Reduction in the Incidence of Clostridium difficile-Associated Diarrhea in an Acute Care Hospital and a Skilled Nursing Facility following Replacement of Electronic Thermometers with Single-Use Disposables

1992 ◽  
Vol 13 (2) ◽  
pp. 98-103 ◽  
Author(s):  
Steven E. Brooks ◽  
Rebecca O. Veal ◽  
Martin Kramer ◽  
Laura Dore ◽  
Nicole Schupf ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Acute Care ◽  
Skilled Nursing Facility ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Single Use ◽  
Clostridium Difficile Associated Diarrhea

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 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

A Comprehensive Assessment Across the Healthcare Continuum: Risk of Hospital-Associated Clostridium difficile Infection Due to Outpatient and Inpatient Antibiotic Exposure

2015 ◽  
Vol 36 (12) ◽  
pp. 1409-1416 ◽  
Author(s):  
Sara Y. Tartof ◽  
Gunter K. Rieg ◽  
Rong Wei ◽  
Hung Fu Tseng ◽  
Steven J. Jacobsen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Southern California ◽  
Skilled Nursing Facility ◽  
Antibiotic Exposure ◽  
Kaiser Permanente ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Transfer Factors ◽  
Adjusted Risk

BACKGROUNDLimitations in sample size, overly inclusive antibiotic classes, lack of adjustment of key risk variables, and inadequate assessment of cases contribute to widely ranging estimates of risk factors for Clostridium difficile infection (CDI).OBJECTIVETo incorporate all key CDI risk factors in addition to 27 antibiotic classes into a single comprehensive model.DESIGNRetrospective cohort study.SETTINGKaiser Permanente Southern California.PATIENTSMembers of Kaiser Permanente Southern California at least 18 years old admitted to any of its 14 hospitals from January 1, 2011, through December 31, 2012.METHODSHospital-acquired CDI cases were identified by polymerase chain reaction assay. Exposure to major outpatient antibiotics (10 classes) and those administered during inpatient stays (27 classes) was assessed. Age, sex, self-identified race/ethnicity, Charlson Comorbidity Score, previous hospitalization, transfer from a skilled nursing facility, number of different antibiotic classes, statin use, and proton pump inhibitor use were also assessed. Poisson regression estimated adjusted risk of CDI.RESULTSA total of 401,234 patients with 2,638 cases of incident CDI (0.7%) were detected. The final model demonstrated highest CDI risk associated with increasing age, exposure to multiple antibiotic classes, and skilled nursing facility transfer. Factors conferring the most reduced CDI risk were inpatient exposure to tetracyclines and first-generation cephalosporins, and outpatient macrolides.CONCLUSIONSAlthough type and aggregate antibiotic exposure are important, the factors that increase the likelihood of environmental spore acquisition should not be underestimated. Operationally, our findings have implications for antibiotic stewardship efforts and can inform empirical and culture-driven treatment approaches.Infect. Control Hosp. Epidemiol. 2015;36(12):1409–1416

scholarly journals Racial Disparities in 30-Day Outcomes Following Index Admission for COVID-19

2021 ◽  
Vol 8 ◽  
Author(s):  
Vivek Nimgaonkar ◽  
Jeffrey C. Thompson ◽  
Lauren Pantalone ◽  
Tessa Cook ◽  
Despina Kontos ◽  
...  
Keyword(s):  
Racial Disparities ◽  
Acute Care ◽  
Odds Ratio ◽  
Skilled Nursing Facility ◽  
Index Admission ◽  
Composite Outcome ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Black Patients ◽  
Post Acute Care

We investigated racial disparities in a 30-day composite outcome of readmission and death among patients admitted across a 5-hospital health system following an index COVID-19 admission. A dataset of 1,174 patients admitted between March 1, 2020 and August 21, 2020 for COVID-19 was retrospectively analyzed for odds of readmission among Black patients compared to all other patients, with sequential adjustment for demographics, index admission characteristics, type of post-acute care, and comorbidities. Tabulated results demonstrated a significantly greater odds of 30-day readmission or death among Black patients (18.0% of Black patients vs. 11.3% of all other patients; Univariate Odds Ratio: 1.71, p = 0.002). Sequential adjustment via logistic regression revealed that the odds of 30-day readmission or death were significantly greater among Black patients after adjustment for demographics, index admission characteristics, and type of post-acute care, but not comorbidities. Stratification by type of post-acute care received on discharge revealed that the same disparity in odds of 30-day readmission or death existed among patients discharged home without home services, but not those discharged to home with home services or to a skilled nursing facility or acute rehab facility. Collectively, the findings suggest that weighing comorbidity burdens in post-acute care decisions may be relevant in addressing racial disparities in 30-day outcomes following discharge from an index COVID-19 admission.

scholarly journals Outcomes of Patients With Cancer Discharged to a Skilled Nursing Facility After Acute Care Hospitalization

2020 ◽  
Vol 18 (7) ◽  
pp. 856-865
Author(s):  
Sarguni Singh ◽  
Megan Eguchi ◽  
Sung-Joon Min ◽  
Stacy Fischer
Keyword(s):  
Acute Care ◽  
Skilled Nursing Facility ◽  
Home Healthcare ◽  
Categorical Variables ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Patients With Cancer ◽  
Patient Goals ◽  
Patient Groups ◽  
To Receive

Background: After discharge from an acute care hospitalization, patients with cancer may choose to pursue rehabilitative care in a skilled nursing facility (SNF). The objective of this study was to examine receipt of anticancer therapy, death, readmission, and hospice use among patients with cancer who discharge to an SNF compared with those who are functionally able to discharge to home or home with home healthcare in the 6 months after an acute care hospitalization. Methods: A population-based cohort study was conducted using the SEER-Medicare database of patients with stage II–IV colorectal, pancreatic, bladder, or lung cancer who had an acute care hospitalization between 2010 and 2013. A total of 58,770 cases were identified and patient groups of interest were compared descriptively using means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Logistic regression was used to compare patient groups, adjusting for covariates. Results: Of patients discharged to an SNF, 21%, 17%, and 2% went on to receive chemotherapy, radiotherapy, and targeted chemotherapy, respectively, compared with 54%, 28%, and 6%, respectively, among patients discharged home. Fifty-six percent of patients discharged to an SNF died within 6 months of their hospitalization compared with 36% discharged home. Thirty-day readmission rates were 29% and 28% for patients discharged to an SNF and home, respectively, and 12% of patients in hospice received <3 days of hospice care before death regardless of their discharge location. Conclusions: Patients with cancer who discharge to an SNF are significantly less likely to receive subsequent oncologic treatment of any kind and have higher mortality compared with patients who discharge to home after an acute care hospitalization. Further research is needed to understand and address patient goals of care before discharge to an SNF.

Sign in / Sign up

Export Citation Format

Share Document