Utilizing Weapons of Mass Destruction

2003 ◽  
Vol 118 (3) ◽  
pp. 205-214 ◽  
Author(s):  
Denis J. FitzGerald ◽  
Matthew D. Sztajnkrycer ◽  
Todd J. Crocco
Keyword(s):  
Public Health ◽  
Large Scale ◽  
Care Delivery ◽  
The United States ◽  
Weapons Of Mass Destruction ◽  
Chemical Weapon ◽  
Health Departments ◽  
Mass Destruction ◽  
Public Health Departments ◽  
Medical Response

In the wake of the September 11, 2001, attacks and the subsequent anthrax scare, there is growing concern about the United States' vulnerability to terrorist use of Weapons of Mass Destruction (WMD). As part of ongoing preparation for this terrible reality, many jurisdictions have been conducting simulated terrorist incidents to provide training for the public safety community, hospitals, and public health departments. As an example of this national effort to improve domestic preparedness for such events, a large scale, multi-jurisdictional chemical weapons drill was conducted in Cincinnati, Ohio, on May 20, 2000. This drill depicted the components of the early warning system for hospitals and public health departments, the prehospital medical response to terrorism. Over the course of the exercise, emergency medical services personnel decontaminated, triaged, treated, and transported eighty-five patients. Several important lessons were learned that day that have widespread applicability to health care delivery systems nationwide, especially in the areas of decontamination, triage, on-scene medical care, and victim transportation. As this training exercise helped Cincinnati to prepare for dealing with future large scale WMD incidents, such drills are invaluable preparation for all communities in a world increasingly at risk from terrorist attacks.

scholarly journals The Effects of Community Size, Control Over Agenda, and Contextual Variables on Zika Virus Preparation of Public Information Officers at Local Public Health Departments

2019 ◽  
Vol 2 (1) ◽  
pp. 97-119 ◽  
Author(s):  
Elizabeth Avery
Keyword(s):  
Public Health ◽  
Public Information ◽  
Size Control ◽  
The United States ◽  
Health Departments ◽  
Community Size ◽  
Local Public Health ◽  
Public Health Departments ◽  
Public Information Officers ◽  
Local Public Health Departments

As Zika emerged as a major global health threat, public information officers (PIOs) at local public health departments across the United States prepared for outbreaks of the virus amid great uncertainty. Using the crisis and risk emergency communication (CERC) model to inform this study, PIOs (n = 226) at public health departments were surveyed to assess how community size, perceived control over health agenda, and other considerations such as resources and federal influences affected their satisfaction with Zika preparedness in their departments. These contextual, indirect factors may moderate planning efforts for Zika and other health emergencies and thus should be considered in crisis management and planning models such as CERC.

Much to Do about Carbapenem-Resistant Enterobacteriaceae: Why Supplementing Surveillance May Be the Key to Stopping Spread

2014 ◽  
Vol 35 (8) ◽  
pp. 984-986 ◽  
Author(s):  
Christopher D. Pfeiffer ◽  
Zintars G. Beldavs
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Artery Bypass ◽  
Vital Signs ◽  
Surgical Site Infections ◽  
Acute Care Hospitals ◽  
Colon Surgery ◽  
The United States ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

(See the article by Thaden et al, on pages 978–983.)It is critical to the future of public health to understand the burden of carbapenem-resistant Enterobacteriaceae (CRE) so that we can effectively target efforts to limit potential spread. The Centers for Disease Control and Prevention (CDC) classifies CRE as 1 of 3 “urgent” antibiotic resistance threats to public health because of the high mortality associated with CRE infection and its rapid dissemination in the United States.What is the current burden of CRE disease? We can glean a snapshot of the national epidemiology of CRE from the CDC’s national surveillance. Rapid geographic spread is evident in the CDC’s national map of CRE, which indicates that all but 3 states now have identified CRE. Incidence by facility type, procedure, device, and organism all have considerable variation, providing preliminary indications where future prevention efforts might best be focused. The 2013 CRE Vital Signs states that 3.9% of short-stay acute care hospitals and 17.8% of long-term acute care hospitals have identified cases of CRE infection among those with catheter-associated urinary tract infection (CAUTI) or central line–associated bloodstream infection (CLABSI). The CDC also reported that 10% of Klebsiella species in intensive care unit (ICU) CLABSIs, ICU CAUTIs, and surgical site infections after colon surgery or coronary artery bypass grafting in 2011 were carbapenem resistant. Although CRE have been reported in most states, it is increasingly clear that wide regional variation exists, from regions of hyperendemicity, such as parts of New York City, to regions apparently free of CRE, such as Maine.

Impact of California’s mandate for antimicrobial stewardship programs on rates of methicillin-resistant Staphylococcus aureus and Clostridioides difficile infection in acute-care hospitals

2020 ◽  
pp. 1-7
Author(s):  
Alessandra B. Garcia Reeves ◽  
Sally C. Stearns ◽  
Justin G. Trogdon ◽  
James W. Lewis ◽  
David J. Weber ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Fixed Effects ◽  
Acute Care Hospitals ◽  
The United States ◽  
Methicillin Resistant ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
The Impact

Abstract Objective: To estimate the impact of California’s antimicrobial stewardship program (ASP) mandate on methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile infection (CDI) rates in acute-care hospitals. Population: Centers for Medicare and Medicaid Services (CMS)–certified acute-care hospitals in the United States. Data Sources: 2013–2017 data from the CMS Hospital Compare, Provider of Service File and Medicare Cost Reports. Methods: Difference-in-difference model with hospital fixed effects to compare California with all other states before and after the ASP mandate. We considered were standardized infection ratios (SIRs) for MRSA and CDI as the outcomes. We analyzed the following time-variant covariates: medical school affiliation, bed count, quality accreditation, number of changes in ownership, compliance with CMS requirements, % intensive care unit beds, average length of stay, patient safety index, and 30-day readmission rate. Results: In 2013, California hospitals had an average MRSA SIR of 0.79 versus 0.94 in other states, and an average CDI SIR of 1.01 versus 0.77 in other states. California hospitals had increases (P < .05) of 23%, 30%, and 20% in their MRSA SIRs in 2015, 2016, and 2017, respectively. California hospitals were associated with a 20% (P < .001) decrease in the CDI SIR only in 2017. Conclusions: The mandate was associated with a decrease in CDI SIR and an increase in MRSA SIR.

A Survey of Usage Protocols of Syndromic Surveillance Systems by State Public Health Departments in the United States

2009 ◽  
Vol 15 (5) ◽  
pp. 432-438 ◽  
Author(s):  
Lori Uscher-Pines ◽  
Corey L. Farrell ◽  
Jacqueline Cattani ◽  
Yu-Hsiang Hsieh ◽  
Michael D. Moskal ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Syndromic Surveillance ◽  
The United States ◽  
Surveillance Systems ◽  
Health Departments ◽  
Public Health Departments
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