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McGrath CL, Logan LK, Deloney VM, Rubin LG, Ravin KA, Muller M, Bartlett AH, de St. Maurice A, Linam WM, Caughell C, Ramirez-Avila L. Monitoring health disparities in healthcare-associated infection surveillance: A Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) Survey. Infect Control Hosp Epidemiol 2024; 45:526-529. [PMID: 37700531 PMCID: PMC11007321 DOI: 10.1017/ice.2023.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 09/14/2023]
Abstract
We investigated whether and how infection prevention programs monitor for health disparities as part of healthcare-associated infection (HAI) surveillance through a survey of healthcare epidemiology leaders. Most facilities are not assessing for disparities in HAI rates. Professional society and national guidance should focus on addressing this gap.
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Affiliation(s)
| | - Latania K. Logan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | - Lorry G. Rubin
- Department of Pediatrics, Cohen Children’s Medical Center, Northwell Health, New Hyde Park, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Karen A. Ravin
- Division of Infectious Diseases, Nemours Children’s Hospital Delaware, Wilmington, Delaware
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Martha Muller
- Department of Pediatrics, Division of Infectious Diseases, University of New Mexico, Albuquerque, New Mexico
| | - Allison H. Bartlett
- Section of Pediatric Infectious Diseases, Department of Pediatrics, The University of Chicago Medicine Comer Children’s Hospital, Chicago, Illinois
| | | | - W. Matthew Linam
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Carolyn Caughell
- Hospital Epidemiology and Infection Prevention, Department of Quality, University of California San Francisco Health, San Francisco, California
| | - Lynn Ramirez-Avila
- Division of Pediatric Infectious Diseases and Global Health, University of California–San Francisco, San Francisco, California
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Linam WM, Trivedi KK, Schaffzin JK. Don't just do it-Conducting and publishing improvement science in infection prevention and antibiotic stewardship. Antimicrob Steward Healthc Epidemiol 2022; 2:e33. [PMID: 36310783 PMCID: PMC9614962 DOI: 10.1017/ash.2021.259] [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] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 06/16/2023]
Affiliation(s)
- W. Matthew Linam
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Kavita K. Trivedi
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California
| | - Joshua K. Schaffzin
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Raghunandan S, Josephson CD, Verkerke H, Linam WM, Ingram TC, Zerra PE, Arthur CM, Stowell SR, Briones M, Chonat S. Complement Inhibition in Severe COVID-19 Acute Respiratory Distress Syndrome. Front Pediatr 2020; 8:616731. [PMID: 33447586 PMCID: PMC7802050 DOI: 10.3389/fped.2020.616731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/30/2020] [Indexed: 12/24/2022] Open
Abstract
Most children with COVID-19 have asymptomatic or mild illness. Those who become critically ill suffer from acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI). The rapid deterioration of lung function has been linked to microangiopathic and immune-mediated processes seen in the lungs of adult patients with COVID-19. The role of complement-mediated acute lung injury is supported by animal models of SARS-CoV, evaluation of lung tissue in those who died from COVID-19 and response of COVID-19 ARDS to complement inhibition. We present a summary of a child with COVID-19 disease treated with convalescent plasma and eculizumab and provide a detailed evaluation of the inflammatory pathways.
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Affiliation(s)
- Sharmila Raghunandan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Aflac Cancer and Blood Disorders Center, Atlanta, GA, United States
| | - Cassandra D. Josephson
- Aflac Cancer and Blood Disorders Center, Atlanta, GA, United States
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Hans Verkerke
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - W. Matthew Linam
- Division of Pediatric Infectious Diseases, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Treva C. Ingram
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Division of Pediatric Intensive Care Unit, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Patricia E. Zerra
- Aflac Cancer and Blood Disorders Center, Atlanta, GA, United States
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Connie M. Arthur
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Sean R. Stowell
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Joint Program in Transfusion Medicine, Department of Pathology, Harvard Medical School, Boston, MA, United States
| | - Michael Briones
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Aflac Cancer and Blood Disorders Center, Atlanta, GA, United States
| | - Satheesh Chonat
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Aflac Cancer and Blood Disorders Center, Atlanta, GA, United States
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Rostad CA, Chahroudi A, Mantus G, Lapp SA, Teherani M, Macoy L, Tarquinio KM, Basu RK, Kao C, Linam WM, Zimmerman MG, Shi PY, Menachery VD, Oster ME, Edupuganti S, Anderson EJ, Suthar MS, Wrammert J, Jaggi P. Quantitative SARS-CoV-2 Serology in Children With Multisystem Inflammatory Syndrome (MIS-C). Pediatrics 2020; 146:peds.2020-018242. [PMID: 32879033 DOI: 10.1542/peds.2020-018242] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [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] [Accepted: 08/27/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES We aimed to measure severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological responses in children hospitalized with multisystem inflammatory syndrome in children (MIS-C) compared with those with coronavirus disease 2019 (COVID-19), those with Kawasaki disease (KD), and hospitalized pediatric controls. METHODS From March 17, 2020, to May 26, 2020, we prospectively identified hospitalized children with MIS-C (n = 10), symptomatic COVID-19 (n = 10), and KD (n = 5) and hospitalized controls (n = 4) at Children's Healthcare of Atlanta. With institutional review board approval, we obtained prospective and residual blood samples from these children and measured SARS-CoV-2 spike receptor-binding domain (RBD) immunoglobulin M and immunoglobulin G (IgG), full-length spike IgG, and nucleocapsid protein antibodies using quantitative enzyme-linked immunosorbent assays and SARS-CoV-2 neutralizing antibodies using live-virus focus-reduction neutralization assays. We statistically compared the log-transformed antibody titers among groups and performed linear regression analyses. RESULTS All children with MIS-C had high titers of SARS-CoV-2 RBD IgG antibodies, which correlated with full-length spike IgG antibodies (R 2 = 0.956; P < .001), nucleocapsid protein antibodies (R 2 = 0.846; P < .001), and neutralizing antibodies (R 2 = 0.667; P < .001). Children with MIS-C had significantly higher SARS-CoV-2 RBD IgG antibody titers (geometric mean titer 6800; 95% confidence interval 3495-13 231) than children with COVID-19 (geometric mean titer 626; 95% confidence interval 251-1563; P < .001), children with KD (geometric mean titer 124; 95% confidence interval 91-170; P < .001), and hospitalized controls (geometric mean titer 85; P < .001). All children with MIS-C also had detectable RBD immunoglobulin M antibodies, indicating recent SARS-CoV-2 infection. RBD IgG titers correlated with the erythrocyte sedimentation rate (R 2 = 0.512; P < .046) and with hospital (R 2 = 0.548; P = .014) and ICU lengths of stay (R 2 = 0.590; P = .010). CONCLUSIONS Quantitative SARS-CoV-2 serology may have a role in establishing the diagnosis of MIS-C, distinguishing it from similar clinical entities, and stratifying risk for adverse outcomes.
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Affiliation(s)
- Christina A Rostad
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
| | - Ann Chahroudi
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.,Emory Vaccine Center and.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
| | - Grace Mantus
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
| | - Stacey A Lapp
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
| | - Mehgan Teherani
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
| | - Lisa Macoy
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
| | - Keiko M Tarquinio
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Rajit K Basu
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Carol Kao
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
| | - W Matthew Linam
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
| | - Matthew G Zimmerman
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.,Yerkes National Primate Research Center, Emory University, Atlanta, Georgia.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
| | - Pei-Yong Shi
- Departments of Biochemistry and Molecular Biology and
| | - Vineet D Menachery
- Microbiology and Immunology, The University of Texas Medical Branch, Galveston, Texas
| | - Matthew E Oster
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - Evan J Anderson
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Medicine, School of Medicine and.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
| | - Mehul S Suthar
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.,Emory Vaccine Center and.,Yerkes National Primate Research Center, Emory University, Atlanta, Georgia.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
| | - Jens Wrammert
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.,Emory Vaccine Center and.,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
| | - Preeti Jaggi
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia; .,Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia; and
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Vera CN, Linam WM, Gadde JA, Wolf DS, Walson K, Montoya JG, Rostad CA. Congenital Toxoplasmosis Presenting as Eosinophilic Encephalomyelitis With Spinal Cord Hemorrhage. Pediatrics 2020; 145:peds.2019-1425. [PMID: 31941759 DOI: 10.1542/peds.2019-1425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Accepted: 09/30/2019] [Indexed: 11/24/2022] Open
Abstract
A 4-week-old male neonate with a history of intermittent hypothermia in the newborn nursery presented with an acute onset of bilateral lower extremity paralysis and areflexia. Extensive workup demonstrated eosinophilic encephalomyelitis and multifocal hemorrhages of the brain and spinal cord. Funduscopic examination revealed bilateral chorioretinitis with macular scarring. The laboratory values were notable for peripheral eosinophilia and cerebrospinal fluid eosinophilic pleocytosis (28 white blood cells/µL, 28% eosinophils), markedly elevated protein (1214 mg/dL), and hypoglycorrhachia (20 mg/dL). Toxoplasma gondii immunoglobulin M (IgM) test result was positive. Reference testing obtained at the Palo Alto Medical Foundation Toxoplasma Serology Laboratory confirmed the diagnosis of congenital toxoplasmosis in the infant with a positive immunoglobulin G (IgG) dye test result, immunoglobulin A enzyme-linked immunosorbent assay, and IgM immunosorbent agglutination assay. The diagnosis of an infection acquired during gestation in the mother was established by a positive maternal IgG dye test result, IgM enzyme-linked immunosorbent assay, immunoglobulin A, immunoglobulin E, and low IgG avidity. At 6-month follow-up, the infant had marginal improvement in his retinal lesions and residual paraplegia with hyperreflexia and clonus of the lower extremities. A repeat MRI demonstrated interval development of encephalomalacia with suspected cortical laminar necrosis and spinal cord atrophy in the areas of previous hemorrhage. Clinicians should be aware of this severe spectrum of congenital toxoplasmosis disease and should remain vigilant for subtler signs that may prompt earlier testing, diagnosis, and treatment.
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Affiliation(s)
- Casey N Vera
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - W Matthew Linam
- Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Judith A Gadde
- Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - David S Wolf
- Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Karen Walson
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jose G Montoya
- Toxoplasma Serology Laboratory, Palo Alto Medical Foundation, Palo Alto, California; and.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Christina A Rostad
- Children's Healthcare of Atlanta, Atlanta, Georgia; .,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
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Affiliation(s)
- W Matthew Linam
- Pediatric Infectious Diseases Section, Arkansas Children's Hospital, Little Rock, AR, United States.
| | - Jennifer R Cope
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Affiliation(s)
- W Matthew Linam
- Department of Pediatrics, University of Arkansas for Medical Sciences, Pediatric Infectious Diseases Section, Little Rock, Arkansas
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Garlick J, Lee TJ, Shepherd P, Linam WM, Pastula DM, Weinstein S, Schexnayder SM. Locally Acquired Eastern Equine Encephalitis Virus Disease, Arkansas, USA. Emerg Infect Dis 2016; 22:2216-2217. [PMID: 27662563 PMCID: PMC5189158 DOI: 10.3201/eid2212.160844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Linam WM, Honeycutt MD, Gilliam CH, Wisdom CM, Bai S, Deshpande JK. Successful development of a direct observation program to measure health care worker hand hygiene using multiple trained volunteers. Am J Infect Control 2016; 44:544-7. [PMID: 26874409 DOI: 10.1016/j.ajic.2015.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/08/2015] [Accepted: 12/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Direct observation of health care worker (HCW) hand hygiene (HH) remains the gold standard, but implementation is challenging. Our objective was to develop an accurate HH observation program using multiple HCW volunteers. METHODS HH compliance was defined as correct HH performed before and after contact with a patient or a patient's environment. HCW volunteers from each unit at our children's hospital were trained by infection preventionists to covertly collect HH observations during routine care using an electronic tool. Questionnaires sent to observers in February and December 2014 recorded demographic characteristics, observation time, and scenarios assessing accuracy. HCWs were surveyed regarding their awareness that their HH behavior was being recorded. RESULTS There were 146 HH observers. The majority of observers reported making 1-2 observations per shift (65%) and taking ≤10 minutes recording an observation (85%). Between January 2012 and December 2014 there were 22,484 HH observations (average, 622 per month), including nurses (46%), physicians (21%), and other HCWs (33%). Observers correctly recorded HH behavior more than 90% of the time in 5 of the 6 scenarios. Most HCWs (86%) were unaware they were being observed. CONCLUSION A direct observation program staffed by multiple HCW volunteers can inexpensively and accurately collect HCW HH data.
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Affiliation(s)
- W Matthew Linam
- Pediatric Infectious Diseases Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Michele D Honeycutt
- Infection Prevention and Control Department, Arkansas Children's Hospital, Little Rock, AR
| | - Craig H Gilliam
- Infection Prevention and Control Department, St. Jude Children's Research Hospital, Memphis, TN
| | - Christy M Wisdom
- Infection Prevention and Control Department, Arkansas Children's Hospital, Little Rock, AR
| | - Shasha Bai
- Biostatistics Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jayant K Deshpande
- Departments of Pediatrics and Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR
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Sherin K, Linam WM, Jett S. Primary Amebic Meningoencephalitis as Cause of Headache and Fever. Am Fam Physician 2016; 93:644. [PMID: 27175836] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Linam WM, Ahmed M, Cope JR, Chu C, Visvesvara GS, da Silva AJ, Qvarnstrom Y, Green J. Successful treatment of an adolescent with Naegleria fowleri primary amebic meningoencephalitis. Pediatrics 2015; 135:e744-8. [PMID: 25667249 PMCID: PMC4634363 DOI: 10.1542/peds.2014-2292] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [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] [Indexed: 11/24/2022] Open
Abstract
Naegleria fowleri is a thermophilic, free-living ameba that causes primary amebic meningoencephalitis. The infections are nearly always fatal. We present the third well-documented survivor of this infection in North America. The patient's survival most likely resulted from a variety of factors: early identification and treatment, use of a combination of antimicrobial agents (including miltefosine), and management of elevated intracranial pressure based on the principles of traumatic brain injury.
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Affiliation(s)
- W. Matthew Linam
- Pediatric Infectious Diseases Section, Arkansas Children’s Hospital, Little Rock, AR, United States
| | - Mubbasheer Ahmed
- Pediatric Critical Care Section, Arkansas Children’s Hospital, Little Rock, AR, United States
| | - Jennifer R. Cope
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Craig Chu
- Pediatric Critical Care Section, Arkansas Children’s Hospital, Little Rock, AR, United States
| | | | | | - Yvonne Qvarnstrom
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jerril Green
- Pediatric Critical Care Section, Arkansas Children’s Hospital, Little Rock, AR, United States
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Linam WM, Gilliam CH, Honeycutt M, Wisdom C, Swearingen CJ, Romero JR. Parental Perceptions about Required Influenza Immunization of Pediatric Healthcare Personnel. Infect Control Hosp Epidemiol 2015. [DOI: 10.1086/597418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Linam WM, Margolis PA, Staat MA, Britto MT, Hornung R, Cassedy A, Connelly BL. Risk Factors Associated With Surgical Site Infection After Pediatric Posterior Spinal Fusion Procedure. Infect Control Hosp Epidemiol 2015; 30:109-16. [DOI: 10.1086/593952] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective.To identify risk factors associated with surgical site infection (SSI) after pediatric posterior spinal fusion procedure by examining characteristics related to the patient, the surgical procedure, and tissue hypoxia.Design.Retrospective case-control study nested in a hospital cohort study.Setting.A 475-bed, tertiary care children's hospital.Methods.All patients who underwent a spinal fusion procedure during the period from January 1995 through December 2006 were included. SSI cases were identified by means of prospective surveillance using National Nosocomial Infection Surveillance system definitions. Forty-four case patients who underwent a posterior spinal fusion procedure and developed an SSI were identified and evaluated. Each case patient was matched (on the basis of date of surgery, ± 3 months) to 3 control patients who underwent a posterior spinal fusion procedure but did not develop an SSI. Risk factors for SSI were evaluated by univariate analysis and multivariable conditional logistic regression. Odds ratios (ORs), with 95% confidence intervals (CIs) andPvalues, were calculated.Results.From 1995 to 2006, the mean annual rate of SSI after posterior spinal fusion procedure was 4.4% (range, 1.1%—6.7%). Significant risk factors associated with SSI in the univariate analysis included the following: a body mass index (BMI) greater than the 95th percentile (OR, 3.5 [95% CI, 1.5–8.3]); antibiotic prophylaxis with clindamycin, compared with other antibiotics (OR, 3.5 [95% CI, 1.2 10.0]); inappropriately low dose of antibiotic (OR, 2.6 [95% CI, 1.0–6.6]); and a longer duration of hypothermia (ie, a core body temperature of less than 35.5°C) during surgery (OR, 0.4 [95% CI, 0.2–0.9]). An American Society of Anesthesiologists (ASA) score of greater than 2, obesity (ie, a BMI greater than the 95th percentile), antibiotic prophylaxis with clindamycin, and hypothermia were statistically significant in the multivariable model.Conclusion.An ASA score greater than 2, obesity, and antibiotic prophylaxis with clindamycin were independent risk factors for SSI. Hypothermia during surgery appears to provide protection against SSI in this patient population.
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Linam WM, Gilliam CH, Honeycutt M, Wisdom C, Swearingen CJ, Romero JR. Parental perceptions about required influenza immunization of pediatric healthcare personnel. Infect Control Hosp Epidemiol 2014; 35:1301-3. [PMID: 25203187 DOI: 10.1086/678061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Annual influenza vaccination is recommended for all healthcare personnel (HCP). During 2010-2011, a cross-sectional design was used to survey 372 parents of hospitalized children regarding their influenza vaccination perceptions. Independent of their feelings regarding vaccine safety and efficacy, 76% of parents felt that annual influenza vaccination should be required for HCP.
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Affiliation(s)
- W Matthew Linam
- Pediatric Infectious Diseases Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Abstract
OBJECTIVE To use quality-improvement (QI) methods to develop and test a multimodal intervention to improve hand-hygiene compliance among health care workers (HCWs) to >90%. METHODS We used a quasi-experimental staggered intervention that was conducted on 2 similar general pediatric units within a 475-bed tertiary children's hospital. Compliance was defined as acceptable hand hygiene both before and after contact with the patient or the patient's care environment. Measurement of HCW hand-hygiene compliance was performed by covert observations made during routine patient care. Twelve months of preintervention data were collected. QI methods were used to test and implement interventions sequentially in each unit. Interventions addressed leadership support, improving HCW knowledge, hand-hygiene supply availability, and HCW behavior. RESULTS Interventions began on unit A on November 10, 2008. Similar interventions were later tested on unit B starting March 23, 2009. By April 1, 2009, compliance increased on unit A (from 65% to 91%) and unit B (from 74% to 92%). Improvement on each unit occurred only after the interventions were introduced. Identifying HCWs who failed to perform hand hygiene and offering alcohol-based hand rub to them before patient contact resulted in the greatest improvement. Improvements were sustained on both units for 18 months. CONCLUSIONS Use of QI methods to implement a multimodal intervention resulted in sustained improvement in hand-hygiene compliance. Real-time individual performance feedback or other high-reliability human-factor interventions seem to be necessary to reach and sustain high levels of hand-hygiene compliance.
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Affiliation(s)
- W Matthew Linam
- Infectious Diseases Section, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Arkansas 72202-3500, USA.
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Graham J, Shirm S, Storm E, Lyle K, Linam WM, Romero J. Challenges and solutions: pandemic 2009 H1N1 influenza A in a pediatric emergency department. Am J Disaster Med 2011; 6:211-218. [PMID: 22010598 DOI: 10.5055/ajdm.2011.0060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 05/31/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the impact of the 2009 H1N1 influenza pandemic on a pediatric emergency department (ED) at a freestanding children's hospital in the summer and fall of 2009. DESIGN In July 2009, active prospective surveillance for influenza-like illness (ILI) was performed on a daily basis of patients presenting to the ED of Arkansas Children's Hospital. The Centers for Disease Control and Prevention definition of ILI was used. Records of daily ILI volume were kept. A retrospective review of admissions from the ED to the inpatient service was done for patients with ILI and non-ILI. In addition, comparisons of monthly patient census for the months involved were compared with historical census data. RESULTS When public schools started in mid-August 2009, there was a rapid and dramatic increase in the number of patients with ILI seen in the pediatric ED. Within 3 weeks, as many as 120 patients with ILI per day were being seen in the ED. The month of September 2009 was the highest census month ever recorded in this ED. The admission rate of the patients with ILI was lower than patients with non-ILI between September and November 2009 (10.8 percent vs 14.8 percent). CONCLUSIONS The 2009 H1N1 influenza pandemic resulted in unprecedented patient volumes in this pediatric ED; however, patient acuity (based on admission rate) for patients with ILI was lower than patients with non-ILI. Pandemic influenza can overwhelm emergency care resources, even when the overall severity of illness is relatively low.
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Affiliation(s)
- James Graham
- Department of Pediatrics, University of Arkansas College of Medicine and Arkansas Children's Hospital, Little Rock, Arkansas, USA
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Linam WM. Improving patient safety by creating lasting behavior change: lessons learned from hand hygiene. J Ark Med Soc 2011; 107:282-283. [PMID: 21710930] [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: 05/31/2023]
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Kaplan HC, Brady PW, Dritz MC, Hooper DK, Linam WM, Froehle CM, Margolis P. The influence of context on quality improvement success in health care: a systematic review of the literature. Milbank Q 2011; 88:500-59. [PMID: 21166868 DOI: 10.1111/j.1468-0009.2010.00611.x] [Citation(s) in RCA: 446] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT The mixed results of success among QI initiatives may be due to differences in the context of these initiatives. METHODS The business and health care literature was systematically reviewed to identify contextual factors that might influence QI success; to categorize, summarize, and synthesize these factors; and to understand the current stage of development of this research field. FINDINGS Forty-seven articles were included in the final review. Consistent with current theories of implementation and organization change, leadership from top management, organizational culture, data infrastructure and information systems, and years involved in QI were suggested as important to QI success. Other potentially important factors identified in this review included: physician involvement in QI, microsystem motivation to change, resources for QI, and QI team leadership. Key limitations in the existing literature were the lack of a practical conceptual model, the lack of clear definitions of contextual factors, and the lack of well-specified measures. CONCLUSIONS Several contextual factors were shown to be important to QI success, although the current body of literature lacks adequate definitions and is characterized by considerable variability in how contextual factors are measured across studies. Future research should focus on identifying and developing measures of context tied to a conceptual model that examines context across all levels of the health care system and explores the relationships among various aspects of context.
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Affiliation(s)
- Heather C Kaplan
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Kaplan HC, Brady PW, Dritz MC, Hooper DK, Linam WM, Froehle CM, Margolis P. The influence of context on quality improvement success in health care: a systematic review of the literature. Milbank Q 2010. [PMID: 21166868 DOI: 10.1111/j.1468-0009.2010.00611.x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
CONTEXT The mixed results of success among QI initiatives may be due to differences in the context of these initiatives. METHODS The business and health care literature was systematically reviewed to identify contextual factors that might influence QI success; to categorize, summarize, and synthesize these factors; and to understand the current stage of development of this research field. FINDINGS Forty-seven articles were included in the final review. Consistent with current theories of implementation and organization change, leadership from top management, organizational culture, data infrastructure and information systems, and years involved in QI were suggested as important to QI success. Other potentially important factors identified in this review included: physician involvement in QI, microsystem motivation to change, resources for QI, and QI team leadership. Key limitations in the existing literature were the lack of a practical conceptual model, the lack of clear definitions of contextual factors, and the lack of well-specified measures. CONCLUSIONS Several contextual factors were shown to be important to QI success, although the current body of literature lacks adequate definitions and is characterized by considerable variability in how contextual factors are measured across studies. Future research should focus on identifying and developing measures of context tied to a conceptual model that examines context across all levels of the health care system and explores the relationships among various aspects of context.
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Affiliation(s)
- Heather C Kaplan
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Affiliation(s)
- W Matthew Linam
- Division of Infectious Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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