1
|
Gutfreund MC, Kobayashi T, Callado GY, Pardo I, Hsieh MK, Lin V, Perencevich EN, Salinas JL, Edmond MB, Mendonça E, Rizzo LV, Marra AR. The effectiveness of the COVID-19 vaccines in the prevention of post-COVID conditions in children and adolescents: a systematic literature review and meta-analysis. Antimicrob Steward Healthc Epidemiol 2024; 4:e54. [PMID: 38655026 PMCID: PMC11036435 DOI: 10.1017/ash.2024.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 04/26/2024]
Abstract
Objective We performed a systematic literature review and meta-analysis on the effectiveness of coronavirus disease 2019 (COVID-19) vaccination against post-COVID conditions (long COVID) in the pediatric population. Design Systematic literature review/meta-analysis. Methods We searched PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science from December 1, 2019, to August 14, 2023, for studies evaluating the COVID-19 vaccine effectiveness against post-COVID conditions among vaccinated individuals < 21 years old who received at least 1 dose of COVID-19 vaccine. A post-COVID condition was defined as any symptom that was present 4 or more weeks after COVID-19 infection. We calculated the pooled diagnostic odds ratio (DOR) (95% CI) for post-COVID conditions between vaccinated and unvaccinated individuals. Results Eight studies with 23,995 individuals evaluated the effect of vaccination on post-COVID conditions, of which 5 observational studies were included in the meta-analysis. The prevalence of children who did not receive COVID-19 vaccines ranged from 65% to 97%. The pooled prevalence of post-COVID conditions was 21.3% among those unvaccinated and 20.3% among those vaccinated at least once. The pooled DOR for post-COVID conditions among individuals vaccinated with at least 1 dose and those vaccinated with 2 doses were 1.07 (95% CI, 0.77-1.49) and 0.82 (95% CI, 0.63-1.08), respectively. Conclusions A significant proportion of children and adolescents were unvaccinated, and the prevalence of post-COVID conditions was higher than reported in adults. While vaccination did not appear protective, conclusions were limited by the lack of randomized trials and selection bias inherent in observational studies.
Collapse
Affiliation(s)
- Maria Celidonio Gutfreund
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Gustavo Yano Callado
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Isabele Pardo
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Mariana Kim Hsieh
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Vivian Lin
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Eli N. Perencevich
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Jorge L. Salinas
- Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Michael B. Edmond
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Eneida Mendonça
- Department of Biomedical Informatics, University of Cincinnati, Cincinnati, OH, USA
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Luiz Vicente Rizzo
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Alexandre R. Marra
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| |
Collapse
|
2
|
Malheiro DT, Bernardez-Pereira S, Parreira KCJ, Pagliuso JGD, de Paula Gomes E, de Mesquita Escobosa D, de Araújo CI, Pimenta BS, Lin V, de Almeida SM, Tuma P, Laselva CR, Neto MC, Klajner S, Teich VD, Kobayashi T, Edmond MB, Marra AR. Prevalence, predictors, and patient-reported outcomes of long COVID in hospitalized and non-hospitalized patients from the city of São Paulo, Brazil. Front Public Health 2024; 11:1302669. [PMID: 38317683 PMCID: PMC10839020 DOI: 10.3389/fpubh.2023.1302669] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024] Open
Abstract
Background Robust data comparing long COVID in hospitalized and non-hospitalized patients in middle-income countries are limited. Methods A retrospective cohort study was conducted in Brazil, including hospitalized and non-hospitalized patients. Long COVID was diagnosed at 90-day follow-up using WHO criteria. Demographic and clinical information, including the depression screening scale (PHQ-2) at day 30, was compared between the groups. If the PHQ-2 score is 3 or greater, major depressive disorder is likely. Logistic regression analysis identified predictors and protective factors for long COVID. Results A total of 291 hospitalized and 1,118 non-hospitalized patients with COVID-19 were included. The prevalence of long COVID was 47.1% and 49.5%, respectively. Multivariable logistic regression showed female sex (odds ratio [OR] = 4.50, 95% confidence interval (CI) 2.51-8.37), hypertension (OR = 2.90, 95% CI 1.52-5.69), PHQ-2 > 3 (OR = 6.50, 95% CI 1.68-33.4) and corticosteroid use during hospital stay (OR = 2.43, 95% CI 1.20-5.04) as predictors of long COVID in hospitalized patients, while female sex (OR = 2.52, 95% CI 1.95-3.27) and PHQ-2 > 3 (OR = 3.88, 95% CI 2.52-6.16) were predictors in non-hospitalized patients. Conclusion Long COVID was prevalent in both groups. Positive depression screening at day 30 post-infection can predict long COVID. Early screening of depression helps health staff to identify patients at a higher risk of long COVID, allowing an early diagnosis of the condition.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Vivian Lin
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Paula Tuma
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Michael B. Edmond
- West Virginia University School of Medicine, Morgantown, WV, United States
| | - Alexandre R. Marra
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| |
Collapse
|
3
|
Marra AR, Sampaio VS, Ozahata MC, Lopes R, Brito AF, Bragatte M, Kalil J, Miraglia JL, Malheiro DT, Guozhang Y, Teich VD, Victor EDS, Pinho JRR, Cypriano A, Vieira LW, Polonio M, de Oliveira SM, Ricardo VCV, Maezato AM, Callado GY, Schettino GDPP, de Oliveira KG, Santana RAF, Malta FDM, Amgarten D, Boechat AL, Kobayashi T, Perencevich E, Edmond MB, Rizzo LV. Risk factors for long coronavirus disease 2019 (long COVID) among healthcare personnel, Brazil, 2020-2022. Infect Control Hosp Epidemiol 2023; 44:1972-1978. [PMID: 37272468 PMCID: PMC10755155 DOI: 10.1017/ice.2023.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/06/2023] [Revised: 03/26/2023] [Accepted: 04/01/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine risk factors for the development of long coronavirus disease 2019 (COVID-19) in healthcare personnel (HCP). METHODS We conducted a case-control study among HCP who had confirmed symptomatic COVID-19 working in a Brazilian healthcare system between March 1, 2020, and July 15, 2022. Cases were defined as those having long COVID according to the Centers for Disease Control and Prevention definition. Controls were defined as HCP who had documented COVID-19 but did not develop long COVID. Multiple logistic regression was used to assess the association between exposure variables and long COVID during 180 days of follow-up. RESULTS Of 7,051 HCP diagnosed with COVID-19, 1,933 (27.4%) who developed long COVID were compared to 5,118 (72.6%) who did not. The majority of those with long COVID (51.8%) had 3 or more symptoms. Factors associated with the development of long COVID were female sex (OR, 1.21; 95% CI, 1.05-1.39), age (OR, 1.01; 95% CI, 1.00-1.02), and 2 or more SARS-CoV-2 infections (OR, 1.27; 95% CI, 1.07-1.50). Those infected with the SARS-CoV-2 δ (delta) variant (OR, 0.30; 95% CI, 0.17-0.50) or the SARS-CoV-2 o (omicron) variant (OR, 0.49; 95% CI, 0.30-0.78), and those receiving 4 COVID-19 vaccine doses prior to infection (OR, 0.05; 95% CI, 0.01-0.19) were significantly less likely to develop long COVID. CONCLUSIONS Long COVID can be prevalent among HCP. Acquiring >1 SARS-CoV-2 infection was a major risk factor for long COVID, while maintenance of immunity via vaccination was highly protective.
Collapse
Affiliation(s)
- Alexandre R. Marra
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | | | | | - Rafael Lopes
- Instituto Todos Pela Saúde, São Paulo, São Paulo, Brazil
| | | | | | - Jorge Kalil
- Instituto Todos Pela Saúde, São Paulo, São Paulo, Brazil
| | | | | | - Yang Guozhang
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | | | | | | | - Adriana Cypriano
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | | | - Miria Polonio
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Deyvid Amgarten
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | | | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Eli Perencevich
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Michael B. Edmond
- West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | | |
Collapse
|
4
|
Marra AR, Kobayashi T, Callado GY, Pardo I, Gutfreund MC, Hsieh MK, Lin V, Alsuhaibani M, Hasegawa S, Tholany J, Perencevich EN, Salinas JL, Edmond MB, Rizzo LV. The effectiveness of COVID-19 vaccine in the prevention of post-COVID conditions: a systematic literature review and meta-analysis of the latest research. Antimicrob Steward Healthc Epidemiol 2023; 3:e168. [PMID: 38028898 PMCID: PMC10644173 DOI: 10.1017/ash.2023.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 12/01/2023]
Abstract
Objective We performed a systematic literature review and meta-analysis on the effectiveness of coronavirus disease 2019 (COVID-19) vaccination against post-COVID conditions (long COVID) among fully vaccinated individuals. Design Systematic literature review/meta-analysis. Methods We searched PubMed, Cumulative Index to Nursing and Allied Health, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science from December 1, 2019, to June 2, 2023, for studies evaluating the COVID-19 vaccine effectiveness (VE) against post-COVID conditions among fully vaccinated individuals who received two doses of COVID-19 vaccine. A post-COVID condition was defined as any symptom that was present four or more weeks after COVID-19 infection. We calculated the pooled diagnostic odds ratio (DOR) (95% confidence interval) for post-COVID conditions between fully vaccinated and unvaccinated individuals. Vaccine effectiveness was estimated as 100% x (1-DOR). Results Thirty-two studies with 775,931 individuals evaluated the effect of vaccination on post-COVID conditions, of which, twenty-four studies were included in the meta-analysis. The pooled DOR for post-COVID conditions among fully vaccinated individuals was 0.680 (95% CI: 0.523-0.885) with an estimated VE of 32.0% (11.5%-47.7%). Vaccine effectiveness was 36.9% (23.1%-48.2%) among those who received two doses of COVID-19 vaccine before COVID-19 infection and 68.7% (64.7%-72.2%) among those who received three doses before COVID-19 infection. The stratified analysis demonstrated no protection against post-COVID conditions among those who received COVID-19 vaccination after COVID-19 infection. Conclusions Receiving a complete COVID-19 vaccination prior to contracting the virus resulted in a significant reduction in post-COVID conditions throughout the study period, including during the Omicron era. Vaccine effectiveness demonstrated an increase when supplementary doses were administered.
Collapse
Affiliation(s)
- Alexandre R. Marra
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Gustavo Yano Callado
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Isabele Pardo
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Maria Celidonio Gutfreund
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Mariana Kim Hsieh
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Vivian Lin
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Mohammed Alsuhaibani
- Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Shinya Hasegawa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Joseph Tholany
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Eli N. Perencevich
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | | | | | - Luiz Vicente Rizzo
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| |
Collapse
|
5
|
Marra AR, Miraglia JL, Malheiro DT, Guozhang Y, Teich VD, Victor EDS, Pinho JRR, Cypriano A, Vieira LW, Polonio M, Ornelas RH, de Oliveira SM, Borges FA, Oler SCC, Ricardo VCV, Maezato AM, Callado GY, Schettino GDPP, de Oliveira KG, Santana RAF, Malta FDM, Amgarten D, Boechat AL, Kobayashi T, Salinas JL, Edmond MB, Rizzo LV. Longer-term effectiveness of a heterologous coronavirus disease 2019 (COVID-19) vaccine booster in healthcare workers in Brazil. Antimicrob Steward Healthc Epidemiol 2023; 3:e104. [PMID: 37396193 PMCID: PMC10311693 DOI: 10.1017/ash.2023.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 07/04/2023]
Abstract
Objective To compare the long-term vaccine effectiveness between those receiving viral vector [Oxford-AstraZeneca (ChAdOx1)] or inactivated viral (CoronaVac) primary series (2 doses) and those who received an mRNA booster (Pfizer/BioNTech) (the third dose) among healthcare workers (HCWs). Methods We conducted a retrospective cohort study among HCWs (aged ≥18 years) in Brazil from January 2021 to July 2022. To assess the variation in the effectiveness of booster dose over time, we estimated the effectiveness rate by taking the log risk ratio as a function of time. Results Of 14,532 HCWs, coronavirus disease 2019 (COVID-19) was confirmed in 56.3% of HCWs receiving 2 doses of CoronaVac vaccine versus 23.2% of HCWs receiving 2 doses of CoronaVac vaccine with mRNA booster (P < .001), and 37.1% of HCWs receiving 2 doses of ChAdOx1 vaccine versus 22.7% among HCWs receiving 2 doses of ChAdOx1 vaccine with mRNA booster (P < .001). The highest vaccine effectiveness with mRNA booster was observed 30 days after vaccination: 91% for the CoronaVac vaccine group and 97% for the ChAdOx1 vaccine group. Vacine effectiveness declined to 55% and 67%, respectively, at 180 days. Of 430 samples screened for mutations, 49.5% were SARS-CoV-2 delta variants and 34.2% were SARS-CoV-2 omicron variants. Conclusions Heterologous COVID-19 vaccines were effective for up to 180 days in preventing COVID-19 in the SARS-CoV-2 delta and omicron variant eras, which suggests the need for a second booster.
Collapse
Affiliation(s)
- Alexandre R. Marra
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | | | | | - Yang Guozhang
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | - Miria Polonio
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | | | - Michael B. Edmond
- West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | | |
Collapse
|
6
|
Juskowich JJ, Ward A, Spigelmyer AE, Howard CA, Slain D, Guilfoose JA, Edmond MB, Sarwari AR. 1002. Complex Outpatient Antimicrobial Therapy (COpAT) Program at a Rural Academic Medical Center: Evaluation of First 100 Patients. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Literature shows early intravenous (IV) to oral (PO) antimicrobial transition for infective endocarditis (IE) and bone and joint infection (BJI) is noninferior to prolonged IV antimicrobial therapy. COVID-19 pandemic peaks resulted in critical shortages of staffed hospital beds spurring innovation. Outpatient parenteral antimicrobial therapy (OPAT), a well-established program using prolonged IV antimicrobials, faces challenges such as infusion resource needs and social circumstance limitations. Complex outpatient antimicrobial therapy (COpAT) uses PO in place of IV antimicrobials. We hypothesized rapid adoption of COpAT would decrease hospital length of stay and open beds while retaining satisfactory clinical outcomes.
Methods
COpAT protocols (Image 1) and guidelines by infection type and isolated organism (Image 2) were created. Hospitalized patients including persons who inject drugs (PWID) were evaluated for IV to PO antimicrobial transition by an infectious diseases (ID) physician and then followed by an ID physician-pharmacist team. Demographic, ID, and clinical outcome data for the first 100 COpAT patients between December 2020 and February 2022 were obtained by retrospective chart review. Image 1.COpAT Inpatient and Outpatient Protocols
Image 2. COpAT Guidelines by Infection Type and Isolated Organism
MSSA = methicillin-susceptible Staphylococcus aureus; MRSA = methicillin-resistant Staphylococcus aureus; spp. = species; TMP/SMX = trimethoprim-sulfamethoxazole; DS = double strength; SSTI = skin and soft tissue infection; CAP = community-acquired pneumonia
Results
PWID accounted for 78% of COpAT patients. BJI followed by mixed infection (IE and BJI) was most prevalent (Image 3) with bacteremia in 53% of cases. Staphylococcus aureus was most frequently isolated (Image 4). Oral linezolid and fluoroquinolones, often in combination, were most commonly used. IV and PO antimicrobials were taken for a median 28 and 14 days, respectively. The COpAT program saved 1425 IV antimicrobial and 1363 hospital days. Assuming daily inpatient cost of $2050, cost avoided was $2,794,150. COpAT patients participated in ID follow-up and adhered to PO antimicrobials with low 30-day readmission rates (Image 5). Image 3.Infection TypeImage 4.Isolated Organism CoNS = coagulase-negative staphylococci Image 5.Clinical Outcomes
Conclusion
In a sample of 100 COpAT patients including PWID, IV to PO antimicrobial transition safely saved hospital days and mitigated critical bed shortages during pandemic peaks. A successful COpAT program requires a multidisciplinary group: close ID physician-pharmacist collaboration extending to OPAT and antimicrobial stewardship teams. With a COpAT program in place, even earlier IV to PO antimicrobial transitions should be studied.
Disclosures
All Authors: No reported disclosures.
Collapse
Affiliation(s)
| | - Andrew Ward
- West Virginia University , Morgantown, West Virginia
| | | | | | - Douglas Slain
- West Virginia University , Morgantown, West Virginia
| | | | | | | |
Collapse
|
7
|
Marra AR, Kobayashi T, Suzuki H, Alsuhaibani M, Hasegawa S, Tholany J, Perencevich E, Maezato AM, Ricardo VCV, Salinas JL, Edmond MB, Rizzo LV. The effectiveness of coronavirus disease 2019 (COVID-19) vaccine in the prevention of post-COVID-19 conditions: A systematic literature review and meta-analysis. Antimicrob Steward Healthc Epidemiol 2022; 2:e192. [PMID: 36505947 PMCID: PMC9726631 DOI: 10.1017/ash.2022.336] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Although multiple studies have revealed that coronavirus disease 2019 (COVID-19) vaccines can reduce COVID-19-related outcomes, little is known about their impact on post-COVID-19 conditions. We performed a systematic literature review and meta-analysis on the effectiveness of COVID-19 vaccination against post-COVID-19 conditions (ie, long COVID). METHODS We searched PubMed, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science from December 1, 2019, to April 27, 2022, for studies evaluating COVID-19 vaccine effectiveness against post-COVID-19 conditions among individuals who received at least 1 dose of Pfizer/BioNTech, Moderna, AstraZeneca, or Janssen vaccine. A post-COVID-19 condition was defined as any symptom that was present 3 or more weeks after having COVID-19. Editorials, commentaries, reviews, study protocols, and studies in the pediatric population were excluded. We calculated the pooled diagnostic odds ratios (DORs) for post-COVID-19 conditions between vaccinated and unvaccinated individuals. Vaccine effectiveness was estimated as 100% × (1 - DOR). RESULTS In total, 10 studies with 1,600,830 individuals evaluated the effect of vaccination on post-COVID-19 conditions, of which 6 studies were included in the meta-analysis. The pooled DOR for post-COVID-19 conditions among individuals vaccinated with at least 1 dose was 0.708 (95% confidence interval (CI), 0.692-0.725) with an estimated vaccine effectiveness of 29.2% (95% CI, 27.5%-30.8%). The vaccine effectiveness was 35.3% (95% CI, 32.3%-38.1%) among those who received the COVID-19 vaccine before having COVID-19, and 27.4% (95% CI, 25.4%-29.3%) among those who received it after having COVID-19. CONCLUSIONS COVID-19 vaccination both before and after having COVID-19 significantly decreased post-COVID-19 conditions for the circulating variants during the study period although vaccine effectiveness was low.
Collapse
Affiliation(s)
- Alexandre R. Marra
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs Health Care System, Iowa City, Iowa, United States
| | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Hiroyuki Suzuki
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs Health Care System, Iowa City, Iowa, United States
| | - Mohammed Alsuhaibani
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Shinya Hasegawa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs Health Care System, Iowa City, Iowa, United States
| | - Joseph Tholany
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Eli Perencevich
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs Health Care System, Iowa City, Iowa, United States
| | - Aline Miho Maezato
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | - Michael B. Edmond
- West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Luiz Vicente Rizzo
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| |
Collapse
|
8
|
Casaroto E, Generoso JR, Serpa Neto A, Prado M, Gagliardi GM, de Menezes FG, Gonçalves P, Hohmann FB, Olivato GB, Gonçalves GP, Xavier N, Fernandes Miguel M, Edmond MB, Marra AR. Comparing human to electronic observers to monitor hand hygiene compliance in an intensive care unit. Antimicrob Steward Healthc Epidemiol 2022; 2:e161. [PMID: 36483392 PMCID: PMC9726540 DOI: 10.1017/ash.2022.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE We sought to determine whether an electronic hand hygiene (HH) system could monitor HH compliance at similar rates to direct human observation. METHODS This 4-year proof-of-concept study was conducted in an intensive care unit (ICU) of a private tertiary-care hospital in São Paulo, Brazil, where electronic HH systems were installed in 2 rooms. HH compliance was reported respectively using direct observation and electronic counter devices with an infrared system for detecting HH opportunities. RESULTS In phase 1, HH compliance by human observers was 56.3% (564 of 1,001 opportunities), while HH compliance detected by the electronic observer was 51.0% (515 of 1,010 opportunities). In phase 2, human observers registered 484 HH opportunities with a HH compliance rate of 64.7% (313 of 484) versus 70.6% (346 of 490) simultaneously detected by the electronic system. In addition, an enhanced HH electronic system monitored activity 24 hours per day and HH compliance without the presence of a human observer was 40.3% (10,642 of 26,421 opportunities), providing evidence for the Hawthorne effect. CONCLUSIONS The electronic HH monitoring system had good correlation with human HH observation, but compliance was remarkably lower when human observers were not present due to the Hawthorne effect (25%-30% absolute difference). Electronic monitoring systems can replace direct observation and can markedly reduce the Hawthorne effect.
Collapse
Affiliation(s)
- Eduardo Casaroto
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Jose R. Generoso
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Ary Serpa Neto
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, ANZIC-RC, Melbourne, Victoria, Australia
| | - Marcelo Prado
- Universidade de São Paulo, São Carlos, São Paulo, Brazil
| | | | | | | | | | | | | | - Nathalia Xavier
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | | | - Michael B. Edmond
- West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Alexandre R. Marra
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs Health Care System, Iowa City, Iowa, United States
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| |
Collapse
|
9
|
Marra AR, Miraglia JL, Malheiros DT, Guozhang Y, Teich VD, da Silva Victor E, Rebello Pinho JR, Cypriano A, Vieira LW, Polonio M, Ornelas RH, de Oliveira SM, Borges Junior FA, Oler SCC, Schettino GDPP, de Oliveira KG, Ferraz Santana RA, de Mello Malta F, Amgarten D, Boechat AL, Trecenti NMZ, Kobayashi T, Salinas JL, Edmond MB, Rizzo LV. Effectiveness of Heterologous Coronavirus Disease 2019 (COVID-19) Vaccine Booster Dosing in Brazilian Healthcare Workers, 2021. Clin Infect Dis 2022; 76:e360-e366. [PMID: 35639918 PMCID: PMC9213833 DOI: 10.1093/cid/ciac430] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Little is currently known about vaccine effectiveness (VE) for either 2 doses of Oxford-AstraZeneca (ChAdOx1) viral vector vaccine or CoronaVac (Instituto Butantan) inactivated viral vaccine followed by a third dose of mRNA vaccine (Pfizer/BioNTech) among healthcare workers (HCWs). METHODS We conducted a retrospective cohort study among HCWs (aged ≥18 years) working in a private healthcare system in Brazil from January to December 2021. VE was defined as 1 - incidence rate ratio (IRR), with IRR determined using Poisson models with the occurrence of laboratory-confirmed coronavirus disease 2019 (COVID-19) infection as the outcome, adjusting for age, sex, and job type. We compared those receiving viral vector or inactivated viral primary series (2 doses) with those who received an mRNA booster. RESULTS A total of 11 427 HCWs met the inclusion criteria. COVID-19 was confirmed in 31.5% of HCWs receiving 2 doses of CoronaVac vaccine versus 0.9% of HCWs receiving 2 doses of CoronaVac vaccine with mRNA booster (P < .001) and 9.8% of HCWs receiving 2 doses of ChAdOx1 vaccine versus 1% among HCWs receiving 2 doses of ChAdOx1 vaccine with mRNA booster (P < .001). In the adjusted analyses, the estimated VE was 92.0% for 2 CoronaVac vaccines plus mRNA booster and 60.2% for 2 ChAdOx1 vaccines plus mRNA booster, when compared with those with no mRNA booster. Of 246 samples screened for mutations, 191 (77.6%) were Delta variants. CONCLUSIONS While 2 doses of ChAdOx1 or CoronaVac vaccines prevent COVID-19, the addition of a Pfizer/BioNTech booster provided significantly more protection.
Collapse
Affiliation(s)
- Alexandre R Marra
- Correspondence: A. R. Marra, University of Iowa, Department of Internal Medicine, 200 Hawkins Dr, C51-GH, Iowa City, IA 52242 (; )
| | | | | | - Yang Guozhang
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | - Miria Polonio
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Michael B Edmond
- West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | | |
Collapse
|
10
|
Casaroto E, Generoso JR, Tofaneto BM, Bariani LM, Auler MDA, Xavier N, Prado M, Victor EDS, Kobayashi T, Edmond MB, de Menezes FG, Marra AR. Hand hygiene performance in an intensive care unit before and during the COVID-19 pandemic. Am J Infect Control 2022; 50:585-587. [PMID: 35114323 PMCID: PMC8801589 DOI: 10.1016/j.ajic.2022.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/28/2022]
Abstract
The current COVID-19 pandemic has heightened the focus on infection prevention in hospitals. We evaluated hand hygiene compliance with alcohol-based hand rub via electronic observation among healthcare workers in an intensive care unit from 2017 to 2020. The COVID-19 pandemic was not associated with an increase in hand hygiene compliance.
Collapse
|
11
|
Alsuhaibani M, Kobayashi T, McPherson C, Holley S, Marra AR, Trannel A, Dains A, Abosi OJ, Jenn KE, Meacham H, Sheeler L, Etienne W, Kukla ME, Wellington M, Edmond MB, Diekema DJ, Salinas JL. Impact of COVID-19 on an infection prevention and control program, Iowa 2020-2021. Am J Infect Control 2022; 50:277-282. [PMID: 35000801 PMCID: PMC8731683 DOI: 10.1016/j.ajic.2021.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 01/15/2023]
Abstract
Background The COVID-19 pandemic has affected infection prevention and control (IPC) programs worldwide. We evaluated the impact of COVID-19 on the University of Iowa Hospitals & Clinics IPC program by measuring the volume of calls to the program, changes in healthcare-associated infection rates, and team member perceptions. Methods We retrieved the IPC call log and healthcare-associated infection trends for 2018-2020. We defined 2 periods: pre-COVID-19 (2018-2019) and COVID-19 (January-December 2020). We also conducted one-on-one interviews and focus group interviews with members of the IPC program and describe changes in their working conditions during the COVID-19 period. Results A total of 6,564 calls were recorded during 2018-2020. The pre-COVID-19 period had a median of 71 calls and/or month (range: 50-119). During the COVID-19 period, the median call volume increased to 368/month (range: 149-829), and most calls were related to isolation precautions (50%). During the COVID-19 period, the central line-associated bloodstream infection incidence increased significantly. Infection preventionists reported that the ambiguity and conflicting guidance during the pandemic were major challenges. Conclusions Our IPC program experienced a 500% increase in consultation requests. Planning for future bio-emergencies should include creative strategies to increase response capacity within IPC programs.
Collapse
Affiliation(s)
- Mohammed Alsuhaibani
- University of Iowa Hospitals & Clinics, Iowa City, IA, USA; Department of Pediatrics, College of Medicine, Qassim University, Qassim, Saudi Arabia.
| | | | - Chad McPherson
- University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | | | - Alexandre R Marra
- University of Iowa Hospitals & Clinics, Iowa City, IA, USA; Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Oluchi J Abosi
- University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Kyle E Jenn
- University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Holly Meacham
- University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | | | | | - Mary E Kukla
- University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | | | - Michael B Edmond
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | | | | |
Collapse
|
12
|
Marra AR, Kobayashi T, Suzuki H, Alsuhaibani M, Tofaneto BM, Bariani LM, Auler MDA, Salinas JL, Edmond MB, Doll M, Kutner JM, Pinho JRR, Rizzo LV, Miraglia JL, Schweizer ML. Short-term effectiveness of COVID-19 vaccines in immunocompromised patients: A systematic literature review and meta-analysis. J Infect 2022; 84:297-310. [PMID: 34982962 PMCID: PMC8720049 DOI: 10.1016/j.jinf.2021.12.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We aimed to assess the short-term effectiveness of COVID-19 vaccines among immunocompromised patients to prevent laboratory-confirmed symptomatic COVID-19 infection. METHODS Systematic review and meta-analysis. We calculated the pooled diagnostic odds ratio [DOR] (95% CI) for COVID-19 infection between immunocompromised patients and healthy people or those with stable chronic medical conditions. VE was estimated as 100% x (1-DOR). We also investigated the rates of developing anti-SARS-CoV-2 spike protein IgG between the 2 groups. RESULTS Twenty studies evaluating COVID-19 vaccine response, and four studies evaluating VE were included in the meta-analysis. The pooled DOR for symptomatic COVID-19 infection in immunocompromised patients was 0.296 (95% CI: 0.108-0.811) with an estimated VE of 70.4% (95% CI: 18.9%- 89.2%). When stratified by diagnosis, IgG antibody levels were much higher in the control group compared to immunocompromised patients with solid organ transplant (pOR 232.3; 95% Cl: 66.98-806.03), malignant diseases (pOR 42.0, 95% Cl: 11.68-151.03), and inflammatory rheumatic diseases (pOR 19.06; 95% Cl: 5.00-72.62). CONCLUSIONS We found COVID-19 mRNA vaccines were effective against symptomatic COVID-19 among the immunocompromised patients but had lower VE compared to the controls. Further research is needed to understand the discordance between antibody production and protection against symptomatic COVID-19 infection.
Collapse
Affiliation(s)
- Alexandre R Marra
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Hospital Israelita Albert Einstein, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa, IA, USA.
| | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Hiroyuki Suzuki
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa, IA, USA
| | - Mohammed Alsuhaibani
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Department of Pediatrics, College of Medicine, Qassim University, Qassim, Saudi Arabia
| | | | | | | | | | - Michael B Edmond
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Michelle Doll
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | | | - Luiz Vicente Rizzo
- Hospital Israelita Albert Einstein, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - João Luiz Miraglia
- Saúde Populacional, Diretoria de Medicina Diagnóstica Ambulatorial, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marin L Schweizer
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa, IA, USA
| |
Collapse
|
13
|
Generoso JR, Casaroto E, Neto AS, Prado M, Gagliardi GM, de Menezes FG, Gonçalves P, Hohmann FB, Olivato GB, Gonçalves GP, Pereira AM, Xavier N, Miguel MF, da Silva Victor E, Edmond MB, Marra AR. Comparison of two electronic hand hygiene systems using real-time feedback via wireless technology to improve hand hygiene compliance in an intensive care unit. Antimicrob Steward Healthc Epidemiol 2022; 2:e127. [PMID: 36483415 PMCID: PMC9726596 DOI: 10.1017/ash.2022.270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 04/25/2023]
Abstract
BACKGROUND Most hand hygiene (HH) intervention studies use a quasi-experimental design, are primarily uncontrolled before-and-after studies, or are controlled before-and-after studies with a nonequivalent control group. Well-funded studies with improved designs and HH interventions are needed. OBJECTIVES To evaluate healthcare worker (HCW) HH compliance with alcohol-based hand rub (ABHR) through direct observation (human observer), 2 electronic technologies, a radio frequency identification (RFID) badge system, and an invasive device sensor. METHODS In our controlled experimental study, 2,269 observations were made over a 6-month period from July 1 to December 30, 2020, in a 4-bed intensive care unit. We compared HH compliance between a basic feedback loop system with RFID badges and an enhanced feedback loop system that utilized sensors on invasive devices. RESULTS Real-time feedback by wireless technology connected to a patient's invasive device (enhanced feedback loop) resulted in a significant increase in HH compliance (69.5% in the enhanced group vs 59.1% in the basic group; P = .0001). CONCLUSION An enhanced feedback loop system connected to invasive devices, providing real-time alerts to HCWs, is effective in improving HH compliance.
Collapse
Affiliation(s)
- José R Generoso
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Eduardo Casaroto
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Ary Serpa Neto
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Monash University, ANZIC-RC, Melbourne, New South Wales, Australia
| | - Marcelo Prado
- Universidade de São Paulo, São Carlos, São Paulo, Brazil
| | | | | | - Priscila Gonçalves
- Infection Control Unit, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Fábio Barlem Hohmann
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Guilherme Benfatti Olivato
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Gustavo Potratz Gonçalves
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Andréa Marques Pereira
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Nathalia Xavier
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Marcelo Fernandes Miguel
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Elivane da Silva Victor
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Michael B Edmond
- West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Alexandre R Marra
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| |
Collapse
|
14
|
Abosi OJ, Kobayashi T, Holley S, Kukla ME, Dains A, Alsuhaibani M, Marra AR, Jenn KE, Meacham H, Sheeler LL, Etienne W, Trannel A, Garringer J, Millard W, Diekema DJ, Edmond MB, Wellington M, Salinas JL. Stable Clostridioides difficile infection rates after the discontinuation of ultraviolet light for terminal disinfection at a tertiary care center, Iowa 2019-2020. Am J Infect Control 2021; 49:1567-1568. [PMID: 34400244 DOI: 10.1016/j.ajic.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
We compared the incidence of Clostridioides difficile infection before and after the discontinuation of Ultraviolet light used in addition to bleach in terminal disinfection of hospital rooms. We found no difference in C. difficile infection rates but found a decreased turn over time. The benefit of Ultraviolet light may be diminished in hospitals with a high thoroughness of manual cleaning.
Collapse
|
15
|
Pakyz AL, Wang H, Ozcan YA, Edmond MB, Vogus TJ. Leapfrog Hospital Safety Score, Magnet Designation, and Healthcare-Associated Infections in United States Hospitals. J Patient Saf 2021; 17:445-450. [PMID: 28452915 DOI: 10.1097/pts.0000000000000378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/21/2022]
Abstract
OBJECTIVE Healthcare-associated infections (HAIs) pose a challenge to patient safety. Although studies have explored individual level, few have focused on organizational factors such as a hospital's safety infrastructure (indicated by Leapfrog Hospital Safety Score) or workplace quality (Magnet recognition). The aim of the study was to determine whether Magnet and hospitals with better Leapfrog Hospital Safety Scores have fewer HAIs. METHODS Ordered probit regression analyses tested associations between Safety Score, Magnet status, and standardized infection ratios, depicting whether a hospital had a Clostridium difficile infection (CDI) and methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection standardized infection ratio that was "better," "no different," or "worse" than a National Benchmark as per Centers for Disease Control and Prevention's National Healthcare Safety Network definitions. RESULTS Accounting for confounders, relative to "A" hospitals, "B" and "C" hospitals had significant and negative relationships with CDI (-0.16, P < 0.01, and -0.14, P < 0.05, respectively) but not MRSA bacteremia. Magnet hospitals had a significant and positive relationship with MRSA bloodstream infections (0.74, P < 0.001) but a significant negative relationship with CDI (-0.21, P < 0.01) compared with non-Magnet. CONCLUSIONS A hospitals performed better on CDI but not MRSA bloodstream infections. In contrast, Magnet designation was associated with fewer than expected MRSA infections but more than expected CDIs. These mixed results indicate that hospital global assessments of safety and workplace quality differentially and imperfectly predict its level of HAIs, suggesting the need for more precise organizational measures of safety and more nuanced approaches to infection prevention and reduction.
Collapse
Affiliation(s)
- Amy L Pakyz
- From the Departments of Pharmacotherapy and Outcomes Science, School of Pharmacy
| | - Hui Wang
- Biostatistics, School of Medicine
| | - Yasar A Ozcan
- Health Administration, School of Allied Health Professions, Virginia Commonwealth University, Richmond, Virginia
| | - Michael B Edmond
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Timothy J Vogus
- Owen Graduate School of Management, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
16
|
de Almeida SM, de Menezes FG, Martino MDV, Tachira CR, Toniolo ADR, Fukumoto HL, Edmond MB, Marra AR. Impact of a surgical safety checklist on surgical site infections, antimicrobial resistance, antimicrobial consumption, costs and mortality. J Hosp Infect 2021; 116:10-15. [PMID: 34004223 DOI: 10.1016/j.jhin.2021.05.003] [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: 01/11/2021] [Revised: 04/25/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In 2010, following the recommendations of the World Health Organization (WHO), our hospital implemented a surgical safety programme centred around a surgical safety checklist. AIM The aim of this study was to compare indicators of surgical site infection, antimicrobial consumption, antimicrobial resistance, costs and in-hospital mortality before (January 2006 to July 2010) and after (August 2010 to December 2014) implementation of the programme. METHODS A case-control study was carried out matching patients with surgical site infection (SSI) to surgical patients without infection to examine the impact of the intervention. FINDINGS Use of the surgical checklist was associated with a significant reduction in SSI. When comparing the two time periods, we also identified a reduction in infections due to micro-organisms in the ESKAPE group (from 90.7% to 73.9%, P<0.001), a reduction of SSI in patients with contaminated, infected and potentially contaminated wounds, and for those in whom perioperative antimicrobial prophylaxis was discontinued in less than 48 hours. Overall, there was a reduction in antimicrobial resistance, though there was increased resistance to carbapenems for, to glycopeptides for Enterococcus faecium, and to clindamycin for Staphylococcus aureus. We also detected increased antimicrobial consumption of second- and third-generation cephalosporins and clindamycin. We observed a reduction in hospital deaths from 6.4% to 3.2% (P=0.001), but we did not observe any reduction in costs. CONCLUSIONS Implementation of a surgical checklist was an independent predictor of SSI reduction, and was also associated with a decrease in antimicrobial resistance and reduced in-hospital mortality.
Collapse
Affiliation(s)
| | - F G de Menezes
- Hospital Infection Control Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - M D V Martino
- Clinical Microbiology Laboratory Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - C R Tachira
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - A do R Toniolo
- Hospital Infection Control Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - H L Fukumoto
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - M B Edmond
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - A R Marra
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA; Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| |
Collapse
|
17
|
Marra AR, Edmond MB, Popescu SV, Perencevich EN. Examining the need for eye protection for coronavirus disease 2019 (COVID-19) prevention in the community. Infect Control Hosp Epidemiol 2021; 42:646-647. [PMID: 32576322 PMCID: PMC7338438 DOI: 10.1017/ice.2020.314] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Alexandre R. Marra
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, United States
- Department of Internal Medicine, University of Iowa Hospital & Clinics, Iowa City, Iowa, United States
- Albert Einstein Jewish Institute for Education and Research, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Michael B. Edmond
- Department of Internal Medicine, University of Iowa Hospital & Clinics, Iowa City, Iowa, United States
| | | | - Eli N. Perencevich
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, United States
- Department of Internal Medicine, University of Iowa Hospital & Clinics, Iowa City, Iowa, United States
| |
Collapse
|
18
|
Alzunitan MA, Perencevich EN, Edmond MB. Assessing health care worker perceptions of face coverings during the COVID-19 pandemic. Am J Infect Control 2021; 49:521-522. [PMID: 32980435 PMCID: PMC7513918 DOI: 10.1016/j.ajic.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/03/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022]
Abstract
The Coronavirus Disease 2019 pandemic created a significant disruption in the personal protective equipment (PPE) supply chain while simultaneously creating unprecedented demand for their use. Hospitals pursued different PPE strategies based on local factors, PPE availability, and interpretation of the evolving data on the epidemiology of the disease. After instituting universal face coverings, we sought to assess the comfort and tolerability, along with the advantages and disadvantages for face masks and face shields through a survey of employees at an academic medical center.
Collapse
|
19
|
Marins TA, Marra AR, Edmond MB, Colombo LRP, Vieira SF, de Oliveira Xavier F, Chauvin AG, Pinho JRR, de Almeida SM, Junior MSD. Adverse drug reactions and drug interactions in the treatment of hospitalized patients with coronavirus disease 2019 (COVID-19). Antimicrob Steward Healthc Epidemiol 2021; 1:e38. [PMID: 36168493 PMCID: PMC9495530 DOI: 10.1017/ash.2021.196] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 04/16/2023]
Abstract
OBJECTIVES To identify drugs that were administered off label to hospitalized patients with suspected coronavirus disease 2019 (COVID-19) and to identify adverse drug reactions (ADRs) and drug-drug interactions associated with these therapies. METHODS This case-control study was conducted in a Brazilian hospital from March to April 2020 among patients with suspected COVID-19, comparing those with positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction (RT-PCR) results and those with negative results. RESULTS The most commonly used medications in both groups were azithromycin and hydroxychloroquine. There was a significantly higher prevalence of reactions among patients with positive RT-PCR for SARS-CoV-2 (48.5% vs 28.8%; P = .008) in the propensity score-matched cohort, and the most commonly reported ADRs among these patients were diarrhea (43.8%), elevated liver enzymes (31.3%), and nausea and vomiting (29.7%). CONCLUSIONS Our data demonstrate that ADRs and drug-drug interactions are common with off-label treatments for COVID-19.
Collapse
Affiliation(s)
- Tatiana A. Marins
- Department of Clinical Pharmacy, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Alexandre R. Marra
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
- Author for correspondence: Alexandre R. Marra, PharmD, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA52242. E-mail:
| | - Michael B. Edmond
- West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | | | | | | | | | | | - Silvana M. de Almeida
- Department of Clinical Pharmacy, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | |
Collapse
|
20
|
Haessler S, Martin EM, Scales ME, Kang L, Doll M, Stevens MP, Uslan DZ, Pryor R, Edmond MB, Godbout E, Abbas S, Bearman G. Stopping the routine use of contact precautions for management of MRSA and VRE at three academic medical centers: An interrupted time series analysis. Am J Infect Control 2020; 48:1466-1473. [PMID: 32634537 DOI: 10.1016/j.ajic.2020.06.219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/19/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Contact precautions (CP) are a widely adopted strategy to prevent cross-transmission of organisms, commonly methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Some hospitals have discontinued CP for patients with MRSA or VRE; however, the impact on hospital-acquired infection rates (HAI) has not been assessed systematically. METHODS Retrospective multicenter interrupted time series between 2002 and 2017 at three academic hospitals. Participating hospitals discontinued CP for patients with contained body fluids who were colonized or infected with MRSA or VRE. The primary intervention was stopping the use of CP. Secondary interventions were horizontal infection prevention strategies. The primary outcomes were rates of central line-associated bloodstream infections, catheter-associated urinary tract infections, mediastinal surgical site infection, and ventilator-associated pneumonia due to MRSA, VRE, or any organism using Centers for Disease Control and Prevention National Healthcare Safety Network surveillance definitions. RESULTS Central line-associated bloodstream infections, catheter-associated urinary tract infections, mediastinal surgical site infection, and ventilator-associated pneumonia rates trended down at each institution. There were no statistically significant increases in these infections associated with discontinuing CP. Individual horizontal infection prevention strategies variably impacted HAI outcomes. CONCLUSIONS Stopping the routine use of CP for patients with contained body fluids who are colonized or infected with MRSA or VRE did not result in increased HAIs. Bundled horizontal infection prevention strategies resulted in sustained HAI reductions.
Collapse
Affiliation(s)
- Sarah Haessler
- Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School-Baystate, Springfield, MA.
| | - Elise M Martin
- Division of Infectious Diseases, University of Pittsburgh Medical Center-Presbyterian Hospital, Pittsburgh, PA
| | - Mary Ellen Scales
- Division of Healthcare Quality, Baystate Medical Center, Springfield, MA
| | - Le Kang
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA
| | - Michelle Doll
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, VA
| | - Michael P Stevens
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, VA
| | - Daniel Z Uslan
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Rachel Pryor
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, VA
| | - Michael B Edmond
- Division of Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Emily Godbout
- Division of Pediatric Infectious Diseases, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Salma Abbas
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Gonzalo Bearman
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, VA
| |
Collapse
|
21
|
Kobayashi T, Trannel A, Holley SA, Alsuhaibani M, Abosi OJ, Jenn KE, Meacham H, Sheeler LL, Etienne W, Dains A, Casado F, Kukla ME, Ward E, Ford B, Edmond MB, Wellington M, Diekema DJ, Salinas JL. COVID-19 Serial Testing among Hospitalized Patients in a Midwest Tertiary Medical Center, July-September 2020. Clin Infect Dis 2020; 73:e3116-e3119. [PMID: 33103196 PMCID: PMC7665386 DOI: 10.1093/cid/ciaa1630] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Indexed: 01/12/2023] Open
Abstract
We implemented serial COVID-19 testing for inpatients with a negative test on admission. The conversion rate (negative to positive) on repeat testing was one percent. We identified patients during their incubation period and hospital-onset cases, rapidly isolated them, and potentially reduced exposures. Serial testing and infectiousness determination were resource intensive.
Collapse
Affiliation(s)
| | | | | | | | | | - Kyle E Jenn
- University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Holly Meacham
- University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | | | | | | | | | - Mary E Kukla
- University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Emily Ward
- University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Bradley Ford
- University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | | | | | | | | |
Collapse
|
22
|
Duane TM, Zuo JX, Wolfe LG, Bearman G, Edmond MB, Lee K, Cooksey L, Stevens MP. Surgeons Do Not Listen: Evaluation of Compliance with Antimicrobial Stewardship Program Recommendations. Am Surg 2020. [DOI: 10.1177/000313481307901218] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to determine if there are differences in interventions (int) required and compliance (comp) to recommendations (rec) by medical and surgical services as determined by an antimicrobial stewardship program (ASP). Concurrently collected ASP data from January 2008 through May 2011 were evaluated to determine number of int required and response to int. Results for medical (med) and surgical (surg) services were compared. There were 2322 int, of which 1108 were for med and 1214 were for surg. Recs were as follows: 242 appropriate coverage (AC) med versus 212 AC surg and 866 selective pressure (SP) med and 1002 SP surg. Comp with recs was higher for med: AC: 90.5 per cent (219 of 242) med versus 82.1 per cent (174 of 212) surg ( P = 0.0086) and SP: 81.1 per cent (702 of 866) med versus 69.5 per cent (696 of 1002) surg ( P < 0.0001). Overall surgical comp with ASP recs was better for AC than for SP. Moreover, less than half (seven of 15) of the surgical subspecialties demonstrated a comp of 75 per cent or greater with SP recs with only one-fifth having a comp over 80 per cent. Surgical services demonstrate poor compliance with ASP recommendations; this is especially true for interventions targeting selective pressure. By identifying services that are less compliant, programs can target their educational efforts to improve outcomes.
Collapse
Affiliation(s)
- Therese M. Duane
- From Virginia Commonwealth University Health System, Richmond, Virginia
| | - Jessica X. Zuo
- From Virginia Commonwealth University Health System, Richmond, Virginia
| | - Luke G. Wolfe
- From Virginia Commonwealth University Health System, Richmond, Virginia
| | - Gonzalo Bearman
- From Virginia Commonwealth University Health System, Richmond, Virginia
| | - Michael B. Edmond
- From Virginia Commonwealth University Health System, Richmond, Virginia
| | - Kimberly Lee
- From Virginia Commonwealth University Health System, Richmond, Virginia
| | - Laurie Cooksey
- From Virginia Commonwealth University Health System, Richmond, Virginia
| | | |
Collapse
|
23
|
Affiliation(s)
- Eli N Perencevich
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa
- Carver College of Medicine, Department of Internal Medicine, The University of Iowa, Iowa City
| | - Daniel J Diekema
- Carver College of Medicine, Department of Internal Medicine, The University of Iowa, Iowa City
| | - Michael B Edmond
- Carver College of Medicine, Department of Internal Medicine, The University of Iowa, Iowa City
| |
Collapse
|
24
|
Tartari E, Saris K, Kenters N, Marimuthu K, Widmer A, Collignon P, Cheng VCC, Wong SC, Gottlieb T, Tambyah PA, Perencevich E, Allegranzi B, Dramowski A, Edmond MB, Voss A. Not sick enough to worry? "Influenza-like" symptoms and work-related behavior among healthcare workers and other professionals: Results of a global survey. PLoS One 2020; 15:e0232168. [PMID: 32401751 PMCID: PMC7219706 DOI: 10.1371/journal.pone.0232168] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 10/29/2019] [Accepted: 04/09/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Healthcare workers (HCWs) and non-HCWs may contribute to the transmission of influenza-like illness (ILI) to colleagues and susceptible patients by working while sick (presenteeism). The present study aimed to explore the views and behavior of HCWs and non-HCWs towards the phenomenon of working while experiencing ILI. METHODS The study was a cross-sectional online survey conducted between October 2018 and January 2019 to explore sickness presenteeism and the behaviour of HCWs and non-HCWs when experiencing ILI. The survey questionnaire was distributed to the members and international networks of the International Society of Antimicrobial Chemotherapy (ISAC) Infection Prevention and Control (IPC) Working Group, as well as via social media platforms, including LinkedIn, Twitter and IPC Blog. RESULTS In total, 533 respondents from 49 countries participated (Europe 69.2%, Asia-Pacific 19.1%, the Americas 10.9%, and Africa 0.8%) representing 249 HCWs (46.7%) and 284 non-HCWs (53.2%). Overall, 312 (58.5%; 95% confidence interval [CI], 56.2-64.6) would continue to work when sick with ILI, with no variation between the two categories. Sixty-seven (26.9%) HCWs and forty-six (16.2%) non-HCWs would work with fever alone (p<0 .01) Most HCWs (89.2-99.2%) and non-HCWs (80%-96.5%) would work with "minor" ILI symptoms, such as sore throat, sinus cold, fatigue, sneezing, runny nose, mild cough and reduced appetite. CONCLUSION A future strategy to successfully prevent the transmission of ILI in healthcare settings should address sick-leave policy management, in addition to encouraging the uptake of influenza vaccine.
Collapse
Affiliation(s)
- Ermira Tartari
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Katja Saris
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
- REshape Center for Innovation, Radboudumc, Nijmegen, The Netherlands
| | - Nikki Kenters
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
| | - Kalisvar Marimuthu
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andreas Widmer
- University of Basel Hospitals and Clinics, Basel, Switzerland
| | - Peter Collignon
- Medical School, The Australian National University, Canberra, ACT, Australia
| | - Vincent C. C. Cheng
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hospital Authority, Hong Kong SAR, China
| | - Shuk C. Wong
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hospital Authority, Hong Kong SAR, China
| | - Thomas Gottlieb
- Department of Microbiology and Infectious Diseases Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Paul A. Tambyah
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Eli Perencevich
- Divisions of General Internal Medicine and Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, IA, United States of Amrerica
| | - Benedetta Allegranzi
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Stellenbosch University, Cape Town, South Africa
| | - Michael B. Edmond
- University of Iowa Hospitals and Clinics, Iowa City, IA, United States of America
| | - Andreas Voss
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
- REshape Center for Innovation, Radboudumc, Nijmegen, The Netherlands
| | | |
Collapse
|
25
|
Marra AR, Puig-Asensio M, Edmond MB, Schweizer ML, Bender D. Infectious complications of laparoscopic and robotic hysterectomy: a systematic literature review and meta-analysis. Int J Gynecol Cancer 2020; 29:518-530. [PMID: 30833440 DOI: 10.1136/ijgc-2018-000098] [Citation(s) in RCA: 4] [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: 10/12/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE We performed a systematic review of the literature and meta-analysis of the infectious complications of hysterectomy, comparing robotic-assisted hysterectomy to conventional laparoscopic-assisted hysterectomy. METHODS We searched PubMed, CINAHL, CDSR, and EMBASE through July 2018 for studies evaluating robotic-assisted hysterectomy, laparoscopic-assisted hysterectomy, and infectious complications. We employed random-effect models to obtain pooled OR estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. Pooled ORs were calculated separately based on the reason for hysterectomy (eg, benign uterine diseases, endometrial cancer, and cervical cancer). RESULTS Fifty studies were included in the final review for the meta-analysis with 176 016 patients undergoing hysterectomy. There was no statistically significant difference in the number of infectious complication events between robotic-assisted hysterectomy and laparoscopic-assisted hysterectomy (pooled OR 0.97; 95 % CI 0.74 to 1.28). When we performed a stratified analysis, similar results were found with no statistically significant difference in infectious complications comparing robotic-assisted hysterectomy to laparoscopic-assisted hysterectomy among patients with benign uterine disease (pooled OR 1.10; 95 % CI 0.70 to 1.73), endometrial cancer (pooled OR 0.97; 95 % CI 0.55 to 1.73), or cervical cancer (pooled OR 1.09; 95 % CI 0.60 to 1.97). CONCLUSION In our meta-analysis the rate of infectious complications associated with robotic-assisted hysterectomy was no different than that associated with conventional laparoscopic-assisted hysterectomy.
Collapse
Affiliation(s)
- Alexandre R Marra
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mireia Puig-Asensio
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
| | - Michael B Edmond
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Marin L Schweizer
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - David Bender
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| |
Collapse
|
26
|
Marra AR, Algwizani A, Alzunitan M, Brennan TMH, Edmond MB. Descriptive Epidemiology of Safety Events at an Academic Medical Center. Int J Environ Res Public Health 2020; 17:ijerph17010353. [PMID: 31947963 PMCID: PMC6982027 DOI: 10.3390/ijerph17010353] [Citation(s) in RCA: 4] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/26/2019] [Accepted: 01/02/2020] [Indexed: 11/16/2022]
Abstract
Background: Adverse safety events in healthcare are of great concern, and despite an increasing focus on the prevention of error and harm mitigation, the epidemiology of safety events remains incomplete. Methods: We performed an analysis of all reported safety events in an academic medical center using a voluntary incident reporting surveillance system for patient safety. Safety events were classified as: serious (reached the patient and resulted in moderate to severe harm or death); precursor (reached the patient and resulted in minimal or no detectable harm); and near miss (did not reach the patient). Results: During a three-year period, there were 31,817 events reported. Most of the safety events were precursor safety events (reached the patient and resulted in minimal harm or no detectable harm), corresponding to 77.3%. Near misses accounted for 10.8%, and unsafe conditions for 11.8%. The number of reported serious safety events was low, accounting for only 0.1% of all safety events. Conclusions: The reports analysis of these events should lead to a better understanding of risks in patient care and ways to mitigate it.
Collapse
Affiliation(s)
- Alexandre R. Marra
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
- Division of Medical Practice, Hospital Israelita Albert Einstein, 05652 São Paulo, Brazil
- Correspondence: ; Tel.: +1-319-353-7155; Fax: +1-319-353-7043
| | - Abdullah Algwizani
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
- Division of Infectious Diseases, Prince Mohammad Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia
| | - Mohammed Alzunitan
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
- Department of Infection Prevention and Control, King Abdulaziz Medical City, National Guard-Health Affairs, Riyadh 14611, Saudi Arabia
| | - Theresa M. H. Brennan
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
| | - Michael B. Edmond
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; (A.A.); (M.A.); (T.M.H.B.); (M.B.E.)
| |
Collapse
|
27
|
Abstract
Metronidazole is commonly used in the treatment of anaerobic infections. While neuropathy is known to be associated with metronidazole, encephalopathy has been rarely reported. We herein present a case of metronidazole-induced encephalopathy presenting as frequent falls and slurred speech. Magnetic resonance imaging of the brain demonstrated T2/FLAIR hyperintensity in the dentate nuclei bilaterally. Soon after the discontinuation of metronidazole, dysarthria and dysmetria resolved. Metronidazole-induced encephalopathy should be considered in patients presenting with new neurologic symptoms after the initiation of metronidazole.
Collapse
Affiliation(s)
- Htay Phyu
- Division of Infectious Diseases, University of Iowa Hospitals and Clinics, United States
| | - Michael B Edmond
- Division of Infectious Diseases, University of Iowa Hospitals and Clinics, United States
| | - Takaaki Kobayashi
- Division of Infectious Diseases, University of Iowa Hospitals and Clinics, United States
| |
Collapse
|
28
|
Godbout EJ, Masroor N, Doll M, Edmond MB, Bearman G, Stevens MP. Bare below the elbows in an academic medical center. Am J Infect Control 2019; 47:1030-1031. [PMID: 30638675 DOI: 10.1016/j.ajic.2018.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 11/24/2022]
Abstract
We investigated the compliance of health care personnel with a voluntary, institution-wide bare below the elbows (BBE) approach to inpatient care at an academic medical center. BBE compliance increased significantly across all provider types over a 2-year period. The overall compliance with BBE by health care personnel nearly doubled from 2016-2017, increasing significantly from 40% to 84%.
Collapse
|
29
|
Verbeek JH, Rajamaki B, Ijaz S, Tikka C, Ruotsalainen JH, Edmond MB, Sauni R, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2019; 7:CD011621. [PMID: 31259389 PMCID: PMC6601138 DOI: 10.1002/14651858.cd011621.pub3] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In epidemics of highly infectious diseases, such as Ebola Virus Disease (EVD) or Severe Acute Respiratory Syndrome (SARS), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Contact precautions by means of personal protective equipment (PPE) can reduce the risk. It is unclear which type of PPE protects best, what is the best way to remove PPE, and how to make sure HCW use PPE as instructed. OBJECTIVES To evaluate which type of full body PPE and which method of donning or doffing PPE have the least risk of self-contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS We searched MEDLINE (PubMed up to 15 July 2018), Cochrane Central Register of Trials (CENTRAL up to 18 June 2019), Scopus (Scopus 18 June 2019), CINAHL (EBSCOhost 31 July 2018), and OSH-Update (up to 31 December 2018). We also screened reference lists of included trials and relevant reviews, and contacted NGOs and manufacturers of PPE. SELECTION CRITERIA We included all controlled studies that compared the effects of PPE used by HCW exposed to highly infectious diseases with serious consequences, such as Ebola or SARS, on the risk of infection, contamination, or noncompliance with protocols. This included studies that used simulated contamination with fluorescent markers or a non-pathogenic virus.We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training in PPE use on the same outcomes. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, extracted data and assessed risk of bias in included trials. We planned to perform meta-analyses but did not find sufficiently similar studies to combine their results. MAIN RESULTS We included 17 studies with 1950 participants evaluating 21 interventions. Ten studies are Randomised Controlled Trials (RCTs), one is a quasi RCT and six have a non-randomised controlled design. Two studies are awaiting assessment.Ten studies compared types of PPE but only six of these reported sufficient data. Six studies compared different types of donning and doffing and three studies evaluated different types of training. Fifteen studies used simulated exposure with fluorescent markers or harmless viruses. In simulation studies, contamination rates varied from 10% to 100% of participants for all types of PPE. In one study HCW were exposed to Ebola and in another to SARS.Evidence for all outcomes is based on single studies and is very low quality.Different types of PPEPPE made of more breathable material may not lead to more contamination spots on the trunk (Mean Difference (MD) 1.60 (95% Confidence Interval (CI) -0.15 to 3.35) than more water repellent material but may have greater user satisfaction (MD -0.46; 95% CI -0.84 to -0.08, scale of 1 to 5).Gowns may protect better against contamination than aprons (MD large patches -1.36 95% CI -1.78 to -0.94).The use of a powered air-purifying respirator may protect better than a simple ensemble of PPE without such respirator (Relative Risk (RR) 0.27; 95% CI 0.17 to 0.43).Five different PPE ensembles (such as gown vs. coverall, boots with or without covers, hood vs. cap, length and number of gloves) were evaluated in one study, but there were no event data available for compared groups.Alterations to PPE design may lead to less contamination such as added tabs to grab masks (RR 0.33; 95% CI 0.14 to 0.80) or gloves (RR 0.22 95% CI 0.15 to 0.31), a sealed gown and glove combination (RR 0.27; 95% CI 0.09 to 0.78), or a better fitting gown around the neck, wrists and hands (RR 0.08; 95% CI 0.01 to 0.55) compared to standard PPE.Different methods of donning and doffing proceduresDouble gloving may lead to less contamination compared to single gloving (RR 0.36; 95% CI 0.16 to 0.78).Following CDC recommendations for doffing may lead to less contamination compared to no guidance (MD small patches -5.44; 95% CI -7.43 to -3.45).Alcohol-based hand rub used during the doffing process may not lead to less contamination than the use of a hypochlorite based solution (MD 4.00; 95% CI 0.47 to 34.24).Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4).Different types of trainingThe use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7).A video lecture on donning PPE may lead to better skills scores (MD 30.70; 95% CI 20.14,41.26) than a traditional lecture.Face to face instruction may reduce noncompliance with doffing guidance more (OR 0.45; 95% CI 0.21 to 0.98) than providing folders or videos only.There were no studies on effects of training in the long term or on resource use.The quality of the evidence is very low for all comparisons because of high risk of bias in all studies, indirectness of evidence, and small numbers of participants. AUTHORS' CONCLUSIONS We found very low quality evidence that more breathable types of PPE may not lead to more contamination, but may have greater user satisfaction. Alterations to PPE, such as tabs to grab may decrease contamination. Double gloving, following CDC doffing guidance, and spoken instructions during doffing may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than video or folder based training. Because data come from single small studies with high risk of bias, we are uncertain about the estimates of effects.We still need randomised controlled trials to find out which training works best in the long term. We need better simulation studies conducted with several dozen participants to find out which PPE protects best, and what is the safest way to remove PPE. Consensus on the best way to conduct simulation of exposure and assessment of outcome is urgently needed. HCW exposed to highly infectious diseases should have their use of PPE registered and should be prospectively followed for their risk of infection in the field.
Collapse
Affiliation(s)
- Jos H Verbeek
- University of Eastern FinlandCochrane Work Review GroupKuopioFinland70201
| | - Blair Rajamaki
- University of Eastern FinlandInstitute of Public Health and Clinical Nutrition, Occupational Health UnitKuopioFinland
| | - Sharea Ijaz
- University of BristolPopulation Health Sciences, Bristol Medical SchoolBristolUKBS1 2NT
| | - Christina Tikka
- Finnish Institute of Occupational HealthCochrane Work Review GroupTYÖTERVEYSLAITOSFinlandFI‐70032
| | - Jani H Ruotsalainen
- Coronel Institute of Occupational HealthCochrane Work Review GroupAcademic Medical Center, University of AmsterdamPO Box 22700AmsterdamNetherlands1100 DE
| | - Michael B Edmond
- University of Iowa Hospitals and ClinicsC512 GH, 200 Hawkins DriveIowa CityIAUSA52241
| | - Riitta Sauni
- Finnish Institute of Occupational HealthP.O.Box 486TampereFinlandFI‐33101
| | - F Selcen Kilinc Balci
- Centers for Disease Control and Prevention (CDC)National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH)626 Cochrans Mill RoadPittsburghPAUSA15236
| | | |
Collapse
|
30
|
Abosi OJ, Salinas JL, Pottinger J, Holley S, Kukla M, Dains A, Diekema DJ, Edmond MB, Millard B. Improving Environmental Disinfection through Objective Assessments at a Large Teaching Hospital. Am J Infect Control 2019. [DOI: 10.1016/j.ajic.2019.04.027] [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: 10/26/2022]
|
31
|
Abstract
In 2010, the Society for Healthcare Epidemiology published a recommendation that annual influenza vaccination of healthcare workers be made a condition of employment despite no high-level evidence to support this recommendation. A better strategy for reducing the transmission of respiratory viruses in the healthcare setting would be to encourage vaccination and reduce presenteeism, which is very common among healthcare workers with influenza-like illness. In a hospital with a baseline vaccination compliance of 70%, reducing presenteeism by 2% has the equivalent impact of mandating vaccination in terms of the number of healthcare workers with influenza-like illness at work. Expectations for compliance with interventions to improve the quality of care should be correlated tightly to the underlying evidence to support the intervention, reserving mandates for interventions with very high quality supporting evidence.
Collapse
|
32
|
Marra AR, Puig-Asensio M, Edmond MB, Schweizer ML, Nepple KG. Infectious Complications of Conventional Laparoscopic vs Robotic Laparoscopic Prostatectomy: A Systematic Literature Review and Meta-Analysis. J Endourol 2019; 33:179-188. [PMID: 30632396 DOI: 10.1089/end.2018.0815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Recent studies have shown that using minimally invasive surgical techniques (conventional laparoscopy or robotic) for prostatectomy is associated with lower perioperative complication rates compared with open radical retropubic prostatectomy. However, differences in infectious complications between these minimally invasive approaches are not well characterized. To study this further, we performed a systematic review of the literature and meta-analysis of the infectious complications of prostatectomy, comparing robotic prostatectomy (RP) with conventional laparoscopic prostatectomy (LP). METHODS We searched PubMed, CINAHL, CDSR, and EMBASE through September 2018 for studies evaluating minimally invasive prostatectomy and infectious complications. We employed random-effect models to obtain pooled odds ratio (pOR) estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. pORs were calculated separately based on the indication for prostatectomy. RESULTS Fifteen studies were included in the final review for the meta-analysis with 14,121 patients undergoing minimally invasive prostatectomy. There was no statistically significant difference in the number of infectious complication events between RP and LP (pOR 0.94; 95% CI 0.50, 1.76). When we performed a stratified analysis, similar results were found with no statistically significant difference in infectious complications comparing RP with LP among patients with prostate cancer (pOR 0.73; 95% CI 0.43, 1.24). We observed that infectious complications were nearly threefold higher with the robotic approach in earlier studies (published between 2007 and 2012, pOR 2.81; 95% CI 1.07, 7.39), but no significant difference was found in later studies (between 2013 and 2018, pOR 0.80, 95% CI 0.40, 1.57). CONCLUSIONS The rate of infectious complications associated with RP was no different than that associated with conventional LP.
Collapse
Affiliation(s)
- Alexandre R Marra
- 1 Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,2 Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa.,3 Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mireia Puig-Asensio
- 1 Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,2 Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa
| | - Michael B Edmond
- 1 Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,2 Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa.,4 Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Marin L Schweizer
- 2 Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa.,5 The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
| | - Kenneth G Nepple
- 6 Department of Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| |
Collapse
|
33
|
Marra AR, Diekema DJ, Edmond MB. Mycobacterium chimaera Infections Associated With Contaminated Heater-Cooler Devices for Cardiac Surgery: Outbreak Management. Clin Infect Dis 2018; 65:669-674. [PMID: 28430899 DOI: 10.1093/cid/cix368] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 02/27/2017] [Accepted: 04/18/2017] [Indexed: 12/17/2022] Open
Abstract
The global outbreak of Mycobacterium chimaera infections associated with heater-cooler devices (HCDs) presents several important, unique challenges for the infection prevention community. The primary focus of this article is to assist hospitals in establishing a rapid response for identification, notification, and evaluation of exposed patients, and management of HCDs with regard to placement and containment, environmental culturing, and disinfection.
Collapse
Affiliation(s)
- Alexandre R Marra
- Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City.,Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Daniel J Diekema
- Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City.,Division of Medical Microbiology, Department of Pathology, University of Iowa Carver College of Medicine, Iowa City.,Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Michael B Edmond
- Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City.,Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
| |
Collapse
|
34
|
Marins TA, Marra AR, Edmond MB, Martino MDV, Yokota PKO, Mafra ACCN, Durão Junior MS. Evaluation of Candida bloodstream infection and antifungal utilization in a tertiary care hospital. BMC Infect Dis 2018; 18:187. [PMID: 29669521 PMCID: PMC5907302 DOI: 10.1186/s12879-018-3094-9] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/12/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Candida bloodstream infections carry a significant mortality risk, justifying the importance of adequate antifungal therapy. This study describes trends in antifungal consumption using the Defined Daily Dose (DDD) and Days of Therapy (DOT) metrics, identifies the microbiological profile, the time to initiation of empirical therapy, the adjustment after positive blood culture results for Candida, and the impact on in-hospital mortality rate in patients with candidemia. METHODS An analysis of antifungal consumption from 2008 to 2016, and of candidemia cases from 2012 to 2016 was carried out in a private tertiary hospital. RESULTS A total of 11,273 admissions were identified with a prescription for at least one type of antifungal therapy. Fluconazole was the most prescribed antifungal drug in terms of general consumption. Through the DDD and DOT metrics, we observed that over time, there was an increase in the consumption of liposomal amphotericin B, micafungin and voriconazole. Candida albicans was the most isolated species in blood cultures. Regarding candidemia, we analyzed samples from 115 patients. Empirical therapy was started within 24 h of blood culture in 44.3% of the cases, and in 81.7% of the cases, the antifungal was deemed to be adequate based in antifungal susceptibility testing, both of which were not associated with the in-hospital mortality rate. CONCLUSIONS Our study reinforces the importance of monitoring the consumption of antifungal agents, which helps in proposing actions that lead to their rational use and, consequently, reduces the appearance of resistant strains.
Collapse
Affiliation(s)
| | - Alexandre R. Marra
- Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - Michael B. Edmond
- Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | | | | | | | | |
Collapse
|
35
|
Masse V, Hartley MJ, Edmond MB, Diekema DJ. Comparing and optimizing ultraviolet germicidal irradiation systems use for patient room terminal disinfection: an exploratory study using radiometry and commercial test cards. Antimicrob Resist Infect Control 2018; 7:29. [PMID: 29484174 PMCID: PMC5824448 DOI: 10.1186/s13756-018-0317-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Ultraviolet germicidal irradiation (UVGI) systems are gaining popularity, however objective comparisons of their characteristics are lacking. While environmental cultures and reduction of hospital-associated infections rates are excellent study endpoints, they are impractical for centers with limited resources who want to compare or optimize UVGI systems use. Methods We evaluated radiometry and commercial test cards, two simple and low cost tools, to compare 2 full size UVGI systems (Tru-D and Optimum-UV Enlight) and 2 small units (Lumalier EDU 435 and MRSA-UV Turbo-UV). Results Radiometry-derived output curves show that if both large devices emit enough energy to reach C. difficile lethal doses at 10 ft, the reduction in output in distance is almost perfectly logarithmic. In a patient room environment, Enlight and Tru-D performed similarly when compared using radiometry and commercial test cards. The two small devices reached C. difficile range around the bathroom with the device raised above the floor, but longer times are needed. Conclusions Despite different workflows and price points, no clear superiority emerges between Tru-D and Enlight. Bathroom disinfection should be dealt with separately from the main room and small, cheaper units can be used. Radiometry and commercial test cards are promising ways to compare UVGI systems, but further validation is needed using correlation with environmental cultures. Trial registration Not applicable.
Collapse
Affiliation(s)
- Vincent Masse
- 1Department of Internal Medicine, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, 200 Hawkins Drive # C512-GH, Iowa City, IA 52242 USA.,2Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec Canada
| | - Michael J Hartley
- 3Department of Hospital Administration, University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - Michael B Edmond
- 1Department of Internal Medicine, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, 200 Hawkins Drive # C512-GH, Iowa City, IA 52242 USA.,4Office of Clinical Quality Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - Daniel J Diekema
- 1Department of Internal Medicine, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, 200 Hawkins Drive # C512-GH, Iowa City, IA 52242 USA.,5Department of Pathology, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, Iowa City, IA USA
| |
Collapse
|
36
|
Masse V, Edmond MB, Diekema DJ. Infection prevention strategies for procedures performed outside operating rooms: A conceptual integrated model. Am J Infect Control 2018; 46:94-96. [PMID: 28941559 DOI: 10.1016/j.ajic.2017.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/27/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 11/19/2022]
Abstract
No comprehensive guidelines or classification exist for infection prevention strategies for medical procedures performed outside operating rooms. We reviewed the available literature and used our clinical experience to develop a progressive, 5-tiered classification of procedures, encompassing clean, aseptic, sterile-superficial, sterile-invasive, and surgical-like procedures to address this need. We provide a description of these categories, along with relevant examples. We fully acknowledge the limitations of our work, which is intended as a starting point for future efforts and not to be definitive.
Collapse
Affiliation(s)
- Vincent Masse
- Department of Internal Medicine, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, Iowa City, IA; Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada.
| | - Michael B Edmond
- Department of Internal Medicine, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, Iowa City, IA; Office of Clinical Quality Safety and Quality Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Daniel J Diekema
- Department of Internal Medicine, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, Iowa City, IA; Department of Pathology, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, Iowa City, IA
| |
Collapse
|
37
|
Opilla MT, Kirby DF, Edmond MB. Use of Ethanol Lock Therapy to Reduce the Incidence of Catheter-Related Bloodstream Infections in Home Parenteral Nutrition Patients. JPEN J Parenter Enteral Nutr 2017; 31:302-5. [PMID: 17595439 DOI: 10.1177/0148607107031004302] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [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: 11/16/2022]
Abstract
BACKGROUND Catheter-related bloodstream infection (CRBSI) is a serious complication for home parenteral nutrition (HPN) patients. To reduce the incidence of infection in frequently infected HPN patients, prophylactic ethanol lock therapy (ELT) was initiated. METHODS Nine patients were selected as candidates for ELT because of their history of recurrent CRBSI. Diagnosis of CRBSI was determined by symptoms correlating with positive peripheral and access device blood cultures. Medical-grade ethyl alcohol 25%-70% was instilled into the central venous access device and allowed to dwell for 2-4 hours. The incidence of CRBSI and catheter changes was compared before and after initiation of ELT. RESULTS Nine patients experienced 81 CRBSIs (8.3 per 1,000 catheter-days) before starting ELT vs 9 infections (2.7 per 1,000 catheter-days: relative risk [RR], 0.325; confidence interval [CI] 95%, 0.17-0.64) after ELT. Catheter changes were also reduced from 69 (7.0 per 1000 days) before ELT to 1 (0.3 per 1,000 days: RR, 0.043; CI 95%, 0.01-0.25) after ELT. No significant adverse effects were noted, although some patients complained of transient dizziness and nausea. CONCLUSIONS ELT shows promise in reducing the incidence of CRBSI in the frequently infected HPN population. Further studies are warranted.
Collapse
Affiliation(s)
- Marianne T Opilla
- Department of Nursing, Nutrishare, Inc., Elk Grove, California, USA.
| | | | | |
Collapse
|
38
|
Yokota PKO, Marra AR, Belucci TR, Victor EDS, dos Santos OFP, Edmond MB. Outcomes and Predictive Factors Associated with Adequacy of Antimicrobial Therapy in Patients with Central Line-Associated Bloodstream Infection. Front Public Health 2016; 4:284. [PMID: 28066761 PMCID: PMC5179579 DOI: 10.3389/fpubh.2016.00284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/14/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Central venous catheters are significant risk factors for bloodstream infection (BSI), which are directly associated with increased morbidity and mortality. METHODS This study was a retrospective cohort study for the time period of July 2011-June 2014 in patients with central line-associated bloodstream infection (CLABSI) to determine the microbiological profile and antimicrobial adequacy of patients with CLABSI in a tertiary hospital. RESULTS One hundred and twenty-one CLABSI cases were identified. Ninety-two percent (n = 111) of patients had monomicrobial BSI. Gram-negative bacteria were the most prevalent (49%, n = 63), with Klebsiella spp. predominating (30%, n = 19). Among the Gram-positive bacteria (n = 43, 33%), coagulase-negative staphylococci was the major pathogen (58%, n = 25), and all isolates were methicillin resistant. Antimicrobial therapy was assessed as adequate in 81% (n = 98) of cases. In-hospital mortality was 36% (n = 43 cases). CONCLUSION Our CLABSI patients had a high mortality, although antimicrobial therapy was appropriate. Gram-negative bacteria were responsible for almost half of the cases and there was a high rate of bacteria resistance to extended-spectrum antibiotics.
Collapse
Affiliation(s)
| | | | | | - Elivane da Silva Victor
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Michael B. Edmond
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| |
Collapse
|
39
|
Ferracini FT, Marra AR, Schvartsman C, Dos Santos OFP, Victor EDS, Negrini NMM, Filho WMB, Edmond MB. Using Positive Deviance to reduce medication errors in a tertiary care hospital. BMC Pharmacol Toxicol 2016; 17:36. [PMID: 27497977 PMCID: PMC4976064 DOI: 10.1186/s40360-016-0082-9] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background The number of medication errors occurring in healthcare is large and many are preventable. To analyze medication errors and evaluate whether Positive Deviance is effective in reducing them. Methods The study was divided into three phases: (2011- Phase I, control period; 2012 - Phase II, manager intervention, and 2013 - Phase III, frontline healthcare worker intervention). In Phases II and III, the Positive Deviance method (PD) was used to mitigate medication errors classified as “C” and higher according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). The errors reported were compared across the three study phases, as well as by the location of the hospital unit, shift, cause, consequence, and the professional associated with the error. Results A total of 4013 reported medication errors were analyzed. The largest number of errors occurred at the time the medications were administered, accounting for 35.5 % of errors in Phase I; 43.1 % in Phase II, and 55.6 % in Phase III. Nursing staff was most commonly associated with errors; 46.4 % of errors in Phase I, 48.5 % in Phase II, and 58.7 % in Phase III. With each intervention, a decrease was observed in the reported error rate of 0.12 (CI 95 %, 0.18 to 0.07). Conclusion Positive Deviance proved to be effective, primarily when healthcare professionals who were involved in errors participated, as was observed in Phase III of this study.
Collapse
Affiliation(s)
| | - Alexandre R Marra
- Division of Medical Practice, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627 - bloco A1, 1° andar, sala 108, Morumbi, São Paulo, Brazil, 05651-901. .,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Claudio Schvartsman
- Division of Medical Practice, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627 - bloco A1, 1° andar, sala 108, Morumbi, São Paulo, Brazil, 05651-901
| | - Oscar F Pavão Dos Santos
- Division of Medical Practice, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627 - bloco A1, 1° andar, sala 108, Morumbi, São Paulo, Brazil, 05651-901
| | - Elivane da Silva Victor
- Statistics Department, Instituto Israelita de Ensino e Pesquisa (IIEP), Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Neila Maria Marques Negrini
- Board of Healthcare Practice, Quality, Safety, and Environment, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Michael B Edmond
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| |
Collapse
|
40
|
Regagnin DA, da Silva Alves DS, Maria Cavalheiro A, Sampaio Camargo TZ, Marra AR, da Silva Victor E, Edmond MB. Sustainability of a program for continuous reduction of catheter-associated urinary tract infection. Am J Infect Control 2016; 44:642-6. [PMID: 26831277 DOI: 10.1016/j.ajic.2015.11.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/28/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Urinary tract infections account for 8%-21% of health care-associated infections; of these, 80% are associated with the use of a urinary catheter. METHODS A quasi-experimental study was conducted in 2 medical-surgical intensive care units (ICUs) with 48 beds and 3 step-down units (SDUs) with 95 beds in a private tertiary care hospital in Sao Paulo, Brazil. The study had 3 phases over a 9-year period to determine the sustainability of a program for continuous reduction of catheter-associated urinary tract infection (CAUTI). RESULTS Over the 3 phases of the study, rates of CAUTI in the ICUs fell from 7.0 to 3.5 to 0.9 infections per 1,000 catheter days. In the SDUs, CAUTI rates decreased from 14.9 to 6.6 to 1.0 per 1,000 catheter days. Comparisons of CAUTI rates in the 3 study phases, both in the ICUs and SDUs, showed significant reductions both between the 3 periods and in all possible combinations of analysis phases (all P < .001). CONCLUSIONS These results suggest that it is possible to reduce CAUTI rates to near zero and sustain these rates, but it requires a multidisciplinary team with different strategies that require continuous monitoring.
Collapse
|
41
|
Pellerin J, Bearman G, Sorah J, Sanogo K, Stevens M, Edmond MB. Healthcare Worker Perception of Bare Below the Elbows: Readiness for Change? Infect Control Hosp Epidemiol 2016; 35:740-2. [DOI: 10.1086/676422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
42
|
Verbeek JH, Ijaz S, Mischke C, Ruotsalainen JH, Mäkelä E, Neuvonen K, Edmond MB, Sauni R, Balci FSK, Mihalache RC. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2016; 4:CD011621. [PMID: 27093058 PMCID: PMC10068873 DOI: 10.1002/14651858.cd011621.pub2] [Citation(s) in RCA: 55] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In epidemics of highly infectious diseases, such as Ebola Virus Disease (EVD) or SARS, healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Contact precautions by means of personal protective equipment (PPE) can reduce the risk. It is unclear which type of PPE protects best, what is the best way to remove PPE, and how to make sure HCWs use PPE as instructed. OBJECTIVES To evaluate which type or component of full-body PPE and which method of donning or removing (doffing) PPE have the least risk of self-contamination or infection for HCWs, and which training methods most increase compliance with PPE protocols. SEARCH METHODS We searched MEDLINE (PubMed up to 8 January 2016), Cochrane Central Register of Trials (CENTRAL up to 20 January 2016), EMBASE (embase.com up to 8 January 2016), CINAHL (EBSCOhost up to 20 January 2016), and OSH-Update up to 8 January 2016. We also screened reference lists of included trials and relevant reviews, and contacted NGOs and manufacturers of PPE. SELECTION CRITERIA We included all eligible controlled studies that compared the effect of types or components of PPE in HCWs exposed to highly infectious diseases with serious consequences, such as EVD and SARS, on the risk of infection, contamination, or noncompliance with protocols. This included studies that simulated contamination with fluorescent markers or a non-pathogenic virus.We also included studies that compared the effect of various ways of donning or removing PPE, and the effects of various types of training in PPE use on the same outcomes. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, extracted data and assessed risk of bias in included trials. We intended to perform meta-analyses but we did not find sufficiently similar studies to combine their results. MAIN RESULTS We included nine studies with 1200 participants evaluating ten interventions. Of these, eight trials simulated the exposure with a fluorescent marker or virus or bacteria containing fluids. Five studies evaluated different types of PPE against each other but two did not report sufficient data. Another two studies compared different types of donning and doffing and three studies evaluated the effect of different types of training.None of the included studies reported a standardised classification of the protective properties against viral penetration of the PPE, and only one reported the brand of PPE used. None of the studies were conducted with HCWs exposed to EVD but in one study participants were exposed to SARS. Different types of PPE versus each otherIn simulation studies, contamination rates varied from 25% to 100% of participants for all types of PPE. In one study, PPE made of more breathable material did not lead to a statistically significantly different number of spots with contamination but did have greater user satisfaction (Mean Difference (MD) -0.46 (95% Confidence Interval (CI) -0.84 to -0.08, range 1 to 5, very low quality evidence). In another study, gowns protected better than aprons. In yet another study, the use of a powered air-purifying respirator protected better than a now outdated form of PPE. There were no studies on goggles versus face shields, on long- versus short-sleeved gloves, or on the use of taping PPE parts together. Different methods of donning and doffing procedures versus each otherTwo cross-over simulation studies (one RCT, one CCT) compared different methods for donning and doffing against each other. Double gloving led to less contamination compared to single gloving (Relative Risk (RR) 0.36; 95% CI 0.16 to 0.78, very low quality evidence) in one simulation study, but not to more noncompliance with guidance (RR 1.08; 95% CI 0.70 to 1.67, very low quality evidence). Following CDC recommendations for doffing led to less contamination in another study (very low quality evidence). There were no studies on the use of disinfectants while doffing. Different types of training versus each otherIn one study, the use of additional computer simulation led to less errors in doffing (MD -1.2, 95% CI -1.6 to -0.7) and in another study additional spoken instruction led to less errors (MD -0.9, 95% CI -1.4 to -0.4). One retrospective cohort study assessed the effect of active training - defined as face-to-face instruction - versus passive training - defined as folders or videos - on noncompliance with PPE use and on noncompliance with doffing guidance. Active training did not considerably reduce noncompliance in PPE use (Odds Ratio (OR) 0.63; 95% CI 0.31 to 1.30) but reduced noncompliance with doffing procedures (OR 0.45; 95% CI 0.21 to 0.98, very low quality evidence). There were no studies on how to retain the results of training in the long term or on resource use.The quality of the evidence was very low for all comparisons because of high risk of bias in studies, indirectness of evidence, and small numbers of participants. This means that it is likely that the true effect can be substantially different from the one reported here. AUTHORS' CONCLUSIONS We found very low quality evidence that more breathable types of PPE may not lead to more contamination, but may have greater user satisfaction. We also found very low quality evidence that double gloving and CDC doffing guidance appear to decrease the risk of contamination and that more active training in PPE use may reduce PPE and doffing errors more than passive training. However, the data all come from single studies with high risk of bias and we are uncertain about the estimates of effects.We need simulation studies conducted with several dozens of participants, preferably using a non-pathogenic virus, to find out which type and combination of PPE protects best, and what is the best way to remove PPE. We also need randomised controlled studies of the effects of one type of training versus another to find out which training works best in the long term. HCWs exposed to highly infectious diseases should have their use of PPE registered and should be prospectively followed for their risk of infection.
Collapse
Affiliation(s)
- Jos H Verbeek
- Cochrane Work Review Group, Finnish Institute of Occupational Health, Kuopio, Finland
| | - Sharea Ijaz
- Cochrane Work Review Group, Finnish Institute of Occupational Health, Kuopio, Finland
| | - Christina Mischke
- Cochrane Work Review Group, Finnish Institute of Occupational Health, Kuopio, Finland
| | - Jani H Ruotsalainen
- Cochrane Work Review Group, Finnish Institute of Occupational Health, Kuopio, Finland
| | - Erja Mäkelä
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Kaisa Neuvonen
- Cochrane Work Review Group, Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Riitta Sauni
- Finnish Institute of Occupational Health, Tampere, Finland
| | - F Selcen Kilinc Balci
- National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Pittsburgh, PA, USA
| | - Raluca C Mihalache
- Cochrane Work Review Group, Finnish Institute of Occupational Health, Kuopio, Finland
| |
Collapse
|
43
|
Doi AM, Pignatari ACC, Edmond MB, Marra AR, Camargo LFA, Siqueira RA, da Mota VP, Colombo AL. Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program. PLoS One 2016; 11:e0146909. [PMID: 26808778 PMCID: PMC4726651 DOI: 10.1371/journal.pone.0146909] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [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: 05/01/2015] [Accepted: 12/23/2015] [Indexed: 01/06/2023] Open
Abstract
Candidemia is a growing problem in hospitals all over the world. Despite advances in the medical support of critically ill patients, candidiasis leads to prolonged hospitalization, and has a crude mortality rate around 50%. We conducted a multicenter surveillance study in 16 hospitals distributed across five regions of Brazil to assess the incidence, species distribution, antifungal susceptibility, and risk factors for bloodstream infections due to Candida species. From June 2007 to March 2010, we studied a total of 2,563 nosocomial bloodstream infection (nBSI) episodes. Candida spp. was the 7th most prevalent agent. Most of the patients were male, with a median age of 56 years. A total of 64 patients (46.7%) were in the ICU when candidemia occurred. Malignancies were the most common underlying condition (32%). The crude mortality rate of candidemia during the hospital admission was 72.2%. Non-albicans species of Candida accounted for 65.7% of the 137 yeast isolates. C. albicans (34.3%), Candida parapsilosis (24.1%), Candida tropicalis (15.3%) and Candida glabrata (10.2%) were the most prevalent species. Only 47 out of 137 Candida isolates were sent to the reference laboratory for antifungal susceptibility testing. All C. albicans, C. tropicalis and C. parapsilosis isolates were susceptible to the 5 antifungal drugs tested. Among 11 C. glabrata isolates, 36% were resistant to fluconazole, and 64% SDD. All of them were susceptible to anidulafungin and amphotericin B. We observed that C. glabrata is emerging as a major player among non-albicans Candida spp. and fluconazole resistance was primarily confined to C. glabrata and C. krusei strains. Candida resistance to echinocandins and amphotericin B remains rare in Brazil. Mortality rates remain increasingly higher than that observed in the Northern Hemisphere countries, emphasizing the need for improving local practices of clinical management of candidemia, including early diagnosis, source control and precise antifungal therapy.
Collapse
Affiliation(s)
- André Mario Doi
- Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Michael B. Edmond
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
| | | | - Luis Fernando Aranha Camargo
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Ricardo Andreotti Siqueira
- Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Arnaldo Lopes Colombo
- Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- * E-mail:
| |
Collapse
|
44
|
Edmond MB. THE POWER OF POOP: FECAL MICROBIOTA TRANSPLANTATION FOR CLOSTRIDIUM DIFFICILE INFECTION. Trans Am Clin Climatol Assoc 2016; 127:71-80. [PMID: 28066039 PMCID: PMC5216499] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The human gut is colonized with 200 to 1,000 bacterial species. Administration of antibiotics reduces the diversity of the intestinal microbiota, reduces colonization resistance, and can lead to infection with Clostridium difficile. These infections have become more prevalent and increasingly patients are experiencing multiple recurrences that are incurable with standard treatment. Although fecal microbiota transplantation (FMT) has been used for centuries in human and veterinary medicine, only recently has it be shown to be highly effective for recurrent C. difficile infection. The goal of FMT is to re-introduce a complete, stable community of gut microorganisms to repair or replace the disrupted native microbiota. FMT can be delivered via nasoenteric tube, colonoscopy, or enema. Despite a cure rate approximating 90%, many barriers to FMT have limited its availability to patients. The recent development of a not-for-profit stool bank has helped to make this therapy more accessible. Additional indications for FMT are currently under investigation.
Collapse
|
45
|
Neves L, Marra AR, Camargo TZS, dos Santos MC, Zulin F, da Silva PC, de Moura NA, Victor EDS, Pasternak J, dos Santos OFP, Edmond MB, Martino MDV. Correlation between mass and volume of collected blood with positivity of blood cultures. BMC Res Notes 2015; 8:383. [PMID: 26311144 PMCID: PMC4551380 DOI: 10.1186/s13104-015-1365-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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] [Received: 10/30/2014] [Accepted: 08/18/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The collection of blood cultures is an extremely important method in the management of patients with suspected infection. Microbiology laboratories should monitor blood culture collection. METHODS Over an 8-month period we developed a prospective, observational study in an adult Intensive Care Unit (ICU). We correlated the mass contained in the blood vials with blood culture positivity and we also verified the relationship between the mass of blood and blood volume collected for the diagnosis of bloodstream infection (BSI), as well as we explored factors predicting positive blood cultures. RESULTS We evaluated 345 patients with sepsis, severe sepsis or septic shock for whom blood culture bottles were collected for the diagnosis of BSI. Of the 55 patients with BSI, 40.0% had peripheral blood culture collection only. BSIs were classified as nosocomial in 34.5%. In the multivariate model, the blood culture mass (in grams) remained a significant predictor of positivity, with an odds ratio 1.01 (i.e., for each additional 1 mL of blood collected there was a 1% increase in positivity; 95% CI 1.01-1.02, p = 0.001; Nagelkerke R Square [R(2)] = 0.192). For blood volume collected, the adjusted odds ratio was estimated at 1.02 (95% CI: 1.01-1.03, p < 0.001; R(2) = 0.199). For each set of collected blood cultures beyond one set, the adjusted odds ratio was estimated to be 1.27 (95% CI: 1.14-1.41, p < 0.001; R(2) = 0.221). CONCLUSIONS Our study was a quality improvement project that showed that microbiology laboratories can use the weight of blood culture bottles to determine if appropriate volume has been collected to improve the diagnosis of BSI.
Collapse
Affiliation(s)
- Lariessa Neves
- Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | - Alexandre Rodrigues Marra
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil. .,Division of Medical Practice, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 1st floor, Room 108, Bloco A1, Morumbi, São Paulo, 05651-901, Brazil.
| | | | | | - Flávia Zulin
- Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | | | | | | | - Jacyr Pasternak
- Department of Microbiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | - Oscar Fernando Pavão dos Santos
- Division of Medical Practice, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 1st floor, Room 108, Bloco A1, Morumbi, São Paulo, 05651-901, Brazil.
| | - Michael B Edmond
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | | |
Collapse
|
46
|
Vaidotas M, Yokota PKO, Marra AR, Sampaio Camargo TZ, Victor EDS, Gysi DM, Leal F, dos Santos OFP, Edmond MB. Measuring hand hygiene compliance rates at hospital entrances. Am J Infect Control 2015; 43:694-6. [PMID: 25934063 DOI: 10.1016/j.ajic.2015.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite the importance of hand hygiene in the health care setting, there are no studies evaluating hand hygiene compliance at hospital entrances. METHODS The study was prospectively performed over a 33-week period from March 30, 2014-November 15, 2014, to evaluate hand hygiene compliance in 2 hospital reception areas. We compared electronic handwash counters with the application of radiofrequency identification (GOJO SMARTLINK) (electronic observer) that counts each activation of alcohol gel dispensers to direct observation (human observer) via remote review of video surveillance. RESULTS We found low hand hygiene compliance rates of 2.2% (99/4,412) and 1.7% (140/8,277), respectively, at reception areas A and D, detected by direct observation. Using the electronic observer, we measured rates of 17% (15,624/91,724) and 7.1% (51,605/730,357) at reception areas A and D, respectively. For the overall time period of simultaneous electronic and human observation, the human observer captured 1% of the hand hygiene episodes detected by the electronic observer. CONCLUSIONS Our study showed very low hand hygiene compliance in hospital reception areas, and we found an electronic hand hygiene system to be a useful method to monitor hand hygiene compliance.
Collapse
|
47
|
Casaroto E, Marra AR, Camargo TZS, de Souza ARA, de Almeida CES, Pedroti EP, Victor EDS, dos Santos OFP, Edmond MB, Campos AH. Agreement on the prescription of antimicrobial drugs. BMC Infect Dis 2015; 15:248. [PMID: 26123222 PMCID: PMC4484637 DOI: 10.1186/s12879-015-0992-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 06/19/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There is universal awareness of the difficulties faced by doctors when prescribing antimicrobials. METHODS Over a six-month period patients hospitalized in the ICU and under treatment with antibiotics and/or antifungals were eligible to participate in the study. The data were assessed by two infectious diseases specialists. Once completed, all case forms were sent independently to both evaluators (TZSC and ARM) by e-mail. Based on the data received, the evaluator completed a form automatically generated on the e-mail and returned it to the original mailbox for further analysis. We assessed the level of agreement between infectious disease specialists and the physicians directly responsible for the decision to begin antimicrobial therapy, as well as to assess the appropriateness of the regimen prescribed. RESULTS Among the antimicrobial regimens prescribed to the 177 patients, 36% were considered inappropriate by specialist #1 and 38% were considered inappropriate by specialist #2. We found 78% agreement by at least one of the infectious disease specialists with the prescribed antimicrobial regimen, and in 49% of cases both specialists agreed with the prescribed regimen. Both disagreed with the prescribed regimen in 22% of the cases and they disagreed between themselves in 29% of the cases. CONCLUSION This study highlights the difficulties in prescribing effective empirical antimicrobial therapy--they are of such magnitude that even two specialists in infectious diseases, well acquainted with our hospital's resistance patterns and our patients' profiles have considerable disagreement.
Collapse
Affiliation(s)
- Eduardo Casaroto
- Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | - Alexandre R Marra
- Division of Medical Practice, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - 1st floor - Bloco A1 - Room 108 Morumbi, 05651-901, São Paulo, Brazil.
| | | | | | | | | | - Elivane da Silva Victor
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | - Oscar Fernando Pavão dos Santos
- Division of Medical Practice, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - 1st floor - Bloco A1 - Room 108 Morumbi, 05651-901, São Paulo, Brazil.
| | - Michael B Edmond
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Alexandre Holthausen Campos
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil.
| |
Collapse
|
48
|
Affiliation(s)
- Richard P Wenzel
- From the Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (R.P.W.); and the Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City (M.B.E.)
| | | |
Collapse
|
49
|
Verbeek JH, Ijaz S, Mischke C, Ruotsalainen JH, Mäkelä E, Neuvonen K, Edmond MB, Garner P, Sauni R, Hopping K. Personal protective equipment for preventing highly infectious diseases due to contact with contaminated body fluids in health care staff. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011621] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
50
|
Magnus TP, Marra AR, Camargo TZS, Victor EDS, Costa LSSD, Cardoso VJ, Santos OFPD, Edmond MB. Measuring hand hygiene compliance rates in different special care settings: a comparative study of methodologies. Int J Infect Dis 2015; 33:205-8. [DOI: 10.1016/j.ijid.2015.02.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/22/2015] [Accepted: 02/18/2015] [Indexed: 12/11/2022] Open
|