Molecular investigation of a RSV outbreak in a geriatric hospital

Abstract Background Acquired infections in hospitalized elderly people are a growing concern. In long-term care facilities with multiple staff and visitor contacts, virus outbreaks are a common challenge for infection prevention teams. Although several studies have reported nosocomial RSV outbreaks in long term care facilities, molecular epidemiology data are scarce. Methods RSV RNA was detected in respiratory samples from 19 patients in a long-term care hospital for elderly in Paris in March 2019 over a 3 weeks period. Genotyping was performed using nucleotide sequencing. Sociodemographic and clinical characteristics of cases part of a unique cluster, were retrospectively reviewed. Results Molecular investigation of theses RSV cases, revealed a unique cluster of 12 nosocomial cases in 2 adjacent wards. Mean age of these outbreak’s cases was 89. All patients had underlying medical conditions. Seven exhibited lower respiratory symptoms and three experienced decompensation of underlying chronic heart condition. Two patients died. Conclusions This case report highlights the importance of RSV in causing substantial disease in elderly in case of nosocomial outbreak and the contributions of molecular epidemiology in investigation and management of such outbreak.

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EPIDEMIOLOGY AND TRANSMISSION OF CARBAPENEMASE-PRODUCING ENTEROBACTERIACEAE IN A HEALTHCARE NETWORK OF AN ACUTE HOSPITAL AND ITS AFFILIATED INTERMEDIATE- AND LONG-TERM CARE FACILITIES IN SINGAPORE

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02584-20 ◽

2021 ◽

Author(s):

Aung-Hein Aung ◽

Kala Kanagasabai ◽

Jocelyn Koh ◽

Pei-Yun Hon ◽

Brenda Ang ◽

...

Keyword(s):

Risk Factors ◽

Long Term Care ◽

Acute Care Hospital ◽

Care Hospital ◽

Cross Sectional ◽

Term Care ◽

Healthcare Network ◽

Care Facilities ◽

Facility Type

BACKGROUND Movement of patients in a healthcare network poses challenges for the control of carbapenemase-producing Enterobacteriaceae (CPE). We aimed to identify intra- and inter-facility transmission events and facility type-specific risk factors of CPE in an acute care hospital (ACH) and its intermediate-term and long-term care facilities (ILTCFs). METHODS Serial cross-sectional studies were conducted in June-July of 2014-2016 to screen for CPE. Whole genome sequencing was done to identify strain relatedness and CPE genes (blaIMI; blaIMP-1; blaKPC-2; blaNDM-1; blaOXA-48). Multivariable logistic regression models, stratified by facility type were used to determine independent risk factors. RESULTS Of 5357 patients, half (55%) were from the ACH. CPE prevalence was 1.3% in the ACH and 0.7% in ILTCFs (p=0.029). After adjusting for socio-demographics, screening year, and facility type, the odds of CPE colonization increased significantly with hospital stay ≥ 3 weeks (aOR 2.67, 95%CI 1.17-6.05), penicillins use (aOR 3.00, 95%CI 1.05–8.56), proton pump inhibitors use (aOR 3.20, 95%CI 1.05–9.80), dementia (aOR 3.42, 95%CI 1.38–8.49), connective tissue disease (aOR 5.10, 95%CI 1.19-21.81), and prior carbapenem-resistant Enterobacteriaceae (CRE) carriage (aOR 109.02, 95%CI 28.47–417.44) in the ACH. For ILTCFs, presence of wound (aOR 5.30, 95%CI 1.01–27.72), respiratory procedures (aOR 4.97, 95%CI 1.09-22.71), vancomycin-resistant Enterococci carriage (aOR 16.42, 95%CI 1.52–177.48), and CRE carriage (aOR 758.30, 95%CI 33.86-16982.52) showed significant association. Genomic analysis revealed only possible intra-ACH transmission, and no evidence for ACH-to-ILTCFs transmission. CONCLUSIONS Although CPE colonization was predominantly in the ACH, risk factors varied between facilities. Targeted screening and precautionary measures are warranted.

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Hospital adoption of electronic health record functions to support age-friendly care: results from a national survey

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa129 ◽

2020 ◽

Vol 27 (8) ◽

pp. 1206-1213 ◽

Cited By ~ 1

Author(s):

Julia Adler-Milstein ◽

Katherine Raphael ◽

Alice Bonner ◽

Leslie Pelton ◽

Terry Fulmer

Keyword(s):

Older Adults ◽

Electronic Health Record ◽

Acute Care ◽

Long Term Care ◽

Health Record ◽

Care Hospital ◽

Term Care ◽

Care Facilities ◽

Electronic Health

Abstract Objective To measure US hospitals’ adoption of electronic health record (EHR) functions that support care for older adults, focusing on structured documentation of the 4Ms (What Matters, Medication, Mentation, and Mobility) and electronic health information exchange/communication with patients, caregivers, and long-term care providers. Materials and Methods In an online survey of a national, random sample of 797 US acute-care hospitals in 2018–2019, 479 (60.1%) responded. We calculated nationally representative measures of the percentages of hospitals with EHRs that include structured documentation of the 4Ms and exchange/communications functions. Results Structured EHR documentation of the 4Ms was fully implemented in at least 1 unit in 64.0% of hospitals and across all units in 41.5% of hospitals. Of the 4Ms, structured documentation was the highest for medications (91.3% in at least 1 unit) and the lowest for mentation (70.3% in at least 1 unit). All exchange/communication functions had been implemented in at least 1 unit in 16.2% of facilities and across all units in 7.6% of hospitals. Less than half of the hospitals had an EHR portal for long-term care facilities to access hospital information (45.4% in at least 1 unit), sent information electronically to long-term care facilities (44.6%), and had training for adults/caregivers on the patient portal (32.1%). Discussion Despite significant national investment in EHRs, hospital EHRs do not yet include key documentation, exchange, and communication functions needed to support evidence-based care for the older adults who comprise the majority of the inpatient population. Additional policy efforts are likely needed to promote the expansion of EHR capabilities into these high-value domains. Conclusions US acute-care hospital EHRs are lacking key functions that support care for older adults.

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Data Collection as the First Step in Program Development the Experience of a Chronic Care Palliative Unit

Journal of Palliative Care ◽

10.1177/082585979701300207 ◽

1997 ◽

Vol 13 (2) ◽

pp. 39-42 ◽

Cited By ~ 5

Author(s):

Barry Munn ◽

Frances Worobec

Keyword(s):

Palliative Care ◽

Program Development ◽

Chronic Care ◽

Long Term Care ◽

Care Program ◽

Care Hospital ◽

Term Care ◽

Patient Profile ◽

Care Facilities

This retrospective descriptive study of 73 patients who died in St. Peter's Hospital examines and contrasts the patient profile and referral sources of a palliative care unit in a chronic care hospital over two six-month periods during 1994 and 1995. Shortened length of stay (83.8 and 43.2 days respectively), documentation issues, CPR practices (CPR was desired by seven patients up to the time of death), and lack of referrals from long-term care facilities have led St. Peter's Hospital to ask further questions of its palliative care program, e.g. given the lack of referrals from long-term care facilities, how is palliative care being managed in this sector? In Ontario, palliative care has been placed under the domain of chronic care and program development depends in part on the knowledge of the population it serves. This study is a first step.

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Molecular Epidemiology ofStaphylococcus aureusColonization in 2 Long-Term Care Facilities

Infection Control and Hospital Epidemiology ◽

10.1086/500618 ◽

2006 ◽

Vol 27 (2) ◽

pp. 212-214 ◽

Cited By ~ 1

Author(s):

Lona Mody ◽

Erica Flannery ◽

Andrew Bielaczyc ◽

Suzanne F. Bradley

Keyword(s):

Staphylococcus Aureus ◽

Nursing Home ◽

Molecular Epidemiology ◽

Long Term Care ◽

Nursing Home Residents ◽

Term Care ◽

Methicillin Resistant ◽

Care Facilities

Persistent colonization withStaphylococcus aureuswas assessed in 22 nursing home residents. Eighteen residents (82%) remained colonized with the same strain found at baseline; 6 (33%) of 18 residents transiently acquired a new strain. Four residents (18%) acquired a new persistent strain. Residents colonized with methicillin-resistantS. aureuswere more likely to acquire a new strain (67%) than were residents colonized with methicillin-susceptibleS. aureus(20%) (P= .04).

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