scholarly journals 472. The Utility of Infectious Diseases E-consults in the Era of COVID-19

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S302-S303
Author(s):  
Hala Saad ◽  
Kruti Yagnik ◽  
Helen King ◽  
Roger Bedimo ◽  
Richard J Medford
Keyword(s):  
Health Care ◽  
Infectious Diseases ◽  
Infection Prevention ◽  
Panel Member ◽  
University Hospital ◽  
North Texas ◽  
Review Panel ◽  
The North ◽  
Time To Completion ◽  
Texas Health

Abstract Background During the COVID-19 pandemic, rapid Infectious Diseases (ID) consultation has been required to answer novel questions regarding SARS-CoV-2 testing and infection prevention. We sought to evaluate the utility of e-consults to triage and provide rapid ID recommendations to providers. Methods We performed a retrospective study reviewing ID e-consults in three institutions in the North Texas region: Clements University Hospital (CUH), Parkland Hospital and Health System (PHHS), and the VA North Texas Health Care System (VA) from March 1, 2020 to May 15, 2020. Variables collected include age, sex, ethnicity, comorbidities, time to completion, reason for consult and outcome of consult (initiation or removal of personal protective equipment (PPE) and recommendation to test or retest for COVID-19). Results We performed all analysis using R studio (Version 1.3.959). Characteristics of 198 patients included: 112(57%) male, 86(43%) female, 86(43%) Caucasian, 71(36%) Hispanic, 42(21%) African American, 6(3%) Asian and mean(sd) age of 55.1(15.9). Patient comorbidities included: 89(45%) with a heart condition, 77(39%) diabetes, 30(15%) asthma and 14(7%) liver disease. Median time to completion for all hospitals was 4 hours(h); ((CUH (4h) vs PHHS (2h), p< 0.05; VA (5.5h) vs PHHS (2h) p< 0.05)). Most common reasons for e-consult included: (63)32% regarding re-testing ((CUH 14(21%) vs PHHS 43(50%), p< 0.05; CUH vs VA 14(27%), p< 0.05; PHHS vs VA, p< 0.05)), (61)31% testing ((CUH 25(37%) vs PHHS 39(45%), p< 0.05; CUH vs VA 7(16%), p< 0.05; PHHS vs VA, p< 0.05)) and 61(31%) infection prevention (IP). Based on the e-consult recommendation, 53(27%) of patients were tested ((CUH 31(45%) vs PHHS 11(13%), p< 0.05, CUH vs VA 11(25%), PHHS vs VA, p< 0.05)), 45(23%) were re-tested, 44(22%) of patients had PPE started on and 19% had PPE removed ((CUH 0(0%) vs PHHS 16(19%), p< 0.05; CUH vs VA 21(48%), p< 0.05; PHHS vs VA, p< 0.05)). Reason for Consult Conclusion E-consult services can provide prompt ID input during the COVID-19 pandemic, minimizing the risk of infection to the patient and health care workers while preserving PPE and testing supplies. Disclosures Roger Bedimo, MD, MS, Gilead Sciences (Consultant)Merck & Co. (Advisor or Review Panel member)ViiV Healthcare (Advisor or Review Panel member, Research Grant or Support)

scholarly journals 506. Variation in Occupational Activities and Infection Prevention Practices in Healthcare Personnel Based on Exposure to COVID-19 Units

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S319-S319
Author(s):  
Jessica Howard-Anderson ◽  
Carly Adams ◽  
Amy C Sherman ◽  
William C Dube ◽  
Teresa C Smith ◽  
...  
Keyword(s):  
Infection Prevention ◽  
Panel Member ◽  
Healthcare Personnel ◽  
Similar Proportion ◽  
Review Panel ◽  
High Exposure ◽  
Material Support ◽  
Social Distancing ◽  
Occupational Activities ◽  
Low Exposure

Abstract Background Healthcare personnel (HCP) may be at increased risk for COVID-19, but differences in risk by work activities are poorly defined. Centers for Disease Control and Prevention recommends cohorting hospitalized patients with COVID-19 to reduce in-hospital transmission of SARS-CoV-2, but it is unknown if occupational and non-occupational behaviors differ based on exposure to COVID-19 units. Methods We analyzed a subset of HCP from an ongoing CDC-funded SARS-CoV-2 serosurveillance study. HCP were recruited from four Atlanta hospitals of different sizes and patient populations. All HCP completed a baseline REDCap survey. We used logistic regression to compare occupational activities and infection prevention practices among HCP stratified by exposure to COVID-19 units: low (0% of shifts), medium (1–49% of shifts) or high (≥50% of shifts). Results Of 211 HCP enrolled (36% emergency department [ED] providers, 35% inpatient RNs, 17% inpatient MDs/APPs, 7% radiology technicians and 6% respiratory therapists [RTs]), the majority (79%) were female and the median age was 35 years. Nearly half of the inpatient MD/APPs (46%) and RNs (47%) and over two-thirds of the RTs (67%) worked primarily in the ICU. Aerosol generating procedures were common among RNs, MD/APPs, and RTs (26–58% performed ≥1), but rare among ED providers (0–13% performed ≥1). Compared to HCP with low exposure to COVID-19 units, those with medium or high exposure spent a similar proportion of shifts directly at the bedside and were about as likely to practice universal masking. Being able to consistently social distance from co-workers was rare (33%); HCP with high exposure to COVID-19 units were less likely to report social distancing in the workplace compared to those with low exposure; however, this was not significantly different (OR 0.6; 95% CI: 0.3, 1.1). Concerns about personal protective equipment in COVID-19 units were similar across levels of exposure (Table 1). Table 1: Occupational activities and infection prevention behaviors of healthcare personnel stratified by level of exposure to COVID-19 units Conclusion The proportion of time spent in dedicated COVID-19 units did not appear to influence time HCP spend directly at the bedside or infection prevention practices (social distancing and universal masking) in the workplace. Risk for SARS-CoV-2 infection in HCP may depend more on factors acting at the individual level rather than those related to location of work. Disclosures Jessica Howard-Anderson, MD, Antibacterial Resistance Leadership Group (ARLG) (Other Financial or Material Support, The ARLG fellowship provides salary support for ID fellowship and mentored research training) Ben Lopman, PhD, MSc, Takeda Pharmaceuticals (Advisor or Review Panel member, Research Grant or Support, Other Financial or Material Support, Personal fees)World Health Organization (Advisor or Review Panel member, Other Financial or Material Support, Personal fees for technical advice and analysis)

scholarly journals 303. Evaluation of Antimicrobial Utilization and the Incidence of Bacterial Pneumonia Co-infection in Non-ICU COVID-19 Patients at an Urban Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S257-S258
Author(s):  
Sara Groome ◽  
Claudine El-Beyrouty ◽  
Meghan Mitchell
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Pneumonia ◽  
Academic Medical Center ◽  
Panel Member ◽  
University Hospital ◽  
Respiratory Pathogen ◽  
Nasopharyngeal Swab ◽  
Review Panel ◽  
Academic Medical ◽  
Objective Evidence

Abstract Background The management of COVID-19 poses diagnostic challenges with regard to concomitant bacterial pneumonia. This may result in unnecessary antibiotic therapy. This analysis described the experience of an urban academic medical center’s management of non-ICU patients diagnosed with COVID-19 during the initial months of the pandemic and assessed the rate of concomitant bacterial pneumonia in this population. Methods This retrospective analysis evaluated patients 18 years and older admitted to Thomas Jefferson University Hospital (TJUH) between March 1, 2020 and July 31, 2020 who had a positive COVID-19 test, were symptomatic, and received at least one dose of antibiotics. Antibiotic therapy was considered appropriate if there was objective evidence of bacterial pneumonia. Per the TJUH COVID-19 guidelines, objective diagnostic criteria assessed included the following: MRSA nasopharyngeal swab, urine Legionella pneumophilia or Streptococcus pneumoniae antigen test, respiratory pathogen panel, and sputum culture. If patients did not have evidence of bacterial pneumonia, the threshold for appropriate discontinuation of antibiotics was 48 hours. Results 50 patients were included in the final analysis. Upon admission, 7 (14%) patients had clear chest radiographs, and 9 (25%) of the 36 patients with a procalcitonin drawn had a level ≥ 0.25, indicating a potential bacterial infection. 15 (30%) patients were known to be COVID-19 positive prior to being administered antibiotics. Additionally, 22 (44%) patients had an infectious diseases service consult during their admission. 25 (50%) patients were continued on antibiotics > 48 hours. The mean duration of antibiotic therapy in the entire population was 3.4 days (82 hours). The monthly average duration of antibiotic therapy trended downward as the pandemic progressed. The most common empiric antibiotic regimen was ceftriaxone and azithromycin, received by 28 (56%) patients. Only 2 (4%) patients were diagnosed with bacterial pneumonia. Conclusion In a sample of 50 COVID patients the overall rate of concomitant bacterial pneumonia was 4%. Given this finding, it is vital to remain judicious with the use of antibiotics and to employ the assistance of antimicrobial stewardship colleagues when managing patients diagnosed with COVID-19. Disclosures Claudine El-Beyrouty, PharmD, BCPS, Astellas (Advisor or Review Panel member)Shionogi (Advisor or Review Panel member)

scholarly journals 677. Compliance and Performance Characteristics of Subject Collected Versus Health-care Worker Collected Nasal Swabs for Respiratory Viral Surveillance

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S440-S441
Author(s):  
Michelle Kautz ◽  
Nusrat J Epsi ◽  
Stephanie A Richard ◽  
Rhonda E Colombo ◽  
Anuradha Ganesan ◽  
...  
Keyword(s):  
Health Care ◽  
Symptom Onset ◽  
Panel Member ◽  
Respiratory Pathogens ◽  
Review Panel ◽  
Detection Rates ◽  
Nasal Swabs ◽  
And Performance ◽  
Care Worker ◽  
Symptom Diary

Abstract Background Self-collection of mid-nasal swabs (SCNS) at home is a convenient alternative to health-care worker-collected nasal swabs (HCWC) for determining the pathogen-specific epidemiology of influenza-like illness (ILI). We evaluated the compliance and performance characteristics of SCNS vs. HCWC for respiratory pathogens during 2019-2020 flu season. Methods Adult Military Health System (MHS) beneficiaries were enrolled in an influenza vaccine effectiveness trial (PAIVED). Following vaccination, subjects were instructed on SCNS and completion of a symptom diary and were contacted weekly to ascertain ILI symptoms (fever, sore throat, and/or cough). In the event of an ILI, subjects completed the symptom diary and SCNS and were scheduled a clinic visit for HCWC. Swabs were tested with the Luminex NxTAG® Respiratory Pathogen Panel. We evaluated compliance with swab collection, positive percent agreement (PPA) of SCNS using PCR detection from either HCWC or SCNS as the reference standard, and agreement between paired swabs using the Cohen Kappa coefficient (Κ). Results 1808 ILI were reported by 972 participants enrolled during the study period. Compliance with HCWC was higher than SCNS (58% [1042] vs. 42% [766]; p< 0.001). SCNS were associated with a shorter interval from symptom onset (median: 4 days [IQR:2-6 days] vs. clinic collect: 7 days [IQR:4-9 days]; p < 0.001). 663 paired swabs were available for 609 participants (Table 1). The overall detection rate was higher in SCNS (36%) than HCWC (26%; p< 0.001) (Figure 1). The overall PPA was 85.7% and a PPA of approximately 80% of greater was observed for influenza, rhino/enterovirus, parainfluenza and respiratory syncytial virus. Agreement between paired swabs was poor due to the lower detection rates in HCWC. Table 1. Demographics and swab collection data for 609 participants who provided 663 paired swabs Figure 1. Detection by pathogen in 663 paired swabs Conclusion SCNS were associated with higher detection rates compared to HCWC, likely due to the shorter interval between symptom onset and swab collection. Strategies to improve compliance with SCNS and minimize the interval between symptom onset and swab collection are needed to optimize detection of respiratory pathogens in this MHS cohort. Disclosures Ryan C. Maves, MD, EMD Serono (Advisor or Review Panel member)Heron Therapeutics (Advisor or Review Panel member) Jitu Modi, MD, GSK (Speaker's Bureau)

Rapid HIV testing experience at Veterans Affairs North Texas Health Care System's Homeless Stand Downs

AIDS Care ◽  
2013 ◽  
Vol 26 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Dina Hooshyar ◽  
Alina M. Surís ◽  
Maggie Czarnogorski ◽  
James P. LePage ◽  
Roger Bedimo ◽  
...  
Keyword(s):  
Health Care ◽  
Hiv Testing ◽  
Veterans Affairs ◽  
North Texas ◽  
Rapid Hiv Testing ◽  
Texas Health

scholarly journals 57. Evaluating the Utility of a Penicillin Allergy Reconciliation Program within an Infectious Diseases Consult Population in a Community Health System

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S49-S50
Author(s):  
Bruce M Jones ◽  
Emily Plauche ◽  
Susan E Smith ◽  
Christopher M Bland
Keyword(s):  
Infectious Diseases ◽  
Health System ◽  
Community Health ◽  
Intervention Program ◽  
Primary Outcome ◽  
Panel Member ◽  
Penicillin Allergy ◽  
Secondary Outcome ◽  
Research Support ◽  
Research Grant

Abstract Background Penicillin allergy reconciliation is an important aspect of antimicrobial stewardship with ~10% of the population reporting a penicillin allergy. Our facility utilizes a Penicillin Allergy Reconciliation Program (PARP) led by an Infectious Diseases (ID) Pharmacist and pharmacy students to identify patients with penicillin allergies to reconcile and intervene when necessary. Information is collected by interview, electronic medical record (EMR) review, prescription outpatient fill history. This study evaluated reconciliations with and without a PARP in patients in a community health system. Methods This was a retrospective study that compared reconciliations performed on adult patients admitted at least once in 2019 with a self-reported penicillin allergy and ID physician consult at a hospital with a PARP (Institution 1) and one without a formal evaluation and intervention program (Institution 2) within the same community health system with same ID physicians. The primary outcome was documented reconciliation of a patient’s penicillin allergy during an inpatient visit in 2019. Reconciliation was defined as an edit or clarification (updating the severity, reaction, or comments section, as well as deleting) to a patient’s penicillin allergy in the EMR. The secondary outcome evaluated the percentage of total and ID consult patients with a penicillin allergy. Results There were 245 patients who met criteria and were included in the study, 113 from Institution 1 and 132 from Institution 2. For the primary outcome, there were 82 (72.6%) reconciliations at Institution 1 and 15 (11.4%) reconciliations at Institution 2 (p < 0.001). Interventions at Institution 1 and 2 resulted in 74 EMR updates and 8 removals and 14 EMR updates and 1 removal, respectively. Reconciliation was performed on the same visit as the ID consult in 59/82 patients (72%) at Institution 1 and 11/15 patients (73.3%) at Institution 2. All reconciliations at Institution 2 were made by pharmacist (10) or nurses (5). For the secondary outcome, 10.9% of patients with an ID consult and 12.6% of all patients admitted in 2019 had a penicillin allergy (p=0.027). Conclusion A PARP led by an ID pharmacist and students was an effective method to perform penicillin allergy reconciliations, even in the presence of active ID consultation. Disclosures Bruce M. Jones, PharmD, BCPS, ALK-Abello (Research Grant or Support)Allergan/Abbvie (Speaker’s Bureau) Christopher M. Bland, PharMD, FCCP, FIDSA, BCPS, ALK Abello, Inc. (Grant/Research Support)Biomerieux (Consultant)Merck (Consultant, Grant/Research Support, Advisor or Review Panel member, Speaker’s Bureau)Tetraphase (Speaker’s Bureau)

scholarly journals Results of screening for emergent highly resistant bacteria in Tunisian intensive care units

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Ben Rejeb ◽  
A Ben Cheikh ◽  
S Bhiri ◽  
H Ghali ◽  
M Kahloul ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Early Identification ◽  
Infection Prevention ◽  
Screening Program ◽  
Control Measures ◽  
University Hospital ◽  
Infection Prevention And Control ◽  
Resistant Bacteria ◽  
Prevention Interventions

Abstract Background The infections caused by emergent highly resistant bacteria (eHBR) that develop in intensive care units (ICUs) may result in significant patient illnesses and deaths, extend the duration of hospital stays and generate added costs. Facing this problem, the screening that emphasizes early identification of colonized patients, reduces the prevalence and incidence of infection, improves patient outcomes and reduces healthcare costs. In this context, we have implemented a screening for eHBR in ICUs of Sahloul university hospital of Sousse (Tunisia), which we report in this study the first six-months outcomes. Methods Rectal swab cultures were collected to detect Vancomycin resistant enterococcus (VRE) and Carbapenemase producing Enterobacteriaceae (CPE) among patients admitted in six ICUs of Sahloul university hospital of Sousse (Tunisia) and more than three times, at least one week apart, between 1 June and 31 December 2018. Results During the study period 174 patients were screened. Of them, 69.5% were male and 73.6% were admitted in surgical ICU. In total, 161 and 152 samples were realized respectively for the detection of CPE and VRE. These samples were positive in 15% and 8.5% respectively for CPE and VRE. Klebsiella pneumoniae OXA 48 was the most isolated CPE (80%). Conclusions Our screening program helped us in infection control by early identification of patients, thereby facilitating an informed decision about infection prevention interventions. Moreover, these results encouraged us to improve and generalize this program throughout the hospital. Key messages eHRB screening becomes an important axis in the prevention of eHRB infections in our facilities. eHRB screening allows the reinforcement of the basic infection prevention and control measures.

Sign in / Sign up

Export Citation Format

Share Document