scholarly journals Stethoscope hygiene: A call to action. Recommendations to update the CDC guidelines

2021 ◽  
pp. 1-3
Author(s):  
Sarathi Kalra ◽  
Alpesh Amin ◽  
Nancy Albert ◽  
Cindy Cadwell ◽  
Cole Edmonson ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Acoustic Properties ◽  
Patient Encounter ◽  
Call To Action ◽  
The Us ◽  
Cdc Guidelines ◽  
Control And Prevention ◽  
Healthcare Acquired Infections ◽  
Current Guidance ◽  
Tremendous Challenge

Abstract Healthcare-acquired infections are a tremendous challenge to the US medical system. Stethoscopes touch many patients, but current guidance from the Centers for Disease Control and Prevention does not support disinfection between each patient. Stethoscopes are rarely disinfected between patients by healthcare providers. When cultured, even after disinfection, stethoscopes have high rates of pathogen contamination, identical to that of unwashed hands. The consequence of these practices may bode poorly in the coronavirus 2019 disease (COVID-19) pandemic. Alternatively, the CDC recommends the use of disposable stethoscopes. However, these instruments have poor acoustic properties, and misdiagnoses have been documented. They may also serve as pathogen vectors among staff sharing them. Disposable aseptic stethoscope diaphragm barriers can provide increased safety without sacrificing stethoscope function. We recommend that the CDC consider the research regarding stethoscope hygiene and effective solutions to contemporize this guidance and elevate stethoscope hygiene to that of the hands, by requiring stethoscope disinfection or change of disposable barrier between every patient encounter.

scholarly journals Perceived Barriers to COVID-19 Testing

2021 ◽  
Vol 18 (5) ◽  
pp. 2278
Author(s):  
Pearl A. McElfish ◽  
Rachel Purvis ◽  
Laura P. James ◽  
Don E. Willis ◽  
Jennifer A. Andersen
Keyword(s):  
Analytical Approach ◽  
Nasal Swab ◽  
Healthcare Providers ◽  
Research Participant ◽  
Perceived Barriers ◽  
Lower Income ◽  
The Us ◽  
Qualitative Descriptive ◽  
Descriptive Method ◽  
Background Prior

(1) Background: Prior studies have documented that access to testing has not been equitable across all communities in the US, with less testing availability and lower testing rates documented in rural counties and lower income communities. However, there is limited understanding of the perceived barriers to coronavirus disease 2019 (COVID-19) testing. The purpose of this study was to document the perceived barriers to COVID-19 testing. (2) Methods: Arkansas residents were recruited using a volunteer research participant registry. Participants were asked an open-ended question regarding their perceived barriers to testing. A qualitative descriptive analytical approach was used. (3) Results: Overall, 1221 people responded to the open-ended question. The primary barriers to testing described by participants were confusion and uncertainty regarding testing guidelines and where to go for testing, lack of accessible testing locations, perceptions that the nasal swab method was too painful, and long wait times for testing results. (4) Conclusions: This study documents participant reported barriers to COVID-19 testing. Through the use of a qualitative descriptive method, participants were able to discuss their concerns in their own words. This work provides important insights that can help public health leaders and healthcare providers with understanding and mitigating barriers to COVID-19 testing.

scholarly journals Covid-19 Preparedness and Response Capability: A Case Study of the Hanoi Primary Healthcare System

2021 ◽  
Vol 14 ◽  
pp. 117863292110192
Author(s):  
Minh Van Hoang ◽  
Anh Tuan Tran ◽  
Trang Thu Vu ◽  
Tuan Kim Duong
Keyword(s):  
Public Information ◽  
Enabling Factors ◽  
Cross Sectional ◽  
Emergency Operations ◽  
The Us ◽  
Local Stakeholders ◽  
Control And Prevention ◽  
Issue Public ◽  
Analytical Frameworks

This study examined the coronavirus disease 2019 (COVID-19) preparedness and response of the health system (HS) in Hanoi, Vietnam, and identified enabling factors and barriers. This cross-sectional, mixed-methods study was conducted in 4 urban and peri-urban districts that included some wards with COVID-19-positive cases and some without. The US Centers for Disease Control and Prevention (CDC) analytical frameworks were used. Overall, 10% of health facilities (HFs) failed to fully implement COVID-19 risk determination; 8.8% failed to fully implement stronger community partnerships with local stakeholders to support public health (PH) preparedness; 35% and 2.5% incompletely implemented and did not implement evaluation of PH emergency operations, respectively; 10% did not identify communication channels to issue public information, alerts, warnings, and notifications; 25% incompletely implemented identification, development of guidance, and standards for information; 72.5% had good preventive and treatment collaboration; and 10% did not fully implement procedures for laboratory testing and reporting results. Enablers included sufficient infrastructure and equipment, strong leadership, and good cross-public-sector collaboration with police and military forces. Barriers included workforce constraints, overburdened and inconsistent reporting systems, inappropriate financial mechanisms, ambiguous health governance, and lack of private-sector engagement. Nonetheless, the HS preparedness and response were satisfactory, although further coordinated efforts in evaluation, coordination, communication, and volunteering remain necessary.

Abstract 220: Early Assessment of Real-world Utilization and Dosing of Sacubitril/Valsartan in the US

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Chun-Lan Chang ◽  
Xue Song ◽  
Tina Willson ◽  
Carol Duffy
Keyword(s):  
Real World ◽  
Maintenance Dose ◽  
Healthcare Providers ◽  
Dose Titration ◽  
Dose Increase ◽  
Early Assessment ◽  
Reduced Ejection Fraction ◽  
Starting Dose ◽  
The Us ◽  
Medicare Patients

Background: Based on the PARADIGM-HF trial, sacubitril/valsartan was approved for the treatment of patients with heart failure and reduced ejection fraction. This study provides an early view of its real-world utilization and dosing in the US before recent guideline updates. Methods: Adult patients with >=1 sacubitril/valsartan claim in 7/7/2015 - 3/31/2016 were selected from a large national claims dataset; their 1st sacubitril/valsartan claim was the index date. Data was required for >=24 months pre-index and >=3 months post-index. Dose at index and the maximum dose achieved post-index were obtained. Dose up-titration, defined as 1st appearance of a sacubitril/valsartan claim with a dose increase from the index strength, and the time to 1st dose increase were reported. Results: Among 981 qualified patients with a mean follow-up of 185 (SD ±81) days, 25% commenced sacubitril/valsartan on the suggested prescribing information (PI) starting dose of 49/51 mg b.i.d.; 58% started on 24/26 mg b.i.d.; 4% started on an even lower dose, and 13% indexed at the target maintenance dose of 97/103 b.i.d.. The target maintenance dose of 97/103 mg b.i.d. was achieved in 30% of patients. For those 856 patients indexing on <=49/51/ mg b.i.d., 58% had no dose up-titration post-index; 31% took >4 weeks to have up-titration initiated and 11% initiated up-titration within 4 weeks. Only 25% of Medicare patients compared to 35% of Commercial patients achieved the target dose of 97/103mg b.i.d.. (Table 1) Conclusion: Most patients commenced sacubitril/valsartan at lower doses than recommended in the PI and were poorly optimized, with the majority of patients having no upward dose titration. Approximately 13% actually indexed at the target maintenance dose. The reasons for these findings need further exploration. Healthcare providers should consider following the appropriate starting doses, with timely dose adjustment of sacubitril/valsartan as recommended in the PI to ensure patients receive the full clinical benefit of this medication as demonstrated in the PARADIGM-HF trial.

A HIPAA Security and Privacy Compliance Audit and Risk Assessment Mitigation Approach

2021 ◽  
Vol 3 (2) ◽  
pp. 28-45
Author(s):  
Young B. Choi ◽  
Christopher E. Williams
Keyword(s):  
Healthcare System ◽  
Information Assurance ◽  
Healthcare Providers ◽  
Security And Privacy ◽  
Privacy Requirements ◽  
Security Controls ◽  
The Us ◽  
Compliance Audit ◽  
And Control ◽  
Health Laws

Data breaches have a profound effect on businesses associated with industries like the US healthcare system. This task extends more pressure on healthcare providers as they continue to gain unprecedented access to patient data, as the US healthcare system integrates further into the digital realm. Pressure has also led to the creation of the Health Insurance Portability and Accountability Act, Omnibus Rule, and Health Information Technology for Economic and Clinical Health laws. The Defense Information Systems Agency also develops and maintains security technical implementation guides that are consistent with DoD cybersecurity policies, standards, architectures, security controls, and validation procedures. The objective is to design a network (physician's office) in order to meet the complexity standards and unpredictable measures posed by attackers. Additionally, the network must adhere to HIPAA security and privacy requirements required by law. Successful implantation of network design will articulate comprehension requirements of information assurance security and control.

Mycobacterium chimaera infections among cardiothoracic surgery patients associated with heater-cooler devices—Kansas and California, 2019

2021 ◽  
pp. 1-6
Author(s):  
Kerui Xu ◽  
Lauren E. Finn ◽  
Robert L. Geist ◽  
Christopher Prestel ◽  
Heather Moulton-Meissner ◽  
...  
Keyword(s):  
Operating Room ◽  
Environmental Samples ◽  
Chart Review ◽  
Whole Genome ◽  
Environmental Isolates ◽  
Outbreak Strain ◽  
Medical Chart Review ◽  
The Us ◽  
Control And Prevention ◽  
Cleaning And Disinfection

Abstract Background: In 2015, an international outbreak of Mycobacterium chimaera infections among patients undergoing cardiothoracic surgeries was associated with exposure to contaminated LivaNova 3T heater-cooler devices (HCDs). From June 2017 to October 2020, the Centers for Disease Control and Prevention was notified of 18 patients with M. chimaera infections who had undergone cardiothoracic surgeries at 2 hospitals in Kansas (14 patients) and California (4 patients); 17 had exposure to 3T HCDs. Whole-genome sequencing of the clinical and environmental isolates matched the global outbreak strain identified in 2015. Methods: Investigations were conducted at each hospital to determine the cause of ongoing infections. Investigative methods included query of microbiologic records to identify additional cases, medical chart review, observations of operating room setup, HCD use and maintenance practices, and collection of HCD and environmental samples. Results: Onsite observations identified deviations in the positioning and maintenance of the 3T HCDs from the US Food and Drug Administration (FDA) recommendations and the manufacturer’s updated cleaning and disinfection protocols. Additionally, most 3T HCDs had not undergone the recommended vacuum and sealing upgrades by the manufacturer to decrease the dispersal of M. chimaera–containing aerosols into the operating room, despite hospital requests to the manufacturer. Conclusions: These findings highlight the need for continued awareness of the risk of M. chimaera infections associated with 3T HCDs, even if the devices are newly manufactured. Hospitals should maintain vigilance in adhering to FDA recommendations and the manufacturer’s protocols and in identifying patients with potential M. chimaera infections with exposure to these devices.

Should Blood Lead Screening Recommendations Be Revised?

PEDIATRICS ◽  
1994 ◽  
Vol 93 (2) ◽  
pp. 201-204
Author(s):  
Birt Harvey
Keyword(s):  
Universal Screening ◽  
Human Services ◽  
Blood Lead ◽  
Consensus Conference ◽  
National Institutes Of Health ◽  
Department Of Health ◽  
Area Of Interest ◽  
The Us ◽  
Control And Prevention ◽  
Blood Lead Screening

In October 1991, the Centers for Disease Control and Prevention (CDC) recommended blood lead (BPb) screening for virtually all 1-year-old children and, preferably, for all 2-year-old children as well.1 In April 1993, the US Department of Health and Human Services distributed guidelines recommending that all newborns, regardless of race or ethnicity, be screened for sickle cell anemia.2 In June 1993, the National Institutes of Health issued a consensus conference recommendation that all infants be tested for hearing impairment within the first 3 months of life, preferably before newborns leave the hospital.3 In each instance, these screening recommendations were developed because a group of experts, after identifying a child health problem within its area of interest, believed that universal screening was indicated.

Adherence to Recommended Post-Splenectomy Immunizations to Reduce the Risk of Sepsis: The University of Washington Experience

2020 ◽  
Vol 35 (5) ◽  
pp. 405-410
Author(s):  
Nikita Pozdeyev ◽  
Arpit Patel ◽  
Paul S. Pottinger ◽  
Michael Leu ◽  
Thomas H. Payne
Keyword(s):  
Streptococcus Pneumoniae ◽  
Haemophilus Influenzae Type ◽  
Haemophilus Influenzae Type B ◽  
Type B ◽  
National Immunization ◽  
The Us ◽  
Control And Prevention ◽  
Life Threatening ◽  
Reduce Risk ◽  
The University

Immunizations against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b are recommended for patients undergoing splenectomy to decrease the risk of developing overwhelming infections. The authors sought to determine adherence to these recommendations by providers at UW Medicine. Regional immunization records for patients who underwent splenectomy between October 2015 and January 2019 were analyzed to measure compliance with immunization guidelines from the US Centers for Disease Control and Prevention (CDC). Among 253 patients who underwent splenectomy, 38 (15%) received all 7 immunizations against S pneumoniae, N meningitidis, and H influenzae type b recommended by the CDC; 95% of patients received at least 1 pneumococcal vaccine; 26% percent of patients did not receive MenB-4C vaccine. Many patients (3% to 10%) received redundant immunizations not in accordance with CDC recommendations. Development of state and national immunization registries and systems to improve adherence with post-splenectomy immunization guidelines may reduce risk for life-threatening infections.

scholarly journals Stroke Rehabilitation - An Overview of Existing Guidelines and Standards of Care

2011 ◽  
Vol 6 (3) ◽  
pp. 170 ◽  
Author(s):  
Richard D Zorowitz ◽  
Keyword(s):  
Stroke Rehabilitation ◽  
Healthcare Providers ◽  
Standards Of Care ◽  
Interdisciplinary Management ◽  
Stroke Survivors ◽  
Level Of Evidence ◽  
The Us ◽  
Guidelines And Standards ◽  
Complications Of Stroke ◽  
The Uk

Over seven million stroke survivors live in the US today. Despite the publication of the first post-stroke rehabilitation clinical practice guideline in 1995, many healthcare providers are unaware not only of stroke survivors’ potential for functional recovery, but also common secondary complications of stroke. This article summarises the best available evidence-based recommendations for the interdisciplinary management of stroke survivors and caregivers from five sources: two in the US, one in Canada, and two in the UK. Unique characteristics of each guideline are described, followed by a list of common clinical recommendations found in most, if not all, of the guidelines. Despite the advances in stroke rehabilitation over the past 16 years, much research still needs to be done to improve the level of evidence in stroke rehabilitation.

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