802. Corynebacterium striatum Outbreak Among Ventilated COVID-19 Patients in an Acute Care Hospital – California, 2021

Background

Corynebacterium striatum (CS), a common human commensal colonizing the skin and nasopharynx, has been associated with nosocomial infections in immunocompromised and chronically ill patients. During the winter 2020-2021 COVID-19 surge, a 420-bed California hospital reported a marked increase in CS respiratory cultures among ventilated COVID-19 patients. We conducted a public health investigation to assess and mitigate nosocomial transmission and contributing infection prevention and control (IPC) practices.

Methods

A case was defined as a patient with CS in respiratory cultures from January 1, 2020 - February 28, 2021. We reviewed clinical characteristics on a subset of cases in 2021 and IPC practices in affected hospital locations. CS respiratory isolates collected on different dates and locations were assessed for relatedness by whole genome sequencing (WGS) on MiSeq.

Results

Eighty-three cases were identified, including 75 among COVID-19 patients (Figure 1). Among 62 patients identified in 2021, all were ventilated; 58 also had COVID-19, including 4 cases identified on point prevalence survey (PPS). The median time from admission to CS culture was 19 days (range, 0-60). Patients were critically ill; often it was unclear whether CS cultures represented colonization or infection. During the COVID-19 surge, two hospital wings (7W and 7S) were converted to negative-pressure COVID-19 units. Staff donned and doffed personal protective equipment in anterooms outside the units; extended use of gowns was practiced, and lapses in glove changes and hand hygiene (HH) between patients likely occurred. In response to the CS outbreak, patients were placed in Contact precautions and cohorted. Staff were re-educated on IPC for COVID-19 patients. Gowns were changed between CS patients. Subsequent PPS were negative. Two CS clusters were identified by WGS: cluster 1 (5 cases) in unit 7W, and cluster 2 (2 cases) in unit 7S (Figure 2).

Figure 1. Corynebacterium striatum Respiratory Cultures January 2020-February 2021

Conclusion

A surge in patients, extended use of gowns and lapses in core IPC practices including HH and environmental cleaning and disinfection during the winter 2020-2021 COVID-19 surge likely contributed to this CS outbreak. WGS provides supportive evidence for nosocomial CS transmission among critically ill COVID-19 patients.

Disclosures

All Authors: No reported disclosures

A 51-Year-Old Woman With Rapidly Progressive Dyspnea

CASE PRESENTATION

A 51-year-old woman with a history of diabetes mellitus and anemia sought treatment at the emergency room for a 2-month history of dry cough and shortness of breath and a 1-week history of substernal chest tightness. One month before her presentation, she was seen at a separate hospital for dyspnea and was found to be anemic. She underwent chest radiography and CT scanning of the chest that was unrevealing to the cause of dyspnea. She received a blood transfusion, although no cause of the anemia was found. One week before presentation, she started experiencing dyspnea on exertion with associated chest pressure, prompting her to seek treatment at the emergency room. On presentation, she reported no fevers, night sweats, joint pain, paroxysmal nocturnal dyspnea, orthopnea, edema, palpitations, lightheadedness, or syncope. She noted a 10- to 20-pound involuntary weight loss over 5 to 6 months. Of note, she had never undergone esophagogastroduodenoscopy or colonoscopy. Medications included an oral diabetic medication. She had no significant family history. She never smoked and had no history of illicit drug or alcohol use.

Protected code blue: using in situ simulation to develop a protected code blue and modify staff training protocol-experience in a large community teaching hospital during the COVID-19 pandemic

The surge in clinical demand, shortage in personal protective equipment and high-exposure risk for healthcare workers during the COVID-19 pandemic has challenged hospital common practices and forced a reassessment of care delivery models. Code blue teams are highly specialised units that partake in life-saving situations that can jeopardise the safety of team members. There is a paucity of guidance in regards to proper infection control measures to protect the responders.This study describes a methodical approach to assessing vulnerabilities to transmission of SARS-CoV-2 within existing code blue practices, modalities to limit the number of code blue team responders and modifications to the protocol at a large community teaching hospital. The effort undertaken faced challenges due to the nature of the pandemic and the increased demand on healthcare workers. Quality improvement methods facilitated our protocol design and implementation. To this date, there has been no identified COVID-19 disease in any protected code blue (PCB) team members. We recommend that similar practices be considered and adopted widely and practised periodically.

Ingestion of A Common Plant's Leaves Leads to Acute Respiratory Arrest and Paralysis: A Case Report

Background

Nicotiana glauca is a plant known to cause acute toxicity upon ingestion or dermal exposure due to the nicotinic alkaloid, anabasine. Nicotinic alkaloids cause toxicity by acting as agonists on nicotinic-type acetylcholine receptors (nAChRs). Initial stimulation of these receptors leads to symptoms such as tachycardia, miosis, and tremors. The effects of high doses of nicotinic alkaloids are biphasic, and eventual persistent depolarization of nAChRs at the neuromuscular junction occurs. This causes apnea, paralysis, and cardiovascular collapse.

Case Report

In this report, we present a case of respiratory arrest due to nicotinic alkaloid poisoning from the ingestion of Nicotiana glauca. The diagnosis was suspected after the patient’s family gave a history of the patient ingesting a plant prior to arrival. They were able to also provide a physical sample of the plant.

Conclusion

The phone application, “Plant Snap”, determined the plant species and helped confirm the diagnosis. This case describes how modern technology and thorough history taking can combine to provide the best possible patient care.

Effect of enamel preparation method on in vitro marginal microleakage of a flowable composite used as pit and fissure sealant

OBJECTIVES

The aim of this in vitro study was to evaluate the microleakage in occlusal surfaces, after preparation with Er:YAG laser and compared to the diamond-bur conventional technique.

METHODS

Thirty premolars were divided into three groups: I - high-speed handpiece + 37% phosphoric acid; II - Er:YAG laser (350 mJ, 4 Hz and 112 J/cm(2)) + 37% phosphoric acid; and III - Er:YAG laser (350 mJ, 4 Hz and 112 J/cm(2)) + Er:YAG laser (80 mJ, 4 Hz, and 25 mJ/cm(2)). All cavities received the same adhesive system and were restored with flowable composite according to manufacturer's instructions. Teeth were submitted to thermal cycling and immersed in 50% silver nitrate solutions for 8 h in total darkness. Specimens were sectioned longitudinally in the bucco-lingual direction, in slices of 1 mm thick. Each slice was immersed into photo developing solution and was photographed, and microleakage was scored from 0 to 7, by three calibrated examiners.

RESULTS

A statistically significant difference (P < 0.0001) was observed between Er:YAG laser prepared and etched specimens and those in the other groups.

CONCLUSIONS

It can be concluded that no significant difference was noted between the two types of enamel preparation when etching was performed. Preparing and treating the enamel surface exclusively by Er:YAG laser resulted in the highest degree of leakage.

Time to abandon electroconvulsion as a treatment in modern psychiatry

This review examines the evidence for the current use of electroconvulsive therapy (ECT) in psychiatry. The history of ECT is discussed because ECT emerged with no scientific evidence, and the absence of other suitable therapy for psychiatric illness was decisive in its adoption as a treatment. Evidence for the current recommendation of ECT in psychiatry is reconsidered. We suggest that ECT is an unscientific treatment and a symbol of authority of the old psychiatry. ECT is not necessary as a treatment modality in the modern practice of psychiatry.

Evidence for the existence of schizophrenia in medieval Islamic society

It has been claimed that descriptions of schizophrenia-like disorders were rare before 1800 in the Western world. Historical evidence from medieval Islamic society shows that madness was common in that society. Despite the limitations of the evidence, we propose that medieval Islamic physicians probably diagnosed and treated many cases of schizophrenia.

The impact of group reminiscence counseling on a depressed elderly population

Elderly patients present an enormous challenge to the mental health care system. Statistics have shown a high rate of mental disorders, especially depression and suicide, among this population group. Reminiscing about the past has been theoretically linked to positive adjustment in old age. The purpose of this study was to assess the effect of group reminiscence counseling on the level of depression of elderly women residing in nursing homes. A sample of 60 women 65 years and older participated in this study. Subjects were randomly classified into two experimental groups and one control group. An interview schedule that included demographics and Beck's Depression Inventory was employed to collect data. Chi-square analysis was used to test the homogeneity of the three groups with respect to their demographic characteristics. Analysis of data using the analysis of variance method showed that the differences between the levels of depression before and after the reminiscence counseling sessions were statistically significant in the younger subjects (65 to 74 years), and insignificant in the older subjects (over 74 years). Findings imply that group reminiscence counseling did have an effect on the elderly's level of depression. From the findings of this study, implications and recommendations are drawn.

Discharge planning for psychiatric patients: the effects of a family-patient teaching programme

The aims of this study were (1) to develop and implement a family-patient teaching programme for psychiatric inpatients prior to their discharge, and (2) to assess the effect of the teaching programme on patients' functional level and readmission rate. The population of this study consisted of 30 hospitalized psychiatric patients, with schizo-affective disorders. Subjects were randomly assigned to two groups--a control group and an experimental group. Families of the experimental group subjects were involved in the patient-family education sessions twice a week. The subjects were followed-up after discharge for a 12-month period. In analysing the data, results indicated that improvement in functional level based on the Global Assessment Scale (GAS) was clearly noticed among subjects of the experimental group. In addition, the findings of this study lend support to other studies which showed that patient-family education is an effective means of reducing the readmission rate among psychiatric patients.

Crisis intervention: a group-therapy approach for hospitalized breast cancer patients

The purpose of this study was to assess the effect of nursing intervention on the level of depression and the self-esteem of hospitalized breast cancer patients. The theoretical framework was based on crisis theory (Caplan 1964). The population of this study consisted of 18 female hospitalized breast cancer patients. Ten were in the control group and eight in the experimental group. Two self-administered instruments were selected for the pre- and post-testing of all clients. Nursing intervention was employed for the experimental group, over a 2-month period. The findings demonstrated that there was a change in the level of depression and improvement in self-esteem among the subjects in the experimental group after nursing intervention.

Adherence to therapy in psychiatric patients: an empirical investigation

Patient adherence, i.e. the extent to which a patient's behavior, in terms of taking medications and keeping scheduled appointments, has been demonstrated to be essential for the successful treatment of various psychiatric disorders. The purpose of this study was to assess the impact of patient education on patient compliance to psychotropic medication after discharge from hospital. A sample of 36 psychiatric patients discharged from an inpatient care facility and receiving an oral form of psychotropic drug were the subjects of this study. Subjects were randomly assigned to two groups: a control group; and a directive patient education group. The subjects were followed up after discharge for a 6-month period. In analyzing the data, results indicated that the difference in percentage of compliance between the two groups was statistically significant. Findings imply that patient education did have an effect on patient compliance to medication. The findings of the study support a technique that can be incorporated in both in-patient and out-patient programs in psychiatric mental health facilities. It would increase patient compliance to medication and hence decrease chances of rehospitalization.

Compliance with therapeutic regimens: a follow-up study for patients with affective disorders

The purpose of this study was to assess the impact of patient education on patient compliance to psychotropic medication after discharge from the hospital. A sample of 36 patients discharged from an in-patient care facility and receiving an oral form of psychotropic drug were the subjects of this study. All subjects were patients of affective disorders. Subjects were randomly assigned to two groups: a control group; and a directive patient-education group. The subjects were followed up after discharge for a 6-month period. In analyzing the data, results indicated that the difference in percentage of compliance between the two groups was statistically significant. Findings imply that patient education did have an effect on patient compliance to medication. The findings of the study support a technique that can be incorporated in both in-patient and out-patient programmes in psychiatric-mental health nursing. It would increase patient compliance to medication and hence decrease chances of rehospitalization.