scholarly journals Use of Simulations to Evaluate the Effectiveness of Barrier Precautions for Prevention of pathogen Transmission

2020 ◽  
Vol 41 (S1) ◽  
pp. s82-s83
Author(s):  
Heba Alhmidi ◽  
Daniel Li ◽  
Jennifer Cadnum ◽  
Natalia Pinto Herrera ◽  
Muhammed Fawwaz Haq ◽  
...  
Keyword(s):  
Group Versus ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Clinical Settings ◽  
Surrogate Markers ◽  
Bacteriophage Ms2 ◽  
Different Types ◽  
Healthcare Associated ◽  
Standardized Examinations ◽  
Different Levels

Background: Barrier precautions (eg, gloves and gowns) are often used in clinical settings to reduce the risk for transmission of healthcare-associated pathogens. However, uncertainty persists regarding the efficacy of different types of barrier precautions in preventing transmission. Methods: We used simulated patient care interactions to compare the effectiveness of different levels of barrier precautions in reducing transfer of pathogen surrogate markers. Overall, 30 personnel performed standardized examinations of contaminated mannequins while wearing either no barriers, gloves, or gloves plus cover gowns followed by examination of a noncontaminated mannequin; the order of the barrier precautions was randomly assigned. Participants used their usual technique for hand hygiene, stethoscope cleaning, and protective equipment removal. The surrogate markers included cauliflower mosaic virus DNA, bacteriophage MS2, nontoxigenic Clostridium difficile spores, and a fluorescent tracer. We compared the frequency and route of transfer of each of the surrogate markers to the second mannequin or to the surrounding environment. Results: As shown in Fig. 1, wearing gloves alone or gloves plus gowns significantly reduced transfer of each of the surrogate markers by the hands of participants (P < .05 for each marker). However, wearing gloves or gloves plus gowns only modestly reduced transfer by stethoscopes despite cleaning of stethoscopes between exams by approximately half of the participants. Contamination of the clothing of participants was significantly reduced in the glove plus gown group versus the gloves only or no-barriers groups (P < .05). Conclusion: Barrier precautions are effective in reducing hand transfer of pathogens from patient to patient, but transfer may still occur via devices such as stethoscopes. Cover gowns reduce the risk for contamination of the clothing of personnel.Funding: Proprietary Organization: The Center for Disease Control.Disclosures: None

Use of simulations to evaluate the effectiveness of barrier precautions to prevent patient-to-patient transfer of healthcare-associated pathogens

2020 ◽  
pp. 1-6
Author(s):  
Heba Alhmidi ◽  
Daniel F. Li ◽  
Jennifer L. Cadnum ◽  
Muhammed F. Haq ◽  
Natalia C. Pinto-Herrera ◽  
...  
Keyword(s):  
Mosaic Virus ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Surrogate Markers ◽  
Fluorescent Tracer ◽  
Clostridioides Difficile ◽  
Bacteriophage Ms2 ◽  
Different Types ◽  
Healthcare Associated ◽  
Standardized Examinations

Abstract Background: There is controversy regarding whether the addition of cover gowns offers a substantial benefit over gloves alone in reducing personnel contamination and preventing pathogen transmission. Design: Simulated patient care interactions. Objective: To evaluate the efficacy of different types of barrier precautions and to identify routes of transmission. Methods: In randomly ordered sequence, 30 personnel each performed 3 standardized examinations of mannequins contaminated with pathogen surrogate markers (cauliflower mosaic virus DNA, bacteriophage MS2, nontoxigenic Clostridioides difficile spores, and fluorescent tracer) while wearing no barriers, gloves, or gloves plus gowns followed by examination of a noncontaminated mannequin. We compared the frequency and routes of transfer of the surrogate markers to the second mannequin or the environment. Results: For a composite of all surrogate markers, transfer by hands occurred at significantly lower rates in the gloves-alone group (OR, 0.02; P < .001) and the gloves-plus-gown group (OR, 0.06; P = .002). Transfer by stethoscope diaphragms was common in all groups and was reduced by wiping the stethoscope between simulations (OR, 0.06; P < .001). Compared to the no-barriers group, wearing a cover gown and gloves resulted in reduced contamination of clothing (OR, 0.15; P < .001), but wearing gloves alone did not. Conclusions: Wearing gloves alone or gloves plus gowns reduces hand transfer of pathogens but may not address transfer by devices such as stethoscopes. Cover gowns reduce the risk of contaminating the clothing of personnel.

scholarly journals Dissemination of Methicillin-Resistant Staphylococcus aureus (MRSA) and Viral Surrogate Markers Outside Patient Rooms

2020 ◽  
Vol 41 (S1) ◽  
pp. s193-s194
Author(s):  
Daniel Li ◽  
Natalia Pinto Herrera ◽  
Heba Alhmidi ◽  
Jennifer Cadnum ◽  
Curtis Donskey
Keyword(s):  
Staphylococcus Aureus ◽  
Mosaic Virus ◽  
Dna Marker ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Surrogate Markers ◽  
Viral Dna ◽  
Term Care ◽  
Methicillin Resistant ◽  
Bacteriophage Ms2

Background: Patients with methicillin-resistant Staphylococcus aureus (MRSA) colonization often shed MRSA, resulting in contamination of surfaces in their room. It is not known whether MRSA-colonized patients also frequently contaminate surfaces during medical appointments and other activities outside their room. Methods: We conducted an observational cohort study of MRSA-colonized long-term care facility (LTCF) residents to determine the frequency and mechanisms of contamination of surfaces outside patient rooms. Nares, skin, and clothing of patients in contact precautions for MRSA were cultured for MRSA, and high-touch surfaces in the residents’ room were contaminated with the live virus bacteriophage MS2 and cauliflower mosaic virus DNA. The participants were observed during activities and medical appointments outside their rooms for 3 days, and sites that were contacted were sampled for recovery of MRSA, bacteriophage MS2, and cauliflower mosaic virus DNA. Results: As shown in Fig. 1, bacteriophage MS2 and cauliflower mosaic virus DNA was transferred to 1 or more surfaces outside the resident’s room by 5 of the 7 participants, and MRSA was recovered from surfaces touched by 6 (86%) participants. MRSA was recovered during 16 of 35 episodes (46%) where sampling was performed, and recovery was similar for medical appointments (eg, hemodialysis, physical therapy) and nonmedical activities (eg, using the dining room or activity center). Moreover, MRSA, MS2, and the viral DNA marker were recovered both from sites contacted only by participants’ hands and from sites contacted only by clothing. Bacteriophage MS2 and the viral DNA marker were also recovered from portable equipment and from the nursing station. Conclusions: MRSA-colonized LTCF residents frequently disseminated MRSA and viral surrogate markers to surfaces outside their rooms through contact with contaminated hands and clothing. Efforts to reduce contamination of hands and clothing might reduce the risk for pathogen transmission.Funding: NoneDisclosures: None

scholarly journals 1142. Use of DNA Markers to Assess the Potential for Pathogen Transmission from Physicians’ White Coats

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S343-S343
Author(s):  
Daniel Van Aartsen ◽  
Manish Thakur ◽  
Khalid M Dousa ◽  
Anubhav Kanwar ◽  
Jennifer Cadnum ◽  
...  
Keyword(s):  
Dna Markers ◽  
Dna Marker ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Clinical Settings ◽  
Dress Code ◽  
Indirect Contact ◽  
Environmental Surfaces ◽  
Polymerase Chain ◽  
Healthcare Associated

Abstract Background Physicians’ white coats are often contaminated, but seldom cleaned. A “bare below the elbows” dress code policy has been advocated as a strategy to reduce the risk for transmission of healthcare-associated pathogens by white coats. However, transfer of contamination by clothing has not been demonstrated in clinical settings and it is not known if long sleeves are the major source of transfer. Methods We observed physicians during routine patient encounters and characterized the frequency of direct and indirect contact between white coats and the patient or environmental surfaces. To assess transfer from white coats in clinical settings, we applied one cauliflower mosaic virus DNA marker to the sleeve cuffs and another to the coat pockets of physicians prior to routine patient encounters. Polymerase chain reaction was used to determine whether DNA markers from the clothing sites were transferred to patients or environmental surfaces. Results Ninety percent of observed patient encounters included one or more direct or indirect contacts between a physician’s white coat and a patient or the environment. Direct contact occurred on average 1.7 times per encounter and indirect contact (i.e., physicians’ hands contacting the coat prior to touching the patient or environment) occurred on average 2.3 times per encounter. The figure shows the frequency and distribution of sites of direct and indirect contact with white coats. Of 11 patient encounters with DNA-contaminated white coats, five (45%) resulted in transfer of one or both DNA markers; there were three transfers from sleeve cuffs and three from coat pockets. Conclusion Contaminated white coats may be an under-appreciated source for transmission of healthcare-associated pathogens. Our results provide support for the bare below the elbows policy, but also highlight the potential for indirect transfer of pathogens from other sites on white coats. Disclosures All authors: No reported disclosures.

scholarly journals Evaluation of Viral Surrogate Markers for Study of Pathogen Dissemination During Simulations of Patient Care

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Heba Alhmidi ◽  
Amrita John ◽  
Thriveen C. Mana ◽  
Sreelatha Koganti ◽  
Jennifer L. Cadnum ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Patient Care ◽  
Mosaic Virus ◽  
Personal Protective Equipment ◽  
Cauliflower Mosaic Virus ◽  
Protective Equipment ◽  
Surrogate Markers ◽  
Bacteriophage Ms2

Abstract During patient care simulations, cauliflower mosaic virus DNA and bacteriophage MS2 performed similarly as surrogate markers of pathogen dissemination. These markers disseminated to the environment in a manner similar to Clostridium difficile spores but were more frequently detected on skin and clothing of personnel after personal protective equipment removal.

Use of viral DNA surrogate markers to study routes of transmission of healthcare-associated pathogens

2020 ◽  
pp. 1-6
Author(s):  
Manish Thakur ◽  
Heba Alhmidi ◽  
Jennifer L. Cadnum ◽  
Annette L. Jencson ◽  
Jessica Bingham ◽  
...  
Keyword(s):  
Dna Markers ◽  
Veterans Affairs ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Healthcare Personnel ◽  
Portable Equipment ◽  
Environmental Surfaces ◽  
Observational Cohort ◽  
Healthcare Associated

Abstract Background: The hands of healthcare personnel are the most important source for transmission of healthcare-associated pathogens. The role of contaminated fomites such as portable equipment, stethoscopes, and clothing of personnel in pathogen transmission is unclear. Objective: To study routes of transmission of cauliflower mosaic virus DNA markers from 31 source patients and from environmental surfaces in their rooms. Design: A 3-month observational cohort study. Setting: A Veterans’ Affairs hospital. Methods: After providing care for source patients, healthcare personnel were observed during interactions with subsequent patients. Putative routes of transmission were identified based on recovery of DNA markers from sites of contact with the patient or environment. To assess plausibility of fomite-mediated transmission, we assessed the frequency of transfer of methicillin-resistant Staphylococcus aureus (MRSA) from the skin of 25 colonized patients via gloved hands versus fomites. Results: Of 145 interactions involving contact with patients and/or the environment, 41 (28.3%) resulted in transfer of 1 or both DNA markers to the patient and/or the environment. The DNA marker applied to patients’ skin and clothing was transferred most frequently by stethoscopes, hands, and portable equipment, whereas the marker applied to environmental surfaces was transferred only by hands and clothing. The percentages of MRSA transfer from the skin of colonized patients via gloved hands, stethoscope diaphragms, and clothing were 52%, 40%, and 48%, respectively. Conclusions: Fomites such as stethoscopes, clothing, and portable equipment may be underappreciated sources of pathogen transmission. Simple interventions such as decontamination of fomites between patients could reduce the risk for transmission.

scholarly journals Timing and Route of Contamination of Patient Rooms With Healthcare-Associated Pathogens

2020 ◽  
Vol 41 (S1) ◽  
pp. s412-s412
Author(s):  
Sarah Redmond ◽  
Jennifer Cadnum ◽  
Basya Pearlmutter ◽  
Natalia Pinto Herrera ◽  
Curtis Donskey
Keyword(s):  
Acute Care Hospital ◽  
Current Control ◽  
Pathogen Transmission ◽  
Control Measures ◽  
Effective Control ◽  
Portable Devices ◽  
Care Hospital ◽  
Spa Typing ◽  
Persistent Problem ◽  
Healthcare Associated

Background: Transmission of healthcare-associated pathogens such as Clostridioides difficile and methicillin-resistant Staphylococcus aureus (MRSA) is a persistent problem in healthcare facilities despite current control measures. A better understanding of the routes of pathogen transmission is needed to develop effective control measures. Methods: We conducted an observational cohort study in an acute-care hospital to identify the timing and route of transfer of pathogens to rooms of newly admitted patients with negative MRSA nares results and no known carriage of other healthcare-associated pathogens. Rooms were thoroughly cleaned and disinfected prior to patient admission. Interactions of patients with personnel and portable equipment were observed, and serial cultures for pathogens were collected from the skin of patients and from surfaces, including those observed to come in contact with personnel and equipment. For MRSA, spa typing was used to determine relatedness of patient and environmental isolates. Results: For the 17 patients enrolled, 1 or more environmental cultures became positive for MRSA in rooms of 10 patients (59%), for C. difficile in rooms of 2 patients (12%) and for vancomycin-resistant enterococci (VRE) in rooms of 2 patients (12%). The patients interacted with an average of 2.4 personnel and 0.6 portable devices per hour of observation. As shown in Figure 1, MRSA contamination of the floor occurred rapidly as personnel entered the room. In a subset of patients, MRSA was subsequently recovered from patients’ socks and bedding and ultimately from the high-touch surfaces in the room (tray table, call button, bedrail). For several patients, MRSA isolates recovered from the floor had the same spa type as isolates subsequently recovered from other sites (eg, socks, bedding, and/or high touch surfaces). The direct transfer of healthcare-associated pathogens from personnel or equipment to high-touch surfaces was not detected. Conclusions: Healthcare-associated pathogens rapidly accumulate on the floor of patient rooms and can be transferred to the socks and bedding of patients and to high-touch surfaces. Healthcare facility floors may be an underappreciated source of pathogen dissemination not addressed by current infection control measures.Funding: NoneDisclosures: None

Timing and route of contamination of hospitalized patient rooms with healthcare-associated pathogens

2021 ◽  
pp. 1-6
Author(s):  
Sarah N. Redmond ◽  
Basya S. Pearlmutter ◽  
Yilen K. Ng-Wong ◽  
Heba Alhmidi ◽  
Jennifer L. Cadnum ◽  
...  
Keyword(s):  
Pathogen Detection ◽  
Veterans Affairs ◽  
Portable Equipment ◽  
Healthcare Facilities ◽  
Clostridioides Difficile ◽  
Bacteriophage Ms2 ◽  
Vancomycin Resistant Enterococci ◽  
Observational Cohort ◽  
Vancomycin Resistant ◽  
Healthcare Associated

Abstract Objective: To investigate the timing and routes of contamination of the rooms of patients newly admitted to the hospital. Design: Observational cohort study and simulations of pathogen transfer. Setting: A Veterans’ Affairs hospital. Participants: Patients newly admitted to the hospital with no known carriage of healthcare-associated pathogens. Methods: Interactions between the participants and personnel or portable equipment were observed, and cultures of high-touch surfaces, floors, bedding, and patients’ socks and skin were collected for up to 4 days. Cultures were processed for Clostridioides difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE). Simulations were conducted with bacteriophage MS2 to assess plausibility of transfer from contaminated floors to high-touch surfaces and to assess the effectiveness of wearing slippers in reducing transfer. Results: Environmental cultures became positive for at least 1 pathogen in 10 (59%) of the 17 rooms, with cultures positive for MRSA, C. difficile, and VRE in the rooms of 10 (59%), 2 (12%), and 2 (12%) participants, respectively. For all 14 instances of pathogen detection, the initial site of recovery was the floor followed in a subset of patients by detection on sock bottoms, bedding, and high-touch surfaces. In simulations, wearing slippers over hospital socks dramatically reduced transfer of bacteriophage MS2 from the floor to hands and to high-touch surfaces. Conclusions: Floors may be an underappreciated source of pathogen dissemination in healthcare facilities. Simple interventions such as having patients wear slippers could potentially reduce the risk for transfer of pathogens from floors to hands and high-touch surfaces.

Accessing offshoring advantages: what and how to offshore

2015 ◽  
Vol 8 (2/3) ◽  
pp. 262-283 ◽  
Author(s):  
Alona Mykhaylenko ◽  
Ágnes Motika ◽  
Brian Vejrum Waehrens ◽  
Dmitrij Slepniov
Keyword(s):  
Performance Outcomes ◽  
Offshore Outsourcing ◽  
Strategic Decisions ◽  
Content Type ◽  
Different Types ◽  
Captive Offshoring ◽  
Performance Results ◽  
Governance Modes ◽  
Different Levels ◽  
Do So

Purpose – The purpose of this paper is to advance the understanding of factors that affect offshoring performance results. To do so, this paper focuses on the access to location-specific advantages, rather than solely on the properties of the offshoring company, its strategy or environment. Assuming that different levels of synergy may exist between particular offshoring strategic decisions (choosing offshore outsourcing or captive offshoring and the type of function) and different offshoring advantages, this work advocates that the actual fact of realization of certain offshoring advantages (getting or not getting access to them) is a more reliable predictor of offshoring success. Design/methodology/approach – A set of hypotheses derived from the extant literature is tested on the data from a quantitative survey of 1,143 Scandinavian firms. Findings – The paper demonstrates that different governance modes and types of offshored function indeed provide different levels of access to different types of location-specific offshoring advantages. This difference may help to explain the ambiguity of offshoring initiatives performance results. Research limitations/implications – Limitations of the work include using only the offshoring strategy elements and only their limited variety as factors potentially influencing access to offshoring advantages. Also, the findings are limited to Scandinavian companies. Originality/value – The paper introduces a new concept of access, which can help to more reliably predict performance outcomes of offshoring initiatives. Recommendations are also provided to practitioners dealing with offshoring initiatives.

Sticks and Stones May Break My Bones . . . Reasoning About Illness Causality and Body Functioning in Children Who Have a Chronic Illness

PEDIATRICS ◽  
1991 ◽  
Vol 88 (3) ◽  
pp. 608-619
Author(s):  
Ellen C. Perrin ◽  
Aline G. Sayer ◽  
John B. Willett
Keyword(s):  
Chronic Illness ◽  
Age Differences ◽  
Conceptual Development ◽  
Seizure Disorder ◽  
Healthy Children ◽  
Cognitive Reasoning ◽  
Different Types ◽  
Reasoning Skills ◽  
Experience Of Illness ◽  
Different Levels

Children's concepts about illness causality and bodily functioning change in a predictable way with advancing age. Differences in the understanding of these concepts in healthy children vs children with a chronic illness have not been clearly delineated. This study included 49 children with a seizure disorder, 47 children with an orthopaedic condition, and 96 healthy children, all with normal intelligence and ranging in age from 5 to 16 years. It demonstrates systematic differences in children's general reasoning skills and in their understanding of concepts about illness causality and bodily functioning, as a function of their age and experience of illness. At all ages, children who had a condition with orthopaedic involvement reported less sophisticated general reasoning and concepts about illness than did healthy children; children with a seizure disorder reported similar general reasoning skills to those of healthy children, but considerably less sophisticated concepts about illness. children's concepts about body functioning did not differ as a function of the presence of a chronic illness. When their different levels of general cognitive reasoning were statistically controlled, children with a chronic illness had somewhat more sophisticated concepts about bodily functioning than did healthy children. Differences in conceptual development among children with different types of illnesses lead to interesting speculations with regard to the effects of particular illness characteristics on children's cognitive development.

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