Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-8 (of 8 Records) |
Query Trace: Gaynes R[original query] |
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Stopping Hospital Infections with Environmental Services (shine): A cluster-randomized trial of intensive monitoring methods for terminal room cleaning on rates of multidrug-resistant organisms in the intensive care unit
Ziegler MJ , Babcock HH , Welbel SF , Warren DK , Trick WE , Tolomeo P , Omorogbe J , Garcia D , Habrock-Bach T , Donceras O , Gaynes S , Cressman L , Burnham JP , Bilker W , Reddy SC , Pegues D , Lautenbach E , Kelly BJ , Fuchs B , Martin ND , Han JH . Clin Infect Dis 2022 75 (7) 1217-1223 BACKGROUND: Multidrug-resistant organisms (MDROs) frequently contaminate hospital environments. We performed a multicenter, cluster-randomized, crossover trial of two methods for monitoring of terminal cleaning effectiveness. METHODS: Six intensive care units (ICUs) at three medical centers received both interventions sequentially, in randomized order. Ten surfaces were surveyed each in five rooms weekly, after terminal cleaning, with ATP monitoring or an ultraviolet fluorescent marker (UV/F). Results were delivered to environmental services staff in real-time with failing surfaces recleaned. We measured monthly rates of MDRO infection or colonization, including methicillin-resistant Staphylococcus aureus, Clostridioides difficile, vancomycin-resistant Enterococcus, and MDR gram-negative bacilli (MDR-GNB) during a 12-month baseline period and sequential 6-month intervention periods, separated by a 2-month washout. Primary analysis compared only the randomized intervention periods, while secondary analysis included the baseline. RESULTS: The ATP method was associated with a reduction in incidence rate of MDRO infection or colonization compared to the UV/F period (incidence rate ratio (IRR) 0.876, 95% confidence-interval (CI) 0.807 - 0.951, P=0.002). Including the baseline period, the ATP method was associated with reduced infection with MDROs (IRR 0.924, 95% CI 0.855 - 0.998, P=0.04), and MDR-GNB infection or colonization (IRR 0.856, 95% CI 0.825 - 0.887, P<0.001). The UV/F intervention was not associated with a statistically significant impact on these outcomes. Room turn-around time increased by a median of one minute with the ATP intervention and 4.5 minutes with UV/F compared to baseline. CONCLUSIONS: Intensive monitoring of ICU terminal room cleaning with an ATP modality is associated with a reduction of MDRO infection and colonization. |
Longitudinal analysis of depressive symptoms, perceived social support, and alcohol use among HIV-infected men who inject drugs in Northern Vietnam
Hershow RB , Gottfredson NC , Ha TV , Chu VA , Lancaster KE , Quan VM , Levintow SN , Sripaipan T , Gaynes BN , Pence BW , Go VF . Subst Use Misuse 2020 55 (8) 1-9 Background: Limited research examines depressive symptoms, alcohol use, and social support among HIV-infected people who inject drugs. Objectives: Using longitudinal data, we investigated whether perceived social support moderates the relationship between depressive symptoms and alcohol use among HIV-infected men who inject drugs in Vietnam. Methods: Data were collected from participants (N = 455; mean age 35 years) in a four-arm randomized controlled trial in Thai Nguyen, Vietnam. Data were collected at baseline, 6, 12, 18, and 24 months with 94% retention excluding dead (N = 103) or incarcerated (N = 37) participants. Multilevel growth models were used to assess whether: (1) depressive symptoms predict when risk of alcohol use is elevated (within-person effects); (2) depressive symptoms predict who is at risk for alcohol use (between-person effects); and (3) within- and between-person perceived social support moderates the depressive symptoms-alcohol relationship. Results: Participants reported high but declining levels of depressive symptoms and alcohol use. Participants with higher depressive symptoms drank less on average (B = -0.0819, 95% CI -0.133, -0.0307), but within-person, a given individual was more likely to drink when they were feeling more depressed than usual (B = 0.136, 95% CI 0.0880, 0.185). The positive relationship between within-person depressive symptoms and alcohol use grew stronger at higher levels of within-person perceived social support. Conclusions: HIV-infected men who inject drugs have increased alcohol use when they are experiencing higher depressive symptoms than usual, while those with higher average depressive symptoms over time report less alcohol use. Social support strengthens the positive relationship between within-person depressive symptoms and alcohol use. |
Duration of colonization with methicillin-resistant Staphylococcus aureus in an acute care facility: a study to assess epidemiologic features
Rogers C , Sharma A , Rimland D , Stafford C , Jernigan J , Satola S , Crispell E , Gaynes R . Am J Infect Control 2014 42 (3) 249-53 BACKGROUND: Patients with a history of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection are often presumed to remain colonized when they are readmitted to the hospital. This assumption underlies the hospital practice that flags MRSA-positive patients so that these patients can be placed in contact isolation at hospital admission and, when necessary, be given the appropriate empirical therapy and/or antibiotic prophylaxis. METHODS: To determine the duration of and factors associated with MRSA colonization among patients following discharge, we designed a cohort study of patients hospitalized between October 1, 2007, and July 31, 2009, at the Atlanta Veterans Affairs Medical Center, a 128-bed acute care facility. We defined 3 cohorts: cohort A; patients with both a MRSA infection during hospitalization and nasal colonization at discharge; cohort B; patients with a MRSA infection but no nasal colonization at discharge; and cohort C; patients only nasally colonized at discharge. We collected information on demographic characteristics, underlying conditions, infections, and antibiotic use. We cultured nasal swabs obtained from patients at home. We calculated hazard ratios (HR), comparing cohorts A, B, and C after controlling for other factors. RESULTS: We obtained 231 swabs (23 in cohort A, 34 in cohort B, and 174 in cohort C). We documented MRSA colonization in 92 (39.9%) of the 231 patients who returned swabs. The median duration of colonization was 33.3 months. Factors significantly associated with persistent MRSA colonization were (1) total duration of hospital stay from previous admissions prior to study entry and (2) a member of cohort A who had a longer duration of colonization compared with cohorts B and C (P < .001). CONCLUSION: Our data suggest that higher initial inocula of bacteria may be an important determinant of persistent colonization with MRSA. |
Methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in residents of Veterans Affairs long-term care facilities: role of antimicrobial exposure and MRSA acquisition
Stone ND , Lewis DR , Johnson TM 2nd , Hartney T , Chandler D , Byrd-Sellers J , McGowan JE Jr , Tenover FC , Jernigan JA , Gaynes RP . Infect Control Hosp Epidemiol 2012 33 (6) 551-7 OBJECTIVE: To identify risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) acquisition in long-term care facility (LTCF) residents. DESIGN: Multicenter, prospective cohort followed over 6 months. SETTING: Three Veterans Affairs (VA) LTCFs. Participants. All current and new residents except those with short stay (<2 weeks). METHODS: MRSA carriage was assessed by serial nares cultures and classified into 3 groups: persistent (all cultures positive), intermittent (at least 1 but not all cultures positive), and noncarrier (no cultures positive). MRSA acquisition was defined by an initial negative culture followed by more than 2 positive cultures with no subsequent negative cultures. Epidemiologic data were collected to identify risk factors, and MRSA isolates were typed by pulsed-field gel electrophoresis (PFGE). RESULTS: Among 412 residents at 3 LTCFs, overall MRSA prevalence was 58%, with similar distributions of carriage at all 3 facilities: 20% persistent, 39% intermittent, 41% noncarriers. Of 254 residents with an initial negative swab, 25 (10%) acquired MRSA over the 6 months; rates were similar at all 3 LTCFs, with no clusters evident. Multivariable analysis demonstrated that receipt of systemic antimicrobials during the study was the only significant risk factor for MRSA acquisition (odds ratio, 7.8 [95% confidence interval, 2.1-28.6]; [Formula: see text]). MRSA strains from acquisitions were related by PFGE to those from a roommate in 9/25 (36%) cases; 6 of these 9 roommate sources were persistent carriers. CONCLUSIONS: MRSA colonization prevalence was high at 3 separate VA LTCFs. MRSA acquisition was strongly associated with antimicrobial exposure. Roommate sources were often persistent carriers, but transmission from roommates accounted for only approximately one-third of MRSA acquisitions. |
Nursing home-associated infections in Department of Veterans Affairs community living centers
Tsan L , Langberg R , Davis C , Phillips Y , Pierce J , Hojlo C , Gibert C , Gaynes R , Montgomery O , Bradley S , Danko L , Roselle G . Am J Infect Control 2010 38 (6) 461-6 BACKGROUND: Little is known about factors contributing to nursing home-associated infections (NHAIs). We conducted a survey of residents in 133 Department of Veterans Affairs community living centers to determine the roles of indwelling device use, bed locations, and treatment codes on NHAIs. METHODS: A Web-based point prevalence survey of NHAIs using modified Centers for Disease Control and Prevention definitions for health care-associated infections was conducted on November 14, 2007. RESULTS: Among 10,939 residents, 575 had at least one NHAI, for a point prevalence rate of 5.3%. Urinary tract infection, skin infection, asymptomatic bacteriuria, and pneumonia were the most prevalent NHAIs. A total of 2687 residents had one or more indwelling devices; 290 of these also had an NHAI, for a prevalence of 10.8%. In contrast, the prevalence of NHAIs in residents without indwelling devices was 3.5% (P < .0001). Indwelling urinary catheters, percutaneous gastrostomy tubes, peripherally inserted central catheters, and suprapubic urinary catheters were the most commonly used devices. There were 4027 residents in designated units and 6912 residents in dispersed units. The rate of device use was 21.4% in the designated units and 26.4% in the dispersed units (P < .0001). The prevalence of NHAIs was 4.5% in the designated units and 5.7% in the dispersed units (P < .001). Rates of NHAIs and device use varied greatly among the various treatment codes; however, there was a positive correlation between the rates of NHAIs and device use. Stepwise logistic regression analysis of data from long-stay and short-stay skilled nursing care residents revealed that only the presence of an indwelling device, not length of stay or bed location, affected the rate of NHAIs. CONCLUSION: Indwelling device use, but not bed location or treatment code, was found to be associated with increased rate of NHAIs. |
Hospitalization earlier than 1 year prior to admission as an additional risk factor for methicillin-resistant Staphylococcus aureus colonization
McAllister L , Gaynes RP , Rimland D , McGowan Jr JE . Infect Control Hosp Epidemiol 2010 31 (5) 538-40 Our case-control study sought to identify risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission among patients with no known healthcare-related risk factors. We found that patients whose most recent hospitalization occurred greater than 1 year before their current hospital admission were more likely to have MRSA colonization. In addition, both the time that elapsed since the most recent hospitalization and the duration of that hospitalization affected risk. |
Influenza vaccination rates among healthcare workers in the Department of Veterans Affairs community living centers
Tsan L , Langberg R , Gibert C , Davis C , Hojlo C , Pierce J , Phillips Y , Gaynes R , Montgomery O , Danko L , Roselle G . Infect Control Hosp Epidemiol 2009 31 (2) 191-2 Vaccination is the primary means to prevent influenza, limit | transmission, and reduce complications from influenza in | long-term care facilities.1 | The Centers for Disease Control | and Prevention recommend annual influenza vaccination for | all residents of long-term care facilities and for all healthcare | workers (HCWs) who have contact with residents and visitors.2 | However, despite the Centers for Disease Control and | Prevention's recommendation, on average, less than 40% of | HCWs receive influenza vaccination each year.3 | The National | Healthy People 2010 goal for annual influenza vaccination | coverage of HCWs in long-term care facilities is 60%." | The Department of Veterans Affairs (VA), with 133 community living centers (formerly called nursing home care | units), is the largest single provider of nursing home care in | the United States. Annual influenza vaccination is provided | free of charge to all residents and HCWs of VA community | living centers. Here, we report the influenza vaccination rates | among HCWs at VA community living centers during the | 2006 and 2007 influenza seasons. |
A multicenter study on optimizing piperacillin-tazobactam use: lessons on why interventions fail
Gaynes RP , Gould CV , Edwards J , Antoine TL , Blumberg HM , Desilva K , King M , Kraman A , Pack J , Ribner B , Seybold U , Steinberg J , Jernigan JA . Infect Control Hosp Epidemiol 2009 30 (8) 794-6 We examined interventions to optimize piperacillin-tazobactam use at 4 hospitals. Interventions for rotating house staff did not affect use. We could target empiric therapy in only 35% of cases. Because prescribing practices seemed to be institution specific, interventions should address attitudes of local prescribers. Interventions should target empiric therapy and ordering of appropriate cultures. |
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