scholarly journals Reduction of Methicillin-ResistantStaphylococcus aureusInfection among Veterans in Atlanta

2013 ◽  
Vol 34 (1) ◽  
pp. 62-68 ◽  
Author(s):  
Edward Stenehjem ◽  
Cortney Stafford ◽  
David Rimland
Keyword(s):  
Active Surveillance ◽  
Medical Center ◽  
Veterans Health ◽  
Health Administration ◽  
Healthcare Settings ◽  
Surveillance Cultures ◽  
Mrsa Infection ◽  
The Impact ◽  
Mrsa Colonization ◽  
Community Onset

Objective.Describe local changes in the incidence of community-onset and hospital-onset methicillin-resistantStaphylococcus aureus(MRSA) infection and evaluate the impact of MRSA active surveillance on hospital-onset infection.Design.Observational study using prospectively collected data.Setting.Atlanta Veterans Affairs Medical Center (AVAMC).Patients.All patients seen at the AVAMC over an 8-year period with clinically and microbiologically proven MRSA infection.Methods.All clinical cultures positive for MRSA were prospectively identified, and corresponding clinical data were reviewed. MRSA infections were classified into standard clinical and epidemiologic categories. The Veterans Health Administration implemented the MRSA directive in October 2007, which required active surveillance cultures in acute care settings.Results.The incidence of community-onset MRSA infection peaked in 2007 at 5.45 MRSA infections per 1,000 veterans and decreased to 3.14 infections per 1,000 veterans in 2011 (P< .001 for trend). Clinical and epidemiologic categories of MRSA infections did not change throughout the study period. The prevalence of nasal MRSA colonization among veterans admitted to AVAMC decreased from 15.8% in 2007 to 11.2% in 2011 (P<.001 for trend). The rate of intensive care unit (ICU)-related hospital-onset MRSA infection decreased from October 2005 through March 2007, before the MRSA directive. Rates of ICU-related hospital-onset MRSA infection remained stable after the implementation of active surveillance cultures. No change was observed in rates of non-ICU-related hospital-onset MRSA infection.Conclusions.Our study of the AVAMC population over an 8-year period shows a consistent trend of reduction in the incidence of MRSA infection in both the community and healthcare settings. The etiology of this reduction is most likely multifactorial.

Active Surveillance to Determine the Impact of Methicillin-Resistant Staphylococcus aureus Colonization on Patients in Intensive Care Units of a Veterans Affairs Medical Center

2008 ◽  
Vol 29 (6) ◽  
pp. 503-509 ◽  
Author(s):  
Mukesh Patel ◽  
Jeffrey D. Weinheimer ◽  
Ken B. Waites ◽  
John W. Baddley
Keyword(s):  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Active Surveillance ◽  
Medical Center ◽  
Veterans Affairs ◽  
Icu Patients ◽  
All Cause Mortality ◽  
Mrsa Infection ◽  
The Impact ◽  
Mrsa Colonization

Objective.The impact of methicillin-resistant Staphylococcus aureus (MRSA) colonization on mortality has not been well characterized. We sought to describe the impact of MRSA colonization on patients admitted to intensive care units (ICUs) in the Birmingham Veterans Affairs Medical Center (VAMC).Methods.We conducted a retrospective cohort study of ICU patients at the Birmingham VAMC during 2005 to evaluate the predictors of MRSA colonization and determine its effect on clinical outcomes. Surveillance cultures for MRSA were performed on admission to the ICU and weekly thereafter. Clinical findings, the incidence of MRSA infection, and mortality within 3 months after ICU admission were recorded. Predictors of mortality and S. aureus colonization were determined using multivariable models.Results.S. aureus colonization was present in 97 (23.3%) of 416 patients screened, of whom 67 (16.1%) were colonized with methicillin-susceptible S. aureus (MSSA) and 30 (7.2%) with MRSA. All-cause mortality at 3 months among MRSA-colonized patients was significantly greater than that among MSSA-colonized patients (46.7% vs 19.4%; P = .009). MRSA colonization was an independent predictor of death (adjusted odds ratio [OR] ,3.7 [95% confidence interval {CI}, 1.5–8.9]; P = .003) and onset of MRSA infection after hospital discharge (adjusted OR, 7.6 [95% CI, 2.48–23.2]; P < .001). Risk factors for MRSA colonization included recent antibiotic use (adjusted OR, 4.8 [95% CI, 1.9–12.2]; P = .001) and dialysis (adjusted OR, 18.9 [95% CI, 2.1–167.8]; P = .008).Conclusions.Among ICU patients, MRSA colonization is associated with subsequent MRSA infection and an all-cause mortality that is greater than that for MSSA colonization. Active surveillance for MRSA colonization may identify individuals at risk for these adverse outcomes. Prospective studies of outcomes in MRSA-colonized patients may better define the role of programs for active MRSA surveillance.

scholarly journals Cost-Effectiveness of Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in an Intensive Care Unit

2015 ◽  
Vol 36 (1) ◽  
pp. 17-27 ◽  
Author(s):  
Courtney A. Gidengil ◽  
Charlene Gay ◽  
Susan S. Huang ◽  
Richard Platt ◽  
Deborah Yokoe ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Cost Effectiveness ◽  
Active Surveillance ◽  
Chlorhexidine Gluconate ◽  
Standard Precautions ◽  
Surveillance Cultures ◽  
Mrsa Infection ◽  
Mrsa Colonization ◽  
Gluconate Baths

OBJECTIVETo create a national policy model to evaluate the projected cost-effectiveness of multiple hospital-based strategies to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection.DESIGNCost-effectiveness analysis using a Markov microsimulation model that simulates the natural history of MRSA acquisition and infection.PATIENTS AND SETTINGHypothetical cohort of 10,000 adult patients admitted to a US intensive care unit.METHODSWe compared 7 strategies to standard precautions using a hospital perspective: (1) active surveillance cultures; (2) active surveillance cultures plus selective decolonization; (3) universal contact precautions (UCP); (4) universal chlorhexidine gluconate baths; (5) universal decolonization; (6) UCP + chlorhexidine gluconate baths; and (7) UCP+decolonization. For each strategy, both efficacy and compliance were considered. Outcomes of interest were: (1) MRSA colonization averted; (2) MRSA infection averted; (3) incremental cost per colonization averted; (4) incremental cost per infection averted.RESULTSA total of 1989 cases of colonization and 544 MRSA invasive infections occurred under standard precautions per 10,000 patients. Universal decolonization was the least expensive strategy and was more effective compared with all strategies except UCP+decolonization and UCP+chlorhexidine gluconate. UCP+decolonization was more effective than universal decolonization but would cost $2469 per colonization averted and $9007 per infection averted. If MRSA colonization prevalence decreases from 12% to 5%, active surveillance cultures plus selective decolonization becomes the least expensive strategy.CONCLUSIONSUniversal decolonization is cost-saving, preventing 44% of cases of MRSA colonization and 45% of cases of MRSA infection. Our model provides useful guidance for decision makers choosing between multiple available hospital-based strategies to prevent MRSA transmission.Infect Control Hosp Epidemiol 2015;36(1): 17–27

Longitudinal Evaluation of Clinical and Colonization Methicillin-Resistant Staphylococcus aureus Isolates Among Veterans

2015 ◽  
Vol 36 (5) ◽  
pp. 587-589 ◽  
Author(s):  
Edward Stenehjem ◽  
Emily K. Crispell ◽  
David Rimland ◽  
Monica M. Farley ◽  
Sarah W. Satola
Keyword(s):  
Staphylococcus Aureus ◽  
Genetic Relatedness ◽  
Surveillance Program ◽  
Veterans Health ◽  
Health Administration ◽  
Methicillin Resistant ◽  
Infection Surveillance ◽  
The Usa ◽  
Mrsa Infection ◽  
Mrsa Colonization

Using the Veterans’ Health Administration MRSA Directive as a platform to collect methicillin-resistant Staphylococcus aureus (MRSA) colonization isolates and an active MRSA infection surveillance program, the genetic relatedness of colonization and infection isolates was evaluated. Infection and colonization strain concordance was found in 85.7% of patients. The USA 500 MRSA strain was identified in 31.8% of patients.Infect Control Hosp Epidemiol 2015;00(0): 1–3

Palliative Radiotherapy Within the Veterans Health Administration: Barriers to Referral and Timeliness of Treatment

2021 ◽  
pp. OP.20.00981
Author(s):  
Ruchika Gutt ◽  
Sheetal Malhotra ◽  
Michael P. Hagan ◽  
Steve P. Lee ◽  
Katherine Faricy-Anderson ◽  
...  
Keyword(s):  
Palliative Radiotherapy ◽  
Veterans Health Administration ◽  
Cord Compression ◽  
Veterans Health ◽  
Radiation Oncologist ◽  
Health Administration ◽  
Chi Square ◽  
Palliative Radiation Therapy ◽  
Chi Square Analysis ◽  
The Impact

PURPOSE: Most Veterans Health Administration hospitals do not have radiation oncology (RO) departments on-site. The purpose of this study is to determine the impact of on-site RO on referral patterns and timeliness of palliative radiation therapy (PRT). MATERIALS AND METHODS: A survey was sent to medical directors at 149 Veterans Health Administration centers. Questions evaluated frequency of referral for PRT, timeliness of RO consults and treatment, and barriers to referral for PRT. Chi-square analysis was used to evaluate differences between centers that have on-site RO and centers that refer to outside facilities. RESULTS: Of 108 respondents, 33 (31%) have on-site RO. Chi-square analysis revealed that RO consult within 1 week is more likely at centers with on-site RO (68% v 31%; P = .01). Centers with on-site RO more frequently deliver PRT for spinal cord compression within 24 hours (94% v 70%; P = .01). Those without on-site RO were more likely to want increased radiation oncologist involvement (64% v 26%; P < .001). Barriers to referral for PRT included patient ability to travel (81%), patient noncompliance (31%), delays in consult and/or treatment (31%), difficulty contacting a radiation oncologist (14%), and concern regarding excessive number of treatments (13%). Respondents with on-site RO less frequently reported delays in consult and/or treatment (6% v 41%; P < .0001) and difficulty contacting a radiation oncologist (0% v 20%; P = .0056) as barriers. CONCLUSION: Respondents with on-site RO reported improved communication with radiation oncologists and more timely consultation and treatment initiation. Methods to improve timeliness of PRT for veterans at centers without on-site RO should be considered.

Abstract 244: Real World Evaluation of Implementing a Mock Cardiac Arrest Program

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Brad Trumpower ◽  
Lee A Kamphuis ◽  
Joseph McEvoy ◽  
Pamela J Weber ◽  
Sarah Krein ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Training Program ◽  
Program Implementation ◽  
Medical Center ◽  
Veterans Health ◽  
Health Administration ◽  
Response Team ◽  
Study Team ◽  
National Initiative ◽  
Data Elements

Introduction: In 2019, the Veterans Health Administration (VHA) began rolling out a national initiative to create a standardized mock code training program through the Resuscitation Education Initiative (REdI). We partnered with REdI and the local REdI Mock Code Program team at a Midwestern VA medical center to evaluate the launch of this mock cardiac arrest training program using a mixed methods approach. Methods: The REdI mock cardiac arrest program provided training to VA medical center clinical and non-clinical staff using didactic, small group, and hands-on simulation activities over a 2-day site visit in January 2019 where all facets of the resuscitation team were reviewed. Following this training visit at one VA medical center, 10 mock cardiac arrests were conducted between March 2019 and December 2019. One mock cardiac arrest included a hospital-wide activation and nine were conducted on individual units without activation of the cardiac arrest response team. The research team was composed of clinical and methodological experts who observed 8 of the mock cardiac arrests. We used an observation template to record structured data elements and take field notes during the mock code (e.g., how participants made decisions, assigned roles and quality of communication between the participants). At the end of the mock code, facilitators and the study team collected oral and written feedback from the participants. Results: In the 8 mock cardiac arrests observed, we identified 54 participants. Participants overwhelmingly rated the mock cardiac arrests as positive (83.3%, 45/54). Debriefing-feedback after the mock cardiac arrest was identified as the most helpful aspect (42.6%, 23/54). Areas for improving implementation of the mock cardiac arrest training program focused primarily on the need for a better introduction to the exercise. This included understanding the manikin’s functionality (9.3%, 5/54) and the expectation that participants should perform CPR just as they would in an actual cardiac arrest event (7.4%, 4/54). Two critical takeaways frequently cited by participants related to performance during the mock cardiac arrest were a need for better communication (20.4%, 11/54) and defined roles (18.5%, 10/54). Conclusions: Implementation of a mock cardiac arrest program was positively received by participants at a VA medical center. Moreover, participants identified both opportunities for improving resuscitation performance and optimizing learning experiences as part of program implementation.

scholarly journals Impact of Availability of Telehealth Programs on Documented HIV Viral Suppression: A Cluster-Randomized Program Evaluation in the Veterans Health Administration

2019 ◽  
Vol 6 (6) ◽  
Author(s):  
Michael E Ohl ◽  
Kelly Richardson ◽  
Maria C Rodriguez-Barradas ◽  
Roger Bedimo ◽  
Vincent Marconi ◽  
...  
Keyword(s):  
Primary Care ◽  
Viral Suppression ◽  
Veterans Health ◽  
Health Administration ◽  
Primary Care Clinics ◽  
Intention To Treat ◽  
Service Areas ◽  
Hiv Viral Suppression ◽  
Cluster Randomized ◽  
The Impact

Abstract Background Telehealth may improve care for people with HIV who live far from HIV specialty clinics. We conducted a cluster-randomized evaluation to determine the impact of availability of HIV telehealth programs on documented viral suppression in Veterans Administration clinics. Methods In 2015–2016, people who previously traveled to HIV specialty clinics were offered telehealth visits in nearby primary care clinics. Patients were cluster-randomized to immediate telehealth availability (n = 925 patients in service areas of 13 primary care clinics offering telehealth) or availability 1 year later (n = 745 patients in 12 clinics). Measures during the evaluation year included telehealth use among patients in areas where telehealth was available and documented HIV viral suppression (viral load performed and &lt;200 copies/mL). Impact of telehealth availability was determined using intention-to-treat (ITT) analyses that compared outcomes for patients in areas where telehealth was available with outcomes for patients where telehealth was not available, regardless of telehealth use. Complier average causal effects (CACEs) compared outcomes for telehealth users with outcomes for control patients with equal propensity to use telehealth, when available. Results Overall, 120 (13.0%) patients utilized telehealth when it was available. Availability of telehealth programs led to small improvements in viral suppression in ITT analyses (78.3% vs 74.1%; relative risk [RR], 1.06; 95% confidence interval [CI], 1.01 to 1.11) and large improvements among telehealth users in CACE analyses (91.5% vs 80.0%; RR, 1.14; 95% CI, 1.01 to 1.30). Conclusions Availability of telehealth programs improved documented viral suppression. HIV clinics should offer telehealth visits for patients facing travel burdens.

Patient Safety Trilogy: Perspectives from Clinical Engineering

2013 ◽  
Vol 47 (2) ◽  
pp. 137-142 ◽  
Author(s):  
Izabella Gieras ◽  
Paul Sherman ◽  
Dennis Minsent
Keyword(s):  
Patient Safety ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Engineering ◽  
Veterans Health ◽  
Health Administration ◽  
Healthcare Technology ◽  
Academic Medical ◽  
Clinical Engineers

This article examines the role a clinical engineering or healthcare technology management (HTM) department can play in promoting patient safety from three different perspectives: a community hospital, a national government health system, and an academic medical center. After a general overview, Izabella Gieras from Huntington Hospital in Pasadena, CA, leads off by examining the growing role of human factors in healthcare technology, and describing how her facility uses clinical simulations in medical equipment evaluations. A section by Paul Sherman follows, examining patient safety initiatives from the perspective of the Veterans Health Administration with a focus on hazard alerts and recalls. Dennis Minsent from Oregon Health & Science University writes about patient safety from an academic healthcare perspective, and details how clinical engineers can engage in multidisciplinary safety opportunities.

scholarly journals Shift to community-onset Clostridium difficile infection in the national Veterans Health Administration, 2003-2014

2018 ◽  
Vol 46 (4) ◽  
pp. 431-435 ◽  
Author(s):  
Kelly R. Reveles ◽  
Mary Jo V. Pugh ◽  
Kenneth A. Lawson ◽  
Eric M. Mortensen ◽  
Jim M. Koeller ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Community Onset

Academic Detailing to Reduce Sedative-Hypnotic Prescribing in Older Veterans

2019 ◽  
pp. 089719001987094 ◽  
Author(s):  
Addison P. Ragan ◽  
Garrett B. Aikens ◽  
Mark Bounthavong ◽  
Kevin Brittain ◽  
Anna Mirk
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Benzodiazepine Receptor ◽  
Educational Outreach ◽  
Potentially Inappropriate Medications ◽  
Veterans Health ◽  
Academic Detailing ◽  
Health Administration ◽  
Prescribing Trends ◽  
The Impact

Background: Sedative-hypnotics, including benzodiazepines (BZDs) and benzodiazepine receptor agonists (BZD-RA), are considered potentially inappropriate medications (PIMs) in older adults. Academic detailing, an educational outreach delivered by trained clinicians to other clinicians to encourage evidence-based care, can promote deprescribing of PIMs. Objective: To evaluate the impact of academic detailing on sedative-hypnotic prescribing to older veterans. Methods: A retrospective analysis was performed to evaluate the impact of academic detailing on BZD and BZD-RA prescribing to veterans aged 75 years and older. Prescribing trends for primary care and mental health prescribers in the Veterans Health Administration (VA) Southeast Network were calculated for the 18 months before and after an initial academic detailing session for each prescriber. Pre–post interrupted time series analyses (ITSAs) were conducted, and period prevalence was calculated as the number of prescriptions per 1000 older veterans. Results: A total of 155 prescribers were followed for 36 months. BZD prevalence declined by 23% (69.08-53.33 per 1000 population; P < .001) and by 15% for BZD-RA (18.07-15.38 per 1000 population; P < .001). New starts on BZD declined by 54% (2.36-1.09 per 1000 population; P < .001) and new starts on BZD-RA declined by 53% (1.02-0.48 per 1000 population; P < .001). Alternative medications for insomnia increased by 23% (39.98-49.27 per 1000 population; P < .001). Findings from the ITSA confirmed those of the pre–post analysis with sustained effects in the postintervention period. Conclusions: Academic detailing was associated with reduced sedative-hypnotic prescribing in the primary care and mental health setting.

Colonization With Methicillin-Resistant Staphylococcus aureus in ICU Patients Morbidity, Mortality, and Glycopeptide Use

2001 ◽  
Vol 22 (11) ◽  
pp. 687-692 ◽  
Author(s):  
Maité Garrouste-Orgeas ◽  
Jean-Francois Timsit ◽  
Hatem Kallel ◽  
Adel Ben Ali ◽  
Marie Francoise Dumay ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Tertiary Care ◽  
Icu Mortality ◽  
Icu Patients ◽  
Methicillin Resistant ◽  
Saps Ii ◽  
Icu Stay ◽  
Mrsa Infection ◽  
The Impact ◽  
Mrsa Colonization

Abstract Objective: To determine the impact of methicillin-resis-tant Staphylococcus aureus (MRSA) colonization on the occurrence of S aureus infections (methicillin-resistant and methicillin-suscep-tible), the use of glycopeptides, and outcome among intensive care unit (ICU) patients. Design: Prospective observational cohort survey. Setting: A medical-surgical ICU with 10 single-bed rooms in a 460-bed, tertiary-care, university-affiliated hospital. Patients: A total of 1,044 ICU patients were followed for the detection of MRSA colonization from July 1, 1995, to July, 1 1998. Methods: MRSA colonization was detected using nasal samples in all patients plus wound samples in surgical patients within 48 hours of admission or within the first 48 hours of ICU stay and weekly thereafter. MRSA infections were defined using Centers for Disease Control and Prevention standard definitions, except for ventilator-associated pneumonia and catheter-related infections, which were defined by quantitative distal culture samples. Results: One thousand forty-four patients (70% medical patients) were included in the analysis. Mean age was 61±18 years; mean Simplified Acute Physiologic Score (SAPS) II was 36.4±20; and median ICU stay was 4 (range, 1-193) days. Two hundred thirty-one patients (22%) died in the ICU. Fifty-four patients (5.1%) were colonized with MRSA on admission, and 52 (4.9%) of 1,044 acquired MRSA colonization in the ICU. Thirty-five patients developed a total of 42 S aureus infections (32 MRSA, 10 methi-cillin-susceptible). After factors associated with the development of an S aureus infection were adjusted for in a multivariate Cox model (SAPS II &gt;36: hazard ratio [HR], 1.64; P=.09; male gender: HR, 2.2; P=.05), MRSA colonization increased the risk of S aureus infection (HR, 3.84; P=.0003). MRSA colonization did not influence ICU mortality (HR, 1.01; P=.94). Glycopeptides were used in 11.4% of the patients (119/1,044) for a median duration of 5 days. For patients with no colonization, MRSA colonization on admission, and ICU-acquired MRSA colonization, respectively, glycopeptide use per 1,000 hospital days was 37.7, 235.2, and 118.3 days. MRSA colonization per se increased by 3.3-fold the use of glycopeptides in MRSA-colonized patients, even when an MRSA infection was not demonstrated, compared to non-colonized patients. Conclusions: In our unit, MRSA colonization greatly increased the risk of S aureus infection and of glycopeptide use in colonized and non-colonized patients, without influencing ICU mortality. MRSA colonization influenced glycopeptide use even if an MRSA infection was not demonstrated; thus, an MRSA control program is warranted to decrease vancomycin use and to limit glycopeptide resistance in gram-positive cocci.

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