1
|
Dukes KC, Reisinger HS, Schweizer M, Ward MA, Chapin L, Ryken TC, Perl TM, Herwaldt LA. Examining barriers to implementing a surgical-site infection bundle. Infect Control Hosp Epidemiol 2024; 45:13-20. [PMID: 37493031 PMCID: PMC10782202 DOI: 10.1017/ice.2023.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Surgical-site infections (SSIs) can be catastrophic. Bundles of evidence-based practices can reduce SSIs but can be difficult to implement and sustain. OBJECTIVE We sought to understand the implementation of SSI prevention bundles in 6 US hospitals. DESIGN Qualitative study. METHODS We conducted in-depth semistructured interviews with personnel involved in bundle implementation and conducted a thematic analysis of the transcripts. SETTING The study was conducted in 6 US hospitals: 2 academic tertiary-care hospitals, 3 academic-affiliated community hospitals, 1 unaffiliated community hospital. PARTICIPANTS In total, 30 hospital personnel participated. Participants included surgeons, laboratory directors, clinical personnel, and infection preventionists. RESULTS Bundle complexity impeded implementation. Other barriers varied across services, even within the same hospital. Multiple strategies were needed, and successful strategies in one service did not always apply in other areas. However, early and sustained interprofessional collaboration facilitated implementation. CONCLUSIONS The evidence-based SSI bundle is complicated and can be difficult to implement. One implementation process probably will not work for all settings. Multiple strategies were needed to overcome contextual and implementation barriers that varied by setting and implementation climate. Appropriate adaptations for specific settings and populations may improve bundle adoption, fidelity, acceptability, and sustainability.
Collapse
Affiliation(s)
- Kimberly C. Dukes
- Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System (ICVAHCS), Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- College of Public Health, University of Iowa, Iowa City, Iowa
| | - Heather Schacht Reisinger
- Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System (ICVAHCS), Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | - Marin Schweizer
- Department of Internal Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Melissa A. Ward
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Timothy C. Ryken
- MercyOne Northeast Iowa Neurosurgery, Iowa City, Iowa
- Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Trish M. Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Loreen A. Herwaldt
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- College of Public Health, University of Iowa, Iowa City, Iowa
- University of Iowa Hospitals and Clinics (UIHC), Iowa City, Iowa
| |
Collapse
|
2
|
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Casazza JA, Thakur B, Perl TM, Hanna JJ, Diaz MI, Ho M, Lanier H, Pickering M, Saleh SN, Shah P, Shah D, Navar AM, Lehmann CU, Medford RJ, Turer RW. Is there an association between peri-diagnostic vaccination and clinical outcomes in COVID-19 patients? Antimicrob Steward Healthc Epidemiol 2023; 3:e150. [PMID: 37771735 PMCID: PMC10523550 DOI: 10.1017/ash.2023.417] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 09/30/2023]
Abstract
Background Peri-diagnostic vaccination contemporaneous with SARS-CoV-2 infection might boost antiviral immunity and improve patient outcomes. We investigated, among previously unvaccinated patients, whether vaccination (with the Pfizer, Moderna, or J&J vaccines) during the week before or after a positive COVID-19 test was associated with altered 30-day patient outcomes. Methods Using a deidentified longitudinal EHR repository, we selected all previously unvaccinated adults who initially tested positive for SARS-CoV-2 between December 11, 2020 (the date of vaccine emergency use approval) and December 19, 2021. We assessed whether vaccination between days -7 and +7 of a positive test affected outcomes. The primary measure was progression to a more severe disease outcome within 30 days of diagnosis using the following hierarchy: hospitalization, intensive care, or death. Results Among 60,031 hospitalized patients, 543 (0.91%) were initially vaccinated at the time of diagnosis and 59,488 (99.09%) remained unvaccinated during the period of interest. Among 316,337 nonhospitalized patients, 2,844 (0.90%) were initially vaccinated and 313,493 (99.1%) remained unvaccinated. In both analyses, individuals receiving vaccines were older, more often located in the northeast, more commonly insured by Medicare, and more burdened by comorbidities. Among previously unvaccinated patients, there was no association between receiving an initial vaccine dose between days -7 and +7 of diagnosis and progression to more severe disease within 30 days compared to patients who did not receive vaccines. Conclusions Immunization during acute SARS-CoV-2 infection does not appear associated with clinical progression during the acute infectious period.
Collapse
Affiliation(s)
| | - Bhaskar Thakur
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, USA
- O’Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Trish M. Perl
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - John J. Hanna
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Marlon I. Diaz
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Milan Ho
- UT Southwestern Medical School, Dallas, TX, USA
| | | | - Madison Pickering
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sameh N. Saleh
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Pankil Shah
- Department of Urology, UT Health San Antonio, San Antonio, TX, USA
| | - Dimpy Shah
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
| | - Ann Marie Navar
- O’Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Christoph U. Lehmann
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, USA
- O’Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
- Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Richard J. Medford
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
- Chief Medical Informatics and Digital Health Officer, ECU Health, Greenville, NC, USA
| | - Robert W. Turer
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
5
|
Hanna JJ, Geresu LB, Diaz MI, Ho M, Casazza JA, Pickering MA, Lanier HD, Radunsky AP, Cooper LN, Saleh SN, Bedimo RJ, Most ZM, Perl TM, Lehmann CU, Turer RW, Chow JY, Medford RJ. Risk Factors for SARS-CoV-2 Infection and Severe Outcomes Among People With Human Immunodeficiency Virus: Cohort Study. Open Forum Infect Dis 2023; 10:ofad400. [PMID: 37577110 PMCID: PMC10416813 DOI: 10.1093/ofid/ofad400] [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: 04/14/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023] Open
Abstract
Background Studies on COVID-19 in people with HIV (PWH) have had limitations. Further investigations on risk factors and outcomes of SARS-CoV-2 infection among PWH are needed. Methods This retrospective cohort study leveraged the national OPTUM COVID-19 data set to investigate factors associated with SARS-CoV-2 positivity among PWH and risk factors for severe outcomes, including hospitalization, intensive care unit stays, and death. A subset analysis was conducted to examine HIV-specific variables. Multiple variable logistic regression was used to adjust for covariates. Results Of 43 173 PWH included in this study, 6472 had a positive SARS-CoV-2 result based on a polymerase chain reaction test or antigen test. For PWH with SARS-CoV-2 positivity, higher odds were found for those who were younger (18-49 years), Hispanic White, African American, from the US South, uninsured, and a noncurrent smoker and had a higher body mass index and higher Charlson Comorbidity Index. For PWH with severe outcomes, higher odds were identified for those who were SARS-CoV-2 positive, older, from the US South, receiving Medicaid/Medicare or uninsured, a current smoker, and underweight and had a higher Charlson Comorbidity Index. In a subset analysis including PWH with HIV care variables (n = 5098), those with unsuppressed HIV viral load, a low CD4 count, and no antiretroviral therapy had higher odds of severe outcomes. Conclusions This large US study found significant ethnic, racial, and geographic differences in SARS-CoV-2 infection among PWH. Chronic comorbidities, older age, lower body mass index, and smoking were associated with severe outcomes among PWH during the COVID-19 pandemic. SARS-CoV-2 infection was associated with severe outcomes, but once we adjusted for HIV care variables, SARS-CoV-2 was no longer significant; however, low CD4 count, high viral load, and lack of antiretroviral therapy had higher odds of severe outcomes.
Collapse
Affiliation(s)
- John J Hanna
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Liyu B Geresu
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Healthcare Informatics, Children’s Health Hospitals and Health Care, Dallas, Texas, USA
| | - Marlon I Diaz
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Milan Ho
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Julia A Casazza
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madison A Pickering
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Heather D Lanier
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexander P Radunsky
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lauren N Cooper
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sameh N Saleh
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Roger J Bedimo
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zachary M Most
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
- Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Robert W Turer
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jeremy Y Chow
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Richard J Medford
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
6
|
Saleh SN, McDonald SA, Basit MA, Kumar S, Arasaratnam RJ, Perl TM, Lehmann CU, Medford RJ. Public perception of COVID-19 vaccines through analysis of Twitter content and users. Vaccine 2023; 41:4844-4853. [PMID: 37385887 PMCID: PMC10288320 DOI: 10.1016/j.vaccine.2023.06.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 05/03/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND With the global continuation of the COVID-19 pandemic, the large-scale administration of a SARS-CoV-2 vaccine is crucial to achieve herd immunity and curtail further spread of the virus, but success is contingent on public understanding and vaccine uptake. We aim to understand public perception about vaccines for COVID-19 through the wide-scale, organic discussion on Twitter. METHODS This cross-sectional observational study included Twitter posts matching the search criteria (('covid*' OR 'coronavirus') AND 'vaccine') posted during vaccine development from February 1st through December 11th, 2020. These COVID-19 vaccine related posts were analyzed with topic modeling, sentiment and emotion analysis, and demographic inference of users to provide insight into the evolution of public attitudes throughout the study period. FINDINGS We evaluated 2,287,344 English tweets from 948,666 user accounts. Individuals represented 87.9 % (n = 834,224) of user accounts. Of individuals, men (n = 560,824) outnumbered women (n = 273,400) by 2:1 and 39.5 % (n = 329,776) of individuals were ≥40 years old. Daily mean sentiment fluctuated congruent with news events, but overall trended positively. Trust, anticipation, and fear were the three most predominant emotions; while fear was the most predominant emotion early in the study period, trust outpaced fear from April 2020 onward. Fear was more prevalent in tweets by individuals (26.3 % vs. organizations 19.4 %; p < 0.001), specifically among women (28.4 % vs. males 25.4 %; p < 0.001). Multiple topics had a monthly trend towards more positive sentiment. Tweets comparing COVID-19 to the influenza vaccine had strongly negative early sentiment but improved over time. INTERPRETATION This study successfully explores sentiment, emotion, topics, and user demographics to elucidate important trends in public perception about COVID-19 vaccines. While public perception trended positively over the study period, some trends, especially within certain topic and demographic clusters, are concerning for COVID-19 vaccine hesitancy. These insights can provide targets for educational interventions and opportunity for continued real-time monitoring.
Collapse
Affiliation(s)
- Sameh N Saleh
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Clinical Informatics Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States.
| | - Samuel A McDonald
- Clinical Informatics Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Mujeeb A Basit
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Clinical Informatics Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Sanat Kumar
- Clinical Informatics Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Lebanon Trail High School, 5151 Ohio Dr, Frisco, TX 75035, United States
| | - Reuben J Arasaratnam
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Trish M Perl
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Departments of Pediatrics, Bioinformatics, Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Richard J Medford
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Clinical Informatics Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| |
Collapse
|
7
|
Govind A, Lazarte SM, Kitchell E, Chow JY, Estelle CD, Fixsen E, Helm C, Jain MK, Mehta R, Perl TM, Sutaria JM, Thomas C, Dominguez AR, Utay NS. Severe Mpox Infections in People With Uncontrolled Human Immunodeficiency Virus. Clin Infect Dis 2023; 76:1843-1846. [PMID: 36718662 DOI: 10.1093/cid/ciad052] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
In the current mpox outbreak, infections are usually self-limited. We describe 3 patients with uncontrolled HIV and mpox infections lasting months, causing debilitating lesions, complications, and death, despite initiating anti-mpox and antiretroviral therapy. Delayed treatment of mpox with antiviral agents may contribute to poor outcomes in severely immunocompromised patients.
Collapse
Affiliation(s)
- Anusha Govind
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
| | - Susana M Lazarte
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
| | - Ellen Kitchell
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
| | - Jeremy Y Chow
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
| | - Carolee D Estelle
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
| | - Emma Fixsen
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Caitlin Helm
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mamta K Jain
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
| | - Roma Mehta
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
| | - Jaini M Sutaria
- Parkland Health, Dallas, Texas, USA
- Division of Hospital Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cristina Thomas
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Arturo R Dominguez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Netanya S Utay
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
| |
Collapse
|
8
|
Ho M, Most ZM, Perl TM, Diaz MI, Casazza JA, Saleh S, Pickering M, Radunsky AP, Hanna JJ, Thakur B, Lehmann CU, Medford RJ, Turer RW. Incidence and Risk Factors for Severe Outcomes in Pediatric Patients With COVID-19. Hosp Pediatr 2023; 13:450-462. [PMID: 37038904 DOI: 10.1542/hpeds.2022-006833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVES Throughout the pandemic, children with COVID-19 have experienced hospitalization, ICU admission, invasive respiratory support, and death. Using a multisite, national dataset, we investigate risk factors associated with these outcomes in children with COVID-19. METHODS Our data source (Optum deidentified COVID-19 Electronic Health Record Dataset) included children aged 0 to 18 years testing positive for COVID-19 between January 1, 2020, and January 20, 2022. Using ordinal logistic regression, we identified factors associated with an ordinal outcome scale: nonhospitalization, hospitalization, or a severe composite outcome (ICU, intensive respiratory support, death). To contrast hospitalization for COVID-19 and incidental positivity on hospitalization, we secondarily identified patient factors associated with hospitalizations with a primary diagnosis of COVID-19. RESULTS In 165 437 children with COVID-19, 3087 (1.8%) were hospitalized without complication, 2954 (1.8%) experienced ICU admission and/or intensive respiratory support, and 31 (0.02%) died. We grouped patients by age: 0 to 4 years old (35 088), and 5 to 11 years old (75 574), 12 to 18 years old (54 775). Factors positively associated with worse outcomes were preexisting comorbidities and residency in the Southern United States. In 0- to 4-year-old children, there was a nonlinear association between age and worse outcomes, with worse outcomes in 0- to 2-year-old children. In 5- to 18-year-old patients, vaccination was protective. Findings were similar in our secondary analysis of hospitalizations with a primary diagnosis of COVID-19, though region effects were no longer observed. CONCLUSIONS Among children with COVID-19, preexisting comorbidities and residency in the Southern United States were positively associated with worse outcomes, whereas vaccination was negatively associated. Our study population was highly insured; future studies should evaluate underinsured populations to confirm generalizability.
Collapse
Affiliation(s)
- Milan Ho
- UT Southwestern Medical School, Dallas, Texas
| | | | | | | | | | | | | | | | - John J Hanna
- Department of Internal Medicine
- Clinical Informatics Center
| | - Bhaskar Thakur
- Department of Population and Data Science
- Department of Emergency Medicine, and
| | - Christoph U Lehmann
- Department of Pediatrics
- Clinical Informatics Center
- Department of Population and Data Science
- Lyda Hill Department of Bioinformatics, Utah Southwestern Medical Center, Dallas, Texas
| | | | - Robert W Turer
- Clinical Informatics Center
- Department of Emergency Medicine, and
| |
Collapse
|
9
|
Cooper LN, Radunsky AP, Hanna JJ, Most ZM, Perl TM, Lehmann CU, Medford RJ. Analyzing an Emerging Pandemic on Twitter: Monkeypox. Open Forum Infect Dis 2023; 10:ofad142. [PMID: 37035497 PMCID: PMC10077829 DOI: 10.1093/ofid/ofad142] [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: 11/04/2022] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Background Social media platforms like Twitter provide important insights into the public's perceptions of global outbreaks like monkeypox. By analyzing tweets, we aimed to identify public knowledge and opinions on the monkeypox virus and related public health issues. Methods We analyzed English-language tweets using the keyword "monkeypox" from 1 May to 23 July 2022. We reported gender, ethnicity, and race of Twitter users and analyzed tweets to identify predominant sentiment and emotions. We performed topic modeling and compared cohorts of users who self-identify as LGBTQ+ (an abreviation for lesbian, gay, bisexual, transgender, queer, and/or questioning) allies versus users who do not, and cohorts identified as "bots" versus humans. Results A total of 48 330 tweets were written by LGBTQ+ self-identified advocates or allies. The mean sentiment score for all tweets was -0.413 on a -4 to +4 scale. Negative tweets comprised 39% of tweets. The most common emotions expressed were fear and sadness. Topic modeling identified unique topics among the 4 cohorts analyzed. Conclusions The spread of mis- and disinformation about monkeypox was common in our tweet library. Various conspiracy theories about the origins of monkeypox, its relationship to global economic concerns, and homophobic and racial comments were common. Conversely, many other tweets helped to provide information about monkeypox vaccines, disease symptoms, and prevention methods. Discussion of rising monkeypox case numbers globally was also a large aspect of the conversation. Conclusions We demonstrated that Twitter is an effective means of tracking sentiment about public healthcare issues. We gained insight into a subset of people, self-identified LGBTQ+ allies, who were more affected by monkeypox.
Collapse
Affiliation(s)
- Lauren N Cooper
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexander P Radunsky
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John J Hanna
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zachary M Most
- Department of Pediatrics, Division of Pediatric Infectious Disease, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Trish M Perl
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Richard J Medford
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
10
|
Ganguly A, de la Flor C, Alvarez K, Brown LS, Mang NS, Smartt J, King H, Perl TM, Filizola H, Bhavan KP. Safety and Efficacy of Ceftriaxone in the Treatment of Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections: A Noninferiority Retrospective Cohort Study. Ann Pharmacother 2023; 57:425-431. [PMID: 35942602 DOI: 10.1177/10600280221115460] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Antistaphylococcal penicillins and cefazolin are the treatments of choice for methicillin-susceptible Staphylococcus aureus (MSSA) infections, requiring multiple doses daily. At Parkland, eligible uninsured patients with MSSA bloodstream infections (BSI) receive self-administered outpatient parenteral antimicrobial therapy (S-OPAT). Ceftriaxone was used in a cohort of S-OPAT patients for ease of once-daily dosing. OBJECTIVE A retrospective study was conducted to evaluate clinical outcomes for patients discharged with ceftriaxone versus cefazolin to treat MSSA BSI. METHODS A retrospective cohort noninferiority study design was used to assess treatment efficacy of ceftriaxone versus cefazolin among Parkland S-OPAT patients treated from April 2012 to March 2020. Demographic, clinical, and treatment-related adverse events data were collected. Clinical outcomes included treatment failure as defined by repeat positive blood culture or retreatment within 6 months, all-cause 30-day readmission rates, and central line-associated bloodstream infection (CLABSI) rates. RESULTS Of 368 S-OPAT patients with MSSA BSI, 286 (77.7%) received cefazolin, and 82 (22.3%) received ceftriaxone. Demographics and comorbidities were similar for both groups. There were no treatment failures in the ceftriaxone group compared with 4 (1%) in the cefazolin group (P = 0.58). No difference in 30-day readmission rate between groups was found. The CLABSI rates were lower in ceftriaxone group (2%) compared with cefazolin (11%; P = 0.02). Limitations include retrospective cohort design. CONCLUSIONS Ceftriaxone was found to be noninferior to cefazolin in this study. Our findings suggest that ceftriaxone is a safe and effective treatment of MSSA BSI secondary to osteoarticular or skin and soft tissue infections when used in the S-OPAT setting. POSTER ABSTRACT OFID on 2018 Nov; 5(Suppl 1): S316: doi: 10.1093/ofid/ofy210.894.
Collapse
Affiliation(s)
- Anisha Ganguly
- Internal Medicine Residency Program, University of Washington Medical Center, Seattle, WA, USA
| | - Carolina de la Flor
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | | | - Helen King
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Trish M Perl
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hector Filizola
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kavita P Bhavan
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Parkland Health, Dallas, TX, USA
| |
Collapse
|
11
|
Most ZM, Nyquist AC, Radonovich LJ, Rodriguez-Barradas MC, Price CS, Simberkoff MS, Bessesen MT, Cummings DAT, Rattigan SM, Warren-Gash C, Gaydos CA, Gibert CL, Gorse GJ, Perl TM. Preschool-Aged Household Contacts as a Risk Factor for Viral Respiratory Infections in Healthcare Personnel. Open Forum Infect Dis 2023; 10:ofad057. [PMID: 36824623 PMCID: PMC9942663 DOI: 10.1093/ofid/ofad057] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Background Viral respiratory infections (VRIs) are common and are occupational risks for healthcare personnel (HCP). VRIs can also be acquired at home and other settings among HCPs. We sought to determine if preschool-aged household contacts are a risk factor for VRIs among HCPs working in outpatient settings. Methods We conducted a secondary analysis of data from a cluster randomized trial at 7 medical centers in the United States over 4 influenza seasons from 2011-2012 to 2014-2015. Adult HCPs who routinely came within 6 feet of patients with respiratory infections were included. Participants were tested for respiratory viruses whenever symptomatic and at 2 random times each season when asymptomatic. The exposure of interest was the number of household contacts 0-5 years old (preschool-aged) at the beginning of each HCP-season. The primary outcome was the rate of polymerase chain reaction-detected VRIs, regardless of symptoms. The VRI incidence rate ratio (IRR) was calculated using a mixed-effects Poisson regression model that accounted for clustering at the clinic level. Results Among the 4476 HCP-seasons, most HCPs were female (85.4%) and between 30 and 49 years of age (54.6%). The overall VRI rate was 2.04 per 100 person-weeks. In the adjusted analysis, HCPs having 1 (IRR, 1.22 [95% confidence interval {CI}, 1.05-1.43]) and ≥2 (IRR, 1.35 [95% CI, 1.09-1.67]) preschool-aged household contacts had higher VRI rates than those with zero preschool-aged household contacts. Conclusions Preschool-aged household contacts are a risk factor for developing VRIs among HCPs working in outpatient settings.
Collapse
Affiliation(s)
- Zachary M Most
- Pediatric Infectious Diseases Program, Children’s Health System of Texas, Dallas, Texas, USA
- Division of Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ann-Christine Nyquist
- Department of Infectious Disease, Children’s Hospital Colorado, Aurora, Colorado, USA
- Division of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lewis J Radonovich
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Connie Savor Price
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
- Infectious Disease Department, Denver Health Medical Center, Denver, Colorado, USA
| | - Michael S Simberkoff
- Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, New York, USA
- Division of Infectious Diseases, New York University Grossman School of Medicine, New York, New York, USA
| | - Mary T Bessesen
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
- Medical Service/Infectious Disease, Veterans Affairs Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Derek A T Cummings
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan M Rattigan
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Charlotte Warren-Gash
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charlotte A Gaydos
- Department of Medicine and Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Cynthia L Gibert
- Medical Service/Infectious Disease, Veterans Affairs Medical Center, Washington, District of Columbia, USA
- Department of Medicine, George Washington University School of Medical and Health Sciences, Washington, District of Columbia, USA
| | - Geoffrey J Gorse
- Division of Infectious Diseases, Allergy and Immunology, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Trish M Perl
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
12
|
Hanna JJ, Geresu LB, Diaz M, Pickering M, Casazza JA, Ho M, Lanier H, Radunsky ALEP, Saleh SN, Most ZM, Perl TM, Turer RW, Lehmann CU, Chow JY, Medford RJ. 2357. Risk Factors for COVID-19 Infection and Outcomes in People Living with HIV. Open Forum Infect Dis 2022. [PMCID: PMC9751943 DOI: 10.1093/ofid/ofac492.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background As the risk for concomitant COVID-19 infection in people living with HIV (PLHIV) remains largely unknown, we explored a large national database to identify risk factors for COVID-19 infection among PLHIV. Methods Using the COVID-19 OPTUM de-identified national multicenter database, we identified 29,393 PLHIV with either a positive HIV test or documented HIV ICD9/10 codes. Using a multiple logistic regression model, we compared risk factors among PLHIV, who tested positive for COVID-19 (5,134) and those who tested negative (24,259) from January 20, 2020, to January 20, 2022. We then compared secondary outcomes including hospitalization, Intensive Care Unit (ICU) stay, and death within 30 days of test among the 2 cohorts, adjusting for COVID-19 positivity and covariates. We adjusted all models for the following covariates: age, gender, race, ethnicity, U.S. region, insurance type, adjusted Charlson Comorbidity Index (CCI), Body Mass Index (BMI), and smoking status. Results Among PLHIV, factors associated with higher odds for acquiring COVID-19 (Figure 1) included lower age (compared to age group 18–49, age groups 50–64 and >65 were associated with odds ratios (OR) of 0.8 and 0.75, P= 0.001), female gender (compared to males, OR 1.06, P= 0.07), Hispanic White ethnicity/race (OR 2.75, P= 0.001), Asian (OR 1.35, P= 0.04), and African American (OR 1.23, P= 0.001) [compared to non-Hispanic White], living in the U.S. South (compared to the Northeast, OR 2.18, P= 0.001), being uninsured (compared to commercial insurance, OR 1.46, P= 0.001), higher CCI (OR 1.025, P= 0.001), higher BMI category (compared to having BMI< 30, Obesity category 1 or 2, OR 1.2 and obesity category 3, OR 1.34, P= 0.001), and noncurrent smoking status (compared to current smoker, OR 1.46, P= 0.001). Compared to PLHIV who tested negative for COVID-19, PLHIV who tested positive, had an OR 1.01 for hospitalization (P = 0.79), 1.03 for ICU stay (P=0.73), and 1.47 for death (P=0.001). Conclusion Our study found that among PLHIV, being Hispanic, living in the South, lacking insurance, having higher BMI, and higher CCI scores were associated with increased odds of testing positive for COVID-19. PLHIV who tested positive for COVID-19 had higher odds of death. Disclosures Christoph U. Lehmann, MD, Celanese: Stocks/Bonds|Markel: Stocks/Bonds|Springer: Honoraria|UTSW: Employee Jeremy Y. Chow, M.D., M.S., Gilead Sciences: Grant/Research Support.
Collapse
Affiliation(s)
| | | | - Marlon Diaz
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Julia A Casazza
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Milan Ho
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | | - Zachary M Most
- University of Texas at Southwestern Medical Center, Dallas, Texas
| | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert W Turer
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | |
Collapse
|
13
|
Ho M, Most ZM, Diaz M, Casazza JA, Thakur B, Saleh S, Pickering M, Perl TM, Lehmann CU, Medford RJ, Turer RW. 2298. Clinical and Demographic Characteristics of COVID-19 in Pediatric Patients in the United States. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
The percentage of children infected with COVID-19 has outpaced that of adults. As children >5 years are now eligible to receive vaccines, it is necessary to understand the effect of vaccination in the context of demographic characteristics, clinical factors, and variants on pediatric COVID-19 illness severity.
Methods
We conducted a descriptive study of patients ≤18 years from the Optum® COVID-19 electronic health record dataset. Patients were included if positive for COVID-19 by polymerase chain reaction or antigen testing for the first time from 3/12/2020 to 1/20/2022. We compare race and ethnicity, age, gender, US region of residence, vaccination status, body mass index (BMI), pediatric comorbidity index (PCI) (Sun, Am. J. Epidemiol. 2021), and predominant variant (by time and region) with 2-tailed t-test, multi-category chi-square test, and odds ratios (R version 4.1.2; α = 0.05). PCI is a validated comorbidity index predicting hospitalization in pediatric patients.
Results
Of all pediatric patients in our dataset, 165,468 (13.2%) tested positive for COVID-19. 3,087 (1.9%) were hospitalized, 1,417 (0.9%) were admitted to the ICU, 1545 (0.9%) received respiratory support, and 31 (0.02%) died, comparable to AAP-reported hospitalization and mortality rates in US children. Patients with severe outcomes were more likely to be younger, non-Caucasian, from the US South, unvaccinated, and have a higher PCI (Figure 1). Excluding non-severe outcomes, rates of death and ICU admission were higher in 0–4-year-olds compared to 5–11 or 12–18-year-olds (Figure 2). All patients receiving at least one dose of the vaccine survived. The odds ratio of a severe outcome is 0.11 (95% CI 0.07–0.16) in fully vaccinated patients compared to unvaccinated patients. The odds ratio of a severe outcome is 0.55 (95% CI 0.49–0.63) in partially vaccinated patients compared to unvaccinated patients.
Demographic and clinical characteristics of pediatric patients with COVID-19
Relative proportion of clinically severe outcomes within age groups, excluding non-severe outcomes
Conclusion
In this large population, incidence rate of severe outcomes from COVID-19 in pediatric patients was higher among non-Caucasian patients, living in the South, with underlying comorbid illness, and those not yet eligible for vaccination. These findings reinforce the need for a vaccine for younger patients and targeted vaccine outreach to racial and ethnic minorities and children with chronic conditions.
Disclosures
Christoph U. Lehmann, MD, Celanese: Stocks/Bonds|Markel: Stocks/Bonds|Springer: Honoraria|UTSW: Employee.
Collapse
Affiliation(s)
- Milan Ho
- University of Texas Southwestern Medical Center , Dallas, TX
| | - Zachary M Most
- University of Texas at Southwestern Medical Center , Dallas, Texas
| | - Marlon Diaz
- University of Texas Southwestern Medical Center , Dallas, TX
| | - Julia A Casazza
- University of Texas Southwestern Medical Center , Dallas, TX
| | - Bhaskar Thakur
- University of Texas Southwestern Medical Center , Dallas, TX
| | - Sameh Saleh
- Children's Hospital of Pennsylvania , Philadelphia, Pennsylvania
| | | | - Trish M Perl
- University of Texas Southwestern Medical Center , Dallas, TX
| | | | | | - Robert W Turer
- University of Texas Southwestern Medical Center , Dallas, TX
| |
Collapse
|
14
|
Miller MJ, Cash-Goldwasser S, Marx GE, Schrodt CA, Kimball A, Padgett K, Noe RS, McCormick DW, Wong JM, Labuda SM, Borah BF, Zulu I, Asif A, Kaur G, McNicholl JM, Kourtis A, Tadros A, Reagan-Steiner S, Ritter JM, Yu Y, Yu P, Clinton R, Parker C, Click ES, Salzer JS, McCollum AM, Petersen B, Minhaj FS, Brown E, Fischer MP, Atmar RL, DiNardo AR, Xu Y, Brown C, Goodman JC, Holloman A, Gallardo J, Siatecka H, Huffman G, Powell J, Alapat P, Sarkar P, Hanania NA, Bruck O, Brass SD, Mehta A, Dretler AW, Feldpausch A, Pavlick J, Spencer H, Ghinai I, Black SR, Hernandez-Guarin LN, Won SY, Shankaran S, Simms AT, Alarcón J, O’Shea JG, Brooks JT, McQuiston J, Honein MA, O’Connor SM, Chatham-Stephens K, O’Laughlin K, Rao AK, Raizes E, Gold JAW, Morris SB, Duessel S, Danaie D, Hickman A, Griffith B, Sanneh H, Hutchins H, Phyathep C, Carpenter A, Shelus V, Petras J, Hennessee I, Davis M, McArdle C, Dawson P, Gutelius B, Bisgard K, Wong K, Galang RR, Perkins KM, Filardo TD, Davidson W, Hutson C, Lowe D, Zucker JE, Wheeler DA, He L, Jain AK, Semeniuk O, Chatterji D, McClure M, Li LX, Mata J, Beselman S, Cross SL, Menzies B, Keller M, Chaturvedi V, Thet A, Carroll R, Hebert C, Patel G, Gandhi V, Abrams-Downey A, Nawab M, Landon E, Lee G, Kaplan-Lewis E, Miranda C, Carmack AE, Traver EC, Lazarte S, Perl TM, Chow J, Kitchell E, Nijhawan A, Habib O, Bernus A, Andujar G, Davar K, Holtom P, Wald-Dickler N, Lorio MA, Gaviria J, Chu V, Wolfe CR, McKellar MS, Farran S, Diaz Wong RA, Schliep T, Shaw R, Tebas P, Richterman A, Aurelius M, Peterson L, Trible R, Rehman T, Sabzwari R, Hines E, Birkey T, Stokich D, King J, Farabi A, Jenny-Avital E, Touleyrou L, Sandhu A, Newman G, Bhamidipati D, Bhamidipati D, Vigil K, Caro M, Banowski K, Chinyadza TW, Rosenzweig J, Jones MS, Camargo JF, Marsh KJ, Liu EW, Guerrero-Wooley R, Pottinger P. Severe Monkeypox in Hospitalized Patients - United States, August 10-October 10, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1412-1417. [PMID: 36327164 PMCID: PMC9639440 DOI: 10.15585/mmwr.mm7144e1] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
As of October 21, 2022, a total of 27,884 monkeypox cases (confirmed and probable) have been reported in the United States.§ Gay, bisexual, and other men who have sex with men have constituted a majority of cases, and persons with HIV infection and those from racial and ethnic minority groups have been disproportionately affected (1,2). During previous monkeypox outbreaks, severe manifestations of disease and poor outcomes have been reported among persons with HIV infection, particularly those with AIDS (3-5). This report summarizes findings from CDC clinical consultations provided for 57 patients aged ≥18 years who were hospitalized with severe manifestations of monkeypox¶ during August 10-October 10, 2022, and highlights three clinically representative cases. Overall, 47 (82%) patients had HIV infection, four (9%) of whom were receiving antiretroviral therapy (ART) before monkeypox diagnosis. Most patients were male (95%) and 68% were non-Hispanic Black (Black). Overall, 17 (30%) patients received intensive care unit (ICU)-level care, and 12 (21%) have died. As of this report, monkeypox was a cause of death or contributing factor in five of these deaths; six deaths remain under investigation to determine whether monkeypox was a causal or contributing factor; and in one death, monkeypox was not a cause or contributing factor.** Health care providers and public health professionals should be aware that severe morbidity and mortality associated with monkeypox have been observed during the current outbreak in the United States (6,7), particularly among highly immunocompromised persons. Providers should test all sexually active patients with suspected monkeypox for HIV at the time of monkeypox testing unless a patient is already known to have HIV infection. Providers should consider early commencement and extended duration of monkeypox-directed therapy†† in highly immunocompromised patients with suspected or laboratory-diagnosed monkeypox.§§ Engaging all persons with HIV in sustained care remains a critical public health priority.
Collapse
|
15
|
Hughes AE, Medford RJ, Perl TM, Basit MA, Kapinos KA. District-Level Universal Masking Policies and COVID-19 Incidence During the First 8 Weeks of School in Texas. Am J Public Health 2022; 112:871-875. [PMID: 35500198 DOI: 10.2105/ajph.2022.306769] [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: 11/04/2022]
Abstract
Texas discontinued state-sponsored business restrictions and mask mandates on March 10, 2021, and mandated that no government officials, including public school officials, may implement mask requirements even in areas where COVID-19 hospitalizations comprised more than 15% of hospitalizations. Nonetheless, some public school districts began the 2021-2022 school year with mask mandates in place. We used quasi-experimental methods to analyze the impact of school mask mandates, which appear to have resulted in approximately 40 fewer student cases per week in the first eight weeks of school. (Am J Public Health. Published online ahead of print May 2, 2022: e1-e5. https://doi.org/10.2105/AJPH.2022.306769).
Collapse
Affiliation(s)
- Amy E Hughes
- Amy E. Hughes is with the Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, and the Harold C. Simmons Comprehensive Cancer Center, Dallas. Kandice A. Kapinos is with the Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, and the RAND Corporation, Arlington, VA. Trish M. Perl, Mujeeb A. Basit, and Richard J. Medford are with the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Richard J Medford
- Amy E. Hughes is with the Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, and the Harold C. Simmons Comprehensive Cancer Center, Dallas. Kandice A. Kapinos is with the Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, and the RAND Corporation, Arlington, VA. Trish M. Perl, Mujeeb A. Basit, and Richard J. Medford are with the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Trish M Perl
- Amy E. Hughes is with the Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, and the Harold C. Simmons Comprehensive Cancer Center, Dallas. Kandice A. Kapinos is with the Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, and the RAND Corporation, Arlington, VA. Trish M. Perl, Mujeeb A. Basit, and Richard J. Medford are with the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Mujeeb A Basit
- Amy E. Hughes is with the Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, and the Harold C. Simmons Comprehensive Cancer Center, Dallas. Kandice A. Kapinos is with the Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, and the RAND Corporation, Arlington, VA. Trish M. Perl, Mujeeb A. Basit, and Richard J. Medford are with the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Kandice A Kapinos
- Amy E. Hughes is with the Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, and the Harold C. Simmons Comprehensive Cancer Center, Dallas. Kandice A. Kapinos is with the Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, and the RAND Corporation, Arlington, VA. Trish M. Perl, Mujeeb A. Basit, and Richard J. Medford are with the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| |
Collapse
|
16
|
Bessesen MT, Rattigan S, Frederick J, Cummings DA, Gaydos CA, Gibert CL, Gorse GJ, Nyquist AC, Price CS, Reich NG, Simberkoff MS, Brown AC, Radonovich LJ, Perl TM, Rodriguez-Barradas MC. Outpatient healthcare personnel knowledge and attitudes towards infection prevention measures for protection from respiratory infections. Am J Infect Control 2021; 49:1369-1375. [PMID: 34182066 DOI: 10.1016/j.ajic.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 05/21/2021] [Accepted: 06/21/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Healthcare personnel (HCP) knowledge and attitudes toward infection control measures are important determinants of practices that can protect them from transmission of infectious diseases. METHODS Healthcare personnel were recruited from Emergency Departments and outpatient clinics at seven sites. They completed knowledge surveys at the beginning and attitude surveys at the beginning and end of each season of participation. Attitudes toward infection prevention and control measures, especially medical masks and N95 respirators, were compared. The proportion of participants who correctly identified all components of an infection control bundle for seven clinical scenarios was calculated. RESULTS The proportion of participants in the medical mask group who reported at least one reason to avoid using medical masks fell from 88.5% on the pre-season survey to 39.6% on the post-season survey (odds ratio [OR] for preseason vs. postseason 0.11, 95% CI 0.10-0.14). Among those wearing N95 respirators, the proportion fell from 87.9% to 53.6% (OR 0.24, 95% CI 0.21-0.28). Participants correctly identified all components of the infection control bundle for 4.9% to 38.5% of scenarios. CONCLUSIONS Attitudes toward medical masks and N95 respirators improved significantly between the beginning and end of each season. The proportion of HCP who correctly identified the infection control precautions needed for clinical scenarios was low, but it improved over successive years of participation in the study.
Collapse
|
17
|
Estelle CD, Perl TM. To Test or Not to Test: COVID-19 Prevention Strategies to Keep Large Gatherings Safe. Ann Intern Med 2021; 174:1470-1471. [PMID: 34280334 PMCID: PMC8296719 DOI: 10.7326/m21-2976] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Llibre and colleagues' brief research report investigated the effect of point-of-care onsite testing, use of face masks, and improved ventilation in preventing SARS-CoV-2 transmission at a large indoor concert. The editorialists evaluate factors that contributed to the success of these multimethod prevention strategies and the cost-effectiveness of such measures. They also consider how these measures could be adapted to prevent SARS-CoV-2 transmission in other settings.
Collapse
Affiliation(s)
- Carolee D Estelle
- UT Southwestern Medical Center and Parkland Health and Hospital System, Dallas, Texas (C.D.E.)
| | - Trish M Perl
- UT Southwestern Medical Center, Dallas, Texas (T.M.P.)
| |
Collapse
|
18
|
Gorse GJ, Rattigan SM, Kirpich A, Simberkoff MS, Bessesen MT, Gibert C, Nyquist AC, Price CS, Gaydos CA, Radonovich LJ, Perl TM, Rodriguez-Barradas MC, Cummings DAT. Influence of Pre-Season Antibodies against Influenza Virus on Risk of Influenza Infection among Health Care Personnel. J Infect Dis 2021; 225:891-902. [PMID: 34534319 DOI: 10.1093/infdis/jiab468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The association of hemagglutination inhibition (HAI) antibodies with protection from influenza among healthcare personnel (HCP) with occupational exposure to influenza viruses has not been well-described. METHODS The Respiratory Protection Effectiveness Clinical Trial was a cluster-randomized, multi-site study that compared medical masks to N95 respirators in preventing viral respiratory infections among HCP in outpatient healthcare settings for 5,180 participant-seasons. Serum HAI antibody titers before each influenza season and influenza virus infection confirmed by polymerase chain reaction were studied over four study years. RESULTS In univariate models, the risk of influenza A(H3N2) and B virus infections was associated with HAI titers to each virus, study year, and site. HAI titers were strongly associated with vaccination. Within multivariate models, each log base 2 increase in titer was associated with 15%, 26% and 33-35% reductions in the hazard of influenza A(H3N2), A(H1N1) and B infections, respectively. Best models included pre-season antibody titers and study year, but not other variables. CONCLUSIONS HAI titers were associated with protection from influenza among HCP with routine exposure to patients with respiratory illness and influenza season contributed to risk. HCP can be reassured about receiving influenza vaccination to stimulate immunity.
Collapse
Affiliation(s)
- Geoffrey J Gorse
- Section of Infectious Diseases, Veterans Affairs St. Louis Health Care System, St. Louis, MO, 63106 USA.,Division of Infectious Diseases, Allergy and Immunology, Saint Louis University School of Medicine, St. Louis, MO, 63104 USA
| | - Susan M Rattigan
- Department of Biology and the Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Alexander Kirpich
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA USA
| | - Michael S Simberkoff
- Department of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, NY, USA.,Division of Infectious Diseases, New York University Grossman School of Medicine, New York, NY, USA
| | - Mary T Bessesen
- Veterans Affairs Eastern Colorado Healthcare System, Aurora, CO, 80045 USA.,Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cynthia Gibert
- Medical Service, Washington D.C. Veterans Affairs Medical Center, Washington, DC, USA
| | - Ann-Christine Nyquist
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Pediatrics, Section of Pediatric Infectious Disease and Epidemiology Children's Hospital Colorado, Aurora, CO, USA
| | - Connie Savor Price
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA.,Infectious Diseases, Denver Health, Denver, CO, USA
| | - Charlotte A Gaydos
- Department of Medicine and Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lewis J Radonovich
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV USA
| | - Trish M Perl
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Derek A T Cummings
- Department of Biology and the Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
19
|
Sood G, Perl TM. Outbreaks in Health Care Settings. Infect Dis Clin North Am 2021; 35:631-666. [PMID: 34362537 DOI: 10.1016/j.idc.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Outbreaks and pseudo-outbreaks in health care settings are complex and should be evaluated systematically using epidemiologic and molecular tools. Outbreaks result from failures of infection prevention practices, inadequate staffing, and undertrained or overcommitted health care personnel. Contaminated hands, equipment, supplies, water, ventilation systems, and environment may also contribute. Neonatal intensive care, endoscopy, oncology, and transplant units are areas at particular risk. Procedures, such as bronchoscopy and endoscopy, are sources of infection when cleaning and disinfection processes are inadequate. New types of equipment can be introduced and lead to contamination or equipment and medications can be contaminated at the manufacturing source.
Collapse
Affiliation(s)
- Geeta Sood
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower, 3rd Floor, 5200 Eastern Avenue, Baltimore, MD 21224, USA.
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Y7;302, Dallas, TX 75390, USA
| |
Collapse
|
20
|
Randad PR, Larsen J, Kaya H, Pisanic N, Ordak C, Price LB, Aziz M, Nadimpalli ML, Rhodes S, Stewart JR, Love DC, Mohr D, Davis MF, Miller LS, Hall D, Carroll KC, Perl TM, Heaney CD. Transmission of Antimicrobial-Resistant Staphylococcus aureus Clonal Complex 9 between Pigs and Humans, United States. Emerg Infect Dis 2021; 27:740-748. [PMID: 33622471 PMCID: PMC7920674 DOI: 10.3201/eid2703.191775] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Transmission of livestock-associated Staphylococcus aureus clonal complex 9 (LA-SA CC9) between pigs raised on industrial hog operations (IHOs) and humans in the United States is poorly understood. We analyzed whole-genome sequences from 32 international S. aureus CC9 isolates and 49 LA-SA CC9 isolates from IHO pigs and humans who work on or live near IHOs in 10 pig-producing counties in North Carolina, USA. Bioinformatic analysis of sequence data from the 81 isolates demonstrated 3 major LA-SA CC9 clades. North Carolina isolates all fell within a single clade (C3). High-resolution phylogenetic analysis of C3 revealed 2 subclades of intermingled IHO pig and human isolates differing by 0–34 single-nucleotide polymorphisms. Our findings suggest that LA-SA CC9 from pigs and humans share a common source and provide evidence of transmission of antimicrobial-resistant LA-SA CC9 between IHO pigs and humans who work on or live near IHOs in North Carolina.
Collapse
|
21
|
Los J, Gaydos CA, Gibert CL, Gorse GJ, Lykken J, Nyquist AC, Price CS, Radonovich LJ, Rattigan S, Reich N, Rodriguez-Barradas M, Simberkoff M, Bessesen M, Brown A, Cummings DAT, Perl TM. Take-home kits to detect respiratory viruses among healthcare personnel: Lessons learned from a cluster randomized clinical trial. Am J Infect Control 2021; 49:893-899. [PMID: 33581146 PMCID: PMC7874979 DOI: 10.1016/j.ajic.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Health care personnel (HCP) working in outpatient settings routinely interact with patients with acute respiratory illnesses. Absenteeism following symptom development and lack of staff trained to obtain samples limit efforts to identify pathogens among infected HCP. METHODS The Respiratory Protection Effectiveness Clinical Trial assessed respiratory infection incidence among HCP between 2011 and 2015. Research assistants obtained anterior nasal and oropharyngeal swabs from HCP in the workplace following development of respiratory illness symptoms and randomly while asymptomatic. Participants received take-home kits to self-collect swabs when absent from work. Samples mailed to a central laboratory were tested for respiratory viruses by reverse transcription polymerase chain reaction. RESULTS Among 2,862 participants, 3,467 swabs were obtained from symptomatic participants. Among symptomatic HCP, respiratory virus was detected in 904 of 3,467 (26.1%) samples. Self-collected samples by symptomatic HCP at home had higher rates of viral detection (40.3%) compared to 24% obtained by trained research assistants in the workplace (P < .001). CONCLUSIONS In this randomized clinical trial, take-home kits were an easily implemented, effective method to self-collect samples by HCP. Other studies have previously shown relative equivalence of self-collected samples to those obtained by trained healthcare workers. Take-home kit self-collection could diminish workforce exposures and decrease the demand for personnel protective equipment worn to protect workers who collect respiratory samples.
Collapse
Affiliation(s)
- Jenna Los
- Johns Hopkins University School of Medicine, Baltimore, MD.
| | | | | | - Geoffrey J Gorse
- VA St. Louis Health Care System and Saint Louis University School of Medicine St. Louis, MO
| | | | - Ann-Christine Nyquist
- Children's Hospital Colorado, Aurora, CO; University of Colorado School of Medicine, Aurora, CO
| | - Connie S Price
- University of Colorado School of Medicine, Aurora, CO; Denver Health and Hospital, Denver, CO
| | - Lewis J Radonovich
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | - Mary Bessesen
- University of Colorado School of Medicine, Aurora, CO; VA-Eastern Colorado Healthcare System, Denver, CO
| | | | | | - Trish M Perl
- Johns Hopkins University School of Medicine, Baltimore, MD; University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
22
|
Abstract
Klompas and colleagues report an investigation of a SARS-CoV-2 cluster in an acute care hospital with transmission between patients and staff. The editorialists remind us of the need to reinforce and reeducate to improve practice of and adherence to important strategies that protect the entire health care ecosystem.
Collapse
Affiliation(s)
- Minji Kang
- University of Texas Southwestern Medical Center Dallas, Texas
| | - Trish M Perl
- University of Texas Southwestern Medical Center Dallas, Texas
| |
Collapse
|
23
|
Long A, Mathew S, Alvarez KS, Smartt J, Shah M, Madden C, Perl TM, Cerise FP, Bhavan KP. Co-Created Messaging for Influenza Vaccination in a High-Risk Hispanic Community Provides Groundwork for COVID-19 Vaccine. Health Equity 2021; 5:345-352. [PMID: 34084986 PMCID: PMC8170719 DOI: 10.1089/heq.2020.0132] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2021] [Indexed: 01/07/2023] Open
Abstract
Purpose: Influenza/pneumonia is the eighth leading cause of death in the United States. The 2020-2021 influenza season is predicted to be further impacted by COVID-19 infections. Historical data reflect disproportionate morbidity and mortality rates in the Hispanic population for influenza and COVID-19. Influenza vaccination rates remain low in the Hispanic community. We aim to improve vaccination through a community-led event, partnering with the Cristo Rey School Dallas, located in a zip code with a higher age-adjusted influenza/pneumonia mortality rate. A survey was administered to adults attending the Influenza vaccine event to understand attitudes and perceptions about influenza, vaccination, and effective messaging strategies for the campaign. Methods: Messaging was cocreated with student health ambassadors to promote immunization and delivered through trusted sources. The health department administered vaccines to individuals >age 3 at no cost. Adults were asked to complete a 19-question survey postvaccination offered in both English and Spanish. Results: Two hundred and forty-one of 394 (61.2%) participants completed the survey. Ninety-eight percent identified as Hispanic/Latino, and the majority of surveys were administered in Spanish. Among Spanish language participants, the church bulletins (57.3%) and Spanish language radio (30.5%) were reported to be most effective modes of messaging versus word of mouth (32.9%) and social media (26.3%) for English-speaking participants. Sixteen percent of participants surveyed had never received an influenza vaccine before this event. Conclusion: Cocreated messaging delivered by trusted sources in the Hispanic community led to a successful Influenza vaccine drive with the Dallas County health department.
Collapse
Affiliation(s)
- Apple Long
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sheryl Mathew
- Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Kristin S Alvarez
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Jillian Smartt
- Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Monal Shah
- Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Christopher Madden
- Health Systems Operations Administration, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Trish M Perl
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Fred P Cerise
- Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Kavita P Bhavan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
| |
Collapse
|
24
|
Most ZM, Holcomb M, Jamieson AR, Perl TM. A Silver Lining? Fewer non-SARS-CoV-2 Respiratory Viruses during the COVID-19 Pandemic. J Infect Dis 2021; 224:1751-1755. [PMID: 33830238 PMCID: PMC8083319 DOI: 10.1093/infdis/jiab191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/06/2021] [Indexed: 12/02/2022] Open
Abstract
Non-pharmaceutical interventions (NPIs) have “flattened the curve” of the COVID-19 pandemic, however the effect of these interventions on other respiratory viruses is unknown. We used aggregate level case count data for eight respiratory viruses and compared the institutional and statewide case counts before and during the period that NPIs were active. We observed a 61% (IRR 0.39, 95% CI 0.37 to 0.41, P < 0.0001) decrease in non-SARS-CoV-2 respiratory viral infections when NPIs were implemented. This finding, if further verified, should guide future public health initiatives to mitigate viral epidemics.
Collapse
Affiliation(s)
- Zachary M Most
- Division of Infectious Disease, Department of Pediatrics, University of Texas Southwestern Medical Center Dallas, TX USA
| | - Michael Holcomb
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Andrew R Jamieson
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Trish M Perl
- Division of Infectious Disease and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX USA
| |
Collapse
|
25
|
Arvisais-Anhalt S, Lehmann CU, Park JY, Araj E, Holcomb M, Jamieson AR, McDonald S, Medford RJ, Perl TM, Toomay SM, Hughes AE, McPheeters ML, Basit M. What the Coronavirus Disease 2019 (COVID-19) Pandemic Has Reinforced: The Need for Accurate Data. Clin Infect Dis 2021; 72:920-923. [PMID: 33146707 PMCID: PMC7665390 DOI: 10.1093/cid/ciaa1686] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 10/12/2020] [Accepted: 10/28/2020] [Indexed: 11/14/2022] Open
Abstract
The COVID-19 pandemic has challenged the United States’ existing national public health informatics infrastructure. This report details the factors that have contributed to COVID-19 data inaccuracies and reporting delays and their effect on the modeling and monitoring of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Simone Arvisais-Anhalt
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ellen Araj
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Holcomb
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew R Jamieson
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samuel McDonald
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Richard J Medford
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Trish M Perl
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Seth M Toomay
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amy E Hughes
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Melissa L McPheeters
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee, USA.,Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, USA.,Center for Improving the Public's Health through Informatics, Vanderbilt University, Nashville, Tennessee, USA
| | - Mujeeb Basit
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
26
|
Maxwell DN, Perl TM, Cutrell JB. "The Art of War" in the Era of Coronavirus Disease 2019 (COVID-19). Clin Infect Dis 2020; 71:2215-2217. [PMID: 32147715 PMCID: PMC7108175 DOI: 10.1093/cid/ciaa229] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Daniel N Maxwell
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James B Cutrell
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
27
|
Most ZM, Hendren N, Drazner MH, Perl TM. Striking Similarities of Multisystem Inflammatory Syndrome in Children and a Myocarditis-Like Syndrome in Adults: Overlapping Manifestations of COVID-19. Circulation 2020; 143:4-6. [PMID: 32787714 DOI: 10.1161/circulationaha.120.050166] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zachary M Most
- Department of Pediatrics, Division of Infectious Disease (Z.M.M.), University of Texas Southwestern Medical Center, Dallas
| | - Nicholas Hendren
- Department of Internal Medicine, Division of Cardiology (N.H., M.H.D.), University of Texas Southwestern Medical Center, Dallas
| | - Mark H Drazner
- Department of Internal Medicine, Division of Cardiology (N.H., M.H.D.), University of Texas Southwestern Medical Center, Dallas
| | - Trish M Perl
- Department of Internal Medicine, Division of Infectious Disease and Geographic Medicine (T.M.P.), University of Texas Southwestern Medical Center, Dallas
| |
Collapse
|
28
|
Cummings DAT, Radonovich LJ, Gorse GJ, Gaydos CA, Bessesen MT, Brown AC, Gibert CL, Hitchings MDT, Lessler J, Nyquist AC, Rattigan SM, Rodriguez-Barradas MC, Price CS, Reich NG, Simberkoff MS, Perl TM. Risk Factors for Healthcare Personnel Infection with Endemic Coronaviruses (HKU1, OC43, NL63, 229E): Results from the Respiratory Protection Effectiveness Clinical Trial (ResPECT). Clin Infect Dis 2020; 73:e4428-e4432. [PMID: 32645144 PMCID: PMC7454439 DOI: 10.1093/cid/ciaa900] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 04/22/2020] [Accepted: 07/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background SARS-CoV-2 presents a large risk to healthcare personnel. Quantifying the risk of coronavirus infection associated with workplace activities is an urgent need. Methods We assessed the association of worker characteristics, occupational roles and behaviors, and participation in procedures with the risk of endemic coronavirus infection among healthcare personnel who participated in the Respiratory Protection Effectiveness Trial (ResPECT), a cluster randomized trial to assess personal protective equipment to prevent respiratory infections and illness conducted from 2011 to 2016. Results Among 4,689 HCP-seasons, we detected coronavirus infection in 387 (8%). HCP who participated in an aerosol generation procedure (AGP) at least once during the viral respiratory season were 105% (95% CI 21%, 240%) more likely to be diagnosed with a laboratory-confirmed coronavirus infection. Younger individuals, those who saw pediatric patients and those with household members under the age of five were at increased risk of coronavirus infection. Conclusions Our analysis suggests the risk of HCP becoming infected with an endemic coronavirus increases approximately two-fold with exposures to AGP. Our findings may be relevant to the Coronavirus Disease 2019 (COVID-19) pandemic; however, SARS-COV-2, the virus that causes COVID-19, may differ from endemic coronaviruses in important ways.
Collapse
Affiliation(s)
| | - Lewis J Radonovich
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Geoffrey J Gorse
- Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA.,Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Mary T Bessesen
- Veterans Affairs Eastern Colorado Healthcare System, Denver, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Cynthia L Gibert
- Veterans Affairs Medical Center, Washington, DC, USA.,George Washington University School of Medical and Health Sciences, Washington, DC, USA
| | | | - Justin Lessler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ann-Christine Nyquist
- University of Colorado School of Medicine, Aurora, CO, USA.,Children's Hospital Colorado, Aurora, CO, USA
| | | | - Maria C Rodriguez-Barradas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Baylor College of Medicine, Houston, Texas, USA
| | - Connie Savor Price
- University of Colorado School of Medicine, Aurora, CO, USA.,Denver Health Medical Center, Denver, CO, USA
| | | | - Michael S Simberkoff
- Veterans Affairs New York Harbor Healthcare System, New York, NY, USA.,NYU School of Medicine, New York, NY, USA
| | - Trish M Perl
- Johns Hopkins School of Medicine, Baltimore, MD, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
29
|
Medford RJ, Saleh SN, Sumarsono A, Perl TM, Lehmann CU. An "Infodemic": Leveraging High-Volume Twitter Data to Understand Early Public Sentiment for the Coronavirus Disease 2019 Outbreak. Open Forum Infect Dis 2020; 7:ofaa258. [PMID: 33117854 DOI: 10.1101/2020.04.03.20052936] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 04/22/2020] [Accepted: 06/22/2020] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Twitter has been used to track trends and disseminate health information during viral epidemics. On January 21, 2020, the Centers for Disease Control and Prevention activated its Emergency Operations Center and the World Health Organization released its first situation report about coronavirus disease 2019 (COVID-19), sparking significant media attention. How Twitter content and sentiment evolved in the early stages of the COVID-19 pandemic has not been described. METHODS We extracted tweets matching hashtags related to COVID-19 from January 14 to 28, 2020 using Twitter's application programming interface. We measured themes and frequency of keywords related to infection prevention practices. We performed a sentiment analysis to identify the sentiment polarity and predominant emotions in tweets and conducted topic modeling to identify and explore discussion topics over time. We compared sentiment, emotion, and topics among the most popular tweets, defined by the number of retweets. RESULTS We evaluated 126 049 tweets from 53 196 unique users. The hourly number of COVID-19-related tweets starkly increased from January 21, 2020 onward. Approximately half (49.5%) of all tweets expressed fear and approximately 30% expressed surprise. In the full cohort, the economic and political impact of COVID-19 was the most commonly discussed topic. When focusing on the most retweeted tweets, the incidence of fear decreased and topics focused on quarantine efforts, the outbreak and its transmission, as well as prevention. CONCLUSIONS Twitter is a rich medium that can be leveraged to understand public sentiment in real-time and potentially target individualized public health messages based on user interest and emotion.
Collapse
Affiliation(s)
- Richard J Medford
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, Dallas, Texas, USA
- University of Texas Southwestern Medical Center, Clinical Informatics Center, Dallas, Texas, USA
| | - Sameh N Saleh
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Dallas, Texas, USA
- University of Texas Southwestern Medical Center, Clinical Informatics Center, Dallas, Texas, USA
| | - Andrew Sumarsono
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Dallas, Texas, USA
| | - Trish M Perl
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, Dallas, Texas, USA
| | - Christoph U Lehmann
- University of Texas Southwestern Medical Center, Clinical Informatics Center, Dallas, Texas, USA
| |
Collapse
|
30
|
Medford RJ, Saleh SN, Sumarsono A, Perl TM, Lehmann CU. An "Infodemic": Leveraging High-Volume Twitter Data to Understand Early Public Sentiment for the Coronavirus Disease 2019 Outbreak. Open Forum Infect Dis 2020; 7:ofaa258. [PMID: 33117854 PMCID: PMC7337776 DOI: 10.1093/ofid/ofaa258] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
Background Twitter has been used to track trends and disseminate health information during viral epidemics. On January 21, 2020, the Centers for Disease Control and Prevention activated its Emergency Operations Center and the World Health Organization released its first situation report about coronavirus disease 2019 (COVID-19), sparking significant media attention. How Twitter content and sentiment evolved in the early stages of the COVID-19 pandemic has not been described. Methods We extracted tweets matching hashtags related to COVID-19 from January 14 to 28, 2020 using Twitter’s application programming interface. We measured themes and frequency of keywords related to infection prevention practices. We performed a sentiment analysis to identify the sentiment polarity and predominant emotions in tweets and conducted topic modeling to identify and explore discussion topics over time. We compared sentiment, emotion, and topics among the most popular tweets, defined by the number of retweets. Results We evaluated 126 049 tweets from 53 196 unique users. The hourly number of COVID-19-related tweets starkly increased from January 21, 2020 onward. Approximately half (49.5%) of all tweets expressed fear and approximately 30% expressed surprise. In the full cohort, the economic and political impact of COVID-19 was the most commonly discussed topic. When focusing on the most retweeted tweets, the incidence of fear decreased and topics focused on quarantine efforts, the outbreak and its transmission, as well as prevention. Conclusions Twitter is a rich medium that can be leveraged to understand public sentiment in real-time and potentially target individualized public health messages based on user interest and emotion.
Collapse
Affiliation(s)
- Richard J Medford
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, Dallas, Texas, USA.,University of Texas Southwestern Medical Center, Clinical Informatics Center, Dallas, Texas, USA
| | - Sameh N Saleh
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Dallas, Texas, USA.,University of Texas Southwestern Medical Center, Clinical Informatics Center, Dallas, Texas, USA
| | - Andrew Sumarsono
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Dallas, Texas, USA
| | - Trish M Perl
- University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, Dallas, Texas, USA
| | - Christoph U Lehmann
- University of Texas Southwestern Medical Center, Clinical Informatics Center, Dallas, Texas, USA
| |
Collapse
|
31
|
Jamieson DJ, Steinberg JP, Martinello RA, Perl TM, Rasmussen SA. Obstetricians on the Coronavirus Disease 2019 (COVID-19) Front Lines and the Confusing World of Personal Protective Equipment. Obstet Gynecol 2020; 135:1257-1263. [PMID: 32304512 PMCID: PMC7188024 DOI: 10.1097/aog.0000000000003919] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 12/14/2022]
Abstract
As health care systems struggle to maintain adequate supplies of personal protective equipment, there is confusion and anxiety among obstetricians and others about how to best protect themselves, their coworkers, and their patients. Although use of personal protective equipment is a critical strategy to protect health care personnel from coronavirus disease 2019 (COVID-19), other strategies also need to be implemented on labor and delivery units to reduce the risk of health care-associated transmission, including screening of all pregnant women who present for care (case identification), placing a mask on and rapidly isolating ill pregnant women, and minimizing the number of personnel who enter the room of an ill patient (physical distancing). Although the mechanism of transmission of COVID-19 is not known with certainty, current evidence suggests that COVID-19 is transmitted primarily through respiratory droplets. Therefore, strict adherence to hand hygiene and consistent use of recommended personal protective equipment are cornerstones for reducing transmission. In addition, it is critical that health care professionals receive training on and practice correct donning (putting on) and doffing (removing) of personal protective equipment and avoid touching their faces as well as their facial protection to minimize self-contamination.
Collapse
Affiliation(s)
- Denise J Jamieson
- Departments of Gynecology and Obstetrics and Medicine, Emory University School of Medicine, Atlanta, Georgia; the Departments of Medicine and Pediatrics, Yale School of Medicine, and the Department of Infection Prevention, Yale New Haven Health, New Haven, Connecticut; the University of Texas Southwestern Medical Center, Dallas, Texas; and the Departments of Pediatrics and Epidemiology, University of Florida College of Medicine & College of Public Health and Health Professions, Gainesville, Florida
| | | | | | | | | |
Collapse
|
32
|
Abstract
In the setting of emerging infections, such as COVID-19, this commentary argues that all members of the health care team need training on how to integrate key epidemiologic information, such as travel history, into their risk assessments in the same way they are trained to ask about tobacco exposure to assess cancer and heart disease risk.
Collapse
Affiliation(s)
- Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas (T.M.P.)
| | - Connie Savor Price
- Denver Health and Hospital, Denver, and the University of Colorado School of Medicine, Aurora, Colorado (C.S.P.)
| |
Collapse
|
33
|
Affiliation(s)
- Lewis J Radonovich
- National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania
| | | | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas
| |
Collapse
|
34
|
Nyquist AC, Rattigan SM, Gibert CL, Gorse G, Perl TM, Perl TM, Price CS, Radonovich L, Rodriguez-Barradas MC, Simberkoff M, Bessesen MT, Gaydos CA, Cummings D. 1204. Increased Risk of Respiratory Infections Among Healthcare Personnel (HCP) Caring for Children. Open Forum Infect Dis 2019. [PMCID: PMC6809447 DOI: 10.1093/ofid/ofz360.1067] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Healthcare personnel (HCP) are exposed to many individuals with respiratory illness while providing care. Because children more frequently present for care with respiratory infections compared with older individuals, we hypothesized that HCP working in pediatric settings might experience greater risks of respiratory infection than HCP working in adult settings. The Respiratory Protection Effectiveness Clinical Trial (ResPECT) prospectively compared respiratory protection among HCP at seven health systems across the United States between 2011 and 2015. Methods Swabs were collected from asymptomatic participants twice each respiratory season. Swabs were collected from symptomatic HCP within 24 hours of self-reported respiratory symptoms and again if participants were still symptomatic after 7 days. PCR confirmation for 13 viruses was done by a single laboratory. We compared hazards of multiple outcomes associated with respiratory infections among HCP working in pediatric clinics and HCP working in clinics that care for adults. Results The main outcomes were risk factors for symptomatic and asymptomatic viral respiratory infections. A total of 5,180 participant-seasons were evaluated from 2011–2015, 1,130 of which worked solely with children. There were 403 and 1,162 incidents of asymptomatic and symptomatic PCR-confirmed respiratory infection, respectively. Risk factors associated with respiratory infection in the entire cohort included age, race, vaccination status, smoking status, wearing contacts, total household members, study site, and age of patient population. HCP working exclusively with pediatric patients had 1.5 (95% CI 1.2–1.8) times the rate of respiratory virus infection compared with HCP working only with adults. HCP who worked with both populations had 1.4 times (95% CI: 1.2–1.7) the rate of infection with respiratory viruses. Conclusion The risk of respiratory infections was increased among HCP that saw children. This risk was not mitigated by working only part-time with children and extended to those who identified as working with both adult and pediatric populations. Our findings highlight the need to target interventions in pediatric settings to decrease HCP acquisition of respiratory infections. Disclosures Trish M. Perl, MD; MSc, 7–11: Advisory Board; medimmune: Research Grant.
Collapse
Affiliation(s)
| | | | - Cynthia L Gibert
- George Washington University School of Medicine and Health Sciences, Washington DC
| | - Geoffrey Gorse
- Saint Louis University School of Medicine and St. Louis VA Health Care System, Saint Louis, Missouri
| | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Connie S Price
- Denver Health and Hospital, University of Colorado School of Medicine, Denver, Colorado
| | - Lewis Radonovich
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
| | | | | | | | | | | |
Collapse
|
35
|
Estelle CD, Sreeramoju P, Collinsworth KA, Gaffney D, Yerks L, Blast DL, Hollaway R, Cavuoti D, Voy-Hatter K, Ehrhart KL, Potithavoranant K, Perl TM, Perl TM. 547. Multidrug-Resistant Pseudomonas aeruginosa in an Academic Regional Burn Intensive Care Unit. Open Forum Infect Dis 2019. [PMCID: PMC6811197 DOI: 10.1093/ofid/ofz360.616] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Pseudomonas aeruginosa infection can lead to morbidity, mortality and increased hospital length of stay especially in Burn Intensive Care Units (BICU) patients. Reports of multi-drug-resistant Pseudomonas aeruginosa outbreaks in the BICU are increasing. We investigated the epidemiology of Carbapenem-Resistant Pseudomonas aeruginosa (CRPA) in our BICU. Methods Clinical and laboratory characteristics of all CRPA isolates identified between 5/8/16 and 3/14/19, in an 11-bed BICU in an academic 870-bed public safety-net hospital were reviewed and defined as Meropenem MIC 4 or greater. Retained isolates were sent for pulse-field gel electrophoresis (PFGE). Infection prevention (IP) observations and interventions were intensified and environmental cultures were collected. Patient charts were reviewed. Results 27 patients between ages 5–61 years old were found to have CRPA (only 2 patients < 18 years). 21/27 (77.7%) were male. 21/27 (77.7%) had >40% total body surface area (TBSA) burns, 3/27 (11.1%) had 20–39% TBSA burn and 1/27 (3.7%) had < 20% TBSA burn. 19/27 (70.3%) patients had bacteremia, 6 had respiratory infections with 3 (11.1%) Infection-related Ventilator-Associated Complications (IVAC), 3 had urinary tract infection, and 1 had CRPA from a central venous catheter tip. There were very few co-morbidities. Twenty isolates from 11 different patients were typed and revealed 2 different clonal strains. 5/11 (45%) patients had strain A, and 2/11 (18%) patients had strain B. 3/11 (27.2%) patients had unique strains. CRPA was isolated from 5 different rooms. Water cultures did not reveal CRPA. Failure of hand hygiene, non-adherence to isolation/PPE protocols and clutter were found. Each failure was corrected. No new CRPA patient isolates have been identified. Conclusion Transmission was halted by reinforcement of IP measures. Importantly water was not a source of CRPA in this setting and the data suggest transmission due to environmental contamination. Disclosures Trish M. Perl, MD; MSc, 7–11: Advisory Board; medimmune: Research Grant
Collapse
Affiliation(s)
| | | | | | - Donna Gaffney
- Parkland Health and Hospital System, Grand Prairie, Texas
| | - Lisa Yerks
- Parkland Health and Hospital System, Grand Prairie, Texas
| | | | - Rita Hollaway
- University of Texas Southwestern Medical Center, Plano, Texas
| | | | | | | | | | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
36
|
Bessesen MT, Radonovich L, Rattigan SM, Cummings D, Rodriguez-Barradas MC, Simberkoff M, Gibert CL, Nyquist AC, Price CS, Gorse G, Gaydos CA, Perl TM, Perl TM. 1205. Healthcare Personnel Knowledge, Attitudes, and Beliefs Towards Infection Prevention and Control Measures for Protection from Respiratory Infections. Open Forum Infect Dis 2019. [PMCID: PMC6809034 DOI: 10.1093/ofid/ofz360.1068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Healthcare personnel (HCP) knowledge and attitudes toward Infection Prevention and Control (IPC) measures are important determinants of practices that can protect them from acquisition of infectious diseases from patients. We aimed to describe HCP knowledge and attitudes concerning IPC measures over time in the context of a clinical trial. Methods ResPECT was a multi-center, multi-season cluster randomized clinical trial designed to compare the effectiveness of medical masks (MM) and N95 respirators (N95) for preventing acute respiratory illnesses in HCP employed in outpatient clinical settings. At the beginning of each respiratory virus season, participants completed a survey instrument to measure IPC knowledge. At the beginning and end of each season participants completed a survey to assess attitudes and beliefs about IPC measures, especially MM and N95. Results A pre-study and post-study survey pair was available for 88.1% of participant seasons. There were no significant differences in demographic variables or job assignment between survey respondents and nonrespondents for each participant season. Participants correctly identified 59.8% to 63.4% of IPC measures that should be used by HCP when exposed to patients with symptoms of acute respiratory illness, or at high risk of infection. There was modest improvement in the knowledge score over time among providers who participated for multiple years in the study. In the first pre-study survey of IPC attitudes and beliefs, 88.5% and 87.9% of participants identified at least one reason to avoid using either MM and N95, respectively (Figure 1). At the post-season survey, the proportion of participants reporting a reason to avoid MM fell to 39.6% (IRR for pre- vs. post-season 0.15, 95% CI 0.13–0.17) and 53.6% reported a reason to avoid N95 (IRR 0.57, 95% CI 0.51–0.66). Conclusion HCPknowledge of IPC precautions was poor, suggesting a need for better IPC education and accountability in the outpatient setting. When given incentives to comply with processes toward which they had negative attitudes at baseline, HCP realized that medical masks and N95 respirators were comfortable enough to wear for patient encounters and interfered with their work processes less than expected. ![]()
Disclosures Trish M. Perl, MD; MSc, 7–11: Advisory Board; medimmune: Research Grant.
Collapse
Affiliation(s)
| | - Lewis Radonovich
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
| | | | | | | | | | - Cynthia L Gibert
- George Washington University School of Medicine and Health Sciences, Washington DC
| | | | - Connie S Price
- Denver Health and Hospital, University of Colorado School of Medicine, Denver, Colorado
| | - Geoffrey Gorse
- Saint Louis University School of Medicine and St. Louis VA Health Care System, Saint Louis, Missouri
| | | | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Trish M Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
37
|
Radonovich LJ, Simberkoff MS, Bessesen MT, Brown AC, Cummings DAT, Gaydos CA, Los JG, Krosche AE, Gibert CL, Gorse GJ, Nyquist AC, Reich NG, Rodriguez-Barradas MC, Price CS, Perl TM. N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial. JAMA 2019; 322:824-833. [PMID: 31479137 PMCID: PMC6724169 DOI: 10.1001/jama.2019.11645] [Citation(s) in RCA: 295] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/25/2019] [Indexed: 01/04/2023]
Abstract
Importance Clinical studies have been inconclusive about the effectiveness of N95 respirators and medical masks in preventing health care personnel (HCP) from acquiring workplace viral respiratory infections. Objective To compare the effect of N95 respirators vs medical masks for prevention of influenza and other viral respiratory infections among HCP. Design, Setting, and Participants A cluster randomized pragmatic effectiveness study conducted at 137 outpatient study sites at 7 US medical centers between September 2011 and May 2015, with final follow-up in June 2016. Each year for 4 years, during the 12-week period of peak viral respiratory illness, pairs of outpatient sites (clusters) within each center were matched and randomly assigned to the N95 respirator or medical mask groups. Interventions Overall, 1993 participants in 189 clusters were randomly assigned to wear N95 respirators (2512 HCP-seasons of observation) and 2058 in 191 clusters were randomly assigned to wear medical masks (2668 HCP-seasons) when near patients with respiratory illness. Main Outcomes and Measures The primary outcome was the incidence of laboratory-confirmed influenza. Secondary outcomes included incidence of acute respiratory illness, laboratory-detected respiratory infections, laboratory-confirmed respiratory illness, and influenzalike illness. Adherence to interventions was assessed. Results Among 2862 randomized participants (mean [SD] age, 43 [11.5] years; 2369 [82.8%]) women), 2371 completed the study and accounted for 5180 HCP-seasons. There were 207 laboratory-confirmed influenza infection events (8.2% of HCP-seasons) in the N95 respirator group and 193 (7.2% of HCP-seasons) in the medical mask group (difference, 1.0%, [95% CI, -0.5% to 2.5%]; P = .18) (adjusted odds ratio [OR], 1.18 [95% CI, 0.95-1.45]). There were 1556 acute respiratory illness events in the respirator group vs 1711 in the mask group (difference, -21.9 per 1000 HCP-seasons [95% CI, -48.2 to 4.4]; P = .10); 679 laboratory-detected respiratory infections in the respirator group vs 745 in the mask group (difference, -8.9 per 1000 HCP-seasons, [95% CI, -33.3 to 15.4]; P = .47); 371 laboratory-confirmed respiratory illness events in the respirator group vs 417 in the mask group (difference, -8.6 per 1000 HCP-seasons [95% CI, -28.2 to 10.9]; P = .39); and 128 influenzalike illness events in the respirator group vs 166 in the mask group (difference, -11.3 per 1000 HCP-seasons [95% CI, -23.8 to 1.3]; P = .08). In the respirator group, 89.4% of participants reported "always" or "sometimes" wearing their assigned devices vs 90.2% in the mask group. Conclusions and Relevance Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza. Trial Registration ClinicalTrials.gov Identifier: NCT01249625.
Collapse
Affiliation(s)
- Lewis J. Radonovich
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
| | - Michael S. Simberkoff
- Veterans Affairs New York Harbor Healthcare System, New York
- New York University School of Medicine, New York
| | - Mary T. Bessesen
- Veterans Affairs Eastern Colorado Healthcare System, Denver
- University of Colorado School of Medicine, Aurora
| | | | - Derek A. T. Cummings
- University of Florida, Gainesville
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jenna G. Los
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Amanda E. Krosche
- Johns Hopkins School of Medicine, Baltimore, Maryland
- Weill Cornell Medicine, New York, New York
| | - Cynthia L. Gibert
- Veterans Affairs Medical Center, Washington, DC
- George Washington University School of Medical and Health Sciences, Washington, DC
| | - Geoffrey J. Gorse
- Veterans Affairs St Louis Healthcare System, St Louis, Missouri
- St Louis University School of Medicine, St Louis, Missouri
| | - Ann-Christine Nyquist
- University of Colorado School of Medicine, Aurora
- Children’s Hospital Colorado, Aurora
| | | | - Maria C. Rodriguez-Barradas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Connie Savor Price
- University of Colorado School of Medicine, Aurora
- Denver Health Medical Center, Denver, Colorado
| | - Trish M. Perl
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- University of Texas Southwestern Medical Center, Dallas
| |
Collapse
|
38
|
Seetharaman S, Wilson C, Landrum M, Qasba S, Katz M, Ladikos N, Harris JE, Galiatsatos P, Yousem DM, Knight AM, Pearse DB, Blanding R, Bennett R, Galai N, Perl TM, Sood G. Does Use of Electronic Alerts for Systemic Inflammatory Response Syndrome (SIRS) to Identify Patients With Sepsis Improve Mortality? Am J Med 2019; 132:862-868. [PMID: 30831065 DOI: 10.1016/j.amjmed.2019.01.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/03/2019] [Revised: 01/13/2019] [Accepted: 01/15/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study was to assess whether earlier antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) and evidence of organ dysfunction identified through electronic alerts improves patient mortality. METHODS This is a retrospective observational cohort study of adult patients admitted across 5 acute-care hospitals. Mortality, Premier CareScienceTM Analytics Expected Mortality Score, and clinical and demographic variables were obtained through the electronic medical record and Premier (Premier Healthcare Solutions, Inc, Charlotte NC) reports. Patients with 2 SIRS criteria and organ dysfunction were identified through an automated alert. Univariate and multivariate logistic regression was performed. RESULTS Of those with SIRS and organ dysfunction, 8146 patients were identified through the electronic Best Practice Alert (BPA). Overall 30-day mortality rate was 8.7%. There was no significant association between time to antibiotic administration from BPA alert and mortality (P = 0.21) after adjusting for factors that could influence mortality, including age, heart rate, blood pressure, plasma lactate levels, creatinine, bilirubin levels, and the CareScienceTM Predicted Mortality Risk Score. Female gender (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.06-1.63) and facility were also independently associated with mortality. CONCLUSION The use of alerts in the electronic medical record may misclassify patients with SIRS as having sepsis. Time to antibiotic administration in patients meeting SIRS criteria and evidence of end-organ dysfunction through BPA alerts did not affect 30-day mortality rates across a health system. Patient severity of illness, gender, and facility also independently predicted mortality. There were higher rates of antibiotic use and Clostridioides difficile infection in patients with BPA alerts.
Collapse
Affiliation(s)
| | | | | | | | - Morgan Katz
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | | | | | | | - David M Yousem
- Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD
| | - Amy M Knight
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - David B Pearse
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Renee Blanding
- Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Anesthesia and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Richard Bennett
- Johns Hopkins Bayview Medical Center, Baltimore, MD; Department of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Geeta Sood
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
| |
Collapse
|
39
|
Perl TM, Talbot TR. Universal Influenza Vaccination Among Healthcare Personnel: Yes We Should. Open Forum Infect Dis 2019; 6:ofz096. [PMID: 31012441 PMCID: PMC6468130 DOI: 10.1093/ofid/ofz096] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/22/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Thomas R Talbot
- Departments of Medicine and Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
40
|
Klein EY, Jiang W, Mojica N, Tseng KK, McNeill R, Cosgrove SE, Perl TM. National Costs Associated With Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus Hospitalizations in the United States, 2010-2014. Clin Infect Dis 2019; 68:22-28. [PMID: 29762662 PMCID: PMC6293004 DOI: 10.1093/cid/ciy399] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/07/2018] [Indexed: 12/22/2022] Open
Abstract
Background Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) have been associated with worse patient outcomes and higher costs of care than methicillin-susceptible (MSSA) infections. However, since prior studies found these differences, the healthcare landscape has changed, including widespread dissemination of community-associated strains of MRSA. We sought to provide updated estimates of the excess costs of MRSA infections. Methods We conducted a retrospective analysis using data from the National Inpatient Sample from the Agency for Healthcare Research and Quality for the years 2010-2014. We calculated costs for hospitalizations, including MRSA- and MSSA-related septicemia and pneumonia infections, as well as MRSA- and MSSA-related infections from conditions classified elsewhere and of an unspecified site ("other infections"). Differences in the costs of hospitalization were estimated using propensity score-adjusted mortality outcomes for 2010-2014. Results In 2014, estimated costs were highest for pneumonia and sepsis-related hospitalizations. Propensity score-adjusted costs were significantly higher for MSSA-related pneumonia ($40725 vs $38561; P = .045) and other hospitalizations ($15578 vs $14792; P < .001) than for MRSA-related hospitalizations. Similar patterns were observed from 2010 to 2013, although crude cost differences between MSSA- and MRSA-related pneumonia hospitalizations rose from 25.8% in 2010 to 31.0% in 2014. Compared with MSSA-related hospitalizations, MRSA-related hospitalizations had a higher adjusted mortality rate. Conclusions Although MRSA infections had been previously associated with higher hospitalization costs, our results suggest that, in recent years, costs associated with MSSA-related infections have converged with and may surpass costs of similar MRSA-related hospitalizations.
Collapse
Affiliation(s)
- Eili Y Klein
- Department of Emergency Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Wendi Jiang
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Nestor Mojica
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Katie K Tseng
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Ryan McNeill
- Reuters News Agency, New York
- City University of New York Graduate School of Journalism, New York
| | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Trish M Perl
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas
| |
Collapse
|
41
|
Nadimpalli ML, Stewart JR, Pierce E, Pisanic N, Love DC, Hall D, Larsen J, Carroll KC, Tekle T, Perl TM, Heaney CD. Face Mask Use and Persistence of Livestock-associated Staphylococcus aureus Nasal Carriage among Industrial Hog Operation Workers and Household Contacts, USA. Environ Health Perspect 2018; 126:127005. [PMID: 30675826 PMCID: PMC6371678 DOI: 10.1289/ehp3453] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 11/16/2018] [Accepted: 11/17/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND Industrial hog operation (IHO) workers may persistently carry antibiotic-resistant, livestock-associated Staphylococcus aureus in their nasal cavities. It is unclear whether IHO work activities can alter IHO workers' and their household members' exposure to these bacteria. OBJECTIVE Our objective was to investigate the relationship of IHO work activities with persistence of antibiotic-resistant, livestock-associated S. aureus nasal carriage among IHO workers and their household members. METHODS At biweekly intervals over 4 months, IHO workers and their household members completed questionnaires and provided nasal swabs that were assessed for S. aureus, multidrug-resistant S. aureus (MDRSA), and livestock-associated markers (tetracycline resistance, scn absence, spa type). We examined the association between transient and habitual IHO work activities and S. aureus nasal carriage outcomes. RESULTS One hundred one IHO workers and 79 household members completed 1,456 study visits. Face mask use (each 25% increase) was associated with reduced odds of nasal carriage of MDRSA (odds ratio [OR]: 0.65 [95% confidence interval (CI): 0.46, 0.92], tetracycline-resistant S. aureus [OR = 0.74 (95% CI: 0.56, 0.97)], and S. aureus clonal complex (CC) 398/CC9 [OR = 0.77 (95% CI: 0.60, 0.99)]. IHO workers who ever (vs. never) gave pigs injections had higher odds of these outcomes. Among household members, living with an IHO worker who consistently ([Formula: see text] of the time) versus sometimes or never used a face mask was associated with reduced odds of carrying scn-negative S. aureus, tetracycline-resistant S. aureus, and S. aureus CC398/CC9 (OR range: 0.12-0.20, all [Formula: see text]), and consistent IHO worker coveralls use was associated with reduced odds of household member MDRSA carriage only. Living with an IHO worker who habitually had contact with [Formula: see text] hogs (vs. [Formula: see text]) was associated with higher odds of household member livestock-associated S. aureus carriage. CONCLUSIONS Consistent face mask use was associated with reduced exposure to antibiotic-resistant, livestock-associated S. aureus among IHO workers and their household members. https://doi.org/10.1289/EHP3453.
Collapse
Affiliation(s)
- Maya L Nadimpalli
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jill R Stewart
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth Pierce
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David C Love
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland, USA
| | - Devon Hall
- Rural Empowerment Association for Community Help, Warsaw, North Carolina, USA
| | - Jesper Larsen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Karen C Carroll
- Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Microbiology Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Tsigereda Tekle
- Microbiology Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Trish M Perl
- Division of Infectious Diseases, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christopher D Heaney
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
42
|
Townsend J, Keller S, Tibuakuu M, Thakker S, Webster B, Siegel M, Psoter KJ, Mansour O, Perl TM. Outpatient Parenteral Therapy for Complicated Staphylococcus aureus Infections: A Snapshot of Processes and Outcomes in the Real World. Open Forum Infect Dis 2018; 5:ofy274. [PMID: 30488039 PMCID: PMC6251475 DOI: 10.1093/ofid/ofy274] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/23/2018] [Indexed: 12/23/2022] Open
Abstract
Background In the United States, patients discharged on outpatient parenteral antimicrobial therapy (OPAT) are often treated by home health companies (HHCs) or skilled nursing facilities (SNFs). Little is known about differences in processes and outcomes between these sites of care. Methods We performed a retrospective study of 107 patients with complicated Staphylococcus aureus infections discharged on OPAT from 2 academic medical centers. Clinical characteristics, site of posthospital care, process measures (lab test monitoring, clinic follow-up), adverse events (adverse drug events, Clostridium difficile infection, line events), and clinical outcomes at 90 days (cure, relapse, hospital readmission) were collected. Comparisons between HHCs and SNFs were conducted. Results Overall, 33% of patients experienced an adverse event during OPAT, and 64% were readmitted at 90 days. Labs were received for 44% of patients in SNFs and 56% of patients in HHCs. At 90 days after discharge, a higher proportion of patients discharged to an SNF were lost to follow-up (17% vs 3%; P = .03) and had line-related adverse events (18% vs 2%; P < .01). Patients discharged to both sites of care experienced similar clinical outcomes, with favorable outcomes occurring in 61% of SNF patients and 70% of HHC patients at 90 days. There were no differences in rates of relapse, readmission, or mortality. Conclusions Patients discharged to SNFs may be at higher risk for line events than patients discharged to HHCs. Efforts should be made to strengthen basic OPAT processes, such as lab monitoring and clinic follow-up, at both sites of care.
Collapse
Affiliation(s)
- Jennifer Townsend
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sara Keller
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martin Tibuakuu
- Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri
| | - Sameer Thakker
- Johns Hopkins University Medical School, Baltimore, Maryland
| | - Bailey Webster
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Maya Siegel
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevin J Psoter
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Omar Mansour
- Center for Drug Safety and Effectiveness, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Trish M Perl
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
43
|
Sood G, Vaidya D, Dam L, Grubb LM, Zenilman J, Krout K, Khouri-Stevens Z, Bennett R, Blanding R, Riedel S, Milner S, Price LA, Perl TM. A polymicrobial fungal outbreak in a regional burn center after Hurricane Sandy. Am J Infect Control 2018; 46:1047-1050. [PMID: 29609856 DOI: 10.1016/j.ajic.2018.01.011] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe a polymicrobial fungal outbreak after Hurricane Sandy. DESIGN An observational concurrent outbreak investigation and retrospective descriptive review. SETTING A regional burn intensive care unit that serves the greater Baltimore area, admitting 350-450 burn patients annually. PATIENTS Patients with burn injuries and significant dermatologic diseases such as toxic epidermal necrolysis who were admitted to the burn intensive care unit. METHODS An outbreak investigation and a retrospective review of all patients with non-candida fungal isolates from 2009-2016 were performed. RESULTS A polymicrobial fungal outbreak in burn patients was temporally associated with Hurricane Sandy and associated with air and water permeations in the hospital facility. The outbreak abated after changes to facility design. CONCLUSIONS Our results suggest a possible association between severe weather events like hurricanes and nosocomial fungal outbreaks. This report adds to the emerging literature on the effect of severe weather on healthcare-associated infections.
Collapse
Affiliation(s)
- Geeta Sood
- The Johns Hopkins University, School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Baltimore, MD.
| | - Dhananjay Vaidya
- The Johns Hopkins University, School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Lisa Dam
- Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Lisa M Grubb
- Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Jonathan Zenilman
- The Johns Hopkins University, School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Baltimore, MD
| | - Kelly Krout
- Johns Hopkins Bayview Medical Center, Baltimore, MD
| | | | | | | | - Stefan Riedel
- The Johns Hopkins University, School of Medicine, Department of Pathology, Division of Microbiology, Baltimore, MD
| | - Stephen Milner
- The Johns Hopkins University, School of Medicine, Department of Plastic Surgery, Baltimore, MD
| | - Leigh Ann Price
- The Johns Hopkins University, School of Medicine, Department of Plastic Surgery, Baltimore, MD
| | - Trish M Perl
- The Johns Hopkins University, School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Baltimore, MD
| |
Collapse
|
44
|
Rule AM, Apau O, Ahrenholz SH, Brueck SE, Lindsley WG, de Perio MA, Noti JD, Shaffer RE, Rothman R, Grigorovitch A, Noorbakhsh B, Beezhold DH, Yorio PL, Perl TM, Fisher EM. Healthcare personnel exposure in an emergency department during influenza season. PLoS One 2018; 13:e0203223. [PMID: 30169507 PMCID: PMC6118374 DOI: 10.1371/journal.pone.0203223] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/16/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction Healthcare personnel are at high risk for exposure to influenza by direct and indirect contact, droplets and aerosols, and by aerosol generating procedures. Information on air and surface influenza contamination is needed to assist in developing guidance for proper prevention and control strategies. To understand the vulnerabilities of healthcare personnel, we measured influenza in the breathing zone of healthcare personnel, in air and on surfaces within a healthcare setting, and on filtering facepiece respirators worn by healthcare personnel when conducting patient care. Methods Thirty participants were recruited from an adult emergency department during the 2015 influenza season. Participants wore personal bioaerosol samplers for six hours of their work shift, submitted used filtering facepiece respirators and medical masks and completed questionnaires to assess frequency and types of interactions with potentially infected patients. Room air samples were collected using bioaerosol samplers, and surface swabs were collected from high-contact surfaces within the adult emergency department. Personal and room bioaerosol samples, surface swabs, and filtering facepiece respirators were analyzed for influenza A by polymerase chain reaction. Results Influenza was identified in 42% (53/125) of personal bioaerosol samples, 43% (28/ 96) of room bioaerosol samples, 76% (23/30) of pooled surface samples, and 25% (3/12) of the filtering facepiece respirators analyzed. Influenza copy numbers were greater in personal bioaerosol samples (17 to 631 copies) compared to room bioaerosol samples (16 to 323 copies). Regression analysis suggested that the amount of influenza in personal samples was approximately 2.3 times the amount in room samples (Wald χ2 = 16.21, p<0.001). Conclusions Healthcare personnel may encounter increased concentrations of influenza virus when in close proximity to patients. Occupations that require contact with patients are at an increased risk for influenza exposure, which may occur throughout the influenza season. Filtering facepiece respirators may become contaminated with influenza when used during patient care.
Collapse
Affiliation(s)
- Ana M. Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Otis Apau
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Steven H. Ahrenholz
- Division of Surveillance, Hazard Evaluations, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health, Cincinnati, Ohio, United States of America
| | - Scott E. Brueck
- Division of Surveillance, Hazard Evaluations, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health, Cincinnati, Ohio, United States of America
| | - William G. Lindsley
- Health Effects Laboratory Division (HELD, National Institute for Occupational Safety and Health, Morgantown, West Virginia, United States of America
| | - Marie A. de Perio
- Division of Surveillance, Hazard Evaluations, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health, Cincinnati, Ohio, United States of America
| | - John D. Noti
- Health Effects Laboratory Division (HELD, National Institute for Occupational Safety and Health, Morgantown, West Virginia, United States of America
| | - Ronald E. Shaffer
- National Personal Protective Technology Lab (NPPTL), National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, United States of America
| | - Richard Rothman
- Johns Hopkins Hospital, Adult Emergency Department, Baltimore, Maryland, United States of America
| | - Alina Grigorovitch
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Bahar Noorbakhsh
- Health Effects Laboratory Division (HELD, National Institute for Occupational Safety and Health, Morgantown, West Virginia, United States of America
| | - Donald H. Beezhold
- Health Effects Laboratory Division (HELD, National Institute for Occupational Safety and Health, Morgantown, West Virginia, United States of America
| | - Patrick L. Yorio
- National Personal Protective Technology Lab (NPPTL), National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, United States of America
| | - Trish M. Perl
- Division of Infectious Diseases, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Edward M. Fisher
- National Personal Protective Technology Lab (NPPTL), National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| |
Collapse
|
45
|
Bodurtha Smith AJ, Holzman SB, Manesh RS, Perl TM. Gonococcal Conjunctivitis: A Case Report of an Unusual Mode of Transmission. J Pediatr Adolesc Gynecol 2017; 30:501-502. [PMID: 27871917 DOI: 10.1016/j.jpag.2016.11.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/23/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Outside of the newborn period, development of gonococcal conjunctivitis is rare and predominantly occurs through autoinoculation. We report an unusual case of gonococcal conjunctivitis in a young woman exposed through direct inoculation. CASE A 19-year-old woman presented with purulent ocular discharge, severe pain, and decreased vision unresponsive to topical antibiotics or ganciclovir approximately 3 weeks after accidental ocular exposure to seminal fluid during unprotected oral sex. Cultured ocular drainage grew Neisseria gonorrhea; vaginal and throat cultures were negative. She was successfully treated with ceftriaxone and doxycycline for 10 days. SUMMARY AND CONCLUSION Clinicians should be aware of the potential for vision-threatening gonococcal conjunctivitis from exposure during sexual contact.
Collapse
Affiliation(s)
- Anna Jo Bodurtha Smith
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Samuel B Holzman
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Reza Sedighi Manesh
- Department of Medicine, Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Trish M Perl
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
46
|
Affiliation(s)
- Geeta Sood
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord Building Center Tower, 3rd Floor, 5200 Eastern Avenue, Baltimore, MD 21224, USA.
| | - Trish M Perl
- Bloomberg School of Public Health, Johns Hopkins School of Medicine, 725 North Wolfe Street, Suite 228 PCTB, Baltimore, MD 21205, USA
| |
Collapse
|
47
|
Teter J, Guajardo I, Al-Rammah T, Rosson G, Perl TM, Manahan M. Assessment of operating room airflow using air particle counts and direct observation of door openings. Am J Infect Control 2017; 45:477-482. [PMID: 28209451 DOI: 10.1016/j.ajic.2016.12.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/23/2016] [Accepted: 12/23/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The role of the operating room (OR) environment has been thought to contribute to surgical site infection rates. The quality of OR air, disruption of airflow, and other factors may increase contamination risks. We measured air particulate counts (APCs) to determine if they increased in relation to traffic, door opening, and other common activities. METHODS During 1 week, we recorded APCs in 5-minute intervals and movement of health care workers. Trained observers recorded information about traffic, door openings, job title of the opener, and the reason for opening. RESULTS At least 1 OR door was open during 47% of all readings. There were 13.4 door openings per hour during cases. Door opening rates ranged from 0.19-0.28 per minute. During this time, a total of 660 air measurements were obtained. The mean APCs were 9,238 particles (95% confidence interval [CI], 5,494- 12,982) at baseline and 14,292 particles (95% CI, 12,382-16,201) during surgery. Overall APCs increased 13% when either door was opened (P < .15). Larger particles that correlated to bacterial size were elevated significantly (P < .001) on door opening. CONCLUSIONS We observed numerous instances of verbal communication and equipment movement. Improving efficiency of communication and equipment can aid in reduction of traffic. Further study is needed to examine links between microbiologic sampling, outcome data, and particulate matter to enable study of risk factors and effects of personnel movement.
Collapse
Affiliation(s)
- Jonathan Teter
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Isabella Guajardo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tamrah Al-Rammah
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gedge Rosson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Trish M Perl
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins University, School of Public Health, Baltimore, MD
| | - Michele Manahan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| |
Collapse
|
48
|
Mantyh CR, Xi H, Pearson L, Perl TM. Minimizing hair dispersal: Is this an opportunity for improvement in health care-acquired infection prevention? Am J Infect Control 2017; 45:308-310. [PMID: 27814925 DOI: 10.1016/j.ajic.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 01/16/2023]
Abstract
We performed a study to understand common practices in surgical site hair removal and barriers to guideline compliance in surgical site hair removal. We found most health care providers in the United States do not remove hair outside of the operating room. Our findings reveal minimizing hair dispersal in the operating room, including improved and innovative ways for collecting clipped loose hair, is a significant area for improvement in surgical quality and health care-acquired infection prevention.
Collapse
Affiliation(s)
| | - Hugo Xi
- Becton, Dickinson and Company, Vernon Hills, IL
| | | | - Trish M Perl
- Department of Medicine, Division of Infectious Diseases, UTSouthwestern Medical Center, Dallas, TX
| |
Collapse
|
49
|
Krosche A, Bessesen M, Cummings D, Gaydos C, Gibert C, Gorse G, Los J, Nyquist AC, Price C, Radonovich L, Reich N, Rodriguez-Barradas MC, Simberkoff MS, Perl TM. Correlation of Corrective Eyewear to Acute Respiratory Infection (ARI) Among Outpatient Healthcare Personnel (HCP). Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.992] [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: 11/14/2022] Open
Affiliation(s)
- Amanda Krosche
- Hospital Epidemiology and Infection Control, Johns Hopkins University, Baltimore, Maryland
| | - Mary Bessesen
- VA Eastern Colorado Healthcare System, Denver, Colorado
| | - Derek Cummings
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Charlotte Gaydos
- Medicine, Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
| | - Cynthia Gibert
- Washington, District of Columbia, VAMC, Washington, District of Columbia
| | | | - Jenna Los
- Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ann-Christine Nyquist
- University of Colorado School of Medicine/Children's Hospital of Colorado, Aurora, Colorado
| | - Connie Price
- Infectious Diseases, University of Colorado School of Medicine/Denver Health and Hospital, Denver, Colorado
| | - Lewis Radonovich
- Department of Veterans Affairs Veterans Health Administration Office of Public Health, Gainesville, Florida
| | - Nicholas Reich
- Department of Biostatistics and Epidemiology, School of Public Health, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Maria C. Rodriguez-Barradas
- Section of Infectious Diseases, Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas
| | | | - Trish M. Perl
- Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| |
Collapse
|
50
|
Cummings D, Pierce R, Kaye KS, Price C, Herwaldt LA, Sreeramoju P, Murthy R, Milstone AM, Klein E, Maragakis LL, Eickhoff M, Sifakis F, Los J, Perl TM. Ventilator-Associated Staphylococcus aureus and Pseudomonas aeruginosa Infections Among Intensive Care Unit (ICU) Patients in Six Healthcare Systems: Temporal Trends and Risk Factors. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.284] [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: 11/14/2022] Open
Affiliation(s)
| | - Rebecca Pierce
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Keith S. Kaye
- Detroit Medical Center and Wayne State University, Detroit, Michigan
| | - Connie Price
- Infectious Diseases, University of Colorado School of Medicine/Denver Health and Hospital, Denver, Colorado
| | - Loreen A. Herwaldt
- Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Rekha Murthy
- Hospital Epidemiology, Cedars-Sinai Health System, Los Angeles, California
| | | | - Eili Klein
- Emergency Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Jenna Los
- Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Trish M. Perl
- Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| |
Collapse
|