scholarly journals 90. Impact of Infection Control Assessment and Response (ICAR) Visit on Candida auris Colonization Rates at Seven Long Term Acute Care Hospitals (LTACH) in Los Angeles County

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S57-S57
Author(s):  
Kiran Bhurtyal ◽  
Jennifer Nguyen ◽  
Anthony Clarke ◽  
Kelsey OYong ◽  
Sandeep Bhaurla ◽  
...  
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Infection Control ◽  
Acute Care ◽  
Los Angeles County ◽  
Acute Care Hospitals ◽  
Candida Auris ◽  
Colonization Rates ◽  
Environmental Disinfection

Abstract Background Public health authorities often use Infection Control Assessment and Response (ICAR) visits during Candida auris (C. auris) outbreak investigation to identify facility-level infection prevention and control (IPC) practice gaps and make recommendations to address those gaps. As an adjunct to ICAR visit, point prevalence surveys (PPS) provide an objective measure to determine if IPC recommendations are implemented. Because they require significant public health resources to perform, we evaluated the impact of ICAR visits on C. auris colonization rates. Methods PPS were conducted at seven long-term acute-care hospitals (LTACH) with C. auris outbreaks in Los Angeles County from July 2020 to May 2021. Skin swabs collected at PPS were tested for C. auris colonization by PCR technique. Pre-ICAR PPS results were compared with the average of two serial post-ICAR PPS results using repeated measures ANOVA test. Linear regression was used to estimate associations between individual ICAR domains and C. auris colonization. Results 54 PPS were conducted at seven LTACHs with at least one ICAR visit made for every two PPS. On average, PPS were conducted 14 days (range 1-15 days) before and 10 days (range 4-33 days) after an ICAR visit. PPS positive rates with ICAR visit dates for each LTACH are shown in figure 1. Overall, ICAR visits were associated with a significant decrease (p=0.035) in the average of the positive rates in two serial post-ICAR PPS. When individual domain (hand hygiene, contact precautions, and environmental disinfection) of ICAR tool was analyzed, only adherence to environmental disinfection was significantly associated (p=0.038) with decrease in C. auris colonization rates. There was a moderate negative correlation (R2 = 0.26, β= -0.33) between environmental disinfection adherence and the magnitude of decrease in the colonization rates across all LTACHs (Figure 2). Figure 1 Figure 2 Conclusion ICAR visits were found to be significantly associated with a decrease in the average PPS positive rate on serial PPS. Parts of the ICAR tool that assessed environmental disinfection at the facility seemed most correlated with decrease in C. auris colonization rate. Streamlining the ICAR process to focus on the most impactful parts of ICAR tool may be a more efficient intervention to control C. auris outbreaks. Disclosures All Authors: No reported disclosures

scholarly journals Public Health Oversight of Interfacility Transfers During a Candida auris Outbreak—Orange County, California, 2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s76-s77
Author(s):  
Kathleen O'Donnell ◽  
Ellora Karmarkar ◽  
Brendan R Jackson ◽  
Erin Epson ◽  
Matthew Zahn
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Orange County ◽  
Acute Care Hospitals ◽  
Nursing Facilities ◽  
Candida Auris ◽  
Retrospective Case ◽  
California Department ◽  
Healthcare Facilities ◽  
Contact Precautions

Background: In February 2019, the Orange County Health Care Agency (OCHCA) identified an outbreak of Candida auris, an emerging fungus that spreads rapidly in healthcare facilities. Patients in long-term acute-care hospitals (LTACHs) and skilled nursing facilities that provide ventilator care (vSNFs) are at highest risk for C. auris colonization. With assistance from the California Department of Public Health and the Centers for Disease Control and Prevention, OCHCA instituted enhanced surveillance, communication, and screening processes for patients colonized with or exposed to C. auris. Method: OCHCA implemented enhanced surveillance by conducting point-prevalence surveys (PPSs) at all 3 LTACHs and all 14 vSNFs in the county. Colonized patients were identified through axilla/groin skin swabbing with C. auris detected by PCR and/or culture. In facilities where >1 C. auris colonized patient was found, PPSs were repeated every 2 weeks to identify ongoing transmission. Retrospective case finding was instituted at 2 LTACHs with a high burden of colonized patients; OCHCA contacted patients discharged after January 1, 2019, and offered C. auris screening. OCHCA tracked the admission or discharge of all colonized patients, and facilities with ongoing transmission were required to report transfers of any patient, regardless of colonization status. OCHCA tracked all patients discharged from facilities with ongoing transmission to ensure that accepting facilities conducted admission surveillance testing of exposed patients and implemented appropriate environmental and contact precautions. Result: From February–October 2019, 192 colonized patients were identified. All 3 LTACHs and 6 of 14 VSNFs had at least 1 C. auris–colonized patient identified on initial PPS, and 2 facilities had ongoing transmission identified on serial PPS. OCHCA followed 96 colonized patients transferred a total of 230 times (an average of 2.4 transfers per patient) (Fig. 1) and 677 exposed patients discharged from facilities with ongoing transmission (Fig. 2). Admission screening of 252 exposed patients on transfer identified 13 (5.2%) C. auris–colonized patients. As of November 1, 2019, these 13 patients were admitted 21 times to a total of 6 acute-care hospitals, 2 LTACHs, and 3 vSNFs. Transferring facilities did not consistently communicate the colonized patient’s status and the requirements for isolation and testing of exposed patients. Conclusion: OCHCA oversight of interfacility transfer, though labor-intensive, improved identification of patients colonized with C. auris and implementation of appropriate environmental and contact precautions, reducing the risk of transmission in receiving healthcare facilities.Funding: NoneDisclosures: None

A Survey of Hospital Postpartum and Postabortion Rubella Vaccination Policies in Los Angeles County, 1992

1993 ◽  
Vol 14 (9) ◽  
pp. 513-516
Author(s):  
Diana G. Garcia ◽  
Donnell P. Ewert ◽  
Laurene Mascola
Keyword(s):  
Los Angeles ◽  
Infection Control ◽  
Hospital Discharge ◽  
Acute Care ◽  
Los Angeles County ◽  
Prevention Strategies ◽  
Postpartum Screening ◽  
Widespread Implementation ◽  
Induced Abortions ◽  
Rubella Vaccination

AbstractObjective:To determine the proportion of Los Angeles County (LAC) hospitals offering obstetrical services that have postpartum and postabortion rubella vaccination policies.Design:A survey was sent to the infection control practitioners (ICPs) of all operational acute care hospitals (N = 133) in LAC in 1992. A reminder and second survey was mailed to ICPs who did not respond to the first mailing.Results:Of 75 hospitals with obstetrical departments, 56 (75%) responded. Thirty-four (61%) of the 56 respondent hospitals had postpartum rubella vaccination policies. Of the 34 hospitals with policies, 30 (88%) accepted only a written record of rubella seropositivity as proof of immunity, 30 (88%) screened women with unknown immunity status before hospital discharge, and 32 (94%) vaccinated susceptible women before hospital discharge. Of the 32 hospitals that performed induced abortions, only two (6%) provided screening and vaccination services for these women.Conclusion:Only 61% of hospitals in LAC offering obstetrical services had postpartum rubella vaccination policies while only minimal screening and vaccination occurred in association with abortion services. Widespread implementation of postabortion screening and vaccination, and more stringent compliance with Advisory Committee on Immunization Practices recommendations for postpartum screening and vaccination in hospitals offering obstetrical services would reduce the number of rubella-susceptible women who have been missed by other prevention strategies.

scholarly journals Social Network Analysis across Healthcare Entities, Orange County, FL, 2016

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Danielle Rankin
Keyword(s):  
Public Health ◽  
Social Network ◽  
Social Network Analysis ◽  
Network Analysis ◽  
Disease Control ◽  
Acute Care ◽  
Orange County ◽  
Acute Care Hospitals ◽  
Patient Movement

Objective: To create a baseline social network analysis to assess connectivity of healthcare entities through patient movement in Orange County, Florida.Introduction: In the realm of public health, there has been an increasing trend in exploration of social network analyses (SNAs). SNAs are methodological and theoretical tools that describe the connections of people, partnerships, disease transmission, the interorganizational structure of health systems, the role of social support, and social capital1. The Florida Department of Health in Orange County (DOH-Orange) developed a reproducible baseline social network analysis of patient movement across healthcare entities to gain a county-wide perspective of all actors and influences in our healthcare system. The recognition of the role each healthcare entity contributes to Orange County, Florida can assist DOH-Orange in developing facility-specific implementations such as increased usage of personal protective equipment, environmental assessments, and enhanced surveillance.Methods: DOH-Orange received Centers for Medicare and Medicaid Services data from the Centers for Disease Control and Prevention Division of Health Care Quality Promotion. The dataset contains the frequency of patients transferred across Medicare accepting healthcare entities during 2016. We constructed a directional sociogram using R package statnet version 2016.9, built under R version 3.3.3. Node colors are categorized by the type of healthcare entity represented (e.g., long-term care facilities, acute care hospitals, post-acute care hospitals, and other) and depict the frequency of patients transferred with weighted edges. Node sizes are proportional to the log reduction of the total degree of patients transferred, and are arranged with the Fruchterman-Reingold layout. We calculated standard network indices to assess the magnitude of connectedness across healthcare entities in Orange County, Florida. Additionally, we calculated node-level indices to gain a perspective of the strength of each individual entity.Results: A total of 48 healthcare entities were included in the sociogram, with 44% representing Orange County, Florida. Although the majority of the healthcare entities are located in nearby counties, 90% of patient movement occurred across Orange County entities. The range of patient movement was 1 to 5196 with a median of 15 patients transferred in 2016. The network in Orange County is sparse with a density of 0.05, but the movement of patients across the healthcare entities is predominately symmetric (reciprocity=97%). The sociogram is centralized (degree centrality= 0.70) and contains a vast amount of entities that serve as connectors (betweenness centrality=0.53). The node-level indices identified our acute care hospitals and long term acute care hospitals are the connectors of our county health system.Conclusions: The SNA of patient movement across healthcare entities in Orange County, Florida provides public health with knowledge of the influences entities contribute to the county healthcare system. This will contribute to identifying changes in the network in future research on the transmission risks of specific diseases/conditions, which will enhance prioritization of targeted interventions within healthcare entities. In addition, SNAs can assist in targeting disease control efforts during outbreak investigations and support health communication. A SNA toolkit will be distributed to other local county health departments for reproduction to determine baseline data and integrate county-specific SNAs.

scholarly journals 542. Los Angeles County Acute Care Regional Antibiogram Suggests Changing Landscape of MDRO Threats Between 2015 and 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S258-S259
Author(s):  
James McKinnell ◽  
Chelsea Foo ◽  
Kelsey OYong ◽  
Janet Hindler ◽  
Sandra Ceja ◽  
...  
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Acute Care ◽  
Los Angeles County ◽  
Multivariable Analysis ◽  
Multidrug Resistant ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Level Data ◽  
Facility Level

Abstract Background National surveillance for multidrug-resistant organisms (MDRO) are limited by narrow geographic sampling, few hospitals, and failure to account for local epidemiology. A Los Angeles County (LAC) regional antibiogram was created to inform public health interventions and provide a baseline for susceptibility patterns countywide. We present data to compare the 2015 and 2017 LAC regional antibiogram. Methods We conducted a cross-sectional survey of cumulative facility-level antibiograms from all hospitals in LAC; 83 hospitals (AH) and 9 Long-term Acute Care (LTAC). For 2015, submission was voluntary, 2017 data were collected by public health order. Non-respondents were contacted by phone and in person. Isolates from sterile sources were pooled. Countywide susceptibility was calculated by weighting each facility’s isolate count by its reported susceptibility rate with minimum–maximim observed (2015) and Interquartile range (IQR) for 2017. Change from 2015 mean susceptibility is reported. Results Seventy-five (75) facilities submitted antibiograms for 2015 and 86 facilities for 2017. Among non-respondents in 2017, two facilities could not provide an adequate antibiogram and 4 were specialty hospitals with too few cultures to create an antibiogram. Regional summmary tables are presented in Tables 1–4. Klebsiella pneumoniae (n = 50 hospitals/19,382 isolates) % S to meropenem was 97% (IQR 94–100%), no change from 2015. Pseudomonas aeruginosa (PA) (n = 52 hospitals/17,770 isolates)% S to meropenem was 84% (IQR 74–93%), no change from 2015. Susceptibility to Acinetobacter baumannii (AB) was reported by 48 hospitals, including 1,4361 isolates,% S to meropenem was 39% (IQR 25–75%), 14% lower than 2015. Streptococcus agalactiae (n = 13 hospitals/647 isolates)% S to clindamycin was 43% (IQR 13–59%), a 22% increase from 2015. Conclusion LAC regional antibiograms identified stable patterns of antimicrobial resistance for most pathogens, but concerning results with AB and PA. Analysis of highly drug-resistant pathogens such as AB and PA would be improved with patient-level data to generate a combination antibiogram. We favor presenting IQR %S as done for 2017. Ongoing analysis will include multivariable analysis of observed changed S controlling for hospital characteristics. Disclosures All authors: No reported disclosures.

scholarly journals Bedside Registered Nurse Roles in Antimicrobial Stewardship: A Survey of Acute-Care Hospitals in Los Angeles County

2017 ◽  
Vol 38 (10) ◽  
pp. 1263-1265 ◽  
Author(s):  
Crystal D. Cadavid ◽  
Sharon D. Sakamoto ◽  
Dawn M. Terashita ◽  
Benjamin Schwartz
Keyword(s):  
Los Angeles ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Los Angeles County ◽  
Registered Nurse ◽  
Acute Care Hospitals

scholarly journals 2449. Early Detection of Candida auris is Essential to Control Spread: Four Effective Active Surveillance Strategies

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S846-S847
Author(s):  
Snigdha Vallabhaneni ◽  
Matthew Zahn ◽  
Erin Epson ◽  
Kathleen ODonnell ◽  
Sam Horwich-Scholefield ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Early Detection ◽  
Infection Control ◽  
Species Identification ◽  
Acute Care ◽  
Department Of Health ◽  
Admission Screening ◽  
High Prevalence

Abstract Background C. auris has been identified from > 1600 US patients. Risk factors include high-acuity post-acute care admissions (e.g., long-term acute care hospitals (LTACHs)), hospitalization abroad, and carbapenemase-producing organism (CPO) colonization. Early detection of C. auris is key to controlling spread. We describe four active surveillance strategies that led to early C. auris identification. Methods Based on known risk factors, state health departments used active C. auris surveillance strategies: (1) species identification of yeast from urine cultures from LTACHs, (2) screening patients with a CPO and hospitalization abroad, (3) LTACH C. auris point prevalence surveys (PPS), or (4) admission screening in acute and long-term care settings. Results (1)A laboratory in Southern California serving 12 LTACHs began species identification for all Candida from urine cultures, which would have otherwise been discarded because they are assumed to be not clinically significant. Within 5 months, testing of 271 Candida urine isolates identified the region’s first C. auris case, prompting contact tracing and identification of additional cases and facilities. (2) When CPOs were identified in patients with recent hospitalizations outside of the United States, the Maryland Department of Health screened patients for C.auris colonization. Of four screened, one, who received care in Kenya, was C. auris colonized. (3) The Indiana State Department of Health implemented monthly PPS at an LTACH that frequently admits patients transferred from a high prevalence area. Of 38 patients screened, two were colonized. (4) The Connecticut Department of Public Health offers C. auris admission screening for patients who received inpatient care in high prevalence areas; of 12 screened, one C. auris colonized patient was found. Infection control assessments and implementation of infection control measures followed each detection. Conclusion Early detection of C. auris is important but is impacted by infrequent yeast species identification and a reservoir of asymptomatic colonized patients. Healthcare facilities and public health jurisdictions can consider adopting one or more of these strategies based on epidemiology and resource availability. Disclosures All authors: No reported disclosures.

State Public Health and Long Term Acute Care Hospitals: Collaboration from Prevention Assessment to Infection Prevention Action Plans

2014 ◽  
Vol 42 (6) ◽  
pp. S165
Author(s):  
Vicki Keller ◽  
Sue Chen ◽  
Linda Becker ◽  
Tracy Lanier ◽  
Teresa Nelson ◽  
...  
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Infection Prevention ◽  
Acute Care Hospitals ◽  
Action Plans

scholarly journals 174. Increase in Candida auris cases in New Jersey healthcare facilities during the COVID-19 pandemic — 2017–2020

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S106-S107
Author(s):  
Reed Magleby ◽  
Gabriel Innes ◽  
Diya Cherian ◽  
Jessica Arias ◽  
Jason Mehr ◽  
...  
Keyword(s):  
New Jersey ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Point Prevalence ◽  
Candida Auris ◽  
Healthcare Facilities ◽  
Clinical Specimens ◽  
Department Of Health ◽  
Percent Positivity

Abstract Background Candida auris is a fungal pathogen associated with multidrug resistance, high mortality, and healthcare transmission. Since its U.S. emergence in 2017, to March 19, 2021, 1708 clinical infections were reported nationwide, of which 235 (13.8%) were reported in New Jersey. The New Jersey Department of Health (NJDOH) maintains C. auris surveillance in healthcare facilities (HCF) such as acute care hospitals, long-term acute care hospitals (LTACHs), and skilled nursing facilities, to monitor clinical infections and patient colonization. We aimed to characterize the epidemiology of C. auris infection and colonization among HCF patients during 2017–2020. Methods HCFs report C. auris cases identified from clinical specimens and surveillance activities such as admission screenings and point prevalence surveys (PPS) to NJDOH. Cases are classified as either infection or colonization using National Notifiable Diseases Surveillance System case definitions. We analyzed cases reported during 2017–2020 to describe types of cases, facilities reporting cases, and demographics of affected patients. We analyzed PPS results to calculate percent positivity of tests from patients without previously identified infection and compared percent positivity between types of facilities. We examined quarterly trends for all variables before and after the COVID-19 pandemic peak in the second quarter of 2020. Results During 2017–2020, 614 C. auris cases identified from clinical specimens were reported to NJDOH [243 (39.6%) infection, 371 (60.4%) colonization]; of these, 139 (57.2%) and 301 (81.1%) , respectively, were identified at long-term acute care hospitals (LTACHs). PPS percent positivity was higher at LTACHs (mean 7.6%) compared with all other facility types (mean 3.6%) for 13 of 16 quarters during 2017–2020. Case reports increased 2.6-fold from the Q2 2020 peak of the COVID-19 pandemic to Q3 2020.From Q1 to Q4 2020, PPS percent positivity increased from 4.8% to 10.5%. Figure 1. Candida auris cases reported to New Jersey Department of Health, 2017–2020 Figure 2. Candida auris test percent positivity among healthcare facility patients sampled for point prevalence surveys* and total number of C. auris point prevalence tests performed, New Jersey, 2017–2020. *Excluding individuals already known to be cases Conclusion The COVID-19 pandemic may have exacerbated C. auris transmission in HCF and potential causes should be further explored. LTACHs carry a disproportionate burden of patients colonized with C. auris and should be prioritized for surveillance and containment efforts. Disclosures All Authors: No reported disclosures

scholarly journals Public Health Law Analysis of Shared Use Agreements in Los Angeles County,

2017 ◽  
Vol 15 (2) ◽  
pp. 69-74
Author(s):  
Benjamin D. Winig ◽  
Tony Kuo
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Los Angeles County ◽  
Best Practice ◽  
Public Health Practice ◽  
Health Law ◽  
Legal Analysis ◽  
Public Health Law ◽  
Legal Mechanism

Los Angeles County communities have implemented a variety of shared use arrangements to promote physical activity among residents who live near schools. However, little has been documented or is presently known about the strengths and limitations of these legal arrangements for achieving this goal. This legal analysis addresses a gap in public health practice. A public health law analysis was conducted to review 20 shared used agreements implemented in Los Angeles County during 2010-2014. Some schools and communities have entered into lengthy, detailed contracts; others have opted for simple applications, licenses, and permits; others have used memoranda of understanding. Findings suggest that regardless of the legal mechanism used to document the parties’ intentions, including language that describes each party’s interest in community health, health equity, and long-term sustainability represents a best practice that should be considered in every shared use agreement.

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