604. Gram-Negative Bacilli Carrying Multiple Carbapenemases: the United States, 2012–2018

Abstract Background Gram-negative bacilli carrying multiple carbapenemase genes (multi-CP-GNB) present an emerging public health threat; to date, most isolates reported in the literature have been from outside the United States. We reviewed multi-CP-GNB reported to CDC. Methods Reports of multi-CP-GNB isolates carrying genes encoding >1 targeted carbapenemases (i.e., KPC, NDM, OXA-48-type, VIM, or IMP) were received from healthcare facilities, health departments, and public health laboratories, and included isolates tested through the AR Laboratory Network (ARLN) beginning in 2017 as well as isolates sent to CDC for reference testing. Epidemiologic data were gathered by health departments during public health investigations. Results From October 2012 to November 2018, 111 multi-CP-GNB isolates from 71 patients in 20 states were identified. Two patients had three different multi-CP-GNB and one patient had two different multi-CP-GNB. The majority of cases (76%) were reported in 2017 or later, after ARLN testing began. Among patients with multi-CP-GNB, the most common organism-mechanisms combination was Klebsiella pneumoniae carrying NDM and OXA-48-type enzymes (table). Urine (44%) and rectal (20%) were the most frequent specimen sources for isolates. The median age of patients was 63 years (range 2–89 years); most had specimens collected at acute care hospitals (87%) or post-acute care facilities (9%). Of 50 patients with information available, 37 traveled internationally in the 12 months prior to culture collection. Among these, 88% were hospitalized for ≥1 night while outside the United States with 10 countries reported, of which India was most common (n = 18). All 5 patients with Pseudomonas aeruginosa co-carrying carbapenemases reported recent hospitalization outside the United States. Conclusion The multi-CP-GNB reported to CDC include diverse organisms and carbapenemase combinations and often harbored carbapenemases from different β-lactamase classes, which may severely limit treatment options. Healthcare exposures outside the United States were common; providers should ask about this exposure at healthcare admission and, when present, institute interventions to stop transmission in order to slow further US emergence. Disclosures All authors: No reported disclosures.

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Assessment of Potential Clostridioides difficile Public Health Notification Thresholds in Acute-Care Hospitals

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.644 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s132-s132

Author(s):

Ariella Dale ◽

Meghana Parikh ◽

Wendy Bamberg ◽

Marion Kainer

Keyword(s):

Public Health ◽

Acute Care ◽

Acute Care Hospitals ◽

The United States ◽

Health Departments ◽

Healthcare Facilities ◽

Public Health Departments ◽

Threshold Levels ◽

Clostridioides Difficile ◽

Alert Threshold

Background:Clostridioides difficile remains a pervasive issue throughout healthcare facilities in the United States. Currently, no national guidelines exist for healthcare facilities to notify public health about suspected C. difficile transmission. Identification of a threshold for public health notification is needed to improve efforts to target prevention in facilities and to contain the spread of C. difficile.Methods: We analyzed C. difficile data reported by acute-care hospitals (ACHs) during October 2017–September 2018 via the CDC NHSN in Colorado and Tennessee. Threshold levels of ≥2, ≥3, and ≥4 C. difficile infections per calendar month per unit were assessed to identify ACH units that would trigger facility reporting to public health. Values meeting thresholds were defined as “alerts.” Facilities were further stratified by size and medical teaching status. Recurrent alerts were defined as meeting the threshold at least twice within 12 months. Presence and recurrence of facility alerts were compared to facility-specific standardized infection ratios (SIRs) and cumulative attributable differences (CADs). Results: Of 105 ACHs in Tennessee and 50 in Colorado, 46 in Tennessee (44%) and 28 in Colorado (56%) had alerts with a threshold of ≥2 cases per calendar month per unit; 20 in Tennessee (19%) and 19 in Colorado (38%) had ≥3 cases per calendar month per unit; and 7 in Tennessee (7%) and 10 in Colorado (20%) had ≥4 cases per calendar month per unit. Most alerts with each threshold were in facilities with ≥400 beds and in major teaching hospitals. Using a threshold of ≥2, 64% of Tennessee and 79% of Colorado alerts were associated with recurrent alerting units. Using an alert threshold of ≥3, 85% of Tennessee facilities (17 of 20) and 75% of Colorado facilities (15 of 20) with the highest CAD values had at least 1 alert. Using state-based CAD values, 79% of the CAD value for Tennessee (356 of 449) and 91% of the CAD value for Colorado (309 of 340) were attributable to facilities with at least 1 alert. Facilities above a threshold of ≥3 had a pooled SIR of 0.92 in Tennessee (range, 0.46–7.94) and 1.07 in Colorado (range, 0.74–1.74). Conclusions: Using alert threshold levels identified ACHs with higher levels of C. difficile. Recurrent alerts account for a substantial proportion of the total alerts in ACHs, even as thresholds increased. Alerts were strongly correlated with high CAD values. Because NHSN C. difficile data are not available to public health departments until several months after cases are identified, public health departments should consider working with ACHs to implement a threshold model for public health notification, enabling earlier intervention than those prompted by SIR and CAD calculations.Disclosures: NoneFunding: None

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Application for Public Health Accreditation Among US Local Health Departments in 2013 to 2019: Impact of Service and Activity Mix

American Journal of Public Health ◽

10.2105/ajph.2020.306007 ◽

2020 ◽

pp. e1-e8

Author(s):

Jonathon P. Leider ◽

Jessica Kronstadt ◽

Valerie A. Yeager ◽

Kellie Hall ◽

Chelsey K. Saari ◽

...

Keyword(s):

Public Health ◽

United States ◽

Latent Class ◽

The United States ◽

Local Health ◽

Health Departments ◽

Local Health Departments ◽

Profile Data ◽

The Public ◽

Funding Support

Objectives. To examine correlates of applying for accreditation among small local health departments (LHDs) in the United States through 2019. Methods. We used administrative data from the Public Health Accreditation Board (PHAB) and 2013, 2016, and 2019 Profile data from the National Association of County and City Health Officials to examine correlates of applying for PHAB accreditation. We fit a latent class analysis (LCA) to characterize LHDs by service mix and size. We made bivariate comparisons using the t test and Pearson χ2. Results. By the end of 2019, 126 small LHDs had applied for accreditation (8%). When we compared reasons for not pursuing accreditation, we observed a difference by size for perceptions that standards exceeded LHD capacity (47% for small vs 22% for midsized [P < .001] and 0% for large [P < .001]). Conclusions. Greater funding support, considering differing standards by LHD size, and recognition that service mix might affect practicality of accreditation are all relevant considerations in attempting to increase uptake of accreditation for small LHDs. Public Health Implications. Overall, small LHDs represented about 60% of all LHDs that had not yet applied to PHAB. (Am J Public Health. Published online ahead of print December 22, 2020: e1–e8. https://doi.org/10.2105/AJPH.2020.306007 )

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Epidemiology Workforce Capacity in 27 Large Urban Health Departments in the United States, 2017

Public Health Reports ◽

10.1177/0033354919856935 ◽

2019 ◽

Vol 134 (4) ◽

pp. 386-394

Author(s):

Meghan D. McGinty ◽

Nancy Binkin ◽

Jessica Arrazola ◽

Mia N. Israel ◽

Chrissie Juliano

Keyword(s):

Public Health ◽

United States ◽

Urban Health ◽

The United States ◽

Health Problems ◽

Full Time ◽

Health Departments ◽

Public Health Services ◽

Full Time Equivalent ◽

Workforce Capacity

Objectives: The Council of State and Territorial Epidemiologists (CSTE) has periodically assessed the epidemiological capacity of states since 2001, but the data do not reflect the total US epidemiology capacity. CSTE partnered with the Big Cities Health Coalition (BCHC) in 2017 to assess epidemiology capacity in large urban health departments. We described the epidemiology workforce capacity of large urban health departments in the United States and determined gaps in capacity among BCHC health departments. Methods: BCHC, in partnership with CSTE, modified the 2017 State Epidemiology Capacity Assessment for its 30 member departments. Topics in the assessment included epidemiology leadership, staffing, funding, capacity to perform 4 epidemiology-related Essential Public Health Services, salary ranges, hiring requirements, use of competencies, training needs, and job vacancies. Results: The 27 (90%) BCHC-member health departments that completed the assessment employed 1091 full-time equivalent epidemiologists. All or nearly all health departments provided epidemiology services for programs in infectious disease (n = 27), maternal and child health (n = 27), preparedness (n = 27), chronic diseases (n = 25), vital statistics (n = 25), and environmental health (n = 23). On average, funding for epidemiology activities came from local (47%), state (24%), and federal (27%) sources. Health departments reported needing a 40% increase from the current number of epidemiologists to achieve ideal epidemiology capacity. Twenty-five health departments reported substantial-to-full capacity to monitor health problems, 21 to diagnose health problems, 11 to conduct evaluations, and 9 to perform applied research. Conclusions: Strategies to meet 21st century challenges and increase substantial-to-full epidemiological capacity include seeking funds from nongovernmental sources, partnering with schools and programs of public health, and identifying creative solutions to hiring and retaining epidemiologists.

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