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 539. Canaries in a Coal Mine?: Early Identification of Regional Spread of Novel Multidrug-resistant Organisms (MDROs) Using Sentinel Surveillance in Skilled Nursing Facilities Caring For Ventilated Patients (vSNFs)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S257-S258
Author(s):  
Prabasaj Paul ◽  
Rachel Slayton ◽  
Maroya S Walters ◽  
John A Jernigan
Keyword(s):  
Real Time ◽  
Acute Care ◽  
Clinical Microbiology ◽  
Acute Care Hospitals ◽  
Sentinel Surveillance ◽  
Point Prevalence ◽  
Care Hospital ◽  
Real Time Monitoring ◽  
Healthcare Facilities

Abstract Background Regional containment of novel or targeted MDROs depends on detecting their presence as soon as possible following their introduction. Prior modeling studies suggest that after importation to a region, novel MDROs appear relatively quickly in certain high-risk post-acute long-term care facilities via patient movement. Sentinel surveillance in such facilities might facilitate early detection of emergent MDROs, thereby enhancing the effectiveness of containment efforts. Methods We simulated the introduction and spread of carbapenem-resistant Enterobacteriaceae (CRE) in a region using an adaptation of a previously described susceptible-infectious-susceptible model (Clin Infect Dis. 2019 March 28 doi: 10.1093/cid/ciz248). The model includes the patient sharing network among healthcare facilities in an exemplar US state, using claims data and the Minimum Data Set from the Centers for Medicare & Medicaid Services for 2015. Disease progression, transmission and testing rates were estimated for CRE using data from the literature. Each simulated outbreak was initiated with a single importation to a Dartmouth Atlas of Health Care hospital referral region. The predicted timing of first CRE detection using two different data sources was compared: (1) real-time monitoring of clinical microbiology test results, or (2) results from quarterly point prevalence colonization surveys (PPSs). For each data source, the timing of earliest detection was compared according to availability of data from: (a) all healthcare facilities statewide, (b) only long-term acute care hospitals, (c) only vSNFs, or (d) only the largest acute care hospitals in the state (n = 23). Results Compared with real-time monitoring of clinical microbiology testing results from all facilities statewide, quarterly PPSs at all facilities detected CRE 446 days (median; range 312–608 days) earlier, while PPSs at only vSNFs (representing 4.4% of inpatient beds statewide) detected CRE 385 days (range 194–553 days) earlier (figures). Conclusion Regular point prevalence surveys in vSNFs may detect new MDROs in a region approximately one year sooner than real-time monitoring of clinical microbiology results, and may be an efficient strategy for early regional detection and subsequent containment. 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

Prevalence and Trend in the Use of Hospital-Based Standing Orders Programs for Influenza and Pneumococcal Vaccination

2007 ◽  
Vol 28 (8) ◽  
pp. 899-904 ◽  
Author(s):  
Sri Ram Pentakota ◽  
William Halperin
Keyword(s):  
New Jersey ◽  
Influenza Vaccination ◽  
Acute Care ◽  
State Government ◽  
Pneumococcal Vaccination ◽  
Acute Care Hospitals ◽  
Health Department ◽  
The State ◽  
Healthcare Facilities ◽  
Hospital Characteristics

Background.In 2002, federal regulations authorized the use of standing orders programs (SOPs) for promoting influenza and pneumococcal vaccination. In 2003, the New Jersey Hospital Association conducted a demonstration project illustrating the efficacy of SOPs, and the state health department informed healthcare facilities of their benefits. We describe the prevalence of reported use of SOPs in New Jersey hospitals in 2003 and 2005 and identify hospital characteristics associated with the use of SOPs.Methods.A survey was mailed to the directors of infection control at 117 New Jersey hospitals during the period from January to May 2005 (response rate, 90.6%). Data on hospital characteristics were obtained from hospital directories and online resources.Results.The prevalence of use of SOPs for influenza vaccination was 50% (95% confidence interval [CI], 40.1%-59.9%) in 2003, and it increased to 78.3% (95% CI, 69.2%-85.7%) in 2005. The prevalence of SOP use for pneumococcal vaccination was similar. In 2005, the reported rate of use of SOPs for inpatients (influenza vaccination, 76.4%; pneumococcal vaccination, 75.5%) was significantly higher than that for outpatients (influenza vaccination, 9.4%; pneumococcal vaccination, 8.5%). Prevalence ratios for SOP use comparing acute care and non-acute care hospitals were 1.71 (95% CI, 1.2-2.5) for influenza vaccination SOPs and 1.8 for (95% CI, 1.2-2.7) pneumococcal vaccination SOPs. Acute care hospitals with a ratio of admissions to total beds greater than 36.7 reported greater use of SOPs for pneumococcal vaccination, compared with those that had a ratio of less than 36.7.Conclusion.The increase in the prevalence of reported use of SOPs among New Jersey hospitals in 2005, compared with 2003, was contemporaneous with SOP-related actions taken by the federal government, the state government, and the New Jersey Hospital Association. Opportunities persist for increased use of SOPs among non-acute care hospitals and for outpatients.

scholarly journals Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017

2018 ◽  
Vol 23 (46) ◽  
Author(s):  
Carl Suetens ◽  
Katrien Latour ◽  
Tommi Kärki ◽  
Enrico Ricchizzi ◽  
Pete Kinross ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Acute Care ◽  
Long Term Care ◽  
Acute Care Hospitals ◽  
Point Prevalence ◽  
Healthcare Associated Infections ◽  
Term Care ◽  
Care Facilities ◽  
Healthcare Associated

Point prevalence surveys of healthcare-associated infections (HAI) and antimicrobial use in the European Union and European Economic Area (EU/EEA) from 2016 to 2017 included 310,755 patients from 1,209 acute care hospitals (ACH) in 28 countries and 117,138 residents from 2,221 long-term care facilities (LTCF) in 23 countries. After national validation, we estimated that 6.5% (cumulative 95% confidence interval (cCI): 5.4–7.8%) patients in ACH and 3.9% (95% cCI: 2.4–6.0%) residents in LTCF had at least one HAI (country-weighted prevalence). On any given day, 98,166 patients (95% cCI: 81,022–117,484) in ACH and 129,940 (95% cCI: 79,570–197,625) residents in LTCF had an HAI. HAI episodes per year were estimated at 8.9 million (95% cCI: 4.6–15.6 million), including 4.5 million (95% cCI: 2.6–7.6 million) in ACH and 4.4 million (95% cCI: 2.0–8.0 million) in LTCF; 3.8 million (95% cCI: 3.1–4.5 million) patients acquired an HAI each year in ACH. Antimicrobial resistance (AMR) to selected AMR markers was 31.6% in ACH and 28.0% in LTCF. Our study confirmed a high annual number of HAI in healthcare facilities in the EU/EEA and indicated that AMR in HAI in LTCF may have reached the same level as in ACH.

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 Identification of Colonized Patients During an Outbreak of Candida auris Using a Regional Health Information Exchange

2020 ◽  
Vol 41 (S1) ◽  
pp. s255-s256
Author(s):  
Richard Brooks ◽  
Elisabeth Vaeth ◽  
Heather Saunders ◽  
Tim Blood ◽  
Brittany Grace ◽  
...  
Keyword(s):  
Health Information ◽  
Acute Care ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Acute Care Hospitals ◽  
Regional Health ◽  
Candida Auris ◽  
Notification System ◽  
Healthcare Facilities ◽  
Care Facilities

Background: In June 2019, the Maryland Department of Health (MDH) was notified of a hospitalized patient with Candida auris bloodstream infection. The MDH initiated a contact investigation to identify additional patients with C. auris colonization. Many of the contacts had been discharged home from the hospital and were therefore not available for screening. Healthcare facilities in Maryland, Virginia, and Washington, DC, submit patient data to a regional health information exchange (HIE) called the Chesapeake Regional Information System for our Patients (CRISP). CRISP includes a notification system that alerts providers when flagged patients have healthcare encounters. We aimed to use this system to identify discharged C. auris contacts on their next inpatient encounter to rapidly screen them and to detect new cases. Methods:C. auris contacts were defined as patients located on an inpatient unit on the same day, receiving wound care from the same team, or having a procedure in the same operating room on the same day as the index patient or any patients subsequently identified as having C. auris infection or colonization detected either during the normal course of clinical care or through screening. Contacts who remained hospitalized were screened during inpatient point prevalence surveys (PPSs). Contacts discharged to postacute-care facilities were screened by facility staff. Contacts who had been discharged home were flagged in CRISP, and MDH staff received CRISP encounter alerts when these patients were readmitted. MDH staff then contacted the admitting facilities to recommend screening for C. auris. Axilla and groin swabs were collected and tested by rt-PCR at the Mid-Atlantic Regional Antibiotic Resistance Laboratory Network laboratory. Results: As of October 8, 2019, 4,017 contacts were identified. Among these, 936 (23%) contacts at 56 healthcare facilities (33 acute-care hospitals and 23 postacute-care facilities) were screened for C. auris, and 10 patients with C. auris colonization were identified (1.1% of contacts who underwent C. auris screening). Of these, 6 (60%) were identified through CRISP notification and 4 (40%) were identified by PPSs conducted in acute-care hospitals. Conclusions: In this ongoing C. auris outbreak, a large proportion of colonized patients was identified using an electronic encounter notification system within a regional HIE. This approach was effective for identifying opportunities to screen contacts at their next healthcare encounter and can augment other means of case detection, like PPSs. HIEs should incorporate mechanisms to facilitate contact tracing for public health investigations.Funding: NoneDisclosures: None

scholarly journals Characterization and evolution of infection control practices among SARS-CoV-2 infected healthcare workers of acute care hospitals and long-term care facilities in Quebec, Canada, Spring 2020

2021 ◽  
pp. 1-37
Author(s):  
Sara Carazo ◽  
Denis Laliberté ◽  
Jasmin Villeneuve ◽  
Richard Martin ◽  
Pierre Deshaies ◽  
...  
Keyword(s):  
Acute Care ◽  
Attack Rate ◽  
Healthcare Workers ◽  
Long Term Care ◽  
Acute Care Hospitals ◽  
Exposure Period ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Care Facilities

ABSTRACT Objectives: To estimate the SARS-CoV-2 infection rate and the secondary attack rate among healthcare workers (HCWs) in Quebec, the most affected province of Canada during the first wave; to describe the evolution of work-related exposures and infection prevention and control (IPC) practices in infected HCWs; and to compare the exposures and practices between acute care hospitals (ACHs) and long-term care facilities (LTCFs). Design: Survey of cases Participants: Quebec HCWs from private and public institutions with laboratory-confirmed COVID-19 diagnosed between 1st March and 14th June 2020. HCWs ≥18 years old, having worked during the exposure period and survived their illness were eligible for the survey. Methods: After obtaining consent, 4542 HCWs completed a standardized questionnaire. COVID-19 rates and proportions of exposures and practices were estimated and compared between ACHs and LTCFs. Results: HCWs represented 25% (13,726/54,005) of all reported COVID-19 cases in Quebec and had an 11-times greater rate than non-HCWs. Their secondary household attack rate was 30%. Most affected occupations were healthcare support workers, nurses and nurse assistants, working in LTCFs (45%) and ACHs (30%). Compared to ACHs, HCWs of LTCFs had less training, higher staff mobility between working sites, similar PPE use but better self-reported compliance with at-work physical distancing. Sub-optimal IPC practices declined over time but were still present at the end of the first wave. Conclusion: Quebec HCWs and their families were severely affected during the first wave of COVID-19. Insufficient pandemic preparedness and suboptimal IPC practices likely contributed to high transmission in both LTCFs and ACHs.

Post–Intensive Care Syndrome in Family Decision Makers of Long-term Acute Care Hospital Patients

2017 ◽  
Vol 26 (5) ◽  
pp. 416-422 ◽  
Author(s):  
Amy Petrinec
Keyword(s):  
Quality Of Life ◽  
Intensive Care ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Summary Score ◽  
Decision Makers ◽  
Family Decision ◽  
Post Intensive Care Syndrome

Background Family members of critically ill patients experience indications of post–intensive care syndrome, including anxiety, depression, and posttraumatic stress disorder. Despite increased use of long-term acute care hospitals for critically ill patients, little is known about the impact of long-term hospitalization on patients’ family members. Objectives To examine indications of post–intensive care syndrome, coping strategies, and health-related quality of life among family decision makers during and after patients’ long-term hospitalization. Methods A single-center, prospective, longitudinal descriptive study was undertaken of family decision makers of adult patients admitted to long-term acute care hospitals. Indications of post–intensive care syndrome and coping strategies were measured on the day of hospital admission and 30 and 60 days later. Health-related quality of life was measured by using the Short Form-36, version 2, at admission and 60 days later. Results The sample consisted of 30 family decision makers. On admission, 27% reported moderate to severe anxiety, and 20% reported moderate to severe depression. Among the decision makers, 10% met criteria for a provisional diagnosis of posttraumatic stress disorder. At admission, the mean physical summary score for quality of life was 47.8 (SD, 9.91) and the mean mental summary score was 48.00 (SD, 10.28). No significant changes occurred during the study period. Problem-focused coping was the most frequently used coping strategy at all time points. Conclusion Family decision makers of patients in long-term acute care hospitals have a significant prevalence of indications of post–intensive care syndrome.

scholarly journals Health problems and violence experiences of nurses working in acute care hospitals, long-term care facilities, and home-based long-term care in Germany: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260050
Author(s):  
Andrea Schaller ◽  
Teresa Klas ◽  
Madeleine Gernert ◽  
Kathrin Steinbeißer
Keyword(s):  
Mental Health ◽  
Acute Care ◽  
Long Term Care ◽  
Mental Health Problems ◽  
Acute Care Hospitals ◽  
Health Problems ◽  
Term Care ◽  
Home Based ◽  
Care Facilities

Background Working in the nursing sector is accompanied by great physical and mental health burdens. Consequently, it is necessary to develop target-oriented, sustainable profession-specific support and health promotion measures for nurses. Objectives The present review aims to give an overview of existing major health problems and violence experiences of nurses in different settings (acute care hospitals, long-term care facilities, and home-based long-term care) in Germany. Methods A systematic literature search was conducted in PubMed and PubPsych and completed by a manual search upon included studies’ references and health insurance reports. Articles were included if they had been published after 2010 and provided data on health problems or violence experiences of nurses in at least one care setting. Results A total of 29 studies providing data on nurses health problems and/or violence experience were included. Of these, five studies allowed for direct comparison of nurses in the settings. In addition, 14 studies provided data on nursing working in acute care hospitals, ten on nurses working in long-term care facilities, and four studies on home-based long-term care. The studies either conducted a setting-specific approach or provided subgroup data from setting-unspecific studies. The remaining studies did not allow setting-related differentiation of the results. The available results indicate that mental health problems are the highest for nurses in acute care hospitals. Regarding violence experience, nurses working in long-term care facilities appear to be most frequently affected. Conclusion The state of research on setting-specific differences of nurses’ health problems and violence experiences is insufficient. Setting-specific data are necessesary to develop target-group specific and feasible interventions to support the nurses’ health and prevention of violence, as well as dealing with violence experiences of nurses.

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