1
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Ginestra JC, Coz Yataco AO, Dugar SP, Dettmer MR. Hospital-Onset Sepsis Warrants Expanded Investigation and Consideration as a Unique Clinical Entity. Chest 2024; 165:1421-1430. [PMID: 38246522 PMCID: PMC11177099 DOI: 10.1016/j.chest.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/27/2023] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
Sepsis causes more than a quarter million deaths among hospitalized adults in the United States each year. Although most cases of sepsis are present on admission, up to one-quarter of patients with sepsis develop this highly morbid and mortal condition while hospitalized. Compared with patients with community-onset sepsis (COS), patients with hospital-onset sepsis (HOS) are twice as likely to require mechanical ventilation and ICU admission, have more than two times longer ICU and hospital length of stay, accrue five times higher hospital costs, and are twice as likely to die. Patients with HOS differ from those with COS with respect to underlying comorbidities, admitting diagnosis, clinical manifestations of infection, and severity of illness. Despite the differences between these patient populations, patients with HOS sepsis are understudied and warrant expanded investigation. Here, we outline important knowledge gaps in the recognition and management of HOS in adults and propose associated research priorities for investigators. Of particular importance are questions regarding standardization of research and clinical case identification, understanding of clinical heterogeneity among patients with HOS, development of tailored management recommendations, identification of impactful prevention strategies, optimization of care delivery and quality metrics, identification and correction of disparities in care and outcomes, and how to ensure goal-concordant care for patients with HOS.
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Affiliation(s)
- Jennifer C Ginestra
- Palliative and Advanced Illness Research (PAIR) Center, Division of Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA
| | - Angel O Coz Yataco
- Division of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Siddharth P Dugar
- Division of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Matthew R Dettmer
- Division of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH; Center for Emergency Medicine, Emergency Services Institute, Cleveland Clinic, Cleveland, OH.
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2
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Merz S, Aksakal T, Hibtay A, Yücesoy H, Fieselmann J, Annaç K, Yılmaz-Aslan Y, Brzoska P, Tezcan-Güntekin H. Racism against healthcare users in inpatient care: a scoping review. Int J Equity Health 2024; 23:89. [PMID: 38698455 PMCID: PMC11067303 DOI: 10.1186/s12939-024-02156-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/19/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Racism in the healthcare system has become a burgeoning focus in health policy-making and research. Existing research has shown both interpersonal and structural forms of racism limiting access to quality healthcare for racialised healthcare users. Nevertheless, little is known about the specifics of racism in the inpatient sector, specifically hospitals and rehabilitation facilities. The aim of this scoping review is therefore to map the evidence on racial discrimination experienced by people receiving treatment in inpatient settings (hospitals and rehabilitation facilities) or their caregivers in high-income countries, focusing specifically on whether intersectional axes of discrimination have been taken into account when describing these experiences. METHODS Based on the conceptual framework developed by Arksey and O'Malley, this scoping review surveyed existing research on racism and racial discrimination in inpatient care in high-income countries published between 2013 and 2023. The software Rayyan was used to support the screening process while MAXQDA was used for thematic coding. RESULTS Forty-seven articles were included in this review. Specifics of the inpatient sector included different hospitalisation, admission and referral rates within and across hospitals; the threat of racial discrimination from other healthcare users; and the spatial segregation of healthcare users according to ethnic, religious or racialised criteria. While most articles described some interactions between race and other social categories in the sample composition, the framework of intersectionality was rarely considered explicitly during analysis. DISCUSSION While the USA continue to predominate in discussions, other high-income countries including Canada, Australia and the UK also examine racism in their own healthcare systems. Absent from the literature are studies from a wider range of European countries as well as of racialised and disadvantaged groups other than refugees or recent immigrants. Research in this area would also benefit from an engagement with approaches to intersectionality in public health to produce a more nuanced understanding of the interactions of racism with other axes of discrimination. As inpatient care exhibits a range of specific structures, future research and policy-making ought to consider these specifics to develop targeted interventions, including training for non-clinical staff and robust, transparent and accessible complaint procedures.
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Affiliation(s)
- Sibille Merz
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
| | - Tuğba Aksakal
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Ariam Hibtay
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
| | - Hilâl Yücesoy
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
| | - Jana Fieselmann
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Kübra Annaç
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Yüce Yılmaz-Aslan
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Patrick Brzoska
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
| | - Hürrem Tezcan-Güntekin
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
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3
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Smith M, Crnich C, Donskey C, Evans CT, Evans M, Goto M, Guerrero B, Gupta K, Harris A, Hicks N, Khader K, Kralovic S, McKinley L, Rubin M, Safdar N, Schweizer ML, Tovar S, Wilson G, Zabarsky T, Perencevich EN. Research agenda for transmission prevention within the Veterans Health Administration, 2024-2028. Infect Control Hosp Epidemiol 2024:1-10. [PMID: 38600795 DOI: 10.1017/ice.2024.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Matthew Smith
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Chris Crnich
- William. S. Middleton Memorial VA Hospital, Madison, WI, USA
| | - Curtis Donskey
- Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
- Department of Preventive Medicine and Center for Health Services and Outcomes Research, Northwestern University of Feinberg School of Medicine, Chicago, IL, USA
| | - Martin Evans
- MRSA/MDRO Division, VHA National Infectious Diseases Service, Patient Care Services, VA Central Office and the Lexington VA Health Care System, Lexington, KY, USA
| | - Michihiko Goto
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Bernardino Guerrero
- Environmental Programs Service (EPS), Veterans Affairs Central Office, Washington, DC, USA
| | - Kalpana Gupta
- VA Boston Healthcare System and Boston University School of Medicine, Boston, MA, USA
| | - Anthony Harris
- Department of Epidemiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Natalie Hicks
- National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Karim Khader
- DEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Stephen Kralovic
- Veterans Health Administration National Infectious Diseases Service, Washington, DC, USA
- Cincinnati VA Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Linda McKinley
- William. S. Middleton Memorial VA Hospital, Madison, WI, USA
| | - Michael Rubin
- DEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Nasia Safdar
- William. S. Middleton Memorial VA Hospital, Madison, WI, USA
| | - Marin L Schweizer
- William. S. Middleton Memorial VA Hospital, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Hospital, Madison, WI, USA
| | - Suzanne Tovar
- National Infectious Diseases Service (NIDS), Veterans Affairs Central Office, Washington, DC, USA
| | - Geneva Wilson
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines Jr. Veterans Affairs Hospital, Hines, IL, USA
- Department of Preventive Medicine, Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Trina Zabarsky
- Environmental Programs Service (EPS), Veterans Affairs Central Office, Washington, DC, USA
| | - Eli N Perencevich
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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4
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Herrera M, Eichenblat S, Campbell E, Shick J, Brown H, Brinkley C, Kester S, Layell J, Passaretti CL, Sampson MM. Beyond the surface: a color-inclusive guide to central line site assessment. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e41. [PMID: 38628376 PMCID: PMC11019580 DOI: 10.1017/ash.2024.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 04/19/2024]
Abstract
Significant gaps exist in representation of diverse populations in central-line assessment education and tools. We review some of these gaps and provide some real-world guidance on how to assess central line sites in patients of all skin tones.
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Affiliation(s)
- Meredith Herrera
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | | | - Eileen Campbell
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | - Julia Shick
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | - Heather Brown
- Department of Nursing Professional Development, Atrium Health, Charlotte, NC, USA
| | - Chelsea Brinkley
- Department of Nursing Professional Development, Atrium Health, Charlotte, NC, USA
| | - Shelley Kester
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | - Jessica Layell
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | - Catherine L Passaretti
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mindy M Sampson
- Division of Infectious Diseases & Geographic Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
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5
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Kaur Singh H, Prakash-Asrani R, Pall A, Ray SM, Tobin-D’Angelo M, Fridkin SK. Quantifying racial disparities in risk of invasive Staphylococcus aureus infection in Metropolitan Atlanta, Georgia, during the 2020-2021 coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2024; 45:534-536. [PMID: 38149355 PMCID: PMC11007357 DOI: 10.1017/ice.2023.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 12/28/2023]
Abstract
We estimated the racial disparity in rates of invasive S. aureus infections based on community coronavirus disease 2019 (COVID-19) rates at the county level. Our data suggest that COVID-19 infection burden (1) affects not only hospital-onset MRSA invasive infection risk but also community-onset S. aureus invasive infection risk and (2) affects Black residents ∼60% more than White residents.
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Affiliation(s)
- Herveen Kaur Singh
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Allison Pall
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta, Georgia
- Atlanta Veterans’ Affairs Health System, Atlanta, Georgia
| | - Susan M. Ray
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta, Georgia
| | | | - Scott K. Fridkin
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
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6
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McGrath CL, Logan LK, Deloney VM, Rubin LG, Ravin KA, Muller M, Bartlett AH, de St. Maurice A, Linam WM, Caughell C, Ramirez-Avila L. Monitoring health disparities in healthcare-associated infection surveillance: A Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) Survey. Infect Control Hosp Epidemiol 2024; 45:526-529. [PMID: 37700531 PMCID: PMC11007321 DOI: 10.1017/ice.2023.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 09/14/2023]
Abstract
We investigated whether and how infection prevention programs monitor for health disparities as part of healthcare-associated infection (HAI) surveillance through a survey of healthcare epidemiology leaders. Most facilities are not assessing for disparities in HAI rates. Professional society and national guidance should focus on addressing this gap.
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Affiliation(s)
| | - Latania K. Logan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | - Lorry G. Rubin
- Department of Pediatrics, Cohen Children’s Medical Center, Northwell Health, New Hyde Park, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Karen A. Ravin
- Division of Infectious Diseases, Nemours Children’s Hospital Delaware, Wilmington, Delaware
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Martha Muller
- Department of Pediatrics, Division of Infectious Diseases, University of New Mexico, Albuquerque, New Mexico
| | - Allison H. Bartlett
- Section of Pediatric Infectious Diseases, Department of Pediatrics, The University of Chicago Medicine Comer Children’s Hospital, Chicago, Illinois
| | | | - W. Matthew Linam
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Carolyn Caughell
- Hospital Epidemiology and Infection Prevention, Department of Quality, University of California San Francisco Health, San Francisco, California
| | - Lynn Ramirez-Avila
- Division of Pediatric Infectious Diseases and Global Health, University of California–San Francisco, San Francisco, California
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7
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Marcelin JR, Hicks LA, Evans CD, Wiley Z, Kalu IC, Abdul-Mutakabbir JC. Advancing health equity through action in antimicrobial stewardship and healthcare epidemiology. Infect Control Hosp Epidemiol 2024; 45:412-419. [PMID: 38351853 DOI: 10.1017/ice.2024.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Affiliation(s)
- Jasmine R Marcelin
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Lauri A Hicks
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher D Evans
- Healthcare-Associated Infections and Antimicrobial Resistance Program, Tennessee Department of Health, Nashville, Tennessee
| | - Zanthia Wiley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Ibukunoluwa C Kalu
- Division of Pediatric Infectious Disease, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Jacinda C Abdul-Mutakabbir
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California
- Division of the Black Diaspora and African American Studies, University of California San Diego, La Jolla, California
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8
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Evans C, Wiley Z. Demographic and Geographic Inequities in Antimicrobial Use and Prescribing. Infect Dis Clin North Am 2023; 37:715-728. [PMID: 37567855 DOI: 10.1016/j.idc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
Little is known about how social determinants of health may impact antimicrobial prescribing among racial and ethnic minority populations, different age groups and genders, and across geographic regions. The factors that influence antimicrobial prescribing are complex, but evidence suggests that demographic and socioeconomic factors do influence prescribing patterns. This review describes the inequities observed in antimicrobial use and prescribing that have been heretofore published, with a focus on differences observed by race and ethnicity, age, gender, and geographic region of the United States.
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Affiliation(s)
- Christopher Evans
- Healthcare-Associated Infections and Antimicrobial Resistance Program, Tennessee Department of Health, Andrew Johnson Tower, 3.419C 710 James Robertson Parkway, Nashville, TN 37243, USA.
| | - Zanthia Wiley
- Emory Division of Infectious Diseases, Emory University Hospital Midtown, 550 Peachtree Street NE, Atlanta, GA 30308, USA
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9
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Prochaska EC, Caballero TM, Fabre V, Milstone AM. Infection prevention requires attention to patient and caregiver language: Removing language barriers from infection prevention education. Infect Control Hosp Epidemiol 2023; 44:1707-1710. [PMID: 37039600 PMCID: PMC10691433 DOI: 10.1017/ice.2023.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- Erica C. Prochaska
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Health System, Baltimore, MD, USA
| | - Tania Maria Caballero
- Department of Pediatrics, Division of General Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valeria Fabre
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron M. Milstone
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Health System, Baltimore, MD, USA
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10
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Gettler EB, Kalu IC, Okeke NL, Lewis SS, Anderson DJ, Smith BA, Advani SD. Disparities in central line-associated bloodstream infection and catheter-associated urinary tract infection rates: An exploratory analysis. Infect Control Hosp Epidemiol 2023; 44:1857-1860. [PMID: 37057848 PMCID: PMC10665875 DOI: 10.1017/ice.2023.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/01/2023] [Accepted: 03/12/2023] [Indexed: 04/15/2023]
Abstract
This retrospective review of 4-year surveillance data revealed a higher central line-associated bloodstream infection (CLABSI) rate in non-Hispanic Black patients and higher catheter-associated urinary tract infection (CAUTI) rates in Asian and non-Hispanic Black patients compared with White patients despite similar catheter utilization between the groups.
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Affiliation(s)
- Erin B. Gettler
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
| | - Ibukunoluwa C. Kalu
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Nwora L. Okeke
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sarah S. Lewis
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
| | - Deverick J. Anderson
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
| | - Becky A. Smith
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
| | - Sonali D. Advani
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
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11
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Pedersen LL, Pryor R, Bearman G. "Healthcare worker perceptions of healthcare-associated infections and health inequity". ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e134. [PMID: 37592965 PMCID: PMC10428151 DOI: 10.1017/ash.2023.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 08/19/2023]
Affiliation(s)
| | - Rachel Pryor
- Virginia Commonwealth University Health System, Richmond, VA, USA
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12
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McGrath CL, Bettinger B, Stimpson M, Bell SL, Coker TR, Kronman MP, Zerr DM. Identifying and Mitigating Disparities in Central Line-Associated Bloodstream Infections in Minoritized Racial, Ethnic, and Language Groups. JAMA Pediatr 2023; 177:700-709. [PMID: 37252746 PMCID: PMC10230370 DOI: 10.1001/jamapediatrics.2023.1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/02/2023] [Indexed: 05/31/2023]
Abstract
Importance Although inequitable care due to racism and bias is well documented in health care, the impact on health care-associated infections is less understood. Objective To determine whether disparities in first central catheter-associated bloodstream infection (CLABSI) rates existed for pediatric patients of minoritized racial, ethnic, and language groups and to evaluate the outcomes associated with quality improvement initiatives for addressing these disparities. Design, Setting, and Participants This cohort study retrospectively examined outcomes of 8269 hospitalized patients with central catheters from October 1, 2012, to September 30, 2019, at a freestanding quaternary care children's hospital. Subsequent quality improvement interventions and follow-up were studied, excluding catheter days occurring after the outcome and episodes with catheters of indeterminate age through September 2022. Exposures Patient self-reported (or parent/guardian-reported) race, ethnicity, and language for care as collected for hospital demographic purposes. Main Outcomes and Measures Central catheter-associated bloodstream infection events identified by infection prevention surveillance according to National Healthcare Safety Network criteria were reported as events per 1000 central catheter days. Cox proportional hazards regression was used to analyze patient and central catheter characteristics, and interrupted time series was used to analyze quality improvement outcomes. Results Unadjusted infection rates were higher for Black patients (2.8 per 1000 central catheter days) and patients who spoke a language other than English (LOE; 2.1 per 1000 central catheter days) compared with the overall population (1.5 per 1000 central catheter days). Proportional hazard regression included 225 674 catheter days with 316 infections and represented 8269 patients. A total of 282 patients (3.4%) experienced a CLABSI (mean [IQR] age, 1.34 [0.07-8.83] years; female, 122 [43.3%]; male, 160 [56.7%]; English-speaking, 236 [83.7%]; LOE, 46 [16.3%]; American Indian or Alaska Native, 3 [1.1%]; Asian, 14 [5.0%]; Black, 26 [9.2%]; Hispanic, 61 [21.6%]; Native Hawaiian or Other Pacific Islander, 4 [1.4%]; White, 139 [49.3%]; ≥2 races, 14 [5.0%]; unknown race and ethnicity or refused to answer, 15 [5.3%]). In the adjusted model, a higher hazard ratio (HR) was observed for Black patients (adjusted HR, 1.8; 95% CI, 1.2-2.6; P = .002) and patients who spoke an LOE (adjusted HR, 1.6; 95% CI, 1.1-2.3; P = .01). Following quality improvement interventions, infection rates in both subgroups showed statistically significant level changes (Black patients: -1.77; 95% CI, -3.39 to -0.15; patients speaking an LOE: -1.25; 95% CI, -2.23 to -0.27). Conclusions and Relevance The study's findings show disparities in CLABSI rates for Black patients and patients who speak an LOE that persisted after adjusting for known risk factors, suggesting that systemic racism and bias may play a role in inequitable hospital care for hospital-acquired infections. Stratifying outcomes to assess for disparities prior to quality improvement efforts may inform targeted interventions to improve equity.
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Affiliation(s)
- Caitlin L. McGrath
- University of Washington, Seattle, Washington
- Seattle Children’s Research Institute, Seattle, Washington
| | | | | | - Shaquita L. Bell
- University of Washington, Seattle, Washington
- Seattle Children’s Hospital, Seattle, Washington
| | - Tumaini R. Coker
- University of Washington, Seattle, Washington
- Seattle Children’s Research Institute, Seattle, Washington
| | - Matthew P. Kronman
- University of Washington, Seattle, Washington
- Seattle Children’s Research Institute, Seattle, Washington
| | - Danielle M. Zerr
- University of Washington, Seattle, Washington
- Seattle Children’s Research Institute, Seattle, Washington
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13
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Burton KL, Ritchwood TD, Metzger IW. Structural Racism and Racial Trauma Among African Americans at Elevated Risk for HIV Infection. Am J Public Health 2023; 113:S102-S106. [PMID: 37339423 PMCID: PMC10282852 DOI: 10.2105/ajph.2023.307223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Kelsey L Burton
- Kelsey L. Burton and Tiarney D. Ritchwood are with the Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC. Tiarney D. Ritchwood is also a guest editor of this special issue. Isha W. Metzger is with the Department of Psychology, Georgia State University, Atlanta
| | - Tiarney D Ritchwood
- Kelsey L. Burton and Tiarney D. Ritchwood are with the Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC. Tiarney D. Ritchwood is also a guest editor of this special issue. Isha W. Metzger is with the Department of Psychology, Georgia State University, Atlanta
| | - Isha W Metzger
- Kelsey L. Burton and Tiarney D. Ritchwood are with the Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC. Tiarney D. Ritchwood is also a guest editor of this special issue. Isha W. Metzger is with the Department of Psychology, Georgia State University, Atlanta
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14
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Coyner AS, Singh P, Brown JM, Ostmo S, Chan RP, Chiang MF, Kalpathy-Cramer J, Campbell JP. Association of Biomarker-Based Artificial Intelligence With Risk of Racial Bias in Retinal Images. JAMA Ophthalmol 2023; 141:543-552. [PMID: 37140902 PMCID: PMC10160994 DOI: 10.1001/jamaophthalmol.2023.1310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/01/2023] [Indexed: 05/05/2023]
Abstract
Importance Although race is a social construct, it is associated with variations in skin and retinal pigmentation. Image-based medical artificial intelligence (AI) algorithms that use images of these organs have the potential to learn features associated with self-reported race (SRR), which increases the risk of racially biased performance in diagnostic tasks; understanding whether this information can be removed, without affecting the performance of AI algorithms, is critical in reducing the risk of racial bias in medical AI. Objective To evaluate whether converting color fundus photographs to retinal vessel maps (RVMs) of infants screened for retinopathy of prematurity (ROP) removes the risk for racial bias. Design, Setting, and Participants The retinal fundus images (RFIs) of neonates with parent-reported Black or White race were collected for this study. A u-net, a convolutional neural network (CNN) that provides precise segmentation for biomedical images, was used to segment the major arteries and veins in RFIs into grayscale RVMs, which were subsequently thresholded, binarized, and/or skeletonized. CNNs were trained with patients' SRR labels on color RFIs, raw RVMs, and thresholded, binarized, or skeletonized RVMs. Study data were analyzed from July 1 to September 28, 2021. Main Outcomes and Measures Area under the precision-recall curve (AUC-PR) and area under the receiver operating characteristic curve (AUROC) at both the image and eye level for classification of SRR. Results A total of 4095 RFIs were collected from 245 neonates with parent-reported Black (94 [38.4%]; mean [SD] age, 27.2 [2.3] weeks; 55 majority sex [58.5%]) or White (151 [61.6%]; mean [SD] age, 27.6 [2.3] weeks, 80 majority sex [53.0%]) race. CNNs inferred SRR from RFIs nearly perfectly (image-level AUC-PR, 0.999; 95% CI, 0.999-1.000; infant-level AUC-PR, 1.000; 95% CI, 0.999-1.000). Raw RVMs were nearly as informative as color RFIs (image-level AUC-PR, 0.938; 95% CI, 0.926-0.950; infant-level AUC-PR, 0.995; 95% CI, 0.992-0.998). Ultimately, CNNs were able to learn whether RFIs or RVMs were from Black or White infants regardless of whether images contained color, vessel segmentation brightness differences were nullified, or vessel segmentation widths were uniform. Conclusions and Relevance Results of this diagnostic study suggest that it can be very challenging to remove information relevant to SRR from fundus photographs. As a result, AI algorithms trained on fundus photographs have the potential for biased performance in practice, even if based on biomarkers rather than raw images. Regardless of the methodology used for training AI, evaluating performance in relevant subpopulations is critical.
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Affiliation(s)
- Aaron S. Coyner
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland
| | - Praveer Singh
- Radiology, MGH/Harvard Medical School, Charlestown, Massachusetts
- MGH & BWH Center for Clinical Data Science, Boston, Massachusetts
| | - James M. Brown
- School of Computer Science, University of Lincoln, Lincoln, United Kingdom
| | - Susan Ostmo
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland
| | - R.V. Paul Chan
- Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago
| | - Michael F. Chiang
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Jayashree Kalpathy-Cramer
- Radiology, MGH/Harvard Medical School, Charlestown, Massachusetts
- MGH & BWH Center for Clinical Data Science, Boston, Massachusetts
| | - J. Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland
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15
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Schrodt CA, Hart AM, Calanan RM, McLees AW, Perz JF, Perkins KM. Health equity: The missing data elements in healthcare outbreak response. Infect Control Hosp Epidemiol 2023; 44:849-850. [PMID: 37185267 PMCID: PMC10860638 DOI: 10.1017/ice.2023.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Caroline A. Schrodt
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Commissioned Corps, US Public Health Service, Rockville, Maryland
| | - Ayana M. Hart
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Chenega Enterprise, Systems and Solutions, Anchorage, Alaska
| | - Renee M. Calanan
- Commissioned Corps, US Public Health Service, Rockville, Maryland
- Centers of Disease Control and Prevention, Atlanta, Georgia
| | - Anita W. McLees
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph F. Perz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kiran M. Perkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Commissioned Corps, US Public Health Service, Rockville, Maryland
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16
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Gouel-Cheron A, Swihart BJ, Warner S, Mathew L, Strich JR, Mancera A, Follmann D, Kadri SS. Epidemiology of ICU-Onset Bloodstream Infection: Prevalence, Pathogens, and Risk Factors Among 150,948 ICU Patients at 85 U.S. Hospitals. Crit Care Med 2022; 50:1725-1736. [PMID: 36190259 PMCID: PMC10829879 DOI: 10.1097/ccm.0000000000005662] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Bloodstream infections (BSIs) acquired in the ICU represent a detrimental yet potentially preventable condition. We determined the prevalence of BSI acquired in the ICU (ICU-onset BSI), pathogen profile, and associated risk factors. DESIGN Retrospective cohort study. DATA SOURCES Eighty-five U.S. hospitals in the Cerner Healthfacts Database. PATIENT SELECTION Adult hospitalizations between January 2009 and December 2015 including a (≥ 3 d) ICU stay. DATA EXTRACTION AND DATA SYNTHESIS Prevalence of ICU-onset BSI (between ICU Day 3 and ICU discharge) and associated pathogen and antibiotic resistance distributions were compared with BSI present on (ICU) admission (ICU-BSI POA ); and BSI present on ICU admission day or Day 2. Cox models identified risk factors for ICU-onset BSI among host, care setting, and treatment-related factors. Among 150,948 ICU patients, 5,600 (3.7%) had ICU-BSI POA and 1,306 (0.9%) had ICU-onset BSI. Of those with ICU-BSI POA , 4,359 (77.8%) were admitted to ICU at hospital admission day. Patients with ICU-onset BSI (vs ICU-BSI POA ) displayed higher crude mortality of 37.9% (vs 20.4%) ( p < 0.001) and longer median (interquartile range) length of stay of 13 days (8-23 d) (vs 5 d [3-8 d]) ( p < 0.001) (considering all ICU stay). Compared with ICU-BSI POA , ICU-onset BSI displayed more Pseudomonas , Acinetobacter , Enterococcus, Candida , and Coagulase-negative Staphylococcus species, and more methicillin-resistant staphylococci, vancomycin-resistant enterococci, ceftriaxone-resistant Enterobacter , and carbapenem-resistant Enterobacterales and Acinetobacter species, respectively. Being younger, male, Black, Hispanic, having greater comorbidity burden, sepsis, trauma, acute pulmonary or gastrointestinal presentations, and pre-ICU exposure to antibacterial and antifungal agents was associated with greater ICU-onset BSI risk after adjusted analysis. Mixed ICUs (vs medical or surgical ICUs) and urban and small/medium rural hospitals were also associated with greater ICU-onset BSI risk. The associated risk of acquiring ICU-onset BSI manifested with any duration of mechanical ventilation and 7 days after insertion of central venous or arterial catheters. CONCLUSIONS ICU-onset BSI is a serious condition that displays a unique pathogen and resistance profile compared with ICU-BSI POA . Further scrutiny of modifiable risk factors for ICU-onset BSI may inform control strategies.
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Affiliation(s)
- Aurelie Gouel-Cheron
- Clinical Epidemiology Section, Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MD
- Biostatistics Research Branch, NIAID, NIH, Bethesda, MD
- Department of Anesthesiology and Intensive Care, Bichat Hospital, AP-HP, Paris Cité University, Paris, France
- Unit of Antibodies in Therapy and Pathology, Pasteur Institute, UMR 1222 INSERM, 75015 Paris, France
| | | | - Sarah Warner
- Clinical Epidemiology Section, Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - Lauren Mathew
- Clinical Epidemiology Section, Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MD
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai West and Morningside, New York, NY
| | - Jeffrey R Strich
- Clinical Epidemiology Section, Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MD
- United States Public Health Service Commissioned Corps, Rockville, MD
| | - Alex Mancera
- Clinical Epidemiology Section, Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - Dean Follmann
- Biostatistics Research Branch, NIAID, NIH, Bethesda, MD
| | - Sameer S Kadri
- Clinical Epidemiology Section, Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MD
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Ojemolon PE, Shaka H, Kwei-Nsoro R, Laswi H, Ebhohon E, Shaka A, Abusalim AR, Mba B. Trends and Disparities in Outcomes of Clostridioides difficile Infection Hospitalizations in the United States: A Ten-Year Joinpoint Trend Analysis. J Clin Med Res 2022; 14:474-486. [PMID: 36578367 PMCID: PMC9765321 DOI: 10.14740/jocmr4828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background Clostridioides difficile infection (CDI) is the most frequently reported nosocomial infection. This study aimed to describe epidemiological trends, sex, race, and economic disparities in clinical and mortality outcomes among CDI hospitalizations over a decade. Methods We queried Nationwide Inpatient Sample databases from 2010 to 2019, identified hospitalizations with CDI, and obtained the incidence and admission rate of CDI per 100,000 adult hospitalizations each year. We analyzed trends in mortality rate, mean length of hospital stay (LOS), and mean total hospital charge (THC). We highlighted disparities in outcomes stratified by sex, race, and mean household income quartile. Results Of the 305 million hospitalizations included in our study, over 3.3 million were complicated by CDI, with 1.01 million principal admissions for CDI. Among primary admissions for CDI, the mortality rate decreased from 3.2% in 2010 to 1.4% in 2019. Mean LOS reduced from 6.6 to 5.3 days while mean THC increased from US$40,593 to US$42,934 between 2010 and 2019. Females had a 21% decrease in adjusted odds of mortality compared to males (all P-trends < 0.001). Middle-aged and elderly patients had aOR of 4.96 and 14.74 respectively for mortality when compared to young adults (P < 0.001). Mortality rates showed a steady decline among Whites over the study period. Mean LOS trends were similar across racial subgroups. Conclusions Outcomes of CDI hospitalizations improved over the studied decade. Older age, male sex, and being from a minority racial group were associated with worse clinical and mortality outcomes. Further studies are needed to elucidate the reasons for these findings.
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Affiliation(s)
- Pius Ehiremen Ojemolon
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA,Corresponding Author: Pius Ehiremen Ojemolon, Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, USA.
| | - Hafeez Shaka
- Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Robert Kwei-Nsoro
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Hisham Laswi
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Ebehiwele Ebhohon
- Department of Internal Medicine, Lincoln Medical Center, Bronx, NY, USA
| | | | - Abdul-Rahman Abusalim
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Benjamin Mba
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA,Professor of Medicine, Rush Medical College, Chicago, IL, USA
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Vaismoradi M, Fredriksen Moe C, Ursin G, Ingstad K. Looking through racism in the nurse-patient relationship from the lens of culturally congruent care: A scoping review. J Adv Nurs 2022; 78:2665-2677. [PMID: 35441739 PMCID: PMC9544978 DOI: 10.1111/jan.15267] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/19/2022] [Accepted: 04/05/2022] [Indexed: 02/06/2023]
Abstract
AIM This review aimed to identify the nature of racism in the nurse-patient relationship and summarize international research findings about it. DESIGN A scoping review of the international literature. DATA SOURCES The search process encompassed three main online databases of PubMed (including MEDLINE), Scopus and Embase, from 2009 until 2021. REVIEW METHODS The scoping review was informed by the Levac et al.'s framework to map the research phenomenon and summarize current empirical research findings. Also, the review findings were reflected in the three-dimensional puzzle model of culturally congruent care in the discussion section. RESULTS The search process led to retrieving 149 articles, of which 10 studies were entered into data analysis and reporting results. They had variations in the research methodology and the context of the nurse-patient relationship. The thematical analysis of the studies' findings led to the development of three categories as follows: bilateral ignition of racism, hidden and manifest consequences of racism and encountering strategies. CONCLUSION Racism threatens patients' and nurses' dignity in the healthcare system. There is a need to develop a framework of action based on the principles of culturally congruent care to eradicate racism from the nurse-patient relationship in the globalized context of healthcare. IMPACT Racism in the nurse-patient relationship has remained a relatively unexplored area of the nursing literature. It hinders efforts to meet patients' and families' needs and increases their dissatisfaction with nursing care. Also, racism from patients towards nurses causes emotional trauma and enhances job-related stress among nurses. Further research should be conducted on this culturally variant phenomenon. Also, the participation of patients and nurses should be sought to prohibit racism in healthcare settings.
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Affiliation(s)
| | | | - Gøril Ursin
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
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Cervantes D, Hei H. Journal club: "Racial disparities in catheter related urinary tract infections among elderly trauma patients in the US". Am J Infect Control 2022; 50:120-121. [PMID: 34955189 DOI: 10.1016/j.ajic.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/01/2022]
Abstract
In this article for Journal Club commentary entitled "Racial Disparities in Catheter Related Urinary Tract Infections Among Elderly Trauma Patients in the US", Keneally et al, conducted a study with the goal of assessing the role of social disparities in catheter associated urinary tract infections (CAUTIs). This cross-sectional study utilized secondary data to determine the possible CAUTI risk in ventilated, older (≥ 65 years of age) trauma patients exploring possible racial structural bias in healthcare. The analysis addressed the following questions in this specific population:While this study does consider race and discusses structural biases, which are important and sparsely researched in healthcare-associated infection (HAI) outcomes, the practice implementations are somewhat limited due to study design and analysis. Therefore, the focus of this Journal Club commentary will be reviewing basic steps Infection Preventionists (IPs) can take to critically appraise the literature for application in their facility's patient population.
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