scholarly journals Controlling a Multicenter Outbreak Involving the New York/Japan Methicillin-ResistantStaphylococcus aureusClone

2007 ◽  
Vol 28 (7) ◽  
pp. 845-852 ◽  
Author(s):  
G. W. Coombs ◽  
H. Van Gessel ◽  
J. C. Pearson ◽  
M.-R. Godsell ◽  
F. G. O'Brien ◽  
...  
Keyword(s):  
Public Health ◽  
New York ◽  
Molecular Typing ◽  
Management Strategies ◽  
Research Unit ◽  
Management Policy ◽  
Teaching Hospitals ◽  
Term Care ◽  
Outbreak Management ◽  
Healthcare Facilities

Objective.To describe the control of an outbreak of infection and colonization with the New York/Japan methicillin-resistantStaphylococcus aureus(MRSA) clone in multiple healthcare facilities, and to demonstrate the importance of making an MRSA management policy involving molecular typing of MRSA into a statewide public health responsibility.Setting.A range of healthcare facilities, including 2 metropolitan teaching hospitals and a regional hospital, as well as several community hospitals and long-term care facilities in a nonmetropolitan healthcare region.Interventions.A comprehensive, statewide MRSA epidemiological investigation and management policy.Results.In May 2005, there were 3 isolates referred to the Western Australian Gram-Positive Bacteria Typing and Research Unit that were identified as the New York/Japan MRSA clone, a pandemic MRSA clone with the ability to spread and replace existing clones in a region. Subsequent investigation identified 28 additional cases of infection and/or colonization dating from 2002 onward, including 1 involving a colonized healthcare worker (HCW) who had previously been hospitalized overseas. Of the 31 isolates detected, 25 were linked epidemiologically and via molecular typing to the isolate recovered from the colonized HCW. Four isolates appeared to have been introduced separately from overseas. Although the isolate from the single remaining case patient was genetically indistinct from the isolates that spread within Western Australia, no specific epidemiological link could be established. The application of standard outbreak management strategies reduced further spread.Conclusions.The elimination of the New/York Japan MRSA clone in a healthcare region demonstrates the importance of incorporating MRSA management policy into statewide public health programs. The mainstays of such programs should include a comprehensive and effective outbreak identification and management policy (including pre-employment screening of HCWs, where applicable) and MRSA clone identification by multilocus sequence typing.

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.

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 )

Medical Waste: A Minimal Hazard

1991 ◽  
Vol 12 (11) ◽  
pp. 682-685 ◽  
Author(s):  
John H. Keene
Keyword(s):  
Public Health ◽  
New York ◽  
Healthcare Providers ◽  
Medical Waste ◽  
Healthcare Facilities ◽  
The Public ◽  
Treatment And Disposal ◽  
Elected Representatives ◽  
Potential Public Health ◽  
Medical Wastes

Healthcare providers need to be aware of the facts regarding the environmental impact of regulated medical wastes and be prepared to voice concern over unnecessary and costly regulations. The wash-ups of waste, a small percentage of which was medical waste, on the beaches on New York and New Jersey in the summers of 1987 and 1988 prompted an immediate response by state and federal governments. Although it was demonstrated that this medical waste did not originate in healthcare facilities,' the public demanded that their elected representatives do something about what they perceived to be the degradation of the environment and a risk to public health caused by “uncontrolled dumping” of “medical wastes” into the ocean. As a result of these and other occurrences, several environmental concerns regarding the treatment and disposal of medical waste were voiced by the public and acknowledged by the legislators. These included the following: aesthetic damage to the environment; potential public health problems associated with infectious agents in medical waste; and potential environmental contamination with hazardous chemicals and radioactivity associated with medical wastes.

scholarly journals Epidemiology and Management of Seasonal Influenza Outbreaks in Long-Term Care Facilities in the Health Service Executive East Area of Ireland During the 2013-2014 Influenza Season

2017 ◽  
Vol 1 (1) ◽  
pp. 22-32 ◽  
Author(s):  
L. O’Connor ◽  
H. Murphy ◽  
E. Montague ◽  
M. Boland
Keyword(s):  
Public Health ◽  
Seasonal Influenza ◽  
Long Term Care ◽  
Influenza Season ◽  
Term Care ◽  
Health Service Executive ◽  
Outbreak Management ◽  
Vaccination Rates ◽  
Care Facilities

We describe seasonal influenza-like illness (ILI) outbreaks in long-term care facilities in the Health Service Executive (HSE) East area of Ireland in the 2013/2014 influenza season, risk factors associated with outbreak duration and attack rates, and management challenges. Separate questionnaires were distributed to 28 facilities who reported an outbreak and to public health specialists leading outbreak management, with a 79% response rate. Mean outbreak duration (21 vs 17 days; p=0.046) was longer in facilities with staff vaccination rates of <40%. Facilities with a high attack rate (≥50%) were less likely to have an outbreak plan (p=0.03). Smaller facilities (under 50 residents) had a higher attack rate (50% vs 23%, p=0.003) even when controlled for staff vaccination rate (p=0.01). Prior to the outbreak, resident vaccination rates were high (82%, above the World Health Organization target of 75%) but staff vaccination rates were low (39%). Reported challenges to ILI outbreak management in long term care facilities included visitor restrictions, staff education issues, outbreak notification delays and lack of outbreak lead in facilities. Targeted public health-assisted planning, training and response, comprising of staff vaccination, education, written policies, with early notification and prompt response would facilitate a more co-ordinated approach to the management of outbreaks, and reduction in infection rates and consequent morbidity.

scholarly journals Interfacility Spread of OXA-23–Producing Carbapenem-Resistant Acinetobacter—Connecticut, 2018–2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s304-s304
Author(s):  
Sydney Jones ◽  
Meghan Maloney ◽  
Anu Paranandi ◽  
Dana Pepe ◽  
Elizabeth Nazarian ◽  
...  
Keyword(s):  
Public Health ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Care Hospital ◽  
Term Care ◽  
Environmental Cleaning ◽  
Healthcare Facilities ◽  
Contact Precautions ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB), a multidrug-resistant gram-negative bacterium, can cause difficult-to-treat infections with mortality in approximately half of CRAB cases. CRAB can spread among healthcare facilities after transfer of an infected or colonized patient. Strategies to limit CRAB spread include adherence to contact precautions, environmental cleaning with bleach, and screening to identify colonized patients. During July–September 2018, the Connecticut Department of Public Health (DPH) worked with an acute-care hospital (hospital A) to contain an outbreak of OXA-23–producing CRAB (OXA-23 is an enzyme that confers resistance to carbapenems). During November 2018–March 2019, statewide CRAB surveillance identified additional cases of related OXA-23–producing CRAB at other healthcare facilities. DPH, Connecticut State Public Health Laboratory (SPHL), and the Antibiotic Resistance Laboratory Network (ARLN) investigated to prevent additional cases. Methods: Since January 2017, CRAB isolates have been routinely sent to SPHL and ARLN for carbapenemase gene detection and whole-genome sequencing (WGS) to determine isolate relatedness. During November 2018–March 2019, DPH collected patient healthcare history for patients with CRAB isolates to identify outbreaks and provide assistance in infection control and prevention to healthcare facilities reporting CRAB cases. Beginning May 2019, DPH and ARLN offered facilities screening to identify patients colonized with OXA-23–producing CRAB. Results: Of 10 OXA-23–producing CRAB isolates reported to DPH during November 2018–March 2019, 3 were closely related to the 9 isolates from hospital A’s outbreak by WGS (single-nucleotide polymorphism difference range, 1–16). One isolate was from a patient who had been admitted to hospital A during July 2018. All 3 patients with CRAB isolates shared a history of residence at long-term–care facility A (LTCF A). Two patients received a CRAB infection diagnosis upon admission to hospital B after transfer from LTCF A. Both LTCF A and hospital B performed environmental cleaning with bleach and placed CRAB-identified patients on contact precautions. LTCF A declined screening patients for CRAB, whereas hospitals B and C, which receive frequent transfers from LTCF A, screened all patients on admission from LTCF A. During May–September 2019, among 6 patients screened, 1 was colonized with OXA-23–producing CRAB and was placed on contact precautions. Conclusions: Transfer of patients who are infected or colonized with CRAB among hospitals and LTCFs can facilitate the regional spread of CRAB. Strategies for containing the spread of carbapenemase-producing organisms include adherence to contact precautions, colonization screening, interfacility communication, and collaboration with public health.Funding: NoneDisclosures: None

scholarly journals Factors associated with transmission in COVID-19 outbreaks in long-term care facilities

2021 ◽  
Author(s):  
Rohit Vijh ◽  
Carmen H Ng ◽  
Mehdi Shirmaleki ◽  
Aamir Bharmal
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Long Term Care ◽  
Term Care ◽  
Outbreak Management ◽  
Factors Associated ◽  
Health Measures ◽  
Modifiable Factors ◽  
Care Facilities

Background: Severe acute respiratory syndrome coronavirus 2 (SARSCoV2) has had a disproportionate impact on residents in long-term care facilities (LTCFs). Through our experience and data from managing COVID-19 exposures and outbreaks in LTCFs in the Fraser Health region in British Columbia, Canada, we identified risk factors associated with outbreak severity to inform current outbreak management strategies and future pandemic preparedness planning efforts. Methods: We used a retrospective cohort study design to evaluate the association between non-modifiable factors (facility building, organization level, and resident population characteristics), modifiable factors (assessments for infection prevention and control (IPC) and public health measures), and severity of COVID-19 outbreaks (attack rate) in LTCFs. We modelled the COVID-19 attack rates in LTCF outbreaks using negative binomial regression models. Results: From March 1, 2020 to January 10, 2021, a total of 145 exposures to at least one confirmed case of COVID-19 in 82 LTCFs occurred. For every item not met in the assessment tool, a 22% increase in the attack rate was observed (rate ratio 1.2 [95% CI 1.1 to 1.4]) after adjusting for other risk factors such as age of the facility, index case type (resident vs. staff) and proportion of single bed rooms. Conclusion: Our findings highlight the importance of assessing IPC and public health measures for outbreak management. They also demonstrate the important modifiable and non-modifiable risk factors associated with COVID-19 outbreaks in our jurisdiction. We hope these findings will inform ongoing outbreak management and future pandemic planning efforts.

Körperliche Beschwerden bei älteren Migranten in Deutschland 1Erstellt unter Mitwirkung der Arbeitsgruppe «Abuse of the Elderly in the European Region» (ABUEL): Joaquim F. J. Soares, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; Francisco Torres-González, Departmental Section of Psychiatry and Psychological Medicine, University of Granada, Spain; Elisabeth Ioannidi-Kapolou, National School of Public Health, Department of Sociology, Athens, Greece; Giovanni Lamura, Italian National Research Centre on Ageing Department of Gerontological Research, Unit of Health Economics, Ancona, Italy; Mindaugas Stankunas, Kaunas University of Medicine, Department of Health Management, A. Mickeviciaus, Kaunas, Lithuania; Henrique Barros, Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.

2010 ◽  
Vol 58 (3) ◽  
pp. 199-206 ◽  
Author(s):  
Rosina-Martha Csöff ◽  
Gloria Macassa ◽  
Jutta Lindert
Keyword(s):  
Public Health ◽  
Health Management ◽  
The Elderly ◽  
Health Department ◽  
Research Unit ◽  
Research Centre ◽  
Public Health Department ◽  
Karolinska Institute ◽  
Psychological Medicine ◽  
Körperliche Beschwerden

Körperliche Beschwerden sind bei Älteren weit verbreitet; diese sind bei Migranten bislang in Deutschland und international noch wenig untersucht. Unsere multizentrische Querschnittstudie erfasste körperliche Beschwerden bei Menschen im Alter zwischen 60 und 84 Jahren mit Wohnsitz in Stuttgart anhand der Kurzversion des Gießener Beschwerdebogens (GBB-24). In Deutschland wurden 648 Personen untersucht, davon 13.4 % (n = 87) nicht in Deutschland geborene. Die Geschlechterverteilung war bei Migranten und Nichtmigranten gleich; der sozioökonomische Status lag bei den Migranten etwas niedriger: 8.0 % (n = 7) der Migranten und 2.5 % (n = 14) der Nichtmigranten verfügten über höchstens vier Jahre Schulbildung; 12.6 % (n = 11) der Migranten und 8.2 % (n = 46) der Nichtmigranten hatten ein monatliches Haushaltsnettoeinkommen von unter 1000€; 26.4 % der Migranten und 38.1 % (n = 214) der Nichtmigranten verfügten über mehr als 2000€ monatlich. Somatische Beschwerden lagen bei den Migranten bei 65.5 % (n = 57) und bei den Nichtmigranten bei 55.8 % (n = 313). Frauen wiesen häufiger somatische Beschwerden auf (61.8 %) als Männer (51.8 %). Mit steigendem Alter nahmen somatische Beschwerden zu. Mit Ausnahme der Altersgruppe der 70–74-Jährigen konnte kein signifikanter Unterschied zwischen Migranten und Nichtmigranten hinsichtlich der Häufigkeit körperlicher Beschwerden gezeigt werden. Ausblick: Es werden dringend bevölkerungsrepräsentative Studien zu körperlichen Beschwerden bei Migranten benötigt.

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