scholarly journals Large Multisite Clinical Field Study Characterizing Contamination Levels in Patient Used Endoscopes After Manual Cleaning

2020 ◽  
Vol 41 (S1) ◽  
pp. s11-s12
Author(s):  
Marco Bommarito ◽  
Mark Meyer
Keyword(s):  
The United States ◽  
Multidrug Resistant ◽  
Data Set ◽  
Mean Values ◽  
Mortality And Morbidity ◽  
Verification Method ◽  
Upper Gi ◽  
Atp Levels ◽  
Contamination Levels ◽  
Site Variability

Background: Multiple outbreaks multidrug-resistant organisms (MDROs) have been associated with flexible endoscopes resulting in unacceptable patient mortality and morbidity. Evidence highlights the importance of effective cleaning to achieve effective high-level disinfection (HLD). This study presents an analysis of >700,000 measurements of adenosine-triphosphate (ATP) contamination levels found in flexible endoscopes after manual cleaning. Method: This 2018–2019 study consists of 702,768 measurements of ATP levels found in the suction/biopsy channel of instruments used on patients after manual cleaning: gastroscopes (267,533 measurements from 223 sites), duodenoscopes (123,697 measurements from 161 sites), colonoscopes (252,249 measurements from 229 sites), and bronchoscopes (59,289 measurements from 107 sites). Sites were located across the United States and employed protocols that included routine cleaning verification performed by the reprocessing technicians using a handheld luminometer and the associated ATP water test (3M Clean-Trace). Results: Figure 1 shows a boxplot analysis of the ATP levels by endoscope type. Upper gastrointestinal (GI) endoscopes (gastroscopes and duodenoscopes) show a significantly (P < .005) greater level of ATP contamination after manual cleaning. The pairwise mean differences are all significant (P < .005) except for colonoscopes when compared to bronchoscopes (P = .203). Also shown on Fig. 1 is a literature supported adequate cleanliness value of 200 RLUs [=2.3log(RLUs)] (MJ Alfa et al.; Am J Infec Control 2013;41:245–253 and ANSI/AAMI ST91; 2015). A 95% confidence interval analysis performed against this literature value (Table 1) showed that a high number of gastroscopes (12%) and duodenoscopes (10%) are not adequately clean. Figure 2 shows a box-plot analysis of the data set by endoscope type and by site. There is significant (P < .005) site-to-site variability for all endoscope types as demonstrated by variation in mean values, box size, and many outliers. Conclusions: This study highlights the importance of using a quantitative cleaning verification method to better understand process capability and to provide more robust quality assurance for manual cleaning. Significant differences were detected in the level of cleanliness between upper GI scopes and lower GI scopes and bronchoscopes. When compared to a literature-supported level for adequate cleanliness, upper GI scopes exhibited failure rates in excess of 10%. Furthermore, significant site-to-site variability occurred, and many outliers fell well beyond the normal process envelope, representing significant cleaning lapses. Root causes to these concerning findings could range from inadequate execution of the cleaning protocol, to device design, to age and existing damage that could prevent achieving adequate cleaning and possibly impair the effectiveness of HLD.Funding: NoneDisclosures: Marco Bommarito, 3M (salary)

scholarly journals 910. A Comprehensive, One Year, Hospital-Wide Snapshot of All Serious Infectious Complications in People Who Inject Drugs

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S489-S490
Author(s):  
John T Henderson ◽  
Evelyn Villacorta Cari ◽  
Nicole Leedy ◽  
Alice Thornton ◽  
Donna R Burgess ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Vertebral Osteomyelitis ◽  
The United States ◽  
Infectious Complications ◽  
Data Set ◽  
Cumulative Impact ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
Risk Of Death ◽  
The Impact

Abstract Background There has been a dramatic rise in IV drug use (IVDU) and its associated mortality and morbidity, however, the scope of this effect has not been described. Kentucky is at the epicenter of this epidemic and is an ideal place to better understand the health complications of IVDU in order to improve outcomes. Methods All adult in-patient admissions to University of Kentucky hospitals in 2018 with an Infectious Diseases (ID) consult and an ICD 9/10 code associated with IVDU underwent thorough retrospective chart review. Demographic, descriptive, and outcome data were collected and analyzed by standard statistical analysis. Results 390 patients (467 visits) met study criteria. The top illicit substances used were methamphetamine (37.2%), heroin (38.2%), and cocaine (10.3%). While only 4.1% of tested patients were HIV+, 74.2% were HCV antibody positive. Endocarditis (41.1%), vertebral osteomyelitis (20.8%), bacteremia without endocarditis (14.1%), abscess (12.4%), and septic arthritis (10.4%) were the most common infectious complications. The in-patient death rate was 3.0%, and 32.2% of patients were readmitted within the study period. The average length of stay was 26 days. In multivariable analysis, infectious endocarditis was associated with a statistically significant increase in risk of death, ICU admission, and hospital readmission. Although not statistically significant, trends toward mortality and ICU admission were identified for patients with prior endocarditis and methadone was correlated with decreased risk of readmission and ICU stay. FIGURE 1: Reported Substances Used FIGURE 2: Comorbidities FIGURE 3: Types of Severe Infectious Complications Conclusion We report on a novel, comprehensive perspective on the serious infectious complications of IVDU in an attempt to measure its cumulative impact in an unbiased way. This preliminary analysis of a much larger dataset (2008-2019) reveals some sobering statistics about the impact of IVDU in the United States. While it confirms the well accepted mortality and morbidity associated with infective endocarditis and bacteremia, there is a significant unrecognized impact of other infectious etiologies. Additional analysis of this data set will be aimed at identifying key predictive factors in poor outcomes in hopes of mitigating them. Disclosures All Authors: No reported disclosures

scholarly journals 2260. Clofazimine Safety and Efficacy for Treatment of Multidrug-Resistant Non-Tuberculous Mycobacteria (NTM)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S773-S774
Author(s):  
Reem Alameer ◽  
Herman Pfaeffle ◽  
Scott Heysell
Keyword(s):  
Patient Characteristics ◽  
The United States ◽  
Multidrug Resistant ◽  
Symptom Improvement ◽  
Continuation Phase ◽  
Mortality And Morbidity ◽  
Randomized Controlled Studies ◽  
Resistance Patterns ◽  
The Individual

Abstract Background Nontuberculous mycobacteria (NTM) are increasingly detected and challenging to cure given complex drug-resistance patterns and need to use often intolerable drug multidrug regimens over months to years of duration. As such, NTM infection can be associated with significant mortality and morbidity. Clofazimine is a repurposed drug used in the treatment of leprosy worldwide and increasingly in multidrug-resistant (MDR) tuberculosis. Some centers in the United States have incorporated clofazimine in the treatment of NTM but experience is limited and procurement restrictions have hampered its more widespread use Methods A prospective cohort study was performed in patients diagnosed with pulmonary or extrapulmonary NTM infection among those treated with clofazimine from a single center serving referrals from across the state of Virginia under an investigational new drug protocol. Data were collected through the center’s electronic medical record and included both pretreatment and follow-up host characteristics, radiological, microbiological and pathology data. Outcomes were assessed, radiological resolution, symptom improvement, and change in pulmonary function test (among patients with cystic fibrosis). Results Thirty-seven patients received clofazimine. NTM species for which the treatment was indicated were M. abscessus in 21 (58%), M. avium complex in 17 (45%) and 3 with M. chelonae. The most common companion drugs for M. abscessus included imipenem, tigecycline, linezolid or tedizolid, amikacin (IV induction followed by inhaled continuation phase) and azithromycin. For other basic patient characteristics refer to Table 1. Survival rate was 97%, while 73.5% had documented improvement in symptoms and only 2.9% had worsening of symptoms. Radiological resolution or partially improving were documented in 38% of the patients. there were no severe adverse events from clofazimine. Conclusion Adding clofazimine to multi-class antibiotic regimens for drug-resistant NTM treatment, including pulmonary M. abscessus disease, was well tolerated and led to clinical improvement in the majority of those treated. Randomized controlled studies are needed to determine the individual impact of clofazimine within and otherwise optimized regimen. Disclosures All authors: No reported disclosures.

State Medical Boards' Perceptions of a Minimum Data Set and Current Practices for Collecting Physician Information

2013 ◽  
Vol 99 (4) ◽  
pp. 40-45 ◽  
Author(s):  
Aaron Young ◽  
Philip Davignon ◽  
Margaret B. Hansen ◽  
Mark A. Eggen
Keyword(s):  
Media Coverage ◽  
The United States ◽  
Minimum Data Set ◽  
Direct Patient Care ◽  
Physician Workforce ◽  
Data Set ◽  
Minimum Data ◽  
State Medical Boards ◽  
The Impact ◽  
Current Practices

ABSTRACT Recent media coverage has focused on the supply of physicians in the United States, especially with the impact of a growing physician shortage and the Affordable Care Act. State medical boards and other entities maintain data on physician licensure and discipline, as well as some biographical data describing their physician populations. However, there are gaps of workforce information in these sources. The Federation of State Medical Boards' (FSMB) Census of Licensed Physicians and the AMA Masterfile, for example, offer valuable information, but they provide a limited picture of the physician workforce. Furthermore, they are unable to shed light on some of the nuances in physician availability, such as how much time physicians spend providing direct patient care. In response to these gaps, policymakers and regulators have in recent years discussed the creation of a physician minimum data set (MDS), which would be gathered periodically and would provide key physician workforce information. While proponents of an MDS believe it would provide benefits to a variety of stakeholders, an effort has not been attempted to determine whether state medical boards think it is important to collect physician workforce data and if they currently collect workforce information from licensed physicians. To learn more, the FSMB sent surveys to the executive directors at state medical boards to determine their perceptions of collecting workforce data and current practices regarding their collection of such data. The purpose of this article is to convey results from this effort. Survey findings indicate that the vast majority of boards view physician workforce information as valuable in the determination of health care needs within their state, and that various boards are already collecting some data elements. Analysis of the data confirms the potential benefits of a physician minimum data set (MDS) and why state medical boards are in a unique position to collect MDS information from physicians.

Legislative Diversity and the Rise of Women Lobbyists

2021 ◽  
pp. 106591292110093
Author(s):  
James M. Strickland ◽  
Katelyn E. Stauffer
Keyword(s):  
Gender Diversity ◽  
Personal Characteristics ◽  
The United States ◽  
Revolving Door ◽  
Women And Politics ◽  
Political Equality ◽  
Data Set ◽  
Women Legislators ◽  
Organized Interests ◽  
American States

Despite a growing body of literature examining the consequences of women’s inclusion among lobbyists, our understanding of the factors that lead to women’s initial emergence in the profession is limited. In this study, we propose that gender diversity among legislative targets incentivizes organized interests to hire women lobbyists, and thus helps to explain when and how women emerge as lobbyists. Using a comprehensive data set of registered lobbyist–client pairings from all American states in 1989 and 2011, we find that legislative diversity influences not only the number of lobby contracts held by women but also the number of former women legislators who become revolving-door lobbyists. This second finding further supports the argument that interests capitalize on the personal characteristics of lobbyists, specifically by hiring women to work in more diverse legislatures. Our findings have implications for women and politics, lobbying, and voice and political equality in the United States.

scholarly journals Actors, Partisan Inclination, and Emotions: An Analysis of Government Shutdown News Stories Shared on Twitter

2021 ◽  
Vol 7 (2) ◽  
pp. 205630512110088
Author(s):  
Colin Agur ◽  
Lanhuizi Gan
Keyword(s):  
Emotional Responses ◽  
The United States ◽  
Online Information ◽  
News Frames ◽  
Data Set ◽  
Political Issues ◽  
News Stories ◽  
News Sharing ◽  
Government Shutdown

Scholars have recognized emotion as an increasingly important element in the reception and retransmission of online information. In the United States, because of existing differences in ideology, among both audiences and producers of news stories, political issues are prone to spark considerable emotional responses online. While much research has explored emotional responses during election campaigns, this study focuses on the role of online emotion in social media posts related to day-to-day governance in between election periods. Specifically, this study takes the 2018–2019 government shutdown as its subject of investigation. The data set shows the prominence of journalistic and political figures in leading the discussion of news stories, the nuance of emotions employed in the news frames, and the choice of pro-attitudinal news sharing.

STEM-Focused Career Courses and College Pipeline for Students with Learning Disabilities

2021 ◽  
pp. 089590482110199
Author(s):  
Jennifer A. Freeman ◽  
Michael A. Gottfried ◽  
Jay Stratte Plasman
Keyword(s):  
High School ◽  
Learning Disabilities ◽  
High School Students ◽  
The United States ◽  
Students With Learning Disabilities ◽  
School Students ◽  
Data Set ◽  
Stem Majors ◽  
Career And Technical ◽  
Nationally Representative

Recent educational policies in the United States have fostered the growth of science, technology, engineering, and mathematics (STEM) career-focused courses to support high school students’ persistence into these fields in college and beyond. As one key example, federal legislation has embedded new types of “applied STEM” (AS) courses into the career and technical education curriculum (CTE), which can help students persist in STEM through high school and college. Yet, little is known about the link between AS-CTE coursetaking and college STEM persistence for students with learning disabilities (LDs). Using a nationally representative data set, we found no evidence that earning more units of AS-CTE in high school influenced college enrollment patterns or major selection in non-AS STEM fields for students with LDs. That said, students with LDs who earned more units of AS-CTE in high school were more likely to seriously consider and ultimately declare AS-related STEM majors in college.

scholarly journals Investigation and Containment of New Delhi Metallo-β-Lactamase (NDM)–Producing Carbapenem-Resistant Enterobacteriaceae (CRE) in a Hospital Intensive Care Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s305-s305
Author(s):  
Karoline Sperling ◽  
Amy Priddy ◽  
Nila Suntharam ◽  
Adam Karlen
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Outpatient Surgery ◽  
The United States ◽  
Multidrug Resistant ◽  
New Delhi ◽  
Point Prevalence Study ◽  
Carbapenem Resistant ◽  
Multidrug Resistant Organisms ◽  
Carbapenem Resistant Enterobacteriaceae

Background: With increasing medical tourism and international healthcare, emerging multidrug resistant organisms (MDROs) or “superbugs” are becoming more prevalent. These MDROs are unique because they are resistant to antibiotics and can carry special resistance mechanisms. In April 2019, our hospital was notified that a superbug, New Delhi Metallo-β-lactamase(NDM)–producing carbapenem-resistant Enterobacteriaceae (CRE), was identified in a patient who had been transferred to another hospital after being at our hospital for 3 weeks. Our facility had a CRE admission screening protocol in place since 2013, but this patient did not meet the criteria to be screened on admission. Methods: The infection prevention (IP) team consulted with the Minnesota Department of Health (MDH) and gathered stakeholders to discuss containment strategies using the updated 2019 CDC Interim Guidance for Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms (MDROs) to determine whether transmission to other patients had occurred. NDM CRE was classified under tier 2 organisms, meaning those primarily associated with healthcare settings and not commonly identified in the region, and we used this framework to conduct an investigation. A point-prevalence study was done in an intensive care unit that consisted of rectal screening of 7 patients for both CRE and Candida auris, another emerging MDRO. These swabs were sent to the Antibiotic Resistance Laboratory Network (ARLN) Central Regional Lab at MDH for testing. An on-site infection control risk assessment was done by the MDH Infection Control Assessment and Response (ICAR) team. Results: All 7 patients were negative for both CRE and C. auris, and no further screening was done. During the investigation, it was discovered that the patient had had elective ambulatory surgery outside the United States in March 2019. The ICAR team assessment provided overall positive feedback to the nursing unit about isolation procedures, cleaning products, and hand hygiene product accessibility. Opportunities included set-up of soiled utility room and updating our process to the 2019 MDH recommendation to screen patients for CRE and C. auris on admission who have been hospitalized, had outpatient surgery, or hemodialysis outside the United States in the previous year. Conclusions: Point-prevalence study results showed no transmission of CRE and highlighted the importance of standard precautions. This event supports the MDH recommendation to screen for CRE any patients who have been hospitalized, had outpatient surgery, or had hemodialysis outside the United States in the previous year.Funding: NoneDisclosures: None

scholarly journals The COVID Connection: Pandemic Anxiety, COVID-19 Comprehension, and Digital Confidence

2021 ◽  
pp. 000276422110031
Author(s):  
Laura Robinson ◽  
Jeremy Schulz ◽  
Øyvind N. Wiborg ◽  
Elisha Johnston
Keyword(s):  
Logistic Models ◽  
The United States ◽  
Sociodemographic Factors ◽  
Future Research ◽  
Lower Probability ◽  
Data Set ◽  
Digital Inequality ◽  
Partner Status ◽  
General Anxiety ◽  
Nationally Representative

This article presents logistic models examining how pandemic anxiety and COVID-19 comprehension vary with digital confidence among adults in the United States during the first wave of the pandemic. As we demonstrate statistically with a nationally representative data set, the digitally confident have lower probability of experiencing physical manifestations of pandemic anxiety and higher probability of adequately comprehending critical information on COVID-19. The effects of digital confidence on both pandemic anxiety and COVID-19 comprehension persist, even after a broad range of potentially confounding factors are taken into account, including sociodemographic factors such as age, gender, race/ethnicity, metropolitan status, and partner status. They also remain discernable after the introduction of general anxiety, as well as income and education. These results offer evidence that the digitally disadvantaged experience greater vulnerability to the secondary effects of the pandemic in the form of increased somatized stress and decreased COVID-19 comprehension. Going forward, future research and policy must make an effort to address digital confidence and digital inequality writ large as crucial factors mediating individuals’ responses to the pandemic and future crises.

scholarly journals 130. increase in Multidrug Resistance (2011–2018) and the Emergence of Extensive Drug Resistance (2020) in shigella Sonnei in the United States

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S195-S195
Author(s):  
Naeemah Z Logan ◽  
Beth E Karp ◽  
Kaitlin A Tagg ◽  
Claire Burns-Lynch ◽  
Jessica Chen ◽  
...  
Keyword(s):  
United States ◽  
Multidrug Resistance ◽  
Disease Surveillance ◽  
Sequence Data ◽  
The United States ◽  
Multidrug Resistant ◽  
Shigella Sonnei ◽  
Short Read ◽  
Men 2 ◽  
The Us

Abstract Background Multidrug-resistant (MDR) Shigella sonnei infections are a serious public health threat, and outbreaks are common among men who have sex with men (MSM). In February 2020, Australia’s Department of Health notified CDC of extensively drug-resistant (XDR) S. sonnei in 2 Australian residents linked to a cruise that departed from Florida. We describe an international outbreak of XDR S. sonnei and report on trends in MDR among S. sonnei in the United States. Methods Health departments (HDs) submit every 20th Shigella isolate to CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory for susceptibility testing. We defined MDR as decreased susceptibility to azithromycin (MIC ≥32 µg/mL) with resistance to ampicillin, ciprofloxacin, and cotrimoxazole, and XDR as MDR with additional resistance to ceftriaxone. We used PulseNet, the national subtyping network for enteric disease surveillance, to identify US isolates related to the Australian XDR isolates by short-read whole genome sequencing. We screened these isolates for resistance determinants (ResFinder v3.0) and plasmid replicons (PlasmidFinder) and obtained patient histories from HDs. We used long-read sequencing to generate closed plasmid sequences for 2 XDR isolates. Results NARMS tested 2,781 S. sonnei surveillance isolates during 2011–2018; 80 (2.9%) were MDR, including 1 (0.04%) that was XDR. MDR isolates were from men (87%), women (9%), and children (4%). MDR increased from 0% in 2011 to 15.3% in 2018 (Figure). In 2020, we identified XDR isolates from 3 US residents on the same cruise as the Australians. The US residents were 41–42 year-old men; 2 with available information were MSM. The US and Australian isolates were highly related (0–1 alleles). Short-read sequence data from all 3 US isolates mapped to the blaCTX-M-27 harboring IncFII plasmids from the 2 Australian isolates with &gt;99% nucleotide identity. blaCTX-M-27 genes confer ceftriaxone resistance. Increase in Percentage of Shigella sonnei Isolates with Multidrug Resistance* in the United States, 2011–2018† Conclusion MDR S. sonnei is increasing and is most often identified among men. XDR S. sonnei infections are emerging and are resistant to all recommended antibiotics, making them difficult to treat without IV antibiotics. This outbreak illustrates the alarming capacity for XDR S. sonnei to disseminate globally among at-risk populations, such as MSM. Disclosures All Authors: No reported disclosures

scholarly journals Candida auris and Carbapenemase-Producing Organism Prevalence in an Extended Stay Pediatric Hospital, Chicago, Illinois, 2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s145-s146
Author(s):  
Kelly Walblay ◽  
Tristan McPherson ◽  
Elissa Roop ◽  
David Soglin ◽  
Ann Valley ◽  
...  
Keyword(s):  
The United States ◽  
Multidrug Resistant ◽  
Pediatric Hospital ◽  
Mechanical Ventilators ◽  
Candida Auris ◽  
Term Care ◽  
Healthcare Settings ◽  
High Acuity ◽  
Gastrostomy Tubes

Background:Candida auris and carbapenemase-producing organisms (CPO) are multidrug-resistant organisms that can colonize people for prolonged periods and can cause invasive infections and spread in healthcare settings, particularly in high-acuity long-term care facilities. Point-prevalence surveys (PPSs) conducted in long-term acute-care hospitals in the Chicago region identified median prevalence of colonization to be 31% for C. auris and 24% for CPO. Prevalence of C. auris colonization has not been described in pediatric populations in the United States, and limited data exist on CPO colonization in children outside intensive care units. The Chicago Department of Public Health (CDPH) conducted a PPS to assess C. auris and CPO colonization in a pediatric hospital serving high-acuity patients with extended lengths of stay (LOS). Methods: CDPH conducted a PPS in August 2019 in a pediatric hospital with extended LOS to screen for C. auris and CPO colonization. Medical devices (ie, gastrostomy tubes, tracheostomies, mechanical ventilators, and central venous catheters [CVC]) and LOS were documented. Screening specimens consisted of composite bilateral axillae and groin swabs for C. auris and rectal swabs for CPO testing. The Wisconsin State Laboratory of Hygiene tested all specimens. Real-time polymerase chain reaction (PCR) assays were used to detect C. auris DNA and carbapenemase genes: blaKPC, blaNDM, blaVIM, blaOXA-48, and blaIMP (Xpert Carba-R Assay, Cepheid, Sunnyvale, CA). All axillae and groin swabs were processed by PCR and culture to identify C. auris. For CPO, culture was only performed on PCR-positive specimens. Results: Of the 29 patients hospitalized, 26 (90%) had gastrostomy tubes, 24 (83%) had tracheostomies, 20 (69%) required mechanical ventilation, and 3 (10%) had CVCs. Also, 25 (86%) were screened for C. auris and CPO; 4 (14%) lacked parental consent and were not swabbed. Two rectal specimens were unsatisfactory, producing invalid CPO test results. Median LOS was 35 days (range, 1–300 days). No patients were positive for C. auris. From CPO screening, blaOXA-48 was detected in 1 patient sample, yielding a CPO prevalence of 3.4% (1 of 29). No organism was recovered from the blaOXA-48 positive specimen. Conclusions: This is the first documented screening of C. auris colonization in a pediatric hospital with extended LOS. Despite a high prevalence of C. auris and CPOs in adult healthcare settings of similar acuity in the region, C. auris was not identified and CPOs were rare at this pediatric facility. Additional evaluations in pediatric hospitals should be conducted to further understand C. auris and CPO prevalence in this population.Funding: NoneDisclosures: None

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