Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-30 (of 43 Records) |
Query Trace: Thompson ND[original query] |
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Hepatitis C virus testing, infection, and cases reported through public health surveillance during expanded screening recommendations, United States, 2013-2021
Ly KN , Niles JK , Jiles RB , Kaufman HW , Weng MK , Patel P , Meyer WA 3rd , Thompson WW , Thompson ND . Public Health Rep 2024 333549231224199 OBJECTIVES: Hepatitis C virus (HCV) infection is the most common bloodborne infection in the United States. We assessed trends in HCV testing, infection, and surveillance cases among US adults. METHODS: We used Quest Diagnostics data from 2013-2021 to assess trends in the numbers tested for HCV antibody and proportion of positivity for HCV antibody and HCV RNA. We also assessed National Notifiable Diseases Surveillance System 2013-2020 data for trends in the number and proportion of hepatitis C cases. We applied joinpoint regression for trends testing. RESULTS: Annual HCV antibody testing increased from 1.7 million to 4.8 million from 2013 to 2021, and the positivity proportion declined (average, 0.2% per year) from 5.5% to 3.7%. The greatest percentage-point increase in HCV antibody testing occurred in hospitals and substance use disorder treatment facilities and among addiction medicine providers. HCV RNA positivity was stable at about 60% in 2013-2015 and declined to 41.0% in 2021 (2015-2021 average, -3.2% per year). Age-specific HCV RNA positivity was highest among people aged 40-59 years during 2013-2015 and among people aged 18-39 years during 2016-2021. The number of reported hepatitis C cases (acute and chronic) declined from 179 341 in 2015 to 105 504 in 2020 (average decline, -13 177 per year). The proportion of hepatitis C cases among those aged 18-39 years increased by an average of 1.4% per year during 2013-2020; among individuals aged 40-59 years, it decreased by an average of 2.3% per year during 2013-2018. CONCLUSIONS: HCV testing increased, suggesting improved universal screening. Various data sources are valuable for monitoring elimination progress. |
Hepatitis B care continuum models-data to inform public health action
Spradling PR , Bocour A , Kuncio DE , Ly KN , Harris AM , Thompson ND . Public Health Rep 2024 333549231218277 The application of a care continuum model (CCM) can identify gaps in diagnosis, care, and treatment of populations with a common condition, but challenges are inherent in developing a CCM for chronic hepatitis B. In contrast with treatment for HIV or hepatitis C, treatment is not indicated for all people with chronic hepatitis B, clinical endpoints are not clear for those receiving treatment, and those for whom treatment is not indicated remain at risk for complications. This topical review examines the data elements necessary to develop and apply chronic hepatitis B CCMs at the jurisdictional health department level. We conducted a nonsystematic review of US-based publications in Ovid MEDLINE (1946-present), Ovid Embase (1974-present), and Scopus (not date limited) databases, which yielded 724 publications for review. Jurisdictional health departments, if properly supported, could develop locale-specific focused CCMs using person-level chronic hepatitis B registries, updated longitudinally using electronic laboratory reporting data and case reporting data. These CCMs could be applied to identify disparities and improve rates in testing and access to care and treatment, which are necessary to reduce liver disease and chronic hepatitis B mortality. Investments in public health surveillance infrastructure, including substantial enhancements in electronic laboratory reporting and case reporting and the use of supplementary data sources, could enable jurisdictional health departments to develop modified CCMs for chronic hepatitis B that focus, at least initially, on "early" CCM steps, which emphasize optimization of hepatitis B diagnosis, linkage to care, and ongoing clinical follow-up of diagnosed people, all of which can lead to improved outcomes. |
Frequency of children diagnosed with perinatal hepatitis C, United States, 2018-2020
Newton SM , Woodworth KR , Chang D , Sizemore L , Wingate H , Pinckney L , Osinski A , Orkis L , Reynolds BD , Carpentieri C , Halai UA , Lyu C , Longcore N , Thomas N , Wills A , Akosa A , Olsen EO , Panagiotakopoulos L , Thompson ND , Gilboa SM , Tong VT . Emerg Infect Dis 2024 30 (1) 202-204 We describe hepatitis C testing of 47 (2%) of 2,266 children diagnosed with perinatal hepatitis C who were exposed during 2018-2020 in 7 jurisdictions in the United States. Expected frequency of perinatal transmission is 5.8%, indicating only one third of the cases in this cohort were reported to public health authorities. |
Assessing pathogen transmission opportunities: Variation in nursing home staff-resident interactions
Nelson Chang NC , Leecaster M , Fridkin S , Dube W , Katz M , Polgreen P , Roghmann MC , Khader K , Li L , Dumyati G , Tsay R , Lynfield R , Mahoehney JP , Nadle J , Hutson J , Pierce R , Zhang A , Wilson C , Haroldsen C , Mulvey D , Reddy SC , Stone ND , Slayton RB , Thompson ND , Stratford K , Samore M , Visnovsky LD . J Am Med Dir Assoc 2023 24 (5) 735 e1-735 e9 OBJECTIVES: The Centers for Disease Control and Prevention (CDC) recommends implementing Enhanced Barrier Precautions (EBP) for all nursing home (NH) residents known to be colonized with targeted multidrug-resistant organisms (MDROs), wounds, or medical devices. Differences in health care personnel (HCP) and resident interactions between units may affect risk of acquiring and transmitting MDROs, affecting EBP implementation. We studied HCP-resident interactions across a variety of NHs to characterize MDRO transmission opportunities. DESIGN: 2 cross-sectional visits. SETTING AND PARTICIPANTS: Four CDC Epicenter sites and CDC Emerging Infection Program sites in 7 states recruited NHs with a mix of unit care types (≥30 beds or ≥2 units). HCP were observed providing resident care. METHODS: Room-based observations and HCP interviews assessed HCP-resident interactions, care type provided, and equipment use. Observations and interviews were conducted for 7-8 hours in 3-6-month intervals per unit. Chart reviews collected deidentified resident demographics and MDRO risk factors (eg, indwelling devices, pressure injuries, and antibiotic use). RESULTS: We recruited 25 NHs (49 units) with no loss to follow-up, conducted 2540 room-based observations (total duration: 405 hours), and 924 HCP interviews. HCP averaged 2.5 interactions per resident per hour (long-term care units) to 3.4 per resident per hour (ventilator care units). Nurses provided care to more residents (n = 12) than certified nursing assistants (CNAs) and respiratory therapists (RTs) (CNA: 9.8 and RT: 9) but nurses performed significantly fewer task types per interaction compared to CNAs (incidence rate ratio (IRR): 0.61, P < .05). Short-stay (IRR: 0.89) and ventilator-capable (IRR: 0.94) units had less varied care compared with long-term care units (P < .05), although HCP visited residents in these units at similar rates. CONCLUSIONS AND IMPLICATIONS: Resident-HCP interaction rates are similar across NH unit types, differing primarily in types of care provided. Current and future interventions such as EBP, care bundling, or targeted infection prevention education should consider unit-specific HCP-resident interaction patterns. |
Risk Factors for SARS-CoV-2 Infection Among US Healthcare Personnel, May-December 2020.
Chea N , Brown CJ , Eure T , Ramirez RA , Blazek G , Penna AR , Li R , Czaja CA , Johnston H , Barter D , Miller BF , Angell K , Marshall KE , Fell A , Lovett S , Lim S , Lynfield R , Davis SS , Phipps EC , Sievers M , Dumyati G , Concannon C , McCullough K , Woods A , Seshadri S , Myers C , Pierce R , Ocampo VLS , Guzman-Cottrill JA , Escutia G , Samper M , Thompson ND , Magill SS , Grigg CT . Emerg Infect Dis 2022 28 (1) 95-103 To determine risk factors for coronavirus disease (COVID-19) among US healthcare personnel (HCP), we conducted a case-control analysis. We collected data about activities outside the workplace and COVID-19 patient care activities from HCP with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test results (cases) and from HCP with negative test results (controls) in healthcare facilities in 5 US states. We used conditional logistic regression to calculate adjusted matched odds ratios and 95% CIs for exposures. Among 345 cases and 622 controls, factors associated with risk were having close contact with persons with COVID-19 outside the workplace, having close contact with COVID-19 patients in the workplace, and assisting COVID-19 patients with activities of daily living. Protecting HCP from COVID-19 may require interventions that reduce their exposures outside the workplace and improve their ability to more safely assist COVID-19 patients with activities of daily living. |
Practices and activities among healthcare personnel with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection working in different healthcare settings-ten Emerging Infections Program sites, April-November 2020.
Chea N , Eure T , Penna AR , Brown CJ , Nadle J , Godine D , Frank L , Czaja CA , Johnston H , Barter D , Miller BF , Angell K , Marshall K , Meek J , Brackney M , Carswell S , Thomas S , Wilson LE , Perlmutter R , Marceaux-Galli K , Fell A , Lim S , Lynfield R , Davis SS , Phipps EC , Sievers M , Dumyati G , Concannon C , McCullough K , Woods A , Seshadri S , Myers C , Pierce R , Ocampo VLS , Guzman-Cottrill JA , Escutia G , Samper M , Pena SA , Adre C , Groenewold M , Thompson ND , Magill SS . Infect Control Hosp Epidemiol 2021 43 (8) 1-17 Healthcare personnel with SARS-CoV-2 infection were interviewed to describe activities and practices in and outside the workplace. Among 2,625 healthcare personnel, workplace-related factors that may increase infection risk were more common among nursing home personnel than hospital personnel, whereas selected factors outside the workplace were more common among hospital personnel. |
Antimicrobial Use in a Cohort of US Nursing Homes, 2017
Thompson ND , Stone ND , Brown CJ , Penna AR , Eure TR , Bamberg WM , Barney GR , Barter D , Clogher P , DeSilva MB , Dumyati G , Frank L , Felsen CB , Godine D , Irizarry L , Kainer MA , Li L , Lynfield R , Mahoehney JP , Maloney M , Nadle J , Ocampo VLS , Pierce R , Ray SM , Davis SS , Sievers M , Srinivasan K , Wilson LE , Zhang AY , Magill SS . JAMA 2021 325 (13) 1286-1295 IMPORTANCE: Controlling antimicrobial resistance in health care is a public health priority, although data describing antimicrobial use in US nursing homes are limited. OBJECTIVE: To measure the prevalence of antimicrobial use and describe antimicrobial classes and common indications among nursing home residents. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, 1-day point-prevalence surveys of antimicrobial use performed between April 2017 and October 2017, last survey date October 31, 2017, and including 15 276 residents present on the survey date in 161 randomly selected nursing homes from selected counties of 10 Emerging Infections Program (EIP) states. EIP staff reviewed nursing home records to collect data on characteristics of residents and antimicrobials administered at the time of the survey. Nursing home characteristics were obtained from nursing home staff and the Nursing Home Compare website. EXPOSURES: Residence in one of the participating nursing homes at the time of the survey. MAIN OUTCOMES AND MEASURES: Prevalence of antimicrobial use per 100 residents, defined as the number of residents receiving antimicrobial drugs at the time of the survey divided by the total number of surveyed residents. Multivariable logistic regression modeling of antimicrobial use and percentages of drugs within various classifications. RESULTS: Among 15 276 nursing home residents included in the study (mean [SD] age, 77.6 [13.7] years; 9475 [62%] women), complete prevalence data were available for 96.8%. The overall antimicrobial use prevalence was 8.2 per 100 residents (95% CI, 7.8-8.8). Antimicrobial use was more prevalent in residents admitted to the nursing home within 30 days before the survey date (18.8 per 100 residents; 95% CI, 17.4-20.3), with central venous catheters (62.8 per 100 residents; 95% CI, 56.9-68.3) or with indwelling urinary catheters (19.1 per 100 residents; 95% CI, 16.4-22.0). Antimicrobials were most often used to treat active infections (77% [95% CI, 74.8%-79.2%]) and primarily for urinary tract infections (28.1% [95% CI, 15.5%-30.7%]). While 18.2% (95% CI, 16.1%-20.1%) were for medical prophylaxis, most often use was for the urinary tract (40.8% [95% CI, 34.8%-47.1%]). Fluoroquinolones were the most common antimicrobial class (12.9% [95% CI, 11.3%-14.8%]), and 33.1% (95% CI, 30.7%-35.6%) of antimicrobials used were broad-spectrum antibiotics. CONCLUSIONS AND RELEVANCE: In this cross-sectional survey of a cohort of US nursing homes in 2017, prevalence of antimicrobial use was 8.2 per 100 residents. This study provides information on the patterns of antimicrobial use among these nursing home residents. |
International comparison of pressure ulcer measures in long-term care facilities: Assessing the methodological robustness of 4 approaches to point prevalence measurement
Poldrugovac M , Padget M , Schoonhoven L , Thompson ND , Klazinga NS , Kringos DS . J Tissue Viability 2021 30 (4) 517-526 INTRODUCTION: Pressure ulcer indicators are among the most frequently used performance measures in long-term care settings. However, measurement systems vary and there is limited knowledge about the international comparability of different measurement systems. The aim of this analysis was to identify possible avenues for international comparisons of data on pressure ulcer prevalence among residents of long-term care facilities. MATERIAL AND METHODS: A descriptive analysis of the four point prevalence measurement systems programs used in 28 countries on three continents was performed. The criteria for the description and analysis were based on the scientific literature on criteria for indicator selection, on issues in international comparisons of data and on specific challenges of pressure ulcer measurements. RESULTS: The four measurement systems use a prevalence measure based on very similar numerator and denominator definitions. All four measurement systems also collect data on patient mobility. They differ in the pressure ulcer classifications used and the requirements for a head-to-toe resident examination. The regional or country representativeness of long-term care facilities also varies among the four measurement systems. CONCLUSIONS: Methodological differences among the point prevalence measurement systems are an important barrier to reliable comparisons of pressure ulcer prevalence data. The alignment of the methodologies may be improved by implementing changes to the study protocols, such as aligning the classification of pressure ulcers and requirements for a head-to-toe resident skin assessment. The effort required for each change varies. All these elements need to be considered by any initiative to facilitate international comparison and learning. |
Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: Summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013-2017
Eure TR , Stone ND , Mungai EA , Bell JM , Thompson ND . Infect Control Hosp Epidemiol 2020 42 (1) 1-6 OBJECTIVE: Antibiotic resistance (AR) is a growing and highly prevalent problem in nursing homes. We describe selected AR phenotypes from pathogens causing urinary tract infections (UTIs) reported by nursing homes to the National Healthcare Safety Network (NHSN). DESIGN: Pathogens and antibiotic susceptibility testing results for UTI events in nursing homes between January 2013 and December 2017 were analyzed. The pathogen distribution and pooled mean proportion of isolates that tested resistant to select antibiotic agents are reported. SETTING AND PARTICIPANTS: US nursing homes voluntarily participating in the Long-Term Care Facility component of the NHSN. RESULTS: Overall, 243 nursing homes reported 1 or more UTIs: 121 (50%) were nonprofit facilities, median bed size was 91 (range: 9-801), and average occupancy was 87%. In total, 6,157 pathogens were reported for 5,485 UTI events. Moreover, 9 pathogens accounted for 90% of all reported UTIs; the 3 most frequently identified were Escherichia coli (41%), Proteus species (14%), and Klebsiella pneumoniae/oxytoca (13%). Among E. coli, fluoroquinolone, and extended-spectrum cephalosporin resistance were most prevalent (50% and 20%, respectively). Although Staphylococcus aureus and Enterococcus faecium represented <5% of pathogens reported, they had the highest rates of resistance (67% methicillin resistant and 60% vancomycin resistant, respectively). Multidrug resistance was most common in Pseudomonas aeruginosa (11%). For the resistant phenotypes we assessed, 36% of all UTIs reported were associated with a resistant pathogen. CONCLUSIONS: This is the first summary of AR among common pathogens causing UTIs reported to NHSN by nursing homes. Improved understanding of the resistance burden among common infections helps inform facility infection prevention and antibiotic stewardship efforts. |
Facility-Wide Testing for SARS-CoV-2 in Nursing Homes - Seven U.S. Jurisdictions, March-June 2020.
Hatfield KM , Reddy SC , Forsberg K , Korhonen L , Garner K , Gulley T , James A , Patil N , Bezold C , Rehman N , Sievers M , Schram B , Miller TK , Howell M , Youngblood C , Ruegner H , Radcliffe R , Nakashima A , Torre M , Donohue K , Meddaugh P , Staskus M , Attell B , Biedron C , Boersma P , Epstein L , Hughes D , Lyman M , Preston LE , Sanchez GV , Tanwar S , Thompson ND , Vallabhaneni S , Vasquez A , Jernigan JA . MMWR Morb Mortal Wkly Rep 2020 69 (32) 1095-1099 Undetected infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) contributes to transmission in nursing homes, settings where large outbreaks with high resident mortality have occurred (1,2). Facility-wide testing of residents and health care personnel (HCP) can identify asymptomatic and presymptomatic infections and facilitate infection prevention and control interventions (3-5). Seven state or local health departments conducted initial facility-wide testing of residents and staff members in 288 nursing homes during March 24-June 14, 2020. Two of the seven health departments conducted testing in 195 nursing homes as part of facility-wide testing all nursing homes in their state, which were in low-incidence areas (i.e., the median preceding 14-day cumulative incidence in the surrounding county for each jurisdiction was 19 and 38 cases per 100,000 persons); 125 of the 195 nursing homes had not reported any COVID-19 cases before the testing. Ninety-five of 22,977 (0.4%) persons tested in 29 (23%) of these 125 facilities had positive SARS-CoV-2 test results. The other five health departments targeted facility-wide testing to 93 nursing homes, where 13,443 persons were tested, and 1,619 (12%) had positive SARS-CoV-2 test results. In regression analyses among 88 of these nursing homes with a documented case before facility-wide testing occurred, each additional day between identification of the first case and completion of facility-wide testing was associated with identification of 1.3 additional cases. Among 62 facilities that could differentiate results by resident and HCP status, an estimated 1.3 HCP cases were identified for every three resident cases. Performing facility-wide testing immediately after identification of a case commonly identifies additional unrecognized cases and, therefore, might maximize the benefits of infection prevention and control interventions. In contrast, facility-wide testing in low-incidence areas without a case has a lower proportion of test positivity; strategies are needed to further optimize testing in these settings. |
Documentation of acute change in mental status in nursing homes highlights opportunity to augment infection surveillance criteria
Penna AR , Sancken CL , Stone ND , Eure TR , Bamberg W , Barney G , Barter D , Carswell S , Clogher P , Dumyati G , Felsen CB , Frank L , Godine D , Johnston H , Kainer MA , Li L , Lynfield R , Mahoehney JP , Nadle J , Pierce R , Ray SM , Davis SS , Sievers M , Wilson LE , Zhang AY , Magill SS , Thompson ND . Infect Control Hosp Epidemiol 2020 41 (7) 1-3 Acute change in mental status (ACMS), defined by the Confusion Assessment Method, is used to identify infections in nursing home residents. A medical record review revealed that none of 15,276 residents had an ACMS documented. Using the revised McGeer criteria with a possible ACMS definition, we identified 296 residents and 21 additional infections. The use of a possible ACMS definition should be considered for retrospective nursing home infection surveillance. |
Epidemiology of antibiotic use for urinary tract infection in nursing home residents
Thompson ND , Penna A , Eure TR , Bamberg WM , Barney G , Barter D , Clogher P , DeSilva MB , Dumyati G , Epson E , Frank L , Godine D , Irizarry L , Kainer MA , Li L , Lynfield R , Mahoehney JP , Nadle J , Ocampo V , Perry L , Ray SM , Davis SS , Sievers M , Wilson LE , Zhang AY , Stone ND , Magill SS . J Am Med Dir Assoc 2019 21 (1) 91-96 OBJECTIVES: Describe antibiotic use for urinary tract infection (UTI) among a large cohort of US nursing home residents. DESIGN: Analysis of data from a multistate, 1-day point prevalence survey of antimicrobial use performed between April and October 2017. SETTING AND PARTICIPANTS: Residents of 161 nursing homes in 10 US states of the Emerging Infections Program (EIP). METHODS: EIP staff reviewed nursing home medical records to collect data on systemic antimicrobial drugs received by residents, including therapeutic site, rationale for use, and planned duration. For drugs with the therapeutic site documented as urinary tract, pooled mean and nursing home-specific prevalence rates were calculated per 100 nursing home residents, and proportion of drugs by selected characteristics were reported. Data were analyzed in SAS, version 9.4. RESULTS: Among 15,276 residents, 407 received 424 antibiotics for UTI. The pooled mean prevalence rate of antibiotic use for UTI was 2.66 per 100 residents; nursing home-specific rates ranged from 0 to 13.6. One-quarter of antibiotics were prescribed for UTI prophylaxis, with a median planned duration of 111 days compared with 7 days when prescribed for UTI treatment (P < .001). Fluoroquinolones were the most common (18%) drug class used. CONCLUSIONS AND IMPLICATIONS: One in 38 residents was receiving an antibiotic for UTI on a given day, and nursing home-specific prevalence rates varied by more than 10-fold. UTI prophylaxis was common with a long planned duration, despite limited evidence to support this practice among older persons in nursing homes. The planned duration was >/=7 days for half of antibiotics prescribed for treatment of a UTI. Fluoroquinolones were the most commonly used antibiotics, despite their association with significant adverse events, particularly in a frail and older adult population. These findings help to identify priority practices for nursing home antibiotic stewardship. |
The National Healthcare Safety Network Long-term Care Facility Component early reporting experience: January 2013-December 2015
Palms DL , Mungai E , Eure T , Anttila A , Thompson ND , Dudeck MA , Edwards JR , Bell JM , Stone ND . Am J Infect Control 2018 46 (6) 637-642 BACKGROUND: In 2012, the Centers for Disease Control and Prevention launched the Long-term Care Facility (LTCF) Component of the National Healthcare Safety Network (NHSN) designed for LTCFs to monitor Clostridium difficile infections (CDIs), urinary tract infections (UTIs), infections due to multidrug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), and infection prevention process measures. METHODS: We describe characteristics and reporting patterns of facilities enrolled in the first 3 years of the surveillance system and rate estimates for CDI, UTI, and MRSA data submitted between 2013 and 2015. RESULTS: From 2013-2015, 279 LTCFs were enrolled and eligible to report to the NHSN with variability in reporting from year to year. Crude rate estimates pooled over these 3 years from reporting facilities were 0.98 incident LTCF-onset CDI cases per 10,000 resident days, 0.59 UTI cases per 1,000 resident days, and 0.10 LTCF-onset MRSA cases per 1,000 resident days. CONCLUSIONS: These initial data demonstrate the capability of the NHSN LTCF Component as a national surveillance system for monitoring infections in LTCFs. Further investigation is needed to understand factors associated with successful enrollment and reporting. As participation increases, data from a larger group of LTCFs will be used to establish national baselines and track prevention goals. |
Measuring antibiotic appropriateness for urinary tract infections in nursing home residents
Eure T , LaPlace LL , Melchreit R , Maloney M , Lynfield R , Whitten T , Warnke L , Dumyati G , Quinlan G , Concannon C , Thompson D , Stone ND , Thompson ND . Infect Control Hosp Epidemiol 2017 38 (8) 1-4 We assessed the appropriateness of initiating antibiotics in 49 nursing home (NH) residents receiving antibiotics for urinary tract infection (UTI) using 3 published algorithms. Overall, 16 residents (32%) received prophylaxis, and among the 33 receiving treatment, the percentage of appropriate use ranged from 15% to 45%. Opportunities exist for improving UTI antibiotic prescribing in NH. Infect Control Hosp Epidemiol 2017;1-4. |
Impact of removing mucosal barrier injury laboratory-confirmed bloodstream infections from central line-associated bloodstream infection rates in the National Healthcare Safety Network, 2014
See I , Soe MM , Epstein L , Edwards JR , Magill SS , Thompson ND . Am J Infect Control 2016 45 (3) 321-323 Central line-associated bloodstream infection (CLABSI) event data reported to the National Healthcare Safety Network from 2014, the first year of required use of the mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) definition, were analyzed to assess the impact of removing MBI-LCBI events from CLABSI rates. CLABSI rates decreased significantly in some location types after removing MBI-LCBI events, and MBI-LCBI events will be removed from publicly reported CLABSI rates. |
Prevalence of antimicrobial use and opportunities to improve prescribing practices in U.S. nursing homes
Thompson ND , LaPlace L , Epstein L , Thompson D , Dumyati G , Concannon C , Quinlan G , Witten T , Warnke L , Lynfield R , Maloney M , Melchreit R , Stone ND . J Am Med Dir Assoc 2016 17 (12) 1151-1153 OBJECTIVES: To describe the prevalence and epidemiology of antimicrobial use (AU) in nursing home residents. DESIGN: One-day point prevalence survey. SETTING AND PARTICIPANTS: Nine nursing homes in four states; 1,272 eligible residents. MEASUREMENT: Frequency of antimicrobials prescribed, drug name, start date, duration, route, rationale, and treatment site. AU prevalence per 100 residents overall and by resident characteristic. RESULTS: AU prevalence was 11.1% (95% confidence interval, 9.4%-12.9%) and varied by resident characteristics. Most (32%) antimicrobials were given for urinary tract infection. For 38% of AU, key prescribing information was not documented. CONCLUSION: Opportunities to improve AU documentation and prescribing exist in nursing homes. |
Evaluation of manual and automated bloodstream infection surveillance in outpatient dialysis centers
Thompson ND , Wise M , Belflower R , Kanago M , Kainer MA , Lovell C , Patel PR . Infect Control Hosp Epidemiol 2016 37 (4) 1-3 Outpatient hemodialysis bloodstream infection rates, now used for performance measurement and were significantly higher for manual compared with automated surveillance (P<.001), largely owing to the absence of blood culture data in the dialysis electronic health record. Improvement in data sharing between hospitals and outpatient dialysis centers is necessary. |
Completeness of methicillin-resistant Staphylococcus aureus bloodstream infection reporting from outpatient hemodialysis facilities to the National Healthcare Safety Network, 2013
Nguyen DB , See I , Gualandi N , Shugart A , Lines C , Bamberg W , Dumyati G , Harrison LH , Lesher L , Nadle J , Petit S , Ray SM , Schaffner W , Townes J , Njord L , Sievert D , Thompson ND , Patel PR . Infect Control Hosp Epidemiol 2015 37 (2) 1-3 Reports of bloodstream infections caused by methicillin-resistant Staphylococcus aureus among chronic hemodialysis patients to 2 Centers for Disease Control and Prevention surveillance systems (National Healthcare Safety Network Dialysis Event and Emerging Infections Program) were compared to evaluate completeness of reporting. Many methicillin-resistant S. aureus bloodstream infections identified in hospitals were not reported to National Healthcare Safety Network Dialysis Event. |
Evaluating the use of the case mix index for risk adjustment of healthcare-associated infection data: an illustration using Clostridium difficile infection data from the National Healthcare Safety Network
Thompson ND , Edwards JR , Dudeck MA , Fridkin SK , Magill SS . Infect Control Hosp Epidemiol 2015 37 (1) 1-7 BACKGROUND: Case mix index (CMI) has been used as a facility-level indicator of patient disease severity. We sought to evaluate the potential for CMI to be used for risk adjustment of National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) data. METHODS: NHSN facility-wide laboratory-identified Clostridium difficile infection event data from 2012 were merged with the fiscal year 2012 Inpatient Prospective Payment System (IPPS) Impact file by CMS certification number (CCN) to obtain a CMI value for hospitals reporting to NHSN. Negative binomial regression was used to evaluate whether CMI was significantly associated with healthcare facility-onset (HO) CDI in univariate and multivariate analysis. RESULTS: Among 1,468 acute care hospitals reporting CDI data to NHSN in 2012, 1,429 matched by CCN to a CMI value in the Impact file. CMI (median, 1.49; interquartile range, 1.36-1.66) was a significant predictor of HO CDI in univariate analysis (P<.0001). After controlling for community onset CDI prevalence rate, medical school affiliation, hospital size, and CDI test type use, CMI remained highly significant (P<.0001), with an increase of 0.1 point in CMI associated with a 3.4% increase in the HO CDI incidence rate. CONCLUSIONS: CMI was a significant predictor of NHSN HO CDI incidence. Additional work to explore the feasibility of using CMI for risk adjustment of NHSN data is necessary. |
Mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBI): descriptive analysis of data reported to National Healthcare Safety Network (NHSN), 2013
Epstein L , See I , Edwards JR , Magill SS , Thompson ND . Infect Control Hosp Epidemiol 2015 37 (1) 1-6 OBJECTIVES: To determine the impact of mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs) on central-line-associated bloodstream infection (CLABSI) rates during the first year of MBI-LCBI reporting to the National Healthcare Safety Network (NHSN) DESIGN: Descriptive analysis of 2013 NHSN data SETTING: Selected inpatient locations in acute care hospitals METHODS: A descriptive analysis of MBI-LCBI cases was performed. CLABSI rates per 1,000 central-line days were calculated with and without the inclusion of MBI-LCBIs in the subset of locations reporting ≥1 MBI-LCBI, and in all locations (regardless of MBI-LCBI reporting) to determine rate differences overall and by location type. RESULTS: From 418 locations in 252 acute care hospitals reporting ≥1 MBI-LCBIs, 3,162 CLABSIs were reported; 1,415 (44.7%) met the MBI-LCBI definition. Among these locations, removing MBI-LCBI from the CLABSI rate determination produced the greatest CLABSI rate decreases in oncology (49%) and ward locations (45%). Among all locations reporting CLABSI data, including those reporting no MBI-LCBIs, removing MBI-LCBI reduced rates by 8%. Here, the greatest decrease was in oncology locations (38% decrease); decreases in other locations ranged from 1.2% to 4.2%. CONCLUSIONS: An understanding of the potential impact of removing MBI-LCBIs from CLABSI data is needed to accurately interpret CLABSI trends over time and to inform changes to state and federal reporting programs. Whereas the MBI-LCBI definition may have a large impact on CLABSI rates in locations where patients with certain clinical conditions are cared for, the impact of MBI-LCBIs on overall CLABSI rates across inpatient locations appears to be more modest. |
Estimating central line-associated bloodstream infection incidence rates by sampling of denominator data: a prospective, multicenter evaluation
Thompson ND , Edwards JR , Bamberg W , Beldavs ZG , Dumyati G , Godine D , Maloney M , Kainer M , Ray S , Thompson D , Wilson L , Magill SS . Am J Infect Control 2015 43 (8) 853-6 BACKGROUND: Large-scale, prospective, evaluation of sampling for central line-associated bloodstream infection (CLABSI) denominator data was necessary prior to National Healthcare Safety Network (NHSN) implementation. METHODS: In a sample of volunteer hospitals from states in the Emerging Infections Program, prospective collection of CLABSI denominators (patient days, central line days [CLDs]) was performed in eligible locations for ≥6 and ≤12 consecutive months using the current NHSN method (daily collection) and also by a second data collector who sampled the denominator data 1 d/wk. The quality of the sampled data was evaluated and used to calculate estimated CLDs and CLABSI rates, which were compared with actual CLDs and CLABSI rates (daily counts). RESULTS: In total, 89 locations in 66 acute care hospitals participated. Sampled data were collected as intended 88% of the time; the quality of the data was comparable with the data collected daily. In locations with higher CLDs per month (≥75), estimated CLDs and CLABSI rates were similar to actual CLDs and CLABSI rates; however, there were significant differences in actual and estimated values among locations with lower (≤74) CLDs per month.Sampling was successfully implemented, but significant differences in the accuracy of estimated CLDs and CLABSI rates, based on the actual number of CLDs per month, were noted. CONCLUSION: For locations with a higher number of CLDs per month, sampling 1 d/wk is a valid and accurate alternative to daily collection of CLABSI denominator data. |
Outbreak of hepatitis C virus infection associated with narcotics diversion by an hepatitis C virus-infected surgical technician.
Warner AE , Schaefer MK , Patel PR , Drobeniuc J , Xia G , Lin Y , Khudyakov Y , Vonderwahl CW , Miller L , Thompson ND . Am J Infect Control 2014 43 (1) 53-8 BACKGROUND: Drug diversion by health care personnel poses a risk for serious patient harm. Public health identified 2 patients diagnosed with acute hepatitis C virus (HCV) infection who shared a common link with a hospital. Further investigation implicated a drug-diverting, HCV-infected surgical technician who was subsequently employed at an ambulatory surgical center. METHODS: Patients at the 2 facilities were offered testing for HCV infection if they were potentially exposed. Serum from the surgical technician and patients testing positive for HCV but without evidence of infection before their surgical procedure was further tested to determine HCV genotype and quasi-species sequences. Parenteral medication handling practices at the 2 facilities were evaluated. RESULTS: The 2 facilities notified 5970 patients of their possible exposure to HCV, 88% of whom were tested and had results reported to the state public health departments. Eighteen patients had HCV highly related to the surgical technician's virus. The surgical technician gained unauthorized access to fentanyl owing to limitations in procedures for securing controlled substances. CONCLUSIONS: Public health surveillance identified an outbreak of HCV infection due to an infected health care provider engaged in diversion of injectable narcotics. The investigation highlights the value of public health surveillance in identifying HCV outbreaks and uncovering a method of drug diversion and its impacts on patients. |
Hepatitis C virus screening and management of seroconversions in hemodialysis facilities
Mbaeyi C , Thompson ND . Semin Dial 2013 26 (4) 439-46 Over the past two decades, healthcare-associated exposure has increasingly been proved to be a means of hepatitis C virus (HCV) transmission, especially in hemodialysis facilities. The prevalence of HCV among hemodialysis patients is known to be several times greater than that of the general population of the United States, and chronic HCV infection is associated with significant morbidity and mortality among these patients. During 2008-2011, HCV infection outbreaks were identified in multiple US hemodialysis facilities, resulting in at least 46 new HCV infections among hemodialysis patients. These outbreaks, linked to infection control breaches, also highlight the failure of some facilities to follow established guidelines for routine HCV antibody (anti-HCV) screening and response to new HCV infection among hemodialysis patients. Current national guidelines recommend screening of hemodialysis patients for anti-HCV on facility admission and, for susceptible patients, on a semiannual basis. Here, we seek to underscore the importance of compliance with national recommendations for anti-HCV screening of hemodialysis patients and actions to be taken in the event of possible HCV transmission within a hemodialysis facility. These include general steps to ensure that: hemodialysis patients are routinely screened for anti-HCV to facilitate early detection of new infections; newly infected patients are informed of the change in their HCV status and undergo clinical evaluation; and public health officials are notified of new HCV infections in a timely manner. We then focus on the need to assess infection control practices at the facility, with particular attention given to safe handling of injectable medications, hand hygiene and disinfection practices. In the absence of a vaccine, routine screening and adherence to standard infection control practices will remain the key strategies for preventing HCV transmission in hemodialysis units. |
Mucosal barrier injury laboratory-confirmed bloodstream infection: results from a field test of a new National Healthcare Safety Network definition
See I , Iwamoto M , Allen-Bridson K , Horan T , Magill SS , Thompson ND . Infect Control Hosp Epidemiol 2013 34 (8) 769-76 OBJECTIVE: To assess challenges to implementation of a new National Healthcare Safety Network (NHSN) surveillance definition, mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI). DESIGN: Multicenter field test. SETTING: Selected locations of acute care hospitals participating in NHSN central line-associated bloodstream infection (CLABSI) surveillance. METHODS: Hospital staff augmented their CLABSI surveillance for 2 months to incorporate MBI-LCBI: a primary bloodstream infection due to a selected group of organisms in patients with either neutropenia or an allogeneic hematopoietic stem cell transplant with gastrointestinal graft-versus-host disease or diarrhea. Centers for Disease Control and Prevention (CDC) staff reviewed submitted data to verify whether CLABSIs met MBI-LCBI criteria and summarized the descriptive epidemiology of cases reported. RESULTS: Eight cancer, 2 pediatric, and 28 general acute care hospitals including 193 inpatient units (49% oncology/bone marrow transplant [BMT], 21% adult ward, 20% adult critical care, 6% pediatric, 4% step-down) conducted field testing. Among 906 positive blood cultures reviewed, 282 CLABSIs were identified. Of the 103 CLABSIs that also met MBI-LCBI criteria, 100 (97%) were reported from oncology/BMT locations. Agreement between hospital staff and CDC classification of reported CLABSIs as meeting the MBI-LCBI definition was high (90%; [Formula: see text]). Most MBI-LCBIs (91%) occurred in patients meeting neutropenia criteria. Some hospitals indicated that their laboratories' methods of reporting cell counts prevented application of neutropenia criteria; revised neutropenia criteria were created using data from field testing. CONCLUSIONS: Hospital staff applied the MBI-LCBI definition accurately. Field testing informed modifications for the January 2013 implementation of MBI-LCBI in the NHSN. |
Outbreak of hepatitis C virus infections at an outpatient hemodialysis facility: the importance of infection control competencies
Rao AK , Luckman E , Wise ME , MacCannell T , Blythe D , Lin Y , Xia G , Drobeniuc J , Noble-Wang J , Arduino MJ , Thompson ND , Patel PR , Wilson LE . Nephrol Nurs J 2013 40 (2) 101-164 In the United States, the prevalence of hepatitis C virus infection among patients treated in hemodialysis facilities is five times higher than among the general population. This study investigated eight new hepatitis C virus infections among patients treated at an outpatient hemodialysis facility. Epidemiologic investigation and viral sequencingdemonstrated that transmission likely occurred between patients typically treated during the same or consecutive shifts at the same or a nearby station. Several infection control breaches were observed, including lapses involving the preparation, handling, and administration of parenteral medications. Improved infection control education and training for all hemodialysis facility staff is an important component of assuring adherence to appropriate procedures and preventing future outbreaks. |
Infections in long-term care populations in the United States
Dwyer LL , Harris-Kojetin LD , Valverde RH , Frazier JM , Simon AE , Stone ND , Thompson ND . J Am Geriatr Soc 2013 61 (3) 342-9 OBJECTIVES: To estimate infection prevalence and explore associated risk factors in nursing home (NH) residents, individuals receiving home health care (HHC), and individuals receiving hospice care. DESIGN: Cross-sectional. SETTING: Nationally representative samples of 1,174 U.S. NHs in the 2004 National Nursing Home Survey (NNHS) and 1,036 U.S. HHC and hospice agencies in the 2007 National Home and Hospice Care Survey (NHHCS). PARTICIPANTS: A nationally representative sample of 12,270 NH residents, 4,394 individuals receiving HHC, and 4,410 individuals receiving hospice care. MEASUREMENTS: International Classification of Diseases, Ninth Revision, Clinical Modification, codes were used to identify the presence of infection, including community-acquired infection and those acquired during earlier healthcare exposures. RESULTS: Unweighted response rates were 78% for the 2004 NHHS and 67% for the 2007 NHHCS. Approximately 12% of NH residents and 12% of individuals receiving HHC had an infection at the time of the survey interview, and more than 10% of individuals receiving hospice care had an infection when discharged from hospice care. The most common infections were urinary tract infection (3.0-5.2%), pneumonia (2.2-4.4%), and cellulitis (1.6-2.0%). Short length of care and recent inpatient stay in a healthcare facility were associated with infections in all three populations. Taking 10 or more medications and urinary catheter exposure were significant in two of these three long-term care populations. CONCLUSION: Infection prevalence in HHC, hospice, and NH populations is similar. Although these infections may be community acquired or acquired during earlier healthcare exposures, these findings fill an important gap in understanding the national infection burden and may help inform future research on infection epidemiology and prevention strategies in long-term care populations. |
Investigating systematic misclassification of central line-associated bloodstream infection (CLABSI) to secondary bloodstream infection during health care-associated infection reporting
Thompson ND , Yeh LL , Magill SS , Ostroff SM , Fridkin SK . Am J Med Qual 2013 28 (1) 56-9 Central line-associated bloodstream infection (CLABSI) rates are an important measure of health care quality. However, reputational or financial risks associated with public reporting and disclosure of hospital CLABSI rates may introduce reporting biases, including intentional underreporting. To assess systematic case misclassification of CLABSI to secondary bloodstream infection (BSI; ie, intentional underreporting of CLABSI), the authors assessed data reported to the National Healthcare Safety Network by hospitals in Pennsylvania, the only state in which both CLABSI and secondary BSI reporting are mandatory. CLABSI rates decreased over the 2-year analysis period, but the authors found no evidence of increasing secondary BSI rates, suggesting that systematic case misclassification is not widespread. |
Evaluating the accuracy of sampling to estimate central line-days: simplification of the National Healthcare Safety Network surveillance methods
Thompson ND , Edwards JR , Bamberg W , Beldavs ZG , Dumyati G , Godine D , Maloney M , Kainer M , Ray S , Thompson D , Wilson L , Magill SS . Infect Control Hosp Epidemiol 2013 34 (3) 221-8 OBJECTIVE: To evaluate the accuracy of weekly sampling of central line-associated bloodstream infection (CLABSI) denominator data to estimate central line-days (CLDs). DESIGN: Obtained CLABSI denominator logs showing daily counts of patient-days and CLD for 6-12 consecutive months from participants and CLABSI numerators and facility and location characteristics from the National Healthcare Safety Network (NHSN). SETTING AND PARTCIPANTS: Convenience sample of 119 inpatient locations in 63 acute care facilities within 9 states participating in the Emerging Infections Program. METHODS: Actual CLD and estimated CLD obtained from sampling denominator data on all single-day and 2-day (day-pair) samples were compared by assessing the distributions of the CLD percentage error. Facility and location characteristics associated with increased precision of estimated CLD were assessed. The impact of using estimated CLD to calculate CLABSI rates was evaluated by measuring the change in CLABSI decile ranking. RESULTS: The distribution of CLD percentage error varied by the day and number of days sampled. On average, day-pair samples provided more accurate estimates than did single-day samples. For several day-pair samples, approximately 90% of locations had CLD percentage error of less than or equal to +/-5%. A lower number of CLD per month was most significantly associated with poor precision in estimated CLD. Most locations experienced no change in CLABSI decile ranking, and no location's CLABSI ranking changed by more than 2 deciles. CONCLUSIONS: Sampling to obtain estimated CLD is a valid alternative to daily data collection for a large proportion of locations. Development of a sampling guideline for NHSN users is underway. |
Transmission of hepatitis B virus from an orthopedic surgeon with a high viral load
Enfield KB , Sharapov U , Hall KK , Leiner J , Berg CL , Xia GL , Thompson ND , Ganova-Raeva L , Sifri CD . Clin Infect Dis 2013 56 (2) 218-24 BACKGROUND: During the evaluation of a needle-stick injury, an orthopedic surgeon was found to be unknowingly infected with hepatitis B virus (HBV) (viral load >17.9 million IU/mL). He had previously completed two 3-dose series of hepatitis B vaccine without achieving a protective level of surface antibody. We investigated whether any surgical patients had acquired HBV infection while under his care. METHODS: A retrospective cohort study of all patients who underwent surgery by the surgeon was conducted. Patients were notified of their potential exposure and need for testing, and samples with positive HBV loads underwent DNA sequencing. Characteristics of the surgical procedures for the cohort were evaluated. RESULTS: A total of 232 (70.7%) of potentially exposed patients consented to testing; 2 were found to have acute infection and 6 had possible transmission (evidence of past exposure without risk factors). Genome sequence analysis of HBV DNA from the infected surgeon and patients with acute infection revealed genetically related virus (>99.9% nucleotide identity). Only age was found to be statistically different between those with confirmed or possible HBV transmission and those who remained susceptible to HBV. CONCLUSIONS: We documented HBV transmission during orthopedic surgery to 2 patients from a surgeon with HBV. This investigation highlights the importance of evaluating individuals who do not respond to 2 series of HBV vaccination, the increased risk of HBV transmission from providers with high viral loads, and the need to evaluate the clinical practice of providers with HBV and implement appropriate procedure-based practice restrictions. |
Outbreak of hepatitis B virus infections associated with assisted monitoring of blood glucose in an assisted living facility - Virginia, 2010
Bender TJ , Wise ME , Utah O , Moorman AC , Sharapov U , Drobeniuc J , Khudyakov Y , Fricchione M , White-Comstock MB , Thompson ND , Patel PR . PLoS One 2012 7 (12) e50012 INTRODUCTION: In January 2010, the Virginia Department of Health received reports of 2 hepatitis B virus (HBV) infections (1 acute, 1 chronic) among residents of a single assisted living facility (ALF). Both infected residents had diabetes and received assisted monitoring of blood glucose (AMBG) at the facility. An investigation was initiated in response. OBJECTIVE: To determine the extent and mechanism of HBV transmission among ALF residents. DESIGN: Retrospective cohort study. SETTING: An ALF that primarily housed residents with neuropsychiatric disorders in 2 adjacent buildings in Virginia. PARTICIPANTS: Residents of the facility as of March 2010. MEASUREMENTS: HBV serologic testing, relevant medical history, and HBV genome sequences. Risk ratios (RR) and 95% confidence intervals (CIs) were used to identify risk factors for HBV infection. RESULTS: HBV serologic status was determined for 126 (91%) of 139 residents. Among 88 susceptible residents, 14 became acutely infected (attack rate, 16%), and 74 remained uninfected. Acute HBV infection developed among 12 (92%) of 13 residents who received AMBG, compared with 2 (3%) of 75 residents who did not (RR = 35; 95% CI, 8.7, 137). Identified infection control breaches during AMBG included shared use of fingerstick devices for multiple residents. HBV genome sequencing demonstrated 2 building-specific phylogenetic infection clusters, each having 99.8-100% sequence identity. LIMITATIONS: Transfer of residents out of the facility prior to our investigation might have contributed to an underestimate of cases. Resident interviews provided insufficient information to fully assess behavioral risk factors for HBV infection. CONCLUSIONS: Failure to adhere to safe practices during AMBG resulted in a large HBV outbreak. Protection of a growing and vulnerable ALF population requires improved training of staff and routine facility licensing inspections that scrutinize infection control practices. |
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