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Mumma JM, Howard-Anderson JR, Morgan JS, Schink K, Wheatley MJ, Kraft CS, Lane MA, Kaufman NH, Ayeni O, Brownsword EA, Jacob JT. Healthcare worker mental models of patient care tasks in the context of infection prevention and control. Infect Control Hosp Epidemiol 2022; 43:1123-1128. [PMID: 34503596 PMCID: PMC10499001 DOI: 10.1017/ice.2021.368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/05/2022]
Abstract
OBJECTIVE Understanding the cognitive determinants of healthcare worker (HCW) behavior is important for improving the use of infection prevention and control (IPC) practices. Given a patient requiring only standard precautions, we examined the dimensions along which different populations of HCWs cognitively organize patient care tasks (ie, their mental models). DESIGN HCWs read a description of a patient and then rated the similarities of 25 patient care tasks from an infection prevention perspective. Using multidimensional scaling, we identified the dimensions (ie, characteristics of tasks) underlying these ratings and the salience of each dimension to HCWs. SETTING Adult inpatient hospitals across an academic hospital network. PARTICIPANTS In total, 40 HCWs, comprising infection preventionists and nurses from intensive care units, emergency departments, and medical-surgical floors rated the similarity of tasks. To identify the meaning of each dimension, another 6 nurses rated each task in terms of specific characteristics of tasks. RESULTS Each HCW population perceived patient care tasks to vary along 3 common dimensions; most salient was the perceived magnitude of infection risk to the patient in a task, followed by the perceived dirtiness and risk of HCW exposure to body fluids, and lastly, the relative importance of a task for preventing versus controlling an infection in a patient. CONCLUSIONS For a patient requiring only standard precautions, different populations of HCWs have similar mental models of how various patient care tasks relate to IPC. Techniques for eliciting mental models open new avenues for understanding and ultimately modifying the cognitive determinants of IPC behaviors.
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Affiliation(s)
- Joel M Mumma
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica R Howard-Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Colleen S Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Morgan A Lane
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Noah H Kaufman
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Oluwateniola Ayeni
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Erik A Brownsword
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jesse T Jacob
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
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Lane MA, Walawender M, Brownsword EA, Pu S, Saikawa E, Kraft CS, Davis RE. The impact of cold weather on respiratory morbidity at Emory Healthcare in Atlanta. Sci Total Environ 2022; 813:152612. [PMID: 34963597 DOI: 10.1016/j.scitotenv.2021.152612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Research on temperature and respiratory hospitalizations is lacking in the southeastern U.S. where cold weather is relatively rare. This retrospective study examined the association between cold waves and pneumonia and influenza (P&I) emergency department (ED) visits and hospitalizations in three metro-Atlanta hospitals. METHODS We used a case-crossover design, restricting data to the cooler seasons of 2009-2019, to determine whether cold waves influenced ED visits and hospitalizations. This analysis considered effects by race/ethnicity, age, sex, and severity of comorbidities. We used generalized additive models and distributed lag non-linear models to examine these relationships over a 21-day lag period. RESULTS The odds of a P&I ED visit approximately one week after a cold wave were increased by as much as 11%, and odds of an ED visit resulting in hospitalization increased by 8%. For ED visits on days with minimum temperatures >20 °C, there was an increase of 10-15% in relative risk (RR) for short lags (0-2 days), and a slight decrease in RR (0-5%) one week later. For minimum temperatures <0 °C, RR decreased at short lags (5-10%) before increasing (1-5%) one week later. Hospital admissions exhibited a similar, but muted, pattern. CONCLUSION Unusually cold weather influenced P&I ED visits and admissions in this population.
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Affiliation(s)
- Morgan A Lane
- Division of Infectious Diseases, Department of Medicine Emory University, 201 Dowman Dr., Atlanta, GA 30322, USA.
| | - Maria Walawender
- Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, USA.
| | - Erik A Brownsword
- Division of Infectious Diseases, Department of Medicine Emory University, 201 Dowman Dr., Atlanta, GA 30322, USA.
| | - Siyan Pu
- Emory College of Arts and Sciences, Emory University, 550 Asbury Cir, Atlanta, GA 30322, USA.
| | - Eri Saikawa
- Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, USA; Emory College of Arts and Sciences, Emory University, 550 Asbury Cir, Atlanta, GA 30322, USA.
| | - Colleen S Kraft
- Division of Infectious Diseases, Department of Medicine Emory University, 201 Dowman Dr., Atlanta, GA 30322, USA; Department of Pathology and Laboratory Medicine, Emory University, 201 Dowman Dr., Atlanta, GA 30322, USA; Emory Healthcare, 1364 Clifton Rd., Atlanta, GA 30322, USA.
| | - Robert E Davis
- Department of Environmental Sciences, University of Virginia, 291 McCormick Rd, Charlottesville, VA 22904, USA.
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Lane MA, Walawender M, Webster AS, Brownsword EA, Ingersoll JM, Miller C, Waggoner J, Uyeki TM, Lindsley WG, Kraft CS. Sampling for SARS-CoV-2 Aerosols in Hospital Patient Rooms. Viruses 2021; 13:2347. [PMID: 34960615 PMCID: PMC8703426 DOI: 10.3390/v13122347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/21/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 12/21/2022] Open
Abstract
Evidence varies as to how far aerosols spread from individuals infected with SARS-CoV-2 in hospital rooms. We investigated the presence of aerosols containing SARS-CoV-2 inside of dedicated COVID-19 patient rooms. Three National Institute for Occupational Safety and Health BC 251 two-stage cyclone samplers were set up in each patient room for a six-hour sampling period. Samplers were place on tripods, which each held two samplers at various heights above the floor. Extracted samples underwent reverse transcription polymerase chain reaction for selected gene regions of the SARS-CoV-2 virus nucleocapsid. Patient medical data were compared between participants in rooms where virus-containing aerosols were detected and those where they were not. Of 576 aerosols samples collected from 19 different rooms across 32 participants, 3% (19) were positive for SARS-CoV-2, the majority from near the head and foot of the bed. Seven of the positive samples were collected inside a single patient room. No significant differences in participant clinical characteristics were found between patients in rooms with positive and negative aerosol samples. SARS-CoV-2 viral aerosols were detected from the patient rooms of nine participants (28%). These findings provide reassurance that personal protective equipment that was recommended for this virus is appropriate given its spread in hospital rooms.
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Affiliation(s)
- Morgan A. Lane
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA 30322, USA; (A.S.W.); (E.A.B.); (J.W.); (C.S.K.)
| | - Maria Walawender
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Andrew S. Webster
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA 30322, USA; (A.S.W.); (E.A.B.); (J.W.); (C.S.K.)
- Department of Infectious Diseases, Atlanta VA Health Care System, Decatur, GA 30033, USA
| | - Erik A. Brownsword
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA 30322, USA; (A.S.W.); (E.A.B.); (J.W.); (C.S.K.)
| | - Jessica M. Ingersoll
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA; (J.M.I.); (C.M.)
| | - Candace Miller
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA; (J.M.I.); (C.M.)
| | - Jesse Waggoner
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA 30322, USA; (A.S.W.); (E.A.B.); (J.W.); (C.S.K.)
- Emory Healthcare, Atlanta, GA 30322, USA
| | - Timothy M. Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30322, USA;
| | - William G. Lindsley
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26508, USA;
| | - Colleen S. Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA 30322, USA; (A.S.W.); (E.A.B.); (J.W.); (C.S.K.)
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA; (J.M.I.); (C.M.)
- Emory Healthcare, Atlanta, GA 30322, USA
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Lane MA, Brownsword EA, Babiker A, Ingersoll JM, Waggoner J, Ayers M, Klopman M, Uyeki TM, Lindsley WG, Kraft CS. Bioaerosol sampling for SARS-CoV-2 in a referral center with critically ill COVID-19 patients March-May 2020. Clin Infect Dis 2021; 73:e1790-e1794. [PMID: 33506256 PMCID: PMC7953966 DOI: 10.1093/cid/ciaa1880] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 11/10/2020] [Indexed: 12/23/2022] Open
Abstract
Background Previous research has shown that rooms of patients with coronavirus disease 2019 (COVID-19) present the potential for healthcare-associated transmission through aerosols containing severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, data on the presence of these aerosols outside of patient rooms are limited. We investigated whether virus-containing aerosols were present in nursing stations and patient room hallways in a referral center with critically ill COVID-19 patients. Methods Eight National Institute for Occupational Safety and Health BC 251 2-stage cyclone samplers were set up throughout 6 units, including nursing stations and visitor corridors in intensive care units and general medical units, for 6 h each sampling period. Samplers were placed on tripods which held 2 samplers positioned 102 cm and 152 cm above the floor. Units were sampled for 3 days. Extracted samples underwent reverse transcription polymerase chain reaction for selected gene regions of the SARS-CoV-2 virus nucleocapsid and the housekeeping gene human RNase P as an internal control. Results The units sampled varied in the number of laboratory-confirmed COVID-19 patients present on the days of sampling. Some of the units included patient rooms under negative pressure, while most were maintained at a neutral pressure. Of 528 aerosol samples collected, none were positive for SARS-CoV-2 RNA by the estimated limit of detection of 8 viral copies/m3 of air. Conclusions Aerosolized SARS-CoV-2 outside of patient rooms was undetectable. While healthcare personnel should avoid unmasked close contact with each other, these findings may provide reassurance for the use of alternatives to tight-fitting respirators in areas outside of patient rooms during the current pandemic.
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Affiliation(s)
- Morgan A Lane
- Division of Infectious Diseases, Department of Medicine Emory University, Atlanta, GA, USA
| | - Erik A Brownsword
- Division of Infectious Diseases, Department of Medicine Emory University, Atlanta, GA, USA
| | - Ahmed Babiker
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Jessica M Ingersoll
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Jesse Waggoner
- Division of Infectious Diseases, Department of Medicine Emory University, Atlanta, GA, USA.,Emory Healthcare, Atlanta, GA
| | | | - Matthew Klopman
- Emory Healthcare, Atlanta, GA.,Department of Anesthesiology, Emory University, Atlanta, GA, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Colleen S Kraft
- Division of Infectious Diseases, Department of Medicine Emory University, Atlanta, GA, USA.,Emory Healthcare, Atlanta, GA.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
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Lane MA, Brownsword EA, Morgan JS, Babiker A, Vanairsdale SA, Lyon GM, Mehta AK, Ingersoll JM, Lindsley WG, Kraft CS. Bioaerosol sampling of a ventilated patient with COVID-19. Am J Infect Control 2020; 48:1540-1542. [PMID: 32763347 PMCID: PMC7402277 DOI: 10.1016/j.ajic.2020.07.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/02/2020] [Accepted: 07/23/2020] [Indexed: 12/14/2022]
Abstract
Bioaerosol samples were collected in an airborne infection isolation room, bathroom, and anteroom of a ventilated patient with coronavirus disease 2019. Twenty-eight samples were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid, possibly due to the patient being on a closed-circuit ventilator or the efficiency of the air exchanges in the room.
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Pompeii LA, Kraft CS, Brownsword EA, Lane MA, Benavides E, Rios J, Radonovich LJ. Training and Fit Testing of Health Care Personnel for Reusable Elastomeric Half-Mask Respirators Compared With Disposable N95 Respirators. JAMA 2020; 323:1849-1852. [PMID: 32211889 PMCID: PMC7097838 DOI: 10.1001/jama.2020.4806] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 11/14/2022]
Abstract
This study examines the feasibility of rapidly training and fit testing health care workers to use elastomeric half-mask respirators (EHMRs), widely used in construction and manufacturing, as an alternative to N95 respirators during periods of shortage.
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Affiliation(s)
- Lisa A. Pompeii
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Colleen S. Kraft
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | | | - Morgan A. Lane
- Division of Infectious Diseases, Emory University, Atlanta, Georgia
| | - Elisa Benavides
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Janelle Rios
- Department of Epidemiology, Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, Houston
| | - Lewis J. Radonovich
- National Institute for Occupational Safety and Health Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
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