scholarly journals Evaluation of Patient Risk Factors for Carbapenemase-Producing Organism Colonization

2020 ◽  
Vol 41 (S1) ◽  
pp. s229-s230
Author(s):  
Carolyn Stover ◽  
Allison Chan ◽  
Snigdha Vallabhaneni ◽  
Allison Brown ◽  
Amelia Keaton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Antibiotic Resistance ◽  
Nursing Homes ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Stool Incontinence ◽  
A Value ◽  
Admission Screening

Background: Carbapenemase-producing organisms (CPOs) are a growing antibiotic resistance threat. Colonization screening can be used to identify asymptomatically colonized individuals for implementation of transmission-based precautions. Identifying high-risk patients and settings to prioritize screening recommendations can preserve facility resources. To inform screening recommendations, we analyzed CPO admission screens and screening conducted on point-prevalence surveys (PPSs) performed through the Antibiotic Resistance Laboratory Network’s Southeast Regional Laboratory (SE AR Lab Network). Methods: During 2017–2019, the SE AR Lab Network collected data via a REDCap survey for a subset of CPO screens on a limited set of easily determined patient risk factors. Rectal swabs were collected and tested with the Cepheid Carba-R. Specimens collected within 2 days of admission were classified as admission screening and the remainder were classified as PPS. Index cases were excluded from analyses. Odd ratios (ORs) and 95% confidence intervals were calculated, and a value of 0.1 was used for cells with a value of zero. Results: In total, 520 screens were conducted, which included 366 admission screens at 2 facilities and 154 screens from 27 PPSs at 8 facilities. CPOs were detected in 14 (2.7%) screens, including in 10 (2.7%) admission screens and in 4 (2.6%) contacts during PPSs; carbapenemases detected were Klebsiella pneumoniae carbapenemase (KPC) (n = 12), New Delhi Metallo-β-lactamase (NDM) (n = 1) and Verona Integron-Encoded Metallo-β-lactamase (VIM) (n = 1). One long-term acute care hospital (LTACH) performed universal admission screening, which accounted for 96% of admission screens and all 10 CPOs detected by admission screening. Mechanical ventilation (OR, 5.0; 95% CI, 1.4–18.0) and the presence of a tracheostomy (OR, 5.4; 95% CI, 1.5–19.4) were associated with a positive admission screen. Moreover, 8 facilities conducted PPSs: 4 acute care hospitals, 2 long-term acute care hospitals, and 2 nursing homes. CPO prevalence in long-term acute care hospitals was 4.8% (2 of 42), 2.4% (1 of 41) in acute care hospitals, and 1.5% (1 of 69) in nursing homes. Requiring assistance with bathing (OR, 4.8; 95% CI, 1.6–8.0) and stool incontinence (OR, 16.6; 95% CI, 13.4–19.8) were associated with a positive screen on PPSs. All 7 roommates of known cases tested negative for CPO colonization. Conclusions: Findings suggest that patients with certain easily assessed characteristics, such as mechanical ventilation, tracheostomy, or stool incontinence or who require bathing assistance, may be associated with CPO positivity during screening. Further data collection and analysis of such risk factors may provide insight for the development of more targeted admission and contact screening strategies.Funding: NoneDisclosures: None

scholarly journals 2449. Early Detection of Candida auris is Essential to Control Spread: Four Effective Active Surveillance Strategies

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S846-S847
Author(s):  
Snigdha Vallabhaneni ◽  
Matthew Zahn ◽  
Erin Epson ◽  
Kathleen ODonnell ◽  
Sam Horwich-Scholefield ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Early Detection ◽  
Infection Control ◽  
Species Identification ◽  
Acute Care ◽  
Department Of Health ◽  
Admission Screening ◽  
High Prevalence

Abstract Background C. auris has been identified from > 1600 US patients. Risk factors include high-acuity post-acute care admissions (e.g., long-term acute care hospitals (LTACHs)), hospitalization abroad, and carbapenemase-producing organism (CPO) colonization. Early detection of C. auris is key to controlling spread. We describe four active surveillance strategies that led to early C. auris identification. Methods Based on known risk factors, state health departments used active C. auris surveillance strategies: (1) species identification of yeast from urine cultures from LTACHs, (2) screening patients with a CPO and hospitalization abroad, (3) LTACH C. auris point prevalence surveys (PPS), or (4) admission screening in acute and long-term care settings. Results (1)A laboratory in Southern California serving 12 LTACHs began species identification for all Candida from urine cultures, which would have otherwise been discarded because they are assumed to be not clinically significant. Within 5 months, testing of 271 Candida urine isolates identified the region’s first C. auris case, prompting contact tracing and identification of additional cases and facilities. (2) When CPOs were identified in patients with recent hospitalizations outside of the United States, the Maryland Department of Health screened patients for C.auris colonization. Of four screened, one, who received care in Kenya, was C. auris colonized. (3) The Indiana State Department of Health implemented monthly PPS at an LTACH that frequently admits patients transferred from a high prevalence area. Of 38 patients screened, two were colonized. (4) The Connecticut Department of Public Health offers C. auris admission screening for patients who received inpatient care in high prevalence areas; of 12 screened, one C. auris colonized patient was found. Infection control assessments and implementation of infection control measures followed each detection. Conclusion Early detection of C. auris is important but is impacted by infrequent yeast species identification and a reservoir of asymptomatic colonized patients. Healthcare facilities and public health jurisdictions can consider adopting one or more of these strategies based on epidemiology and resource availability. Disclosures All authors: No reported disclosures.

scholarly journals Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitals

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Berna Demiralp ◽  
Lane Koenig ◽  
Jing Xu ◽  
Samuel Soltoff ◽  
John Votto
Keyword(s):  
Mechanical Ventilation ◽  
Endotracheal Intubation ◽  
Acute Care ◽  
Prolonged Mechanical Ventilation ◽  
Acute Care Hospitals ◽  
Care Hospital ◽  
Mechanical Ventilator ◽  
Ventilated Patients ◽  
Ventilator Patients

Abstract Background Long-term acute care hospitals (LTACHs) treat mechanical ventilator patients who are difficult to wean and expected to be on mechanical ventilator for a prolonged period. However, there are varying views on who should be transferred to LTACHs and when they should be transferred. The purpose of this study is to assess the relationship between length of stay in a short-term acute care hospital (STACH) after endotracheal intubation (time to LTACH) and weaning success and mortality for ventilated patients discharged to an LTACH. Methods Using 2014–2015 Medicare claims and assessment data, we identified patients who had an endotracheal intubation in STACH and transferred to an LTACH with prolonged mechanical ventilation (defined as 96 or more consecutive hours on a ventilator). We controlled for age, gender, STACH stay procedures and diagnoses, Elixhauser comorbid conditions, and LTACH quality characteristics. We used instrumental variable estimation to account for unobserved patient and provider characteristics. Results The study cohort included 13,622 LTACH cases with median time to LTACH of 18 days. The unadjusted ventilator weaning rate at LTACH was 51.7%, and unadjusted 90-day mortality rate was 43.7%. An additional day spent in STACH after intubation is associated with 11.6% reduction in the odds of weaning, representing a 2.5 percentage point reduction in weaning rate at 18 days post endotracheal intubation. We found no statistically significant relationship between time to LTACH and the odds of 90-day mortality. Conclusions Discharging ventilated patients earlier from STACH to LTACH is associated with higher weaning probability for LTACH patients on prolonged mechanical ventilation. Our findings suggest that delaying ventilated patients’ discharge to LTACH may negatively influence the patients’ chances of being weaned from the ventilator.

The Role of Long-Term Ventilator Hospitals

2014 ◽  
Author(s):  
Jeremy M Kahn
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Acute Care ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
Acute Care Hospitals ◽  
Cost Of Care ◽  
Current Evidence ◽  
Chronically Critically Ill

Long-term ventilator facilities play an increasingly important role in the care of chronically critically ill patients in the recovery phase of their acute illness. These hospitals can take several forms, depending on the country and health system, including �step-down� units within acute care hospitals and dedicated centres that specialize in weaning patients from prolonged mechanical ventilation. These hospitals may improve outcomes through increased clinical experience at applying protocolized weaning approaches and specialized, multidisciplinary, rehabilitation-focused care; they may also worsen outcomes by fragmenting the episode of acute care across multiple hospitals, leading to communication delays and hardship for families. Long-term ventilator facilities may also have important �spillover effects�, in that they free ICU beds in acute care hospitals to be filled with greater numbers of acute critically ill patients. Current evidence suggests that mortality of chronically critically ill patients is equivalent between acute care hospitals and specialized weaning centres; however, mechanical ventilation may be longer and cost of care higher in patients who remain in acute care hospitals. Given the rising incidence of prolonged mechanical ventilation and capacity constraints on acute care ICUs, long-term ventilator hospitals are likely to serve a key function in critical illness recovery.

Risk Factors of Falls in Elderly Population in Acute Care Hospitals and Nursing Homes in North Italy

2008 ◽  
Vol 23 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Cristina Tommasini ◽  
Renato Talamini ◽  
Ettore Bidoli ◽  
Nicola Sicolo ◽  
Alvisa Palese
Keyword(s):  
Risk Factors ◽  
Nursing Homes ◽  
Acute Care ◽  
Elderly Population ◽  
Acute Care Hospitals ◽  
Falls In Elderly

scholarly journals A 10-year Review of Clostridium difficile Infection in Acute Care Hospitals in the United States

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S393-S393
Author(s):  
Ruihong Luo ◽  
Tamar Barlam ◽  
Janice Weinberg
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
The United States ◽  
Health Facilities ◽  
Annual Rate ◽  
Hospital Charges ◽  
Hospital Death

Abstract Background Many strategies reported to decrease CDI occurrence have been implemented in acute care hospitals in recent years. We assessed the change in incidence, mortality and hospital charges of CDI patients in acute care hospitals during 2005–2014. We also investigated risk factors for hospital-onset CDI (HOCDI) and predictive factors for mortality of CDI patients. Methods Using the Nationwide Inpatient Sample database, we identified adult patients (¡Ý 18 years) with CDI by ICD-9-CM codes. The trends of CDI incidence, mortality and hospital charges were evaluated by Poisson regression. The risk for HOCDI and factors to predict in-hospital death of CDI patients were analyzed by logistic regression. Results 3,337,910 cases of CDI were identified out of a total of 318,703,355 hospitalizations (1.05%). Incidences of non-HOCDI and HOCDI were 0.42% and 0.63% respectively. In the 10-year study period, CDI incidence increased with an annual rate of 3.3% (P < 0.001). The annual incidences of HOCDI and non-HOCDI increased with a rate of 1.4% and 2.0% respectively (P < 0.001). After adjusting for demographics, length of hospital stay and Charlson index, transfer from long-term health facilities (OR=2.02, 95% CI 1.83–2.23) and admission to a teaching hospital (OR=1.10, 95% CI 1.05–1.15) were independent risk factors for HOCDI. The in-hospital mortality of CDI associated hospitalization decreased from 9.7% in 2005 to 6.8% in 2014 (P < 0.001). Transfer from long-term health facilities significantly predicted the risk for in-hospital death in CDI patients (OR= 1.34, 95% CI 1.32–1.36). The sum charge of all CDI hospitalizations increased with an annual rate of 2.0% (P < 0.001). The median charge per CDI hospitalization increased during 2005–2009 (P < 0.001), and then decreased during 2010–2014 (P < 0.001). Conclusion During 2005–2014, the mortality in CDI hospitalized patients decreased, but CDI incidence in acute care hospitals increased, resulting in increased total CDI associated hospital charges. Patients transferred from long-term healthcare facilities increased the risk for HOCDI and CDI associated in-hospital mortality. They should be considered as high-risk patients for CDI surveillance when developing mitigation strategies. Disclosures All authors: No reported disclosures.

Antibiotic Resistance in Long-Term Acute Care Hospitals The Perfect Storm

2006 ◽  
Vol 27 (9) ◽  
pp. 920-925 ◽  
Author(s):  
Carolyn V. Gould ◽  
Richard Rothenberg ◽  
James P. Steinberg
Keyword(s):  
Antibiotic Resistance ◽  
Acute Care ◽  
Methicillin Resistance ◽  
Horizontal Transmission ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Hospital Level ◽  
Medical Icus

Objective.To examine bacterial antibiotic resistance and antibiotic use patterns in long-term acute care hospitals (LTACHs) and to evaluate effects of antibiotic use and other hospital-level variables on the prevalence of antibiotic resistance.Design.Multihospital ecologic study.Methods.Antibiograms, antibiotic purchasing data, and demographic variables from 2002 and 2003 were obtained from 45 LTACHs. Multivariable regression models were constructed, controlling for other hospital-level variables, to evaluate the effects of antibiotic use on resistance for selected pathogens. Results of active surveillance in 2003 at one LTACH were available.Results.Among LTACHs, median prevalences of resistance for several antimicrobial-organism pairs were greater than the 90th percentile value for National Nosocomial Infections Surveillance system (NNIS) medical intensive care units (ICUs). The median prevalence of methicillin resistance amongStaphylococcus aureusisolates was 84%. More than 60% of patients in one LTACH were infected or colonized with methicillin-resistantS. aureusand/or vancomycin-resistantEnterococcusat the time of admission. Antibiotic consumption in LTACHs was comparable to consumption in NNIS medical ICUs. In multivariable logistic regression modeling, the only significant association between antibiotic use and the prevalence of antibiotic resistance was for carbapenems and imipenem resistance amongPseudomonas aeruginosaisolates (odds ratio, 11.88 [95% confidence interval, 1.42-99.13];P= .02).Conclusions.The prevalence of antibiotic resistance among bacteria recovered from patients in LTACHs is extremely high. Although antibiotic use in LTACHs likely contributes to resistance prevalence for some antimicrobial-organism pairs, for the majority of such pairs, other variables, such as prior colonization with and horizontal transmission of antimicrobial-resistant pathogens, may be more important determinants. Further research on antibiotic resistance in LTACHs is needed, particularly with respect to determining optimal infection control practices in this environment.

scholarly journals Characterization and evolution of infection control practices among SARS-CoV-2 infected healthcare workers of acute care hospitals and long-term care facilities in Quebec, Canada, Spring 2020

2021 ◽  
pp. 1-37
Author(s):  
Sara Carazo ◽  
Denis Laliberté ◽  
Jasmin Villeneuve ◽  
Richard Martin ◽  
Pierre Deshaies ◽  
...  
Keyword(s):  
Acute Care ◽  
Attack Rate ◽  
Healthcare Workers ◽  
Long Term Care ◽  
Acute Care Hospitals ◽  
Exposure Period ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Care Facilities

ABSTRACT Objectives: To estimate the SARS-CoV-2 infection rate and the secondary attack rate among healthcare workers (HCWs) in Quebec, the most affected province of Canada during the first wave; to describe the evolution of work-related exposures and infection prevention and control (IPC) practices in infected HCWs; and to compare the exposures and practices between acute care hospitals (ACHs) and long-term care facilities (LTCFs). Design: Survey of cases Participants: Quebec HCWs from private and public institutions with laboratory-confirmed COVID-19 diagnosed between 1st March and 14th June 2020. HCWs ≥18 years old, having worked during the exposure period and survived their illness were eligible for the survey. Methods: After obtaining consent, 4542 HCWs completed a standardized questionnaire. COVID-19 rates and proportions of exposures and practices were estimated and compared between ACHs and LTCFs. Results: HCWs represented 25% (13,726/54,005) of all reported COVID-19 cases in Quebec and had an 11-times greater rate than non-HCWs. Their secondary household attack rate was 30%. Most affected occupations were healthcare support workers, nurses and nurse assistants, working in LTCFs (45%) and ACHs (30%). Compared to ACHs, HCWs of LTCFs had less training, higher staff mobility between working sites, similar PPE use but better self-reported compliance with at-work physical distancing. Sub-optimal IPC practices declined over time but were still present at the end of the first wave. Conclusion: Quebec HCWs and their families were severely affected during the first wave of COVID-19. Insufficient pandemic preparedness and suboptimal IPC practices likely contributed to high transmission in both LTCFs and ACHs.

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