scholarly journals The Epidemiology of Methicillin-ResistantStaphylococcus aureuson a Burn Trauma Unit

2012 ◽  
Vol 33 (11) ◽  
pp. 1118-1125 ◽  
Author(s):  
Marin Schweizer ◽  
Melissa Ward ◽  
Sandra Cobb ◽  
Jennifer McDanel ◽  
Laurie Leder ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Nasal Carriage ◽  
Burn Trauma ◽  
Trauma Unit ◽  
Time Period ◽  
Academic Medical ◽  
A Site ◽  
Mrsa Colonization

Objective.We assessed the frequency and relatedness of methicillin-resistantStaphylococcus aureus(MRSA) isolates to determine whether healthcare workers, the environment, or admitted patients could be a reservoir for MRSA on a burn trauma unit (BTU). We also assessed risk factors for MRSA colonization among BTU patients.Design.Prospective cohort study and surveillance for MRSA carriage.Setting.BTU of a Midwestern academic medical center.Patients and Participants.Patients admitted to a BTU from February 2009 through January 2010 and healthcare workers on this unit during the same time period.Methods.Samples for MRSA culture were collected on admission from the nares and wounds of all BTU patients. We also had collected culture samples from the throat, axilla, antecubital fossa, groin, and perianal area of 12 patients per month. Samples collected from healthcare workers' nares and from environmental sites were cultured quarterly. MRSA isolates were typed by pulsed-field gel electrophoresis.Results.Of 144 patients, 24 (17%) carried MRSA in their nares on admission. Male sex (odds ratio [OR], 5.51; 95% confidence interval [95% CI], 1.25–24.30), admission for necrotizing fasciitis (OR, 7.66; 95% CI, 1.64–35.81), and MRSA colonization of a site other than the nares (OR, 23.40; 95% CI, 6.93–79.01) were independent predictors of MRSA nasal carriage. Cultures of samples collected from 4 healthcare workers and 4 environmental cultures had positive results. Two patients were colonized with strains that were indistinguishable from strains collected from a healthcare worker or the environment.Conclusions.Patients were a major reservoir for MRSA. Infection control efforts should focus on preventing transmission of MRSA from patients who are MRSA carriers to other patients on the unit.

scholarly journals 421. Effect of SARs-Cov-2 mRNA Vaccination in Healthcare Workers with Household COVID Exposure

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S311-S311
Author(s):  
Laura Selby ◽  
Richard Starlin
Keyword(s):  
Healthcare Workers ◽  
Screening Program ◽  
Medical Center ◽  
Severe Disease ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Limited Data ◽  
Viral Shedding ◽  
Academic Medical ◽  
Significant Burden

Abstract Background Healthcare workers have experienced a significant burden of COVID-19 disease. COVID mRNA vaccines have shown great efficacy in prevention of severe disease and hospitalization due to COVID infection, but limited data is available about acquisition of infection and asymptomatic viral shedding. Methods Fully vaccinated healthcare workers at a tertiary-care academic medical center in Omaha Nebraska who reported a household exposure to COVID-19 infection are eligible for a screening program in which they are serially screened with PCR but allowed to work if negative on initial test and asymptomatic. Serial screening by NP swab was completed every 5-7 days, and workers became excluded from work if testing was positive or became symptomatic. Results Of the 94 employees who were fully vaccinated at the time of the household exposure to COVID-19 infection, 78 completed serial testing and were negative. Sixteen were positive on initial or subsequent screening. Vaccine failure rate of 17.0% (16/94). Healthcare workers exposed to household COVID positive contact Conclusion High risk household exposures to COVID-19 infection remains a significant potential source of infections in healthcare workers even after workers are fully vaccinated with COVID mRNA vaccines especially those with contact to positive domestic partners. Disclosures All Authors: No reported disclosures

scholarly journals In depth characterization of vaccine breakthrough infections with SARS-CoV-2 among healthcare workers of a Dutch academic medical center

2021 ◽  
Author(s):  
Lidewij W Rümke ◽  
Femke C Groenveld ◽  
Yvonne M G van Os ◽  
Patrique Praest ◽  
Anniek A N Tanja ◽  
...  
Keyword(s):  
Immune Responses ◽  
Healthcare Workers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Risk Exposure ◽  
Live Virus ◽  
Viral Loads ◽  
Academic Medical ◽  
T Cell Immune Responses

Abstract SARS-CoV-2 infection after COVID-19 vaccination raises concerns about the emergence of vaccine escape variants. Here we characterize 14 breakthrough infections among 5860 fully vaccinated Dutch healthcare workers ≥14 days post final dose of vaccination with either BNT162b2, mRNA-1273 or Ad26.COV2.S. These breakthrough infections presented with regular B.1.1.7 (Alpha) and B.1.617.2 (Delta) variants and high viral loads, despite normal vaccine induced B- and T-cell immune responses detected by live virus neutralization assays and ELISpot. High-risk exposure settings, such as in households, indicate a potential risk of viral transmission despite full vaccination.

Abstract T P168: A Wake-up Call for Wake-up Strokes

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Josephine F Huang ◽  
Jennifer E Fugate ◽  
Alejandro A Rabinstein
Keyword(s):  
Ischemic Stroke ◽  
Medical Center ◽  
Academic Medical Center ◽  
Stroke Treatment ◽  
Good Outcome ◽  
Time Period ◽  
Academic Medical ◽  
Younger Age ◽  
Stroke Mechanism

INTRODUCTION: Studies suggest 8%-28% of ischemic strokes present as wake-up strokes (WUS). The unknown time of symptom onset precludes these patients from approved treatments for acute ischemic stroke, but a substantial proportion of patients may be deemed candidates for treatment if other factors are considered. The aim of this study was to identify characteristics associated with clinical outcomes of WUS patients. METHODS: We retrospectively reviewed the medical record of patients with ischemic stroke admitted to a large academic medical center between January 2011 and May 2012. We identified patients with stroke symptoms upon awakening or those who were found with stroke symptoms with an unknown time of onset. Baseline demographics, stroke mechanism, presenting NIHSS, Alberta Stroke Program Early Computed Tomography Score (ASPECTS), and modified Rankin Scale (mRS) scores on discharge and at 3-month follow-up were obtained. A good outcome was defined as mRS 0-2. RESULTS: WUS patients comprised 22% (162/731) of all patients with ischemic stroke at our institution during this time period. Median age was 74 years (range 15-100), median presenting NIHSS was 5 (range 0-28), and median initial ASPECTS 10 (range 0-10). A cardioembolic mechanism was identified in 68 patients (42%). Predictors of good outcome at hospital discharge were lower initial NIHSS (3.5 versus 12.0, p<0.0001) and higher ASPECTS (9.8 versus 8.1, p=0.0002). The predictors of good outcomes at 3 months were younger age (69.1 versus 75.8, p=0.009), lower initial NIHSS (5.0 versus 12.6, p<0.0001), and higher ASPECTS (9.5 versus 8.1, p=0.0006). One hundred and eleven patients (68.5%) had initial ASPECTS of 10. Of those, 19 had NIHSS≥10 and 7 were treated with acute recanalization therapies. Four of the 7 treated patients had good outcomes, and 2 of the 12 untreated patients had good outcomes. CONCLUSIONS: Few patients with strokes of unknown onset and severe deficits have good outcomes without acute stroke treatment. Patients with NIHSS≥10 and ASPECTS 10 may be candidates for acute recanalization therapy.

Growth and Management of Repaired Complete Tracheal Rings after Slide Tracheoplasty

2019 ◽  
Vol 161 (1) ◽  
pp. 164-170 ◽  
Author(s):  
Lyndy J. Wilcox ◽  
Claudia Schweiger ◽  
Catherine K. Hart ◽  
Alessandro de Alarcon ◽  
Nithin S. Peddireddy ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Balloon Dilation ◽  
Case Series ◽  
Slide Tracheoplasty ◽  
Time Period ◽  
Academic Medical ◽  
Operative Notes ◽  
Over Time

ObjectiveThis study documents the growth and course of repaired complete tracheal rings over time after slide tracheoplasty.Study DesignCase series with review.SettingTertiary pediatric academic medical center.Subjects/MethodsMedical records of pediatric patients with confirmed tracheal rings on bronchoscopy who underwent slide tracheoplasty between January 2001 and December 2015 were reviewed. Patients who had operative notes documenting tracheal sizing over time were included. Exclusion criteria included tracheal stenosis not caused by complete tracheal rings, surgical repair prior to presentation at our institution, or lack of adequate sizing information. The postoperative follow-up was examined and airway growth over time documented.ResultsOf 197 slide tracheoplasties performed during the study time period, 139 were for complete tracheal rings, and 40 of those children met inclusion criteria. The median age at time of surgery was 7 months, and the median initial airway size was 3.9 mm (n = 34). The median growth postoperatively was 1.9 mm over a median follow-up period of 57 months (0.42 mm/year), which is similar to growth rates of unrepaired complete tracheal rings ( P = .53). Children underwent a median of 10 postoperative endoscopies, with time between endoscopies increasing further out from surgery. The most commonly performed adjunctive procedure was balloon dilation.ConclusionsThis is the first study documenting continued growth of repaired complete tracheal rings after slide tracheoplasty. Postoperative endoscopic surveillance ensures adequate growth. Intervals between airway endoscopies can be increased as the child gets older, as the airway increases in size, and as long as symptoms are minimal.

scholarly journals Reducing Unnecessary Preoperative Blood Orders and Costs by Implementing an Updated Institution-specific Maximum Surgical Blood Order Schedule and a Remote Electronic Blood Release System

2014 ◽  
Vol 121 (3) ◽  
pp. 501-509 ◽  
Author(s):  
Steven M. Frank ◽  
Michael J. Oleyar ◽  
Paul M. Ness ◽  
Aaron A. R. Tobian
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Substantial Reduction ◽  
Information Management System ◽  
Surgical Patients ◽  
Release System ◽  
Time Period ◽  
Academic Medical ◽  
Utilization Data ◽  
Transfusion Ratio

Abstract Background: Using blood utilization data acquired from the anesthesia information management system, an updated institution-specific maximum surgical blood order schedule was introduced. The authors evaluated whether the maximum surgical blood order schedule, along with a remote electronic blood release system, reduced unnecessary preoperative blood orders and costs. Methods: At a large academic medical center, data for preoperative blood orders were analyzed for 63,916 surgical patients over a 34-month period. The new maximum surgical blood order schedule and the electronic blood release system (Hemosafe®; Haemonetics Corp., Braintree, MA) were introduced mid-way through this time period. The authors assessed whether these interventions led to reductions in unnecessary preoperative orders and associated costs. Results: Among patients having surgical procedures deemed not to require a type and screen or crossmatch (n = 33,216), the percent of procedures with preoperative blood orders decreased by 38% (from 40.4% [7,167 of 17,740 patients] to 25.0% [3,869 of 15,476 patients], P &lt; 0.001). Among all hospitalized inpatients, the crossmatch-to-transfusion ratio decreased by 27% (from 2.11 to 1.54; P &lt; 0.001) over the same time period. The proportion of patients who required emergency release uncrossmatched blood increased from 2.2 to 3.1 per 1,000 patients (P = 0.03); however, most of these patients were having emergency surgery. Based on the realized reductions in blood orders, annual costs were reduced by $137,223 ($6.08 per patient) for surgical patients, and by $298,966 ($6.20/patient) for all hospitalized patients. Conclusion: Implementing institution-specific, updated maximum surgical blood order schedule–directed preoperative blood ordering guidelines along with an electronic blood release system results in a substantial reduction in unnecessary orders and costs, with a clinically insignificant increase in requirement for emergency release blood transfusions.

scholarly journals 565. Risk of COVID-19 Among Healthcare Workers After Launch of Vaccination Campaign at an Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S384-S385
Author(s):  
Bhagyashri D Navalkele ◽  
Jose Lucar ◽  
James B Brock ◽  
Jason Parham
Keyword(s):  
Healthcare Workers ◽  
Medical Center ◽  
Severe Disease ◽  
Vaccination Campaign ◽  
Academic Medical Center ◽  
Complete Recovery ◽  
Healthcare Facility ◽  
Asymptomatic Infection ◽  
Academic Medical ◽  
The Impact

Abstract Background Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 virus affected healthcare workers (HCWs) adding additional burden on staffing shortages. COVID-19 vaccination (mRNA 1273 and BNT162b2) has been shown to protect against severe disease, death and reduced risk of asymptomatic infection and transmission from fully vaccinated individuals. Here, we present the impact of COVID-19 vaccination (CoVac) on risk of developing COVID-19 based on test results among unvaccinated and vaccinated HCWs. Methods Our academic medical center with 11,785 HCWs on its Jackson campus initiated non-mandatory CoVac among HCWs with BNT162b2 on December 16, 2020. Individuals ≥ 2 weeks after 1st dose of vaccine were defined as partially vaccinated and those ≥2 weeks from 2nd dose of vaccine were defined as fully vaccinated. Per facility policy, all symptomatic HCWs (irrespective of vaccination status) were recommended to undergo SARS-CoV-2 RT-PCR testing. Asymptomatic HCWs were also tested upon household exposure, however, this policy was changed on March 9th 2021 to allow fully vaccinated asymptomatic HCWs to work without need for quarantine or testing. Universal masking policy among HCWs remained effective at our center during study period. Results Between the launch of COVID-19 vaccination on December 16, 2020 and April 30, 2021, 5,855 HCWs received one dose of vaccine, and 5,687 received both doses. A total of 1,329 unique HCWs underwent COVID-19 testing between January 4, 2021 and April 30, 2021. Of those, 217 (16.3%) tested positive for SARS-CoV-2 infection; 204 were unvaccinated, 7 were partially vaccinated, and 6 were fully vaccinated (figure 1). Of the 6 fully vaccinated employees, 1 was asymptomatic (testing for travel purposes), 4 had mild symptoms, and one elderly employee required hospitalization with oxygen supplementation and had a complete recovery. No facility outbreaks were reported related to asymptomatic, work exposed, fully vaccinated HCWs. Unvaccinated healthcare workers were more likely to test positive for SARS-CoV-2 compared to partially and fully vaccinated healthcare workers. Conclusion COVID-19 vaccination protected HCWs by reducing risk for developing COVID-19. Vaccinating healthcare workers is a crucial infection prevention measure to reduce disease burden, avoid staffing shortages and create a safe environment in the healthcare facility to prevent transmission to other staff and at-risk patients. Disclosures All Authors: No reported disclosures

Prevalence of and Risk Factors for Colonization With Methicillin-ResistantStaphylococcus aureusat the Time of Hospital Admission

2003 ◽  
Vol 24 (6) ◽  
pp. 409-414 ◽  
Author(s):  
John A. Jernigan ◽  
Amy L. Pullen ◽  
Laura Flowers ◽  
Michael Bell ◽  
William R. Jarvis
Keyword(s):  
Risk Factors ◽  
Hospital Admission ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Healthcare Facility ◽  
Healthcare Facilities ◽  
Academic Medical ◽  
Mrsa Colonization ◽  
Control Study

AbstractObjectives:To determine the prevalence of methicillin-resistantStaphylococcus aureus(MRSA) colonization among patients presenting for hospital admission and to identify risk factors for MRSA colonization.Design:Surveillance cultures were performed at the time of hospital admission to identify patients colonized with S.aureus.A case-control study was performed to identify risk factors for MRSA colonization.Setting:A tertiary-care academic medical center.Patients:Adults presenting for hospital admission (N = 974).Results:S.aureuswas isolated from 205 (21%) of the patients for whom cultures were performed. Methicillin-sensitive S.aureuswas isolated from 179 (18.4%) of the patients, and MRSA was isolated from 26 (2.7%) of the patients. All 26 MRSA-colonized patients had been admitted to a healthcare facility in the preceding year, had at least one chronic illness, or both. In multivariate analyses comparing MRSA-colonized patients with control-patients, admission to a nursing home (odds ratio [OR], 16.5; 95% confidence interval [CI95], 1.4 to 192.1;P= .025) or a hospitalization of 5 days or longer during the preceding year (OR, 3.91; CI95, 1.1 to 13.9;P= .035) were independent predictors of MRSA colonization.Conclusions:Patients colonized with MRSA admitted to this hospital likely acquired the organism during previous encounters with healthcare facilities. There was no evidence that MRSA colonization occurs commonly among low-risk individuals in this community. These data suggest that evaluation of recent healthcare exposures is essential if true community acquisition of MRSA is to be confirmed.

A single-center cost analysis assessing a change in vasopressin formulation

2021 ◽  
Author(s):  
Courtney E Kelly ◽  
Christopher Miller ◽  
William Darko ◽  
Greg Cwikla ◽  
Bryan Mogle ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Single Center ◽  
Cost Estimates ◽  
Time Period ◽  
Academic Medical ◽  
Formulation Change ◽  
The Impact ◽  
Pharmacy Leaders

Abstract Purpose Cost savings achieved at an academic medical center by reformulating the institution’s standard vasopressin infusions to reduce waste are described. Summary After a retrospective review of vasopressin utilization over a 4-month period revealed that only approximately 40% of dispensed vasopressin units were actually administered to patients, pharmacy leaders determined that the institution’s standard vasopressin concentration for continuous infusions (100 units in 100 mL of sodium chloride 0.9% injection) was resulting in substantial waste, as many infusion preparations were not needed within the 18- to 24-hour expiration window. A concentration of 20 units/100 mL was adopted as the new standard formulation for vasopressin continuous infusions, with use of alternative concentrations allowed on a restricted basis. A pre-post study to assess the impact of the formulation change indicated a 38.7% decrease in vasopressin utilization (from 21,900 to 8,480 units) relative to utilization in a retrospective sample of patients who received vasopressin infusions prior to the formulation change. This reduced utilization equated to a cost decrease of $55,656.20 (as calculated on the basis of 2017 cost estimates) or $77,214.23 (as calculated on the basis of 2019 cost estimates) for the time period collected. It was estimated that the new formulations could yield annual cost savings ranging from $222,625 to $308,857. Conclusion To our knowledge, this is the first description of cost savings following a change in formulation of vasopressin for continuous infusions. Other institutions could consider employing a similar approach in addition to the previously reported cost-saving interventions, such as lower vasopressin starting doses and vasopressin restriction policies.

scholarly journals COVID-19 screening system utilizing daily symptom attestation helps identify hospital employees who should be tested to protect patients and co-workers

2021 ◽  
pp. 1-17
Author(s):  
Ellen Kim ◽  
Charles Morris ◽  
Michael Klompas ◽  
Haipeng Zhang ◽  
Adam Landman ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Data Linkage ◽  
Medical Center ◽  
Academic Medical Center ◽  
Health Records ◽  
Hospital Employees ◽  
Runny Nose ◽  
Symptom Screening ◽  
Academic Medical ◽  
Chi Squared

ABSTRACT Objective: To investigate the effectiveness of a daily attestation system used by employees of a multi-institutional academic medical center, which comprised of symptom-screening, self-referrals to the Occupational Health team, and/or a COVID-19 test. Design: Retrospective cohort study of all employee attestations and COVID-19 tests performed between March and June 2020. Setting: A large multi-institutional academic medical center, including both inpatient and ambulatory settings. Participants: All employees who worked at the study site. Methods: Data was combined from the attestation system (COVIDPass), the employee database, and the electronic health records, and was analyzed using descriptive statistics including chi-squared, Wilcoxon, and Kruskal-Wallis tests. We investigated whether an association existed between symptomatic attestations by the employees and them testing positive for COVID-19. Results: After data linkage and cleaning, there were 2,117,298 attestations submitted by 65,422 employees between March and June 2020. Most attestations were asymptomatic (99.9%). The most commonly reported symptoms were sore throat (910), runny nose (637), and cough (570). Of the 2,026 employees who ever attested symptomatic, 905 employees were tested within 14 days of a symptomatic attestation, and 114 (13%) of these tests were positive. The most common symptoms associated with a positive COVID-19 test were anosmia (23% vs 4%) and fever (46% vs 19%). Conclusions: Daily symptom attestations amongst healthcare workers identified a handful of employees with Covid-19. While the number of positives was low, attestations may help keep unwell employees off campus to try to prevent transmissions.

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