Promoting COVID-19 vaccination among healthcare personnel: a multifaceted intervention at a tertiary care center in Japan

Abstract Objective The COVID-19 vaccine may hold the key to ending the pandemic, but vaccine hesitancy is hindering the vaccination of healthcare personnel (HCP). Design Before-after trial Participants and setting Healthcare personnel at a 790-bed tertiary care center in Tokyo, Japan. Interventions A pre-vaccination questionnaire was administered to HCP to examine their perceptions of the COVID-19 vaccine. Then, a multifaceted intervention involving (1) distribution of informational leaflets to all HCP, (2) hospital-wide announcements encouraging vaccination, (3) a mandatory lecture, (4) an educational session about the vaccine for pregnant or breastfeeding HCP, and (5) allergy testing for HCP at risk of allergic reactions to the vaccine was implemented. A post-vaccination survey was also performed. Results Of 1,575 HCP eligible for enrollment, 1,224 (77.7%) responded to the questionnaire, 43.5% (n =533) expressed willingness to be vaccinated, 48.4% (n = 593) were uncertain, and 8.0% (n=98) expressed unwillingness to be vaccinated. The latter two groups were concerned about the vaccine’s safety rather than its efficacy. Post-intervention, the overall vaccination rate reached 89.7% (1,413/1,575), with 88.9% (614/691) of the pre-vaccination survey respondents who answered “unwilling” or “unsure” eventually receiving a vaccination. In the post-vaccination questionnaire, factors contributing to increased COVID-19 vaccination included information and endorsement of vaccination at the medical center (26.4%; 274/1,037). Conclusions The present, multifaceted intervention increased COVID-19 vaccinations among HCP at a Japanese hospital. Frequent support and provision of information were crucial for increasing the vaccination rate and may be applicable to the general population as well.

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A Successful Strategy for Increasing the Influenza Vaccination Rate of Healthcare Workers without a Mandatory Policy Outside of the United States: A Multifaceted Intervention in a Japanese Tertiary Care Center

Infection Control and Hospital Epidemiology ◽

10.1086/673452 ◽

2013 ◽

Vol 34 (11) ◽

pp. 1194-1200 ◽

Cited By ~ 15

Author(s):

Hitoshi Honda ◽

Yumiko Sato ◽

Akinori Yamazaki ◽

Simi Padival ◽

Akira Kumagai ◽

...

Keyword(s):

Influenza Vaccination ◽

Healthcare Workers ◽

Care Center ◽

Tertiary Care ◽

Vaccination Rate ◽

Multifaceted Intervention ◽

Tertiary Care Center ◽

Vaccination Programs ◽

Mandatory Vaccination ◽

Vaccination Period

Objective.Although mandatory vaccination programs have been effective in improving the vaccination rate among healthcare workers, implementing this type of program can be challenging because of varied reasons for vaccine refusal. The purpose of our study is to measure improvement in the influenza vaccination rate from a multifaceted intervention at a Japanese tertiary care center where implementing a mandatory vaccination program is difficult.Design.Before-and-after trial.Participants and Setting.Healthcare workers at a 550-bed, tertiary care, academic medical center in Sapporo, Japan.Interventions.We performed a multifaceted intervention including (1) use of a declination form, (2) free vaccination, (3) hospital-wide announcements during the vaccination period, (4) prospective audit and real-time telephone interview for healthcare workers who did not receive the vaccine, (5) medical interview with the hospital executive for noncompliant (no vaccine, no declination form) healthcare workers during the vaccination period, and (6) mandatory submission of a vaccination document if vaccinated outside of the study institution.Results.With the new multifaceted intervention, the vaccination rate in the 2012-2013 season increased substantially, up to 97%. This rate is similar to that reported in studies with a mandatory vaccination program. Improved vaccination acceptance, particularly among physicians, likely contributed to the overall increase in the vaccination rate reported in the study.Conclusions.Implementation of comprehensive strategies with strong leadership can lead to substantial improvements in vaccine uptake among healthcare workers even without a mandatory vaccination policy. The concept is especially important for institutions where implementing mandatory vaccination programs is challenging.

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Case-control study evaluating risk factors for SARS-CoV-2 outbreak amongst healthcare personnel at a tertiary care center

American Journal of Infection Control ◽

10.1016/j.ajic.2021.09.004 ◽

2021 ◽

Author(s):

Joelle I. Rosser ◽

Ralph Tayyar ◽

Richard Giardina ◽

Peter Kolonoski ◽

Diane Kenski ◽

...

Keyword(s):

Risk Factors ◽

Case Control Study ◽

Care Center ◽

Tertiary Care ◽

Case Control ◽

Healthcare Personnel ◽

Tertiary Care Center ◽

Control Study

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Epidemiology and Control of Pertussis Outbreaks in a Tertiary Care Center and the Resource Consumption Associated With These Outbreaks

Infection Control and Hospital Epidemiology ◽

10.1086/596774 ◽

2009 ◽

Vol 30 (5) ◽

pp. 467-473 ◽

Cited By ~ 20

Author(s):

Surbhi Leekha ◽

Rodney L. Thompson ◽

Priya Sampathkumar

Keyword(s):

Care Center ◽

Tertiary Care ◽

Public Health Problem ◽

Clinical Syndrome ◽

Resource Consumption ◽

Healthcare Personnel ◽

Infection Prevention And Control ◽

Tertiary Care Center ◽

Healthcare Facilities ◽

And Control

Objective.To describe the epidemiology and control of 2 separate outbreaks of pertussis at a large tertiary care center and the resource consumption associated with these outbreaks.Design.Descriptive study.Setting.The Mayo Clinic in Rochester, Minnesota, a tertiary care center catering to both referral patients and patients from the community.Methods.We reviewed routine and enhanced surveillance data collected by infection prevention and control practitioners during the outbreaks. Pertussis was diagnosed either on the basis of a nasopharyngeal specimen positive for Bordetella pertussis by use of polymerase chain reaction (PCR) or on the basis of a compatible clinical syndrome along with an epidemiologic link to PCR-confirmed cases.Results.Two pertussis outbreaks, the first community based and the second hospital based (ie, due to transmission among healthcare personnel), occurred during the period from October 2004 through October 2005. In the first outbreak from November 2004 through March 2005, there were 109 cases diagnosed; 105 (96%) of these cases were diagnosed on the basis of a nasopharyngeal specimen positive for B. pertussis by use of PCR. Adolescents 10-19 years of age were most affected (77 cases [71%]). Only 13 cases (12%) occurred among healthcare personnel; however, many healthcare personnel required postexposure prophylaxis. A second outbreak of 122 cases occurred during the period from July through October 2005; of these 122 cases, 96 (79%) were diagnosed on the basis of a nasopharyngeal specimen positive for B. pertussis by use of PCR, and 64 (52%) involved healthcare personnel. There were many instances of transmission among healthcare personnel and from patients to healthcare personnel, but no documented transmission from healthcare personnel to Patients. The outbreaks were controlled by aggressive case finding, treatment of those infected, prophylaxis of all healthcare personnel and patients who had contact with both probable and confirmed cases, implementation of educational efforts, and compliance with respiratory etiquette. Vaccination of healthcare personnel against pertussis began in October 2005.Conclusion.Pertussis remains a public health problem. Outbreaks in healthcare facilities consume the resources of those facilities in terms of personnel, testing, treatment of cases, and prophylaxis of those individuals who were in contact with those cases. Adult vaccination may reduce the disease burden.

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The Importance of Ground Critical Care Transport

Journal of Intensive Care Medicine ◽

10.1177/0885066616668484 ◽

2016 ◽

Vol 32 (2) ◽

pp. 163-169 ◽

Cited By ~ 6

Author(s):

Susan R. Wilcox ◽

Michael Ries ◽

Ted A. Bouthiller ◽

E. Dean Berry ◽

Travis L. Dowdy ◽

...

Keyword(s):

Critical Care ◽

Life Support ◽

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Respiratory Acidosis ◽

Advanced Life Support ◽

Integrated Approach ◽

Tertiary Care Center ◽

Transport Services

Critical care transport (CCT) teams are specialized transport services, comprised of highly trained paramedics, nurses, and occasionally respiratory therapists, offering an expanded scope of practice beyond advanced life support (ALS) emergency medical service teams. We report 4 cases of patients with severe acute respiratory distress syndrome from influenza in need of extracorporeal membrane oxygenation evaluation at a tertiary care center, transported by ground. Our medical center did not previously have a ground CCT service, and therefore, in these cases, a physician and/or a respiratory therapist was sent with the paramedic team. In all 4 cases, the ground transport team enhanced the intensive care provided to these patients prior to arrival at the tertiary care center. In 2 of the cases, although limited by the profound hypoxemia, the team decreased the pressures and tidal volumes in an effort to approach evidence-based ventilator goals. In 3 cases, they stopped bicarbonate drips being used to treat mixed metabolic and respiratory acidosis, and in 1 case, they administered furosemide. In 1 case, they started cisatracurium, and in 3 others, they initiated inhaled epoprostenol. Existing literature supports the use of CCT teams over ALS teams for transport of the most critically ill patients, and helicopter CCT is not always available or practical. Therefore, offering comparable air and ground options, with similar staffing and resources, is a hallmark of a mature medical system with an integrated approach to CCT.

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First Candida auris Outbreak during a COVID-19 Pandemic in a Tertiary-Care Center in Lebanon

Pathogens ◽

10.3390/pathogens10020157 ◽

2021 ◽

Vol 10 (2) ◽

pp. 157

Author(s):

Fatima Allaw ◽

Nada Kara Zahreddine ◽

Ahmad Ibrahim ◽

Joseph Tannous ◽

Hussein Taleb ◽

...

Keyword(s):

Infection Control ◽

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Arab Countries ◽

Infection Prevention And Control ◽

Tertiary Care Center ◽

Candida Auris ◽

American University ◽

American University Of Beirut

Candida auris is an emerging fungal pathogen considered as a global health threat. Recently there has been growing concern regarding drug resistance, difficulty in identification, as well as problems with eradication. Although outbreaks have been reported throughout the globe including from several Arab countries, there were no previous reports from Lebanon. We herein report the first cases of C. auris infection from the American University of Beirut Medical Center, a tertiary care center in Lebanon describing the clinical features of the affected patients in addition to the infection control investigation and applied interventions to control the outbreak. Fourteen patients with C. auris infection/colonization identified using MALDI-TOF and VITEK 2- Compact system were reported over a period of 13 weeks. Patients were admitted to four separate critical care units. All of them came through the emergency room and had comorbid conditions. Half of the patients were infected with COVID-19 prior to isolation of the C. auris. C. auris was isolated from blood (two isolates), urine (three isolates), respiratory tract (10 isolates) and skin (one isolate). All the patients had received broad spectrum antibiotics prior to isolation of C. auris. Six patients received antifungal treatment, while the remaining eight patients were considered colonized. Environmental cultures were taken from all four units and failed to isolate the organism from any cultured surfaces. A series of interventions were initiated by the Infection Prevention and Control team to contain the outbreak. Rapid detection and reporting of cases are essential to prevent further hospital transmission. A national standardized infection control registry needs to be established to identify widespread colonization.

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2024. A Multifaceted Intervention to Improve Oral Antimicrobial Prescription at the Emergency Department at a Japanese Tertiary Care Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1704 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S679-S679

Author(s):

Yasuaki Tagashira ◽

Hitoshi Honda

Keyword(s):

Emergency Department ◽

Care Center ◽

Tertiary Care ◽

Developed Countries ◽

Multifaceted Intervention ◽

Evidence Based ◽

Antimicrobial Use ◽

Tertiary Care Center ◽

Appropriate Prescription ◽

Antimicrobial Prescription

Abstract Background The emergency department (ED) is one of the most important settings where antimicrobials are frequently prescribed in developed countries, and at least 30% of antimicrobials prescribed at the ED are inappropriate. Some studies revealed that various factors, especially the physician-related factors were associated with inappropriate antimicrobial use. Implementing effective strategies to modify prescribing practice is needed to optimize antimicrobial therapy at the ED. Methods We implemented a multifaceted intervention to patients discharged with oral antimicrobial agents in the ED at a Japanese tertiary care center from October 2018 to March 2019. The intervention included (1) an educational didactic session to physicians, (2) an evidence-based tool book regarding antimicrobial use for common diagnoses, (3) antimicrobial order sets for common diagnoses, (4) monthly reports of the appropriateness of antimicrobial use, and (5) post-prescription review and feedback by an infectious diseases physician. The proportion of appropriate discharge antimicrobial prescription at ED, and changes in the prescription density, measured as the number of prescription per 1,000 patient visits between pre- and post-intervention were evaluated. Results The total number of patient visits at the ED during the study period was 52,274. With the intervention, the mean monthly discharge antimicrobial prescription decreased from 42.7 to 34.2 per 1,000 visits (proportional reduction 0.20; P < 0.01). Overall, appropriate prescription rate significantly increased from 47.7% (742/1,555) to 77.4% (421/544) (P < 0.01). The rate of unnecessary and inappropriate discharge antimicrobial prescription accounted from 27.5% (428/1,555) and 21.7% (337/1,555) to 8.5% (46/544) and 10.7% (58/544), respectively. A substantial improvement in discharge antimicrobial prescription against intra-abdominal infections and odontogenic infections during the intervention period was observed (changes in the proportion of appropriate prescription was 0.37 [P < 0.01] and 0.51 [P < 0.01], respectively. Conclusion An evidence-based, multifaceted intervention led to decreasing unnecessary prescription and optimizing physicians’ antimicrobial prescriptions at the ED. Disclosures All authors: No reported disclosures.

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Building and Validating a Computerized Algorithm for Surveillance of Ventilator-Associated Events

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.127 ◽

2015 ◽

Vol 36 (9) ◽

pp. 999-1003 ◽

Cited By ~ 13

Author(s):

Tal Mann ◽

Joseph Ellsworth ◽

Najia Huda ◽

Anupama Neelakanta ◽

Thomas Chevalier ◽

...

Keyword(s):

Infection Control ◽

Predictive Value ◽

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Mechanically Ventilated ◽

Automated Method ◽

Sensitivity Specificity ◽

Infection Preventionists

OBJECTIVETo develop an automated method for ventilator-associated condition (VAC) surveillance and to compare its accuracy and efficiency with manual VAC surveillanceSETTINGThe intensive care units (ICUs) of 4 hospitalsMETHODSThis study was conducted at Detroit Medical Center, a tertiary care center in metropolitan Detroit. A total of 128 ICU beds in 4 acute care hospitals were included during the study period from August to October 2013. The automated VAC algorithm was implemented and utilized for 1 month by all study hospitals. Simultaneous manual VAC surveillance was conducted by 2 infection preventionists and 1 infection control fellow who were blinded to each another’s findings and to the automated VAC algorithm results. The VACs identified by the 2 surveillance processes were compared.RESULTSDuring the study period, 110 patients from all the included hospitals were mechanically ventilated and were evaluated for VAC for a total of 992 mechanical ventilation days. The automated VAC algorithm identified 39 VACs with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%. In comparison, the combined efforts of the IPs and the infection control fellow detected 58.9% of VACs, with 59% sensitivity, 99% specificity, 91% PPV, and 92% NPV. Moreover, the automated VAC algorithm was extremely efficient, requiring only 1 minute to detect VACs over a 1-month period, compared to 60.7 minutes using manual surveillance.CONCLUSIONSThe automated VAC algorithm is efficient and accurate and is ready to be used routinely for VAC surveillance. Furthermore, its implementation can optimize the sensitivity and specificity of VAC identification.Infect. Control Hosp. Epidemiol. 2015;36(9):999–1003

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Trends of Multidrug-Resistant Pathogens, Difficult to Treat Bloodstream Infections, and Antimicrobial Consumption at a Tertiary Care Center in Lebanon from 2015–2020: COVID-19 Aftermath

Antibiotics ◽

10.3390/antibiotics10081016 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1016

Author(s):

Amanda Chamieh ◽

Rita Zgheib ◽

Sabah El-Sawalhi ◽

Laure Yammine ◽

Gerard El-Hajj ◽

...

Keyword(s):

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Bloodstream Infections ◽

Multidrug Resistant ◽

Infection Prevention And Control ◽

P Value ◽

Tertiary Care Center ◽

Antimicrobial Consumption ◽

Dynamic Collaboration

Introduction: We studied the trend of antimicrobial resistance and consumption at Saint George Hospital University Medical Center (SGHUMC), a tertiary care center in Beirut, Lebanon, with a focus on the SARS-CoV-2 pandemic. Materials and Methods: We calculated the isolation density/1000 patient-days (PD) of the most isolated organisms from 1 January 2015–31 December 2020 that included: E. coli (Eco), K. pneumoniae (Kp), P. aeruginosa (Pae), A. baumannii (Ab), S. aureus (Sau), and E. faecium (Efm). We considered March–December 2020 a surrogate of COVID-19. We considered one culture/patient for each antimicrobial susceptibility and excluded Staphylococcus epidermidis, Staphylococcus coagulase-negative, and Corynebacterium species. We analyzed the trends of the overall isolates, the antimicrobial susceptibilities of blood isolates (BSI), difficult-to-treat (DTR) BSI, carbapenem-resistant Enterobacteriaceae (CRE) BSI, and restricted antimicrobial consumption as daily-defined-dose/1000 PD. DTR implies resistance to carbapenems, beta-lactams, fluoroquinolones, and additional antimicrobials where applicable. Results and Discussion: After applying exclusion criteria, we analyzed 1614 blood cultures out of 8314 cultures. We isolated 85 species, most commonly Eco, at 52%. The isolation density of total BSI in 2020 decreased by 16%: 82 patients were spared from bacteremia, with 13 being DTR. The isolation density of CRE BSI/1000 PD decreased by 64% from 2019 to 2020, while VREfm BSI decreased by 34%. There was a significant decrease of 80% in Ab isolates (p-value < 0.0001). During COVID-19, restricted antimicrobial consumption decreased to 175 DDD/1000 PD (p-value < 0.0001). Total carbapenem consumption persistently decreased by 71.2% from 108DDD/1000 PD in 2015–2019 to 31 DDD/1000 PD in 2020. At SGHUMC, existing epidemics were not worsened by the pandemic. We attribute this to our unique and dynamic collaboration of antimicrobial stewardship, infection prevention and control, and infectious disease consultation.

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Pediatric Cataract Audit at a Tertiary Care Center in Karachi

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i1.898 ◽

2020 ◽

Vol 36 (1) ◽

Author(s):

Rabia Khawar Chaudhry ◽

Nasar Qamar Khan ◽

Weiji Kumar Dembra ◽

Areej Riaz ◽

Gaintry Vickash

Keyword(s):

Visual Acuity ◽

Congenital Cataract ◽

Medical Center ◽

Intraoperative Complications ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Traumatic Cataract ◽

Pediatric Cataract ◽

Visual Outcomes

Purpose: To perform pediatric cataract surgery audit at a tertiary care center in Karachi. Study Design: Descriptive observational study. Place and Duration of Study: From January, 2016 to July, 2018 at Ophthalmology Department of Jinnah Postgraduate Medical Center, Karachi. Material and Methods: All patients with congenital cataract were included in study regardless of presence or absence of systemic association. Patients who were lost to follow up at three months were excluded from the study. Hospital records were reviewed retrospectively and data on patient demographics, preoperative presentations, intraoperative complications and postoperative visual outcomes was documented on predesigned proformas. All patients underwent lens aspiration, posterior capsulotomy and anterior vitrectomy. Surgeries were performed under general anesthesia. Preoperative and postoperative visual acuity was assessed with ability to fix and follow light/objects, Kay picture test and Snellen’s chart according to patient’s age. Results: Three hundred and twenty six eyes underwent surgery for congenital cataract and sixty for traumatic cataract. Number of male patients was 54.93% and female was 45.07%. The average age of patients with congenital cataract was 5.01 years and that for traumatic cataract was 7.8 years. Amblyopia, nystagmus and strabismus were the commonest ocular comorbidities. Uncorrected visual acuity ranged from 6/18 to light perception preoperatively. Postoperatively 55% children with congenital cataract and 15% children with traumatic cataract had visual acuity better than 6/24. Conclusion: Early surgery in congenital cataract gives good visual outcomes. In traumatic cataract extraction, the final visual outcome depends on other effects of trauma on ocular structures.

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