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Bartsch SM, Weatherwax C, Wasserman MR, Chin KL, Martinez MF, Velmurugan K, Singh RD, John DC, Heneghan JL, Gussin GM, Scannell SA, Tsintsifas AC, O'Shea KJ, Dibbs AM, Leff B, Huang SS, Lee BY. How the Timing of Annual COVID-19 Vaccination of Nursing Home Residents and Staff Affects Its Value. J Am Med Dir Assoc 2024; 25:639-646.e5. [PMID: 38432644 PMCID: PMC10990766 DOI: 10.1016/j.jamda.2024.02.005] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To evaluate the epidemiologic, clinical, and economic value of an annual nursing home (NH) COVID-19 vaccine campaign and the impact of when vaccination starts. DESIGN Agent-based model representing a typical NH. SETTING AND PARTICIPANTS NH residents and staff. METHODS We used the model representing an NH with 100 residents, its staff, their interactions, COVID-19 spread, and its health and economic outcomes to evaluate the epidemiologic, clinical, and economic value of varying schedules of annual COVID-19 vaccine campaigns. RESULTS Across a range of scenarios with a 60% vaccine efficacy that wanes starting 4 months after protection onset, vaccination was cost saving or cost-effective when initiated in the late summer or early fall. Annual vaccination averted 102 to 105 COVID-19 cases when 30-day vaccination campaigns began between July and October (varying with vaccination start), decreasing to 97 and 85 cases when starting in November and December, respectively. Starting vaccination between July and December saved $3340 to $4363 and $64,375 to $77,548 from the Centers for Medicare & Medicaid Services and societal perspectives, respectively (varying with vaccination start). Vaccination's value did not change when varying the COVID-19 peak between December and February. The ideal vaccine campaign timing was not affected by reducing COVID-19 levels in the community, or varying transmission probability, preexisting immunity, or COVID-19 severity. However, if vaccine efficacy wanes more quickly (over 1 month), earlier vaccination in July resulted in more cases compared with vaccinating later in October. CONCLUSIONS AND IMPLICATIONS Annual vaccination of NH staff and residents averted the most cases when initiated in the late summer through early fall, at least 2 months before the COVID-19 winter peak but remained cost saving or cost-effective when it starts in the same month as the peak. This supports tethering COVID vaccination to seasonal influenza campaigns (typically in September-October) for providing protection against SARS-CoV-2 winter surges in NHs.
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Affiliation(s)
- Sarah M Bartsch
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Colleen Weatherwax
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | | | - Kevin L Chin
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Marie F Martinez
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Kavya Velmurugan
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Raveena D Singh
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Danielle C John
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Pandemic Response Institute, New York City, NY, USA
| | - Jessie L Heneghan
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Gabrielle M Gussin
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Sheryl A Scannell
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Alexandra C Tsintsifas
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Kelly J O'Shea
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Alexis M Dibbs
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Bruce Leff
- Division of Geriatric Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan S Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Bruce Y Lee
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Pandemic Response Institute, New York City, NY, USA.
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2
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Gussin GM, McKinnell JA, Singh RD, Miller LG, Kleinman K, Saavedra R, Tjoa T, Gohil SK, Catuna TD, Heim LT, Chang J, Estevez M, He J, O’Donnell K, Zahn M, Lee E, Berman C, Nguyen J, Agrawal S, Ashbaugh I, Nedelcu C, Robinson PA, Tam S, Park S, Evans KD, Shimabukuro JA, Lee BY, Fonda E, Jernigan JA, Slayton RB, Stone ND, Janssen L, Weinstein RA, Hayden MK, Lin MY, Peterson EM, Bittencourt CE, Huang SS. Reducing Hospitalizations and Multidrug-Resistant Organisms via Regional Decolonization in Hospitals and Nursing Homes. JAMA 2024:2817010. [PMID: 38557703 PMCID: PMC10985619 DOI: 10.1001/jama.2024.2759] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/16/2024] [Indexed: 04/04/2024]
Abstract
Importance Infections due to multidrug-resistant organisms (MDROs) are associated with increased morbidity, mortality, length of hospitalization, and health care costs. Regional interventions may be advantageous in mitigating MDROs and associated infections. Objective To evaluate whether implementation of a decolonization collaborative is associated with reduced regional MDRO prevalence, incident clinical cultures, infection-related hospitalizations, costs, and deaths. Design, Setting, and Participants This quality improvement study was conducted from July 1, 2017, to July 31, 2019, across 35 health care facilities in Orange County, California. Exposures Chlorhexidine bathing and nasal iodophor antisepsis for residents in long-term care and hospitalized patients in contact precautions (CP). Main Outcomes and Measures Baseline and end of intervention MDRO point prevalence among participating facilities; incident MDRO (nonscreening) clinical cultures among participating and nonparticipating facilities; and infection-related hospitalizations and associated costs and deaths among residents in participating and nonparticipating nursing homes (NHs). Results Thirty-five facilities (16 hospitals, 16 NHs, 3 long-term acute care hospitals [LTACHs]) adopted the intervention. Comparing decolonization with baseline periods among participating facilities, the mean (SD) MDRO prevalence decreased from 63.9% (12.2%) to 49.9% (11.3%) among NHs, from 80.0% (7.2%) to 53.3% (13.3%) among LTACHs (odds ratio [OR] for NHs and LTACHs, 0.48; 95% CI, 0.40-0.57), and from 64.1% (8.5%) to 55.4% (13.8%) (OR, 0.75; 95% CI, 0.60-0.93) among hospitalized patients in CP. When comparing decolonization with baseline among NHs, the mean (SD) monthly incident MDRO clinical cultures changed from 2.7 (1.9) to 1.7 (1.1) among participating NHs, from 1.7 (1.4) to 1.5 (1.1) among nonparticipating NHs (group × period interaction reduction, 30.4%; 95% CI, 16.4%-42.1%), from 25.5 (18.6) to 25.0 (15.9) among participating hospitals, from 12.5 (10.1) to 14.3 (10.2) among nonparticipating hospitals (group × period interaction reduction, 12.9%; 95% CI, 3.3%-21.5%), and from 14.8 (8.6) to 8.2 (6.1) among LTACHs (all facilities participating; 22.5% reduction; 95% CI, 4.4%-37.1%). For NHs, the rate of infection-related hospitalizations per 1000 resident-days changed from 2.31 during baseline to 1.94 during intervention among participating NHs, and from 1.90 to 2.03 among nonparticipating NHs (group × period interaction reduction, 26.7%; 95% CI, 19.0%-34.5%). Associated hospitalization costs per 1000 resident-days changed from $64 651 to $55 149 among participating NHs and from $55 151 to $59 327 among nonparticipating NHs (group × period interaction reduction, 26.8%; 95% CI, 26.7%-26.9%). Associated hospitalization deaths per 1000 resident-days changed from 0.29 to 0.25 among participating NHs and from 0.23 to 0.24 among nonparticipating NHs (group × period interaction reduction, 23.7%; 95% CI, 4.5%-43.0%). Conclusions and Relevance A regional collaborative involving universal decolonization in long-term care facilities and targeted decolonization among hospital patients in CP was associated with lower MDRO carriage, infections, hospitalizations, costs, and deaths.
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Affiliation(s)
- Gabrielle M. Gussin
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - James A. McKinnell
- Division of Infectious Diseases, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Raveena D. Singh
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Loren G. Miller
- Division of Infectious Diseases, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Ken Kleinman
- Program in Biostatistics, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst
| | - Raheeb Saavedra
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Thomas Tjoa
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Shruti K. Gohil
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Tabitha D. Catuna
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Lauren T. Heim
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Justin Chang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Marlene Estevez
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Jiayi He
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Kathleen O’Donnell
- Healthcare-Associated Infections Program, Center for Healthcare Quality, California Department of Public Health, Richmond
| | - Matthew Zahn
- Epidemiology and Assessment, Orange County Health Care Agency, Santa Ana, California
| | - Eunjung Lee
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Chase Berman
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Jenny Nguyen
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Shalini Agrawal
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Isabel Ashbaugh
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Christine Nedelcu
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Philip A. Robinson
- Division of Infectious Diseases, Hoag Hospital, Newport Beach, California
| | - Steven Tam
- Division of Geriatric Medicine and Gerontology, University of California Irvine Health, Orange
| | - Steven Park
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
| | - Kaye D. Evans
- Clinical Microbiology Laboratory, University of California Irvine Health, Orange
| | - Julie A. Shimabukuro
- Clinical Microbiology Laboratory, University of California Irvine Health, Orange
| | - Bruce Y. Lee
- PHICOR (Public Health Informatics Computational Operations Research), Department of Health Policy and Management, City University of New York Graduate School of Public Health, New York
| | | | - John A. Jernigan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachel B. Slayton
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nimalie D. Stone
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lynn Janssen
- Healthcare-Associated Infections Program, Center for Healthcare Quality, California Department of Public Health, Richmond
| | - Robert A. Weinstein
- Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois
- Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois
| | - Mary K. Hayden
- Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Michael Y. Lin
- Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Ellena M. Peterson
- Department of Pathology and Laboratory Medicine, University of California Irvine Health, Orange
| | - Cassiana E. Bittencourt
- Department of Pathology and Laboratory Medicine, University of California Irvine Health, Orange
| | - Susan S. Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine
- Department of Epidemiology and Infection Prevention, University of California Irvine Health, Orange
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3
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Gussin GM, Singh RD, Gohil SK, Saavedra R, Tjoa TT, Nguyen KP, Pedroza R, Hsi JB, O'Brien K, Berman C, Park J, Hsi EA, Ghasemian K, Osalvo A, Chun S, Fonda E, Huang SS. Impact of universal chlorhexidine bathing with or without COVID-19 intensive training on staff and resident COVID-19 case rates in nursing homes. Infect Control Hosp Epidemiol 2024:1-4. [PMID: 38440877 DOI: 10.1017/ice.2024.30] [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: 03/06/2024]
Abstract
We evaluated whether universal chlorhexidine bathing (decolonization) with or without COVID-19 intensive training impacted COVID-19 rates in 63 nursing homes (NHs) during the 2020-2021 Fall/Winter surge. Decolonization was associated with a 43% lesser rise in staff case-rates (P < .001) and a 52% lesser rise in resident case-rates (P < .001) versus control.
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Affiliation(s)
- Gabrielle M Gussin
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Raveena D Singh
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Shruti K Gohil
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Raheeb Saavedra
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Thomas T Tjoa
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Kristine P Nguyen
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Robert Pedroza
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Joshua B Hsi
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Kevin O'Brien
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Chase Berman
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Jessica Park
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Emily A Hsi
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Kimia Ghasemian
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Avy Osalvo
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Stephanie Chun
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | | | - Susan S Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
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4
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Bartsch SM, Weatherwax C, Martinez MF, Chin KL, Wasserman MR, Singh RD, Heneghan JL, Gussin GM, Scannell SA, White C, Leff B, Huang SS, Lee BY. Cost-effectiveness of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing and isolation strategies in nursing homes. Infect Control Hosp Epidemiol 2024:1-8. [PMID: 38356377 DOI: 10.1017/ice.2024.9] [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: 02/16/2024]
Abstract
OBJECTIVE Nursing home residents may be particularly vulnerable to coronavirus disease 2019 (COVID-19). Therefore, a question is when and how often nursing homes should test staff for COVID-19 and how this may change as severe acute respiratory coronavirus virus 2 (SARS-CoV-2) evolves. DESIGN We developed an agent-based model representing a typical nursing home, COVID-19 spread, and its health and economic outcomes to determine the clinical and economic value of various screening and isolation strategies and how it may change under various circumstances. RESULTS Under winter 2023-2024 SARS-CoV-2 omicron variant conditions, symptom-based antigen testing averted 4.5 COVID-19 cases compared to no testing, saving $191 in direct medical costs. Testing implementation costs far outweighed these savings, resulting in net costs of $990 from the Centers for Medicare & Medicaid Services perspective, $1,545 from the third-party payer perspective, and $57,155 from the societal perspective. Testing did not return sufficient positive health effects to make it cost-effective [$50,000 per quality-adjusted life-year (QALY) threshold], but it exceeded this threshold in ≥59% of simulation trials. Testing remained cost-ineffective when routinely testing staff and varying face mask compliance, vaccine efficacy, and booster coverage. However, all antigen testing strategies became cost-effective (≤$31,906 per QALY) or cost saving (saving ≤$18,372) when the severe outcome risk was ≥3 times higher than that of current omicron variants. CONCLUSIONS SARS-CoV-2 testing costs outweighed benefits under winter 2023-2024 conditions; however, testing became cost-effective with increasingly severe clinical outcomes. Cost-effectiveness can change as the epidemic evolves because it depends on clinical severity and other intervention use. Thus, nursing home administrators and policy makers should monitor and evaluate viral virulence and other interventions over time.
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Affiliation(s)
- Sarah M Bartsch
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, New York
| | - Colleen Weatherwax
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, New York
| | - Marie F Martinez
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, New York
| | - Kevin L Chin
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, New York
| | - Michael R Wasserman
- Los Angeles Jewish Home, Reseda, California
- California Association of Long Term Care Medicine, Santa Clarita, California
| | - Raveena D Singh
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Jessie L Heneghan
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, New York
| | - Gabrielle M Gussin
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Sheryl A Scannell
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, New York
| | - Cameron White
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, New York
| | - Bruce Leff
- Center for Transformative Geriatric Research, Division of Geriatric Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan S Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Bruce Y Lee
- Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, New York
- Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, New York
- New York City Pandemic Response Institute (PRI), CUNY Graduate School of Public Health and Health Policy, New York City, New York
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5
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Sansom SE, Gussin GM, Schoeny M, Singh RD, Adil H, Bell P, Benson EC, Bittencourt CE, Black S, Del Mar Villanueva Guzman M, Froilan MC, Fukuda C, Barsegyan K, Gough E, Lyman M, Makhija J, Marron S, Mikhail L, Noble-Wang J, Pacilli M, Pedroza R, Saavedra R, Sexton DJ, Shimabukuro J, Thotapalli L, Zahn M, Huang SS, Hayden MK. Rapid Environmental Contamination with Candida auris and Multidrug-Resistant Bacterial Pathogens Near Colonized Patients. Clin Infect Dis 2023:ciad752. [PMID: 38059527 DOI: 10.1093/cid/ciad752] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Environmental contamination is suspected to play an important role in Candida auris transmission. Understanding speed and risks of contamination after room disinfection could inform environmental cleaning recommendations. METHODS We conducted a prospective multicenter study of environmental contamination associated with C. auris colonization at six ventilator-capable skilled nursing facilities and one acute-care hospital in Illinois and California. Known C. auris carriers were sampled at five body-sites followed by sampling of nearby room surfaces before disinfection and at 0, 4, 8, and 12-hours post-disinfection. Samples were cultured for C. auris and bacterial multidrug-resistant organisms (MDROs). Odds of surface contamination after disinfection were analyzed using multilevel generalized estimating equations. RESULTS Among 41 known C. auris carriers, colonization was detected most frequently on palms/fingertips (76%) and nares (71%). C. auris contamination was detected on 32.2% (66/205) of room surfaces pre-disinfection and 20.5% (39/190) of room surfaces by 4-hours post-disinfection. A higher number of C. auris-colonized body sites was associated with higher odds of environmental contamination at every time point following disinfection, adjusting for facility of residence. In the rooms of 38 (93%) C. auris carriers co-colonized with a bacterial MDRO, 2%-24% of surfaces were additionally contaminated with the same MDRO by 4-hours post-disinfection. CONCLUSIONS C. auris can contaminate the healthcare environment rapidly after disinfection, highlighting the challenges associated with environmental disinfection. Future research should investigate long-acting disinfectants, antimicrobial surfaces, and more effective patient skin antisepsis to reduce the environmental reservoir of C. auris and bacterial MDROs in healthcare settings.
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Affiliation(s)
- Sarah E Sansom
- Rush University Medical Center, Division of Infectious Diseases, Chicago IL, USA
| | - Gabrielle M Gussin
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine CA, USA
| | - Michael Schoeny
- Rush University Medical Center, College of Nursing, Chicago IL, USA
| | - Raveena D Singh
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine CA, USA
| | - Hira Adil
- Chicago Department of Public Health, Chicago IL, USA
| | - Pamela Bell
- Rush University Medical Center, Division of Infectious Diseases, Chicago IL, USA
| | - Ellen C Benson
- Rush University Medical Center, Division of Infectious Diseases, Chicago IL, USA
| | - Cassiana E Bittencourt
- University of California, Irvine School of Medicine, Department of Pathology and Laboratory Medicine, Irvine CA, USA
| | | | | | - Mary Carl Froilan
- Rush University Medical Center, Division of Infectious Diseases, Chicago IL, USA
| | - Christine Fukuda
- Rush University Medical Center, Division of Infectious Diseases, Chicago IL, USA
| | - Karina Barsegyan
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine CA, USA
| | - Ellen Gough
- Rush University Medical Center, Division of Infectious Diseases, Chicago IL, USA
| | - Meghan Lyman
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Jinal Makhija
- Rush University Medical Center, Division of Infectious Diseases, Chicago IL, USA
| | - Stefania Marron
- Rush University Medical Center, Division of Infectious Diseases, Chicago IL, USA
| | | | - Judith Noble-Wang
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta GA, USA
| | | | - Robert Pedroza
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine CA, USA
| | - Raheeb Saavedra
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine CA, USA
| | - D Joseph Sexton
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - Julie Shimabukuro
- University of California, Irvine School of Medicine, Department of Pathology and Laboratory Medicine, Irvine CA, USA
| | - Lahari Thotapalli
- Rush University Medical Center, Division of Infectious Diseases, Chicago IL, USA
| | - Matthew Zahn
- Orange County Health Care Agency, Santa Ana CA, USA
| | - Susan S Huang
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine CA, USA
| | - Mary K Hayden
- Rush University Medical Center, Division of Infectious Diseases, Chicago IL, USA
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Miller LG, McKinnell JA, Singh RD, Gussin GM, Kleinman K, Saavedra R, Mendez J, Catuna TD, Felix J, Chang J, Heim L, Franco R, Tjoa T, Stone ND, Steinberg K, Beecham N, Montgomery J, Walters D, Park S, Tam S, Gohil SK, Robinson PA, Estevez M, Lewis B, Shimabukuro JA, Tchakalian G, Miner A, Torres C, Evans KD, Bittencourt CE, He J, Lee E, Nedelcu C, Lu J, Agrawal S, Sturdevant SG, Peterson E, Huang SS. Decolonization in Nursing Homes to Prevent Infection and Hospitalization. N Engl J Med 2023; 389:1766-1777. [PMID: 37815935 DOI: 10.1056/nejmoa2215254] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
BACKGROUND Nursing home residents are at high risk for infection, hospitalization, and colonization with multidrug-resistant organisms. METHODS We performed a cluster-randomized trial of universal decolonization as compared with routine-care bathing in nursing homes. The trial included an 18-month baseline period and an 18-month intervention period. Decolonization entailed the use of chlorhexidine for all routine bathing and showering and administration of nasal povidone-iodine twice daily for the first 5 days after admission and then twice daily for 5 days every other week. The primary outcome was transfer to a hospital due to infection. The secondary outcome was transfer to a hospital for any reason. An intention-to-treat (as-assigned) difference-in-differences analysis was performed for each outcome with the use of generalized linear mixed models to compare the intervention period with the baseline period across trial groups. RESULTS Data were obtained from 28 nursing homes with a total of 28,956 residents. Among the transfers to a hospital in the routine-care group, 62.2% (the mean across facilities) were due to infection during the baseline period and 62.6% were due to infection during the intervention period (risk ratio, 1.00; 95% confidence interval [CI], 0.96 to 1.04). The corresponding values in the decolonization group were 62.9% and 52.2% (risk ratio, 0.83; 95% CI, 0.79 to 0.88), for a difference in risk ratio, as compared with routine care, of 16.6% (95% CI, 11.0 to 21.8; P<0.001). Among the discharges from the nursing home in the routine-care group, transfer to a hospital for any reason accounted for 36.6% during the baseline period and for 39.2% during the intervention period (risk ratio, 1.08; 95% CI, 1.04 to 1.12). The corresponding values in the decolonization group were 35.5% and 32.4% (risk ratio, 0.92; 95% CI, 0.88 to 0.96), for a difference in risk ratio, as compared with routine care, of 14.6% (95% CI, 9.7 to 19.2). The number needed to treat was 9.7 to prevent one infection-related hospitalization and 8.9 to prevent one hospitalization for any reason. CONCLUSIONS In nursing homes, universal decolonization with chlorhexidine and nasal iodophor led to a significantly lower risk of transfer to a hospital due to infection than routine care. (Funded by the Agency for Healthcare Research and Quality; Protect ClinicalTrials.gov number, NCT03118232.).
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Affiliation(s)
- Loren G Miller
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - James A McKinnell
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Raveena D Singh
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Gabrielle M Gussin
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Ken Kleinman
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Raheeb Saavedra
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Job Mendez
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Tabitha D Catuna
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - James Felix
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Justin Chang
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Lauren Heim
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Ryan Franco
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Thomas Tjoa
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Nimalie D Stone
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Karl Steinberg
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Nancy Beecham
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Jocelyn Montgomery
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - DeAnn Walters
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Steven Park
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Steven Tam
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Shruti K Gohil
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Philip A Robinson
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Marlene Estevez
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Brian Lewis
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Julie A Shimabukuro
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Gregory Tchakalian
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Aaron Miner
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Crystal Torres
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Kaye D Evans
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Cassiana E Bittencourt
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Jiayi He
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Eunjung Lee
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Christine Nedelcu
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Julia Lu
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Shalini Agrawal
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - S Gwynn Sturdevant
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Ellena Peterson
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
| | - Susan S Huang
- From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.)
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Nguyen KP, Singh RD, Saavedra R, Gohil SK, Billimek JT, Tam SP, Steinberg KE, Porter L, Huang SS. Central-line team effort: Recognizing insertion-site concerns in nursing homes. Infect Control Hosp Epidemiol 2023; 44:1887-1889. [PMID: 37539731 PMCID: PMC10665860 DOI: 10.1017/ice.2023.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Kristine P. Nguyen
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Raveena D. Singh
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Raheeb Saavedra
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Shruti K. Gohil
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California, USA
| | - John T. Billimek
- Department of Family Medicine, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Steven P. Tam
- Division of Geriatrics and Gerontology, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Karl E. Steinberg
- Shiley Haynes Institute for Palliative Care, California State University, San Marcos, San Marcos, California, USA
| | - Lori Porter
- National Association of Health Care Assistants. Carl Junction, Missouri, USA
| | - Susan S. Huang
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California, USA
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Gussin GM, Singh RD, Tjoa TT, Saavedra R, Kaplan SH, Huang SS. Evaluating barriers and potential solutions to speaking up about coronavirus disease 2019 (COVID-19) symptoms: A survey among nursing home workers. Infect Control Hosp Epidemiol 2023; 44:1834-1839. [PMID: 37990904 DOI: 10.1017/ice.2023.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Quantify the frequency and drivers of unreported coronavirus disease 2019 (COVID-19) symptoms among nursing home (NH) staff. DESIGN Confidential telephone survey. SETTING The study was conducted in 70 NHs in Orange County, California, December 2020-February 2022. PARTICIPANTS The study included 120 NH staff with COVID-19. METHODS We designed a 40-item telephone survey of NH staff to assess COVID-19 symptom reporting behavior and types of barriers [monetary, logistic, and emotional (fear or stigma)] and facilitators of symptom reporting using 5-point Likert scales. Summary statistics, reliability of survey constructs, and construct and discriminant validity were assessed. RESULTS Overall, 49% of surveys were completed during the 2020-2021 COVID-19 winter wave and 51% were completed during severe acute respiratory coronavirus virus 2 (SARS-CoV-2) δ (delta)/ (omicron) waves, with a relatively even distribution of certified nursing assistants, licensed vocational or registered nurses, and nonfrontline staff. Most COVID-19 cases (71%) were detected during mandated weekly NH surveillance testing and most staff (67%) had ≥1 symptom prior to their test. Only 34% of those with symptoms disclosed their symptom to a supervisor. Responses were consistent across 8 discrete survey constructs with Cronbach α > 0.70. In the first wave of the pandemic, fear and lack of knowledge were drivers of symptom reporting. In later waves, adequate staffing and sick days were drivers of symptom reporting. COVID-19 help lines and encouragement from supervisors facilitated symptom reporting and testing. CONCLUSIONS Mandatory COVID-19 testing for NH staff is key to identifying staff COVID-19 cases due to reluctance to speak up about existing symptoms. Active encouragement from supervisors to report symptoms and stay home when ill was a major driver of symptom reporting and resultant infection prevention and worker safety measures.
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Affiliation(s)
- Gabrielle M Gussin
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, California
| | - Raveena D Singh
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, California
| | - Thomas T Tjoa
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, California
| | - Raheeb Saavedra
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, California
| | - Sherrie H Kaplan
- Health Policy Research Institute, University of California Irvine, Irvine, California
| | - Susan S Huang
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, California
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Hsi JB, Singh RD, Pedroza R, Gussin GM, Tjoa TT, Gohil SK. Impact of Alzheimer's disease and related dementias (ADRD) on the quality of room cleaning in nursing homes. Infect Control Hosp Epidemiol 2023; 44:1508-1510. [PMID: 36756757 DOI: 10.1017/ice.2023.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Persons with Alzheimer's disease and related dementias (ADRD) are prone to receiving reduced quality of care. We compared the quality of room cleaning of rooms with ADRD residents and rooms with non-ADRD residents in nursing homes using an ultraviolet (UV) marker. ADRD status was associated with greater failure of UV marker removal (odds ratio, 1.68; 95% confidence interval, 1.04-2.71; P = .03).
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Affiliation(s)
- Joshua B Hsi
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Raveena D Singh
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Robert Pedroza
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Gabrielle M Gussin
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Thomas T Tjoa
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Shruti K Gohil
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
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Nguyen KP, Singh RD, Saavedra R, Billimek JT, Tam SP, Steinberg KE, Porter L, Mitchell J, Huang SS. Not as simple as it seems: extensive facility and training gaps in nursing home bathing. Infect Control Hosp Epidemiol 2023; 44:1490-1493. [PMID: 37325907 PMCID: PMC10507494 DOI: 10.1017/ice.2023.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 06/17/2023]
Abstract
Standardized observation of bed baths and showers for 100 residents in 8 nursing homes revealed inadequate cleansing of body sites (88%-100% failure) and >90% process failure involving lather, firm massage, changing dirty wipes or cloths, and following clean-to-dirty sequence. Insufficient water warmth affected 86% of bathing opportunities. Bathing training and adequate resources are needed.
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Affiliation(s)
- Kristine P. Nguyen
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
| | - Raveena D. Singh
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
| | - Raheeb Saavedra
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
| | - John T. Billimek
- Department of Family Medicine, University of California, Irvine School of Medicine, Irvine, California
| | - Steven P. Tam
- Division of Geriatrics and Gerontology, University of California, Irvine School of Medicine, Irvine, California
| | - Karl E. Steinberg
- Shiley Haynes Institute for Palliative Care, California State University–San Marcos, San Marcos, California
| | - Lori Porter
- National Association of Health Care Assistants, Carl Junction, Missouri
| | - John Mitchell
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
| | - Susan S. Huang
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
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Gussin GM, Singh RD, Tifrea DF, Tjoa T, Bittencourt CE, Edwards RA, Monuki ES, Huang SS. Beyond Costs: Pragmatic Considerations for Pooling of SARS-CoV-2 Test Samples for Nursing Home Surveillance. Microbiol Spectr 2023; 11:e0388022. [PMID: 36722961 PMCID: PMC10100904 DOI: 10.1128/spectrum.03880-22] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/16/2023] [Indexed: 02/02/2023] Open
Abstract
Pooling of samples can increase throughput and reduce costs for large-scale SARS-CoV-2 testing when incidence is low. In a cross-sectional study of serial SARS-CoV-2 sampling of staff and residents at three nursing homes, laboratory labor constraints limited the feasibility of pooling prior to the maximal incidence that favored cost savings. IMPORTANCE This study highlights the pragmatic considerations surrounding SARS-CoV-2 sample pooling beyond accuracy and costs. We performed a cost analysis to determine the percent positivity at which pooling would reduce costs versus single testing. We found that the need for a stable amount of daily work hours staffed by a highly trained workforce was a major limitation in pooling as test positivity increased. For the COVID-19 pandemic and future pandemic threats, laboratories should carefully consider the thresholds at which sample pooling is beneficial, with a particular focus on the impact on laboratory staff.
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Affiliation(s)
- Gabrielle M. Gussin
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, California, USA
| | - Raveena D. Singh
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, California, USA
| | - Delia F. Tifrea
- University of California Irvine Health, Orange, California, USA
| | - Thomas Tjoa
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, California, USA
| | | | - Robert A. Edwards
- Department of Pathology & Laboratory Medicine, University of California Irvine School of Medicine, Irvine, California, USA
| | - Edwin S. Monuki
- Department of Pathology & Laboratory Medicine, University of California Irvine School of Medicine, Irvine, California, USA
| | - Susan S. Huang
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, California, USA
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12
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Gussin GM, Singh RD, Tjoa TT, Saavedra R, Kaplan SH, Huang SS. 1401. Evaluating Barriers and Potential Solutions to Speaking Up About COVID-19 Symptoms: A Survey Among Nursing Home Workers. Open Forum Infect Dis 2022. [PMCID: PMC9752929 DOI: 10.1093/ofid/ofac492.1230] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Nursing homes (NHs) are high risk settings for COVID. Staff are the primary source for introducing COVID into a NH. Preventing staff from working when ill is key to resident safety. NH staff face significant socioeconomic pressures that may influence their willingness to report COVID symptoms. Understanding the drivers behind unreported illness can inform ways to prevent working when ill. Methods We conducted a confidential survey of 120 COVID-positive NH staff in Orange County, CA from Dec ‘20-Feb ‘22 to quantify the frequency and drivers of unreported COVID symptoms. We designed a 40-item survey to assess demographics, course of illness, symptom reporting behavior, and monetary, logistic, and emotional (stigma/fear) barriers to reporting using a 5-point Likert scale. Recruitment flyers were shared with all 70 NHs in the county and referrals were accepted from NH leadership. Participants received $50 for completing the 20-30 min phone-based survey. We calculated summary statistics, transformed all data to a 0-100 scale, assessed the reliability of each factor related to reporting at the group level using Cronbach’s alpha, and assessed discriminant validity with t-tests comparing responses among subsets expected to differ. Results Table 1 shows participant characteristics. 49% of surveys were during the 2020-21 winter wave and 51% were during the Delta/Omicron waves, with a relatively even distribution of certified nursing assistants (CNAs), nurses, and non-frontline staff. Most cases (70%) were detected by routine testing at the NH and most (63%) had ≥1 symptom prior to their test. Only 39% disclosed their symptom to a supervisor. It is unknown how many staff would have disclosed symptoms if they were not captured during routine testing. Responses were consistent across 15 discrete factors with Cronbach alpha >0.7. Overall, fear and encouragement from supervisors were the most salient factors for speaking up about COVID symptoms (Table 2). Responses varied between the two waves and between frontline vs non-frontline workers.
![]() ![]() Conclusion Frequent surveillance testing of NH staff during a pandemic is critical due to many factors that drive reluctance to speak up about potential symptoms. Encouragement from supervisors to report symptoms and stay home when ill may improve NH safety. Disclosures Gabrielle M. Gussin, MS, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products Raveena D. Singh, MA, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products Raheeb Saavedra, AS, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products Susan S. Huang, MD, MPH, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Molnlyke: Conducted clinical studies in which hospitals received contributed antiseptic product|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic product.
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Affiliation(s)
- Gabrielle M Gussin
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Raveena D Singh
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Thomas T Tjoa
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Raheeb Saavedra
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Sherrie H Kaplan
- University of California, Irvine, School of Medicine, Irvine, California
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13
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Gussin GM, Singh RD, Tjoa TT, Berman C, Saavedra R, Macapulay J, Pedroza R, Gordeychev K, Shimabukuro JA, Evans KD, Bittencourt CE, Huang SS. 87. Impact of Universal Decolonization With and Without Enhanced Cleaning on MultiDrug-Resistant Organism (MDRO) Body-Site Carriage and Environmental Contamination in Nursing Homes (NHs): The CLEAN Study. Open Forum Infect Dis 2022. [PMCID: PMC9751953 DOI: 10.1093/ofid/ofac492.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Decolonization (decol) and environmental cleaning are strategies to reduce MDRO transmission and infection. While decol in NHs has been proven to reduce MDRO carriage, infection-related hospitalization, and contamination, the impact of enhanced cleaning (EC) with or without decol has not been evaluated. Methods We performed a 4-phase study in 2 NHs from 2019–21 to compare 1) decol, 2) EC, and 3) decol plus EC on MDRO carriage and contamination vs routine care (control). Decol involved nasal iodophor on admission x 5d and then M-F biweekly plus chlorhexidine for routine bathing for all residents. EC involved standardized training for cart setup, disinfectant preparation and saturation, color-coded microfiber cloths for specific items, and UV marker feedback. Outcomes were serial MDRO point prevalence (6 per phase) of nares/skin and MDRO contamination of high-touch bedroom and common area objects. Swabs were processed for MRSA, VRE, ESBL, and CRE. We used generalized linear mixed models to compare phases while clustering by NH. Analyses of objects also clustered by room. Results Table 1 shows crude MDRO prevalence and environmental contamination by study phase. Table 2 shows the impact of each phase vs control. Decol had the greatest impact on MDRO carriage with a 46% reduction vs control. EC alone did not decrease MDRO carriage, and EC plus decol did not further reduce MDRO carriage vs decol alone. The impact of decol vs EC on carriage differed for Gram-positive (GP) vs negative (GN) pathogens. Only decol reduced MRSA and VRE carriage, while both decol and EC reduced GN carriage. The reduction in GN carriage was enhanced with both decol and EC, although this was not statistically significant. With EC, 24-hour UV marker removal of high-touch objects increased from 7% to 45%. Decol and EC both reduced MDRO object contamination, by 84% and 75%, respectively. The impact of decol on object contamination was not enhanced with EC. This table shows the crude MDRO prevalence and environmental contamination results by study phase. Each phase involved 6 serial point prevalence sweeps of 40 residents per nursing home (N=480 total residents per phase), and 6 serial sweeps of high-touch bedroom and common area objects (N=504 total objects per phase). This table shows the odds ratios and 95% confidence intervals for any MDRO and specific MDRO-types for each study phase for the outcomes of 1) MDRO body-site prevalence and 2) MDRO contamination of high-touch objects. The P-value reported represents the overall comparison of the intervention study phases versus control (routine care). Conclusion Multimodal strategies are needed to reduce MDRO burden in NHs. While both decolonization and cleaning independently reduced MDRO object contamination, only decolonization significantly reduced MDRO carriage prevalence. Decolonization provided substantial reductions in MDRO carriage and environmental contamination compared to cleaning alone. Disclosures Gabrielle M. Gussin, MS, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products Raveena D. Singh, MA, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products Raheeb Saavedra, AS, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products Susan S. Huang, MD, MPH, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Molnlyke: Conducted clinical studies in which hospitals received contributed antiseptic product|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic product.
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Affiliation(s)
- Gabrielle M Gussin
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Raveena D Singh
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Thomas T Tjoa
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Chase Berman
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Raheeb Saavedra
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Jessica Macapulay
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Robert Pedroza
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Karina Gordeychev
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | | | - Kaye D Evans
- University of California, Irvine Health, Orange, California
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Sansom S, Gussin GM, Singh RD, Bell PB, Benson EC, Makhija J, Froilan MC, Saavedra R, Pedroza R, Thotapalli L, Fukuda C, Gough E, Rodriguez SM, del Mar Villanueva Guzman M, Shimabukuro JA, Mikhail L, Black SR, Pacilli M, Adil H, Bittencourt CE, Zahn M, Moore NM, Sexton J, Noble-Wang J, Lyman M, Whitton A, Schoeny M, Lin MY, Huang SS, Hayden MK. 88. Increasing Bioburden of Candida auris Body Site Colonization is Associated with Environmental Contamination. Open Forum Infect Dis 2022; 9:ofac492.013. [PMCID: PMC9751825 DOI: 10.1093/ofid/ofac492.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Environmental contamination is suspected to play a key role in transmission of Candida auris in healthcare facilities. We recently showed that environmental surfaces near C. auris-colonized patients are commonly recontaminated within hours after disinfection. Clinical factors contributing to environmental contamination are not well characterized. Methods We conducted a multi-regional (Chicago, IL; Irvine, CA) prospective study of environmental contamination associated with C. auris colonization at six long-term care facilities (LTCF) and 1 acute-care hospital (ACH). On day of sampling, 5 participant body sites were cultured once, followed by routine daily room cleaning by facility staff, then targeted disinfection of high-touch surfaces with hydrogen peroxide wipes by research staff. Surfaces were cultured for C. auris using pre-moistened sponge-sticks and neutralizer immediately pre- and post-disinfection, and 4, 8, and 12 hours post-disinfection. We calculated the odds of surface recontamination after disinfection as a function of body site colonization with C. auris using generalized estimating equations to account for clustering among multiple surfaces within timepoints, patients, and facilities. Models included an interaction between facility type and colonization. Results C. auris was cultured from ≥1 body site in 41 participants (12 ACH and 29 LTCF patients, 205 body sites) on day of sampling. Proportion of body sites colonized did not vary by facility type (Table). Although environmental contamination rates were similar prior to disinfection [ACH 38% (n=60 samples) vs LTCF 29%, (n=145 samples), p=0.209)], the proportion of surfaces recontaminated between 4–12 hours after disinfection was higher in ACH vs LTCF (n=574 samples) (Figure). Number of body sites colonized with C. auris was associated with higher odds of environmental recontamination [ACH: OR 2.16 (95% CI 1.63–2.88), p< 0.001; LTCF: OR 1.40 (95% CI 1.07–1.84), p=0.015; Interaction ACH vs LTCF p< 0.001]. Conclusion The number of body sites colonized was associated with odds of C. auris environmental contamination. Differences in environmental recontamination by facility type may be related to greater provider-patient interactions in ACH as a driving factor. Disclosures Gabrielle M. Gussin, MS, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products Raveena D. Singh, MA, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products Raheeb Saavedra, AS, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products Nicholas M. Moore, PhD, D(ABMM), Abbott Molecular: Grant/Research Support|Cepheid: Grant/Research Support Susan S. Huang, MD, MPH, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Molnlyke: Conducted clinical studies in which hospitals received contributed antiseptic product|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic product Mary K. Hayden, MD, Sanofi: Member, clinical adjudication panel for an investigational SARS-CoV-2 vaccine.
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Affiliation(s)
- Sarah Sansom
- Rush University Medical Center, Chicago, Illinois
| | - Gabrielle M Gussin
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Raveena D Singh
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | | | | | | | | | - Raheeb Saavedra
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Robert Pedroza
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | | | | | - Ellen Gough
- Rush University Medical Center, Chicago, Illinois
| | | | | | | | - Lydia Mikhail
- Orange County Health Care Agency, Orange County, California
| | | | | | | | | | - Matt Zahn
- Orange County Health Care Agency, Orange County, California
| | | | - Joe Sexton
- Centers for Disease Control and Prevention, GA
| | | | | | | | | | | | - Susan S Huang
- University of California, Irvine School of Medicine, Irvine, CA
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15
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Gohil SK, Bahadori B, Nourollahi S, Tjoa TT, Saito H, Bethlahmy J, Alsharif M, Chang J, Nelson EL, Van Etten RA, Armendariz L, Torres V, Masson S, Rasheed S, Esteves M, Saavedra R, Singh RD, Huang SS. 1668. The SAFER Lines Project: A Mobile-App Strategy for Prevention of Outpatient Central Line Associated Bloodstream Infection (CLABSI). Open Forum Infect Dis 2022. [PMCID: PMC9752337 DOI: 10.1093/ofid/ofac492.134] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Outpatient peripherally inserted central catheters (PICC) use has grown without standardized protocols for their management. We assessed the impact of a mobile app strategy for outpatient CLABSI prevention using photo-monitoring, assessment, and response to lines with local inflammation/infection in a cohort of cancer clinic patients. Methods This prospective cohort study evaluated adults with PICCs at an academic cancer clinic at baseline (7/2015–12/2016) and after implementing the SAFER (Standardizing Assessment For Effective Response) Lines program (intervention 5/2017–11/2018). This included a mobile app enabling (1) clinic assessment of localized inflammation or infection defined as Central Line Insertion Site Assessment (CLISA) score 2 or 3, respectively (Table 1), (2) photo-documentation, and (3) score-based automated physician alerts for remote response. We assessed demographics, malignancy type, and line characteristics. Generalized linear mixed effects model assessed program impact on frequency of CLISA 2 or 3 lines, clustered by patient. Cox proportional hazards and Kaplan Meier models assessed days to line removal after CLISA 2 or 3 were identified. Results Among 4,894 assessments of 528 PICCs in 380 outpatients, there were 272 lines (199 patients) at baseline and 256 lines (181 patients) after SAFER program implementation. Mean age, gender, PICC dwell time, and history of prior PICC were similar at baseline and intervention. The proportion of inflamed (CLISA 2) and infected (CLISA 3) lines decreased 40% (from 26% to 16%, and 19% to 11%, respectively) during intervention compared to baseline. Lines with peeling dressings decreased 80% (from 46% to 9%). Mean days to removal of inflamed lines decreased 59% (from 19 to 8 days); removal of infected lines decreased 85% (from 11 to < 2 days). Intervention was associated with 46% lower risk of local inflammation/infection (OR 0.46, CI=0.26–0.83, p< 0.01, Table 2) and faster line removal when such lines were identified (HR 0.18, CI=0.12–0.27, p< 0.01).
Conclusion The SAFER Lines mobile app and program decreased the frequency of locally inflamed or infected PICC insertion sites and increased the speed of removal when local inflammation/infection was found in cancer clinic patients. Disclosures Raheeb Saavedra, AS, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products Raveena D. Singh, MA, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products Susan S. Huang, MD, MPH, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Molnlyke: Conducted clinical studies in which hospitals received contributed antiseptic product|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic product.
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Affiliation(s)
| | | | | | - Thomas T Tjoa
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Hiroki Saito
- St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Kanagawa, Japan
| | | | | | | | | | | | | | | | | | | | | | - Raheeb Saavedra
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
| | - Raveena D Singh
- University of California, Irvine School of Medicine, Division of Infectious Diseases, Irvine, California
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16
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Gussin GM, Singh RD, Nguyen KP, Huang SS. Value of a confidential COVID-19 helpline for nursing home staff. Am J Infect Control 2022:S0196-6553(22)00788-X. [PMID: 36403708 PMCID: PMC9671874 DOI: 10.1016/j.ajic.2022.11.004] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
We hosted a confidential helpline to address concerns about COVID-19 prevention among staff in 12 nursing homes in Orange County, California. We fielded 301 inquiries from April 2021-April 2022, most commonly involving questions about vaccines (40%), nursing home COVID-19 prevention (28%), SARS-CoV-2 variants (18%), symptom reporting (10%), and home and community COVID-19 prevention (5%). During COVID-19 surges, staff dominantly expressed fear, anger, and exhaustion. During nadirs, sentiment shifted towards optimism and acceptance.
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Affiliation(s)
- Gabrielle M Gussin
- Address correspondence to Gabrielle Gussin, MS, University of California Irvine School of Medicine, 100 Theory, Suite 120, Irvine, CA 92617
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17
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McKinnell JA, Singh RD, Miller LG, Kleinman K, Gussin G, He J, Saavedra R, Dutciuc TD, Estevez M, Chang J, Heim L, Yamaguchi S, Custodio H, Gohil SK, Park S, Tam S, Robinson PA, Tjoa T, Nguyen J, Evans KD, Bittencourt CE, Lee BY, Mueller LE, Bartsch SM, Jernigan JA, Slayton RB, Stone ND, Zahn M, Mor V, McConeghy K, Baier RR, Janssen L, O'Donnell K, Weinstein RA, Hayden MK, Coady MH, Bhattarai M, Peterson EM, Huang SS. The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California. Clin Infect Dis 2020; 69:1566-1573. [PMID: 30753383 DOI: 10.1093/cid/ciz119] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/05/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Multidrug-resistant organisms (MDROs) spread between hospitals, nursing homes (NHs), and long-term acute care facilities (LTACs) via patient transfers. The Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County is a regional public health collaborative involving decolonization at 38 healthcare facilities selected based on their high degree of patient sharing. We report baseline MDRO prevalence in 21 NHs/LTACs. METHODS A random sample of 50 adults for 21 NHs/LTACs (18 NHs, 3 LTACs) were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum β-lactamase-producing organisms (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE) using nares, skin (axilla/groin), and peri-rectal swabs. Facility and resident characteristics associated with MDRO carriage were assessed using multivariable models clustering by person and facility. RESULTS Prevalence of MDROs was 65% in NHs and 80% in LTACs. The most common MDROs in NHs were MRSA (42%) and ESBL (34%); in LTACs they were VRE (55%) and ESBL (38%). CRE prevalence was higher in facilities that manage ventilated LTAC patients and NH residents (8% vs <1%, P < .001). MDRO status was known for 18% of NH residents and 49% of LTAC patients. MDRO-colonized adults commonly harbored additional MDROs (54% MDRO+ NH residents and 62% MDRO+ LTACs patients). History of MRSA (odds ratio [OR] = 1.7; confidence interval [CI]: 1.2, 2.4; P = .004), VRE (OR = 2.1; CI: 1.2, 3.8; P = .01), ESBL (OR = 1.6; CI: 1.1, 2.3; P = .03), and diabetes (OR = 1.3; CI: 1.0, 1.7; P = .03) were associated with any MDRO carriage. CONCLUSIONS The majority of NH residents and LTAC patients harbor MDROs. MDRO status is frequently unknown to the facility. The high MDRO prevalence highlights the need for prevention efforts in NHs/LTACs as part of regional efforts to control MDRO spread.
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Affiliation(s)
- James A McKinnell
- Infectious Disease Clinical Outcomes Research, LA Biomed at Harbor-University of California Los Angeles Medical Center, Torrance
| | - Raveena D Singh
- Division of Infectious Diseases, University of California Irvine School of Medicine, Orange
| | - Loren G Miller
- Infectious Disease Clinical Outcomes Research, LA Biomed at Harbor-University of California Los Angeles Medical Center, Torrance
| | - Ken Kleinman
- University of Massachusetts Amherst School of Public Health and Health Sciences, Orange
| | - Gabrielle Gussin
- Division of Infectious Diseases, University of California Irvine School of Medicine, Orange
| | - Jiayi He
- Division of Infectious Diseases, University of California Irvine School of Medicine, Orange
| | - Raheeb Saavedra
- Division of Infectious Diseases, University of California Irvine School of Medicine, Orange
| | - Tabitha D Dutciuc
- Division of Infectious Diseases, University of California Irvine School of Medicine, Orange
| | - Marlene Estevez
- Division of Infectious Diseases, University of California Irvine School of Medicine, Orange
| | - Justin Chang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Orange
| | - Lauren Heim
- Division of Infectious Diseases, University of California Irvine School of Medicine, Orange
| | - Stacey Yamaguchi
- Division of Infectious Diseases, University of California Irvine School of Medicine, Orange
| | - Harold Custodio
- Division of Infectious Diseases, University of California Irvine School of Medicine, Orange
| | - Shruti K Gohil
- Division of Infectious Diseases, University of California Irvine School of Medicine, Orange
| | - Steven Park
- University of California Irvine Health, Orange
| | - Steven Tam
- Division of Geriatrics, Department of Medicine, University of California Irvine, Orange
| | | | - Thomas Tjoa
- Division of Infectious Diseases, University of California Irvine School of Medicine, Orange
| | - Jenny Nguyen
- Division of Infectious Diseases, University of California Irvine School of Medicine, Orange
| | | | | | - Bruce Y Lee
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Leslie E Mueller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah M Bartsch
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John A Jernigan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachel B Slayton
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nimalie D Stone
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew Zahn
- Epidemiology and Assessment, Orange County Health Care Agency, Santa Ana, California
| | - Vincent Mor
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Rhode Island.,Center of Innovation in Long-Term Services and Supports, Veterans Affairs Medical Center, Providence VA Medical Center, Rhode Island.,Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, Rhode Island
| | - Kevin McConeghy
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Rhode Island.,Center of Innovation in Long-Term Services and Supports, Veterans Affairs Medical Center, Providence VA Medical Center, Rhode Island.,Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, Rhode Island
| | - Rosa R Baier
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Rhode Island.,Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, Rhode Island
| | - Lynn Janssen
- Healthcare-associated Infections Program, Center for Healthcare Quality, California Department of Public Health, Richmond, California
| | - Kathleen O'Donnell
- Epidemiology and Assessment, Orange County Health Care Agency, Santa Ana, California.,Healthcare-associated Infections Program, Center for Healthcare Quality, California Department of Public Health, Richmond, California
| | - Robert A Weinstein
- Cook County Health and Hospitals System, Chicago, Illinois.,Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Mary K Hayden
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Micaela H Coady
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Megha Bhattarai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Susan S Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Orange.,Health Policy Research Institute, University of California Irvine School of Medicine
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18
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McKinnell JA, Miller LG, Singh RD, Gussin G, Kleinman K, Mendez J, Laurner B, Catuna TD, Heim L, Saavedra R, Felix J, Torres C, Chang J, Estevez M, Mendez J, Tchakalian G, Bloomfield L, Ceja S, Franco R, Miner A, Hurtado A, Hean R, Varasteh A, Robinson PA, Park S, Tam S, Tjoa T, He J, Agrawal S, Yamaguchi S, Custodio H, Nguyen J, Bittencourt CE, Evans KD, Mor V, McConeghy K, Weinstein RA, Hayden MK, Stone ND, Steinberg K, Beecham N, Montgomery J, DeAnn W, Peterson EM, Huang SS. High Prevalence of Multidrug-Resistant Organism Colonization in 28 Nursing Homes: An "Iceberg Effect". J Am Med Dir Assoc 2020; 21:1937-1943.e2. [PMID: 32553489 DOI: 10.1016/j.jamda.2020.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 01/07/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum beta-lactamase producing organisms (ESBLs), and carbapenem-resistant Enterobacteriaceae (CRE) among residents and in the environment of nursing homes (NHs). DESIGN Point prevalence sampling of residents and environmental sampling of high-touch objects in resident rooms and common areas. SETTING Twenty-eight NHs in Southern California from 2016 to 2017. PARTICIPANTS NH participants in Project PROTECT, a cluster-randomized trial of enhanced bathing and decolonization vs routine care. METHODS Fifty residents were randomly sampled per NH. Twenty objects were sampled, including 5 common room objects plus 5 objects in each of 3 rooms (ambulatory, total care, and dementia care residents). RESULTS A total of 2797 swabs were obtained from 1400 residents in 28 NHs. Median prevalence of multidrug-resistant organism (MDRO) carriage per NH was 50% (range: 24%-70%). Median prevalence of specific MDROs were as follows: MRSA, 36% (range: 20%-54%); ESBL, 16% (range: 2%-34%); VRE, 5% (range: 0%-30%); and CRE, 0% (range: 0%-8%). A median of 45% of residents (range: 24%-67%) harbored an MDRO without a known MDRO history. Environmental MDRO contamination was found in 74% of resident rooms and 93% of common areas. CONCLUSIONS AND IMPLICATIONS In more than half of the NHs, more than 50% of residents were colonized with MDROs of clinical and public health significance, most commonly MRSA and ESBL. Additionally, the vast majority of resident rooms and common areas were MDRO contaminated. The unknown submerged portion of the iceberg of MDRO carriers in NHs may warrant changes to infection prevention and control practices, particularly high-fidelity adoption of universal strategies such as hand hygiene, environmental cleaning, and decolonization.
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Affiliation(s)
- James A McKinnell
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA; Los Angeles County Department of Public Health, Healthcare Outreach Unit, Los Angeles, CA, USA; Expert Stewardship, Newport, CA, USA.
| | - Loren G Miller
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Raveena D Singh
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Gabrielle Gussin
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Ken Kleinman
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, USA
| | - Job Mendez
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Bryn Laurner
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Tabitha D Catuna
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Lauren Heim
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Raheeb Saavedra
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - James Felix
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Crystal Torres
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Justin Chang
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Marlene Estevez
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Joanna Mendez
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Gregory Tchakalian
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Leah Bloomfield
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Sandra Ceja
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ryan Franco
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Aaron Miner
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Aura Hurtado
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ratharo Hean
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Alex Varasteh
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Philip A Robinson
- Expert Stewardship, Newport, CA, USA; Hoag Hospital, Newport, CA, USA
| | - Steven Park
- Department of Pathology and Laboratory Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Steven Tam
- Division of Geriatrics, Department of Medicine, University of California Irvine, Orange, CA, USA
| | - Thomas Tjoa
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Jiayi He
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Shalini Agrawal
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Stacey Yamaguchi
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Harold Custodio
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Jenny Nguyen
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Cassiana E Bittencourt
- Department of Pathology and Laboratory Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Kaye D Evans
- Department of Pathology and Laboratory Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Vincent Mor
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Veterans Affairs Medical Center, Providence VA Medical Center, Providence, RI, USA; Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, RI, USA
| | - Kevin McConeghy
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Veterans Affairs Medical Center, Providence VA Medical Center, Providence, RI, USA; Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, RI, USA
| | - Robert A Weinstein
- Cook County Health and Hospitals System, Chicago, IL, USA; Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Mary K Hayden
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Nimalie D Stone
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karl Steinberg
- California Association of Long Term Care Medicine, Santa Clarita, CA, USA
| | - Nancy Beecham
- The National Association of Directors of Nursing Administration in Long Term Care, Springdale, OH, USA
| | | | - Walters DeAnn
- California Association of Health Facilities, Sacramento, CA, USA
| | - Ellena M Peterson
- Department of Pathology and Laboratory Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Susan S Huang
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA; Department of Medicine, Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, USA
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Singh RD, Banerjee J, Sasmal S, Muir J, Arora A. High xylan recovery using two stage alkali pre-treatment process from high lignin biomass and its valorisation to xylooligosaccharides of low degree of polymerisation. Bioresour Technol 2018; 256:110-117. [PMID: 29433045 DOI: 10.1016/j.biortech.2018.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 05/11/2023]
Abstract
In the present work, xylan from arecanut husk was extracted using 2 stage alkaline pretreatment process. In first step, biomass was incubated in alkali at different temperatures (25 °C, 50 °C and 65 °C), alkali concentrations (5%, 10%, 15% and 20% w/v), and incubation periods (8 h, 16 h and 24 h) and evaluated for xylan recovery. It was observed that 40-52% of available xylan could be recovered using 10% alkali when incubated for 8-24 h at 65 °C. Subsequently, the alkali pretreatment operating conditions which provided good xylan recovery were processed further using hydrothermal treatment to extract more xylan. For maximum xylan recovery (>90%), best operating conditions were identified when biomass was treated under hydrothermal treatment (1, 1.5 and 2 h) with varying incubation periods (8, 16, 24 h) and alkali concentrations (5%, 10%) using full factorial design. Incubating arecanut husk with 10% w/v NaOH, at 65 °C for a period of 8 h, followed by hydrothermal treatment at 121 °C for 1 h helped recover >94% xylan. In the next step, enzymatic hydrolysis process was optimized to recover maximum XOS (Optimized condition: 50 °C, pH 4 and 10 U enzyme dose). The hydrolysate comprised of xylobiose: 25.0 ± 1.2 g/100 g xylan (∼71% of XOS), xylotriose: 9.2 ± 0.65 g/100 g xylan (26.2% of XOS) and xylotetrose: 0.9 ± 0.04 g/100 g xylan (2% of XOS). The developed process enables to reduce alkali consumption for high recovery of xylan from biomass with relatively higher lignin content for its valorisation into a potential prebiotic oligosaccharide.
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Affiliation(s)
- R D Singh
- Indian Institute of Technology Bombay-Monash Research Academy, Indian Institute of Technology, Bombay, India; Bio-Processing Laboratory, Centre for Technology Alternatives for Rural Areas, Indian Institute of Technology, Bombay, India
| | - J Banerjee
- Indian Institute of Technology Bombay-Monash Research Academy, Indian Institute of Technology, Bombay, India; Bio-Processing Laboratory, Centre for Technology Alternatives for Rural Areas, Indian Institute of Technology, Bombay, India
| | - S Sasmal
- Bio-Processing Laboratory, Centre for Technology Alternatives for Rural Areas, Indian Institute of Technology, Bombay, India
| | - J Muir
- Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - A Arora
- Indian Institute of Technology Bombay-Monash Research Academy, Indian Institute of Technology, Bombay, India; Bio-Processing Laboratory, Centre for Technology Alternatives for Rural Areas, Indian Institute of Technology, Bombay, India.
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20
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Patel KR, Vajaria BN, Singh RD, Begum R, Patel PS. Clinical implications of p53 alterations in oral cancer progression: a review from India. Exp Oncol 2018; 40:10-18. [PMID: 29600984] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
p53 plays a central role in prevention of normal cell from the development of the malignant phenotype. Somatic alterations (mutations, loss of heterozygosity, deletions) in p53 are a hallmark of most human cancers and cause defects in normal p53 function. However, in the tumors harboring wild-type p53, there are alterations in the regulation of the p53. Thus, understanding why p53 is unable to perform its role as a tumor suppressor in these wild-type tumors is very crucial. Germ-line polymorphisms in p53 are also anticipated to cause measurable disturbance in p53 function. Over-expression as well as polymorphic variants of MDM2 might have effects on cancer development. In addition, degradation of p53 by E6 protein of high risk human papillomavirus is also suggested as one of the mechanisms which attenuate p53 responses in oral carcinogenesis. p53 has also been demonstrated to mediate cellular responses upon various DNA damaging cancer therapies, importantly, apoptosis. These responses have been implicated in an individual's ability to respond to these cancer therapies. Thus, exploring mechanisms by which normal function of p53 is affected in the comprehensive way in oral cancer might aid in the identification of tumor characteristics, prognosis and thus in the development of a new approach to treat the oral cancer.
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Affiliation(s)
- K R Patel
- Biochemistry Research Division, Gujarat Cancer & Research Institute, Asarwa, Ahmedabad 380016, Gujarat, India
| | - B N Vajaria
- Biochemistry Research Division, Gujarat Cancer & Research Institute, Asarwa, Ahmedabad 380016, Gujarat, India
| | - R D Singh
- Biochemistry Research Division, Gujarat Cancer & Research Institute, Asarwa, Ahmedabad 380016, Gujarat, India
| | - R Begum
- Department of Biochemistry, M.S. University of Baroda, Vadodara 390002, Gujarat, India
| | - P S Patel
- Biochemistry Research Division, Gujarat Cancer & Research Institute, Asarwa, Ahmedabad 380016, Gujarat, India
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21
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McKinnell JA, Miller L, Singh RD, Mendez J, Franco R, Gussin G, Chang J, Dutciuc TD, Saavedra R, Kleinman K, Peterson EM, Evans KD, Heim L, Miner A, Estevez M, Custodio H, Yamaguchi S, Nguyen J, Varasteh A, Launer B, Agrawal S, Tjoa T, He J, Park S, Tam S, Gohil SK, Stone ND, Steinberg K, Montgomery J, Beecham N, Huang SS. When a Home is Not a Home: MultiDrug-Resistant Organism (MDRO) Colonization and Environmental Contamination in 28 Nursing Homes (NHs). Open Forum Infect Dis 2017. [PMCID: PMC5632077 DOI: 10.1093/ofid/ofx162.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The majority of healthcare-associated infections due to MDROs occur in the post-discharge setting. Understanding MDRO spread and containment in NHs can help identify infection prevention activities needed to care for vulnerable patients in a medical home setting.
Methods
We conducted a baseline point prevalence study of MDRO colonization in residents of 28 Southern California NHs participating in a decolonization trial. In Fall 2016, residents were randomly sampled to obtain a set of 50 nares and skin (axilla/groin) swabs from each NH. Nasal swabs were processed for MRSA and skin swabs were processed for MRSA, VRE, ESBL, and CRE. In addition, environmental swabs were collected from high touch objects in resident rooms (bedrail, call button/TV remote, door knobs, light switch, bathroom) and common areas (nursing station, table, chair, railing, and drinking fountain).
Results
A total of 2,797 body swabs were obtained from 1400 residents. Overall, 48.6% (N = 680) of residents harbored MDROs. MRSA was found in 37% of residents (29.5% nares, 24.4% skin), followed by ESBL in 16% (Table 1). Resident MDRO status was only known for 11% of MRSA (59/518), 18% ESBL (40/228), 4% VRE (4/99), and none of the CRE (0/13) carriers. Colonization did not differ between long stay (48.8%, 534/1094) vs. post-acute (47.7%, 146/306) residents (P = NS), but bedbound residents were more likely to be MDRO colonized (58.7%, 182/310) vs. ambulatory residents (45.7%, 497/1088, P < 0.001). A total of 560 environmental swabs were obtained with 93% of common areas and 74% of resident rooms having an MDRO+ object with an average of 2.5 and 1.9 objects found to be contaminated (Table 2).
Conclusion
One in two NH residents are colonized with MDROs, which is largely unknown to the facility. MDRO carriage is associated with total care needs, but not long stay status. Environmental contamination in resident rooms and common areas is common. The burden of MDRO colonization and contamination is sufficiently high that universal strategies to reduce colonization and transmission are warranted.
Disclosures
J. A. McKinnell, Allergan: Research Contractor, Scientific Advisor and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium; Achaogen: Research Contractor, Scientific Advisor and Shareholder, Research support; Cempra: Research Contractor and Scientific Advisor, Research support; Theravance: Research Contractor, Research support; Science 37: Research Contractor, Salary; Expert Stewardship, LLC: Board Member and Employee, Salary; Thermo Fisher: Scientific Advisor, Salary; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; L. Miller, 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; R. D. Singh, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; J. Mendez, Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; R. Franco, Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; G. Gussin, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; L’Oreal: Consultant, Consulting fee; J. Chang, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; T. D. Dutciuc, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; R. Saavedra, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; K. Kleinman, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Molnlycke: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; E. M. Peterson, Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; L. Heim, Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; A. Miner, Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; M. Estevez, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; H. Custodio, Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; S. Yamaguchi, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; J. Nguyen, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; A. Varasteh, Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Sage Product: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; B. Launer, 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; S. Agrawal, Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; T. Tjoa, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; J. He, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; S. Park, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; S. Tam, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; S. K. Gohil, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; S. S. Huang, Sage Products: Receipt of contributed product, Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product; Clorox: Receipt of contributed product, Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product; 3M: Receipt of contributed product, Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product; Molnlycke: Receipt of contributed product, Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product
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Affiliation(s)
- James A McKinnell
- David Geffen School of Medicine at UCLA, Torrance, California
- Expert Stewardship, LLC, Newport Beach, California
- Los Angeles County Department of Public Health, Healthcare Outreach Unit (HOU), Los Angeles, California
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Loren Miller
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Raveena D Singh
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Job Mendez
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Ryan Franco
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Gabrielle Gussin
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Justin Chang
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Tabitha D Dutciuc
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Raheeb Saavedra
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Ken Kleinman
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts
| | | | - Kaye D Evans
- University of California Irvine Health, Orange, California
| | - Lauren Heim
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Aaron Miner
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Marlene Estevez
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Harold Custodio
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Stacey Yamaguchi
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Jenny Nguyen
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Alex Varasteh
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Bryn Launer
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Shalini Agrawal
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Thomas Tjoa
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Jiayi He
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Steven Park
- University of California Irvine Health, Orange, California
| | - Steven Tam
- Division of Geriatrics, Department of Medicine, University of California Irvine, Orange, California
| | - Shruti K Gohil
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Nimalie D Stone
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karl Steinberg
- The Society for Post-Acute and Long-Term Care Medicine (AMDA), San Diego, California
| | - Jocelyn Montgomery
- California Association of Health Facilities (CaliforniaHF), Sacramento, California
| | - Nancy Beecham
- National Association Directors of Nursing Administration in Long-Term Care (NADONA), San Diego, California
| | - Susan S Huang
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
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22
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Singh RD, Jernigan JA, Slayton RB, Stone ND, McKinnell JA, Miller LG, Kleinman K, Heim L, Dutciuc TD, Estevez M, Gussin G, Chang J, Peterson EM, Evans KD, Lee BY, Mueller LE, Bartsch SM, Zahn M, Janssen L, Weinstein RA, Hayden MK, Gohil SK, Park S, Tam S, Saavedra R, Yamaguchi S, Custodio H, Nguyen J, Tjoa T, He J, O’Donnell K, Coady MH, Platt R, Huang SS. The CDC SHIELD Orange County Project – Baseline Multi Drug-Resistant Organism (MDRO) Prevalence in a Southern California Region. Open Forum Infect Dis 2017. [PMCID: PMC5631751 DOI: 10.1093/ofid/ofx162.109] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
MDROs can spread between hospitals, nursing homes (NH), and long-term acute care facilities (LTACs) via shared patients. SHIELD OC is a regional decolonization collaborative involving 38 of 104 countywide adult facilities identified by their high degree of direct and indirect patient sharing with one another. We report baseline MDRO prevalence in these facilities.
Methods
Adult patients in 38 facilities (17 hospitals, 18 NHs, 3 LTACs) underwent point-prevalence screening between September 2016–April 2017 for MRSA, VRE, ESBL, and CRE using nares, skin (axilla/groin), and peri-rectal swabs. In NHs and LTACs, residents were randomly selected until 50 sets of swabs were obtained. Swabbing in hospitals involved all patients in contact precautions. An additional set of swabs were also performed for all LTAC admissions from November 2016–February 2017.
Results
The overall prevalence of any MDRO among patients was 64% (44%–88%) in NHs, 80% (range 72%–86%) in LTACs, and 64% (54–84%) in hospitals (contact precaution patients) (Table 1). Only 25%, 64%, and 81% of patients were already known to harbor an MDRO in NHs, LTACs, and hospitals, respectively. Known MDRO patients also harbored another MDRO 49%, 63%, and 34% of the time for NHs, LTACs, and hospitals, respectively. In LTACs, MDRO point prevalence was 38% higher than the usual admission prevalence (65% higher for MRSA, 34% higher for VRE, 95% higher for ESBL, and 50% higher for CRE).
Conclusion
MDRO carriage in highly inter-connected NHs and LTACs was widespread, rivaling that found in hospitalized patients on contact precautions. MRSA, VRE, and ESBL carriage far outnumbered CRE carriage. A history of MDRO was insensitive for identifying MDRO carriers, and many patients carried multiple MDROs. The extensive MDRO burden and transmission in long-term care settings suggests that regional MDRO prevention efforts must include MDRO control in long-term care facilities.
Disclosures
R. D. Singh, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; J. A. McKinnell, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; L. G. Miller, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; K. Kleinman, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Molnlycke: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; L. Heim, Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; T. D. Dutciuc, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; M. Estevez, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; G. Gussin, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; L’Oreal: Consultant, Consulting fee; J. Chang, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; E. M. Peterson, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; B. Y. Lee, GSK: Consultant, Consulting fee; R. A. Weinstein, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Molnlycke: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; OpGen Company: Study support, Provided services at no charge; M. K. Hayden, Sage Products: Receipt of contributed product, Sage is contributing product to healthcare facilities participating in a regional collaborative on which I am a co-investigator. Neither I nor my hospital receive product.; Clorox: Receipt of contributed product, Research support; CDC: Grant Investigator and Receipt of contributed product, Research grant; Molnlycke: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; OpGen Company: Study support, Provided services at no charge for studies; S. K. Gohil, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; S. Park, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; S. Tam, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; R. Saavedra, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; S. Yamaguchi, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; H. Custodio, Xttrium Laboratories: Study coordination, Conducting studies in healthcare facilities that are receiving contributed product; Sage Products: Study coordination, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Study coordination, Conducting studies in healthcare facilities that are receiving contributed product; J. Nguyen, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; T. Tjoa, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; J. He, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; 3M: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; M. H. Coady, Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Molnlycke: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; R. Platt, Sage Products: Receipt of contributed product, Conducting clinical studies in which participating healthcare facilities are receiving contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting clinical studies in which participating healthcare facilities are receiving contributed product; Clorox: Receipt of contributed product, Conducting clinical studies in which participating healthcare facilities are receiving contributed product; receive research funds from Clorox, but Clorox has no role in the design; Molnlycke: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; S. S. Huang, Sage Products: Receipt of contributed product, Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product; Xttrium Laboratories: Receipt of contributed product, Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product; Clorox: Receipt of contributed product, Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product; 3M: Receipt of contributed product, Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product; Molnlycke: Receipt of contributed product, Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product
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Affiliation(s)
- Raveena D Singh
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - John A Jernigan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachel B Slayton
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nimalie D Stone
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James A McKinnell
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Loren G Miller
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Ken Kleinman
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts
| | - Lauren Heim
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Tabitha D Dutciuc
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Marlene Estevez
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Gabrielle Gussin
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Justin Chang
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | | | - Kaye D Evans
- University of California Irvine Health, Orange, California
| | - Bruce Y Lee
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Sarah M Bartsch
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Matthew Zahn
- Epidemiology and Assessment, Orange County Health Care Agency, Santa Ana, California
| | - Lynn Janssen
- Healthcare-Associated Infections Program, Center for Healthcare Quality, California Department of Public Health, Richmond, California
| | | | - Mary K Hayden
- Internal Medicine (Infectious Diseases) and Pathology, Rush University Medical Center, Chicago, Illinois
| | - Shruti K Gohil
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Steven Park
- University of California Irvine Health, Orange, California
| | - Steven Tam
- Division of Geriatrics, Department of Medicine, University of California Irvine, Orange, California
| | - Raheeb Saavedra
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Stacey Yamaguchi
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Harold Custodio
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Jenny Nguyen
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Thomas Tjoa
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Jiayi He
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
| | - Kathleen O’Donnell
- Epidemiology and Assessment, Orange County Health Care Agency, Santa Ana, California
| | - Micaela H Coady
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Richard Platt
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Susan S Huang
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
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23
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Gohil SK, Alsharif M, Nourollahi S, Tam S, Rashid S, Chang J, Bahadori B, Singh RD, Huang SS. Prolonged and Inappropriate Central Line Utilization in Nursing Homes (NH) Related to Broad Spectrum Antibiotics. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Jaryan V, Uniyal SK, Gupta RC, Singh RD. Phenological documentation of an invasive species, Sapium sebiferum (L.) Roxb. Environ Monit Assess 2014; 186:4423-4429. [PMID: 24633786 DOI: 10.1007/s10661-014-3708-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 03/05/2014] [Indexed: 06/03/2023]
Abstract
Phenological documentation and plant invasion are key contemporary issues in the biological sciences. Recognizing this, the present paper describes the phenological stages of an invasive species, Sapium sebiferum (L.) Roxb. A tree of the species was marked, and daily visits were made for recording its phenology. The Biologische Bundesanstalt, Bundessortenamt and CHemical industry (BBCH) scale was used for documenting the same. Of the total ten principal stages, eight were observed in the species. These stages started with bud development (stage 01) in the month of March and ended with leaf fall (stage 97) in the month of December. Descriptions of the phenological stages and their dates are provided in the text. It is hoped that such a phenological scale will be helpful in managing plant invasion.
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Affiliation(s)
- Vikrant Jaryan
- Biodiversity Division, CSIR-Institute of Himalayan Bioresource Technology, Palampur, 176061, India
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25
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Qaiser D, Khan MS, Singh RD, Khan ZH. Time resolved spectroscopy and gain studies of Fullerenes C60 and C70. Spectrochim Acta A Mol Biomol Spectrosc 2013; 113:400-407. [PMID: 23747380 DOI: 10.1016/j.saa.2013.04.085] [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] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 04/13/2013] [Accepted: 04/24/2013] [Indexed: 06/02/2023]
Abstract
The fluorescence decay time of Fullerenes C60 and C70 in pure form as well as in mixture with Coumarin C440 and Quinizarine dyes are studied. Results indicate that the decay of pure fullerenes is constant throughout the solute concentration and it is also independent of excitation wavelength, whereas in the case of mixture with dyes different behavior is noticed. We have also calculated the Stern-Volmer quenching constant and optical gain of both the fullerenes from which it is found that the optical gain is positive for Fullerene C70 only in a very narrow range of concentration.
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Affiliation(s)
- Darakhshan Qaiser
- Department of Physics, Jamia Millia Islamia, New Delhi 110 025, India.
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26
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Rashmikant US, Chand P, Singh SV, Singh RD, Arya D, Kant S, Agarwal SP. Cephalometric evaluation of mandibular advancement at different horizontal jaw positions in obstructive sleep apnoea patients: a pilot study. Aust Dent J 2013; 58:293-300. [PMID: 23981209 DOI: 10.1111/adj.12079] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/21/2012] [Accepted: 10/24/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim of this study was to comparatively evaluate the efficacy of the mandibular advancement device (MAD) at 50% (P2) and 75% (P3) of maximum mandibular advancement, relative to maximum intercuspation (P1) subjectively and objectively. METHODS Eighteen subjects previously diagnosed with obstructive sleep apnoea (OSA) were selected for the study. ESS score, VAS score, soft palate angle, MP-H distance, S-H distance, a C4 -H distance, a Pu -p Pu distance and total pharyngeal area were calculated at P1, P2 and P3 positions with the help of an adjustable MAD. The results were statistically analysed. RESULTS ESS score, VAS score, soft palate angle, MP-H distance, S-H distance and radius of curvature of airway at P2 and P3 were significantly lower compared to P1, but there was no significant difference between P2 and P3. CONCLUSIONS The MAD produced significant improvement in objective signs and subjective symptoms at both 50% and 75% of the maximum mandibular protrusion positions at comparable comfort levels. Therefore, MAD may be given at 50% of maximum advancement in order to reduce dental or temporomandibular joint disturbances.
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Affiliation(s)
- U S Rashmikant
- Department of Prosthodontics, Faculty of Dental Sciences, Chhatrapati Shahuji Maharaj Medical University (UP), Lucknow, Uttar Pradesh, India
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27
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Singh RD, Haridas N, Shah FD, Patel JB, Shukla SN, Patel PS. Gene polymorphisms, tobacco exposure and oral cancer susceptibility: a study from Gujarat, West India. Oral Dis 2013; 20:84-93. [DOI: 10.1111/odi.12079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 01/08/2013] [Accepted: 01/12/2013] [Indexed: 12/23/2022]
Affiliation(s)
- RD Singh
- Biochemistry Research Division; The Gujarat Cancer and Research Institute; Ahmedabad Gujarat India
| | - N Haridas
- Pramukhswami Medical College; Karamsad Gujarat India
| | - FD Shah
- Biochemistry Research Division; The Gujarat Cancer and Research Institute; Ahmedabad Gujarat India
| | - JB Patel
- Biochemistry Research Division; The Gujarat Cancer and Research Institute; Ahmedabad Gujarat India
| | - SN Shukla
- The Gujarat Cancer and Research Institute; Ahmedabad Gujarat India
| | - PS Patel
- Biochemistry Research Division; The Gujarat Cancer and Research Institute; Ahmedabad Gujarat India
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28
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Eisenman ST, Gibbons SJ, Singh RD, Bernard CE, Wu J, Sarr MG, Kendrick ML, Larson DW, Dozois EJ, Shen KR, Farrugia G. Distribution of TMEM100 in the mouse and human gastrointestinal tract--a novel marker of enteric nerves. Neuroscience 2013; 240:117-28. [PMID: 23485812 DOI: 10.1016/j.neuroscience.2013.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/30/2013] [Accepted: 02/14/2013] [Indexed: 02/02/2023]
Abstract
Identification of markers of enteric neurons has contributed substantially to our understanding of the development, normal physiology, and pathology of the gut. Previously identified markers of the enteric nervous system can be used to label all or most neuronal structures or for examining individual cells by labeling just the nucleus or cell body. Most of these markers are excellent but have some limitations. Transmembrane protein 100 (TMEM100) is a gene at locus 17q32 encoding a 134-amino acid protein with two hypothetical transmembrane domains. TMEM100 expression has not been reported in adult mammalian tissues but does appear in the ventral neural tube of embryonic mice and plays a role in signaling pathways associated with development of the enteric nervous system. We showed that TMEM100 messenger RNA is expressed in the gastrointestinal tract and demonstrated that TMEM100 is a membrane-associated protein. Furthermore TMEM100 immunoreactivity was restricted to enteric neurons and vascular tissue in the muscularis propria of all regions of the mouse and human gastrointestinal tract. TMEM100 immunoreactivity colocalized with labeling for the pan-neuronal marker protein gene product 9.5 (PGP9.5) but not with the glial marker S100ß or Kit, a marker of interstitial cells of Cajal. The signaling molecule, bone morphogenetic protein (BMP) 4, was also expressed in enteric neurons of the human colon and co-localized with TMEM100. TMEM100 is also expressed in neuronal cell bodies and fibers in the mouse brain and dorsal root ganglia. We conclude that TMEM100 is a novel, membrane-associated marker for enteric nerves and is as effective as PGP9.5 for identifying neuronal structures in the gastrointestinal tract. The expression of TMEM100 in the enteric nervous system may reflect a role in the development and differentiation of cells through a transforming growth factor β, BMP or related signaling pathway.
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Affiliation(s)
- S T Eisenman
- Enteric Neuroscience Program, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
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29
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Senthil Kumar AR, Goyal MK, Ojha CSP, Singh RD, Swamee PK. Application of artificial neural network, fuzzy logic and decision tree algorithms for modelling of streamflow at Kasol in India. Water Sci Technol 2013; 68:2521-2526. [PMID: 24355836 DOI: 10.2166/wst.2013.491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The prediction of streamflow is required in many activities associated with the planning and operation of the components of a water resources system. Soft computing techniques have proven to be an efficient alternative to traditional methods for modelling qualitative and quantitative water resource variables such as streamflow, etc. The focus of this paper is to present the development of models using multiple linear regression (MLR), artificial neural network (ANN), fuzzy logic and decision tree algorithms such as M5 and REPTree for predicting the streamflow at Kasol located at the upstream of Bhakra reservoir in Sutlej basin in northern India. The input vector to the various models using different algorithms was derived considering statistical properties such as auto-correlation function, partial auto-correlation and cross-correlation function of the time series. It was found that REPtree model performed well compared to other soft computing techniques such as MLR, ANN, fuzzy logic, and M5P investigated in this study and the results of the REPTree model indicate that the entire range of streamflow values were simulated fairly well. The performance of the naïve persistence model was compared with other models and the requirement of the development of the naïve persistence model was also analysed by persistence index.
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Affiliation(s)
| | | | - C S P Ojha
- Indian Institute of Technology, Roorkee, India
| | - R D Singh
- National Institute of Hydrology, Roorkee, India
| | - P K Swamee
- Indian Institute of Technology, Roorkee, India
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30
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Jain CK, Singh RD. Technological options for the removal of arsenic with special reference to South East Asia. J Environ Manage 2012; 107:1-18. [PMID: 22579769 DOI: 10.1016/j.jenvman.2012.04.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 03/22/2012] [Accepted: 04/09/2012] [Indexed: 05/31/2023]
Abstract
Arsenic contamination in ground water, used for drinking purpose, has been envisaged as a problem of global concern. However, arsenic contamination of ground water in parts of South East Asia is assuming greater proportions and posing a serious threat to the health of millions of people. A variety of treatment technologies based on oxidation, co-precipitation, adsorption, ion exchange and membrane process are available for the removal of arsenic from ground water. However, question remains regarding the efficiency and applicability/appropriateness of the technologies, particularly because of low influent arsenic concentration and differences in source water composition. Some of these methods are quite simple, but the disadvantage associated with them is that they produce large amounts of toxic sludge, which needs further treatment before disposal into the environment. Besides, the system must be economically viable and socially acceptable. In this paper an attempt has been made to review and update the recent advances made in the technological development in arsenic removal technologies to explore the potential of those advances to address the problem of arsenic contamination in South East Asia.
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Affiliation(s)
- C K Jain
- NIH-Centre for Flood Management Studies, G.S. Road, Sapta Sahid Path, Mathura Nagar, Dispur, Guwahati, Assam 781 006, India.
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31
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Qaiser D, Khan MS, Singh RD, Khan ZH, Chawla S. Förster's resonance energy transfer between Fullerene C60 and Coumarin C440. Spectrochim Acta A Mol Biomol Spectrosc 2010; 77:1065-1068. [PMID: 20869302 DOI: 10.1016/j.saa.2010.08.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 08/09/2010] [Accepted: 08/26/2010] [Indexed: 05/29/2023]
Abstract
The interaction between Coumarin C440 with Fullerene C60 has been studied by fluorescence and time resolved spectroscopic techniques. The Coumarin C440-Fullerene C60 pair shows Forster's resonance energy transfer (FRET) from Coumarin C440 (donor) to Fullerenes C60 (acceptor). The FRET efficiency of this pair increases with the increase of the acceptor concentration. The critical energy transfer distance (R0) at which transfer efficiency is 50% is found to be 34Ǻ. Stern-Volmer plot indicates static as well as dynamic quenching. However, the FRET studies show highest efficiency at the critical stage of dimer formation.
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Affiliation(s)
- Darakhshan Qaiser
- Department of Physics, Jamia Millia Islamia, New Delhi 110025, India.
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32
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Arora M, Rathore DS, Singh RD, Kumar R, Kumar A. Estimation of Melt Contribution to Total Streamflow in River Bhagirathi and River DhauliGanga at Loharinag Pala and Tapovan Vishnugad Project Sites. ACTA ACUST UNITED AC 2010. [DOI: 10.4236/jwarp.2010.27073] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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33
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Sharma AK, Ahlawat DS, Mohan D, Singh RD. Concentration-dependent energy transfer studies in ternary dye mixture of Stilbene-420, Coumarin-540 and Nile Blue. Spectrochim Acta A Mol Biomol Spectrosc 2009; 71:1631-1633. [PMID: 18930436 DOI: 10.1016/j.saa.2007.05.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 05/26/2007] [Indexed: 05/26/2023]
Abstract
The energy transfer studies in the case of ternary dye mixture [Stilbene-420 (donor)+Coumarin-540 (intermediator)+Nile Blue (acceptor)] have been done and discussed through optical gain characteristics at various acceptor concentrations under nitrogen laser excitation. The concentration of the other two dyes were kept constant. It is observed that the concentration of the acceptor dye plays a very critical role in energy transfer dye laser (ETDL) as small change in its concentration varies the intensity of the laser output in the red region by large amount. Also, the highest laser output in the red region is obtained when the concentration of the acceptor dye is slightly higher than that of the intermediator dye. The present studies are helpful in deciding the optimum concentration of the acceptor dye to be used in ternary dye mixture for maximum gain and tuning range. The ternary dye mixture under study provides an ETDL tuning range up to 700 nm.
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Affiliation(s)
- A K Sharma
- Department of Physics, MD University, Rohtak 124001, India.
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34
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Singh RD, Bhagat A, Pandey AK. Bilateral ptosis following wasp sting. J Assoc Physicians India 2003; 51:828-9. [PMID: 14651153] [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: 04/27/2023]
Abstract
We report a case of bilateral ptosis due to wasp sting which was completely treatable.
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Affiliation(s)
- R D Singh
- Department of Medicine, Patna Medical College and Hospital, Patna, India
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35
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Kapoor S, Singh RD, Sharma PC, Khullar M. Anaerobiosis induced virulence of Salmonella typhi. Indian J Med Res 2002; 115:184-8. [PMID: 12362557] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND & OBJECTIVES Anaerobic conditions are frequently encountered by pathogens invading the gastrointestinal tract due to low/limiting oxygen conditions prevalent in the small intestine. This anaerobic stress has been suggested to enhance the virulence of gut pathogens. In the present study, we examined the effect of anaerobiosis on the virulence of Salmonella Typhi, a Gram negative bacteria which invades through the gut mucosa and is responsible for typhoid fever. METHODS Salmonella Typhi (ty2) was cultured in aerobic and anaerobic conditions to compare its virulence by rabbit ileal loop assay, hydrophobicity assay, expression of outer membrane proteins (OMPs) and antioxidant enzymes assay. RESULTS Anaerobically grown S. Typhi showed significantly higher cell surface hydrophobicity as compared to aerobic bacteria. In vivo toxin production by rabbit ileal loop assay also showed significantly higher fluid accumulation with anaerobic S. Typhi. Expression of OMPs in anaerobic S. Typhi showed a distinct induction of five outer membrane proteins. We observed that exposure of anaerobic S. Typhi to aerobic conditions induced significantly higher level of antioxidant enzymes like superoxide dismutase (SOD) and catalase. INTERPRETATION & CONCLUSION Our results suggest that exposure of S. Typhi to anaerobic conditions enhances its virulence.
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Affiliation(s)
- Sarika Kapoor
- Department of Experimental Medicine & Biotechnology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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36
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Puri V, Watanabe R, Singh RD, Dominguez M, Brown JC, Wheatley CL, Marks DL, Pagano RE. Clathrin-dependent and -independent internalization of plasma membrane sphingolipids initiates two Golgi targeting pathways. J Cell Biol 2001; 154:535-47. [PMID: 11481344 PMCID: PMC2196434 DOI: 10.1083/jcb.200102084] [Citation(s) in RCA: 259] [Impact Index Per Article: 11.3] [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] [Indexed: 01/25/2023] Open
Abstract
Sphingolipids (SLs) are plasma membrane constituents in eukaryotic cells which play important roles in a wide variety of cellular functions. However, little is known about the mechanisms of their internalization from the plasma membrane or subsequent intracellular targeting. We have begun to study these issues in human skin fibroblasts using fluorescent SL analogues. Using selective endocytic inhibitors and dominant negative constructs of dynamin and epidermal growth factor receptor pathway substrate clone 15, we found that analogues of lactosylceramide and globoside were internalized almost exclusively by a clathrin-independent ("caveolar-like") mechanism, whereas an analogue of sphingomyelin was taken up approximately equally by clathrin-dependent and -independent pathways. We also showed that the Golgi targeting of SL analogues internalized via the caveolar-like pathway was selectively perturbed by elevated intracellular cholesterol, demonstrating the existence of two discrete Golgi targeting pathways. Studies using SL-binding toxins internalized via clathrin-dependent or -independent mechanisms confirmed that endogenous SLs follow the same two pathways. These findings (a) provide a direct demonstration of differential SLs sorting into early endosomes in living cells, (b) provide a "vital marker" for endosomes derived from caveolar-like endocytosis, and (c) identify two independent pathways for lipid transport from the plasma membrane to the Golgi apparatus in human skin fibroblasts.
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Affiliation(s)
- V Puri
- Department of Biochemistry and Molecular Biology, Thoracic Diseases Research Unit, Mayo Clinic and Foundation, Rochester, MN 55905, USA
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37
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38
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Abstract
Intestinal pathogens are exposed to various stress conditions during their infectious cycle. Anaerobiosis, one of such hostile condition, is offered by the host within gut and intestinal lumen, where survival, multiplication and entry into intestinal epithelial cells is priority for the invading pathogen. In the present study, a virulent strain of S. typhimurium (1402/84) was grown under anaerobic conditions and its virulence characteristics such as host cell binding, penetration and intracellular survival were compared with aerobic S. typhimurium. Anaerobically grown S. typhimurium showed significantly higher binding to immobilized mice enterocytes and intestinal mucus as compared to bacteria grown aerobically. Anaerobic bacteria also showed an early penetration of mucus and subsequent binding to underlying immobilized enterocytes, in vitro. Anaerobic S. typhimurium exhibited increased intracellular survival within spleen macrophages of mice and caused significantly higher fluid accumulation in ligated rabbit ileal loops as compared to aerobic bacteria. LD50 of anaerobic S. typhimurium was also observed to be 2 fold lower when compared to aerobic bacteria. Cell surface hydrophobicity of anaerobic S. typhimurium was also found to be significantly higher than aerobic bacteria. Thus, it appears that exposure of S. typhimurium to anaerobiosis results in its enhanced virulence, adhesion and penetration of host cells.
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Affiliation(s)
- R D Singh
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Mental functions of 388 (6-8 years of age) rural primary school children matched for social and educational status were assessed in relation to anaemia and nutritional status. Malin's intelligence scale for Indian children and an arithmetic test were administered to assess intelligence, attention and concentration. No significant differences were found between the IQ scores of anaemic and non-anaemic groups, except for the subtest digit span. In contrast, there was an effect of nutritional status on IQ scores. Observations on the arithmetic test showed that anaemia is associated with lower levels of attention and concentration.
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Affiliation(s)
- D K Agarwal
- Department of Paediatrics, Banaras Hindu University, Varanasi, India
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Singh RD. Dermatoglyphic variations in four castes of Uttar Pradesh, India. Hum Biol 1978; 50:251-6. [PMID: 721083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Srivastava LS, Pescovitz H, Singh RD, Perisutti G, Knowles HC. Radioimmunoassay of some hormones simultaneously measured in serum and breast cyst fluid. Experientia 1977; 33:1659-60. [PMID: 590470 DOI: 10.1007/bf01934057] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Blood and breast cyst fluid were drawn simultaneously for hormonal determination. There was no difference between serum and cyst fluid values of PRL and TSH. A significant difference was noted for LH (p less than 0.01) and FSH (p less than 0.05), serum concentrations being higher than cyst fluid concentrations.
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Singh RD. Labour migration and its impact on employment and income in a small farm economy. Int Labour Rev 1977; 116:331-341. [PMID: 12278813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Farkas WR, Singh RD. Guanine aminohydrolase in rat and mouse red cells: a potent inhibitor of guanylation of tRNA. Biochim Biophys Acta 1975; 377:166-73. [PMID: 1122285 DOI: 10.1016/0005-2744(75)90297-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
1. The red blood cells of mice and rats contained guanine aminohydrolase (EC 3.5.4.3). This enzyme was not present in rabbit, sheep or human red blood cells. 2. The enzyme from rat blood cells was separated into two activities by column chromatography on DEAE-cellulose. Both isozymes were labile but it was possible to show that the more abundant enzyme followed Michaelis-Menten kinetics, had an apparent Km of 4.0-10-6 M and was not activated by GTP nor inhibited by allantoin. 3. We believe, therefore, that guanine aminohydrolase was the protein in rat and mouse red blood cells that inhibited the enzyme (in rabbit reticulocytes) responsible for guanylation of tRNA.
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Singh RD. Problems of techniques in anthropometric studies in India. Am J Phys Anthropol 1974; 40:221-6. [PMID: 4815135 DOI: 10.1002/ajpa.1330400209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Farkas WR, Singh RD. Guanylation of transfer ribonucleic acid by a cell-free lysate of rabbit reticulocytes. J Biol Chem 1973; 248:7780-5. [PMID: 4750426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Gupta VD, Dwivedi AM, Singh RD. Dispersion curves of poly-L-proline I & II chains. Indian J Biochem Biophys 1973; 10:79-84. [PMID: 4779282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Singh RD, Swami AK. Pulmonary amoeboma. Indian J Chest Dis 1968; 10:43-5. [PMID: 5761037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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