scholarly journals Failure to Communicate: Transmission of Extensively Drug-ResistantblaOXA-237-ContainingAcinetobacter baumannii—Multiple Facilities in Oregon, 2012–2014

2017 ◽  
Vol 38 (11) ◽  
pp. 1335-1341 ◽  
Author(s):  
Genevieve L. Buser ◽  
P. Maureen Cassidy ◽  
Margaret C. Cunningham ◽  
Susan Rudin ◽  
Andrea M. Hujer ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Acute Care ◽  
Skilled Nursing Facility ◽  
Acute Care Hospital ◽  
Healthcare Facility ◽  
Care Hospital ◽  
Skilled Nursing ◽  
Environmental Cleaning ◽  
Carbapenemase Gene

OBJECTIVETo determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR)Acinetobacter baumannii.DESIGNOutbreak investigation.SETTING AND PARTICIPANTSResidents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals.METHODSA case was defined as the incident isolate from clinical or surveillance cultures of XDRAcinetobacter baumanniiresistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed.RESULTSWe identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n=8), or skilled nursing facility A (n=8), or both (n=1) prior to XDRA. baumanniiisolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase geneblaOXA-237was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission.CONCLUSIONSInterfacility transmission of XDRA. baumanniicarrying the rare blaOXA-237was facilitated by transfer of affected patients without communication to receiving facilities.Infect Control Hosp Epidemiol2017;38:1335–1341

scholarly journals 1186. Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S425-S425
Author(s):  
Maureen Banks ◽  
Andrew Phillips ◽  
Keith Chin ◽  
Lou Ann Bruno-Murtha
Keyword(s):  
Data Collection ◽  
Hand Hygiene ◽  
Monitoring System ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Intervention Period ◽  
Environmental Cleaning ◽  
Clostridioides Difficile

Abstract Background Hand hygiene (HH) is the cornerstone of infection prevention and improved compliance has been associated with reduced healthcare-associated infections (HAIs). However, traditional methods for HH data collection have limitations and may not accurately reflect true compliance. We sought to evaluate whether an electronic hand hygiene monitoring system (HHMS) can improve data collection, compliance, and reduce HAIs. Methods A HHMS was implemented as part of a pilot at a single facility in June 2018 for all healthcare workers (HCWs) who entered patient rooms. The system prompted HCWs to perform HH with an audible and visual reminder emitted from a badge if a HH event had not been registered within specific timeframes of entering or exiting a patient room. The system captured compliance with preferential handwashing (soap and water) for at least 15 seconds upon exit of Clostridioides difficile (C. difficile) designated rooms. All HH data were collected by the HHMS. Hand hygiene compliance and HAI data were compared for the pre-intervention (June 2017-May 2018) and intervention periods (July 2018-March 2019). No changes were made to environmental cleaning protocols or compliance monitoring, nor in antibiotic stewardship practices. Results HH compliance by direct observation in the pre-intervention period was 91% (1,612 observations). HH compliance with the HHMS during the intervention period was 97% (2,778,402 observations). The mean monthly HH opportunities recorded during the pre-intervention period was 134, while the HHMS captured 308,711, a greater than 2,300-fold increase. The incidence of healthcare facility-onset C. difficile infections (HO-CDI) pre-intervention was 9.60 per 10,000 patient-days (41 GDH+/Toxin+ laboratory-identified [labID] events/42,726 patient-days). With the HHMS, HO-CDI decreased 70% (P = 0.0003) to 2.89 per 10,000 patient-days (9 labID events/31,169 patient-days). No policy changes in environmental cleaning of high-touch surfaces were made or observed during the pilot. Conclusion The use of an HHMS facilitated more comprehensive HH data and improved compliance. The preliminary findings also support an association between more robust HH compliance data and a significant decrease in toxin-producing CDI. Disclosures All authors: No reported disclosures.

scholarly journals 70. Lack of SARS-CoV-2 Antibody Seroconversion After Prompt Identification and Cohorting of Sentinel sars-cov-2-positive Residents in a Skilled Nursing Facility

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S165-S166
Author(s):  
Debika Bhattacharya ◽  
Alexander Winnett ◽  
Jennifer A Fulcher ◽  
Linda Sohn ◽  
Feliza Calub ◽  
...  
Keyword(s):  
Acute Care ◽  
Serological Test ◽  
Skilled Nursing Facility ◽  
Acute Care Hospital ◽  
Nasopharyngeal Swab ◽  
Care Hospital ◽  
Nursing Facilities ◽  
Antibody Testing ◽  
Skilled Nursing ◽  
Serologic Testing

Abstract Background Despite numerous outbreaks, antibody responses to SARS-CoV-2 in residents of skilled nursing facilities (SNF) are not well described. We reviewed serological test results in a cohort of SNF residents who had been repetitively screened for SARS-CoV-2 infection by nasopharyngeal swab PCR. Methods In late March 2019, we identified symptomatic SARS-CoV-2 PCR positive residents at a SNF. In response, all remaining SNF patients were serially screened, and all SARS-CoV-2 PCR positive patients were transferred to the acute care hospital or cohorted in a separate COVID Recovery Unit (CRU) in the SNF. In early June, all SNF residents (SARS-CoV-2 PCR positive and negative) underwent serologic testing for SARS-CoV-2 Spike (S1/S2) IgG (DiaSorin). DiaSorin IgG-positive results for patients that were SARS-CoV-2 PCR-negative were reflexed to nucleocapsid IgG (Abbott). Antibody testing occurred a median of 69 days (63–70 IQR) after PCR positivity. Results Nineteen SARS-CoV-2 PCR positive residents were identified from the outbreak and an additional 9 were transferred from the acute care hospital to the CRU; 1 died and 1 received convalescent plasma leaving 26 SARS-CoV-2 PCR positive residents, including 6 who were asymptomatic, that were eligible for serologic testing. Twenty-four of the 26 were positive for IgG by the DiaSorin assay; one seronegative resident was one of the asymptomatic residents. There were an additional 121 residents in the SNF whose SARS-CoV-2 PCR was negative at least once. Among these 121 SNF residents with negative SARS-CoV-2 RT-PCR, all but two were seronegative by the Diasorin assay. The two seropositive residents had no nucleocapsid antibodies when reflex tested by the Abbott assay. Conclusion In a limited sample of SNF residents with SARS-CoV-2 PCR positivity, the sensitivity of the Diasorin assay was 92% (24/26) and the specificity was 98% (119/121). None of the residents with negative SARS-CoV-2 PCR had confirmed positive antibody results using reflex testing (DiaSorin/Abbott). Despite high risk exposure in congregate living facilities, we found no evidence of additional SARS-CoV-2 exposure, reinforcing the importance of serial surveillance SARS-CoV-2 testing and early cohorting in SNF settings. Disclosures All Authors: No reported disclosures

scholarly journals Comparative Effectiveness of Long-Term Acute Care Hospital versus Skilled Nursing Facility Transfer

2020 ◽  
Author(s):  
Anil Makam ◽  
Oanh Kieu Nguyen ◽  
Michael E. Miller ◽  
Sachin J Shah ◽  
Kandice A. Kapinos ◽  
...  
Keyword(s):  
Acute Care ◽  
Inpatient Care ◽  
Acute Care Hospital ◽  
Healthcare Spending ◽  
Care Hospital ◽  
Skilled Nursing ◽  
Medicare Claims ◽  
One Year ◽  
At Home

Abstract BACKGROUND: Long-term acute care hospital (LTACH) use varies considerably across the U.S., which may reflect uncertainty about the effectiveness of LTACHs vs. skilled nursing facilities (SNF), the principal post-acute care alternative. Given that LTACHs receive over triple the reimbursement of SNFs for comparable diagnoses, we sought to compare outcomes and spending between LTACH versus SNF transfer. METHODS: Using Medicare claims linked to electronic health record (EHR) data from six Texas Hospitals between 2009-2010, we conducted a retrospective cohort study of patients hospitalized on a medicine service in a high-LTACH use region and discharged to either an LTACH or SNF and followed for one year. The primary outcomes included mortality, 60-day recovery without inpatient care, days at home, and healthcare spending.RESULTS: Of 3,503 patients, 18% were transferred to an LTACH. Patients transferred to LTACHs were younger (median 71 vs. 82 years), less likely to be female (50.5 vs 66.6%) and white (69.0 vs. 84.1%), but were sicker (24.3 vs. 14.2% for prolonged intensive care unit stay; median diagnosis resource intensity weight of 2.03 vs. 1.38). In unadjusted analyses, patients transferred to an LTACH vs. SNF were less likely to survive (59.1 vs. 65.0%) or recover (62.5 vs 66.0%), and spent fewer days at home (186 vs. 200). Adjusting for demographic and clinical confounders available in Medicare claims and EHR data, LTACH transfer was not significantly associated with differences in mortality (HR, 1.12, 95% CI, 0.94-1.33), recovery (SHR, 1.07, 0.93-1.23), and days spent at home (IRR, 0.96, 0.83-1.10), but was associated with greater Medicare spending ($16,689 for one year, 95% CI, $12,216-$21,162).CONCLUSION: LTACH transfer for Medicare beneficiaries is associated with similar clinical outcomes but with higher healthcare spending compared to SNF transfer. LTACH use should be reserved for patients who require complex inpatient care and cannot be cared for in SNFs.

scholarly journals Comparative effectiveness of long-term acute care hospital versus skilled nursing facility transfer

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anil N. Makam ◽  
Oanh Kieu Nguyen ◽  
Michael E. Miller ◽  
Sachin J. Shah ◽  
Kandice A. Kapinos ◽  
...  
Keyword(s):  
Intensive Care ◽  
Acute Care ◽  
Inpatient Care ◽  
Acute Care Hospital ◽  
Healthcare Spending ◽  
Care Hospital ◽  
Skilled Nursing ◽  
One Year ◽  
At Home

Abstract Background Long-term acute care hospital (LTACH) use varies considerably across the U.S., which may reflect uncertainty about the effectiveness of LTACHs vs. skilled nursing facilities (SNF), the principal post-acute care alternative. Given that LTACHs provide more intensive care and thus receive over triple the reimbursement of SNFs for comparable diagnoses, we sought to compare outcomes and spending between LTACH versus SNF transfer. Methods Using Medicare claims linked to electronic health record (EHR) data from six Texas Hospitals between 2009 and 2010, we conducted a retrospective cohort study of patients hospitalized on a medicine service in a high-LTACH use region and discharged to either an LTACH or SNF and followed for one year. The primary outcomes included mortality, 60-day recovery without inpatient care, days at home, and healthcare spending Results Of 3503 patients, 18% were transferred to an LTACH. Patients transferred to LTACHs were younger (median 71 vs. 82 years), less likely to be female (50.5 vs 66.6%) and white (69.0 vs. 84.1%), but were sicker (24.3 vs. 14.2% for prolonged intensive care unit stay; median diagnosis resource intensity weight of 2.03 vs. 1.38). In unadjusted analyses, patients transferred to an LTACH vs. SNF were less likely to survive (59.1 vs. 65.0%) or recover (62.5 vs 66.0%), and spent fewer days at home (186 vs. 200). Adjusting for demographic and clinical confounders available in Medicare claims and EHR data, LTACH transfer was not significantly associated with differences in mortality (HR, 1.12, 95% CI, 0.94–1.33), recovery (SHR, 1.07, 0.93–1.23), and days spent at home (IRR, 0.96, 0.83–1.10), but was associated with greater Medicare spending ($16,689 for one year, 95% CI, $12,216–$21,162). Conclusion LTACH transfer for Medicare beneficiaries is associated with similar clinical outcomes but with higher healthcare spending compared to SNF transfer. LTACH use should be reserved for patients who require complex inpatient care and cannot be cared for in SNFs.

Successful Control of an Outbreak ofKlebsiella pneumoniaeCarbapenemase—ProducingK. pneumoniaeat a Long-Term Acute Care Hospital

2010 ◽  
Vol 31 (4) ◽  
pp. 341-347 ◽  
Author(s):  
L. Silvia Munoz-Price ◽  
Mary K. Hayden ◽  
Karen Lolans ◽  
Sarah Won ◽  
Karen Calvert ◽  
...  
Keyword(s):  
Acute Care ◽  
Horizontal Transmission ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Gram Negative ◽  
Environmental Cleaning ◽  
Quasi Experimental ◽  
Horizontal Spread ◽  
Clinical Cases

Objective.To determine the effect of a bundle of infection control interventions on the horizontal transmission ofKlebsiella pneumoniaecarbapenemase (KPC)-producingK. pneumoniaeduring an outbreak.Design.Quasi-experimental study.Setting.Long-term acute care hospital.Intervention.On July 23,2008, a bundled intervention was implemented: daily 2% Chlorhexidine gluconate baths for patients, enhanced environmental cleaning, surveillance cultures at admission, serial point prevalence surveillance (PPS), isolation precautions, and training of personnel. Baseline PPS was performed before the intervention was implemented. Any gram-negative rod isolate suspected of KPC production underwent a modified Hodge test and, if results were positive, confirmatory polymerase chain reaction testing. Clinical cases were defined to occur for patients whose samples yielded KPC-positive gram-negative rods in clinical cultures.Results.Baseline PPS performed on June 17, 2008, showed a prevalence of colonization with KPC-producing isolates of 21% (8 of 39 patients screened). After implementation of the intervention, monthly PPS was performed 5 times, which showed prevalences of colonization with KPC-producing isolates of 12%, 5%, 3%, 0%, and 0% (P< .001). From January 1, 2008, until the intervention, 8 KPC-positive clinical cases—suspected to be due to horizontal transmission—were detected. From implementation of the intervention through December 31, 2008, only 2 KPC-positive clinical cases, both in August 2008, were detected. From January 1 through December 31, 2008, 8 patients were detected as carriers of KPC-producing isolates at admission to the institution, 4 patients before and 4 patients after the intervention.Conclusion.A bundled intervention was successful in preventing horizontal spread of KPC-producing gram-negative rods in a long-term acute care hospital, despite ongoing admission of patients colonized with KPC producers.

scholarly journals Effect of copper-impregnated linens on multidrug-resistant organism acquisition and Clostridium difficile infection at a long-term acute-care hospital

2018 ◽  
Vol 39 (11) ◽  
pp. 1384-1386 ◽  
Author(s):  
Gregory R. Madden ◽  
Brenda E. Heon ◽  
Costi D. Sifri
Keyword(s):  
Clostridium Difficile ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Healthcare Facility ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Care Hospital ◽  
Healthcare Settings ◽  
Effect Of Copper

AbstractCopper-impregnated surfaces and linens have been shown to reduce infections and multidrug-resistant organism (MDRO) acquisition in healthcare settings. However, retrospective analyses of copper linen deployment at a 40-bed long-term acute-care hospital demonstrated no significant reduction in incidences of healthcare facility-onset Clostridium difficile infection or MDRO acquisition.

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