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.

scholarly journals Evolving oxygenation management reasoning in COVID-19

Diagnosis ◽  
2020 ◽  
Vol 7 (4) ◽  
pp. 381-383
Author(s):  
Steven Liu ◽  
Cara Sweeney ◽  
Nalinee Srisarajivakul-Klein ◽  
Amanda Klinger ◽  
Irina Dimitrova ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
New York ◽  
New York City ◽  
Intensive Care ◽  
Initial Phase ◽  
The United States ◽  
Lessons Learned ◽  
Hypoxemic Respiratory Failure ◽  
Hospital Wards

AbstractThe initial phase of the SARS-CoV-2 pandemic in the United States saw rapidly-rising patient volumes along with shortages in personnel, equipment, and intensive care unit (ICU) beds across many New York City hospitals. As our hospital wards quickly filled with unstable, hypoxemic patients, our hospitalist group was forced to fundamentally rethink the way we triaged and managed cases of hypoxemic respiratory failure. Here, we describe the oxygenation protocol we developed and implemented in response to changing norms for acuity on inpatient wards. By reflecting on lessons learned, we re-evaluate the applicability of these oxygenation strategies in the evolving pandemic. We hope to impart to other providers the insights we gained with the challenges of management reasoning in COVID-19.

Intrauterine Infections (Ciba Foundation Symposium 10, new series). Amsterdam/London/New York: Associated Scientific Publishers, 1973, 219 pp., $10.50

PEDIATRICS ◽  
1974 ◽  
Vol 53 (1) ◽  
pp. 132-134
Author(s):  
Alex J. Steigman
Keyword(s):  
United States ◽  
New York ◽  
Great Britain ◽  
The United States ◽  
Lessons Learned ◽  
Economic Losses ◽  
Ciba Foundation Symposium ◽  
European Continent ◽  
Intrauterine Infections ◽  
Scientific Publishers

This interesting volume is the result of a proper symposium rather than a collection of submitted reports. The authoritative findings are sprinkled generously with a free flowing discussion which brings sharply into focus what remains to be learned and how to go about it. The 22 well-qualified participants include 17 from Great Britain, 4 from the European continent, and 1 from the United States. Wisely included are the observations of a veterinarian-scientist; lessons learned from studies made primarily to prevent economic losses in animals may become useful to clinicians.

Improving the Fate of Nursing Homes During the COVID-19 Pandemic: The Need for Policy

2021 ◽  
pp. e1-e3
Author(s):  
R. Tamara Konetzka
Keyword(s):  
Public Health ◽  
United States ◽  
New York ◽  
Nursing Homes ◽  
Long Term Care ◽  
New York Times ◽  
The United States ◽  
Term Care ◽  
Care Facilities

Approximately 40% of all COVID-19 deaths in the United States have been linked to long-term care facilities.1 Early in the pandemic, as the scope of the problem became apparent, the nursing home sector generated significant media attention and public alarm. A New York Times article in mid-April referred to nursing homes as “death pits”2 because of the seemingly uncontrollable spread of the virus through these facilities. This devastation continued during subsequent surges,3 but there is a role for policy to change this trajectory. (Am J Public Health. Published online ahead of print January 28, 2021: e1–e3. https://doi.org/10.2105/AJPH.2020.306107 )

Maintrainenance: Keeping Heavy Rail Maintenance on Track

2019 ◽  
Vol 2673 (7) ◽  
pp. 192-203
Author(s):  
Sreekar Shashank Boddupalli ◽  
Andrea Sherman ◽  
Joe Zerkus ◽  
Alice Grossman
Keyword(s):  
United States ◽  
New York ◽  
Asset Management ◽  
Best Practice ◽  
The United States ◽  
Lessons Learned ◽  
Rapid Transit ◽  
Bay Area ◽  
Transit Agencies ◽  
Heavy Rail

Infrastructure management is an important aspect of transportation engineering. Contrasting views have emerged on feasible best practice in asset management for various transportation modes. The differences in current practice can provide insight into best practices and lessons learned. This paper focuses on heavy rail maintenance state of practice in the United States and compares the maintenance practices, strategies, and procedures implemented by four transit agencies across the country. The objective of the paper is to provide guidance and examples for other transit agencies in the United States to meet the short-term challenges they face and provide recommendations to improve services nationwide. This paper examines rail maintenance practices at the Metropolitan Atlanta Rapid Transit Authority (MARTA), Bay Area Rapid Transit (BART), Washington Metropolitan Area Transit Authority (WMATA), and the New York Metropolitan Transit Authority (MTA). The paper found that out of the four agencies studied, MARTA has the highest maintenance to operations budget ratio, and most of the maintenance expenditure is on labor. WMATA found that automation of inspection improved maintenance efficiency, and BART is working toward adopting more automated processes. New York City’s MTA shows an example of the importance of clear governance in effective budgeting.

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

scholarly journals Regional Emergence of Candida auris in Chicago and Lessons Learned From Intensive Follow-up at 1 Ventilator-Capable Skilled Nursing Facility

2020 ◽  
Vol 71 (11) ◽  
pp. e718-e725 ◽  
Author(s):  
Massimo Pacilli ◽  
Janna L Kerins ◽  
Whitney J Clegg ◽  
Kelly A Walblay ◽  
Hira Adil ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Lessons Learned ◽  
Candida Auris ◽  
Public Health Response ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Healthcare Facilities ◽  
High Acuity

Abstract Background Since the identification of the first 2 Candida auris cases in Chicago, Illinois, in 2016, ongoing spread has been documented in the Chicago area. We describe C. auris emergence in high-acuity, long-term healthcare facilities and present a case study of public health response to C. auris and carbapenemase-producing organisms (CPOs) at one ventilator-capable skilled nursing facility (vSNF-A). Methods We performed point prevalence surveys (PPSs) to identify patients colonized with C. auris and infection-control (IC) assessments and provided ongoing support for IC improvements in Illinois acute- and long-term care facilities during August 2016–December 2018. During 2018, we initiated a focused effort at vSNF-A and conducted 7 C. auris PPSs; during 4 PPSs, we also performed CPO screening and environmental sampling. Results During August 2016–December 2018 in Illinois, 490 individuals were found to be colonized or infected with C. auris. PPSs identified the highest prevalence of C. auris colonization in vSNF settings (prevalence, 23–71%). IC assessments in multiple vSNFs identified common challenges in core IC practices. Repeat PPSs at vSNF-A in 2018 identified increasing C. auris prevalence from 43% to 71%. Most residents screened during multiple PPSs remained persistently colonized with C. auris. Among 191 environmental samples collected, 39% were positive for C. auris, including samples from bedrails, windowsills, and shared patient-care items. Conclusions High burden in vSNFs along with persistent colonization of residents and environmental contamination point to the need for prioritizing IC interventions to control the spread of C. auris and CPOs.

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.

A Will and a Way, What the United States Can Learn from Canada about Caring for the Elderly. R.L. Kane and R.A. Kane, New York: Columbia University Press, 1985 ($35.00).

1987 ◽  
Vol 6 (2) ◽  
pp. 177-180 ◽  
Author(s):  
Neena L. Chappell
Keyword(s):  
United States ◽  
New York ◽  
Management Practices ◽  
The Elderly ◽  
The United States ◽  
Columbia University ◽  
Term Care ◽  
Care Systems ◽  
Good Resource

SUMMARYIn A Will and a Way, Kane and Kane have once again demonstrated their ability to accumulate masses of data. This book offers a wealth of descriptive information on three long term care systems in Canada, as well as some of the features of these systems which may be appropriate for the United States (such as universal programs based on need, case management practices, panelling practices, and size of jurisdiction). Those interested in specific practical questions and/or figures on utilization will find this book a good resource. However, those interested in a broader discussion from a theoretically informed perspective or a good discussion of existing research in this area will be disappointed.

Tuberculosis in Long-Term–Care Facilities

2000 ◽  
Vol 21 (9) ◽  
pp. 611-616 ◽  
Author(s):  
Philip W. Smith ◽  
Shobita Rajagopalan ◽  
Thomas T. Yoshikawa
Keyword(s):  
United States ◽  
Long Term Care ◽  
Clinical Manifestations ◽  
The Elderly ◽  
The United States ◽  
Community Dwelling ◽  
Infection Prevention And Control ◽  
Age Group ◽  
Term Care

AbstractThe geriatric population represents the largest reservoir ofMycobacterium tuberculosisinfection in developed nations, including the United States. Tuberculosis (TB) case rates in the United States are highest for this age group compared with other age categories. The subtle clinical manifestations of TB in the elderly often can pose potential diagnostic dilemmas and therapeutic challenges, resulting in increased morbidity and mortality in this age group; this treatable infection unfortunately often is detected only at autopsy. Compared with their community-dwelling counterparts, the institutionalized elderly are at a greater risk both for reactivation of latent TB and for the acquisition of new TB infection. Prevention and control of TB in facilities providing long-term care to the elderly thus cannot be overemphasized.

LATs in the United States

2020 ◽  
pp. 37-51
Author(s):  
Cynthia Grant Bowman
Keyword(s):  
United States ◽  
New York ◽  
Qualitative Interviews ◽  
New York State ◽  
The United States ◽  
York State ◽  
Survey Statistics

This chapter presents the findings of my 2016 surveys of LATs in New York State and nationally and my qualitative interviews with LATs in the United States and England, which support many of the findings of the literature from other countries and diverge from them in certain respects. The survey statistics show that living apart is as common here as in Europe, with couples displaying similar arrangements and interactions. Data about economic interrelationship of the partners and mutual caregiving differ somewhat from those reported in previous studies.

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