Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-16 (of 16 Records) |
Query Trace: Waechter J [original query] |
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Infection preventionists' current and preferred training strategies and tools
Rebmann T , Evans C , Hughes AM , Mazzara RL , Lugo KA , Waechter J , Drummond S , Carnes A , Carlson AL , Glowicz J . Am J Infect Control 2024 BACKGROUND: Educating healthcare staff on infection prevention and control (IPC) is an essential role of infection preventionists (IP), but the COVID-19 pandemic diverted resources away from IPC education. This study's purpose was to conduct an assessment of current IPC training needs. METHODS: Association for Professionals in Infection Control and Epidemiology members were invited to complete an online survey in May - June, 2023 to assess their current and preferred approaches and tools for training healthcare personnel on IPC. Vendors, retirees, APIC staff, or those not working in a healthcare setting or public health were excluded. RESULTS: In all, 2,432 IPs participated. IPs were more likely to report engaging in impromptu healthcare worker training (i.e., just-in-time teaching and team huddles) versus planned educational activities (i.e., learning modules, formal presentations, train-the-trainer, or simulation; KW=288, p <.001). IPs' top preferred teaching methodologies included simulation or interactive activity and their lowest preferred approach was independent learning modules. IPC training apps were the most frequently requested technology. DISCUSSION: IPs ranked simulation as their top preferred teaching method; however, simulation was one of the least frequently used approaches. IP education should include strategies for delivering effective impromptu training and how to develop and implement interactive simulation-based education. CONCLUSIONS: The expressed needs and preferences of IPs should be considered when developing IPC-related teaching and training tools. |
Extensively drug-resistant typhoid fever in the United States
Hughes MJ , Birhane MG , Dorough L , Reynolds JL , Caidi H , Tagg KA , Snyder CM , Yu AT , Altman SM , Boyle MM , Thomas D , Robbins AE , Waechter HA , Cody I , Mintz ED , Gutelius B , Langley G , Francois Watkins LK . Open Forum Infect Dis 2021 8 (12) ofab572 Cases of extensively drug-resistant (XDR) typhoid fever have been reported in the United States among patients who did not travel internationally. Clinicians should consider if and where the patient traveled when selecting empiric treatment for typhoid fever. XDR typhoid fever should be treated with a carbapenem, azithromycin, or both. |
Notes from the Field: Recurrence of a Multistate Outbreak of Salmonella Typhimurium Infections Linked to Contact with Hedgehogs - United States and Canada, 2020.
Waltenburg MA , Nichols M , Waechter H , Higa J , Cronquist L , Lowe AM , Adams JK , McFadden K , McConnell JA , Blank R , Basler C . MMWR Morb Mortal Wkly Rep 2021 70 (32) 1100-1102 In July 2020, PulseNet, the national molecular subtyping network for enteric disease surveillance, detected a cluster of 17 Salmonella Typhimurium infections. The isolates were closely related genetically to each other (four allele differences) by whole genome sequencing (WGS) analysis and related to isolates from two previous outbreaks of S. Typhimurium infections linked to pet hedgehogs (1,2). An investigation was initiated to characterize illnesses and identify the outbreak source. | | A case was defined as the isolation of S. Typhimurium closely related by WGS to the outbreak strain in a specimen from a patient with illness onset during April–November 2020. State and local officials interviewed patients about hedgehog exposures and purchase information. Animal and environmental sampling of hedgehog enclosures was conducted at some patient residences. Hedgehog purchase locations were contacted in an attempt to identify a possible common source or supplier of hedgehogs. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.* |
Cost comparison between 2 responses to hepatitis A virus incidents in restaurant food handlers - New York City, 2015 and 2017
Baum SE , Reddy V , Vora NM , Balter S , Daskalakis D , Barbot O , Misener M , Rakeman J , Rojas J , Starr D , Waechter H , Zucker J , Lee D . J Public Health Manag Pract 2020 26 (2) 176-179 CONTEXT: While the New York City Department of Health and Mental Hygiene (DOHMH) can use agency-wide emergency activation to respond to a hepatitis A virus-infected food handler, there is a need to identify alternative responses that conserve scarce resources. OBJECTIVE: To compare the costs incurred by DOHMH of responding to a hepatitis A case in restaurant food handlers using an agency-wide emergency activation (2015) versus the cost of collaborating with a private network of urgent care clinics (2017). DESIGN: We partially evaluate the costs incurred by DOHMH of responding to a hepatitis A case in a restaurant food handler using agency-wide emergency activation (2015) with the cost of collaborating with a private network of urgent care clinics (2017) estimated for a scenario in which DOHMH incurred the retail cost of services rendered. RESULTS: Costs incurred by DOHMH for emergency activation were $65 831 ($238 per restaurant employee evaluated) of which DOHMH personnel services accounted for 85% ($55 854). Costs of collaboration would have totaled $50 914 ($253 per restaurant employee evaluated) of which personnel services accounted for 6% ($3146). CONCLUSIONS: Accounting for incident size, collaborating with the clinic network was more expensive than agency-wide emergency activation, though required fewer DOHMH personnel services. |
Flea market finds and global exports: Four multistate outbreaks of human Salmonella infections linked to small turtles, United States-2015
Gambino-Shirley K , Stevenson L , Concepcion-Acevedo J , Trees E , Wagner D , Whitlock L , Roberts J , Garrett N , Van Duyne S , McAllister G , Schick B , Schlater L , Peralta V , Reporter R , Li L , Waechter H , Gomez T , Fernandez Ordenes J , Ulloa S , Ragimbeau C , Mossong J , Nichols M . Zoonoses Public Health 2018 65 (5) 560-568 Zoonotic transmission of Salmonella infections causes an estimated 11% of salmonellosis annually in the United States. This report describes the epidemiologic, traceback and laboratory investigations conducted in the United States as part of four multistate outbreaks of Salmonella infections linked to small turtles. Salmonella isolates indistinguishable from the outbreak strains were isolated from a total of 143 ill people in the United States, pet turtles, and pond water samples collected from turtle farm A, as well as ill people from Chile and Luxembourg. Almost half (45%) of infections occurred in children aged <5 years, underscoring the importance of the Centers for Disease Control and Prevention recommendation to keep pet turtles and other reptiles out of homes and childcare settings with young children. Although only 43% of the ill people who reported turtle exposure provided purchase information, most small turtles were purchased from flea markets or street vendors, which made it difficult to locate the vendor, trace the turtles to a farm of origin, provide education and enforce the United States federal ban on the sale and distribution of small turtles. These outbreaks highlight the importance of improving public awareness and education about the risk of Salmonella from small turtles not only in the United States but also worldwide. |
The incidence of traumatic intracranial hemorrhage in head-injured older adults transported by EMS with and without anticoagulant or antiplatelet use
Nishijima DK , Gaona SD , Waechter T , Maloney R , Blitz A , Elms AR , Farrales RD , Montoya J , Bair T , Howard C , Gilbert M , Trajano R , Hatchel K , Faul M , Bell JM , Coronado V , Vinson DR , Ballard DW , Tancredi DJ , Garzon H , Mackey KE , Shahlaie K , Holmes JF . J Neurotrauma 2017 35 (5) 750-759 Field triage guidelines recommend transport of head-injured patients on anticoagulants or antiplatelets to a higher-level trauma center based on studies suggesting a high incidence of traumatic intracranial hemorrhage (tICH). We compared the incidence of tICH in older adults transported by EMS with and without anticoagulation or antiplatelet use and evaluated the accuracies of different sets of field triage criteria to identify tICH. This was a prospective, observational study at 5 EMS agencies and 11 hospitals. Older adults (≥55 years) with head trauma and transported by EMS from Aug 2015 to Sept 2016 were eligible. EMS providers completed standardized data forms and patients were followed through ED or hospital discharge. We enrolled 1,304 patients; 1147 (88%) received a cranial CT scan and were eligible for analysis. 434 (33%) patients had anticoagulant or antiplatelet use and 112 (10%) had tICH. The incidence of tICH in patients with (11%, 95%CI 8-14%) and without (9%, 95%CI 7-11%) anticoagulant or antiplatelet use was similar. Anticoagulant or antiplatelet use was not predictive of tICH on adjusted analysis. Steps 1-3 criteria alone were not sensitive in identifying tICH (27%) while the addition of anticoagulant or antiplatelet criterion improved sensitivity (63%). Other derived sets of triage criteria were highly sensitive (>98%) but poorly specific (<11%). The incidence of tICH was similar between patients with and without anticoagulant or antiplatelet use. Use of anticoagulant or antiplatelet medications was not a risk factor for tICH. We were unable to identify a set of triage criteria that was accurate for trauma center need. |
Notes from the field: Increase in reported hepatitis A infections among men who have sex with men - New York City, January-August 2017
Latash J , Dorsinville M , Del Rosso P , Antwi M , Reddy V , Waechter H , Lawler J , Boss H , Kurpiel P , Backenson PB , Gonzalez C , Rowe S , Poissant T , Lin Y , Xia GL , Balter S . MMWR Morb Mortal Wkly Rep 2017 66 (37) 999-1000 Since 2011, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has typically been notified of three or fewer cases of hepatitis A virus (HAV) infection each year among men who have sex with men (MSM) who reported no travel to countries where HAV is endemic. This year, DOHMH noted an increase in HAV infections among MSM with onsets in January-March 2017, and notified other public health jurisdictions via Epi-X, CDC's communication exchange network. As a result, 51 patients with HAV infection involving MSM were linked to the increase in NYC. |
Out-of-hospital triage of older adults with head injury: A retrospective study of the effect of adding "anticoagulation or antiplatelet medication use" as a criterion
Nishijima DK , Gaona SD , Waechter T , Maloney R , Bair T , Blitz A , Elms AR , Farrales RD , Howard C , Montoya J , Bell JM , Faul M , Vinson DR , Garzon H , Holmes JF , Ballard DW . Ann Emerg Med 2017 70 (2) 127-138 e6 STUDY OBJECTIVE: Field triage guidelines recommend that emergency medical services (EMS) providers consider transport of head-injured older adults with anticoagulation use to trauma centers. However, the triage patterns and the incidence of intracranial hemorrhage or neurosurgery in these patients are unknown. Our objective is to describe the characteristics and outcomes of older adults with head trauma who are transported by EMS, particularly for patients who do not meet physiologic, anatomic, or mechanism-of-injury (steps 1 to 3) field triage criteria but are receiving anticoagulant or antiplatelet medications. METHODS: This was a retrospective study at 5 EMS agencies and 11 hospitals (4 trauma centers, 7 nontrauma centers). Patients aged 55 years or older with head trauma who were transported by EMS were included. The primary outcome was the presence of intracranial hemorrhage. The secondary outcome was a composite measure of inhospital death or neurosurgery. RESULTS: Of the 2,110 patients included, 131 (6%) had intracranial hemorrhage and 41 (2%) had inhospital death or neurosurgery. There were 162 patients (8%) with steps 1 to 3 criteria. Of the remaining 1,948 patients without steps 1 to 3 criteria, 566 (29%) had anticoagulant or antiplatelet use. Of these patients, 52 (9%) had traumatic intracranial hemorrhage and 15 (3%) died or had neurosurgery. The sensitivity (adjusted for clustering by EMS agency) of steps 1 to 3 criteria was 19.8% (26/131; 95% confidence interval [CI] 5.5% to 51.2%) for identifying traumatic intracranial hemorrhage and 34.1% (14/41; 95% CI 9.9% to 70.1%) for death or neurosurgery. The additional criterion of anticoagulant or antiplatelet use improved the sensitivity for intracranial hemorrhage (78/131; 59.5%; 95% CI 42.9% to 74.2%) and death or neurosurgery (29/41; 70.7%; 95% CI 61.0% to 78.9%). CONCLUSION: Relatively few patients met steps 1 to 3 triage criteria. For individuals who did not have steps 1 to 3 criteria, nearly 30% had anticoagulant or antiplatelet use. A relatively high proportion of these patients had intracranial hemorrhage, but a much smaller proportion died or had neurosurgery during hospitalization. Use of steps 1 to 3 triage criteria alone is not sufficient in identifying intracranial hemorrhage and death or neurosurgery in this patient population. The additional criterion of anticoagulant or antiplatelet use improves the sensitivity of the instrument, with only a modest decrease in specificity. |
Hepatitis A cases among food handlers: A local health department response - New York City, 2013
Ridpath A , Reddy V , Layton M , Misener M , Scaccia A , Starr D , Stavinsky F , Varma JK , Waechter H , Zucker JR , Balter S . J Public Health Manag Pract 2017 23 (6) 571-576 During 2013, the New York City Department of Health and Mental Hygiene (DOHMH) received reports of 6 hepatitis A cases among food handlers. We describe our decision-making process for public notification, type of postexposure prophylaxis (PEP) offered, and lessons learned. For 3 cases, public notification was issued and DOHMH offered only hepatitis A vaccine as PEP. Subsequent outbreaks resulted from 1 case for which no public notification was issued or PEP offered, and 1 for which public notification was issued and PEP was offered too late. DOHMH continues to use environmental assessments to guide public notification decisions and offer only hepatitis A vaccine as PEP after public notification but recognizes the need to evaluate each situation individually. The PEP strategy employed by DOHMH should be considered because hepatitis A vaccine is immunogenic in all age groups, can be obtained by local jurisdictions more quickly, and is logistically easier to administer in mass clinics than immunoglobulin. |
Increasing antibiotic resistance in Shigella spp. from infected New York City Residents, New York, USA
Murray K , Reddy V , Kornblum JS , Waechter H , Chicaiza LF , Rubinstein I , Balter S , Greene SK , Braunstein SL , Rakeman JL , Dentinger CM . Emerg Infect Dis 2017 23 (2) 332-335 Approximately 20% of Shigella isolates tested in New York City, New York, USA, during 2013-2015 displayed decreased azithromycin susceptibility. Case-patients were older and more frequently male and HIV infected than those with azithromycin-susceptible Shigella infection; 90% identified as men who have sex with men. Clinical interpretation guidelines for azithromycin resistance and outcome studies are needed. |
Two Listeria monocytogenes pseudo-outbreaks caused by contaminated laboratory culture media
Matanock A , Katz LS , Jackson KA , Kucerova Z , Conrad AR , Glover WA , Nguyen V , Mohr MC , Marsden-Haug N , Thompson D , Dunn JR , Stroika S , Melius B , Tarr C , Dietrich SE , Kao AS , Kornstein L , Li Z , Maroufi A , Marder EP , Meyer R , Perez-Osorio AC , Reddy V , Reporter R , Carleton H , Tweeten S , Waechter H , Yee LM , Wise ME , Davis K , Jackson B . J Clin Microbiol 2015 54 (3) 768-70 Listeriosis is a serious foodborne infection that disproportionately affects elderly adults, pregnant women, newborns, and immunocompromised individuals. Diagnosis is made by culturing Listeria monocytogenes from sterile body fluids or products of conception. This report describes investigations of two listeriosis pseudo-outbreaks caused by contaminated laboratory media made from sheep blood. |
Multistate outbreak of listeriosis caused by imported cheese and evidence of cross-contamination of other cheeses, USA, 2012
Heiman KE , Garalde VB , Gronostaj M , Jackson KA , Beam S , Joseph L , Saupe A , Ricotta E , Waechter H , Wellman A , Adams-Cameron M , Ray G , Fields A , Chen Y , Datta A , Burall L , Sabol A , Kucerova Z , Trees E , Metz M , Leblanc P , Lance S , Griffin PM , Tauxe RV , Silk BJ . Epidemiol Infect 2015 144 (13) 1-11 Listeria monocytogenes is a foodborne pathogen that can cause bacteraemia, meningitis, and complications during pregnancy. In July 2012, molecular subtyping identified indistinguishable L. monocytogenes isolates from six patients and two samples of different cut and repackaged cheeses. A multistate outbreak investigation was initiated. Initial analyses identified an association between eating soft cheese and outbreak-related illness (odds ratio 17.3, 95% confidence interval 2.0-825.7) but no common brand. Cheese inventory data from locations where patients bought cheese and an additional location where repackaged cheese yielded the outbreak strain were compared to identify cheeses for microbiological sampling. Intact packages of imported ricotta salata yielded the outbreak strain. Fourteen jurisdictions reported 22 cases from March-October 2012, including four deaths and a fetal loss. Six patients ultimately reported eating ricotta salata; another reported eating cheese likely cut with equipment also used for contaminated ricotta salata, and nine more reported eating other cheeses that might also have been cross-contaminated. An FDA import alert and US and international recalls followed. Epidemiology-directed microbiological testing of suspect cheeses helped identify the outbreak source. Cross-contamination of cheese highlights the importance of using validated disinfectant protocols and routine cleaning and sanitizing after cutting each block or wheel. |
Challenges to implementing communicable disease surveillance in New York City evacuation shelters after Hurricane Sandy, November 2012
Ridpath AD , Bregman B , Jones L , Reddy V , Waechter H , Balter S . Public Health Rep 2015 130 (1) 48-53 Hurricane Sandy hit New York City (NYC) on October 29, 2012. Before and after the storm, 73 temporary evacuation shelters were established. The total census of these shelters peaked at approximately 6,800 individuals. Concern about the spread of communicable diseases in shelters prompted the NYC Department of Health and Mental Hygiene (DOHMH) to rapidly develop a surveillance system to report communicable diseases and emergency department transports from shelters. We describe the implementation of this system. Establishing effective surveillance in temporary shelters was challenging and required in-person visits by DOHMH staff to ensure reporting. After system establishment, surveillance data were used to identify some potential disease clusters. For the future, we recommend pre-event planning for disease surveillance. |
Salmonellosis and meat purchased at live-bird and animal-slaughter markets, United States, 2007-2012
Imanishi M , Anderson TC , Routh J , Brown C , Conidi G , Glenn L , Reddy V , Waechter H , Malavet M , Nyaku M , Bohm S , Bidol S , Arends K , Saupe A , Higa J , Nguyen TA , Pringle J , Behravesh CB , Bosch S . Emerg Infect Dis 2014 20 (1) 167-9 Salmonella spp. cause ≈1.2 million human illnesses annually in the United States (1). Infections are primarily acquired through exposure to contaminated food or infected animals (1,2). Since 2007, state and local health departments and the Centers for Disease Control and Prevention have investigated multiple salmonellosis outbreaks linked to meat purchased at live-bird markets (LBMs) and live-animal markets (LAMs), where poultry and livestock are sold for onsite slaughter. These markets typically operate in large cities and serve populations of diverse ethnic backgrounds (3). | | In 2007, an outbreak involving 62 case-patients infected with 1 of 3 S. enterica serotype Schwarzengrund strains was investigated in Massachusetts; 61% were children <5 years of age, including 14 (23%) infants <1 year of age, and 96% were Asian (Table). A case-patient was defined as a person infected with S. enterica who had a pulsed-field gel electrophoresis XbaI restriction enzyme pattern indistinguishable from the outbreak strain. Exposure to poultry purchased at LBMs was reported, and environmental sampling at an implicated LBM identified 6 S. enterica serotypes, including 1 outbreak strain. |
Creating student sleuths: how a team of graduate students helped solve an outbreak of Salmonella Heidelberg infections associated with kosher broiled chicken livers
Hanson H , Hancock WT , Harrison C , Kornstein L , Waechter H , Reddy V , Luker J , Malavet M , Huth P , Gieraltowski L , Balter S . J Food Prot 2014 77 (8) 1390-3 Since 2009, the New York City Department of Health and Mental Hygiene (DOHMH) has received FoodCORE funding to hire graduate students to conduct in-depth food exposure interviews of salmonellosis case patients. In 2011, an increase in the number of Salmonella Heidelberg infections with pulsed-field gel electrophoresis Xba I pattern JF6X01.0022 among observant Jewish communities in New York and New Jersey was investigated. As this pattern is common nationwide, some cases identified were not associated with the outbreak. To reduce the number of background cases, DOHMH focused on the community initially identified in the outbreak and defined a case as a person infected with the outbreak strain of Salmonella Heidelberg with illness onset from 1 April to 17 November 2011 and who consumed a kosher diet, spoke Yiddish, or self-identified as Jewish. Nationally, 190 individuals were infected with the outbreak strain of Salmonella Heidelberg; 63 New York City residents met the DOHMH case definition. In October 2011, the graduate students (Team Salmonella) interviewed three case patients who reported eating broiled chicken livers. Laboratory testing of chicken liver samples revealed the outbreak strain of Salmonella Heidelberg. Although they were only partially cooked, the livers appeared fully cooked, and consumers and retail establishment food handlers did not cook them thoroughly before eating or using them in a ready-to-eat spread. This investigation highlighted the need to prevent further illnesses from partially cooked chicken products. Removing background cases helped to focus the investigation. Training graduate students to collect exposure information can be a highly effective model for conducting foodborne disease surveillance and outbreak investigations for local and state departments of public health. |
Using online reviews by restaurant patrons to identify unreported cases of foodborne illness - New York City, 2012-2013
Harrison C , Jorder M , Stern H , Stavinsky F , Reddy V , Hanson H , Waechter H , Lowe L , Gravano L , Balter S . MMWR Morb Mortal Wkly Rep 2014 63 (20) 441-5 While investigating an outbreak of gastrointestinal disease associated with a restaurant, the New York City Department of Health and Mental Hygiene (DOHMH) noted that patrons had reported illnesses on the business review website Yelp (http://www.yelp.com) that had not been reported to DOHMH. To explore the potential of using Yelp to identify unreported outbreaks, DOHMH worked with Columbia University and Yelp on a pilot project to prospectively identify restaurant reviews on Yelp that referred to foodborne illness. During July 1, 2012-March 31, 2013, approximately 294,000 Yelp restaurant reviews were analyzed by a software program developed for the project. The program identified 893 reviews that required further evaluation by a foodborne disease epidemiologist. Of the 893 reviews, 499 (56%) described an event consistent with foodborne illness (e.g., patrons reported diarrhea or vomiting after their meal), and 468 of those described an illness within 4 weeks of the review or did not provide a period. Only 3% of the illnesses referred to in the 468 reviews had also been reported directly to DOHMH via telephone and online systems during the same period. Closer examination determined that 129 of the 468 reviews required further investigation, resulting in telephone interviews with 27 reviewers. From those 27 interviews, three previously unreported restaurant-related outbreaks linked to 16 illnesses met DOHMH outbreak investigation criteria; environmental investigation of the three restaurants identified multiple food-handling violations. The results suggest that online restaurant reviews might help to identify unreported outbreaks of foodborne illness and restaurants with deficiencies in food handling. However, investigating reports of illness in this manner might require considerable time and resources. |
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