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Chatterjee A, Ambrose K, Canaday DH, Delair S, Ezike N, Huber VC, Jhaveri R, Nyquist AC, Sporer A, Varman M, Vivekanandan R, Wojcik R, Jandhyala R. The association between influenza vaccine effectiveness and egg-based manufacturing technology: literature review and US expert consensus. Curr Med Res Opin 2024; 40:335-343. [PMID: 38054898 DOI: 10.1080/03007995.2023.2284386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Influenza is associated with significant disease burden in the US and is currently best controlled by vaccination programs. Influenza vaccine effectiveness (VE) is low and may be reduced by several factors, including egg adaptations. Although non-egg-based influenza vaccines reportedly have greater VE in egg-adapted seasons, evidence for egg adaptations' reduction of VE is indirect and dissociated, apart from two previous European consensuses. METHODS This study replicated the methodology used in a 2020 literature review and European consensus, providing an updated review and consensus opinion of 10 US experts on the evidence for a mechanistic basis for reduction of VE due to egg-based manufacturing methods. A mechanistic basis was assumed if sufficient evidence was found for underlying principles proposed to give rise to such an effect. Evidence for each principle was brought forward from the 2020 review and identified here by structured literature review and expert panel. Experts rated the strength of support for each principle and a mechanistic basis for reduction of VE due to egg-based influenza vaccine manufacture in a consensus method (consensus for strong/very strong evidence = ≥ 3.5 on 5-point Likert scale). RESULTS Experts assessed 251 references (from previous study: 185; this study: 66). The majority of references for all underlying principles were rated as strong or very strong supporting evidence (52-86%). Global surveillance, WHO candidate vaccine virus selection, and manufacturing stages involving eggs were identified as most likely to impact influenza VE. CONCLUSION After review of extensive evidence for reduction of VE due to egg-based influenza vaccine manufacture, influenza experts in the US joined those in Europe in unanimous agreement for a mechanistic basis for the effect. Vaccine providers and administrators should consider use of non-egg-based influenza vaccine manufacture to reduce the risk of egg adaptations and likely impact on VE.
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Affiliation(s)
- Archana Chatterjee
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | | | | | | | | | - Ravi Jhaveri
- Feinberg School of Medicine, Northwestern, IL, USA
| | | | | | | | | | | | - Ravi Jandhyala
- Medialis Ltd, Milton Keynes, UK
- King's College London, London, UK
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Calderwood MS, Anderson DJ, Bratzler DW, Dellinger EP, Garcia-Houchins S, Maragakis LL, Nyquist AC, Perkins KM, Preas MA, Saiman L, Schaffzin JK, Schweizer M, Yokoe DS, Kaye KS. Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:695-720. [PMID: 37137483 PMCID: PMC10867741 DOI: 10.1017/ice.2023.67] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing their surgical-site infection (SSI) prevention efforts. This document updates the Strategies to Prevent Surgical Site Infections in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Affiliation(s)
| | - Deverick J. Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina, United States
| | - Dale W. Bratzler
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | | | | | - Lisa L. Maragakis
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Ann-Christine Nyquist
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Kiran M. Perkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Michael Anne Preas
- University of Maryland Medical System, Baltimore, Maryland, United States
| | - Lisa Saiman
- Columbia University Irving Medical Center and NewYork–Presbyterian Hospital, New York, New York, United States
| | - Joshua K. Schaffzin
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Marin Schweizer
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, University of Iowa, Iowa City, Iowa
| | - Deborah S. Yokoe
- University of California-San Francisco, San Francisco, California, United States
| | - Keith S. Kaye
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
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3
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Most ZM, Nyquist AC, Radonovich LJ, Rodriguez-Barradas MC, Price CS, Simberkoff MS, Bessesen MT, Cummings DAT, Rattigan SM, Warren-Gash C, Gaydos CA, Gibert CL, Gorse GJ, Perl TM. Preschool-Aged Household Contacts as a Risk Factor for Viral Respiratory Infections in Healthcare Personnel. Open Forum Infect Dis 2023; 10:ofad057. [PMID: 36824623 PMCID: PMC9942663 DOI: 10.1093/ofid/ofad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Background Viral respiratory infections (VRIs) are common and are occupational risks for healthcare personnel (HCP). VRIs can also be acquired at home and other settings among HCPs. We sought to determine if preschool-aged household contacts are a risk factor for VRIs among HCPs working in outpatient settings. Methods We conducted a secondary analysis of data from a cluster randomized trial at 7 medical centers in the United States over 4 influenza seasons from 2011-2012 to 2014-2015. Adult HCPs who routinely came within 6 feet of patients with respiratory infections were included. Participants were tested for respiratory viruses whenever symptomatic and at 2 random times each season when asymptomatic. The exposure of interest was the number of household contacts 0-5 years old (preschool-aged) at the beginning of each HCP-season. The primary outcome was the rate of polymerase chain reaction-detected VRIs, regardless of symptoms. The VRI incidence rate ratio (IRR) was calculated using a mixed-effects Poisson regression model that accounted for clustering at the clinic level. Results Among the 4476 HCP-seasons, most HCPs were female (85.4%) and between 30 and 49 years of age (54.6%). The overall VRI rate was 2.04 per 100 person-weeks. In the adjusted analysis, HCPs having 1 (IRR, 1.22 [95% confidence interval {CI}, 1.05-1.43]) and ≥2 (IRR, 1.35 [95% CI, 1.09-1.67]) preschool-aged household contacts had higher VRI rates than those with zero preschool-aged household contacts. Conclusions Preschool-aged household contacts are a risk factor for developing VRIs among HCPs working in outpatient settings.
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Affiliation(s)
- Zachary M Most
- Pediatric Infectious Diseases Program, Children’s Health System of Texas, Dallas, Texas, USA
- Division of Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ann-Christine Nyquist
- Department of Infectious Disease, Children’s Hospital Colorado, Aurora, Colorado, USA
- Division of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lewis J Radonovich
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Connie Savor Price
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
- Infectious Disease Department, Denver Health Medical Center, Denver, Colorado, USA
| | - Michael S Simberkoff
- Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, New York, USA
- Division of Infectious Diseases, New York University Grossman School of Medicine, New York, New York, USA
| | - Mary T Bessesen
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
- Medical Service/Infectious Disease, Veterans Affairs Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Derek A T Cummings
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan M Rattigan
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Charlotte Warren-Gash
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charlotte A Gaydos
- Department of Medicine and Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Cynthia L Gibert
- Medical Service/Infectious Disease, Veterans Affairs Medical Center, Washington, District of Columbia, USA
- Department of Medicine, George Washington University School of Medical and Health Sciences, Washington, District of Columbia, USA
| | - Geoffrey J Gorse
- Division of Infectious Diseases, Allergy and Immunology, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Trish M Perl
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Valdez S, Walton K, Loresto F, Nyquist AC, Givens P. Protecting Pediatric Healthcare Personnel With Personal Protective Equipment-Specific Roles. J Nurs Adm 2022; 52:330-331. [PMID: 35608976 DOI: 10.1097/nna.0000000000001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
During the height of the COVID-19 pandemic, organizations had to prioritize protecting healthcare personnel (HCP) through effective communication and providing necessary personal protective equipment (PPE). Inadequate and inconsistent supply of PPE has been noted as a cause of anxiety and concern for HCPs. A pediatric hospital in the Western United States responded by developing a system of processes to protect their staff. This column describes the creation of specific COVID-19 roles to support the communication and the resourcing of PPE.
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Affiliation(s)
- Sondra Valdez
- Author Affiliations: Director Patient Care Services (Ms Valdez), Children's Hospital Colorado South Metro, Highlands Ranch; Director of Patient Care Services (Dr Walton), Center for Cancer & Blood Disorders, Nurse Scientist (Dr Loresto), Chief Safety and Epidemiology Officer (Dr Nyquist), and Chief Nurse Executive (Dr Givens), Children's Hospital Colorado; and Professor of Pediatrics at University of Colorado School of Medicine (Dr Nyquist), Aurora
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Bessesen MT, Rattigan S, Frederick J, Cummings DA, Gaydos CA, Gibert CL, Gorse GJ, Nyquist AC, Price CS, Reich NG, Simberkoff MS, Brown AC, Radonovich LJ, Perl TM, Rodriguez-Barradas MC. Outpatient healthcare personnel knowledge and attitudes towards infection prevention measures for protection from respiratory infections. Am J Infect Control 2021; 49:1369-1375. [PMID: 34182066 DOI: 10.1016/j.ajic.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 05/21/2021] [Accepted: 06/21/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Healthcare personnel (HCP) knowledge and attitudes toward infection control measures are important determinants of practices that can protect them from transmission of infectious diseases. METHODS Healthcare personnel were recruited from Emergency Departments and outpatient clinics at seven sites. They completed knowledge surveys at the beginning and attitude surveys at the beginning and end of each season of participation. Attitudes toward infection prevention and control measures, especially medical masks and N95 respirators, were compared. The proportion of participants who correctly identified all components of an infection control bundle for seven clinical scenarios was calculated. RESULTS The proportion of participants in the medical mask group who reported at least one reason to avoid using medical masks fell from 88.5% on the pre-season survey to 39.6% on the post-season survey (odds ratio [OR] for preseason vs. postseason 0.11, 95% CI 0.10-0.14). Among those wearing N95 respirators, the proportion fell from 87.9% to 53.6% (OR 0.24, 95% CI 0.21-0.28). Participants correctly identified all components of the infection control bundle for 4.9% to 38.5% of scenarios. CONCLUSIONS Attitudes toward medical masks and N95 respirators improved significantly between the beginning and end of each season. The proportion of HCP who correctly identified the infection control precautions needed for clinical scenarios was low, but it improved over successive years of participation in the study.
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Gorse GJ, Rattigan SM, Kirpich A, Simberkoff MS, Bessesen MT, Gibert C, Nyquist AC, Price CS, Gaydos CA, Radonovich LJ, Perl TM, Rodriguez-Barradas MC, Cummings DAT. Influence of Pre-Season Antibodies against Influenza Virus on Risk of Influenza Infection among Health Care Personnel. J Infect Dis 2021; 225:891-902. [PMID: 34534319 DOI: 10.1093/infdis/jiab468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The association of hemagglutination inhibition (HAI) antibodies with protection from influenza among healthcare personnel (HCP) with occupational exposure to influenza viruses has not been well-described. METHODS The Respiratory Protection Effectiveness Clinical Trial was a cluster-randomized, multi-site study that compared medical masks to N95 respirators in preventing viral respiratory infections among HCP in outpatient healthcare settings for 5,180 participant-seasons. Serum HAI antibody titers before each influenza season and influenza virus infection confirmed by polymerase chain reaction were studied over four study years. RESULTS In univariate models, the risk of influenza A(H3N2) and B virus infections was associated with HAI titers to each virus, study year, and site. HAI titers were strongly associated with vaccination. Within multivariate models, each log base 2 increase in titer was associated with 15%, 26% and 33-35% reductions in the hazard of influenza A(H3N2), A(H1N1) and B infections, respectively. Best models included pre-season antibody titers and study year, but not other variables. CONCLUSIONS HAI titers were associated with protection from influenza among HCP with routine exposure to patients with respiratory illness and influenza season contributed to risk. HCP can be reassured about receiving influenza vaccination to stimulate immunity.
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Affiliation(s)
- Geoffrey J Gorse
- Section of Infectious Diseases, Veterans Affairs St. Louis Health Care System, St. Louis, MO, 63106 USA.,Division of Infectious Diseases, Allergy and Immunology, Saint Louis University School of Medicine, St. Louis, MO, 63104 USA
| | - Susan M Rattigan
- Department of Biology and the Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Alexander Kirpich
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA USA
| | - Michael S Simberkoff
- Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, NY, USA.,Division of Infectious Diseases, New York University Grossman School of Medicine, New York, NY, USA
| | - Mary T Bessesen
- Veterans Affairs Eastern Colorado Healthcare System, Aurora, CO, 80045 USA.,Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cynthia Gibert
- Medical Service, Washington D.C. Veterans Affairs Medical Center, Washington, DC, USA
| | - Ann-Christine Nyquist
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Pediatrics, Section of Pediatric Infectious Disease and Epidemiology Children's Hospital Colorado, Aurora, CO, USA
| | - Connie Savor Price
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA.,Infectious Diseases, Denver Health, Denver, CO, USA
| | - Charlotte A Gaydos
- Department of Medicine and Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lewis J Radonovich
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV USA
| | - Trish M Perl
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Derek A T Cummings
- Department of Biology and the Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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7
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Los J, Gaydos CA, Gibert CL, Gorse GJ, Lykken J, Nyquist AC, Price CS, Radonovich LJ, Rattigan S, Reich N, Rodriguez-Barradas M, Simberkoff M, Bessesen M, Brown A, Cummings DAT, Perl TM. Take-home kits to detect respiratory viruses among healthcare personnel: Lessons learned from a cluster randomized clinical trial. Am J Infect Control 2021; 49:893-899. [PMID: 33581146 PMCID: PMC7874979 DOI: 10.1016/j.ajic.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Health care personnel (HCP) working in outpatient settings routinely interact with patients with acute respiratory illnesses. Absenteeism following symptom development and lack of staff trained to obtain samples limit efforts to identify pathogens among infected HCP. METHODS The Respiratory Protection Effectiveness Clinical Trial assessed respiratory infection incidence among HCP between 2011 and 2015. Research assistants obtained anterior nasal and oropharyngeal swabs from HCP in the workplace following development of respiratory illness symptoms and randomly while asymptomatic. Participants received take-home kits to self-collect swabs when absent from work. Samples mailed to a central laboratory were tested for respiratory viruses by reverse transcription polymerase chain reaction. RESULTS Among 2,862 participants, 3,467 swabs were obtained from symptomatic participants. Among symptomatic HCP, respiratory virus was detected in 904 of 3,467 (26.1%) samples. Self-collected samples by symptomatic HCP at home had higher rates of viral detection (40.3%) compared to 24% obtained by trained research assistants in the workplace (P < .001). CONCLUSIONS In this randomized clinical trial, take-home kits were an easily implemented, effective method to self-collect samples by HCP. Other studies have previously shown relative equivalence of self-collected samples to those obtained by trained healthcare workers. Take-home kit self-collection could diminish workforce exposures and decrease the demand for personnel protective equipment worn to protect workers who collect respiratory samples.
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Affiliation(s)
- Jenna Los
- Johns Hopkins University School of Medicine, Baltimore, MD.
| | | | | | - Geoffrey J Gorse
- VA St. Louis Health Care System and Saint Louis University School of Medicine St. Louis, MO
| | | | - Ann-Christine Nyquist
- Children's Hospital Colorado, Aurora, CO; University of Colorado School of Medicine, Aurora, CO
| | - Connie S Price
- University of Colorado School of Medicine, Aurora, CO; Denver Health and Hospital, Denver, CO
| | - Lewis J Radonovich
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | - Mary Bessesen
- University of Colorado School of Medicine, Aurora, CO; VA-Eastern Colorado Healthcare System, Denver, CO
| | | | | | - Trish M Perl
- Johns Hopkins University School of Medicine, Baltimore, MD; University of Texas Southwestern Medical Center, Dallas, TX
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Cummings DAT, Radonovich LJ, Gorse GJ, Gaydos CA, Bessesen MT, Brown AC, Gibert CL, Hitchings MDT, Lessler J, Nyquist AC, Rattigan SM, Rodriguez-Barradas MC, Price CS, Reich NG, Simberkoff MS, Perl TM. Risk Factors for Healthcare Personnel Infection with Endemic Coronaviruses (HKU1, OC43, NL63, 229E): Results from the Respiratory Protection Effectiveness Clinical Trial (ResPECT). Clin Infect Dis 2020; 73:e4428-e4432. [PMID: 32645144 PMCID: PMC7454439 DOI: 10.1093/cid/ciaa900] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background SARS-CoV-2 presents a large risk to healthcare personnel. Quantifying the risk of coronavirus infection associated with workplace activities is an urgent need. Methods We assessed the association of worker characteristics, occupational roles and behaviors, and participation in procedures with the risk of endemic coronavirus infection among healthcare personnel who participated in the Respiratory Protection Effectiveness Trial (ResPECT), a cluster randomized trial to assess personal protective equipment to prevent respiratory infections and illness conducted from 2011 to 2016. Results Among 4,689 HCP-seasons, we detected coronavirus infection in 387 (8%). HCP who participated in an aerosol generation procedure (AGP) at least once during the viral respiratory season were 105% (95% CI 21%, 240%) more likely to be diagnosed with a laboratory-confirmed coronavirus infection. Younger individuals, those who saw pediatric patients and those with household members under the age of five were at increased risk of coronavirus infection. Conclusions Our analysis suggests the risk of HCP becoming infected with an endemic coronavirus increases approximately two-fold with exposures to AGP. Our findings may be relevant to the Coronavirus Disease 2019 (COVID-19) pandemic; however, SARS-COV-2, the virus that causes COVID-19, may differ from endemic coronaviruses in important ways.
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Affiliation(s)
| | - Lewis J Radonovich
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Geoffrey J Gorse
- Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA.,Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Mary T Bessesen
- Veterans Affairs Eastern Colorado Healthcare System, Denver, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Cynthia L Gibert
- Veterans Affairs Medical Center, Washington, DC, USA.,George Washington University School of Medical and Health Sciences, Washington, DC, USA
| | | | - Justin Lessler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ann-Christine Nyquist
- University of Colorado School of Medicine, Aurora, CO, USA.,Children's Hospital Colorado, Aurora, CO, USA
| | | | - Maria C Rodriguez-Barradas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Baylor College of Medicine, Houston, Texas, USA
| | - Connie Savor Price
- University of Colorado School of Medicine, Aurora, CO, USA.,Denver Health Medical Center, Denver, CO, USA
| | | | - Michael S Simberkoff
- Veterans Affairs New York Harbor Healthcare System, New York, NY, USA.,NYU School of Medicine, New York, NY, USA
| | - Trish M Perl
- Johns Hopkins School of Medicine, Baltimore, MD, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
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Abstract
Chemical and biological events (including infectious disease outbreaks) may affect children disproportionately, and the threat of a chemical or biological attack remains in the United States and worldwide. Although federal programs and funding support a broad range of federal initiatives for public health preparedness and response, funding at the state and local levels has been flat or is decreasing, potentially leaving communities vulnerable. Consequently, pediatricians need to prepare and be ready to care for children in their communities before, during, and after a chemical or biological event, including during long-term recovery. Some medical countermeasures for particular chemical and biological agents have not been adequately studied or approved for children. The American Academy of Pediatrics provides resources and education on disaster preparedness and response, including information on the pediatrician's role in disasters, pediatric medical countermeasures, and mental health after an event as well as individual and family preparedness. This policy statement addresses the steps that clinicians and policy makers can take to protect children and mitigate the effects of a chemical or biological attack.
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Affiliation(s)
- Sarita Chung
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts;
| | - Carl R Baum
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, School of Medicine, Yale University, New Haven, Connecticut; and
| | - Ann-Christine Nyquist
- Section of Pediatric Infectious Diseases and Epidemiology, Department of Pediatrics, Children's Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado
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10
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Abstract
Children are potential victims of chemical or biological terrorism. In recent years, children have been victims of terrorist acts such as the chemical attacks (2017-2018) in Syria. Consequently, it is necessary to prepare for and respond to the needs of children after a chemical or biological attack. A broad range of public health initiatives have occurred since the terrorist attacks of September 11, 2001. However, in many cases, these initiatives have not ensured the protection of children. Since 2001, public health preparedness has broadened to an all-hazards approach, in which response plans for terrorism are blended with those for unintentional disasters or outbreaks (eg, natural events such as earthquakes or pandemic influenza or man-made catastrophes such as a hazardous-materials spill). In response to new principles and programs that have evolved over the last decade, this technical report supports the accompanying update of the American Academy of Pediatrics 2006 policy statement "Chemical-Biological Terrorism and its Impact on Children." The roles of the pediatrician and public health agencies continue to evolve, and only their coordinated readiness and response efforts will ensure that the medical and mental health needs of children will be met successfully. In this document, we will address chemical and biological incidents. Radiation disasters are addressed separately.
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Affiliation(s)
- Sarita Chung
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts;
| | - Carl R Baum
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, School of Medicine, Yale University, New Haven, Connecticut; and
| | - Ann-Christine Nyquist
- Section of Pediatric Infectious Diseases and Epidemiology, Department of Pediatrics, Children's Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado
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Brown AC, Lauer SA, Robinson CC, Nyquist AC, Rao S, Reich NG. Evaluating the ALERT algorithm for local outbreak onset detection in seasonal infectious disease surveillance data. Stat Med 2020; 39:1145-1155. [PMID: 31985869 PMCID: PMC7169531 DOI: 10.1002/sim.8467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/29/2019] [Accepted: 12/14/2019] [Indexed: 11/06/2022]
Abstract
Estimation of epidemic onset timing is an important component of controlling the spread of seasonal infectious diseases within community healthcare sites. The Above Local Elevated Respiratory Illness Threshold (ALERT) algorithm uses a threshold-based approach to suggest incidence levels that historically have indicated the transition from endemic to epidemic activity. In this paper, we present the first detailed overview of the computational approach underlying the algorithm. In the motivating example section, we evaluate the performance of ALERT in determining the onset of increased respiratory virus incidence using laboratory testing data from the Children's Hospital of Colorado. At a threshold of 10 cases per week, ALERT-selected intervention periods performed better than the observed hospital site periods (2004/2005-2012/2013) and a CUSUM method. Additional simulation studies show how data properties may effect ALERT performance on novel data. We found that the conditions under which ALERT showed ideal performance generally included high seasonality and low off-season incidence.
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Affiliation(s)
- Alexandria C Brown
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Stephen A Lauer
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Christine C Robinson
- Department of Pediatrics, Section of Infectious Diseases and Epidemiology, Department of Epidemiology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Ann-Christine Nyquist
- Department of Pediatrics, Section of Infectious Diseases and Epidemiology, Department of Epidemiology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Suchitra Rao
- Pediatric Infectious Diseases/Hospital Medicine/Epidemiology, Children's Hospital Colorado and University of Colorado, Aurora, Colorado
| | - Nicholas G Reich
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
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Nyquist AC, Rattigan SM, Gibert CL, Gorse G, Perl TM, Perl TM, Price CS, Radonovich L, Rodriguez-Barradas MC, Simberkoff M, Bessesen MT, Gaydos CA, Cummings D. 1204. Increased Risk of Respiratory Infections Among Healthcare Personnel (HCP) Caring for Children. Open Forum Infect Dis 2019. [PMCID: PMC6809447 DOI: 10.1093/ofid/ofz360.1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Healthcare personnel (HCP) are exposed to many individuals with respiratory illness while providing care. Because children more frequently present for care with respiratory infections compared with older individuals, we hypothesized that HCP working in pediatric settings might experience greater risks of respiratory infection than HCP working in adult settings. The Respiratory Protection Effectiveness Clinical Trial (ResPECT) prospectively compared respiratory protection among HCP at seven health systems across the United States between 2011 and 2015. Methods Swabs were collected from asymptomatic participants twice each respiratory season. Swabs were collected from symptomatic HCP within 24 hours of self-reported respiratory symptoms and again if participants were still symptomatic after 7 days. PCR confirmation for 13 viruses was done by a single laboratory. We compared hazards of multiple outcomes associated with respiratory infections among HCP working in pediatric clinics and HCP working in clinics that care for adults. Results The main outcomes were risk factors for symptomatic and asymptomatic viral respiratory infections. A total of 5,180 participant-seasons were evaluated from 2011–2015, 1,130 of which worked solely with children. There were 403 and 1,162 incidents of asymptomatic and symptomatic PCR-confirmed respiratory infection, respectively. Risk factors associated with respiratory infection in the entire cohort included age, race, vaccination status, smoking status, wearing contacts, total household members, study site, and age of patient population. HCP working exclusively with pediatric patients had 1.5 (95% CI 1.2–1.8) times the rate of respiratory virus infection compared with HCP working only with adults. HCP who worked with both populations had 1.4 times (95% CI: 1.2–1.7) the rate of infection with respiratory viruses. Conclusion The risk of respiratory infections was increased among HCP that saw children. This risk was not mitigated by working only part-time with children and extended to those who identified as working with both adult and pediatric populations. Our findings highlight the need to target interventions in pediatric settings to decrease HCP acquisition of respiratory infections. Disclosures Trish M. Perl, MD; MSc, 7–11: Advisory Board; medimmune: Research Grant.
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Affiliation(s)
| | | | - Cynthia L Gibert
- George Washington University School of Medicine and Health Sciences, Washington DC
| | - Geoffrey Gorse
- Saint Louis University School of Medicine and St. Louis VA Health Care System, Saint Louis, Missouri
| | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Connie S Price
- Denver Health and Hospital, University of Colorado School of Medicine, Denver, Colorado
| | - Lewis Radonovich
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
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13
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Bessesen MT, Radonovich L, Rattigan SM, Cummings D, Rodriguez-Barradas MC, Simberkoff M, Gibert CL, Nyquist AC, Price CS, Gorse G, Gaydos CA, Perl TM, Perl TM. 1205. Healthcare Personnel Knowledge, Attitudes, and Beliefs Towards Infection Prevention and Control Measures for Protection from Respiratory Infections. Open Forum Infect Dis 2019. [PMCID: PMC6809034 DOI: 10.1093/ofid/ofz360.1068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Healthcare personnel (HCP) knowledge and attitudes toward Infection Prevention and Control (IPC) measures are important determinants of practices that can protect them from acquisition of infectious diseases from patients. We aimed to describe HCP knowledge and attitudes concerning IPC measures over time in the context of a clinical trial. Methods ResPECT was a multi-center, multi-season cluster randomized clinical trial designed to compare the effectiveness of medical masks (MM) and N95 respirators (N95) for preventing acute respiratory illnesses in HCP employed in outpatient clinical settings. At the beginning of each respiratory virus season, participants completed a survey instrument to measure IPC knowledge. At the beginning and end of each season participants completed a survey to assess attitudes and beliefs about IPC measures, especially MM and N95. Results A pre-study and post-study survey pair was available for 88.1% of participant seasons. There were no significant differences in demographic variables or job assignment between survey respondents and nonrespondents for each participant season. Participants correctly identified 59.8% to 63.4% of IPC measures that should be used by HCP when exposed to patients with symptoms of acute respiratory illness, or at high risk of infection. There was modest improvement in the knowledge score over time among providers who participated for multiple years in the study. In the first pre-study survey of IPC attitudes and beliefs, 88.5% and 87.9% of participants identified at least one reason to avoid using either MM and N95, respectively (Figure 1). At the post-season survey, the proportion of participants reporting a reason to avoid MM fell to 39.6% (IRR for pre- vs. post-season 0.15, 95% CI 0.13–0.17) and 53.6% reported a reason to avoid N95 (IRR 0.57, 95% CI 0.51–0.66). Conclusion HCPknowledge of IPC precautions was poor, suggesting a need for better IPC education and accountability in the outpatient setting. When given incentives to comply with processes toward which they had negative attitudes at baseline, HCP realized that medical masks and N95 respirators were comfortable enough to wear for patient encounters and interfered with their work processes less than expected. ![]()
Disclosures Trish M. Perl, MD; MSc, 7–11: Advisory Board; medimmune: Research Grant.
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Affiliation(s)
| | - Lewis Radonovich
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
| | | | | | | | | | - Cynthia L Gibert
- George Washington University School of Medicine and Health Sciences, Washington DC
| | | | - Connie S Price
- Denver Health and Hospital, University of Colorado School of Medicine, Denver, Colorado
| | - Geoffrey Gorse
- Saint Louis University School of Medicine and St. Louis VA Health Care System, Saint Louis, Missouri
| | | | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
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14
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Radonovich LJ, Simberkoff MS, Bessesen MT, Brown AC, Cummings DAT, Gaydos CA, Los JG, Krosche AE, Gibert CL, Gorse GJ, Nyquist AC, Reich NG, Rodriguez-Barradas MC, Price CS, Perl TM. N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial. JAMA 2019; 322:824-833. [PMID: 31479137 PMCID: PMC6724169 DOI: 10.1001/jama.2019.11645] [Citation(s) in RCA: 295] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/25/2019] [Indexed: 01/04/2023]
Abstract
Importance Clinical studies have been inconclusive about the effectiveness of N95 respirators and medical masks in preventing health care personnel (HCP) from acquiring workplace viral respiratory infections. Objective To compare the effect of N95 respirators vs medical masks for prevention of influenza and other viral respiratory infections among HCP. Design, Setting, and Participants A cluster randomized pragmatic effectiveness study conducted at 137 outpatient study sites at 7 US medical centers between September 2011 and May 2015, with final follow-up in June 2016. Each year for 4 years, during the 12-week period of peak viral respiratory illness, pairs of outpatient sites (clusters) within each center were matched and randomly assigned to the N95 respirator or medical mask groups. Interventions Overall, 1993 participants in 189 clusters were randomly assigned to wear N95 respirators (2512 HCP-seasons of observation) and 2058 in 191 clusters were randomly assigned to wear medical masks (2668 HCP-seasons) when near patients with respiratory illness. Main Outcomes and Measures The primary outcome was the incidence of laboratory-confirmed influenza. Secondary outcomes included incidence of acute respiratory illness, laboratory-detected respiratory infections, laboratory-confirmed respiratory illness, and influenzalike illness. Adherence to interventions was assessed. Results Among 2862 randomized participants (mean [SD] age, 43 [11.5] years; 2369 [82.8%]) women), 2371 completed the study and accounted for 5180 HCP-seasons. There were 207 laboratory-confirmed influenza infection events (8.2% of HCP-seasons) in the N95 respirator group and 193 (7.2% of HCP-seasons) in the medical mask group (difference, 1.0%, [95% CI, -0.5% to 2.5%]; P = .18) (adjusted odds ratio [OR], 1.18 [95% CI, 0.95-1.45]). There were 1556 acute respiratory illness events in the respirator group vs 1711 in the mask group (difference, -21.9 per 1000 HCP-seasons [95% CI, -48.2 to 4.4]; P = .10); 679 laboratory-detected respiratory infections in the respirator group vs 745 in the mask group (difference, -8.9 per 1000 HCP-seasons, [95% CI, -33.3 to 15.4]; P = .47); 371 laboratory-confirmed respiratory illness events in the respirator group vs 417 in the mask group (difference, -8.6 per 1000 HCP-seasons [95% CI, -28.2 to 10.9]; P = .39); and 128 influenzalike illness events in the respirator group vs 166 in the mask group (difference, -11.3 per 1000 HCP-seasons [95% CI, -23.8 to 1.3]; P = .08). In the respirator group, 89.4% of participants reported "always" or "sometimes" wearing their assigned devices vs 90.2% in the mask group. Conclusions and Relevance Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza. Trial Registration ClinicalTrials.gov Identifier: NCT01249625.
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Affiliation(s)
- Lewis J. Radonovich
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
| | - Michael S. Simberkoff
- Veterans Affairs New York Harbor Healthcare System, New York
- New York University School of Medicine, New York
| | - Mary T. Bessesen
- Veterans Affairs Eastern Colorado Healthcare System, Denver
- University of Colorado School of Medicine, Aurora
| | | | - Derek A. T. Cummings
- University of Florida, Gainesville
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jenna G. Los
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Amanda E. Krosche
- Johns Hopkins School of Medicine, Baltimore, Maryland
- Weill Cornell Medicine, New York, New York
| | - Cynthia L. Gibert
- Veterans Affairs Medical Center, Washington, DC
- George Washington University School of Medical and Health Sciences, Washington, DC
| | - Geoffrey J. Gorse
- Veterans Affairs St Louis Healthcare System, St Louis, Missouri
- St Louis University School of Medicine, St Louis, Missouri
| | - Ann-Christine Nyquist
- University of Colorado School of Medicine, Aurora
- Children’s Hospital Colorado, Aurora
| | | | - Maria C. Rodriguez-Barradas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Connie Savor Price
- University of Colorado School of Medicine, Aurora
- Denver Health Medical Center, Denver, Colorado
| | - Trish M. Perl
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- University of Texas Southwestern Medical Center, Dallas
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15
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Puopolo KM, Lynfield R, Cummings JJ, Hand I, Adams-Chapman I, Poindexter B, Stewart DL, Aucott SW, Goldsmith JP, Mowitz M, Watterberg K, Maldonado YA, Zaoutis TE, Banerjee R, Barnett ED, Campbell JD, Gerber JS, Kourtis AP, Munoz FM, Nolt D, Nyquist AC, O’Leary ST, Sawyer MH, Steinbach WJ, Zangwill K. Management of Infants at Risk for Group B Streptococcal Disease. Pediatrics 2019; 144:peds.2019-1881. [PMID: 31285392 DOI: 10.1542/peds.2019-1881] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Group B streptococcal (GBS) infection remains the most common cause of neonatal early-onset sepsis and a significant cause of late-onset sepsis among young infants. Administration of intrapartum antibiotic prophylaxis is the only currently available effective strategy for the prevention of perinatal GBS early-onset disease, and there is no effective approach for the prevention of late-onset disease. The American Academy of Pediatrics joins with the American College of Obstetricians and Gynecologists to reaffirm the use of universal antenatal microbiologic-based testing for the detection of maternal GBS colonization to facilitate appropriate administration of intrapartum antibiotic prophylaxis. The purpose of this clinical report is to provide neonatal clinicians with updated information regarding the epidemiology of GBS disease as well current recommendations for the evaluation of newborn infants at risk for GBS disease and for treatment of those with confirmed GBS infection. This clinical report is endorsed by the American College of Obstetricians and Gynecologists (ACOG), July 2019, and should be construed as ACOG clinical guidance.
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Affiliation(s)
- Karen M. Puopolo
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ruth Lynfield
- Minnesota Department of Health, St Paul, Minnesota; and
| | - James J. Cummings
- Departments of Pediatrics and Bioethics, Alden March Bioethics Institute, Albany Medical College, Albany, New York
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16
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Puopolo KM, Benitz WE, Zaoutis TE, Cummings J, Juul S, Hand I, Eichenwald E, Poindexter B, Stewart DL, Aucott SW, Goldsmith JP, Watterberg K, Byington CL, Maldonado YA, Banerjee R, Barnett ED, Campbell JD, Gerber JS, Lynfield R, Munoz FM, Nolt D, Nyquist AC, O’Leary ST, Rathore MH, Sawyer MH, Steinbach WJ, Tan TQ. Management of Neonates Born at ≤34 6/7 Weeks' Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. Pediatrics 2018; 142:peds.2018-2896. [PMID: 30455344 DOI: 10.1542/peds.2018-2896] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Early-onset sepsis (EOS) remains a serious and often fatal illness among infants born preterm, particularly among newborn infants of the lowest gestational age. Currently, most preterm infants with very low birth weight are treated empirically with antibiotics for risk of EOS, often for prolonged periods, in the absence of a culture-confirmed infection. Retrospective studies have revealed that antibiotic exposures after birth are associated with multiple subsequent poor outcomes among preterm infants, making the risk/benefit balance of these antibiotic treatments uncertain. Gestational age is the strongest single predictor of EOS, and the majority of preterm births occur in the setting of other factors associated with risk of EOS, making it difficult to apply risk stratification strategies to preterm infants. Laboratory tests alone have a poor predictive value in preterm EOS. Delivery characteristics of extremely preterm infants present an opportunity to identify those with a lower risk of EOS and may inform decisions to initiate or extend antibiotic therapies. Our purpose for this clinical report is to provide a summary of the current epidemiology of preterm neonatal sepsis and provide guidance for the development of evidence-based approaches to sepsis risk assessment among preterm newborn infants.
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Affiliation(s)
- Karen M. Puopolo
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Children’s Hospital of Philadelphia, and
| | - William E. Benitz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
| | - Theoklis E. Zaoutis
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Roberts Center for Pediatric Research, Philadelphia, Pennsylvania; and
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17
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Puopolo KM, Benitz WE, Zaoutis TE, Cummings J, Juul S, Hand I, Eichenwald E, Poindexter B, Stewart DL, Aucott SW, Goldsmith JP, Watterberg K, Byington CL, Maldonado YA, Banerjee R, Barnett ED, Campbell JD, Gerber JS, Lynfield R, Munoz FM, Nolt D, Nyquist AC, O’Leary ST, Rathore MH, Sawyer MH, Steinbach WJ, Tan TQ. Management of Neonates Born at ≥35 0/7 Weeks' Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. Pediatrics 2018; 142:peds.2018-2894. [PMID: 30455342 DOI: 10.1542/peds.2018-2894] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The incidence of neonatal early-onset sepsis (EOS) has declined substantially over the last 2 decades, primarily because of the implementation of evidence-based intrapartum antimicrobial therapy. However, EOS remains a serious and potentially fatal illness. Laboratory tests alone are neither sensitive nor specific enough to guide EOS management decisions. Maternal and infant clinical characteristics can help identify newborn infants who are at risk and guide the administration of empirical antibiotic therapy. The incidence of EOS, the prevalence and implications of established risk factors, the predictive value of commonly used laboratory tests, and the uncertainties in the risk/benefit balance of antibiotic exposures all vary significantly with gestational age at birth. Our purpose in this clinical report is to provide a summary of the current epidemiology of neonatal sepsis among infants born at ≥35 0/7 weeks' gestation and a framework for the development of evidence-based approaches to sepsis risk assessment among these infants.
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Affiliation(s)
- Karen M. Puopolo
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Children’s Hospital of Philadelphia, and
| | - William E. Benitz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
| | - Theoklis E. Zaoutis
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Roberts Center for Pediatric Research, Philadelphia, Pennsylvania; and
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18
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Radonovich L, Simberkoff MS, Bessesen M, Brown AC, Cummings D, Gaydos C, Los J, Krosche A, Gibert C, Gorse G, Nyquist AC, Reich N, Rodriguez-Barradas M, Price C, Perl T. 1716. Results of the Respiratory Protection Effectiveness Clinical Trial (ResPECT). Open Forum Infect Dis 2018. [PMCID: PMC6252805 DOI: 10.1093/ofid/ofy209.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Results of the Respiratory Protection Effectiveness Clinical Trial (ResPECT)
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Affiliation(s)
- Lewis Radonovich
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
| | | | - Mary Bessesen
- VA Eastern Colorado Healthcare System, Denver, Colorado
| | | | - Derek Cummings
- Department of Biology and Emerging Pathogens Institute;, University of Florida, Gainesville, Florida
| | - Charlotte Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jenna Los
- Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Amanda Krosche
- College of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Geoffrey Gorse
- FIDSA, VA St. Louis Healthcare System, St. Louis, Missouri
| | - Ann-Christine Nyquist
- University of Colorado School of Medicine/Children’s Hospital Colorado, Aurora, Colorado
| | - Nicholas Reich
- Department of Biostatistics and Epidemiology, School of Public Health, University of Massachusetts Amherst, Amherst, Massachusetts
| | | | - Connie Price
- Infectious Diseases, University of Colorado School of Medicine/ Denver Health and Hospital, Denver, Colorado
| | - Trish Perl
- Division of Infectious Diseases Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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19
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Affiliation(s)
- Suchitra Rao
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora
- Children's Hospital Colorado, Aurora
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Ann-Christine Nyquist
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora
- Children's Hospital Colorado, Aurora
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora
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20
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Rathore MH, Jackson MA, Byington CL, Maldonado YA, Barnett ED, Davies HD, Edwards KM, Lynfield R, Munoz FM, Nolt D, Nyquist AC, Sawyer MH, Steinbach WJ, Tan TQ, Zaoutis TE. Infection Prevention and Control in Pediatric Ambulatory Settings. Pediatrics 2017; 140:peds.2017-2857. [PMID: 29061869 DOI: 10.1542/peds.2017-2857] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Since the American Academy of Pediatrics published its statement titled "Infection Prevention and Control in Pediatric Ambulatory Settings" in 2007, there have been significant changes that prompted this updated statement. Infection prevention and control is an integral part of pediatric practice in ambulatory medical settings as well as in hospitals. Infection prevention and control practices should begin at the time the ambulatory visit is scheduled. All health care personnel should be educated regarding the routes of transmission and techniques used to prevent the transmission of infectious agents. Policies for infection prevention and control should be written, readily available, updated every 2 years, and enforced. Many of the recommendations for infection control and prevention from the Centers for Disease Control and Prevention for hospitalized patients are also applicable in the ambulatory setting. These recommendations include requirements for pediatricians to take precautions to identify and protect employees likely to be exposed to blood or other potentially infectious materials while on the job. In addition to emphasizing the key principles of infection prevention and control in this policy, we update those that are relevant to the ambulatory care patient. These guidelines emphasize the role of hand hygiene and the implementation of diagnosis- and syndrome-specific isolation precautions, with the exemption of the use of gloves for routine diaper changes and wiping a well child's nose or tears for most patient encounters. Additional topics include respiratory hygiene and cough etiquette strategies for patients with a respiratory tract infection, including those relevant for special populations like patients with cystic fibrosis or those in short-term residential facilities; separation of infected, contagious children from uninfected children when feasible; safe handling and disposal of needles and other sharp medical devices; appropriate use of personal protective equipment, such as gloves, gowns, masks, and eye protection; and appropriate use of sterilization, disinfection, and antisepsis. Lastly, in this policy, we emphasize the importance of public health interventions, including vaccination for patients and health care personnel, and outline the responsibilities of the health care provider related to prompt public health notification for specific reportable diseases and communication with colleagues who may be providing subsequent care of an infected patient to optimize the use of isolation precautions and limit the spread of contagions.
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Affiliation(s)
- Mobeen H. Rathore
- University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES) and Infectious Diseases and Immunology, Wolfson Children’s Hospital, Jacksonville, Florida; and
| | - Mary Anne Jackson
- Division of Infectious Diseases, Department of Pediatrics, University of Missouri–Kansas City School of Medicine and Children’s Mercy Kansas City, Kansas City, Missouri
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21
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Davies HD, Jackson MA, Rice SG, Byington CL, Maldonado YA, Barnett ED, Campbell JD, Lynfield R, Munoz FM, Nolt D, Nyquist AC, O’Leary S, Rathore MH, Sawyer MH, Steinbach WJ, Tan TQ, Zaoutis TE, LaBella CR, Brooks MA, Canty GS, Diamond A, Hennrikus W, Logan K, Moffatt KA, Nemeth B, Pengel B, Peterson A, Stricker P. Infectious Diseases Associated With Organized Sports and Outbreak Control. Pediatrics 2017; 140:peds.2017-2477. [PMID: 28947608 DOI: 10.1542/peds.2017-2477] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Participation in organized sports has a variety of health benefits but also has the potential to expose the athlete to a variety of infectious diseases, some of which may produce outbreaks. Major risk factors for infection include skin-to-skin contact with athletes who have active skin infections, environmental exposures and physical trauma, and sharing of equipment and contact with contaminated fomites. Close contact that is intrinsic to team sports and psychosocial factors associated with adolescence are additional risks. Minimizing risk requires leadership by the organized sports community (including the athlete's primary care provider) and depends on outlining key hygiene behaviors, recognition, diagnosis, and treatment of common sports-related infections, and the implementation of preventive interventions.
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Affiliation(s)
- H. Dele Davies
- Pediatric Infectious Diseases and Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mary Anne Jackson
- Infectious Diseases, Children’s Mercy Kansas City and Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Stephen G. Rice
- Sports Medicine, Jersey Shore University Medical Center and Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, Neptune, New Jersey
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22
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Bernstein HH, Bocchini JA, Byington CL, Maldonado YA, Barnett ED, Campbell JD, Davies HD, Lynfield R, Munoz FM, Nolt D, Nyquist AC, O’Leary S, Rathore MH, Sawyer MH, Steinbach WJ, Tan TQ, Zaoutis TE. Practical Approaches to Optimize Adolescent Immunization. Pediatrics 2017; 139:peds.2016-4187. [PMID: 28167515 DOI: 10.1542/peds.2016-4187] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
With the expansion of the adolescent immunization schedule during the past decade, immunization rates notably vary by vaccine and by state. Addressing barriers to improving adolescent vaccination rates is a priority. Every visit can be viewed as an opportunity to update and complete an adolescent's immunizations. It is essential to continue to focus and refine the appropriate techniques in approaching the adolescent patient and parent in the office setting. Health care providers must continuously strive to educate their patients and develop skills that can help parents and adolescents overcome vaccine hesitancy. Research on strategies to achieve higher vaccination rates is ongoing, and it is important to increase the knowledge and implementation of these strategies. This clinical report focuses on increasing adherence to the universally recommended vaccines in the annual adolescent immunization schedule of the American Academy of Pediatrics, the American Academy of Family Physicians, the Centers for Disease Control and Prevention, and the American Congress of Obstetricians and Gynecologists. This will be accomplished by (1) examining strategies that heighten confidence in immunizations and address patient and parental concerns to promote adolescent immunization and (2) exploring how best to approach the adolescent and family to improve immunization rates.
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Affiliation(s)
- Henry H. Bernstein
- Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York; and
| | - Joseph A. Bocchini
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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23
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Krosche A, Bessesen M, Cummings D, Gaydos C, Gibert C, Gorse G, Los J, Nyquist AC, Price C, Radonovich L, Reich N, Rodriguez-Barradas MC, Simberkoff MS, Perl TM. Correlation of Corrective Eyewear to Acute Respiratory Infection (ARI) Among Outpatient Healthcare Personnel (HCP). Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Amanda Krosche
- Hospital Epidemiology and Infection Control, Johns Hopkins University, Baltimore, Maryland
| | - Mary Bessesen
- VA Eastern Colorado Healthcare System, Denver, Colorado
| | - Derek Cummings
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Charlotte Gaydos
- Medicine, Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
| | - Cynthia Gibert
- Washington, District of Columbia, VAMC, Washington, District of Columbia
| | | | - Jenna Los
- Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ann-Christine Nyquist
- University of Colorado School of Medicine/Children's Hospital of Colorado, Aurora, Colorado
| | - Connie Price
- Infectious Diseases, University of Colorado School of Medicine/Denver Health and Hospital, Denver, Colorado
| | - Lewis Radonovich
- Department of Veterans Affairs Veterans Health Administration Office of Public Health, Gainesville, Florida
| | - Nicholas Reich
- Department of Biostatistics and Epidemiology, School of Public Health, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Maria C. Rodriguez-Barradas
- Section of Infectious Diseases, Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas
| | | | - Trish M. Perl
- Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Harris AD, Pineles L, Anderson DJ, Woeltje KF, Trick WE, Kaye KS, Yokoe DS, Nyquist AC, Calfee DP, Leekha S. Which Comorbid Conditions Should We Be Analyzing as Risk Factors for Healthcare-Associated Infections? Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anthony D. Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | | | | | | | | | | | - Ann-Christine Nyquist
- University of Colorado School of Medicine/Children's Hospital of Colorado, Aurora, CO
| | | | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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Krosche A, Bessesen M, Cummings D, Gaydos C, Gibert C, Gorse G, Los J, Nyquist AC, Price C, Radonovich L, Reich N, Rodriguez-Barradas MC, Simberkoff MS, Perl TM, Team TRS. Acute Respiratory Infections (ARIs) Among Outpatient Healthcare Personnel (HCP). Open Forum Infect Dis 2016. [PMCID: PMC7117593 DOI: 10.1093/ofid/ofw194.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Amanda Krosche
- Hospital Epidemiology and Infection Control, Johns Hopkins University, Baltimore, Maryland
| | - Mary Bessesen
- VA Eastern Colorado Healthcare System, Denver, Colorado
| | - Derek Cummings
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Charlotte Gaydos
- Medicine, Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
| | - Cynthia Gibert
- Washington, District of Columbia, VA Medical Center, Washington, District of Columbia
| | | | - Jenna Los
- Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ann-Christine Nyquist
- University of Colorado School of Medicine/Children's Hospital of Colorado, Aurora, Colorado; Infectious Diseases, Children's Hospital Colorado, Aurora, Colorado
| | - Connie Price
- Infectious Diseases, University of Colorado School of Medicine/Denver Health and Hospital, Denver, Colorado
| | - Lewis Radonovich
- Department of Veterans Affairs Veterans Health Administration Office of Public Health, Gainesville, Florida
| | - Nicholas Reich
- Department of Biostatistics and Epidemiology, School of Public Health, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Maria C. Rodriguez-Barradas
- Section of Infectious Diseases, Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas
| | | | - Trish M. Perl
- Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - The ResPECT Study Team
- Hospital Epidemiology and Infection Control, Johns Hopkins University, Baltimore, Maryland
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Nyquist AC. Unexplained Fever. It's Hot. J Pediatric Infect Dis Soc 2016; 5:257-8. [PMID: 26407278 DOI: 10.1093/jpids/piv046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/03/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Ann-Christine Nyquist
- University of Colorado School of Medicine, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado
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Radonovich LJ, Bessesen MT, Cummings DA, Eagan A, Gaydos C, Gibert C, Gorse GJ, Nyquist AC, Reich NG, Rodrigues-Barradas M, Savor-Price C, Shaffer RE, Simberkoff MS, Perl TM. The Respiratory Protection Effectiveness Clinical Trial (ResPECT): a cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel. BMC Infect Dis 2016; 16:243. [PMID: 27255755 PMCID: PMC4890247 DOI: 10.1186/s12879-016-1494-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/18/2016] [Indexed: 12/04/2022] Open
Abstract
Background Although N95 filtering facepiece respirators and medical masks are commonly used for protection against respiratory infections in healthcare settings, more clinical evidence is needed to understand the optimal settings and exposure circumstances for healthcare personnel to use these devices. A lack of clinically germane research has led to equivocal, and occasionally conflicting, healthcare respiratory protection recommendations from public health organizations, professional societies, and experts. Methods The Respiratory Protection Effectiveness Clinical Trial (ResPECT) is a prospective comparison of respiratory protective equipment to be conducted at multiple U.S. study sites. Healthcare personnel who work in outpatient settings will be cluster-randomized to wear N95 respirators or medical masks for protection against infections during respiratory virus season. Outcome measures will include laboratory-confirmed viral respiratory infections, acute respiratory illness, and influenza-like illness. Participant exposures to patients, coworkers, and others with symptoms and signs of respiratory infection, both within and beyond the workplace, will be recorded in daily diaries. Adherence to study protocols will be monitored by the study team. Discussion ResPECT is designed to better understand the extent to which N95s and MMs reduce clinical illness among healthcare personnel. A fully successful study would produce clinically relevant results that help clinician-leaders make reasoned decisions about protection of healthcare personnel against occupationally acquired respiratory infections and prevention of spread within healthcare systems. Trial registration The trial is registered at clinicaltrials.gov, number NCT01249625 (11/29/2010).
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Affiliation(s)
- Lewis J Radonovich
- U.S. Department of Veterans Affairs, National Center for Occupational Health and Infection Control, 1601 SW Archer Road, Mailstop 151E, Gainesville, FL, 32608, USA.
| | - Mary T Bessesen
- Veterans Affairs Eastern Colorado Healthcare System, Denver, CO, USA.,University of Colorado School of Medicine, Denver, CO, USA
| | - Derek A Cummings
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,University of Florida, Gainesville, Florida, USA
| | - Aaron Eagan
- U.S. Department of Veterans Affairs, National Center for Occupational Health and Infection Control, 1601 SW Archer Road, Mailstop 151E, Gainesville, FL, 32608, USA
| | | | - Cynthia Gibert
- Veterans Affairs Medical Center and George Washington University School of Medical and Health Sciences, Washington, DC, USA
| | - Geoffrey J Gorse
- Veterans Affairs St. Louis Healthcare System and Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Ann-Christine Nyquist
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado School of Medicine, Denver, CO, USA
| | - Nicholas G Reich
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA, USA
| | | | - Connie Savor-Price
- Denver Health, Denver, CO, USA.,University of Colorado School of Medicine, Denver, CO, USA
| | - Ronald E Shaffer
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, PA, USA
| | | | - Trish M Perl
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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Frederick J, Dansky M, Brown AC, Bessesen M, Cummings D, Gibert C, Gorse G, Nyquist AC, Perl TM, Price C, Radonovich L, Reich NG, Rodriguez-Barradas M, Simberkoff MS, Study R. The Impact of Mandatory Versus Non-Mandatory Vaccination Programs on Employee Sick Days During Three Consecutive Acute Respiratory Illness Seasons: Observations From the ResPECT Study. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Hymes S, Gagliardo C, Hong DK, Creech CB, Nyquist AC. Impact of the Implementation of an Enhanced Social Media Strategy by the Pediatric Infectious Diseases Society (PIDS). Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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30
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Midgley CM, Watson JT, Nix WA, Curns AT, Rogers SL, Brown BA, Conover C, Dominguez SR, Feikin DR, Gray S, Hassan F, Hoferka S, Jackson MA, Johnson D, Leshem E, Miller L, Nichols JB, Nyquist AC, Obringer E, Patel A, Patel M, Rha B, Schneider E, Schuster JE, Selvarangan R, Seward JF, Turabelidze G, Oberste MS, Pallansch MA, Gerber SI. Severe respiratory illness associated with a nationwide outbreak of enterovirus D68 in the USA (2014): a descriptive epidemiological investigation. Lancet Respir Med 2015; 3:879-87. [PMID: 26482320 PMCID: PMC5693332 DOI: 10.1016/s2213-2600(15)00335-5] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/14/2015] [Accepted: 08/17/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Enterovirus D68 (EV-D68) has been infrequently reported historically, and is typically associated with isolated cases or small clusters of respiratory illness. Beginning in August, 2014, increases in severe respiratory illness associated with EV-D68 were reported across the USA. We aimed to describe the clinical, epidemiological, and laboratory features of this outbreak, and to better understand the role of EV-D68 in severe respiratory illness. METHODS We collected regional syndromic surveillance data for epidemiological weeks 23 to 44, 2014, (June 1 to Nov 1, 2014) and hospital admissions data for epidemiological weeks 27 to 44, 2014, (June 29 to Nov 1, 2014) from three states: Missouri, Illinois and Colorado. Data were also collected for the same time period of 2013 and 2012. Respiratory specimens from severely ill patients nationwide, who were rhinovirus-positive or enterovirus-positive in hospital testing, were submitted between Aug 1, and Oct 31, 2014, and typed by molecular sequencing. We collected basic clinical and epidemiological characteristics of EV-D68 cases with a standard data collection form submitted with each specimen. We compared patients requiring intensive care with those who did not, and patients requiring ventilator support with those who did not. Mantel-Haenszel χ(2) tests were used to test for statistical significance. FINDINGS Regional and hospital-level data from Missouri, Illinois, and Colorado showed increases in respiratory illness between August and September, 2014, compared with in 2013 and 2012. Nationwide, 699 (46%) of 1529 patients tested were confirmed as EV-D68. Among the 614 EV-D68-positive patients admitted to hospital, age ranged from 3 days to 92 years (median 5 years). Common symptoms included dyspnoea (n=513 [84%]), cough (n=500 [81%]), and wheezing (n=427 [70%]); 294 (48%) patients had fever. 338 [59%] of 574 were admitted to intensive care units, and 145 (28%) of 511 received ventilator support; 322 (52%) of 614 had a history of asthma or reactive airway disease; 200 (66%) of 304 patients with a history of asthma or reactive airway disease required intensive care compared with 138 (51%) of 270 with no history of asthma or reactive airway disease (p=0·0004). Similarly, 89 (32%) of 276 patients with a history of asthma or reactive airway disease required ventilator support compared with 56 (24%) of 235 patients with no history of asthma or reactive airway disease (p=0·039). INTERPRETATION In 2014, EV-D68 caused widespread severe respiratory illness across the USA, disproportionately affecting those with asthma. This unexpected event underscores the need for robust surveillance of enterovirus types, enabling improved understanding of virus circulation and disease burden. FUNDING None.
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Affiliation(s)
- Claire M Midgley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - John T Watson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Allan Nix
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aaron T Curns
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shannon L Rogers
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Betty A Brown
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Craig Conover
- Illinois Department of Public Health, Chicago, IL, USA
| | | | - Daniel R Feikin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samantha Gray
- Cook County Department of Public Health, Oak Forest, IL, USA
| | - Ferdaus Hassan
- Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | | | | | - Daniel Johnson
- The University of Chicago Comer Children's Hospital, Chicago, IL, USA
| | - Eyal Leshem
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa Miller
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | | | | | - Emily Obringer
- The University of Chicago Comer Children's Hospital, Chicago, IL, USA
| | - Ajanta Patel
- The University of Chicago Comer Children's Hospital, Chicago, IL, USA
| | - Megan Patel
- Cook County Department of Public Health, Oak Forest, IL, USA
| | - Brian Rha
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eileen Schneider
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Jane F Seward
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - George Turabelidze
- Missouri Department of Health and Senior Services, Jefferson City, MO, USA
| | - M Steven Oberste
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark A Pallansch
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan I Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Reich NG, Cummings DAT, Lauer SA, Zorn M, Robinson C, Nyquist AC, Price CS, Simberkoff M, Radonovich LJ, Perl TM. Triggering interventions for influenza: the ALERT algorithm. Clin Infect Dis 2015; 60:499-504. [PMID: 25414260 PMCID: PMC4304363 DOI: 10.1093/cid/ciu749] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 09/15/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early, accurate predictions of the onset of influenza season enable targeted implementation of control efforts. Our objective was to develop a tool to assist public health practitioners, researchers, and clinicians in defining the community-level onset of seasonal influenza epidemics. METHODS Using recent surveillance data on virologically confirmed infections of influenza, we developed the Above Local Elevated Respiratory Illness Threshold (ALERT) algorithm, a method to identify the period of highest seasonal influenza activity. We used data from 2 large hospitals that serve Baltimore, Maryland and Denver, Colorado, and the surrounding geographic areas. The data used by ALERT are routinely collected surveillance data: weekly case counts of laboratory-confirmed influenza A virus. The main outcome is the percentage of prospective seasonal influenza cases identified by the ALERT algorithm. RESULTS When ALERT thresholds designed to capture 90% of all cases were applied prospectively to the 2011-2012 and 2012-2013 influenza seasons in both hospitals, 71%-91% of all reported cases fell within the ALERT period. CONCLUSIONS The ALERT algorithm provides a simple, robust, and accurate metric for determining the onset of elevated influenza activity at the community level. This new algorithm provides valuable information that can impact infection prevention recommendations, public health practice, and healthcare delivery.
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Affiliation(s)
| | | | | | | | | | - Ann-Christine Nyquist
- Children's Hospital Colorado, Aurora
- University of Colorado School of Medicine, Aurora, Colorado
| | - Connie S. Price
- Division of Infectious Diseases, Denver Health Medical Center
- University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Trish M. Perl
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Dolan SA, Littlehorn C, Glodé MP, Dowell E, Xavier K, Nyquist AC, Todd JK. Association ofBacillus cereusInfection with Contaminated Alcohol Prep Pads. Infect Control Hosp Epidemiol 2015; 33:666-71. [DOI: 10.1086/666334] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.Bacillusspecies have caused healthcare-associated outbreaks of invasive disease as well as pseudo-outbreaks. We report an outbreak investigation of blood cultures positive forBacillus cereusassociated with alcohol prep pads (APPs) contaminated withB. cereusandBacillusspecies resulting in a rapid internal product recall and subsequent international product recall.Design.Epidemiologic and microbiologic outbreak investigation.Setting.A 300-bed tertiary care children's hospital in Aurora, Colorado.Patients.Patients with blood or cerebrospinal fluid cultures positive forB. cereus.Methods.Three patients with blood cultures positive forB. cereuswere identified in late 2010. Breaches in procedural and surgical techniques, common interventions, and products were explored. The following 3 common products were cultured: sterile saline syringes, chlorhexidine/alcohol skin preparation solution, and APPs. Repetitive sequence-based polymerase chain reaction (Rep-PCR) was used to compare isolates obtained from patients and from APPs and was confirmed by independent pulsed-field gel electrophoresis.Results.There appeared to be a significant increase in blood cultures positive forB. cereusduring 2009-2010.B. cereusand otherBacillusspecies were cultured from the internal contents of 63.3% of APPs not labeled as sterile, and 8 of the 10 positive lots were manufactured after 2007. None of the isolates obtained from the patients matched strains isolated from the APPs. However, some lots of APPs had strains that were indistinguishable from one another.Conclusions.APPs that were not labeled as sterile were contaminated withBacillusspecies. The product was immediately recalled internally and replaced with APPs from another manufacturer that were labeled as sterile. On January 3, 2011, the manufacturer voluntarily recalled its APPs. Healthcare facilities, healthcare providers, and users of APPs should avoid the use of APPs not specifically labeled as sterile.
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Mushtaq M, Adams J, Zorn M, Bessesen M, Gibert C, Nyquist AC, Perl TM, Price CS, Radonovich L, Simberkoff MS, Rodriguez-Barradas MC. 932Behaviors and attitudes towards Facial Protective Equipment (FPE) use among Healthcare Personnel (HCP) in the ResPECT study: Impact of study participation and a compliance education effort. Open Forum Infect Dis 2014. [DOI: 10.1093/ofid/ofu052.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mahwish Mushtaq
- Medicine-Infectious Disease, Baylor College of Medicine, Houston, TX; Infectious Disease, Michael E. DeBakey VA Medical Center, Houston, TX
- Medicine-Infectious Disease, Baylor College of Medicine, Houston, TX; Infectious Disease, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Jill Adams
- Infectious Disease, VA Eastern Colorado Healthcare System, Denver, CO
- Medicine-Infectious Disease, Baylor College of Medicine, Houston, TX; Infectious Disease, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Martha Zorn
- University of Massachusetts, Amherst, MA
- Medicine-Infectious Disease, Baylor College of Medicine, Houston, TX; Infectious Disease, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Mary Bessesen
- VA Eastern Colorado Healthcare System, Denver, CO
- Medicine-Infectious Disease, Baylor College of Medicine, Houston, TX; Infectious Disease, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Cynthia Gibert
- VA Medical Center, Washington, DC
- Medicine-Infectious Disease, Baylor College of Medicine, Houston, TX; Infectious Disease, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Ann-Christine Nyquist
- University of Colorado, Denver, CO
- Medicine-Infectious Disease, Baylor College of Medicine, Houston, TX; Infectious Disease, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Trish M. Perl
- Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD
- Medicine-Infectious Disease, Baylor College of Medicine, Houston, TX; Infectious Disease, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Connie S. Price
- Department of Medicine, Division of Infectious Diseases, Denver Health Medical Center, Denver, CO
- Medicine-Infectious Disease, Baylor College of Medicine, Houston, TX; Infectious Disease, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Lewis Radonovich
- Department of Veterans Affairs Veterans Health Administration Office of Public Health, Gainesville, FL
- Medicine-Infectious Disease, Baylor College of Medicine, Houston, TX; Infectious Disease, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Michael S. Simberkoff
- VA New York Harbor Healthcare System, New York, NY
- Medicine-Infectious Disease, Baylor College of Medicine, Houston, TX; Infectious Disease, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Maria C. Rodriguez-Barradas
- Infectious Diseases and Medicine, Michael E. DeBakey VA Medical Center, Houston, TX; Baylor College of Medicine, Houston, TX
- Medicine-Infectious Disease, Baylor College of Medicine, Houston, TX; Infectious Disease, Michael E. DeBakey VA Medical Center, Houston, TX
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Los J, Gaydos C, Bessesen M, Cummings D, Gibert C, Holden J, Nyquist AC, Price CS, Radonovich L, Rodriguez-Barradas M, Simberkoff MS, Perl TM. 129Acute Respiratory Viral Infection among Outpatient Healthcare Personnel. Open Forum Infect Dis 2014. [PMCID: PMC7107846 DOI: 10.1093/ofid/ofu051.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jenna Los
- Medicine, Johns Hopkins University, Baltimore, MD
- Medicine, Johns Hopkins University, Baltimore, MD
| | - Charlotte Gaydos
- Medicine, Johns Hopkins University, Baltimore, MD
- Medicine, Johns Hopkins University, Baltimore, MD
| | - Mary Bessesen
- Medicine, Infectious Diseases, Johns Hopkins University, Baltimore, MD
- Medicine, Johns Hopkins University, Baltimore, MD
| | - Derek Cummings
- VA Eastern Colorado Healthcare System, Denver, CO
- Medicine, Johns Hopkins University, Baltimore, MD
| | - Cynthia Gibert
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Medicine, Johns Hopkins University, Baltimore, MD
| | - Jeffrey Holden
- Washington, DC, VAMC, Washington, DC; Geoffrey Gorse, MD, VA St. Louis Healthcare System, St. Louis, MO
- Medicine, Johns Hopkins University, Baltimore, MD
| | - Ann-Christine Nyquist
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD
- Medicine, Johns Hopkins University, Baltimore, MD
| | - Connie S. Price
- Children's Hospital Colorado, Aurora, CO
- Medicine, Johns Hopkins University, Baltimore, MD
| | - Lewis Radonovich
- Department of Medicine, Division of Infectious Diseases, Denver Health Medical Center, Denver, CO
- Medicine, Johns Hopkins University, Baltimore, MD
| | - Maria Rodriguez-Barradas
- Department of Veterans Affairs Veterans Health Administration Office of Public Health, Gainesville, FL
- Medicine, Johns Hopkins University, Baltimore, MD
| | - Michael S. Simberkoff
- VA Michael E. DeBakey Medical Center, Houston, TX
- Medicine, Johns Hopkins University, Baltimore, MD
| | - Trish M. Perl
- Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
- Medicine, Johns Hopkins University, Baltimore, MD
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Irwin A, O'malley S, Gorman K, Bessesen M, Gibert C, Nyquist AC, Perl TM, Radonovich LJ, Rodriguez-Barradas MC, Simberkoff MS, Price C. 1508Expected vs Actual WHO Five Moments Compliance among Paramedic Emergency Responders. Open Forum Infect Dis 2014. [DOI: 10.1093/ofid/ofu052.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amy Irwin
- Medicine, Denver Health Medical Center, Denver, CO
| | | | | | | | | | | | - Trish M. Perl
- Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | | | | | | | - Connie Price
- Infectious Diseases, Denver Health Medical Center, Denver, CO
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Abstract
In Colorado, USA, diagnoses coded as toxic shock syndrome (TSS) constituted 27.3% of infectious shock cases during 1993–2006. The incidence of staphylococcal TSS did not change significantly overall or in female patients 10–49 years of age but increased for streptococcal TSS. TSS may be underrecognized among all ages and both sexes.
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Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, Nyquist AC, Saiman L, Yokoe DS, Maragakis LL, Kaye KS. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35:605-27. [PMID: 24799638 PMCID: PMC4267723 DOI: 10.1086/676022] [Citation(s) in RCA: 542] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their surgical site infection (SSI) prevention efforts. This document updates “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals,”1 published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.2
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Affiliation(s)
| | | | | | - Dale W. Bratzler
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Linda Greene
- Highland Hospital and University of Rochester Medical Center, Rochester, New York
| | - Ann-Christine Nyquist
- Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Lisa Saiman
- Columbia University Medical Center, New York, New York
| | - Deborah S. Yokoe
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Keith S. Kaye
- Detroit Medical Center and Wayne State University, Detroit, Michigan
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LaGreca J, Hotchkiss M, Carry P, Messacar K, Nyquist AC, Erickson M, Garg S. Bacteriology and Risk Factors for Development of Late (Greater Than One Year) Deep Infection Following Spinal Fusion With Instrumentation. Spine Deform 2014; 2:186-190. [PMID: 27927416 DOI: 10.1016/j.jspd.2013.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN Retrospective cohort review. OBJECTIVES To evaluate patients who underwent instrumented spinal fusion procedures and compare late (more than 1 year) and early infection (less than 1 year). SUMMARY OF BACKGROUND DATA Centers for Disease Control and Prevention criteria for surgical site infections with implants include infections occurring at less than 1 year postoperatively. The authors observed a high rate of deep infection at more 1 year after instrumented spinal fusion. Retrospective review was conducted to determine whether differences in bacteriology, patient demographics, or surgical factors exist between late and early infection. METHODS A total of 1,390 patients underwent spinal fusion with instrumentation from 2000 to 2009. Deep infection requiring operative debridement occurred in 112 patients (70 at less than 1 year and 42 at more than 1 year after the index surgery). Clinical, operative, and microbiology reports were reviewed and logistic regression was performed to evaluate the relationship between these factors and time of infection. RESULTS The most common organisms in the greater than 1 year group were Propionibacterium acnes, compared with Staphylococcus aureus in the less than 1 year group. The odds of late infection in the P acnes group were 15.5 (95% confidence interval [CI], 4.36-54.72) times the odds among all other organisms (p < .0001). Patient demographics and surgical factors were not different between groups. Among all patients, the infection rate was significantly higher in patients who received stainless-steel implants (11.56%) compared with those who received titanium implants (3.53%) (p < .0001). In univariate analysis, the odds of late infection in the stainless-steel group were 6.09 (95% CI, 1.62-39.88) times the odds in the titanium group (p = .0042). However, in multivariate analysis, controlling for organism type reduced the odds ratio to 4.62 (95% CI, .53-40.14), with only a trend to significance (p = .1656). CONCLUSIONS Propionibacterium acnes was more commonly identified in late infection. Patients with stainless-steel implants had a higher incidence of late infection than those with titanium implants, but this was not significant after controlling for organism type.
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Affiliation(s)
- Jaren LaGreca
- Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO 80045, USA
| | - Mark Hotchkiss
- Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO 80045, USA
| | - Patrick Carry
- Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO 80045, USA
| | - Kevin Messacar
- Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO 80045, USA
| | - Ann-Christine Nyquist
- Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO 80045, USA
| | - Mark Erickson
- Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO 80045, USA
| | - Sumeet Garg
- Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO 80045, USA.
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Southard C, Zorn M, Bessesen M, Gaydos C, Nyquist AC, Pearl T, Price CS, Radonovich L, Reich NG, Rodriguez-Barradas M, Simberkoff MS, Gibert C. 791Does Smoking Increase the Risk for Respiratory Illness or Isolation of Respiratory Viral Pathogens among Healthcare Personnel Using Facial Protective Equipment in Outpatient Healthcare Settings? Open Forum Infect Dis 2014. [DOI: 10.1093/ofid/ofu052.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Smit MA, Nyquist AC, Todd JK. Infectious Shock and Toxic Shock Syndrome Diagnoses in Hospitals, Colorado, USA. Emerg Infect Dis 2013; 19:1855-8. [DOI: 10.3201/eid1011.121547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Guzman-Cottrill JA, Phillipi CA, Dolan SA, Nyquist AC, Win A, Siegel J. Free vaccine programs to cocoon high-risk infants and children against influenza and pertussis. Am J Infect Control 2012; 40:872-6. [PMID: 23116758 DOI: 10.1016/j.ajic.2012.05.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 04/30/2012] [Accepted: 05/01/2012] [Indexed: 11/17/2022]
Abstract
An adult immunization strategy called "cocooning" is a relatively new concept, referring to immunizing close contacts of infants and high-risk children, thereby limiting pathogen exposure. This report explores the adoption of free vaccine programs in US children's hospitals and shares our own institutions' experiences in implementing free vaccine programs for close contacts of our patients.
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Cowden J, Crane L, Lezotte D, Glover J, Nyquist AC. Pre-pandemic planning survey of healthcare workers at a tertiary care children's hospital: ethical and workforce issues. Influenza Other Respir Viruses 2011; 4:213-22. [PMID: 20836796 PMCID: PMC4940933 DOI: 10.1111/j.1750-2659.2010.00145.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Prior to the development of written policies and procedures for pandemic influenza, worker perceptions of ethical and workforce issues must be identified. OBJECTIVE To determine the relationship between healthcare worker (HCW) reporting willingness to work during a pandemic and perception of job importance, belief that one will be asked to work, and sense of professionalism and to assess HCW's opinions regarding specific policy issues as well as barriers and motivators to work during a pandemic. METHODS A survey was conducted in HCWs at The Children's Hospital in Denver, Colorado, from February to June 2007. Characteristics of workers reporting willingness to work during a pandemic were compared with those who were unwilling or unsure. Importance of barriers and motivators was compared by gender and willingness to work. RESULTS Sixty percent of respondents reported willingness to work (overall response rate of 31%). Belief one will be asked to work (OR 4.6, P < 0.0001) and having a high level of professionalism (OR 8.6, P < 0.0001) were associated with reporting willingness to work. Hospital infrastructure support staffs were less likely to report willingness to work during a pandemic than clinical healthcare professionals (OR 0.39, P < 0.001). Concern for personal safety, concern for safety of family, family's concern for safety, and childcare issues were all important barriers to coming to work. CONCLUSIONS Educational programs should focus on professional responsibility and the importance of staying home when ill. Targeted programs toward hospital infrastructure support and patient and family support staff stressing the essential nature of these jobs may improve willingness to work.
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Affiliation(s)
- Jessica Cowden
- Department of Pediatrics, University of Colorado, Denver, CO, USA.
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Pilishvili T, Zell ER, Farley MM, Schaffner W, Lynfield R, Nyquist AC, Vazquez M, Bennett NM, Reingold A, Thomas A, Jackson D, Schuchat A, Whitney CG. Risk factors for invasive pneumococcal disease in children in the era of conjugate vaccine use. Pediatrics 2010; 126:e9-17. [PMID: 20547641 DOI: 10.1542/peds.2009-2150] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE We conducted a case-control study to evaluate risk factors for invasive pneumococcal disease (IPD) among children who were aged 3 to 59 months in the era of pneumococcal conjugate vaccine (PCV7). METHODS IPD cases were identified through routine surveillance during 2001-2004. We matched a median of 3 control subjects to each case patient by age and zip code. We calculated odds ratios for potential risk factors for vaccine-type and non-vaccine-type IPD by using multivariable conditional logistic regression. RESULTS We enrolled 782 case patients (45% vaccine-type IPD) and 2512 matched control subjects. Among children who received any PCV7, children were at increased risk for vaccine-type IPD when they had underlying illnesses, were male, or had no health care coverage. Vaccination with PCV7 did not influence the risk for non-vaccine-type IPD. Presence of underlying illnesses increased the risk for non-vaccine-type IPD, particularly among children who were not exposed to household smoking. Non-vaccine-type case patients were more likely than control subjects to attend group child care, be male, live in low-income households, or have asthma; case patients were less likely than control subjects to live in households with other children. CONCLUSIONS Vaccination with PCV7 has reduced the risk for vaccine-type IPD that is associated with race and group child care attendance. Because these factors are still associated with non-vaccine-type IPD risk, additional reductions in disparities should be expected with new, higher valency conjugate vaccines.
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Affiliation(s)
- Tamar Pilishvili
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Ivy DD, Calderbank M, Wagner BD, Dolan S, Nyquist AC, Wade M, Nickels WM, Doran AK. Closed-hub systems with protected connections and the reduction of risk of catheter-related bloodstream infection in pediatric patients receiving intravenous prostanoid therapy for pulmonary hypertension. Infect Control Hosp Epidemiol 2009; 30:823-9. [PMID: 19637961 DOI: 10.1086/605320] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intravenous prostanoids (epoprostenol and treprostinil) are effective therapies for pulmonary arterial hypertension but carry a risk of catheter-related bloodstream infection (CR-BSI). Prevention of CR-BSI during long-term use of indwelling central venous catheters is important. OBJECTIVE To evaluate whether using a closed-hub system and waterproofing catheter hub connections reduces the rate of CR-BSI per 1,000 catheter-days. DESIGN Single-center open observational study (January 2003-December 2008). PATIENTS Pediatric patients with pulmonary arterial hypertension who received intravenous prostanoids. METHODS In July 2007, CR-BSI preventive measures were implemented, including the use of a closed-hub system and the waterproofing of catheter hub connections during showering. Rates of CR-BSI before and after implementing preventive measures were compared with respect to medication administered and type of bacterial infection. RESULTS Fifty patients received intravenous prostanoid therapy for a total of 41,840 catheter-days. The rate of CR-BSI during the study period was 0.51 infections per 1,000 catheter-days for epoprostenol and 1.38 infections per 1,000 catheter-days for treprostinil, which differed significantly (P < .01). CR-BSIs caused by gram-negative pathogens occurred more frequently with treprostinil than with epoprostenol (0.91 infections per 1,000 catheter-days vs 0.08 infections per 1,000 catheter-days; P < .01). Patients treated with treprostinil after the implemented changes had a significant decrease in CR-BSI rate (1.95 infections per 1,000 catheter-days vs 0.19 infections per 1,000 catheter-days; P < .01). CONCLUSION The closed-hub system and the maintenance of dry catheter hub connections significantly reduced the incidence of CR-BSI (particularly infections caused by gram-negative pathogens) in patients receiving intravenous treprostinil.
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Affiliation(s)
- D Dunbar Ivy
- University of Colorado Denver School of Medicine, The Children's Hospital, Aurora, 80045, USA.
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Abstract
Case-based surveillance provides more information than any other influenza surveillance component. Colorado became the first state to make laboratory-confirmed influenza-associated hospitalizations a case-based reportable condition in 2004. We summarized surveillance for influenza hospitalizations in Colorado during the first 4 recorded influenza seasons (2004–2008). We highlight the similarities and differences among influenza seasons; no 2 seasons were entirely the same. The 2005–06 influenza season had 2 distinct waves of activity (types A and B), the 2006–07 season was substantially later and milder, and 2007–08 had substantially greater influenza B activity. The case-based surveillance for influenza hospitalizations provides information regarding the time course of seasonal influenza activity, reported case numbers and population-based rates by age group and influenza virus type, and a measure of relative severity. Influenza hospitalization surveillance provides more information about seasonal influenza activity than any other surveillance measure (e.g., surveillance for influenza-like illness) currently in widespread use among states. More states should consider implementing case-based surveillance for influenza hospitalizations.
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Nyquist AC, Todd JK. The epidemiology, microbiology, and antimimcrobial management of head and neck infections in children--a different perspective. Adv Pediatr 2008; 55:327-8. [PMID: 19048736 DOI: 10.1016/j.yapd.2008.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ann-Christine Nyquist
- Department of Pediatrics, University of Colorado at Denver School of Medicine, Aurora, CO, USA.
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Nyquist AC. Influenza virus mutation and transmission. Manag Care 2007; 16:6-19. [PMID: 17927017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Whitney CG, Pilishvili T, Farley MM, Schaffner W, Craig AS, Lynfield R, Nyquist AC, Gershman KA, Vazquez M, Bennett NM, Reingold A, Thomas A, Glode MP, Zell ER, Jorgensen JH, Beall B, Schuchat A. Effectiveness of seven-valent pneumococcal conjugate vaccine against invasive pneumococcal disease: a matched case-control study. Lancet 2006; 368:1495-502. [PMID: 17071283 DOI: 10.1016/s0140-6736(06)69637-2] [Citation(s) in RCA: 438] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND When seven-valent pneumococcal conjugate vaccine was introduced in the USA, many children were vaccinated on schedules that differed from those tested in clinical trials. Our aim was to assess the effectiveness of the vaccine against various pneumococcal serotypes, and to measure the effectiveness of the recommended dose schedule and of catch-up and incomplete schedules. METHODS Invasive disease, defined as isolation of pneumococcus from a sterile site, was identified in children aged 3-59 months through the US Centers for Disease Control and Prevention's Active Bacterial Core surveillance. We tested isolates for serotype and antimicrobial susceptibility. Three controls, matched for age and zip code were selected for each case. We calculated the matched odds ratio for vaccination using conditional logistic regression, controlling for underlying conditions. Vaccine effectiveness was calculated as one minus the adjusted matched odds ratio times 100%. FINDINGS We enrolled 782 cases and 2512 controls. Effectiveness of one or more doses against vaccine serotypes was 96% (95% CI 93-98) in healthy children and 81% (57-92) in those with coexisting disorders. It was 76% (63-85) against infections that were not susceptible to penicillin. Vaccination prevented disease caused by all seven vaccine serotypes, and by vaccine-related serotype 6A. Several schedules were more protective than no vaccination; three infant doses with a booster were more protective against vaccine-type disease than were three infant doses alone (p=0.0323). INTERPRETATION The seven-valent pneumococcal conjugate vaccine prevents invasive disease in both healthy and chronically ill children. The vaccine is effective when used with various non-standard schedules.
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Affiliation(s)
- Cynthia G Whitney
- Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Abstract
We report a case of a 4-year-old girl with a complex congenital heart defect who developed Mycoplasma endocarditis after surgical repair. This is the first reported case of Mycoplasma endocarditis in a child and suggests consideration of this organism as a cause of culture-negative endocarditis.
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Abstract
OBJECTIVES Antimicrobial surgical prophylaxis comprises one third of all antibiotic use in pediatric hospitals and 80% of all antibiotic use in surgery. Previous studies reported that antimicrobial surgical prophylaxis is often inconsistent with recommended guidelines. An electronic surveillance system was developed to measure antimicrobial utilization and to identify opportunities to improve and monitor the administration of antibiotics for surgical prophylaxis. METHODS A retrospective cohort study was conducted on patients with selected inpatient surgical procedures performed from May 1999 to April 2000 at 4 US children's hospitals. International Classification of Diseases, Ninth Revision surgical procedure codes were divided into clean or unclean categories, and an electronic surveillance system was designed using antibiotic and microbiologic culture utilization data to measure appropriate antimicrobial use associated with the surgical procedure. A medical chart review was conducted to validate the electronic system. RESULTS Ninety percent of cases were classified properly by the electronic surveillance system as confirmed by medical chart review. Surgical antibiotic prophylaxis was not in accordance with the American Academy of Pediatrics (AAP) guidelines for almost half of all procedures. Prolonged antimicrobial administration in clean surgical procedures was the most frequent deviation from guidelines. Statistical differences between the index hospital and the comparison hospitals reflect both over- and underutilization of surgical prophylaxis with significant opportunity to improve prophylaxis for all hospitals. CONCLUSIONS Antimicrobial surgical prophylaxis at the children's hospitals studied is not always consistent with published AAP guidelines. This electronic surveillance system provides a rapid, reproducible, and validated tool to measure easily the efforts to improve adherence to AAP surgical prophylaxis guidelines.
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Affiliation(s)
- Sara Bornstein Voit
- Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado, USA
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