scholarly journals Infection Control in Small Residential Care Settings: Insights From a National Survey and Washington State Data

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 980-980
Author(s):  
Carolyn Ham ◽  
Anna Unutzer
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Residential Care ◽  
Online Survey ◽  
Family Care ◽  
Environmental Safety ◽  
Washington State ◽  
Residential Home ◽  
Health Staff ◽  
Term Care

Abstract Infection control is a vital issue in long-term care, and the increasing popularity of small residential care facilities (SRCF) raises questions about the effectiveness of this model for preventing facility-acquired infections. In SRCF, care is provided in a residential home to a small number of residents. The setting lacks common terminology, and states license SRCF under various titles including Adult Family Homes, Adult Foster Homes and Family Care Homes. To better inform infection control efforts in this unique setting type, DOH staff conducted a comprehensive search to locate states that license SRCF. A total of 24 states were identified and approached to participate in a qualitative research study; 21 responded, three declined and nine were unable to participate due to staff time constraints. Between March 12th and April 15th, 2021, ten public health and regulatory staff from nine states completed semi-structured telephonic interviews on infection control in SRCF. Infection control licensing requirements and public health oversight for SRCF varied significantly across participating states. Data from these interviews was analyzed and compared with two Washington State Adult Family Home (AFH) sources: 1) online survey of AFH providers 2) Infection Control Assessment and Response evaluations conducted by public health staff. Four themes were identified in all three data sets: access to personal protective equipment, environmental safety, staffing issues and knowledge deficits. SRCF are valued by states that license them. Despite the challenges of implementing infection control in the home-like environment, extraordinary opportunities exist for improving care and preventing infections in this setting.

scholarly journals The Impact of Enhanced Antimicrobial Stewardship Support on Antibiotic Starts in Long-Term Care Facilities

2020 ◽  
Vol 41 (S1) ◽  
pp. s527-s527
Author(s):  
Gabriela Andujar-Vazquez ◽  
Kirthana Beaulac ◽  
Shira Doron ◽  
David R Snydman
Keyword(s):  
Public Health ◽  
Pilot Study ◽  
Infection Control ◽  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Medical Center ◽  
Term Care ◽  
Care Facilities ◽  
The Impact

Background: The Tufts Medical Center Antimicrobial Stewardship (ASP) Team has partnered with the Massachusetts Department of Public Health (MDPH) to provide broad-based educational programs (BBEP) to long-term care facilities (LTCFs) in an effort to improve ASP and infection control practices. LTCFs have consistently expressed interest in individualized and hands-on involvement by ASP experts, yet they lack resources. The goal of this study was to determine whether “enhanced” individualized guidance provided by an ASP expert would lead to antibiotic start decreases in LTCFs participating in our pilot study. Methods: A pilot study was conducted to test the feasibility and efficacy of providing enhanced ASP and infection control practices to LTCFs. In total, 10 facilities already participating in MDPH BBEP and submitting monthly antibiotic start data were enrolled, were stratified by bed size and presence of dementia unit, and were randomized 1:1 to the “enhanced” group (defined as reviewing protocols and antibiotic start cases, providing lectures and feedback to staff and answering questions) versus the “nonenhanced” group. Antibiotic start data were validated and collected prospectively from January 2018 to July 2019, and the interventions began in April 2019. Due to staff turnover and lack of engagement, intervention was not possible in 2 of the 5 LTCFs randomized to the enhanced group, which were therefore analyzed as a nonenhanced group. An incidence rate ratios (IRRs) with 95% CIs were calculated comparing the antibiotic start rate per 1,000 resident days between periods in the pilot groups. Results: The average bed sizes for enhanced groups versus nonenhanced groups were 121 (±71.0) versus 108 (±32.8); the average resident days per facility per month were 3,415.7 (±2,131.2) versus 2,911.4 (±964.3). Comparatively, 3 facilities in the enhanced group had dementia unit versus 4 in the nonenhanced group. In the per protocol analysis, the antibiotic start rate in the enhanced group before versus after the intervention was 11.35 versus 9.41 starts per 1,000 resident days (IRR, 0.829; 95% CI, 0.794–0.865). The antibiotic start rate in the nonenhanced group before versus after the intervention was 7.90 versus 8.23 antibiotic starts per 1,000 resident days (IRR, 1.048; 95% CI, 1.007–1.089). Physician hours required for ASP for the enhanced group totaled 8.9 (±2.2) per facility per month. Conclusions: Although the number of hours required for intervention by an expert was not onerous, maintaining engagement proved difficult and in 2 facilities could not be achieved. A statistically significant 20% decrease in the antibiotic start rate was achieved in the enhanced group after interventions, potentially reflecting the benefit of enhanced ASP support by an expert.Funding: This study was funded by the Leadership in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) fellowship training grant award from the CDC.Disclosures: None

scholarly journals 208 - Person-centred infection prevention and control during a pandemic: The Dementia Isolation Toolkit

2021 ◽  
Vol 33 (S1) ◽  
pp. 11-11
Author(s):  
Andrea Iaboni ◽  
Hannah Quirt ◽  
Steven Stewart ◽  
Alisa Grigorovich ◽  
Claudia Barned ◽  
...  
Keyword(s):  
Infection Control ◽  
Online Survey ◽  
Moral Distress ◽  
Well Being ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Care Plans ◽  
Infection Control Measures ◽  
People With Dementia

Objectives:People working in long-term care homes (LTCH) face ethical dilemmas about how to minimize the risk of spread of COVID-19, while also minimizing psychological hardship and other harms of infection control measures on residents. The Dementia Isolation Toolkit (www.dementiaisolationtoolkit.com; DIT) was developed to address the gap in ethical guidance for LTCH on how to safely and effectively isolate people with dementia while supporting the personhood and well-being of residents. In this presentation, we will present the DIT and report on the results of a survey of LTCH staff in Ontario, Canada on their experiences isolating residents in LTCH and the use of the DIT in supporting person-centred isolation care.Methods:A link to an online survey was distributed to LTCH staff through provincial organizations and agencies as well as through social media and the DIT website. Inclusion criteria were LTCH staff working on-site at a LTCH since March 1, 2020, who had direct or indirect experience with the isolation/quarantine of LTCH residents. Results were summarized descriptively.Results:A broad sample of LTCH staff (n=207) participated in the survey, most of whom had experienced an outbreak in their LTCH. Dementia (96%) was the most important barrier to implementation of infection control measures in LTCH, followed by staff distress about the effects of isolation on residents (61%). Important facilitators for isolation included delivery of 1:1 activities in the resident’s room (81%) and designating essential caregivers to provide support (67%), while inadequate staffing levels were reported as a barrier (55%). 65% of respondents indicated some familiarity with the DIT, and of those who had used the toolkit, 62% found it helpful in supporting isolation care, particularly in developing care plans and making and communicating decisions. Of those who had used the DIT, 48% found it fairly or very helpful at reducing their level of distress.Conclusions:Isolation as an infection control and prevention (ICP) measure in LTCH environments can be harmful to residents and create moral distress in staff. ICP guidance and support of LTCH needs to address how to minimize these harms by providing dementia-specific guidance such as in the DIT.

scholarly journals Multifacility Outbreak of NDM/OXA-23–Producing Acinetobacter baumannii in California, 2020–2021

2021 ◽  
Vol 1 (S1) ◽  
pp. s79-s79
Author(s):  
Diana Holden ◽  
Tisha Mitsunaga ◽  
Denise Sanford ◽  
Tanya Fryer ◽  
June Nash ◽  
...  
Keyword(s):  
Public Health ◽  
Antibiotic Resistance ◽  
Infection Control ◽  
Acinetobacter Baumannii ◽  
The United States ◽  
Infection Prevention And Control ◽  
Care Hospital ◽  
Public Health Response ◽  
Term Care ◽  
Healthcare Network

Background: NDM/OXA-23 carbapenemase-producing Acinetobacter baumannii isolates have been reported worldwide, but rarely in the United States. A California acute-care hospital (ACH) A identified 3 patients with pan-nonsusceptible A. baumannii during May–June 2020, prompting a public health investigation to prevent further transmission among the regional healthcare network. Methods: A clinical isolate was defined as NDM/OXA-23–producing A. baumannii from a patient at ACH A or B, or an epidemiologically linked patient identified through colonization screening during May 2020–January 2021. ACHs A and B are sentinel sites for carbapenem-resistant A. baumannii surveillance through the Antibiotic Resistance Laboratory Network (AR Lab Network), where isolates are tested for carbapenemase genes. The California Department of Public Health with 3 local health departments conducted an epidemiological investigation, contact tracing, colonization screening, and whole-genome sequencing (WGS). Results: In total, 11 cases were identified during May 2020–January 2021, including 3 cases at ACH A during May–June 2020, and 8 additional cases during November 2020–January 2021: 5 at ACH A, 1 at ACH B, and 2 at skilled nursing facility (SNF) A. Isolates from ACHs A and B were identified through testing at the AR Lab Network. Of the 11 patients (including the index patient), 4 had exposure at SNF A, where 2 cases were identified through colonization screening. Screening conducted at ACH A and 5 other long-term care facilities (LTCFs) identified no additional cases. WGS results for the first 8 cases identified showed 2–13 single-nucleotide polymorphism differences. Antibiotic resistance genes for all isolates sequenced included NDM-1 and OXA-23. On-site assessments related to a COVID-19 outbreak conducted at ACH A identified infection control gaps. Conclusions: Hospital participation in public health laboratory surveillance allows early detection of novel multidrug-resistant organisms (MDROs), which enabled outbreak identification and public health response. A high COVID-19 burden and related changes in infection control practices have been associated with MDRO transmission elsewhere in California. This factor might have contributed to spread at ACH A and hampered earlier screening efforts at SNF A, likely leading to undetected transmission. Extensive movement of positive patients among a regional healthcare network including at least 6 ACHs and 7 LTCFs likely contributed to the prolonged duration of this outbreak. This investigation highlights the importance of enhanced novel MDRO surveillance strategies coupled with strong infection prevention and control practices as important factors in identifying outbreaks and preventing further transmission in regional networks.Funding: NoDisclosures: None

The Relationship Between the Position of Name Generator Questions and Responsiveness in Multiple Name Generator Surveys

2017 ◽  
Vol 48 (2) ◽  
pp. 243-262 ◽  
Author(s):  
Reza Yousefi-Nooraie ◽  
Alexandra Marin ◽  
Robert Hanneman ◽  
Eleanor Pullenayegum ◽  
Lynne Lohfeld ◽  
...  
Keyword(s):  
Public Health ◽  
Relative Position ◽  
Online Survey ◽  
Information Sources ◽  
Moderating Effect ◽  
Health Staff ◽  
Question Types ◽  
Public Health Staff ◽  
The Relationship

Using randomly ordered name generators, we tested the effect of name generators’ relative position on the likelihood of respondents’ declining to respond or satisficing in their response. An online survey of public health staff elicited names of information sources, information seekers, perceived experts, and friends. Results show that when name generators are asked later, they are more likely to go unanswered and respondents are more likely to respond that they do not know anyone or list fewer names. The effect of sequence was not consistent in different question types, which could be the result of the moderating effect of willingness to answer and question sensitivity.

scholarly journals Public Health Importance of Invasive Methicillin-sensitive Staphylococcus aureus Infections: Surveillance in 8 US Counties, 2016

2019 ◽  
Author(s):  
Kelly A Jackson ◽  
Runa H Gokhale ◽  
Joelle Nadle ◽  
Susan M Ray ◽  
Ghinwa Dumyati ◽  
...  
Keyword(s):  
Public Health ◽  
Staphylococcus Aureus ◽  
Infection Control ◽  
Care Facility ◽  
Public Health Problem ◽  
The United States ◽  
Multivariate Logistic Regression Model ◽  
Public Health Importance ◽  
Term Care ◽  
Healthcare Associated

Abstract Background Public health and infection control prevention and surveillance efforts in the United States have primarily focused on methicillin-resistant Staphylococcus aureus (MRSA). We describe the public health importance of methicillin-susceptible S. aureus (MSSA) in selected communities. Methods We analyzed Emerging Infections Program surveillance data for invasive S. aureus (SA) infections (isolated from a normally sterile body site) in 8 counties in 5 states during 2016. Cases were considered healthcare-associated if culture was obtained >3 days after hospital admission; if associated with dialysis, hospitalization, surgery, or long-term care facility (LTCF) residence within 1 year prior; or if a central venous catheter was present ≤2 days prior. Incidence per 100 000 census population was calculated, and a multivariate logistic regression model with random intercepts was used to compare MSSA risk factors with those of MRSA. Results Invasive MSSA incidence (31.3/100 000) was 1.8 times higher than MRSA (17.5/100 000). Persons with MSSA were more likely than those with MRSA to have no underlying medical conditions (adjusted odds ratio [aOR], 2.06; 95% confidence interval [CI], 1.26–3.39) and less likely to have prior hospitalization (aOR, 0.70; 95% CI, 0.60–0.82) or LTCF residence (aOR, 0.37; 95% CI, 0.29–0.47). MSSA accounted for 59.7% of healthcare-associated cases and 60.1% of deaths. Conclusions Although MRSA tended to be more closely associated with healthcare exposures, invasive MSSA is a substantial public health problem in the areas studied. Public health and infection control prevention efforts should consider MSSA prevention in addition to MRSA.

scholarly journals 2462. Public Health Response to Contain the First Outbreak of New Delhi Metallo-β-Lactamase-Producing Klebsiella pneumoniae in Minnesota

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S852-S852
Author(s):  
Brittany VonBank ◽  
Sean O’Malley ◽  
Paula Snippes Vagnone ◽  
Mary Ellen Bennett ◽  
Tammy Hale ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Infection Control ◽  
Care Facility ◽  
The United States ◽  
New Delhi ◽  
Surveillance Culture ◽  
Public Health Response ◽  
Term Care ◽  
Health Response

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) producing the New Delhi-metallo-β-lactamase (NDM) carbapenemase are uncommon in the United States but are a serious threat for untreatable antibiotic-resistant infections. In Minnesota (MN), NDM-CRE is typically associated with receipt of healthcare abroad. We describe the public health response to contain the first outbreak of NDM-CRE in MN. Methods CRE is reportable, with isolate submission to the MN Department of Health (MDH) for MALDI-TOF identification, phenotypic carbapenemase production testing, and PCR for carbapenemase genes. On December 24, 2018, MDH identified a case of NDM-K. pneumoniae in a long-term care facility (LTCF) without travel. MDH initiated an investigation. We defined a case as having NDM-K. pneumoniae matching the outbreak PFGE pattern from a clinical or surveillance culture. Cases were identified through surveillance, point prevalence survey (PPS) rectal swab colonization testing, and PFGE at MDH. MDH collected a healthcare exposure history for all cases. A containment response occurred in any facility where a case received healthcare in the 30 days prior. Results Nine cases of clonal NDM-K. pneumoniae with specimen collection dates between December 24, 2018 and March 26, 2019 were identified; 8 were residents of LTCF A and 1 was a roommate in LTCF B of a former LTCF A resident. PPS testing of 260 healthcare contacts occurred in 6 facilities, including LTCF A, LTCF B, and 4 acute care hospitals (ACH) that accepted LTCF A transfers; 7/9 cases were identified through PPS and 2/9 cases were identified through CRE surveillance. One case from LTCF A was identified in an ACH, but PPS did not identify transmission in ACHs. MDH conducted on-site infection control assessments in 2 LTCFs, identified numerous infection control (IC) lapses at LTCF A, and provided telephone IC consultation to 4 ACHs. Conclusion Surveillance and PPS uncovered an outbreak of NDM CRE in 2 LTCFs. Patient transfers led to a regional public health response lasting several months that included IC consultation and additional PPS. Intervention to coordinate containment responses among interconnected healthcare facilities is critical to containing the spread of novel resistance mechanisms in the United States. Disclosures All authors: No reported disclosures.

Enteric Illness in Ontario, Canada, from 1997 to 2001

2003 ◽  
Vol 66 (6) ◽  
pp. 953-961 ◽  
Author(s):  
MARILYN B. LEE ◽  
DEAN MIDDLETON
Keyword(s):  
Public Health ◽  
Hepatitis A ◽  
Enteric Pathogens ◽  
Health Staff ◽  
Local Health ◽  
Term Care ◽  
Staff Members ◽  
Modes Of Transmission ◽  
Electronic Reporting ◽  
Public Health Staff

Enteric illness is a common problem worldwide. In Ontario (population of 11.4 million, 2001 Census of Canada), laboratory-confirmed cases of “reportable” enteric diseases are reported to local health units. Public health staff members investigate these illnesses and subsequently report details to the Ministry of Health and Long-Term Care through an electronic reporting system. From 1997 to 2001, 44,451 sporadic cases of illness attributable to eight enteric pathogens (Campylobacter, Salmonella, verotoxin-producing Escherichia coli, Yersinia, Shigella, hepatitis A, Listeria, and Clostridium botulinum) were reported. This number was less than the 56,690 cases reported from 1992 to 1996. Campylobacter accounted for the highest annual average incidence rate at 42.3 cases per 100,000 persons, with Salmonella following at 22.6, verotoxin-producing E. coli at 3.7, Yersinia at 3.0, Shigella at 2.7, hepatitis A at 2.3, and Listeria at 0.3. The 4 months from June to September accounted for almost half (46.5%) of all cases. For 74.0% of the outbreaks associated with these eight enteric pathogens, foodborne contamination was identified as the mode of transmission. Poultry and other meat items accounted for 68.4% of the food items when food was identified as the vehicle. Admittedly, the “foods” and “modes of transmission” identified may have been subject to investigator bias based on previous knowledge. The most common risk setting, which was reported in approximately half of the cases, was private homes; travel-associated illness and restaurants were the second and third most frequently reported risk settings at 24.6 and 14.1%, respectively. Findings from this study suggest that public health efforts should be directed toward safe food handling in the home during the summer months.

scholarly journals Modeling Transmission of Human Metapneumovirus in a Long-Term Care Facility

2020 ◽  
Vol 41 (S1) ◽  
pp. s318-s319
Author(s):  
Erica Washington ◽  
Ashley Terry ◽  
Julie Hand ◽  
Alexa Ramirez
Keyword(s):  
Public Health ◽  
Nursing Home ◽  
Hand Hygiene ◽  
Infection Control ◽  
Mathematical Models ◽  
Average Rate ◽  
Human Metapneumovirus ◽  
Infectious Period ◽  
Worst Case ◽  
Term Care

Background: In September 2019, the Louisiana Department of Health (LDH) was notified of a possible outbreak of influenza in a nursing home. Upon investigation, the infectious agent was determined to be human metapneumovirus (HMPV). By the conclusion of the outbreak, 35 (31.3%) symptomatic cases were identified of which 15 were laboratory-confirmed HMPV. Public health coordination, infection control interventions, environmental cleaning audits, halting new admissions, and ceasing group activities are credited with stopping transmission. Considering the high attack rate, LDH epidemiologists examined scenarios wherein the aforementioned interventions were not utilized. The aim of this analysis is to describe transmission of HMPV in a 112-bed nursing home using mathematical models under conditions wherein interventions were not readily implemented. Methods: Two deterministic and 1 stochastic susceptible–preinfectious–infectious–recovered (SEIR) models are presented. Although recovered persons can be susceptible to HMPV following an infection experience, the potential for reinfection was not considered for this analysis. Fixed variables considered include a 5-day incubation period, basic reproduction number of 2, 14-day infectious period, and 112 susceptible patients. Three counterfactual modeling conditions are considered: delaying notification of an outbreak to public health epidemiologists (model 1), staff hand hygiene compliance of 50% (model 2), and continuing to accept new admissions (model 3). Average rate of recovery per day was and other metrics are used to demonstrate the number of susceptible individuals. Excel workbooks developed by Vynnycky and White (2010) were used for analysis. Results: In model 1, the average rate of onset of infectiousness per day = 0.20, and the average recovery rate per day = 0.07. With no notification to public health epidemiologists, all 112 patients would have been infected with HMPV after 94 days. The reproductive number was doubled to 4 in model 2 to posit poor healthcare worker hand hygiene of 50% compliance. Given this, the number of days until all patients are infected with HMPV decreases to 39 days. Finally, the stochastic scenario (model 3) demonstrates that the number of newly infected persons per day = 0.86, and the hazard rate for infectious individuals becoming immune = 0.07. Conclusions: Infection control interventions are extremely useful for containing viral respiratory diseases for which there is no vaccine or treatment. Mathematical models can communicate utility of public health interventions in the presence of outbreaks. These models demonstrate worst-case scenarios for infection spread.Funding: NoneDisclosures: None

scholarly journals Engaging Local Health Departments in Disaster Research: A Washington State Survey

2019 ◽  
Vol 14 (2) ◽  
pp. 163-167
Author(s):  
Ali Everhart ◽  
Resham Patel ◽  
Nicole A. Errett
Keyword(s):  
Public Health ◽  
Emergency Preparedness ◽  
Disaster Response ◽  
Online Survey ◽  
Washington State ◽  
Local Health ◽  
Health Departments ◽  
Local Health Departments ◽  
Disaster Research ◽  
Research Activities

AbstractObjective:Disaster research can inform effective, efficient, and evidence-based public health practices and decision making; identify and address knowledge gaps in current disaster preparedness and response efforts; and evaluate disaster response strategies. This study aimed to identify challenges and opportunities experienced by Washington State local health departments (LHDs) regarding engagement in disaster research activities.Methods:An online survey was disseminated to the emergency preparedness representative for the 35 LHDs in Washington State. Survey questions sought to assess familiarity and experience with disaster research, as well as identify facilitators and barriers to their involvement. The survey was first piloted with 7 local and state public health emergency preparedness practitioners.Results:A total of 82.9% of Washington’s 35 LHDs responded to our survey. Only 17.2% of respondents had previous experience with disaster research. Frequently reported barriers to engaging in disaster research included funding availability, competing everyday priorities, staff capacity, and competing priorities during disaster response.Conclusions:These findings can inform efforts to support disaster research partnerships with Washington State LHDs and facilitate future collaboration. Researchers and public health practitioners should develop relationships and work to incorporate disaster research into LHD planning, training, and exercises to foster practice-based disaster research capacity.

scholarly journals Prevalence surveillance system of nosocomial infections in Norway

2007 ◽  
Vol 12 (35) ◽  
Author(s):  
T Bruun ◽  
H L Loewer
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Nosocomial Infections ◽  
Surveillance System ◽  
Long Term Care ◽  
Control Programme ◽  
Term Care ◽  
Care Facilities ◽  
Infection Control Programme

In 1996, the Norwegian Ministry of Health issued regulations on the prevention of nosocomial infections (NIs). The regulations were revised in 2005. As part of the infection control programme, hospitals and long-term care facilities are obliged to have a surveillance system for NIs in place and to report the results to the Norwegian Institute of Public Health.

Sign in / Sign up

Export Citation Format

Share Document