Last data update: May 28, 2024. (Total: 46864 publications since 2009)
Records 1-15 (of 15 Records) |
Query Trace: Keaton A [original query] |
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The role of stroke care infrastructure on the effectiveness of a hub-and-spoke telestroke model in South Carolina
Srinivasan M , Scott A , Soo J , Sreedhara M , Popat S , Beasley KL , Jackson TN , Abbas A , Keaton WA , Holmstedt C , Harvey J , Kruis R , McLeod S , Ahn R . J Stroke Cerebrovasc Dis 2024 107702 OBJECTIVE: To examine the relationship between stroke care infrastructure and stroke quality-of-care outcomes at 29 spoke hospitals participating in the <name concealed for blinding purposes> hub-and-spoke telestroke network. MATERIALS AND METHODS: Encounter-level data from <name concealed for blinding purposes> telestroke patient registry were filtered to include encounters during 2015-2022 for patients aged 18 and above with a clinical diagnosis of acute ischemic stroke, and who received intravenous tissue plasminogen activator. Unadjusted and adjusted generalized estimating equations assessed associations between time-related stroke quality-of-care metrics captured during the encounter and the existence of the two components of stroke care infrastructure-stroke coordinators and stroke center certifications-across all hospitals and within hospital subgroups defined by size and rurality. RESULTS: Telestroke encounters at spoke hospitals with stroke coordinators and stroke center certifications were associated with shorter door-to-needle (DTN) times (60.9 min for hospitals with both components and 57.3 min for hospitals with one, vs. 81.2 min for hospitals with neither component, p <.001). Similar patterns were observed for the percentage of encounters with DTN time of ≤60 min (63.8% and 68.9% vs. 32.0%, p <.001) and ≤45 min (34.0% and 38.4% vs. 8.42%, p <.001). Associations were similar for other metrics (e.g., door-to-registration time), and were stronger for smaller (vs. larger) hospitals and rural (vs. urban) hospitals. CONCLUSIONS: Stroke coordinators or stroke center certifications may be important for stroke quality of care, especially at spoke hospitals with limited resources or in rural areas. |
Containment of a Verona integron-encoded metallo-beta-lactamase-producing pseudomonas aeruginosa outbreak associated with an acute care hospital sink-Tennessee, 2018-2020
Chan A , Thure K , Tobey K , Shugart A , Schmedes S , Burks JAth , Hardin H , Moore C , Carpenter T , Brooks S , Gable P , Moulton Meissner H , McAllister G , Lawsin A , Laufer Halpin A , Spalding Walters M , Keaton A . Open Forum Infect Dis 2023 10 (5) ofad194 BACKGROUND: Contaminated healthcare facility wastewater plumbing is recognized as a source of carbapenemase-producing organism transmission. In August 2019, the Tennessee Department of Health (TDH) identified a patient colonized with Verona integron-encoded metallo-beta-lactamase-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA). A record review revealed that 33% (4 of 12) of all reported patients in Tennessee with VIM had history of prior admission to acute care hospital (ACH) A intensive care unit (ICU) Room X, prompting further investigation. METHODS: A case was defined as polymerase chain reaction detection of bla(VIM) in a patient with prior admission to ACH A from November 2017 to November 2020. The TDH performed point prevalence surveys, discharge screening, onsite observations, and environmental testing at ACH A. The VIM-CRPA isolates underwent whole-genome sequencing (WGS). RESULTS: In a screening of 44% (n = 11) of 25 patients admitted to Room X between January and June 2020, we identified 36% (n = 4) colonized with VIM-CRPA, resulting in 8 cases associated with Room X from March 2018 to June 2020. No additional cases were identified in 2 point-prevalence surveys of the ACH A ICU. Samples from the bathroom and handwashing sink drains in Room X grew VIM-CRPA; all available case and environmental isolates were found to be ST253 harboring bla(VIM-1) and to be closely related by WGS. Transmission ended after implementation of intensive water management and infection control interventions. CONCLUSIONS: A single ICU room's contaminated drains were associated with 8 VIM-CRPA cases over a 2-year period. This outbreak highlights the need to include wastewater plumbing in hospital water management plans to mitigate the risk of transmission of antibiotic-resistant organisms to patients. |
Outbreaks of SARS-CoV-2 infections in nursing homes during periods of Delta and Omicron predominance, United States, July 2021-March 2022
Wilson WW , Keaton AA , Ochoa LG , Hatfield KM , Gable P , Walblay KA , Teran RA , Shea M , Khan U , Stringer G , Ganesan M , Gilbert J , Colletti JG , Grogan EM , Calabrese C , Hennenfent A , Perlmutter R , Janiszewski KA , Brandeburg C , Kamal-Ahmed I , Strand K , Donahue M , Ashraf MS , Berns E , MacFarquhar J , Linder ML , Tran DJ , Kopp P , Walker RM , Ess R , Baggs J , Jernigan JA , Kallen A , Hunter JC . Emerg Infect Dis 2023 29 (4) 761-770 SARS-CoV-2 infections among vaccinated nursing home residents increased after the Omicron variant emerged. Data on booster dose effectiveness in this population are limited. During July 2021-March 2022, nursing home outbreaks in 11 US jurisdictions involving >3 infections within 14 days among residents who had received at least the primary COVID-19 vaccine(s) were monitored. Among 2,188 nursing homes, 1,247 outbreaks were reported in the periods of Delta (n = 356, 29%), mixed Delta/Omicron (n = 354, 28%), and Omicron (n = 536, 43%) predominance. During the Omicron-predominant period, the risk for infection within 14 days of an outbreak start was lower among boosted residents than among residents who had received the primary vaccine series alone (risk ratio [RR] 0.25, 95% CI 0.19-0.33). Once infected, boosted residents were at lower risk for all-cause hospitalization (RR 0.48, 95% CI 0.40-0.49) and death (RR 0.45, 95% CI 0.34-0.59) than primary vaccine-only residents. |
Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) outbreaks in nursing homes involving residents who had completed a primary coronavirus disease 2019 (COVID-19) vaccine series-13 US jurisdictions, July-November 2021.
Wyatt Wilson W , Keaton AA , Ochoa LG , Hatfield KM , Gable P , Walblay KA , Teran RA , Shea M , Khan U , Stringer G , Colletti JG , Grogan EM , Calabrese C , Hennenfent A , Perlmutter R , Janiszewski KA , Kamal-Ahmed I , Strand K , Berns E , MacFarquhar J , Linder M , Tran DJ , Kopp P , Walker RM , Ess R , Read JS , Yingst C , Baggs J , Jernigan JA , Kallen A , Hunter JC . Infect Control Hosp Epidemiol 2023 44 (6) 1-5 Among nursing home outbreaks of coronavirus disease 2019 (COVID-19) with ≥3 breakthrough infections when the predominant severe acute respiratory coronavirus virus 2 (SARS-CoV-2) variant circulating was the SARS-CoV-2 δ (delta) variant, fully vaccinated residents were 28% less likely to be infected than were unvaccinated residents. Once infected, they had approximately half the risk for all-cause hospitalization and all-cause death compared with unvaccinated infected residents. |
Evaluation of a Virtual Training to Enhance Public Health Capacity for COVID-19 Infection Prevention and Control in Nursing Homes.
Penna AR , Hunter JC , Sanchez GV , Mohelsky R , Barnes LEA , Benowitz I , Crist MB , Dozier TR , Elbadawi LI , Glowicz JB , Jones H , Keaton AA , Ogundimu A , Perkins KM , Perz JF , Powell KM , Cochran RL , Stone ND , White KA , Weil LM . J Public Health Manag Pract 2022 28 (6) 682-692 CONTEXT: Between April 2020 and May 2021, the Centers for Disease Control and Prevention (CDC) awarded more than $40 billion to health departments nationwide for COVID-19 prevention and response activities. One of the identified priorities for this investment was improving infection prevention and control (IPC) in nursing homes. PROGRAM: CDC developed a virtual course to train new and less experienced public health staff in core healthcare IPC principles and in the application of CDC COVID-19 healthcare IPC guidance for nursing homes. IMPLEMENTATION: From October 2020 to August 2021, the CDC led training sessions for 12 cohorts of public health staff using pretraining reading materials, case-based scenarios, didactic presentations, peer-learning opportunities, and subject matter expert-led discussions. Multiple electronic assessments were distributed to learners over time to measure changes in self-reported knowledge and confidence and to collect feedback on the course. Participating public health programs were also assessed to measure overall course impact. EVALUATION: Among 182 enrolled learners, 94% completed the training. Most learners were infection preventionists (42%) or epidemiologists (38%), had less than 1 year of experience in their health department role (75%), and had less than 1 year of subject matter experience (54%). After training, learners reported increased knowledge and confidence in applying the CDC COVID-19 healthcare IPC guidance for nursing homes (≥81%) with the greatest increase in performing COVID-19 IPC consultations and assessments (87%). The majority of participating programs agreed that the course provided an overall benefit (88%) and reduced training burden (72%). DISCUSSION: The CDC's virtual course was effective in increasing public health capacity for COVID-19 healthcare IPC in nursing homes and provides a possible model to increase IPC capacity for other infectious diseases and other healthcare settings. Future virtual healthcare IPC courses could be enhanced by tailoring materials to health department needs, reinforcing training through applied learning experiences, and supporting mechanisms to retain trained staff. |
Effectiveness of COVID-19 mRNA vaccines against infection during an outbreak of SARS-CoV-2 Beta (B.1.351) variant in a skilled nursing facility - Virginia, March-April 2021.
Moline HL , Keaton A , Rice W , Varghese J , Deng L , Waters A , Barringer A , Winston D , Fields V , Slifka KJ , Verani JR , Schrag SJ , Jernigan J , Tate JE , Fleming-Dutra KE . Clin Infect Dis 2022 75 S155-S158 In April 2021, we assessed mRNA vaccine effectiveness (VE) in the context of a COVID-19 outbreak in a skilled nursing facility. Among 28 cases, genomic sequencing was performed on four specimens on four different patients, and all were classified by sequence analysis as the Beta (B.1.351) variant. Adjusted VE among residents was 65% (95% Confidence Interval: 25-84%). These findings underscore the importance of vaccination for prevention of COVID-19 in skilled nursing facilities. |
Multistate outbreak of Salmonella mbandaka infections linked to sweetened puffed wheat cereal-United States, 2018
Keaton AA , Schwensohn CA , Brandenburg JM , Pereira E , Adcock B , Tecle S , Hinnenkamp R , Havens J , Bailey K , Applegate B , Whitney P , Gibson D , Manion K , Griffin M , Ritter J , Biskupiak C , Ajileye K , Golwalkar M , Gosciminski M , Viveiros B , Caron G , McCullough L , Smith L , Vidyaprakash E , Doyle M , Hardy C , Elliot EL , Gieraltowski LB . Epidemiol Infect 2022 150 1-14 In May of 2018, PulseNet, the national molecular subtyping network for enteric pathogens, detected a multistate cluster of illnesses caused by an uncommon molecular subtype of Salmonella serovar Mbandaka. A case was defined as an illness in a person infected with the outbreak strain of Salmonella Mbandaka with illness onset on or after 3 March 2018 and before 1 September 2018. One-hundred thirty-six cases from 36 states were identified; 35 hospitalisations and no deaths were reported. Ill people ranged in age from <1 year to 95 years (median: 57 years). When standardised questionnaires did not generate a strong hypothesis, opened-ended interviews were performed. Sixty-three of 84 (75%) ultimately reported consuming or possibly consuming a specific sweetened puffed wheat cereal in the week before illness onset. Environmental sampling performed at the cereal manufacturing facility yielded the outbreak strain. The outbreak strain was also isolated from open cereal samples from ill people's homes and from a sealed retail sample. Due to these findings, the brand owner of the product issued a voluntary recall of the cereal on 14 June 2018. Additional investigation of the manufacturing facility identified persistent environmental contamination with Salmonella Mbandaka that was closely genetically related to other isolates in the outbreak. This investigation highlights the ability of Salmonella to survive in low-moisture environments, and the potential for prolonged outbreaks linked to products with long shelf lives and large distribution areas. |
Clinical outcomes of monoclonal antibody therapy during a COVID-19 outbreak in a skilled nursing facility-Arizona, 2021.
Dale AP , Hudson MJ , Armenta D , Friebus H , Ellingson KD , Davis K , Cullen T , Brady S , Komatsu KK , Stone ND , Uyeki TM , Slifka KJ , Perez-Velez CM , Keaton AA . J Am Geriatr Soc 2022 70 (4) 960-967 BACKGROUND: Adult residents of skilled nursing facilities (SNF) have experienced high morbidity and mortality from SARS-CoV-2 infection and are at increased risk for severe COVID-19 disease. Use of monoclonal antibody (mAb) treatment improves clinical outcomes among high-risk outpatients with mild-to-moderate COVID-19, but information on mAb effectiveness in SNF residents with COVID-19 is limited. We assessed outcomes in SNF residents with mild-to-moderate COVID-19 associated with an outbreak in Arizona during January-February 2021 that did and did not receive a mAb. METHODS: Medical records were reviewed to describe the effect of bamlanivimab therapy on COVID-19 mortality. Secondary outcomes included referral to an acute care setting and escalation of medical therapies at the SNF (e.g., new oxygen requirements). Residents treated with bamlanivimab were compared to residents who were eligible for treatment under the FDA's Emergency Use Authorization (EUA) but were not treated. Multivariable logistic regression was used to determine association between outcomes and treatment status. RESULTS: Seventy-five residents identified with COVID-19 during this outbreak met eligibility for mAb treatment, of whom 56 received bamlanivimab. Treated and untreated groups were similar in age and comorbidities associated with increased risk of severe COVID-19 disease. Treatment with bamlanivimab was associated with reduced 21-day mortality (adjusted OR=0.06; 95% CI: 0.01, 0.39) and lower odds of initiating oxygen therapy (adjusted OR=0.07; 95% CI: 0.02, 0.34). Referrals to acute care were not significantly different between treated and untreated residents. CONCLUSIONS: mAb therapy was successfully administered to SNF residents with COVID-19 in a large outbreak setting. Treatment with bamlanivimab reduced 21-day mortality and reduced initiation of oxygen therapy. As the COVID-19 pandemic evolves and newer immunotherapies gain FDA authorization, more studies of the effectiveness of mAb therapies for treating emerging SARS-CoV-2 variants of concern in high-risk congregate settings are needed. This article is protected by copyright. All rights reserved. |
Evaluating the Presence of Replication-Competent SARS-CoV-2 from Nursing Home Residents with Persistently Positive RT-PCR Results.
Lutgring JD , Tobolowsky FA , Hatfield KM , Lehnertz NB , Sullivan MM , Martin KG , Keaton A , Sexton DJ , Tamin A , Harcourt JL , Thornburg NJ , Reddy SC , Jernigan JA . Clin Infect Dis 2021 74 (3) 525-528 Replication-competent virus has not been detected in individuals with mild to moderate COVID-19 more than 10 days after symptom onset. It is unknown whether these findings apply to nursing home residents. Of 273 specimens collected from nursing home residents >10 days from the initial positive test, none were culture positive. |
Administration of Bamlanivimab to Skilled Nursing Facility Residents During a COVID-19 Outbreak, January-February 2021, Arizona.
Dale AP , Hudson M , Cullen T , Ellingson K , Davis K , Armenta D , Friebus H , Currie C , Bhattarai R , Brady S , Komatsu K , Stone N , Uyeki T , Slifka KJ , Perez-Velez C , Keaton A . J Am Med Dir Assoc 2021 22 (7) 1357-1358 In November 2020, the Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for bamlanivimab, a monoclonal antibody (mAb), for treatment of mild to moderate COVID-19 in nonhospitalized individuals at high risk for severe disease.1 Since that time, several other mAb therapies, either alone or in combination, have also been issued EUA for use in the treatment of mild-to-moderate COVID-19.2 Although COVID-19 poses a high morbidity and mortality risk among older adult residents of long-term care facilities, reports on mAb use in the management of COVID-19 in skilled nursing facilities (SNFs) are limited, and perceived logistical barriers to on-site infusion of the mAb therapy may reduce their use in these settings.3 , 4 This letter describes the use of bamlanivimab during a large SARS-CoV-2 outbreak at a 270-bed SNF (Facility A). |
Identification of substance-exposed newborns and neonatal abstinence syndrome using ICD-10-CM - 15 hospitals, Massachusetts, 2017
Goyal S , Saunders KC , Moore CS , Fillo KT , Ko JY , Manning SE , Shapiro-Mendoza C , Gupta M , Romero L , Coy KC , McDow KB , Keaton AA , Sinatra J , Jones K , Alpren C , Barfield WD , Diop H . MMWR Morb Mortal Wkly Rep 2020 69 (29) 951-955 Opioid use disorder and neonatal abstinence syndrome (NAS) increased in Massachusetts from 1999 to 2013 (1,2). In response, in 2016, the state passed a law requiring birth hospitals to report the number of newborns who were exposed to controlled substances to the Massachusetts Department of Public Health (MDPH)* by mandating monthly reporting of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes related to maternal dependence on opioids (F11.20) or benzodiazepines (F13.20) and to newborns affected by maternal use of drugs of addiction (P04.49) or experiencing withdrawal symptoms from maternal drugs of addiction (P96.1) separately.(†) MDPH uses these same codes for monthly, real-time crude estimates of NAS and uses P96.1 alone for official NAS state reporting.(§) MDPH requested CDC's assistance in evaluating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of either maternal or newborn codes to identify substance-exposed newborns, and of newborn exposure codes (both exposure [P04.49] or withdrawal [P96.1]) and the newborn code for withdrawal alone (P96.1) to identify infants with NAS cases related to three exposure scenarios: 1) opioids, 2) opioids or benzodiazepines, and 3) any controlled substance. Confirmed diagnoses of substance exposure and NAS abstracted from linked clinical records for 1,123 infants born in 2017 and their birth mothers were considered the diagnostic standard and were compared against hospital-reported ICD-10-CM codes. For identifying substance-exposed newborns across the three exposure scenarios, the newborn exposure codes had higher sensitivity (range = 31%-61%) than did maternal drug dependence codes (range = 16%-41%), but both sets of codes had high PPV (≥74%). For identifying NAS, for all exposure scenarios, the sensitivity for either newborn code (P04.49 or P96.1) was ≥92% and the PPV was ≥64%; for P96.1 alone the sensitivity was ≥79% and the PPV was ≥92% for all scenarios. Whereas ICD-10-CM codes are effective for NAS surveillance in Massachusetts, they should be applied cautiously for substance-exposed newborn surveillance. Surveillance for substance-exposed newborns using ICD-10-CM codes might be improved by increasing the use of validated substance-use screening tools and standardized facility protocols and improving communication between patients and maternal health and infant health care providers. |
Cyclosporiasis epidemiologically linked to consumption of green onions: Houston Metropolitan Area, August 2017
Hall NB , Chancey RJ , Keaton AA , Heines V , Cantu V , Vakil V , Long S , Short K , Franciscus E , Wahab N , Gieraltowski L , Straily A . J Food Prot 2020 83 (2) 326-330 During July 2017, Texas public health officials noted an increase in the number of reported cyclosporiasis cases. They detected a cluster in the Houston metropolitan area that involved four locations of a Mediterranean restaurant chain, restaurant A. A case-control study was conducted among patrons of restaurant A to identify a common food vehicle among items containing fresh produce. In matched case-control ingredient-level analyses that included both probable and confirmed cases, consumption of green onions, red onions, tomatoes, and cabbage was significantly associated with illness. A substantial percentage of case patients reported consumption of green onions, and only green onions remained statistically significantly associated with illness, whether probable and confirmed cases were included in analyses (matched odds ratio: 11.3; 95% confidence interval: 2.5 to 104.7), or only confirmed cases were included in analyses (matched odds ratio: 17.6; 95% confidence interval: 2.5 to 775.7). These results provide evidence that green onions were the likely vehicle of infection. It was not possible to trace the green onions to their source due to the need to redirect public health resources to Hurricane Harvey response efforts in Texas. |
Shiga Toxin-Producing E. coli Infections Associated with Romaine Lettuce - United States, 2018.
Bottichio L , Keaton A , Thomas D , Fulton T , Tiffany A , Frick A , Mattioli M , Kahler A , Murphy J , Otto M , Tesfai A , Fields A , Kline K , Fiddner J , Higa J , Barnes A , Arroyo F , Salvatierra A , Holland A , Taylor W , Nash J , Morawski BM , Correll S , Hinnenkamp R , Havens J , Patel K , Schroeder MN , Gladney L , Martin H , Whitlock L , Dowell N , Newhart C , Watkins LF , Hill V , Lance S , Harris S , Wise M , Williams I , Basler C , Gieraltowski L . Clin Infect Dis 2019 71 (8) e323-e330 BACKGROUND: Produce-associated outbreaks of Shiga toxin-producing Escherichia coli (STEC) were first identified in 1991. In April 2018, New Jersey and Pennsylvania officials reported a cluster of STEC O157 infections associated with multiple locations of a restaurant chain. CDC queried PulseNet, the national laboratory network for foodborne disease surveillance, for additional cases and began a national investigation. METHODS: A case was defined as an infection between March 13 and August 22, 2018 with one of the 22 identified outbreak-associated E. coli O157:H7 or E. coli O61 pulsed-field gel electrophoresis pattern combinations, or with a strain STEC O157 that was closely related to the main outbreak strain by whole genome sequencing. We conducted epidemiologic and traceback investigations to identify illness sub-clusters and common sources. An FDA-led environmental assessment, which tested water, soil, manure, compost, and scat samples, was conducted to evaluate potential sources of STEC contamination. RESULTS: We identified 240 case-patients from 37 states; 104 were hospitalized, 28 developed hemolytic uremic syndrome, and five died. Of 179 people who were interviewed, 152 (85%) reported consuming romaine lettuce in the week before illness onset. Twenty sub-clusters were identified. Product traceback from sub-cluster restaurants identified numerous romaine lettuce distributors and growers; all lettuce originated from the Yuma growing region. Water samples collected from an irrigation canal in the region yielded the outbreak strain of STEC O157. CONCLUSION: We report on the largest multistate leafy green-linked STEC O157 outbreak in several decades. The investigation highlights the complexities associated with investigating outbreaks involving widespread environmental contamination. |
Increase in acute flaccid myelitis - United States, 2018
McKay SL , Lee AD , Lopez AS , Nix WA , Dooling KL , Keaton AA , Spence-Davizon E , Herlihy R , Clark TA , Hopkins SE , Pastula DM , Sejvar J , Oberste MS , Pallansch MA , Patel M , Routh JA . MMWR Morb Mortal Wkly Rep 2018 67 (45) 1273-1275 In August 2018, CDC noted an increased number of reports of patients having symptoms clinically compatible with acute flaccid myelitis (AFM), a rare condition characterized by rapid onset of flaccid weakness in one or more limbs and spinal cord gray matter lesions, compared with August 2017. Since 2014, CDC has conducted surveillance for AFM using a standardized case definition (1,2). An Epi-X* notice was issued on August 23, 2018, to increase clinician awareness and provide guidance for case reporting. |
Notes from the field: Cyclosporiasis cases associated with dining at a Mediterranean-style restaurant chain - Texas, 2017
Keaton AA , Hall NB , Chancey RJ , Heines V , Cantu V , Vakil V , Long S , Short K , Franciscus E , Wahab N , Haynie A , Gieraltowski L , Straily A . MMWR Morb Mortal Wkly Rep 2018 67 (21) 609-610 During July 21–August 8, 2017, the Texas Department of State Health Services (DSHS) was notified of 20 cases of cyclosporiasis among persons who dined at a Mediterranean-style restaurant chain (chain A) in the Houston area. On August 10, 2017, DSHS requested assistance from CDC to support ongoing investigations by the City of Houston Health Department, Harris County Public Health, Fort Bend County Health and Human Services, and Brazoria County Health Department. The objectives of this investigation were to determine the source of the illnesses in the Houston area and to generate hypotheses about the source of the national increase in cyclosporiasis in 2017. |
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