scholarly journals Crossmatch to Transfusion Ratios in the Operating Room with an Expanding Hospital Footprint

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S159-S159
Author(s):  
M S Virk
Keyword(s):  
Operating Room ◽  
Blood Product ◽  
Qualitative Interviews ◽  
The United States ◽  
Blood Bank ◽  
University Hospital ◽  
Post Intervention ◽  
Improvement Project ◽  
Surgical Subspecialty ◽  
Surgical Teams

Abstract Introduction/Objective The crossmatch to transfusion (CT) ratio is one of several metrics used to assess the efficiency of blood product utilization. A ratio of 2:1 has been suggested as a hospitalwide limit that indicates appropriate use of red blood cells (RBCs), and the Q Probe Study found that the average CT ratio for hospitals in the United States is 1.85:1. This ratio can vary widely from one patient location to another due to anticipatory or unknown needs within the operating room (OR) compared to laboratory or symptomatic based orders for patients on the floor. Following a recent hospital expansion at Stanford University Hospital that led to the creation of multiple adult OR locations and a move of our blood bank, we monitored the CT ratios of various OR locations and surgical subspecialties to assess the drivers of increased blood product utilization and interventions that could improve these metrics. Methods/Case Report This quality improvement project involved the collection of blood product order information through our LIS (SafeTrace) and clinical system (EPIC), creation of an on-demand report to provide constant updates to that data, qualitative interviews with OR staff, and process mapping for multiple subspecialties. Results (if a Case Study enter NA) Prior to our hospital expansion there was an appropriate CT ratio of 2.1:1 in our adult ORs. Post-expansion, this ratio has been between 3-5:1, depending on the OR location. This led us to focus our efforts on the OR locations that were furthest from the blood bank and existed prior to the hospital expansion. In discussions with our OR colleagues, we found that the major driver for this increased ratio was a longer travel path for blood products and delays in delivery which led to larger amounts of anticipatory orders. In addition, these concerns caused duplicative efforts in the OR with surgical teams and Anesthesiologists placing pre-operative orders for the same cases. To address this concern, remote blood product dispensing was implemented. To address duplicative ordering workflows, we partnered with Anesthesiology to determine the blood ordering workflow agreements with each surgical subspecialty to ensure appropriate division of roles and responsibilities. Evaluation of CT ratios after these interventions is ongoing, but early data suggests a significant reduction. Conclusion Post-intervention phase ongoing and will be updated with additional data & conclusions prior to conference.

Operating Room Blood Delivery Turnaround Time

2002 ◽  
Vol 126 (8) ◽  
pp. 909-914 ◽  
Author(s):  
David A. Novis ◽  
Richard C. Friedberg ◽  
Stephen W. Renner ◽  
Frederick A. Meier ◽  
Molly K. Walsh
Keyword(s):  
United States ◽  
Operating Room ◽  
Median Time ◽  
The United States ◽  
Blood Bank ◽  
Blood Component ◽  
Blood Components ◽  
Improvement Program ◽  
Delivery Times ◽  
Blood Banks

Abstract Objectives.—To determine the normative distribution of time elapsed for blood bank personnel to fill nonscheduled operating room (OR) blood component orders in hospital communities throughout the United States, and to examine hospital blood bank practices associated with faster blood component delivery times. Design.—Participants in the College of American Pathologists Q-Probes laboratory quality improvement program collected data prospectively on the times elapsed for blood bank personnel to fill nonscheduled emergent orders from hospital ORs for red blood cell (RBC) products, fresh frozen plasma (FFP), and platelets (PLTs). Participants also completed questionnaires describing their hospitals' and blood banks' laboratory and transfusion practices. Setting and Participants.—Four hundred sixty-six public and private institutions located in 48 states in the United States (n = 444), Canada (n = 9), Australia (n = 8), the United Kingdom (n = 4), and Spain (n = 1). Main Outcome Measures.—The median time elapsed between requests for blood components by OR personnel and the retrieval of those components by blood component transport personnel, and the median time elapsed between requests for blood components by OR personnel and the arrival of those components in ORs. Results.—Participants submitted data on 12 647 units of RBCs, FFP, and PLTs. The median aggregate request-to-retrieval turnaround times (TATs) for RBCs, FFP, and PLTs ranged from 30 to 35 minutes, and the median aggregate request-to-arrival TATs for RBCs, FFP, and PLTs ranged from 33 to 39 minutes. Most of the TAT was consumed by events occurring prior to, rather than after release of components from blood banks. Shorter prerelease TATs were associated with having surgical schedules that listed patients' names and procedures available to blood bank personnel prior to surgeries, and having adequate clotted specimens in the blood bank and completed type-and-screen procedures performed before requests for blood components were submitted to blood banks. Among the fastest-performing 10% of participants (90th percentile and above), request-to-retrieval TATs ranged from 12 to 24 minutes for the 3 blood components, whereas among the slowest-performing 10% of participants (10th percentile and below), request-to-retrieval TATs ranged from 63 to 115 minutes for the 3 components. Median TATs ranged from 33 to 37 minutes for the 3 components. Institutions with TATs in the fastest-performing 25th percentile more frequently stored cross-matched RBCs in the OR daily, stocked PLTs for unexpected surgical use, stored PLTs in or near the OR, and had laboratory rather than nonlaboratory personnel deliver components to the OR than did those institutions with TATs in the slowest-performing 25th percentile. Conclusions.—Hospital blood bank personnel can deliver blood components to the OR in slightly longer than 30 minutes, measured from the time that those units are requested by OR personnel. Practices aimed at saving time before components are released from blood banks will be more efficient in reducing overall TAT than those practices aimed at saving time after components are released from blood banks. Specific practices associated with shorter blood delivery TATs included providing blood bank personnel with access to the names of surgical patients potentially requiring blood components, having pretransfusion testing completed on those patients prior to surgery, having ample blood products on hand, and having laboratory personnel control blood product delivery.

Optimization of inpatient chemotherapy administration utilizing evaluation intervals.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 75-75
Author(s):  
Sabarina Ramanathan ◽  
Avani Yenamandra ◽  
Aparna Vuppala ◽  
Khine Shan ◽  
Hugo R. Lara-Martinez ◽  
...  
Keyword(s):  
Interdisciplinary Approach ◽  
Primary Outcome Measure ◽  
University Hospital ◽  
Post Intervention ◽  
Improvement Project ◽  
Equal Distribution ◽  
Chemotherapy Administration ◽  
Time Stamps ◽  
Patient Arrival ◽  
Chemotherapy Initiation

75 Background: Inpatient chemotherapy requires an interdisciplinary approach to achieve shorter hospital stays and decrease cost. A quality improvement project at Hahnemann University Hospital was undertaken to identify delays in the process from admission to chemotherapy initiation in this population. Methods: Time stamps were recorded for patient arrival (door to floor), order placement (floor to order), and administration (order to chemo) to establish a baseline. A multidisciplinary team of pharmacy, nursing, and physicians was developed to address inefficiencies. There were three evaluation intervals: May - October 2015 (Part I), January 2017 - October 2018 (Part II) and October - December 2018 (Part III). Data collected from Part I established a baseline door-to-chemo time (DTC) of 7.2 hrs. Post Part I, prompt communication of patient arrival and delays in chemotherapy hanging were addressed. Part II interventions were outpatient consents and labs, timely order placement, and utilization of order sets. Pharmacy-nurse communication and equal distribution of patients through the week was implemented in Part III. The primary outcome measure was difference in DTC. Results: 200 admissions were reviewed. Results of the evaluation intervals are shown in Table. After the first evaluation interval, DTC improved from 7.18 to 5.96 hrs. DTC further decreased to 5.78 hrs post intervention II. The longest delay was between chemotherapy order and administration. Conclusions: DTC significantly improved between intervals with the above interventions. Utilizing a standardized nursing checklist and biweekly multidisciplinary meetings to emphasize prioritization will further decrease DTC. DTC reduction will decrease cost and increase patient satisfaction. [Table: see text]

A Procedure for Rapid Issue of Red Cells for Emergency Use

2005 ◽  
Vol 129 (4) ◽  
pp. 492-496
Author(s):  
Richard B. Weiskopf ◽  
Mary Webb ◽  
Deena Stangle ◽  
Gunter Klinbergs ◽  
Pearl Toy
Keyword(s):  
Red Blood Cells ◽  
Operating Room ◽  
Blood Cells ◽  
Blood Bank ◽  
Red Cells ◽  
University Hospital ◽  
Delivery Time ◽  
Delivery Times ◽  
The Times ◽  
Time Required

Abstract Context.—A College of American Pathologists Q-Probe revealed that the median turnaround times for emergency requests for red blood cells from the operating room were 30 minutes to release of cells from the blood bank and 34 minutes to delivery to the operating room. These times may not be adequate to permit the red cells to provide sufficiently rapid delivery of oxygen in massively bleeding patients. Objective.—To improve the time from emergency request for red cells to delivery to the operating room. Design.—A new emergency issue program was implemented for only the operating rooms; emergency issue to all other hospital locations remained unchanged. Six units of group O Rh-negative red blood cells (RBCs) are maintained in the blood bank in a separate basket with transfusion forms containing the unit numbers and expiration dates and a bag with one blood tubing segment from each unit. The times to issue and to delivery to the operating room suite were compared with time to issue of 2 group O Rh-negative RBCs for other hospital locations using the older system during the same time period and with the time to issue of 2 units to all other hospital locations during the preceding 2 years. Setting.—A university hospital. Main Outcome Measures.—Time between emergency request for red cells and delivery to the operating room. Results.—The time between blood bank notification and arrival in the operating room of the 6 units of RBCs was significantly shorter than the time required to just issue (not including delivery time) 2 units of RBCs to other hospital locations. With the new procedure, 82% of units issued reached the operating room within 2 minutes of request, 91% arrived within 3 minutes, and 100% arrived within 4 minutes. These percentages are significantly higher than those for only issue of blood (without delivery) using the older issuing procedure for all hospital locations during the previous 2 years (37%, 49%, and 66%, respectively; P = .007, .009, and .02, respectively) and for other locations during the same 7-month period (29%, 46%, and 73%, respectively; P = .004, .01, and .09, respectively). Time (mean [95% confidence interval]) from blood bank notification to delivery of RBCs to the operating room suite (2.1 [1.6–2.6] minutes, of which approximately 50–60 seconds is attributable to delivery time) was less than issue times (not including delivery times) using the older issuing procedure for other hospital locations during the same period (4.1 [3.1–5.0] minutes; P = .007). Conclusions.—An emergency issue procedure can be used to issue several units of RBCs within 1 minute and have them delivered to the operating room within 2 minutes while maintaining sufficient controls and providing required information to satisfy patient and blood bank requirements.

scholarly journals Surgical site infection prevention: An analysis of compliance with good practice in a teaching hospital

2017 ◽  
Vol 18 (6) ◽  
pp. 301-306 ◽  
Author(s):  
Adriana Cristina de Oliveira ◽  
Camila Sarmento Gama
Keyword(s):  
Surgical Site Infection ◽  
Operating Room ◽  
Infection Prevention ◽  
Good Practice ◽  
Critical Role ◽  
University Hospital ◽  
Site Infection ◽  
Cross Sectional ◽  
Belo Horizonte ◽  
Surgical Teams

Background: Surgical teams play a critical role in reducing surgery-related risks during preoperative and intraoperative phases. Aim: To analyse the preoperative and intraoperative practices adopted by surgical teams in surgical site infections prevention. Methods: This was a cross-sectional study conducted during April–September 2013 in a large university hospital in Belo Horizonte, Minas Gerais, Brazil. It was conducted through observation of the surgical practice during preoperative and intraoperative phases of procedures used by a gastroenterological, cardiovascular and paediatric surgical team. Results: A total of 100 surgeries were monitored. Hair removal was performed for 20% of the patients inside the operating room by professionals using clippers in 65% of operations. The antimicrobial agent of choice was appropriate/satisfactory in 62% of the operations and administered up to 60 min before surgical incision in 90.3% of the cases. The operating room door was kept closed in 4% of these procedures. Discussion: Some preoperative measures for surgical site infection prevention were not adhered to by the professionals who were monitored in this study. It is recommended that surgical teams undergo professional surveillance and training to highlight the necessity and importance of implementing measures to improve the quality of care provided to surgical patients.

scholarly journals An opportunistic evaluation of a routine service improvement project to reduce falls in hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Diane Sheppard ◽  
Elaine Clarke ◽  
Karla Hemming ◽  
James Martin ◽  
Richard Lilford
Keyword(s):  
Time Series ◽  
Health Research ◽  
Research Collaboration ◽  
Safety Issue ◽  
Routine Data ◽  
University Hospital ◽  
Service Improvement ◽  
Post Intervention ◽  
Improvement Project ◽  
Roll Out

Abstract Background Preventing falls in hospital is a perennial patient safety issue. The University Hospital Coventry and Warwickshire initiated a programme to train ward staff in accordance with guidelines. The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West Midlands was asked to expedite an independent evaluation of the initiative. We set out to describe the intervention to implement the guidelines and to evaluate it by means of a step-wedge cluster study using routinely collected data. Methods The evaluation was set up as a partially randomised, step-wedge cluster study, but roll-out across wards was more rapid than planned. The study was therefore analysed as a time-series. Primary outcome was rate of falls per 1000 Occupied Bed Days (OBDs) collected monthly using routine data. Data was analysed using a mixed-effects Poisson regression model, with a fixed effect for intervention, time and post-intervention time. We allowed for random variations across clusters in initial fall rate, pre-intervention slope and post-intervention slope. Results There was an average of 6.62 falls per 1000 OBDs in the control phase, decreasing to an average of 5.89 falls per 1000 OBDs in the period after implementation to the study end. Regression models showed no significant step change in fall rates (IRR: 1.02, 95% CI: 0.92–1.14). However, there was a gradual decrease, of approximately 3%, after the intervention was introduced (IRR: 0.97 per month, 95% CI: 0.95–0.99). Conclusion The intervention was associated with a small but statistically significantly improvement in falls rates. Expedited roll-out of an intervention may vitiate a step-wedge cluster design, but the intervention can still be studied using a time-series analysis. Assuming that there is some value in time series analyses, this is better than no evaluation at all. However, care is needed in making causal inferences given the non-experimental nature of the design.

The effect of obesity on operating room (OR) utilization in breast surgery.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 36-36
Author(s):  
Julie Dunderdale ◽  
Borko Jovanovic ◽  
Swati Kulkarni
Keyword(s):  
Lymph Node ◽  
Operating Room ◽  
Breast Surgery ◽  
The United States ◽  
Axillary Lymph ◽  
Improvement Project ◽  
Highest Weight ◽  
Significant Difference ◽  
Patient Weight ◽  
The Difference

36 Background: More than one-third of adults in the United States are obese. Studies have shown that obesity-related comorbidities increase health care costs, but the effect of obesity on operating room utilization has not been completely evaluated. The purpose of our study was to examine how operative time (OPT) for common procedures in breast surgery is affected by patient weight. We expected that weight affected OPT more so for extensive procedures, such as axillary lymph node dissection (ALND) and mastectomy, than for minimally invasive procedures, such as lumpectomy and sentinel lymph node biopsy (SLNB). Methods: OPT and weight for ten breast surgeries were analyzed from the American College of Surgeons 2010 National Surgical Quality Improvement Project database. Only women were included, and those who underwent additional procedures or had incomplete data were excluded. Patients were divided into three groups based on their weight (<135 lbs, 135-199 lbs, and ≥200 lbs). Using the two-sample t-test, OPT for the procedures was compared among the lowest and highest weight categories. We specifically looked at lumpectomy, lumpectomy plus SLNB, ALND, mastectomy, and modified radical mastectomy (MRM). Results: In all, 16,077 patients were included in the analysis. When the lowest and highest weight groups (<135 lbs and ≥200 lbs) were compared for all procedures, a significant difference of 13 min was seen (p<0.0001). For these same groups, a significant, but not relevant for scheduling, difference in OPT was noted for lumpectomy alone (37 vs. 41 min, p<0.0001) and lumpectomy plus SLNB (71 vs. 80 min, p<0.0001). However, weight affected ALND and mastectomy more drastically. The difference for lumpectomy plus ALND was 22 min (93 vs. 115 min, p=0.0004), while the differences for simple mastectomy and mastectomy plus SLNB were 24 min (89 vs. 113 min, p<0.0001) and 23 min (102 vs. 125 min, p<0.0001), respectively. In addition, the difference for MRM was 22 min (104 vs. 126 min, p<0.0001). Conclusions: Patient weight does significantly affect OPT for lumpectomy and SLNB, but the difference is much greater for ALND, mastectomy, and MRM. Therefore, when scheduling more extensive procedures for obese patients, additional time should be allotted to improve OR utilization.

scholarly journals Effect of student-directed solicitation of evaluation forms on the timeliness of completion by preceptors in the United States

2019 ◽  
Vol 16 ◽  
pp. 32
Author(s):  
Conrad Krawiec ◽  
Vonn Walter ◽  
Abigail Kate Myers
Keyword(s):  
Medical Students ◽  
Clinical Training ◽  
Clinical Performance ◽  
The United States ◽  
Summative Evaluation ◽  
Training Experience ◽  
Post Intervention ◽  
Improvement Project ◽  
Intervention Phase ◽  
Evaluation Form

Purpose: Summative evaluation forms assessing a student’s clinical performance are often completed by a faculty preceptor at the end of a clinical training experience. At our institution, despite the use of an electronic system, timeliness of completion has been suboptimal, potentially limiting our ability to monitor students’ progress. The aim of the present study was to determine whether a student-directed approach to summative evaluation form collection at the end of a pediatrics clerkship would enhance timeliness of completion for third-year medical students. Methods: This was a pre- and post-intervention educational quality improvement project focused on 156 (82 pre-intervention, 74 post-intervention) third-year medical students at Penn State College of Medicine completing their 4-week pediatric clerkship. Utilizing REDCap (Research Electronic Data Capture) informatics support, student-directed evaluation form solicitation was encouraged. The Wilcoxon rank-sum test was applied to compare the pre-intervention (May 1, 2017 to March 2, 2018) and post-intervention (April 2, 2018 to December 21, 2018) percentages of forms completed before the rotation midpoint.Results: In total, 740 evaluation forms were submitted during the pre-intervention phase and 517 during the post-intervention phase. The percentage of forms completed before the rotation midpoint increased after implementing student-directed solicitation (9.6% vs. 39.7%, P<0.05).Conclusion: Our clerkship relies on subjective summative evaluations to track students’ progress, deploy improvement strategies, and determine criteria for advancement; however, our preceptors struggled with timely submission. Allowing students to direct the solicitation of evaluation forms enhanced the timeliness of completion and should be considered in clerkships facing similar challenges.

Effectiveness of a vancomycin dosing protocol guided by area under the concentration-time curve to minimal inhibitory concentration (AUC/MIC) with multidisciplinary team support to improve hospital-wide adherence to a vancomycin dosing protocol: A pilot study

2021 ◽  
pp. 1-6
Author(s):  
Panipak Katawethiwong ◽  
Anucha Apisarnthanarak ◽  
Kittiya Jantarathaneewat ◽  
David J. Weber ◽  
David K. Warren ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Multidisciplinary Team ◽  
Kidney Injury ◽  
University Hospital ◽  
Routine Practice ◽  
Post Intervention ◽  
Coagulase Negative Staphylococci ◽  
Time Curve ◽  
Concentration Time ◽  
Quasi Experimental

Abstract Background: Limited data are available on the implementation of an area under the concentration-time curve (AUC)–based dosing protocol with multidisciplinary team (MT) support to improve adherence with vancomycin dosing protocol. Objective: To evaluate the effectiveness of an AUC-based dosing protocol with MT support intervention with adherence to a hospital-wide vancomycin dosing protocol at Thammasat University Hospital. Method: We conducted a quasi-experimental study in patients who were prescribed intravenous vancomycin. The study was divided into 2 periods; (1) the preintervention period when the vancomycin dosing protocol was already applied in routine practice and (2) the post-intervention period when the implementation of an AUC-based dosing protocol with MT support was added to the existing vancomycin dosing protocol. The primary outcome was the rate of adherence, and the secondary outcomes included acute kidney injury events, vancomycin-related adverse events, and 30-day mortality rate. Results: In total, 240 patients were enrolled. The most common infections were skin and soft-tissue infections (24.6%) and bacteremia (24.6%). The most common pathogens were coagulase-negative staphylococci (19.6%) and Enterococcus spp (15.4%). Adherence with the vancomycin dosing protocol was significantly higher in the postintervention period (90.8% vs 55%; P ≤ .001). By multivariate analysis, an AUC-based dosing protocol with MT support was the sole predictor for adherence with the vancomycin dosing protocol (adjusted odds ratio, 10.31; 95% confidence interval, 4.54–23.45; P ≤ .001). The 30-day mortality rate was significantly lower during the postintervention period (8.3% vs 20%; P = .015). Conclusions: AUC-based dosing protocol with MT support significantly improved adherence with vancomycin dosing protocol and was associated with a lower 30-day mortality rate.

scholarly journals Treating sleep problems in young people at ultra-high-risk of psychosis: study protocol for a single-blind parallel group randomised controlled feasibility trial (SleepWell)

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e045235
Author(s):  
Felicity Waite ◽  
Thomas Kabir ◽  
Louise Johns ◽  
Jill Mollison ◽  
Apostolos Tsiachristas ◽  
...  
Keyword(s):  
Mental Health ◽  
High Risk ◽  
Young People ◽  
Sleep Problems ◽  
Qualitative Interviews ◽  
Feasibility Trial ◽  
Psychotic Experiences ◽  
Post Intervention ◽  
Ultra High Risk ◽  
Randomised Controlled

BackgroundEffective interventions, targeting key contributory causal factors, are needed to prevent the emergence of severe mental health problems in young people. Insomnia is a common clinical issue that is problematic in its own right but that also leads to the development and persistence of psychotic experiences. The implication is that treating sleep problems may prevent the onset of psychosis. We collected initial case series data with 12 young people at ultra-high-risk of psychosis. Post-intervention, there were improvements in sleep, depression and psychotic experiences. Now we test the feasibility of a randomised controlled trial, with a clinical aim to treat sleep problems and hence reduce depression, psychotic experiences, and prevent transition to psychosis.Methods and analysisA randomised controlled feasibility trial will be conducted. Forty patients aged 14 to 25 years who are at ultra-high-risk of psychosis and have sleep disturbance will be recruited from National Health Service (NHS) mental health services. Participants will be randomised to receive either a novel, targeted, youth-focussed sleep intervention in addition to usual care or usual care alone. Assessor-blinded assessments will be conducted at baseline, 3 months (post-intervention) and 9 months (follow-up). The eight-session psychological intervention will target the key mechanisms which disrupt sleep: circadian rhythm irregularities, low sleep pressure, and hyperarousal. To gain an in-depth understanding of participants’ views on the acceptability of the intervention and study procedures, 16 participants (n=10 intervention, n=6 control) will take part in qualitative interviews. Analyses will focus on feasibility outcomes (recruitment, retention, and treatment uptake rates) and provide initial CI estimates of intervention effects. Thematic analysis of the qualitative interviews will assess the acceptability of the intervention and trial procedures.Ethics and disseminationThe trial has received ethical approval from the NHS Health Research Authority. Findings will be disseminated through peer-reviewed publications, conference presentations, and lay networks.Trial registration numberISRCTN85601537.

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.

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