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Yokoe DS, Advani SD, Anderson DJ, Babcock HM, Bell M, Berenholtz SM, Bryant KA, Buetti N, Calderwood MS, Calfee DP, Dubberke ER, Ellingson KD, Fishman NO, Gerding DN, Glowicz J, Hayden MK, Kaye KS, Klompas M, Kociolek LK, Landon E, Larson EL, Malani AN, Marschall J, Meddings J, Mermel LA, Patel PK, Perl TM, Popovich KJ, Schaffzin JK, Septimus E, Trivedi KK, Weinstein RA, Maragakis LL. Executive Summary: A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute-Care Hospitals: 2022 Updates. Infect Control Hosp Epidemiol 2023; 44:1540-1554. [PMID: 37606298 PMCID: PMC10587377 DOI: 10.1017/ice.2023.138] [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: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Deborah S. Yokoe
- University of California San Francisco School of Medicine, UCSF Health-UCSF Medical Center, San Francisco, California, United States
| | - Sonali D. Advani
- Duke University School of Medicine, Durham, North Carolina, United States
| | | | - Hilary M. Babcock
- BJC Healthcare, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Michael Bell
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | | | - Kristina A. Bryant
- Norton Healthcare, University of Louisville School of Medicine, Louisville, Kentucky, United States
| | - Niccolò Buetti
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland
- IAME-U1137, Université Paris-Cité, INSERM, Paris, France
| | | | | | - Erik R. Dubberke
- Washington University School of Medicine, St. Louis, Missouri, United States
| | | | - Neil O. Fishman
- Penn Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Dale N. Gerding
- Edward Hines Jr. Veterans’ Affairs Hospital, Hines, Illinois, United States
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Mary K. Hayden
- Rush University Medical Center, Chicago, Illinois, United States
| | - Keith S. Kaye
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Michael Klompas
- Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Larry K. Kociolek
- Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States
| | - Emily Landon
- The University of Chicago Medical Center, MacLean Center for Clinical Medical Ethics, Chicago, Illinois, United States
| | | | | | - Jonas Marschall
- Washington University School of Medicine, St. Louis, Missouri, United States
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jennifer Meddings
- University of Michigan Medical School, Ann Arbor, Michigan, United States
- Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Leonard A. Mermel
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
- Lifespan Hospital System, Providence, Rhode Island, United States
| | - Payal K. Patel
- Intermountain Healthcare, Salt Lake City, Utah, United States
| | - Trish M. Perl
- University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kyle J. Popovich
- Rush University Medical Center, Chicago, Illinois, United States
| | - Joshua K. Schaffzin
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Septimus
- Texas A&M College of Medicine, Houston, Texas, United States
- Harvard Pilgrim Healthcare, Boston, Massachusetts, United States
| | - Kavita K. Trivedi
- Alameda County Public Health Department, San Leandro, California, United States
| | - Robert A. Weinstein
- Rush University Medical Center, Chicago, Illinois, United States
- Cook County Health, Chicago, Illinois, United States
| | - Lisa L. Maragakis
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, United States
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Yokoe DS, Advani SD, Anderson DJ, Babcock HM, Bell M, Berenholtz SM, Bryant KA, Buetti N, Calderwood MS, Calfee DP, Deloney VM, Dubberke ER, Ellingson KD, Fishman NO, Gerding DN, Glowicz J, Hayden MK, Kaye KS, Kociolek LK, Landon E, Larson EL, Malani AN, Marschall J, Meddings J, Mermel LA, Patel PK, Perl TM, Popovich KJ, Schaffzin JK, Septimus E, Trivedi KK, Weinstein RA, Maragakis LL. Introduction to A Compendium of Strategies to Prevent Healthcare-Associated Infections In Acute-Care Hospitals: 2022 Updates. Infect Control Hosp Epidemiol 2023; 44:1533-1539. [PMID: 37855077 PMCID: PMC10587365 DOI: 10.1017/ice.2023.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 10/20/2023]
Abstract
Since the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals in 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthcare epidemiology, infection prevention, antimicrobial stewardship, and implementation science research has led to improvements in our understanding of effective strategies for HAI prevention. Despite these advances, HAIs continue to affect ∼1 of every 31 hospitalized patients, leading to substantial morbidity, mortality, and excess healthcare expenditures, and persistent gaps remain between what is recommended and what is practiced.The widespread impact of the coronavirus disease 2019 (COVID-19) pandemic on HAI outcomes in acute-care hospitals has further highlighted the essential role of infection prevention programs and the critical importance of prioritizing efforts that can be sustained even in the face of resource requirements from COVID-19 and future infectious diseases crises.The Compendium: 2022 Updates document provides acute-care hospitals with up-to-date, practical expert guidance to assist in prioritizing and implementing HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Pediatric Infectious Disease Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), the Surgical Infection Society (SIS), and others.
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Affiliation(s)
- Deborah S. Yokoe
- School of Medicine, UCSF Health-UCSF Medical Center, University of California, San Francisco, California, United States
| | - Sonali D. Advani
- Duke University School of Medicine, Durham, North Carolina, United States
| | | | - Hilary M. Babcock
- BJC Healthcare, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Michael Bell
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | | | - Kristina A. Bryant
- University of Louisville School of Medicine, Norton HealthcareLouisville, Kentucky, United States
| | - Niccolò Buetti
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland
- IAME-U1137, Université Paris-Cité, INSERM, Paris, France
| | | | | | - Valerie M. Deloney
- Society for Healthcare Epidemiology of America, Arlington, Virginia, United States
| | - Erik R. Dubberke
- Washington University School of Medicine, St. Louis, Missouri, United States
| | | | - Neil O. Fishman
- Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Dale N. Gerding
- Edward Hines Jr. Veterans’ Affairs Hospital, Hines, Illinois, United States
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Mary K. Hayden
- Rush University Medical Center, Chicago, Illinois, United States
| | - Keith S. Kaye
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Larry K. Kociolek
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States
| | - Emily Landon
- The University of Chicago Medical Center, MacLean Center for Clinical Medical Ethics, Chicago, Illinois, United States
| | | | | | - Jonas Marschall
- Washington University School of Medicine, St. Louis, Missouri, United States
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jennifer Meddings
- University of Michigan Medical School, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Leonard A. Mermel
- Warren Alpert Medical School of Brown University, Lifespan Hospital System, Providence, Rhode Island, United States
| | - Payal K. Patel
- Intermountain Healthcare, Salt Lake City, Utah, United States
| | - Trish M. Perl
- University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kyle J. Popovich
- Rush University Medical Center, Chicago, Illinois, United States
| | - Joshua K. Schaffzin
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Septimus
- Texas A&M College of Medicine, Houston, Texas, United States
- Harvard Pilgrim Health Care, Boston, Massachusetts, United States
| | - Kavita K. Trivedi
- Alameda County Public Health Department, San Leandro, California, United States
| | - Robert A. Weinstein
- Rush University Medical Center, Chicago, Illinois, United States
- Cook County Health, Chicago, Illinois, United States
| | - Lisa L. Maragakis
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, United States
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Thind P, Vargas CY, Reed C, Wang L, Alba LR, Larson EL, Saiman L, Stockwell MS. Acceptability, Feasibility, and Validity of Detecting Respiratory Pathogens During Acute Respiratory Illness in Participant-Collected Swabs in a Low-Income, Community Sample. Open Forum Infect Dis 2023; 10:ofad068. [PMID: 36879622 PMCID: PMC9985149 DOI: 10.1093/ofid/ofad068] [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: 10/23/2022] [Indexed: 02/18/2023] Open
Abstract
Background Community surveillance for acute respiratory illness (ARI) can include unsupervised participant-collected nasal swabs. Little is known about use of self-swabs in low-income populations or among households including extended family members and the validity of self-collected swabs. We assessed the acceptability, feasibility, and validity of unsupervised participant-collected nasal swabs in a low-income, community sample. Methods This was a substudy of a larger prospective community-based ARI surveillance study in 405 households in New York City. Participating household members self-collected swabs on the day of a research home visit for an index case, and for 3-6 subsequent days. Demographics associated with agreement to participate and swab collection were assessed, and index case self-collected versus research staff-collected swab results were compared. Results Most households (n = 292 [89.6%]) agreed to participate, including 1310 members. Being <18 years old, female, and the household reporter or member of the nuclear family (parents and children) were associated with both agreement to participate and self-swab collection. Being born in the United States or immigrating ≥10 years ago was associated with participation, and being Spanish-speaking and having less than a high school education were associated with swab collection. In all, 84.4% collected at least 1 self-swabbed specimen; self-swabbing rates were highest during the first 4 collection days. Concordance between research staff-collected swabs and self-swabs was 88.4% for negative swabs, 75.0% for influenza, and 69.4% for noninfluenza pathogens. Conclusions Self-swabbing was acceptable, feasible, and valid in this low-income, minoritized population. Some differences in participation and swab collection were identified that could be noted by future researchers and modelers.
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Affiliation(s)
- Priyam Thind
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Celibell Y Vargas
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Carrie Reed
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Liqun Wang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Luis R Alba
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Elaine L Larson
- School of Nursing, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa Saiman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Department of Infection Prevention and Control, New York–Presbyterian Hospital, New York, New York, USA
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
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Radix AE, Larson EL, Harris AB, Chiasson MA. HIV prevalence among transmasculine individuals at a New York City Community Health Centre: a cross-sectional study. J Int AIDS Soc 2022; 25 Suppl 5:e25981. [PMID: 36225145 PMCID: PMC9557011 DOI: 10.1002/jia2.25981] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/30/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Multiple studies have demonstrated elevated incidence and prevalence of HIV among transgender women; however, few studies have been conducted among transmasculine individuals. HIV prevalence among transgender men in the United States is estimated to be 0-4%; however, there have not been any US studies examining HIV prevalence that stratify by the gender of sexual partners. The aim of this research was to examine HIV prevalence and its association with socio-demographic and other factors, including the gender of sexual partners and receipt of gender-affirming care (hormones/surgery), among transmasculine individuals at the Callen-Lorde Community Health Center in New York City. METHODS The Transgender Data Project was an Institutional Review Board-approved retrospective chart review of all transgender and gender diverse clients at the clinic, ages 18+, between 1 January 2009 and 12 December 2010. Charts were reviewed manually. Data included birth sex, gender, race/ethnicity, education, employment, housing, insurance status, gender of sexual partners, HIV screening and status, and receipt of gender-affirming care. Bivariate and multivariable logistic regression models were used to assess the association between HIV status and other variables. RESULTS AND DISCUSSION Five hundred and seventy-seven transmasculine individuals, mean age 32.1 years (18.3-70.5), were included in this analysis. A small majority were White (55% White, 13.9% Black and 11.7% Hispanic). The majority, 78.9%, had received hormones (testosterone) and 41.6% had received at least one gender-affirming surgery. The HIV screening rate was 43.4%. HIV prevalence was 2.8%, (95% CI: 1.13%, 5.68%) among those screened, notably higher than the US population prevalence. HIV prevalence was highest among transmasculine individuals who had sex exclusively with cisgender men (11.1%). In the multivariable model (age, education and gender of sexual partners), the adjusted odds ratio of HIV for those who had sex exclusively with cisgender male partners compared to no cisgender male partners was 10.58 (95% CI: 1.33, 84.17). CONCLUSIONS Although HIV prevalence has been estimated to be low among transgender men, the analysis found heterogeneous results when stratified by gender of sexual partners. The results underscore the need to understand sexual risk among transmasculine individuals and to disaggregate HIV data for those having sex with cisgender men, thus also allowing for better inclusion in HIV prevention efforts.
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Affiliation(s)
- Asa E. Radix
- Department of MedicineCallen‐Lorde Community Health CenterNew York CityNew YorkUSA,Department of EpidemiologyColumbia University Mailman School of Public HealthNew York CityNew YorkUSA
| | - Elaine L. Larson
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew York CityNew YorkUSA
| | - Alexander B. Harris
- Department of MedicineCallen‐Lorde Community Health CenterNew York CityNew YorkUSA
| | - Mary Ann Chiasson
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew York CityNew YorkUSA,Division of Infectious Diseases, Department of MedicineColumbia University Irving Medical CenterNew York CityNew YorkUSA
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5
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Stockwell MS, Reed C, Vargas CY, Wang L, Alba LR, Jia H, LaRussa P, Larson EL, Saiman L. Five-Year Community Surveillance Study for Acute Respiratory Infections Using Text Messaging: Findings From the MoSAIC Study. Clin Infect Dis 2022; 75:987-995. [PMID: 35037056 PMCID: PMC9383201 DOI: 10.1093/cid/ciac027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Acute respiratory infections (ARI) are the most common infectious diseases globally. Community surveillance may provide a more comprehensive picture of disease burden than medically attended illness alone. METHODS In this longitudinal study conducted from 2012 to 2017 in the Washington Heights/Inwood area of New York City, we enrolled 405 households with 1915 individuals. Households were sent research text messages twice weekly inquiring about ARI symptoms. Research staff confirmed symptoms by follow-up call. If ≥2 criteria for ARI were met (fever/feverish, cough, congestion, pharyngitis, myalgias), staff obtained a mid-turbinate nasal swab in participants' homes. Swabs were tested using the FilmArray reverse transcription polymerase chain reaction (RT-PCR) respiratory panel. RESULTS Among participants, 43.9% were children, and 12.8% had a chronic respiratory condition. During the 5 years, 114 724 text messages were sent; the average response rate was 78.8% ± 6.8%. Swabs were collected for 91.4% (2756/3016) of confirmed ARI; 58.7% had a pathogen detected. Rhino/enteroviruses (51.9%), human coronaviruses (13.9%), and influenza (13.2%) were most commonly detected. The overall incidence was 0.62 ARI/person-year, highest (1.73) in <2 year-olds and lowest (0.46) in 18-49 year-olds. Approximately one-fourth of those with ARI sought healthcare; percents differed by pathogen, demographic factors, and presence of a chronic respiratory condition. CONCLUSIONS Text messaging is a novel method for community-based surveillance that could be used both seasonally as well as during outbreaks, epidemics and pandemics. The importance of community surveillance to accurately estimate disease burden is underscored by the findings of low rates of care-seeking that varied by demographic factors and pathogens.
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Affiliation(s)
- Melissa S Stockwell
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
- NewYork-Presbyterian Hospital, New York, New York, USA
| | - Carrie Reed
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Celibell Y Vargas
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Liqun Wang
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Luis R Alba
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Haomiao Jia
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
- School of Nursing, Columbia University Irving Medical Center, New York, New York, USA
| | - Philip LaRussa
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Elaine L Larson
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
- School of Nursing, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- NewYork-Presbyterian Hospital, New York, New York, USA
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Kulage KM, Corwin EJ, Liu J, Schnall R, Smaldone A, Soled KR, Usseglio J, Larson EL. A 10-year examination of a one-on-one grant writing partnership for nursing pre- and post-doctoral trainees. Nurs Outlook 2022; 70:465-477. [DOI: 10.1016/j.outlook.2022.01.007] [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] [Received: 08/26/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 10/18/2022]
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Rubano MD, Kieffer EF, Larson EL. Long-term care and COVID-19: An equitable recovery. Am J Infect Control 2022; 50:364-365. [PMID: 34800581 PMCID: PMC8598254 DOI: 10.1016/j.ajic.2021.11.010] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Elaine L Larson
- New York Academy of Medicine, New York, NY; Columbia University, New York, NY
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Matsumoto H, Larson EL, Warren SI, Hammoor BT, Bonsignore-Opp L, Troy MJ, Barrett KK, Striano BM, Li G, Terry MB, Roye BD, Lenke LG, Skaggs DL, Glotzbecker MP, Flynn JM, Roye DP, Vitale MG. A Clinical Risk Model for Surgical Site Infection Following Pediatric Spine Deformity Surgery. J Bone Joint Surg Am 2022; 104:364-375. [PMID: 34851324 DOI: 10.2106/jbjs.21.00751] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite tremendous efforts, the incidence of surgical site infection (SSI) following the surgical treatment of pediatric spinal deformity remains a concern. Although previous studies have reported some risk factors for SSI, these studies have been limited by not being able to investigate multiple risk factors at the same time. The aim of the present study was to evaluate a wide range of preoperative and intraoperative factors in predicting SSI and to develop and validate a prediction model that quantifies the risk of SSI for individual pediatric spinal deformity patients. METHODS Pediatric patients with spinal deformity who underwent primary, revision, or definitive spinal fusion at 1 of 7 institutions were included. Candidate predictors were known preoperatively and were not modifiable in most cases; these included 31 patient, 12 surgical, and 4 hospital factors. The Centers for Disease Control and Prevention definition of SSI within 90 days of surgery was utilized. Following multiple imputation and multicollinearity testing, predictor selection was conducted with use of logistic regression to develop multiple models. The data set was randomly split into training and testing sets, and fivefold cross-validation was performed to compare discrimination, calibration, and overfitting of each model and to determine the final model. A risk probability calculator and a mobile device application were developed from the model in order to calculate the probability of SSI in individual patients. RESULTS A total of 3,092 spinal deformity surgeries were included, in which there were 132 cases of SSI (4.3%). The final model achieved adequate discrimination (area under the receiver operating characteristic curve: 0.76), as well as calibration and no overfitting. Predictors included in the model were nonambulatory status, neuromuscular etiology, pelvic instrumentation, procedure time ≥7 hours, American Society of Anesthesiologists grade >2, revision procedure, hospital spine surgical cases <100/year, abnormal hemoglobin level, and overweight or obese body mass index. CONCLUSIONS The risk probability calculator encompassing patient, surgical, and hospital factors developed in the present study predicts the probability of 90-day SSI in pediatric spinal deformity surgery. This validated calculator can be utilized to improve informed consent and shared decision-making and may allow the deployment of additional resources and strategies selectively in high-risk patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Elaine L Larson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.,School of Nursing, Columbia University Irving Medical Center, New York, NY
| | - Shay I Warren
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Bradley T Hammoor
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Lisa Bonsignore-Opp
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Michael J Troy
- Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Kody K Barrett
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, California
| | - Brendan M Striano
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gen Li
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Benjamin D Roye
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - David L Skaggs
- Spine Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michael P Glotzbecker
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital, University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - John M Flynn
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David P Roye
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Michael G Vitale
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
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Rubano MD, Kieffer EF, Larson EL. Infection prevention and control in nursing homes during COVID-19: An environmental scan. Geriatr Nurs 2021; 43:51-57. [PMID: 34808421 PMCID: PMC8810224 DOI: 10.1016/j.gerinurse.2021.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/04/2022]
Abstract
To examine processes and programmatic elements of infection prevention and control (IPC) efforts and identify themes and promising approaches in nursing homes (NHs), an environmental scan was conducted. Data sources included a literature search, relevant listservs and websites, and expert consensus based on a virtual summit of leaders in IPC in long-term care settings. Three thematic areas emerged which have the potential to improve overall IPC practices in the long-term care setting: staffing and resource availability, training and knowledge of IPC practices, and organizational culture. If improved IPC practices and reduced cross-transmission of infections in NHs are to be sustained, both short-term and long-term changes in these areas are essential to fully engage staff, build trust, and enhance a 'just' organizational culture.
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Affiliation(s)
- Mario D Rubano
- New York Academy of Medicine, 1216 5th Avenue - Office #441, New York, NY 10029, United States.
| | - Elana F Kieffer
- New York Academy of Medicine, 1216 5th Avenue - Office #441, New York, NY 10029, United States
| | - Elaine L Larson
- New York Academy of Medicine, 1216 5th Avenue - Office #441, New York, NY 10029, United States; Columbia University, New York, NY, United States
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Carter EJ, Usseglio J, Pahlevan-Ibrekic C, Vose C, Rivera RR, Larson EL. Differentiating research and quality improvement activities: A scoping review and implications for clinical scholarship. J Clin Nurs 2021; 30:2480-2488. [PMID: 33462858 DOI: 10.1111/jocn.15668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/11/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Differentiating activities that are research or quality improvement (QI) is challenging. PURPOSE Compare tools that distinguish research from QI and evaluate the utility of tools to determine whether institutional review board (IRB) approval is required for a test-project. METHODS Scoping review of the literature to identify tools that distinguish QI from research. Two reviewers independently screened records in PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Google Scholar and extracted information from tools. Inclusion criteria were English language peer-reviewed publications or publicly available tools with scoring systems to differentiate between research and QI. The reporting of this review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We then applied a test-project to evaluate the utility of the tools. FINDINGS One-hundred forty sources were reviewed; 13 met inclusion criteria. Tools consistently used project intent/purpose, design and intervention as differentiating criteria; additional criteria varied. Five studies described tool development, and one reported that the tool had been tested. Our application of a test-project proved challenging as tools commonly presented research and QI as discrete activities. DISCUSSION Based on the core criteria common across tools to distinguish research from QI, we propose a simple four-criteria decision tool for assessing the need for IRB submission.
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Affiliation(s)
- Eileen J Carter
- University of Connecticut School of Nursing, Storrs, CT, USA
| | - John Usseglio
- Augustus C. Long Health Sciences Library/Columbia University Irving Medical Center, New York, NY, USA
| | | | - Courtney Vose
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
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Rodriguez E, Pahlevan-Lbrekic C, Larson EL. Facilitating Timely Institutional Review Board Review: Common Issues and Recommendations. J Empir Res Hum Res Ethics 2021; 16:255-262. [PMID: 33861164 DOI: 10.1177/15562646211009680] [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: 11/16/2022]
Abstract
Review of clinical research by institutional review boards (IRBs) is integral to the protection of human subjects and necessary for the conduct of legal and ethical research. Because such review is time and resource intensive, it is critical to identify common issues that contribute to delayed review and approval of research. Hence, the aim of this quality improvement project was to identify factors associated with long delays in IRB approval and identify potential strategies to streamline the review process. In collaboration with the human subjects research protection program at a large academic health center in the northeastern United States, we conducted a content analysis of minutes of convened IRB meetings for every new protocol (initial submission) approved between January and September 2019 that required greater than or equal to two full board reviews prior to approval (n = 33). We also examined characteristics of new protocols that were reviewed less than twice at convened meetings during the same time frame (n = 244). Using χ2 or Fisher's exact tests, the characteristics of protocols with multiple reviews by the convened IRBs were compared with those protocol submissions reviewed by the convened IRBs only once. Three factors significantly associated with increased delays were researcher conflict of interest (30% vs. 12%, respectively, p < .01), need for radiation safety evaluation (36% vs. 20%, respectively, p = .03), and protocols that were clinical trials (73% vs. 60%, respectively, p < .01). Other factors associated with delayed IRB approval were excessive technical jargon (93.94%, n = 31), inadequate description of data security or inability to meet data security requirements of the institution (75.76%, n = 25), protocol design affecting patient safety (57.58%, n = 19), and lack of clarity regarding compensation and payment or study duration (n = 18, 54.54% each). Approaches to mitigate delays in approval and increase the efficiency and efficacy of the IRB process are recommended.
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Affiliation(s)
- Emily Rodriguez
- School of Professional Studies, 5798Columbia University, Tampa, FL, USA
| | | | - Elaine L Larson
- School of Nursing, 5798Columbia University, New York, NY, USA
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Gracner T, Agarwal M, Murali KP, Stone PW, Larson EL, Furuya EY, Harrison JM, Dick AW. Association of Infection-Related Hospitalization With Cognitive Impairment Among Nursing Home Residents. JAMA Netw Open 2021; 4:e217528. [PMID: 33890988 PMCID: PMC8065379 DOI: 10.1001/jamanetworkopen.2021.7528] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Hospitalizations for infections among nursing home (NH) residents remain common despite national initiatives to reduce them. Cognitive impairment, which markedly affects quality of life and caregiving needs, has been associated with hospitalizations, but the association between infection-related hospitalizations and long-term cognitive function among NH residents is unknown. OBJECTIVE To examine whether there are changes in cognitive function before vs after infection-related hospitalizations among NH residents. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Minimum Data Set 3.0 linked to Medicare hospitalization data from 2011 to 2017 for US nursing home residents aged 65 years or older who had experienced an infection-related hospitalization and had at least 2 quarterly Minimum Data Set assessments before and 4 or more after the infection-related hospitalization. Analyses were performed from September 1, 2019, to December 21, 2020. EXPOSURE Infection-related hospitalization lasting 1 to 14 days. MAIN OUTCOMES AND MEASURES Using an event study approach, associations between infection-related hospitalizations and quarterly changes in cognitive function among NH residents were examined overall and by sex, age, Alzheimer disease and related dementias (ADRD) diagnosis, and sepsis vs other infection-related diagnoses. Resident-level cognitive function was measured using the Cognitive Function Scale (CFS), with scores ranging from 1 (intact) to 4 (severe cognitive impairment). RESULTS Of the sample of 20 698 NH residents, 71.0% were women and 82.6% were non-Hispanic White individuals; the mean (SD) age at the time of transfer to the hospital was 82 (8.5) years. The mean CFS score was 2.17, and the prevalence of severe cognitive impairment (CFS score, 4) was 9.0%. During the first quarter after an infection-related hospitalization, residents experienced a mean increase of 0.06 points in CFS score (95% CI, 0.05-0.07 points; P < .001), or 3%. The increase in scores was greatest among residents aged 85 years or older vs younger residents by approximately 0.022 CFS points (95% CI, 0.004-0.040 points; P < .05). The prevalence of severe cognitive impairment increased by 1.6 percentage points (95% CI, 1.2-2.0 percentage points; P < .001), or 18%; the increases were observed among individuals with ADRD but not among those without it. After an infection-related hospitalization, cognition among residents who had experienced sepsis declined more than for residents who had not by about 0.02 CFS points (95% CI, 0.00-0.04 points; P < .05). All observed differences persisted without an accelerated rate of decline for at least 6 quarters after infection-related hospitalization. No differences were observed by sex. CONCLUSIONS AND RELEVANCE In this cohort study, infection-related hospitalization was associated with immediate and persistent cognitive decline among nursing home residents, with the largest increase in CFS scores among older residents, those with ADRD, and those who had experienced sepsis. Identification of NH residents at risk of worsened cognition after an infection-related hospitalization may help to ensure that their care needs are addressed to prevent further cognitive decline.
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Affiliation(s)
- Tadeja Gracner
- RAND Corporation, Arlington, Virginia
- Now with RAND Corporation, Santa Monica, California
| | - Mansi Agarwal
- Center for Health Policy, Columbia University School of Nursing, New York, New York
- Now with Washington University School of Medicine, St Louis, Missouri
| | - Komal P. Murali
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Patricia W. Stone
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Elaine L. Larson
- Columbia University School of Nursing, New York, New York
- Columbia University Mailman School of Public Health, New York, New York
| | - E. Yoko Furuya
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Shang J, Russell D, Dowding D, McDonald MV, Murtaugh C, Liu J, Larson EL, Sridharan S, Brickner C. A Predictive Risk Model for Infection-Related Hospitalization Among Home Healthcare Patients. J Healthc Qual 2021; 42:136-147. [PMID: 32371832 DOI: 10.1097/jhq.0000000000000214] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Infection prevention is a high priority for home healthcare (HHC), but tools are lacking to identify patients at highest risk of developing infections. The purpose of this study was to develop and test a predictive risk model to identify HHC patients at risk of an infection-related hospitalization or emergency department visit. A nonexperimental study using secondary data was conducted. The Outcome and Assessment Information Set linked with relevant clinical data from 112,788 HHC admissions in 2014 was used for model development (70% of data) and testing (30%). A total of 1,908 patients (1.69%) were hospitalized or received emergency care associated with infection. Stepwise logistic regression models discriminated between individuals with and without infections. Our final model, when classified by highest risk of infection, identified a high portion of those who were hospitalized or received emergent care for an infection while also correctly categorizing 90.5% of patients without infection. The risk model can be used by clinicians to inform care planning. This is the first study to develop a tool for predicting infection risk that can be used to inform how to direct additional infection control intervention resources on high-risk patients, potentially reducing infection-related hospitalizations, emergency department visits, and costs.
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Abstract
PhD Summit attendees, as part of moderated roundtable discussions, responded to two questions: What PhD competencies should guide the preparation of PhD prepared nurses to function in current and emerging roles? and How has innovation in programs and curricula changed the landscape to prepare and support PhD students for success? The purpose of this report is to summarize Summit discussion around these issues and assess the current relevance of 2010 AACN competencies and whether they are adequate to meet the needs of emerging nurse scientists.
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Affiliation(s)
- Arlene Smaldone
- Columbia University School of Nursing, New York, NY, United States of America; College of Dental Medicine, Columbia University Medical Center, New York, NY, United States of America.
| | - Elaine L Larson
- Columbia University School of Nursing, New York, NY, United States of America; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Bruzzese JM, Usseglio J, Goldberg J, Begg MD, Larson EL. Professional development outcomes associated with interdisciplinary research: An integrative review. Nurs Outlook 2020; 68:449-458. [PMID: 32448512 DOI: 10.1016/j.outlook.2020.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/13/2020] [Accepted: 03/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Interdisciplinary research among health care professionals has gained importance over the last 20 years, but little is known about its impact on career development. PURPOSE This study examined professional development outcomes associated with interdisciplinary research. METHODS An integrative review was conducted using Whittmore and Knafl's framework. PubMed, Embase, PsycInfo, Web of Science, and CINAHL were searched to identify studies. FINDINGS Thirteen studies were included. The majority used bibliometric analyses, finding that moderate level of interdisciplinary collaboration was associated with a greater amount and higher quality of publications. Interdisciplinary publications allocated more credit (i.e., had more authors). Interdisciplinary research proposals had less funding success than single discipline proposals. Important cultural and personal aspects of interdisciplinary research (e.g., work and communication styles, research goals) have not been assessed to date. DISCUSSION Rigorous qualitative studies are needed to characterize benefits and challenges of interdisciplinary research to scholars and to institutions.
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Affiliation(s)
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center, New York, NY
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Matsumoto H, Simhon ME, Campbell ML, Vitale MG, Larson EL. Risk Factors Associated with Surgical Site Infection in Pediatric Patients Undergoing Spinal Deformity Surgery: A Systematic Review and Meta-Analysis. JBJS Rev 2020; 8:e0163. [PMID: 32224638 DOI: 10.2106/jbjs.rvw.19.00163] [Citation(s) in RCA: 3] [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] [Indexed: 11/14/2022]
Abstract
BACKGROUND Considerable variation exists in surgical site infection (SSI) prevention practices for pediatric patients undergoing spinal deformity surgery, but the incidence of SSI has been reported to remain high in the United States. The literature reports various risk factors associated with SSI but findings are inconsistent. The purpose of this systematic review and meta-analysis was to assess the published literature investigating associations between various risk factors and SSI in pediatric patients undergoing spinal surgery. METHODS The systematic review and the meta-analysis were conducted according to Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines among peer-reviewed journals published in English between January 2000 and April 2019. Studies that involved pediatric patients with spinal deformity undergoing surgical procedures in North America and assessed risk factors for SSI were included. The quality of individual studies was assessed, and weighted risk ratios and mean differences were calculated for each risk factor. RESULTS Of 763 potential articles identified, 13 met inclusion criteria; 7 studies were rated as average and 6, as poor quality based on the quality checklist. The meta-analysis demonstrated that the SSI risk increased by the following factors: 2.53 (95% confidence interval [CI], 1.26 to 5.10) for overweight to obese patients compared with patients with normal weight, 2.84 (95% CI, 1.67 to 4.81) for patients with a neuromuscular etiology compared with non-neuromuscular etiology, 1.69 (95% CI, 1.41 to 2.02) for patients with a gastrostomy tube (G-tube) compared with those without, 3.45 (95% CI, 2.08 to 5.72) for nonambulatory patients compared with ambulators, and 3.39 (95% CI, 2.38 to 4.83) for patients with pelvic instrumentation compared with those without. Patients who developed SSI also had 158.38 mL (95% CI, 46.78 to 269.97 mL) greater estimated blood loss compared with those who did not. CONCLUSIONS Despite the limited quality of the available studies and wide variety of populations and outcome definitions, evidence suggests that overweight to obese status, neuromuscular etiology, use of a G-tube, nonambulatory status, instrumentation to the pelvis, and greater estimated blood loss are risk factors for SSI. The use of a common SSI definition and strong methodology are warranted for future studies. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete list of levels of evidence.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
| | - Matthew E Simhon
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
| | - Megan L Campbell
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
| | - Michael G Vitale
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
| | - Elaine L Larson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.,School of Nursing, Columbia University, New York, NY
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Song J, Tark A, Larson EL. The relationship between pocket hematoma and risk of wound infection among patients with a cardiovascular implantable electronic device: An integrative review. Heart Lung 2020; 49:92-98. [DOI: 10.1016/j.hrtlng.2019.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/05/2019] [Accepted: 09/25/2019] [Indexed: 01/31/2023]
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Feeg VD, Larson EL. Leadership Corner. Nurs Outlook 2019; 68:123-125. [PMID: 31836293 DOI: 10.1016/j.outlook.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Veronica D Feeg
- Hagan School of Nursing, Molloy College, Rockville Centre, NY.
| | - Elaine L Larson
- Hagan School of Nursing, Molloy College, Rockville Centre, NY
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Larson EL. Transitions and Looking Ahead. Am J Infect Control 2019; 47:1408. [PMID: 31331715 DOI: 10.1016/j.ajic.2019.06.018] [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: 06/14/2019] [Accepted: 06/16/2019] [Indexed: 11/17/2022]
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Larson EL. Musings on retirement. Nurs Outlook 2019; 67:789-790. [PMID: 31421861 DOI: 10.1016/j.outlook.2019.04.008] [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: 04/08/2019] [Accepted: 04/27/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Elaine L Larson
- Mailman School of Public Health, Columbia University School of Nursing, New York, NY.
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21
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Needleman J, Liu J, Shang J, Larson EL, Stone PW. Association of registered nurse and nursing support staffing with inpatient hospital mortality. BMJ Qual Saf 2019; 29:10-18. [DOI: 10.1136/bmjqs-2018-009219] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/03/2022]
Abstract
BackgroundThe association of nursing staffing with patient outcomes has primarily been studied by comparing high to low staffed hospitals, raising concern other factors may account for observed differences. We examine the association of inpatient mortality with patients’ cumulative exposure to shifts with low registered nurse (RN) staffing, low nursing support staffing and high patient turnover.MethodsCumulative counts of exposure to shifts with low staffing and high patient turnover were used as time-varying covariates in survival analysis of data from a three-campus US academic medical centre for 2007–2012. Staffing below 75% of annual median unit staffing for each staff category and shift type was characterised as low. High patient turnover per day was defined as admissions, discharges and transfers 1 SD above unit annual daily averages.ResultsModels included cumulative counts of patient exposure to shifts with low RN staffing, low nursing support staffing, both concurrently and high patient turnover. The HR for exposure to shifts with low RN staffing only was 1.027 (95% CI 1.002 to 1.053, p<0.001), low nursing support only, 1.030 (95% CI 1.017 to 1.042, p<0.001) and shifts with both low, 1.025 (95% CI 1.008 to 1.043, p=0.035). For a model examining cumulative exposure over the second to fifth days of an admission, the HR for exposure to shifts with low RN staffing only was 1.048 (95% CI 0.998 to 1.100, p=0.061), low nursing support only, 1.032 (95% CI 1.008 to 1.057, p<0.01) and for shifts with both low,1.136 (95% CI 1.089 to 1.185, p<0.001). No relationship was observed for high patient turnover and mortality.ConclusionLow RN and nursing support staffing were associated with increased mortality. The results should encourage hospital leadership to assure both adequate RN and nursing support staffing.
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Cios K, Cohen B, Quittell LM, Liu J, Larson EL. Impact of colonizing organism in the respiratory tract on the incidence, duration, and time between subsequent hospitalizations among patients with cystic fibrosis. Am J Infect Control 2019; 47:750-754. [PMID: 30732978 DOI: 10.1016/j.ajic.2018.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study aimed to examine the association between colonizing respiratory tract organism and frequency, duration, and time between subsequent hospitalizations among hospitalized patients with cystic fibrosis (CF). METHODS This retrospective cohort study of 312 CF patients from 2 New York City hospitals (2006-2016) examined the effects of colonization with Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus aureus (MSSA) or methicillin-resistant S aureus (MRSA), co-colonization on incidence of hospitalization, time to next hospitalization, and total length of stay (LOS). RESULTS Annual rate of subsequent hospitalizations was highest in patients with P aeruginosa: adjusted incidence rate ratios (aIRRs) were 2.75 (95% confidence interval [CI], 1.72-4.41) for P aeruginosa versus MSSA, 2.57 (95% CI, 1.52-4.31) for co-colonization versus MSSA, and 1.77 (95% CI, 1.04-3.01) for P aeruginosa versus MRSA. Time to readmission was shortest for P aeruginosa: aIRRs were 1.75 (95% CI, 1.05-2.94) for MRSA versus P aeruginosa, 1.64 (95% CI, 1.03-2.59) for MSSA versus P aeruginosa, and 1.61 (95% CI, 1.04-2.47) for co-colonization versus P aeruginosa. LOS was longest for P aeruginosa: aIRRs were 3.41 (95% CI, 2.19-5.32) for P aeruginosa versus MSSA, 1.66 (95% CI, 1.01-2.75) for co-colonization versus MSSA, 2.50 (95% CI, 1.58-3.93) for P aeruginosa versus MRSA, and 2.05 (95% CI, 1.32-3.18) for P aeruginosa versus co-colonization. CONCLUSIONS CF patients with P aeruginosa alone experienced more hospitalizations, longer LOS, and shorter time to readmission versus patients with S aureus or both organisms.
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Affiliation(s)
- Klaudia Cios
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Bevin Cohen
- School of Nursing, Columbia University, New York, NY.
| | - Lynne M Quittell
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jianfang Liu
- School of Nursing, Columbia University, New York, NY
| | - Elaine L Larson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; School of Nursing, Columbia University, New York, NY
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Hessels AJ, Kelly AM, Chen L, Cohen B, Zachariah P, Larson EL. Impact of infectious exposures and outbreaks on nurse and infection preventionist workload. Am J Infect Control 2019; 47:623-627. [PMID: 30979563 DOI: 10.1016/j.ajic.2019.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/07/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Staff nurse and infection preventionist (IP) workload increases in response to exposures and outbreaks. Understanding the time burden associated with responding to specific pathogens may improve resource allocation. The purpose of this study was to evaluate workload increases reported by nurses and IPs in response to common exposures and outbreaks. METHODS Surveys were distributed to nurses in a New York hospital network and to IPs who attended the 2018 Association for Professionals in Infection Control and Epidemiology annual conference or to IPs who were members of local Association for Professionals in Infection Control and Epidemiology chapters. Respondents were asked to rate their daily workload increase and to rank their most time-consuming activities in response to exposure and outbreak scenarios. RESULTS A total of 150 nurses and 228 IPs responded. Among the nurses, >60-minute workload increases were reported for Clostridium difficile (76%), lice or scabies (46%), and influenza (45%). Among the IPs, >60-minute increases were reported for mumps or measles (66%), tuberculosis (64%), and C difficile (50%). Among the nurses, isolation precautions, patient and family education, and staffing changes were the most frequently reported time-consuming activities. Among the IPs, chart review, exposure list compiling, and preventive measures for exposures were the most frequently reported time-consuming activities. CONCLUSIONS Organisms that are easier to treat and more difficult to spread, such as scabies or lice, can contribute substantially to nursing workload. Notably, three-quarters of the nurses and one-half of the IPs reported that C difficile adds >1 hour to their daily workload.
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Abstract
PURPOSE Residents of pediatric long-term care facilities (pLTCF) are particularly vulnerable to healthcare-associated infections. The aims of this qualitative study were to (a) explore perspectives on infection prevention among families visiting children in pLTCF and (b) identify facilitators of and barriers to optimal hand hygiene. DESIGN AND METHODS Semistructured, in-depth interviews with 10 family members visiting two New York City metropolitan area facilities were analyzed to identify themes. FINDINGS "Everyone follows the rules" and "infections are inevitable" were primary themes. Participants reported "common sense" as a facilitator and "distraction" as a major barrier to prevention practices. CONCLUSION Current education for visitors may be inadequate to improve infection prevention behaviors. CLINICAL RELEVANCE Nurse-led education strategies for infection prevention should be tested and modified for families visiting pLTCF.
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Affiliation(s)
- Sibyl Wilmont
- The Center for Interdisciplinary Research to Prevent Infections, Columbia University School of Nursing, New York
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Abstract
Ordinal rankings of schools of nursing by research funding in total dollars awarded by the National Institutes of Health (NIH) is a common metric for demonstrating research productivity; however, these data are not based on the number of doctorally prepared faculty eligible to apply for funding. Therefore, we examined an alternative method for measuring research productivity which accounts for size differences in schools: NIH funding ranked "per capita." We extracted data on total average funding and compared them with average funding secured per faculty member across top-ranked schools of nursing in the United States from 2013 to 2017. When examining data by number of doctorally prepared faculty, 4 of 12 (33%) schools that ranked lower in total average funding ranked higher in average funding per faculty member. School size is an important but neglected factor in current funding rankings; therefore, we encourage schools to use multiple approaches to track their research productivity.
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Russell D, Dowding DW, McDonald MV, Adams V, Rosati RJ, Larson EL, Shang J. Factors for compliance with infection control practices in home healthcare: findings from a survey of nurses' knowledge and attitudes toward infection control. Am J Infect Control 2018; 46:1211-1217. [PMID: 29866633 DOI: 10.1016/j.ajic.2018.05.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/03/2018] [Accepted: 05/03/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Infection is a leading cause of hospitalization among home healthcare patients. Nurses play an important role in reducing infection among home healthcare patients by complying with infection control procedures. However, few studies have examined the compliance of home healthcare nurses with infection control practices or the range of sociocultural and organizational factors that may be associated with compliance. METHODS This study analyzed survey responses from nurses at 2 large, certified home healthcare agencies (n = 359), to explore levels of compliance with infection control practices and identify associated demographic, knowledge, and attitudinal correlates. RESULTS Nurses reported a high level of infection control compliance (mean = 0.89, standard deviation [SD] = 0.16), correct knowledge (mean = 0.85, SD = 0.09), and favorable attitudes (mean = 0.81, SD = 0.14). Multivariate mixed regression analyses revealed significant positive associations of attitudinal scores with reported level of compliance (P < .001). However, knowledge of inflection control practices was not associated with compliance. Older (P < .05) and non-Hispanic black (P < .001) nurses reported higher compliance with infection control practices than younger and white non-Hispanic nurses. CONCLUSION These findings suggest that efforts to improve compliance with infection control practices in home healthcare should focus on strategies to alter perceptions about infection risk and other attitudinal factors.
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Affiliation(s)
- David Russell
- Department of Sociology, Appalachian State University, Boone, NC; Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY.
| | - Dawn W Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY
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Shang J, Dick AW, Larson EL, Stone PW. A research agenda for infection prevention in home healthcare. Am J Infect Control 2018; 46:1071-1073. [PMID: 29703637 PMCID: PMC6119629 DOI: 10.1016/j.ajic.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/31/2018] [Accepted: 03/11/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Jingjing Shang
- Center for Health Policy, Columbia University School of Nursing, New York, NY.
| | | | - Elaine L Larson
- Center for Health Policy, Columbia University School of Nursing, New York, NY
| | - Patricia W Stone
- Center for Health Policy, Columbia University School of Nursing, New York, NY
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Russell KE, Fowlkes A, Stockwell MS, Vargas CY, Saiman L, Larson EL, LaRussa P, Di Lonardo S, Popowich M, St. George K, Steffens A, Reed C. Comparison of outpatient medically attended and community-level influenza-like illness-New York City, 2013-2015. Influenza Other Respir Viruses 2018; 12:336-343. [PMID: 29350791 PMCID: PMC5907822 DOI: 10.1111/irv.12540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Surveillance of influenza-like illness (ILI) in the United States is primarily conducted through medical settings despite a significant burden of non-medically attended ILI. OBJECTIVES To assess consistency between surveillance for respiratory viruses in outpatient and community settings using ILI surveillance from the Centers for Disease Control and Prevention Influenza Incidence Surveillance Project (IISP) and the Mobile Surveillance for Acute Respiratory Infections (ARI) and Influenza-Like Illness in the Community (MoSAIC) Study. METHODS The Influenza Incidence Surveillance Project conducts ILI surveillance in 3 primary care clinics in New York City, and MoSAIC conducts community-based ILI/ARI surveillance through text messaging among a cohort of New York City residents. Both systems obtain respiratory specimens from participants with ILI/ARI and test for multiple pathogens. We conducted a retrospective review of ILI cases in IISP and MoSAIC from January 2013 to May 2015 with descriptive analyses of clinical and laboratory data. RESULTS Five-hundred twelve MoSAIC and 669 IISP participants met an ILI criteria (fever with cough or sore throat) and were included. Forty percent of MoSAIC participants sought care; the majority primary care. Pathogens were detected in 63% of MoSAIC and 70% of IISP cases. The relative distribution of influenza and other respiratory viruses detected was similar; however, there were statistically significant differences in the frequency that were not explained by care seeking. CONCLUSIONS Outpatient and community-based surveillance in the one found similar timing and relative distribution of respiratory viruses, but community surveillance in a single neighborhood may not fully capture the variations in ILI etiology that occur more broadly.
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Affiliation(s)
- Kate E. Russell
- Epidemic Intelligence ServiceCenters for Disease Control and PreventionAtlantaGAUSA
- Influenza DivisionNational Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Ashley Fowlkes
- Influenza DivisionNational Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Melissa S. Stockwell
- Columbia University Medical CenterNew YorkNYUSA
- NewYork‐Presbyterian HospitalNew YorkNYUSA
| | | | - Lisa Saiman
- Columbia University Medical CenterNew YorkNYUSA
- NewYork‐Presbyterian HospitalNew YorkNYUSA
| | | | | | - Steve Di Lonardo
- New York City Department of Health and Mental HygieneNew YorkNYUSA
| | | | | | - Andrea Steffens
- Influenza DivisionNational Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Carrie Reed
- Influenza DivisionNational Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
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Cohen CC, Liu J, Cohen B, Larson EL, Glied S. Financial Incentives to Reduce Hospital-Acquired Infections Under Alternative Payment Arrangements. Infect Control Hosp Epidemiol 2018; 39:509-515. [PMID: 29457583 PMCID: PMC6047523 DOI: 10.1017/ice.2018.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVEThe financial incentives for hospitals to improve care may be weaker if higher insurer payments for adverse conditions offset a portion of hospital costs. The purpose of this study was to simulate incentives for reducing hospital-acquired infections under various payment configurations by Medicare, Medicaid, and private payers.DESIGNMatched case-control study.SETTINGA large, urban hospital system with 1 community hospital and 2 tertiary-care hospitals.PATIENTSAll patients discharged in 2013 and 2014.METHODSUsing electronic hospital records, we identified hospital-acquired bloodstream infections (BSIs) and urinary tract infections (UTIs) with a validated algorithm. We assessed excess hospital costs, length of stay, and payments due to infection, and we compared them to those of uninfected patients matched by propensity for infection.RESULTSIn most scenarios, hospitals recovered only a portion of excess HAI costs through increased payments. Patients with UTIs incurred incremental costs of $6,238 (P<.01), while payments increased $1,901 (P<.05) at public diagnosis-related group (DRG) rates. For BSIs, incremental costs were $15,367 (P<.01), while payments increased $7,895 (P<.01). If private payers reimbursed a 200% markup over Medicare DRG rates, hospitals recovered 55% of costs from BSI and UTI among private-pay patients and 54% for BSI and 33% for UTI, respectively, across all patients. Under per-diem payment for private patients with no markup, hospitals recovered 71% of excess costs of BSI and 88% for UTI. At 150% markup and per-diem payments, hospitals profited.CONCLUSIONSHospital incentives for investing in patient safety vary by payer and payment configuration. Higher payments provide resources to improve patient safety, but current payment structures may also reduce the willingness of hospitals to invest in patient safety.Infect Control Hosp Epidemiol 2018;39:509-515.
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Affiliation(s)
| | - Jianfang Liu
- Columbia University School of Nursing, New York, New York
| | - Bevin Cohen
- Columbia University School of Nursing, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Elaine L. Larson
- Columbia University School of Nursing, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Sherry Glied
- Wagner School of Public Health, New York University, New York, New York
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Carter EJ, Greendyke WG, Furuya EY, Srinivasan A, Shelley AN, Bothra A, Saiman L, Larson EL. Exploring the nurses' role in antibiotic stewardship: A multisite qualitative study of nurses and infection preventionists. Am J Infect Control 2018; 46:492-497. [PMID: 29395509 PMCID: PMC6495548 DOI: 10.1016/j.ajic.2017.12.016] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is a growing recognition of the need to partner with nurses to promote effective antibiotic stewardship. In this study, we explored the attitudes of nurses and infection preventionists toward 5 nurse-driven antibiotic stewardship practices: 1) questioning the need for urine cultures; 2) ensuring proper culturing technique; 3) recording an accurate penicillin drug allergy history; 4) encouraging the prompt transition from intravenous (IV) to oral (PO) antibiotics; and 5) initiating an antibiotic timeout. METHODS Nine focus groups and 4 interviews with 49 clinical nurses, 5 nurse managers, and 7 infection preventionists were conducted across 2 academic pediatric and adult hospitals. RESULTS Nurse-driven antibiotic stewardship was perceived as an extension of the nurses' role as patient advocate. Three practices were perceived most favorably: questioning the necessity of urinary cultures, ensuring proper culturing techniques, and encouraging the prompt transition from IV to PO antibiotics. Remaining recommendations were perceived to lack relevance or to challenge traditionally held nursing responsibilities. Prescriber and family engagement were noted to assist the implementation of select recommendations. Infection preventionists welcomed the opportunity to assist in providing nurse stewardship education. CONCLUSIONS Nurses appeared to be enthusiastic about participating in antibiotic stewardship. Efforts to engage nurses should address knowledge needs and consider the contexts in which nurse-driven antibiotic stewardship occurs.
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Affiliation(s)
- Eileen J Carter
- Columbia University School of Nursing, New York, NY; Department of Nursing, NewYork-Presbyterian, New York, NY.
| | - William G Greendyke
- Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY; Department of Medicine, Columbia University Medical Center, New York, NY
| | - E Yoko Furuya
- Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY; Department of Medicine, Columbia University Medical Center, New York, NY
| | - Arjun Srinivasan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alexa N Shelley
- Columbia University School of Nursing, New York, NY; Department of Nursing, NewYork-Presbyterian, New York, NY
| | - Aditi Bothra
- Columbia University Mailman School of Public Health, New York, NY
| | - Lisa Saiman
- Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY; Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Elaine L Larson
- Columbia University School of Nursing, New York, NY; Columbia University Mailman School of Public Health, New York, NY
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Furuya EY, Cohen B, Jia H, Larson EL. Long-Term Impact of Universal Contact Precautions on Rates of Multidrug-Resistant Organisms in ICUs: A Comparative Effectiveness Study. Infect Control Hosp Epidemiol 2018; 39:534-540. [PMID: 29562944 PMCID: PMC5935260 DOI: 10.1017/ice.2018.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVETo evaluate the impact of universal contact precautions (UCP) on rates of multidrug-resistant organisms (MDROs) in intensive care units (ICUs) over 9 yearsDESIGNRetrospective, nonrandomized observational studySETTINGAn 800-bed adult academic medical center in New York CityPARTICIPANTSAll patients admitted to 6 ICUs, 3 of which instituted UCP in 2007METHODSUsing a comparative effectiveness approach, we studied the longitudinal impact of UCP on MDRO incidence density rates, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and carbapenem-resistant Klebsiella pneumoniae. Data were extracted from a clinical research database for 2006-2014. Monthly MDRO rates were compared between the baseline period and the UCP period, utilizing time series analyses based on generalized linear models. The same models were also used to compare MDRO rates in the 3 UCP units to 3 ICUs without UCPs.RESULTSOverall, MDRO rates decreased over time, but there was no significant decrease in the trend (slope) during the UCP period compared to the baseline period for any of the 3 intervention units. Furthermore, there was no significant difference between UCP units (6.6% decrease in MDRO rates per year) and non-UCP units (6.0% decrease per year; P=.840).CONCLUSIONThe results of this 9-year study suggest that decreases in MDROs, including multidrug-resistant gram-negative bacilli, were more likely due to hospital-wide improvements in infection prevention during this period and that UCP had no detectable additional impact.Infect Control Hosp Epidemiol 2018;39:534-540.
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Affiliation(s)
- E. Yoko Furuya
- Division of Infectious Diseases, Columbia University Medical Center, New York, New York
- Department of Infection Prevention & Control, New York-Presbyterian Hospital, New York, New York
| | - Bevin Cohen
- School of Nursing, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Haomiao Jia
- School of Nursing, Columbia University, New York, New York
- Department of Biostatitics, Mailman School of Public Health, Columbia University, New York, New York
| | - Elaine L. Larson
- School of Nursing, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Rikin S, Jia H, Vargas CY, Castellanos de Belliard Y, Reed C, LaRussa P, Larson EL, Saiman L, Stockwell MS. Assessment of temporally-related acute respiratory illness following influenza vaccination. Vaccine 2018. [PMID: 29525279 PMCID: PMC7115556 DOI: 10.1016/j.vaccine.2018.02.105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We investigated risk of acute respiratory illness post-influenza vaccination. Post-vaccination risk of non-influenza respiratory pathogen was higher in children. Patient perceptions of illness following influenza vaccination may be supported. Assessments of potential mechanisms for findings are needed.
Background A barrier to influenza vaccination is the misperception that the inactivated vaccine can cause influenza. Previous studies have investigated the risk of acute respiratory illness (ARI) after influenza vaccination with conflicting results. We assessed whether there is an increased rate of laboratory-confirmed ARI in post-influenza vaccination periods. Methods We conducted a cohort sub-analysis of children and adults in the MoSAIC community surveillance study from 2013 to 2016. Influenza vaccination was confirmed through city or hospital registries. Cases of ARI were ascertained by twice-weekly text messages to household to identify members with ARI symptoms. Nasal swabs were obtained from ill participants and analyzed for respiratory pathogens using multiplex PCR. The primary outcome measure was the hazard ratio of laboratory-confirmed ARI in individuals post-vaccination compared to other time periods during three influenza seasons. Results Of the 999 participants, 68.8% were children, 30.2% were adults. Each study season, approximately half received influenza vaccine and one third experienced ≥1 ARI. The hazard of influenza in individuals during the 14-day post-vaccination period was similar to unvaccinated individuals during the same period (HR 0.96, 95% CI [0.60, 1.52]). The hazard of non-influenza respiratory pathogens was higher during the same period (HR 1.65, 95% CI [1.14, 2.38]); when stratified by age the hazard remained higher for children (HR 1·71, 95% CI [1.16, 2.53]) but not for adults (HR 0.88, 95% CI [0.21, 3.69]). Conclusion Among children there was an increase in the hazard of ARI caused by non-influenza respiratory pathogens post-influenza vaccination compared to unvaccinated children during the same period. Potential mechanisms for this association warrant further investigation. Future research could investigate whether medical decision-making surrounding influenza vaccination may be improved by acknowledging patient experiences, counseling regarding different types of ARI, and correcting the misperception that all ARI occurring after vaccination are caused by influenza.
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Affiliation(s)
- Sharon Rikin
- Department of Medicine, Columbia University, New York, NY, USA
| | - Haomiao Jia
- School of Nursing, Columbia University, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | - Carrie Reed
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philip LaRussa
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Elaine L Larson
- School of Nursing, Columbia University, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University, New York, NY, USA; NewYork-Presbyterian Hospital, New York, NY, USA
| | - Melissa S Stockwell
- Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Pediatrics, Columbia University, New York, NY, USA; NewYork-Presbyterian Hospital, New York, NY, USA.
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Burgermaster M, Murray M, Saiman L, Seres DS, Larson EL. Associations Between Enteral Nutrition and Acute Respiratory Infection Among Patients in New York Metropolitan Region Pediatric Long-Term Care Facilities. Nutr Clin Pract 2018; 33:865-871. [PMID: 29446855 DOI: 10.1002/ncp.10017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/18/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pediatric long-term care facilities (pLTCF) serve a complicated and resource-intensive patient population with high usage of nutrition support. However, the relationship between nutrition support and outcomes among pLTCF residents is not well understood. We described this relationship in three metropolitan New York pLTCF and a subsample of infants from one of these facilities with a feeding disorders unit. METHODS In this prospective cohort study, we used logistic regression to assess relationships between enteral nutrition (EN), and acute respiratory infections (ARI) among residents (n = 720, 50% male, mean age = 5.5 years, mean number comorbidities = 2.1) and infant subsample (<1 year, n = 208, 50% male, mean number comorbidities = 2.0). We tested these associations in multivariable models controlling for numbers of comorbidities and infections. RESULTS Many residents received nutrition via percutaneous (59%) or nasogastric (15%) feeding tubes. In univariate analyses, residents receiving EN had more comorbidities. In multivariable analyses, EN was associated with ARI (incidence rate ratio = 1.65, p < .001). Among infants in the specialized unit, greater risk of ARI was associated only with percutaneous (incidence rate ratio = 1.94, p < .01) feeding. EN was associated with lower odds of being discharged home (OR = 0.45, p < .01). CONCLUSION The prevalence of EN, complexity of cases, and necessity of long-term EN make nutrition support important in pLTCFs. Differences in EN types and adverse outcomes in the infant subsample suggest different care is necessary for this subpopulation. Results provide context for improving quality of care and clinician/caregiver education for this population.
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Affiliation(s)
- Marissa Burgermaster
- Division of Preventive Medicine and Nutrition, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Meghan Murray
- School of Nursing, Columbia University Medical Center, New York, New York, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Medical Center, New York, New York, USA.,Department of Infection Prevention & Control, NewYork-Presbyterian Hospital, New York, New York, USA
| | - David S Seres
- Division of Preventive Medicine and Nutrition, Department of Medicine and Institute of Human Nutrition, Columbia University Medical Center, New York, New York, USA
| | - Elaine L Larson
- Associate Dean for Research, Anna Maxwell Professor of Nursing Research, School of Nursing, Columbia University, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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Larson EL, Murray MT, Cohen B, Simpser E, Pavia M, Jackson O, Jia H, Hutcheon RG, Mosiello L, Neu N, Saiman L. Behavioral Interventions to Reduce Infections in Pediatric Long-term Care Facilities: The Keep It Clean for Kids Trial. Behav Med 2018; 44. [PMID: 28632004 PMCID: PMC5732083 DOI: 10.1080/08964289.2017.1288607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children in pediatric long-term care facilities (pLTCF) represent a highly vulnerable population and infectious outbreaks occur frequently, resulting in significant morbidity, mortality, and resource use. The purpose of this quasi-experimental trial using time series analysis was to assess the impact of a 4-year theoretically based behavioral intervention on infection prevention practices and clinical outcomes in three pLTCF (288 beds) in New York metropolitan area including 720 residents, ages 1 day to 26 years with mean lengths of stay: 7.9-33.6 months. The 5-pronged behavioral intervention included explicit leadership commitment, active staff participation, work flow assessments, training staff in the World Health Organization "'five moments of hand hygiene (HH)," and electronic monitoring and feedback of HH frequency. Major outcomes were HH frequency, rates of infections, number of hospitalizations associated with infections, and outbreaks. Mean infection rates/1000 patient days ranged from 4.1-10.4 pre-intervention and 2.9-10.0 post-intervention. Mean hospitalizations/1000 patient days ranged from 2.3-9.7 before and 6.4-9.8 after intervention. Number of outbreaks/1000 patient days per study site ranged from 9-24 pre- and 9-18 post-intervention (total = 95); number of cases/outbreak ranged from 97-324 (total cases pre-intervention = 591 and post-intervention = 401). Post-intervention, statistically significant increases in HH trends occurred in one of three sites, reductions in infections in two sites, fewer hospitalizations in all sites, and significant but varied changes in the numbers of outbreaks and cases/outbreak. Modest but inconsistent improvements occurred in clinically relevant outcomes. Sustainable improvements in infection prevention in pLTCF will require culture change; increased staff involvement; explicit administrative support; and meaningful, timely behavioral feedback.
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Hessels AJ, Darby SW, Simpser E, Saiman L, Larson EL. National Testing of the Nursing-Kids Intensity of Care Survey for Pediatric Long-term Care. J Pediatr Nurs 2017; 37:86-90. [PMID: 28869067 PMCID: PMC5681364 DOI: 10.1016/j.pedn.2017.08.026] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 07/17/2017] [Accepted: 08/15/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study is to test the Nursing-Kids Intensity of Care, a measure of the intensity of nursing care needs, defined as the quantity and type of direct and indirect care activities performed by caregivers in a national sample. DESIGN AND METHODS A 40-item tool previously tested in a small sample was psychometrically tested on a sample of 116 children with complex medical conditions by 33 nurse raters across 11 pediatric sites. RESULTS The Nursing-Kids Intensity of Care tool demonstrated components of usability, feasibility, inter-rater, test-retest and internal consistency reliability and construct validity in the national study sample. CONCLUSIONS Additional testing to further establish psychometric sufficiency and expanded use to quantify the intensity of nursing care needs of children with complex medical conditions in pediatric long-term care settings is recommended. PRACTICE IMPLICATIONS This novel measure could assist the nursing administrators, educators and staff of pediatric long-term care facilities assess the intensity of care needs of their residents.
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Affiliation(s)
- Amanda J Hessels
- Columbia University, School of Nursing, New York, NY, USA; Hackensack Meridian Health, Ann May Center for Nursing, Neptune, NJ, USA.
| | - Sharon W Darby
- Children's Hospital of Richmond at VCU, Richmond, VA, USA.
| | - Edwin Simpser
- St. Mary's Healthcare System for Children, New York, USA.
| | - Lisa Saiman
- Columbia University Medical Center, Pediatric Infectious Diseases, New York, NY, USA.
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Murray MT, Johnson CL, Cohen B, Jackson O, Jones LK, Saiman L, Larson EL, Neu N. Use of antibiotics in paediatric long-term care facilities. J Hosp Infect 2017; 99:139-144. [PMID: 29111352 DOI: 10.1016/j.jhin.2017.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adult long-term care (LTC) facilities have high rates of antibiotic use, raising concerns about antimicrobial resistance. Few studies have examined antibiotic use in paediatric LTC facilities. AIM To describe antibiotic use in three paediatric LTC facilities and to describe the factors associated with use. METHODS A retrospective cohort study was conducted from September 2012 to December 2015 in three paediatric LTC facilities. Medical records were reviewed for demographics, healthcare-associated infections (HAIs), antimicrobial use and diagnostic testing. Logistic regression was used to identify predictors for antibiotic use. The association between susceptibility testing results and appropriate antibiotic coverage was determined using Chi-squared test. FINDINGS Fifty-eight percent (413/717) of residents had at least one HAI, and 79% (325/413) of these residents were treated with at least one antibiotic course, totalling 2.75 antibiotic courses per 1000 resident-days. Length of enrolment greater than one year, having a neurological disorder, having a tracheostomy, and being hospitalized at least once during the study period were significantly associated with receiving antibiotics when controlling for facility (all P < 0.001). Diagnostic testing was performed for 40% of antibiotic-treated HAIs. Eighty-six percent of antibiotic courses for identified bacterial pathogens (201/233) provided appropriate coverage. Access to susceptibility testing was not associated with appropriate antibiotic choice (P = 0.26). CONCLUSION Use of antibiotics in paediatric LTC facilities is widespread. There is further need to assess antibiotic use in paediatric LTC facilities. Evaluation of the adverse outcomes associated with inappropriate antibiotic use, including the prevalence of resistant organisms in paediatric LTC facilities, is critical.
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Affiliation(s)
- M T Murray
- School of Nursing, Columbia University Medical Center, New York, NY, USA.
| | - C L Johnson
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - B Cohen
- School of Nursing, Columbia University Medical Center, New York, NY, USA
| | - O Jackson
- Elizabeth Seton Paediatric Center, Yonkers, NY, USA
| | | | - L Saiman
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA; Department of Infection Prevention and Control, New York Presbyterian Hospital, New York, NY, USA
| | - E L Larson
- School of Nursing, Columbia University Medical Center, New York, NY, USA
| | - N Neu
- School of Nursing, Columbia University Medical Center, New York, NY, USA; Elizabeth Seton Paediatric Center, Yonkers, NY, USA
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Agarwal M, Shiau S, Larson EL. Repeat gram-negative hospital-acquired infections and antibiotic susceptibility: A systematic review. J Infect Public Health 2017; 11:455-462. [PMID: 29066020 PMCID: PMC5910289 DOI: 10.1016/j.jiph.2017.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/25/2017] [Accepted: 09/30/2017] [Indexed: 12/31/2022] Open
Abstract
Repeat HAIs among frequently hospitalized patients may be contributing to the high rates of antibiotic resistance seen in gram-negative bacteria (GNB) in hospital settings. This systematic review examines the state of the literature assessing the association between repeat GNB HAIs and changes in antibiotic susceptibility patterns. A systematic search of English language published literature was conducted to identify studies in peer-reviewed journals from 2000 to 2015. Studies must have assessed drug resistance in repeat GNB infections longitudinally at the patient level. Two researchers independently reviewed search results for papers meeting inclusion criteria and extracted data. Risk of bias was assessed using a modified quality assessment tool based on the Checklist for Measuring Study Quality and the Quality Assessment Checklist for Cases Series. From 3385 articles identified in the search, seven met inclusion criteria. Five reported lower antibiotic susceptibility in repeated infections, one found a change but did not specify in which direction, and one reported no change. All studies were of low to average quality. Despite the dearth of studies examining repeat GNB infections, evidence suggests that repeat infections result in lower antibiotic susceptibility among hospitalized patients. Larger scale studies with strong methodology are warranted.
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Affiliation(s)
- Mansi Agarwal
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 168th St, New York, NY 10032, United States; School of Nursing, Columbia University, 617 W 168th St, New York, NY 10032, United States.
| | - Stephanie Shiau
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 168th St, New York, NY 10032, United States
| | - Elaine L Larson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 168th St, New York, NY 10032, United States; School of Nursing, Columbia University, 617 W 168th St, New York, NY 10032, United States
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Agarwal M, Larson EL. Risk of drug resistance in repeat gram-negative infections among patients with multiple hospitalizations. J Crit Care 2017; 43:260-264. [PMID: 28946105 DOI: 10.1016/j.jcrc.2017.09.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/05/2017] [Accepted: 09/15/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Drug resistance in gram-negative bacterial hospital-acquired infections (GNB HAIs) has become ubiquitous in recent years. Patients who experience multiple hospitalizations are at high risk of developing repeat GNB HAIs. This study aims to evaluate the relationship between repeat GNB HAIs and antibiotic susceptibility patterns. METHODS Using electronic medical records from three hospitals, 4053 patients were identified with at least one HAI caused by K. pneumoniae or P. aeruginosa over multiple hospitalizations in a 9-year period. Modified Poisson regression was used to evaluate the risk of drug resistance with increasing number of prior susceptible infections. Drug resistance was defined as resistant to carbapenems for K. pneumoniae and resistant to levofloxacin for P. aeruginosa. RESULTS In patients with repeat infections, almost 15% of consecutive infections changed from susceptible to drug-resistant. Patients with K. pneumoniae infections had a 1.14 times increased risk of acquiring a drug-resistant HAI with each prior HAI, after adjusting for potential confounders and antibiotic use prior to infection. Patients with P. aeruginosa infections had a 1.23 times increased risk of a drug-resistant infection with each prior P. aeruginosa HAI. CONCLUSIONS Prevention of repeat infections in high healthcare utilizers may be important in reducing drug resistance in this population.
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Affiliation(s)
- Mansi Agarwal
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, United States; School of Nursing, Columbia University, 617 West 168th Street, New York, NY 10032, United States.
| | - Elaine L Larson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, United States; School of Nursing, Columbia University, 617 West 168th Street, New York, NY 10032, United States
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Patel SJ, Green N, Clock SA, Paul DA, Perlman JM, Zaoutis T, Ferng YH, Alba L, Jia H, Larson EL, Saiman L. Gram-Negative Bacilli in Infants Hospitalized in The Neonatal Intensive Care Unit. J Pediatric Infect Dis Soc 2017; 6:227-230. [PMID: 27302327 PMCID: PMC5907873 DOI: 10.1093/jpids/piw032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 05/15/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND Gram-negative bacilli (GNB) account for a significant burden of infection and colonization in neonatal intensive care units (NICUs), and antibiotic resistance among these pathogens is of increasing concern. METHODS A prospective cohort study was performed in 4 NICUs between May 2009 and April 2012. The body sites from which GNB were isolated, antimicrobial susceptibilities of the GNB isolated, and antimicrobial therapy were assessed. RESULTS Attending neonatologists treated 3.0% (188 of 6184) of eligible infants for GNB infection; 23% of 214 GNB isolates were nonsusceptible to antimicrobial agents, including gentamicin (14.8%), piperacillin-tazobactam (9.9%), third-generation cephalosporin (7.0%), and/or carbapenem agents (4.5%). Gentamicin was the most commonly used antibiotic overall, and much of its use was empiric. However, third-generation cephalosporin agents and cefepime were used more commonly as targeted therapy for identified Gram-negative pathogens. CONCLUSIONS One-quarter of the GNB isolates were nonsusceptible to ≥1 antibiotic. Antimicrobial stewardship strategies for reducing antimicrobial use in NICUs should be implemented.
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Affiliation(s)
- Sameer J Patel
- Department of Pediatrics, Columbia University Medical Center, New York, New York;,Correspondence: S. J. Patel, MD, MPH, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Chicago, IL 60611 (
| | - Nicole Green
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Sarah A Clock
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - David A Paul
- Department of Pediatrics, Section of Neonatology, Christiana Care Health System, Newark, Delaware
| | - Jeffrey M Perlman
- Department of Pediatrics, Weill Cornell Medical Center, New York, New York
| | - Theoklis Zaoutis
- Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania
| | - Yu-hui Ferng
- School of Nursing, Columbia University Medical Center, and
| | - Luis Alba
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Haomiao Jia
- School of Nursing, Columbia University Medical Center, and
| | | | - Lisa Saiman
- Department of Pediatrics, Columbia University Medical Center, New York, New York;,Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York
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40
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Clock SA, Ferng YH, Tabibi S, Alba L, Patel SJ, Jia H, DeLaMora P, Perlman JM, Paul DA, Zaoutis T, Larson EL, Saiman L. Colonization With Antimicrobial-Resistant Gram-Negative Bacilli at Neonatal Intensive Care Unit Discharge. J Pediatric Infect Dis Soc 2017; 6:219-226. [PMID: 27021036 PMCID: PMC5907870 DOI: 10.1093/jpids/piw014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 02/29/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND The epidemiology of the colonization of infants with antimicrobial-resistant Gram-negative bacilli (GNB) at discharge from the neonatal intensive care unit (NICU) is not well understood. METHODS A multicenter study in which rectal surveillance samples for culture were obtained at NICU discharge from infants hospitalized ≥14 days was performed. Factors associated with colonization with GNB resistant to gentamicin, third/fourth-generation cephalosporin agents, or carbapenem agents were assessed by using a fixed-effects model. RESULTS Of these infants, 9% (119 of 1320) were colonized with ≥1 antimicrobial-resistant GNB. Prolonged treatment (≥10 days) with meropenem or third/fourth-generation cephalosporin agents or treatment for ≥5 days with a β-lactam/β-lactamase combination agent were associated with an increased risk of colonization with GNB resistant to gentamicin. Surgery and ≥5 days of treatment with third/fourth-generation cephalosporin agents, a β-lactam/β-lactamase combination agent, or metronidazole were associated with an increased risk of colonization with GNB resistant to third/fourth-generation cephalosporin agents. Female sex and prolonged treatment (≥10 days) with meropenem were associated with colonization with GNB resistant to carbapenem agents. CONCLUSIONS Prolonged treatment with broad-spectrum antibiotics was associated with the colonization of infants with antimicrobial-resistant GNB within 7 days of NICU discharge. These findings suggest the potential for dissemination of resistant GNB from colonized infants to other NICUs, the community, or pediatric long-term care facilities. Antimicrobial stewardship efforts aimed at improving appropriate antibiotic use could have a beneficial effect on the emergence of antimicrobial-resistant GNB in the NICU population.
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Affiliation(s)
| | - Yu-Hui Ferng
- School of Nursing, Columbia University Medical Center
| | | | | | | | - Haomiao Jia
- School of Nursing, Columbia University Medical Center
| | - Patricia DeLaMora
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Jeffrey M Perlman
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - David A Paul
- Department of Pediatrics, Section of Neonatology, Christiana Care Health System, Newark, Delaware
| | | | | | - Lisa Saiman
- Department of Pediatrics,Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York,Correspondence: L. Saiman, MD, MPH, Department of Pediatrics, 650 West 168th St, PH 4W-470, New York, NY 10032 ()
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41
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Szeto B, Kaba F, Herzig CTA, Befus M, Lowy FD, Miko BA, Rosner Z, Larson EL. Drug Use Is Associated With Purulent Skin and Soft Tissue Infections in a Large Urban Jail: 2011-2015. Open Forum Infect Dis 2017; 4:ofx135. [PMID: 32695839 PMCID: PMC7364227 DOI: 10.1093/ofid/ofx135] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/10/2017] [Indexed: 11/19/2022] Open
Abstract
Background Skin and soft tissue infections (SSTIs) are a common problem in jails in the United States. This study aimed to identify factors associated with purulent SSTIs in the New York City jail system. Methods We conducted a case-control study of purulent SSTIs at the New York City jail. Cases were matched to controls by visit date to the jail’s urgent care clinic. Bivariate and multivariable analyses were conducted using conditional logistic regression. Results From April 2011 to April 2015, 1010 cases of SSTIs were identified and matched to 1010 controls. In multivariable analyses, report upon entry to jail of current injection drug use (odds ratio [OR], 2.76; 95% confidence interval [CI], 1.77–4.31), current snorting of drugs (OR, 1.50; 95% CI, 1.12–2.00), current heroin use (OR, 1.53; 95% CI, 1.08–2.17), current cocaine use (OR, 1.76; 95% CI, 1.18–2.65), and antibiotic use within the previous 6 months (OR, 4.05; 95% CI, 2.98–5.49) were significantly associated with SSTI diagnosis. Conclusions Skin and soft tissue infections were strongly associated with a history of drug use at jail entry. Targeting intravenous drug use may be a preventive strategy for SSTIs in this population. Strategies such as harm reduction programs may be investigated.
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Affiliation(s)
- Betsy Szeto
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | - Fatos Kaba
- Correctional Health Services, New York City Health and Hospitals Corporation
| | - Carolyn T A Herzig
- Department of Epidemiology, Mailman School of Public Health, Columbia University.,Columbia University School of Nursing
| | - Montina Befus
- Department of Epidemiology, Mailman School of Public Health, Columbia University.,Columbia University School of Nursing
| | - Franklin D Lowy
- Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons, New York
| | - Benjamin A Miko
- Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons, New York
| | - Zachary Rosner
- Correctional Health Services, New York City Health and Hospitals Corporation
| | - Elaine L Larson
- Department of Epidemiology, Mailman School of Public Health, Columbia University.,Columbia University School of Nursing
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42
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Conway LJ, Liu J, Harris AD, Larson EL. Response. Am J Crit Care 2017; 26:268. [PMID: 28668909 DOI: 10.4037/ajcc2017434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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43
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Cohn EG, Hamilton N, Larson EL, Williams JK. Self-reported race and ethnicity of US biobank participants compared to the US Census. J Community Genet 2017; 8:229-238. [PMID: 28623623 PMCID: PMC5496846 DOI: 10.1007/s12687-017-0308-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/24/2016] [Accepted: 05/11/2017] [Indexed: 12/17/2022] Open
Abstract
Precision medicine envisions a future of effective diagnosis, treatment, and prevention grounded in precise understandings of the genetic and environmental determinants of disease. Given that the original genome-wide association studies represented a predominately European White population, and that diversity in genomic studies must account for genetic variation both within and across racial categories, new research studies are at a heightened risk for inadequate representation. Currently biological samples are being made available for sequencing in biobanks across the USA, but the diversity of those samples is unknown. The aims of this study were to describe the types of recruitment and enrollment materials used by US biobanks and the diversity of the samples contained within their collection. Biobank websites and brochures were evaluated for reading level, health literacy, and factors known to encourage the recruitment of minorities, such as showing pictures of diverse populations. Biobank managers were surveyed by mail on the methods and materials used for enrollment, recruitment, consent, and the self-reported race/ethnicity of biobank participants. From 51 US biobanks (68% response rate), recruitment and enrollment materials were in English only, and most of the websites and brochures exceeded a fifth-grade reading level. When compared to the 2015 US Census, self-reported race/ethnicity of participants was not significantly different for Whites (61%) and blacks (13%). The percentages were significantly lower for Hispanics and Latinos (18 vs. 7%, p = 0.00) and Hawaiian/Pacific Islanders (0.2 vs. 0.01%; p = 0.01) and higher for Asians (13 vs. 5%, p = 0.01). Materials for recruitment predominantly in English may limit participation by underrepresented populations.
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Affiliation(s)
- Elizabeth Gross Cohn
- School of Nursing, Columbia University, New York, NY, USA.
- Adelphi University, Garden City, NY, USA.
| | - Nalo Hamilton
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
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Abstract
Carbapenem antibiotics are used as a last resort to treat serious Gram-negative bacteria (GNB) infections; however, carbapenemase-producing strains of GNB have emerged as a major source of resistance. Owing to the highly transmissible nature of plasmid-borne carbapenemases, numerous reports have warned about the likely spread into the community from healthcare settings. Since the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in the community is largely unknown, we conducted a scoping review of the literature to assess the percentage of CRE isolates that could be associated with the community. Initially, 361 studies were assessed and 15 met the inclusion criteria. Although 5 studies (33.3%) found no community-associated CRE, the remaining 10 studies identified percentages ranging from 0.04% to 29.5% of either community-associated or community-onset CRE among their samples, with US-based studies alone ranging from 5.6 to 10.8%. The presence of CRE in the community poses an urgent public health threat.
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Affiliation(s)
- Ana M Kelly
- Center for Interdisciplinary Research to Prevent Infections, School of Nursing, Columbia University, 630 West 168th Street, New York, NY 10032, USA.
| | - Barun Mathema
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Elaine L Larson
- Center for Interdisciplinary Research to Prevent Infections, School of Nursing, Columbia University, 630 West 168th Street, New York, NY 10032, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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45
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Kulage KM, Larson EL. Intramural pilot funding and internal grant reviews increase research capacity at a school of nursing. Nurs Outlook 2017; 66:11-17. [PMID: 28669559 DOI: 10.1016/j.outlook.2017.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 03/17/2017] [Revised: 05/26/2017] [Accepted: 06/05/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Strategies for increasing research capacity such as internal funding mechanisms and internal peer reviews for grants are essential for schools of nursing. Although these are documented in the literature, their processes and outcomes have not been reported. PURPOSE The purposes of this study were to describe three protocols for building research capacity at a school of nursing-intramural pilot grants, Specific Objectives and Aims Reviews, and mock reviews-and quantify their outcomes. METHODS We assessed outcome data on 14 intramural pilot grants and 88 external grant applications from 2012 to 2016. FINDINGS Pilot grants produced 16 peer-reviewed articles, 33 presentations, and 11 funded grants. For grant applications that underwent any type of internal review, 41.7% (20/48) received funding compared with 20% (8/40) that did not participate, p = .03. Given the resources required to prepare grant applications, internal funding and reviews can enhance return on investment. CONCLUSION Schools of nursing should consider implementing intramural pilot grants and internal review sessions.
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Affiliation(s)
| | - Elaine L Larson
- Columbia University School of Nursing, New York, NY; Mailman School of Public Health, Columbia University, New York, NY
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Carter EJ, Mancino D, Hessels AJ, Kelly AM, Larson EL. Reported hours of infection education received positively associated with student nurses' ability to comply with infection prevention practices: Results from a nationwide survey. Nurse Educ Today 2017; 53:19-25. [PMID: 28365555 PMCID: PMC5553115 DOI: 10.1016/j.nedt.2017.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/28/2016] [Accepted: 02/26/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Eileen J Carter
- Columbia University School of Nursing, 617 W. 168th Street, New York, NY 10032, United States; New York-Presbyterian Hospital, 435 East 70th Street, Suite 4K, New York, NY 10021, United States.
| | - Diane Mancino
- National Student Nurses' Association, 45 Main Street, Suite 606, Brooklyn, NY 11201, United States.
| | - Amanda J Hessels
- Center for Interdisciplinary Research to Prevent Infections (CIRI), Columbia University, School of Nursing, 617 West 168th St, New York, NY 10032, United States; Nurse Scientist, Hackensack-Meridian Health, Ann May Center for Nursing, 1350 Campus Parkway, Suite 101, Neptune, NJ 07753, United States.
| | - Ana M Kelly
- Center for Interdisciplinary Research to Prevent Infections (CIRI), Columbia University, School of Nursing, 617 West 168th St, New York, NY 10032, United States.
| | - Elaine L Larson
- Columbia University School of Nursing, 617 W. 168th Street, New York, NY 10032, United States; Mailman School of Public Health, 722 W. 168th Street , New York, NY 10032, United States.
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Herzig CTA, Dick AW, Sorbero M, Pogorzelska-Maziarz M, Cohen CC, Larson EL, Stone PW. Infection Trends in US Nursing Homes, 2006-2013. J Am Med Dir Assoc 2017; 18:635.e9-635.e20. [PMID: 28552333 DOI: 10.1016/j.jamda.2017.04.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/29/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The objectives of this study were to estimate trends in the prevalence of infections in nursing home (NH) residents using 2006-2013 Minimum Data Set (MDS) data, estimate the number of all infections in 2013, and evaluate differences in trends between MDS versions 2.0 and 3.0. DESIGN Retrospective study. SETTING NHs in the United States. PARTICIPANTS All NH residents with a quarterly or annual MDS assessment in 2006-2013 (n = 30,366,807 assessments). MEASUREMENTS MDS 2.0 and 3.0 quarterly and annual assessment data (2006-2013) from over 15,000 NHs were used to estimate the 7-day prevalence of multidrug-resistant organism (MDRO) infection, pneumonia, septicemia, viral hepatitis, and wound infection and 30-day prevalence of urinary tract infection (UTI). Admission assessments were excluded. Annual infection counts were estimated using 2013 data. Changes in the prevalence of reported infections over time and differences in trends between MDS 2.0 and 3.0 were examined using tests of linear trends. RESULTS In 2013, there were an estimated 1.13 to 2.68 million infections in NH residents. UTI and pneumonia were the most commonly reported infections in every quarter, ranging from 5.6% to 8.1% and 1.4% to 2.5%, respectively. Prevalence of all infections increased in 2006-2010 (P values < .01). In 2011-2013, prevalence of UTI, MDRO, and wound infections decreased and viral hepatitis increased (P values < .0001). Between MDS 2.0 and 3.0, the prevalence of UTI, MDRO, and wound infections decreased and the prevalence of viral hepatitis increased (P values < .0001). CONCLUSION Infections are a major and persistent problem in NHs. Although MDS data are useful for identifying trends in infection prevalence, revisions in definitions need to be accounted for when evaluating trends over time. Additional research is needed to identify factors that contribute to changes in infection prevalence.
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Affiliation(s)
- Carolyn T A Herzig
- Center for Health Policy, Columbia University School of Nursing, New York, NY
| | | | | | | | - Catherine C Cohen
- Center for Health Policy, Columbia University School of Nursing, New York, NY
| | - Elaine L Larson
- Center for Health Policy, Columbia University School of Nursing, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Patricia W Stone
- Center for Health Policy, Columbia University School of Nursing, New York, NY.
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Cohen B, Cohen CC, Løyland B, Larson EL. Transmission of health care-associated infections from roommates and prior room occupants: a systematic review. Clin Epidemiol 2017; 9:297-310. [PMID: 28579835 PMCID: PMC5448698 DOI: 10.2147/clep.s124382] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pathogens that cause health care-associated infections (HAIs) are known to survive on surfaces and equipment in health care environments despite routine cleaning. As a result, the infection status of prior room occupants and roommates may play a role in HAI transmission. We performed a systematic review of the literature evaluating the association between patients' exposure to infected/colonized hospital roommates or prior room occupants and their risk of infection/colonization with the same organism. A PubMed search for English articles published in 1990-2014 yielded 330 studies, which were screened by three reviewers. Eighteen articles met our inclusion criteria. Multiple studies reported positive associations between infection and exposure to roommates with influenza and group A streptococcus, but no associations were found for Clostridium difficile, methicillin-resistant Staphylococcus aureus, Cryptosporidium parvum, or Pseudomonas cepacia; findings were mixed for vancomycin-resistant enterococci (VRE). Positive associations were found between infection/colonization and exposure to rooms previously occupied by patients with Pseudomonas aeruginosa and Acinetobacter baumannii, but no associations were found for resistant Gram-negative organisms; findings were mixed for C. difficile, methicillin-resistant S. aureus, and VRE. Although the majority of studies suggest a link between exposure to infected/colonized roommates and prior room occupants, methodological improvements such as increasing the statistical power and conducting universal screening for colonization would provide more definitive evidence needed to establish causality.
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Affiliation(s)
- Bevin Cohen
- Columbia University School of Nursing, New York, NY, USA
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Abstract
PURPOSE The purpose of this study was to test the reliability, feasibility and utility of a modified patient safety survey for use in pediatric long term care (pLTC) settings and describe patient safety culture in a sample of providers from pLTC facilities. METHODS A survey was adapted from the Agency for Healthcare Research and Quality Nursing Home Survey on Patient Safety Culture (PSC-pLTC) and administered to a convenience sample of providers who work in pLTC during an educational workshop in November 2015. RESULTS Forty-nine respondents from 32 facilities across all 4 U.S. census regions completed the survey. The adapted survey demonstrated excellent face validity, usability, feasibility and internal consistency reliability (Cronbach alpha = 0.94). Highest ratings were given to overall perceptions of safety, feedback and incident communication, supervisors' expectations and actions and management support. Lower ratings were given to dimensions of teamwork, communication, handoffs and transitions, with the lowest ratings given to staffing and organizational learning. Ratings were associated with population and geographic region served. CONCLUSION This survey to measure patient safety culture adapted for pLTC demonstrated components of reliability and validity, was useable and group discussants were eager for such a measure.
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Affiliation(s)
- Amanda J. Hessels
- Columbia University, School of Nursing, New York, NY, USA
- Hackensack-Meridian Health, New York, NY, USA
| | - Mansi Agarwal
- Columbia University, School of Nursing, New York, NY, USA
| | - Lisa Saiman
- Columbia University Medical Center, New York, NY, USA
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50
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Swanson KM, Larson EL, Malone B. Mentors' perspectives on supporting nurse faculty scholars. Nurs Outlook 2017; 65:315-323. [DOI: 10.1016/j.outlook.2017.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/31/2016] [Accepted: 01/08/2017] [Indexed: 11/26/2022]
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