Point-of-Use Membrane Filtration and Hyperchlorination to Prevent Patient Exposure to Rapidly Growing Mycobacteria in the Potable Water Supply of a Skilled Nursing Facility

2011 ◽  
Vol 32 (9) ◽  
pp. 837-844 ◽  
Author(s):  
Margaret M. Williams ◽  
Tai-Ho Chen ◽  
Tim Keane ◽  
Nadege Toney ◽  
Sean Toney ◽  
...  
Keyword(s):  
Water Supply ◽  
Potable Water ◽  
Skilled Nursing Facility ◽  
Water System ◽  
Nursing Facility ◽  
Mycobacterium Chelonae ◽  
Skilled Nursing ◽  
Rapidly Growing Mycobacteria ◽  
Membrane Filters ◽  
Point Of Use

Background.Healthcare-associated outbreaks and pseudo-outbreaks of rapidly growing mycobacteria (RGM) are frequently associated with contaminated tap water. A pseudo-outbreak ofMycobacterium chelonae–M. abscessusin patients undergoing bronchoscopy was identified by 2 acute care hospitals. RGM was identified in bronchoscopy specimens of 28 patients, 25 of whom resided in the same skilled nursing facility (SNF). An investigation ruled out bronchoscopy procedures, specimen collection, and scope reprocessing at the hospitals as sources of transmission.Objective.To identify the reservoir for RGM within the SNF and evaluate 2 water system treatments, hyperchlorination and point-of-use (POU) membrane filters, to reduce RGM.Design.A comparative in situ study of 2 water system treatments to prevent RGM transmission.Setting.An SNF specializing in care of patients requiring ventilator support.Methods.RGM and heterotrophic plate count (HPC) bacteria were examined in facility water before and after hyperchlorination and in a subsequent 24-week assessment of filtered water by colony enumeration on Middlebrook and R2A media.Results.Mycobacterium chelonaewas consistently isolated from the SNF water supply. Hyperchlorination reduced RGM by 1.5 log10initially, but the population returned to original levels within 90 days. Concentration of HPC bacteria also decreased temporarily. RGM were reduced below detection level in filtered water, a 3-log10reduction. HPC bacteria were not recovered from newly installed filters, although low quantities were found in water from 2-week-old filters.Conclusion.POU membrane filters may be a feasible prevention measure for healthcare facilities to limit exposure of sensitive individuals to RGM in potable water systems.

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

Meeting Focuses on Skilled Nursing Facility Concerns

ASHA Leader ◽  
2010 ◽  
Vol 15 (4) ◽  
pp. 17-17
Author(s):  
Janet Brown
Keyword(s):  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing

Medicare Skilled Nursing Facility Reimbursement and Upcoding

2012 ◽  
Author(s):  
John R. Bowblis ◽  
Christopher Brunt
Keyword(s):  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing

The Role of Ownership and Chain Affiliation in Skilled Nursing Facility Length of Stay

2013 ◽  
Author(s):  
John R. Bowblis ◽  
John Horowitz ◽  
Christopher Scott Brunt
Keyword(s):  
Length Of Stay ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing

Physical Activity Behavior of Skilled Nursing Facility Patients: A 21-day Longitudinal Cohort Study (Preprint)

2020 ◽  
Author(s):  
Wenhao Zhang ◽  
Ramin Ramezani ◽  
Zhuoer Xie ◽  
John Shen ◽  
David Elashoff ◽  
...  
Keyword(s):  
Physical Activity ◽  
Energy Intensity ◽  
Indoor Localization ◽  
Pearson Correlation ◽  
Patent Application ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Longitudinal Changes ◽  
Therapy Room

BACKGROUND The availability of low cost ubiquitous wearable sensors has enabled researchers, in recent years, to collect a large volume of data in various domains including healthcare. The goal has been to harness wearables to further investigate human activity, physiology and functional patterns. As such, on-body sensors have been primarily used in healthcare domain to help predict adverse outcomes such as hospitalizations or fall, thereby enabling clinicians to develop better intervention guidelines and personalized models of care to prevent harmful outcomes. In the previous studies [9,10] and the patent application [11], we introduced a generic framework (Sensing At-Risk Population) that draws on the classification of human movements using a 3-axial accelerometer and extraction of indoor localization using BLE beacons, in concert. This work is to address the longitudinal analyses of a particular cohort using the introduced framework in a skilled nursing facility. OBJECTIVE (a) To observe longitudinal changes of physical activity and indoor localization features of rehabilitation-dwelling patients, (b) to assess if such changes can be used at early stages during the rehabilitation period to discriminate between patients that will be re-hospitalized versus the ones that will be discharged to a community setting and (c) to investigate if the sensor based longitudinal changes can imitate patients changes captured by therapist assessments over the course of rehabilitation. METHODS Pearson correlation was used to compare occupational therapy (OT) and physical therapy (PT) assessments with sensor-based features. Generalized Linear Mixed Model was used to find associations between functional measures with sensor based features. RESULTS Energy intensity at therapy room was positively associated with transfer general (β=0.22;SE=0.08;p<.05). Similarly, sitting energy intensity showed positive association with transfer general (β=0.16;SE=0.07;p<.05). Laying down energy intensity was negatively associated with hygiene grooming (β=-0.27;SE=0.14;p<.05). The interaction of sitting energy intensity with time (β=-0.13;SE=.06;p<.05) was associated with toileting general. Dressing lower body was strongly correlated with overall energy intensity (r = 0.66), standing energy intensity (r = 0.61), and laying down energy intensity (r = 0.72) on the first clinical assessment session. CONCLUSIONS This study demonstrates that a combination of indoor localization and physical activity tracking produces a series of features, a subset of which can provide crucial information on the storyline of daily and longitudinal activity patterns of rehabilitation-dwelling patients.

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