scholarly journals Implementing Admission Screening for Candida auris

2020 ◽  
Vol 41 (S1) ◽  
pp. s281-s281
Author(s):  
Jenna Rasmusson ◽  
Nancy Wengenack ◽  
Priya Sampathkumar
Keyword(s):  
United States ◽  
At Risk ◽  
New York ◽  
Patient Care ◽  
Health Department ◽  
The United States ◽  
Case Finding ◽  
State Health ◽  
Candida Auris ◽  
State Health Department

Background:Candida auris is a globally emerging, multidrug-resistant fungal pathogen that causes serious, difficult-to-treat infections in hospitalized patients. C. auris cases in the United States have been linked to receipt of healthcare overseas. Outbreaks have also occurred in New York City, New Jersey, Chicago, and most recently in California. We provide care to patients from all 50 states and 138 countries; therefore, we are at risk for encountering C. auris in our facility. Setting: An academic, tertiary-care center with 1,297 licensed beds and >62,000 admissions each year. Methods: Infection prevention and control (IPAC) initiated a C. auris screening program in August 2019 in partnership with the State Health Department. A case-finding tool was created to identify adult patients admitted in the previous 24 hours from countries and areas of the United States (Chicago, New Jersey, and New York metropolitan areas) with known C. auris transmission based on the zip code of their primary address. IPAC sends an electronic communication via the electronic medical record (EMR) alerting the patient care team that the patient meets criteria for screening along with information on C. auris and links to a tool kit with additional resources to help answer questions. After obtaining verbal consent, the patient’s primary nurse collects a composite axilla–groin skin swab using a nylon-flocked swab (BD ESwab collection and transport system; Becton Dickinson, Sparks, MD). The sample is sent to the State Health Department laboratory for testing by polymerase chain reaction (PCR). Results are communicated back to IPAC and then scanned into the patient’s EMR. Results: From August 2019 to November 2019, 157 patients were identified for C. auris screening using the case-finding tool. Testing was performed on 95 patients; all tests were negative. The primary reasons for testing not to be performed on eligible patients were inability to obtain verbal consent and patient dismissal before sample could be obtained. The need for a special swab that is not routinely stocked on patient care units has been a limitation to timely specimen collection. Conclusions: The EMR can be leveraged for early identification and screening of patients at risk of C. auris colonization. Case finding tools can be effectively replicated and modified to respond to emerging infections and changing surveillance guidelines.Funding: NoneDisclosures: None

Nutrition and Infant Mortality

PEDIATRICS ◽  
1973 ◽  
Vol 51 (6) ◽  
pp. 1107-1108
Author(s):  
Tom Brewer
Keyword(s):  
United States ◽  
Infant Mortality ◽  
Newborn Infant ◽  
Infant Health ◽  
Health Department ◽  
The United States ◽  
Practical Significance ◽  
State Health ◽  
State Health Department ◽  
Provisional Data

In your December 1972 issue,1 Myron Wegman presents some "provisional" data on infant mortality in the United States, 1970 and 1971. These data are allegedly received from state health department offices, "a 10% sample of material received . . . between two dates, one month apart, regardless of when the event occurred." What is the practical significance of such data? What bearing do these statistical manipulations have on the problem of improving human maternal, fetal, and newborn infant health in our nation in the 1970s? How accurately does this sample reflect the real events?

Patient Information About Zika Virus and Perinatal Risks on State Health Department Websites in the United States [17I]

2017 ◽  
Vol 129 ◽  
pp. 97S ◽  
Author(s):  
Ryan Menchaca ◽  
Sarah M. Page-Ramsey ◽  
Emma Rodriguez ◽  
Jordan Gray ◽  
Kayla Ireland ◽  
...  
Keyword(s):  
United States ◽  
Patient Information ◽  
Zika Virus ◽  
Health Department ◽  
The United States ◽  
State Health ◽  
State Health Department ◽  
Perinatal Risks

scholarly journals Preparedness and response to an emerging health threat—Lessons learned from Candida auris outbreaks in the United States

2021 ◽  
pp. 1-6
Author(s):  
Diane Meyer ◽  
Elena K. Martin ◽  
Syra Madad ◽  
Priya Dhagat ◽  
Jennifer B. Nuzzo
Keyword(s):  
United States ◽  
New York ◽  
Qualitative Interviews ◽  
The United States ◽  
Lessons Learned ◽  
Infection Prevention And Control ◽  
Healthcare Organizations ◽  
Candida Auris ◽  
Term Care ◽  
Healthcare Facilities

Abstract Objective: Candida auris infections continue to occur across the United States and abroad, and healthcare facilities that care for vulnerable populations must improve their readiness to respond to this emerging organism. We aimed to identify and better understand challenges faced and lessons learned by those healthcare facilities who have experienced C. auris cases and outbreaks to better prepare those who have yet to experience or respond to this pathogen. Design: Semi-structured qualitative interviews. Setting: Health departments, long-term care facilities, acute-care hospitals, and healthcare organizations in New York, Illinois, and California. Participants: Infectious disease physicians and nurses, clinical and environmental services, hospital leadership, hospital epidemiology, infection preventionists, emergency management, and laboratory scientists who had experiences either preparing for or responding to C. auris cases or outbreaks. Methods: In total, 25 interviews were conducted with 84 participants. Interviews were coded using NVivo qualitative coding software by 2 separate researchers. Emergent themes were then iteratively discussed among the research team. Results: Key themes included surveillance and laboratory capacity, inter- and intrafacility communication, infection prevention and control, environmental cleaning and disinfection, clinical management of cases, and media concerns and stigma. Conclusions: Many of the operational challenges noted in this research are not unique to C. auris, and the ways in which we address future outbreaks should be informed by previous experiences and lessons learned, including the recent outbreaks of C. auris in the United States.

Human Relationships in Public Health

PEDIATRICS ◽  
1949 ◽  
Vol 4 (2) ◽  
pp. 266-266
Keyword(s):  
Public Health ◽  
Mental Health ◽  
New York ◽  
Health Services ◽  
Health Department ◽  
State Health ◽  
Public Health Services ◽  
State Health Department ◽  
Human Relationships ◽  
Commonwealth Fund

This is the title of a small pamphlet just issued by the Commonwealth Fund of New York. Written by Geddes Smith, an associate of the Fund, it describes an institute on mental health in public health which was held in the summer of 1948. Students at the institute were health officers of California counties and cities, or bureau chiefs in the State Health Department, with representatives of public health services of Tennessee, Mississippi, and Oklahoma.

PCBs in Breast Milk

PEDIATRICS ◽  
1978 ◽  
Vol 62 (3) ◽  
pp. 407-407
Keyword(s):  
United States ◽  
Breast Milk ◽  
Occupational Exposures ◽  
Health Department ◽  
The United States ◽  
The Body ◽  
State Health ◽  
The Past ◽  
Breast Feed ◽  
History Of

Publicity has raised concern about the presence of polychlorinated biphenyls (PCBs) in breast milk. There are no known effects in children at levels found in people in the United States. In Kyushu, Japan, pregnant women who ingested cooking oil that was heavily contaminated with PCBs and other chemicals had small-for-gestational-age infants who had transient darkening of the skin. PCBs are stored in body fat and are not readily excreted, except in the fat of breast milk. In the past, PCBs have entered the body through a variety of foods. More recently, contaminated game fish and occupational exposures have been the main sources. The only women in the United States who may have been heavily exposed are those who worked with PCBs or who have eaten large amounts of sports fish from PCB-contaminated waters such as the Saint Lawrence Seaway. Unless women have a history of exposure to PCBs, they should be encouraged to breast-feed their infants as usual. When a well-documented history of exposure to PCBs is obtained and the mother wants to breast-feed her infant, the mother's PCB level could be measured in about three weeks' time. The advice of state health department officials should be sought in the rare instances when a high PCB level is found.

scholarly journals Statelessness in the United States: A Study to Estimate and Profile the US Stateless Population

2020 ◽  
Vol 8 (2) ◽  
pp. 150-213
Author(s):  
Donald Kerwin ◽  
Daniela Alulema ◽  
Michael Nicholson ◽  
Robert Warren
Keyword(s):  
United States ◽  
At Risk ◽  
New York ◽  
Legal Status ◽  
The United States ◽  
Census Bureau ◽  
Executive Summary ◽  
Public And Private ◽  
Data Limitations ◽  
The Us

Executive Summary In October 2017, the Center for Migration Studies of New York (CMS) initiated a study to map the stateless population in the United States. This study sought to: Develop a methodology to estimate the US stateless population; Provide provisional estimates and profiles of persons who are potentially stateless or potentially at risk of statelessness in the United States; Create a research methodology that encouraged stateless persons to come forward and join a growing network of persons committed to educating the public on and pursuing solutions to this problem; and Establish an empirical basis for public and private stakeholders to develop services, programs, and policy interventions to prevent and reduce statelessness (UNHCR 2014g, 6), and to safeguard the rights of stateless persons ( UNHCR 2014d ). This report describes a unique methodology to produce estimates and set forth the characteristics of US residents who are potentially stateless or potentially at risk of statelessness. The methodology relies on American Community Survey (ACS) data from the US Census Bureau, supplemented by very limited administrative data on stateless refugees and asylum seekers. 1 As part of the study, CMS developed extensive, well-documented profiles of non–US citizen residents who are potentially stateless or potentially at risk of statelessness. It then used these profiles to query ACS data to develop provisional estimates and determine the characteristics of these populations. The report finds that the population in the United States that is potentially stateless or potentially at risk of statelessness is larger and more diverse than previously assumed, albeit with the caveat that severe data limitations make it impossible to provide precise estimates of this population. Stateless determinations require individual screening, which the study could not undertake. Individuals deemed potentially stateless or potentially at risk of statelessness in this report may in fact have been able to secure nationality in their home countries or in third countries. They may also be on a path to citizenship in the United States, although nobody in CMS’s estimates had yet to obtain US citizenship. According to CMS’s analysis, roughly 218,000 US residents are potentially stateless or potentially at risk of statelessness. These groups live in all 50 states, 2 with the largest populations in California (20,600), New York (18,500), Texas (15,200), Ohio (13,200), Minnesota (11,200), Illinois (8,600), Pennsylvania (8,200), Wisconsin (7,300), Georgia (6,600), and Virginia (6,500). The report recommends ways to improve data collection and, thus, develop better estimates in the future. It also lifts up the voices and challenges of stateless persons, and outlines steps to reduce statelessness and safeguard the rights of stateless persons in the United States. As it stands, the paucity of reliable federal data on the stateless, the lack of a designated path to legal status for them under US law, and the indifference of government agencies contribute to the vulnerability and isolation of these populations.

scholarly journals LB13. Candida auris in NYC: A Health System’s Experience Treating the Emerging Drug-Resistant Yeast

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S764-S764
Author(s):  
Dana Mazo ◽  
Lindsey Gottlieb ◽  
Sarah Schaefer ◽  
Kinta Alexander ◽  
Jordan Ehni ◽  
...  
Keyword(s):  
United States ◽  
New York ◽  
Mortality Rate ◽  
Health System ◽  
New York State ◽  
The United States ◽  
Antifungal Treatment ◽  
Clinical Microbiology Laboratory ◽  
Candida Auris ◽  
Mount Sinai

Abstract Background Candida auris is emerging multidrug-resistant yeast that can cause serious infections with published mortality rates as high as 60%. It was first recognized in 2009 and has been reported in over a dozen countries. The current United States outbreak was identified in 2016 with New York City (NYC) as the epicenter. The aim of this evaluation was to describe the clinical infections and outcomes with C. auris in a large health system in NYC. Methods Cases were identified from clinical specimens collected December 2015–June 2018 from the Mount Sinai Hospital Clinical Microbiology Laboratory, the central laboratory for the Mount Sinai Health System, which encompasses seven hospitals across NYC. All C. auris isolates were confirmed by the New York State Department of Health Wadsworth Center. Medical charts were reviewed. A case was included if C. auris grew from a sterile body site, an antifungal treatment was initiated or the patient expired before the yeast was identified on Gram stain. Results Twenty-nine possible cases were identified with 23 meeting the case definition. These cases included 19 bloodstream infections (BSI), two intra-abdominal abscesses, one skin soft tissue infection, and one otitis externa. Using the MIC breakpoints recommended by the Centers for Disease Control and Prevention, 100% of isolates tested were susceptible to caspofungin, 29% were susceptible to amphotericin B, and 17% were susceptible to fluconazole. Nineteen patients received antifungal treatment, 13 with caspofungin monotherapy and four with sequential therapy of caspofungin followed by an azole (three with fluconazole, one with posaconazole). Fifteen (65%) patients expired within 90 days of the positive culture. Fourteen of the deaths were in candidemic patients, despite that eight (57%) of these patients had documented microbiologic clearance after appropriate therapy. The 90-day mortality rate was 74% for BSI. Conclusions This case series is the largest reported in the United States. Candidemia was the most common site of infection and had a very high 90-day mortality rate, despite sterilization of the blood. These findings highlight the significant morbidity and mortality associated with C. auris and the need to focus efforts on rapid diagnostics and infection prevention. Disclosures All authors: No reported disclosures.

scholarly journals Comparative analysis of state public health measures and number of COVID-19 cases in California, Texas, and New York (April to July 2020)

2020 ◽  
Author(s):  
Yasmin Khajenoori ◽  
Lina Kamil ◽  
Joyita Bhattacharjee ◽  
Ellie Feng ◽  
Sanvi Pal
Keyword(s):  
Public Health ◽  
United States ◽  
New York ◽  
State Policy ◽  
Health Department ◽  
The United States ◽  
Contact Tracing ◽  
The Public ◽  
Health Measures ◽  
Global Pandemic

In response to the spread of COVID-19 in the United States, every state has utilized varying degrees of public health policies yielding different trends in the number of cases. Due to the lack of a unified approach taken in response to the global pandemic in the United States, we can look at the general trends in case numbers from different states in the context of the public health measures that have been implemented. Through the use of multiple databases, we collected data from each states health department websites and policy data came from the COVID-19 US State Policy Database on the CDR, as well as the KFF state policy database in order to graph the number of daily new cases in three different states while marking the dates when the certain policies were implemented. The scope of this particular review focuses on California, New York, and Texas, each of which have taken different approaches and are reflective of three different areas of the continental United States. The four policies that are analyzed include shelter in place orders, mask mandates, the closure and reopening of non-essential businesses, and the closure and reopening of restaurants for in person dining. To further understand the reopening strategies of these three states, we have utilized the “National Coronavirus Response: A Roadmap to Reopening” guide to compare the points at which each state decided to open considering testing capacity, contact tracing, and case numbers/trend in cases at that point in time. Based on this data, we comparatively analyzed trends in cases and policy measures, taking into account other factors like tracing and testing capacity to evaluate the appropriateness of each state’s measures in its overall goal of reopening. Overall, we have found New York which began as the hotspot for COVID-19 cases, to ultimately be the most successful state in regard to reducing the number of daily new cases and surpassing goals for contact tracing and testing. Conversely California, which began as a success story, has seen a sharp rise in cases after moving into phases of reopening. Similarly, Texas has also seen a rise in cases over recent months with the relaxation of public health measures before meeting the markers for reopening. Both California and Texas have been far behind on testing and contact tracing capabilities. Not only abiding by public health policy recommendations but also being consistent with these measures throughout the course of the pandemic are correlated with lower numbers of cases when comparing New York with California and Texas. This finding implies that for future pandemics, and moving forward with the current pandemic, extreme caution should be taken in timing public health measures and tracking cases.

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