Clostridium difficileOutbreak Strain BI Is Highly Endemic in Chicago Area Hospitals

2011 ◽  
Vol 32 (9) ◽  
pp. 897-902 ◽  
Author(s):  
Stephanie R. Black ◽  
Kingsley N. Weaver ◽  
Roderick C. Jones ◽  
Kathleen A. Ritger ◽  
Laurica A. Petrella ◽  
...  
Keyword(s):  
Severe Disease ◽  
Restriction Endonuclease Analysis ◽  
Term Care ◽  
Healthcare Facilities ◽  
Chicago Area ◽  
Crude Mortality Rate ◽  
Crude Mortality ◽  
Endemic Strain ◽  
Acute Healthcare

Objective.Describe the clinical and molecular epidemiology of incidentClostridium difficileinfection (CDI) cases in Chicago area acute healthcare facilities (HCFs).Design and Setting.Laboratory, clinical, and epidemiologic information was collected for patients with incident CDI who were admitted to acute HCFs in February 2009. Stool cultures and restriction endonuclease analysis typing of the recoveredC. difficileisolates was performed.Patients.Two hundred sixty-three patients from 25 acute HCFs.Results.Acute HCF rates ranged from 2 to 7 patients with CDI per 10,000 patient-days. The crude mortality rate was 8%, with 20 deaths occurring in patients with CDI. Forty-two (16%) patients had complications from CDI, including 4 patients who required partial, subtotal, or total colectomy, 3 of whom died.C. difficilewas isolated and typed from 129 of 178 available stool specimens. The BI strain was identified in 79 (61%) isolates. Of patients discharged to long-term care who had their isolate typed, 36 (67%) had BI-associated CDI.Conclusions.Severe disease was common and crude mortality was substantial among patients with CDI in Chicago area acute HCFs in February 2009. The outbreak-associated BI strain was the predominant endemic strain identified, accounting for nearly two-thirds of cases. Focal HCF outbreaks were not reported, despite the presence of the BI strain. Transfer of patients between acute and long-term HCFs may have contributed to the high incidence of BI cases in this investigation.

Discharge of pharmaceuticals into municipal sewers from hospitals and long-term care facilities

2012 ◽  
Vol 47 (2) ◽  
pp. 140-152 ◽  
Author(s):  
Muhammad Riaz ul Haq ◽  
Chris Metcalfe ◽  
Hongxia Li ◽  
Wayne Parker
Keyword(s):  
Long Term Care ◽  
Treatment Plant ◽  
Biological Response ◽  
Care Homes ◽  
Pharmaceutically Active Compounds ◽  
Term Care ◽  
Healthcare Facilities ◽  
Antibiotic Compounds ◽  
Composite Samples

The presence of pharmaceutically active compounds in the aquatic environment has become well established, and their presence is of potential concern because they are designed to produce biological response in the target receptor, may bear intrinsic toxicity (e.g. cytostatic agents, antibiotics) and they possess the potential to foster and maintain drug resistance. For both risk assessment and risk management purposes, it is important to identify the major sources of pharmaceuticals in the environment. Healthcare facilities may be major sources of the discharges of these compounds into municipal sewers. In this study, we investigated the contributions to the wastewater treatment plant (WWTP) influents from two hospitals and two long-term care homes of nine compounds. Twenty-four hour composite samples were collected over 5 consecutive days from the effluents of these facilities. The WWTPs receiving sewage from these facilities were also sampled on the same days to facilitate mass balance calculations. The results showed that the healthcare facilities contributed a greater proportion of the antibiotic compounds to the WWTPs than the other target compounds; with maximum contributions of ciprofloxacin by hospitals and long-term care homes of 26.7 and 37%, respectively.

scholarly journals Role of interleukin 6 as a predictive factor for a severe course of Covid-19: retrospective data analysis of patients from a long-term care facility during Covid-19 outbreak

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
P. Sabaka ◽  
A. Koščálová ◽  
I. Straka ◽  
J. Hodosy ◽  
R. Lipták ◽  
...  
Keyword(s):  
Long Term Care ◽  
Screening Tool ◽  
Severe Disease ◽  
Initial Assessment ◽  
Retrospective Data ◽  
Term Care ◽  
Effective Screening ◽  
Retrospective Data Analysis

Abstract Background Covid-19 is a disease with high morbidity and mortality among elderly residents of long-term care facilities (LTCF). During an outbreak of SARS-CoV-2 infection in the LTCF an effective screening tool is essential to identify the patients at risk for severe disease. We explored the role of interleukin 6 (IL-6) as a predictor for severe disease during the outbreak of Covid-19 in one LTCF in Slovakia. Methods We conducted a retrospective data analysis of cases of COVID-19, diagnosed during the outbreak in one LTCF in Slovakia between April 11, 2020, and May 5, 2020. Within 24 h after the diagnosis of Covid-19, clinical and laboratory screening was performed in the LTCF to identify patients in need of hospitalization. Patients with oxygen saturation below 90% were immediately referred to the hospital. Patients staying in the LFTC were monitored daily and those that developed hypoxemia were transferred to the hospital. We analyzed the association between the IL-6 at the initial assessment and development of hypoxemia during follow up and determined the cut-off of the IL-6 able to predict the development of hypoxemia requiring oxygen therapy. Results Fifty-three patients (11 men, 42 women) with diagnosed Covid-19 were included in the analysis. 19 (53%) patients developed hypoxemia during the disease. Patients with hypoxemia had significantly higher concentrations of IL-6, C-reactive protein, procalcitonin, fibrinogen, total bilirubin, aspartate aminotransferase and alanine aminotransferase at initial screening. ROC analyses identified IL-6 as the most robust predictor of hypoxemia. The concentration of IL-6 > 24 pg/mL predicted the development of hypoxemia with the sensitivity of 100% and specificity of 88.9%. The positive and negative predictive values were 76.9, and 100% respectively. Conclusions The concentration of IL-6 > 24 pg/mL at initial assessment predicted the development of hypoxemia requiring hospitalization with excellent sensitivity and good specificity. IL-6 appears as a potential predictor for the development of the severe Covid-19 and might serve for early identification of patients in need of hospitalization. Further studies are needed to evaluate the robustness of the use of IL-6 as an effective screening tool for the severe course of Covid-19.

scholarly journals Clues To Mortality Trends And Their Related Factors In IgG4-Related Disease: A Japanese Single-Center Retrospective Study

2021 ◽  
Author(s):  
Hiroyuki Kawahara ◽  
Ichiro Mizushima ◽  
Shunsuke Tsuge ◽  
Seung Shin ◽  
Takahiro Yoshinobu ◽  
...  
Keyword(s):  
Cox Regression ◽  
Organ Involvement ◽  
Regression Analyses ◽  
Mortality Trends ◽  
Related Factors ◽  
Crude Mortality Rate ◽  
Crude Mortality ◽  
Long Term Prognosis

Abstract Background: Few observations on the long-term prognosis have been conducted in immunoglobulin G4-related disease (IgG4-RD) patients with various organ involvement, not limited to autoimmune pancreatitis. Especially, mortality and its related factors in patients with IgG4-RD with various organ involvement are not well known. This study aimed to clarify mortality trends and its related factors in IgG4-RD with various organ involvement.Methods: We retrospectively reviewed the medical records of patients with IgG4-RD at a single center in Japan. We calculated the crude mortality rate and the standardized mortality ratio (SMR) using national Japan mortality statistics and investigated the cause of death. We performed Cox regression analyses to assess mortality-related factors.Results: A total of 179 patients with IgG4-RD were included and the median follow-up from diagnosis was 47 months (IQR 19-96). Ten patients (5.6%) in our cohort died during the follow-up period. The crude mortality rate was 11.1 per 1,000 person-years. According to national Japan mortality statistics, 11.6 age- and sex-matched deaths would have been expected to occur within the follow-up period, resulting in an SMR of 0.86 (95% confidence interval [CI] 0.41-1.59). Univariate Cox regression analyses indicated that the number of affected organs at diagnosis (hazard ratio [HR] 1.45, 95% CI 1.02-2.05), eGFR <45 mL/min/1.73m2 at diagnosis (vs. ≥45, HR 8.48, 95% CI 2.42-29.79), and the presence of malignancy during the clinical course (HR 3.93, 95% CI 1.10-14.02) had a significant impact on the time to death.Conclusions: Our findings suggested that IgG4-RD does not significantly affect long-term patient survival. On the other hand, multi-organ involvement and renal dysfunction as well as malignancy might be associated with higher mortality trends in IgG4-RD. Early detection and appropriate management of risk factors may improve the long-term prognosis of IgG4-RD.

scholarly journals Nasal Carriage of Epidemic Methicillin-Resistant Staphylococcus aureus 15 (EMRSA-15) Clone Observed in Three Chicago-Area Long-Term Care Facilities

2013 ◽  
Vol 57 (9) ◽  
pp. 4551-4553 ◽  
Author(s):  
Sanchita Das ◽  
Christopher J. Anderson ◽  
Althea Grayes ◽  
Katherine Mendoza ◽  
Maureen Harazin ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Long Term Care ◽  
The United States ◽  
Health Concern ◽  
Term Care ◽  
Methicillin Resistant ◽  
Content Type ◽  
Chicago Area ◽  
Care Facilities

ABSTRACTThe spread of pandemic methicillin-resistantStaphylococcus aureus(MRSA) clones such as USA300 and EMRSA-15 is a global health concern. As a part of a surveillance study of three long-term care facilities in the Greater Chicago area, phenotypic and molecular characterization of nasal MRSA isolates was performed. We report a cluster of pandemic EMRSA-15, an MRSA clone rarely reported from the United States, detected during this study.

scholarly journals The Niche for Escherichia coli Sequence Type 131 Among Veterans: Urinary Tract Abnormalities and Long-Term Care Facilities

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Dimitri M. Drekonja ◽  
Michael A. Kuskowski ◽  
Ruth Anway ◽  
Brian D. Johnston ◽  
James R. Johnson
Keyword(s):  
Escherichia Coli ◽  
Long Term Care ◽  
Severe Disease ◽  
Care Facility ◽  
Epidemiological Data ◽  
Initial Therapy ◽  
Sequence Type ◽  
Term Care ◽  
E Coli

Abstract Background.  Antimicrobial resistance among Escherichia coli is increasing, driven largely by the global emergence of sequence type 131 (ST131). However, the clinical significance of ST131 status is unknown. Among veterans, we assessed whether ST131 causes more severe, persistent, or recurrence-prone infections than non-ST131 E. coli. Methods.  Isolates were assessed by polymerase chain reaction for membership in ST131 and relevant subclones thereof (H30R and H30Rx) and by broth microdilution for susceptibility to 11 antibiotics. Clinical and epidemiological data were systematically abstracted from the medical record. Between-group comparisons were made using t tests and Fisher's exact test. Results.  Of the 311 unique E. coli isolates, 61 (19.6%) represented ST131. Of these, most (51 of 61, 83.6%) represented the H30R subclone; only 5 of 51 (9.8%) represented H30Rx. Relative to non-ST131 and non-H30R isolates, neither ST131 nor H30R were associated with more severe disease, worse clinical outcomes, or more robust hosts. Instead, both were more likely to be isolated from patients without manifestations of infection (for ST131, 36.1% vs 21.2% [P = .02]; for H30R, 39% vs 21% [P = .008]) and who had prior healthcare contact or long-term care facility (LTCF) exposure (for ST131, 33% vs 14% [P = .002]; for H30R, 37% vs 14% [P &lt; .001]). Despite a greater likelihood of discordant initial therapy, outcomes did not differ between ST131 and H30R isolates vs other E. coli isolates. Conclusions.  Among veterans, ST131 and its H30R subclone were associated with LTCF-exposed hosts but not with worse outcomes.

scholarly journals Exploring work engagement in the context of person-centred practices: a qualitative study in municipal long-term care facilities for older people

2021 ◽  
Vol 11 (2) ◽  
pp. 1-17
Author(s):  
Hilde Hovda Midje ◽  
◽  
Kjell Ivar Øvergård ◽  
Steffen Torp ◽  
◽  
...  
Keyword(s):  
Older People ◽  
Work Engagement ◽  
Social Group ◽  
Group Process ◽  
Long Term Care ◽  
Theory And Practice ◽  
Meaning Of Work ◽  
Term Care ◽  
Healthcare Facilities

Background: To provide high-quality and cost-effective person-centred care, organisations need employees who are committed to perform at their best. Employee work engagement, defined as a positive, fulfilling approach to work, is known to correlate favourably with employee wellbeing and performance and with the service climate. Extended understanding about the meaning of work engagement can promote the development of environments that are both conducive to person-centred practices and good places to work. Aim: To explore the meaning of work engagement in the context of person-centred practices in municipal healthcare facilities for older people. Methods: A total of 16 individual interviews were conducted with a purposive sample of registered nurses and nursing assistants working in municipal healthcare facilities for older people in Norway. Data were analysed using a stepwise-deductive-inductive approach. Findings were generated inductively from the themes that emerged in the interviews and were later reflected on in relation to both theory and practice. Findings: Work engagement is manifest at individual and collective levels, involving intrapersonal, interpersonal and social/group components. Engagement is experienced as contributing to employee work capacity and team effectiveness with respect to person-centred processes. Conclusion: At individual, collective and environmental levels, employee engagement facilitates the development of person-centred practices in organisations providing long-term care for older people, to the benefit of residents and staff. Implications for practice: • Work engagement should be recognised as a condition that fosters employees’ ability and willingness to suspend judgment and appreciate the service user’s perspective • Individual-level engagement is contagious, facilitating development of supportive work environments, which, in turn, enables person-centred practices • Engagement should be approached simultaneously as an intrapersonal, interpersonal, and social/group process, with individual- and group-level outcomes

scholarly journals Rapid antigen testing as a reactive response to surges in nosocomial SARS-CoV-2 outbreak risk

2022 ◽  
Vol 13 (1) ◽  
Author(s):  
David R. M. Smith ◽  
Audrey Duval ◽  
Jean Ralph Zahar ◽  
Niels Hendrickx ◽  
Kévin Jean ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Economic Benefits ◽  
Care Hospital ◽  
Rt Pcr ◽  
Term Care ◽  
Healthcare Facilities ◽  
Containment Measures ◽  
Transmission Prevention ◽  
Antigen Testing

AbstractHealthcare facilities are vulnerable to SARS-CoV-2 introductions and subsequent nosocomial outbreaks. Antigen rapid diagnostic testing (Ag-RDT) is widely used for population screening, but its health and economic benefits as a reactive response to local surges in outbreak risk are unclear. We simulate SARS-CoV-2 transmission in a long-term care hospital with varying COVID-19 containment measures in place (social distancing, face masks, vaccination). Across scenarios, nosocomial incidence is reduced by up to 40-47% (range of means) with routine symptomatic RT-PCR testing, 59-63% with the addition of a timely round of Ag-RDT screening, and 69-75% with well-timed two-round screening. For the latter, a delay of 4-5 days between the two screening rounds is optimal for transmission prevention. Screening efficacy varies depending on test sensitivity, test type, subpopulations targeted, and community incidence. Efficiency, however, varies primarily depending on underlying outbreak risk, with health-economic benefits scaling by orders of magnitude depending on the COVID-19 containment measures in place.

Post-discharge mortality in patients hospitalized with MRSA infection and/or colonization

2012 ◽  
Vol 141 (6) ◽  
pp. 1187-1198 ◽  
Author(s):  
A. SHARMA ◽  
C. ROGERS ◽  
D. RIMLAND ◽  
C. STAFFORD ◽  
S. SATOLA ◽  
...  
Keyword(s):  
Medical Center ◽  
Veterans Affairs ◽  
Post Discharge ◽  
Healthcare Settings ◽  
Crude Mortality Rate ◽  
Crude Mortality ◽  
Mrsa Infection ◽  
Independent Risk Factors ◽  
Long Term Mortality

SUMMARYMethicillin-resistantStaphylococcus aureus(MRSA) infection is known to increase in-hospital mortality, but little is known about its association with long-term health. Two hundred and thirty-seven deaths occurred among 707 patients with MRSA infection at the time of hospitalization and/or nasal colonization followed for almost 4 years after discharge from the Atlanta Veterans Affairs Medical Center, USA. The crude mortality rate in patients with an infection and colonization (23·57/100 person-years) was significantly higher than the rate in patients with only colonization (15·67/100 person-years,P = 0·037). MRSA infection, hospitalization within past 6 months, and histories of cancer or haemodialysis were independent risk factors. Adjusted mortality rates in patients with infection were almost twice as high compared to patients who were only colonized: patients infected and colonized [hazard ratio (HR) 1·93, 95% confidence interval (CI) 1·31–2·84]; patients infected but not colonized (HR 1·96, 95% CI 1·22–3·17). Surviving MRSA infection adversely affects long-term mortality, underscoring the importance of infection control in healthcare settings.

scholarly journals Coronavirus Disease 2019 (COVID-19) Infections Among Healthcare Workers, Los Angeles County, February–May 2020

2020 ◽  
Author(s):  
Stacy Hartmann ◽  
Zachary Rubin ◽  
Heidi Sato ◽  
Kelsey O Yong ◽  
Dawn Terashita ◽  
...  
Keyword(s):  
Los Angeles ◽  
Healthcare Workers ◽  
Los Angeles County ◽  
Infectious Period ◽  
Risk Of Infection ◽  
Term Care ◽  
Healthcare Facilities ◽  
Patient Interviews ◽  
The Impact

Abstract Across the world, healthcare workers (HCW) are at a greater risk of infection by coronavirus disease 2019 (COVID-19) due to the nature of their work. The Los Angeles County Department of Public Health (LAC DPH) set out to understand the impact of COVID-19 on healthcare facilities and HCWs by tracking and analyzing data from case-patient interviews of HCWs. As of 31 May, over 3 months into the pandemic, nearly 5500 positive HCWs were reported to LAC DPH, representing 9.6% of all cases. Cases reported working in 27 different setting types, including outpatient medical offices, correctional facilities, emergency medical services, and so forth, with the highest proportion from long-term care facilities (46.6%) and hospitals (27.7%). Case patients included both clinical and nonclinical roles, with nearly half (49.4%) of positive HCWs being nurses. Over two-thirds of HCWs (68.6%) worked at some point during their infectious period, and nearly half (47.9%) reported a known exposure to a positive patient and/or coworker within their facility. Overall, compared to all LAC cases, HCWs reported lower rates of hospitalization (5.3% vs 12.2%) and death (0.7% vs 4.3%) from COVID-19. There are many factors that increase HCWs risk of infection, including high-risk work environment, limited supply of personal protective equipment, and even pressure to help and work during a pandemic. In response to these data, LAC DPH created resources and provided guidance for healthcare facilities to best protect their patients and staff during the COVID-19 pandemic.

scholarly journals Canine-Assisted Therapy Improves Well-Being in Nurses

2019 ◽  
Vol 16 (19) ◽  
pp. 3670 ◽  
Author(s):  
Kristýna Machová ◽  
Michaela Součková ◽  
Radka Procházková ◽  
Zdislava Vaníčková ◽  
Kamal Mezian
Keyword(s):  
Well Being ◽  
Working Process ◽  
Term Care ◽  
Healthcare Facilities ◽  
Salivary Cortisol Level ◽  
Cortisol Levels ◽  
Condition C ◽  
Low Cortisol ◽  
Female Nurses

As nursing is one of the most stressful occupations worldwide, its management warrants more attention to identify possible ways to cope with its pressures. This study aims to evaluate whether animal-assisted therapy (AAT) with the presence of a dog affects the stress level of nurses. As a stress biomarker, we used salivary cortisol level testing. Twenty female nurses (mean age: 30) in physical medicine (PMR) (n = 11) and the department of internal medicine and long-term care (IM < C) (n = 9). On each of the three observed days, saliva was collected at 10 a.m. and then again after 50 min. The first sampling was performed during a normal working process without a break (Condition A), the second was carried out during a normal working process with a break of choice (Condition B), and the third sampling was performed during a normal working process with a break with AAT (Condition C). All participants were enrolled in all three interventional conditions in a randomized order. The results demonstrated the effect of a reduction of cortisol levels in Condition C, where AAT was included (p = 0.02) only in nurses recruited from the IM < C department. By way of explanation, nurses from the PMR department already showed low cortisol levels at baseline. We propose including AAT with a dog in healthcare facilities where nurses are at a high risk of stress.

Sign in / Sign up

Export Citation Format

Share Document