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Beck A, Bjork J, Biggerstaff BJ, Eisen L, Eisen R, Foster E, Signs K, Tsao JI, Kough E, Peterson M, Schiffman E, Muganda CP, Osborn R, Wozniak R, Bron GM, Phaneuf D, Smith D, Bartholomay L, Paskewitz S, Hinckley AF. Knowledge, attitudes, and behaviors regarding tick-borne disease prevention in Lyme disease-endemic areas of the Upper Midwest, United States. Ticks Tick Borne Dis 2022; 13:101925. [PMID: 35255349 PMCID: PMC10947721 DOI: 10.1016/j.ttbdis.2022.101925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 11/19/2022]
Abstract
Lyme disease and other tick-borne diseases are a major public health threat in the Upper Midwestern United States, including Michigan, Minnesota, and Wisconsin. To prevent tick bites and tick-borne diseases, public health officials commonly recommend personal protective measures and property management techniques. Adoption of tick-borne disease prevention behaviors and practices by individuals are, however, highly variable. We aimed to characterize current tick-borne disease knowledge, attitudes, and prevention behaviors (KAB) practiced by the public in these states, as well as their willingness to use specific tick control methods. We conducted a population-based survey in summer 2019 in 48 high-risk counties (those having a five-year average (2013-2017) Lyme disease incidence of ≥ 10 cases per 100,000 persons per year), in Michigan, Minnesota, and Wisconsin. A total of 2713 surveys were analyzed; survey weights were used to account for household selection probability and post-stratified to match county-level joint age and sex population distributions in population-level inference. An estimated 98% of the population had heard of Lyme disease, with most perceiving it as very or extremely serious (91%); however, only an estimated 25% perceived tick-borne diseases as very or extremely common in their community. Among those who spent time in places with ticks from April through October, an estimated 68% check themselves thoroughly for ticks most of the time or always and 43% use bug repellent on skin or clothing most of the time or always. An estimated 13% of the population had ever treated their property with a pesticide to kill ticks, and 3% had ever used devices that apply pesticide to rodents to kill ticks on their property. Willingness to practice tick bite prevention behaviors, however, was estimated to be much higher; with 82% being willing to perform tick checks at least once a day, and more than 60% willing to use bug repellent, tick control products on pets, or to bathe within two hours of being outdoors. We found that residents would likely be willing to support a county-wide tick control program to reduce the risk of tick-borne disease in their community (81%) or to apply tick control products to their property to reduce the risk of tick-borne disease in their household (79%). Tick checks were more likely to be practiced among participants who perceived tick-borne diseases to be highly prevalent in their community, if they or a household member had been previously diagnosed with a tick-borne disease?, or if they perceived tick exposure to be likely around their home, cabin, or vacation home. In addition, property-based tick control methods were associated with perceived risk of encountering ticks around the home, cabin, or vacation home. Participants who had seen information from state health departments were also more likely to practice preventive measures. The most common reported barriers to using any of these methods were forgetfulness, safety concerns, and lack of awareness. Our survey findings shed light on how residents from these Upper Midwest states may adopt tick control and tick bite prevention measures and how public health outreach may be most effective for this population.
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Affiliation(s)
- Alyssa Beck
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, 3156 Rampart Road, Fort Collins, CO 80521, United States; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States
| | - Jenna Bjork
- Minnesota Department of Health, 625 Robert Street North, Saint Paul, MN 55155, United States
| | - Brad J Biggerstaff
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, 3156 Rampart Road, Fort Collins, CO 80521, United States
| | - Lars Eisen
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, 3156 Rampart Road, Fort Collins, CO 80521, United States
| | - Rebecca Eisen
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, 3156 Rampart Road, Fort Collins, CO 80521, United States
| | - Erik Foster
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, 3156 Rampart Road, Fort Collins, CO 80521, United States
| | - Kimberly Signs
- Michigan Department of Health and Human Services, 333 South Grand Avenue, South Grand Building, Lansing, MI 48933, United States
| | - Jean I Tsao
- Michigan State University, Department of Fisheries and Wildlife and Department of Large Animal Clinical Sciences, 480 Wilson Road, Natural Resources Building, East Lansing, MI 48824, United States
| | - Erin Kough
- Minnesota Department of Health, 625 Robert Street North, Saint Paul, MN 55155, United States
| | - Molly Peterson
- Minnesota Department of Health, 625 Robert Street North, Saint Paul, MN 55155, United States
| | - Elizabeth Schiffman
- Minnesota Department of Health, 625 Robert Street North, Saint Paul, MN 55155, United States
| | - Christine P Muganda
- Wisconsin Department of Health Services, 1 West Wilson Street, Madison, WI 53703, United States
| | - Rebecca Osborn
- Wisconsin Department of Health Services, 1 West Wilson Street, Madison, WI 53703, United States
| | - Ryan Wozniak
- Wisconsin Department of Health Services, 1 West Wilson Street, Madison, WI 53703, United States
| | - Gebbiena M Bron
- University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, United States
| | - Daniel Phaneuf
- University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, United States
| | - Danielle Smith
- University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, United States
| | - Lyric Bartholomay
- University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, United States
| | - Susan Paskewitz
- University of Wisconsin-Madison, 1656 Linden Drive, Madison, WI 53706, United States
| | - Alison F Hinckley
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, 3156 Rampart Road, Fort Collins, CO 80521, United States.
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Hecker MT, Fox CJ, Son AH, Cydulka RK, Siff JE, Emerman CL, Sethi AK, Muganda CP, Donskey CJ. Effect of a stewardship intervention on adherence to uncomplicated cystitis and pyelonephritis guidelines in an emergency department setting. PLoS One 2014; 9:e87899. [PMID: 24498394 PMCID: PMC3912125 DOI: 10.1371/journal.pone.0087899] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 12/30/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate adherence to uncomplicated urinary tract infections (UTI) guidelines and UTI diagnostic accuracy in an emergency department (ED) setting before and after implementation of an antimicrobial stewardship intervention. METHODS The intervention included implementation of an electronic UTI order set followed by a 2 month period of audit and feedback. For women age 18-65 with a UTI diagnosis seen in the ED with no structural or functional abnormalities of the urinary system, we evaluated adherence to guidelines, antimicrobial use, and diagnostic accuracy at baseline, after implementation of the order set (period 1), and after audit and feedback (period 2). RESULTS Adherence to UTI guidelines increased from 44% (baseline) to 68% (period 1) to 82% (period 2) (P≤.015 for each successive period). Prescription of fluoroquinolones for uncomplicated cystitis decreased from 44% (baseline) to 14% (period 1) to 13% (period 2) (P<.001 and P = .7 for each successive period). Unnecessary antibiotic days for the 200 patients evaluated in each period decreased from 250 days to 119 days to 52 days (P<.001 for each successive period). For 40% to 42% of cases diagnosed as UTI by clinicians, the diagnosis was deemed unlikely or rejected with no difference between the baseline and intervention periods. CONCLUSIONS A stewardship intervention including an electronic order set and audit and feedback was associated with increased adherence to uncomplicated UTI guidelines and reductions in unnecessary antibiotic therapy and fluoroquinolone therapy for cystitis. Many diagnoses were rejected or deemed unlikely, suggesting a need for studies to improve diagnostic accuracy for UTI.
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Affiliation(s)
- Michelle T. Hecker
- Department of Medicine, Division of Infectious Diseases, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Clinton J. Fox
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Andrea H. Son
- Department of Pharmacy, MetroHealth Medical Center, Cleveland, Ohio, United States of America
| | - Rita K. Cydulka
- Department of Emergency Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Jonathan E. Siff
- Department of Emergency Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Charles L. Emerman
- Department of Emergency Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Ajay K. Sethi
- Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Christine P. Muganda
- Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Curtis J. Donskey
- Geriatric Research, Education and Clinical Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
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Jury LA, Sitzlar B, Kundrapu S, Cadnum JL, Summers KM, Muganda CP, Deshpande A, Sethi AK, Donskey CJ. Outpatient healthcare settings and transmission of Clostridium difficile. PLoS One 2013; 8:e70175. [PMID: 23894609 PMCID: PMC3722238 DOI: 10.1371/journal.pone.0070175] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/15/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Recent reports suggest that community-associated Clostridium difficile infection (CDI) (i.e., no healthcare facility admission within 90 days) may be increasing in frequency. We hypothesized that outpatient clinics could be an important source for acquisition of community-associated CDI. METHODS We performed a 6-month prospective study of CDI patients to determine frequency of and risk factors for skin and environmental shedding during outpatient visits and to derive a prediction rule for positive cultures. We performed a point-prevalence culture survey to assess the frequency of C. difficile contamination in outpatient settings and evaluated the frequency of prior outpatient visits in patients with community-associated CDI. RESULTS Of 67 CDI patients studied, 54 (81%) had 1 or more outpatient visits within 12 weeks after diagnosis. Of 44 patients cultured during outpatient visits, 14 (32%) had skin contamination and 12 (27%) contaminated environmental surfaces. Decreased mobility, fecal incontinence, and treatment with non-CDI antibiotics were associated with positive cultures, whereas vancomycin taper therapy was protective. In patients not on CDI therapy, a prediction rule including incontinence or decreased mobility was 90% sensitive and 79% specific for detection of spore shedding. Of 84 clinic and emergency department rooms cultured, 12 (14%) had 1 or more contaminated environmental sites. For 33 community-associated CDI cases, 31 (94%) had an outpatient visit during the 12 weeks prior to onset of diarrhea. CONCLUSIONS Patients with recent CDI present a significant risk for transmission of spores during outpatient visits. The outpatient setting may be an underappreciated source of community-associated CDI cases.
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Affiliation(s)
- Lucy A. Jury
- Geriatric Research Education and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Brett Sitzlar
- Geriatric Research Education and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Sirisha Kundrapu
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Jennifer L. Cadnum
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Kim M. Summers
- Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Christine P. Muganda
- Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Abhishek Deshpande
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Ajay K. Sethi
- Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Curtis J. Donskey
- Geriatric Research Education and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- * E-mail:
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