Last data update: May 20, 2024. (Total: 46824 publications since 2009)
Records 1-30 (of 73 Records) |
Query Trace: Noble G[original query] |
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Rapid environmental contamination with candida auris and multidrug-resistant bacterial pathogens near colonized patients
Sansom SE , Gussin GM , Schoeny M , Singh RD , Adil H , Bell P , Benson EC , Bittencourt CE , Black S , Del Mar Villanueva Guzman M , Froilan MC , Fukuda C , Barsegyan K , Gough E , Lyman M , Makhija J , Marron S , Mikhail L , Noble-Wang J , Pacilli M , Pedroza R , Saavedra R , Sexton DJ , Shimabukuro J , Thotapalli L , Zahn M , Huang SS , Hayden MK . Clin Infect Dis 2023 BACKGROUND: Environmental contamination is suspected to play an important role in Candida auris transmission. Understanding speed and risks of contamination after room disinfection could inform environmental cleaning recommendations. METHODS: We conducted a prospective multicenter study of environmental contamination associated with C. auris colonization at six ventilator-capable skilled nursing facilities and one acute-care hospital in Illinois and California. Known C. auris carriers were sampled at five body-sites followed by sampling of nearby room surfaces before disinfection and at 0, 4, 8, and 12-hours post-disinfection. Samples were cultured for C. auris and bacterial multidrug-resistant organisms (MDROs). Odds of surface contamination after disinfection were analyzed using multilevel generalized estimating equations. RESULTS: Among 41 known C. auris carriers, colonization was detected most frequently on palms/fingertips (76%) and nares (71%). C. auris contamination was detected on 32.2% (66/205) of room surfaces pre-disinfection and 20.5% (39/190) of room surfaces by 4-hours post-disinfection. A higher number of C. auris-colonized body sites was associated with higher odds of environmental contamination at every time point following disinfection, adjusting for facility of residence. In the rooms of 38 (93%) C. auris carriers co-colonized with a bacterial MDRO, 2%-24% of surfaces were additionally contaminated with the same MDRO by 4-hours post-disinfection. CONCLUSIONS: C. auris can contaminate the healthcare environment rapidly after disinfection, highlighting the challenges associated with environmental disinfection. Future research should investigate long-acting disinfectants, antimicrobial surfaces, and more effective patient skin antisepsis to reduce the environmental reservoir of C. auris and bacterial MDROs in healthcare settings. |
Posttransfusion sepsis attributable to bacterial contamination in platelet collection set manufacturing facility, United States
Kracalik I , Kent AG , Villa CH , Gable P , Annambhotla P , McAllister G , Yokoe D , Langelier CR , Oakeson K , Noble-Wang J , Illoh O , Halpin AL , Eder AF , Basavaraju SV . Emerg Infect Dis 2023 29 (10) 1979-1989 During May 2018‒December 2022, we reviewed transfusion-transmitted sepsis cases in the United States attributable to polymicrobial contaminated apheresis platelet components, including Acinetobacter calcoaceticus‒baumannii complex or Staphylococcus saprophyticus isolated from patients and components. Transfused platelet components underwent bacterial risk control strategies (primary culture, pathogen reduction or primary culture, and secondary rapid test) before transfusion. Environmental samples were collected from a platelet collection set manufacturing facility. Seven sepsis cases from 6 platelet donations from 6 different donors were identified in patients from 6 states; 3 patients died. Cultures identified Acinetobacter calcoaceticus‒baumannii complex in 6 patients and 6 transfused platelets, S. saprophyticus in 4 patients and 4 transfused platelets. Whole-genome sequencing showed environmental isolates from the manufacturer were closely related genetically to patient and platelet isolates, indicating the manufacturer was the most probable source of recurrent polymicrobial contamination. Clinicians should maintain awareness of possible transfusion-transmitted sepsis even when using bacterial risk control strategies. |
Influenza and other respiratory viral infections associated with absence from school among schoolchildren in Pittsburgh, Pennsylvania, USA: a cohort study (preprint)
Read JM , Zimmer S , Vukotich CJr , Schweizer ML , Galloway D , Lingle C , Yearwood G , Calderone P , Noble E , Quadelacy T , Grantz K , Rinaldo C , Gao H , Rainey J , Uzicanin A , Cummings DAT . medRxiv 2020 2020.04.16.20068593 Background Information on the etiology and age-specific burden of respiratory viral infections among school-aged children remains limited.Methods We conducted a cohort study to determine the etiology of ILI (influenza like illness) among 2,519 K–12 students during the 2012–13 influenza season. We obtained nasal swabs from students with ILI-related absences. Generalized linear mixed-effect regressions determined associations of outcomes, including ILI and laboratory-confirmed respiratory virus infection, with school grade and other covariates.Results Overall, 459 swabs were obtained from 552 ILI–related absences. Respiratory viruses were found in 292 (63.6%) samples. Influenza was found in 189 (41.2%) samples. with influenza B found in 134 (70.9%). Rates of influenza B were significantly higher in grades 1 (10.1%, 95% CI 6.8%–14.4%), 2 (9.7%, 6.6%–13.6%), 3 (9.3%, 6.3%–13.2%), and 4 (9.9%, 6.8%–13.8%) than in kindergarteners (3.2%, 1.5%–6.0%). After accounting for grade, sex and self-reported vaccination status, influenza B infection risk was lower among kindergarteners in half-day programs compared to kindergarteners in full-day programs (OR = 0.19; 95% CI 0.08–0.45).Conclusions ILI and influenza infection is concentrated in younger schoolchildren. Reduced infection by respiratory viruses is associated with a truncated school day for kindergarteners, but requires further investigation in other grades and populations.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis work was supported by Cooperative Agreement number [1U01CK00179] from the US Centers for Disease Control and Prevention (CDC, www.cdc.gov). The findings and conclusions in this study are solely the responsibility of the authors and do not necessarily represent the official position of CDC. JMR acknowledges additional support from the Engineering and Physical Sciences Research Council (EP/N014499/1).Author DeclarationsAll relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.YesAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesData for reproduction of major results and figures is made available through the DRYAD archive. |
Age-specific social mixing of school-aged children in a US setting using proximity detecting sensors and contact surveys (preprint)
Grantz KH , Cummings DAT , Zimmer S , Vukotich C , Galloway D , Schweizer ML , Guclu H , Cousins J , Lingle C , Yearwood GMH , Li K , Calderone PA , Noble E , Gao H , Rainey J , Uzicanin A , Read JM . medRxiv 2020 Comparisons of the utility and accuracy of methods for measuring social interactions relevant to disease transmission are rare. To increase the evidence base supporting specific methods to measure social interaction, we compared data from self-reported contact surveys and wearable proximity sensors from a cohort of schoolchildren in the Pittsburgh metropolitan area. Although the number and type of contacts recorded by each participant differed between the two methods, we found good correspondence between the two methods in aggregate measures of age-specific interactions. Fewer, but longer, contacts were reported in surveys, relative to the generally short proximal interactions captured by wearable sensors. When adjusted for expectations of proportionate mixing, though, the two methods produced highly similar, assortative age-mixing matrices. These aggregate mixing matrices, when used in simulation, resulted in similar estimates of risk of infection by age. While proximity sensors and survey methods may not be interchangeable for capturing individual contacts, they can generate highly correlated data on age-specific mixing patterns relevant to the dynamics of respiratory virus transmission. |
Assessment of neurodevelopment in infants with and without exposure to asymptomatic or mild maternal SARS-CoV-2 infection during pregnancy
Firestein MR , Shuffrey LC , Hu Y , Kyle M , Hussain M , Bianco C , Hott V , Hyman SP , Kyler M , Rodriguez C , Tejeda Romero M , Tzul Lopez H , Alcántara C , Amso D , Austin J , Bain JM , Barbosa J , Battarbee AN , Bruno A , Ettinger S , Factor-Litvak P , Gilboa S , Goldman S , Gyamfi-Bannerman C , Maniatis P , Marsh R , Morrill T , Mourad M , Muhle R , Newes-Adeyi G , Noble KG , O'Reilly KC , Penn AA , Reichle L , Sania A , Semenova V , Silver WG , Smotrich G , Tita AT , Tottenham N , Varner M , Welch MG , Zork N , Garey D , Fifer WP , Stockwell MS , Monk C , Dawood F , Dumitriu D . JAMA Netw Open 2023 6 (4) e237396 IMPORTANCE: Associations between prenatal SARS-CoV-2 exposure and neurodevelopmental outcomes have substantial public health relevance. A previous study found no association between prenatal SARS-CoV-2 infection and parent-reported infant neurodevelopmental outcomes, but standardized observational assessments are needed to confirm this finding. OBJECTIVE: To assess whether mild or asymptomatic maternal SARS-CoV-2 infection vs no infection during pregnancy is associated with infant neurodevelopmental differences at ages 5 to 11 months. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included infants of mothers from a single-site prospective cross-sectional study (COVID-19 Mother Baby Outcomes [COMBO] Initiative) of mother-infant dyads and a multisite prospective cohort study (Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 in Pregnancy and Infancy [ESPI]) of pregnant individuals. A subset of ESPI participants was subsequently enrolled in the ESPI COMBO substudy. Participants in the ongoing COMBO study were enrolled beginning on May 26, 2020; participants in the ESPI study were enrolled from May 7 to November 3, 2021; and participants in the ESPI COMBO substudy were enrolled from August 2020 to March 2021. For the current analysis, infant neurodevelopment was assessed between March 2021 and June 2022. A total of 407 infants born to 403 mothers were enrolled (204 from Columbia University Irving Medical Center in New York, New York; 167 from the University of Utah in Salt Lake City; and 36 from the University of Alabama in Birmingham). Mothers of unexposed infants were approached for participation based on similar infant gestational age at birth, date of birth, sex, and mode of delivery to exposed infants. EXPOSURES: Maternal symptomatic or asymptomatic SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES: Infant neurodevelopment was assessed using the Developmental Assessment of Young Children, second edition (DAYC-2), adapted for telehealth assessment. The primary outcome was age-adjusted standard scores on 5 DAYC-2 subdomains: cognitive, gross motor, fine motor, expressive language, and receptive language. RESULTS: Among 403 mothers, the mean (SD) maternal age at delivery was 32.1 (5.4) years; most mothers were of White race (240 [59.6%]) and non-Hispanic ethnicity (253 [62.8%]). Among 407 infants, 367 (90.2%) were born full term and 212 (52.1%) were male. Overall, 258 infants (63.4%) had no documented prenatal exposure to SARS-CoV-2 infection, 112 (27.5%) had confirmed prenatal exposure, and 37 (9.1%) had exposure before pregnancy or at an indeterminate time. In adjusted models, maternal SARS-CoV-2 infection during pregnancy was not associated with differences in cognitive (β = 0.31; 95% CI, -2.97 to 3.58), gross motor (β = 0.82; 95% CI, -1.34 to 2.99), fine motor (β = 0.36; 95% CI, -0.74 to 1.47), expressive language (β = -1.00; 95% CI, -4.02 to 2.02), or receptive language (β = 0.45; 95% CI, -2.15 to 3.04) DAYC-2 subdomain scores. Trimester of exposure and maternal symptom status were not associated with DAYC-2 subdomain scores. CONCLUSIONS AND RELEVANCE: In this study, results of a novel telehealth-adapted observational neurodevelopmental assessment extended a previous finding of no association between prenatal exposure to maternal SARS-CoV-2 infection and infant neurodevelopment. Given the widespread and continued high prevalence of COVID-19, these data offer information that may be helpful for pregnant individuals who experience asymptomatic or mild SARS-CoV-2 infections. |
Surface area matters: An evaluation of swabs and surface area for environmental surface sampling of healthcare pathogens
West RM , Shams AM , Chan MY , Rose LJ , Noble-Wang JA . Infect Control Hosp Epidemiol 2022 44 (5) 1-3 Flocked and foam swabs were used to sample five healthcare pathogens from three sizes of steel and plastic coupons; 26 cm(2), 323 cm(2), and 645 cm(2). As surface area increased, 1-2 log(10) decrease in recovered organisms (P < .05) was observed. Sampling 26-cm(2) yielded the optimal median percent of pathogens recovered. |
Clinical Characteristics and Outcomes Among Adults Hospitalized with Laboratory-Confirmed SARS-CoV-2 Infection During Periods of B.1.617.2 (Delta) and B.1.1.529 (Omicron) Variant Predominance - One Hospital, California, July 15-September 23, 2021, and December 21, 2021-January 27, 2022.
Modes ME , Directo MP , Melgar M , Johnson LR , Yang H , Chaudhary P , Bartolini S , Kho N , Noble PW , Isonaka S , Chen P . MMWR Morb Mortal Wkly Rep 2022 71 (6) 217-223 In mid-December 2021, the B.1.1.529 (Omicron) variant of SARS-CoV-2, the virus that causes COVID-19, surpassed the B.1.617.2 (Delta) variant as the predominant strain in California.() Initial reports suggest that the Omicron variant is more transmissible and resistant to vaccine neutralization but causes less severe illness compared with previous variants (1-3). To describe characteristics of patients hospitalized with SARS-CoV-2 infection during periods of Delta and Omicron predominance, clinical characteristics and outcomes were retrospectively abstracted from the electronic health records (EHRs) of adults aged 18 years with positive reverse transcription-polymerase chain reaction (RT-PCR) SARS-CoV-2 test results admitted to one academic hospital in Los Angeles, California, during July 15-September 23, 2021 (Delta predominant period, 339 patients) and December 21, 2021-January 27, 2022 (Omicron predominant period, 737 patients). Compared with patients during the period of Delta predominance, a higher proportion of adults admitted during Omicron predominance had received the final dose in a primary COVID-19 vaccination series (were fully vaccinated) (39.6% versus 25.1%), and fewer received COVID-19-directed therapies. Although fewer required intensive care unit (ICU) admission and invasive mechanical ventilation (IMV), and fewer died while hospitalized during Omicron predominance, there were no significant differences in ICU admission or IMV when stratified by vaccination status. Fewer fully vaccinated Omicron-period patients died while hospitalized (3.4%), compared with Delta-period patients (10.6%). Among Omicron-period patients, vaccination was associated with lower likelihood of ICU admission, and among adults aged 65 years, lower likelihood of death while hospitalized. Likelihood of ICU admission and death were lowest among adults who had received a booster dose. Among the first 131 Omicron-period hospitalizations, 19.8% of patients were clinically assessed as admitted for non-COVID-19 conditions. Compared with adults considered likely to have been admitted because of COVID-19, these patients were younger (median age=38 versus 67 years) and more likely to have received at least one dose of a COVID-19 vaccine (84.6% versus 61.0%). Although 20% of SARS-CoV-2-associated hospitalizations during the period of Omicron predominance might be driven by non-COVID-19 conditions, large numbers of hospitalizations place a strain on health systems. Vaccination, including a booster dose for those who are fully vaccinated, remains critical to minimizing risk for severe health outcomes among adults with SARS-CoV-2 infection. |
Factors influencing environmental sampling recovery of healthcare pathogens from non-porous surfaces with cellulose sponges
Rose LJ , Houston H , Martinez-Smith M , Lyons AK , Whitworth C , Reddy SC , Noble-Wang J . PLoS One 2022 17 (1) e0261588 Results from sampling healthcare surfaces for pathogens are difficult to interpret without understanding the factors that influence pathogen detection. We investigated the recovery of four healthcare-associated pathogens from three common surface materials, and how a body fluid simulant (artificial test soil, ATS), deposition method, and contamination levels influence the percent of organisms recovered (%R). Known quantities of carbapenemase-producing KPC+ Klebsiella pneumoniae (KPC), Acinetobacter baumannii, vancomycin-resistant Enterococcus faecalis, and Clostridioides difficile spores (CD) were suspended in Butterfield's buffer or ATS, deposited on 323cm2 steel, plastic, and laminate surfaces, allowed to dry 1h, then sampled with a cellulose sponge wipe. Bacteria were eluted, cultured, CFU counted and %R determined relative to the inoculum. The %R varied by organism, from <1% (KPC) to almost 60% (CD) and was more dependent upon the organism's characteristics and presence of ATS than on surface type. KPC persistence as determined by culture also declined by >1 log10 within the 60 min drying time. For all organisms, the %R was significantly greater if suspended in ATS than if suspended in Butterfield's buffer (p<0.05), and for most organisms the %R was not significantly different when sampled from any of the three surfaces. Organisms deposited in multiple droplets were recovered at equal or higher %R than if spread evenly on the surface. This work assists in interpreting data collected while investigating a healthcare infection outbreak or while conducting infection intervention studies. |
The Effect of Disinfectants on the Microbial Community on Environmental Healthcare Surfaces using Next Generation Sequencing.
Perry-Dow KA , de Man T , Halpin AL , Shams AM , Rose LJ , Noble-Wang JA . Am J Infect Control 2021 50 (1) 54-60 BACKGROUND: Healthcare-associated infections (HAIs) are a significant economic burden and cause of avoidable morbidity and mortality within healthcare systems. The contribution of environmental contamination to HAI transmission has been recognized, but the mechanisms by which transmission occurs are still being investigated. The objective of this study was to characterize the microbial communities of disinfected, non-critical healthcare surfaces using next generation sequencing technology. METHODS: Composite environmental surface samples were from high-touch surfaces in rooms of patients isolated for infections with multidrug-resistant organisms during their hospitalization. Information on the disinfectant product used and cleaning type (routine or terminal) was collected. 16S rRNA gene amplicon sequencing and analysis were performed. Community analysis was conducted to determine the bacterial composition and compare the detection of target pathogens by culture from 94 Contact Precaution rooms. RESULTS: Overall percent agreement between culture and sequence methods ranged from 52% to 88%. A significant difference was observed in bacterial composition between rooms cleaned with bleach and those cleaned with a quaternary ammonium compound (QAC) for composite 2 (overbed table, intravenous pole, and inner room door handle) (ANOSIM R2 = 0.66, p = 0.005) but not composite 1 (bed rails, television remote control unit, call buttons, and telephone). CONCLUSIONS: Surfaces in bleach-cleaned rooms contained a higher proportion of gram-positive microbiota, whereas rooms cleaned with QAC contained a higher proportion of gram-negative microbiota, suggesting disinfectant products may impact the healthcare environment microbiome. |
SARS-CoV-2 Wastewater Surveillance for Public Health Action.
McClary-Gutierrez JS , Mattioli MC , Marcenac P , Silverman AI , Boehm AB , Bibby K , Balliet M , de Los Reyes FL 3rd , Gerrity D , Griffith JF , Holden PA , Katehis D , Kester G , LaCross N , Lipp EK , Meiman J , Noble RT , Brossard D , McLellan SL . Emerg Infect Dis 2021 27 (9) 1-8 Wastewater surveillance for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has garnered extensive public attention during the coronavirus disease pandemic as a proposed complement to existing disease surveillance systems. Over the past year, methods for detection and quantification of SARS-CoV-2 viral RNA in untreated sewage have advanced, and concentrations in wastewater have been shown to correlate with trends in reported cases. Despite the promise of wastewater surveillance, for these measurements to translate into useful public health tools, bridging the communication and knowledge gaps between researchers and public health responders is needed. We describe the key uses, barriers, and applicability of SARS-CoV-2 wastewater surveillance for supporting public health decisions and actions, including establishing ethics consideration for monitoring. Although wastewater surveillance to assess community infections is not a new idea, the coronavirus disease pandemic might be the initiating event to make this emerging public health tool a sustainable nationwide surveillance system, provided that these barriers are addressed. |
Validation of the wave 1 and wave 2 Population Assessment of Tobacco and Health (PATH) study indicators of tobacco dependence using biomarkers of nicotine exposure across tobacco products
Strong DR , Leas E , Noble M , White M , Glasser A , Taylor K , Edwards KC , Frissell KC , Compton WM , Conway KP , Lambert E , Kimmel HL , Silveira ML , Hull LC , van Bemmel D , Schroeder MJ , Cummings KM , Hyland A , Feng J , Blount B , Lanqing W , Niaura R . Nicotine Tob Res 2021 24 (1) 10-19 INTRODUCTION: This study examined the predictive relationships between biomarkers of nicotine exposure and 16-item self-reported level of tobacco dependence (TD) and subsequent tobacco use outcomes. METHODS: The Population Assessment of Tobacco and Health (PATH) Study surveyed adult current established tobacco users who provided urine biospecimens at Wave 1 (September 2013-December 2014) and completed the Wave 2 (October 2014-October 2015) interview (n=6872). Mutually exclusive user groups at Wave 1 included: Cigarette Only, E-cigarette Only, Cigar Only, Hookah Only, Smokeless Tobacco Only, Cigarette Plus E-cigarette, multiple tobacco product users who smoked cigarettes, and multiple tobacco product users who did not smoke cigarettes. Total Nicotine Equivalents (TNE-2) and TD were measured at Wave 1. Approximate one-year outcomes included frequency/quantity used, quitting, and adding/switching to different tobacco products. RESULTS: For Cigarette Only smokers and multiple tobacco product users who smoked cigarettes, higher TD and TNE-2 were associated with: a tendency to smoke more, smoking more frequently over time, decreased likelihood of switching away from cigarettes, and decreased probability of quitting after one year. For other product user groups, Wave 1 TD and/or TNE-2 were less consistently related to changes in quantity and frequency of product use, or for adding or switching products, but higher TNE-2 was more consistently predictive of decreased probability of quitting. CONCLUSIONS: Self-reported TD and nicotine exposure assess common and independent aspects of dependence in relation to tobacco use behaviors for cigarette smokers. For other product user groups, nicotine exposure is a more consistent predictor of quitting than self-reported TD. IMPLICATIONS: This study suggests that smoking cigarettes leads to the most coherent pattern of associations consistent with a syndrome of TD. Because cigarettes continue to be prevalent and harmful, efforts to decrease their use may be accelerated via conventional means (e.g., smoking cessation interventions and treatments), but also perhaps by decreasing their dependence potential. The implications for noncombustible tobacco products are less clear as the stability of tobacco use patterns that include products such as e-cigarettes continue to evolve. TD, nicotine exposure measures, and consumption could be used in studies that attempt to understand and predict product-specific tobacco use behavioral outcomes. |
Sampling efficiency of Candida auris from healthcare surfaces: culture and nonculture detection methods
Furin WA , Tran LH , Chan MY , Lyons AK , Noble-Wang J , Rose LJ . Infect Control Hosp Epidemiol 2021 43 (10) 1-3 Sponges and swabs were evaluated for their ability to recover Candida auris dried 1 hour on steel and plastic surfaces. Culture recovery ranged from <0.1% (sponges) to 8.4% (swabs), and cells detected with an esterase activity assay revealed >50% recovery (swabs), indicating that cells may enter a viable but nonculturable state. |
Improving laboratory quality and capacity through leadership and management training: Lessons from Zambia 2016-2018
Gopolang F , Zulu-Mwamba F , Nsama D , Kruuner A , Nsofwa D , Kasvosve I , Gomo R , Motlhabane T , Chohan B , Soge O , Osterhage D , Campbell N , Noble M , Downer A , Flandin JF , Nartker A , Koehn C , Nonde LK , Shibemba A , Ndongmo CB , Steinau M , Perrone LA . Afr J Lab Med 2021 10 (1) 1225 BACKGROUND: Competent leadership and management are imperative for delivering quality laboratory services; however, few laboratory managers receive job-specific training in organisational management and leadership. OBJECTIVE: To develop and evaluate participants' competencies in organisational leadership and management as measured through learner and laboratory quality improvement assessments. METHODS: This professional development programme employed a mentored, blended learning approach, utilising in-person didactic and online training, with the practical application of a capstone project in the laboratories. Programme impact was evaluated through a series of pre- and post-laboartory assessments using the Stepwise Laboratory Improvement Process Towards Accreditation checklist, as well as learner-competency assessments through online quizzes and discussions. RESULTS: From 2016 to 2018, 31 managers and quality officers from 16 individual laboratories graduated from the programme having completed capstone projects addressing areas in the entire laboratory testing process. Laboratories increased their compliance with the International Organization for Standardization 15189 standard and all but two laboratories significantly increased their accreditation scores. Two laboratories gained three stars, two laboratories gained two stars, and five laboratories gained one star. Five laboratories subsequently achieved International Organization for Standardization 15189 accreditation in 2019. CONCLUSION: This programme taught leadership theory to laboratory managers and allowed them to implement leadership and management practices in the laboratory setting. Programmes such as this complement existing laboratory quality management training programmes such as Strengthening Laboratory Management Toward Accreditation. |
Positive correlation between Candida auris skin-colonization burden and environmental contamination at a ventilator-capable skilled nursing facility in Chicago
Sexton DJ , Bentz ML , Welsh RM , Derado G , Furin W , Rose LJ , Noble-Wang J , Pacilli M , McPherson TD , Black S , Kemble SK , Herzegh O , Ahmad A , Forsberg K , Jackson B , Litvintseva AP . Clin Infect Dis 2021 73 (7) 1142-1148 BACKGROUND: Candida auris is an emerging multidrug-resistant yeast that contaminates healthcare environments causing healthcare-associated outbreaks. The mechanisms facilitating contamination are not established. METHODS: C. auris was quantified in residents' bilateral axillary/inguinal composite skin swabs and environmental samples during a point-prevalence survey at a ventilator-capable skilled-nursing facility (vSNF A) with documented high colonization prevalence. Environmental samples were collected from all doorknobs, windowsills and handrails of each bed in 12 rooms. C. auris concentrations were measured using culture and C. auris-specific qPCR. The relationship between C. auris concentrations in residents' swabs and associated environmental samples were evaluated using Kendall's tau-b (τb) correlation coefficient. RESULTS: C. auris was detected in 70 /100 tested environmental samples and 31/ 57 tested resident skin swabs. The mean C. auris concentration in skin swabs was 1.22 x 10 5 cells/mL by culture and 1.08 x 10 6 cells/mL by qPCR. C. auris was detected on all handrails of beds occupied by colonized residents, as well as 10/24 doorknobs and 9/12 windowsills. A positive correlation was identified between the concentrations of C. auris in skin swabs and associated handrail samples based on culture (τb = 0.54, p = 0.0004) and qPCR (τb = 0.66, p = 3.83e -6). Two uncolonized residents resided in beds contaminated with C. auris. CONCLUSIONS: Colonized residents can have high C. auris burdens on their skin, which was positively related with contamination of their surrounding healthcare environment. These findings underscore the importance of hand hygiene, transmission-based precautions, and particularly environmental disinfection in preventing spread in healthcare facilities. |
Influenza and other respiratory viral infections associated with absence from school among schoolchildren in Pittsburgh, Pennsylvania, USA: a cohort study
Read JM , Zimmer S , Vukotich CJr , Schweizer ML , Galloway D , Lingle C , Yearwood G , Calderone P , Noble E , Quadelacy T , Grantz K , Rinaldo C , Gao H , Rainey J , Uzicanin A , Cummings DAT . BMC Infect Dis 2021 21 (1) 291 BACKGROUND: Information on the etiology and age-specific burden of respiratory viral infections among school-aged children remains limited. Though school aged children are often recognized as driving the transmission of influenza as well as other respiratory viruses, little detailed information is available on the distribution of respiratory infections among children of different ages within this group. Factors other than age including gender and time spent in school may also be important in determining risk of infection but have been little studied in this age group. METHODS: We conducted a cohort study to determine the etiology of influenza like illness (ILI) among 2519 K-12 students during the 2012-13 influenza season. We obtained nasal swabs from students with ILI-related absences. Generalized linear mixed-effect regressions determined associations of outcomes, including ILI and laboratory-confirmed respiratory virus infection, with school grade and other covariates. RESULTS: Overall, 459 swabs were obtained from 552 ILI-related absences. Respiratory viruses were found in 292 (63.6%) samples. Influenza was found in 189 (41.2%) samples. With influenza B found in 134 (70.9%). Rates of influenza B were significantly higher in grades 1 (10.1, 95% CI 6.8-14.4%), 2 (9.7, 6.6-13.6%), 3 (9.3, 6.3-13.2%), and 4 (9.9, 6.8-13.8%) than in kindergarteners (3.2, 1.5-6.0%). After accounting for grade, sex and self-reported vaccination status, influenza B infection risk was lower among kindergarteners in half-day programs compared to kindergarteners in full-day programs (OR = 0.19; 95% CI 0.08-0.45). CONCLUSIONS: ILI and influenza infection is concentrated in younger schoolchildren. Reduced infection by respiratory viruses is associated with a truncated school day for kindergarteners but this finding requires further investigation in other grades and populations. |
Recovery efficiency of two glove-sampling methods
Lyons AK , Rose LJ , Noble-Wang J . Infect Control Hosp Epidemiol 2021 43 (3) 1-3 Two methods to sample pathogens from gloved hands were compared: direct imprint onto agar and a sponge-wipe method. The sponge method was significantly better at recovering Clostridiodes difficile spores, and no difference was observed between the methods at 101 inoculum for carbapenemase-producing KPC+ Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, and Acinetobacter baumannii. |
Environmental contamination of contact precaution and non-contact precaution patient rooms in six acute care facilities
Tanner WD , Leecaster MK , Zhang Y , Stratford KM , Mayer J , Visnovsky LD , Alhmidi H , Cadnum JL , Jencson AL , Koganti S , Bennett CP , Donskey CJ , Noble-Wang J , Reddy SC , Rose LJ , Watson L , Ide E , Wipperfurth T , Safdar N , Arasim M , Macke C , Roman P , Krein SL , Loc-Carrillo C , Samore MH . Clin Infect Dis 2021 72 S8-s16 BACKGROUND: Environmental contamination is an important source of hospital multidrug-resistant organism (MDRO) transmission. Factors such as patient MDRO contact precautions (CP) status, patient proximity to surfaces, and unit type likely influence MDRO contamination and bacterial bioburden levels on patient room surfaces. Identifying factors associated with environmental contamination in patient rooms and on shared unit surfaces could help identify important environmental MDRO transmission routes. METHODS: Surfaces were sampled from MDRO CP and non-CP rooms, nursing stations, and mobile equipment in acute care, intensive care, and transplant units within 6 acute care hospitals using a convenience sampling approach blinded to cleaning events. Precaution rooms had patients with clinical or surveillance tests positive for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, carbapenem-resistant Enterobacteriaceae or Acinetobacter within the previous 6 months, or Clostridioides difficile toxin within the past 30 days. Rooms not meeting this definition were considered non-CP rooms. Samples were cultured for the above MDROs and total bioburden. RESULTS: Overall, an estimated 13% of rooms were contaminated with at least 1 MDRO. MDROs were detected more frequently in CP rooms (32% of 209 room-sample events) than non-CP rooms (12% of 234 room-sample events). Surface bioburden did not differ significantly between CP and non-CP rooms or MDRO-positive and MDRO-negative rooms. CONCLUSIONS: CP room surfaces are contaminated more frequently than non-CP room surfaces; however, contamination of non-CP room surfaces is not uncommon and may be an important reservoir for ongoing MDRO transmission. MDRO contamination of non-CP rooms may indicate asymptomatic patient MDRO carriage, inadequate terminal cleaning, or cross-contamination of room surfaces via healthcare personnel hands. |
Age-specific social mixing of school-aged children in a US setting using proximity detecting sensors and contact surveys
Grantz KH , Cummings DAT , Zimmer S , Vukotich CJr , Galloway D , Schweizer ML , Guclu H , Cousins J , Lingle C , Yearwood GMH , Li K , Calderone P , Noble E , Gao H , Rainey J , Uzicanin A , Read JM . Sci Rep 2021 11 (1) 2319 Comparisons of the utility and accuracy of methods for measuring social interactions relevant to disease transmission are rare. To increase the evidence base supporting specific methods to measure social interaction, we compared data from self-reported contact surveys and wearable proximity sensors from a cohort of schoolchildren in the Pittsburgh metropolitan area. Although the number and type of contacts recorded by each participant differed between the two methods, we found good correspondence between the two methods in aggregate measures of age-specific interactions. Fewer, but longer, contacts were reported in surveys, relative to the generally short proximal interactions captured by wearable sensors. When adjusted for expectations of proportionate mixing, though, the two methods produced highly similar, assortative age-mixing matrices. These aggregate mixing matrices, when used in simulation, resulted in similar estimates of risk of infection by age. While proximity sensors and survey methods may not be interchangeable for capturing individual contacts, they can generate highly correlated data on age-specific mixing patterns relevant to the dynamics of respiratory virus transmission. |
Human health and ocean pollution
Landrigan PJ , Stegeman JJ , Fleming LE , Allemand D , Anderson DM , Backer LC , Brucker-Davis F , Chevalier N , Corra L , Czerucka D , Bottein MD , Demeneix B , Depledge M , Deheyn DD , Dorman CJ , Fénichel P , Fisher S , Gaill F , Galgani F , Gaze WH , Giuliano L , Grandjean P , Hahn ME , Hamdoun A , Hess P , Judson B , Laborde A , McGlade J , Mu J , Mustapha A , Neira M , Noble RT , Pedrotti ML , Reddy C , Rocklöv J , Scharler UM , Shanmugam H , Taghian G , van de Water Jajm , Vezzulli L , Weihe P , Zeka A , Raps H , Rampal P . Ann Glob Health 2020 86 (1) 151 BACKGROUND: Pollution - unwanted waste released to air, water, and land by human activity - is the largest environmental cause of disease in the world today. It is responsible for an estimated nine million premature deaths per year, enormous economic losses, erosion of human capital, and degradation of ecosystems. Ocean pollution is an important, but insufficiently recognized and inadequately controlled component of global pollution. It poses serious threats to human health and well-being. The nature and magnitude of these impacts are only beginning to be understood. GOALS: (1) Broadly examine the known and potential impacts of ocean pollution on human health. (2) Inform policy makers, government leaders, international organizations, civil society, and the global public of these threats. (3) Propose priorities for interventions to control and prevent pollution of the seas and safeguard human health. METHODS: Topic-focused reviews that examine the effects of ocean pollution on human health, identify gaps in knowledge, project future trends, and offer evidence-based guidance for effective intervention. ENVIRONMENTAL FINDINGS: Pollution of the oceans is widespread, worsening, and in most countries poorly controlled. It is a complex mixture of toxic metals, plastics, manufactured chemicals, petroleum, urban and industrial wastes, pesticides, fertilizers, pharmaceutical chemicals, agricultural runoff, and sewage. More than 80% arises from land-based sources. It reaches the oceans through rivers, runoff, atmospheric deposition and direct discharges. It is often heaviest near the coasts and most highly concentrated along the coasts of low- and middle-income countries. Plastic is a rapidly increasing and highly visible component of ocean pollution, and an estimated 10 million metric tons of plastic waste enter the seas each year. Mercury is the metal pollutant of greatest concern in the oceans; it is released from two main sources - coal combustion and small-scale gold mining. Global spread of industrialized agriculture with increasing use of chemical fertilizer leads to extension of Harmful Algal Blooms (HABs) to previously unaffected regions. Chemical pollutants are ubiquitous and contaminate seas and marine organisms from the high Arctic to the abyssal depths. ECOSYSTEM FINDINGS: Ocean pollution has multiple negative impacts on marine ecosystems, and these impacts are exacerbated by global climate change. Petroleum-based pollutants reduce photosynthesis in marine microorganisms that generate oxygen. Increasing absorption of carbon dioxide into the seas causes ocean acidification, which destroys coral reefs, impairs shellfish development, dissolves calcium-containing microorganisms at the base of the marine food web, and increases the toxicity of some pollutants. Plastic pollution threatens marine mammals, fish, and seabirds and accumulates in large mid-ocean gyres. It breaks down into microplastic and nanoplastic particles containing multiple manufactured chemicals that can enter the tissues of marine organisms, including species consumed by humans. Industrial releases, runoff, and sewage increase frequency and severity of HABs, bacterial pollution, and anti-microbial resistance. Pollution and sea surface warming are triggering poleward migration of dangerous pathogens such as the Vibrio species. Industrial discharges, pharmaceutical wastes, pesticides, and sewage contribute to global declines in fish stocks. HUMAN HEALTH FINDINGS: Methylmercury and PCBs are the ocean pollutants whose human health effects are best understood. Exposures of infants in utero to these pollutants through maternal consumption of contaminated seafood can damage developing brains, reduce IQ and increase children's risks for autism, ADHD and learning disorders. Adult exposures to methylmercury increase risks for cardiovascular disease and dementia. Manufactured chemicals - phthalates, bisphenol A, flame retardants, and perfluorinated chemicals, many of them released into the seas from plastic waste - can disrupt endocrine signaling, reduce male fertility, damage the nervous system, and increase risk of cancer. HABs produce potent toxins that accumulate in fish and shellfish. When ingested, these toxins can cause severe neurological impairment and rapid death. HAB toxins can also become airborne and cause respiratory disease. Pathogenic marine bacteria cause gastrointestinal diseases and deep wound infections. With climate change and increasing pollution, risk is high that Vibrio infections, including cholera, will increase in frequency and extend to new areas. All of the health impacts of ocean pollution fall disproportionately on vulnerable populations in the Global South - environmental injustice on a planetary scale. CONCLUSIONS: Ocean pollution is a global problem. It arises from multiple sources and crosses national boundaries. It is the consequence of reckless, shortsighted, and unsustainable exploitation of the earth's resources. It endangers marine ecosystems. It impedes the production of atmospheric oxygen. Its threats to human health are great and growing, but still incompletely understood. Its economic costs are only beginning to be counted.Ocean pollution can be prevented. Like all forms of pollution, ocean pollution can be controlled by deploying data-driven strategies based on law, policy, technology, and enforcement that target priority pollution sources. Many countries have used these tools to control air and water pollution and are now applying them to ocean pollution. Successes achieved to date demonstrate that broader control is feasible. Heavily polluted harbors have been cleaned, estuaries rejuvenated, and coral reefs restored.Prevention of ocean pollution creates many benefits. It boosts economies, increases tourism, helps restore fisheries, and improves human health and well-being. It advances the Sustainable Development Goals (SDG). These benefits will last for centuries. RECOMMENDATIONS: World leaders who recognize the gravity of ocean pollution, acknowledge its growing dangers, engage civil society and the global public, and take bold, evidence-based action to stop pollution at source will be critical to preventing ocean pollution and safeguarding human health.Prevention of pollution from land-based sources is key. Eliminating coal combustion and banning all uses of mercury will reduce mercury pollution. Bans on single-use plastic and better management of plastic waste reduce plastic pollution. Bans on persistent organic pollutants (POPs) have reduced pollution by PCBs and DDT. Control of industrial discharges, treatment of sewage, and reduced applications of fertilizers have mitigated coastal pollution and are reducing frequency of HABs. National, regional and international marine pollution control programs that are adequately funded and backed by strong enforcement have been shown to be effective. Robust monitoring is essential to track progress.Further interventions that hold great promise include wide-scale transition to renewable fuels; transition to a circular economy that creates little waste and focuses on equity rather than on endless growth; embracing the principles of green chemistry; and building scientific capacity in all countries.Designation of Marine Protected Areas (MPAs) will safeguard critical ecosystems, protect vulnerable fish stocks, and enhance human health and well-being. Creation of MPAs is an important manifestation of national and international commitment to protecting the health of the seas. |
Multipronged Approach to Controlling a Tuberculosis Outbreak Among Persons Experiencing Homelessness.
Muloma E , Stewart R , Townsend H , Koch S , Burkholder S , Railey S , White K , Redington-Noble R , Caine V . J Public Health Manag Pract 2020 28 (2) 199-202 In May 2009, the Marion County Public Health Department in Indiana declared a tuberculosis (TB) outbreak among persons experiencing homelessness in Marion County, began active case finding to detect additional cases, and formed a TB outbreak response team to plan and coordinate outbreak activities. Outbreak-associated cases had 1 of 2 outbreak genotypes and either reported experiencing homelessness themselves or had an epidemiologic link to a shelter or a person experiencing homelessness. The last of 53 outbreak-associated cases was detected in 2019 after more than 2 years without a case. The Marion County Public Health Department continues to address TB-related issues and implement prevention measures at homeless shelters and among persons experiencing homelessness in 2019. This example, in addition to other published guidance, can be used by jurisdictions to plan and implement their own TB outbreak prevention and response activities among persons experiencing homelessness. |
Persistence of Bacteriophage Phi 6 on Porous and Nonporous Surfaces and the Potential for Its Use as an Ebola Virus or Coronavirus Surrogate.
Whitworth C , Mu Y , Houston H , Martinez-Smith M , Noble-Wang J , Coulliette-Salmond A , Rose L . Appl Environ Microbiol 2020 86 (17) The infection of healthcare workers during the 2013 -2016 Ebola outbreak raised concerns about fomite transmission. In the wake of the Coronavirus Disease 2019 (COVID-19) pandemic, investigations are ongoing to determine the role of fomites in coronavirus transmission as well. The bacteriophage Phi 6 has a phospholipid envelope and is commonly used in environmental studies as a surrogate for human enveloped viruses. The persistence of Phi 6 was evaluated as a surrogate for EBOV and coronaviruses on porous and nonporous hospital surfaces. Phi 6 was suspended in a body fluid simulant and inoculated onto 1 cm(2) coupons of steel, plastic, and two fabric curtain types. The coupons were placed at two controlled absolute humidity (AH) levels; a low AH of 3.0 g/m(3) and a high AH of 14.4 g/m(3) Phi 6 declined at a slower rate on all materials under low AH conditions with a decay rate of 0.06 log10PFU/d to 0.11 log10PFU/d, as compared to the higher AH conditions with a decay rate of 0.65 log10PFU/h to 1.42 log10PFU/d. There was a significant difference in decay rates between porous and non-porous surfaces at both low AH (P < 0.0001) and high AH (P < 0.0001). Under these laboratory-simulated conditions, Phi 6 was found to be a conservative surrogate for EBOV under low AH conditions, in that it persisted longer than Ebola virus in similar AH conditions. Additionally, some coronaviruses persist longer than phi6 under similar conditions, therefore Phi6 may not be a suitable surrogate for coronaviruses.IMPORTANCE Understanding the persistence of enveloped viruses helps inform infection control practices and procedures in healthcare facilities and community settings. These data convey to public health investigators that enveloped viruses can persist and remain infective on surfaces, thus demonstrating a potential risk for transmission. Under these laboratory-simulated western indoor hospital conditions, Phi 6 was used to assess suitability as a surrogate for environmental persistence research related to enveloped viruses, including EBOV and coronaviruses. |
Performance of oropharyngeal swab testing compared to nasopharyngeal swab testing for diagnosis of COVID-19 -United States, January-February 2020
Patel MR , Carroll D , Ussery E , Whitham H , Elkins CA , Noble-Wang J , Rasheed JK , Lu X , Lindstrom S , Bowen V , Waller J , Armstrong G , Gerber S , Brooks JT . Clin Infect Dis 2020 72 (3) 403-410 Among 146 nasopharyngeal (NP) and oropharyngeal (OP) swab pairs collected </=7 days since illness onset, CDC real-time RT-PCR SARS-CoV-2 assay diagnostic results were 95.2% concordant. However, NP swab Ct values were lower (indicating more virus) in 66.7% of concordant-positive pairs, suggesting NP swabs may more accurately detect amount of SARS-CoV-2. |
Performance of Oropharyngeal Swab Testing Compared With Nasopharyngeal Swab Testing for Diagnosis of Coronavirus Disease 2019-United States, January 2020-February 2020.
Patel MR , Carroll D , Ussery E , Whitham H , Elkins CA , Noble-Wang J , Rasheed JK , Lu X , Lindstrom S , Bowen V , Waller J , Armstrong G , Gerber S , Brooks JT . Clin Infect Dis 2020 72 (3) 403-410 Among 146 nasopharyngeal (NP) and oropharyngeal (OP) swab pairs collected </=7 days since illness onset, CDC real-time RT-PCR SARS-CoV-2 assay diagnostic results were 95.2% concordant. However, NP swab Ct values were lower (indicating more virus) in 66.7% of concordant-positive pairs, suggesting NP swabs may more accurately detect amount of SARS-CoV-2. |
Multispecies Outbreak of Verona Integron-Encoded Metallo-ß-Lactamase-Producing Multidrugresistant Bacteria Driven by a Promiscuous Incompatibility Group A/C2.
de Man TJB , Yaffee AQ , Zhu W , Batra D , Alyanak E , Rowe LA , McAllister G , Moulton-Meissner H , Boyd S , Flinchum A , Slayton RB , Hancock S , Spalding Walters M , Laufer Halpin A , Rasheed JK , Noble-Wang J , Kallen AJ , Limbago BM . Clin Infect Dis 2020 72 (3) 414-420 BACKGROUND: Antibiotic resistance is often spread through bacterial populations via conjugative plasmids. However, plasmid transfer is not well recognized in clinical settings because of technical limitations, and health care-associated infections are usually caused by clonal transmission of a single pathogen. In 2015, multiple species of carbapenem-resistant Enterobacteriaceae (CRE), all producing a rare carbapenemase, were identified among patients in an intensive care unit. This observation suggested a large, previously unrecognized plasmid transmission chain and prompted our investigation. METHODS: Electronic medical record reviews, infection control observations, and environmental sampling completed the epidemiologic outbreak investigation. A laboratory analysis, conducted on patient and environmental isolates, included long-read whole-genome sequencing to fully elucidate plasmid DNA structures. Bioinformatics analyses were applied to infer plasmid transmission chains and results were subsequently confirmed using plasmid conjugation experiments. RESULTS: We identified 14 Verona integron-encoded metallo-ss-lactamase (VIM)-producing CRE in 12 patients, and 1 additional isolate was obtained from a patient room sink drain. Whole-genome sequencing identified the horizontal transfer of blaVIM-1, a rare carbapenem resistance mechanism in the United States, via a promiscuous incompatibility group A/C2 plasmid that spread among 5 bacterial species isolated from patients and the environment. CONCLUSIONS: This investigation represents the largest known outbreak of VIM-producing CRE in the United States to date, which comprises numerous bacterial species and strains. We present evidence of in-hospital plasmid transmission, as well as environmental contamination. Our findings demonstrate the potential for 2 types of hospital-acquired infection outbreaks: those due to clonal expansion and those due to the spread of conjugative plasmids encoding antibiotic resistance across species. |
Estimating the costs and cost-effectiveness of HIV self-testing among men who have sex with men, United States
Shrestha RK , Chavez PR , Noble M , Sansom SL , Sullivan PS , Mermin JH , MacGowan RJ . J Int AIDS Soc 2020 23 (1) e25445 INTRODUCTION: HIV testing is an essential prerequisite for accessing treatment with antiretroviral therapy or prevention using pre-exposure prophylaxis. Internet distribution of HIV self-tests is a novel approach, and data on the programmatic cost of this approach are limited. We analyse the costs and cost-effectiveness of a self-testing programme. METHODS: Men who have sex with men (MSM) reporting unknown or negative HIV status were enrolled from March to August 2015 into a 12-month trial of HIV self-testing in the United States. Participants were randomly assigned either to the self-testing arm or the control arm. All participants received information on HIV testing services and locations in their community. Self-testing participants received up to four self-tests each quarter, which they could use themselves or distribute to their social network associates. Quarterly follow-up surveys collected testing outcomes, including number of tests used and new HIV diagnoses. Using trial expenditure data, we estimated the cost of implementing a self-testing programme. Primary outcomes of this analysis included total programme implementation costs, cost per self-test completed, cost per person tested, cost per new HIV diagnosis among those self-tested and cost per quality adjusted life year (QALY) saved. RESULTS: A total of 2665 men were assigned either to the self-testing arm (n = 1325) or the control arm (n = 1340). HIV testing was reported by 971 self-testing participants who completed a total of 5368 tests. In the control arm, 619 participants completed 1463 HIV tests. The self-testing participants additionally distributed 2864 self-tests to 2152 social network associates. Testing during the trial identified 59 participants and social network associates with newly diagnosed HIV infection in the self-testing arm; 11 control participants were newly diagnosed with HIV. The implementation cost of the HIV self-testing programme was $449,510. The cost per self-test completed, cost per person tested at least once, and incremental cost per new HIV diagnosis was $61, $145 and $9365 respectively. We estimated that self-testing programme potentially averted 3.34 transmissions, saved 14.86 QALYs and nearly $1.6 million lifetime HIV treatment costs. CONCLUSIONS: The HIV self-testing programme identified persons with newly diagnosed HIV infection at low cost, and the programme is cost saving. |
Elution efficiency of healthcare pathogens from environmental sampling tools
West-Deadwyler RM , Moulton-Meissner HA , Rose LJ , Noble-Wang JA . Infect Control Hosp Epidemiol 2019 41 (2) 1-3 Standardizing healthcare surface sampling requires the evaluation of sampling tools for organism adherence. Here, 7 sampling tools were evaluated to assess their elution efficiencies in the presence of 5 pathogens. Foam sponges (80.6%), microfiber wipes (80.5%), foam swabs (77.9%), and cellulose sponges (66.5%) yielded the highest median elution efficiencies. |
Effect of glove decontamination on bacterial contamination of healthcare personnel hands
Kpadeh-Rogers Z , Robinson GL , Alserehi H , Morgan DJ , Harris AD , Herrera NB , Rose LJ , Noble-Wang J , Johnson JK , Leekha S . Clin Infect Dis 2019 69 S224-s227 We examined the effect of glove decontamination prior to removal on bacterial contamination of healthcare personnel hands in a laboratory simulation study. Glove decontamination reduced bacterial contamination of hands following removal. However, hand contamination still occurred with all decontamination methods, reinforcing the need for hand hygiene following glove removal. |
Development of a rapid-viability PCR method for detection of Clostridioides difficile spores from environmental samples.
Shams AM , Rose LJ , Noble-Wang J . Anaerobe 2019 61 102077 Clostridioides difficile is a common pathogen that is well known to survive for extended periods of time on environmental healthcare surfaces from fecal contamination. During epidemiological investigations of healthcare-associated infections, it is important to be able to detect whether or not there are viable spores of C. difficile on surfaces. Current methods to detect C. difficile can take up to 7 days for culture and in the case of detection by PCR, viability of the spores cannot be ascertained. Prevention of C. difficile infection in healthcare settings includes adequate cleaning and disinfection of environmental surfaces which increases the likelihood of detecting dead organisms from an environmental sample during an investigation. In this study, we were able to adapt a rapid-viability PCR (RV-PCR) method, first developed for detection of viable Bacillus anthracis spores, for the detection of viable C. difficile spores. RV-PCR uses the change in cycle threshold after incubation to confirm the presence of live organisms. Using this modified method we were able to detect viable C. difficile after 22h of anaerobic incubation in Cycloserine Cefoxitin Fructose Broth (CCFB). This method also used bead beating combined with the Maxwell 16 Casework kit for DNA extraction and purification and a real-time duplex PCR assay for toxin B and cdd3 genes to confirm the identity of the C. difficile spores. Spiked environmental sponge-wipes with and without added organic load were tested to determine the limit of detection (LOD). The LOD from spiked environmental sponge-wipe samples was 10(4) spores/mL but after incubation initial spore levels of 10(1) spores/mL were detected. Use of this method would greatly decrease the amount of time required to detect viable C. difficile spores; incubation of samples is only required for germination (22h or less) instead of colony formation, which can take up to 7 days. In addition, PCR can then quickly confirm or deny the identity of the organism at the same time it would confirm viability. The presence of viable C. difficile spores could be detected at very low levels within 28h total compared to the 2 to 10-day process that would be needed for culture, identification and toxin detection. |
Development and implementation of evidence-based laboratory safety management tools for a public health laboratory
Keckler MS , Anderson K , McAllister S , Rasheed JK , Noble-Wang J . Saf Sci 2019 117 205-216 We developed an evidence-based continuous quality improvement (CQI) cycle for laboratory safety as a method of utilizing survey data to improve safety in a public health laboratory setting. Expert Opinion: The CQI cycle begins with the solicitation of laboratory staff input via an annual survey addressing potential chemical, physical and radiological hazards associated with multiple laboratory activities. The survey collects frequency, severity and exposure data related to these activities in the context of the most pathogenic organisms handled at least weekly. Gap Analysis: Step 2 of the CQI cycle used survey data to identify areas needing improvement. Typically, the traditional two-dimensional risk assessment matrix is used to prioritize mitigations. However, we added an additional dimension - frequency of exposure - to create three-dimensional risk maps to better inform and communicate risk priorities. Mitigation Measures: Step 3 of the CQI cycle was to use these results to develop mitigations. This included evaluating the identified risks to determine what risk control measures (elimination, substitution, engineering, administrative or PPE) were needed. In the 2016 iteration of the CQI cycle described here, all mitigations were based on administrative controls. Evaluation and Feedback: The last step of the CQI cycle was to evaluate the inferred effects of interventions through subsequent surveys, allowing for qualitative assessment of intervention effectiveness while simultaneously restarting the cycle by identifying new hazards.Here we describe the tools used to drive this CQI cycle, including the survey tool, risk analysis method, design of interventions and inference of mitigation effectiveness. |
Comparison of two glove-sampling methods to discriminate between study arms of a hand hygiene and glove-use study
Robinson GL , Otieno L , Johnson JK , Rose LJ , Harris AD , Noble-Wang J , Thom KA . Infect Control Hosp Epidemiol 2018 39 (7) 884-885 In the absence of a gold standard, we compared two glove-sampling methodologies, direct imprint and the sponge stick, to detect a difference between two arms in our study relative to total amount and presence of bacteria. |
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