scholarly journals 1263. Managing an Influenza Outbreak Which Spilled Over to an Acute Care Hospital from a Behavioral Health Unit

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S385-S385
Author(s):  
Colleen M Clay ◽  
Leonardo Girio-Herrera ◽  
Faheem Younus
Keyword(s):  
Behavioral Health ◽  
Acute Care ◽  
Influenza A ◽  
Average Length ◽  
Acute Care Hospital ◽  
Control Measures ◽  
Care Hospital ◽  
Prevention Measures ◽  
Influenza Outbreak ◽  
Hospital Acquired

Abstract Background Behavioral health units (BHU) have been implicated in influenza outbreaks due to group activities, low availability of alcohol-based hand gels and unique host factors. We describe the management of an unusual influenza outbreak, which started in the BHU and then spilled over to the acute care hospital (ACH). Methods University of Maryland Harford Memorial Hospital is a 95-bed ACH with a 14-bed closed-door adult BHU located on the fifth floor. Two cases each of hospital-acquired influenza were identified in our BHU during 2016 and 2017. In January 2018, however, hospital-acquired influenza cases in the BHU spilled over to the adjacent ACH to cause an outbreak. A case was defined as a patient with fever of >100.4°F, presence of influenza-like illness, and a positive influenza test >72 hours after admission. Outbreak control measures included twice daily fever screening, enhanced droplet precautions, visitor restrictions, discontinuing community activities, enforcing hand hygiene at all hospital entrances, and hospital-wide chemoprophylaxis with oseltamivir. Results On January 15, 2018, the index patient developed influenza in the BHU followed by a second case in BHU 4-days later. Over the next 10 days, five more patients on the third and fourth floors of ACH tested positive. Attack rate was 3% and average length of stay was 8.9 days. Chemoprophylaxis with oseltamivir 75 mg orally once a day was given to 71% of all eligible hospitalized patients for a week (at a cost of $17,000). All seven patients yielded influenza A, subtype H3N2 and were successfully treated with oseltamivir 75 mg orally twice a day for 7 days. The outbreak lasted 11 days. Figure 1 shows the epidemiologic curve. Conclusion Special attention should be paid to influenza prevention in the BHUs due to the risk of spillover effect to sicker patients in the adjacent ACH. A short, 7-day course of hospital-wide oseltamivir chemoprophylaxis, in addition to promptly implementing the infection prevention measures was effective in controlling the outbreak. Disclosures All authors: No reported disclosures.

scholarly journals 161. Prevalence and Risk Factors for Candida auris Colonization Among Patients in a Long-term Acute Care Hospital—New Jersey, 2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S14-S14
Author(s):  
Faye Rozwadowski ◽  
Jarred McAteer ◽  
Nancy A Chow ◽  
Kimberly Skrobarcek ◽  
Kaitlin Forsberg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Clinical Information ◽  
Control Measures ◽  
Resistant Organism ◽  
Invasive Infection ◽  
Care Hospital ◽  
Candida Auris

Abstract Background Candida auris can be transmitted in healthcare settings, and patients can become asymptomatically colonized, increasing risk for invasive infection and transmission. We investigated an ongoing C. auris outbreak at a 30-bed long-term acute care hospital to identify colonization for C. auris prevalence and risk factors. Methods During February–June 2017, we conducted point prevalence surveys every 2 weeks among admitted patients. We abstracted clinical information from medical records and collected axillary and groin swabs. Swabs were tested for C. auris. Data were analyzed to identify risk factors for colonization with C. auris by evaluating differences between colonized and noncolonized patients. Results All 101 hospitalized patients were surveyed, and 33 (33%) were colonized with C. auris. Prevalence of colonization ranged from 8% to 38%; incidence ranged from 5% to 20% (figure). Among colonized patients with available data, 19/27 (70%) had a tracheostomy, 20/31 (65%) had gastrostomy tubes, 24/33 (73%) ventilator use, and 12/27 (44%) had hemodialysis. Also, 31/33 (94%) had antibiotics and 13/33 (34%) antifungals during hospitalization. BMI for colonized patients (mean = 30.3, standard deviation (SD) = 10) was higher than for noncolonized patients (mean = 26.5, SD = 7.9); t = −2.1; P = 0.04). Odds of colonization were higher among Black patients (33%) vs. White patients (16%) (odds ratio [OR] 3.5; 95% confidence interval [CI] 1.3–9.8), and those colonized with other multidrug-resistant organism (MDRO) (72%) vs. noncolonized (44%) (OR 3.2; CI 1.3–8.0). Odds of death were higher among colonized patients (OR 4.6; CI 1.6—13.6). Conclusion Patients in long-term acute care facilities and having high prevalences of MDROs might be at risk for C. auris. Such patients with these risk factors could be targeted for enhanced surveillance to facilitate early detection of C. auris. Infection control measures to reduce MDROs’ spread, including hand hygiene, contact precautions, and judicious use of antimicrobials, could prevent further C. auris transmission. Acknowledgements The authors thank Janet Glowicz and Kathleen Ross. Disclosures All authors: No reported disclosures.

Hospital-Acquired Infections in Elderly Versus Younger Patients in an Acute Care Hospital

2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Perla Sarai Solis-Hernandez ◽  
Melissa Vidales-Reyes ◽  
Elvira Garza-Gonzalez ◽  
Guillermo Guajardo-Alvarez ◽  
Susana Chavez-Moreno ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Younger Patients ◽  
Hospital Acquired Infections ◽  
Hospital Acquired

scholarly journals COVID-19 Outbreak in an Acute-Care Hospital: Lessons Learned

2021 ◽  
Vol 1 (S1) ◽  
pp. s56-s57
Author(s):  
Supriya Narasimhan ◽  
Vidya Mony ◽  
Tracey Stoll ◽  
Sherilyn Oribello ◽  
Karanas Yvonne ◽  
...  
Keyword(s):  
Acute Care ◽  
Infection Prevention ◽  
Environmental Control ◽  
Acute Care Hospital ◽  
Lessons Learned ◽  
Control Measures ◽  
Additional Patient ◽  
Care Hospital ◽  
Eye Protection ◽  
Containment Measures

Background: We describe the infection prevention investigation of a cluster of 15 healthcare workers (HCWs) and 7 patients in a single non–COVID-19 unit of an acute-care hospital in September 2020. Methods: The infection prevention team was notified of 13 SARS-CoV-2–positive, symptomatic HCWs in an acute-care non–COVID-19 unit in 1 week (August 30, 2020, to September 3, 2020). In the same week, 2 patients who had been on the unit were diagnosed with nosocomial COVID-19. An epidemiologic investigation identified the exposure period to be between August 19, 2020, and September 3, 2020. The following immediate containment measures were implemented: closing the unit to new admissions, restricting float staff, moving existing patients to private rooms, mandatory masking of patients, and mandatory respirator and eye protection on unit entry for all HCWs. Exposed unit staff were tested immediately and then every 4 days until September 18, 2020. Likewise, exposed patients, including those discharged, were notified and offered testing. Hospital-wide HCW surveillance testing was conducted. Enhanced environmental control measures were conducted, including terminal cleaning and ultraviolet C (UV-C) disinfection of common areas and patient rooms and a thorough investigation of airflow. Detailed staff interviews were performed to identify causes of transmission. Multiple town hall meetings were held for staff education and updates. Results: In total, 108 total patients were deemed exposed: 33 were inpatients and 75 had been discharged. Testing identified 5 additional patient cases among 57 patients who received testing; 51 chose to self-monitor for symptoms. Staff testing identified 2 additional cases. Thus, 15 HCWs and 7 patients were linked in this cluster. The containment measures successfully ended staff transmission as of September 5, 2020. The last patient case was detected on September 10, 2020. Secondary cases were noted in 6 HCW families. We identified staff presenteeism, complacency, and socialization in break rooms and outside work as major causes of transmission. Suboptimal compliance with universal eye protection and hand hygiene (67%) were contributing factors. We determined by contact tracing and temporality that the outbreak could have stemmed from nursing home patient(s) through floating HCWs to staff on the affected unit. Directionality of transmission was from staff to patients in this cluster. Conclusions: Many facets of pandemic fatigue were apparent in this outbreak, namely, inability of HCWs to adhere to changing PPE guidance, presenteeism pressures due to workforce needs, and socialization with peers due to a false sense of security conferred by biweekly surveillance testing. Ongoing PPE education, repeated reinforcement, as well as engagement in staff wellness are crucial to combatting pandemic fatigue, conserving our workforce, and preventing future outbreaks.Funding: NoDisclosures: None

scholarly journals Predictive validity of the INTEGRARE scale in identifying the risk of hospital-acquired pressure ulcers in acute care hospital settings

2022 ◽  
Author(s):  
Ana María Porcel-Gálvez ◽  
Regina Allande-Cussó ◽  
Elena Fernández-García ◽  
Alonso Naharro-Álvarez ◽  
Sergio Barrientos-Trigo
Keyword(s):  
Acute Care ◽  
Predictive Validity ◽  
Pressure Ulcers ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Hospital Acquired

Impact of hospital-wide surveillance on hospital-acquired infections in an acute-care hospital in The Netherlands

2000 ◽  
Vol 46 (1) ◽  
pp. 36-42 ◽  
Author(s):  
A.J Mintjes-de Groot ◽  
C.A.N van Hassel ◽  
J.A Kaan ◽  
R.P Verkooyen ◽  
H.A Verbrugh
Keyword(s):  
The Netherlands ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Hospital Acquired Infections ◽  
Hospital Acquired

scholarly journals Patient Recommendations to Improve the Implementation of and Engagement With Portals in Acute Care: Hospital-Based Qualitative Study

10.2196/13337 ◽  
2020 ◽  
Vol 22 (1) ◽  
pp. e13337 ◽  
Author(s):  
S Ryan Greysen ◽  
Yimdriuska Magan ◽  
Jamie Rosenthal ◽  
Ronald Jacolbia ◽  
Andrew D Auerbach ◽  
...  
Keyword(s):  
Acute Care ◽  
Qualitative Data ◽  
Average Length ◽  
Acute Care Hospital ◽  
Outpatient Setting ◽  
Bring Your Own Device ◽  
Inpatient Setting ◽  
Successful Implementation ◽  
Care Hospital ◽  
Patient Portals

Background The inclusion of patient portals into electronic health records in the inpatient setting lags behind progress in the outpatient setting. Objective The aim of this study was to understand patient perceptions of using a portal during an episode of acute care and explore patient-perceived barriers and facilitators to portal use during hospitalization. Methods We utilized a mixed methods approach to explore patient experiences in using the portal during hospitalization. All patients received a tablet with a brief tutorial, pre- and postuse surveys, and completed in-person semistructured interviews. Qualitative data were coded using thematic analysis to iteratively develop 18 codes that were integrated into 3 themes framed as patient recommendations to hospitals to improve engagement with the portal during acute care. Themes from these qualitative data guided our approach to the analysis of quantitative data. Results We enrolled 97 participants: 53 (53/97, 55%) women, 44 (44/97, 45%) nonwhite with an average age of 48 years (19-81 years), and the average length of hospitalization was 6.4 days. A total of 47 participants (47/97, 48%) had an active portal account, 59 participants (59/97, 61%) owned a smartphone, and 79 participants (79/97, 81%) accessed the internet daily. In total, 3 overarching themes emerged from the qualitative analysis of interviews with these patients during their hospital stay: (1) hospitals should provide both access to a device and bring-your-own-device platform to access the portal; (2) hospitals should provide an orientation both on how to use the device and how to use the portal; and (3) hospitals should ensure portal content is up to date and easy to understand. Conclusions Patients independently and consistently identified basic needs for device and portal access, education, and usability. Hospitals should prioritize these areas to enable successful implementation of inpatient portals to promote greater patient engagement during acute care. Trial Registration ClinicalTrials.gov NCT00102401; https://clinicaltrials.gov/ct2/show/NCT01970852

scholarly journals 1268. Transmissibility of Candida auris by Type of Inpatient Healthcare Facility

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S386-S387
Author(s):  
Prabasaj Paul ◽  
Kaitlin Forsberg ◽  
Snigdha Vallabhaneni ◽  
Shawn R Lockhart ◽  
Anastasia P Litvintseva ◽  
...  
Keyword(s):  
Acute Care ◽  
Reproduction Number ◽  
Acute Care Hospital ◽  
Healthcare Facility ◽  
Control Measures ◽  
Care Hospital ◽  
Candida Auris ◽  
Healthcare Facilities ◽  
Colonization Pressure ◽  
Facility Type

Abstract Background Candida auris is a multidrug-resistant yeast causing outbreaks in healthcare settings. Stopping the spread of C. auris requires rapid identification of healthcare facilities at risk of higher transmission to help targeted implementation of infection control measures. We used data collected during public health investigations to quantify transmissibility of C. auris by type of healthcare facility. Methods In two states, 3,159 patient swabs were collected during 96 C. auris point prevalence surveys conducted at 36 inpatient healthcare facilities in November 2016 and April 2018. We estimated facility transmissibility and facility reproduction number (number infected by one index colonized patient per day, and per stay, respectively, at the facility) of C. auris based on estimated colonization pressure, a count of newly colonized patients between successive surveys at the same facility, and mean lengths of stay at facilities (estimated from CMS administrative data). The results were summarized by facility type: acute care hospital (ACH), long-term acute care hospital (LTACH) or ventilator unit at skilled nursing facility (VSNF), and were compared with previous estimates for transmissibility of carbapenem-resistant Enterobacteriaceae (CRE). Results Swabs were collected from 13 ACHs, 12 LTACHs, and 11 VSNFs. The C. auris facility reproduction number may exceed the critical value of 1 in both ACHs and VSNFs, and may exceed that for CRE in ACHs (table). Conclusion Transmissibility of C. auris is comparable to that of CRE. The transmissibility within VSNFs emphasizes their potential role as amplifiers in the outbreak. Understanding transmissibility by facility type helps evaluate the potential impact of interventions in various settings. Disclosures All authors: No reported disclosures.

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