Utility of Dual Skin Tests to Evaluate Tuberculin Skin Test Reactions of 10 to 14 mm in Healthcare Workers

2003 ◽  
Vol 24 (11) ◽  
pp. 821-824 ◽  
Author(s):  
Bryan J. Marsh ◽  
Joshua San Vicente ◽  
C. Fordham von Reyn
Keyword(s):  
Occupational Health ◽  
Skin Test ◽  
Healthcare Workers ◽  
Medical Center ◽  
Skin Testing ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Health Department ◽  
The United States ◽  
Skin Tests

AbstractObjective:To define the utility of 10- to 14-mm reactions to a Mycobacterium tuberculosis purified protein derivative (PPD) skin test for healthcare workers (HCWs).Design:Blinded dual skin testing, using PPD and M. avium sensitin, of HCWs at a single medical center who had a 10-to 14-mm reaction to PPD when tested by personnel from the Occupational Health Department as part of routine annual screening.Setting:A single tertiary-care academic medical center.Participants:Employees of the medical center who underwent routine annual PPD screening and were identified by the Occupational Health Department as having a reaction of 10 to 14 mm to PPD.Results:Nineteen employees were identified as candidates and 11 underwent dual skin testing. Only 4 (36%) had repeat results for PPD in the 10- to 14-mm range, whether read by Occupational Health Department personnel or study investigators. For only 5 (45%) of the subjects did the Occupational Health Department personnel and study investigators concur (± 3 mm) on the size of the PPD reaction. Two of the 4 subjects with reactions of 10 to 14 mm as measured by the study investigators were M. avium sensitin dominant, 1 was PPD dominant, and 1 was nondominant.Conclusion:A reaction of 10 to 14 mm to PPD should not be used as an indication for the treatment of latent tuberculosis (TB) infection in healthy HCWs born in the United States with no known exposure to TB.

scholarly journals Communications and Screening for 2019 Novel Coronavirus at a Tertiary-Care Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s84-s84
Author(s):  
Lorinda Sheeler ◽  
Mary Kukla ◽  
Oluchi Abosi ◽  
Holly Meacham ◽  
Stephanie Holley ◽  
...  
Keyword(s):  
Screening Tool ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The United States ◽  
World Health ◽  
Communication Campaign ◽  
Electronic Screening ◽  
Novel Coronavirus ◽  
The Impact

Background: In December of 2019, the World Health Organization reported a novel coronavirus (severe acute respiratory coronavirus virus 2 [SARS-CoV-2)]) causing severe respiratory illness originating in Wuhan, China. Since then, an increasing number of cases and the confirmation of human-to-human transmission has led to the need to develop a communication campaign at our institution. We describe the impact of the communication campaign on the number of calls received and describe patterns of calls during the early stages of our response to this emerging infection. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center with >200 outpatient clinics. In response to the coronavirus disease 2019 (COVID-19) outbreak, we launched a communications campaign on January 17, 2020. Initial communications included email updates to staff and a dedicated COVID-19 webpage with up-to-date information. Subsequently, we developed an electronic screening tool to guide a risk assessment during patient check in. The screening tool identifies travel to China in the past 14 days and the presence of symptoms defined as fever >37.7°C plus cough or difficulty breathing. The screening tool was activated on January 24, 2020. In addition, university staff contacted each student whose primary residence record included Hubei Province, China. Students were provided with medical contact information, signs and symptoms to monitor for, and a thermometer. Results: During the first 5 days of the campaign, 3 calls were related to COVID-19. The number of calls increased to 18 in the 5 days following the implementation of the electronic screening tool. Of the 21 calls received to date, 8 calls (38%) were generated due to the electronic travel screen, 4 calls (19%) were due to a positive coronavirus result in a multiplex respiratory panel, 4 calls (19%) were related to provider assessment only (without an electronic screening trigger), and 2 calls (10%) sought additional information following the viewing of the web-based communication campaign. Moreover, 3 calls (14%) were for people without travel history but with respiratory symptoms and contact with a person with recent travel to China. Among those reporting symptoms after travel to China, mean time since arrival to the United States was 2.7 days (range, 0–11 days). Conclusion: The COVID-19 outbreak is evolving, and providing up to date information is challenging. Implementing an electronic screening tool helped providers assess patients and direct questions to infection prevention professionals. Analyzing the types of calls received helped tailor messaging to frontline staff.Funding: NoneDisclosures: None

scholarly journals 421. Effect of SARs-Cov-2 mRNA Vaccination in Healthcare Workers with Household COVID Exposure

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S311-S311
Author(s):  
Laura Selby ◽  
Richard Starlin
Keyword(s):  
Healthcare Workers ◽  
Screening Program ◽  
Medical Center ◽  
Severe Disease ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Limited Data ◽  
Viral Shedding ◽  
Academic Medical ◽  
Significant Burden

Abstract Background Healthcare workers have experienced a significant burden of COVID-19 disease. COVID mRNA vaccines have shown great efficacy in prevention of severe disease and hospitalization due to COVID infection, but limited data is available about acquisition of infection and asymptomatic viral shedding. Methods Fully vaccinated healthcare workers at a tertiary-care academic medical center in Omaha Nebraska who reported a household exposure to COVID-19 infection are eligible for a screening program in which they are serially screened with PCR but allowed to work if negative on initial test and asymptomatic. Serial screening by NP swab was completed every 5-7 days, and workers became excluded from work if testing was positive or became symptomatic. Results Of the 94 employees who were fully vaccinated at the time of the household exposure to COVID-19 infection, 78 completed serial testing and were negative. Sixteen were positive on initial or subsequent screening. Vaccine failure rate of 17.0% (16/94). Healthcare workers exposed to household COVID positive contact Conclusion High risk household exposures to COVID-19 infection remains a significant potential source of infections in healthcare workers even after workers are fully vaccinated with COVID mRNA vaccines especially those with contact to positive domestic partners. Disclosures All Authors: No reported disclosures

scholarly journals An innovative resident-driven mortality case review curriculum to teach and drive system-based practice improvements in the United States

2018 ◽  
Vol 15 ◽  
pp. 31
Author(s):  
Nila S. Radhakrishnan ◽  
Margaret C. Lo ◽  
Rohit Bishnoi ◽  
Subhankar Samal ◽  
Robert Leverence ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Systems Of Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The United States ◽  
Case Review ◽  
Failure To Rescue ◽  
Internal Medicine Residents ◽  
Mortality Case

Purpose: Traditionally, the morbidity and mortality conference (M&MC) is a forum where possible medical errors are discussed. Although M&MCs can facilitate identification of opportunities for systemwide improvements, few studies have described their use for this purpose, particularly in residency training programs. This paper describes the use of M&MC case review as a quality improvement activity that teaches system-based practice and can engage residents in improving systems of care. Methods: Internal medicine residents at a tertiary care academic medical center reviewed 347 consecutive mortalities from March 2014 to September 2017. The residents used case review worksheets to categorize and track causes of mortality, and then debriefed with a faculty member. Selected cases were then presented at a larger interdepartmental meeting and action items were implemented. Descriptive statistics and thematic analysis were used to analyze the results. Results: The residents identified a possible diagnostic mismatch at some point from admission to death in 54.5% of cases (n= 189) and a possible need for improved management in 48.0% of cases. Three possible management failure themes were identified, including failure to plan, failure to communicate, and failure to rescue, which accounted for 21.9%, 10.7 %, and 10.1% of cases, respectively. Following these reviews, quality improvement initiatives proposed by residents led to system-based changes. Conclusion: A resident-driven mortality review curriculum can lead to improvements in systems of care. This novel type of curriculum can be used to teach system-based practice. The recruitment of teaching faculty with expertise in quality improvement and mortality case analyses is essential for such a project.

Interactive iBook-Based Patient Education in a NeuroTrauma Clinic

Neurosurgery ◽  
2017 ◽  
Vol 81 (5) ◽  
pp. 787-794 ◽  
Author(s):  
Ronald Sahyouni ◽  
Amin Mahmoodi ◽  
Amir Mahmoodi ◽  
Ramin R Rajaii ◽  
Bima J Hasjim ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Educational Interventions ◽  
The United States ◽  
Outpatient Setting ◽  
Educational Material ◽  
Patient Knowledge ◽  
Academic Medical ◽  
Baseline Knowledge

Abstract BACKGROUND Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Educational interventions may alleviate the burden of TBI for patients and their families. Interactive modalities that involve engagement with the educational material may enhance patient knowledge acquisition when compared to static text-based educational material. OBJECTIVE To determine the effects of educational interventions in the outpatient setting on self-reported patient knowledge, with a focus on iPad-based (Apple, Cupertino, California) interactive modules. METHODS Patients and family members presenting to a NeuroTrauma clinic at a tertiary care academic medical center completed a presurvey assessing baseline knowledge of TBI or concussion, depending on the diagnosis. Subjects then received either an interactive iBook (Apple) on TBI or concussion, or an informative pamphlet with identical information in text format. Subjects then completed a postsurvey prior to seeing the neurosurgeon. RESULTS All subjects (n = 152) significantly improved on self-reported knowledge measures following administration of either an iBook (Apple) or pamphlet (P < .01, 95% confidence interval [CI]). Subjects receiving the iBook (n = 122) performed significantly better on the postsurvey (P < .01, 95% CI), despite equivalent presurvey scores, when compared to those receiving pamphlets (n = 30). Lastly, patients preferred the iBook to pamphlets (P < .01, 95% CI). CONCLUSION Educational interventions in the outpatient NeuroTrauma setting led to significant improvement in self-reported measures of patient and family knowledge. This improved understanding may increase compliance with the neurosurgeon's recommendations and may help reduce the potential anxiety and complications that arise following a TBI.

Healthcare Workers' Knowledge and Attitudes About Pertussis and Pertussis Vaccination

2007 ◽  
Vol 28 (11) ◽  
pp. 1284-1289 ◽  
Author(s):  
William P. Goins ◽  
William Schaffner ◽  
Kathryn M. Edwards ◽  
Thomas R. Talbot
Keyword(s):  
Pertussis Vaccine ◽  
Healthcare Workers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Significant Risk ◽  
Direct Patient Care ◽  
Knowledge And Attitudes ◽  
Personal Recommendation ◽  
To Receive

Objective.To determine knowledge and attitudes about pertussis and pertussis vaccination among healthcare workers (HCWs).Design.Self-administered, Web-based survey.Setting.Tertiary-care academic medical center.Participants.Medical center employees who participated in direct patient care were recruited to complete the survey through institutional e-mail.Results.Of 14,893 potentially eligible employees, 1,819 (12%) completed the survey. Most respondents (87%) did not plan to receive the pertussis vaccine. Intent to receive vaccination (which included recent history of vaccination) was associated with the following 4 factors: receipt of a physician recommendation for vaccination (odds ratio [OR], 9.01), awareness of Centers for Disease Control and Prevention recommendations for pertussis vaccination for HCWs (OR, 6.89), receipt of encouragement to be vaccinated from a coworker (OR, 4.72), the belief that HCWs may spread pertussis to patients and family (OR, 1.80). Two factors were negatively associated with intent to receive vaccination: the presence of children in the HCW's home (OR, 0.69) and employment as a nurse (OR, 0.59). Reasons cited by those who did not intend to receive vaccination included lack of a personal recommendation for vaccination (78%), receipt of vaccination as a child (51%), and perception that there was no significant risk for contracting pertussis (38%).Conclusions.Of the HCWs surveyed, only 13% intended to receive the pertussis vaccine. A perceived lack of recommendation for vaccination and inaccurate conceptions about pertussis and pertussis vaccination were cited as reasons HCWs did not intend to be vaccinated. Institutional pertussis vaccination campaigns should focus on the risks of healthcare-associated pertussis and new recommendations for pertussis vaccination.

scholarly journals A Pragmatic Machine Learning Model to Predict Carbapenem Resistance

2021 ◽  
Author(s):  
Ryan J. McGuire ◽  
Sean C. Yu ◽  
Philip R. O. Payne ◽  
Albert M. Lai ◽  
M. Cristina Vazquez-Guillamet ◽  
...  
Keyword(s):  
Machine Learning ◽  
Predictive Value ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
The United States ◽  
Gradient Boosting ◽  
Negative Case ◽  
Extreme Gradient Boosting

Infection caused by carbapenem resistant (CR) organisms is a rising problem in the United States. While the risk factors for antibiotic resistance are well known, there remains a large need for the early identification of antibiotic resistant infections. Using machine learning (ML), we sought to develop a prediction model for carbapenem resistance. All patients >18 years of age admitted to a tertiary-care academic medical center between Jan 1, 2012 and Oct 10, 2017 with ≥1 bacterial culture were eligible for inclusion. All demographic, medication, vital sign, procedure, laboratory, and culture/sensitivity data was extracted from the electronic health record. Organisms were considered CR if a single isolate was reported as intermediate or resistant. CR and non-CR patients were temporally matched to maintain positive/negative case ratio. Extreme gradient boosting was used for model development. In total, 68,472 patients met inclusion criteria with 1,088 CR patients identified. Sixty-seven features were used for predictive modeling. The most important features were number of prior antibiotic days, recent central venous catheter placement, and inpatient surgery. After model training, the area under the receiver operating characteristic curve was 0.846. The sensitivity of the model was 30%, with a positive predictive value (PPV) of 30% and a negative predictive value of 99%. Using readily available clinical data, we were able to create a ML model capable of predicting CR infections at the time of culture collection with a high PPV.

scholarly journals 493. Clinical and Epidemiological Features of Healthcare Workers Detected with Coronavirus Disease

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S313-S313
Author(s):  
Melissa Campbell ◽  
Rupak Datta ◽  
Anne Wyllie ◽  
Arnau Casanovas-Massana ◽  
Ryan Handoko ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Healthcare Workers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Severity Of Illness ◽  
Face Mask ◽  
Health Department ◽  
Nasopharyngeal Swab ◽  
Symptom Screening ◽  
Healthcare Associated

Abstract Background Data early in the SARS-CoV-2 pandemic suggested frontline healthcare workers (HCW) may account for 10–20% of all infections. CDC estimated 600,000 infections in HCWs. Symptom screening is a strategy to prevent healthcare-associated transmission. This method may not identify asymptomatic or pre-symptomatic carriers. Methods We conducted a prospective cohort study in asymptomatic or minimally symptomatic healthcare workers in a 1541-bed academic medical center. Although recruitment began in designated COVID-19 units, we expanded to all HCWs providing care to hospitalized patients during the pandemic. Data was gathered on demographics, work area in the hospital and daily questionnaires were sent listing symptoms of SARS-CoV-2. Protocol included twice weekly self-collected nasopharyngeal swab and saliva for SARS-CoV-2 N1 and N2.Those with positive PCR result, underwent telephone survey to assess symptomatology and severity of illness. Results A total 525 HCWs began the study protocol and 16 were identified as PCR positive. Samples included concordant saliva and NP samples on 9 (56%), exclusively NP samples on 5 (31%) and 2 (12%) HCWs were positive by saliva PCR only. Majority were female, and all were nursing staff; with 19% reported not working in a designated COVID-19 unit. During the course of this active surveillance, universal masking was mandated in the institution. Rhinorrhea and headache were reported by 6 (38%), 5 (31%) reported cough and 3 (19%) developed myalgia. Changes in smell and taste preceded the positive PCR test in 2 (12%). One HCW reported developing a fever with acute illness. All were notified about their PCR positive status by institution’s occupational health department and self-isolated to monitor for symptoms. Conclusion The spectrum of disease in this HCW cohort is similar to mild disease in the community. Due to high incidence of asymptomatic or mildly symptomatic HCWs, active surveillance with routine testing proves be beneficial to prevent hospital transmission of SARS-CoV-2. Universal masking significantly decreased the HCW positive rate in our study, underscoring the need for universal efforts to mitigate healthcare-associated transmission with self-monitoring, face mask use, and other infection prevention behaviors like hand hygiene. Disclosures All Authors: No reported disclosures

Use of airborne infection isolation in potential cases of pulmonary tuberculosis

2020 ◽  
Vol 41 (5) ◽  
pp. 505-509 ◽  
Author(s):  
James H. England ◽  
Daniel W. Byrne ◽  
Bryan D. Harris ◽  
Thomas R. Talbot
Keyword(s):  
United States ◽  
Pulmonary Tuberculosis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Risk Groups ◽  
The United States ◽  
Pulmonary Tb ◽  
Airborne Infection ◽  
Academic Medical

AbstractObjective:To identify risk factors of patients placed in airborne infection isolation (AII) for possible pulmonary tuberculosis (TB) to better predict TB diagnosis and allow more judicious use of AII.Methods:Case-control, retrospective study at a single tertiary-care academic medical center. The study included all adult patients admitted from October 1, 2014, through October 31, 2017, who were placed in AII for possible pulmonary TB. Cases were defined as those ultimately diagnosed with pulmonary TB. Controls were defined as those not diagnosed with pulmonary TB. Those with TB diagnosed prior to admission were excluded. In total, 662 admissions (558 patients) were included.Results:Overall, 15 cases of pulmonary TB were identified (2.7%); of these, 2 were people living with human immunodeficiency virus (HIV; PLWH). Statistical analysis was limited by low case number. Those diagnosed with pulmonary TB were more likely to have been born outside the United States (53% vs 13%; P < .001) and to have had prior positive TB testing, regardless of prior treatment (50% vs 19%; P = .015). A multivariate analysis using non–US birth and prior positive TB testing predicted an 18.2% probability of pulmonary TB diagnosis when present, compared with 1.0% if both factors were not present.Conclusions:The low number of pulmonary TB cases indicated AII overuse, especially in PLWH, and more judicious use of AII is warranted. High-risk groups, including those born outside the United States and those with prior positive TB testing, should be considered for AII in the appropriate clinical setting.

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