Last data update: May 06, 2024. (Total: 46732 publications since 2009)
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Query Trace: Cardo D[original query] |
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Principles of health equity science for public health action
Burton DC , Kelly A , Cardo D , Daskalakis D , Huang DT , Penman-Aguilar A , Raghunathan PL , Zhu BP , Bunnell R . Public Health Rep 2023 333549231213162 Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health, and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.1 Science is a cornerstone of public health and central to efforts to achieve health equity. Science designed to generate knowledge to advance equity can improve population health and promote health for all members of society.2 In contrast, science and interventions not designed and implemented with equity in mind may inadvertently perpetuate or widen disparities, even while fostering overall improvements in population health.3 | Health equity science provides a conceptual framework for scientific endeavors that are designed and conducted to advance health equity.4 Health equity science investigates patterns and underlying contributors to health inequities and builds an evidence base that can guide action across the domains of the public health program, surveillance, policy, communication, and scientific inquiry to move toward eliminating, rather than simply documenting, inequities. | Building on extensive work in developing the importance and application of equity concepts in public health practice,5-7 we describe an equity-focused scientific framework and set of principles to guide public health efforts to fulfill the health equity mission of the Centers for Disease Control and Prevention (CDC).8 |
Contribution of PEPFAR-supported HIV and TB molecular diagnostic networks to COVID-19 testing preparedness in 16 countries
Romano ER , Sleeman K , Hall-Eidson P , Zeh C , Bhairavabhotla R , Zhang G , Adhikari A , Alemnji G , Cardo YR , Pinheiro A , Pocongo B , Eno LT , Shang JD , Ndongmo CB , Rosario H , Moreno O , DeLen LAC , Fonjungo P , Kabwe C , Ahuke-Mundeke S , Gama D , Dlamini S , Maphalala G , Abreha T , Purfield A , Gebrehiwot YT , Desalegn DM , Basiye F , Mwangi J , Bowen N , Mengistu Y , Lecher S , Kampira E , Kaba M , Bitilinyu-Bangoh J , Masamha G , Viegas SO , Beard RS , vanRooyen G , Shiningavamwe AN , I JM , Iriemenam NC , Mba N , Okoi C , Katoro J , Kenyi DL , Bior BK , Mwangi C , Nabadda S , Kaleebu P , Yingst SL , Chikwanda P , Veri L , Simbi R , Alexander H . Emerg Infect Dis 2022 28 (13) S59-s68 The US President's Emergency Plan for AIDS Relief (PEPFAR) supports molecular HIV and tuberculosis diagnostic networks and information management systems in low- and middle-income countries. We describe how national programs leveraged these PEPFAR-supported laboratory resources for SARS-CoV-2 testing during the COVID-19 pandemic. We sent a spreadsheet template consisting of 46 indicators for assessing the use of PEPFAR-supported diagnostic networks for COVID-19 pandemic response activities during April 1, 2020, to March 31, 2021, to 27 PEPFAR-supported countries or regions. A total of 109 PEPFAR-supported centralized HIV viral load and early infant diagnosis laboratories and 138 decentralized HIV and TB sites reported performing SARS-CoV-2 testing in 16 countries. Together, these sites contributed to >3.4 million SARS-CoV-2 tests during the 1-year period. Our findings illustrate that PEPFAR-supported diagnostic networks provided a wide range of resources to respond to emergency COVID-19 diagnostic testing in 16 low- and middle-income countries. |
Health Care Safety during the Pandemic and Beyond - Building a System That Ensures Resilience.
Fleisher LA , Schreiber M , Cardo D , Srinivasan A . N Engl J Med 2022 386 (7) 609-611 For about two decades, the U.S. health care system was making strides in improving patient safety, as demonstrated by the reduction of health care–associated infections and other complications of care.1 Though there was still room for improvement, the trends were certainly in the right direction. Since the Covid-19 pandemic began, however, many indicators make it clear that health care safety has declined. The public health emergency has put enormous stress on the health care system and disrupted many normal activities in hospitals and other facilities. Unfortunately, these stressors have caused safety problems for both patients and staff. Managing the competing priorities of providing care for large numbers of patients with Covid, as well as for the patients without Covid who need care every day, and of maintaining safety efforts such as robust infection-control practices is both difficult and essential. |
Sex differences in HIV testing - 20 PEPFAR-supported sub-Saharan African Countries, 2019
Drammeh B , Medley A , Dale H , De AK , Diekman S , Yee R , Aholou T , Lasry A , Auld A , Baack B , Duffus W , Shahul E , Wong V , Grillo M , Al-Samarrai T , Ally S , Nyangulu M , Nyirenda R , Olivier J , Chidarikire T , Khanyile N , Kayange AA , Rwabiyago OE , Kategile U , Bisimba J , Weber RA , Ncube G , Maguwu O , Pietersen I , Mali D , Dzinotyiweyi E , Nelson L , Bosco MJ , Dalsone K , Apolot M , Anangwe S , Soo LK , Mugambi M , Mbayiha A , Mugwaneza P , Malamba SS , Phiri A , Chisenga T , Boyd M , Temesgan C , Shimelis M , Weldegebreal T , Getachew M , Balachandra S , Eboi E , Shasha W , Doumatey N , Adjoua D , Meribe C , Gwamna J , Gado P , John-Dada I , Mukinda E , Lukusa LFK , Kalenga L , Bunga S , Achyut V , Mondi J , Loeto P , Mogomotsi G , Ledikwe J , Ramphalla P , Tlhomola M , Mirembe JK , Nkwoh T , Eno L , Bonono L , Honwana N , Chicuecue N , Simbine A , Malimane I , Dube L , Mirira M , Mndzebele P , Frawley A , Cardo YMR , Behel S . MMWR Morb Mortal Wkly Rep 2020 69 (48) 1801-1806 Despite progress toward controlling the human immunodeficiency virus (HIV) epidemic, testing gaps remain, particularly among men and young persons in sub-Saharan Africa (1). This observational study used routinely collected programmatic data from 20 African countries reported to the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) from October 2018 to September 2019 to assess HIV testing coverage and case finding among adults (defined as persons aged ≥15 years). Indicators included number of HIV tests conducted, number of HIV-positive test results, and percentage positivity rate. Overall, the majority of countries reported higher HIV case finding among women than among men. However, a slightly higher percentage positivity was recorded among men (4.7%) than among women (4.1%). Provider-initiated counseling and testing (PITC) in health facilities identified approximately two thirds of all new cases, but index testing had the highest percentage positivity in all countries among both sexes. Yields from voluntary counseling and testing (VCT) and mobile testing varied by sex and by country. These findings highlight the need to identify and implement the most efficient strategies for HIV case finding in these countries to close coverage gaps. Strategies might need to be tailored for men who remain underrepresented in the majority of HIV testing programs. |
Implementation research for the prevention of antimicrobial resistance and healthcare-associated infections; 2017 Geneva infection prevention and control (IPC)-think tank (part 1)
Zingg W , Storr J , Park BJ , Ahmad R , Tarrant C , Castro-Sanchez E , Tomczyk S , Kilpatrick C , Allegranzi B , Cardo D , Pittet D . Antimicrob Resist Infect Control 2019 8 87 Background: Around 5-15% of all hospital patients worldwide suffer from healthcare-associated infections (HAIs), and years of excessive antimicrobial use in human and animal medicine have created emerging antimicrobial resistance (AMR). A considerable amount of evidence-based measures have been published to address these challenges, but the largest challenge seems to be their implementation. Methods: In June 2017, a total of 42 experts convened at the Geneva IPC-Think Tank to discuss four domains in implementation science: 1) teaching implementation skills; 2) fostering implementation of IPC and antimicrobial stewardship (AMS) by policy making; 3) national/international actions to foster implementation skills; and 4) translational research bridging social sciences and clinical research in infection prevention and control (IPC) and AMR. Results: Although neglected in the past, implementation skills have become a priority in IPC and AMS. They should now be part of any curriculum in health care, and IPC career paths should be created. Guidelines and policies should be aligned with each other and evidence-based, each document providing a section on implementing elements of IPC and AMS in patient care. International organisations should be advocates for IPC and AMS, framing them as patient safety issues and emphasizing the importance of implementation skills. Healthcare authorities at the national level should adopt a similar approach and provide legal frameworks, guidelines, and resources to allow better implementation of patient safety measures in IPC and AMS. Rather than repeating effectiveness studies in every setting, we should invest in methods to improve the implementation of evidence-based measures in different healthcare contexts. For this, we need to encourage and financially support collaborations between social sciences and clinical IPC research. Conclusions: Experts of the 2017 Geneva Think Tank on IPC and AMS, CDC, and WHO agreed that sustained efforts on implementation of IPC and AMS strategies are required at international, country, and hospital management levels, to provide an adequate multimodal framework that addresses (not exclusively) leadership, resources, education and training for implementing IPC and AMS. Future strategies can build on this agreement to make strategies on IPC and AMS more effective. |
Technology for the prevention of antimicrobial resistance and healthcare-associated infections; 2017 Geneva IPC-Think Tank (Part 2).
Zingg W , Park BJ , Storr J , Ahmad R , Tarrant C , Castro-Sanchez E , Perencevich E , Widmer A , Krause KH , Kilpatrick C , Tomczyk S , Allegranzi B , Cardo D , Pittet D . Antimicrob Resist Infect Control 2019 8 83 Background: The high burden of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) is partially due to excessive antimicrobial use both in human and animal medicine worldwide. How can technology help to overcome challenges in infection prevention and control (IPC) and to prevent HAI and emerging AMR? Methods: In June 2017, 42 international experts convened in Geneva, Switzerland to discuss four potential domains of technology in IPC and AMR: 1) role and potential contribution of microbiome research; 2) whole genome sequencing; 3) effectiveness and benefit of antimicrobial environmental surfaces; and 4) future research in hand hygiene. Results: Research on the microbiome could expand understanding of antimicrobial use and also the role of probiotics or even faecal transplantation for therapeutic purposes. Whole genome sequencing will provide new insights in modes of transmission of infectious diseases. Although it is a powerful tool for public health epidemiology, some challenges with interpretation and costs still need to be addressed. The effectiveness and cost-effectiveness of antimicrobially coated or treated environmental high-touch surfaces requires further research before they can be recommended for routine use. Hand hygiene implementation can be advanced, where technological enhancement of surveillance, technique and compliance are coupled with reminders for healthcare professionals. Conclusions: The four domains of technological innovation contribute to the prevention of HAI and AMR at different levels. Microbiome research may offer innovative concepts for future prevention, whole genome sequencing could detect new modes of transmission and become an additional tool for effective public health epidemiology, antimicrobial surfaces might help to decrease the environment as source of transmission but continue to raise more questions than answers, and technological innovation may have a role in improving surveillance approaches and supporting best practice in hand hygiene. |
Broadening the infection prevention and control network globally; 2017 Geneva IPC-think tank (part 3)
Zingg W , Storr J , Park BJ , Jernigan JA , Harbarth S , Grayson ML , Tacconelli E , Allegranzi B , Cardo D , Pittet D . Antimicrob Resist Infect Control 2019 8 (1) 74 Background: Healthcare-associated infection (HAI) is a major challenge for patient safety worldwide, and is further complicated by antimicrobial resistance (AMR) due to excessive antimicrobial use in both humans and animals. Existing infection prevention and control (IPC) networks must be strengthened and adapted to better address the global challenges presented by emerging AMR. Methods: In June 2017, 42 international experts convened in Geneva, Switzerland, to discuss two key areas for strengthening the global IPC network: 1) broadening collaboration in IPC; and 2) how to bring the fields IPC and AMR control together. Results: The US Centers for Disease Prevention and Control, the European Centre for Disease Prevention and Control, and the World Health Organization (WHO) convened together with international experts to discuss collaboration and networks, demonstrating the participating organizations' commitment to close collaboration in IPC. The challenge of emerging AMR can only be addressed by strengthening this collaboration across international organisations and between public health and academia. The WHO SAVE LIVES: Clean Your Hands initiative is an example of a successful collaboration between multiple global stakeholders including academia and international public health organisations; it can be used as a model. IPC-strategies are included within the four pillars to combat AMR: surveillance, IPC, antimicrobial and diagnostic stewardship, research and development. The prevention of transmission of multidrug-resistant microorganisms is a patient safety issue, and must be strengthened in the fight against AMR. Conclusions: The working group determined that international organisations should take the lead in creating new networks, which will in turn attract academia and other stakeholders to join. At the same time, they should invest in bringing existing IPC and AMR networks under one umbrella. Transmission of multidrug-resistant microorganisms in hospitals and in the community threatens the success of antimicrobial stewardship programmes, and thus, research and development in IPC should be addressed as an enhanced global priority. |
Vital Signs: Epidemiology and recent trends in methicillin-resistant and in methicillin-susceptible Staphylococcus aureus bloodstream infections - United States
Kourtis AP , Hatfield K , Baggs J , Mu Y , See I , Epson E , Nadle J , Kainer MA , Dumyati G , Petit S , Ray SM , Ham D , Capers C , Ewing H , Coffin N , McDonald LC , Jernigan J , Cardo D . MMWR Morb Mortal Wkly Rep 2019 68 (9) 214-219 INTRODUCTION: Staphylococcus aureus is one of the most common pathogens in health care facilities and in the community, and can cause invasive infections, sepsis, and death. Despite progress in preventing methicillin-resistant S. aureus (MRSA) infections in health care settings, assessment of the problem in both health care and community settings is needed. Further, the epidemiology of methicillin-susceptible S. aureus (MSSA) infections is not well described at the national level. METHODS: Data from the Emerging Infections Program (EIP) MRSA population surveillance (2005-2016) and from the Premier and Cerner Electronic Health Record databases (2012-2017) were analyzed to describe trends in incidence of hospital-onset and community-onset MRSA and MSSA bloodstream infections and to estimate the overall incidence of S. aureus bloodstream infections in the United States and associated in-hospital mortality. RESULTS: In 2017, an estimated 119,247 S. aureus bloodstream infections with 19,832 associated deaths occurred. During 2005-2012 rates of hospital-onset MRSA bloodstream infection decreased by 17.1% annually, but the decline slowed during 2013-2016. Community-onset MRSA declined less markedly (6.9% annually during 2005-2016), mostly related to declines in health care-associated infections. Hospital-onset MSSA has not significantly changed (p = 0.11), and community-onset MSSA infections have slightly increased (3.9% per year, p<0.0001) from 2012 to 2017. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Despite reductions in incidence of MRSA bloodstream infections since 2005, S. aureus infections account for significant morbidity and mortality in the United States. To reduce the incidence of these infections further, health care facilities should take steps to fully implement CDC recommendations for prevention of device- and procedure-associated infections and for interruption of transmission. New and novel prevention strategies are also needed. |
Vital Signs: Containment of novel multidrug-resistant organisms and resistance mechanisms - United States, 2006-2017
Woodworth KR , Walters MS , Weiner LM , Edwards J , Brown AC , Huang JY , Malik S , Slayton RB , Paul P , Capers C , Kainer MA , Wilde N , Shugart A , Mahon G , Kallen AJ , Patel J , McDonald LC , Srinivasan A , Craig M , Cardo DM . MMWR Morb Mortal Wkly Rep 2018 67 (13) 396-401 BACKGROUND: Approaches to controlling emerging antibiotic resistance in health care settings have evolved over time. When resistance to broad-spectrum antimicrobials mediated by extended-spectrum beta-lactamases (ESBLs) arose in the 1980s, targeted interventions to slow spread were not widely promoted. However, when Enterobacteriaceae with carbapenemases that confer resistance to carbapenem antibiotics emerged, directed control efforts were recommended. These distinct approaches could have resulted in differences in spread of these two pathogens. CDC evaluated these possible changes along with initial findings of an enhanced antibiotic resistance detection and control strategy that builds on interventions developed to control carbapenem resistance. METHODS: Infection data from the National Healthcare Safety Network from 2006-2015 were analyzed to calculate changes in the annual proportion of selected pathogens that were nonsusceptible to extended-spectrum cephalosporins (ESBL phenotype) or resistant to carbapenems (carbapenem-resistant Enterobacteriaceae [CRE]). Testing results for CRE and carbapenem-resistant Pseudomonas aeruginosa (CRPA) are also reported. RESULTS: The percentage of ESBL phenotype Enterobacteriaceae decreased by 2% per year (risk ratio [RR] = 0.98, p<0.001); by comparison, the CRE percentage decreased by 15% per year (RR = 0.85, p<0.01). From January to September 2017, carbapenemase testing was performed for 4,442 CRE and 1,334 CRPA isolates; 32% and 1.9%, respectively, were carbapenemase producers. In response, 1,489 screening tests were performed to identify asymptomatic carriers; 171 (11%) were positive. CONCLUSIONS: The proportion of Enterobacteriaceae infections that were CRE remained lower and decreased more over time than the proportion that were ESBL phenotype. This difference might be explained by the more directed control efforts implemented to slow transmission of CRE than those applied for ESBL-producing strains. Increased detection and aggressive early response to emerging antibiotic resistance threats have the potential to slow further spread. |
The power of policy change, federal collaboration and state coordination in HAI prevention
Srinivasan A , Craig M , Cardo D . Clin Infect Dis 2012 55 (3) 426-31 Policymakers have prioritized the prevention of healthcare-associated infections (HAIs) as a double-win that can both improve health outcomes and reduce healthcare costs. In the past few years, state and federal policymakers have developed policies to improve coordination and promote transparency and prevention. At the federal level, Congressional oversight, policy directives, and targeted funding have helped focus national HAI prevention efforts through the "Department of Health and Human Services (HHS) Action Plan to Prevent Healthcare-Associated Infections." The development of this Action Plan and the collaboration of its implementing agencies -- the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS), and the Agency for Healthcare Research and Quality (AHRQ) - has heightened nationwide awareness of HAIs and their preventability, and provided an infrastructure and tools to reduce HAIs. State policymakers have also acted to promote local transparency and tailor prevention efforts to local needs. The collaboration and action generated by these state and federal efforts have helped accelerate HAI prevention across the United States. |
A research framework for reducing preventable patient harm
Pronovost PJ , Cardo DM , Goeschel CA , Berenholtz SM , Saint S , Jernigan JA . Clin Infect Dis 2011 52 (4) 507-13 Programs to reduce central line-associated bloodstream infections (CLABSIs) have improved the safety of hospitalized patients. Efforts are underway to disseminate these successes broadly to reduce other types of hospital-acquired infectious and noninfectious preventable harms. Unfortunately, the ability to broadly measure and prevent other types of preventable harms, especially infectious harms, needs enhancement. Moreover, an overarching research framework for creating and integrating evidence will help expedite the development of national prevention programs. This article outlines a 5-phase translational (T) framework to develop robust research programs that reduce preventable harm, as follows: phase T0, discover opportunities and approaches to prevent adverse health care events; phase T1, use T0 discoveries to develop and test interventions on a small scale; phase T2, broaden and strengthen the evidence base for promising interventions to develop evidence-based guidelines; phase T3, translate guidelines into clinical practice; and phase T4, implement and evaluate T3 work on a national and international scale. Policy makers should use this framework to fill in the knowledge gaps, coordinate efforts among federal agencies, and prioritize research funding. |
Moving toward elimination of healthcare-associated infections: a call to action
Cardo D , Dennehy PH , Halverson P , Fishman N , Kohn M , Murphy CL , Whitley RJ , Brennan PJ , Bright J , Curry C , Graham D , Haerum B , Kainer M , Kaye K , Lundstrom T , Richards C , Tomlinson L , Skillen EL , Streed S , Young M , Septimus E . Infect Control Hosp Epidemiol 2010 31 (11) 1101-5 Jointly, the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the Association of State and Territorial Health Officials (ASTHO), the Council of State and Territorial Epidemiologists (CSTE), Pediatric Infectious Diseases Society (PIDS), and the Centers for Disease Control and Prevention (CDC) propose a call to action to move toward the elimination of healthcare-associated infections (HAIs) by adapting the concept and plans used for the elimination of other diseases, including infections. Elimination, as defined for other infectious diseases, is the maximal reduction of “the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts; continued measures to prevent reestablishment of transmission are required.” (p24) This definition has been useful for elimination efforts directed toward polio, tuberculosis, and syphilis and can be readily adapted to HAIs. Sustained elimination of HAIs can be based on this public health model of constant action and vigilance. Elimination will require the implementation of evidence-based practices, the alignment of financial incentives, the closing of knowledge gaps, and the acquisition of information to assess progress and to enable response to emerging threats. These efforts must be under-pinned by substantial research investments, the development of novel prevention tools, improved organizational and personal accountabilities, strong collaboration among a broad coalition of public and private stakeholders, and a clear national will to succeed in this arena. |
Prevention of community-associated methicillin-resistant staphylococcus aureus infection among Asian/Pacific Islanders: a qualitative assessment
Ciccarone RM , Kim M , Tice AD , Nakata M , Effler P , Jernigan DB , Cardo DM , Sinkowitz-Cochran RL . Hawaii Med J 2010 69 (6) 142-4 BACKGROUND: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has been increasingly reported over the past decade, including in Asian/Pacific Islanders (A/PIs). METHODS: We conducted ethnographic interviews in Oahu and Kauai, Hawaii, with 10 Asian/Pacific Islanders identified as having a history of CA-MRSA infections. RESULTS: Most (7/10) thought skin infections were not a new problem in Hawaii. Most (8/9) attempted to self-treat the infection prior to seeking medical care with a range of home remedies and store- bought solutions. Most respondents did not initially comprehend the severity of their infection and only sought medical treatment after concern from family, unbearable pain, and/or other symptoms of illness. CONCLUSION: Clinicians should be aware of the reportedly frequent use of home remedies by this population, as it may potentially contribute to interactions when treatments are combined. If clinicians and public health professionals do not address perceptions and misperceptions of how MRSA is acquired, it will be very difficult to prevent infection, and may also delay individuals from seeking treatment. |
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