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Parker SH, Jesso MN, Wolf LD, Leigh KA, Booth S, Gualandi N, Garrick RE, Kliger AS, Patel PR. Human Factors Contributing to Infection Prevention in Outpatient Hemodialysis Centers: A Mixed Methods Study. Am J Kidney Dis 2024:S0272-6386(24)00626-7. [PMID: 38447708 DOI: 10.1053/j.ajkd.2023.12.024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/18/2023] [Accepted: 12/23/2023] [Indexed: 03/08/2024]
Abstract
RATIONALE & OBJECTIVE Infection prevention efforts in dialysis centers can avert patient morbidity and mortality but are challenging to implement. The objective of this study was to better understand how the design of the work system might contribute to infection prevention in outpatient dialysis centers. STUDY DESIGN Mixed methods, observational study. SETTING & PARTICIPANTS Six dialysis facilities across the United States visited by a multidisciplinary team over 8 months. ANALYTICAL APPROACH At each facility, structured macroergonomic observations were undertaken by a multidisciplinary team using the SEIPS 1.0 model. Ethnographic observations were collected about staff encounters with dialysis patients including the content of staff conversations. Selective and axial coding were used for qualitative analysis and quantitative data were reported using descriptive statistics. RESULTS Organizational and sociotechnical barriers and facilitators to infection prevention in the outpatient dialysis setting were identified. Features related to human performance, (eg, alarms, interruptions, and task stacking), work system design (eg, physical space, scheduling, leadership, and culture), and extrinsic factors (eg, patient-related characteristics) were identified. LIMITATIONS This was an exploratory evaluation with a small sample size. CONCLUSIONS This study used a systematic macroergonomic approach in multiple outpatient dialysis facilities to identify infection prevention barriers and facilitators related to human performance. Several features common across facilities were identified that may influence infection prevention in outpatient care and warrant further exploration.
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Affiliation(s)
| | | | | | | | - Stephanie Booth
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Gualandi
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Renee E Garrick
- New York Medical and Westchester Medical Center, Valhalla, New York
| | - Alan S Kliger
- Department of Medicine, Section of Nephrology, School of Medicine, Yale University, New Haven, Connecticut
| | - Priti R Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Prestel C, Moulton-Meissner H, Gable P, Stanton RA, Glowicz J, Franco L, McConnell M, Torres T, John D, Blackwell G, Yates R, Brown C, Reyes K, McAllister GA, Kunz J, Conners EE, Benedict KM, Kirby A, Mattioli M, Xu K, Gualandi N, Booth S, Novosad S, Arduino M, Halpin AL, Wells K, Walters MS. Dialysis Water Supply Faucet as Reservoir for Carbapenemase-Producing Pseudomonas aeruginosa. Emerg Infect Dis 2022; 28:2069-2073. [PMID: 36148936 PMCID: PMC9514332 DOI: 10.3201/eid2810.220731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
During June 2017-November 2019, a total 36 patients with carbapenem-resistant Pseudomonas aeruginosa harboring Verona-integron-encoded metallo-β-lactamase were identified in a city in western Texas, USA. A faucet contaminated with the organism, identified through environmental sampling, in a specialty care room was the likely source for infection in a subset of patients.
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Karmarkar EN, O'Donnell K, Prestel C, Forsberg K, Gade L, Jain S, Schan D, Chow N, McDermott D, Rossow J, Toda M, Ruiz R, Hun S, Dale JL, Gross A, Maruca T, Glowicz J, Brooks R, Bagheri H, Nelson T, Gualandi N, Khwaja Z, Horwich-Scholefield S, Jacobs J, Cheung M, Walters M, Jacobs-Slifka K, Stone ND, Mikhail L, Chaturvedi S, Klein L, Vagnone PS, Schneider E, Berkow EL, Jackson BR, Vallabhaneni S, Zahn M, Epson E. Rapid Assessment and Containment of Candida auris Transmission in Postacute Care Settings-Orange County, California, 2019. Ann Intern Med 2021; 174:1554-1562. [PMID: 34487450 PMCID: PMC10984253 DOI: 10.7326/m21-2013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Candida auris, a multidrug-resistant yeast, can spread rapidly in ventilator-capable skilled-nursing facilities (vSNFs) and long-term acute care hospitals (LTACHs). In 2018, a laboratory serving LTACHs in southern California began identifying species of Candida that were detected in urine specimens to enhance surveillance of C auris, and C auris was identified in February 2019 in a patient in an Orange County (OC), California, LTACH. Further investigation identified C auris at 3 associated facilities. OBJECTIVE To assess the prevalence of C auris and infection prevention and control (IPC) practices in LTACHs and vSNFs in OC. DESIGN Point prevalence surveys (PPSs), postdischarge testing for C auris detection, and assessments of IPC were done from March to October 2019. SETTING All LTACHs (n = 3) and vSNFs (n = 14) serving adult patients in OC. PARTICIPANTS Current or recent patients in LTACHs and vSNFs in OC. INTERVENTION In facilities where C auris was detected, PPSs were repeated every 2 weeks. Ongoing IPC support was provided. MEASUREMENTS Antifungal susceptibility testing and whole-genome sequencing to assess isolate relatedness. RESULTS Initial PPSs at 17 facilities identified 44 additional patients with C auris in 3 (100%) LTACHs and 6 (43%) vSNFs, with the first bloodstream infection reported in May 2019. By October 2019, a total of 182 patients with C auris were identified by serial PPSs and discharge testing. Of 81 isolates that were sequenced, all were clade III and highly related. Assessments of IPC identified gaps in hand hygiene, transmission-based precautions, and environmental cleaning. The outbreak was contained to 2 facilities by October 2019. LIMITATION Acute care hospitals were not assessed, and IPC improvements over time could not be rigorously evaluated. CONCLUSION Enhanced laboratory surveillance and prompt investigation with IPC support enabled swift identification and containment of C auris. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Ellora N Karmarkar
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, and the California Department of Public Health, Richmond, California (E.N.K.)
| | - Kathleen O'Donnell
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Christopher Prestel
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Kaitlin Forsberg
- Centers for Disease Control and Prevention and IHRC, Atlanta, Georgia (K.F.)
| | - Lalitha Gade
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Seema Jain
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Douglas Schan
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Nancy Chow
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Darby McDermott
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - John Rossow
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Mitsuru Toda
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Ryan Ruiz
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Sopheay Hun
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Jennifer L Dale
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Annastasia Gross
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Tyler Maruca
- Maryland Department of Health Laboratories Administration, Baltimore, Maryland (T.M., L.K.)
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Richard Brooks
- Centers for Disease Control and Prevention, Atlanta, Georgia, and the Maryland Department of Health, Infectious Disease Epidemiology and Outbreak Response Bureau, Baltimore, Maryland (R.B.)
| | - Hosniyeh Bagheri
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Teresa Nelson
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Nicole Gualandi
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Zenith Khwaja
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Sam Horwich-Scholefield
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Josh Jacobs
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Michele Cheung
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Maroya Walters
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Kara Jacobs-Slifka
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Nimalie D Stone
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Lydia Mikhail
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | | | - Liore Klein
- Maryland Department of Health Laboratories Administration, Baltimore, Maryland (T.M., L.K.)
| | - Paula Snippes Vagnone
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Emily Schneider
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Elizabeth L Berkow
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Brendan R Jackson
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Snigdha Vallabhaneni
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Matthew Zahn
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Erin Epson
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
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Wilson WW, Bardossy AC, Gable P, Herzig C, Beshearse E, Gualandi N, Sabour S, Brown N, Brown AC, Kutty P, Tobin-D'Angelo M, Lea JP, Apata IW, Novosad S. Absence of SARS-CoV-2 infections among patients with end-stage renal disease following facility-wide testing in four outpatient hemodialysis facilities. Am J Infect Control 2021; 49:1318-1321. [PMID: 34375701 PMCID: PMC8349431 DOI: 10.1016/j.ajic.2021.07.022] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
Facility-wide testing performed at 4 outpatient hemodialysis facilities in the absence of an outbreak or escalating community incidence did not identify new SARS-CoV-2 infections and illustrated key logistical considerations essential to successful implementation of SARS-CoV-2 screening. Facilities could consider prioritizing facility-wide SARS-CoV-2 testing during suspicion of an outbreak in the facility or escalating community spread without robust infection control strategies in place. Being prepared to address operational considerations will enhance implementation of facility-wide testing in the outpatient dialysis setting.
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Affiliation(s)
- W Wyatt Wilson
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Ana C Bardossy
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Paige Gable
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Carolyn Herzig
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth Beshearse
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah Sabour
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nicole Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Allison C Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Preeta Kutty
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Janice P Lea
- Division of Renal Medicine, Department of Medicine, Emory School of Medicine, Atlanta, GA
| | - Ibironke W Apata
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; Division of Renal Medicine, Department of Medicine, Emory School of Medicine, Atlanta, GA
| | - Shannon Novosad
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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D'Agata EMC, Apata IW, Booth S, Boyce JM, Deaver K, Gualandi N, Neu A, Nguyen D, Novosad S, Palevsky PM, Rodgers D. Suggestions for the prevention of Clostridioides difficile spread within outpatient hemodialysis facilities. Kidney Int 2021; 99:1045-1053. [PMID: 33667504 PMCID: PMC10506371 DOI: 10.1016/j.kint.2021.02.028] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/23/2021] [Accepted: 02/04/2021] [Indexed: 11/26/2022]
Abstract
Clostridioides difficile infections (CDIs) cause substantial morbidity and mortality. Patients on maintenance hemodialysis are 2 to 2.5 times more likely to develop CDI, with mortality rates 2-fold higher than the general population. Hospitalizations due to CDI among the maintenance hemodialysis population are high, and the frequency of antibiotic exposures and hospitalizations may contribute to CDI risk. In this report, a panel of experts in clinical nephrology, infectious diseases, and infection prevention provide guidance, based on expert opinion and published literature, aimed at preventing the spread of CDI in outpatient hemodialysis facilities.
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Affiliation(s)
- Erika M C D'Agata
- Division of Infectious Diseases, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Ibironke W Apata
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephanie Booth
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John M Boyce
- J.M. Boyce Consulting, LLC, Middletown, Connecticut, USA
| | - Karen Deaver
- University of Virginia Dialysis Program, Charlottesville, Virginia, USA
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alicia Neu
- Division of Pediatric Nephrology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Duc Nguyen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon Novosad
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul M Palevsky
- Renal Section, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA; Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Darlene Rodgers
- American Society of Nephrology Alliance for Kidney Health, Washington, DC, USA
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Gualandi N, Mu Y, Bamberg WM, Dumyati G, Harrison LH, Lesher L, Nadle J, Petit S, Ray SM, Schaffner W, Townes J, McDonald M, See I. Racial Disparities in Invasive Methicillin-resistant Staphylococcus aureus Infections, 2005-2014. Clin Infect Dis 2019; 67:1175-1181. [PMID: 29659728 DOI: 10.1093/cid/ciy277] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/04/2018] [Indexed: 01/26/2023] Open
Abstract
Background Despite substantial attention to the individual topics, little is known about the relationship between racial disparities and antimicrobial-resistant and/or healthcare-associated infection trends, such as for methicillin-resistant Staphylococcus aureus (MRSA). Methods We analyzed Emerging Infections Program 2005-2014 surveillance data (9 US states) to determine whether reductions in invasive MRSA incidence (isolated from normally sterile body sites) affected racial disparities in rates. Case classification included hospital-onset (HO, culture >3 days after admission), healthcare-associated community onset (HACO, culture ≤3 days after admission and dialysis, hospitalization, surgery, or long-term care residence within 1 year prior), or community-associated (CA, all others). Negative binomial regression models were used to evaluate the adjusted rate ratio (aRR) of MRSA in black patients (vs in white patients) controlling for age, sex, and temporal trends. Results During 2005-2014, invasive HO and HACO (but not CA) MRSA rates decreased. Despite this, blacks had higher rates for HO (aRR, 3.20; 95% confidence interval [CI], 2.35-4.35), HACO (aRR, 3.84; 95% CI, 2.94-5.01), and CA (aRR, 2.78; 95% CI, 2.30-3.37) MRSA. Limiting the analysis to chronic dialysis patients reduced, but did not eliminate, the higher HACO MRSA rates among blacks (aRR, 1.83; 95% CI, 1.72-1.96), even though invasive MRSA rates among dialysis patients decreased during 2005-2014. These racial differences did not change over time. Conclusions Previous reductions in healthcare-associated MRSA infections have not affected racial disparities in MRSA rates. Improved understanding of the underlying causes of these differences is needed to develop effective prevention interventions that reduce racial disparities in MRSA infections.
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Affiliation(s)
- Nicole Gualandi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yi Mu
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wendy M Bamberg
- Colorado Department of Public Health and Environment, Denver
| | - Ghinwa Dumyati
- New York-Rochester Emerging Infections Program and University of Rochester Medical Center
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Sue Petit
- Connecticut Department of Public Health, Hartford
| | - Susan M Ray
- Georgia Emerging Infections Program and Emory University School of Medicine, Decatur
| | | | - John Townes
- Oregon Health & Science University, Portland
| | - Mariana McDonald
- Office of Health Disparities, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Isaac See
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Novosad SA, Lake J, Nguyen D, Soda E, Moulton-Meissner H, Pho MT, Gualandi N, Bepo L, Stanton RA, Daniels JB, Turabelidze G, Van Allen K, Arduino M, Halpin AL, Layden J, Patel PR. Multicenter Outbreak of Gram-Negative Bloodstream Infections in Hemodialysis Patients. Am J Kidney Dis 2019; 74:610-619. [PMID: 31375298 PMCID: PMC10826890 DOI: 10.1053/j.ajkd.2019.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/05/2019] [Indexed: 01/25/2023]
Abstract
RATIONALE & OBJECTIVE Contaminated water and other fluids are increasingly recognized to be associated with health care-associated infections. We investigated an outbreak of Gram-negative bloodstream infections at 3 outpatient hemodialysis facilities. STUDY DESIGN Matched case-control investigations. SETTING & PARTICIPANTS Patients who received hemodialysis at Facility A, B, or C from July 2015 to November 2016. EXPOSURES Infection control practices, sources of water, dialyzer reuse, injection medication handling, dialysis circuit priming, water and dialysate test findings, environmental reservoirs such as wall boxes, vascular access care practices, pulsed-field gel electrophoresis, and whole-genome sequencing of bacterial isolates. OUTCOMES Cases were defined by a positive blood culture for any Gram-negative bacteria drawn July 1, 2015 to November 30, 2016 from a patient who had received hemodialysis at Facility A, B, or C. ANALYTICAL APPROACH Exposures in cases and controls were compared using matched univariate conditional logistic regression. RESULTS 58 cases of Gram-negative bloodstream infection occurred; 48 (83%) required hospitalization. The predominant organisms were Serratia marcescens (n=21) and Pseudomonas aeruginosa (n=12). Compared with controls, cases had higher odds of using a central venous catheter for dialysis (matched odds ratio, 54.32; lower bound of the 95% CI, 12.19). Facility staff reported pooling and regurgitation of waste fluid at recessed wall boxes that house connections for dialysate components and the effluent drain within dialysis treatment stations. Environmental samples yielded S marcescens and P aeruginosa from wall boxes. S marcescens isolated from wall boxes and case-patients from the same facilities were closely related by pulsed-field gel electrophoresis and whole-genome sequencing. We identified opportunities for health care workers' hands to contaminate central venous catheters with contaminated fluid from the wall boxes. LIMITATIONS Limited patient isolates for testing, on-site investigation occurred after peak of infections. CONCLUSIONS This large outbreak was linked to wall boxes, a previously undescribed source of contaminated fluid and biofilms in the immediate patient care environment.
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Affiliation(s)
- Shannon A Novosad
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Jason Lake
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Duc Nguyen
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth Soda
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Atlanta, GA
| | - Heather Moulton-Meissner
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mai T Pho
- Illinois Department of Public Health, Chicago, IL
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lurit Bepo
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Richard A Stanton
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jonathan B Daniels
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Matthew Arduino
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Priti R Patel
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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8
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Karmarkar E, Karmarkar E, O’Donnell K, Prestel C, Forsberg K, Forsberg K, Schan DK, Chow NA, McDermott DS, Rossow JA, Toda M, Toda M, Glowicz J, Brooks R, Brooks R, Bagheri H, Nelson T, Gualandi N, Khwaja Z, Horwich-Scholefield S, Jacobs J, Cheung M, Mikhail L, Walters MS, Walters MS, Jacobs-Slifka K, Stone ND, Stone ND, Gade L, Berkow EL, Berkow EL, Jackson BR, Jackson BR, Vallabhaneni S, Vallabhaneni S, Zahn M, Epson E, Epson E. LB1. Regional Assessment and Containment of Candida auris Transmission in Post-Acute Care Settings—Orange County, California, 2019. Open Forum Infect Dis 2019. [PMCID: PMC6810421 DOI: 10.1093/ofid/ofz415.2484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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
Abstract
Background
Patients in long-term acute care hospitals (LTACHs) and skilled nursing facilities with ventilator units (VSNFs) are at high risk for Candida auris colonization; among patients colonized with this emerging pathogen, 5%–10% develop invasive disease with >45% mortality. In September 2018, a California LTACH-affiliated laboratory began enhanced C. auris surveillance by classifying species of Candida isolated from routine urine specimens. In February 2019, the first known Southern California case was detected in an Orange County (OC) LTACH; the patient had not traveled outside the region, indicating local acquisition. We performed point prevalence surveys (PPS) and infection prevention (IP) assessments at all OC LTACHs and VSNF subacute units to identify patients colonized with C. auris and control transmission.
Methods
During March–August 2019, we conducted PPS at facilities by collecting composite axilla and groin swabs for C. auris polymerase chain reaction testing and reflex culture from all patients who assented. Facilities with ≥1 C. auris-colonized patient repeated a PPS every 2 weeks to assess for new transmission. Isolate relatedness was assessed by whole-genome sequencing (WGS). We evaluated hand hygiene (HH) adherence, access to alcohol-based hand rubs (ABHR), and cleaning of high-touch surfaces to guide IP recommendations.
Results
The first PPS at all OC LTACHs (n = 3) and adult VSNFs (n = 14) identified 45 C. auris-colonized patients in 3 (100%) LTACHs and 6 (43%) VSNFs; after repeated PPS, the total count reached 124. Most patients (70%) were at 2 facilities (Table 1). Three of 124 patients developed candidemia. To date, isolates from 48 patients have completed WGS; all were highly related (<11 single-nucleotide polymorphisms) in the African clade. Of 9 facilities with C. auris, 5 had HH adherence < 50%, 3 had limited ABHR, and at 2, <60% of assessed high-touch surfaces were clean. We recommended regular HH and cleaning audits, and increased ABHR.
Conclusion
Our investigation, prompted by enhanced surveillance, identified C. auris at 9 OC facilities. WGS indicated a single introduction and local transmission. Early detection, followed by rapid county-wide investigation and IP support, enabled containment efforts for C. auris in OC.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Ellora Karmarkar
- Centers for Disease Control and Prevention, Richmond, California
| | - Ellora Karmarkar
- Centers for Disease Control and Prevention, Richmond, California
| | | | | | - Kaitlin Forsberg
- Centers for Disease Control and Prevention; IHRC, Inc., Atlanta, Georgia
| | - Kaitlin Forsberg
- Centers for Disease Control and Prevention; IHRC, Inc., Atlanta, Georgia
| | | | | | | | - John A Rossow
- Centers for Disease Control and Prevention, Richmond, California
| | - Mitsuru Toda
- Centers for Disease Control and Prevention, Richmond, California
| | - Mitsuru Toda
- Centers for Disease Control and Prevention, Richmond, California
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Richmond, California
| | - Richard Brooks
- Centers for Disease Control and Prevention, Richmond, California
| | - Richard Brooks
- Centers for Disease Control and Prevention, Richmond, California
| | - Hosniyeh Bagheri
- California Department of Public Health (CDPH), Rancho Santa Margarita, California
| | - Teresa Nelson
- California Department of Public Health, Redlands, California
| | | | | | | | - Joshua Jacobs
- Orange County Health Care Agency, Los Angeles, California
| | - Michele Cheung
- Orange County Health Care Agency, Los Angeles, California
| | - Lydia Mikhail
- Orange County Health Care Agency, Los Angeles, California
| | - Maroya S Walters
- Centers for Disease Control and Prevention, Richmond, California
| | - Maroya S Walters
- Centers for Disease Control and Prevention, Richmond, California
| | | | - Nimalie D Stone
- CDC Division of Healthcare Quality and Promotion, Atlanta, Georgia
| | - Nimalie D Stone
- CDC Division of Healthcare Quality and Promotion, Atlanta, Georgia
| | | | | | | | | | | | | | | | - Matt Zahn
- Orange County Health Care Agency, Los Angeles, California
| | - Erin Epson
- California Department of Public Health, Redlands, California
| | - Erin Epson
- California Department of Public Health, Redlands, California
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9
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Grigg C, Palms D, Stone ND, Gualandi N, Bamberg W, Dumyati G, Harrison LH, Lynfield R, Nadle J, Petit S, Ray S, Schaffner W, Townes J, See I. Burden of Invasive Methicillin-Resistant Staphylococcus aureus Infections in Nursing Home Residents. J Am Geriatr Soc 2018; 66:1581-1586. [PMID: 30094828 PMCID: PMC11009933 DOI: 10.1111/jgs.15451] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the epidemiology and incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in nursing home (NH) residents, which has previously not been well characterized. DESIGN Retrospective analysis of public health surveillance data. SETTING Healthcare facilities in 33 U.S. counties. PARTICIPANTS Residents of the surveillance area. MEASUREMENTS Counts of NH-onset and hospital-onset (HO) invasive MRSA infections (cultured from sterile body sites) identified from the Centers for Disease Control and Prevention Emerging Infections Program (EIP) population-based surveillance from 2009 to 2013 were compared. Demographic characteristics and risk factors of NH-onset cases were analyzed. Using NH resident-day denominators from the Centers for Medicare and Medicaid Services Skilled Nursing Facility Cost Reports, incidence of NH-onset invasive MRSA infections from facilities in the EIP area was determined. RESULTS A total of 4,607 NH-onset and 4,344 HO invasive MRSA cases were reported. Of NH-onset cases, median age was 74, most infections were bloodstream infections, and known risk factors for infection were common: 1,455 (32%) had previous MRSA infection or colonization, 1,014 (22%) had decubitus ulcers, 1,098 (24%) had recent central venous catheters, and 1,103 (24%) were undergoing chronic dialysis; 2,499 (54%) had been discharged from a hospital in the previous 100 days. The in-hospital case-fatality rate was 19%. The 2013 pooled mean incidence of NH-onset invasive MRSA infections in the surveillance area was 2.4 per 100,000 patient-days. CONCLUSION More NH-onset than HO cases occurred, primarily in individuals with known MRSA risk factors. These data reinforce the importance of infection prevention practices during wound and device care in NH residents, especially those with a history of MRSA infection or colonization.
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Affiliation(s)
- Cheri Grigg
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Danielle Palms
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nimalie D. Stone
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wendy Bamberg
- Disease Control and Environmental Epidemiology Division, Colorado Department of Public Health and Environment, Denver, Colorado
| | - Ghinwa Dumyati
- Infectious Diseases Division and Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York
| | - Lee H. Harrison
- Department of International Health, Maryland Emerging Infections Program, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Ruth Lynfield
- Executive Office, Minnesota Department of Health, St. Paul, Minnesota
| | - Joelle Nadle
- Hospital Associated Infections Projects, California Emerging Infections Program, Oakland, California
| | - Susan Petit
- Epidemiology and Emerging Infections Program, Connecticut Department of Public Health, Hartford, Connecticut
| | - Susan Ray
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
| | - William Schaffner
- Department of Health Policy, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - John Townes
- Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon
| | - Isaac See
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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10
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See I, Wesson P, Gualandi N, Dumyati G, Harrison LH, Lesher L, Nadle J, Petit S, Reisenauer C, Schaffner W, Tunali A, Mu Y, Ahern J. Socioeconomic Factors Explain Racial Disparities in Invasive Community-Associated Methicillin-Resistant Staphylococcus aureus Disease Rates. Clin Infect Dis 2017; 64:597-604. [PMID: 28362911 PMCID: PMC5656382 DOI: 10.1093/cid/ciw808] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/27/2016] [Indexed: 01/30/2023] Open
Abstract
Background Invasive community-associated methicillin-resistant Staphylococcus aureus (MRSA) incidence in the United States is higher among black persons than white persons. We explored the extent to which socioeconomic factors might explain this racial disparity. Methods A retrospective cohort was based on the Centers for Disease Control and Prevention's Emerging Infections Program surveillance data for invasive community-associated MRSA cases (isolated from a normally sterile site of an outpatient or on hospital admission day ≤3 in a patient without specified major healthcare exposures) from 2009 to 2011 in 33 counties of 9 states. We used generalized estimating equations to determine census tract-level factors associated with differences in MRSA incidence and inverse odds ratio-weighted mediation analysis to determine the proportion of racial disparity mediated by socioeconomic factors. Results Annual invasive community-associated MRSA incidence was 4.59 per 100000 among whites and 7.60 per 100000 among blacks (rate ratio [RR], 1.66; 95% confidence interval [CI], 1.52-1.80). In the mediation analysis, after accounting for census tract-level measures of federally designated medically underserved areas, education, income, housing value, and rural status, 91% of the original racial disparity was explained; no significant association of black race with community-associated MRSA remained (RR, 1.05; 95% CI, .92-1.20). Conclusions The racial disparity in invasive community-associated MRSA rates was largely explained by socioeconomic factors. The specific factors that underlie the association between census tract-level socioeconomic measures and MRSA incidence, which may include modifiable social (eg, poverty, crowding) and biological factors (not explored in this analysis), should be elucidated to define strategies for reducing racial disparities in community-associated MRSA rates.
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Affiliation(s)
- Isaac See
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul Wesson
- Division of Epidemiology, School of Public Health, University of California, Berkeley, USA
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ghinwa Dumyati
- University of Rochester Medical Center, Rochester, New York, USA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Joelle Nadle
- California Emerging Infections Program, Oakland, USA
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, USA
| | | | | | - Amy Tunali
- Georgia Emerging Infections Program, Atlanta, USA
| | - Yi Mu
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley, USA
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11
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See I, Chang J, Gualandi N, Buser GL, Rohrbach P, Smeltz DA, Bellush MJ, Coffin SE, Gould JM, Hess D, Hennessey P, Hubbard S, Kiernan A, O’Donnell J, Pegues DA, Miller JR, Magill SS. Clinical Correlates of Surveillance Events Detected by National Healthcare Safety Network Pneumonia and Lower Respiratory Infection Definitions-Pennsylvania, 2011-2012. Infect Control Hosp Epidemiol 2016; 37:818-24. [PMID: 27072043 PMCID: PMC5662932 DOI: 10.1017/ice.2016.74] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 11/07/2022]
Abstract
OBJECTIVE To determine the clinical diagnoses associated with the National Healthcare Safety Network (NHSN) pneumonia (PNEU) or lower respiratory infection (LRI) surveillance events DESIGN Retrospective chart review SETTING A convenience sample of 8 acute-care hospitals in Pennsylvania PATIENTS All patients hospitalized during 2011-2012 METHODS Medical records were reviewed from a random sample of patients reported to the NHSN to have PNEU or LRI, excluding adults with ventilator-associated PNEU. Documented clinical diagnoses corresponding temporally to the PNEU and LRI events were recorded. RESULTS We reviewed 250 (30%) of 838 eligible PNEU and LRI events reported to the NHSN; 29 reported events (12%) fulfilled neither PNEU nor LRI case criteria. Differences interpreting radiology reports accounted for most misclassifications. Of 81 PNEU events in adults not on mechanical ventilation, 84% had clinician-diagnosed pneumonia; of these, 25% were attributed to aspiration. Of 43 adult LRI, 88% were in mechanically ventilated patients and 35% had no corresponding clinical diagnosis (infectious or noninfectious) documented at the time of LRI. Of 36 pediatric PNEU events, 72% were ventilator associated, and 70% corresponded to a clinical pneumonia diagnosis. Of 61 pediatric LRI patients, 84% were mechanically ventilated and 21% had no corresponding clinical diagnosis documented. CONCLUSIONS In adults not on mechanical ventilation and in children, most NHSN-defined PNEU events corresponded with compatible clinical conditions documented in the medical record. In contrast, NHSN LRI events often did not. As a result, substantial modifications to the LRI definitions were implemented in 2015. Infect Control Hosp Epidemiol 2016;37:818-824.
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Affiliation(s)
- Isaac See
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA
| | - Julia Chang
- UCLA Geffen School of Medicine, Los Angeles, CA
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Genevieve L. Buser
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA
- Oregon Health Authority, Portland, OR
| | | | | | | | | | - Jane M. Gould
- St. Christopher’s Hospital for Children, Philadelphia, PA
| | - Debra Hess
- Lancaster General Hospital, Lancaster, PA
| | | | - Sydney Hubbard
- The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Andrea Kiernan
- St. Christopher’s Hospital for Children, Philadelphia, PA
| | | | | | - Jeffrey R. Miller
- Career Epidemiology Field Officer, Office of Public Health Preparedness and Response, CDC, assigned to the Pennsylvania Department of Health, Harrisburg, PA
| | - Shelley S. Magill
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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12
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See I, Mu Y, Gualandi N, Dumyati G, Harrison LH, Lynfield R, Nadle J, Petit S, Reisenauer C, Schaffner W, Tunali A, Wesson P, Ahern J. Socioeconomic Factors Explain Racial Disparities in Community-Associated Methicillin-Resistant Staphyloccocus aureus Disease Rates. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.842] [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: 11/12/2022] Open
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13
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Grigg C, Stone N, Gualandi N, Bamberg W, Dumyati G, Harrison L, Lynfield R, Nadle J, Petit S, Ray SM, Schaffner W, Townes JM, See I. Invasive Methicillin-Resistant Staphylococcus aureus Infections in Residents of Long-Term Care Facilities: Targeted Prevention Efforts Needed. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.167] [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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14
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See I, Gualandi N, Dumyati G, Koeck M, Lynfield R, Pasutti L, Schaffner W, Wright D, Magill SS. Public Health Importance of Methicillin-Sensitive Staphylococcus aureus (MSSA): Results From Pilot Surveillance in Five Counties, 2014–2015. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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15
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Nguyen D, See I, Gualandi N, Shugart A, Goding-Sauer A, Cosby C, Aragon D, Dumyati G, Harrison L, Lesher L, Nadle J, Petit S, Ray SM, Schaffner W, Townes J, Patel P, Thompson N. 887Opportunities to Improve Completeness of MRSA Bloodstream Infection Reporting From Outpatient Hemodialysis Facilities to the National Healthcare Safety Network. Open Forum Infect Dis 2014. [PMCID: PMC5781723 DOI: 10.1093/ofid/ofu052.595] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Duc Nguyen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Isaac See
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alicia Shugart
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ann Goding-Sauer
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christi Cosby
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Deborah Aragon
- Colorado Department of Public Health and Environment, Denver, CO
| | | | - Lee Harrison
- Emerging Infections Program, Pittsburgh, PA
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Joelle Nadle
- California Emerging Infections Program, Oakland, CA
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, CT
| | - Susan M. Ray
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - William Schaffner
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - J. Townes
- Oregon Health and Science University, Portland, OR
| | - Priti Patel
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nicola Thompson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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16
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Fagan R, Gualandi N, Beldavs ZG, Dumyati G, Kainer M, Lynfield R, Maloney M, Min JY, Nadle J, Ray SM, Richards K, Fridkin S, Magill SS. 137Developing an Approach to Evaluating the Quality of Antibiotic Prescribing in Hospitalized Patients with Community-Acquired Pneumonia (CAP) and Non-catheter Associated Urinary Tract Infection (UTI). Open Forum Infect Dis 2014. [PMCID: PMC5782073 DOI: 10.1093/ofid/ofu052.03] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ryan Fagan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Zintars G. Beldavs
- Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, OR
| | | | | | | | | | | | - Joelle Nadle
- California Emerging Infections Program, Oakland, CA
| | - Susan M. Ray
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | | | - Scott Fridkin
- Division of Healthcare Quality Promotion (DHQP), Centers for Disease Control and Prevention, Atlanta, GA
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17
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See I, Chang J, Gualandi N, Buser GL, Rohrbach P, Smeltz D, Bellush MJ, Coffin S, Gould JM, Hennessey P, Hess D, Hubbard S, Kiernan A, O'donnell J, Pegues D, Miller JR, Magill SS. 894Evaluating Clinical Credibility of Surveillance Definitions for Healthcare-Associated Pneumonia and Lower Respiratory Infections. Open Forum Infect Dis 2014. [PMCID: PMC5781482 DOI: 10.1093/ofid/ofu052.602] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Isaac See
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Julia Chang
- UCLA Geffen School of Medicine, Los Angeles, CA
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Genevieve L. Buser
- Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, OR
| | | | - Debra Smeltz
- Pennsylvania Department of Health, Harrisburg, PA
| | | | - Susan Coffin
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jane M. Gould
- St. Christopher's Hospital for Children, Philadelphia, PA
| | | | - Debra Hess
- Lancaster General Hospital, Lancaster, PA
| | - Sydney Hubbard
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Andrea Kiernan
- St. Christopher's Hospital for Children, Philadelphia, PA
| | | | - David Pegues
- University of Pennsylvania Health System, Philadelphia, PA
| | - Jeffrey R. Miller
- Career Epidemiology Field Officer, Office of Public Health Preparedness and Response, CDC, assigned to the Pennsylvania Department of Health, Harrisburgh, PA
| | - Shelley S. Magill
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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