Epidemiology of Healthcare-Associated Bloodstream Infection Caused by USA300 Strains of Methicillin-ResistantStaphylococcus aureusin 3 Affiliated Hospitals

Objective.To describe the epidemiology of bloodstream infection caused by USA300 strains of methicillin-resistantStaphylococcus aureus(MRSA), which are traditionally associated with cases of community-acquired infection, in the healthcare setting.Design.Retrospective cohort study.Setting.Three academically affiliated hospitals in Denver, Colorado.Methods.Review of cases of S.aureusbloodstream infection during the period from 2003 through 2007. Polymerase chain reaction was used to identify MRSA USA300 isolates.Results.A total of 330 cases of MRSA bloodstream infection occurred during the study period, of which 286 (87%) were healthcare-associated. The rates of methicillin resistance among theS. aureusisolates recovered did not vary during the study period and were similar among the 3 hospitals. However, the percentages of cases of healthcare-associated MRSA bloodstream infection due to USA300 strains varied substantially among the 3 hospitals: 62%, 19%, and 36% (P< .001) for community-onset cases and 33%, 3%, and 33% (P= .005) for hospital-onset cases, in hospitals A, B, and C, respectively. In addition, the number of cases of healthcare-associated MRSA bloodstream infection caused by USA300 strains increased during the study period at 2 of the 3 hospitals. At each hospital, USA300 strains were most common among cases of community-associated infection and were least common among cases of hospital-onset infection. Admission to hospital A (a safety-net hospital), injection drug use, and human immunodeficiency virus infection were independent risk factors for healthcare-associated MRSA bloodstream infection due to USA300 strains.Conclusions.The prevalence of USA300 strains among cases of healthcare-associated MRSA bloodstream infection varied dramatically among geographically clustered hospitals. USA300 strains are replacing traditional healthcare-related strains of MRSA in some healthcare settings. Our data suggest that the prevalence of USA300 strains in the community is the dominant factor affecting the prevalence of this strain type in the healthcare setting.

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A Continuously Active Antimicrobial Surface Coating Reduces Bioburden in a Healthcare Setting

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1105 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s439-s439

Author(s):

Valerie Beck

Keyword(s):

Surface Coating ◽

Geometric Mean ◽

Healthcare Setting ◽

Aerobic Bacteria ◽

Healthcare Settings ◽

Additional Layer ◽

Clostridioides Difficile ◽

Sustained Reduction ◽

Before And After ◽

Healthcare Associated

Background: It is well known that contaminated surfaces contribute to the transmission of pathogens in healthcare settings, necessitating the need for antimicrobial strategies beyond routine cleaning with momentary disinfectants. A recent publication demonstrated that application of a novel, continuously active antimicrobial surface coating in ICUs resulted in the reduction of healthcare-associated infections. Objective: We determined the general microbial bioburden and incidence of relevant pathogens present in patient rooms at 2 metropolitan hospitals before and after application of a continuously active antimicrobial surface coating. Methods: A continuously active antimicrobial surface coating was applied to patient rooms in intensive care units (ICUs) twice over an 18-month period and in non-ICUs twice over a 6-month study period. The environmental bioburden was assessed 8–16 weeks after each treatment. A 100-cm2 area was swabbed from frequently touched areas in patient rooms: patient chair arm rest, bed rail, TV remote, and backsplash behind the sink. The total aerobic bacteria count was determined for each location by enumeration on tryptic soy agar (TSA); the geometric mean was used to compare bioburden before and after treatment. Each sample was also plated on selective agar for carbapenem-resistant Enterobacteriaceae (CRE), vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridioides difficile to determine whether pathogens were present. Pathogen incidence was calculated as the percentage of total sites positive for at least 1 of the 4 target organisms. Results: Before application of the antimicrobial coating, total aerobic bacteria counts in ICUs were >1,500 CFU/100 cm2, and at least 30% of the sites were positive for a target pathogen (ie, CRE, VRE, MRSA or C. difficile). In non-ICUs, the bioburden before treatment was at least 500 CFU/100 cm2, with >50% of sites being contaminated with a pathogen. After successive applications of the surface coating, total aerobic bacteria were reduced by >80% in the ICUs and >40% in the non-ICUs. Similarly, the incidence of pathogen-positive sites was reduced by at least 50% in both ICUs and non-ICUs. Conclusions: The use of a continuously active antimicrobial surface coating provides a significant (P < .01) and sustained reduction in aerobic bacteria while also reducing the occurrence of epidemiologically important pathogens on frequently touched surfaces in patient rooms. These findings support the use of novel antimicrobial technologies as an additional layer of protection against the transmission of potentially harmful bacteria from contaminated surfaces to patients.Funding: Allied BioScience provided Funding: for this study.Disclosures: Valerie Beck reports salary from Allied BioScience.

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Healthcare Settings

The CDC Field Epidemiology Manual ◽

10.1093/oso/9780190933692.003.0018 ◽

2019 ◽

pp. 341-362 ◽

Cited By ~ 2

Author(s):

Bryan E. Christensen ◽

Ryan P. Fagan

Keyword(s):

Urinary Tract ◽

Respiratory Tract ◽

Medical Devices ◽

Disease Transmission ◽

Healthcare Setting ◽

Healthcare Settings ◽

Outbreak Investigations ◽

Mode Of Transmission ◽

Healthcare Associated ◽

General Community

Healthcare-associated infections (e.g., bloodstream, respiratory tract, urinary tract, or surgical site) can be common in patients. Patients receiving acute and chronic healthcare across various settings, such as hospitals, dialysis clinics, and nursing homes, tend to have comorbidities that make them more susceptible to infection than their counterparts in the general community. Also, some pathogens may be more likely to cause infection in healthcare settings because of the unique exposures that patients can experience, such as invasive procedures or indwelling medical devices. Similar to community outbreak investigations, the primary purpose of an investigation in a healthcare setting is to determine the source of the outbreak, define mode of transmission, disrupt disease transmission, and prevent further transmission.

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Inclusive language regarding gender, sexual orientation, and relationship status: the ongoing process and outcome of revising psychiatric materials

The Journal of Mental Health Training Education and Practice ◽

10.1108/jmhtep-02-2018-0009 ◽

2019 ◽

Vol 14 (6) ◽

pp. 385-398

Author(s):

Rebecca Drill ◽

Johanna Malone ◽

Meredith Flouton-Barnes ◽

Laura Cotton ◽

Sarah Keyes ◽

...

Keyword(s):

Sexual Orientation ◽

Safety Net ◽

Relationship Status ◽

Content Type ◽

Self Identity ◽

Language Bias ◽

Healthcare Settings ◽

Qualitative Feedback ◽

Linguistic Barriers ◽

Safety Net Hospital

Purpose The purpose of this paper is to address the barrier to care experienced by LGBTQIA+ populations by binary language for gender, sexual orientation and relationship status. Design/methodology/approach The authors review the research that shows linguistic barriers are a significant obstacle to healthcare for LGBTQIA+ communities. The authors describe both a process and revisions for addressing language bias in psychiatric intake/research research materials as well as quantify its impact in an adult psychotherapy clinic in a public hospital. Findings Patients self-identified their gender, sexual orientation and relationship status in a variety of ways when not presented with binaries and/or pre-established response choices. In addition, the non-response rate to questions decreased and the authors received positive qualitative feedback. The authors also present the revisions to the intake/research materials. Practical implications Other healthcare settings/clinicians can revise language in order to remove significant barriers to treatment and in doing so, be welcoming, non-pathologizing and empowering for LGBTQIA+ consumers of mental health services (as well as for non-LGBTQIA+ consumers who are in non-traditional relationships). Social implications This work is one step in improving healthcare and the healthcare experience for LGBTQIA+ communities and for those in non-traditional relationships. Originality/value This work is set in a public safety-net hospital providing care for underserved and diverse populations. This paper describes the process of revising psychiatric materials to be more inclusive of the range of self-identity are: gender, sexual orientation and relationship status.

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Reducing hospitalizations: Implementation of CADD pumps in infusion clinic at a Los Angeles safety net hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18648 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18648-e18648

Author(s):

Tiffanie Thy Do ◽

James Jen-Chi Yeh

Keyword(s):

Los Angeles ◽

Medical Center ◽

Cost Savings ◽

Healthcare Setting ◽

Safety Net ◽

Inpatient Hospital ◽

Outpatient Chemotherapy ◽

Safety Net Hospital ◽

Hospital Bed ◽

Hospital Days

e18648 Background: Computerized ambulatory drug delivery (CADD) pumps introduced in the 1980s made it possible to move infusion delivery from the hospital to the home. At Harbor-UCLA Medical Center, hundreds of scheduled chemotherapy admissions occur annually. The procurement and implementation of CADD pumps was a collaborative effort with members of pharmacy, nursing, physicians and administration. The implementation of CADD pumps for home chemotherapy demonstrated a cost-savings by decreasing the number of inpatient hospital days required for scheduled chemotherapy admissions. Methods: The first outpatient chemotherapy infusion by CADD pump began on 12/5/2017. Records from 12/5/2017 through 12/4/2018 (365 days) were reviewed to assess the benefit of CADD pumps, defined by inpatient hospital days avoided. Eight chemotherapy regimens were administered through outpatient CADD pumps; the equivalent number of inpatient hospital days were estimated based on inpatient hospital records between 2015 and 2017. The average number of hospital days that would have occurred inpatient per chemotherapy regimen was multiplied by the number of outpatient CADD pump chemotherapy infusions to estimate the number of inpatient hospital days avoided. Based on information provided by our hospital’s finance department, including reimbursement for inpatient and similar outpatient care, each hospital day avoided was estimated to provide $1,695 in cost-savings. On average, a typical hospitalization for infusional 5-FU chemotherapy was three days in length. Results: Over one year, 35 patients received a total of 178 outpatient CADD infusions. The average number of CADD infusions per patient was five. We estimated that 642 hospital bed days were saved over a 1-year period following the implementation of outpatient CADD pumps. With the estimate that each hospital bed day saved was valued at $1,695, we concluded a savings of $1.1 million dollars at our hospital through the implementation of CADD pumps within the first year. Conclusions: The implementation of CADD pumps for home chemotherapy demonstrated cost-savings by decreasing the number of inpatient hospital days required for scheduled chemotherapy admissions. This shift provides a superior value for the patient with equivalent treatment outpatient, spending less time in the healthcare setting, and reduced health care costs. [Table: see text]

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Pathogens Spread via Respiratory Route

Handbook of Pediatric Infection Prevention and Control ◽

10.1093/med/9780190697174.003.0001 ◽

2019 ◽

pp. 1-30

Author(s):

Claudette Poole ◽

Ann-Christine Nyquist

Keyword(s):

Disease Transmission ◽

Respiratory Infections ◽

Healthcare Setting ◽

Healthcare Personnel ◽

Post Exposure Prophylaxis ◽

Respiratory Pathogens ◽

Healthcare Settings ◽

Hands On ◽

Exposure Prophylaxis ◽

Healthcare Associated

This chapter covers common and epidemiologically significant pediatric respiratory pathogens, and provides recommendations for preventing transmission in the healthcare setting. Respiratory infections in children are one of the most common reasons for evaluation by a healthcare provider in all healthcare settings. These infections pose significant challenges for infection prevention and contribute to the burden of healthcare-associated infections (HAIs). In addition, family members, who may be less aware about disease transmission, provide direct hands-on care for their children while hospitalized, and then move freely throughout the hospital. Strategies for post-exposure prophylaxis are described for pertussis, varicella, measles, and influenza. Special considerations for pregnant and breastfeeding women are described, with an emphasis on healthcare personnel.

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A comparison of clinical outcomes between healthcare-associated infections due to community-associated methicillin-resistantStaphylococcus aureusstrains and healthcare-associated methicillin-resistantS. aureusstrains

Epidemiology and Infection ◽

10.1017/s0950268812002634 ◽

2012 ◽

Vol 141 (10) ◽

pp. 2140-2148 ◽

Cited By ~ 6

Author(s):

S. J. EELLS ◽

J. A. McKINNELL ◽

A. A. WANG ◽

N. L. GREEN ◽

D. WHANG ◽

...

Keyword(s):

Treatment Failure ◽

Female Gender ◽

Apache Ii Score ◽

Healthcare Associated Infections ◽

Limited Data ◽

Factors Associated ◽

Comorbidity Index ◽

Strain Type ◽

Independent Risk Factors ◽

Healthcare Associated

SUMMARYThere are limited data examining whether outcomes of methicillin-resistantStaphylococcus aureus(MRSA) healthcare-associated infections (HAIs) are worse when caused by community-associated (CA) strains compared to HA strains. We reviewed all patients’ charts at our institution from 1999 to 2009 that had MRSA first isolated only after 72 h of hospitalization (n = 724). Of these, 384 patients had a MRSA-HAI according to CDC criteria. Treatment failure was similar in those infected with a phenotypically CA-MRSA strain compared to a phenotypically HA-MRSA strain (23%vs. 15%,P = 0·10) as was 30-day mortality (16%vs. 19%,P = 0·57). Independent risk factors associated with (P < 0·05) treatment failure were higher Charlson Comorbidity Index, higher APACHE II score, and no anti-MRSA treatment. These factors were also associated with 30-day mortality, as were female gender, older age, MRSA bloodstream infection, MRSA pneumonia, and HIV. Our findings suggest that clinical and host factors, not MRSA strain type, predict treatment failure and death in hospitalized patients with MRSA-HAIs.

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