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The CDC SHIELD Orange County Project – Baseline Multi Drug-Resistant Organism (MDRO) Prevalence in a Southern California Region

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Open Forum Infectious Diseases 2017年第SUPPL_1期4卷 S46-S47页

作者： Singh, Raveena D Jernigan, John A Slayton, Rachel B Stone, Nimalie D McKinnell, James A Miller, Loren G Kleinman, Ken Heim, Lauren Dutciuc, Tabitha D Estevez, Marlene Gussin, Gabrielle Chang, Justin Peterson, Ellena M Evans, Kaye D Lee, Bruce Y Mueller, Leslie E Bartsch, Sarah M Zahn, Matthew Janssen, Lynn Weinstein, Robert A Hayden, Mary K Gohil, Shruti K Park, Steven Tam, Steven Saavedra, Raheeb Yamaguchi, Stacey Custodio, Harold Nguyen, Jenny Tjoa, Thomas He, Jiayi O’Donnell, Kathleen Coady, Micaela H Platt, Richard Huang, Susan S CDC Safety and Healthcare Epidemiology prevention Research Development (SHEPheRD) program Division of Infectious Diseases and Health Policy Research Institute University of California Irvine School of Medicine Irvine California Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta Georgia Infectious Disease Clinical Outcomes Research (ID-CORE) LA Biomed at Harbor-UCLA Medical Center Torrance California University of Massachusetts Amherst School of Public Health and Health Sciences Amherst Massachusetts University of California Irvine Health Orange California Johns Hopkins Bloomberg School of Public Health Baltimore MD Epidemiology and Assessment Orange County Health Care Agency Santa Ana California Healthcare-Associated Infections Program Center for Healthcare Quality California Department of Public Health Richmond California Cook County Health and Hospitals System Chicago Illinois Internal Medicine (Infectious Diseases) and Pathology Rush University Medical Center Chicago Illinois Division of Geriatrics Department of Medicine University of California Irvine Orange California Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston Massachusetts

Background MDROs can spread between hospitals, nursing homes (NH), and long-term acute care facilities (LTACs) via shared patients. SHIELD OC is a regional decolonization collaborative involving 38 of 104 countywide adult facilities identified by their high degree of direct and indirect patient sharing with one another. We report baseline MDRO prevalence in these facilities. Methods Adult patients in 38 facilities (17 hospitals, 18 NHs, 3 LTACs) underwent point-prevalence screening between September 2016–April 2017 for MRSA, VRE, ESBL, and CRE using nares, skin (axilla/groin), and peri-rectal swabs. In NHs and LTACs, residents were randomly selected until 50 sets of swabs were obtained. Swabbing in hospitals involved all patients in contact precautions. An additional set of swabs were also performed for all LTAC admissions from November 2016–February 2017. Results The overall prevalence of any MDRO among patients was 64% (44%–88%) in NHs, 80% (range 72%–86%) in LTACs, and 64% (54–84%) in hospitals (contact precaution patients) (Table 1). Only 25%, 64%, and 81% of patients were already known to harbor an MDRO in NHs, LTACs, and hospitals, respectively. Known MDRO patients also harbored another MDRO 49%, 63%, and 34% of the time for NHs, LTACs, and hospitals, respectively. In LTACs, MDRO point prevalence was 38% higher than the usual admission prevalence (65% higher for MRSA, 34% higher for VRE, 95% higher for ESBL, and 50% higher for CRE). Conclusion MDRO carriage in highly inter-connected NHs and LTACs was widespread, rivaling that found in hospitalized patients on contact precautions. MRSA, VRE, and ESBL carriage far outnumbered CRE carriage. A history of MDRO was insensitive for identifying MDRO carriers, and many patients carried multiple MDROs. The extensive MDRO burden and transmission in long-term care settings suggests that regional MDRO prevention efforts must include MDRO control in long-term care facilities. Open in a separate window Disclosures R. D. Sing

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Quality Standard for Assurance of Measles Immunity Among Health Care Workers

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Infection control & Hospital Epidemiology 2015年第3期15卷 193-199页

作者： Peter J. Krause Peter A. Gross Trisha L. Barrett E. Patchen Dellinger William J. Martone John E. McGowan Jr Richard L. Sweet Richard P. Wenzel Hartford Hospital Hartford andthe University of Connecticut School of Medicine Farmington Connecticut Hackensack Medical Center Hackensack andNew Jersey Medical School Newark New Jersey Alta Bates Medical Center Berkeley California University of Washington Medical Center Seattle Washington Hospital Infections Program Centers for Disease Control and Prevention Atlanta Georgia Magee Women's Hospital and University of Pittsburgh School of Medicine Pittsburgh Pennsylvania University of Iowa Hospitals and Clinics Iowa City Iowa

Objective:The objective of this quality standard is to prevent nosocomial transmission of measles by assuring universal measles-mumps-rubella (MMR) vaccination of all healthcare workers who lack immunity to measles. Although the primary emphasis is on healthcare workers in hospitals, those at other sites, such as clinics, nursing homes, and schools, are also included. It will be the responsibility of designated individuals at these institutions to implement the ***:We considered advocating the use of measles vaccine rather than MMR but chose the latter because it also protects against mumps and rubella and because it is more readily ***:The desired outcome is a reduction in the nosocomial transmission of ***:Although direct comparative studies are lacking, nosocomial outbreaks of measles have been reported (as recently as 1992) in institutions where measles immunization of nonimmune healthcare workers is not universal, whereas such outbreaks have not been reported in institutions with universal *** and Validation:We consulted more than 50 infectious-disease experts in epidemiology, government, medicine, nursing, obstetrics and gynecology pediatrics, and surgery. In light of disagreement regarding the implementation of the standard, we used group discussions to reach a ***, Harms, and Cost:The consequences of the transmission of measles (and of mumps and rubella) in a healthcare institution include not only the morbidity and mortality attributable to the disease, but also the significant cost of evaluating and containing an outbreak and the serious disruption of regular hospital routines when control measures are instituted. The potential harm to healthcare workers after the implementation of the standard consists of untoward effects of MMR vaccine, although the reactions of vaccines should be minimal with adherence to recommended vaccination procedures. Implementation of the standard should enta

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American journal of obstetrics and gynecology 2016年第5期214卷 667-8页

作者： Robert A Bednarczyk Daniella Figueroa-Downing Kevin Ault Hubert Department of Global Health and Department of Epidemiology Rollins School of Public Health Emory University Cancer Prevention and Control Program Winship Cancer Institute and Emory Vaccine Center Atlanta GA. Electronic address: rbednar@emory.edu. Hubert Department of Global Health and Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA. Department of Obstetrics and Gynecology University of Kansas Medical Center Kansas City KS.

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Public Health Department Contact Investigation and Directly Observed Prophylactic Therapy Enhance Completion of Latent Tuberculosis Infection (LTBI) Therapy in Children Compared with Adults

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Open Forum Infectious Diseases 2016年第SUPPL_1期3卷

作者： Souder, Emily Vodzak, Jennifer Long, Sarah S. Dogbey, Christina Gould, Jane M. St. Christopher's Hospital for Children Drexel University College of Medicine Philadelphia Pennsylvania Infectious Diseases St. Christopher's Hospital for Children Drexel University College of Medicine Philadelphia Pennsylvania St. Christopher's Hospital for Children Philadelphia Pennsylvania Tuberculosis Control Program Philadelphia Department of Public Health Philadelphia Pennsylvania Infectious Diseases and Infection Prevention St. Christopher's Hospital for Children Drexel University College of Medicine Philadelphia Pennsylvania

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Prospective Case-control Study of Risk Factors for Incident Syphilis Infection Among Men Who Have Sex With Men in Tokyo, Japan

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Open Forum Infectious Diseases 2016年第SUPPL_1期3卷

作者： Ishikane, Masahiro Arima, Yuzo Itoda, Ichiro Takahashi, Takuri Yamagishi, Takuya Matsui, Tamano Sunagawa, Tomimasa Ohnishi, Makoto Oishi, Kazunori Field Epidemiology Training Program National Institute of Infectious Diseases Tokyo Japan Disease Control and Prevention Center National Center for Global Health and Medicine Tokyo Japan Division of Global Infectious Diseases Department of Infection and Epidemiology Graduate School of Medicine Tohoku University Miyagi Japan Infectious Disease Surveillance Center National Institute of Infectious Diseases Tokyo Japan Shirakaba Clinic Tokyo Japan Department of Bacteriology I National Institute of Infectious Diseases Tokyo Japan

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HEPATITIS B

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 2014年第3期145卷 230-+页

作者： Osborn, Thomas R. Program Manager Division of Acute Disease Epidemiology South Carolina Department of Health and Environmental Control Columbia Director Division of Infectious Disease Epidemiology Office of Epidemiology and Prevention Services Bureau for Public Health West Virginia Department of Health and Human Services Charleston

A letter to the editor is presented in response to the article 'Hepatitis B Virus Transmissions Associated With a Portable Dental Clinic, West Virginia, 2009' by Doctor Rachel Radcliffe and colleagues, which a... 详细信息

关键词： COMMUNICABLE diseases -- prevention COMMUNICABLE diseases -- Transmission DENTAL clinics EPIDEMICS HEPATITIS B MEDICAL equipment

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Prevalence of Respiratory Viral Pathogen Testing and Co-Detections Among Patients Hospitalized With Influenza, 2012–2015

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Open Forum Infectious Diseases 2016年第SUPPL_1期3卷 1744-1744页

作者： Cohen, Jessica Anderson, Evan J. Lindegren, Mary Lou Kirley, Pam Daily Zansky, Shelley M. Thomas, Ann Lynfield, Ruth Miller, Lisa Bargsten, Marisa Meek, James I. Bennett, Nancy M. Collins, James Monroe, Maya Reed, Gregg M. Tatham, Lilith Fry, Alicia M. Garg, Shikha Atlanta Research and Education Foundation Atlanta Georgia Centers for Disease Control and Prevention Atlanta Georgia Pediatrics and Medicine Emory University School of Medicine Atlanta Georgia Vanderbilt University School of Medicine Nashville Tennessee California Emerging Infections Program Oakland California New York State Department of Health Albany New York Department of Human Services Health Services Portland Oregon Minnesota Department of Health St. Paul Minnesota Colorado Department of Public Health and Environment Denver Colorado New Mexico Department of Health Santa Fe New Mexico Connecticut Emerging Infections Program Yale School of Public Health New Haven Connecticut University of Rochester Medical Center Rochester New York Michigan Department of Health and Human Services Lansing Michigan Maryland Department of Health and Mental Hygiene Baltimore Maryland Bureau of Epidemiology Utah Department of Health Salt Lake City Utah Ohio Department of Health Columbus Ohio Influenza Division Centers for Disease Control and Prevention Atlanta Georgia

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Quality Standard for the Treatment of Bacteremia

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Infection control & Hospital Epidemiology 2015年第3期15卷 189-192页

作者： Peter A. Gross Trisha L. Barrett E. Patchen Dellinger Peter J. Krause William J. Martone John E. McGowan Jr Richard L. Sweet Richard P. Wenzel Hackensack Medical Center Hackensack and New Jersey Medical School Newark New Jersey Alta Bates Medical Center Berkeley California University of Washington Medical Center Seattle Washington Hartford Hospital Hartford andthe University of Connecticut School of Medicine Farmington Connecticut Hospital Infections Program Centers for Disease Control and Prevention Atlanta Georgia Magee Women's Hospital and University of Pittsburgh School of Medicine Pittsburgh Pennsylvania University of Iowa Hospitals and Clinics Iowa City Iowa

Objective:The objective of this quality standard is to optimize the treatment of bacteremia in hospitalized patients by ensuring that the antibiotic given is appropriate in terms of the blood culture susceptibility of the pathogen. Although this standard may appear to be minimal in scope, it is needed because appropriate antimicrobial treatment is not given in 5% to 17% of cases. To implement the standard, physicians, pharmacists, and microbiologists will need to devise a coordinated ***:We considered criteria for appropriate dosing, most cost-effective selection, proper antibiotic levels in serum, least toxicity, narrowest spectrum, specific clinical indications, and optimal duration of treatment. All these criteria were rejected as the basis for the standard because they were too controversial and too difficult to be applied by a nonphysician chart reviewer. In contrast, the selection of an antibiotic to which the pathogen is sensitive is a non-controversial criterion and easy for a chart reviewer to ***:The standard is designed to reduce the incidence of adverse outcomes of septicemia such as renal failure, prolonged hos-pitalization, and ***:Several well-designed clinical trials without randomization as well as case-controlled studies have confirmed the benefit of using an antibiotic that is appropriate in light of the susceptibility of the isolate in blood culture. Prospective, randomized, placebo-controlled trials are not ***:Our premise is that the presence of bacteremia is a risk factor for serious adverse outcomes. We also believe that the administration of antibiotics must always be guided by the susceptibility report for the pathogen(s) obtained from blood cultures. This concern is more critical for pathogens from the blood than for those from most other body sites. We had evidence that susceptibility reports for pathogens from positive blood cultures were not always used properly. We used group discussion t

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Skin and Mucous Membrane Contacts With Blood During Surgical Procedures: Risk and prevention

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Infection control & Hospital Epidemiology 2015年第12期16卷 703-711页

作者： Jerome I. Tokars David H. Culver Meryl H. Mendelson Edward P. Sloan Bruce F. Farber Denise J. Fligner Mary E. Chamberland Ruthanne Marcus Penny S. McKibben David M. Bell Hospital Infections Program National Center for Infectious Diseases Centers for Disease Control and Prevention Atlanta Georgia Division of Infectious Diseases Department of Medicine Mount Sinai School of Medicine New York New York Department of Trauma Cook County Hospital University of Illinois College of Medicine Chicago Illinois Division of Infectious Diseases Department of Medicine North Shore University Hospital Cornell University Medical College Manhasset New York Department of Emergency Medicine Christ Hospital and Medical Center Oak Lawn Illinois

Objective:To study the epidemiology and preventability of blood contact with skin and mucous membranes during surgical ***:Observers present at 1,382 surgical procedures recorded information about the procedure, the personnel present, and the contacts that ***:Four US teaching hospitals during ***:Operating room personnel in five surgical *** Outcome Measures:Numbers and circumstances of contact between the patient's blood (or other infective fluids) and surgical personnel's mucous membranes (mucous membrane contacts) or skin (skin contacts, excluding percutaneous injuries).Results:A total of 1,069 skin (including 620 hand, 258 body, and 172 face) and 32 mucous membrane (all affecting eyes) contacts were observed. Surgeons sustained most contacts (19% had ≥1 skin contact and 0.5% had ≥1 mucous membrane-eye contact). Hand contacts were 72% lower among surgeons who double gloved, and face contacts were prevented reliably by face shields. Mucous membrane-eye contacts were significantly less frequent in surgeons wearing eyeglasses and were absent in surgeons wearing goggles or face shields. Among surgeons, risk factors for skin contact depended on the area of contact: hand contacts were associated most closely with procedure duration (adjusted odds ratio [OR], 9.4; ≥4 versus <1 hour); body contacts (arms, legs, and torso) with estimated blood losses (adjusted OR, 8.4; ≥1,000 versus <100 mL); and face contacts, with orthopedic service (adjusted OR, 7.5 compared with general surgery).Conclusion:Skin and mucous membrane contacts are preventable by appropriate barrier precautions, yet occur commonly during surgery. Surgeons who perform procedures similar to those included in this study should strongly consider double gloving, changing gloves routinely during surgery, or both.

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Consensus Development of Quality Standards

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Infection control & Hospital Epidemiology 2015年第3期15卷 180-181页

作者： Peter A. Gross Trisha L. Barrett E. Patchen Dellinger Peter J. Krause William J. Martone John E. McGowan Jr Richard L. Sweet Richard P. Wenzel Hackensack Medical Center Hackensack and New Jersey Medical School Newark New Jersey Alta Bates Medical Center Berkeley California University of Washington Medical Center Seattle Washington Hartford Hospital Hartford Connecticut Hospital infections Program Centers for Disease Control and Prevention Emory University School of Medicine Atlanta Georgia Magee Women's Hospital and University of Pittsburgh School of Medicine Pittsburgh Pennsylvania University of Iowa Hospitals and Clinics Iowa City Iowa

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