Methicillin-resistantStaphylococcus aureusin Canada: a historical perspective and lessons learned

2010 ◽  
Vol 56 (2) ◽  
pp. 89-120 ◽  
Author(s):  
Nevio Cimolai
Keyword(s):  
The United States ◽  
Management Control ◽  
Lessons Learned ◽  
Teaching Hospitals ◽  
Medical Problems ◽  
Term Care ◽  
Dramatic Rise ◽  
History Of ◽  
Hospital Acquired ◽  
And Control

The history of methicillin-resistant Staphylococcus aureus (MRSA) in Canada has many similarities to MRSA evolution worldwide, but especially to that in the United States and United Kingdom. Reports of MRSA occurred as early as 1964, and community isolates were cited in the 1970s. Nosocomial outbreaks were becoming common by 1978 and flourished gradually thereafter. Endemic institutional MRSA became predominant in the 1990s, threatening large teaching hospitals in particular. In the last decade, both hospital-acquired and community-acquired MRSA have created major medical problems in Canada. More recently, an epidemic of Canadian community-acquired MRSA-10, has led to heightened public health concerns. Canadian contributions to MRSA science are numerous, with organized surveillance continuing to mature across the nation. A typing system for epidemic clones is now available and is being judiciously applied. Estimated costs for MRSA surveillance, treatment, and control are extraordinary, paralleling the dramatic rise in the number of MRSA isolations. Whereas surveillance continues to form an essential aspect of MRSA management, control, eradication, and overall diminution, MRSA reservoirs deserve much greater attention. Such efforts, however, must be as widely publicized in the community and in patient homes as they are in medical institutions responsible for both acute and long-term care.

scholarly journals Preparedness and response to an emerging health threat—Lessons learned from Candida auris outbreaks in the United States

2021 ◽  
pp. 1-6
Author(s):  
Diane Meyer ◽  
Elena K. Martin ◽  
Syra Madad ◽  
Priya Dhagat ◽  
Jennifer B. Nuzzo
Keyword(s):  
United States ◽  
New York ◽  
Qualitative Interviews ◽  
The United States ◽  
Lessons Learned ◽  
Infection Prevention And Control ◽  
Healthcare Organizations ◽  
Candida Auris ◽  
Term Care ◽  
Healthcare Facilities

Abstract Objective: Candida auris infections continue to occur across the United States and abroad, and healthcare facilities that care for vulnerable populations must improve their readiness to respond to this emerging organism. We aimed to identify and better understand challenges faced and lessons learned by those healthcare facilities who have experienced C. auris cases and outbreaks to better prepare those who have yet to experience or respond to this pathogen. Design: Semi-structured qualitative interviews. Setting: Health departments, long-term care facilities, acute-care hospitals, and healthcare organizations in New York, Illinois, and California. Participants: Infectious disease physicians and nurses, clinical and environmental services, hospital leadership, hospital epidemiology, infection preventionists, emergency management, and laboratory scientists who had experiences either preparing for or responding to C. auris cases or outbreaks. Methods: In total, 25 interviews were conducted with 84 participants. Interviews were coded using NVivo qualitative coding software by 2 separate researchers. Emergent themes were then iteratively discussed among the research team. Results: Key themes included surveillance and laboratory capacity, inter- and intrafacility communication, infection prevention and control, environmental cleaning and disinfection, clinical management of cases, and media concerns and stigma. Conclusions: Many of the operational challenges noted in this research are not unique to C. auris, and the ways in which we address future outbreaks should be informed by previous experiences and lessons learned, including the recent outbreaks of C. auris in the United States.

Animal Pain Scales in Public Policy

1990 ◽  
Vol 18 (1_part_1) ◽  
pp. 41-50
Author(s):  
F. Barbara Orlans
Keyword(s):  
Public Policy ◽  
Animal Welfare ◽  
The United States ◽  
Pain Scale ◽  
Laboratory Animals ◽  
Practical Applications ◽  
Animal Pain ◽  
Pain Scales ◽  
History Of ◽  
And Control

Pain scales classify the severity of pain inflicted on laboratory animals from little or none up to severe. A pain scale as part of public policy serves beneficial purposes that promote animal welfare. It can be used to educate people about the two alternatives of refinement and replacement, and the need to reduce animal pain. Furthermore, a pain scale has practical applications: 1) in review procedures for animal welfare concerns; 2) in developing policies on the use of animals in education; and 3) as a basis for collecting national data on animal experimentation, so that meaningful data can be collected on trends in reduction and control in animal pain. So far, only a few countries (including Sweden, the Netherlands, Canada and New Zealand) have adopted pain scales as part of their public policy. Most countries, including the United States, have not yet done so. The history of the development and adoption of pain scales by various countries is described and the case is presented for wider adoption of a pain scale in countries not currently using one.

Introduction

2019 ◽  
pp. 1-30
Author(s):  
Natalie Fixmer-Oraiz
Keyword(s):  
United States ◽  
Homeland Security ◽  
Nation Building ◽  
The United States ◽  
Reproductive Politics ◽  
Security Culture ◽  
History Of ◽  
And Control ◽  
Theoretical Foundations

This chapter explores how recent discourses of motherhood and nation are deeply enmeshed and mutually constitutive. I trace a brief history of reproductive politics in the United States, clarifying how the project of nation building has consistently enlisted motherhood and worked to govern women’s reproduction through differential modes of surveillance and control. This chapter provides the historical and theoretical foundations for the book; it notes the precedents to homeland maternity while also elaborating on how contemporary alignments of motherhood and nation are distinct and specific to homeland security culture.

scholarly journals 972. Asymptomatic Carriage of Clostridiodes difficile and Risk of Subsequent Infection

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S38-S38
Author(s):  
Katrina Espiritu ◽  
Michael Vernon ◽  
Donna Schora ◽  
Lance Peterson ◽  
Kamaljit Singh
Keyword(s):  
Care Facility ◽  
The United States ◽  
Term Care ◽  
Asymptomatic Carriers ◽  
Long Term Care Facility ◽  
Patient Demographics ◽  
Asymptomatic Carriage ◽  
Admission Screening ◽  
History Of ◽  
Healthcare Associated

Abstract Background C. difficile is one of the most common healthcare-associated infections in the United States. Studies of patients with asymptomatic carriage of toxigenic C. difficile have reported conflicting results on the risk of subsequent C. difficile infection (CDI). Older studies suggest that the risk was low and colonization may be protective. Subsequent studies indicate that asymptomatic carriers have a 6-fold greater risk of developing CDI. The aims of our study were to assess the burden of asymptomatic C. difficile carriage and risk of subsequent CDI. Methods Adult inpatients at NorthShore University HealthSystem, Illinois hospitals between August 1, 2017 and February 28, 2018 were eligible for the study. Focused admission screening of patients at high risk of C. difficile carriage was performed: (1) history of CDI or colonization, (2) prior hospitalization past 2 months, or (3) admission from a long-term care facility. A rectal swab was collected and tested using the cobas® Cdif Test (Roche) real-time PCR. The development of hospital onset CDI (HO-CDI) in colonized patients was monitored prospectively for at least 2 months. HO-CDI testing of colonized patients was performed using the Cepheid GeneXpert RT-PCR. HO-CDI was defined as patients hospitalized for at least 72 hours with 3 or more episodes of diarrhea/24 hours, in the absence of other potential causes of diarrhea. Patient demographics were collected using a standardized form and data analyzed using VassarStats. Results There were 6,104 patients enrolled in the study and 528 (8.7%) were positive on admission for toxigenic C. difficile carriage. The mean age of colonized patients was 75.5 years (range 24–103) and 56.4% (298 patients) were females. Of 528 colonized patients, 21 (4%) had a positive CDI test. A total of 7 patients (1.3%) developed HO-CDI. Mean time to positive HO-CDI was 46.1 days (range 5–120 days). Of 5,576 patients that were negative for C difficile carriage on admission, 14 (0.3%) patients developed HO-CDI. The relative risk of HO-CDI was 5.28 (95% CI: 2.14–13.03, P = 0.05). Conclusion We found that 8.7% of at-risk admissions were asymptomatic toxigenic C. difficile carriers. While only 1.3% developed HO-CDI, asymptomatic carriers had a 5 times higher risk of subsequent CDI compared with non-carriers. Disclosures All authors: No reported disclosures.

Research Priority Dynamics in Weed Science

1994 ◽  
Vol 8 (2) ◽  
pp. 396-399 ◽  
Author(s):  
John R. Abernathy ◽  
David C. Bridges
Keyword(s):  
Crop Production ◽  
Cultural Practices ◽  
Science Research ◽  
The United States ◽  
Weed Science ◽  
Great Loss ◽  
Research Priority ◽  
History Of ◽  
And Control ◽  
And Training

For this presentation we would like to discuss some history of weeds and their control, the evolution of weed science, the development of herbicides and the changing dynamics of weed science research. As mentioned by previous speakers, weeds cause great loss to almost every crop production enterprise in the United States and around the world. Man has sought to control weeds by various methods including cultural practices, cultivation, hoeing, and with herbicides. Pioneer weed scientists were individuals trained in the areas of physiology, botany, and agronomy. They applied their knowledge and training to the understanding of growth, development, and control of weeds in the late 1800's and early 1900's.

Red History, Blue Mood: Labor History and Solidarity in an Age of Fragmentation

2019 ◽  
Vol 16 (4) ◽  
pp. 35-47
Author(s):  
Jefferson Cowie
Keyword(s):  
United States ◽  
Working Class ◽  
Labor History ◽  
The United States ◽  
Class Formation ◽  
Political Fragmentation ◽  
History Of ◽  
And Control ◽  
Class Community

Beginning with labor historians’ efforts to create a synthesis of the field in the 1980s, this essay explores the problem of working-class political fragmentation and the intellectual problems that posed for the generation of “new” labor historians. Looking to culture, class, community, and control as their themes, historians overlooked deeper problems in American class formation as well as the monumental complexity of discussing the history of class in the United States.

scholarly journals Genomic characterization of Canine circovirus detected in a dog with intermittent hemorrhagic gastroenteritis in Brazil

2020 ◽  
Vol 50 (5) ◽  
Author(s):  
Taís Fukuta Cruz ◽  
Thiago Neves Batista ◽  
Ester Mariane Vieira ◽  
Luiz Marcos Frediani Portela ◽  
Amanda Mahnke Baccarin ◽  
...  
Keyword(s):  
Complete Genome ◽  
The United States ◽  
Diagnostic Tools ◽  
German Shepherd ◽  
German Shepherd Dog ◽  
History Of ◽  
Genomic Characterization ◽  
And Control ◽  
Generation Sequencing

ABSTRACT: Because Canine circovirus (CanineCV) is a new species of the genus Circovirus, several issues related to its epidemiology, pathogenesis and clinical disease remain unknown. Thus, this study aimed to perform the characterization of the first complete genome sequence of CanineCV detected in a dog with diarrhea in Brazil. A stool sample was collected of a ten-month-old female German Shepherd dog which had signs of intermittent hemorrhagic gastroenteritis, vomiting, and a history of eating raw pork. The complete CanineCV genome was sequenced by Next-Generation Sequencing. The sequence had 2,063 nucleotides, showed a typical genomic organization for circovirus, and was grouped with strain 214 described in the United States by phylogenetic analysis. One amino acid change was found in the replicase protein, and because of that it was considered unique to CanineCV. Therefore, the characterization of the complete genome of Brazilian CanineCV can be used in future studies of molecular epidemiology, pathogenesis and development of diagnostic tools for the prevention and control of this disease.

scholarly journals The Ethical Dilemma of Safety Versus Self-Determination in Long-Term Care Community Residents During COVID-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 160-160
Author(s):  
Rebecca Davis ◽  
Cheryl Monturo ◽  
Maria O'Reilly ◽  
Diana Sturdevant
Keyword(s):  
Long Term Care ◽  
Ethical Reasoning ◽  
Well Being ◽  
The United States ◽  
Lessons Learned ◽  
Self Determination ◽  
Term Care ◽  
Care Community ◽  
Basic Care

Abstract The pandemic profoundly affected the care of older adults in long term care communities (LTCC) across the world. More than one third of pandemic deaths were linked to nursing homes. Most nations and states had strict guidelines on visitation, with many, especially in the United States, totally prohibiting visitation for over an entire year. Well-intentioned measures to protect through isolation caused a profound ethical tension between safety and self-determination. The aim of the project was to examine this dilemma using a case study and the Madison Collaborative Ethical Reasoning in Action Framework. Eight key questions of fairness, outcomes, rights, responsibilities, character, liberty, empathy, and authority were applied in the context of federal and state mandates in the US and Australia. Results highlighted issues of ageism, paternalism vs empathy, regulatory vs family authority, a focus on short-term outcomes while forfeiting long-term outcomes, community responsibilities to the resident trumped individual resident rights, the potential loss of community character in lieu of basic care provision, a loss of personal freedoms, and the emphasis of physical well-being over holistic well-being. The results of this analysis can inform future policy and provide lessons learned for the future.

scholarly journals COVID-19 and Ventilator-Associated Event Discordance

2021 ◽  
Vol 1 (S1) ◽  
pp. s45-s45
Author(s):  
Kelly Cawcutt ◽  
Mark Rupp ◽  
Lauren Musil
Keyword(s):  
Chart Review ◽  
Respiratory Illness ◽  
The United States ◽  
Healthcare Facilities ◽  
Mechanically Ventilated ◽  
Viral Shedding ◽  
History Of ◽  
Healthcare Acquired Infections ◽  
Hospital Acquired ◽  
Present On Admission

Background: The COVID-19 pandemic has challenged healthcare facilities since its discovery in late 2019. Notably, the subsequent COVID-19 pandemic has led to an increase in healthcare-acquired infections such as ventilator associated events (VAEs). Many hospitals in the United States perform surveillance for the NHSN for VAEs by monitoring mechanically ventilated patients for metrics that are generally considered to be objective and preventable and that lead to poor patient outcomes. The VAE definition is met in a stepwise manner. Initially, a ventilator-associated condition (VAC) is met when there an increase in ventilator requirements after a period of stability or improvement. An IVAC is then met when there is evidence of an infectious process such as leukocytosis or fever and a new antimicrobial agent is started. Finally, possible ventilator-associated pneumonia (PVAP) is met when there is evidence of microbial growth or viral detection. Since the beginning of the COVID-19 pandemic, our hospital has seen an increase in VAEs, which is, perhaps, not unexpected during a respiratory illness pandemic. However, the NSHN definitions of VAE, and PVAP in particular, do not account for the novelty and nuances of COVID-19. Methods: We performed a chart review of 144 patients who had a VAE reported to the NHSN between March 1 and December 31, 2020. Results: Of the 144 patients with a VAE reported to NHSN, 39 were SARS-CoV-2 positive. Of the 39 patients, 4 patients (10.25%) met the NHSN PVAP definition due to a positive SARS-CoV-2 PCR that was collected in the prolonged viral shedding period of their illness (< 90 days). One of the four patients also had a bacterial infection in addition to their subsequent positive COVID-19 result. All these patients were admitted to the hospital with a COVID-19 diagnosis and their initial PCR swab was performed upon admission. Conclusions: We believe that the PVAP definition was inappropriately triggered by patients who were decompensating on the ventilator due to a novel respiratory virus that was present on admission. Early in the pandemic, frequent swabbing of these patients was performed to try and understand the duration of viral shedding and to determine when it would be safe to transfer patients from isolation after prolonged hospitalization. The NSHN definition should take into consideration the prolonged viral shedding period of COVID-19 and natural history of the illness, and subsequent COVID-19 testing within 90 days of an initial positive should not require classification as a hospital-acquired PVAP.Funding: NoDisclosures: None

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