Optimal Bandaging of Smallpox Vaccination Sites to Decrease the Potential for Secondary Vaccinia Transmission Without Impairing Lesion Healing

Objective.To assess the optimal method for covering smallpox vaccination sites to prevent transmission of vaccinia.Design.Randomized, nonblinded clinical trial.Setting.Tertiary care medical center.Participants.Vaccinia-naive and vaccinia-experienced volunteers.Interventions.After vaccination, study participants were randomized to receive 1 of 3 types of bandage: gauze, occlusive with gauze lining, or foam. Vaccination sites were assessed every 3 to 5 days until the lesion healed. During each visit, specimens were obtained from the vaccination site, the bandage surface before removal, and the index finger contralateral to the vaccination site and were cultured for vaccinia. Time to lesion healing was assessed.Results.All 48 vaccinia-naive and 47 (87%) of 54 vaccinia-experienced participants developed a vesicle or pustule at the injection site 6-11 days after vaccination. Fourteen (14%) of 102 participants had bandage cultures positive for vaccinia. All but 1 of these vaccinia-positive cultures were of a bandage from participants randomized to the gauze bandage group, and all but 3 were of bandages from vaccinia-naive participants. No finger-specimen cultures were positive for vaccinia. One episode of neck autoinoculation occurred in a vaccinia-naive individual who had vaccinia recovered from his gauze bandage on multiple visits. The foam bandage was associated with more local adverse effects (skin irritation and induration). The time to healing did not differ among the bandage groups.Conclusions.The potential for transmission of vaccinia from a vaccination site is greater if the site is covered by gauze than if it is covered by occlusive or foam bandages. Use of an occlusive bandage with a gauze lining is the best choice for coverage of smallpox vaccination sites because of a reduced potential for vaccinia transmission and a lower reactogenicity rate. Bandage choice did not affect vaccination lesion healing.

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Coronavirus disease 2019 (COVID-19) vaccination uptake among healthcare workers

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.421 ◽

2021 ◽

pp. 1-6

Author(s):

Mayan Gilboa ◽

Ilana Tal ◽

Einav G. Levin ◽

Shoshi Segal ◽

Ana Belkin ◽

...

Keyword(s):

Healthcare Workers ◽

Medical Center ◽

Demographic Data ◽

Tertiary Care ◽

Vaccine Safety ◽

Vaccine Uptake ◽

Multivariate Logistic Regression Model ◽

Educational Backgrounds ◽

Tertiary Care Medical Center ◽

To Receive

Abstract Objective: To assess reasons for noncompliance with COVID-19 vaccination among healthcare workers (HCWs). Design: Cohort observational and surveillance study. Setting: Sheba Medical Center, a 1,600-bed tertiary-care medical center in Israel. Participants: The study included 10,888 HCWs including all employees, students, and volunteers. Intervention: The BNT162b2 mRNA COVID-19 vaccine was offered to all HCWs of the hospital. Noncompliance was assessed, and pre-rollout and post-rollout surveys were conducted. Data regarding uptake of the vaccine as well as demographic data and compliance with prior influenza vaccination were collected, and 2 surveys were distributed. The survey before the rollout pertained to the intention to receive the vaccine, and the survey after the rollout pertained to all unvaccinated HCWs regarding causes of hesitancy. Results: In the pre-rollout survey, 1,673 (47%) of 3,563 HCWs declared their intent to receive the vaccine. Overall, 8,108 (79%) HCWs received the COVID-19 vaccine within 40 days of rollout. In a multivariate logistic regression model, the factors that were significant predictors of vaccine uptake were male sex, age 40–59 years, occupation (paramedical professionals and doctors), high socioeconomic level, and compliance with flu vaccine. Among 425 unvaccinated HCWs who answered the second survey, the most common cause for hesitancy was the risk during pregnancy (31%). Conclusions: Although vaccine uptake among HCWs was higher than expected, relatively low uptake was observed among young women and those from lower socioeconomic levels and educational backgrounds. Concerns regarding vaccine safety during pregnancy were common and more data about vaccine safety, especially during pregnancy, might improve compliance.

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EVALUATION OF FACTORS ASSOCIATED WITH MORTALITY AMONGST PATIENTS ADMITTED TO A TERTIARY CARE MEDICAL CENTER FOR COVID-19 INFECTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)04478-8 ◽

2021 ◽

Vol 77 (18) ◽

pp. 3123

Author(s):

Anish Samuel ◽

Ashesha Mechineni ◽

Robin Craven ◽

Wilbert Aronow ◽

Mourad Ismail ◽

...

Keyword(s):

Medical Center ◽

Tertiary Care ◽

Factors Associated ◽

Tertiary Care Medical Center

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Evaluation of post-ERCP pancreatitis after biliary stenting with self-expandable metal stents vs. plastic stents in benign and malignant obstructions

Endoscopy International Open ◽

10.1055/a-1388-6964 ◽

2021 ◽

Vol 09 (06) ◽

pp. E888-E894

Author(s):

Nichol S. Martinez ◽

Sumant Inamdar ◽

Sheila N. Firoozan ◽

Stephanie Izard ◽

Calvin Lee ◽

...

Keyword(s):

Pancreatic Duct ◽

Medical Center ◽

Tertiary Care ◽

Plastic Stents ◽

Metal Stents ◽

Limited Data ◽

Sems Group ◽

Tertiary Care Medical Center ◽

Stent Type ◽

Pancreatic Duct Stent

Abstract Background and study aims There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions. Patients and methods A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Results Among the 1136 patients included in our study, 399 had SEMS placed and 737 had PS placed. Patients with PS were more likely to have pancreatic duct cannulation, pancreatic duct stent placement, double guidewire technique, sphincterotomy and sphincteroplasty as compared to the SEMS group. On multivariate analysis, PEP rates were higher in the SEMS group (8.0 %) versus the PS group (4.8 %) (OR 2.27 [CI, 1.22, 4.24]) for all obstructions. For malignant obstructions, PEP rates were 7.8 % and 6.6 % for SEMS and plastic stents, respectively (OR 1.54 [CI, 0.72, 3.30]). For benign obstructions the PEP rate was higher in the SEMS group (8.8 %) compared to the PS group (4.2 %) (OR 3.67 [CI, 1.50, 8.97]). No significant differences between PEP severity were identified based on stent type when stratified based on benign and malignant. Conclusions PEP rates were higher when SEMS were used for benign obstruction as compared to PS. For malignant obstruction, no difference was identified in PEP rates with use of SEMS vs PS.

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Utility of electroencephalography: Experience from a U.S. tertiary care medical center

Clinical Neurophysiology ◽

10.1016/j.clinph.2016.08.013 ◽

2016 ◽

Vol 127 (10) ◽

pp. 3335-3340 ◽

Cited By ~ 12

Author(s):

Kapil Gururangan ◽

Babak Razavi ◽

Josef Parvizi

Keyword(s):

Medical Center ◽

Tertiary Care ◽

Tertiary Care Medical Center

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Nosocomial Methicillin-Resistant and Methicillin-SusceptibleStaphylococcus AureusPrimary Bacteremia: At What Costs?

Infection Control and Hospital Epidemiology ◽

10.1086/501641 ◽

1999 ◽

Vol 20 (6) ◽

pp. 408-411 ◽

Cited By ~ 224

Author(s):

Murray A. Abramson ◽

Daniel J. Sexton

Keyword(s):

Hospital Stay ◽

Medical Center ◽

A Priori ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Bloodstream Infections ◽

Methicillin Resistant ◽

Tertiary Care Medical Center ◽

Matching Criteria ◽

Nested Case Control

Objective:To determine the attributable hospital stay and costs for nosocomial methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistantS aureus(MRSA) primary bloodstream infections (BSIs).Design:Pairwise-matched (1:1) nested case-control study.Setting:University-based tertiary-care medical center.Patients:Patients admitted between December 1993 and March 1995 were eligible. Cases were defined as patients with a primary nosocomialS aureusBSI; controls were selected according to a priori matching criteria.Measurements:Length of hospital stay and total and variable direct costs of hospitalization.Results:The median hospital stay attributable to primary nosocomial MSSA BSI was 4 days, compared with 12 days for MRSA (P=.023). Attributable median total cost for MSSA primary nosocomial BSIs was $9,661 versus $27,083 for MRSA nosocomial infections (P=.043).Conclusion:Nosocomial primary BSI due toS aureussignificantly prolongs the hospital stay. Primary nosocomial BSIs due to MRSA result in an approximate threefold increase in direct cost, compared with those due to MSSA.

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